A Biomechanical Evaluation of Casting Technique and Cast Core Size Effect.

BACKGROUNDS: The goals of this study were to (1) compare the effect of casting technique on biomechanical function with different casting materials and different cast core diameters, and (2) compare the strength of a cast based on the number of layers in relation to the core diameter. METHODS: Two standardized cylindrical cast model sizes were used to simulate forearm and short leg casts (core diameter: 60 mm, 100 mm) with 2 different casting techniques (non-smoothing vs. smoothing with lamination), utilizing 2 casting materials [fiberglass and Plaster of Paris (POP)]. Each cast was created using 3 different layers (Fiberglass: 2 to 4 layers; POP: 3 to 5 layers). Ultimate load-to-failure and flexural rigidity were analyzed through cyclic 4-point bend testing. RESULTS: The biomechanical comparison between forearm and short leg casts were significantly different regardless of the same number of layers for both casting materials and between 2 casting techniques. Increased cast thickness significantly increased the ultimate load-to-failure and bending strength. An increased core diameter size significantly decreased the cast's ultimate load-to-failure (fiberglass: 50% to 108%; POP: 10% to 93%) and bending strength (fiberglass: 17% to 35%; POP: 37% to 49%). Casting technique with smoothing with lamination technique had a negative biomechanical effect on POP and a minimal effect on fiberglass. CONCLUSION: The number of layers to apply for a cast should be based on the size of the extremity. Smoothing and lamination technique did not significantly improve the cast mechanical behavior. CLINICAL RELEVANCE: The findings of this study provide valuable evidence, analysis, and supplementary knowledge that helps guide physicians in proper casting technique.

Tunable superconductivity and its origin at KTaO3 interfaces.

What causes Cooper pairs to form in unconventional superconductors is often elusive because experimental signatures that connect to a specific pairing mechanism are rare. Here, we observe distinct dependences of the superconducting transition temperature Tc on carrier density n2D for electron gases formed at KTaO3 (111), (001) and (110) interfaces. For the (111) interface, a remarkable linear dependence of Tc on n2D is observed over a range of nearly one order of magnitude. Further, our study of the dependence of superconductivity on gate electric fields reveals the role of the interface in mediating superconductivity. We find that the extreme sensitivity of superconductivity to crystallographic orientation can be explained by pairing via inter-orbital interactions induced by an inversion-breaking transverse optical phonon and quantum confinement. This mechanism is also consistent with the dependence of Tc on n2D. Our study may shed light on the pairing mechanism in other superconducting quantum paraelectrics.

Artificial Graphene Nanoribbons: A Test Bed for Topology and Low-Dimensional Dirac Physics.

We synthesize artificial graphene nanoribbons by positioning carbon monoxide molecules on a copper surface to confine its surface state electrons into artificial atoms positioned to emulate the low-energy electronic structure of graphene derivatives. We demonstrate that the dimensionality of artificial graphene can be reduced to one dimension with proper "edge" passivation, with the emergence of an effectively gapped one-dimensional nanoribbon structure. These one-dimensional structures show evidence of topological effects analogous to graphene nanoribbons. Guided by first-principles calculations, we spatially explore robust, zero-dimensional topological states by altering the topological invariants of quasi-one-dimensional artificial graphene nanostructures. The robustness and flexibility of our platform allow us to toggle the topological invariants between trivial and nontrivial on the same nanostructure. Ultimately, we spatially manipulate the states to understand fundamental coupling between adjacent topological states that are finely engineered and simulate complex Hamiltonians.

Athletic Shoulder Test Differences Exist Bilaterally in Healthy Pitchers.

