Does the proximal humeral bone quality influence alignment after reverse total shoulder arthroplasty with short humeral stems?

PURPOSE: When compared to standard-length humeral stem in reverse total shoulder arthroplasty (RTSA), short humeral stems in RTSA require good proximal humeral metaphyseal bone quality to gain proper and secure fixation during prosthetic implantation. Shorter humeral stems potentially carry more risk of misalignment than standard or long humeral stems. The hypothesis was that misalignment of the short humeral stems is influenced by regional bone quality. METHODS: RTSA with a short curved humeral stem with neck-shaft angle (NSA) default of 132.5° was reviewed. The study group included 35 cases at a mean age of 75.97 (± 6.23) years. Deltoid-tuberosity index (DTI) was measured to evaluate proximal humeral bone quality. The deltoid tuberosity index was measured at immediately above position of the upper end of the deltoid tuberosity. Stem alignment was given by the angle measured in degrees between the intramedullary humeral shaft axis and the axis of the humeral implant stem. RESULTS: The patient's mean DTI was 1.37 ± 0.16 (median, 1.32; range, 1.12-1.80). 22 patients had poor bone quality (DTI < 1.4), compared to 13 patients with acceptable bone quality (DTI > 1.4). After RTSA, ten humeral components (29%) were neutrally aligned, whereas 25 humeral components (71%) were misaligned. There was no correlation between misalignment and DTI (r = 0.117; p = 0.504). But there was a strong correlation between misalignment and the patient's own NSA (r = - 0.47; p = 0.004). The postoperative stem position and stem misalignment are not associated with functional outcomes (p > 0.05). CONCLUSION: The misalignment of the short curved humeral stem frequently occurs. Poor reginal humeral bone quality does not influence misalignment after RTSA with a short humeral stem. Postoperative stem alignment is associated with the patient's preoperative NSA and method of neck cut. The misalignment does not affect functional outcomes for midterm follow-up. Further long-term follow-up studies are needed to confirm its clinical relevance.

Does stress shielding after radial head arthroplasty affect functional outcomes?

BACKGROUND: Various complications related to the prosthesis, such as implant loosening and stress shielding phenomenon, could develop after prosthetic replacement of the radial head. Stress shielding is known to occur around rigidly fixed implants. The purpose of this study was to evaluate the clinical influence and causative factors of the stress shielding phenomenon after radial head arthroplasty (RHA). METHODS: Clinical records and radiographs of 56 patients with unreconstructable radial head fractures who received radial head replacement between 2009 and 2019 were reviewed. Exclusion criteria were infection, loosening, and follow-up of less than 24 months. After exclusion, 35 patients were enrolled. Patients were divided into two groups: an anatomical press-fit group (Anatomical Radial Head System; Acumed, Hillsboro, OR, USA) and a round bipolar cemented group (RHS; Tornier, Montbonnot Saint-Martin, France). Stress shielding around the prosthesis was assessed in the serial radiological examination. Clinical results were assessed using Mayo elbow performance score (MEPS), Quick Disabilities of the Arm, Shoulder, and Hand (q-DASH) score, range of motion (flexion-extension arc and pronation-supination arc), and visual analog scale score (VAS). Correlations between stress shielding phenomenon and demographic data and functional results were analyzed. RESULTS: At an average follow-up of 43.06 (± 14.6) months, 14 (40%) out of 35 fixed stems demonstrated stress shielding. Our results showed that the rate of stress shielding was significantly higher in cases with a bilateral ligament injury and in the anatomical press-fit group (p = 0.028 and p = 0.0091, respectively). However, stress shielding around prostheses did not affect the clinical results (p > 0.05). CONCLUSION: The stress shielding phenomenon around radial head prosthesis may vary according to prosthetic design and severity of ligament injuries. Stress shielding does not affect the mid-term outcomes in the treatment of acute fractures of the radial head. LEVEL OF EVIDENCE III: Retrospective Cohort Comparison; Treatment Study.

Flexion-extension-supination test compared to arthroscopic findings of biceps long head pathology: A physical examination that reflect anatomical evolution of human shoulder girdle.

