Double-network hydrogels improve pH-switchable adhesion

For environmentally-switchable adhesive systems to be reused repeatedly, the adhesive strength must not deteriorate after each adhesion cycle. An important criterion to achieve this goal is that the integrity of the interface must be retained after each adhesion cycle. Furthermore, in order to have practical benefits, reversing the adhesion must be a relatively rapid process. Here, a double-network hydrogel of poly(methacrylic acid) and poly[oligo(ethylene glycol)methyl ether methacrylate] is shown to undergo adhesive failure during pH-switchable adhesion with a grafted (brush) layer of polycationic poly[2-(diethyl amino)ethyl methacrylate], and can be reused at least seven times. The surfaces are attached at pH 6 and detached at pH 1. A single-network hydrogel of poly(methacrylic acid), also exhibits pH-switchable adhesion with poly[2-(diethyl amino)ethyl methacrylate] but cohesive failure leads to an accumulation of the hydrogel on the brush surface and the hydrogel can only be reused at different parts of that surface. Even without an environmental stimulus (i.e. attaching and detaching at pH 6), the double-network hydrogel can be used up to three times at the same point on the brush surface. The single-network hydrogel cannot be reused under such circumstances. Finally, the time taken for the reuse of the doublenetwork hydrogel is relatively rapid, taking no more than an hour to reverse the adhesion

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Adhesion of grafted-to polyelectrolyte brushes functionalized with calix[4]resorcinarene and deposited as a monolayer

Polyelectrolyte adhesives, either poly[2-(dimethylamino)ethyl methacrylate] or poly(methacrylic acid), functionalized with a surface-active calix[4]resorcinarene were grafted onto silicon wafers. Adhesion studies on these grafted-to brushes using polyelectrolyte hydrogels of opposite charge showed that it is the calix[4]resorcinarene, rather than adsorption of polyelectrolyte monomers, that adheres the brush to the silicon substrate. The adhesion measured was similar to that measured using polymers grafted from the surface, and was stronger than a control layer of poly(vinyl acetate) under the same test conditions. The limiting factor was determined to be adhesive failure at the hydrogel-brush interface, rather than the brush-silicon interface. Therefore, the adhesion has not been adversely affected by changing from a grafted-from to a grafted-to brush, demonstrating the possibility of a one-pot approach to creating switchable adhesives