RAPID-ED: A predictive model for risk assessment of patient's early in-hospital deterioration from emergency department.

Introduction: The objective of this multi-center retrospective cohort study was to devise a predictive tool known as RAPID-ED. This model identifies non-traumatic adult patients at significant risk for cardiac arrest within 48 hours post-admission from the emergency department. Methods: Data from 224,413 patients admitted through the emergency department (2016-2020) was analyzed, incorporating vital signs, lab tests, and administered therapies. A multivariable regression model was devised to anticipate early cardiac arrest. The efficacy of the RAPID-ED model was evaluated against traditional scoring systems like National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) and its predictive ability was gauged via the area under the receiver operating characteristic curve (AUC) in both hold-out validation set and external validation set. Results: RAPID-ED outperformed traditional models in predicting cardiac arrest with an AUC of 0.819 in the hold-out validation set and 0.807 in the external validation set. In this critical care update, RAPID-ED offers an innovative approach to assessing patient risk, aiding emergency physicians in post-discharge care decisions from the emergency department. High-risk score patients (≥13) may benefit from early ICU admission for intensive monitoring. Conclusion: As we progress with advancements in critical care, tools like RAPID-ED will prove instrumental in refining care strategies for critically ill patients, fostering an improved prognosis and potentially mitigating mortality rates.

Treatment of Adenoid Cystic Carcinoma of the Palate and Reconstruction of Defect With Nasoseptal Flap: A Clinical Case and Review of Literature.

Adenoid cystic carcinoma (ACC) is a malignant tumor arising from the salivary glands. While surgery is the mainstay of treatment for ACC of the palate, adjuvant radiotherapy and/or chemotherapy should be considered in high-risk cases. Oronasal fistula, a complication of palatal surgery, may cause speech disturbance and food regurgitation; the nasoseptal flap is a potential option to repair this defect as it is readily available and reliable. Here, we present a case of locally advanced ACC of the palate in a patient who underwent endoscopic-assisted transoral tumor excision with nasoseptal flap reconstruction postoperative chemoradiotherapy.

Clinical Validation of the Shock Index, Modified Shock Index, Delta Shock Index, and Shock Index-C for Emergency Department ST-Segment Elevation Myocardial Infarction.

Background: ST-segment elevation myocardial infarction (STEMI) is a leading cause of death worldwide. A shock index (SI), modified SI (MSI), delta-SI, and shock index-C (SIC) are known predictors of STEMI. This retrospective cohort study was designed to compare the predictive value of the SI, MSI, delta-SI, and SIC with thrombolysis in myocardial infarction (TIMI) risk scales. Method: Patients > 20 years old with STEMI who underwent percutaneous coronary intervention (PCI) were included. Receiver operating characteristic (ROC) curve analysis with the Youden index was performed to calculate the optimal cutoff values for these predictors. Results: Overall, 1552 adult STEMI cases were analyzed. The thresholds for the emergency department (ED) SI, MSI, SIC, and TIMI risk scales for in-hospital mortality were 0.75, 0.97, 21.00, and 5.5, respectively. Accordingly, ED SIC had better predictive power than the ED SI and ED MSI. The predictive power was relatively higher than TIMI risk scales, but the difference did not achieve statistical significance. After adjusting for confounding factors, the ED SI > 0.75, MSI > 0.97, SIC > 21.0, and TIMI risk scales > 5.5 were statistically and significantly associated with in-hospital mortality of STEMI. Compared with the ED SI and MSI, SIC (>21.0) had better sensitivity (67.2%, 95% CI, 58.6−75.9%), specificity (83.5%, 95% CI, 81.6−85.4%), PPV (24.8%, 95% CI, 20.2−29.6%), and NPV (96.9%, 95% CI, 96.0−97.9%) for in-hospital mortality of STEMI. Conclusions: SIC had better discrimination ability than the SI, MSI, and delta-SI. Compared with the TIMI risk scales, the ACU value of SIC was still higher. Therefore, SIC might be a convenient and rapid tool for predicting the outcome of STEMI.

