Association of Stability and Size of Unhealed Area With Failure After Internal Fixation for Osteochondritis Dissecans Lesions of the Knee: Radiological Evaluation Using Computed Tomography.

BACKGROUND: Open reduction and internal fixation (ORIF) has been widely performed because the osteochondral component of the osteochondritis dissecans (OCD) lesion is the most suitable for reconstructing the joint structure. PURPOSE: To evaluate radiological healing in terms of reconstructed bony structure after ORIF with bone graft by computed tomography (CT), to identify preoperative prognostic factors for failure, and to determine the cutoff value of radiological healing for risk of failure. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A retrospective cohort study of 42 patients (44 knees) who underwent internal fixation with bone graft for OCD lesions of the knee from 2004 to 2018 was conducted. All patients were evaluated 6 months postoperatively, and if not healed 6 months after surgery, they were evaluated by CT periodically thereafter. Radiological healing was judged according to the following 3 criteria: (1) reossification of the OCD lesion, (2) bony continuity between the OCD lesion and basal floor, and (3) reconstructed bony surface of the femoral condyle reconstructed to match the normal joint. Then, the percentage of the radiological healing area was calculated as the ratio of the healing length to the total lesion length. The nonhealing area was calculated by multiplying the sum of the total nonhealing length. Clinical failure was defined as any definitive reoperation for the same OCD lesion, such as fragment excision, or a cartilage restoration procedure. After 6 months, all eligible patients underwent arthroscopy to check for protrusion of the absorbable pin into the joint; the removal of an absorbable pin protruding into the joint was not considered a failure. RESULTS: Clinical failure was recorded for 4 cases (9.1%). The mean overall percentage of the radiological healing area of OCD 6 months after ORIF with bone graft was 79.5% ± 24.4%, and the mean overall nonhealing area at 6 months was 87.8 ± 107.9 mm2. The percentages of radiological healing area of stable (International Cartilage Regeneration & Joint Preservation Society OCD II) lesions and femoral condylar (lateral femoral condyle + medial femoral condyle) lesions were significantly lower than unstable lesions and femoral groove lesions, respectively (P = .01 and P = .03, respectively). On receiver operating characteristic curve analysis, the cutoff points for predicting a significantly increased risk of failure were 33.9% (sensitivity, 100%; specificity, 100%; area under the curve, 1) for the percentage of radiological healing area and 222.9 mm2 (sensitivity, 95%; specificity, 100%; area under the curve, 0.956) for the nonhealing area 6 months postoperatively. CONCLUSION: A stable lesion and a femoral condylar lesion were the predictors of poor radiological healing on CT images 6 months after ORIF with bone graft. The risk of failure was increased significantly in cases with only approximately one-third of the lesion healed or in cases with large nonhealing areas at 6 months postoperatively.

[Asymptomatic Ball Thrombus in Right Atrium Under Anticoagulant Therapy:Report of a Case].

A rare case of isolated right atrial thrombus under anticoagulant therapy for atrial fibrillation is reported herein. The patient was an 81-year-old man undergoing anticoagulant therapy with oral warfarin for atrial fibrillation. During preoperative screening for eye surgery, echocardiography revealed a mobile mass in the right atrium, and emergency hospital admission was indicated. Excision of the right atrial thrombus was performed, and no residual thrombus was detected on postoperative imaging studies. This case was considered a good indication for surgical resection because of potential risk of fatal embolism.

Metastable atomic-ordered configurations for Al1/2Ga1/2N predicted by Monte-Carlo method based on first-principles calculations.

Metastability of Aln/12Ga1-n/12N (n= 2-10: integer) with the 1-2 monolayer (ML) in-plane configuration towards thec[0001] direction has been demonstrated recently. To theoretically explain the existence of these metastable structures, relatively large calculation cells are needed. However, previous calculations were limited to the use of small calculation cell sizes to estimate the local potential depth (Δσ) of ordered Al1/2Ga1/2N models. In this work, we were able to evaluate large calculation cells based on the interaction energies between proximate Al atoms (δEAl-Al) in AlGaN alloys. To do this,δEAl-Alvalues were estimated by first-principles calculations (FPCs) using a (5a1× 5a2× 5c) cell. Next, a survey of the possible ordered configurations using various large calculation cell models was performed using the estimatedδEAl-Alvalues and the Monte-Carlo method. Then, various Δσvalues were estimated by FPCs and compared with the configurations previously reported by other research groups. We found that the ordered configuration obtained from the (4a1× 2a2× 1c) calculation cell (C42) has the lowest Δσof -9.3 meV/cation and exhibited an in-plane configuration at thec(0001) plane having (-Al-Al-Ga-Ga-) and (-Al-Ga-) sequence arrangements observed along them11-00planes. Hence, we found consistencies between the morphology obtained from experiment and the shape of the primitive cell based on our numerical calculations.