The accuracy of physical examination for diagnosing lesions of the long head of the biceps tendon (LHBT) remains unsatisfactory. The purpose of this study was to describe a new diagnostic test, the Flexion-Extension-Supination (FES) test for diagnosing lesions of the long head of biceps tendon. A prospective study of 162 patients was performed to evaluate the diagnostic value of FES test. All the participants were evaluated on the basis of their clinical presentation, physical examination (FES test), radiologic findings and arthroscopic examination. Shoulder arthroscopy findings were used as the gold standard. To reduce the omission of the hidden lesion, LHBT was checked at the intra- and the extraarticular side via arthroscopic examination. Surgical findings related to biceps pathology were as follows: rotator cuff tears, 89.5% (145/162); subacromial impingement, 8.6% (14/162); and biceps tendinitis, 1.9% (3/162). The prevalence of biceps pathology was 77.2% (125/162) of all arthroscopic procedures. No significant differences for LHBT lesions were observed between the FES test and the arthroscopic findings (P = .850). The interrater reliability of the FES test was 0.747. After excluding inconclusive results between examiners, the sensitivity, specificity, positive predictive value, and negative predictive value of the FES test were 87.9%, 66.7%, 82.9%, and 63.2%, respectively. Positive and negative likelihood ratios were 2.67 and 0.18, respectively. The maneuvers of the FES test irritate intra- and extraarticular lesion of LHBT. The FES test is a reproducible and reliable test that can be used during physical examinations to evaluate patients with LHBT lesions.

Does Fracture Severity of Intertrochanteric Fracture in Elderly Caused by Low-Energy Trauma Affected by Gluteus Muscle Volume?

Purpose: The aim of this study was to determine whether there is a correlation between the type and stability of intertrochanteric fractures caused by low-energy trauma and gluteus muscle volume. Materials and Methods: A total of 205 elderly (>65 years) patients with intertrochanteric fractures caused by low-energy trauma treated from January 2018 to December 2020 were included in this study. The mean age of patients was 81.24 years (range, 65-100 years). Fractures were classified according to the Jensen modification of the Evans classification. The cross-sectional area of the contralateral gluteus muscle (minimus, medius, and maximus) was measured in preoperative axial computed tomography slices. An analysis and comparison of age, body mass index (BMI), weight, height, and the gluteus muscle area in each fracture type group was performed. Results: In the uni-variable analysis, statistically significant taller height was observed in patients in the stable intertrochanteric fracture (modified Evans 1 and 2) group compared with those in the unstable intertrochanteric fracture (modified Evans 3, 4, and 5) group (P<0.05). In addition, significantly higher BMI-adjusted gluteus muscle area (gluteus muscle area/BMI) was observed for the stable intertrochanteric fracture group compared with the unstable intertrochanteric fracture group except for the BMI-adjusted gluteus minimus area (P=0.112). In multivariable analysis, only the BMI-adjusted gluteus maximus (P=0.042) and total gluteus areas (P=0.035) were significantly higher in the stable group. Conclusion: Gluteal muscularity around the hip, especially the gluteus maximus, had a significant effect on the stability of intertrochanteric fractures.

Naturally diffused sintering aid for highly conductive bilayer electrolytes in solid oxide cells.

Solid oxide cells (SOCs) are promising sustainable and efficient electrochemical energy conversion devices. The application of a bilayer electrolyte comprising wide electrolytic oxide and highly conductive oxide is essential to lower the operating temperatures while maintaining high performance. However, a structurally and chemically ideal bilayer has been unattainable through cost-effective conventional ceramic processes. Here, we describe a strategy of naturally diffused sintering aid allowing the fabrication of defect-free doped-zirconia/doped-ceria bilayer electrolyte with full density and reduced interdiffusion layer at lower sintering temperature owing to the supply of small but appropriate amount of sintering aid from doped zirconia to doped ceria that makes the thermal shrinkages of both layers perfectly congruent. The resulting SOCs exhibit a minimal ohmic loss of 0.09 ohm cm2 and remarkable performances in both fuel cell (power density exceeding 1.3 W cm−2) and electrolysis (current density of −1.27 A cm−2 at 1.3 V) operations at 700°C.

