The effect of surgical time on perioperative complications in adolescent idiopathic scoliosis cases. A propensity score analysis.

BACKGROUND: Posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS) can be lengthy and complication-ridden. The aim of this study was to evaluate the effect of surgical time on perioperative complications in this procedure when controlling for confounding variables with propensity score analysis. METHODS: This was an IRB-approved review of electronic health records from 2010 to 2019 at a single tertiary care children's hospital. Patients undergoing PSIF were grouped into "short" (< 6 h) or "long" (≥ 6 h) surgical time groups. Outcome measures were estimated blood loss (EBL), cell saver transfusions, packed red blood cell (pRBC) transfusions, length of stay (LOS), intraoperative monitoring (IOM) alerts, hematocrit, ICU transfer, neurologic loss, surgical site infection, and 90-day readmissions. We controlled for age, sex, BMI, curve severity, number of segments fused, and surgeon factors. RESULTS: After propensity score matching there were 113 patients in each group. The short surgical time group had lower EBL (median 715, IQR 550-900 vs median 875, IQR 650-1100 cc; p < 0.001), received less cell saver blood (median 120, IQR 60-168 vs median 160, IQR 97-225 cc; p = 0.001), received less intraoperative pRBCs (median 0, IQR 0-0 vs median 0, IQR 0-320, p = 0.002), had shorter average LOS (4.8 ± 1.7 vs 5.4 ± 2.5 days; p = 0.039), and fewer IOM alerts (4.3% vs 18%, p = 0.003). CONCLUSIONS: Patients with shorter surgical times had less blood loss, received less transfused blood, had a shorter LOS, and fewer IOM alerts compared to patients with longer surgical times. Surgical times < 6 h may have safety and efficacy advantages over longer times. LEVEL OF EVIDENCE: III.

Recent Advances in Nanomedicine for the Diagnosis and Treatment of Prostate Cancer Bone Metastasis.

Patients with advanced prostate cancer can develop painful and debilitating bone metastases. Currently available interventions for prostate cancer bone metastases, including chemotherapy, bisphosphonates, and radiopharmaceuticals, are only palliative. They can relieve pain, reduce complications (e.g., bone fractures), and improve quality of life, but they do not significantly improve survival times. Therefore, additional strategies to enhance the diagnosis and treatment of prostate cancer bone metastases are needed. Nanotechnology is a versatile platform that has been used to increase the specificity and therapeutic efficacy of various treatments for prostate cancer bone metastases. In this review, we summarize preclinical research that utilizes nanotechnology to develop novel diagnostic imaging tools, translational models, and therapies to combat prostate cancer bone metastases.

Understanding Nanoparticle Toxicity to Direct a Safe-by-Design Approach in Cancer Nanomedicine.

Nanomedicine is a rapidly growing field that uses nanomaterials for the diagnosis, treatment and prevention of various diseases, including cancer. Various biocompatible nanoplatforms with diversified capabilities for tumor targeting, imaging, and therapy have materialized to yield individualized therapy. However, due to their unique properties brought about by their small size, safety concerns have emerged as their physicochemical properties can lead to altered pharmacokinetics, with the potential to cross biological barriers. In addition, the intrinsic toxicity of some of the inorganic materials (i.e., heavy metals) and their ability to accumulate and persist in the human body has been a challenge to their translation. Successful clinical translation of these nanoparticles is heavily dependent on their stability, circulation time, access and bioavailability to disease sites, and their safety profile. This review covers preclinical and clinical inorganic-nanoparticle based nanomaterial utilized for cancer imaging and therapeutics. A special emphasis is put on the rational design to develop non-toxic/safe inorganic nanoparticle constructs to increase their viability as translatable nanomedicine for cancer therapies.

Compliance Is Contagious: Using Informatics Methods to Measure the Spread of a Documentation Standard From a Preoperative Clinic.

