Characterization of the Lithium/Solid Electrolyte Interface in the Presence of Nanometer-thin TiOx Layers for All-Solid-State Batteries.

It is unclear, which role space charge layers (SCLs) play within an all-solid-state battery during operation with high current densities, and to which extent they form. Herein, we use a solid electrolyte with a known SCL formation and investigate it in a symmetric cell under non-blocking conditions with Li metal electrodes. Since the used LICGC™ electrolyte is known for its instability against lithium, it is protected from rapid degradation by nanometer-thin layers of TiOx deployed by atomic layer deposition. Close attention is given to the interfacial properties, as now additional Li+ can traverse through the interface depending on the applied bias potential. The interlayer's impedance response shows efficient lithium-ion conduction for low bias potentials and a diffusion-limiting effect towards high positive and negative potentials. SCLs grow up to a thickness of 5.1 µm. Additionally, estimating the apparent rate constant of the charge transfer across the interface indicates that the potentials where kinetics are hindered coincide with the widest SCLs. In conclusion, the investigation under higher steady-state currents was only possible because of the improved stability due to the interlayer. No chemo-physical failure could be observed after 800+ hours of cycling. However, SEM study shows a new phase at the interface.

Development of probiotic loaded multilayer microcapsules incorporated into dissolving microneedles for potential improvement treatment of vulvovaginal candidiasis: A proof of concept study.

Vulvovaginal candidiasis (VVC) is a vaginal infection caused by abnormal growth of Candida sp., especially Candida albicans, in the vaginal mucosa. A shift in vaginal microbiota is prominent in VVC. The presence of Lactobacillus plays a vital role in maintaining vaginal health. However, several studies have reported resistance of Candida sp. against azoles drugs, which is recommended as VVC treatment. The use of L. plantarum as a probiotic would be an alternative to treat VVC. In order to exert their therapeutic activity, the probiotics needed to remain viable. Multilayer double emulsion was formulated to obtain L. plantarum loaded microcapsules (MCs), thus improving its viability. Furthermore, a vaginal drug delivery system using dissolving microneedles (DMNs) for VVC treatment was developed for the first time. These DMNs showed sufficient mechanical and insertion properties, dissolved rapidly upon insertion, facilitating probiotic release. All formulations proved non-irritating, non-toxic, and safe to apply on the vaginal mucosa. Essentially, the DMNs could inhibit the growth of Candida albicans up to 3-fold than hydrogel and patch dosage forms in ex vivo infection model. Therefore, this study successfully developed the formulation of L. plantarum-loaded MCs with multilayer double emulsion and its combination in DMNs for vaginal delivery to treat VVC.

Utility of optical coherence tomography angiography in pregnancy-associated central serous chorioretinopathy.

PURPOSE: To describe a case of pregnancy-related central serous chorioretinopathy (pCSCR) and the utility of monitoring with optical coherence tomography (OCT) and OCT angiography (OCTA). OBSERVATIONS: A 34-year-old female in her third trimester of pregnancy presented with symptomatic visual disturbances of the right eye. Medical history was otherwise unremarkable. Optical coherence tomography (OCT) disclosed a serous retinal detachment with trace subretinal fibrin and elevation of the retinal pigment epithelium (RPE). OCT angiography (OCTA) demonstrated absence of choroidal neovascular membrane (CNV). It was decided to monitor with weekly OCTs until delivery, after which the patient had full resolution of symptoms and subretinal fluid. CONCLUSIONS AND IMPORTANCE: Pregnancy-related CSCR may be complicated by fibrin deposition and RPE changes suspicious for CNV. This provides evidence of the utility of OCT for monitoring pCSCR progression and of OCTA to non-invasively assess presence of CNV.

Determinants of Chest X-Ray Sensitivity for COVID- 19: A Multi-Institutional Study in the United States.