Background: There is a lack of valid and reliable tests that assess upper extremity strength and function for rehabilitation and injury prevention purposes in throwing athletes. The Athletic Shoulder (ASH) test has been proposed as a reliable measure of shoulder strength, but has not yet been studied in baseball pitchers. Hypothesis/Purpose: The purpose of this study was to establish values for healthy baseball pitchers performing the ASH test, compare those values with other common tests of shoulder strength and function, and compare ASH test performance bilaterally. It was hypothesized that the dominant arm would perform significantly better on the ASH test compared to the non-dominant arm. A secondary purpose of the study was to evaluate if ASH test performance was related to fastball velocity in baseball pitchers. It was hypothesized that ASH test performance would positively correlate with fastball velocity. Study Design: Cross-Sectional Study. Methods: College and high school baseball pitchers were recruited to complete shoulder range of motion (ROM), isokinetic shoulder strength, and isometric shoulder strength testing using the ASH test. The ASH test was used to assess force production as a proxy for strength bilaterally at four levels of shoulder abduction (0°, 90°, 135°, and 180°), using a force plate. Approximately one-week later subjects returned for a bullpen session where fastball velocity was recorded with a radar gun. Bilateral differences in passive ROM, isokinetic, and isometric shoulder strength were examined using paired t-tests while linear relationships between isometric shoulder strength and fastball velocity were assessed using Pearson correlations. Results: Thirty-five healthy pitchers participated in the study (19.7 ± 1.8 years). Pitchers demonstrated significantly greater isometric shoulder strength at the 90° and 135° abduction positions with the throwing arm compared to the non-throwing arm. Pitchers also demonstrated commonly observed musculoskeletal adaptations in the throwing arm such as increased passive external rotation, decreased passive internal rotation, and greater internal and external rotator strength during isokinetic testing. Peak force production during the ASH test was not related to fastball velocity. Conclusion: The ASH test is capable of detecting bilateral shoulder strength adaptations commonly observed in other clinical tests in healthy pitchers. Pitchers demonstrated greater isometric peak force during the ASH test at levels of shoulder abduction similar to those observed in pitching. While these results may be intriguing for clinical use, peak force from the ASH test was not correlated to fastball velocity in pitchers, and therefore should be used with caution for predictions in this realm. Level of Evidence: 2. Clinical Relevance: A need exists for objective measures of shoulder strength for rehabilitation and injury risk monitoring in throwing athletes that are easy to administer, have high reliability and validity, and provide minimal re-injury risk to athletes recovering from injury. What is known about the subject: Data from the ASH test has been published previously in non-throwing athletes and was shown to be valid and reliable in that group. However, the test has not been explored widely in throwing athletes who are known to have significant musculoskeletal adaptations to the throwing shoulder. What this study adds to existing knowledge: The results from this study confirm that the ASH test is sensitive enough to detect the adaptations that are present in the healthy throwing athlete's shoulder. Due to the prior proven validity and reliability and these results, the test can be used to monitor throwing arm strength and function during rehabilitation or as a pre/intra-season screening tool to help describe arm health.

Two Distinct Cu(II)-V(IV) Superexchange Interactions with Similar Bond Angles in a Triangular "CuV2" Fragment.

The strength and sign of superexchange interactions are often predicted on the basis of the bond angles between magnetic ions, but complications may arise in situations with a nontrivial arrangement of the magnetic orbitals. We report on a novel molecular tetramer compound [Cu(H2O)dmbpy]2[V2O2F8] (dmbpy = 4,4'-dimethyl-2,2'-bipyridyl) that is composed of triangular "CuV2" fragments and displays a spin gap behavior. By combining first-principles calculations and electronic models, we reveal that superexchange Cu-V interactions carry drastically different coupling strengths along two Cu-F-V pathways with comparable bond angles in the triangular "CuV2" fragment. Counterintuitively, their strong disparity is found to originate from the restricted symmetry of the half-filled Cu dx2-y2 orbital stabilized by the crystal field, leading to one dominating antiferromagnetic Cu-V coupling in each fragment. We revisit the magnetic properties of the reported spin-gapped chain compound [enH2]Cu(H2O)2[V2O2F8] (enH2 = ethylene diammonium) containing similar triangular "CuV2" fragments, and the magnetic behavior of the molecular tetramer and the chain compounds is rationalized as that of weakly coupled spin dimers and spin trimers, respectively. This work demonstrates that fundamentally different magnetic couplings can be observed between magnetic ions with similar bond angles in a single spin motif, thus providing a strategy to introduce various exchange interactions combined with low dimensionality in heterometallic Cu(II)-V(IV) compounds.

Thumb and Index Finger Amputation after Radial Artery Occlusion in a Patient with COVID-19.

The pathophysiology and predictability of radial artery thromboembolic events in patients with COVID-19 is not fully understood. We report a case of thumb and index finger gangrene and multiple digit amputations secondary to digital artery occlusion after radial artery cannulation in a patient admitted with COVID-19 pneumonia and encephalopathy. The exact association, causality, and potential hand manifestations in this patient population is unclear at this time, but is of particular interest in the current state of the pandemic.

