Revolutionizing Airborne Virus Defense: Electromagnetic MXene-Coated Air Filtration for Superior Aerosol Viral Removal.

The COVID-19 pandemic sparked public health concerns about the transmission of airborne viruses. Current methods mainly capture pathogens without inactivation, leading to potential secondary pollution. Herein, we evaluated the inactivation performance of a model viral species (MS2) in simulated bioaerosol by an electromagnetically enhanced air filtration system under a 300 kHz electromagnetic induction field. A nonwoven fabric filter was coated with a 2D catalyst, MXene (Ti3C2Tx), at a coating density of 4.56 mg·cm-2 to absorb electromagnetic irradiation and produce local heating and electromagnetic field for microbial inactivation. The results showed that the MXene-coated air filter significantly enhanced the viral removal efficiency by achieving a log removal of 3.4 ± 0.15 under an electromagnetic power density of 369 W·cm-2. By contrast, the pristine filter without catalyst coating only garnered a log removal of 0.3 ± 0.04. Though the primary antimicrobial mechanism is the local heating as indicated by the elevated surface temperature of 72.2 ± 4 °C under the electromagnetic field, additional nonthermal effects (e.g., dielectrophoresis) on enhanced viral capture during electromagnetically enhanced filtration were investigated by COMSOL simulation to delineate the potential transmission trajectories of bioaerosol. The results provide unique insights into the mechanisms of pathogen control and thus promote alternative solutions for preventing the transmission of airborne pathogens.

Enhancing Robotic-Based Propeller Blade Sharpening Efficiency with a Laser-Vision Sensor and a Force Compliance Mechanism.

The edge sharpness of a propeller blade plays a vital role in improving energy transmission efficiency and reducing the power required to propel the vehicle. However, producing finely sharpened edges through casting is challenging due to the risk of breakage. Additionally, the blade profile of the wax model can deform during drying, making it difficult to achieve the required edge thickness. To automate the sharpening process, we propose an intelligent system consisting of a six-DoF industrial robot and a laser-vision sensor. The system improves machining accuracy through an iterative grinding compensation strategy that eliminates material residuals based on profile data from the vision sensor. An indigenously designed compliance mechanism is employed to enhance the performance of robotic grinding which is actively controlled by an electronic proportional pressure regulator to adjust the contact force and position between the workpiece and abrasive belt. The system's reliability and functionality are validated using three different workpiece models of four-blade propellers, achieving accurate and efficient machining within the required thickness tolerances. The proposed system provides a promising solution for finely sharpened propeller blade edges, addressing challenges associated with the earlier robotic-based grinding studies.

Comparison of the radiographic outcomes and total blood loss between pinless navigation and conventional method in minimally invasive total knee arthroplasty.

BACKGROUND: Computer-assisted surgical navigation has been used in total knee arthroplasty (TKA) procedures for years trying to the accuracy of prosthesis placement. We conducted this prospective randomized clinical trial to compare the accuracy of the radiographic parameters of the prosthesis, total blood loss (TBL), and related complications, between a new pinless navigation system (Stryker OrthoMap Express Knee Navigation) and conventional method in patients undergoing minimally invasive (MIS) TKA procedures. PATIENT AND METHODS: A consecutive series of 100 patients underwent unilateral primary TKA were randomly assigned into two groups: navigation group and convention group. The radiographic parameters of the knee implant and the alignment of lower limb were measured at 3 months after surgery. TBL was calculated according to Nadler's method. The duplex ultrasonography of both lower limbs was performed in all patients to detect the presence of deep-vein thrombosis (DVT). RESULTS: Totally, 94 patients have completed the radiographic measures. Only the coronal femoral component angle in the navigation group (89.12° ± 1.83°) had significant differences from that in the convention group (90.09° ± 2.18°) (p = 0.022). There were no differences in the rate of outliers. The mean TBL in the navigation group was 841 ± 267 mL, which was similar to that in the convention group at 860 ± 266 mL (p = 0.721). Postoperative DVT risk did not differ between the two groups (2% vs. 0%, p = 0.315). CONCLUSION: This pinless navigation TKA showed a comparable acceptable alignment compared with conventional MIS-TKA. There were no differences regarding postoperative TBL between the two groups.