Arthroscopic Quantitative Measurement of Medial Clear Space for Deltoid Injury of the Ankle: A Cadaveric Comparative Study With Stress Radiography.

BACKGROUND: The deltoid ligament (DL) is an important stabilizer of the ankle. DL injury of varying severity can occur alone or with syndesmotic injury and fibular fracture. Limited diagnostic tools are available to assess DL injury quantitatively. PURPOSE: To establish an arthroscopic quantitative assessment of DL injury and to compare its performance with that of external rotation stress (ERS) and gravity stress (GS) radiography. STUDY DESIGN: Controlled laboratory study. METHODS: In total, 24 cadaveric lower extremities were divided into 4 groups: group 1 consisted of intact DL, group 2 of superficial DL disruption, group 3 of deep DL disruption, and group 4 of complete DL (superficial and deep) disruption. All specimens underwent sequential sectioning of syndesmotic ligaments, and medial clear space (MCS) was measured with ankle arthroscopy, ERS radiography, and GS radiography at different stages of syndesmotic sectioning. RESULTS: For noninjured deltoid (group 1) and injured deltoid (groups 2-4), area under the receiver operating characteristic curve (AUC) of measurement of MCS was 0.939 for arthroscopy, 0.932 for ERS radiography, and 0.874 for GS radiography, with a significant difference between arthroscopy and GS radiography (P = .014). For incomplete deltoid injury (groups 1-3) and complete deltoid injury (group 4), the AUC of MCS was 0.811 for arthroscopy, 0.656 for ERS radiography, and 0.721 for GS radiography, with a significant difference between arthroscopy and ERS radiography (P < .001) and between arthroscopy and GS radiography (P = .035). For all stages of syndesmotic sectioning, cutoff values of arthroscopic MCS with intact fibula were ≤2.5 mm for intact DL, between 2.5 and 3.5 mm for partial DL injury (superficial or deep), and ≥3.5 mm for complete DL injury. Arthroscopy was unable to detect a difference between superficial deltoid injury (group 2) and deep deltoid injury (group 3) in partial DL injury, with a measured MCS between 2.5 and 3.5 mm. The intraclass correlation coefficient of interrater reliability was 0.975 for arthroscopy, 0.917 for ERS radiography, and 0.811 for GS radiography. CONCLUSION: Arthroscopic MCS measurement can differentiate intact DL, partial DL injury, and complete DL injury. Compared with ERS and GS radiography, arthroscopic MCS measurement has greater accuracy with excellent interrater reliability. CLINICAL RELEVANCE: For patients with suspected DL injury, arthroscopic MCS is useful for determining deltoid lesion severity based on defined cutoff values for consideration in preoperative planning to improve surgical outcomes.

Delta Shock Index During Emergency Department Stay Is Associated With in Hospital Mortality in Critically Ill Patients.

Background: Delta shock index (SI; i.e., change in SI over time) has been shown to predict mortality and need for surgical intervention among trauma patients at the emergency department (ED). However, the usefulness of delta SI for prognosis assessment in non-traumatic critically ill patients at the ED remains unknown. The aim of this study was to analyze the association between delta SI during ED management and in-hospital outcomes in patients admitted to the intensive care unit (ICU). Method: This was a retrospective study conducted in two tertiary medical centers in Taiwan from January 1, 2016, to December 31, 2017. All adult non-traumatic patients who visited the ED and who were subsequently admitted to the ICU were included. We calculated delta SI by subtracting SI at ICU admission from SI at ED triage, and we analyzed its association with in-hospital outcomes. SI was defined as the ratio of heart rate to systolic blood pressure (SBP). The primary outcome was in-hospital mortality, and the secondary outcomes were hospital length of stay (HLOS) and early mortality. Early mortality was defined as mortality within 48 h of ICU admission. Result: During the study period, 11,268 patients met the criteria and were included. Their mean age was 64.5 ± 15.9 years old. Overall, 5,830 (51.6%) patients had positive delta SI. Factors associated with a positive delta SI were multiple comorbidities (51.2% vs. 46.3%, p < 0.001) and high Simplified Acute Physiology Score [39 (29-51) vs. 37 (28-47), p < 0.001). Patients with positive delta SI were more likely to have tachycardia, hypotension, and higher SI at ICU admission. In the regression analysis, high delta SI was associated with in-hospital mortality [aOR (95% CI): 1.21 (1.03-1.42)] and early mortality [aOR (95% CI): 1.26 (1.07-1.48)], but not for HLOS [difference (95% CI): 0.34 (-0.48 to 1.17)]. In the subgroup analysis, high delta SI had higher odds ratios for both mortality and early mortality in elderly [aOR (95% CI): 1.59 (1.11-2.29)] and septic patients [aOR (95% CI): 1.54 (1.13-2.11)]. It also showed a higher odds ratio for early mortality in patients with triage SBP <100 mmHg [aOR (95% CI): 2.14 (1.21-3.77)] and patients with triage SI ≥ 0.9 [aOR (95% CI): 1.62 (1.01-2.60)]. Conclusion: High delta SI during ED stay is correlated with in-hospital mortality and early mortality in patients admitted to the ICU via ED. Prompt resuscitation should be performed, especially for those with old age, sepsis, triage SBP <100 mmHg, or triage SI ≥ 0.9.

