Under Ultrasound Research Articles

Combined photothermal and sonodynamic therapy using a 2D black phosphorus nanosheets loaded coating for efficient bacterial inhibition and bone-implant integration

Surgical site infection (SSI) remains a major threat for implant failure in orthopedics. Herein, we report a dual-functional coating on Ti implants (named Ti/PDA/BP) with the integration of two-dimensional (2D) photo-sono sensitive black phosphorus nanosheets (BPNSs) and polydopamine (PDA) for efficient bacterial inhibition and bone-implant integration. For the first time, we employ BPNSs as generators of reactive radicals (ROS) under ultrasound (US) stimuli for implant associated infection. Additionally, the application of PDA improves the stability of BPNSs, the biocompatibility and photothermal performance of this hybrid coating. The as-prepared Ti/PDA/BP coating exhibits superior biocompatibility, bioactivity, photothermal and sonodynamic conversion abilities. Owing to the synergistic effect of hyperthermia and ·OH, Ti/PDA/BP damages the membrane and antioxidant system of Staphylococcus aureus, reaching a high antibacterial activity of 96.6% in vitro and 97.3% in vivo with rapid 10 min NIR irradiation and 20 min US treatment. In addition, we firstly unveil the significant effect of Ti/PDA/BP-based sonodynamic therapy (SDT) on bacterial membrane and oxidative stress at the transcriptome level. Moreover, the Ti/PDA/BP coating remarkably promotes osteogenesis in vitro and bone-implant osseointegration in vivo. Overall, development of Ti/PDA/BP bioactive coating provides a new strategy for combating the implant associated infection.

Self-Adaptive Antibiofilm Effect and Immune Regulation by Hollow Cu2MoS4 Nanospheres for Treatment of Implant Infections.

Implant infections are difficult to cure by traditional antibiotic therapy due to bacterial biofilm-induced antibiotic tolerance and impaired immune responses. To efficiently treat implant infections, therapeutic agents need to kill bacteria and regulate the inflammatory response of immune cells during the biofilm elimination process. Herein, multifunctional smart hollow Cu2MoS4 nanospheres (H-CMS NSs) with pH-responsive enzyme-like activities were prepared for self-adaptively eliminating biofilms and regulating the inflammation of macrophages in implant infections. During biofilm infection, the tissue microenvironment around implants is acidic. H-CMS NSs with oxidase (OXD)/peroxidase (POD)-like activities can catalyze reactive oxidative species (ROS) generation for directly killing bacteria and polarizing macrophages to a proinflammatory phenotype. Moreover, the POD-like activity and antibacterial property of H-CMS NSs can be further enhanced under ultrasound (US) irradiation. After the elimination of biofilms, the tissue microenvironment around implants shifts from acidic to neutral. H-CMS NSs show catalase (CAT)-like activity and eliminate excessive ROS, which polarizes macrophages to anti-inflammatory phenotype and promotes healing of infected tissue. This work provides a smart nanozyme with self-adaptive regulation of the antibiofilm activity and immune response by regulating ROS generation/elimination according to the different pathological microenvironments in implant infections during the different therapeutic stages.

Возможности создания пункционной насадки для конвексного УЗ-датчика с использованием технологии 3D-печати.

Introduction. Percutaneous surgery is one of the methods of surgical treatment of renal stones. The most difficult stage of the operation is the creation of percutaneous access to the pyelocaliceal system of the kidney. To facilitate access under ultrasound (US) guidance, it is customary to use a needle guide which is fixed to the US-probe. Taking into account the sanctions of the equipment manufacturing countries, Russian specialists may potentially find themselves in conditions of a shortage of components and particularly needle guide for ultrasound probes. In this regard, it was decided to develop the possibility of printing a needle guide for an ultrasound probe using 3Dprinting technology. Materials and methods. Using a handheld 3D laser scanner, a metal needle guide for the convex ultrasound probe was scanned, the necessary changes were made for use, and a plastic needle guide was created using 3D printing. Results. The needle, when passed into the grooves with preset angles of the printed needle guide, exactly matches the dotted aim on the monitor of the ultrasound machine, similar to the original probe. Conclusion. The use of 3D-printing in the absence of certain components, in particular, a needle guide for an ultrasound probe, allows to quickly obtain a working sample that is not inferior to the original one.