Influence of the Type of Bone Cement Used in Two-Stage Exchange Arthroplasty for Chronic Periarticular Joint Infection on the Spacer Replacement and Reinfection Rate.

BACKGROUND: Antibiotic-loaded bone cement (ALBC) spacers are used in the first stage when treating periprosthetic joint infection (PJI). This study aimed to investigate whether a spacer made from commercial ALBC or plain bone cement with additional antibiotics could affect the spacer exchange rate before reimplantation. METHODS: Patients undergoing two-stage exchange arthroplasty due to chronic PJI from January 2014 to August 2021 were retrospectively reviewed. The exclusion criteria included arthroplasty in the setting of septic arthritis, megaprosthesis, atypical pathogen infection, spacer placement unrelated to PJI, and spacer exchange due to mechanical complications. The patient demographics, brand of cement, and microbiology were recorded manually. The primary outcome was the incidence of spacer exchange due to persistent infection and the secondary outcome was the incidence of reinfection after reimplantation. A multivariate logistic regression analysis and Chi-square test were conducted to identify the effect of cement type on the spacer exchange. RESULTS: A total of 334 patients underwent two-stage exchange arthroplasty for PJI. The spacer exchange rates in the commercial and non-commercial ALBC groups were 6.4% and 25.1%, respectively (p = 0.004). After controlling for confounding factors, there were significant differences between the commercial group and non-commercial groups in the spacer exchange rate (adjusted OR = 0.25; 95% CI = 0.72-0.87, p = 0.029). The use of commercial ALBC was not associated with a lower reinfection rate after reimplantation (p = 0.160). CONCLUSIONS: In a two-stage exchange arthroplasty scenario, the spacer comprised of commercial ALBC resulted in a lower spacer exchange rate than the plain bone cement, both of which had additional antibiotics. However, the use of commercial ALBC was not associated with a lower incidence of reinfection following reimplantation.

Which Minor Criteria is the Most Accurate Predictor for the Diagnosis of Hip and Knee Periprosthetic Joint Infection in the Asian Population?

BACKGROUND: The aim of this study was to evaluate the diagnostic performance of minor criteria from the 2018 International Consensus Meeting (ICM) for the diagnosis of chronic periprosthetic joint infection (PJI) in an Asian population. METHODS: We retrospectively reviewed 76 patients who underwent a revision knee or hip arthroplasty at an academic institution between September 2018 and December 2019. All major and minor 2018 ICM criteria were available for all patients included. Cases with at least 1 major criterion or score ≥6 in minor criteria were considered as infected. The diagnostic performance was evaluated by a receiver operative characteristic curve analysis and area under the curve (AUC) for each minor criterion. An AUC value of more than 0.9 was considered outstanding and 0.8-0.9 as excellent. RESULTS: When using 2018 ICM threshold, the diagnostic performance ranked based on AUC was the following: alpha defensin (0.92), positive histology (0.83), leukocyte esterase (0.82), synovial white blood cell (0.81), serum erythrocyte sedimentation rate (0.78), synovial polymorphonuclear neutrophils (0.77), serum C-reactive protein (0.74), D-dimer (0.59), single positive culture (0.53), and positive intraoperative purulence (0.51). Alpha defensin was considered as an outstanding test among the 2018 ICM minor criteria. Positive histology, leukocyte esterase, and synovial white blood cell were considered as excellent tests. CONCLUSION: Based on our findings, alpha-defensin has the best diagnostic performance in Asian population among the minor criteria of 2018 ICM.

Impaction Bone Grafting Augmented With a Wire Coil by the Lightbulb Technique for Osteonecrosis of the Femoral Head.

BACKGROUND: Osteonecrosis of the femoral head (ONFH) is a debilitating disease that primarily affects the hips of young adults. The purpose of this study is to report the mid-term results of impaction bone grafting augmented with a wire coil using the lightbulb technique for ONFH. METHODS: From 1998 to 2016, 50 hips with late precollapsed or early postcollapsed ONFH (28 hips with Association Research Circulation Osseous [ARCO] IIC and 22 with IIIA) were treated by impaction bone grafting augmented with a wire coil using the lightbulb technique. The survival rate was analyzed with conversion to total hip arthroplasty (THA) as the end point. RESULTS: Thirty-one of the 50 hips had a successful clinical result without conversion to THA at a mean follow-up of 109.2 months. The 5-year survival rate was 68%, 82.1%, and 50% for the entire cohort, ARCO stage IIC, and ARCO stage IIIA, respectively. The 19 hips that had failed were converted to THA at an average of 52.8 months. The multivariable Cox proportional hazards model showed that an ARCO stage IIIA disease, a lateral lesion, and a necrotic index ≥0.67 were the independent risk factors for conversion to THA. CONCLUSION: As a head-preserving procedure, the lightbulb technique using impaction bone grafting augmented with a wire coil is worthwhile for patients in an earlier stage of disease and smaller lesion size to postpone the need for THA.

