Biomimetic natural biomaterials for tissue engineering and regenerative medicine:new biosynthesis methods,recent advances,and emerging applications

Biomimetic materials have emerged as attractive and competitive alternatives for tissue engineering(TE)and regenerative medicine.In contrast to conventional biomaterials or synthetic materials,biomimetic scaffolds based on natural biomaterial can offer cells a broad spectrum of biochemical and biophysical cues that mimic the in vivo extracellular matrix(ECM).Additionally,such materials have mechanical adaptability,micro-structure interconnectivity,and inherent bioactivity,making them ideal for the design of living implants for specific applications in TE and regenerative medicine.This paper provides an overview for recent progress of biomimetic natural biomaterials(BNBMs),including advances in their preparation,functionality,potential applications and future challenges.We highlight recent advances in the fabrication of BNBMs and outline general strategies for functionalizing and tailoring the BNBMs with various biological and physicochemical characteristics of native ECM.Moreover,we offer an overview of recent key advances in the functionalization and applications of versatile BNBMs for TE applications.Finally,we conclude by offering our perspective on open challenges and future developments in this rapidly-evolving field.

Compositional and Hollow Engineering of Silicon Carbide/Carbon Microspheres as High-Performance Microwave Absorbing Materials with Good Environmental Tolerance

Microwave absorbing materials(MAMs)characterized by high absorption efficiency and good environmental tolerance are highly desirable in practical applications.Both silicon carbide and carbon are considered as stable MAMs under some rigorous conditions,while their composites still fail to produce satisfactory microwave absorption performance regardless of the improvements as compared with the individuals.Herein,we have successfully implemented compositional and structural engineering to fabricate hollow Si C/C microspheres with controllable composition.The simultaneous modulation on dielectric properties and impedance matching can be easily achieved as the change in the composition of these composites.The formation of hollow structure not only favors lightweight feature,but also generates considerable contribution to microwave attenuation capacity.With the synergistic effect of composition and structure,the optimized SiC/C composite exhibits excellent performance,whose the strongest reflection loss intensity and broadest effective absorption reach-60.8 dB and 5.1 GHz,respectively,and its microwave absorption properties are actually superior to those of most SiC/C composites in previous studies.In addition,the stability tests of microwave absorption capacity after exposure to harsh conditions and Radar Cross Section simulation data demonstrate that hollow SiC/C microspheres from compositional and structural optimization have a bright prospect in practical applications.

Interface Engineering of Titanium Nitride Nanotube Composites for Excellent Microwave Absorption at Elevated Temperature

Currently,the microwave absorbers usually suffer dreadful electromagnetic wave absorption(EMWA)performance damping at elevated temperature due to impedance mismatching induced by increased conduction loss.Consequently,the development of high-performance EMWA materials with good impedance matching and strong loss ability in wide temperature spectrum has emerged as a top priority.Herein,due to the high melting point,good electrical conductivity,excellent environmental stability,EM coupling effect,and abundant interfaces of titanium nitride(TiN)nanotubes,they were designed based on the controlling kinetic diffusion procedure and Ostwald ripening process.Benefiting from boosted heterogeneous interfaces between TiN nanotubes and polydimethylsiloxane(PDMS),enhanced polarization loss relaxations were created,which could not only improve the depletion efficiency of EMWA,but also contribute to the optimized impedance matching at elevated temperature.Therefore,the TiN nanotubes/PDMS composite showed excellent EMWA performances at varied temperature(298-573 K),while achieved an effective absorption bandwidth(EAB)value of 3.23 GHz and a minimum reflection loss(RLmin)value of−44.15 dB at 423 K.This study not only clarifies the relationship between dielectric loss capacity(conduction loss and polarization loss)and temperature,but also breaks new ground for EM absorbers in wide temperature spectrum based on interface engineering.

