Sustainable Polymeric Biomaterials from Alternative Feedstocks.

As materials engineered to interact with biological systems for medical purposes, polymeric biomedical materials have revolutionized and are indispensable in modern healthcare. However, aging populations and improving healthcare standards worldwide have resulted in ever-increasing demands for such biomaterials. Currently, many clinically used polymers are derived from nonrenewable petroleum resources, thus spurring the need for exploring alternatives for the next generation of sustainable biomaterials. Other than biomass, this Perspective also spotlights carbon dioxide and postuse plastics as viable resources potentially suitable for biomaterial production. For each alternative feedstock, key recent developments and practical considerations are discussed, including emerging biomaterial applications, possible feedstock sources, and hindrances toward translation and practical adoption. Other than replacements for petroleum-derived polymers, we explore how utilization of these alternatives capitalizes on their intrinsic physiochemical and material properties to achieve their desired therapeutic effects. We hope that this Perspective can stimulate further development in sustainable biomaterials to achieve practical therapeutic benefits as part of a circular materials economy with minimal environmental impact.

Successful 24-hour discharge for total knee arthroplasty: importance of timing of surgery and physiotherapy in enhanced recovery after surgery protocol.

INTRODUCTION: The current literature is mixed on which patient factors, if any, predict the rate of successful discharge within 24 h of enhanced recovery after surgery (ERAS) total knee arthroplasty (TKA). This study aimed to investigate the influence of timing of surgery and physiotherapy on the rate of successful 24-h discharge. METHODS: All 342 patients who underwent ERAS day surgery TKA from August 2020 to July 2021 were followed up prospectively. Patient characteristics and postoperative outcomes, such as number of physiotherapy sessions required before clearance for home, time taken after surgery to ambulate >10 m and length of stay (LOS), were recorded. Patients were grouped based on surgical end time (morning/afternoon/ evening) and time of physiotherapy review (morning/afternoon/evening/morning after). Patients successfully passed ERAS day surgery protocol if they were discharged within 24 h. RESULTS: With regard to the timing of operation, the morning group had the shortest LOS (P = 0.001) and a higher ERAS day surgery pass rate than the afternoon group (P = 0.016). With regard to the timing of physiotherapy, the afternoon group took the shortest time to ambulate >10 m (P < 0.001), had the shortest LOS (P < 0.001) and had a higher ERAS day surgery pass rate as compared to the morning after the operation group (P = 0.005). CONCLUSION: Patients who ended their operations in the morning and received physiotherapy review in the same afternoon were the most likely to be discharged within 24 h due to early ambulation and adequate time for spinal anaesthesia to wear off.

Telehealth-delivered cognitive rehabilitation for people with cognitive impairment as part of the post-COVID syndrome: protocol for a randomised controlled trial as part of the CICERO (Cognitive Impairment in Long COVID: Phenotyping and Rehabilitation) study.

BACKGROUND: Between 25 and 75% of people with persistent post-acute sequelae of SARS-CoV-2 infection (PASC) experience cognitive difficulties, compromising functional ability, quality of life, and activities of daily living, including work. Despite this significant morbidity, there is a paucity of interventions for this disorder that have undergone evaluation within a formal trial setting. Therefore, we have developed a cognitive rehabilitation programme, specifically designed to address the cognitive symptoms of PASC, notably impaired attention and processing speed, while also accounting for other PASC symptoms (fatigue, post-exertional malaise) that may aggravate the cognitive impairment. This study protocol outlines a randomised controlled trial (RCT) designed to evaluate the effectiveness of this programme compared to standard clinical care. METHODS: This is a multi-centre, parallel-group, individually randomised controlled trial, comparing standard clinical care with and without cognitive rehabilitation. We will recruit 120 non-hospitalised adults (aged 30-60 years) from three NHS sites in England with a history of COVID-19 infection and cognitive impairment persisting more than 3 months after the acute infection. Participants will be randomised (1:1) to the intervention or control groups, with the latter represented as a provision of standard clinical care without cognitive rehabilitation. The cognitive rehabilitation programme consists of ten 1-hour sessions, delivered weekly. Outcomes will be collected at baseline, 3, and 6 months, with participant-defined goal-attainment scores, relating to functional goals, at 3 months as the primary outcome measure. Secondary outcomes will be cognitive function, measures of quality of life, social functioning, mental health, fatigue, sleep, post-exertional malaise, and social and health care service use. We will also evaluate the health-economic benefits of cognitive rehabilitation in this population. DISCUSSION: Cognitive impairment in PASC is a major cause of functional disability with no effective treatment. Accordingly, we will undertake an RCT of cognitive rehabilitation, the protocol of which is published here. If this trial is successful in delivering improvements in trial outcomes, it will address a major unmet need relating to this emergent disorder, with a significant impact on affected individuals and the wider health economy. TRIAL REGISTRATION: ClinicalTrials.gov NCT05731570. Registered on February 16, 2023.