Total Knee Arthroplasty with Intra-Articular Resection of Bone for Knee Arthritis Secondary to Malunion of a Tibial Shaft Fracture: A Radiological Evaluation of Correction of the Tibial Deformity.

This retrospective study was aimed to evaluate the clinical outcome and the extent of correction of the tibial deformity by a radiological evaluation following total knee arthroplasty (TKA) combined with intra-articular bone resection, in patients with knee arthritis and ipsilateral malunited tibial fractures. Fifteen patients (15 knees) with severe arthritis of the knee and extra-articular malunion of the tibia were treated using TKA with intra-articular bone resection. The extra-articular deformities in the coronal plane were 10 tibia vara (mean 15°, range 9°-30°), 4 tibia valgum (mean 12°, range 6°-20°), and one double deformity in the tibial shaft. The follow-up duration was 84 months (24-240). At the last follow-up, the mean Knee Society knee and function scores had improved, respectively (p = 0.001). The mean arc of knee motion improved from 97° preoperatively to 118.3° at the last follow-up (p < 0.001). The mean mechanical axis improved from a preoperative 15.5° to 1.5° of varus (p = 0.013). Excluding the patient with a double tibial malunion, in the 10 patients with varus tibial angulations, the tibia vara had improved from 15° preoperatively to 2.6° (p = 0.005). There were no observed complications except for one with a postoperative deep infection. In conclusion, our results indicated that TKA with intra-articular resection of the bone is an effective procedure for the treatment of severe arthritis of the knee with extra-articular malunion of the tibia in the coronal plane (≤30° of varus; ≤20° of valgus).

Comparison of Effects of a Thrombin-Based Hemostatic Agent and Topical Tranexamic Acid on Blood Loss in Patients with Preexisting Thromboembolic Risk Undergoing a Minimally Invasive Total Knee Arthroplasty. A Prospective Randomized Controlled Trial.

BACKGROUND: The efficacy of a thrombin-based hemostatic agent (Floseal®) on reducing postoperative blood loss after total knee arthroplasty (TKA) was still unclear. The aim of our study was to conduct a prospective randomized controlled study to compare the blood conservation effects of Floseal® and topical TXA in patients with preexisting thromboembolic risk undergoing primary minimally invasive TKA. METHODS: Our power analysis of this study was based upon the following description, to obtain a statistical power of 0.90 and an alpha error of 0.05, 30 patients were required in each group. Therefore, we enrolled a total of 103 patients with at least one of the risk factors for thromboembolism who underwent unilateral primary minimally invasive TKA, and the participants were randomly divided into the topical TXA group (n = 34), receiving intra-articular injection of 3 g of TXA in 100 mL saline after TKA, the topical Floseal® group (n = 34), receiving 10 mL of Floseal® intra-articularily during surgery, and the placebo group (n = 35), receiving an intra-articular saline injection only. The total blood loss (TBL) and hemoglobin (Hb) drop were compared among the 3 groups. RESULTS: The TXA group had a lower TBL of 645 mL (227 to 1090) in comparison with 1145 mL (535 to 1942) in the Floseal® group and 1103 mL (424 to 1711) in the placebo (p < 0.001, respectively). The TBL was similar between the Floseal® group and the placebo group (p = 0.819). No patients in any group had symptoms of venous thromboemblism. CONCLUSION: Our prospective randomized controlled study showed that intra-articular application of TXA was superior to hemostatic matrix (Floseal®) in terms of blood conservation in patients with preexisting thromboembolic risk undergoing minimally invasive TKA. This trial is registered with Clinicaltrials.gov (NCT02865174) on 08/09/2016.