Efficacy and Safety of Lactobacillus plantarum K50 on Lipids in Koreans With Obesity: A Randomized, Double-Blind Controlled Clinical Trial.

Background: Only few studies have investigated the role of probiotics in the development of obesity. We aimed to determine the efficacy and safety of an intake of Lactobacillus plantarum K50 (LPK) on body fat and lipid profiles in people with obesity. Methods: This randomized, double-blind, placebo-controlled, clinical trial involved 81 adults with a body mass index of 25-30 kg/m2 who were assigned randomly to a diet including 4 × 109 colony-forming unit of LPK or a placebo. Changes in body fat, anthropometric parameters, and biomarkers of obesity were compared using a linear mixed-effect model. Results: After 12 weeks of treatment, body weight, fat mass, and abdominal fat area did not change significantly in the two groups. However, total cholesterol levels decreased from 209.4 ± 34.4 mg/dL to 203.5 ± 30.9 mg/dL in the LPK group, but increased from 194.7 ± 37.5 mg/dL to 199.9 ± 30.7 mg/dL in the placebo group (P = 0.037). Similarly, triglyceride levels decreased from 135.4 ± 115.8 mg/dL to 114.5 ± 65.9 mg/dL in the LPK group, with a significant difference between groups. LPK supplementation also tended to decrease leptin levels compared with placebo. It also changed the distribution of gut microbiota significantly, with an increase in L. plantarum and a decrease in Actinobacteria, both of whose changes in abundance were correlated with changes in visceral adiposity, with borderline significance. Conclusion: A 12-week consumption of LPK reduced the total cholesterol and triglyceride levels significantly with favorable alterations in microbiota, suggesting potential benefits for controlling blood lipid profiles.

Functionalized Sulfide Solid Electrolyte with Air-Stable and Chemical-Resistant Oxysulfide Nanolayer for All-Solid-State Batteries.

Sulfide solid electrolytes (SEs) with high Li-ion conductivities (σion) and soft mechanical properties have limited applications in wet casting processes for commercial all-solid-state batteries (ASSBs) because of their inherent atmospheric and chemical instabilities. In this study, we fabricated sulfide SEs with a novel core-shell structure via environmental mechanical alloying, while providing sufficient control of the partial pressure of oxygen. This powder possesses notable atmospheric stability and chemical resistance because it is covered with a stable oxysulfide nanolayer that prevents deterioration of the bulk region. The core-shell SEs showed a σion of more than 2.50 mS cm-1 after air exposure (for 30 min) and reaction with slurry chemicals (mixing and drying for 31 min), which was approximately 82.8% of the initial σion. The ASSB cell fabricated through wet casting provided an initial discharge capacity of 125.6 mAh g-1. The core-shell SEs thus exhibited improved powder stability and reliability in the presence of chemicals used in various wet casting processes for commercial ASSBs.

FBG-referenced interrogating system using a double-ring erbium-doped fiber laser for high power and broadband.

In this study, a double-ring erbium-doped fiber (EDF) laser with an optical switch and a fiber Bragg grating (FBG)-referenced interrogating system was developed and demonstrated. This double-ring configuration can achieve high power amplified spontaneous emission, enabling laser oscillation even within the L-band. The output range and signal-to-noise ratio (SNR) of the double-ring EDF laser were measured to be 1512-1610 nm and 55 dB. In addition, the interrogating system using FBGs for reference resulted in precision improvement of ∼25 pm over those achieved in previous studies, reaching a precision of about 7 pm. The high power, broad tuning range, and sufficiently high precision of the proposed interrogating system make it promising for use in FBG-based sensing applications.

Vertical Interfragmentary Doubled Suture for Displaced Patella Fractures: Sequential Compressive Tightening with Nice Knot.