Ionization Engineering of Hydrogels Enables Highly Efficient Salt‑Impeded Solar Evaporation and Night‑Time Electricity Harvesting

Interfacial solar evaporation holds immense potential for brine desalination with low carbon footprints and high energy utilization.Hydrogels,as a tunable material platform from the molecular level to the macroscopic scale,have been considered the most promising candidate for solar evaporation.However,the simultaneous achievement of high evaporation efficiency and satisfactory tolerance to salt ions in brine remains a challenging scientific bottleneck,restricting the widespread application.Herein,we report ionization engineering,which endows polymer chains of hydrogels with electronegativity for impeding salt ions and activating water molecules,fundamentally overcoming the hydrogel salt-impeded challenge and dramatically expediting water evaporating in brine.The sodium dodecyl benzene sulfonate-modified carbon black is chosen as the solar absorbers.The hydrogel reaches a ground-breaking evaporation rate of 2.9 kg m−2 h−1 in 20 wt%brine with 95.6%efficiency under one sun irradiation,surpassing most of the reported literature.More notably,such a hydrogel-based evaporator enables extracting clean water from oversaturated salt solutions and maintains durability under different high-strength deformation or a 15-day continuous operation.Meantime,on the basis of the cation selectivity induced by the electronegativity,we first propose an all-day system that evaporates during the day and generates salinity-gradient electricity using waste-evaporated brine at night,anticipating pioneer a new opportunity for all-day resource-generating systems in fields of freshwater and electricity.

Frilled Lizard Optimization: A Novel Bio-Inspired Optimizer for Solving Engineering Applications

This research presents a novel nature-inspired metaheuristic algorithm called Frilled Lizard Optimization(FLO),which emulates the unique hunting behavior of frilled lizards in their natural habitat.FLO draws its inspiration from the sit-and-wait hunting strategy of these lizards.The algorithm’s core principles are meticulously detailed and mathematically structured into two distinct phases:(i)an exploration phase,which mimics the lizard’s sudden attack on its prey,and(ii)an exploitation phase,which simulates the lizard’s retreat to the treetops after feeding.To assess FLO’s efficacy in addressing optimization problems,its performance is rigorously tested on fifty-two standard benchmark functions.These functions include unimodal,high-dimensional multimodal,and fixed-dimensional multimodal functions,as well as the challenging CEC 2017 test suite.FLO’s performance is benchmarked against twelve established metaheuristic algorithms,providing a comprehensive comparative analysis.The simulation results demonstrate that FLO excels in both exploration and exploitation,effectively balancing these two critical aspects throughout the search process.This balanced approach enables FLO to outperform several competing algorithms in numerous test cases.Additionally,FLO is applied to twenty-two constrained optimization problems from the CEC 2011 test suite and four complex engineering design problems,further validating its robustness and versatility in solving real-world optimization challenges.Overall,the study highlights FLO’s superior performance and its potential as a powerful tool for tackling a wide range of optimization problems.

Trace Cobalt Doping and Defect Engineering of High Surface Area α-Ni(OH)_(2) for Electrocatalytic Urea Oxidation

Owing to the intrinsically sluggish kinetics of urea oxidation reaction(UOR)involving a six-electron transfer process,developing efficient UOR electrocatalyst is a great challenge remained to be overwhelmed.Herein,by taking advantage of 2-Methylimidazole,of which is a kind of alkali in water and owns strong coordination ability to Co^(2+)in methanol,trace Co(1.0 mol%)addition was found to induce defect engineering onα-Ni(OH)_(2)in a dual-solvent system of water and methanol.Physical characterization results revealed that the synthesized electrocatalyst(WM-Ni_(0.99)Co_(0.01)(OH)_(2))was a kind of defective nanosheet with thickness around 5-6 nm,attributing to the synergistic effect of Co doping and defect engineering,its electron structure was finely altered,and its specific surface a rea was tremendously enlarged from 68 to 172.3 m^(2)g^(-1).With all these merits,its overpotential to drive 10 mA cm^(-2)was reduced by 110 mV.Besides,the interfacial behavior of UOR was also well deciphered by operando electrochemical impedance spectroscopy.

Biomaterials and tissue engineering in traumatic brain injury:novel perspectives on promoting neural regeneration

