A family of upconverting nanoparticles (UCNPs) with a tunable UV enhancement is developed via a facile approach. The design leads to a maximum 9-fold enhancement in comparison with known optimal β-phase core/shell UCNPs in water. A highly effective and rapid in situ real-time live-cell photoactivation is recorded for the first time with such nanoparticles.

Upconversion nanoparticles (UCNPs) can convert tissue‐penetrable nearinfrared light into UV emission, making them promising as transducers for photoactivation in biology. However, the choice of the UV emitting UCNPs is limited and their NIR‐to‐UV efficiency is low. G. Han and co‐workers have addressed this issue by developing a family of CaF2‐coated UCNPs with tunable UV enhancement. As reported , such design outperforms known optimal UCNPs and in situ realtime live‐cell photoactivation is recorded for the first time with such nanoparticles. This result is a potential game changer in photoactivation in living systems and a new tool for other biophotonic applications.

Background Textbook outcome (TO) is an emerging concept within multiple surgical domains, which represents a novel effort to define a standardized, composite quality benchmark based on multiple postoperative endpoints that represent the ideal ''textbook'' hospitalization. We sought to define TO for liver transplantation (LT) using a cohort from a high procedural volume center. Methods Patients who underwent LT at our institution between 2014 and 2017 were eligible for the study. The definition of TO was determined by clinician consensus at our institution to include freedom from: mortality within 90 days, primary allograft non-function, early allograft dysfunction (EAD), rejection within 30 days, readmission with 30 days, readmission to the ICU during index hospitalization, hospital length of stay [ 75th percentile of all liver transplant patients, red blood cell (RBC) transfusion requirement greater than the 75th percentile for all liver transplant patients, Clavien-Dindo Grade III complication (re-intervention), and major intraoperative complication.Results Two hundred and thirty-one liver transplants with complete data were performed within the study period. Of those, 71 (31%) achieved a TO. Overall, the most likely event to lead to failure to achieve TO was readmission within 30 days (n = 57, 37%) or reoperation (n = 49, 32%). Overall and rejection-free survival did not differ significantly between the 2 groups. Interestingly, patients who achieved TO incurred approximately $60,000 less in total charges than those who did not. When we limit this to charges specifically attributable to the transplant episode, the difference was approximately $50,000 and remained significantly less for those that achieved TO. Conclusions Here, we present the first definition of TO in LT. Though not associated with long-term outcomes, TO in LT is associated with a significantly lower charges and costs of the initial hospitalization. A multi-institutional study to validate this definition of TO is warranted.

Chronic pancreatitis (CP) is a debilitating disease that leads to varying degrees of pancreatic endocrine and exocrine dysfunction. One of the most difficult symptoms of CP is severe abdominal pain, which is often challenging to control with available analgesics and therapies. In the last decade, total pancreatectomy with autologous islet cell transplantation has emerged as a promising treatment for the refractory pain of CP and is currently performed at approximately a dozen centers in the United States. While total pancreatectomy is not a new procedure, the endocrine function-preserving autologous islet cell isolation and re-implantation have made the prospect of total pancreatectomy more acceptable to patients and clinicians. This review will focus on the current status of total pancreatectomy with autologous islet cell transplant including patient selection, technical considerations, and outcomes. As the procedure is performed at an increasing number of centers, this review will highlight opportunities for quality improvement and outcome optimization.

Background “Textbook outcome” (TO) is a novel composite quality measure that encompasses multiple postoperative endpoints, representing the ideal “textbook” hospitalization for complex surgical procedures. We defined TO for kidney transplantation using a cohort from a high‐volume institution. Methods Adult patients who underwent isolated kidney transplantation at our institution between 2016 and 2019 were included. TO was defined by clinician consensus at our institution to include freedom from intraoperative complication, postoperative reintervention, 30‐day intensive care unit or hospital readmission, length of stay > 75th percentile of kidney transplant patients, 90‐day mortality, 30‐day acute rejection, delayed graft function, and discharge with a Foley catheter. Recipient, operative, financial characteristics, and post‐transplant patient, graft, and rejection‐free survival were compared between patients who achieved and failed to achieve TO. Results A total of 557 kidney transplant patients were included. Of those, 245 (44%) achieved TO. The most common reasons for TO failure were delayed graft function (N = 157, 50%) and hospital readmission within 30 days (N = 155, 50%); the least common was mortality within 90 days (N = 6, 2%). Patient, graft, and rejection‐free survival were significantly improved among patients who achieved TO. On average, patients who achieved TO incurred approximately $50,000 less in total inpatient charges compared to those who failed TO. Conclusions TO in kidney transplantation was associated with favorable post‐transplant outcomes and significant cost‐savings. TO may offer transplant centers a detailed performance breakdown to identify aspects of perioperative care in need of process improvement.