Defect-Modified nano-BaTiO3 as a Sonosensitizer for Rapid and High-Efficiency Sonodynamic Sterilization.

Multidrug-resistant bacteria caused by the unlimited overuse of antibiotics pose a great challenge to global health. An antibacterial method based on reactive oxygen species (ROS) is one of the effective strategies without inducing bacterial resistance. Owing to the ability of generating ROS, piezocatalytic material-mediated sonodynamic therapy (SDT) has drawn much attention. However, its major challenge is the low ROS generation efficiency in the piezocatalytic process due to the poor charge carrier concentration of piezoelectric materials. Vacancy engineering can regulate the charge density and largely promote ROS generation under ultrasound (US) irradiation. Herein, a US-responsive self-doped barium titanate with controlled oxygen vacancy (Vo) concentrations was successfully synthesized through a facile thermal reduction treatment at different temperatures (i.e., 350, 400, and 450 °C), and the corresponding samples were named as BTO-350, BTO-400, and BTO-450, respectively. Then, the effect of Vo concentrations on ROS generation efficiency during the piezocatalytic process was systematically studied. And BTO-400 was found to possess the highest piezocatalytic activity and excellent sonodynamic antibacterial performance against Escherichia coli and Staphylococcus aureus. Furthermore, its antibacterial mechanism was confirmed that the ROS generated under US could damage bacterial cell membrane and cause considerable leakage of cytoplasmic components and irreversible death of bacteria. Notably, the in vivo results illustrated that the BTO-400 could serve as an effective antibacterial agent and accelerate skin healing via SDT therapy. In all, the Vo defect-modified nano-BaTiO3 has a noticeable potential to induce a rapid and efficient sterilization as well as skin tissue repair by SDT.

PtCu Nanosonosensitizers with Inflammatory Microenvironment Regulation for Enhanced Sonodynamic Bacterial Elimination and Tissue Repair

AbstractSonodynamic therapy (SDT) is considered a reliable replacement therapy to overcome the resistance to antibiotics and the limited tissue penetration of traditional photo‐induced therapy. Herein, ultrasmall platinum‐copper alloy nanoparticles (PtCu NPs) modified with poly (maleic anhydridealt‐1‐octadecene)‐polyethylene glycol (C18PMH‐PEG) with high sonodynamic activity, strong catalytic ability, and good glutathione (GSH) depletion performance are synthesized for highly efficient bacterial elimination. PtCu NPs obtained through a thermal decomposition approach can generate high toxic singlet oxygen (1O2) under ultrasound (US) irradiation, showing good sonodynamic performance. Meanwhile, the partial oxygenation formed on the surface of PtCu NPs endows them with good Fenton‐like catalytic performance and superior GSH‐depleting ability, thus enhancing reactive oxygen species (ROS) generation. In vitro experiments confirm that the synthesized PtCu‐ NPs can not only efficiently kill both gram‐positive and gram‐negative bacteria but also eliminate staphylococcus aureus (S. aureus) infection through ROS generation and then accelerate wound healing in the S. aureus‐infected wound model. Meanwhile, the copper ions released from PtCu NPs can promote cell migration and angiogenesis through the up‐regulation of hypoxia inducible factor (HIF‐1α) and platelet endothelial cell adhesion molecule (CD31). Finally, the S. aureus‐induced deep‐seated osteomyelitis infection and bone destruction were successfully inhibited by the PtCu‐mediated combination therapy. Our work highlights a novel SDT strategy for enhanced sonodynamic bacteria elimination and tissue repair.

Defect-Rich Glassy IrTe2 with Dual Enzyme-Mimic Activities for Sono-Photosynergistic-Enhanced Oncotherapy.

