Evaluation of the Anatomical Reference Point in Posterior Minimally Invasive Atlantoaxial Spine Surgery: A Cadaveric Anatomical Study.

OBJECTIVE: Minimally invasive atlantoaxial surgery offers the benefits of reduced trauma and quicker recovery. Previous studies have focused on feasibility and technical aspects, but the lack of comprehensive safety information has limited its availability and widespread use. This study proposes to define the feasibility and range of surgical safety using the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique as a reference point. METHODS: Dissection was performed on 10 fresh cadavers to define the anatomical reference point as the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique muscle. The study aimed to analyze the safety range of minimally invasive atlantoaxial fusion surgery by measuring the distance between the anatomical reference point and the transverse foramen of the axis, the distance between the anatomical reference point and the superior border of the posterior arch of the atlas, and the distance between the anatomical reference point and the spinal canal. Measurements were compared using Student's t test. RESULTS: The point where the occipital greater nerve intersects with the inferior border of the inferior cephalic oblique muscle was defined as the anatomical marker for minimally invasive posterior atlantoaxial surgery. The distance between this anatomical marker and the transverse foramen of the axis was measured to be 9.32 ± 2.04 mm. Additionally, the distance to the superior border of the posterior arch of the atlas was found to be 21.29 ± 1.93 mm, and the distance to the spinal canal was measured to be 11.53 ± 2.18 mm. These measurement results can aid surgeons in protecting the vertebral artery and dura mater during minimally invasive posterior atlantoaxial surgery. CONCLUSIONS: The intersection of the greater occipital nerve with the inferior border of the inferior cephalic oblique muscle is a safe and reliable anatomical landmark in minimally invasive posterior atlantoaxial surgery.

Incidences, causes and risk factors of unplanned reoperation within 30 days of craniovertebral junction surgery: a single-center experience.

PURPOSE: To investigate the incidences, causes, and risk factors for unplanned reoperation within 30 days of craniovertebral junction (CVJ) surgery. METHODS: From January 2002 to December 2018, a retrospective analysis of patients who underwent CVJ surgery at our institution was conducted. The demographics, history of the disease, medical diagnosis, approach and type of operation, surgery duration, blood loss, and complications were recorded. Patients were divided into the no-reoperation group and the unplanned reoperations group. Comparison between two groups in noted parameters was analyzed to identify the prevalence and risk factors of unplanned revision and a binary logistic regression was performed to confirm the risk factors. RESULTS: Of 2149 patients included, 34(1.58%) required unplanned reoperation after the initial surgery. The causes for unplanned reoperation contained wound infection, neurologic deficit, improper screw placement, internal fixation loosens, dysphagia, cerebrospinal fluid leakage, and posterior fossa epidural hematomas. No statistical difference was found in demographics between two groups (P > 0.05). The incidence of reoperation of OCF was significantly higher than that of posterior C1-2 fusion (P = 0.002). In terms of diagnosis, the reoperation rate of CVJ tumor patients was significantly higher than that of malformation patients, degenerative disease patients, trauma patients, and other patients (P = 0.043). The binary logistic regression confirmed that different disease, fusion segment (posterior) and surgery time were independent risk factors. CONCLUSIONS: The unplanned reoperation rate of CVJ surgery was 1.58% and the major causes were implant-related failures and wound infection. Patients with posterior occipitocervical fusion or diagnosed with CVJ tumors had an increased risk of unplanned reoperation.

Treating Pediatric Irreducible Atlantoaxial Rotatory Fixation (IAARF) by Unlocking Facet Joint Through Transoral Approach and Fixing With Slim-TARP Plate (15 Cases Series).