Angiotensin II type 1 receptor agonistic autoantibody blockade improves postpartum hypertension and cardiac mitochondrial function in rat model of preeclampsia.

Women with preeclampsia (PE) have a greater risk of developing hypertension, cardiovascular disease (CVD), and renal disease later in life. Angiotensin II type I receptor agonistic autoantibodies (AT1-AAs) are elevated in women with PE during pregnancy and up to 2-year postpartum (PP), and in the reduced uterine perfusion pressure (RUPP) rat model of PE. Blockade of AT1-AA with a specific 7 amino acid peptide binding sequence ('n7AAc') improves pathophysiology observed in RUPP rats; however, the long-term effects of AT1-AA inhibition in PP is unknown. Pregnant Sprague Dawley rats were divided into three groups: normal pregnant (NP) (n = 16), RUPP (n = 15), and RUPP + 'n7AAc' (n = 16). Gestational day 14, RUPP surgery was performed and 'n7AAc' (144 µg/day) administered via osmotic minipump. At 10-week PP, mean arterial pressure (MAP), renal glomerular filtration rate (GFR) and cardiac functions, and cardiac mitochondria function were assessed. MAP was elevated PP in RUPP vs. NP (126 ± 4 vs. 116 ± 3 mmHg, p < 0.05), but was normalized in in RUPP + 'n7AAc' (109 ± 3 mmHg) vs. RUPP (p < 0.05). PP heart size was reduced by RUPP + 'n7AAc' vs. RUPP rats (p < 0.05). Complex IV protein abundance and enzymatic activity, along with glutamate/malate-driven respiration (complexes I, III, and IV), were reduced in the heart of RUPP vs. NP rats which was prevented with 'n7AAc'. AT1-AA inhibition during pregnancy not only improves blood pressure and pathophysiology of PE in rats during pregnancy, but also long-term changes in blood pressure, cardiac hypertrophy, and cardiac mitochondrial function PP.

Electric field control of magnon spin currents in an antiferromagnetic insulator.

Pure spin currents can be generated via thermal excitations of magnons. These magnon spin currents serve as carriers of information in insulating materials, and controlling them using electrical means may enable energy efficient information processing. Here, we demonstrate electric field control of magnon spin currents in the antiferromagnetic insulator Cr2O3. We show that the thermally driven magnon spin currents reveal a spin-flop transition in thin-film Cr2O3. Crucially, this spin-flop can be turned on or off by applying an electric field across the thickness of the film. Using this tunability, we demonstrate electric field­induced switching of the polarization of magnon spin currents by varying only a gate voltage while at a fixed magnetic field. We propose a model considering an electric field­dependent spin-flop transition, arising from a change in sublattice magnetizations via a magnetoelectric coupling. These results provide a different approach toward controlling magnon spin current in antiferromagnets.

One-Dimensional Lateral Force Anisotropy at the Atomic Scale in Sliding Single Molecules on a Surface.

Using a q+ atomic force microscopy at low temperature, a sexiphenyl molecule is slid across an atomically flat Ag(111) surface along the direction parallel to its molecular axis and sideways to the axis. Despite identical contact area and underlying surface geometry, the lateral force required to move the molecule in the direction parallel to its molecular axis is found to be about half of that required to move it sideways. The origin of the lateral force anisotropy observed here is traced to the one-dimensional shape of the molecule, which is further confirmed by molecular dynamics simulations. We also demonstrate that scanning tunneling microscopy can be used to determine the comparative lateral force qualitatively. The observed one-dimensional lateral force anisotropy may have important implications in atomic scale frictional phenomena on materials surfaces.

Two-dimensional superconductivity and anisotropic transport at KTaO3 (111) interfaces.

The distinctive electronic structure found at interfaces between materials can allow unconventional quantum states to emerge. Here we report on the discovery of superconductivity in electron gases formed at interfaces between (111)-oriented KTaO3 and insulating overlayers of either EuO or LaAlO3 The superconducting transition temperature, as high as 2.2 kelvin, is about one order of magnitude higher than that of the LaAlO3/SrTiO3 system. Notably, similar electron gases at KTaO3 (001) interfaces remain normal down to 25 millikelvin. The critical field and current-voltage measurements indicate that the superconductivity is two-dimensional. In EuO/KTaO3 (111) samples, a spontaneous in-plane transport anisotropy is observed before the onset of superconductivity, suggesting the emergence of a distinct "stripe"-like phase, which is also revealed near the critical field.