The complexity, diversity, and heterogeneity of malignant tumors pose a formidable challenge for antitumor therapy. To achieve the goal of significantly enhancing the antitumor effect, nanomedicine-based synergistic therapy is one of the important strategies. Herein, we innovatively report a defect-rich glassy IrTe2 (G-IrTe2) with weak Ir-Te bond strength for synergistic sonodynamic therapy (SDT), chemodynamic therapy (CDT), and mild photothermal therapy (PTT). G-IrTe2 sonosensitizer under ultrasound (US) stimuli exhibits excellent reactive oxygen species (ROS) production performance. Besides, catalase (CAT)-like activity of G-IrTe2 can provide abundant oxygen to enhance the SDT effect. Then, the theoretical calculation verifies that US stimuli can easily make the irregular Ir-Te bond to be broken in amorphous IrTe2 and free electrons will be released to combine with the oxygen and further form singlet oxygen (1O2). Meanwhile, G-IrTe2 with peroxidase (POD)-like activity can also catalyze endogenous H2O2 to produce more ROS for chemodynamic therapy (CDT), which is conducive to better tumor ablation. Furthermore, the ROS produced by sono-/chemodynamic processes can cause mitochondrial dysfunction and further give rise to heat shock protein (HSP) downregulated expression, maximizing the efficiency of mild PTT. Therefore, such glassy IrTe2 with rich defect could be significantly involved in synergistic oncotherapy and then effectively achieve outstanding antitumor efficacy. This study provides a new research idea for expanding the application of inorganic glassy nanomaterials in promoting the therapeutic effect of tumors.

US-guided central venous catheter placement in the neonatal intensive care unit: Brachiocephalic vein or internal jugular vein?

Centrally inserted central catheters (CICCs) are commonly used to monitor venous pressure and administer parenteral nutrition and drugs in newborns. In the present study, we evaluated cannulation success rates, cannulation time, and frequency of complications in catheterization of the internal jugular vein (IJV) and brachiocephalic vein (BCV). The present study included patients who underwent IJV and BCV catheterization under ultrasound (US) guidance. The patients were divided into two groups, IJV and BCV, depending on the vein in which the CICC was utilized. We documented the diameters of the IJVs and BCVs, first attempt and overall success rates, mean cannulation time, and complication rates. A total of 79 patients were evaluated, 37 in the BCV group and 42 in the IJV group. No significant differences were observed between the two groups in terms of sex, mean age, or weight range (p > 0.05).The mean vein diameter was significantly larger in the BCV group than in the IJV group (p < 0.001); the mean number of attempts was significantly higher in the IJV group than in the BCV group (p < 0.001); the mean cannulation time was significantly longer in the IJV group than in the BCV group (p < 0.001); and the first attempt success rate was 50% in the IJV group, versus 94.6% in the BCV group. The overall success rate was 100% in both groups. The rate of complications was 8.6% in the IJV group, while no complications developed in the BCV group. Given the larger diameter of the vessel, BCV catheterization was found to result in quicker cannulation and lower complication rates. The results of the present study suggest that BCV catheterization should be the first choice for neonatal intensive care unit (NICU) patients who require parenteral support or close venous pressure monitoring.

3D-CEUS tracking of injectable chemo-sonodynamic therapy-enabled mop-up of residual renal cell carcinoma after thermal ablation.

Thermal ablation (TA), as a minimally invasive therapeutic technique, has been extensively used to the treatment of solid tumors, such as renal cell carcinoma (RCC), which, unfortunately, still fails to overcome the high risk of local recurrence and distant metastasis since the incomplete ablation cannot be ignored due to various factors such as the indistinguishable tumor margins and limited ablation zone. Herein, we report the injectable thermosensitive hydrogel by confining curcumin (Cur)-loaded hollow mesoporous organosilica nanoparticles (Cur@HMON@gel) which can locate in tumor site more than half a month and mop up the residual RCC under ultrasound (US) irradiation after transforming from colloidal sol status to elastic gel matrix at physiological temperature. Based on the US-triggered accelerated diffusion of the model chemotherapy drug with multi-pharmacologic functions, the sustained and controlled release of Cur has been demonstrated in vitro. Significantly, US is employed as an external energy to trigger Cur, as a sonosensitizer also, to generate reactive oxygen species (ROS) for sonodynamic tumor therapy (SDT) in parallel. Tracking by the three-dimensional contrast-enhanced ultrasound (3D-CEUS) imaging, the typical decreased blood perfusions have been observed since the residual xenograft tumor after incomplete TA were effectively suppressed during the chemo-sonodynamic therapy process. The high in vivo biocompatibility and biodegradability of the multifunctional nanoplatform confined by thermogel provide the potential of their further clinical translation for the solid tumor eradication under the guidance and monitoring of 3D-CEUS.

