Under Ultrasound Research Articles

An Urchin-Shaped Copper-Based Metalloporphyrin Nanosystem as a Sonosensitizer for Sonodynamic Therapy.

Sonodynamic therapy (SDT), as a novel cancer therapy strategy, might be a promising approach due to the depth-penetration property in tissue. Sonosensitizers are the key element for efficient SDT. However, the development of sonosensitizers with strong sonosensitization efficacy is still a significant challenge. Herein, an urchin-shaped copper-based metalloporphyrin liposome nanosystem (FA–L–CuPP) is constructed and identified as an excellent sonosensitizer. Under ultrasound (US) irradiation, FA–L–CuPP can be highly excited to generate several reactive oxygen species (ROS), such as singlet oxygen (1O2) and free radicals (⋅OH). The molecular orbital distribution calculations reveal that a strong intramolecular charge transfer might occur in the CuPP complex under US irradiation, which could afford enough energy to the surrounding O2 and H2O to concert 1O2, O2− and ⋅OH. Working as “ammunitions”, the largely produced ROS can kill 4T1 tumor cells, effectively inhibiting tumor growth. This work provides an urchin-shaped nanosonosensitizer based on a copper complex, which might provide an idea to design a novel sonosensitizer for noninvasive and precise SDT antitumor applications.

A green protocol for one-pot synthesis of 3,4-dihydropyrano[c]chromenes and biscoumarins by employing WEB as an internal base

A simple, mild and environmentally benign methodology has been developed for the synthesis of 3,4-dihydropyrano[c]chromenes and biscoumarins using water extract of banana peel ash (WEB) as a natural base under ultrasound (US) irradiation. Interestingly, addition of ethanol as a co-solvent improved the yield of desired products. This agro-waste based protocol has simple workup procedure and column-free purification with no need of external base to facilitate the reaction.

Oxygen-Deficient BiOCl Combined with L-Buthionine-Sulfoximine Synergistically Suppresses Tumor Growth through Enhanced Singlet Oxygen Generation under Ultrasound Irradiation.

Excess generation of reactive oxygen species (ROS) based on sensitizers under ultrasound (US) excitation can cause the death of tumor cells via oxidative damage, but sonosensitizers are largely unexplored. Herein, oxygen-deficient black BiOCl (B-BiOCl) nanoplates (NPs) are reported, with post-treatment on conventional BiOCl by simple UV excitation, showing stronger singlet oxygen (1 O2 ) generation than commercial TiO2 nanoparticles and their derivatives under US irradiation. Moreover, L-buthionine-sulfoximine (BSO), a GSH biosynthesis inhibitor, is incorporated into B-BiOCl NPs. The authors find that BSO can be released owing to the degradation of B-BiOCl NPs in the presence of acid and GSH, which are overexpressed in tumors. The results show that BSO/B-BiOCl-PEG NPs have a multifunctional synergistic effect on improving ROS production. In particular, BiOCl has remarkable near-infrared light absorption after UV treatment and is good for photoacoustic imaging that can guide subsequent sonodynamic therapy. This work shows that just with a simple oxygen deficiency treatment, strong 1 O2 generation can be provided to a conventional material under US irradiation and, interestingly, this effect can be amplified by using a small inhibitor BSO, and this is clearly demonstrated in cell and mice experiments.

Photosynthetic Oxygenation-Augmented Sonodynamic Nanotherapy of Hypoxic Tumors.