Interfacial Reactions in Chemical Recycling and Upcycling of Plastics.

Depolymerization of plastics is a leading strategy to combat the escalating global plastic waste crisis through chemical recycling, upcycling, and remediation of micro-/nanoplastics. However, critical processes necessary for polymer chain scission, occurring at the polymer-catalyst or polymer-fluid interfaces, remain largely overlooked. Herein, we spotlight the importance of understanding these interfacial chemical processes as a critical necessity for optimizing kinetics and reactivity in plastics recycling and upcycling, controlling reaction outcomes, product distributions, as well as improving the environmental sustainability of these processes. Several examples are highlighted in heterogeneous processes such as hydrogenation over solid catalysts, reaction of plastics in immiscible media, and biocatalysis. Ultimately, judicious exploitation of interfacial reactivity has practical implications in developing practical, robust, and cost-effective processes to reduce plastic waste and enable a viable post-use circular plastics economy.

Pyrolytic Depolymerization of Polyolefins Catalysed by Zirconium-based UiO-66 Metal-Organic Frameworks.

Polyolefins such as polyethylenes and polypropylenes are the most-produced plastic waste globally, yet are difficult to convert into useful products due to their unreactivity. Pyrolysis is a practical method for large-scale treatment of mixed, contaminated plastic, allowing for their conversion into industrially-relevant petrochemicals. Metal-organic frameworks (MOFs), despite their tremendous utility in heterogeneous catalysis, have been overlooked for polyolefin depolymerization due to their perceived thermal instabilities and inability of polyethylenes and polypropylenes to penetrate their pores. Herein, we demonstrate the viability of UiO-66 MOFs containing coordinatively-unsaturated zirconium nodes, as effective catalysts for pyrolysis that significantly enhances the yields of valuable liquid and gas hydrocarbons, whilst halving the amounts of residual solids produced. Reactions occur on the Lewis-acidic UiO-66 nodes, without the need for noble metals, and yield aliphatic product distributions distinctly different from the aromatic-rich hydrocarbons that can be obtained from zeolite catalysis. We also demonstrate the first unambiguous characterization of polyolefin penetration into UiO-66 pores at pyrolytic temperatures, allowing access to the abundant Zr-oxo nodes within the MOF interior for efficient C-C cleavage. Our work highlights the potential of MOFs as highly-designable heterogeneous catalysts for depolymerisation of plastics, which can complement conventional catalysts in reactivity.

Phosphate selective binding and sensing by halogen bonding tripodal copper(II) metallo-receptors in aqueous media.

Combining the potency of non-covalent halogen bonding (XB) with metal ion coordination, the synthesis and characterisation of a series of hydrophilic XB tripodal Cu(II) metallo-receptors, strategically designed for tetrahedral anion guest binding and sensing in aqueous media is described. The reported metallo-hosts contain a tripodal C3-symmetric tris-iodotriazole XB donor anion recognition motif terminally functionalised with tri(ethylene glycol) and permethylated ß-cyclodextrin functionalities to impart aqueous solubility. Optical UV-vis anion binding studies in combination with unprecedented quantitative EPR anion titration investigations reveal the XB Cu(II) metallo-receptors exhibit strong and selective phosphate recognition over a range of other monocharged anionic species in competitive aqueous solution containing 40% water, notably outperforming a hydrogen bonding (HB) Cu(II) metallo-receptor counterpart. Electrochemical studies demonstrate further the capability of the metallo-receptors to sense anions via significant cathodic perturbations of the respective Cu(II)/Cu(I) redox couple.

