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Theranostics 2024: Molecular imaging of microenvironment by hypoxia-activatable fluorescence probes has emerged as an attractive approach to tumor diagnosis and image-guided treatment....
: Molecular imaging of microenvironment by hypoxia-activatable fluorescence probes has emerged as an attractive approach to tumor diagnosis and image-guided treatment. Difficulties remain in its translational applications due to hypoxia heterogeneity in tumor microenvironments, making it challenging to image hypoxia as a reliable proxy of tumor distribution. : We report a modularized theranostics platform to fluorescently visualize hypoxia via light-modulated signal compensation to overcome tumor heterogeneity, thereby serving as a diagnostic tool for image-guided surgical resection and photodynamic therapy. Specifically, the platform integrating dual modules of fluorescence indicator and photodynamic moderator using supramolecular host-guest self-assembly, which operates cooperatively as a cascaded "AND" logic gate. First, tumor enrichment and specific fluorescence turn-on in hypoxic regions were accessible via tumor receptors and cascaded microenvironment signals as simultaneous inputs of the "AND" gate. Second, image guidance by a lighted fluorescence module and light-mediated endogenous oxygen consumption of a photodynamic module as dual inputs of "AND" gate collaboratively enabled light-modulated signal compensation , indicating homogeneity of enhanced hypoxia-related fluorescence signals throughout a tumor. In and analyses, the biocompatible platform demonstrated several strengths including a capacity for dual tumor targeting to progressively facilitate specific fluorescence turn-on, selective signal compensation, imaging-time window extension conducive to precise normalized image-guided treatment, and the functionality of tumor glutathione depletion to improve photodynamic efficacy. The hypoxia-activatable, image-guided theranostic platform demonstrated excellent potential for overcoming hypoxia heterogeneity in tumors.
Topics: Animals; Theranostic Nanomedicine; Humans; Optical Imaging; Mice; Tumor Microenvironment; Cell Line, Tumor; Fluorescent Dyes; Photochemotherapy; Neoplasms; Mice, Nude; Surgery, Computer-Assisted
PubMed: 38948059
DOI: 10.7150/thno.95590 -
Theranostics 2024The repair of osteoporotic bone defects remains challenging due to excessive reactive oxygen species (ROS), persistent inflammation, and an imbalance between...
The repair of osteoporotic bone defects remains challenging due to excessive reactive oxygen species (ROS), persistent inflammation, and an imbalance between osteogenesis and osteoclastogenesis. Here, an injectable H-releasing hydrogel (magnesium@polyethylene glycol-poly(lactic-co-glycolic acid), Mg@PEG-PLGA) was developed to remodel the challenging bone environment and accelerate the repair of osteoporotic bone defects. This Mg@PEG-PLGA gel shows excellent injectability, shape adaptability, and phase-transition ability, can fill irregular bone defect areas via minimally invasive injection, and can transform into a porous scaffold to provide mechanical support. With the appropriate release of H and magnesium ions, the 2Mg@PEG-PLGA gel (loaded with 2 mg of Mg) displayed significant immunomodulatory effects through reducing intracellular ROS, guiding macrophage polarization toward the M2 phenotype, and inhibiting the IκB/NF-κB signaling pathway. Moreover, experiments showed that the 2Mg@PEG-PLGA gel inhibited osteoclastogenesis while promoting osteogenesis. Most notably, in animal experiments, the 2Mg@PEG-PLGA gel significantly promoted the repair of osteoporotic bone defects by scavenging ROS and inhibiting inflammation and osteoclastogenesis. Overall, our study provides critical insight into the design and development of H-releasing magnesium-based hydrogels as potential implants for repairing osteoporotic bone defects.
Topics: Animals; Magnesium; Reactive Oxygen Species; Mice; Polyethylene Glycols; Hydrogels; Osteoporosis; Osteogenesis; Hydrogen; RAW 264.7 Cells; Bone Regeneration; Immunomodulation; Tissue Scaffolds; Macrophages; Polyesters
PubMed: 38948054
DOI: 10.7150/thno.97412 -
Clinical, Cosmetic and Investigational... 2024Medication-related osteonecrosis of the jaw (MRONJ) can be a debilitating complication that can arise in patients who took or are taking antiresorptive (including...