Reactive oxygen species (ROS) has been employed as a powerful therapeutic agent for eradicating tumor via oxidative stress. As an emerging ROS-involving noninvasive anticancer therapeutic modality, sonodynamic therapy (SDT) with high tissue penetration depth and benign remote spatiotemporal selectivity has been progressively utilized as the distinct alternative for ROS-based tumor treatment. However, the hypoxic tumor microenvironment substantially restricts the sonodynamic effect. In this work, an oxygen self-sufficient hybrid sonosensitizer on the basis of photosynthetic microorganisms cyanobacteria (Cyan) integrated with ultrasmall oxygen-deficient bimetallic oxide Mn1.4 WOx nanosonosensitizers, termed as M@C, is designed and engineered to overcome the critical issue of hypoxia-induced tumor resistance and strengthen the SDT effect. The sustained photosynthetic oxygen production by Cyan under light illumination can promote Mn1.4 WOx nanosonosensitizers to produce more ROS against cancer cells both in vitro and in vivo under ultrasound (US) irradiation. Especially, the sustained oxygen evolution for suppressing the gene expression of hypoxia-inducible factor 1alpha (HIF-1α) further boosts and augments the SDT efficiency. Thus, this work provides the paradigm that the rationally engineered biohybrid microorganism-based multifunctional sonosensitizers can serve as an effective bioplatform for augmenting the therapeutic efficiency of SDT, particularly for the treatment of hypoxic tumors.

Enhancing Cancer Immunotherapeutic Efficacy with Sonotheranostic Strategies.

Immunotherapy has revolutionized the modality for establishing a firm immune response and immunological memory. However, intrinsic limitations of conventional low responsive poor T cell infiltration and immune related adverse effects urge the coupling of cancer nanomedicines with immunotherapy for boosting antitumor response under ultrasound (US) sensitization to mimic dose-limiting toxicities for safe and effective therapy against advanced cancer. US is composed of high-frequency sound waves that mediate targeted spatiotemporal control over release and internalization of the drug. The unconventional US triggered immunogenic nanoengineered arena assists the limited immunogenic dose, limiting toxicities and efficacies. In this Review, we discuss current prospects of enhanced immunotherapy using nanomedicine under US. We highlight how nanotechnology designs and incorporates nanomedicines for the reprogramming of systematic immunity in the tumor microenvironment. We also emphasize the mechanical and biological potential of US, encompassing sonosensitizer activation for enhanced immunotherapeutic efficacies. Finally, the smartly converging combinational platform of US stimulated cancer nanomedicines for amending immunotherapy is summarized. This Review will widen scientists' ability to explore and understand the limiting factors for combating cancer in a precisely customized way.

Sonodynamic cancer therapy by novel iridium-gold nanoassemblies

Metal-based compounds with excellent photo-physical properties show good photochemotherapeutic performance. But, low in-depth tissue penetration of light limits their effectivity for deeply buried tumors. Encouraged by the sonosensitizing ability of the traditional organic photosensitizers, here, we developed AuNPs@Ir1 as a sonosensitizer by hybridizing an organometallic Ir(III) complex (Ir1) with ultrasmall gold nanoparticles (AuNPs) for efficient tumor sonodynamic therapy (SDT) for the first time. AuNPs@Ir1 rapidly entered the cancer cells, produced 1O2, and catalytically oxidized NADH to NAD+ under ultrasound (US) irradiation, thus resulted in cancer cells oncosis. Because of efficient passive retention in tumors post intravenous injection, AuNPs@Ir1 further efficiently inhibited the growth of tumors in-vivo under US stimulation without long-term toxicity to other organs. Overall, this work presents the excellent US triggered in-vitro and in-vivo anticancer profile of the novel AuNPs@Ir1. It is expected to increase the scope of SDT for metal-based anticancer drugs.

A study to evaluate the change in perfusion index as an indicator of successful ultrasound-guided supraclavicular block.

Background and Aims:Perfusion index (PI) is a new simple, objective and non-invasive method for evaluation of the success of central neuraxial and peripheral nerve blocks. So, we conducted a study with an aim to evaluate PI as an indicator for success of ultrasound-guided supraclavicular block (SCB).Methods:65 patients of either sex, age 18–60 years, American Society of Anesthesiologists physical status I and II posted for upper limb surgery under ultrasound (US)-guided SCB were included. PI was recorded at baseline every 2 minutes till 10 minutes and then every 5 minutes till 30 minutes after block. PI ratio was calculated as the ratio between PI at 10 minutes and baseline PI. Sensory and motor blocks were assessed at 5-minutes intervals up to 30 minutes. Descriptive analysis was applied by mean and standard deviation for quantitative, frequency and proportion for categorical variables.Results:Mean PI increased continuously from baseline and reached the maximum at 10 minutes and then slightly decreased up to 30 minutes, but values at subsequent time intervals were quite high as compared to baseline. In case of successful blocks, median PI started increasing 2 minutes after the block and then increased in a linear fashion till 10 minutes, whereas in case of failed blocks, it only increased minimally.Conclusion:PI is an objective and faster indicator for evaluating success of US-guided SCB. A cut-off value of 3.25 for PI and 3.03 for PI ratio showed a fairly good ability with high sensitivity and specificity for predicting the success of SCB.

