Designing the next generation of proton-exchange membrane fuel cells.

With the rapid growth and development of proton-exchange membrane fuel cell (PEMFC) technology, there has been increasing demand for clean and sustainable global energy applications. Of the many device-level and infrastructure challenges that need to be overcome before wide commercialization can be realized, one of the most critical ones is increasing the PEMFC power density, and ambitious goals have been proposed globally. For example, the short- and long-term power density goals of Japan's New Energy and Industrial Technology Development Organization are 6 kilowatts per litre by 2030 and 9 kilowatts per litre by 2040, respectively. To this end, here we propose technical development directions for next-generation high-power-density PEMFCs. We present the latest ideas for improvements in the membrane electrode assembly and its components with regard to water and thermal management and materials. These concepts are expected to be implemented in next-generation PEMFCs to achieve high power density.

In vivo evaluation of sciatic nerve crush injury using diffusion tensor imaging: correlation with nerve function and histology.

OBJECTIVE: The aim of this study was to prospectively estimate magnetic resonance diffusion tensor imaging parameters in distal portions of crushed sciatic nerves in rabbits and correlation with neurological function and histology. METHODS: Thirty-two rabbits were randomly divided into 8 groups and followed up at 10 weeks. The right sciatic nerves were crushed, and the left sciatic nerves served as the control group with sham operation. Another 4 rabbits were chosen in the normal control group. Diffusion tensor imaging scan was obtained on bilateral sciatic nerves using spin-echo single-shot echo planar imaging. The values of fractional anisotropy (FA), apparent diffusion coefficient, and eigenvalue (λ║ and λ⊥) were measured on diffusion tensor imaging. Quantitative assessment of functional recovery in crushed nerves included toe-spreading reflex and modified Tarlov score, as well as pathology of the injured nerves. RESULTS: Fractional anisotropy of distal portions in injured nerves reduced slightly on the first day and dropped to the minimum at the fourth day after surgery. Then, FA increased gradually from the eighth day to the eighth week. After that, FA recovered nearly normal in the 10th week after injury. There was statistical significance in FA during 4 days to the eighth week and λ⊥ values between distal portions of injured nerves and normal control nerves (P < 0.05). Fractional anisotropy of distal portions to injured nerves correlated significantly with the nerve function score(r = 0.898, P < 0.01), whereas λ⊥ of distal portions of injured nerves demonstrated negative correlation with the nerve function score(r = -0.820, <0.01). Fractional anisotropy values of distal portions of injured nerves formed a similar time course as functional recovery, whereas λ⊥ indicated a opposite trend. CONCLUSIONS: The changes in FA and λ⊥ of distal portions of injured sciatic nerves correlate well with functional recovery and histology. Therefore, FA and λ⊥ of distal portions of injured sciatic nerves can be used as a marker to monitor Wallerian degeneration and regeneration of crushed sciatic nerves.

[Analysis of DCX gene mutation in a patient featuring X-linked subcortical laminar heterotopia and epilepsy].

OBJECTIVE: To detect potential mutation of Doublecortin (DCX) gene in a patient featuring X-linked subcortical laminar heterotopia (X-SCLH) and epilepsy. METHODS: Mutation of the DCX gene was screened by PCR and direct sequencing. Pathogenicity of the mutation was analyzed with a PolyPhen-2 software. RESULTS: A de novo missense mutation c.971T>C (p.Phe324Ser) was discovered. CONCLUSION: A diagnostic method for X-SCLH has been established, which may facilitate diagnosis and genetic counseling of patients featuring this disease.

Non-HIV talaromycosis: Radiological and clinical analysis.

To investigate the characteristics of spiral computed tomography (CT), positron emission tomography-computed tomography (PET/CT) and clinical manifestations of talaromycosis to improve the diagnostic level and deepen its recognition in radiology.Radiological, clinical, and pathological manifestations of 15 patients of non-HIV talaromycosis confirmed by bronchofiberscope lung biopsy and/or abscess puncture fluid culture and/or blood culture and/or sputum culture were analyzed retrospectively. All patients underwent chest CT, among them, six had a brain MRI, and six had a PET/CT scan before treatment.On plain CT scan, there were multiple patches and massive consolidation in 6 patients, multiple patchy consolidations and patchy ground-glass opacities in 3 patients, solitary or multiple nodules and masses in 3 patients, multiple cavities and small nodules in 3 patients. Multiple lymphadenectasis appeared in bilateral hila, mediastinum, and neck in 10 patients. In contrast CT scan, the parenchyma of the lesions had a slight enhancement in 10 patients, moderate enhancement in 3 patients, obvious enhancement in 2 patients. Seven cases had bone destruction and hyperplasia, cranial involvement in 1 patient and liver involvement in 3 patients, respectively. On PET/CT, five patients showed elevated standard uptake value (SUV).The radiological manifestations of non-HIV talaromycosis show multiple consolidations, ground-glass opacities, multiple nodules or masses in bilateral lungs, deep-seated enlarged lymph nodes and bone destruction in multiple systems. The final diagnosis should be based on the culture of talaromycosis.

Risk factors analysis of mirror aneurysms: A multi-center retrospective study based on clinical and demographic profile of patients.

