Behavioral changes after hospital discharge in preschool children experiencing emergence delirium after general anesthesia: A prospective observational study.

BACKGROUND: Emergence delirium is well known as early postoperative behavioral change after general anesthesia. However, it is unclear whether children with emergence delirium have negative behavioral changes after hospital discharge. AIM: This observational study investigated the association between emergence delirium and posthospital behavioral changes. METHODS: One-hundred preschoolers aged 2-7 years undergoing elective surgery were enrolled in 2 tertiary university hospitals. Preoperative anxiety level was assessed using modified Yale preoperative anxiety scale. Emergence delirium was defined via pediatric anesthesia emergence delirium score ≥12 at any time in the recovery room. We divided the delirium score into a delirium-specific score (the sum of the first 3 items: eye contact, purposeful movement, and awareness of surrounding) and a pain-related score (the sum of the last 2 items: restlessness and inconsolability). High delirium scores represent severe emergence delirium. Posthospital behavioral changes were assessed by a change in Child Behavior Checklist 1.5-5 scores before and 1 week after surgery. The primary outcome was the total behavior checklist scores 1 week after surgery. Multiple linear regression was performed to identify risk factors for posthospital behavioral changes. RESULTS: Children with emergence delirium (n = 58) had higher postoperative behavior checklist scores than children without emergence delirium (n = 42) [mean (SD), 22.8 (17.5) vs. 14.0 (12.1); mean difference (95% CI), 8.8 (1.5-16.2)]. Increases in preoperative anxiety level [regression coefficient (b) (95% CI) =0.241 (0.126-0.356)] and peak delirium-specific score [b = 0.789 (0.137-1.442)] were associated with an increase in behavior checklist score 1 week after surgery, while pain-related score, type of surgery, premedication, and age were not. CONCLUSION: Children with emergence delirium developed more severe behavior changes 1 week after surgery than those without emergence delirium. High preoperative anxiety level and emergence delirium scores were associated with posthospital behavioral changes.

Effects of dexmedetomidine sedation for magnetic resonance imaging in children: a systematic review and meta-analysis.

PURPOSE: Pediatric sedation is commonly required to obtain high-quality images in magnetic resonance imaging (MRI). We performed a systematic review and meta-analysis to assess the effects of dexmedetomidine sedation for MRI in children. METHODS: A systematic review was conducted to find all randomized controlled trials concerning dexmedetomidine sedation for MRI in children. We searched databases using the Ovid platform in the Cochrane Controlled Trials Register, MEDLINE, and EMBASE. This study was registered in the PROSPERO database: CRD42020198368. RESULTS: Seven studies and 753 participants were included. Dexmedetomidine sedation showed a significantly delayed onset time [weighted mean differences (WMD) = 8.13 min, 95% confidence interval (CI) 4.64 to 11.63, I2 = 98%] and recovery time (WMD = 5.22 min, 95% CI 0.35 to 10.09, I2 = 92%) compared to propofol, ketamine, and midazolam sedation. There was no difference in quality of sedation [risk ratio (RR) = 1.25, 95% CI 0.92 to 1.69, I2 = 89%], or incidence of sedation failure (RR = 1.39, 95% CI 0.53 to 3.66, I2 = 83%) between groups. Although a significantly decreased heart rate (WMD = - 17.34 beats/minute, 95% CI - 22.42 to - 12.26, I2 = 96%) was observed, bradycardia that required treatment was not increased (RR = 8.00, 95% CI 1.02 to 62.64, I2 = 0%). Dexmedetomidine sedation had a lower incidence of desaturation events (RR = 0.42, 95% CI 0.20 to 0.86, I2 = 4%). However, there was no difference in incidence of postoperative vomiting (RR = 0.42, 95% CI 0.15 to 1.17, I2 = 17%) between groups. CONCLUSIONS: Dexmedetomidine sedation provided a similar sedation quality with a reduced incidence of desaturation events. However, the delayed onset and recovery times were drawbacks. The clinical significance of bradycardia is considered to be low. GRADE assessment revealed the quality of the evidence in this meta-analysis ranged from very low to moderate.

