A Comparison of Ultrasound Guided Curettage With and Without Uterine Artery Embolization on Controlling Intraoperative Blood Loss for a Cesarean Scar Pregnancy Treatment: Study Protocol for a Randomized Clinical Trial

IntroductionCesarean scar pregnancy affects 6% of all ectopic pregnancies in women with prior cesarean section, and there is currently no consensus on the optimal treatment. Options of surgical treatment have a risk of intraoperative blood loss; therefore, uterine artery embolization (UAE) has been considered as an option of reducing intraoperative blood loss. However, UAE may be overused in clinical practice, especially in China. We present this protocol for a randomized clinical trial investigating the necessity of performing UAE for cesarean scar pregnancy, in combination with surgical suction curettage, taking into account the different subtypes of cesarean scar pregnancy. We recently developed a risk-scoring system (QRS) to estimate intraoperative blood loss, with 93.8% sensitivity and 6.3% false negative. Through this randomized clinical trial, we will retrospectively validate the QRS score on predicting intraoperative blood loss.Methods and AnalysisWe propose undertaking a randomized clinical trial sequentially recruiting 200 patients. All the patients will randomly receive ultrasound guided curettage with or without UAE. Data on the subtypes of cesarean scar pregnancy (Types 1 and II and III) detected by ultrasound will be collected before operation. The score on estimating intraoperative blood loss assessed by our recently developed quantitative risk-scoring system (QRS) will be collected before the operation. We will primarily compare the duration of the operation, intraoperative blood loss, and complications between the two groups. We will also retrospectively analyze the association of subtypes of cesarean scar pregnancy and the options of treatment and validate the QRS score. Outcomes of subsequent pregnancy within the 2-year follow-up will be secondary outcomes.Trial Registration Number[website], identifier ChiCTR2100041654

A new 3-arylbenzofuran derivative EIE-2 reestablishes Treg-dependent tolerance in rheumatoid arthritis by targeting on Syk induced mTOR and PKCθ imbalance

IntroductionDysfunctional self-tolerance is thought to play a crucial role in the onset of rheumatoid arthritis (RA) pathogenesis. Poorly functioning regulatory T cells (Tregs) lead to extreme situations where self-tolerance is robustly disrupted. However, there are many uncertainties regarding its immunosuppressive pathways, especially concerning therapeutic drugs that are still in their infancy. Therefore, deciphering potential targets and developing novel drugs to ameliorate functional Tregs deficiency appears to be an efficient therapeutic approach for controlling RA.MethodsThe therapeutic effects of EIE-2, a novel 3-arylbenzofuran derivative, were evaluated in collagen-induced arthritis (CIA) rats and carrageenan-induced paw edema mice in vivo, as well as in LPS-, PMA- or TNF-α-stimulated human CD4+ T cells (Jurkat), human synovial sarcoma cells (SW982) and primary isolated lymphocytes in vitro. The role of Syk in Treg-dependent tolerance and the mechanism of EIE-2 were explored using western blotting, quantitative reverse transcription PCR (qRT-PCR) and flow cytometry. Potential mechanistic targets were further validated through siRNA knockdown and molecular docking analysis.ResultsEIE-2 significantly ameliorated arthritic symptoms and pathological damage in CIA rats by reducing pro-inflammatory cytokines and increasing anti-inflammatory factors in synovium and serum, and exhibited similar therapeutic effects in carrageenan-induced pedal edema mice. Moreover, EIE-2 potently suppressed the inflammatory responses in human synoviocyte SW982 cells, primary isolated lymphocytes and CD4+ Jurkat cells. Its therapeutic potential was associated with upregulation of Tregs during the active phase and downregulation during the inactive phase of RA. Mechanistically, EIE-2 modulated the PKCθ/mTOR ratio via Syk targeting, thereby restoring homeostasis in Tregs.DiscussionEIE-2 is a potential therapeutic candidate for RA. The underlying mechanism may involve its targeting on Syk to upregulate the PKCθ/mTOR ratio during the active phase of RA and downregulate the PKCθ/mTOR ratio during the inactive phase of RA, ultimately promoting Treg-dependent tolerance restoration

Fabrication and characterization of steel-magnesium laminated metal composites

In this study, interstitial-free steel and commercial purity magnesium sheets were used to fabricate steel-magnesium laminated metal composites by roll bonding at 300℃. It was found that the steel and magnesium can achieve reasonable bonding after a 47% rolling reduction when the volume fraction of the laminate is 10-15% magnesium. The microstructure of the laminated composites was observed with scanning electron microscope. It was found that a continuous interface between the IF steel and the magnesium was produced during the roll bonding process. There was no evidence of intermetallic formation at the interface. A seven layer steel-magnesium laminate was fabricated by accumulative roll bonding at 300℃ with an overall reduction of 77 percent. Through-width cracks were found in the surface steel layers after the one cycle accumulative roll bonding process. The longitudinal cross-sectional microstructure of the laminate revealed that multi-localizations and even fracture occurred in steel layers inside the laminate. The mechanical properties, including tensile behavior, micro-hardness and bending behavior, of the laminated composites were assessed. The tensile property of the laminated composites was compared with those of monolithic steel and magnesium with equivalent deformation amount deformed under the same conditions. It was found that the UTS of the laminated composites obeyed the simple rule of mixtures. The fracture surfaces of the laminated composites were examined with SEM and compared with those of the monolithic IF steel and magnesium rolled under the same conditions. It was found that the fracture modes of each component were different in the laminated composites compared to the monolithic materials. Three-point bending test was conducted and it was observed that no debonding at the interface occurred for moderate strains. To investigate the fracture behavior of the laminats in bending, a series of U-shape bending tests were conducted and the bend tips were observed. Localization of the outer steel layer was observed, followed by the formation of a major crack at 45 degree to the maximum tensile stress direction. Shear cracks in the magnesium core were also found in some places adjacent to the major crack, and delamination between the steel and magnesium layers occurred.Applied Science, Faculty ofMaterials Engineering, Department ofGraduat

Cold spray of mixed metal powders on carbon fibre reinforced polymers

Metallization of polymers and polymer composites has attracted interest recently. Cold spray is an emerging coating method, but direct cold spray of metals on carbon fibre reinforced polymer (CFRP) is difficult. Previous results show that tin coatings can be cold sprayed on CFRP, but the deposition efficiency is relatively low. In this work, copper and zinc powders were mixed with tin to investigate the effect of mixing on deposition efficiency of the coating. The mixed metal powders were cold sprayed on CFRP with a low-pressure system at various conditions. Results show that the addition of copper and zinc led to much higher deposition efficiencies compared to the pure tin coating. Based on the results, the deposition mechanism of the mixed metal powders on CFRP is discussed, the effect of mixing powders on deposition efficiency is analyzed and several mechanisms are proposed accordingly.Peer reviewed: YesNRC publication: Ye

Observation of a Redisposition Effect While Cold Spraying Sn-Al Mixed Powders onto Carbon Fibre Reinforced Polymers

Abstract Single component tin coatings have been successfully cold-sprayed onto carbon fiber reinforced polymers. Coatings with mixed metal powders have also been sprayed to improve conductivity for lightning strike protection purposes. Test results indicate a noticeable improvement in deposition efficiency with the addition of a secondary metallic powder. This study examines the effect of aluminum powder additions in tin coatings. Following cold spraying of various Sn-Al mixtures over a wide range of gas pressures, unusual coating morphologies were observed. The study of these morphologies reveals two distinct deposition phases depending on spray pressure. The presence of submicron particles also supports the occurrence of a powder melting phenomenon during the spraying process.</jats:p