An eight-week randomized intervention study on Korean adults to evaluate the effect of milk intake on obesity.

The anti-obesity effect of milk intake has been suggested via a variety of designed studies, but findings of obesity interventions for Korean adults are scarcely reported. The study aimed to investigate the anti-obesity effect of cow milk in Korean adults with an 8-wk randomized intervention. A total of 121 adults overweight aged 19 to 60 yr old were randomly assigned to 1 of the 2 groups: milk or control. During the intervention, both groups were encouraged 500 kcal of restriction a day, and the milk group consumed 200 mL of milk twice a day; the same energy intake as the control group, including milk intake, was recommended for 8 wk. We detected no significant differences in body weight (BW) and body mass index (BMI) between the milk and control groups during the 8-wk intervention, although the changes in BW and BMI of those within the milk group were significant. High-density lipoprotein cholesterol levels and serum calcium levels increased significantly in the milk group compared with the control group. Calcium, phosphorus, vitamin A, and riboflavin intakes increased significantly, when compared with the control. In conclusion, 8-wk milk consumption had no effect on weight loss and BMI change but improved some blood biomarkers and nutrient intake in Korean adults who were overweight. To evaluate the effect of milk on obesity reduction, well-designed, long-term, and large-scale studies are needed.

Computed Tomography Detects Hinge Fractures After Medial Opening Wedge High Tibial Osteotomy: A Systematic Review.

PURPOSE: To quantify the increased detection rate of lateral hinge fractures (LHFs) owing to additional computed tomography (CT), determine factors associated with LHFs, and compare radiologic and clinical outcomes of LHFs after medial opening wedge biplanar high tibial osteotomy (MOW-HTO). METHODS: The MEDLINE, Embase, Cochrane Library, and Web of Science databases were systematically searched to identify studies reporting the incidence of LHFs detected using additional CT, showing radiologic factors, or comparing radiologic and clinical outcomes between LHFs and non-LHFs after MOW-HTO. Subgroup analyses were performed to compare stable and unstable LHFs. Two reviewers performed the study screening, risk-of-bias assessment, and data extraction processes. RESULTS: Eleven studies were included in this review. The weighted estimate of the apparent incidence of LHFs in the pooled studies was 24.8%. The weighted estimate of the incidence was increased by 9.9% owing to the use of CT detection, which indicated that approximately 40% of total diagnosed LHFs were missed on plain radiographs or fluoroscopy. The pooled mean opening gap distance ranged from 11.40 to 12.60 mm in the LHF group and from 9.80 to 11.12 mm in the non-LHF group, and the mean difference in the opening gap distance was significantly larger in the LHF group (95% confidence interval, 0.64-1.84 mm; P < .0001). However, no significant differences in correction loss, bone union duration, and clinical outcomes were observed between the LHF and non-LHF groups. Subgroup analyses showed no significant differences between stable and unstable LHFs. CONCLUSIONS: Postoperative CT evaluations increase the detection rate of LHFs compared with plain radiography alone. Furthermore, the opening gap distance was larger in the LHF group than in the non-LHF group, suggesting the need for attention when opening the wedge by more than 11.4 mm. However, the consequences of LHFs after MOW-HTO were not major concerns when proper management was provided. LEVEL OF EVIDENCE: Level III, systematic review.

Femoral Tunnel Widening After Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Autograft Produces a Small Shift of the Tunnel Position in the Anterior and Distal Direction: Computed Tomography-Based Retrospective Cohort Analysis.