High-Performance Core/Shell of ZnO/TiO2 Nanowire with AgCl-Doped CdSe Quantum Dots Arrays as Electron Transport Layer for Perovskite Solar Cells.

Most previous studies of perovskite core/shell structures have been based on ZnO/TiO2 nanowires (NWs), which are not suitable for high photoelectric conversion efficiency. Here, core/shell ZnO/TiO2 NWs with AgCl-doped CdSe quantum dots were fabricated as an electron transport layer (ETL) for perovskite solar cells, based on ZnO/TiO2 arrays. We designed CdSe with AgCl dopants that were synthesized by a colloidal process. An improvement of the recombination barrier (Rct1), due to shell supplementation with AgCl-doped CdSe quantum dots, improved the open circuit voltage, the fill factor, and the adsorption capacity of CH3NH3PbI3 perovskite with NWs. The enhanced cell steady state was attributable to TiO2 with AgCl-doped CdSe QD supplementation. A maximum power conversion efficiency of 15.12% was attained in an atmospheric environment. The mechanism of the recombination and electron transport in the perovskite solar cells becoming the basis of ZnO/TiO2 core/shell arrays was investigated to represent the merit of ZnO/TiO2 core/shell arrays as an electron transport layer in effective devices. These results showed an uncomplicated approach for restraining non-radiative recombination loss in hetero-structure core/shell arrays to significantly improve perovskite solar cell performance and increase the effectiveness of photovoltaics.

Comparative Study on Surface-Initiated ATRP and SI-ARGET ATRP of Oligo(Ethylene Glycol) Methacrylate on Gold.

Oligo(ethylene glycol) methacrylate (OEGMA) was polymerized from a polymerization initiator-presenting gold substrate by Activator ReGenerated by Electron Transfer Atom Transfer Radical Polymerization (ARGET ATRP) in water. Compared with the normal surface-initiated ATRP (SI-ATRP), SI-ARGET ATRP of OEGMA proceeded smoothly in the presence of air with L-ascorbic acid as a reducing agent and a CuBr2/2,2'-bipyridyl complex at the ppm level. In addition, SI-ARGET ATRP did not require the additional steps for removing a polymerization inhibitor from the OEGMA monomer and for deoxygenating the solvent. The ellipsometric measurements showed that the polymerized OEGMA (pOEGMA) films prepared by SI-ARGET ATRP were on average 10 times thicker than those prepared by normal SI-ATRP with the same monomer concentration and polymerization time.

Cytocompatible Polymer Grafting from Individual Living Cells by Atom-Transfer Radical Polymerization.

A cytocompatible method of surface-initiated, activator regenerated by electron transfer, atom transfer radical polymerization (SI-ARGET ATRP) is developed for engineering cell surfaces with synthetic polymers. Dopamine-based ATRP initiators are used for both introducing the ATRP initiator onto chemically complex cell surfaces uniformly (by the material-independent coating property of polydopamine) and protecting the cells from radical attack during polymerization (by the radical-scavenging property of polydopamine). Synthetic polymers are grafted onto the surface of individual yeast cells without significant loss of cell viability, and the uniform and dense grafting is confirmed by various characterization methods including agglutination assay and cell-division studies. This work will provide a strategic approach to the generation of living cell-polymer hybrid structures and open the door to their application in multitude of areas, such as sensor technology, catalysis, theranostics, and cell therapy.

Improvement of interfacial adhesion of biodegradable polymers coated on metal surface by nanocoupling.

