Tip-induced excitonic luminescence nanoscopy of an atomically resolved van der Waals heterostructure.

The electronic and optical properties of van der Waals heterostructures are strongly influenced by the structuration and homogeneity of their nano- and atomic-scale environments. Unravelling this intimate structure-property relationship is a key challenge that requires methods capable of addressing the light-matter interactions in van der Waals materials with ultimate spatial resolution. Here we use a low-temperature scanning tunnelling microscope to probe-with atomic-scale resolution-the excitonic luminescence of a van der Waals heterostructure, made of a transition metal dichalcogenide monolayer stacked onto a few-layer graphene flake supported by a Au(111) substrate. Sharp emission lines arising from neutral, charged and localized excitons are reported. Their intensities and emission energies vary as a function of the nanoscale topography of the van der Waals heterostructure, explaining the variability of the emission properties observed with diffraction-limited approaches. Our work paves the way towards understanding and controlling optoelectronic phenomena in moiré superlattices with atomic-scale resolution.

Many-Body Description of STM-Induced Fluorescence of Charged Molecules.

A scanning tunneling microscope is used to study the fluorescence of a model charged molecule (quinacridone) adsorbed on a sodium chloride (NaCl)-covered metallic sample. Fluorescence from the neutral and positively charged species is reported and imaged using hyperresolved fluorescence microscopy. A many-body model is established based on a detailed analysis of voltage, current, and spatial dependences of the fluorescence and electron transport features. This model reveals that quinacridone adopts a palette of charge states, transient or not, depending on the voltage used and the nature of the underlying substrate. This model has a universal character and clarifies the transport and fluorescence mechanisms of molecules adsorbed on thin insulators.

The influence of obesity and gender on outcome after reversed L-shaped osteotomy for hallux valgus.

BACKGROUND: Hallux valgus deformity (HV) affects around every fourth individual, and surgical treatment is performed in every thousandth person. There is an ongoing quest for the best surgical management and reduction of undesirable outcomes. The aim was to explore associations of obesity and gender with radiological and clinical outcome after reversed L-shaped osteotomy (ReveL) for HV. MATERIALS AND METHODS: This study was carried out in a retrospective cohort design at a single University Hospital in Switzerland between January 2004 and December 2013. It included adult patients treated with ReveL for HV. The primary exposure was body mass index (BMI) at the time of ReveL. The secondary exposure was gender. The primary outcome was radiological relapse of HV (HV angle [HVA] > 15 degrees [°]) at the last follow-up. Secondary outcomes were improvable patient satisfaction, complication, redo surgery, and optional hardware removal. Logistic regression analysis adjusted for confounders. RESULTS: The median weight, height, and BMI were 66.0 (interquartile range [IQR] 57.0-76.0) kilograms (kg), 1.65 (IQR 1.60-1.71) metres (m), and 24.0 (IQR 21.3-27.8) kg/m2. Logistic regression analysis did not show associations of relapse with BMI, independent of age, gender, additional technique, and preoperative HVA (adjusted odds ratio [ORadjusted] = 1.10 [95% (%) confidence interval (CI) = 0.70-1.45], p = 0.675). Relapse was 91% more likely in males (ORadjusted = 1.91 [95% CI = 1.19-3.06], p = 0.007). Improvable satisfaction was 79% more likely in males (ORadjusted = 1.79 [CI = 1.04-3.06], p = 0.035). Hardware removal was 47% less likely in males (ORadjusted = 0.53 [95% CI 0.30-0.94], p = 0.029). CONCLUSIONS: In this study, obesity was not associated with unsatisfactory outcomes after ReveL for HV. This challenges the previous recommendation that preoperative weight loss may be necessary for a successful surgical treatment outcome. Males may be informed about potentially higher associations with unfavourable outcomes. Due to the risk of selection bias and lack of causality, findings may need to be confirmed with clinical trials.

Fano Description of Single-Hydrocarbon Fluorescence Excited by a Scanning Tunneling Microscope.

The detection of fluorescence with submolecular resolution enables the exploration of spatially varying photon yields and vibronic properties at the single-molecule level. By placing individual polycyclic aromatic hydrocarbon molecules into the plasmon cavity formed by the tip of a scanning tunneling microscope and a NaCl-covered Ag(111) surface, molecular light emission spectra are obtained that unravel vibrational progression. In addition, light spectra unveil a signature of the molecule even when the tunneling current is injected well separated from the molecular emitter. This signature exhibits a distance-dependent Fano profile that reflects the subtle interplay between inelastic tunneling electrons, the molecular exciton and localized plasmons in at-distance as well as on-molecule fluorescence. The presented findings open the path to luminescence of a different class of molecules than investigated before and contribute to the understanding of single-molecule luminescence at surfaces in a unified picture.