A Sensorless and Low-Gain Brushless DC Motor Controller Using a Simplified Dynamic Force Compensator for Robot Arm Application.

Robot arms used for service applications require safe human-machine interactions; therefore, the control gain of such robot arms must be minimized to limit the force output during operation, which slows the response of the control system. To improve cost efficiency, low-resolution sensors can be used to reduce cost because the robot arms do not require high precision of position sensing. However, low-resolution sensors slow the response of closed-loop control systems, leading to low accuracy. Focusing on safety and cost reduction, this study proposed a low-gain, sensorless Brushless DC motor control architecture, which performed position and torque control using only Hall-effect sensors and a current sensor. Low-pass filters were added in servo controllers to solve the sensing problems of undersampling and noise. To improve the control system's excessively slow response, we added a dynamic force compensator in the current controllers, simplified the system model, and conducted tuning experiments to expedite the calculation of dynamic force. These approaches achieved real-time current compensation, and accelerated control response and accuracy. Finally, a seven-axis robot arm was used in our experiments and analyses to verify the effectiveness of the simplified dynamic force compensators. Specifically, these experiments examined whether the sensorless drivers and compensators could achieve the required response and accuracy while reducing the control system's cost.

Development of a Virtual Force Sensor for a Low-Cost Collaborative Robot and Applications to Safety Control.

To protect operators and conform to safety standards for human-machine interactions, the design of collaborative robot arms often incorporates flexible mechanisms and force sensors to detect and absorb external impact forces. However, this approach increases production costs, making the introduction of such robot arms into low-cost service applications difficult. This study proposes a low-cost, sensorless rigid robot arm design that employs a virtual force sensor and stiffness control to enable the safety collision detection and low-precision force control of robot arms. In this design, when a robot arm is subjected to an external force while in motion, the contact force observer estimates the external torques on each joint according to the motor electric current and calculation errors of the system model, which are then used to estimate the external contact force exerted on the robot arm's end-effector. Additionally, a torque saturation limiter is added to the servo drive for each axis to enable the real-time adjustment of joint torque output according to the estimated external force, regulation of system stiffness, and achievement of impedance control that can be applied in safety measures and force control. The design this study developed is a departure from the conventional multisensor flexible mechanism approach. Moreover, it is a low-cost and sensorless design that relies on model-based control for stiffness regulation, thereby improving the safety and force control in robot arm applications.

Long-term outcomes of Phemister bone grafting for patients with non-traumatic osteonecrosis of the femoral head.

BACKGROUND: Phemister procedure is an effective treatment for early stage osteonecrosis of femoral head (ONFH). Since the long-term results of the Phemister procedure are less reported in the literature, the purpose of this study was to investigate the long-term outcomes of this bone grafting technique in patients with earlier stages of ONFH. METHODS: From 1994 to 2010, 29 hips with pre-collapsed or early collapsed (< 2 mm) ONFH treated by Phemister procedure were evaluated. Among them, nine hips were Association Research Circulation Osseous (ARCO) stage IIA, 13 stage IIB, 4 stage IIC, and 3 stage IIIA. The mean age was 38.9 years. The mean follow-up was 14 years (1-21 years). Survivorship was analyzed with conversion to total hip arthroplasty (THA) as the endpoint. RESULTS: At the final follow-up, 10 hips underwent THA at a mean of ten years (1-18 years). The overall clinical success rate for hip preserving was 65.5%, and radiological success rate was 31%. The mean Harris Hip Score improved from 50.3 to 76.1. The survival of hips was significantly inferior in female patients (P < 0.01), ARCO stage III disease (P = 0.03), lateral type lesion (P < 0.01), and necrotic index ≥ 0.67 (P < 0.01). The Cox proportional hazards model showed that gender, ARCO stage, and necrotic index were independent risk factors for conversion to THA. CONCLUSION: The study showed acceptable results without complication in patients receiving Phemister procedure for early stage ONFH at a mean follow-up of 14 years. As a head-preserving procedure, Phemister technique is worthwhile for young patients to postpone the need for THA.

The Incidence and Risk Factors of Acute Kidney Disease after Total Knee Arthroplasty with Early Postoperative Volume Supplement.