BACKGROUND: Irreducible atlantoaxial rotatory fixation (IAARF) often requires surgical treatment. Transoral unlocking the facet joints is a key measure for the treatment of IAARF. We investigate a novel method for treating pediatric IAARF by unlocking facet joint through transoral appraoch and fixed with slim-tarp plate in same stage with same approach. OBJECTIVE: The objective of this study is to investigate the method and efficacy of a unique transoral approach to unlock facet joints and fixation with slim-shaped transoral anterior reduction plate (slim-TARP) plate in the treatment of IAARF. METHODS: Fifteen patients diagnosed with AARF were transferred to our hospital. After 1 week of bidirectional cervical cranial traction, they were diagnosed with irreducible AARF that, and then underwent transoral release and fixation with slim-TARP plate procedures. Postoperative computed tomography and magnetic resonance were used to evaluate the reduction effect, bone fusion, and fusion time. Japanese orthopaedic association scores were used to compare the recovery of spinal cord function in patients before and after surgery. Complications such as wound infection, neurovascular injury, and loosening of internal fixation were evaluated too. RESULTS: All 15 patients underwent transoral unlocking facet joint and fixation with slim-TARP procedures smoothly. The operation time were 129.2±11.9 minutes, blood loose were 83±23 mL. There were no neurological injury, wound infections, verified or suspected vertebral artery injury, etc. All patients were followed up for a mean of 17.8±6.6 months (range: 12 to 36 mo). Bony fusion was achieved in all patients. Mean fusion time was 3.6±1.2 months (range: 3 to 6 mo). Complete correction of torticollis was achieved in all 15 cases. Preoperative symptoms of neck pain and limitation of neck movement were effectively alleviated at 3 months after surgery. The 3 patients with preoperative neurological deficits had significant relief after surgery, and their latest follow-up results showed that their Japanese orthopaedic association scores increased from 13.0±1.0 to 16.3±0.6. CONCLUSIONS: Transoral release and fixation with slim-TARP plate by transoral approach is a feasible and safe method for treating pediatric irreducible atlantoaxial rotatory fixation.

Treatment of irreducible atlantoaxial dislocation by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach.

OBJECTIVE: Investigate a novel method for treating irreducible atlantoaxial dislocation (IAAD) or with basilar invagination (BI) by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach. METHOD: From March 2015 to December 2019, 213 consecutive patients diagnosed as IAAD/BI were treated with transoral bony deformity remodeling and releasing combined with plate fixation. The main clinical symptoms include neck pain, headache, numbness of the limbs, weakness, unstable walking, inflexible hand-held objects, and sphincter dysfunction. The bony factors that impact reduction were divided into as follows: type A1 (sloping of upper facet joint in C2), type A2 (osteophyte in lateral mass joints between C1 and C2), type A3 (ball-and-socket deformity of lateral mass joint), type A4 (vertical interlocking between lateral mass joints of C1-C2), type A5 (regional bone fusion in lateral mass joints), type B1 (bony factor hindering reduction between the atlas-dens gap), type B2 (uncinate odontoid deformity), and type B3 (hypertrophic odontoid deformity). All of them were treated with bony deformity osteotomy, remodeling, and releasing techs. RESULT: The operation time was 144 [Formula: see text] 25 min with blood loss of 102 [Formula: see text] 35 ml. The average pre-operative ADI improved from 7.5 [Formula: see text] 3.2 mm pre-surgery to 2.5 [Formula: see text] 1.5 mm post-surgery (p < 0.05). The average VDI improved from 12.3 [Formula: see text] 4.8 mm pre-surgery to 3.3 [Formula: see text] 2.1 mm post-surgery (p < 0.05). The average pre-operative CMA improved from 115 [Formula: see text] 25° pre-surgery to 158 [Formula: see text] 21° post-surgery (p < 0.05); the pre-operative CAA changed from 101 [Formula: see text] 28° pre-surgery to 141 [Formula: see text] 10° post-surgery. After the operation, the clinic symptoms improved, and the JOA score improved from 9.3 [Formula: see text] 2.8 pre-operatively to 13.8 [Formula: see text] 2.5 in the sixth months of follow-up. CONCLUSION: In addition to soft tissue factors, bony obstruction was another important factor impeding atlantoaxial reduction. Transoral bony deformity osteotomy, remodeling, releasing combined with plate fixating was effective in treating IAAD/BI with bony obstruction factors.

Incidence and management of surgical site infection in the cervical spine following a transoral approach.