PURPOSE: To determine whether the femoral tunnel position remains in an anatomical footprint after tunnel widening and shifting. METHODS: Patients who underwent unilateral double-bundle anterior cruciate ligament reconstruction with hamstring autograft and performed computed tomography scan evaluation at the time of 5 days and 1 year postoperatively were included in this retrospective cohort study. Three-dimensional models of the femur and femoral tunnels were reconstructed from computed tomography scan data. The location of the tunnel center and tunnel margins in the anatomical coordinate system, and the mean shifting distance of tunnel center and margin were measured with image analysis software during the period. The change of tunnel center location in Bernard quadrant was confirmed if the tunnel center remained within the boundaries of anatomical position after tunnel widening. RESULTS: A total of 56 patients satisfied the inclusion criteria. The mean shifting distance of AM and PL tunnel centers were 1.7 ± 0.9 mm and 1.6 ± 0.6 mm. The Tunnel margin of the anteromedial (AM) and posteromedial (PL) tunnels were shifted to 2.5 ± 1.3 mm and 2.6 ± 1.4 mm in the anterior direction, and 1.4 ± 0.9 mm and 1.0 ± 0.7 mm in the distal direction, respectively. Among the anatomical located tunnel, 97% (32/33) and 87.1% (27/31) of AM and PL tunnel centers remained in a range of anatomical footprint. The tunnel center was shifted from the anatomical position into a nonanatomical position in 3% (1/33) of the AM tunnel and 12.9% (4/31) of PL tunnel after tunnel widening. The tunnel location which shifted nonanatomically were relatively anterior and distal position. CONCLUSIONS: Tunnel widening shifts the tunnel position to the anterior and distal direction, which could change the initial tunnel position. Nevertheless, the majority of tunnel positions remained in the anatomical position after tunnel widening and shifting. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Remnant-Tensioning Single-Bundle Anterior Cruciate Ligament Reconstruction Provides Comparable Stability to and Better Graft Vascularity Than Double-Bundle Anterior Cruciate Ligament Reconstruction in Acute or Subacute Injury: A Prospective Randomized Controlled Study Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging.

PURPOSE: To compare the clinical, second-look arthroscopic, magnetic resonance imaging (MRI), and dynamic-contrast-enhanced MRI (DCE-MRI) findings between remnant-tensioning single-bundle (RT-SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR). METHODS: Sixty-seven patients with acute or subacute anterior cruciate ligament (ACL) injury were randomized to undergo RT-SB or DB ACLR. Twenty-six patients in the RT-SB group and 28 in the DB group were evaluated using stability tests (Lachman test, pivot-shift test, and KT-2000 arthrometer) and multiple clinical scores. One year postoperatively, all 54 patients underwent MRI for evaluation of graft continuity and graft signal/noise quotient and DCE-MRI for the calculation of normalized area under the curve (nAUC) as a marker of graft vascularity. Among them, 41 patients underwent second-look arthroscopy for the evaluation of graft continuity, graft tension, and synovialization. The results were compared between the 2 groups. RESULTS: At the minimum 2-year follow-up (28.7 ± 6.4 months), the stability tests, clinical scores, second-look arthroscopic findings, and MRI findings were not significantly different between the groups. However, the mean nAUC values on DCE-MRI for the ACL graft were significantly higher in the RT-SB group than those in the DB group in all 3 zones (nAUCproximal, P = .005; nAUCmiddle, P = .021; nAUCdistal, P = .027; and nAUCaverage, P = .008). CONCLUSION: For acute or subacute ACL injury, the RT-SB ACLR showed an outcome comparable to that of DB ACLR in terms of knee stability, clinical scores, MRI findings, and second-look arthroscopic findings. Moreover, RT-SB ACLR showed better graft vascularity 1 year postoperatively than DB ACLR using DCE-MRI. LEVEL OF EVIDENCE: II, prospective randomized controlled trial.

Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy.