In-Hospital Outcomes in Patients Admitted to the Intensive Care Unit after a Return Visit to the Emergency Department.

BACKGROUND: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits. METHOD: This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost. RESULTS: Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: -1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: -303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit. CONCLUSION: ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice.

The high prevalence of sarcopenia and its associated outcomes following hip surgery in Taiwanese geriatric patients with a hip fracture.

BACKGROUND: Sarcopenia, which is a common risk factor for falls and fractures, affects the functional outcome and mortality in geriatric populations. However, the prevalence of sarcopenia among geriatric Taiwanese patients with a hip fracture is unknown, nor is the effect of sarcopenia on the outcome of hip surgery. METHODS: From December 2017 to February 2019, geriatric patients who underwent surgery for a hip fracture were prospectively enrolled. Basic demographic data, responses to questionnaires for dementia screening and quality of life (QoL) and daily living activities (ADL) before the injury were analyzed to identify any association with sarcopenia. The QoL and ADL were monitored at six months after the operation to determine the difference between hip fracture patients with or without sarcopenia. RESULTS: Of 139 hip fracture patients, 70 (50.36%) were diagnosed with sarcopenia. Accounting for all confounding factors in the multivariate logistic regression, lower body mass index (BMI), male gender and a weaker handgrip are the risk factors that are most strongly associated with a diagnosis of sarcopenia in geriatric patients with a hip fracture. Hip fracture patients with sarcopenia also have poor ADL and a lower QoL than patients without sarcopenia before the injury and six months after the operation. CONCLUSION: A high prevalence of sarcopenia among geriatric hip fracture patients is associated with a poor mid-term outcome following hip surgery. Clinicians must recognize the risk of sarcopenia, especially for male hip fracture patients with a lower BMI and a weaker handgrip.

Public Health Interventions for the COVID-19 Pandemic Reduce Respiratory Tract Infection-Related Visits at Pediatric Emergency Departments in Taiwan.

Background and objective: Public health interventions such as social distancing, wearing surgical or N95 masks, and handwashing are effective in significantly reducing the risk of infection. The purpose of this article is to analyze the effect of public health interventions on respiratory tract infection-related visits to pediatric emergency departments during the COVID-19 pandemic in Taiwan. Method: Pediatric emergency department visits between January 1 2020 and April 30 2020 were included for trend analysis and compared to the same period during the past 3 years. The datasets were retrieved from Taiwan National Infectious Disease Statistics System and Kaohsiung Chang Gung Memorial Hospital. Respiratory tract infections with other diagnoses categories, including fever, asthma, and urinary tract infections, were included for subgroup analysis. Result: A significant decrease of more than 50% in respiratory tract infection-related visits was found from February to April 2020 in the national database. With regard to diagnosis category, the proportion of respiratory tract infections in Kaohsiung Chang Gung Hospital also became significantly lower in 2020 during the months of March (43.4 vs. 37.4%, p = 0.024) and April (40.1 vs. 32.2%, p < 0.001). On the other hand, the proportion of urinary tract infections was significantly higher in 2020 during March (3.7 vs. 5.2%, p = 0.033) and April (3.9 vs. 6.5%, p < 0.001), and that of asthma was also higher in April (1.6 vs. 2.6%, p = 0.025). Furthermore, the intensive care unit admission rate was relatively higher in 2020 from February, with significant differences noted in March (1.3 vs. 2.8%, p < 0.001). Conclusion: Due to public health interventions for the COVID-19 pandemic, the transmission of not only COVID-19 but also other air droplet transmitted diseases in children may have been effectively prevented.