Acidity-Biodegradable Iridium-Coordinated Nanosheets for Amplified Ferroptotic Cell Death Through Multiple Regulatory Pathways.

Ferroptosis-based treatment strategies display the potential to suppress some malignant tumors with intrinsic apoptosis resistance. However, current related cancer treatments are still hampered by insufficient intracellular reactive oxygen species (ROS) levels and Fe2+ contents, posing considerable challenges for their clinical translation. Herein, an intracellular acid-biodegradable iridium-coordinated nanosheets (Ir-Hemin) with sonodynamic therapy (SDT) properties to effectively induce ferroptosis in tumor cells through multiple regulatory pathways are proposed. Under ultrasound (US) irradiation, Ir-Hemin nanosheets act as nanosonosensitizers to effectively generate ROS, subsequently causing the accumulation of lipid peroxides (LPO) and inducing ferroptotic cell death. Furthermore, these Ir-Hemin nanosheets decompose quickly to release hemin and Ir(IV), which deplete intracellular glutathione (GSH) to deactivate the enzyme glutathione peroxidase 4 (GPX4) and initiate the ferroptosis pathway. Specifically, the released hemin enables heme oxygenase 1 (HO-1) upregulation for endogenous ferrous ion supplementation, which compensates for the toxicity concerns brought about by the large uptake of exogenous iron. Surprisingly, Ir-Hemin nanosheets exhibit high tumor accumulation and trigger effective ferroptosis for tumor therapy. These Ir-Hemin nanosheets display pronounced synergistic anticancer efficacy under US stimulation both in vitro and in vivo, providing a strong rationale for the application of ferroptosis in cancer treatment.

Self-generated Schottky barriers in niobium carbide MXene nanocatalysts for theory-oriented sonocatalytic and NIR-II photonic hyperthermia tumor therapy

Two-dimensional (2D) transition metal carbides/nitrides (MXenes) have been extensively applied in biomedicine. However, the potential of MXene-based nanomedicine in sonodynamic therapy (SDT) has been rarely explored. Here, under the guidance of theoretical calculation, Nb2C MXenes are engineered as a high-performance sonocatalyst/sonosensitizer through mild in-situ self-oxidation. The work function values of Nb2C MXenes with different oxidation degrees are calculated to determine the optimized conditions to construct efficient Schottky heterojunction in the self-oxidized Nb2C MXenes. Experimentally, the niobium oxide clusters are homogeneously self-generated in-situ in Nb2C MXenes to form efficient Schottky barriers after the mild hydrothermal oxidation. The results reveal that the Schottky heterojunction can accelerate the separation of sono-triggered electron-hole pairs and inhibit their recombination, which profoundly augments the reactive oxygen species (ROS) generation efficiency of the in-situ self-oxidized Nb2C MXenes (denoted as Nb2C-Ox) under ultrasound (US) irradiation. The mild oxidation also allows the Nb2C-Ox to inherit the high photothermal performance of Nb2C MXenes in the second near-infrared (NIR-II) window. Accordingly, the developed Nb2C MXene-originated sonocatalyst/sonosensitizer can achieve high therapeutic efficacy based on the sonodynamic effect and NIR-II photonic hyperthermia. Therefore, this work proposes a theoretical calculation-oriented strategy to design and fabricate new MXene-based sonocatalysts/sonosensitizers for biomedical applications.

Ultrasound-controlled MXene-based Schottky heterojunction improves anti-infection and osteogenesis properties.