W-Doped TiO2 Nanorods for Multimode Tumor Eradication in Osteosarcoma Models under Single Ultrasound Irradiation.

Sonosensitizers play crucial roles in the controlled production of reactive oxygen species (ROS) under ultrasound (US) irradiation with high tissue-penetration depth for noninvasive solid tumor therapy. It is desirable to fabricate structurally simple yet multifunctional sonosensitizers from ultrafine nanoparticles for ROS-based multimode therapy to overcome monomode limitations such as low ROS production yields and endogenous reductive glutathione (GSH) to ROS-based treatment resistance. We report the facile high-temperature solution synthesis of ultrafine W-doped TiO2 (W-TiO2) nanorods for exploration of their sonodynamic, chemodynamic, and GSH-depleting activities in sonodynamic-chemodynamic combination tumor therapy. We found that W5+ and W6+ ions doped in W-TiO2 nanorods play multiple roles in enhancing their ROS production. First, W doping narrows the band gap from 3.2 to 2.3 eV and introduces oxygen and Ti vacancies for enhancing their sonodynamic performance. Second, W5+ doping endows W-TiO2 nanorods with Fenton-like reaction activity to produce •OH from endogenous H2O2 in the tumor. Third, W6+ ions reduce endogenous GSH to glutathione disulfide (GSSG) and, in turn, form W5+ ions that further enhance their chemodynamic activity, which greatly modifies thae oxidation-reduction tumor microenvironment in the tumor. In vivo experiments display the excellent ability of W-TiO2 nanorods for enhanced tumor eradication in human osteosarcoma models under single US irradiation. Importantly, the ultrafine nanorod morphology facilitates rapid excretion from the body, displaying no significant systemic toxicity. Our work suggests that multivalent metal doping in ultrafine nanomaterials is an effective and simple strategy for the introduction of new functions for ROS-based multimode therapy.

A Poly-vinyl Alcohol (PVA)-based phantom and training tool for use in simulated Transrectal Ultrasound (TRUS) guided prostate needle biopsy procedures

Trans-rectal ultrasound-guided needle biopsy is a well-established diagnosis technique for prostate cancer. To enhance the needle manoeuvring skills under ultrasound (US) guidance, it is preferable to train medical practitioners in needle biopsy on tissue-mimicking phantoms. This phantom should mimic the morphology as well as mechanical and acoustic properties of the human male pelvic region to provide a surgical experience and feedback. In this study, polyvinyl alcohol (PVA) was used and evaluated for prostate phantom development, that is stiffness tunable, US-compatible and durable phantom material. Three samples, each with 5%, 10%, and 15% concentration of PVA material, were prepared, and their mechanical and shrinkage characteristics were investigated. The anatomy of male pelvic region was used to develop an anatomically correct phantom. Later US-guided needle biopsy was performed on the phantom. The range of elastic moduli of the PVA samples was 2∼146 kPa. Their elastic moduli and volumes were found to remain statistically close from seventh to eighth freeze-thaw cycle (p>0.05). Initial US scans of the phantom resulted in satisfactory B-mode images, with a clear distinction between the prostate and its surrounding organs. This study demonstrated the applicability of PVA hydrogel as a phantom material for training in US-guided needle biopsy.

Fluorescent Azasteroids through Ultrasound Assisted Cycloaddition Reactions.