PURPOSE: This study aimed to determine which preoperative factors affect the postoperative change in the joint line convergence angle (JLCA) by preoperatively quantifying soft tissue laxity. METHODS: Thirty-four patients who underwent medial open-wedge high tibial osteotomy (HTO) with a navigation were analysed. The JLCA change after HTO was calculated using standing long-bone anteroposterior radiographs taken preoperatively and 6 months postoperatively. Latent soft tissue laxity was defined as the amount of soft tissue that can be extended to valgus or varus from the weight-bearing position, and calculated by subtracting the JLCA on weight-bearing standing radiographs from that on stress radiographs. Multiple linear regression was performed to determine the preoperative factors that statistically correlated with the postoperative JLCA change. RESULTS: In multiple linear regression, JLCA change had a statistically significant correlation with latent medial laxity (R = 0.6) and a statistically borderline significant correlation with correction angle (R = 0.2). These imply that the postoperative JLCA change increased by 0.6° per 1° increase in latent medial laxity, and increased by 0.2° per 1° increase in correction angle. Latent medial laxity was the most crucial factor associated with postoperative JLCA changes. CONCLUSION: The JLCA change could be larger in patients with large latent medial laxity or severe varus deformity requiring a large correction, which could lead to unexpected overcorrection in HTO. Postoperative JLCA change should be considered in preoperative surgical planning. Target point shifting within the hypomochlion point could be a strategy to prevent overcorrection, especially in patients with large latent medial laxity. LEVEL OF EVIDENCE: Level IV.

The clinical and radiological results of individualized surgical treatment depending on pathologic abnormalities in recurrent patellar dislocation: low recurrence rate, but unintended patella baja.

PURPOSE: To evaluate the clinical and radiological outcomes and chondral lesion change using individualized surgery for recurrent patellar dislocation. METHODS: A total of 31 knees with recurrent patellar dislocation underwent surgery depending on individual pathologic abnormalities. Pathologic abnormalities including medial laxity, lateral tightness, increased tibial tuberosity (TT)-to-trochlear groove distance (>20 mm), and patella alta (Caton-Deschamps ratio >1.2) were evaluated in each patient. The abnormalities were corrected through medial patellofemoral ligament reconstruction, TT distalization, TT anteromedialization, and lateral retinacula release. The mean follow-up period was 33 months. RESULTS: There was one recurrent case (3.2%), requiring additional surgery. The mean Kujala scores were significantly (P = 0.002) improved from 75.8 (SD 12.4) to 84.6 (SD 13.1). Tegner scores were significantly improved from 3.7 (range 1-9) to 5.4 (range 2-9) (P < 0.001), as were and visual analogue scale pain scores from 4.7 (SD 2.5) to 2.6 (SD 2.2) (P = 0.001). Caton-Deschamps ratio was significantly decreased from 1.1 (SD 0.2) to 0.9 (SD 0.1) (P < 0.001), regardless of TT distalization. Chondral lesions of the patella and trochlear groove were improved or maintained in 57.1 and 71.4% of patients, respectively. CONCLUSION: Individualized surgery in recurrent patellar dislocation was effective and safe with a low recurrence rate. However, the possibility of unintended patella baja, which might be related to post-operative anterior knee pain, should be considered. LEVEL OF EVIDENCE: IV.

Influence of change of tunnel axis angle on tunnel length during double-bundle ACL reconstruction via the transportal technique.

BACKGROUND: Commercially available flexible reamer and curved guide systems allow a certain degree of control over intra-articular tunnel orientation, therefore allows a wide range of intra-osseous femoral tunnel orientations, contrary to the femoral tunneling technique using a straight guide pin, which are determined by knee flexion angle. We sought to find the clinical relevance of intra-osseous femoral tunnel orientations in the respect of tunnel length. To evaluate the relationship between the tunnel axis angle in three orthogonal planes and tunnel length in the anteromedial (AM) and posterolateral (PL) femoral tunnels in patients who underwent anatomic double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the transportal (TP) technique with a 42o curved guide. METHODS: A total of 40 patients who underwent primary DB-ACLR with the TP technique using a curved guide were evaluated retrospectively. The tunnel axis angle in three orthogonal planes were evaluated on a three-dimensional surface model constructed using an axial computed tomography scan obtained after reconstruction. Then, correlations with tunnel length were analyzed. RESULTS: In the AM tunnel, tunnel axis angles in the coronal (ß = 0.0252, p = 0.022) and sagittal (ß = 0.0168, p = 0.029) plane showed significant correlations with tunnel length, while the axial plane did not (p = 0.493) (adjusted R2 = 0.801). In the PL tunnel, only tunnel axis angles in the axial plane (ß = 0.0262, p = 0.008) showed a significant relationship with tunnel length (adjusted R2 = 0.700). CONCLUSION: Drilling at a higher angle in the coronal and sagittal planes in AM tunnels and at a higher angle in the axial plane in PL tunnels decreases the incidence of short femoral tunnels.