Medication-related osteonecrosis of the jaw (MRONJ) can be a debilitating complication that can arise in patients who took or are taking antiresorptive (including bisphosphonates) or antiangiogenic agents, leading to visible bone or a fistula that continues for more than eight weeks, without any history of radiotherapy. This clinical case aimed to describe the treatment of MRONJ with topical active oxygen therapy using bluem oral gel. A 63-year-old female patient that had been taking weekly sodium alendronate (70 mg) for four years by oral via, presented discomfort and implant movement in the #46 region, by that underwent surgical extraction of the implant. After three months the patient returned and was diagnosed with MRONJ. Initially, conventional therapies were performed, including surgical debridement and antibiotic therapy, but without success. The patient still had clinical signs of osteonecrosis six months after the implant extraction. The entire socket was then filled with bluem oral gel by topical application. The patient was instructed to continue applying the gel to the region every 8 hours for 15 days. After this period, the patient returned, and it was observed that the wound was in the healing process, with the presence of epithelialized tissue and without bone exposure. The 2-year clinical follow-up showed the lesion had healed entirely, and a new implant was installed. After the osseointegration period, the final prosthesis was placed. The patient remains under clinical follow-up. Therefore, it can be concluded that the application of bluem oral gel in this clinical case assisted in the recovery of the osteonecrosis lesion.
PubMed: 38947864
DOI: 10.2147/CCIDE.S462051 -
Cureus May 2024Thymoma and thymic carcinomas are a few of the rarest malignancies seen in humankind. They are mostly seen in the Asian population, many of which are reported in the...
Thymoma and thymic carcinomas are a few of the rarest malignancies seen in humankind. They are mostly seen in the Asian population, many of which are reported in the Southeast Asia region like Japan, China, Vietnam, etc. They usually can be a sequela of other underlying conditions such as myasthenia gravis or some unknown mutations that express later in life. Our patient is a young 41-year-male, a healthy and active individual who presented for evaluation of acute shortness of breath, two months after recovering from SARS-CoV-19 infection. His shortness of breath progressed while on oxygen and diuretics, a Point of Care Ultrasound (POCUS) showed cardiac tamponade and moderate pleural effusion. A Computerized Tomographic (CT) scan of the chest/abdomen/pelvis showed cardiomegaly, pleural effusion, and a mass abutting the heart. A pericardiocentesis revealed malignant cells. Thymic carcinoma was confirmed with a core biopsy and the patient was initiated on treatment rapidly to help improve symptoms and contain the growing mass. .
PubMed: 38947614
DOI: 10.7759/cureus.61455 -
Cureus May 2024With COVID-19 becoming a common disease, primary care facilities such as clinics are required to efficiently triage patients at high risk of severe illness within the...
BACKGROUND
With COVID-19 becoming a common disease, primary care facilities such as clinics are required to efficiently triage patients at high risk of severe illness within the constraints of limited medical resources. However, existing COVID-19 severity risk scores require detailed medical history assessments, such as evaluating the severity of pneumonia via chest CT and accounting for past and comorbid conditions. Therefore, they may not be suitable for practical use in clinical settings with limited medical resources, including personnel and equipment.
PURPOSE
The goal is to identify key variables that predict the need for oxygen therapy in COVID-19 patients and develop a simplified clinical risk score based solely on vital signs to predict oxygen requirements.
PATIENTS AND METHODS
A retrospective observational study of 584 outpatients with COVID-19 confirmed by polymerase chain reaction test visited Sasebo Chuo Hospital between April 28, 2022, and August 18, 2022. Analyses were conducted after adjustment for background factors of age and sex with propensity score matching. We used the Fisher test for nominal variables and the Kruskal-Wallis test for continuous variables.
RESULTS
After adjusting for age and sex, several factors significantly correlated with the need for oxygen within seven days including body temperature (p < 0.001), respiratory rate (p = 0.007), SpO (p < 0.001), and the detection of pneumonia on CT scans (p = 0.032). The area under the receiver-operating characteristic curve for the risk score based on these vital signs and CT was 0.947 (95% confidence interval: 0.911-0.982). The risk score based solely on vital signs was 0.937 (0.900-0.974), demonstrating the ability to predict oxygen administration with no significant differences.
CONCLUSIONS
Body temperature, advanced age, increased respiratory rate, decreased SpO, and the presence of pneumonia on CT scans were significant predictors of oxygen need within seven days among the study participants. The risk score, based solely on vital signs, effectively and simply assesses the likelihood of requiring oxygen therapy within seven days with high accuracy. The risk score, which utilizes only age and vital signs and does not require a detailed patient history or CT scans, could streamline hospital referral processes for admissions.
PubMed: 38947613
DOI: 10.7759/cureus.61270 -
Cureus May 2024Background Hypertension significantly contributes to the severity, prolonged hospitalization, the need for intensive care, and mortality of COVID-19 patients. However,...