Polyurea-urethane Temperature-responsive Hydrogels for Sustained Delivery of Anti-VEGF Therapeutics.

Temperature-responsive hydrogels, or thermogels, have emerged as a leading platform for sustained delivery of both small molecule drugs and macromolecular biologic therapeutics. Although thermogel properties can be modulated by varying the polymer's hydrophilic-hydrophobic balance, molecular weight and degree of branching, varying the supramolecular donor-acceptor interactions on the polymer remains surprisingly overlooked. Herein, to study the influence of enhanced hydrogen bonding on thermogelation, we synthesized a family of amphiphilic polymers containing urea and urethane linkages using quinuclidine as an organocatalyst. Our findings showed that the presence of strongly hydrogen bonding urea linkages significantly enhanced polymer hydration in water, in turn affecting hierarchical polymer self-assembly and macroscopic gel properties such as sol-gel phase transition temperature and gel stiffness. Additionally, analysis of the sustained release profiles of Aflibercept, an FDA-approved protein biologic for anti-angiogenic treatment, showed that urea bonds on the thermogel were able to significantly alter the drug release mechanism and kinetics compared to usage of polyurethane gels of similar composition and molecular weight. Our findings demonstrate the unrealized possibility of modulating gel properties and outcomes of sustained drug delivery through judicious variation of hydrogen bonding motifs on the polymer structure.

Enhanced recovery after surgery day surgery for MAKO® robotic-arm assisted TKA; better outcome for patients, improved efficiency for hospitals.

Introduction: Robotic-assisted Total Knee Arthroplasty (TKA) was designed to improve implant position accuracy by providing surgeons with real-time intra-operative data to tailor the operation to the patient. Proponents of robotic-assisted TKA believe that this translates into meaningful improvements in outcomes. However, there are concerns that the longer surgical duration associated with robotic-assisted TKA leads to longer length of stay (LOS). In this study, the authors investigated the outcome of MAKO® Robotic-arm Assisted TKA combined with ERAS protocol to assess its effect on LOS and short-term outcomes. Methods: All patients who had undergone unilateral MAKO® ERAS Day Surgery TKA from August 2020 to July 2021 were prospectively followed up and matched to patients who underwent conventional ERAS Day Surgery TKA in the same time period. Factors such as surgical duration, LOS, immediate reduction in pain, 30-days complications, and 6-month PROMs and knee ROM were compared between the two groups. Results: 42 patients underwent MAKO® ERAS Day surgery TKA and were matched to 42 patients who underwent conventional ERAS Day surgery TKA. The study found that despite the longer surgical duration, LOS was comparable between both groups (1.1 ± 0.9days in the MAKO® group vs 1.0 ± 0.3days in the conventional group, p = 0.755) with successful 24-hour discharge in 88.1 % of patients in the MAKO® group. The MAKO® group achieved significantly better ROM compared to the conventional group 6-months post operatively. Post-operative PROMs were comparable between both groups. Conclusion: ERAS Day Surgery protocol can significantly reduce the LOS of patient undergoing MAKO® Robotic-arm Assisted TKA, conferring cost savings and making it a valid option for patients.

Oligo-Adenine and Cyanuric Acid Supramolecular DNA-Based Hydrogels Exhibiting Acid-Resistance and Physiological pH-Responsiveness.