We report here the synthesis and optical spectral properties of several new azasteroid derivatives. The formation of these compounds was explained based on the most probable mechanism. The luminescent heterocycles were synthesized by 1,3-dipolar cycloaddition reactions between benzo[f]quinoline and methylpropiolate or dimethyl acetylenedicarboxylate (DMAD). A selective and efficient way for [3+2]-dipolar cycloaddition of benzo[f]quinolinium ylides under ultrasound (US) irradiation (20 kHz processing frequency) is presented. We report substantially higher yields under US irradiation, whereas the solvent amounts required are at least three-fold less compared to classical heating. The azasteroid derivatives are blue emitters with λmax of fluorescence around 430–450 nm. A certain influence of the azasteroid substituents concerning absorption and fluorescent properties was observed. Compounds anchored with a bulky pivaloyl group or without a C=O carbonyl group have shown increased fluorescence intensity.

A highly potent ruthenium(II)-sonosensitizer and sonocatalyst for in vivo sonotherapy

As a basic structure of most polypyridinal metal complexes, [Ru(bpy)3]2+, has the advantages of simple structure, facile synthesis and high yield, which has great potential for scientific research and application. However, sonodynamic therapy (SDT) performance of [Ru(bpy)3]2+ has not been investigated so far. SDT can overcome the tissue-penetration and phototoxicity problems compared to photodynamic therapy. Here, we report that [Ru(bpy)3]2+ is a highly potent sonosensitizer and sonocatalyst for sonotherapy in vitro and in vivo. [Ru(bpy)3]2+ can produce singlet oxygen (1O2) and sono-oxidize endogenous 1,4-dihydronicotinamide adenine dinucleotide (NADH) under ultrasound (US) stimulation in cancer cells. Furthermore, [Ru(bpy)3]2+ enables effective destruction of mice tumors, and the therapeutic effect can reach deep tissues over 10 cm under US irradiation. This work paves a way for polypyridinal metal complexes to be applied to the noninvasive precise sonotherapy of cancer.

Sub 5nm Gd3+ -Hemoporfin Framework Nanodots for Augmented Sonodynamic Theranostics and Fast Renal Clearance.

Metal-organic nanomaterials have emerged as promising therapeutic agents to produce reactive oxygen species (ROS) under ultrasound (US) or light irradiation for tumor treatments. However, their relatively large sizes (ranging from tens to hundreds of nanometers) usually lead to low ROS utilization and body metabolism, thus enlarging their long-term toxicity and low therapeutic effect. To solve these shortcomings, herein the ultrasmall Gd3+ -hemoporfin framework nanodots (GdHF-NDs， ≈5 nm) is reported as efficient nano-sonosensitizers. Compared with GdHF aggregation (GdHF-A, ≈400nm), the ultrasmall GdHF-NDs generate 2.3-fold toxic ROS amount under similar conditions, due to shorter diffusion path and larger relative specific surface area. When the GdHF-NDs dispersion is introvenously injected into tumor-bearing mouse, they are accumulated within tumors to provide high magnetic resonance imaging (MRI) contrast. Under US irradiation, the GdHF-NDs achieve a better sonodynamic therapeutic efficacy for tumors, compared with that from GdHF-A. More importantly, owing to ultrasmall size, most of GdHF-NDs can be rapidly cleared through the renal pathway. Therefore, GdHF-NDs can be used as a biosafety and high-performance sonodynamic agent for cancer theranostics.

Role of percutaneous radiological treatment in biliary complications associated with adult left lobe living donor liver transplantation: a single-center experience.