Does Surgeon Subspecialty Training Affect Outcomes in the Treatment of Displaced Supracondylar Humerus Fractures in Children?

INTRODUCTION: The effect of the treating surgeon's subspecialty training on the outcomes of managing displaced supracondylar humerus fractures in the pediatric cohort remains under debate. The objective of this study was to examine patient outcomes and treatment variables for these injuries based on the surgeon subspecialty training. METHODS: A retrospective study of children who had undergone primary closed reduction and percutaneous fixation for displaced supracondylar humerus fractures was done from January 2012 through May 2019. The following four groups with differing orthopaedic subspecialty training were evaluated: (1) pediatric fellowship trained (2) trauma fellowship trained, (3) sports medicine fellowship trained, and (4) all others. Outcomes examined included time to surgery, surgical time, fluoroscopy usage, postoperative follow-up protocols, radiographic measurements of alignment, and complications between surgeon groups. RESULTS: Two hundred thirty-one cases were included (mean age 6 ± 2 years). Pediatric fellowship-trained surgeons took patients to surgery in a more delayed fashion (>12 hours, P = 0.02). Surgical time and fluoroscopy usage were significantly shorter for pediatric fellowship-trained surgeons (P < 0.001). No statistical difference was noted in pin configuration constructs between the groups. Pediatric fellowship-trained surgeons, on average, saw patients two times postoperatively within a year with most patients being within 30 days. Complications were not statistically different between the groups. CONCLUSIONS: Pediatric fellowship-trained orthopaedic surgeons provide more efficient care on a more delayed basis for displaced supracondylar humerus fractures than other subspecialty-trained orthopaedic surgeons. However, if barriers exist that limit the practicality or availability of these specialists, nonpediatric fellowship-trained surgeons achieve similar and satisfactory outcomes. LEVEL OF EVIDENCE: Level III retrospective cohort study.

Angiotensin II type 1 receptor autoantibody blockade improves cerebral blood flow autoregulation and hypertension in a preclinical model of preeclampsia.

Introduction:Women with preeclampsia (PE) and reduced uterine perfusion pressure (RUPP) pre-clinical rat model of PE have elevated angiotensin II type 1 receptor agonistic autoantibodies (AT1-AA) and cerebrovascular dysfunction. Methods:Sprague Dawley rats had RUPP surgery with/without AT1-AA inhibitor ('n7AAc'144 µg/day) osmotic minipumps. Mean arterial pressure (MAP), CBF autoregulation, blood brain barrier (BBB) permeability, cerebral edema, oxidative stress, and eNOS were assessed. Results:'n7AAc' improved MAP, restored CBF autoregulation, prevented cerebral edema, elevated oxidative stress, and increased phosphorylated eNOS protein in RUPP rats. Conclusion:Inhibiting the AT1-AA in placental ischemic rats prevents hypertension, cerebrovascular dysfunction, and improves cerebral metabolic function.

Negative differential resistance observed on the charge density wave of a transition metal dichalcogenide.

Charge density waves and negative differential resistance are seemingly unconnected physical phenomena. The former is an ordered quantum fluid of electrons, intensely investigated for its relation with superconductivity, while the latter receives much attention for its potential applications in electronics. Here we show that these two phenomena can not only coexist but also that the localized electronic states of the charge density wave are essential to induce negative differential resistance in a transition metal dichalcogenide, 1T-TaS2. Using scanning tunneling microscopy and spectroscopy, we report the observation of negative differential resistance in the commensurate charge density wave state of 1T-TaS2. The observed phenomenon is explained by the interplay of interlayer and intra-layer tunneling with the participation of the atomically localized states of the charge density wave maxima and minima. We demonstrate that lattice defects can locally affect the coupling between the layers and are therefore a mechanism to realize NDR in these materials.

Borophene Synthesis on Au(111).