A method of securing the adhesion of biodegradable polymer coating was investigated for drug-eluting metal stents, using surface-initiated ring-opening polymerization (SI-ROP) of L-lactide. Introduction of oligolactide on the stainless steel (SS) surface was successful and the thickness of the oligolactide grafts remained on the nanometer scale, as determined by ellipsometry. The presence of an oligolactide graft was also identified using attenuated total reflection-Fourier transform infrared (ATR-FTIR) and electron spectroscopy for chemical analysis (ESCA). On top of the grafts, poly(D,L-lactide-co-glycolide) (PLGA) coating was carried out on different substrates such as SS control, plasma-treated SS, and lactide-grafted (referred to as a nanocoupled) SS using electrospraying. When the adhesion forces were measured with a scratch tester, the nanocoupled SS showed the strongest interfacial adhesion between polymer coating layer and metal substrate. The outcome of the peel-off test was also consistent with the result of the scratch test. When degradation behavior of the polymer coating in vitro was examined for up to 4 weeks in a continuous fluid flow, the SEM images demonstrated that polymer degradation was obvious due to hydration and swelling of the polymer matrix. Although the matrix completely disappeared after 4 weeks for SS control and plasma-treated substrates, the nanocoupled SS was persistent with some polymer matrix. In addition, the release profiles of SRL-loaded PLGA coating appeared slightly different between control and nanocoupled groups. This work suggested that the concept of nanocoupling remarkably improved the interfacial adhesion stability between metal surface and polymer layer and controlled drug release, and showed the feasibility of drug-eluting stents.

Surface grafting of blood compatible zwitterionic poly(ethylene glycol) on diamond-like carbon-coated stent.

Blood compatibility is the most important aspect for blood-contacting medical devices including cardiovascular stents. In this study, the surface of nickel-titanium (TiNi) stent was coated with diamond-like carbon (DLC) and then subsequently grafted by using zwitterion (N(+) and SO(3) (-))-linked poly(ethylene glycol) (PEG). We hypothesize that this coupling of zwitterion and PEG may significantly improve blood compatibility of DLC-coated TiNi stent. The surface modified TiNi stents, including PEG-grafted stent (DLC-PEG) and zwitterionic PEG-grafted one (DLC-PEG-N-S) were the main focus on the tests of surface characteristics and blood compatibility. The zwitterionic PEG derivatives were obtained from a series of chemical reactions at room temperature. The results exhibited that as compared to the DLC-PEG, the hydrophilicity was much better with DLC-PEG-N-S and significantly increased atomic percentage of oxygen and nitrogen proved the entity of zwitterions on the surface of DLC-PEG-N-S. Meanwhile, the adsorption of blood proteins such as, human serum albumin (HSA) and fibrinogen was found considerably down-regulated in DLC-PEG-N-S, due mainly to the protein-repellent effect of PEG and zwitterion. Microscopic observation also revealed that as compared with the other substrates without zwitterion, the degree of platelet adhesion was the lowest with DLC-PEG-N-S. In addition, DLC-PEG-N-S retained an extended blood coagulation time as measured by activated partial thromboplastin time (APTT). The present results suggested that surface grafting of zwitterionic PEG derivatives could substantially enhance the blood compatibility of TiNi-DLC stent. In conclusion, anti-fouling properties of PEG and zwitterions are expected to be very useful in advancing overall stent performance.

Ultrasound-guided dynamic needle tip positioning technique for radial artery cannulation in elderly patients: A prospective randomized controlled study.

BACKGROUND: Radial artery cannulation, which is a useful procedure for anesthetic management, is often challenging in elderly patients. Recently, the dynamic needle tip positioning (DNTP) technique was introduced to facilitate ultrasound-guided vascular catheterization. Therefore, we performed this prospective, parallel group, randomized, controlled trial to compare the ultrasound-guided DNTP technique with the palpation method in elderly patients. METHODS: For this study, 256 patients aged 65 years or older were randomly allocated to the ultrasound-guided DNTP technique group (DNTP group) or the palpation method group (palpation group). The primary outcome was first-attempt success rate. The secondary outcomes were overall success rate, numbers of attempts and redirections, cannulation time, and incidence of complications. RESULTS: The first-attempt success rate (85.9% vs. 72.3%; relative risk [RR], 1.47; 95% CI 1.25-1.72; P<0.001) and the overall success rate (99.2% vs. 93.0%; RR, 1.07; 95% CI 1.02-1.12; P = 0.01) were significantly higher in the DNTP group compared to the palpation group. The numbers of attempts [1 (1,1) vs. 1 (1,3), P<0.001] and redirections [0 (0,1) vs. 2 (0,4), P<0.001] were significantly lower in the DNTP group. The cannulation time for successful attempts was 42 (32,55) seconds in the DNTP group and 53 (36,78) seconds in the palpation group (P<0.001). The incidence of hematoma was significantly lower in the DNTP group (7% vs. 24.2%; RR, 0.29; 95% CI, 0.14-0.59; P<0.001). CONCLUSIONS: Ultrasound-guided radial artery cannulation with the DNTP technique improved the efficiency of radial artery cannulation in elderly patients by increasing the success rate while minimizing complications.