BACKGROUND: Etiology of acute kidney disease (AKD) after total knee arthroplasty (TKA) was considered as multifactorial. However, the role of early postoperative volume supplement in AKD rate has not been investigated. The purpose of this study was to evaluate the incidence and risk factors of AKD in patients with early volume supplement following TKA. METHODS: This was a retrospective study with 458 patients who underwent unilateral TKA. All the patients received 6% tetrastarch, 7.5ml/kg, early in the postoperative period. Postoperative AKD was defined as the postoperative creatinine level ≥ 1.5 times compared with preoperative data. Potential variables associated with AKD were analyzed by multivariate logistic regression model to identify the AKD risk factors in TKA patients after early postoperative volume supplement. RESULTS: The AKD rate was 3.3% (15 patients) in all patients. Age (OR = 1.09; P = .031) and coronary artery disease (CAD) (OR = 3.63; P = .034) were associated with increased risk of development of postoperative AKD. Other comorbidities as hypertension, diabetes, and CKD were not statistically significant risk factors. CONCLUSION: Our study demonstrated that age and CAD were independent risk factors of AKD in TKA patients. However, the common risk factors as hypertension, diabetes, and CKD were not significantly associated with AKD after TKA if early postoperative supplement of tetrastarch is administered.

Plasma D-dimer is not useful in the prediction of deep vein thrombosis after total knee arthroplasty in patients using rivaroxaban for thromboprophylaxis.

BACKGROUND: Venous thromboembolism (VTE) is a serious complication following total joint replacement. The use of rivaroxaban, a highly selective and direct factor Xa inhibitor, has been used widely as a safe and efficacious way to prevent VTE after total joint replacements. However, little is known about the diagnostic efficacy of plasma D-dimer test on deep vein thrombosis (DVT) in patients using rivaroxaban for thromboprophylaxis. The study is aimed to investigate the trend and the diagnostic efficacy of D-dimer test on DVT in patients with primary total knee arthroplasty (TKA) using rivaroxaban for thromboprophylaxis. METHODS: Two hundred TKA patients using rivaroxaban postoperatively as chemical prophylaxis were reviewed. D-dimer levels were checked at 4 h after the surgery and on postoperative days 1 and 4. Venography was used to document the presence of DVT. The Mann-Whitney U test was used to detect the differences in the D-dimer levels at different time points in patients with and without DVT, followed by Bonferroni corrections for p values. Receiver operating characteristics (ROC) curves were constructed to determine the best cutoff values of the D-dimer test at each time point after the surgery. RESULTS: Twenty-nine of the 200 patients were found to have deep vein thrombosis by venography, resulting in an incidence of 14.5%. All patients with DVTs occurred in the distal calf veins, and only one patient was symptomatic. We found significant differences in D-dimer concentration between patients with and without DVT at postoperative day 4. The best cutoff value determined by receiver operating characteristics analysis was 3.8 mg/L at postoperative day 4, with an AUC equal to 63.5%, and a sensitivity, specificity, PPV, and NPV of 58.6, 76, 29.3, and 91.5%, respectively. CONCLUSIONS: Rivaroxaban was effective on reducing DVT in patients undergoing TKA. Because all the DVTs occurred in the leg veins, decreased thrombus volume and size might result in poor accuracy of plasma D-dimer test in prediction or diagnosis of postoperative DVT.

Perioperative Complications of Total Knee Arthroplasty in Dialysis Patients.

BACKGROUND: Total hip arthroplasty in patients with end-stage renal disease (ESRD) may be associated with a high complication rate. However, the perioperative complication and mortality rates in these patients after total knee arthroplasty (TKA) have rarely been investigated. The purposes of this study were to measure the mortality and complication rates and to evaluate the 2- to 10-year clinical outcome of TKA in dialysis patients at our hospital during the past decade. METHODS: We retrospectively assessed 21 patients (26 knees) with ESRD who underwent primary TKA between 2007 and 2015. A preoperative medical evaluation was performed in all patients to assess the risk of surgery. All patients had complete clinical and radiographic evaluations, and the outcome was scored using American Knee Society Scores and the Western Ontario and McMaster Universities Arthritis Index. Perioperative complications and mortality were recorded. RESULTS: One patient died of stroke 1 year after surgery (4.8% mortality). The mean follow-up period of other 20 patients was 5.8 years (69.7 months, 24 to 119 months). Six patients (28.5%) had medical complications, including pneumonia (n = 3), stroke (n = 2), and cardiovascular events (n = 3), after discharge from hospital. At the latest follow-up, 19 patients (90.5%) had improved clinical outcomes of the knee after TKA according to the American Knee Society Scores (P < .01) and Western Ontario and McMaster Universities Arthritis Index scores (P < .01). CONCLUSION: Our study showed that TKA was a valid option for dialysis patients after careful preoperative evaluation. Most patients had an improved clinical outcome. There were no instances of prosthetic loosening or deep infection. However, dialysis patients under consideration for TKA need to be informed of the risk of possible medical complications due to the nature of ESRD.