Expanding the functions and applications of DNA by integrating noncanonical bases and structures into biopolymers is a continuous scientific effort. An adenine-rich strand (A-strand) is introduced as functional scaffold revealing, in the presence of the low-molecular-weight cofactor cyanuric acid (CA, pKa 6.9), supramolecular hydrogel-forming efficacies demonstrating multiple pH-responsiveness. At pH 1.2, the A-strand transforms into a parallel A-motif duplex hydrogel cross-linked by AH+-H+A units due to the protonation of adenine (pKa 3.5). At pH 5.2, and in the presence of coadded CA, a helicene-like configuration is formed between adenine and protonated CA, generating a parallel A-CA triplex cross-linked hydrogel. At pH 8.0, the hydrogel undergoes transition into a liquid state by deprotonation of CA cofactor units and disassembly of A-CA triplex into its constituent components. Density functional theory calculations and molecular dynamics simulations, supporting the structural reconfigurations of A-strand in the presence of CA, are performed. The sequential pH-stimulated hydrogel states are rheometrically characterized. The hydrogel framework is loaded with fluorescein-labeled insulin, and the pH-stimulated release of insulin from the hydrogel across the pH barriers present in the gastrointestinal tract is demonstrated. The results provide principles for future application of the hydrogel for oral insulin administration for diabetes.

Knoevenagel C═C Metathesis Enabled Glassy Vitrimers with High Rigidity, Toughness, and Malleability.

Thermosets, characterized by their permanent cross-linked networks, present significant challenges in recyclability and brittleness. In this work, we explore a polarized Knoevenagel C═C metathesis reaction for the development of rigid yet tough and malleable thermosets. Initial investigation on small molecule model reactions reveals the feasibility of conducting the base-catalyzed C═C metathesis reaction in a solvent-free environment. Subsequently, thermosetting poly(α-cyanocinnamate)s (PCCs) were synthesized via Knoevenagel condensation between a triarm cyanoacetate star and a dialdehyde. The thermal and mechanical properties of the developed PCCs can be easily modulated by altering the structure of the dialdehyde. Remarkably, the introduction of ether groups into the PCC leads to a combination of high rigidity and toughness with Young's modulus of ∼1590 MPa, an elongation at break of ∼79%, and a toughness reaching ∼30 MJ m3. These values are competitive to traditional thermosets, in Young's modulus but far exceed them in ductility and toughness. Moreover, the C═C metathesis facilitates stress relaxation within the bulk polymer networks, thus rendering PCCs excellent malleability and reprocessability. This work overcomes the traditional limitations of thermosets, introducing groundbreaking insights for the design of rigid yet tough and malleable thermosets, and contributing significantly to the sustainability of materials.

Recyclable, Malleable, and Strong Thermosets Enabled by Knoevenagel Adducts.

Plastic recycling is critical for waste management and achieving a circular economy, but it entails difficult trade-offs between performance and recyclability. Here, we report a thermoset, poly(α-cyanocinnamate) (PCC), synthesized using Knoevenagel condensation between terephthalaldehyde (TPA) and a triarm cyanoacetate star, that tackles this difficulty by harnessing its intrinsically conjugated and dynamic chemical characteristics. PCCs exhibit extraordinary thermal and mechanical properties with a typical Tg of ∼178 °C, Young's modulus of 3.8 GPa, and tensile strength of 102 MPa, along with remarkable flexibility and dimensional and chemical stabilities. Furthermore, end-of-life PCCs can be selectively degraded and partially recycled back into one starting monomer TPA for a new production cycle or reprocessed through dynamic exchange aided by cyanoacetate chain-ends. This study lays the scientific groundwork for the design of robust and recyclable thermosets, with transformative potential in plastic engineering.

Endoscopic Posterior Cervical Foraminotomy Under Lateral Decubitus Position with Local Anesthesia.

BACKGROUND: Endoscopic posterior cervical foraminotomy is gaining popularity among endoscopic spine surgeons for the treatment of radiculopathy caused by foraminal stenosis. METHODS: This study describes a technique using the lateral decubitus position for endoscopic posterior cervical foraminotomy under monitored anesthesia care and local anesthesia only. RESULTS: A total of 10 patients with contraindications to general anesthesia underwent the procedure, resulting in improvement in cervical radicular pain with no perioperative complications. CONCLUSIONS: The findings suggest that this approach is a viable alternative for patients at high risk of general anesthesia care, expanding the surgical options for the treatment of radiculopathy.