Bright Electroluminescence from Single Graphene Nanoribbon Junctions.

Thanks to their highly tunable band gaps, graphene nanoribbons (GNRs) with atomically precise edges are emerging as mechanically and chemically robust candidates for nanoscale light emitting devices of modulable emission color. While their optical properties have been addressed theoretically in depth, only few experimental studies exist, limited to ensemble measurements and without any attempt to integrate them in an electronic-like circuit. Here we report on the electroluminescence of individual GNRs suspended between the tip of a scanning tunneling microscope (STM) and a Au(111) substrate, constituting thus a realistic optoelectronic circuit. Emission spectra of such GNR junctions reveal a bright and narrow band emission of red light, whose energy can be tuned with the bias voltage applied to the junction, but always lying below the gap of infinite GNRs. Comparison with ab initio calculations indicates that the emission involves electronic states localized at the GNR termini. Our results shed light on unpredicted optical transitions in GNRs and provide a promising route for the realization of bright, robust, and controllable graphene-based light-emitting devices.

Radiological and Clinical Outcome After Reversed L-Shaped Osteotomy: A Large Retrospective Swiss Cohort Study.

The objective was to report radiological and clinical outcomes after reversed L-shaped osteotomy (ReveL) for hallux valgus (HV). A retrospective cohort study was performed between January 2004 and December 2013. The primary outcome was radiological recurrence of HV (HV angle [HVA] >15°). There were various exposure and secondary outcome variables. The results showed a median follow-up of 12.0 months (N = 827). Radiological recurrence, limited patient satisfaction, complication, revision surgery, and elective hardware removal were found in 25.0%, 15.3%, 4.6%, 2.5%, and 26.7%. Median pre- to postoperative changes were highest for HVA (delta = -16.7°). Recurrence was more likely in cases with preoperative HVA ≥40° (adjusted odds ratio [ORadjusted]) 3.63, p < .001). Revisions were more likely with concomitant diseases and bilateral surgery (ORadjusted 12.53, p = .010; ORadjusted 3.35, p = .030). Hardware removal was less likely in patients ≥50 years (ORadjusted 0.67, p = .014). In conclusion, ReveL was a good surgical option for HV because of the relatively low rates of unfavorable outcomes.

Efficient Spin-Flip Excitation of a Nickelocene Molecule.

Inelastic electron tunneling spectroscopy (IETS) within the junction of a scanning tunneling microscope (STM) uses current-driven spin-flip excitations for an all-electrical characterization of the spin state of a single object. Usually decoupling layers between the single object, atom or molecule, and the supporting surface are needed to observe these excitations. Here we study the surface magnetism of a sandwich nickelocene molecule (Nc) adsorbed directly on Cu(100) by means of X-ray magnetic circular dichroism (XMCD) and density functional theory (DFT) calculations and show with IETS that it exhibits an exceptionally efficient spin-flip excitation. The molecule preserves its magnetic moment and magnetic anisotropy not only on Cu(100), but also in different metallic environments including the tip apex. By taking advantage of this robusteness, we are able to functionalize the microscope tip with a Nc, which can be employed as a portable source of inelastic excitations as exemplified by a double spin-flip excitation process.

Vibronic Spectroscopy with Submolecular Resolution from STM-Induced Electroluminescence.

A scanning tunneling microscope is used to generate the electroluminescence of phthalocyanine molecules deposited on NaCl/Ag(111). Photon spectra reveal an intense emission line at ≈1.9 eV that corresponds to the fluorescence of the molecules, and a series of weaker redshifted lines. Based on a comparison with Raman spectra acquired on macroscopic molecular crystals, these spectroscopic features can be associated with the vibrational modes of the molecules and provide a detailed chemical fingerprint of the probed species. Maps of the vibronic features reveal submolecularly resolved structures whose patterns are related to the symmetry of the probed vibrational modes.

Validation of an Arthroscopic Training Device.