Multiplexing of bias-controlled modulation modes on a monolithic III-nitride optoelectronic chip.

III-nitride optoelectronic chips have tremendous potential for developing integrated computing and communication systems with low power consumption. The monolithic, top-down approaches are advantageous for simplifying the fabrication process and reducing the corresponding manufacturing cost. Herein, an ultraviolet optical interconnection system is investigated to discover the way of multiplexing between emission and absorption modulations on a monolithic optoelectronic chip. All on-chip components, the transmitter, monitor, waveguide, modulator, and receiver, share the same quantum well structure. As an example, two bias-controlled modulation modes are used to modulate video and audio signals in the experiment presented in this Letter. The results show that our on-chip optoelectronic system works efficiently in the near ultraviolet band, revealing the potential breadth of GaN optoelectronic integration.

Inactivation characteristics of a 280 nm Deep-UV irradiation dose on aerosolized SARS-CoV-2.

A non-filter virus inactivation unit was developed that can control the irradiation dose of aerosolized viruses by controlling the lighting pattern of a 280 nm deep-UV (DUV)-LED and the air flowrate. In this study, the inactivation properties of aerosolized SARS-CoV-2 were quantitatively evaluated by controlling the irradiation dose to the virus inside the inactivation unit. The RNA concentration of SARS-CoV-2 remained constant when the total irradiation dose of DUV irradiation to the virus exceeded 16.5 mJ/cm2. This observation suggests that RNA damage may occur in regions below the detection threshold of RT-qPCR assay. However, when the total irradiation dose was less than 16.5 mJ/cm2, the RNA concentration monotonically increased with a decreasing LED irradiation dose. However, the nucleocapsid protein concentration of SARS-CoV-2 was not predominantly dependent on the LED irradiation dose. The plaque assay showed that 99.16% of the virus was inactivated at 8.1 mJ/cm2 of irradiation, and no virus was detected at 12.2 mJ/cm2 of irradiation, resulting in a 99.89% virus inactivation rate. Thus, an irradiation dose of 23% of the maximal irradiation capacity of the virus inactivation unit can activate more than 99% of SARS-CoV-2. These findings are expected to enhance versatility in various applications. The downsizing achieved in our study renders the technology apt for installation in narrow spaces, while the enhanced flowrates establish its viability for implementation in larger facilities.

2D-GaN/AlN Multiple Quantum Disks/Quantum Well Heterostructures for High-Power Electron-Beam Pumped UVC Emitters.

This article describes GaN/AlN heterostructures for ultraviolet-C (UVC) emitters with multiple (up to 400 periods) two-dimensional (2D)-quantum disk/quantum well structures with the same GaN nominal thicknesses of 1.5 and 16 ML-thick AlN barrier layers, which were grown by plasma-assisted molecular-beam epitaxy in a wide range of gallium and activated nitrogen flux ratios (Ga/N2*) on c-sapphire substrates. An increase in the Ga/N2* ratio from 1.1 to 2.2 made it possible to change the 2D-topography of the structures due to a transition from the mixed spiral and 2D-nucleation growth to a purely spiral growth. As a result, the emission energy (wavelength) could be varied from 5.21 eV (238 nm) to 4.68 eV (265 nm) owing to the correspondingly increased carrier localization energy. Using electron-beam pumping with a maximum pulse current of 2 A at an electron energy of 12.5 keV, a maximum output optical power of 50 W was achieved for the 265 nm structure, while the structure emitting at 238 nm demonstrated a power of 10 W.

Temperature Field, Flow Field, and Temporal Fluctuations Thereof in Ammonothermal Growth of Bulk GaN-Transition from Dissolution Stage to Growth Stage Conditions.