Background: The current clinical treatment of osteomyelitis is limited by the emergence of drug-resistant bacteria, which often leads to the failure of traditional antibiotic treatment and large bone defects. Sonodynamic therapy (SDT) is a new strategy that is widely used to overcome the problem of bacterial resistance to antibiotic therapy as well as poor tissue penetration using near-infrared light in photodynamic therapy (PDT). Therefore, it is necessary to develop a new sonosensitizer that can kill bacteria and promote bone repair. Methods: Herein, we developed a sonosensitizer, porphyrin metal-organic framework (HNTM), with a Schottky junction modified by Ti3C2 nanosheets (HN-Ti3C2) for highly efficient sonodynamic therapy of osteomyelitis and bone regeneration. Results: Ti3C2 greatly improves the acoustic catalytic performance by rapidly transferring the charge carriers generated by HNTM under ultrasound (US) irradiation, which killing drug-resistant bacteria through the generation of large amounts of reactive oxygen species (ROS). And HN-Ti3C2 shows excellent 99.75% antibacterial effectiveness against MRSA. In addition, HN-Ti3C2 generates a sonocurrent under low-intensity US to promote the repair of bone defects for a long time period. Mechanistic research using CCK-8 and RNA-seq showed that HN-Ti3C2 nanocomposites can promote the proliferation of stem cells by regulating the cell cycle, DNA replication, and apoptosis. In addition, after low-intensity US irradiation, HN-Ti3C2 promotes osteogenic differentiation via some key signaling pathways, including the calcium, Wnt, and TGF-beta signaling pathways, according to the Kyoto Encyclopedia of Genes and Genomes (KEGG). In a MRSA-infected rat tibial osteomyelitis model, HN-Ti3C2 successfully eliminated the infection and significantly improved bone regeneration under US irradiation. Conclusion: This study indicates that engineered HN-Ti3C2 is a distinctive nanocomposite for successful osteomyelitis treatment.

Surgical Transversus Abdominis Plane Block for Postoperative Analgesia in Lower Abdominal Surgeries: A Prospective Interventional Study

Introduction: Pain from lower abdominal surgeries originates from the abdominal wall incision. The Transversus Abdominis Plane (TAP) is a fascial plane between the internal oblique and the transversus abdominis muscle, which contains the nerve bundles. TAP block involves infiltrating this plane with anaesthetic drugs that block the somatic component of postoperative pain. Traditionally, the TAP block is given by anaesthesiologists as a blind procedure or under Ultrasound (US) guidance. In 2010, an innovative surgical TAP block method was developed, where the surgeon gives TAP block under direct vision before closing the abdomen during abdominal surgery. Many studies have recommended surgical TAP block as an intervention for achieving postoperative pain relief. Aim: To evaluate the efficacy of the surgical TAP block technique for postoperative analgesia following lower abdominal surgeries using Visual Analogue Scale (VAS) scores and by comparing the need for rescue analgesia and the total amount of analgesic drugs utilised within the first 24 hours of surgery. Materials and Methods: This hospital-based prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at The Oxford Medical College Hospital and Research Centre, Bengaluru, Karnataka, India, from January 2022 to December 2022. The study participants included 108 women undergoing lower abdominal surgeries under spinal or epidural or combined regional anaesthesia and belonging to the American Society of Anaesthesiologists (ASA) physical status classification system ASA I or ASA II or ASA IIE. The study group included 54 women who received surgical TAP block with 20 mL 0.25% bupivacaine and 4 mg of dexamethasone, intraoperatively on either side before closure of the abdomen. Postoperative pain was assessed using VAS at regular intervals within 24 hours of surgery. VAS was also recorded whenever the participants demanded rescue analgesia. The control group included 54 women who received intravenous tramadol 50 mg eight hourly for postoperative pain relief, while the study group received rescue analgesia on demand or if the VAS score was recorded as three or more. The time for the first request for rescue analgesia and the total dose of rescue analgesic required in the first 24 hours after surgery were also recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 25.0. For inferential statistics, numerical data were analysed by Chi-square test, and for continuous data, the Student’s t-test was used. A p-value &lt;0.05 was considered statistically significant. Results: The study group had significantly lower postoperative pain VAS scores when compared to the control group at four hours and beyond time intervals. The mean VAS scores at six hours were 1.85 in the study group and 2.35 in the control group (p-value=0.01), at 24 hours it was 2.04 in the study group and 2.24 in the control group (p-value=0.04). The mean time for the first rescue analgesia in the study group and control group was 11 hours 25 minutes and 2 hours 43 minutes, respectively, and the total tramadol consumption was 77.78±46.24 mg and 117.59±36.55 mg, respectively. Both results were statistically significant (p-value&lt;0.001). Conclusion: Surgical TAP block significantly delays the need for rescue analgesia and decreases the total analgesia required in the first 24 hours after surgery. It is an effective, safe, and simple technique for achieving postoperative pain relief.