In the treatment of displaced patella fractures, open reduction and internal fixation is essential for patellofemoral congruency and restoration of the knee extension mechanism. Various surgical techniques and materials can be used, and their clinical outcomes are favorable. However, soft-tissue and skin irritation, pain, and limited range of motion due to metallic hardware can occur, and removal of hardware such as screws and K-wire may be required after bony union. We present a vertical interfragmentary suture technique for patella fractures using sequential compressive tightening with the Nice knot. This knot-tying technique is low profile, provides stable fixation enough to hold displaced fractures, and does not require a secondary procedure for hardware removal.

Wearable Hand Module and Real-Time Tracking Algorithms for Measuring Finger Joint Angles of Different Hand Sizes with High Accuracy using FBG Strain Sensor.

This paper presents a wearable hand module which was made of five fiber Bragg grating (FBG) strain sensor and algorithms to achieve high accuracy even when worn on different hand sizes of users. For real-time calculation with high accuracy, FBG strain sensors move continuously according to the size of the hand and the bending of the joint. Representatively, four algorithms were proposed; point strain (PTS), area summation (AREA), proportional summation (PS), and PS/interference (PS/I or PS/I_α). For more accurate and efficient assessments, 3D printed hand replica with different finger sizes was adopted and quantitative evaluations were performed for index~little fingers (77 to 117 mm) and thumb (68~78 mm). For index~little fingers, the optimized algorithms were PS and PS/I_α. For thumb, the optimized algorithms were PS/I_α and AREA. The average error angle of the wearable hand module was observed to be 0.47 ± 2.51° and mean absolute error (MAE) was achieved at 1.63 ± 1.97°. These results showed that more accurate hand modules than other glove modules applied to different hand sizes can be manufactured using FBG strain sensors which move continuously and algorithms for tracking this movable FBG sensors.

Superionic Halogen-Rich Li-Argyrodites Using In Situ Nanocrystal Nucleation and Rapid Crystal Growth.

Although several crystalline materials have been developed as Li-ion conductors for use as solid electrolytes in all-solid-state batteries (ASSBs), producing materials with high Li-ion conductivities is time-consuming and cost-intensive. Herein, we introduce a superionic halogen-rich Li-argyrodite (HRLA) and demonstrate its innovative synthesis using ultimate-energy mechanical alloying (UMA) and rapid thermal annealing (RTA). UMA with a 49 G-force milling energy provides a one-pot process that includes mixing, glassification, and crystallization, to produce as-milled HRLA powder that is ∼70% crystallized; subsequent RTA using an infrared lamp increases this crystallinity to ∼82% within 25 min. Surprisingly, this HRLA exhibits the highest Li-ion conductivity among Li-argyrodites (10.2 mS cm-1 at 25 °C, cold-pressed powder compact) reported so far. Furthermore, we confirm that this superionic HRLA works well as a promising solid electrolyte without a decreased intrinsic electrochemical window in various electrode configurations and delivers impressive cell performance (114.2 mAh g-1 at 0.5 C).

Atomistic Assessments of Lithium-Ion Conduction Behavior in Glass-Ceramic Lithium Thiophosphates.

We determined the interatomic potentials of the Li-[PS43-] building block in (Li2S)0.75(P2S5)0.25 (LPS) and predicted the Li-ion conductivity (σLi) of glass-ceramic LPS from molecular dynamics. The Li-ion conduction characteristics in the crystalline/interfacial/glassy structure were decomposed by considering the structural ordering differences. The superior σLi of the glassy LPS could be attributed to the fact that ∼40% of its structure consists of the short-ranged cubic S-sublattice instead of the hexagonally close-packed γ-phase. This glassy LPS has a σLi of 4.08 × 10-1 mS cm-1, an improvement of ∼100 times relative to that of the γ-phase, which is in agreement with the experiments.

Electrochemical behaviors of Li-argyrodite-based all-solid-state batteries under deep-freezing conditions.

We probe the electrochemical performance of Li-argyrodite-based all-solid-state batteries under deep-freezing conditions (-30 °C) using electrochemical impedance spectroscopy. The performance deterioration is mainly caused by the increased interfacial resistances of electrolyte and active materials resulting from the slow kinetics of Li-ion transport in solid materials at low temperatures.