Biliary complications develop at a higher rate in living donor liver transplantation (LDLT) compared with cadaveric liver transplantation. Almost all studies about biliary complications after LDLT were made with the right lobe. The aim of this study was to determine the frequency of biliary complications developing after adult left lobe LDLT and to evaluate the efficacy of the algorithm followed in diagnosis and treatment, particularly percutaneous radiological treatment. A total of 2185 LDLT operations performed in our center between May 2009 and December 2019 were retrospectively reviewed and patients receiving left lobe LDLT were analyzed regarding biliary complications and treatments. Biliary complications were treated via percutaneous drainage under ultrasound (US) guidance, endoscopic retrograde cholangiopancreatography (ERCP), and percutaneous transhepatic cholangiography (PTC)/ percutaneous transhepatic biliary drainage (PTBD). Patient demographics, ERCP procedures before percutaneous treatment, and percutaneous treatment indications were analyzed. A total of 69 adult patients received left lobe LDLT. Biliary complications requiring endoscopic and/or percutaneous treatment developed in 28 patients (40%). Of these patients, 4 had bile leakage (14%), 20 had anastomosis stricture (72%), and 4 had both leakage and anastomosis stricture (14%). External drainage treatment under ultrasound guidance was sufficient for 2 of 4 patients with bile leakage, and these cases were accepted as minor bile leakage (7%). Overall, 26 patients underwent ERCP; of these, 8 were referred for PTC/PTBD because the guidewire and/or balloon-stent could not pass the anastomosis stricture (n=7) and common bile duct cannulation could not be obtained because of duodenal diverticulum (n=1). Diagnostic PTC was performed in 10 patients, 8 were referred after inadequate/failed ERCP procedure and two were referred directly without ERCP. Anastomosis stricture was found in 7 patients and anastomosis stricture and bile leakage in 3. In 7 patients determined to have stricture, balloon dilatation was applied and then biliary drainage was performed. In 3 patients who had leakage and anastomosis stricture, balloon dilatation was applied for stricture; after dilatation, an IEBD catheter was placed through the leakage region in 2 patients, while a covered metallic stent passing through the leakage region was placed in one patient. Generally, ERCP is the first preferred method in biliary complications of LDLT; however, in cases where a response cannot be obtained by endoscopic treatment or require complex and/or aggressive treatment, percutaneous radiological treatment should be the treatment of choice before surgery in left lobe LDLT.

Supera Stent Implantation with Ultrasound Guidance for Complex Ostial Lesions of Superficial Femoral Artery by Retrograde Approach: The SUGAR Technique

Abstract Purpose The aim of this study was to describe a modified technique for accurate deployment of the Supera stent under ultrasound (US) guidance for complex lesions involving superficial femoral artery (SFA) ostium without jailing profunda femoral artery (PFA) by retrograde approach. Technique Retrograde pedal access was initially taken in all the cases. The stenotic or occlusive femoropopliteal lesions involving the SFA ostium were crossed retrogradely and additional contralateral common femoral artery (CFA) access was taken only if we failed to cross the lesion. In addition to fluoroscopy, extravascular US guidance was freely used whenever required throughout the procedure. After desired predilatation of the SFA lesion, US guidance (gray scale and color Doppler) was used to start deployment of the proximal few centimeters of Supera stent ensuring that the landing of first crown was exactly from the SFA ostium not extending into CFA or jailing the PFA ostium. The rest of the stent was deployed under fluoroscopic guidance. Retrograde pedal access site hemostasis was achieved by manual compression. The Supera stent implantation with Ultrasound Guidance for complex ostial lesions of superficial femoral Artery by Retrograde approach (SUGAR) technique was applied successfully in 35 patients (mean age 58.1 ± 4.4 years; 24 males) with critical limb ischemia via the distal pedal approach. No access site or remote complications were observed. Conclusion The SUGAR technique has superior advantage of utilizing a simple tool like extravascular US in addition to fluoroscopy for retrograde Supera stent deployment by allowing very precise landing at SFA ostium, bypassing the need for multiple oblique projections, unwanted radiation exposure, and extra contrast dye overload.