Infection and revision rates following primary total knee arthroplasty in patients with rheumatoid arthritis versus osteoarthritis: a meta-analysis.

PURPOSE: This meta-analysis compared infection and revision rates in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) who underwent total knee arthroplasty (TKA). Rates of superficial wound and deep periprosthetic infections were compared in the groups, as were whether revision rates associated with infectious and noninfectious causes differed in the RA and OA groups. METHODS: Studies were included in the meta-analysis if they (1) compared infection and revision rates after primary TKA in RA and OA patients; (2) directly compared superficial wound and deep periprosthetic infection rates in RA and OA patients who underwent primary TKA; and (3) reported the actual numbers of RA and OA patients who underwent TKA and developed postoperative infection and/or required revision. RESULTS: The rate of superficial wound infections after primary TKA was similar in the RA and OA groups (15/258 [5.8 %] vs. 77/1609 [4.7 %]; odds ratio [OR] 1.12, 95 % confidence interval [CI] 0.36-3.46; P = n.n.), but the deep infection rate was significantly higher in RA than in OA patients (229/7651 [3.0 %] vs. 642/68628 [0.9 %]; OR 2.04, 95 % CI 1.37-3.05; P < 0.001). The proportion of subjects who required revision resulting from infection after TKA was significantly higher in the RA than in the OA group (86/8201 [1.0 %] vs. 555/118755 [0.5 %]; OR 1.89, 95 % CI 1,34-2.66; P < 0.001), whereas the proportion of subjects requiring revision due to noninfectious causes did not differ significantly (46/594 [7.7 %] vs. 52/904 [5.7 %]; OR 1.22, 95 % CI 0.74-2.00; P = n.n.) CONCLUSION: Following primary TKA, RA patients had a significantly higher rate of deep periprosthetic infections than OA patients, but their superficial infection rates were similar. The revision rate due to infectious causes was significantly higher in RA than in OA patients, but their revision rates due to noninfectious causes did not differ. Therefore, the surgeon should fully explain to RA patients scheduled to undergo primary TKA that, compared to OA patients, they are more likely to experience a deep infection postsurgery. LEVEL OF EVIDENCE: Meta-analysis Level III.

Antiviral activity of Bifidobacterium adolescentis SPM1605 against Coxsackievirus B3.

Bifidobacteria are considered one of the most beneficial probiotics and have been widely studied for their effects against specific pathogens. The present study investigated the antiviral activity of probiotics isolated from Koreans against Coxsackievirus B3 (CVB3). The effect of probiotic isolates against CVB3 was measured by the plaque assay and cellular toxicity of bifidobacteria in HeLa cells was measured using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Among 13 probiotic isolates, 3 Bifidobacterium adolescentis, 2 Bifidobacterium longum and 1 Bifidobacterium pseudocatenulatum had an antiviral effect against CVB3, while the others did not show such effect. B. adolescentis SPM1605 showed the greatest inhibitory properties against CVB3. When the threshold cycle (CT) values for the treated B. adolescentis SPM1605 samples were compared to the results for the non-treated samples, it was shown that the amplified viral sequences from the CVB3 had their copy number lowered by B. adolescentis SPM1605. Moreover, the gene expression in infected HeLa cells was also inhibited by 50%. The results suggest that B. adolescentis SPM1605 suppresses CVB3 and could be used as an alternative therapy against infectious diseases caused by coxsackieviruses.

Postoperative pain management using an intravenous combination of ibuprofen and acetaminophen compared with acetaminophen alone after thyroidectomy: A prospective randomized controlled trial.