Genetic Impairment of Cellulose Biosynthesis Increases Cell Wall Fragility and Improves Lipid Extractability from Oleaginous Alga Nannochloropsis salina.

In microalgae, photosynthesis provides energy and sugar phosphates for the biosynthesis of storage and structural carbohydrates, lipids, and nitrogenous proteins. The oleaginous alga Nannochloropsis salina does not preferentially partition photoassimilates among cellulose, chrysolaminarin, and lipids in response to nitrogenous nutrient deprivation. In the present study, we investigated whether genetic impairment of the cellulose synthase gene (CesA) expression would lead to protein accumulation without the accumulation of storage C polymers in N. salina. Three cesA mutants were generated by the CRISPR/Cas9 approach. Cell wall thickness and cellulose content were reduced in the cesA1 mutant, but not in cesA2 or cesA4 cells. CesA1 mutation resulted in a reduction of chrysolaminarin and neutral lipid contents, by 66.3% and 37.1%, respectively, but increased the soluble protein content by 1.8-fold. Further, N. salina cells with a thinned cell wall were susceptible to mechanical stress, resulting in a 1.7-fold enhancement of lipid extractability. Taken together, the previous and current studies strongly suggest the presence of a controlling mechanism that regulates photoassimilate partitioning toward C and N metabolic pathways as well as the cellulose metabolism as a potential target for cost-effective microalgal cell disruption and as a useful protein production platform.

In-situ derivatization and headspace solid-phase microextraction for gas chromatography-mass spectrometry analysis of alkyl methylphosphonic acids following solid-phase extraction using thin film.

A headspace solid-phase microextraction (HS-SPME) method, involving solid-phase extraction and in-situ derivatization using polymeric thin film, was developed for the gas chromatography-mass spectrometry (GC-MS) analysis of the degradation products of nerve agents. The solid-phase extraction (SPE) was performed using poly([2-(Methacryloyloxy)ethyl]trimethylammonium chloride) film on a gold plate prepared via surface-initiated polymerization. The extracted analytes were directly derivatized with N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA) on the plate. Various parameters like fiber type, headspace time, temperature, and amount of BSTFA were optimized. Under the optimized conditions, the relative standard deviations (RSDs) were in the range 7.0-13.1% and the limits of detection (LODs) were measured to be between 10 and 20 pg mL-1. The application of the developed method was tested using the 35th Organization for Prohibition of Chemical Weapons (OPCW) proficiency test sample.

Solid-phase extraction of nerve agent degradation products using poly[(2-(methacryloyloxy)ethyl)trimethylammonium chloride] thin films.

In this study, a simple solid-phase extraction (SPE) technique was developed to extract organophosphonic acids as degradation products of nerve agents from aqueous samples for identification by instrumental analyses such as FT-IR, TOF-SIMs and GC-MS. To selectively extract the organophosphonic acids, we synthesized an anion exchange polymer film on a gold plate using surface-initiated controlled radical polymerization with 2-[(methacryloyloxy)ethyl]trimethylammonium chloride. Extraction of the organophosphonic acids onto the plates was successfully confirmed by polarized angle fourier transformation-infra red (FT-IR) spectroscopy, X-ray photoelectron spectroscopy, and time-of-flight secondary ion mass spectrometry analyses. The limit of detection of the developed SPE method satisfied the detection limit of Chemical Warfare Agents verification criteria by FT-IR analysis. After optimization, the detection limit values were found to be between 0.1 and 0.4 µg mL-1, and the recovery ranged from 50% to 110% in aqueous solution containing various interference. In addition, the SPE process was successfully applied to the detection of pinacolyl methylphosphonic acid, the degradation product of soman, in the 35th Organization for Prohibition of Chemical Weapons proficiency test sample.

