Nanostructured Non-Newtonian Drug Delivery Barrier Prevents Postoperative Intrapericardial Adhesions.

With the increasing volume of cardiovascular surgeries and the rising adoption rate of new methodologies that serve as a bridge to cardiac transplantation and that require multiple surgical interventions, the formation of postoperative intrapericardial adhesions has become a challenging problem that limits future surgical procedures, causes serious complications, and increases medical costs. To prevent this pathology, we developed a nanotechnology-based self-healing drug delivery hydrogel barrier composed of silicate nanodisks and polyethylene glycol with the ability to coat the epicardial surface of the heart without friction and locally deliver dexamethasone, an anti-inflammatory drug. After the fabrication of the hydrogel, mechanical characterization and responses to shear, strain, and recovery were analyzed, confirming its shear-thinning and self-healing properties. This behavior allowed its facile injection (5.75 ± 0.15 to 22.01 ± 0.95 N) and subsequent mechanical recovery. The encapsulation of dexamethasone within the hydrogel system was confirmed by 1H NMR, and controlled release for 5 days was observed. In vitro, limited cellular adhesion to the hydrogel surface was achieved, and its anti-inflammatory properties were confirmed, as downregulation of ICAM-1 and VCAM-1 was observed in TNF-α activated endothelial cells. In vivo, 1 week after administration of the hydrogel to a rabbit model of intrapericardial injury, superior efficacy was observed when compared to a commercial adhesion barrier, as histological and immunohistochemical examination revealed reduced adhesion formation and minimal immune infiltration of CD3+ lymphocytes and CD68+ macrophages, as well as NF-κß downregulation. We presented a novel nanostructured drug delivery hydrogel system with unique mechanical and biological properties that act synergistically to prevent cellular infiltration while providing local immunomodulation to protect the intrapericardial space after a surgical intervention.

Lessons from a statewide pilot of "the battle of the belts project" in a state without a primary seat belt law.

BACKGROUND: Teen driving issues result in higher rates of injury. The Arizona Department of Health Services recommended addressing teen seat belt use. Driver belt use has been reported as lowest among those transporting passengers of similar age. Self-management is essential for long-term behavioral change. Peer-to-peer approaches have been shown to be effective. A group of trauma center representatives in Arizona replicated the Battle of the Belt program that began in 2005 in Missouri to address teen seat belt use using a peer-to-peer approach. METHODS: Each trauma center "adopted" one school securing an adult champion and a group of students responsible for the project. Monetary awards were made for the schools with the most improved and highest seat belt use. A toolkit was provided. Random observations measured change. Injury Free of Phoenix provided data entry and analysis. RESULTS: Of the six original schools, one withdrew because of the death of a student in a motor vehicle crash. A total of 2,892 vehicles were observed. Significant increases were found for drivers (70.6-91.4%, p = 0.000), front passengers (51.1-67.9%, p = 0.000), and first rear passenger (26.2-68.8%, p = 0.002). Additional rear passenger use also increased, but small numbers created unstable results. The largest changes were seen in schools with closer trauma rep involvement. Odds ratios were computed for the likelihood of belted passengers based on driver seat belt use (baseline 9.08, follow-up 5.5). CONCLUSIONS: The peer-to-peer methods appear to be productive with long-term impact unknown. Results associated with drivers compared with passengers may indicate youth "thinking for themselves."