Comprehensive Understanding of Cathodic and Anodic Polarization Effects on Stability of Nanoscale Oxygen Electrode for Reversible Solid Oxide Cells.

Degradation of oxygen electrode in reversible solid oxide cells operating in both electrolysis and fuel-cell modes is a critical issue that should be tackled. However, origins and mechanisms thereof have been diversely suggested mainly due to the difficulty in precise analysis of microstructural/compositional changes of porous electrode, which is a typical form in solid oxide cells. In this study, we investigate the degradation phenomena of oxygen electrode under electrolysis and fuel-cell long-term operations for 540 h, respectively, using a geometrically well-defined, nanoscale La0.6Sr0.4Co0.2Fe0.8O3-δ (LSCF) dense film with a thickness of ∼70 nm. Based on assessments of electrochemical properties and analyses of microstructural and compositional changes after long-term operations, we suggest consolidated degradation mechanisms of oxygen electrode, including the phenomena of kinetic demixing/decomposition of LSCF, which is not readily observable in the typical porous-structured electrode.

Thermally Induced S-Sublattice Transition of Li3PS4 for Fast Lithium-Ion Conduction.

The ion-transport phenomenon, determined by the interaction of strain and electrostatic energy, is one of the most important examples that confirms the effects of the polymorphism and atomic morphology. We investigated the correlation between the structural morphology and Li-ion conduction characteristics in α-Li3PS4, a high-temperature phase of the Li3PS4, using ab initio molecular dynamics (AIMD) calculations. We successfully reproduced the thermal disorder and partial occupancy observed at high temperatures by AIMD and confirmed the Li-ion sites and its migration pathways. The activation energy and Li-ion conductivity of α-Li3PS4 at room temperature were predicted to be about 0.18 eV and 80 mS cm-1, respectively, indicating that α-Li3PS4 is one of the fastest Li-ion conductors known so far. The fast Li-ion conduction in α-Li3PS4 is mainly caused by the BCC S-sublattice and tetrahedron-tetrahedron pathway with fully occupied Li-ion sites. Therefore, α-Li3PS4 having a BCC S-sublattice offers a promising structural morphology for effective Li-ion conduction.

Supplementary Technique for Unstable Clavicle Shaft Fractures: Interfragmentary Wiring and Temporary Axial K-Wire Pinning.

BACKGROUND: Treatment of unstable clavicle fractures remains a challenge for orthopedic surgeons, but the evolution of treatment strategies has allowed for reliable results with minimal complications. Although several surgical options exist, open reduction with plating remains the treatment of choice for clavicle fractures. The purpose of this study is to determine an easy way to achieve successful preplating reduction while minimizing surrounding soft tissue damage during treatment of midshaft fractures of the clavicle. METHODS: A retrospective study included all consecutive adult patients operated on by a single surgeon for acute displaced clavicular midshaft fracture between January 2010 and October 2014. Hybrid technique with interfragmentary cerclage wiring, temporary axial K-wire pinning, or their combination was used in all patients. The demographic data and clinical outcomes, including operation time, union time, restoration of anatomy, shoulder functional score, and complications were evaluated. RESULTS: There were 54 male and 19 female patients, with an average age of 39.3 years (range, 18 to 77 years) for males and 58.3 years (range, 39 to 77 years) for females. They were followed up for 24 months (range, 12 to 44 months). All patients had reliable bone union after surgery using interfragmentary cerclage wiring and temporary axial K-wire fixation; fracture union was obtained at an average of 11.7 weeks (range, 8 to 21 weeks) postoperatively. Additionally, there was no postoperative loss of fracture reduction or plate loosening. At the final follow-up, all patients had regained excellent functional outcomes. CONCLUSIONS: The cognizant effort to achieve anatomic reduction without surrounding soft tissue insult before definitive plating allows excellent radiologic and functional outcomes. Interfragmentary cerclage wiring and temporary axial K-wire pinning can overcome difficulties associated with unstable clavicle fractures to allow proper fracture reduction. In this article, we introduce a concise technique for achieving the desired outcomes reliably and efficiently when treating unstable clavicle midshaft fractures.