Traumatic brain injury is a serious medical condition that can be attributed to falls, motor vehicle accidents, sports injuries and acts of violence, causing a series of neural injuries and neuropsychiatric symptoms. However, limited accessibility to the injury sites, complicated histological and anatomical structure, intricate cellular and extracellular milieu, lack of regenerative capacity in the native cells, vast variety of damage routes, and the insufficient time available for treatment have restricted the widespread application of several therapeutic methods in cases of central nervous system injury. Tissue engineering and regenerative medicine have emerged as innovative approaches in the field of nerve regeneration. By combining biomaterials, stem cells, and growth factors, these approaches have provided a platform for developing effective treatments for neural injuries, which can offer the potential to restore neural function, improve patient outcomes, and reduce the need for drugs and invasive surgical procedures. Biomaterials have shown advantages in promoting neural development, inhibiting glial scar formation, and providing a suitable biomimetic neural microenvironment, which makes their application promising in the field of neural regeneration. For instance, bioactive scaffolds loaded with stem cells can provide a biocompatible and biodegradable milieu. Furthermore, stem cells-derived exosomes combine the advantages of stem cells, avoid the risk of immune rejection, cooperate with biomaterials to enhance their biological functions, and exert stable functions, thereby inducing angiogenesis and neural regeneration in patients with traumatic brain injury and promoting the recovery of brain function. Unfortunately, biomaterials have shown positive effects in the laboratory, but when similar materials are used in clinical studies of human central nervous system regeneration, their efficacy is unsatisfactory. Here, we review the characteristics and properties of various bioactive materials, followed by the introduction of applications based on biochemistry and cell molecules, and discuss the emerging role of biomaterials in promoting neural regeneration. Further, we summarize the adaptive biomaterials infused with exosomes produced from stem cells and stem cells themselves for the treatment of traumatic brain injury. Finally, we present the main limitations of biomaterials for the treatment of traumatic brain injury and offer insights into their future potential.

Dual-Defect Engineering Strategy Enables High-Durability Rechargeable Magnesium-Metal Batteries

Rechargeable magnesium-metal batteries(RMMBs)are promising next-generation secondary batteries;however,their development is inhibited by the low capacity and short cycle lifespan of cathodes.Although various strategies have been devised to enhance the Mg^(2+)migration kinetics and structural stability of cathodes,they fail to improve electronic conductivity,rendering the cathodes incompatible with magnesium-metal anodes.Herein,we propose a dual-defect engineering strategy,namely,the incorporation of Mg^(2+)pre-intercalation defect(P-Mgd)and oxygen defect(Od),to simultaneously improve the Mg^(2+)migration kinetics,structural stability,and electronic conductivity of the cathodes of RMMBs.Using lamellar V_(2)O_(5)·nH_(2)O as a demo cathode material,we prepare a cathode comprising Mg_(0.07)V_(2)O_(5)·1.4H_(2)O nanobelts composited with reduced graphene oxide(MVOH/rGO)with P-Mgd and Od.The Od enlarges interlayer spacing,accelerates Mg^(2+)migration kinetics,and prevents structural collapse,while the P-Mgd stabilizes the lamellar structure and increases electronic conductivity.Consequently,the MVOH/rGO cathode exhibits a high capacity of 197 mAh g^(−1),and the developed Mg foil//MVOH/rGO full cell demonstrates an incredible lifespan of 850 cycles at 0.1 A g^(−1),capable of powering a light-emitting diode.The proposed dual-defect engineering strategy provides new insights into developing high-durability,high-capacity cathodes,advancing the practical application of RMMBs,and other new secondary batteries.

Phase-engineering modulation of Mn-based oxide cathode for constructing super-stable sodium storage

The Mn-based oxide cathode with enriched crystal phase structure and component diversity can provide the excellent chemistry structure for Na-ion batteries.Nevertheless,the broad application prospect is obstructed by the sluggish Na^(+)kinetics and the phase transitions upon cycling.Herein,we establish the thermodynamically stable phase diagram of various Mn-based oxide composites precisely controlled by sodium content tailoring strategy coupling with co-doping and solid-state reaction.The chemical environment of the P2/P'3 and P2/P3 biphasic composites indicate that the charge compensation mechanism stems from the cooperative contribution of anions and cations.Benefiting from the no phase transition to scavenge the structure strain,P2/P'3 electrode can deliver long cycling stability(capacity retention of 73.8%after 1000 cycles at 10 C)and outstanding rate properties(the discharge capacity of 84.08 mA h g^(-1)at 20 C)than P2/P3 electrode.Furthermore,the DFT calculation demonstrates that the introducing novel P'3 phase can significantly regulate the Na^(+)reaction dynamics and modify the local electron configuration of Mn.The effective phase engineering can provide a reference for designing other high-performance electrode materials for Na-ion batteries.

