Effectiveness of Toothbrushing Technique for Biofilm Removal and Postoperative Infection Control after Spinal Fusion Surgery: A Retrospective Study.

This retrospective study was designed to investigate the effectiveness of using a toothbrush, which is commonly used in our daily life, for biofilm removal and infection control in the treatment of spinal infections occurring after spinal fusion surgery. Currently, a biofilm is thought to form on the surface of the metal inserted during spine fusion surgery. We aim to determine the differences in clinical outcomes between using and not using a toothbrush to remove biofilm while performing conventional drainage, curettage, and debridement. A total of 1081 patients who underwent anterior or posterior spinal fusion surgery between November 2018 and October 2022 were screened. The study included 60 patients who developed surgical site infection and underwent incision and drainage surgery either with a toothbrush (n = 20) or without a toothbrush (n = 40). Failure of infection control that requires revision surgery occurred in 2 patients (10%) in the Toothbrush group and in 14 patients (35%) in the No-Toothbrush group (p = 0.039). Thus, the rate of additional surgery was significantly lower in the Toothbrush group. Additionally, normalization of c-reactive protein levels occurred significantly faster in the Toothbrush group (p = 0.044). Therefore, using a toothbrush to treat spinal infections following spinal fusion surgery appears to have beneficial mechanical debridement effects, resulting in improved clinical results, which were also confirmed based on the electron microscopic images.

Ultrasensitive and Highly Stretchable Multiple-Crosslinked Ionic Hydrogel Sensors with Long-Term Stability.

Flexible hydrogels are receiving significant attention for their application in wearable sensors. However, most hydrogel materials exhibit weak and one-time adhesion, low sensitivity, ice crystallization, water evaporation, and poor self-recovery, thereby limiting their application as sensors. These issues are only partly addressed in previous studies. Herein, a multiple-crosslinked poly(2-(methacryloyloxy)ethyl)dimethyl-(3-sulfopropyl)ammonium hydroxide-co-acrylamide) (P(SBMA-co-AAm)) multifunctional hydrogel is prepared via a one-pot synthesis method to overcome the aforementioned limitations. Specifically, ions, glycerol, and 2-(methacryloyloxy)ethyl)dimethyl-(3-sulfopropyl)ammonium hydroxide are incorporated to reduce the freezing point and improve the moisture retention ability. The proposed hydrogel is superior to existing hydrogels because it exhibits good stretchability (a strain of 2900%), self-healing properties, and transparency through effective energy dissipation in its dynamic crosslinked network. Further, 2-(methacryloyloxy)ethyl)dimethyl-(3-sulfopropyl)ammonium hydroxide as a zwitterion monomer results in an excellent gauge factor of 43.4 at strains of 1300-1600% by improving the ion transportability and achieving a strong adhesion of 20.9 kPa owing to the dipole-dipole moment. The proposed hydrogel is promising for next-generation biomedical applications, such as soft robots, and health monitoring.

Silver-Reduced Poly(Ethylene Glycol) Diacrylate Composites with Microline Arrays for Directional Bending Sensors.

Herein, a soft and flexible polymer composite sensor with a surface structure is manufactured that is sensitive to a wide range of mechanical stimuli, including small actions and large motions. A polymer sensor performing with a piezoresistive mechanism is proposed by synthesizing a new conductive polymer composite to fabricate a microline structure by itself, named Ag-reduced poly(ethylene glycol) diacrylate (PEGDA) composite directional bending sensor (ACBS). A simple but effective process of forming nanoparticles (NPs) and surface structures is a notable characteristic. High sensitivity to a small stimulus was achieved by forming Ag NPs within PEGDA, particularly concentrating on the surface and applying the microline structure. With the structural characteristics of a line structure, the ACBS achieved anisotropic sensitivity to bulk motion along the arranged line direction. The excellent sensitivity of this polymer sensor was experimentally demonstrated via water droplets, blowing, and breathing. Combining the advantages of a simple synthetic and simple fabrication process along with the fabrication ability of the microsurface structure with the material itself and the conductive Ag/PEGDA integrated layer, this ACBS is outstanding as a soft and flexible polymer composite sensor and has potential application in physical devices such as wearable devices and biosensors.

Experimental and Theoretical Investigation of the Effect of Filler Material on the Performance of Flexible and Rigid Thermoelectric Generators.