BACKGROUND: Multiple medications are more effective than single agents for postoperative pain management. We investigated the analgesic effects of an intravenous combination of acetaminophen and ibuprofen immediately after thyroidectomy. METHODS: In this double-blind clinical trial, 62 patients who underwent thyroidectomies were randomized to either the treatment (1000 mg acetaminophen, 300 mg ibuprofen) or control (1000 mg acetaminophen) group. Postoperative pain intensity was assessed using the visual analog scale (VAS) 0, 15, and 30 min after recovery room admission. Opioid rescue consumption was also recorded. RESULTS: The VAS scores were significantly lower in the treatment than in the control group 15 [3 (2-4.3) vs. 5 (3-6); p = 0.015] and 30 [3 (2-4.3) vs. 4 (3-5); p = 0.018] min after recovery room admission, as were the opioid rescue dose requirements (p = 0.033). CONCLUSIONS: Combined intravenous acetaminophen and ibuprofen may be better than acetaminophen alone for immediately acute postoperative pain after thyroidectomy.

Energy Storage Performance of Electrode Materials Derived from Manganese Metal-Organic Frameworks.

Metal-organic frameworks (MOFs) are porous materials assembled using metal and organic linkers, showing a high specific surface area and a tunable pore size. Large portions of metal open sites in MOFs can be exposed to electrolyte ions, meaning they have high potential to be used as electrode materials in energy storage devices such as supercapacitors. Also, they can be easily converted into porous metal oxides by heat treatment. In this study, we obtained high energy storage performance by preparing electrode materials through applying heat treatment to manganese MOFs (Mn-MOFs) under air. The chemical and structural properties of synthesized and thermally treated Mn-MOFs were measured by Fourier-transform infrared spectroscopy (FTIR), Raman spectroscopy, X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and transmission electron microscopy (TEM). The surface area and porosity were investigated by nitrogen adsorption/desorption isotherms. The electrochemical properties were studied by cyclic voltammetry (CV) and galvanostatic charge-discharge (GCD) using a three-electrode cell. It was found that Mn-MOF electrodes that underwent heat treatment at 400 °C under air consisted of Mn2O3 with high specific surface area and porosity. They also showed a superior specific capacitance of 214.0 F g-1 and an energy density value of 29.7 Wh kg-1 (at 0.1 A g-1) compared to non-treated Mn-MOFs.

Single-bundle transtibial posterior cruciate ligament reconstruction using a bioabsorbable cross-pin tibial back side fixation.

PURPOSE: The purpose of this study was to examine a developed surgical technique by performing a mid-term evaluation of clinical and stability results and complications. METHODS: Thirty patients who underwent transtibial posterior cruciate ligament (PCL) reconstruction using a bioabsorbable cross-pin tibial back side fixation method were enrolled in this prospective study. Lysholm and International Knee Documentation Committee (IKDC) knee scales were used to evaluate clinical outcomes. Stability was evaluated using a Telos device with a 150 N force at 90 degrees of knee flexion. Follow-up magnetic resonance imaging (MRI) was also performed in 20 (66.7%) patients, and complications were evaluated. Those with complication by MRI were assigned to an abnormal MRI group. RESULTS: The follow-up period was 47 (range, 25-62) months. On comparing preoperative and final follow-up clinical results, Lysholm and IKDC knee scale scores were found to have improved significantly (P < 0.001). The mean side-to-side difference in posterior translation measured using a Telos device was 13.4 ± 3.1 mm (range 10-20 mm) preoperatively and 3.2 ± 1.5 mm (range 1-7 mm) at last follow-up, which represented a significant improvement in stability (P < 0.001). Five patients showed cyst formation in the tibial tunnel and two patients showed a significant signal increase at the anterior portion of the tibial tunnel, which was believed to indicate a pro-cystic status. The normal and abnormal MRI groups had similar Lysholm and IKDC knee scale scores and stress radiographs (P > 0.05). CONCLUSIONS: Single-bundle transtibial PCL reconstruction using a bioabsorbable cross-pin tibial back side fixation was found to produce satisfactory clinical and stability results. However, despite these satisfactory results, a potential complication of tibial cyst formation was observed. LEVEL OF EVIDENCE: Case series, Level IV.