From VIB‑to VB‑Group Transition Metal Disulfides:Structure Engineering Modulation for Superior Electromagnetic Wave Absorption

The laminated transition metal disulfides(TMDs),which are well known as typical two-dimensional(2D)semiconductive materials,possess a unique layered structure,leading to their wide-spread applications in various fields,such as catalysis,energy storage,sensing,etc.In recent years,a lot of research work on TMDs based functional materials in the fields of electromagnetic wave absorption(EMA)has been carried out.Therefore,it is of great significance to elaborate the influence of TMDs on EMA in time to speed up the application.In this review,recent advances in the development of electromagnetic wave(EMW)absorbers based on TMDs,ranging from the VIB group to the VB group are summarized.Their compositions,microstructures,electronic properties,and synthesis methods are presented in detail.Particularly,the modulation of structure engineering from the aspects of heterostructures,defects,morphologies and phases are systematically summarized,focusing on optimizing impedance matching and increasing dielectric and magnetic losses in the EMA materials with tunable EMW absorption performance.Milestones as well as the challenges are also identified to guide the design of new TMDs based dielectric EMA materials with high performance.

Accelerated Sequential Deposition Reaction via Crystal Orientation Engineering for Low-Temperature,High-Efficiency Carbon-Electrode CsPbBr_(3) Solar Cells

Low-temperature,ambient processing of high-quality CsPbBr_(3)films is demanded for scalable production of efficient,low-cost carbon-electrode perovskite solar cells(PSCs).Herein,we demonstrate a crystal orientation engineering strategy of PbBr_(2)precursor film to accelerate its reaction with CsBr precursor during two-step sequential deposition of CsPbBr_(3)films.Such a novel strategy is proceeded by adding CsBr species into PbBr_(2)precursor,which can tailor the preferred crystal orientation of PbBr_(2)film from[020]into[031],with CsBr additive staying in the film as CsPb_(2)Br_(5)phase.Theoretical calculations show that the reaction energy barrier of(031)planes of PbBr_(2)with CsBr is lower about 2.28 eV than that of(O2O)planes.Therefore,CsPbBr_(3)films with full coverage,high purity,high crystallinity,micro-sized grains can be obtained at a low temperature of 150℃.Carbon-electrode PSCs with these desired CsPbBr_(3)films yield the record-high efficiency of 10.27%coupled with excellent operation stability.Meanwhile,the 1 cm^(2)area one with the superior efficiency of 8.00%as well as the flexible one with the champion efficiency of 8.27%and excellent mechanical bending characteristics are also achieved.

Composition Engineering Opens an Avenue Toward Efficient and Sustainable Nitrogen Fixation

In this work,we open an avenue toward rational design of potential efficient catalysts for sustainable ammonia synthesis through composition engineering strategy by exploiting the synergistic effects among the active sites as exemplified by diatomic metals anchored graphdiyne via the combination of hierarchical high-throughput screening,first-principles calculations,and molecular dynamics simulations.Totally 43 highly efficient catalysts feature ultralow onset potentials(|U_(onset)|≤0.40 V)with Rh-Hf and Rh-Ta showing negligible onset potentials of 0 and-0.04 V,respectively.Extremely high catalytic activities of Rh-Hf and Rh-Ta can be ascribed to the synergistic effects.When forming heteronuclears,the combinations of relatively weak(such as Rh)and relatively strong(such as Hf or Ta)components usually lead to the optimal strengths of adsorption Gibbs free energies of reaction intermediates.The origin can be ascribed to the mediate d-band centers of Rh-Hf and Rh-Ta,which lead to the optimal adsorption strengths of intermediates,thereby bringing the high catalytic activities.Our work provides a new and general strategy toward the architecture of highly efficient catalysts not only for electrocatalytic nitrogen reduction reaction(eNRR)but also for other important reactions.We expect that our work will boost both experimental and theoretical efforts in this direction.

