Necrotizing Soft-Tissue Infections: A Retrospective Review of Predictive Factors for Limb Loss.

Background: Emergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most catastrophic outcome, but limb loss is also one of the most important complications that can have a significant impact on the rest of the patient's life. The purpose of this study was to identify predictive factors for limb loss caused by NSTIs. Methods: The data of patients at our center who were diagnosed with NSTIs from May 2003 to January 2019 were analyzed retrospectively. The inclusion criteria were patients with a definite diagnosis of NSTI involving the upper or lower limb. A total of 49 patient records were analyzed in terms of demography, laboratory data, microbiological causes, treatment, and final outcome. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores at initial admission were also collected as laboratory data. Final outcomes were classified into survival with limb salvage and survival with limb loss. Results: The limb loss rate was 20.4% (10/49) in our study. On comparison between the limb salvage group and the limb loss group, independent risk factors of limb loss were as follows: presence of hypotension at admission (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.7-38.3; p = 0.008); LRINEC score ≥ 9 (OR, 5.8; 95% CI, 1.3-25.6; p = 0.012), and glucose level > 300 mg/dL (OR, 4.5; 95% CI, 0.9-21.9; p = 0.041). Various microbiological organisms were isolated; the most prevalent specimen was streptococci (32.6%), followed by staphylococci (26.5%). Poor outcomes including limb loss and mortality had no correlation with microbiological organisms. Conclusions: For patients with NSTIs, the presence of hypotension at admission, a high glucose level (> 300 mg/dL), and a high LRINEC score (> 9) were independent risk factors for limb loss.

Clinical outcomes of dual 3.5-mm locking compression plate fixation for humeral shaft fractures: Comparison with single 4.5-mm locking compression plate fixation.

BACKGROUND: Recently, several in vitro biomechanical studies that used dual small locking plate fixation for humeral shaft fractures have investigated. However, in vivo studies about dual plate fixation for humeral shaft fractures are limited. The purpose of our study was to report the outcomes of dual small plating for humeral shaft fractures in comparison with those of single large fragment plating. METHODS: Sixty consecutive patients who underwent an open reduction internal fixation for humeral shaft fractures at our institution from September 2014 to December 2017 were included. Single 4.5-mm locking compression plate (LCP) fixation was used in the first 40 cases, and dual 3.5-mm LCP fixation was used in the final 20 consecutive cases. Data were collected to define patient characteristics, injury mechanism, clinical outcomes, time to surgery, operative time, estimated blood loss, and complications. Using simple radiography during the follow-up period (6, 12, 24, and 52 weeks after surgery), the shoulder and elbow joint ranges of motion (ROM) were also evaluated. RESULTS: Demographic data, time to surgery, surgical time, and estimated blood loss had no significant differences between the two groups. No significant differences were observed in nonunion rate and union rate 3 months after surgery. However, two patients (5%) in the single 4.5-mm LCP fixation group showed metal failure and breakage. No significant differences were found in postoperative shoulder and elbow ROM. Three patients (7.5%) in the single plating group and one patient (5%) in the dual plating group developed radial nerve palsy after surgery. No vascular injury and deep infection were observed in either group. CONCLUSION: For diaphyseal humeral fractures, dual 3.5-mm LCP fixation to the humerus is a possible treatment choice. This method showed satisfactory union rate, ROM, and complication rate, without increasing surgical time, in comparison with the conventional single 4.5-mm LCP fixation. Level of evidence: III.

Nonvolatile memory thin-film transistors using biodegradable chicken albumen gate insulator and oxide semiconductor channel on eco-friendly paper substrate.

Nonvolatile memory thin-film transistors (TFTs) fabricated on paper substrates were proposed as one of the eco-friendly electronic devices. The gate stack was composed of chicken albumen gate insulator and In-Ga-Zn-O semiconducting channel layers. All the fabrication processes were performed below 120 °C. To improve the process compatibility of the synthethic paper substrate, an Al2O3 thin film was introduced as adhesion and barrier layers by atomic layer deposition. The dielectric properties of biomaterial albumen gate insulator were also enhanced by the preparation of Al2O3 capping layer. The nonvolatile bistabilities were realized by the switching phenomena of residual polarization within the albumen thin film. The fabricated device exhibited a counterclockwise hysteresis with a memory window of 11.8 V, high on/off ratio of approximately 1.1 × 10(6), and high saturation mobility (µsat) of 11.5 cm(2)/(V s). Furthermore, these device characteristics were not markedly degraded even after the delamination and under the bending situration. When the curvature radius was set as 5.3 cm, the ION/IOFF ratio and µsat were obtained to be 5.9 × 10(6) and 7.9 cm(2)/(V s), respectively.

Direct label-free electrical immunodetection in human serum using a flow-through-apparatus approach with integrated field-effect transistors.

In order to identify changes in the levels of key proteins in response to the onset or development of a disease, the research fields of proteomics and genomics seek to develop new biomarkers. Specifically, simple and fast biomarker screens have a central role in many areas of healthcare, including disease diagnosis and drug discovery. Biologically modified field-effect transistor (BioFET) is one of the most attractive approaches because of the on-chip integration of the sensor array, fast response, high reliability and low-cost mass production. However, the BioFETs used to detect macromolecules have been operated only in buffer solution with low salt concentrations because of the Debye screening length of blood or serum. Here we report a novel detection technique for direct label-free immunodetection of cancer markers in human serum using a Si-FET that was fabricated by conventional photolithographic processes. The proposed sensing method shows no dissociation of antigen-antibody binding as in general immunoassays, unlike the previous reports on Si-FET sensors. This method therefore overcomes the Debye length problem of immunodetection in human fluids, such as serum, that are generally encountered by FET-based biosensors. Our results demonstrate specific label-free and real-time immunodetection of a cancer marker at a concentration of 0.2 ng/mL in human serum, quantitative detection of the marker from 0.2 to 114 ng/mL, and successful multiplexed sensing of three different cancer markers. We believe that connecting our simple electrical detection method, which does not require pretreatment of serum, with well-established whole blood filter technology will contribute to the development of new point-of-care testing (POCT) sensors.

Control of channel doping concentration for enhancing the sensitivity of 'top-down' fabricated Si nanochannel FET biosensors.

The sensitivity of 'top-down' fabricated Si nanochannel field effect transistor (FET) biosensors has been analyzed quantitatively, as a function of the channel width and doping concentration. We have fabricated 130-, 150-, and 220 nm-wide Si FET channels with 40 nm-thick p-type silicon-on-insulator (SOI) layers doped at 8 x 10(17) and 2 x 10(18) cm(-3), and characterized their sensitivity in response to the variation of surface charges as hydrogen ion sensors within buffer solutions of various pH levels. Within the range of channel width and doping concentration investigated, the pH sensitivity of Si channels is enhanced much more effectively by decreasing the doping concentration than by reducing the channel width, which suggests a practical strategy for achieving high sensitivity with less effort than to reduce the channel width. Similar behavior has also been confirmed in the immunodetection of prostate specific antigen (PSA). Combined with excellent reproducibility and uniformity of the channel structure, high controllability of the doping concentration can make the 'top-down' fabrication a very useful approach for the massive fabrication of high-sensitivity sensor platforms in a cost-effective way.