Thermoelectric generators have found many applications where the heat source can be either flat or curved. For a curved heat source, flexible thermoelectric generators are generally used. A filler material with low thermal conductivity can provide additional mechanical support to the thermoelectric module and can reduce convection and radiation losses. Herein, the effect of three different filler materials on the output performance of rigid and flexible thermoelectric generators is investigated. At first, theoretical models are derived and the experimental study validated the models. The experimental study revealed that the flexible thermoelectric modules outperformed the rigid modules; this is due to the reduction of the number of thermal junctions in the flexible modules and due to the differences in the thermal conductivities of the flexible and rigid substrates. Likewise, among TE modules without filler/with air between the TE legs, with polyurethane foam filler material, and with polydimethylsiloxane filler material, air has the lowest thermal conductivity, and therefore, the thermoelectric generator without filler generates higher output power and higher power density than when the other two filler materials are used. For the fixed temperature gradient, the highest power densities for the flexible and rigid thermoelectric generators without filler are 155 and 137.7 µW/cm2 for temperature gradients of 10.8 and 10.3 °C, respectively.

Capillary-Induced Clustering of Thermoresponsive Micropillars.

In this study, we demonstrate the controllable clustering of thermoresponsive high-aspect-ratio hydrogel pillars by modulating the elastic modulus of the materials. Generally, high-aspect-ratio polymeric pillars readily cluster owing to the effect of capillary force and adhesion. However, this unstable behavior hinders the implementation of various functionalities such as wetting, adhesion, and energy harvesting on surfaces with such pillars. Conversely, clustering behavior may be required in the case of digital microfluidic platforms that grip tiny particles or perform biological and chemical analyses. Therefore, it is necessary to develop a reliable method for controlling the clustering behavior. To this end, we fabricate high-aspect-ratio pillars that exhibit capillary-induced clustering behavior based on the cross-linker density of the thermoresponsive hydrogel and the temperature of the surrounding environment. Through experimental and theoretical analyses, a criterion for controlling the clustering and recovery behavior of the fabricated pillars is determined. The established criterion is employed to fabricate a smart mobile camera lens cover that can produce blurred and deblurred images based on optical variations resulting from the clustering and recovery of the pillars. The results of this study can be used to fabricate high-aspect-ratio polymeric pillars for use in diverse applications.

Impact of oxide gate electrode for ferroelectric field-effect transistors with metal-ferroelectric-metal-insulator-semiconductor gate stack using undoped HfO2 thin films prepared by atomic layer deposition.

Ferroelectric field-effect transistors (FETs) with a metal-ferroelectric-metal-insulator-semiconductor (MFMIS) gate stack were fabricated and characterized to elucidate the key process parameters and to optimize the process conditions for guaranteeing nonvolatile memory operations of the device when the undoped HfO2 was employed as ferroelectric gate insulator. The impacts of top gate (TG) for the MFM part on the memory operations of the MFMIS-FETs were intensively investigated when the TG was chosen as metal Pt or oxide ITO electrode. The ferroelectric memory window of the MFMIS-FETs with ITO/HfO2/TiN/SiO2/Si gate stack increased to 3.8 V by properly modulating the areal ratio between two MFM and MIS capacitors. The memory margin as high as 104 was obtained during on- and off-program operations with a program pulse duration as short as 1 µs. There was not any marked degradation in the obtained memory margin even after a lapse of retention time of 104 s at 85 °C and repeated program cycles of 10,000. These obtained improvements in memory operations resulted from the fact that the choice of ITO TG could provide effective capping effects and passivate the interfaces.

Ferroelectric Switching in Trilayer Al2O3/HfZrOx/Al2O3 Structure.

Since ferroelectricity has been observed in simple binary oxide material systems, it has attracted great interest in semiconductor research fields such as advanced logic transistors, non-volatile memories, and neuromorphic devices. The location in which the ferroelectric devices are implemented depends on the specific application, so the process constraints required for device fabrication may be different. In this study, we investigate the ferroelectric characteristics of Zr doped HfO2 layers treated at high temperatures. A single HfZrOx layer deposited by sputtering exhibits polarization switching after annealing at a temperature of 850 °C. However, the achieved ferroelectric properties are vulnerable to voltage stress and higher annealing temperature, resulting in switching instability. Therefore, we introduce an ultrathin 1-nm-thick Al2O3 layer at both interfaces of the HfZrOx. The trilayer Al2O3/HfZrOx/Al2O3 structure allows switching parameters such as remnant and saturation polarizations to be immune to sweeping voltage and pulse cycling. Our results reveal that the trilayer not only makes the ferroelectric phase involved in the switching free from pinning, but also preserves the phase even at high annealing temperature. Simultaneously, the ferroelectric switching can be improved by preventing leakage charge.