PURPOSE: Transoral approach can accomplish ventral decompression directly. However, surgical site infection (SSI) cannot be ignored. This paper aims to review the prevalence of infection and conduct advice for the treatment of SSI in the cervical spine following the transoral approach. METHODS: A retrospective analysis of patients with SSI after transoral atlantoaxial reduction plate (TARP) surgery was performed. SSI was classified into three kinds according to the modified American CDC criteria. RESULTS: 2.9% (17/581) patients who underwent TARP surgery, experienced SSI, of which five had superficial SSI (SI), eight had deep SSI (DI), and four had organ/space SSI (O/SI). The patients with SI underwent intravenous antibiotic treatment and were ultimately cured. Among the remaining 12 patients with DI and O/SI, 11 underwent reoperation for TARP system removal and subsequently one-stage posterior occipitocervical fixation, and one patient experienced infection two months post-operatively and died without receiving treatment. Among patients who underwent revision surgery, three experienced intracranial infection due to intra-operative dural tears, and continuous lumbar cerebrospinal fluid drainage and intrathecal injection of antibiotics were used as effective and appropriate treatments, with outcomes of one recovery and two deaths. All patients with SSI were begun on intravenous antibiotics with conversion to oral antibiotics. CONCLUSIONS: The incidence of SSI was 2.9% (17/581). Adequate peri-operative preparation, early diagnosis, and appropriate treatment of SSI require further research.

Preliminary application of 3D-printed individualised guiding templates for total hip arthroplasty in Crowe type IV developmental dysplasia of the hip.

OBJECTIVE: To evaluate the feasibility and accuracy of three-dimensional (3D)-printed individualised guiding templates in total hip arthroplasty (THA) for the treatment of developmental dysplasia of the hip (DDH). METHODS: 12 hips in 12 patients with Crowe type IV DDH were treated with THA. A 3D digital model of the pelvis and lower limbs was reconstructed using the computed tomography data of the patients. Preoperative surgical simulations were performed to determine the most suitable surgical planning, including femoral osteotomy and prosthesis placement. Based on the ideal surgical planning, individualised guiding templates were designed by software, manufactured using a 3D printer, and used in acetabulum reconstruction and femoral osteotomy during surgery. RESULTS: 12 patients were followed up for an average of 72.42 months (range 38-135 months). During surgery, the guiding template for each case was matched to the bony markers of the acetabulum and proximal femur. Preoperative and follow-up Harris Hip Scores were 34.2 ± 3.7 and 85.2 ± 4.2; leg-length discrepancy, 51.5 ± 6.5 mm and 10.2 ± 1.5 mm; and visual analogue scale scores, 6.2 ± 0.8 and 1.3 ± 0.3, respectively, with statistical difference. Shortened deformity and claudication of the affected limb were obviously improved after surgery. However, 1 patient had artificial hip dislocation 2 weeks after surgery, and another patient had sciatic nerve traction injury, both of whom recovered after physical treatment. CONCLUSIONS: Preoperative surgical simulation and 3D-printed individualised guiding templates can fulfil surgeon-specific requirements for the treatment of Crowe type IV DDH. Accurate THA can be achieved using 3D-printed individualised templates, which provide a new personalised surgical plan for the precise positioning and orientation of acetabular reconstruction and femoral osteotomy.

Surface Defect Engineering on Perovskite Oxides as Efficient Bifunctional Electrocatalysts for Water Splitting.

The design of high-performance and cost-effective electrocatalysts for water splitting is of prime importance for efficient and sustainable hydrogen production. In this work, a surface defect engineering method is developed for optimizing the electrocatalytic activity of perovskite oxides for water electrolysis. A typical ferrite-based perovskite oxide material La0.6Sr0.4Co0.2Fe0.8O3-δ (LSCF) is used and regulated by selective acid etching. The optimal parameters for the surface treatment are identified. An efficient bifunctional perovskite oxide, denoted LSCF-30, is prepared by selectively corroding the A-site Sr element in the surface region, which is found to not only increase the exposure and decrease the coordination of B-site metals but also effectively modulate the electronic structure of these metals. The crystal lattice of the perovskite bulk is kept constant during surface engineering, which ensures the structural stability of the perovskite catalyst. The findings demonstrate an effective strategy of surface defect engineering in enhancing the performance of perovskite oxide electrocatalysts for water splitting.

Anterior reduction and C1-ring osteosynthesis with Jefferson-fracture reduction plate (JeRP) via transoral approach for unstable atlas fractures.