PURPOSE: To evaluate the sensitivity, specificity, and severity of chest x-rays (CXR) and chest CTs over time in confirmed COVID-19+ and COVID-19- patients and to evaluate determinants of false negatives. METHODS: In a retrospective multi-institutional study, 254 RT-PCR verified COVID-19+ patients with at least one CXR or chest CT were compared with 254 age- and gender-matched COVID-19- controls. CXR severity, sensitivity, and specificity were determined with respect to time after onset of symptoms; sensitivity and specificity for chest CTs without time stratification. Performance of serial CXRs against CTs was determined by comparing area under the receiver operating characteristic curves (AUC). A multivariable logistic regression analysis was performed to assess factors related to false negative CXR. RESULTS: COVID-19+ CXR severity and sensitivity increased with time (from sensitivity of 55% at ≤2 days to 79% at >11 days; p<0.001 for trends of both severity and sensitivity) whereas CXR specificity decreased over time (from 83% to 70%, p=0.02). Serial CXR demonstrated increase in AUC (first CXR AUC=0.79, second CXR=0.87, p=0.02), and second CXR approached the accuracy of CT (AUC=0.92, p=0.11). COVID-19 sensitivity of first CXR, second CXR, and CT was 73%, 83%, and 88%, whereas specificity was 80%, 73%, and 77%, respectively. Normal and mild severity CXR findings were the largest factor behind false-negative CXRs (40% normal and 87% combined normal/mild). Young age and African-American ethnicity increased false negative rates. CONCLUSION: CXR sensitivity in COVID-19 detection increases with time, and serial CXRs of COVID-19+ patients has accuracy approaching that of chest CT.

Salmonella enterica serovar Typhi osteomyelitis in a young adult with sickle cell and thalassemia traits: A possible association.

Salmonella osteomyelitis is known to occur in immunocompromised and sickle cell disease patients. It rarely occurs in other hosts. We present a case of chronic femoral osteomyelitis due to S. enterica serovar Typhi seen in a Maryland resident. Potential risk factors included traveling to an endemic area as well as a newly diagnosed sickle cell trait and thalassemia trait. It is postulated that less severe hemoglobinopathies may also contribute to an elevated risk of Salmonella osteomyelitis.

Effects of wearing shoes on the feet: Radiographic comparison of middle-aged partially shod Maasai women's feet and regularly shod Maasai and Korean women's feet.

BACKGROUND: Maasai tribe members walk long distances daily either barefoot or wearing traditional shoes made from recycled car tires, without any foot ailments. To figure out the characteristic of their feet, we designed a radiographic comparative study of middle-aged partially shod Maasai women's feet and regularly shod Maasai and Korean women's feet. METHODS: Weight bearing radiographs of bilateral foot and ankle joints from 20 healthy middle-aged bush-living partially shod (PS) Maasai women were obtained. Same number of radiographs from 20 urban-living regularly shod (RS) Maasai and 20 Korean women were obtained and compared. The hallux valgus angle, the first to second intermetatarsal angle, talonavicular coverage angle, talo-first metatarsal angle, Meary angle, naviculo-cuboidal overlap, and the medial cuneiform height were measured to establish the degree of pes plano-valgus and hallux valgus deformity. RESULTS: On comparing PS and RS Maasai groups radiographically, the talonavicular coverage angle, talo-first metatarsal angle, and naviculo-cuboidal overlap were significantly greater in the PS Maasai group, whereas hallux valgus angle, the first and second intermetatarsal angle, Meary angle, and the medial cuneiform height were greater in the RS Maasai and Korean group. CONCLUSIONS: Regularly wearing shoes would protect the feet from pes plano-valgus deformity, despite potentially contributing to hallux valgus deformity.

Morbid obesity is an independent risk factor for postoperative renal dysfunction in young adults: a review of the American College of Surgeons National Surgical Quality Improvement Program database.

BACKGROUND: Little information exists on the acute effects of elective surgery on renal function. Our aim was to determine if obesity was an independent risk factor for postoperative renal complications (RCs). METHODS: A total of 119,142 patients aged 18 to 35 years with body mass index (BMI) ≥18 kg/m(2) obtained from American College of Surgeons National Surgical Quality Improvement Project (2005 to 2010) were classified into standard BMI categories. Association between BMI and preoperative estimated glomerular filtration rate (eGFR; calculated using modification of diet in renal disease formula) was analyzed. Postoperative changes in eGFR and RCs were measured. Multivariate regression analysis was performed adjusting for all variables. RESULTS: Postoperatively, there was a reduction in eGFR among the overweight (-3.4 mL/min/1.73 m(2), P < .001), obese class I (-3.9 mL/min/1.73 m(2), P = .001), and obese class II (-5.3 mL/min/1.73 m(2), P < .001). The odds of any postoperative RC was significantly higher in obese class III patients (odds ratio = 2.01 95% confidence interval 1.07 to 3.76, P = .029). CONCLUSIONS: Results seen in patients with BMI greater than 40 indicate that BMI can serve as an independent predictor of RCs.

Enchondroma of the Foot.