Activity-based assay of matrix metalloproteinase on nonbiofouling surfaces using time-of-flight secondary ion mass spectrometry.

A label-free, activity-based assay of matrix metalloproteinase (MMP) and its inhibition was demonstrated on peptide-conjugated gold nanoparticles (AuNPs) with nonbiofouling poly(oligo(ethylene glycol) methacrylate) (pOEGMA) films using time-of-flight secondary ion mass spectrometry (TOF-SIMS). Following surface-initiated atom-transfer radical polymerization of OEGMA on a Si/SiO2 substrate, the MMP activity was determined by analyzing the cleaved peptide fragments using TOF-SIMS on the peptide-conjugated AuNPs. The use of nonbiofouling pOEGMA films in conjunction with AuNPs synergistically enhanced the sensitivity of assays for MMP activity and its inhibition in human serum. The detection sensitivity of MMP-7 in serum was as low as 20 ng mL(-1) (1 pmol mL(-1)), and the half-maximal inhibitory concentration (IC50) of minocycline, which is a MMP-7 inhibitor, was estimated to be 450 nM. It is anticipated that the developed system will be broadly useful for conducting activity-based assays of serum proteases, as well as for screening of their inhibitors, with high sensitivity in a high-throughput manner.

Publisher Correction: Antimicrobial spray nanocoating of supramolecular Fe(III)-tannic acid metal-organic coordination complex: applications to shoe insoles and fruits.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Functionalization of poly(oligo(ethylene glycol) methacrylate) films on gold and Si/SiO2 for immobilization of proteins and cells: SPR and QCM studies.

Thin films of a biocompatible and nonbiofouling poly(oligo(ethylene glycol) methacrylate) ( pOEGMA) with various thicknesses were formed on gold and Si/SiO 2 substrates by a combination of the formation of self-assembled monolayers (SAMs) terminating in bromoester-an initiator of atom transfer radical polymerization (ATRP)-and surface-initiated ATRP. After the formation of the pOEGMA films, terminal hydroxyl groups of side chains divergent from the methacrylate backbones were activated with N, N'-disuccinimidyl carbonate (DSC), and the DSC-activated pOEGMA films were reacted with (+)-biotinyl-3,6,9-trioxaundecanediamine (Biotin-NH 2) to form biotinylated pOEGMA films. By surface plasmon resonance experiments with the target protein (streptavidin) and model proteins (fibrinogen and lysozyme), we verified that the resulting films showed the enhanced signal-to-noise ratio ( approximately 10-fold enhancement) for the biospecific binding of streptavidin compared with the biotinylated substrate prepared from carboxylic acid-terminated SAMs. Quartz crystal microbalance measurements were also carried out to obtain the surface coverage of streptavidin and fibrinogen adsorbed onto the biotinylated pOEGMA films with various thicknesses and to investigate the effect of film thicknesses on the biospecific binding of streptavidin. Both the binding capacity of streptavidin and the signal-to-noise ratio of streptavidin/fibrinogen were found to be saturated at the 20 nm thick pOEGMA film. In addition, to demonstrate a wide applicability of the pOEGMA films, we constructed micropatterns of streptavidin and cells by microcontact-printing biotin-NH 2 and poly- l-lysine onto the DSC-activated pOEGMA films, respectively.

Systematic Study of Functionalizable, Non-Biofouling Agarose Films with Protein and Cellular Patterns on Glass Slides.

Herein we demonstrate a systematic investigation of chemically functionalizable, non-biofouling agarose films over large-area glass surfaces. Agarose films, prepared with various concentrations of aqueous agarose, were activated by using periodate oxidation to generate aldehyde groups at the termini of the agarose chains. The non-biofouling efficacy and binding capabilities of the activated films were evaluated by using protein and cellular patterning, performed by using a microarrayer, microcontact printing, and micromolding in capillaries. Characterization by using a fluorescence slide scanner and a scanning-probe microscope revealed that the pore sizes of the agarose films played an important role in achieving desirable film performance; the 0.2 wt % agarose film exhibited the optimum efficacy in this work.