PURPOSE: To investigate the usefulness and conduct validation of a simulated arthroscopy training device to train basic arthroscopy skills. METHODS: Forty-six participants including 12 novices, 12 intermediates, and 22 experts completed a questionnaire regarding demographics, previous arthroscopic experience, training potential, and statements about the device. Furthermore, participants performed a single task on the arthroscopic training device using the 0° camera and a probe. The task consisted of an attempt to carry a rubber ring across a helix inside a box as fast as possible. Construct validity was evaluated by comparing total task time and portal replacements of the camera and probe between all groups (median values [interquartile range]; Kruskal-Wallis test). RESULTS: The median age was 35 (29-44) years. There were 4 female and 42 male participants. A total of 89% of the participants graded the overall training capacity ≥5 (35% graded it as 5, 39% as 6, and 15% as 7), and 83% believed that it is useful to improve any kind of arthroscopy. Ninety-three percent of the participants would recommend the arthroscopic training device to their colleagues. Sixty-one percent of the participants stated that there are certain disadvantages. The median time to complete the task was 108 (58-236) seconds. Novices (259 [123-435] seconds) performed tasks significantly slower than intermediates (169 [67-257] seconds) and experts (75 [49-132] seconds) (P = .005). Furthermore, portal changes were significantly more common in novices and intermediates than experts (P = .019). CONCLUSIONS: High scores in training potential were achieved with this arthroscopy simulator box, and most study participants believed that practice with the arthroscopic training device is useful for any kind of arthroscopy. Construct validity was established since novices, intermediates, and experts in real arthroscopy were discriminated with the arthroscopic training device in terms of time to successful completion of a task. However, 61% of the participants stated that there were certain disadvantages. CLINICAL RELEVANCE: In every training tool using simulation, it is crucial to pass the first steps in the validation cascade. This study provides this step for further evaluation of this arthroscopic training device.

Ordinary and Hot Electroluminescence from Single-Molecule Devices: Controlling the Emission Color by Chemical Engineering.

Single-molecule junctions specifically designed for their optical properties are operated as light-emitting devices using a cryogenic scanning tunneling microscope. They are composed of an emitting unit-a molecular chromophore-suspended between a Au(111) surface and the tip of the microscope by organic linkers. Tunneling electrons flowing through these junctions generate a narrow-line emission of light whose color is controlled by carefully selecting the chemical structure of the emitting unit. Besides the main emission line, red and blue-shifted vibronic features of low intensity are also detected. While the red-shifted features provide a spectroscopic fingerprint of the emitting unit, the blue-shifted ones are interpreted in terms of hot luminescence from vibrationally excited states of the molecule.

Exchange bias and room-temperature magnetic order in molecular layers.

Molecular semiconductors may exhibit antiferromagnetic correlations well below room temperature. Although inorganic antiferromagnetic layers may exchange bias single-molecule magnets, the reciprocal effect of an antiferromagnetic molecular layer magnetically pinning an inorganic ferromagnetic layer through exchange bias has so far not been observed. We report on the magnetic interplay, extending beyond the interface, between a cobalt ferromagnetic layer and a paramagnetic organic manganese phthalocyanine (MnPc) layer. These ferromagnetic/organic interfaces are called spinterfaces because spin polarization arises on them. The robust magnetism of the Co/MnPc spinterface stabilizes antiferromagnetic ordering at room temperature within subsequent MnPc monolayers away from the interface. The inferred magnetic coupling strength is much larger than that found in similar bulk, thin or ultrathin systems. In addition, at lower temperature, the antiferromagnetic MnPc layer induces an exchange bias on the Co film, which is magnetically pinned. These findings create new routes towards designing organic spintronic devices.

Narrow-Line Single-Molecule Transducer between Electronic Circuits and Surface Plasmons.

A molecular wire containing an emitting molecular center is controllably suspended between the plasmonic electrodes of a cryogenic scanning tunneling microscope. Passing current through this circuit generates an ultranarrow-line emission at an energy of ≈1.5 eV which is assigned to the fluorescence of the molecular center. Control over the linewidth is obtained by progressively detaching the emitting unit from the surface. The recorded spectra also reveal several vibronic peaks of low intensities that can be viewed as a fingerprint of the emitter. Surface plasmons localized at the tip-sample interface are shown to play a major role in both excitation and emission of the molecular excitons.

Spin-Dependent Hybridization between Molecule and Metal at Room Temperature through Interlayer Exchange Coupling.