Successful anatomical closure of a photographically documented 30-year-old idiopathic full-thickness macular hole following surgery for concurrent repair of an acute macula-on rhematogenous retinal detachment.

A 62-year-old man with a 30-year-old photographically documented idiopathic full-thickness macular hole and visual acuity of 6/45 developed an acute macula-on rhegmatogenous retinal detachment in his left eye. A pars plana vitrectomy, internal limiting membrane peeling around the macular hole, fluid-air exchange, endolaser retinopexy around the peripheral retinal break and perfluoropropane (C3F8) internal tamponade were performed to repair the detached retina and macular hole. One month postoperatively, the patient developed a large peripheral circumferential retinal tear with shallow retinal detachment which necessitated scleral buckling, repeat vitrectomy, endolaser photocoagulation and C3F8 tamponade. The retina was successfully re-attached and the macula hole was closed. Three years post-vitrectomy, the repaired 30-year-old macular hole remained closed although the visual acuity remained unchanged at 6/45. In summary, we describe the successful anatomical closure of a 30-year-old idiopathic full-thickness macular hole which we believe to be the longest duration photographically documented macular hole closed following surgery.

Postponement of total knee arthroplasties due to pandemic causes significant deterioration on patients' preoperative knee and quality of life scores.

Introduction: Elective surgeries were postponed during the COVID-19 pandemic to alleviate healthcare strains, affecting majority of elective orthopaedic surgeries such as total knee arthroplasties (TKAs). The aim of this study is to evaluate the impact on knee function and quality of life of patients who had their planned TKA postponed due to the pandemic. Methods: This is a retrospective analysis of data collected in a tertiary hospital. Patients included were diagnosed with primary knee osteoarthritis and they were initially scheduled for primary TKA between January to April 2020 but surgery was postponed by at least 6 months from the initial operative date. 160 patients were included in this study (53 males and 107 females, mean age 68.0 ± 8.1). Patients were assessed prior to initial surgery date and assessed again, prior to the postponed surgery date. Clinical scores included Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee scores (OKS) and Short-Form 36 Physical and Mental Component Scores. (SF36 PCS and MCS). Paired T-test was performed for parametric data whereas Wilcoxon signed-rank analysis was performed for non-parametric data. Results: Comparing initial preoperative versus postponement preoperative scores, the cohort had significantly poorer KSKS (38.4 ± 15.4 and 36.5 ± 15.4, p = 0.034), SF36 PCS (34.3 ± 9.2 and 32.7 ± 8.6, p = 0.02) and OKS (34.9 ± 0.77 and 35.8 ± 8.6, p = 0.02) scores respectively. Conclusion: The postponement of elective TKAs has resulted in a significant deterioration of knee scores and physical quality of live scores of patients in a short span of 6 months. Further studies can evaluate if there are repercussions on long term TKAs outcomes. Level of evidence: Retrospective study, Level III.

Programming the Assembly of Oligo-Adenine with Coralyne into a pH-Responsive DNA Hydrogel.

External stimuli-responsive DNA hydrogels present interesting platforms for drug loading and triggered release. Typically, drug molecules are encapsulated within three-dimensionally hybridized DNA networks. However, the utilization of drug molecules as cofactors to facilitate the directed assembly of DNA strands into hydrogel frameworks and their subsequent controlled release remains to be explored. Herein, we introduce the guided assembly of oligo-adenine (A-strand) into an acidic pH-responsive DNA hydrogel using an anticancer drug, coralyne (COR), as a low-molecular-weight cofactor. At pH 7, COR orchestrates the assembly of A-strand into an antiparallel duplex configuration cross-linked by A-COR-A units at a stoichiometric ratio of one COR cofactor per four adenine bases, resulting in a DNA hydrogel characterized by A-COR-A duplex bridges. At pH 4-5, the instability of A-COR-A units results in the disintegration of the duplex into its constituent components, leading to the release of COR and simultaneous dissociation of the DNA hydrogel matrix. This study introduces a method by which drug molecules, exemplified here by COR, facilitate the direct formation of a supramolecular cofactor-DNA complex, subsequently leading to the creation of a stimuli-responsive DNA hydrogel. This approach may inspire future investigations into DNA hydrogels tailored for controlled drug encapsulation and release applications.