Greater Knee Rotatory Instability After Posterior Meniscocapsular Injury Versus Anterolateral Ligament Injury: A Proposed Mechanism of High-Grade Pivot Shift.

Background: For anterolateral rotatory instability as a result of secondary soft tissue injuries in anterior cruciate ligament (ACL)-deficient knees, there is increasing interest in secondary stabilizers to prevent internal rotation (IR) of the tibia. Purpose: To determine which secondary stabilizer is more important in anterolateral rotatory instability in ACL-deficient knees. Study Design: Controlled laboratory study. Methods: The lower extremities of 10 fresh-frozen cadavers (20 extremities) without anterior-posterior or rotational instability were included. Matched-pair randomization was performed, with each side per specimen assigned to 1 of 2 groups. In group 1, the ACL was sectioned, followed by the anterolateral ligament (ALL); in group 2, the ACL was sectioned, followed by sequential sectioning of the posterolateral meniscocapsular complex (PLMCC) and posteromedial meniscocapsular complex (PMMCC). The primary outcome was the change in relative tibial IR during a simulated pivot-shift test with 5 N·m of IR torque and 8.9 N of valgus force. The secondary outcomes were the International Knee Documentation Committee grade in the pivot-shift test and the incidence of the grade 3 pivot shift. Results: In group 1, compared with baseline, the change in relative tibial IR at 0° of knee flexion was 1.4° (95% CI, -0.1° to 2.9°; P = .052) after ALL release. In group 2, it was 2.5° (95% CI, 0.4° to 4.8°; P = .007) after PLMCC release and 4.1° (95% CI, 0.5° to 7.8°; P = .017) after combined PLMCC and PMMCC release. Combined PLMCC and PMMCC release resulted in greater change of tibial IR with statistical significance at 0°, 15°, and 30° of knee flexion (P = .008, .057, and .004, respectively) compared with ALL release. The incidence of grade 3 pivot shifts was 10% in group 1 and 90% in group 2. Conclusion: Posterior meniscocapsular laxity caused an increase in relative tibial IR as much as ALL injury in ACL-deficient knees in our simulated laboratory test, and greater anterolateral rotatory instability occurred with posterior meniscocapsular injury compared with ALL injury. Clinical Relevance: Repair of the injured posterior meniscocapsular complex may be an important treatment option for reducing anterolateral rotatory instability in the ACL-deficient knee.

Antiviral activity of Bifidobacterium adolescentis SPM1005-A on human papillomavirus type 16.

BACKGROUND: Probiotic lactic acid bacteria (LAB) support a functional and balanced immune system, and contribute to immune modulatory effects in combatting microbial pathogens, including viruses. Most cervical cancers are associated with anogenital region infection with high-risk (HR) human papillomavirus (HPV). In this study, we analyzed the antiviral activity of Bifidobacterium adolescentis SPM1005-A in the SiHa cervical cancer cell line expressing HPV type 16. METHODS: We assessed the cellular toxicity of B. adolescentis SPM1005-A in SiHa cells by the Trypan blue dye exclusion assay. Cells (3.6 × 105) in culture plates with or without B. adolescentis SPM1005-A in the same type of medium, were incubated with HPV type 16 at a concentration of 5.1 × 107 cfu/ml. For antiviral analysis, we performed quantitative real-time PCR (qRT-PCR) for E6 and E7 oncogene expressions and observed protein levels by immunoblotting. RESULTS: The qRT-PCR results showed that E6 and E7 mRNA levels decreased simultaneously. Western blot analysis revealed that the E6 protein expression slightly decreased after 24 and 48 h, but the level of E7 protein expression appear unaffected compared with that in the control. Decreased HPV16 E6 and E7 mRNA transcript and protein levels were not associated with cell morphology or significant cytotoxic effects. CONCLUSIONS: This study showed that B. adolescentis SPM1005-A had antiviral activity through suppression E6 and E7 oncogene expression. The results suggest that B. adolescentis SPM1005-A could be potential applications of HPV-associated cervical cancer prevention.