Background Hypertension significantly contributes to the severity, prolonged hospitalization, the need for intensive care, and mortality of COVID-19 patients. However, the data is still evolving. This study investigated the predictors of severity among hypertensive COVID-19 patients. Methodology This cohort study included 333 hospitalized hypertensive COVID-19 patients at the Indus Hospital, Karachi, Pakistan, from April 2021 to October 2021. The study evaluated the clinical features, antihypertensive therapy, and predictors of severity. A multivariable binary logistic regression model was used to determine severity predictors using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, NY, USA). Results The majority of hypertensive COVID-19 patients were females (54.7%), aged <65 years (55.8%), and coexisted with diabetes mellitus (56.5%). The independent predictors of severity were male (aOR 2.65, 95% CI, 1.08-6.51; p < 0.033), fever (aOR 3.52, 95% CI, 1.24-9.92; p = 0.017), shortness of breath (aOR 4.49, 95% CI, 1.73-11.63; p = 0.002), oxygen saturation (<90%) (aOR 87.39, 95% CI, 19.15-398.75; p < 0.001), and D-dimer (>0.5 mcg/ml) (aOR 3.03, 95% CI, 1.19-7.71; p = 0.020). Conclusions Our study concluded that males with fever before admission, shortness of breath, lower oxygen saturation, and elevated D-dimer are the predictors of severity among hypertensive COVID-19 patients.
PubMed: 38947593
DOI: 10.7759/cureus.61356 -
BJA Open Jun 2024Outcomes after oesophagogastric cancer surgery remain poor. Cardiopulmonary exercise testing (CPET) used for risk stratification before oesophagogastric cancer surgery...
Cardiopulmonary exercise variables and their association with postoperative morbidity and mortality after major oesophagogastric cancer surgery-a multicentre observational study.
BACKGROUND
Outcomes after oesophagogastric cancer surgery remain poor. Cardiopulmonary exercise testing (CPET) used for risk stratification before oesophagogastric cancer surgery is based on conflicting evidence. This study explores the relationship between CPET and postoperative outcomes, specifically for patients undergoing neoadjuvant treatment.
METHODS
Patients undergoing oesophagogastric cancer resection and CPET (pre- or post-neoadjuvant treatment, or both) were retrospectively enrolled into a multicentre pooled cohort study. Oxygen uptake at peak exercise (VO peak) was compared with 1-yr postoperative survival. Secondary analyses explored relationships between patient characteristics, tumour pathology characteristics, CPET variables (absolute, relative to weight, ideal body weight, and body surface area), and postoperative outcomes (morbidity, 1-yr and 3-yr survival) were assessed using logistic regression analyses.
RESULTS
Seven UK centres recruited 611 patients completing a 3-yr postoperative follow-up period. Oesophagectomy was undertaken in 475 patients (78%). Major complications occurred in 25%, with 18% 1-yr and 43% 3-yr mortality. No association between VO peak or other selected CPET variables and 1-yr survival was observed in the overall cohort. In the overall cohort, the anaerobic threshold relative to ideal body weight was associated with 3-yr survival (=0.013). Tumour characteristics (ypT/ypN/tumour regression/lymphovascular invasion/resection margin; <0.001) and Clavien-Dindo ≥3a (<0.001) were associated with 1-yr and 3-yr survival. On subgroup analyses, pre-neoadjuvant treatment CPET; anaerobic threshold (absolute; =0.024, relative to ideal body weight; =0.001, body surface area; =0.009) and V/VCO at anaerobic threshold (=0.026) were associated with 3-yr survival. No other CPET variables (pre- or post-neoadjuvant treatment) were associated with survival.
CONCLUSIONS
VO peak was not associated with 1-yr survival after oesophagogastric cancer resection. Tumour characteristics and major complications were associated with survival; however, only some selected pre-neoadjuvant treatment CPET variables were associated with 3-yr survival. CPET in this cohort of patients demonstrates limited outcome predictive precision.
CLINICAL TRIAL REGISTRATION
NCT03637647.
PubMed: 38947220
DOI: 10.1016/j.bjao.2024.100289 -
International Journal of Nanomedicine 2024To address the problem of suboptimal reactive oxygen species (ROS) production in Radiation therapy (RT) which was resulted from exacerbated tumor hypoxia and the...
PURPOSE
To address the problem of suboptimal reactive oxygen species (ROS) production in Radiation therapy (RT) which was resulted from exacerbated tumor hypoxia and the heterogeneous distribution of radiation sensitizers.
MATERIALS AND METHODS
In this work, a novel nanomedicine, designated as PLGA@IR780-Bi-DTPA (PIBD), was engineered by loading the radiation sensitizer Bi-DTPA and the photothermal agent IR780 onto poly(lactic-co-glycolic acid) (PLGA). This design leverages the tumor-targeting ability of IR780 to ensure selective accumulation of the nanoparticles in tumor cells, particularly within the mitochondria. The effect of the photothermal therapy-enhanced radiation therapy was also examined to assess the alleviation of hypoxia and the enhancement of radiation sensitivity.