With the ammonothermal method, one of the most promising technologies for scalable, cost-effective production of bulk single crystals of the wide bandgap semiconductor GaN is investigated. Specifically, etch-back and growth conditions, as well as the transition from the former to the latter, are studied using a 2D axis symmetrical numerical model. In addition, experimental crystal growth results are analyzed in terms of etch-back and crystal growth rates as a function of vertical seed position. The numerical results of internal process conditions are discussed. Variations along the vertical axis of the autoclave are analyzed using both numerical and experimental data. During the transition from quasi-stable conditions of the dissolution stage (etch-back process) to quasi-stable conditions of the growth stage, significant temperature differences of 20 K to 70 K (depending on vertical position) occur temporarily between the crystals and the surrounding fluid. These lead to maximum rates of seed temperature change of 2.5 K/min to 1.2 K/min depending on vertical position. Based on temperature differences between seeds, fluid, and autoclave wall upon the end of the set temperature inversion process, deposition of GaN is expected to be favored on the bottom seed. The temporarily observed differences between the mean temperature of each crystal and its fluid surrounding diminish about 2 h after reaching constant set temperatures imposed at the outer autoclave wall, whereas approximately quasi-stable conditions are reached about 3 h after reaching constant set temperatures. Short-term fluctuations in temperature are mostly due to fluctuations in velocity magnitude, usually with only minor variations in the flow direction.

Rectangular bone-patellar tendon bone grafts reduce early graft failure in chronic ACL-Deficient knees.

BACKGROUND: The aim of this study was to assess early graft failure after anterior cruciate ligament (ACL) reconstruction according to chronicity of ACL deficiency (ACLD) and clarify predisposing factors. METHODS: A total of 731 patients who underwent anatomic ACL reconstruction were divided into 3 groups based on chronicity of ACLD: <6 months (Group 1), 6 months to 2 years (Group 2), and >2 years (Group 3). Types of ACL grafts used included single-bundle hamstring tendon (HT), multiple-bundle HT, and rectangular bone-patellar tendon-bone (BTB) grafts. Preoperatively and immediately postoperatively, lateral radiographs in full extension were taken to examine anterior tibial subluxation (ATS). All ACL grafts were evaluated by MRI at 6 months to identify graft failure. The group with the highest failure rate was further examined to compare possible risk factors between the intact and failure subgroups, followed by multivariate logistic regression analysis to identify predisposing factors. RESULTS: Early graft failure on MRI without any episode of postoperative trauma was observed in 7 (1.4%), 2 (1.8%), and 11 (9.2%) patients in Groups 1, 2, and 3, respectively, with a significantly higher rate in Group 3 (P < 0.001). Of the 119 patients in Group 3, significant differences were observed between intact and failure subgroups with regard to surgical procedure (P = 0.03), chondral lesions (P < 0.01), and preoperative ATS (P < 0.01). Multivariate logistic regression analysis revealed that surgical procedures (odds ratio, 3.8; 95%CI, 1.16-12.59) and preoperative ATS (odd ratio, 2.4; 95%CI, 1.26-4.38) were predisposing factors of early graft failure. CONCLUSION: Patients with ACLD for >2 years experienced early graft failure with an incidence rate of 9.2%. Predisposing factors of early graft failure in these patients included the use of single-bundle HT grafts and preoperative ATS. The use of rectangular BTB grafts resulted in a lower graft failure rate. STUDY DESIGN: Case Series.

Changes in patellar height after anatomical ACL reconstruction with BTB autograft with a focus on patellar tendon removal volume.