PURPOSE: Preoperative documentation is essential to coordinated care and has the potential for standardization, which may facilitate downstream clinical management. DESIGN: An observational pre/post standardization design was used. METHODS: We analyzed the implementation of a preoperative documentation standardization intervention in Vanderbilt's Preoperative Evaluation Clinic (VPEC) and its impact outside VPEC. A phased intervention consisted of clinician education with monthly feedback, followed by the development of a compliance dashboard and inclusion in Ongoing Professional Performance Evaluation system by VPEC. A follow-up survey was administered to measure the impact on clinical management. FINDINGS: Adherence to standardization was improved with the addition of electronic feedback. Implementation of this system in the preoperative clinic had significant impact outside VPEC. Trainee status was a significant predictor of adoption of the standardized format. CONCLUSIONS: Adoption of a preoperative documentation standard in a clinic had a positive impact on standardization practices in a perioperative system.

Photoactivated Polymeric Bilayer Actuators Fabricated via 3D Printing.

4D printing is an emerging additive manufacturing technology that combines the precision of 3D printing with the versatility of smart materials. 4D printed objects can change their shape over time with the application of a stimulus (i.e., heat, light, moisture). Light driven smart materials are attractive because light is wireless, remote, and can induce a rapid shape change. Herein, we present a method for fabricating polymeric bilayer actuators via 3D printing which reversibly change their shape upon exposure to light. The photoactive layer consists of a poly(siloxane) containing pendant azobenzene groups. Two different photoactive polymers were synthesized, and the photomechanical effect displayed by the bilayers was evaluated. These bilayers exhibit rapid actuation with full cycles completed within seconds, and photo generated stresses ranging from 1.03 to 1.70 MPa.

Suitability of N-propanoic acid spiropyrans and spirooxazines for use as sensitizing dyes in dye-sensitized solar cells.

This work deals with the fabrication and evaluation of color-changing dye-sensitized solar cells (DSSCs) that include N-propanoic acid-functionalized spiropyrans and spirooxazines as sensitizing dyes. We investigated the photophysical properties of these compounds in various solvents and pH conditions using UV-Vis spectroscopy, and their behavior on TiO2 photoanode surfaces using a combination of UV-Vis and FT-IR. Their performance as sensitizing dyes for DSSCs was also analyzed. This study revealed a number of unique properties for this class of compounds that affect their performance as both photochromic compounds and DSSC sensitizers, which allow for future creation of efficient photochromic DSSCs.

Ultra-Long Crystalline Red Phosphorus Nanowires from Amorphous Red Phosphorus Thin Films.

Heating red phosphorus in sealed ampoules in the presence of a Sn/SnI4 catalyst mixture has provided bulk black phosphorus at much lower pressures than those required for allotropic conversion by anvil cells. Herein we report the growth of ultra-long 1D red phosphorus nanowires (>1 mm) selectively onto a wafer substrate from red phosphorus powder and a thin film of red phosphorus in the present of a Sn/SnI4 catalyst. Raman spectra and X-ray diffraction characterization suggested the formation of crystalline red phosphorus nanowires. FET devices constructed with the red phosphorus nanowires displayed a typical I-V curve similar to that of black phosphorus and a similar mobility reaching 300 cm(2) V(-1) s with an Ion /Ioff ratio approaching 10(2) . A significant response to infrared light was observed from the FET device.

Growth of 2D black phosphorus film from chemical vapor deposition.

Phosphorene, a novel 2D material isolated from bulk black phosphorus (BP), is an intrinsic p-type material with a variable bandgap for a variety of applications. However, these applications are limited by the inability to isolate large films of phosphorene. Here we present an in situ chemical vapor deposition type approach that demonstrates progress towards growth of large area 2D BP with average areas >3 µm2 and thicknesses representing samples around four layers and thicker samples with average areas >100 µm2. Transmission electron microscopy and Raman spectroscopy have confirmed successful growth of 2D BP from red phosphorus.