Coupling Coordination Analysis of Cropland Intensification and Agroecosystem Services:Evidence from Loess Plateau in Shaanxi Province,China

One of the greatest challenges in the agroecosystem is to improve cropland intensification while preserving agroecosystem services.While many studies have investigated the effect of cropland intensification on agroecosystem service,the interactive coupling and coordination among these factors remain largely unexplored.In view of this,this study performed a case study of the Loess Plateau in Shaanxi Province,China and constructed comprehensive evaluation models to quantify the cropland intensification and agroecosystem service in this area.Balance analysis and the coupling coordination degree model were used to evaluate the interactive relationship between cropland intensification and agroecosystem service,and statistical analysis and spatial autocorrelation were used to analyze the spatial characteristics and potential mechanism of the coupling coordination.Results show that both the cropland intensification and agroecosystem service in the study area were relatively low yet gradually increased from 2000 to 2020.Agroecosystem service lag was identified as the dominant unbalanced development type.Improving the supply capacity of agroecosystem services plays a key role in the balanced development of cropland in the Loess Plateau.The coupling coordination degree between cropland intensification and agroecosystem service ranges from basic coordination to serious incoordination.Therefore,cropland intensification practices in the area should be optimized to enhance this coordination degree.An upward trend was also observed in the coupling coordination degree from2000 to 2020.The withdrawal of marginal cropland in the Grain for Green program is one of the most important reasons for this trend,especially for the northern region.Around 83.6%of the high-high clusters are concentrated in the southern region of the Loess Plateau,whereas 70.5%of the low-low clusters are distributed in the northern region.These clustering characteristics are mainly attributed to the environmental suitability of these areas for agriculture and their degree of economic development.

Defect engineering in transition-metal(Fe,Co,andNi)-based electrocatalysts for water splitting

Electrocatalytic water splitting seems to be an efficient strategy to deal with increasingly serious environmental problems and energy crises but still suffers from the lack of stable and efficient electrocatalysts.Designing practical electrocatalysts by introducing defect engineering,such as hybrid structure,surface vacancies,functional modification,and structural distortions,is proven to be a dependable solution for fabricating electrocatalysts with high catalytic activities,robust stability,and good practicability.This review is an overview of some relevant reports about the effects of defect engineering on the electrocatalytic water splitting performance of electrocatalysts.In detail,the types of defects,the preparation and characterization methods,and catalytic performances of electrocatalysts are presented,emphasizing the effects of the introduced defects on the electronic structures of electrocatalysts and the optimization of the intermediates'adsorption energy throughout the review.Finally,the existing challenges and personal perspectives of possible strategies for enhancing the catalytic performances of electrocatalysts are proposed.An in-depth understanding of the effects of defect engineering on the catalytic performance of electrocatalysts will light the way to design high-efficiency electrocatalysts for water splitting and other possible applications.

Assessment of CH_(4) flux and its influencing drivers in the rice-wheat agroecosystem of the Huai River Basin,China

To understand the CH_(4) flux variations and their climatic drivers in the rice-wheat agroecosystem in the Huai River Basin of China,the CH_(4) flux was observed by using open-path eddy covariance at a typical rice-wheat rotation system in Anhui Province,China from November 2019 to October 2021.The variations and their drivers were then analyzed with the Akaike information criterion method.CH_(4) flux showed distinct diurnal variations with single peaks during 9:00-13:00 local time.The highest peak was 2.15μg m^(-2)s^(-1)which occurred at 11:00 in the vegetative growth stage in the rice growing season(RGS).CH_(4) flux also showed significant seasonal variations.The average CH_(4)flux in the vegetative growth stage in the RGS(193.8±74.2 mg m^(-2)d^(-1))was the highest among all growth stages.The annual total CH_(4) flux in the non-rice growing season(3.2 g m^(-2))was relatively small compared to that in the RGS(23.9 g m^(-2)).CH_(4) flux increased significantly with increase in air temperature,soil temperature,and soil water content in both the RGS and the non-RGS,while it decreased significantly with increase in vapor pressure deficit in the RGS.This study provided a comprehensive understanding of the CH_(4) flux and its drivers in the rice-wheat rotation agroecosystem in the Huai River Basin of China.In addition,our findings will be helpful for the validation and adjustment of the CH_(4) models in this region.

Biomaterials and emerging technologies for tissue engineering and in vitro models

The latest advances in the field of biomaterials have opened new avenues for scientific breakthroughs in tissue engineer-ing which greatly contributed for the successful translation of tissue engineering products into the market/clinics.Bio-materials are easily processed to become similar to natural extracellular matrix,making them ideal temporary supports for mimicking the three-dimensional(3D)microenvironment required for maintaining the adequate cell/tissue functions both in vitro and in vivo^([1]).