BACKGROUND: Although anatomical anterior cruciate ligament reconstruction (ACLR) can provide satisfactory outcomes, little is known about how this procedure impacts patellar height. Since harvesting bone-patellar tendon-bone (BTB) autografts is a potential risk factor for decreased patellar height, we examined changes in patellar height after anatomical ACLR with BTB autograft with a focus on the size of the harvested graft. METHODS: Subjects were 84 patients (49 males, 35 females; mean age, 23 years) who underwent primary anatomical ACLR with central third BTB autograft. Preoperative to postoperative Caton-Deschamps index (CDI) ratio was calculated using lateral knee radiographs before and 6 months after surgery. The length and cross-sectional area (CSA) of the graft were measured intraoperatively, and the CSA of the contralateral patellar tendon was measured by ultrasound 6 months postoperatively. The difference in graft CSA relative to the contralateral tendon CSA, expressed as a percentage (gCSA:ctCSA percentage), was also calculated. RESULTS: Patellar height decreased slightly after surgery (preoperative CDI: 0.856 ± 0.113; postoperative CDI: 0.841 ± 0.113), with a mean difference between preoperative and postoperative CDIs of -0.015 (range: -0.293 to 0.101). Although the CDI of male subjects significantly decreased after surgery (preoperative: 0.852 ± 0.117; postoperative: 0.827 ± 0.115), no significant changes were noted in female subjects (preoperative: 0.862 ± 0.108; postoperative: 0.861 ± 0.108). Graft length and CSA did not significantly impact the CDI ratio (r = -0.138 and r = -0.038, respectively). Moreover, no significant relationship was observed between the gCSA:ctCSA percentage and CDI ratio (r = 0.118). CONCLUSIONS: Although patellar height slightly, but significantly, decreased at 6 months after anatomical ACLR with BTB autograft, it was not affected by the length and CSA of harvested grafts. The decrease in postoperative patellar height was observed only in male subjects, suggesting the potential importance of sex differences in soft tissue healing during the postoperative period.

Photon extraction enhancement of praseodymium ions in gallium nitride nanopillars.

Lanthanoid-doped Gallium Nitride (GaN) integrated into nanophotonic technologies is a promising candidate for room-temperature quantum photon sources for quantum technology applications. We manufactured praseodymium (Pr)-doped GaN nanopillars of varying size, and showed significantly enhanced room-temperature photon extraction efficiency compared to unstructured Pr-doped GaN. Implanted Pr ions in GaN show two main emission peaks at 650.3 nm and 651.8 nm which are attributed to 3P0-3F2 transition in the 4f-shell. The maximum observed enhancement ratio was 23.5 for 200 nm diameter circular pillars, which can be divided into the emitted photon extraction enhancement by a factor of 4.5 and the photon collection enhancement by a factor of 5.2. The enhancement mechanism is explained by the eigenmode resonance inside the nanopillar. Our study provides a pathway for Lanthanoid-doped GaN nano/micro-scale photon emitters and quantum technology applications.

Characteristics of collection and inactivation of virus in air flowing inside a winding conduit equipped with 280 nm deep UV-LEDs.

A general-purpose virus inactivation unit that can inactivate viruses was developed using deep ultraviolet (DUV) LEDs that emit DUV rays with a wavelength of 280 nm. The inside of the virus inactivation unit is a rectangular conduit with a sharp turn of 180° (sharp-turned rectangular conduit). Virus inactivation is attempted by directly irradiating the air passing through the conduit with DUV rays. The flow characteristics of air and virus particles inside the virus inactivation unit were investigated using numerical simulations. The air was locally accelerated at the sharp turn parts and flowed along the partition plate in the sharp-turned rectangular conduit. The aerosol particles moving in the sharp-turned rectangular conduit were greatly bent in orbit at the sharp turn parts, and then rapidly approached the partition plate at the lower part of the conduit. Consequently, many particles collided with the partition plates behind the sharp-turn parts. SARS-CoV-2 virus was nebulized in the virus inactivation unit, and the RNA concentration and virus inactivation rate with and without the emission of DUV-LEDs were measured in the experiment. The concentration of SARS-CoV-2 RNA was reduced to 60% through DUV-LED irradiation. In addition, SARS-CoV-2 passing through the virus inactivation unit was inactivated below the detection limit by the emission of DUV-LEDs. The virus inactivation rate and the value of the detection limit corresponded to 99.38% and 35.36 TCID50/mL, respectively.

High-Energy Computed Tomography as a Prospective Tool for In Situ Monitoring of Mass Transfer Processes inside High-Pressure Reactors-A Case Study on Ammonothermal Bulk Crystal Growth of Nitrides including GaN.