BACKGROUND: To introduce a novel transoral instrumentation in the treatment of unstable fractures of the atlas. METHODS: From January 2008 to May 2018, 22 patients with unstable C1 fractures who received Jefferson-fracture reduction plate (JeRP) via transoral approach were retrospectively analyzed. The case history and the radiographs before and after surgery were noted. The type of fracture, the reduction of the fracture, and position of the internal fixation were assessed through preoperative and postoperative CT scans. RESULTS: All 22 patients successfully underwent anterior C1-ring osteosynthesis using the JeRP system, with a follow-up of 26.84 ± 9.23 months. Among them, 9 patients had transverse atlantal ligament (TAL) injury, including 3 in Dickman type I and 6 in type II. The preoperative lateral mass displacement (LMD) decreased from 7.13 ± 1.46 mm to 1.02 ± 0.65 mm after the operation. Bone union was achieved in all patients without implant failure or loss of reduction. There were no surgery-related complications, such as wound infection, neurological deficit, or vertebral artery injury. However, atlantoaxial dislocation occurred in 3 patients with Dickman type I TAL injury 3 months postoperatively without any neurological symptoms or neck pain. CONCLUSIONS: Transoral C1-ring osteosynthesis with JeRP is an effective surgical strategy to treat unstable atlas fractures with a safe, direct, and satisfactory reduction. The primary indication for the JeRP system is an unstable fracture (Gehweiler type I/III) or/ and TAL injury (Dickman type II).

Classification and Surgical Treatment of Developmental Spinal Canal Stenosis at Atlas Level: A 15-Case Study.

STUDY DESIGN: A retrospective study. OBJECTIVE: Investigate the diagnosis and surgery strategy for treatment of development spinal canal stenosis (DSSA) at atlas plane based on computerized tography (CT) image characters. SUMMARY OF BACKGROUND DATA: The occurrence of spinal canal stenosis in the atlas plane is relatively rare compared with lower cervical. METHODS: Fifteen patients diagnosed with DSSA were included from 2014 to 2018. They are divided into four subgroups based on the character of CT images: group I (small size atlas), group II (hypertrophy of posterior arch of the atlas [PAA]), group III (incurved of PAA), and group IV (hypertrophy odontoid). RESULTS: There are type I 7, type II 3, type III 2, and group IV 3 in the 15 cases. All the patients received different surgery procedures respectively: (1) posterior arch osteotomy were performed for group I/III//IV without atlantoaxial dislocation, (2) posterior arch resect and replantation were performed for group II, (3) occipital cervical fixation and fusion were added to the patients with associated atlantoaxial dislocation (AAD), (4) a new method of odontoid reduce and atlantoaxial fixation by transoral approach were performed for group IV with associated AAD. All cases underwent surgery successfully which included posterior occipitocervical fixation (OCF) + posterior arch resection (PAR) eight cases, PAR four cases, posterior arch remodeling and re-implantation (PARR) two cases, and Dens remodeling + trans-oral anterior reduction and plate fixation (DR+TARP) one case without severe complications. All patients show different improvement in the symptoms. Japanese orthopaedic association score improved from 9.2 to 14.7 in 1 year follow-up. CONCLUSION: DSSA could be easily diagnosed and divided into four subgroups according to the character of CT image, corresponding surgery strategy could receive a fine clinical result.Level of Evidence: 4.

VR motion sickness recognition by using EEG rhythm energy ratio based on wavelet packet transform.

BACKGROUND AND OBJECTIVES: Virtual reality motion sickness (VRMS) is one of the main factors hindering the development of VR technology. At present, the VRMS recognition methods using electroencephalogram (EEG) signals have poor applicability to multiple subjects. METHODS: Aiming at this dilemma, the wavelet packet transform (WPT), was used to propose a feature extraction method for EEG rhythm energy ratios of delta (δ), theta (θ), alpha (α), and beta (ß) in this research. Moreover, VRMS was recognized by combining k-Nearest Neighbor classifier (k-NN), support vector machine (SVM) with polynomial kernel (polynomial-SVM) and radial basis function kernel (RBF-SVM), respectively. The method is that the raw EEG signals were de-noised by an elliptical band-pass filter and segmented by a fixed window, 7-level db4 WPT was performed on each EEG segment, and the wavelet packet energy ratios of delta, theta, alpha and beta rhythms from FP1, FP2, C3, C4, P3, P4, O1 and O2 channels were calculated and combined to form feature vectors for recognizing VRMS. RESULTS: Under the condition of 4-s window size, the average VRMS recognition accuracy of polynomial-SVM for the single subject was 92.85%, and the VRMS recognition accuracy of 18 subjects was about 79.25%. CONCLUSIONS: Compared with other VRMS recognition methods, this method does not only have a higher recognition accuracy to a single subject, but also have better applicability to multiple subjects. Meanwhile, when using the EEG four rhythm energy ratios of FP1, FP2, C3, C4, P3, P4, O1 and O2 channels as feature vectors, the polynomial-SVM achieved better VRMS recognition performance than the k-NN and RBF-SVM.