Arthroscopic Reduction and Minimally Invasive Surgery in Supination-External Rotation Ankle Fractures: A Comparative Study With Open Reduction.

PURPOSE: To describe an algorithm for arthroscopic reduction and minimally invasive surgery (ARMIS) and compare the surgical outcomes with standard open reduction-internal fixation (ORIF) for the treatment of supination-external rotation (SER) ankle fractures. METHODS: The inclusion criteria for this study were patients aged 16 years or older, the presence of a unilateral SER fracture, and injuries less than 2 weeks old. We retrospectively identified patients with SER fractures who underwent ORIF from January 2008 to December 2011 or ARMIS from January 2012 to December 2015. Data collected in December 2013 for the ORIF group and in December 2017 for the ARMIS group were compared. The algorithm for ARMIS was minimally invasive plating for lateral malleolar fractures first, followed by ankle arthroscopy for detection of syndesmotic injuries and then arthroscopic reduction of medial malleolar fractures or mini-open repair of the deltoid ligament. The talocrural angle, fibular length, tibiomedial malleolar angle, medial clear space, and tibiofibular clear space were measured radiographically. Functional evaluations included the visual analog scale pain score, American Orthopaedic Foot & Ankle Society ankle-hindfoot scales, and range of motion of bilateral ankles. Complications and reoperations were recorded for comparison. RESULTS: A total of 105 patients with SER fractures, 65 in the ARMIS group and 40 in the ORIF group, were included. Significantly lower incidences of complications (7.7% vs 27.5%, P = .006) and reoperations (1.5% vs 12.5%, P = .029) were found in the ARMIS group than in the ORIF group. More syndesmotic injuries were detected in the ARMIS group than in the ORIS group (80% vs 57.5%, P = .021). The visual analog scale pain score was significantly lower on day 3 postoperatively in the ARMIS group than in the ORIS group (1.96 ± 1.18 vs 2.83 ± 1.07, P = .027). The postoperative stay was shorter in the ARMIS group than in the ORIF group (3.66 ± 1.39 days vs 4.46 ± 2.23 days, P = .024). The operative time was longer in the ARMIS group than in the ORIS group (105.22 ± 27.13 minutes vs 93.59 ± 22.79 minutes, P = .038). A longer fluoroscopic time (0.43 ± 0.25 minutes vs 0.17 ± 0.07 minutes, P < .001) and a higher dose of irradiation (1,216.46 ± 603.99 µGy vs 389.38 ± 217.89 µGy, P < .001) were observed in the ARMIS group. No significant differences in radiographic measurements were found between the operative and nonoperative ankles in both groups. CONCLUSIONS: Our algorithm and the ARMIS techniques may be a safe, reliable, and effective option in the treatment of SER fractures. ARMIS achieves promising surgical outcomes with less early postoperative pain, a shorter postoperative stay, and lower incidences of complications and reoperations compared with ORIF. However, the operative time is longer and the irradiation dose is higher with the ARMIS techniques. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Risk factors for cut-out failure of Gamma3 nails in treating unstable intertrochanteric fractures: An analysis of 176 patients.