Infected wound repair with an ultrasound-enhanced nanozyme hydrogel scaffold.

Chronic diabetic wounds persistently face the threat of evolving into diabetic foot ulcers owing to severe hypoxia, high levels of reactive oxygen species (ROS), and a complex inflammatory microenvironment. To concurrently surmount these obstacles, we developed an all-round therapeutic strategy based on nanozymes that simultaneously scavenge ROS, generate O2 and regulate the immune system. First, we designed a dynamic covalent bond hybrid of a metal-organic coordination polymer as a synthesis template, obtaining high-density platinum nanoparticle assemblies (PNAs). This compact assembly of platinum nanoparticles not only effectively simulates antioxidant enzymes (CAT, POD) but also, under ultrasound (US), enhances electron polarization through the surface plasmon resonance effect, endowing it with the ability to induce GSH generation by effectively replicating the enzyme function of glutathione reductase (GR). PNAs, by mimicking the activity of CAT and POD, effectively catalyze hydrogen peroxide, alleviate hypoxia, and effectively generate GSH under ultrasound, further enhancing ROS scavenging. Notably, PNAs can regulate macrophage responses in the inflammatory microenvironment, circumventing the use of any additives. It was confirmed that PNAs can enhance cell proliferation and migration, promote neoangiogenesis IN VITRO, and accelerate the healing of infected diabetic wounds IN VIVO. We believe that an all-round therapeutic method based on PNA nanozymes could be a promising strategy for sustained diabetic wound healing.

The utility of chest ultrasound-guided fine-needle biopsy in the diagnosis of plasmacytoma.

Plasmacytoma is a plasma cell dyscrasia originating from a single clone of plasma cells of B-lymphocyte lineage and produces a monoclonal immunoglobulin. Transthoracic fine-needle aspiration (TTNA) under ultrasound (US) guidance is a well-validated technique for the diagnosis of many neoplasms and has been shown to be safe and cost effective, with diagnostic yields comparable to more invasive techniques. However, the role of TTNA in the diagnosis of thoracic plasmacytoma is not well established. The aim of this study was to assess the utility of TTNA and cytology in confirming a diagnosis of plasmacytoma. All cases of plasmacytoma diagnosed from January 2006 to December 2017 by the Division of Pulmonology, Tygerberg Hospital, were retrospectively identified. All patients who underwent an US-guided TTNA and of whose clinical records could be retrieved were included in this cohort. The International Myeloma Working Group's definition of a plasmacytoma was used as the gold standard. A total of 12 cases of plasmacytoma were identified and 11 patients included (one patient was excluded owing to missing medical records). Six of the 11 patients (mean age 59.5 ± 8.5 years) were male. Radiologically, most had multiple lesions (n=7), most commonly bony (n=6) with vertebral body involvement (n=5) and pleural-based lesions (n=2). Rapid onsite evaluation (ROSE) was performed and documented in 6 of the 11 cases, and a provisional diagnosis of plasmacytoma was suggested in 5 of the 6 patients (83.3%). The final laboratory cytological diagnoses of all 11 cases were compatible with plasmacytoma which was further confirmed via a bone marrow biopsy (n=4) and by serum electrophoresis (n=7). US-guided fine-needle aspiration is feasible and is useful to confirm a diagnosis of plasmacytoma. Its minimally invasive nature may be the ideal investigation of choice in suspected cases.

Hollow Co-CeO2@PEG nanospheres: Ultrasound enhanced cascade-nanozyme for synergetic anticancer