Exploiting defective RRAM array as synapses of HTM spatial pooler with boost-factor adjustment scheme for defect-tolerant neuromorphic systems.

A crossbar array architecture employing resistive switching memory (RRAM) as a synaptic element accelerates vector-matrix multiplication in a parallel fashion, enabling energy-efficient pattern recognition. To implement the function of the synapse in the RRAM, multilevel resistance states are required. More importantly, a large on/off ratio of the RRAM should be preferentially obtained to ensure a reasonable margin between each state taking into account the inevitable variability caused by the inherent switching mechanism. The on/off ratio is basically adjusted in two ways by modulating measurement conditions such as compliance current or voltage pulses modulation. The latter technique is not only more suitable for practical systems, but also can achieve multiple states in low current range. However, at the expense of applying a high negative voltage aimed at enlarging the on/off ratio, a breakdown of the RRAM occurs unexpectedly. This stuck-at-short fault of the RRAM adversely affects the recognition process based on reading and judging each column current changed by the multiplication of the input voltage and resistance of the RRAM in the array, degrading the accuracy. To address this challenge, we introduce a boost-factor adjustment technique as a fault-tolerant scheme based on simple circuitry that eliminates the additional process to identify specific locations of the failed RRAMs in the array. Spectre circuit simulation is performed to verify the effect of the scheme on Modified National Institute of Standards and Technology dataset using convolutional neural networks in non-ideal crossbar arrays, where experimentally observed imperfective RRAMs are configured. Our results show that the recognition accuracy can be maintained similar to the ideal case because the interruption of the failure is suppressed by the scheme.

Implementation of an electrically modifiable artificial synapse based on ferroelectric field-effect transistors using Al-doped HfO2 thin films.

Human brain-like synaptic behaviors of the ferroelectric field-effect transistors (FeFETs) were emulated by introducing the metal-ferroelectric-metal-insulator-semiconductor (MFMIS) gate stacks employing Al-doped HfO2 (Al:HfO2) ferroelectric thin films even at a low operation voltage. The synaptic plasticity of the MFMIS-FETs could be gradually modulated by the partial polarization characteristics of the Al:HfO2 thin films, which were examined to be dependent on the applied pulse conditions. Based on the ferroelectric polarization switching dynamics of the Al:HfO2 thin films, the proposed devices successfully emulate biological synaptic functions, including excitatory post-synaptic current (EPSC), paired-pulse facilitation (PPF), and spike timing-dependent plasticity (STDP). The channel conductance of the FeFETs could be controlled by partially switching the ferroelectric polarization of the Al:HfO2 gate insulators by means of pulse-number and pulse-amplitude modulations. Furthermore, the 3 × 3 array integrated with the Al:HfO2 MFMIS-FETs was also fabricated, in which electrically modifiable weighted-sum operation could be well verified in the 3 × 3 synapse array configuration.

Artificial Perspiration Membrane by Programmed Deformation of Thermoresponsive Hydrogels.

Thermal management is essential for living organisms and electronic devices to survive and maintain their own functions. However, developing flexible cooling devices for flexible electronics or biological systems is challenging because conventional coolers are bulky and require rigid batteries. In nature, skins help to maintain a constant body temperature by dissipating heat through perspiration. Inspired by nature, an artificial perspiration membrane that automatically regulates evaporation depending on temperature using the programmed deformation of thermoresponsive hydrogels is presented. The thermoresponsive hydrogel is patterned into pinwheel shapes and supported by a polymeric rigid frame with stable adhesion using copolymerization. Both shape of the valve and mechanical constraint of the frame allow six times larger evaporation area in the open state compared to the closed state, and the transition occurs at a fast rate (≈1 s). A stretchable membrane is selectively coated to prevent unintended evaporation through the hydrogel while allowing swelling or shrinking of the hydrogel by securing path of water. Consequently, a 30% reduction in evaporation is observed at lower temperature, resulting in regulation of the skin temperature at the thermal model of human skins. This simple, small, and flexible cooler will be useful for maintaining temperature of flexible devices.