How Software Engineering Transforms Organizations: An Open and Qualitative Study on the Organizational Objectives and Motivations in Agile Transformations

Agile Transformations are challenging processes for organizations that look to extend the benefits of Agile philosophy and methods beyond software engineering.Despite the impact of these transformations on orga-nizations,they have not been extensively studied in academia.We conducted a study grounded in workshops and interviews with 99 participants from 30 organizations,including organizations undergoing transformations(“final organizations”)and companies supporting these processes(“consultants”).The study aims to understand the motivations,objectives,and factors driving and challenging these transformations.Over 700 responses were collected to the question and categorized into 32 objectives.The findings show that organizations primarily aim to achieve customer centricity and adaptability,both with 8%of the mentions.Other primary important objectives,with above 4%of mentions,include alignment of goals,lean delivery,sustainable processes,and a flatter,more team-based organizational structure.We also detect discrepancies in perspectives between the objectives identified by the two kinds of organizations and the existing agile literature and models.This misalignment highlights the need for practitioners to understand with the practical realities the organizations face.

Research on the Development of Fibroin and Nano-Fiber from Silk Cocoons for Regenerated Tissue Engineering Applications by Electro-Spinning

In this paper, the main goal is to prepare silk fibroin nano-fiber, which is used for regenerated tissue applications. Silk scaffold nano-fibers made by electro-spinning technology can be used in regenerated tissue applications. The purpose of the research is to prepare a silk-fibroin nano-fiber solution for potential applications in tissue engineering. Using a degumming process, pure silk fibroin protein is extracted from silk cocoons. The protein solution for fibroin is purified, and the protein content is determined. The precise chemical composition, exact temperature, time, voltage, distance, ratio, and humidity all have a huge impact on degumming, solubility, and electro-spinning nano-fibers. The SEM investigates the morphology of silk fibroin nano-fibres at different magnifications. It also reveals the surface condition, fiber orientation, and fiber thickness of the silk fibroin nano-fiber. The results show that regenerated silk fibroin and nano-fiber can be used in silk fibroin scaffolds for various tissue engineering applications.

A brief review on the recent development of phonon engineering and manipulation at nanoscales

Phonons are the quantum mechanical descriptions of vibrational modes that manifest themselves in many physical properties of condensed matter systems. As the size of electronic devices continues to decrease below mean free paths of acoustic phonons, the engineering of phonon spectra at the nanoscale becomes an important topic. Phonon manipulation allows for active control and management of heat fow, enabling functions such as regulated heat transport. At the same time, phonon transmission, as a novel signal transmission method, holds great potential to revolutionize modern industry like microelectronics technology, and boasts wide-ranging applications. Unlike fermions such as electrons, polarity regulation is difficult to act on phonons as bosons, making the development of effective phonon modulation methods a daunting task.This work reviews the development of phonon engineering and strategies of phonon manipulation at different scales, reports the latest research progress of nanophononic devices such as thermal rectifiers, thermal transistors, thermal memories, and thermoelectric devices,and analyzes the phonon transport mechanisms involved. Lastly, we survey feasible perspectives and research directions of phonon engineering. Thermoelectric analogies, external field regulation, and acousto-optic co-optimization are expected to become future research hotspots.

Developing fibrin-based biomaterials/scaffolds in tissue engineering

Tissue engineering technology has advanced rapidly in recent years, offering opportunities to construct biologicallyactive tissues or organ substitutes to repair or even enhance the functions of diseased tissues and organs.Tissue-engineered scaffolds rebuild the extracellular microenvironment by mimicking the extracellular matrix.Fibrin-based scaffolds possess numerous advantages, including hemostasis, high biocompatibility, and gooddegradability. Fibrin scaffolds provide an initial matrix that facilitates cell migration, differentiation, proliferation,and adhesion, and also play a critical role in cell-matrix interactions. Fibrin scaffolds are now widelyrecognized as a key component in tissue engineering, where they can facilitate tissue and organ defect repair.This review introduces the properties of fibrin, including its composition, structure, and biology. In addition, themodification and cross-linking modes of fibrin are discussed, along with various forms commonly used in tissueengineering. We also describe the biofunctionalization of fibrin. This review provides a detailed overview of theuse and applications of fibrin in skin, bone, and nervous tissues, and provides novel insights into future researchdirections for clinical treatment.