BACKGROUND: Cut-out failure is one of the most common complications in the Gamma3 nail fixation system. The purpose of this retrospective study was to determine pre-operative or intra-operative risk factors for cut-out failure of lag screws in unstable, intertrochanteric fractures fixed with short Gamma3 nails. METHODS: One hundred and seventy-six patients over 60 years of age, with unstable intertrochanteric fractures (AO/OTA 31-A2, 31-A3) treated with short Gamma3 nails were included in this study. All patients completed a minimum of 1-year follow-up. Analysis of post-operative radiographs included assessment for cut-out failure of lag screw, appropriateness of the entry point, posterior lag screw axis, fracture gaps, posterior displacement of the proximal fragment, and tip-apex distance. RESULTS: Of the 176 patients in this study, 22 patients were identified with cut-out failure. Multivariate logistic regression analysis revealed that improper entry point in an antero-posterior projection (odds ratio 10.39, 95% confidence interval 1.74-78.4), posterior displacement distance of the proximal fragment in a lateral projection (odds ratio 1.35, 95% confidence interval 1.17-1.59), and female sex (odds ratio 17.14, 95% confidence interval 1.88-876.11) were correlated with cut-out failure. CONCLUSION: This study emphasizes the importance of an optimal position of reduction in the lateral projection in reducing the risk of cut-out failure. In addition, sex difference in bone mineral density, proximal femur geometry, and the bone strength in elderly females may explain why female sex is a risk factor.

Block-Copolymer-Templated Hierarchical Porous Carbon Nanostructures with Nitrogen-Rich Functional Groups for Molecular Sensing.

The self-assembly of a block copolymer offers access to micellar nanodomains with tunable dimensions and structural diversity through control of such molecular parameters as the volume fraction and molecular mass. We fabricated hierarchical porous carbon (HPC) nanostructures with bundles of aggregated nanospheres and with nitrogen-rich functional groups through pyrolysis of diblock copolymer micelles in multiple layers. The resultant HPC nanostructures with a considerable specific surface area serve as an excellent substrate for surface-enhanced Raman spectroscopy (SERS), coupled with fluorescence quenching, for molecular sensing of physically adsorbed Rhodamine 6G. The abundant nitrogen atoms terminating on the surface of HPC nanostructures play a critical role in promoting a large Raman enhancement generated via a chemical mechanism. Most importantly, the observed enhancement factors show a clear dependence on the mesoscale porosity within HPC nanostructures, indicating that the chemical enhancement can be steadily tuned with control over the interfacial areas as a function of the nanosphere size. The unique architecture of HPC nanostructures based on the construction of a building block of a well-defined network of core-shell nanospheres provides a new design strategy for fabricating SERS substrates.

Corticosteroid Is Associated with Both Hip Fracture and Fracture-Unrelated Arthropathy.

OBJECTIVE: We aimed to investigate whether and how corticosteroid use was associated with serious hip arthropathy. METHODS AND MATERIALS: This population-based cohort study analyzed the Taiwan National Health Insurance Research Database and screened the one-million random sample from the entire population for eligibility. The steroid cohort consisted of 21,995 individuals who had used systemic corticosteroid for a minimum of 6 months between January 1, 1997 and December 31, 2006. They were matched 1:1 in propensity score on the index calendar date with controls who never used steroid. All participants were followed up until occurrence of serious hip arthropathy that required arthroplasty, withdrawal from the national health insurance, or the end of 2011. Surgical indication was classified as fracture-related and -unrelated. The cumulative incidence of hip arthroplasty was estimated by the Kaplan Meier method. The association with steroid exposure was explored by the Cox proportional hazard model. RESULTS: Cumulative incidences of hip arthroplasty after 12 years of follow-up were 2.96% (95% confidence interval [CI], 2.73-3.2%) and 1.34% (95% CI, 1.2-1.51%) in the steroid users and non-users, respectively (P<0.0001). The difference was evident in fracture-related arthroplasty with 1.89% (95% CI, 1.71-2.09%) versus 1.10% (95% CI, 0.97-1.25%), but more pronounced in fracture-unrelated surgery, 1.09% (95% CI, 0.95-1.24%) versus 0.24% (95% CI, 0.19-0.32%). Multivariate-adjusted Cox regression analysis confirmed steroid use was independently associated with both fracture-related (adjusted hazard ratio [HR], 1.65; 95% CI, 1.43-1.91) and unrelated arthroplasty (adjusted HR, 4.21; 95% CI, 3.2-5.53). Moreover, the risk for fracture-unrelated arthropathy rose with steroid dosage, as the adjusted HR increased from 3.30 (95% CI, 2.44-4.46) in the low-dose subgroup, 4.54 (95% CI, 3.05-6.77) in intermediate-dose users, to 6.54 (95% CI, 4.74-9.02) in the high-dose counterpart (Ptrend<0.0001). CONCLUSIONS: Corticosteroid use is associated with long-term risk of hip arthroplasty, particularly for fracture-unrelated arthropathy.