The limited H2O2 level in tumor microenvironment (TEM) constrains the effect of chemodynamic therapy (CDT). Herein, Co-CeO2@PEG hollow nanospheres are synthesized for two strategies of H2O2-supply. By varying hydrothermal times, hollow Co-CeO2 nanospheres (∼55 nm) are prepared derived from Ostwald ripening. Under ultrasound (US) irradiation, reactive oxygen species (ROS) are generated due to cavitation effect. ESR and capturing experiments reveal the US energy transfer (1O2) and US-generated electrons/dissolved O2 (H2O2) to determine ROS production. The doping of Co increases oxygen vacancy, which is in favor of O2 adsorption and ROS generation. Both density functional theory (DFT) calculation and experimental measurement reveal the decreased band gap of Co-CeO2. The emerging new energy band improves the separation/transfer of electron-hole and ROS production. Besides, hollow structure is significant to introduce extra cavitation nucleus, promoting cavitation effect and ROS generation. Furthermore, Co-CeO2@PEG nanospheres reveal glucose oxidase (GOx) activity, which not only can consume endogenous glucose to introduce starvation therapy but also to produce H2O2. The above two ways can realize intracellular H2O2 replenishment. In addition, Co-CeO2@PEG also show mimic peroxidase (POD) and catalase (CAT) behavior to introduce CDT and O2-supplementation. In comparison with pure CeO2@PEG, the greater nanozyme activity of Co-CeO2@PEG is ascribed to the lower resistance of charge transfer that is further testified by DFT and electrochemical analysis. Synergetic CDT/starvation/sonodynamic therapy (SDT) reveals noteworthy anticancer efficiency and also arouses immune response for metastasis inhibition.

Corticosteroid Versus Dextrose Ultrasound-Guided Injection in the Treatment of Sacroiliac Joint Dysfunction: A Randomized Double-Blinded Clinical Trial

Background: Sacroiliac Joint (SIJ) dysfunction, a common etiology of Low Back Pain (LBP), is a challenging diagnosis. There is controversy over the efficacy of prolotherapy and corticosteroid injections in relieving SIJ dysfunction. Inconsistent success rates reported in previous studies can be due to heterogeneity in selecting the patients and procedures between studies. This study was conducted to compare the efficacy of local injection of dextrose prolotherapy and corticosteroid in treating the SIJ dysfunction.&#x0D; Methods: This 36-week, double-blind, Randomized Controlled Trial (RCT) included 40 patients with SIJ dysfunction. The clinical impression was confirmed by the use of a diagnostic injection of local anesthetic inside SIJ. Participants received a single injection of either hypertonic dextrose solution or triamcinolone under Ultrasound (US) guidance. The primary outcome measurement tools, including the Visual Analog Scale (VAS) for pain and the Dallas Pain Questionnaire (DPQ), were evaluated initially and after 2, 8, and 36 weeks.&#x0D; Results: In both prolotherapy and corticosteroid groups, VAS significantly declined within 36-weeks of follow-up. However, there was no remarkable difference between the two groups at any follow-up timepoints. Similarly, DPQ revealed a remarkable improvement in the corticosteroid group while it did not show any meaningful change in the prolotherapy group.&#x0D; Conclusion: Both local injections of dextrose and corticosteroids can successfully reduce pain in patients with SIJ dysfunction without significant superiority between the two treatments. However, corticosteroid injection was slightly more effective in terms of improvement of functional status. Further investigations are required to extend these results to SIJ dysfunction treatment more reliably.

Triarylboron-Doped Acenethiophenes as Organic Sonosensitizers for Highly Efficient Sonodynamic Therapy with Low Phototoxicity.

The development of efficient organic sonosensitizers is crucial for sonodynamic therapy (SDT) in the field of cancer treatment. Herein, a new strategy for the development of efficient organic sonosensitizers based on triarylboron-doped acenethiophene scaffolds is presented. The attachment of boron to the linear acenethiophenes lowers the lowest unoccupied molecular orbital (LUMO) energy, resulting in redshifted absorptions and emissions. After encapsulation with the amphiphilic polymer DSPE-mPEG2000 , it is found that the nanostructured BAnTh-NPs and BTeTh-NPs (nanoparticles of BAnThand BTeTh) shows efficient hydroxyl radical (• OH) generation under ultrasound (US) irradiation in aqueous solution with almost no phototoxicity, which can overcome the shortcomings of O2 -dependent SDT and avoid the potential cutaneous phototoxicity issue. In vitro and in vivo therapeutic results validate that boron-doped acenethiophenes as sonosensitizers enable high SDT efficiency with low phototoxicity and good biocompatibility, indicating that boron-functionalization of acenes is a promising strategy toward organic sonosensitizers for SDT.