Open-cell voltage and electrical conductivity of a protonic ceramic electrolyte under two chemical potential gradients.

BaZr0.8Y0.2O3-δ, which is a proton-conducting oxide used as an electrolyte for protonic ceramic fuel cells (PCFCs), possesses two mobile ionic charge carriers-oxygen ions and protons-in a crystalline lattice below 500 °C. The equilibrium concentrations of these charge carriers are dependent on water activity. This feature induces a complexity in the distribution of charge carriers within the electrolyte under the influence of the two chemical potential gradients of oxygen and water, which is a typical operating condition in PCFCs. This makes the theoretical derivations of the open-cell voltage and the electrical resistance of the electrolyte difficult. Here, we calculate the distributions of oxygen vacancies and protons across the electrolyte by solving diffusion equations based on the defect chemistry of BaZr0.8Y0.2O3-δ at 500 °C. We then extract the theoretical open-cell voltage and electrical conductivity of the electrolyte in a range of water and oxygen activities that is of interest for PCFCs.

Identification of an Actual Strain-Induced Effect on Fast Ion Conduction in a Thin-Film Electrolyte.

Strain-induced fast ion conduction has been a research area of interest for nanoscale energy conversion and storage systems. However, because of significant discrepancies in the interpretation of strain effects, there remains a lack of understanding of how fast ionic transport can be achieved by strain effects and how strain can be controlled in a nanoscale system. In this study, we investigated strain effects on the ionic conductivity of Gd0.2Ce0.8O1.9-δ (100) thin films under well controlled experimental conditions, in which errors due to the external environment could not intervene during the conductivity measurement. In order to avoid any interference from perpendicular-to-surface defects, such as grain boundaries, the ionic conductivity was measured in the out-of-plane direction by electrochemical impedance spectroscopy analysis. With varying film thickness, we found that a thicker film has a lower activation energy of ionic conduction. In addition, careful strain analysis using both reciprocal space mapping and strain mapping in transmission electron microscopy shows that a thicker film has a higher tensile strain than a thinner film. Furthermore, the tensile strain of thicker film was mostly developed near a grain boundary, which indicates that intrinsic strain is dominant rather than epitaxial or thermal strain during thin-film deposition and growth via the Volmer-Weber (island) growth mode.

Collateral hydrogenation over proton-conducting Ni/BaZr0.85Y0.15O3-δ catalysts for promoting CO2 methanation.

Despite the importance of CO2 methanation for eco-friendly carbon-neutral fuel recycling, the current technologies, relying on catalytic hydrogenation over metal-based catalysts, face technological and economical limitations. Herein, we employ the steam hydrogenation capability of proton conductors to achieve collateral CO2 methanation over the Ni/BaZr0.85Y0.15O3-δ catalyst, which is shown to outperform its conventional Ni/Al2O3 counterpart in terms of CH4 yield (8% higher) and long-term stability (3% higher for 150 h) at 400 °C while exhibiting a CH4 selectivity above 98%. Moreover, infrared and X-ray photoelectron spectroscopy analyses reveal the appearance of distinct mobile proton-related OH bands during the methanation reaction.

Strain-Induced Tailoring of Oxygen-Ion Transport in Highly Doped CeO2 Electrolyte: Effects of Biaxial Extrinsic and Local Lattice Strain.

We explored oxygen-ion transport in highly doped CeO2 through density-functional theory calculations. By applying biaxial strain to 18.75 mol % CeO2:Gd, we predicted the average migration-barrier energy with six different pathways, with results in good agreement with those of experiments. Additionally, we found that the migration-barrier energy could be lowered by increasing the tetrahedron volume, including the space occupied by the oxygen vacancy. Our results indicate that the tetrahedron volume can be expanded by larger codopants, as well as biaxial tensile strain. Thus, the combination of thin-film structure and codoping could offer a new approach to accelerate oxygen-ion transport.