Management of pediatric patients with irreducible atlantoaxial dislocation: transoral anterior release, reduction, and fixation.

OBJECTIVE: Although transoral atlantoaxial reduction plate (TARP) surgery has been confirmed to be safe and effective for adults who have irreducible atlantoaxial dislocation (IAAD) with or without basilar invagination or upper cervical revision surgery, it is rarely used to treat these disorders in children. The authors of this study aimed to report on the use of the anterior technique in treating pediatric IAAD. METHODS: In this retrospective study, the authors identified 8 consecutive patients with IAAD who had undergone surgical reduction at a single institution in the period between January 2011 and June 2104. The patients consisted of 5 males and 3 females. Three had os odontoideum, 2 had basilar invagination, and the other 3 experienced atlantoaxial rotatory fixed dislocation (AARFD). They were all treated using transoral anterior release, reduction, and fusion with the TARP. Preoperative and postoperative CT scans and MR images were obtained. American Spinal Injury Association (ASIA) Impairment Scale grades were determined. RESULTS: All symptoms were relieved in all 8 patients but to varying degrees. Intraoperative loose reduction and fixation of C1-2 were achieved in one stage. The 4 patients with preoperative neurological deficits were significantly improved after surgery, and their latest follow-ups indicated that their ASIA Impairment Scale grades had improved to E. Postoperative pneumonia occurred in 1 patient but was under complete control after anti-infective therapy and fiber optic-guided sputum suction. CONCLUSIONS: One-stage transoral anterior release, reduction, and fixation is an effective, reliable, and safe means of treating pediatric IAAD. The midterm clinical results are satisfactory, with the technique eliminating the need for interval traction and/or second-stage posterior instrumentation and fusion.

Management of Unique Basilar Invagination Combined with C1 Prolapsing into the Foramen Magnum in Children: Report of 2 Cases.

BACKGROUND: Basilar invagination (BI) is a developmental anomaly and commonly presents with neurologic findings. The incidence of BI associated with other osseous anomalies of the craniovertebral junction is high, including incomplete ring of C1 with spreading of the lateral masses, atlanto-occipital assimilation, hypoplasia of the atlas, basiocciput hypoplasia, and occipital condylar hypoplasia. However, BI combined with C1 prolapsing into the foramen magnum (FM) is an extremely rare condition. CASE DESCRIPTION: A previously healthy 6-year-old girl (case 1) presented with extremities numbness and left limb weakness over a period of 3 months. Radiograph and computed tomography (CT) scan demonstrated basilar invagination with C1 and dens upward into the FM and C2-3 congenital fusion. Magnetic resonance imaging (MRI) showed ventral brainstem and medulla compression, and the medulla-cervical angle was about 100°. The patient underwent transoral anterior decompression, reduction, and fusion by transoral atlantoaxial reduction plate surgery. The symptoms of extremities numbness and limb weakness were all alleviated after surgery. Postoperative MRI showed that the medulla-cervical angle improved from 100° to 143°. An 11-year-old boy (case 2) presented with a 2-month history of limbs numbness and weakness. CT scan and MRI demonstrated BI and compression of the spinal cord, with a craniospinal angle of only 63°. The 3-dimensional (3D) printed model showed that the anterior arch and lateral of C1 was 90° flipping and vertically upward prolapsing into the FM together with the dens, and the width of the atlas was greater than the maximum diameter of the FM, which resulted in structural incarceration. The patient received posterior occipitocervical fixation and fusion surgery with hyperextension skull traction. Postoperative CT scan revealed the craniospinal angle increased to 102°. CONCLUSIONS: We present 2 rare cases of BI combined with C1 prolapsing into the FM. We adopted different surgical strategies with satisfying outcome for these patients. We deem that the treatment of unique BI should be individualized according to the different image characteristics. The image-based modern rapid prototyping and 3D printed techniques can provide invaluable information in presurgical planning for complex craniovertebral junction anomalies.