A hypoxia responsive nanoassembly for tumor specific oxygenation and enhanced sonodynamic therapy

The hypoxic tumor microenvironment (TME) and non-specific distribution of sonosensitizers are two major obstacles that limit practical applications of sonodynamic therapy (SDT) in combating tumors. Here we report a hypoxia-responsive nanovesicle (hMVs) as delivery vehicles of a sonosensitizer to enhance the efficacy of SDT via specific payload release and local oxygenation in the tumor. The nanovesicles are composed of densely packed manganese ferrite nanoparticles (MFNs) embedded in hypoxia-responsive amphiphilic polymer membranes. With δ-aminolevulinic acid (ALA) loaded in the hollow cavities, the hMVs could rapidly dissociate into discrete nanoparticles in the hypoxic TME to release the payload and induce the generation of reactive oxygen species (ROS) under ultrasound (US) radiation. Meanwhile, the released MFNs could catalytically generate O2 to overcome the hypoxic TME and thus enhance the efficacy of SDT. After treatment, the dissociated MFNs could be readily excreted from the body via renal clearance to reduce long term toxicity. In vitro and in vivo experiments displayed effective tumor inhibition via hMVs-mediated SDT, indicating the great potential of this unique nanoplatform in effective SDT by generating sufficient ROS in deep-seated hypoxic tumors that are not readily accessible by conventional photodynamic therapy.

Diagnostic and Interventional Radiology Management of Ureteral Iatrogenic Leakage after Gynecologic Surgery.

Objective: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. Methods: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. Results: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. Conclusion: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.

Magnetic Control of a Steerable Guidewire Under Ultrasound Guidance Using Mobile Electromagnets

Endovascular surgery has become a popular minimally invasive approach to diagnose and treat various vascular diseases. However, manipulating conventional passive guidewires and catheters still has technical challenges, such as long duration and undesired trauma. In addition, radiation exposure induced by commonly used fluoroscopic imaging has safety concerns. This letter presents a workflow that performs magnetic control of a steerable guidewire under ultrasound (US) guidance to address these issues. The designed magnetically steerable guidewire is fabricated by replica molding method, then a computational-efficient kinematic model is proposed to describe the relationship between the applied magnetic field and tip deformation. The constructed magnetic actuation system integrates three electromagnets and a US probe into a parallel mechanism, realizing large-workspace magnetic field generation and US feedback. Further, a motorized feeder is incorporated to provide the forward and backward motion of the guidewire. An autonomous control framework is proposed consisting of preoperative and intraoperative stages, through which the guidewire can be delivered to the targeted region automatically. Results show that the proposed kinematic model efficiently estimates the deformation of the guidewire. Furthermore, the overall procedure is experimentally validated on a phantom mimicking vascular structures. This letter provides a preliminary robotic solution to improve catheterization procedures by introducing magnetic actuation and US imaging.