Catalyst-Free α-Acetyl Cinnamate/Acetoacetate Exchange to Enable High Creep-Resistant Vitrimers.

Vitrimers represent an emerging class of polymeric materials that combine the desirable characteristics of both thermoplastics and thermosets achieved through the design of dynamic covalent bonds within the polymer networks. However, these materials are prone to creep due to the inherent instability of dynamic covalent bonds. Consequently, there are pressing demands for the development of robust and stable dynamic covalent chemistries. Here, we report a catalyst-free α-acetyl cinnamate/acetoacetate (α-AC/A) exchange reaction to develop vitrimers with remarkable creep resistance. Small-molecule model studies revealed that the α-AC/A exchange occurred at temperatures above 140 °C in bulk, whereas at 120 °C, this reaction was absent. For demonstration in the case of polymers, copolymers derived from common vinyl monomers were crosslinked with terephthalaldehyde to produce α-AC/A vitrimers with tunable thermal and mechanical performance. All resulting α-AC/A vitrimers exhibited high stability, especially in terms of creep resistance at 120 °C, while retaining commendable reprocessability when subjected to high temperatures. This work showcases the α-AC/A exchange reaction as a novel and robust dynamic covalent chemistry capable of imparting both reprocessability and high stability to cross-linked networks.

Gap patterns and radiographic follow-up of newer-generation cementless total knee arthroplasty designs.

BACKGROUND: Interest in cementless total knee arthroplasty (TKA) has increased with advancement of biomaterials and implant design and associated improved longevity. We sought to evaluate the gap patterns and radiolucent zones radiographically for 2 newer-generation cementless TKA designs. METHODS: We retrospectively reviewed our single-institution database between January 2017 and December 2019. We identified patients with a porous keeled tibia base-plate with 4-bullet cruciform spikes and peri-apatite coated femoral component (study group 1) and patients who received a cementless porous coated femoral component and rotating platform tibia baseplate with 4 peripheral porous coated pegs around a central cone (study group 2). We identified gap patterns at 6 weeks and at 1 year or more postoperatively on radiographs, noting indications for reoperation. RESULTS: We identified 228 patients in study group 1 and 41 patients in study group 2. At 1-year follow-up, we found evidence of resolved femoral gaps in 52 (72.2%) of 72 patients in study group 1 and 10 (58.8%) of 17 patients in study group 2 (p = 0.124). We identified 27 (84.3%) of 32 patients in study group 1 and 7 (70.0%) of 10 patients in study group 2 with resolved tibia gaps (p = 0.313). After 1 year, there were significantly more Zone 3a femoral zonal radiolucent gaps (p = 0.001) and Zone 8 tibia zonal radiolucent gaps (p = 0.002) in study group 2 than in study group 1. There were 4 reoperations for study group 1 and 0 reoperations for study group 2. CONCLUSION: The modern cementless TKA systems have varied gap patterns in postoperative radiographs, which may be attributed to the implant design. Most radiolucent gaps resolve radiographically on follow-up.

Enhancing the photocatalytic upcycling of polystyrene to benzoic acid: a combined computational-experimental approach for acridinium catalyst design.

Converting polystyrene into value-added oxygenated aromatic compounds is an attractive end-of-life upcycling strategy. However, identification of appropriate catalysts often involves laborious and time-consuming empirical screening. Herein, after demonstrating the feasibility of using acridinium salts for upcycling polystyrene into benzoic acid by photoredox catalysis for the first time, we applied low-cost descriptor-based combinatorial in silico screening to predict the photocatalytic performance of a family of potential candidates. Through this approach, we identified a non-intuitive fluorinated acridinium catalyst that outperforms other candidates for converting polystyrene to benzoic acid in useful yields at low catalyst loadings (≤5 mol%). In addition, this catalyst also proved effective with real-life polystyrene waste containing dyes and additives. Our study underscores the potential of computer-aided catalyst design for valorizing polymeric waste into essential chemical feedstock for a more sustainable future.