For the fundamental understanding and the technological development of the ammonothermal method for the synthesis and crystal growth of nitrides, an in situ monitoring technique for tracking mass transport of the nitride throughout the entire autoclave volume is desirable. The feasibility of using high-energy computed tomography for this purpose was therefore evaluated using ex situ measurements. Acceleration voltages of 600 kV were estimated to yield suitable transparency in a lab-scale ammonothermal setup for GaN crystal growth designed for up to 300 MPa operating pressure. The total scan duration was estimated to be in the order of 20 to 40 min, which was sufficient given the comparatively slow crystal growth speed in ammonothermal growth. Even shorter scan durations or, alternatively, lower acceleration voltages for improved contrast or reduced X-ray shielding requirements, were estimated to be feasible in the case of ammonoacidic growth, as the lower pressure requirements for this process variant allow for thinned autoclave walls in an adapted setup designed for improved X-ray transparency. Promising nickel-base and cobalt-base alloys for applications in ammonothermal reactors with reduced X-ray absorption in relation to the maximum operating pressure were identified. The applicability for the validation of numerical simulations of the growth process of GaN, in addition to the applicability of the technique to further nitride materials, as well as larger reactors and bulk crystals, were evaluated.

The Wound Dressing Influenced Effectiveness of Cryotherapy After Anterior Cruciate Ligament Reconstruction: Case-Control Study Comparing Gauze Versus Film Dressing.

Purpose: To compare the clinical effectiveness of cryotherapy after anterior cruciate ligament reconstruction using 2 different wound dressings, conventional postoperative gauze dressings and polyurethane semipermeable transparent film dressings. Methods: In total, 60 patients who had undergone arthroscopic anterior cruciate ligament reconstruction with an autogenous patellar tendon were assigned to 2 groups. The surgical wound was covered with 5 sheets of gauze with an elastic bandage (control group) in 30 patients and film dressing was used (film group) in the remaining 30 patients. Silicone drainage catheters were inserted at the intercondylar notch, beside the distal outlet of the tibial tunnel for 2 days. After 1 hour of cooling using the device, the knee was chilled with an ice bag every 2 hours until the next morning. The severity of pain was evaluated by the number of times an analgesic, 50 mg of diclofenac sodium suppositories, had to be administered in the 24 hours after surgery. The amount of drainage during the following 2 days, the range of motion at 21 days, the change of hemoglobin concentration at 1 and 7 days, and C-reactive protein (CRP) at 1 and 7 days were examined. Results: The number of patients who used an analgesic was 18 in the control group and 7 in the film group (P = .003). The amount of drainage was 165.2 ± 72.9 mL in the control group and 289.7 ± 77.6 mL in the film group (P < .001). The postoperative CRP value was 0.77 ± 0.65 mg/dL at 1 day in the control group and 0.39 ± 0.42 mg/dL in the film group (P = .009). No statistical difference was seen for hemoglobin concentration at 1 or 7 days, CRP at 7 days or range of motion at 21 days. Conclusions: In this study, we found that film dressing enhanced the effect of cryotherapy with respect to pain control, wound drainage, and inflammation immediately after surgery compared with traditional gauze dressing with elastic wrap. Level of Evidence: III, case-control study.

Laser slice thinning of GaN-on-GaN high electron mobility transistors.

As a newly developed technique to slice GaN substrates, which are currently very expensive, with less loss, we previously reported a laser slicing technique in this journal. In the previous report, from the perspective of GaN substrate processing, we could only show that the GaN substrate could be sliced by a laser and that the sliced GaN substrate could be reused. In this study, we newly investigated the applicability of this method as a device fabrication process. We demonstrated the thinning of GaN-on-GaN high-electron-mobility transistors (HEMTs) using a laser slicing technique. Even when the HEMTs were thinned by laser slicing to a thickness of 50 mm after completing the fabrication process, no significant fracture was observed in these devices, and no adverse effects of laser-induced damage were observed on electrical characteristics. This means that the laser slicing process can be applied even after device fabrication. It can also be used as a completely new semiconductor process for fabricating thin devices with thicknesses on the order of 10 mm, while significantly reducing the consumption of GaN substrates.

Interplay of sidewall damage and light extraction efficiency of micro-LEDs.