Wafer-Level-Based Open-Circuit Sensitivity Model from Theoretical ALEM and Empirical OSCM Parameters for a Capacitive MEMS Acoustic Sensor.

We present a simple, accurate open-circuit sensitivity model based on both analytically calculated lumped and empirically extracted lumped-parameters that enables a capacitive acoustic sensor to be efficiently characterized in the frequency domain at the wafer level. Our mixed model is mainly composed of two key strategies: the approximately linearized electric-field method (ALEM) and the open- and short-calibration method (OSCM). Analytical ALEM can separate the intrinsic capacitance from the capacitance of the acoustic sensor itself, while empirical OSCM, on the basis of one additional test sample excluding the membrane, can extract the capacitance value of the active part from the entire sensor chip. FEM simulation verified the validity of the model within an error range of 2% in the unit cell. Dynamic open-circuit sensitivity is modelled from lumped parameters based on the equivalent electrical circuit, leading to a modelled resonance frequency under a bias condition. Thus, eliminating a complex read-out integrated circuit (ROIC) integration process, this mixed model not only simplifies the characterization process, but also improves the accuracy of the sensitivity because it considers the fringing field effect between the diaphragm and each etching hole in the back plate.

Flexible and Robust Thermoelectric Generators Based on All-Carbon Nanotube Yarn without Metal Electrodes.

As practical interest in flexible/or wearable power-conversion devices increases, the demand for high-performance alternatives to thermoelectric (TE) generators based on brittle inorganic materials is growing. Herein, we propose a flexible and ultralight TE generator (TEG) based on carbon nanotube yarn (CNTY) with excellent TE performance. The as-prepared CNTY shows a superior electrical conductivity of 3147 S/cm due to increased longitudinal carrier mobility derived from a highly aligned structure. Our TEG is innovative in that the CNTY acts as multifunctions in the same device. The CNTY is alternatively doped into n- and p-types using polyethylenimine and FeCl3, respectively. The highly conductive CNTY between the doped regions is used as electrodes to minimize the circuit resistance, thereby forming an all-carbon TEG without additional metal deposition. A flexible TEG based on 60 pairs of n- and p-doped CNTY shows the maximum power density of 10.85 and 697 µW/g at temperature differences of 5 and 40 K, respectively, which are the highest values among reported TEGs based on flexible materials. We believe that the strategy proposed here to improve the power density of flexible TEG by introducing highly aligned CNTY and designing a device without metal electrodes shows great potential for the flexible/or wearable power-conversion devices.

Nonlinear Frameworks for Reversible and Pluripotent Wetting on Topographic Surfaces.

Soft, ultrathin frameworks nonlinearly organized in tandem are presented to realize both reversible and pluripotent wetting on topographic surfaces. A design rule is introduced by establishing and proving the theoretical model upon hierarchical textures. Nonlinear frameworks can be conformally and reversibly wet upon complex topography in nature, thereby overcoming the wetting problems in previous conventional solid systems.

Directional Clustering of Slanted Nanopillars by Elastocapillarity.

The unidirectional clustering induced by capillary force of drying liquids between pillars is investigated and a theoretical model to set a criterion of the unidirectional clustering of the slanted nanopillars is proposed.

Durability Improvement of Solid Electrolyte CO2 Sensor Against Humidity Variations.

The sensing materials of potentiometric CO2 sensors utilize alkali/alkali-earth metal carbonates or their combinations. However, lithium carbonate easily responds to humidity resulting in incorrect information regarding CO2 concentration. Herein, the authors report a new sensing material combination (Li2CO3/BaCO3/LiOH/Ba(OH)2 (1:2:0.05:0.1 molar ratio)) for a potentiometric CO2 sensor that is not affected by humidity. The electromotive force (EMF) of the sensor using a combination of Li2CO3, BaCO3, LiOH, and Ba(OH)2 drifted by 1.5% when the relative humidity was changed from 25% to 70%, which is superior to a drift of 6% of a sensor using Li2CO3 and BaCO3, as this sensing material is known to be robust to changes in humidity.

A 3D scaffold for ultra-sensitive reduced graphene oxide gas sensors.