We experimentally and theoretically show that the magnetic coupling at room temperature between paramagnetic Mn within manganese phthalocyanine molecules and a Co layer persists when separated by a Cu spacer. The molecule's magnetization amplitude and direction can be tuned by varying the Cu-spacer thickness and evolves according to an interlayer exchange coupling mechanism. Ab initio calculations predict a highly spin-polarized density of states at the Fermi level of this metal-molecule interface, thereby strengthening prospective spintronics applications.

Electroluminescence of a polythiophene molecular wire suspended between a metallic surface and the tip of a scanning tunneling microscope.

The electroluminescence of a polythiophene wire suspended between a metallic surface and the tip of a scanning tunneling microscope is reported. Under positive sample voltage, the spectral and voltage dependencies of the emitted light are consistent with the fluorescence of the wire junction mediated by localized plasmons. This emission is strongly attenuated for the opposite polarity. Both emission mechanism and polarity dependence are similar to what occurs in organic light emitting diodes (OLED) but at the level of a single molecular wire.

The effect of preoperative embolization on giant cell tumors of the bone localized in the iliosacral region of the pelvis.

INTRODUCTION: Giant cell tumors of the bone (GCTB) are aggressive neoplasms, with rare occurrences in the posterior pelvis and sacral area. Surgical challenges in this region include the inability to apply a tourniquet and limited cementation post-curettage due to proximity to neurovascular structures, leading to potential complications. This case-control study explores the impact of preoperative embolization on GCTB located in the iliosacral region. METHODS: Five surgeries (January-December 2021) for pelvic GCTB (3 sacrum, 2 posterior ilium) were performed on four patients. Diagnosis was confirmed through preoperative CT-guided biopsies. One surgery involved curettage with PMMA cement filling, while four surgeries had curettage without cavity filling. Preoperative embolization of the tumor feeding vessel occurred approximately 16 h before surgery in two cases. Denosumab treatment was not administered. RESULTS: Tumor volume, assessed by preoperative MRI, was comparable between patients with and without preoperative embolization (p = .14). Surgeries without embolization had a mean intraoperative blood loss of 3250 ml, erythrocyte transfusion volume of 1125 ml, and a mean surgical time of 114.5 min for two surgeries. Surgeries with preoperative embolization showed a mean intraoperative blood loss of 1850 ml, no erythrocyte transfusion requirement, and a mean surgical time of 68 min. CONCLUSION: Curettage of GCTB in the posterior pelvis and sacrum presents challenges, with significant intraoperative blood loss impacting surgical time and transfusion needs. Preoperative embolization may be beneficial in reducing blood loss during surgery in these cases.

Submolecular-scale control of phototautomerization.

Optically activated reactions initiate biological processes such as photosynthesis or vision, but can also control polymerization, catalysis or energy conversion. Methods relying on the manipulation of light at macroscopic and mesoscopic scales are used to control on-surface photochemistry, but do not offer atomic-scale control. Here we take advantage of the confinement of the electromagnetic field at the apex of a scanning tunnelling microscope tip to drive the phototautomerization of a free-base phthalocyanine with submolecular precision. We can control the reaction rate and the relative tautomer population through a change in the laser excitation wavelength or through the tip position. Atomically resolved tip-enhanced photoluminescence spectroscopy and hyperspectral mapping unravel an excited-state mediated process, which is quantitatively supported by a comprehensive theoretical model combining ab initio calculations with a parametric open-quantum-system approach. Our experimental strategy may allow insights in other photochemical reactions and proof useful to control complex on-surface reactions.

Conventional vs. endoscopic-assisted curettage of benign bone tumours. An experimental study.

BACKGROUND: This experimental study aimed at directly comparing conventional and endoscopic-assisted curettage towards (1) amount of residual tumour tissue (RTT) and (2) differences between techniques regarding surgical time and surgeons' experience level. METHODS: Three orthopaedic surgeons (trainee, consultant, senior consultant) performed both conventional (4x each) and endoscopic-assisted curettages (4x each) on specifically prepared cortical-soft cancellous femur and tibia sawbone models. "Tumours" consisted of radio-opaque polyurethane-based foam injected into prepared holes. Pre- and postinterventional CT-scans were carried out and RTT assessed on CT-scans. For statistical analyses, percentage of RTT in relation to total lesion's volume was used. T-tests, Wilcoxon rank-sum tests, and Kruskal-Wallis tests were applied to assess differences between surgeons and surgical techniques regarding RTT and timing. RESULTS: Median overall RTT was 1% (IQR 1 - 4%). Endoscopic-assisted curettage was associated with lower amount of RTT (median, 1%, IQR 0 - 5%) compared to conventional curettage (median, 4%, IQR 0 - 15%, p = 0.024). Mean surgical time was prolonged with endoscopic-assisted (9.2 ± 2.9 min) versus conventional curettage (5.9 ± 2.0 min; p = 0.004). No significant difference in RTT amount (p = 0.571) or curetting time (p = 0.251) depending on surgeons' experience level was found. CONCLUSIONS: Endoscopic-assisted curettage appears superior to conventional curettage regarding complete tissue removal, yet at expenses of prolonged curetting time. In clinical practice, this procedure may be reserved for cases at high risk of recurrence (e.g. anatomy, histology).