45 (PB-045) Poster - MINIVAB trial: Minimally invasive breast cancer excision using vacuum assisted biopsy under ultrasound guidance

Background: In this abstract we present the design of the MINIVAB trial, which aimsto assess whether it is feasible to remove small breast cancers completely using vacuum assisted biopsy (VAB) under ultrasound (US) guidance.

Ultrasound-induced destruction of heparin-loaded microbubbles attenuates L-arginine-induced acute pancreatitis

PurposeAcute pancreatitis (AP) involves sudden inflammation caused by abnormal activation of pancreatic enzymes. The mechanisms underlying AP include oxidative stress, high levels of inflammatory mediators and inflammatory cell infiltration. Heparin, a key therapeutic drug, exerts anti-inflammatory, antioxidative, and anticoagulative effects. However, safe and effective drug delivery remains an obstacle. This study is the first to investigate the therapeutic effects of heparin-loaded microbubbles (HPMB) combined with ultrasound (UHPMB) and the role of heparin in acoustic cavitation. MethodsThe characteristics of the microbubbles, including particle size, concentration, release, stability, and development, were studied. Heparin concentration in the HPMB was measured, and heparin-induced anticoagulation was evaluated. Drug safety was explored using hemolysis and cell viability assessments. The ability of HPMB to alleviate oxidative stress and inflammation were investigated in vitro. L-arginine induces AP in vivo. UHPMB was used for AP treatment. Serum amylase levels were measured and pancreatic architecture and pathological features were evaluated to determine AP severity. In vivo efficacy was evaluated, and the underlying mechanism of heparin action during acoustic cavitation was explored. ResultsHPMB was spherical and presented as an emulsion-like solution without aggregation. HPMB was visible and stable and effectively released the drug under ultrasound (US). HPMB and UHPMB led to lower AP severity than in the untreated group. US-targeted microbubble destruction (UTMD) enhanced the therapeutic effect by decreasing oxidative stress and inflammation in AP models without injuring vital organs. UHPMB regulated VEGF/Flt-1 and SOD-1 expression. HPMB can also mitigate oxidative stress and inflammation in H2O2-pretreated cells. ConclusionUHPMB exhibits a strong ability not only to selectively target pancreatic lesions and release heparin but also to provide efficient protection by inhibiting oxidative stress and inflammation.

Prospective analysis on carotid endarterectomy: intermediate-deep ultrasound-guided cervical blockade versus general anesthesia.

The best regional anesthesia plan with the best clinical results for Carotid endarterectomy (CEA) has not been defined yet. Prospective multicentric observational study of two non-randomized matched cohorts including patients undergoing elective unilateral CEA (N.=100) between January-October 2021. Main outcomes were cerebral oximetry measurements, verbal numeric pain score assessment, peripheral nerve blockades and in-hospital stay. The main objective is to compare results achieved after carotid endarterectomy (CEA) performed under loco-regional blockade (LRB) versus general anesthesia (GA), in terms of intraoperative hemodynamic and neurologic variability. Patients undergoing LRB were performed under ultrasound (US) guidance and mild sedation. The LRB and GA groups showed no differences in comorbidities and risk factors. However, there was a significant difference in the intraoperative hemodynamic behavior due to the amount of vasoactive drugs used (0% vs. 16% for phenylephrine, P=0.006). The results showed neurological stability through the cerebral oximetry measurements during the procedure except for the left hemisphere de-clamp values, which were higher in the GA group (68.7±9.9 vs. 72.7±8.8; P=0.035). There were also significant differences in the verbal pain scale scores assessed 6 hours and 12 hours after the procedure; better pain control was evidenced in the LRB group (0[0-1] vs. 1[0-3], P=0.01; 1[0.5-2] vs. 0[0-2], P=0.01). An increased transient hypoglossal and laryngeal nerves blockade was observed in the LRB group (30% vs. 4%; P<0.001). The in-hospital length of stay was longer in the GA group (77.2±36.3 hours vs. 129.1±41.1 hours; P<0.001). Although the use of intermediate-deep cervical plexus blockade for CEA confers similar neurologic stability as GA does, there is a difference on the hemodynamic behaviour due to the differences in vasoactive drug consumption. Loco-regional techniques provide a better postoperative pain control and shorten in-hospital length of stay.