A High-Rate and Stable Quasi-Solid-State Zinc-Ion Battery with Novel 2D Layered Zinc Orthovanadate Array.

Zinc-ion batteries are under current research focus because of their uniqueness in low cost and high safety. However, it is still desirable to improve the rate performance by improving the Zn2+ (de)intercalation kinetics and long-cycle stability by eliminating the dendrite formation problem. Herein, the first paradigm of a high-rate and ultrastable flexible quasi-solid-state zinc-ion battery is constructed from a novel 2D ultrathin layered zinc orthovanadate array cathode, a Zn array anode supported by a conductive porous graphene foam, and a gel electrolyte. The nanoarray structure for both electrodes assures the high rate capability and alleviates the dendrite growth. The flexible Zn-ion battery has a depth of discharge of ≈100% for the cathode and 66% for the anode, and delivers an impressive high-rate of 50 C (discharge in 60 s), long-term durability of 2000 cycles at 20 C, and unprecedented energy density ≈115 Wh kg-1 , together with a peak power density ≈5.1 kW kg-1 (calculation includes masses of cathode, anode, and current collectors). First principles calculations and quantitative kinetics analysis show that the high-rate and stable properties are correlated with the 2D fast ion-migration pathways and the introduced intercalation pseudocapacitance.

TMD-based highly efficient electrocatalysts developed by combined computational and experimental approaches.

As a large family of two-dimensional (2D) materials, transition metal dichalcogenides (TMDs) have been attracting an increasing level of attention and therefore considerable research input, owing to their intriguing catalytic, chemical and physical properties. The high exposed surface area, potentially large number of active sites, and chemical stability provide TMDs with vast opportunities for use as a unique class of electrocatalysts, while their low electrical conductivity and other deficiencies have drawn considerable research efforts for further modification. The optimization of TMDs can be achieved by several approaches, including site doping/modification, phase modulation, control of growth morphology and construction of heterostructures, by both appropriate computational simulations and purposely designed experimental studies. In tuning the TMD-based electrocatalysts, computational calculations have played uniquely important roles in predicting the structure and understanding the operational mechanism of catalytic performance. Indeed, the importance of refined calculations has been growing rapidly to provide comprehensive and unique guidance towards further modification of the existing TMD-based electrocatalysts and the discovery of new ones. In this critical review, we will look into the rapid advancement of the highly efficient TMD-based electrocatalysts that have been developed in recent years, achieved by combined computational and experimental approaches. Aiming to provide a generalized overall picture, we have conducted further computational studies as a systematic approach to unveil the modulation in the structure and the improvement in electrocatalytic properties brought in by appropriate element doping/modification in either basal plane A-(metal atoms) and B-(chalcogen atoms) sites or edge sites of the 2D TMD materials, as well as in some of those non-layered metal disulfides/diselenides. This review is concluded by summarizing the likely future development and perspectives of TMD-based electrocatalysts.

In Situ Grown Epitaxial Heterojunction Exhibits High-Performance Electrocatalytic Water Splitting.

Electrocatalytic performance can be enhanced by engineering a purposely designed nanoheterojunction and fine-tuning the interface electronic structure. Herein a new approach of developing atomic epitaxial in-growth in Co-Ni3 N nanowires array is devised, where a nanoconfinement effect is reinforced at the interface. The Co-Ni3 N heterostructure array is formed by thermal annealing NiCo2 O4 precursor nanowires under an optimized condition, during which the nanowire morphology is retained. The epitaxial in-growth structure of Co-Ni3 N at nanometer scale facilitates the electron transfer between the two different domains at the epitaxial interface, leading to a significant enhancement in catalytic activities for both hydrogen and oxygen evolution reactions (10 and 16 times higher in the respective turn-over frequency compared to Ni3 N-alone nanorods). The interface transfer effect is verified by electronic binding energy shift and density functional theory (DFT) calculations. This nanoconfinement effect occurring during in situ atomic epitaxial in-growth of the two compatible materials shows an effective pathway toward high-performance electrocatalysis and energy storages.