Ten-Year Minimum Follow-up Study of First Metatarsophalangeal Joint Fusion in Young vs Old Patients.

BACKGROUND: Painful degenerative joint disease (DJD) of the first metatarsophalangeal joint (MTP I), or hallux rigidus, mainly occurs in later stages of life. For end-stage hallux rigidus, MTP I arthrodesis is considered the gold standard. As young and active patients are affected considerably less frequently, it currently remains unclear, whether they benefit to the same extent. We hypothesized that MTP I arthrodesis in younger patients would lead to an inferior outcome with decreased rates of overall with lower rates of patient postoperative pain and function compared to an older cohort. METHODS: All patients aged <50 years who underwent MTP I arthrodesis at our institution between 1995 and 2012 were included in this study. This group was then matched and compared with a group of patients aged >60 years. Minimum follow-up was 10 years. Outcome measures were Tegner activity score (TAS), a "Virtual Tegner activity score" (VTAS), the visual analog scale (VAS), and the Foot Function index (FFI). RESULTS: Sixty-one MTP I fusions (n = 28 young, n = 33 old) in 46 patients were included in our study at an average of 14 years after surgery. Younger patients experienced significantly more pain relief as reflected by changes in VAS and FFI Pain subscale scores. No difference in functional outcomes was found with change in the FFI function subscale or in the ability to have desired functional outcomes using the ratio of TAS to VTAS. Revision rate did not differ between the two groups apart from hardware removal, which was significantly more likely in the younger group. CONCLUSION: In patients below the age of 50 years with end-stage DJD of the first metatarsal joint, MTP I arthrodesis not only yielded highly satisfactory postoperative results at least equal outcome compared to an older cohort of patients aged >60 years at an average 14 years' follow-up. Based on these findings, we consider first metatarsal joint fusion even for young patients is a valid option to treat end-stage hallux rigidus. LEVEL OF EVIDENCE: Level III, a case-control study.

Exploring the Role of Excited States' Degeneracy on Vibronic Coupling with Atomic-Scale Optics.

Interactions between molecular electronic and vibrational states manifest themselves in a variety of forms and have a strong impact on molecular physics and chemistry. For example, the efficiency of energy transfer between organic molecules, ubiquitous in biological systems and in organic optoelectronics, is strongly influenced by vibronic coupling. Using an approach based on scanning tunneling microscope-induced luminescence (STML), we reveal vibronic interactions in optical spectra of a series of single phthalocyanine derivative molecules featuring degenerate or near-degenerate excited states. Based on detailed theoretical simulations, we disentangle spectroscopic signatures belonging to Franck-Condon and Herzberg-Teller vibronic progressions in tip-position-resolved STML spectra, and we directly map out the vibronic coupling between the close-lying excited states of the molecules.

Single-Spin Sensing: A Molecule-on-Tip Approach.

Magnetometry plays a pivotal role in addressing the requirements of ultradense storage technology and overcoming challenges associated with downscaled spin qubits. A promising approach for atomic-scale single-spin sensing involves utilizing a magnetic molecule as a spin sensor, although such a realization is still in its early stages. To tackle this challenge and underscore the potential of this method, we combined a nickelocene molecule with scanning tunneling microscopy to perform versatile spin-sensitive imaging of magnetic surfaces. We investigated model Co islands on Cu(111) of different thicknesses having variable magnetic properties. Our method demonstrates robustness and reproducibility, providing atomic-scale sensitivity to spin polarization and magnetization orientation, owing to a direct exchange coupling between the nickelocene-terminated tip and the Co surfaces. We showcase the accessibility of magnetic exchange maps using this technique, revealing unique signatures in magnetic corrugation, which are well described by computed spin-density maps. These advancements significantly improve our capacity to probe and visualize magnetism at the atomic level.