RESULTS
The PIBD nanoparticles exhibited strong capacity in mitochondrial targeting and selective tumor accumulation. Upon activation by 808 nm laser irradiation, the nanoparticles effectively alleviated local hypoxia by photothermal effect enhanced blood supplying to improve oxygen content, thereby enhancing the ROS production for effective RT. Comparative studies revealed that PIBD-induced RT significantly outperformed conventional RT in treating hypoxic tumors.
CONCLUSION
This design of tumor-targeting photothermal therapy-enhanced radiation therapy nanomedicine would advance the development of targeted drug delivery system for effective RT regardless of hypoxic microenvironment.
Topics: Animals; Photothermal Therapy; Reactive Oxygen Species; Nanoparticles; Cell Line, Tumor; Humans; Polylactic Acid-Polyglycolic Acid Copolymer; Mice; Indoles; Tumor Hypoxia; Radiation-Sensitizing Agents; Mice, Inbred BALB C; Mitochondria; Neoplasms; Nanomedicine
PubMed: 38946887
DOI: 10.2147/IJN.S450124 -
Advanced Science (Weinheim,... Jul 2024The rational construction of efficient hypoxia-tolerant nanocatalysts capable of generating singlet oxygen (O) without external stimuli is of great importance for tumor...
The rational construction of efficient hypoxia-tolerant nanocatalysts capable of generating singlet oxygen (O) without external stimuli is of great importance for tumor therapy. Herein, uniformly dispersed and favorable biosafety profile graphitic carbon nitride quantum dots immobilized with Fe-N moieties modulated by axial O atom (denoted as O-Fe-N) are developed for converting HO into O via Russell reaction, without introducing external energy. Notably, O-Fe-N performs two interconnected catalytic properties: glutathione oxidase-mimic activity to provide substrate for subsequent O generation, avoiding the blunting anticancer efficacy by glutathione. The O-Fe-N catalyst demonstrates a specific activity of 79.58 U mg at pH 6.2, outperforming the most reported Fe-N catalysts. Density functional theory calculations demonstrate that the axial O atom can effectively modulate the relative position and electron affinity between Fe and N, lowering the activation energy, strengthening the selectivity, and thus facilitating the Russell-type reaction. The gratifying enzymatic activity stemming from the well-defined Fe-N/O structure can inhibit tumor proliferation by efficiently downregulating glutathione peroxidase 4 activity and inducing lipid peroxidation. Altogether, the O-Fe-N catalyst not only represents an efficient platform for self-cascaded catalysis to address the limitations of O-involved cancer treatment but also provides a paradigm to enhance the performance of the Fe-N catalyst.
PubMed: 38946659
DOI: 10.1002/advs.202307254 -
ACS Applied Materials & Interfaces Jun 2024In this research, a novel MgSiO fiber membrane (MSFM) loaded with indocyanine green (ICG) and doxorubicin (DOX) was prepared. Because of MgSiO's unique lamellar...
In this research, a novel MgSiO fiber membrane (MSFM) loaded with indocyanine green (ICG) and doxorubicin (DOX) was prepared. Because of MgSiO's unique lamellar structure composed of a silicon-oxygen tetrahedron, magnesium ion (Mg) moves easily and can be further replaced with other cations. Therefore, because of the positively charged functional group of ICG, MSFM has a rather high drug loading for ICG. In addition, there is electrostatic attraction between DOX (a cationic drug) and ICG (an anionic drug). Hence, after loading ICG, more DOX can be adsorbed into MSFM because of electrostatic interaction. The ICG endows the MSFM outstanding photothermal therapy (PTT) performance, and DOX as a chemotherapeutic drug can restrain tumor growth. On the one hand, H exchanged with the positively charged DOX based on the MgSiO special lamellar structure. On the other hand, the thermal effect could break the electrostatic interaction between ICG and DOX. Based on the above two points, both tumor acidic microenvironment and photothermal effect can trigger DOX release. What's more, in vitro and in vivo antiosteosarcoma therapy evaluations displayed a superior synergetic PTT-chemotherapy anticancer treatment and excellent biocompatibility of DOX&ICG-MSFM. Finally, the MSFM was proven to greatly promote cell proliferation, differentiation, and bone regeneration performance in vitro and in vivo. Therefore, MSFM provides a creative perspective in the design of multifunctional scaffolds and shows promising applications in controlled drug delivery, antitumor performance, and osteogenesis.
PubMed: 38946103
DOI: 10.1021/acsami.4c05744