Nonaqueous Hybrid Lithium-Ion and Sodium-Ion Capacitors.

Hybrid metal-ion capacitors (MICs) (M stands for Li or Na) are designed to deliver high energy density, rapid energy delivery, and long lifespan. The devices are composed of a battery anode and a supercapacitor cathode, and thus become a tradeoff between batteries and supercapacitors. In the past two decades, tremendous efforts have been put into the search for suitable electrode materials to overcome the kinetic imbalance between the battery-type anode and the capacitor-type cathode. Recently, some transition-metal compounds have been found to show pseudocapacitive characteristics in a nonaqueous electrolyte, which makes them interesting high-rate candidates for hybrid MIC anodes. Here, the material design strategies in Li-ion and Na-ion capacitors are summarized, with a focus on pseudocapacitive oxide anodes (Nb2 O5 , MoO3 , etc.), which provide a new opportunity to obtain a higher power density of the hybrid devices. The application of Mxene as an anode material of MICs is also discussed. A perspective to the future research of MICs toward practical applications is proposed to close.

Ultrafast-Charging Supercapacitors Based on Corn-Like Titanium Nitride Nanostructures.

Ultrahigh rates realized by ALD-made TiN. The symmetric full-cell supercapacitors deliver a typical capacitance of 20.7 F cm-3 at a scan rate of 1 V s-1, and retain 4.3 F cm-3 at high rate of 100 V s-1. The devices can be charged and discharged for 20 000 cycles with negligible capacitance loss and with an ultralow self-discharge current (≈1 µA).

Array of nanosheets render ultrafast and high-capacity Na-ion storage by tunable pseudocapacitance.

Sodium-ion batteries are a potentially low-cost and safe alternative to the prevailing lithium-ion battery technology. However, it is a great challenge to achieve fast charging and high power density for most sodium-ion electrodes because of the sluggish sodiation kinetics. Here we demonstrate a high-capacity and high-rate sodium-ion anode based on ultrathin layered tin(II) sulfide nanostructures, in which a maximized extrinsic pseudocapacitance contribution is identified and verified by kinetics analysis. The graphene foam supported tin(II) sulfide nanoarray anode delivers a high reversible capacity of ∼1,100 mAh g(-1) at 30 mA g(-1) and ∼420 mAh g(-1) at 30 A g(-1), which even outperforms its lithium-ion storage performance. The surface-dominated redox reaction rendered by our tailored ultrathin tin(II) sulfide nanostructures may also work in other layered materials for high-performance sodium-ion storage.

[Application of 3D digital orthopedic techniques in treatment of acetabular fracture].

OBJECTIVE: To evaluate the therapeutic effect of three-dimensional digital orthopedic techniques in treatment of acetabular fractures. METHODS: We retrospectively analyzed 50 cases of acetabular fracture treated between March, 2007 and December, 2013. The lamellar CT scanning data were imported into Mimics software, and 3D anatomical models of the pelvic and proximal femur were reconstructed. Computer-assisted analysis was carried out to understand the condition of fractures and simulate fracture reduction. The pelvic models were manufactured by rapid prototyping technique for definite diagnosis and typing of acetabular fractures and subsequent surgical treatment. RESULTS: Three-dimensional reconstruction images and rapid prototyping pelvic models faithfully represented the findings in operations. Preoperative simulation of the operation shortened the time of operation and reduced the volume of bleeding in the operation. All the patients were followed up for 6 to 24 months. According to Matta imaging score, anatomical reduction was achieved in 41 cases and satisfactory reduction in 9 cases. According to the Harris functional criteria, 32 patients had excellent, 12 had good and 6 had acceptable outcomes with a rate of excellent and good outcomes of 88%. CONCLUSION: Three-dimensional digital orthopedic techniques allow accurate display of the acetabulum and the spatial relation of the anatomic structures to assist in fracture diagnosis, typing and treatment.

All Metal Nitrides Solid-State Asymmetric Supercapacitors.

Two metal nitrides, TiN porous layers and Fe2 N nanoparticles, are grown uniformly with the assistance of atomic layer deposition on vertically aligned graphene nanosheets and used as the cathode and anode for solid-state supercapacitors, respectively. Full cells are constructed and show good flexibility, high-rate capability, and 98% capacitance retention after 20,000 cycles.