As a special subgroup of multiple intracranial aneurysms, mirror aneurysms are located bilaterally on the corresponding intracranial arteries. The current study sought to compare the clinical and demographic features of patients harboring mirror aneurysm, and to elucidate the corresponding risk factors. We performed a retrospective cohort study of 2641 intracranial aneurysms patients, who were admitted to our hospitals between January 2005 and June 2014. Patients were subdivided into three groups based on the inclusion criteria: (i) single (n=2250); (ii) non-mirror multiple (n=285); and (iii) mirror aneurysms (n=106). Clinical and demographic files of the three groups were collected and compared, and medical histories including stroke, hyperlipemia, hypertension, hyperglycemia, valvular heart disease were considered as potential risk factors. Potential morphological reasons for mirror cerebral aneurysms rupture, including aneurysms size, irregular walls and cerebral hemispheric dominance, were also compared. Our data showed that the male to female ratio of mirror aneurysms patients was 1:3.61, which was significantly different from that of single aneurysm (1:1.27) and multiple aneurysms (1:2.00). The prevalence of mirror aneurysms in women is higher than that in men (P<0.001). Older patients (especially 60-69 years old) also appear to be more vulnerable to mirror aneurysm than single aneurysm (P<0.001). In 84 mirror aneurysm patients the aneurysms were located on the internal carotid arteries (79.2%), most typically at the PComA or in the Cavernous ICA. Patients with medical history of hyperlipemia appear to have an increased risk of harboring mirror aneurysms. Larger aneurysm size and presence of an irregular aneurysm wall appear to be the morphological factors that predispose for mirror aneurysms rupture.

Changes in lumbosacral spinal nerve roots on diffusion tensor imaging in spinal stenosis.

Lumbosacral degenerative disc disease is a common cause of lower back and leg pain. Conventional T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) scans are commonly used to image spinal cord degeneration. However, these modalities are unable to image the entire lumbosacral spinal nerve roots. Thus, in the present study, we assessed the potential of diffusion tensor imaging (DTI) for quantitative assessment of compressed lumbosacral spinal nerve roots. Subjects were 20 young healthy volunteers and 31 patients with lumbosacral stenosis. T2WI showed that the residual dural sac area was less than two-thirds that of the corresponding normal area in patients from L3 to S1 stenosis. On T1WI and T2WI, 74 lumbosacral spinal nerve roots from 31 patients showed compression changes. DTI showed thinning and distortion in 36 lumbosacral spinal nerve roots (49%) and abruption in 17 lumbosacral spinal nerve roots (23%). Moreover, fractional anisotropy values were reduced in the lumbosacral spinal nerve roots of patients with lumbosacral stenosis. These findings suggest that DTI can objectively and quantitatively evaluate the severity of lumbosacral spinal nerve root compression.

Successful surgical repair of central slip rupture in finger extensor tendon.

UNLABELLED: The aim of the present study was to develop a novel effective surgical method to repair boutonniere deformity resulting from central slip rupture of finger extensor tendon. Currently, there are not standard methods available to treat boutonniere deformity. PATIENTS AND METHODS: In the current study, 8 patients with boutonniere deformity on the left hand were included. All patients had a central slip rupture of the ring fingers. Autologous palmaris longus tendon was used to surgically repair the central slip rupture. RESULTS: We successfully used the autologous palmaris longus tendons in the effective treatment of central slip rupture of the ring fingers resulting in boutonniere deformity on the left hands. CONCLUSION: To our knowledge, our study was the first illustration for a successful surgical repair of boutonniere deformity which resulted from central slip rupture, using autologous palmaris longus tendon. This method provides an alternative approach for the effective treatment of boutonniere deformity.

[Case-control study on conservative and operative therapy in the treatment of intra-articular fracture of calcaneus].

OBJECTIVE: To explore the traumatic mechanism and the effectiveness of conservative and operative therapy for intra-articular fracture of calcaneus. METHODS: Forty-eight patients (52 feet) with intra-articular fractures were divided into two groups named as conservative group and operative group. There were 30 patients in the conservative group, including 26 males and 4 females, ranging in age from 2 to 73 years, with an average of (49.2 +/- 8.5) years. The patients in conservative group were treated with manual reduction, external fixation and functional exercise at early time. Among 18 patients in the operative group, 14 patients were male and 4 patients were female, ranging in age from 26 to 66 years,with an average of (50.1 +/- 19.3) years. The patients in the operative group were treated with open reduction and internal fixation. The height and width of calcaneus, Böhler and Gissane angles were measured before and after treatment. The assessment in the function of ankle joints was scored according to AOFAS scoring system. RESULTS: All the patients were followed up, and the duration ranged from 8 to 18 months,with a mean of 12 months. The time of weight-bearing ranged from 3 to 6 months, averaged 4 months. The fractures were fused completely on average of 12 months. The height and width of calcaneus, Böhler and Gissane angles had no statistically significance between two groups. According to AOFAS criteria,in the conservative group, 18 patients reached an excellent result, 6 good, 5 poor and 1 bad; in operative group, 4 patients reached an excellent result, 7 good, 6 poor and 1 bad. The therapeutic effect of conservative group was better than that of operative group. CONCLUSION: Operative therapy in intra-articular fracture of calcaneus with steel plate can directly perceive the restoration (or roughly restoration sometimes) of the anatomical shapes of calcaneus, while conservative therapy has advantages such as restoration of the anatomical shapes of calcaneus, early functional practice, early healing, and avoiding operational complications as well.