Photovoltaic performance of dye-sensitized solar cell low temperature growth of ZnO nanorods using chemical bath deposition.

Nanostructured ZnO photoelectrodes were synthesized on fluorine-doped tin oxide (FTO) glass substrates that were spin-coated with a sol-gel based ZnO seed layer via a chemical bath deposition (CBD) method at varying times of 1, 2, 4, and 8 h. Then, TiO2 nanoparticulate electrodes were prepared on ZnO nanorods using the doctor blade technique. The uniformly grown ZnO nanorod layer had a length of approximately 710 nm on the FTO glass substrate with wurtzite structures which was confirmed through X-ray diffraction patterns. The length and diameter of the ZnO nanorods increased with an increase in the deposition time. The DSSCs fabricated with TiO2 nanoparticulate/grown ZnO nanorods and grown for 8 h showed the maximum efficiency (5.51%) with a short circuit current density (J(sc)) of 12.21 mA/cm2 and an open circuit voltage (V(oc)) of 0.70 at 100 mW/cm2 light intensity.

Enhancement of photovoltaic performance in dye-sensitized solar cells with the spin-coated TiO2 blocking layer.

The TiO2 thin film layers were introduced with the spin-coating method between FTO electrode and TiO2 photoanode in dye sensitized solar cell (DSSC) to prevent electron back migration from the FTO electrode to electrolyte. The DSSC containg different thickness of TiO2 thin film (10-30, 40-60 and 120-150 nm) were prepared and photovoltaic performances were analysed with /-Vcurves and electrochemical impedance spectroscopy. The maximum cell performance was observed in DSSC with 10-30 nm of TiO2 thin film thickness (11.92 mA/cm2, 0.74 V, 64%, and 5.62%) to compare with that of pristine DSSC (11.09 mA/cm2, 0.65 V, 62%, and 4.43%). The variation of photoelectric conversion efficiency of the DSSCs with different TiO2 thin film thickness was discussed with the analysis of crystallographic and microstructural properties of TiO2 thin films.

Comparison of femoral graft bending angle and tunnel length between transtibial technique and transportal technique in anterior cruciate ligament reconstruction.

PURPOSE: To investigate which technique would reduce bending stress at the femoral tunnel aperture and make short tunnel length after ACL reconstruction by comparing the femoral graft bending angle and tunnel length between the single-bundle (SB) transtibial (TT) and double-bundle (DB) transportal (TP) technique using three-dimensional-computed tomography using OsiriX(®) imaging software. METHODS: Forty-nine patients underwent an ACL reconstruction using a SB TT (Group I, 20 patients) and DB TP (Group II, 29 patients) technique. Femoral graft bending angle and femoral tunnel length were measured by CT image using OsiriX(®) imaging software. Groups I and II were compared, and statistical analysis was performed using SPSS software. RESULTS: The mean anteromedial (AM) and posterolateral (PL) femoral graft bending angle of group II (111.5 ± 8.8° and 118.9 ± 9.8°, respectively) was significantly more acute than that of group I (125.3 ± 11.1°) (P < 0.001, P = 0.04). The mean femoral tunnel length of group I was significantly longer than that of group II (P = 0.001). CONCLUSIONS: The femoral graft bending angle and the femoral tunnel length of the TP technique performed in the maximally flexed knee position was more acute and shorter than those of the TT technique after ACL reconstruction. This might increase the bending stress at the femoral tunnel aperture and shorter graft length in the tunnel after an ACL reconstruction using TP technique compared to the TT technique. LEVEL OF EVIDENCE: III.

How to achieve an optimal alignment in medial opening wedge high tibial osteotomy?

Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used surgical treatment option for medial compartmental osteoarthritis with varus deformity. It is important that proper lower limb alignment is achieved. However, there has been no consensus about an optimal alignment in MOWHTO. Most studies suggest that achieving valgus alignment is necessary, and recent studies support slight valgus mechanical alignment of less than 3° of mechanical femorotibial angle. Overcorrection and undercorrection is not recommended for achieving good surgical outcomes. To prevent undercorrection and overcorrection in MOWHTO, the method of placing the weight-bearing line in the target range must be precise. There are several ways to place a weight-bearing line within the target range. While the most important factor for a successful MOWHTO is achieving an ideal mechanical axis correction, there are a few other factors to consider, including joint line obliquity, posterior tibial slope, ligament balancing, and patellar height. Several factors exist that lead to undercorrection and overcorrection. Preoperative amount of varus deformity, lateral hinge fracture, and fixation failure can result in undercorrection, while medial soft tissue laxity and the amount of correction angle and target point beyond hypomochlion can result in overcorrection. This study aimed to review the literature on optimal alignment in MOWHTO and report on the factors to be considered to prevent correction errors and how to achieve an optimal alignment.

How to Perform Concomitant Medial Meniscus Pull-Out Repair With Medial Open-Wedge High Tibial Osteotomy Without Technical Failure.

Varus alignment of the knee joint (varus >5°) is known as a poor prognostic factor for medial meniscus root repair, and alignment correction is recommended in patients with varus deformity and medial meniscus root tears. However, simultaneous medial meniscus pull-out repair and high tibial osteotomy are technically demanding procedures due to the long surgical time, poor visualization, and breaking of the pull-out sutures during high tibial osteotomy procedures. In the present Technical Note, we will introduce a surgical method to perform 2 procedures simultaneously without technical difficulty. The main surgical techniques are as follows. (1) Release the superficial medial collateral ligament before arthroscopic medial meniscus pull-out repair, which secures sufficient working space and visualization. Therefore, the operation time could also be reduced by performing the arthroscopic procedure with the anterior portal. (2) Protect the pull-out sutures with an ENDOBUTTON reamer, which prevents pull-out sutures from breaking during the high tibial osteotomy procedure.

Avoiding Overcorrection to Increase Patient Satisfaction After Open Wedge High Tibial Osteotomy.

BACKGROUND: Achieving the postoperative mechanical axis passing through 62.5% of the tibial plateau is considered successful osteotomy surgery. Despite precise preoperative planning and surgical techniques, some procedures result in under- or overcorrection. Few studies have investigated the relationship between clinical outcomes and unintentional under- or overcorrection after open wedge high tibial osteotomy (OWHTO) using whole-leg standing radiographs. PURPOSE: To investigate the relationship between postoperative alignment using whole-leg standing radiographs and clinical outcomes after OWHTO. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 89 knees (72 patients) that underwent OWHTO between October 2013 and September 2018 were included. Patients with postoperative weightbearing line (WBL) ratios within 57% to 67% were classified as appropriate correction (group A; 45 cases), whereas ratios <57% and >67% were classified as undercorrection (group U; 20 cases) and overcorrection (group O; 24 cases), respectively. The following patient-reported outcomes (PROs) were investigated: International Knee Documentation Committee (IKDC) subjective score, Kujala score, and Knee injury and Osteoarthritis Outcome Score (KOOS). The correlation between postoperative WBL and PROs was analyzed. PROs were compared among the 3 groups. RESULTS: Regarding the correlation between postoperative WBL ratio and PROs, a larger postoperative WBL ratio was significantly correlated with a poor IKDC subjective score (P = .002), Kujala score (P = .009), and KOOS. Group O showed inferior postoperative PRO scores when compared with group A or U, whereas group U showed a similar result to group A (mean IKDC subjective scores: group U, 62.0; group A, 61.2; group O, 47.6; P = .004). CONCLUSION: Overcorrection after OWHTO surgery correlated with inferior PROs; therefore, overcorrected alignment should be avoided for patient satisfaction. Knees with an undercorrected alignment showed clinical results similar to those with appropriate correction.