An ultra-sensitive gas sensor based on a reduced graphene oxide nanofiber mat was successfully fabricated using a combination of an electrospinning method and graphene oxide wrapping through an electrostatic self-assembly, followed by a low-temperature chemical reduction. The sensor showed excellent sensitivity to NO2 gas.

SnO2 nanoslab as NO2 sensor: identification of the NO2 sensing mechanism on a SnO2 surface.

Among the various metal oxides, SnO2 has been most widely exploited as a semiconductor gas sensor for its excellent functionalities. Models illustrating the sensing mechanism of SnO2 have been proposed and tested to explain experimentally derived "power laws". The models, however, are often based on somewhat simplistic assumptions; for instance, the net charge transfer from an adsorbate to a sensor surface site is assumed to occur only by integer values independent of the crystallographic planes. In this work, we use layer-shaped SnO2 crystallites with one nanodimension (1ND-crystallites) as NO2 gas sensing elements under flat band conditions, and derive appropriate "power laws" by combining the dynamics of gas molecules on the sensor surface with a depletion theory of semiconductor. Our experimentally measured sensor response as a function of NO2 concentration when compared with the theoretically derived power law indicates that sensing occurs primarily through the chemisorption of single NO2 molecules at oxygen vacancy sites on the sensor surface.

Volatile organic compound gas sensor based on aluminum-doped zinc oxide with nanoparticle.

Thick film semiconductor gas sensors based on aluminum-doped zinc oxide (AZO) with nanoparticle size were fabricated to detect volatile organic compound (VOC) existed in building, especially, formaldehyde (HCHO) gas which was known as the cause of sick building syndrome. The sensing materials for screen printing were prepared using roll milling process with binder. The crystallite sizes of prepared materials were about 15 nm through X-ray diffraction (XRD) analysis and scanning electron microscopy (SEM). Gas response characteristics were examined for formaldehyde (HCHO), benzene, carbon monoxide, carbon dioxide gas existing in building. In particular, the sensors showed responses to HCHO gas at sub ppm as a function of operating temperatures and gas concentrations. Also, we investigated sensitivity, repeativity, selectivity, and response time of sensor. The transients were very sharp, taking less than 2 s for 90% response. The sensor has shown very stable response at 350 degrees C and followed a very good behavior and showed 60% response in 50 ppb HCHO concentration at 350 degrees C operating temperatures.

Microvalves based on ionic polymer-metal composites for microfluidic application.

Simple and highly efficient microvalve systems based on an ionic polymer-metal composite (IPMC) diaphragm actuator have been developed. The microvalve system that was fabricated in this work operates when open and close voltage is applied, due to the phenomena of lithium ion flux and the subsequent electro-osmotic drag of water to the cathode. IPMC was prepared by compositing with platinum nanoparticles on both sides of Nafion thin film. SEM images of the IPMC showed the high density and uniform size distribution of the Pt nanoparticles in the interpenetrating layer to ensure the proper performance of an IPMC actuator. The displacement of the IPMC for the microvalve was measured with a laser displacement meter. The application of open and close voltage made the operation of the valve faster. The fluorescence images of the flow in the fabricated IPMC-based microvalve system showed the successful operation of flow control in the microfluidic channel. The IPMC-based microvalve system shows a potential of IPMC for application as an actuator in microfluidic systems.

Bio-information scanning technology using an optical pick-up head.

We have developed a low cost and a highly compact bio-chip detection technology by modifying a commercially available optical pick-up head for CD/DVD. The highly parallel and miniaturized hybridization assays are addressed by the fluorescence emitted by the DNA-chip using the optical pick-up head. The gap between the objective lens and the bio-chip is regulated by the focus servo during the detection of the fluorescence signal. High-resolution and high-speed scanning is effectively realized by this simple scanning system instead of utilizing high-precision mechanism. Regardless of achievement of effective detection mechanism, the technique of fluorescence detection can prove to be disadvantageous because of the low stability of the dyes with low S/N ratio and an expensive setup such as a PMT detector is always required for fluorescence detection. We propose, for the first time, a novel scanning scheme based on metal nanoparticles in combination with a bio-chip substrate having a phase change recording layer. We found that the phase change process is highly affected by the existence of the densely condensed metal nanoparticles on the phase change layer during the writing process of the pick-up head.