The present study is a review of 20 patients with enchondroma of the foot treated from January 2005 to March 2012. All patients were examined clinically, followed by an evaluation of their enchondroma of the foot radiographically and an assessment of the outcome of their surgical intervention. The patients' sex and age, enchondroma location, findings from imaging studies such as plain radiography, computed tomography, and magnetic resonance imaging, clinical findings, operative findings, and treatment outcomes were recorded. The average postoperative follow-up period was 24 months. Eighty percent of the tumors were located in the proximal phalanx and 14 (70%) patients presented with pathologic fracture. The plain radiographs and computed tomography findings revealed 13 (65%) cases of internal calcification and 11 (55%) with endosteal scalloping. A periosteal reaction was seen only in 4 (20%) cases. Magnetic resonance imaging of 11 (55%) patients showed low T1-weighted and high T2-weighted signal intensity in all cases. Internal septa and nodules with low T2-weighted signal intensity were observed in 9 (82%) out of 11 cases, and adjacent soft tissue edema was noted in 9 (82%). All patients underwent curettage of the tumor and bone grafting as their surgical treatment. No recurrence or postoperative complications were observed during the 24-month follow-up period. Enchondroma of the foot most frequently involves the proximal phalangeal bone and is often associated with pathologic fracture. The unique clinical signs and characteristic radiographic images are easily recognized, making this a relatively easy diagnosis. With appropriate treatment, a good surgical outcome can be expected.

Isolated Talonavicular Arthrodesis as an Option for Severe Rocker Bottom Foot Deformity: A Case Report / 대한족부족관절학회지

We report on a case of post-burn contracture and right foot deformity in a 37-year-old female who underwent two surgical interventions at the age of seven years. The patient remained well without any associated problems until she presented to our hospital at the age of 37 years with severe pain and right foot deformity. A few treatment modalities have been reported, and amputation has been suggested as the best approach. However, our patient was treated with a talonavicular arthrodesis and a soft tissue procedure, which resulted in a stable, plantigrade, and pain-free foot with an unsupported, bipedal gait.

Intraosseous Calcaneal Lipoma with Subtalar Perforation through Cystic Degeneration: A Case Report / 대한족부족관절학회지

Intraosseous lipoma is a benign tumor that originates from proliferating mature lipocytes. It often occurs in the metaphysis of long bones of the lower extremity, and also in the calcaneus, humerus, mandible, sacrum, and rib bones. Frequently, it involutes spontaneously through a process of infarction, calcification, and cyst formation. It can either present as pain, or be asymptomatic and only discovered through an incidental radiological finding. In our case, the patient presented with heel pain. Intraoperatively, it was found that the intraosseous cavity was filled with fat along with an adjacent but separate area of cystic degeneration. There was also a cortical perforation at the cystic lesion which was communicating with the subtalar joint. This cortical breach is most likely the cause of diffuse lateral heel pain experienced by our patient, and such a pathological fracture due to intraosseous lipoma has never been reported.

A dominant adenocarcinoma with multifocal ground glass lesions does not behave as advanced disease.

BACKGROUND: Invasive lung adenocarcinomas increasingly present with synchronous, multifocal, in situ lesions that appear as ground glass opacities (GGOs). The optimal approach in this circumstance (often nonsmokers) remains unclear. We evaluated a general strategy of anatomic resection of the dominant tumor (DT) and wedge resection of accessible ipsilateral GGOs. METHODS: This is a retrospective review of 39 patients with suspected multifocal in situ adenocarcinomas and 1 DT in a predominantly Caucasian population. Mean follow-up is 30.7 months. RESULTS: Forty-nine percent of patients had no or minimal smoking history; 21% were Asian. The resected DT was pathologically "bronchioloalveolar carcinoma" (26%), minimally invasive adenocarcinoma (5%), adenocarcinoma with bronchioloalveolar features (41%), or moderate well-differentiated adenocarcinoma (28%). The p stage of the DT was IA in 20, IB in 15, and IIA in 4, with mean diameter of 2.6 cm. Thirty-two patients (82%) underwent anatomic resection of the DT; 7 (18%) underwent wedge resection. The mean number of GGOs present initially was 2.7 (range, 1 to 7) with a 5.2-mm mean diameter. An unresected nodule increased in size during follow-up in only 9 patients (23%). The mean diameter growth among these was 3.2 mm, with mean doubling time of 49 months. New GGOs (range, 1 to 8) developed in 16 patients (41%), all of which remained at 7 mm or less. Distant metastasis developed in 2 patients (5.2%); only 1 patient has required intervention for progression of a GGO. The overall survival is 100%. CONCLUSIONS: Patients with limited, multifocal, in situ adenocarcinomas and a clinical N0 DT enjoy prolonged survival with generally anatomic resection of the DT and wedge resection of accessible GGOs. These patients should not be considered to harbor T4 or M1a disease.