This Letter describes the impact of shape on micro light-emitting diodes (µLEDs), analyzing 400 µm2 area µLEDs with various mesa shapes (circular, square, and stripes). Appropriate external quantum efficiency (EQE) can yield internal quantum efficiency (IQE) which decreases with increasing peripheral length of the mesas. However, light extraction efficiency (ηe) increased with increasing mesa periphery. We introduce analysis of Jpeak (the current at peak EQE) since it is proportional to the non-radiative recombination. Etching the sidewalls using tetramethylammonium hydroxide (TMAH) increased the peak EQE and decreased the sidewall dependency of Jpeak. Quantitatively, the TMAH etching reduced non-radiative surface recombination by a factor of four. Hence, shrinking µLEDs needs an understanding of the relationship between non-radiative recombination and ηe, where analyzing Jpeak can offer new insights.

Isolated peripheral longitudinal tears in the anterior-middle segment of medial meniscus among young soccer players: A case series.

INTRODUCTION: There was little information about the isolated medial meniscal tears in the anterior-middle segment. This study aimed to report the infrequent cases of the isolated medial meniscal tears in the anterior-middle segment related to kicking motion among young soccer players with a short-term postoperative outcome. PRESENTATION OF CASE: In the retrospective review of the surgical records from 2000 to 2018, there were 15 cases with the corresponding tear. They were all young male soccer players with a mean age of 16.7 years (range: 10-23 years). The cause of injury was kicking motion during playing soccer in all the patients. The most frequent symptom was locking in 80% of the cases. In the arthroscopic evaluation, all the cases presented with a longitudinal (bucket-handle) tear in the anterior-middle segment in the peripheral zone with a length of 25 to 30 mm, while the posterior segment and the cruciate ligaments were intact. Meniscal repair was performed for all the cases. At one year, all the patients could return to play soccer with a pre-injury level without any symptoms. In the second-look arthroscopy at six months among four cases, all meniscal tears healed completely. DISCUSSION AND CONCLUSION: Clinicians should be aware of the possibility of isolated peripheral longitudinal tear in the anterior-middle segment of the medial meniscus, which is related to the kicking motion among young soccer players and mainly causes locking.

Smart-cut-like laser slicing of GaN substrate using its own nitrogen.

We have investigated the possibility of applying lasers to slice GaN substrates. Using a sub-nanosecond laser with a wavelength of 532 nm, we succeeded in slicing GaN substrates. In the laser slicing method used in this study, there was almost no kerf loss, and the thickness of the layer damaged by laser slicing was about 40 µm. We demonstrated that a standard high quality homoepitaxial layer can be grown on the sliced surface after removing the damaged layer by polishing.

[A Giant Right Coronary Artery Aneurysm:Report of a Case].

We report the case of a 49-year-old woman with a giant atherosclerotic thrombus-filled aneurysm of the right coronary artery. She was referred to our hospital because of abnormal finding of the chest X-ray. Echocardiography revealed a large cystic mass adjacent to the right atrium and computed tomography revealed a giant aneurysm of middle segment of the right coronary artery. Based on the size of the aneurysm, the patient underwent exclusion of the aneurysm by proximal and distal ligation and coronary artery bypass surgery. Giant coronary artery aneurysm is rare, and the management should be individualized depending on size, location, and clinical context.

The stability of graphene and boron nitride for III-nitride epitaxy and post-growth exfoliation.

A challenging approach, but one providing a key solution to material growth, remote epitaxy (RE)-a novel concept related to van der Waals epitaxy (vdWE)-requires the stability of a two-dimensional (2-D) material. However, when graphene, a representative 2-D material, is present on substrates that have a nitrogen atom, graphene loss occurs. Although this phenomenon has remained a hurdle for over a decade, restricting the advantages of applying graphene in the growth of III-nitride materials, few previous studies have been conducted. Here, we report the stability of graphene on substrates containing oxygen or nitrogen atoms. Graphene has been observed on highly decomposed Al2O3; however, graphene loss occurred on decomposed AlN at temperatures over 1300 °C. To overcome graphene loss, we investigated 2-D hexagonal boron nitride (h-BN) as an alternative. Unlike graphene on AlN, it was confirmed that h-BN on AlN was intact after the same high-temperature process. Moreover, the overgrown AlN layers on both h-BN/AlN and h-BN/Al2O3 could be successfully exfoliated, which indicates that 2-D h-BN survived after AlN growth and underlines its availability for the vdWE/RE of III-nitrides with further mechanical transfer. By enhancing the stability of the 2-D material on the substrate, our study provides insights into the realization of a novel epitaxy concept.