AQUACEL® Ag Surgical Dressing Reduces Surgical Site Infection and Improves Patient Satisfaction in Minimally Invasive Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study.

The use of modern surgical dressings to prevent wound complications and surgical site infection (SSI) after minimally invasive total knee arthroplasty (MIS-TKA) is lacking. In a prospective, randomized, controlled study, 240 patients were randomized to receive either AQUACEL Ag Surgical dressing (study group) or a standard dressing (control group) after MIS-TKA. The primary outcome was wound complication (SSI and blister). The secondary outcomes were wear time and number of dressing changes in the hospital and patient satisfaction (pain, comfort, and ease of use). In the intention-to-treat analysis, there was a significant reduction in the incidence of superficial SSI (0.8%, 95% CI∶ 0.00-2.48) in the study group compared to 8.3% (95% CI∶ 3.32-13.3) in the control group (p = 0.01). There were no differences in blister and deep/organ-space SSIs between the two groups. Multivariate analysis revealed that AQUACEL Ag Surgical dressing was an independent risk factor for reduction of SSI (odds ratio: 0.07, 95% CI: 0.01-0.58, p = 0.01). The study group had longer wear time (5.2 ± 0.7 versus 1.7 ± 0.4 days, p < 0.0001) and lower number of dressing changes (1.0 ± 0.2 versus 3.6 ± 1.3 times, p < 0.0001). Increased patient satisfaction (p < 0.0001) was also noted in the study group. AQUACEL Ag Surgical dressing is an ideal dressing to provide wound care efficacy, patient satisfaction, reduction of SSI, and cost-effectiveness following MIS-TKA.

Isolated revision of the acetabular component using alumina-on-alumina bearings without a metal sleeve: A preliminary study.

INTRODUCTION: There has been a debate on the use of ceramic-on-ceramic coupling with the retained femoral stem in isolated acetabular revision. The purpose of this study was to retrospectively review the results and complications of isolated revision of the acetabular component using alumina-on-alumina bearings. METHODS: Between August 2010 and December 2013, 22 patients (23 hips) with a mean age of 60.74 years (40-73) underwent isolated revision of the acetabular component from metal-on-polyethylene to alumina-on-alumina bearings without using a metal sleeve on the undamaged trunnion. All patients completed clinical and radiographic evaluation. RESULTS: At a mean follow-up of 3 years (2-5.5), all patients had a significant improvement in the clinical outcome, including Harris Hip Score (84.9 vs. 43, p < 0.001), West Ontario McMaster University Osteoarthritis Index Score (14.4 vs. 49.2, p < 0.001), and visual analogue pain score (1.42 vs. 6.63, p < 0.001). Complications included one aseptic loosening of the acetabular component and three noisy hips (click only). No fracture of the ceramic bearings, dislocation, infection, or squeaking noise were observed in any of the patients. CONCLUSION: Isolated revision of the acetabular component to alumina-on-alumina bearings on the undamaged trunnion may be considered if there is no available titanium sleeves. Our study showed a satisfactory early outcome with minimal complications. However, a longer term follow-up study is necessary.

Fabrication of single Ga-doped ZnS nanowires as high-gain photosensors by focused ion beam deposition.