POS-751 AN UNUSUAL PRESENTATION OF ARTERI-VENOUS FISTULA AFTER RENAL BIOPSY: CASE REPORT

Renal biopsy is an important diagnostic procedure but is associated with a number of significant complications even when performed by a skilled operator. While most of these complications present with haemodynamic disturbance, pain or macroscopic haematuria, some – such as the development of a post-biopsy arteriovenous fistula may be occult. We present an unusual presentation of a post-biopsy arteriovenous fistula which was diagnosed after the patient reported an audible bruit. A 39-year-old woman with end stage renal disease of unknown etiology received her first kidney transplant in February 2020. The right kidney from a deceased after cardiac death donor was transplanted into her right iliac fossa. Before transplantation, she had been on hemodialysis via an arteriovenous fistula (AVF) for a year. There was delayed graft function and the patient was dialysed through her AVF on the 2nd day of transplantation. Graft function was slow to improve and a kidney biopsy was performed on the 6th day post-transplantation. The biopsy was performed under ultrasound (US)control with two passes of a 16 G needle. Post-procedure observations were unremarkable and the patient went home after 6 hours of bed rest.The biopsy showed borderline rejection and the patient was prescribedthree doses of intravenous methylprednisolone. On the second day post-biopsy, graft function remained poor and routine bloods showed a drop in haemoglobin from 107 to 78 g/L. Abdominal US did not show any abnormality. Patient received blood transfusion and was observed overnight. The patient was discharged home next day. On the 5th day post-biopsy, the patient presented with reports of hearing “buzzing” sounds. ENT review was unremarkable. Graft function was poor and the patient remained on dialysis. Abdominal US and Doppler studies showed a large AVF within the transplanted kidney at the site of the earlier biopsy (fig 1). Figure 1: Doppler ultrasound of renal transplant showing post biopsy AVF The fistula was large and, with evidence of recent bleeding, thus underwent coil embolisation in the interventional radiology department (fig 2). Figure 2: Coil embolisation of AVF. Left panel shows initial angiographic appearance; right panel shows appearance following coil embolisation At present, the patient is nine months post-transplantation and remains dialysis independent with stable graft function and an eGFR 25-30 mL/min/1.73m2. Most biopsy-associated AVFs close spontaneously, are asymptomatic, and do not require intervention. The indication for intervention is usually an increase in the size of fistula over time, the development of signs of heart failure, deterioration in kidney function, or a rise in blood pressure. Embolisation of biopsy-associated AVFs has been reported to result in good outcomes with minimal changes in serum creatinine and estimated glomerular filtration rate. The risks include proximal dissemination of the embolisation material and the resultant focal occlusion of the arterial system causing renal, gut and pulmonary ischaemia. Surgical procedures are reserved for large AVFs with high velocity flows. Complications of kidney biopsy can be asymptomatic, and missed because of late and atypical presentation. A possibility of kidney biopsy related complication should always be considered when a patient presents within few weeks of the kidney biopsy.

Conferring Ti-Based MOFs with Defects for Enhanced Sonodynamic Cancer Therapy.

The development of highly efficient, multifunctional, and biocompatible sonosensitizer is still a priority for current sonodynamic therapy (SDT). Herein, a defect-rich Ti-based metal-organic framework (MOF) (D-MOF(Ti)) with greatly improved sonosensitizing effect is simply constructed and used for enhanced SDT. Compared with the commonly used sonosensitizer TiO2 , D-MOF(Ti) results in a superior reactive oxygen species (ROS) yield under ultrasound (US) irradiation due to its narrow bandgap, which principally improves the US-triggered electron-hole separation. Meanwhile, due to the existence of Ti3+ ions, D-MOF(Ti) also exhibits a high level of Fenton-like activity to enable chemodynamic therapy. Particularly, US as the excitation source of SDT can simultaneously enhance the Fenton-like reaction to achieve remarkably synergistic outcomes for oncotherapy. More importantly, D-MOF(Ti) can be degraded and metabolized out of the body after completion of its therapeutic functions without off-target toxicity. Overall, this work identifies a novel Ti-familial sonosensitizer harboring great potential for synergistic sonodynamic and chemodynamic cancer therapy.

Rational construction of CeO2–ZrO2@MoS2 hybrid nanoflowers for enhanced sonophotocatalytic degradation of naproxen: Mechanisms and degradation pathways

This study proposed a novel heterogeneous sonophotocatalytic system to effectively treat pharmaceutical wastewater employing molybdenum disulfide (MoS2) decorated ceria (CeO2)-zirconia (ZrO2) ternary hybrid nanoflowers (CZx/100 M). The generation of dominant oxidizing species, both radical and nonradical, was deeply scrutinized under ultrasound (US) irradiation coupled with visible-light by electron spin resonance spectroscopy analysis and scavenging experiments, for the first time. Interestingly, the pairing of US with visible-light illumination in a sonophotocatalytic degradation system resulted in 96% degradation efficiency of naproxen (NPX) within 40 min, which confirmed that excellent synergistic effect of sono- and photocatalytic mechanisms in the presence of 0.5 g/L sonophotocatalyst at pH 5.8. The sonophotocatalytic activity was also manifested at various reaction time, catalyst dose, solution pH, initial NPX concentrations, and US frequency and power and in the presence of various anions. The mechanism for the catalytic degradation of NPX is proposed in the US/Vis/CZx/100 M system, and transformation products formed during the process were identified by an ultra-high performance liquid chromatography-mass spectrometry technique.