Tailoring Carbon Nanostructure with Diverse and Tunable Morphology by the Pyrolysis of Self-Assembled Lamellar Nanodomains of a Block Copolymer.

The pyrolysis of a block copolymer thin film, the free surface of which was in contact with air or a capping layer of SiO2, produced four carbon nanostructures. Thin films of a diblock copolymer having perpendicularly oriented lamellar nanodomains served as carbon and nitrogen precursors. Before pyrolysis, the lamellar nanodomains were cross-linked with UV irradiation under nitrogen gas (UVIN). Without a capping layer, pyrolysis caused a structural transformation from lamellar nanodomains to short carbon nanowires or to dropletlike nanocarbons in a row via Rayleigh instability, depending on the duration of pyrolysis. When capped with a layer of SiO2 followed by pyrolysis, the lamellar nanodomains were converted to pod-like, spaghetti-like, or long worm-like carbon nanostructures. These carbon nanostructures were driven by controlling the surface or interface tension and the residual yield of solid carbonaceous species.

Excess mortality after hip fracture among the elderly in Taiwan: a nationwide population-based cohort study.

Osteoporotic hip fractures cause high mortality in the elderly population. However, few population studies reported the long-term mortality of hip fracture among the elderly in Asian population. This study assessed the incidence, excess mortality, and risk factors after osteoporotic hip fractures through inpatients aged 60 years or older. A total of 143,595 patients with hip fracture were selected from Taiwan National Health Insurance database in the years 1999 to 2009 and followed up until the end of 2010. Annual incidence, mortality and SMR, and mortality and SMR at different periods after fracture were measured. From 1999 to 2005, hip fracture incidence gradually increased and then fluctuated after 2006. From 1999 to 2009, the male-to-female ratio of annual incidence increased from 0.60 to 0.66, annual mortality for hip fracture decreased from 18.10% to 13.98%, male-to-female ratio of annual mortality increased from 1.38 to 1.64, and annual SMR decreased from 13.80 to 2.98. Follow-up SMR at one, two, five, and ten years post-fracture was 9.67, 5.28, 3.31, and 2.89, respectively. Females had higher follow-up SMR in the younger age groups (60-69 yr of age) but lower follow-up SMR in the older age groups (over 80 yr of age) compared with males. Among the studied patients, incidence is gradually decreasing along with annual mortality and SMR. Hip fracture affects short-term but not long-term mortality.

Optical sensing of urinary melatonin with molecularly imprinted poly(ethylene-co-vinyl alcohol) coated zinc oxide nanorod arrays.

In this work, aligned zinc oxide (ZnO) nanorods were selectively hydrothermally grown on acetate-seeded spots on a gold substrate; the nanorods had an average length and diameter of 1.7µm and 240nm, respectively. Melatonin was imprinted into poly(ethylene-co-vinyl alcohol), EVAL, which was coated onto ZnO nanorod arrays. The ZnO nanorods not only increased the surface area for sensing target molecules, but also constituted an optical sensing element, as the ZnO fluorescence decreases when targets bind to the imprinted EVAL film; the fluorescence decrease, as a function of melatonin concentration, is well fit by a Langmuir adsorption isotherm. Poly(ethylene-co-vinyl alcohol) with 44mol% ethylene showed the best imprinting effectiveness (ratio of the fluorescence decrease on binding melatonin to imprinted vs. non-imprinted EVAL-coated ZnO nanorod arrays) among the several compositions studied. In real urine analysis, the MIP films responded linearly to added (exogenous) melatonin, even in the presence of many possible interfering compounds in urine. This demonstrates the feasibility of using these MIPs as part of a total urinalysis MIP system.