Antimicrobial spray nanocoating of supramolecular Fe(III)-tannic acid metal-organic coordination complex: applications to shoe insoles and fruits.

Numerous coating strategies are available to control the surface properties and confer new properties to substrates for applications in energy, environment, biosystems, etc., but most have the intrinsic limitations in the practical setting: (1) highly specific interactions between coating materials and target surfaces are required for stable and durable coating; (2) the coating of bulk substrates, such as fruits, is time-consuming or is not achievable in the conventional solution-based coating. In this respect, material-independent and rapid coating strategies are highly demanded. We demonstrate spray-assisted nanocoating of supramolecular metal-organic complexes of tannic acid and ferric ions. The spray coating developed is material-independent and extremely rapid (<5 sec), allowing for coating of commodity goods, such as shoe insoles and fruits, in the controlled fashion. For example, the spray-coated mandarin oranges and strawberries show significantly prolonged post-harvest shelf-life, suggesting practical potential in edible coating of perishable produce.

Backfilling-Free Strategy for Biopatterning on Intrinsically Dual-Functionalized Poly[2-Aminoethyl Methacrylate-co-Oligo(Ethylene Glycol) Methacrylate] Films.

We demonstrated protein and cellular patterning with a soft lithography technique using poly[2-aminoethyl methacrylate-co-oligo(ethylene glycol) methacrylate] films on gold surfaces without employing a backfilling process. The backfilling process plays an important role in successfully generating biopatterns; however, it has potential disadvantages in several interesting research and technical applications. To overcome the issue, a copolymer system having highly reactive functional groups and bioinert properties was introduced through a surface-initiated controlled radical polymerization with 2-aminoethyl methacrylate hydrochloride (AMA) and oligo(ethylene glycol) methacrylate (OEGMA). The prepared poly(AMA-co-OEGMA) film was fully characterized, and among the films having different thicknesses, the 35 nm-thick biotinylated, poly(AMA-co-OEGMA) film exhibited an optimum performance, such as the lowest nonspecific adsorption and the highest specific binding capability toward proteins.

Direct patterning and biofunctionalization of a large-area pristine graphene sheet.

Direct patterning of streptavidin and NIH 3T3 fibroblast cells was successfully achieved over a large-area pristine graphene sheet on Si/SiO2 by aryl azide-based photografting with the conventional UV lithographic technique and surface-initiated, atom transfer radical polymerization of oligo(ethylene glycol) methacrylate.

Binding behaviors of protein on spatially controlled poly[oligo(ethylene glycol) methacrylate] brushes grafted from mixed self-assembled monolayers on gold.

Binding behaviors of streptavidin were investigated with different lateral packing densities of biotin-functionalized, non-biofouling pOEGMA brushes, synthesized by surface-initiated polymerization from mixed SAMs with different mole fractions of the polymerization initiator on gold surfaces.

Mesenteric pseudocyst of the small bowel in gastric cancer patient: a case report.

Mesenteric pseudocyst is rare. This term is used to describe the abdominal cystic mass, without the origin of abdominal organ. We presented a case of mesenteric pseudocyst of the small bowel in a 70-year-old man. Esophago-gastro-duodenoscopy showed a 3.5 cm sized excavated lesion on the posterior wall of angle. Endocopic biopsy confirmed a histologic diagnosis of the poorly differentiated adenocarcinoma, which includes the signet ring cell component. Abdominal computed tomography scan showed a focal mucosal enhancement in the posterior wall of angle of the stomach, a 2.4 cm sized enhancing mass on the distal small bowel loop, without distant metastases or ascites in rectal shelf, and multiple gallbladder stones. The patient underwent subtotal gastrectomy with gastroduodenostomy, segmental resection of the small bowel, and cholecystectomy. The final pathological diagnosis was mesenteric pseudocyst. This is the first case report describing incidentally detected mesenteric pseudocyst of the small bowel in gastric cancer patients.