ZnS nanowires were synthesized via a vapor-liquid-solid mechanism and then fabricated into a single-nanowire field-effect transistor by focused ion beam (FIB) deposition. The field-effect electrical properties of the FIB-fabricated ZnS nanowire device, namely conductivity, mobility and hole concentration, were 9.13 Ω-1 cm-1, 13.14 cm2 V-1 s-1and 4.27 × 1018 cm-3, respectively. The photoresponse properties of the ZnS nanowires were studied and the current responsivity, current gain, response time and recovery time were 4.97 × 106 A W-1, 2.43 × 107, 9 s and 24 s, respectively. Temperature-dependent I-V measurements were used to analyze the interfacial barrier height between ZnS and the FIB-deposited Pt electrode. The results show that the interfacial barrier height is as low as 40 meV. The energy-dispersive spectrometer elemental line scan shows the influence of Ga ions on the ZnS nanowire surface on the FIB-deposited Pt contact electrodes. The results of temperature-dependent I-V measurements and the elemental line scan indicate that Ga ions were doped into the ZnS nanowire, reducing the barrier height between the FIB-deposited Pt electrodes and the single ZnS nanowire. The small barrier height results in the FIB-fabricated ZnS nanowire device acting as a high-gain photosensor.

Topical Tranexamic Acid Reduces Blood Loss in Minimally Invasive Total Knee Arthroplasty Receiving Rivaroxaban.

BACKGROUND: It is unclear whether topical (intra-articular) or intravenous TXA reduces blood loss in minimally invasive TKA patients receiving a direct oral anticoagulant for thromboprophylaxis. This study is to investigate whether TXA given intravenously or intra-articularly is effective in reducing blood loss in minimally invasive TKA patients using rivaroxaban for thromboprophylaxis. METHODS: Ninety-three patients who underwent primary minimally invasive TKA were divided into placebo group (30 patients) that received saline both intravenously and intra-articularly, intravenous (IV) group (31 patients) that received 1 g TXA intravenously, and topical group (32 patients) that received 3 g TXA in 100 ml saline intra-articularly. All patients received oral rivaroxaban of 10 mg daily for 14 days postoperatively. RESULTS: p < 0.001 and p = 0.041. The mean total blood loss was 1131 mL (567-1845) in placebo, which was higher than that in the IV group (921 mL; range, 465-1495; p = 0.014) and the topical group (795 mL; range, 336-1350; p < 0.001). The total blood loss did not differ between the IV and the topical group (p = 0.179). CONCLUSION: This prospective, randomized, controlled trial demonstrated an equal efficacy of TXA in blood conservation when administered intravenously or topically in minimally invasive TKA patients receiving rivaroxaban for thromboprophylaxis.

The Efficacy of Combined Use of Rivaroxaban and Tranexamic Acid on Blood Conservation in Minimally Invasive Total Knee Arthroplasty a Double-Blind Randomized, Controlled Trial.

BACKGROUND: Tranexamic acid (TXA) was reportedly to decrease postoperative blood loss after standard total knee arthroplasty (TKA). However, the blood-conservation effect of TXA in minimally invasive TKA, in particular, receiving a direct oral anticoagulant was unclear. The aim of the study was to investigate the efficacy of combined use of TXA and rivaroxaban on postoperative blood loss in primary minimally invasive TKA. METHODS: In a prospective, randomized, controlled trial, 198 patients were assigned to placebo (98 patients, normal saline injection) and study group (100 patients, 1g TXA intraoperative injection) during primary unilateral minimally invasive TKA. All patients received rivaroxaban 10 mg each day for 14 doses postoperatively. Total blood loss was calculated from the maximum hemoglobin drop after surgery plus amount of transfusion. The transfusion rate and wound complications were recorded in all patients. Deep-vein thrombosis was detected by ascending venography of the leg 15 days postoperatively. RESULTS: The mean total blood loss was lower in the study group (1020 mL [95% confidence interval, 960-1080 mL]) compared with placebo (1202 mL [95% confidence interval, 1137-1268 mL]) (P < .001). The transfusion rate was lower in the study group compared with placebo (1% vs 8.2%, P = .018). Postoperative wound hematoma and ecchymosis were higher in placebo than the study group (P = .003). There was no symptomatic deep-vein thrombosis or pulmonary embolism in either group. CONCLUSION: Systemic administration of TXA can effectively reduce the postoperative blood loss which results in lower rate of transfusion requirement and wound hematoma in minimally invasive TKA patients when rivaroxaban is used for thromboprophylaxis. Rivaroxaban has a high rate of bleeding complications when used alone in TKA patients.