Borophene (the first two-dimensional (2D) allotrope of boron) is emerging as a groundbreaking system for boron-based chemistry and, more broadly, the field of low-dimensional materials. Exploration of the phase space for growth is critical because borophene is a synthetic 2D material that does not have a bulk layered counterpart and thus cannot be isolated via exfoliation methods. Herein, we report synthesis of borophene on Au(111) substrates. Unlike previously studied growth on Ag substrates, boron diffuses into Au at elevated temperatures and segregates to the surface to form borophene islands as the substrate cools. These observations are supported by ab initio modeling of interstitial boron diffusion into the Au lattice. Borophene synthesis also modifies the surface reconstruction of the Au(111) substrate, resulting in a trigonal network that templates growth at low coverage. This initial growth is composed of discrete borophene nanoclusters, whose shape and size are consistent with theoretical predictions. As the concentration of boron increases, nanotemplating breaks down and larger borophene islands are observed. Spectroscopic measurements reveal that borophene grown on Au(111) possesses a metallic electronic structure, suggesting potential applications in 2D plasmonics, superconductivity, interconnects, electrodes, and transparent conductors.

Novel ALD Chemistry Enabled Low-Temperature Synthesis of Lithium Fluoride Coatings for Durable Lithium Anodes.

Lithium metal anodes can largely enhance the energy density of rechargeable batteries because of the high theoretical capacity and the high negative potential. However, the problem of lithium dendrite formation and low Coulombic efficiency (CE) during electrochemical cycling must be solved before lithium anodes can be widely deployed. Herein, a new atomic layer deposition (ALD) chemistry to realize the low-temperature synthesis of homogeneous and stoichiometric lithium fluoride (LiF) is reported, which then for the first time, as far as we know, is deposited directly onto lithium metal. The LiF preparation is performed at 150 °C yielding 0.8 Å/cycle. The LiF films are found to be crystalline, highly conformal, and stoichiometric with purity levels >99%. Nanoindentation measurements demonstrate the LiF achieving a shear modulus of 58 GPa, 7 times higher than the sufficient value to resist lithium dendrites. When used as the protective coating on lithium, it enables a stable Coulombic efficiency as high as 99.5% for over 170 cycles, about 4 times longer than that of bare lithium anodes. The remarkable battery performance is attributed to the nanosized LiF that serves two critical functions simultaneously: (1) the high dielectric value creates a uniform current distribution for excellent lithium stripping/plating and ultrahigh mechanical strength to suppress lithium dendrites; (2) the great stability and electrolyte isolation by the pure LiF on lithium prevents parasitic reactions for a much improved CE. This new ALD chemistry for conformal LiF not only offers a promising avenue to implement lithium metal anodes for high-capacity batteries but also paves the way for future studies to investigate failure and evolution mechanisms of solid electrolyte interphase (SEI) using our LiF on anodes such as graphite, silicon, and lithium.

Prior Anterior Cruciate Ligament Reconstruction Effects on Future Total Knee Arthroplasty.

BACKGROUND: The impact of prior anterior cruciate ligament (ACL) reconstruction on total knee arthroplasty (TKA) has rarely been studied. The objective of this study was to compare intraoperative characteristics in patients who underwent TKA with pre-existing hardware from prior ACL reconstruction with a matched cohort control group. METHODS: A retrospective study of patients who had undergone primary TKA with pre-existing hardware from prior ACL reconstruction was performed from June 2012 through June 2017. These patients were 2-to-1 matched to the ACL group based on similar patient demographic and provider variables. Outcomes investigated included operative time, estimated blood loss (EBL), and postoperative complications. RESULTS: One hundred one patients met the inclusion/exclusion criteria. The mean age was 54 ± 9 years, and the mean body mass index was 32.6 ± 6.5 kg/m2. The ACL group was divided into 4 subgroups: group 1, no pre-existing hardware removed (22 TKAs); group 2, pre-existing hardware removed from the femur only (8 TKAs); group 3, pre-existing hardware removed from the tibia only (45 TKAs); and group 4, pre-existing hardware removed from both the femur and tibia (26 TKAs). There was no statistical difference in EBL and postoperative complication between the ACL group and controls. Statistical differences were detected between 2 subgroups regarding mean operative time variables: ACL group 3 (74 ± 23 minutes; control: 64 ± 21 minutes, P = .020) and group 4 (79 ± 24 minutes; control: 65 ± 19 minutes, P = .010). CONCLUSION: Hardware retained, especially on the tibia, from prior ACL reconstruction has a major impact on TKA surgical procedure operative time but not on EBL and/or complications.

Anomalous Kondo resonance mediated by semiconducting graphene nanoribbons in a molecular heterostructure.

Kondo resonances in heterostructures formed by magnetic molecules on a metal require free host electrons to interact with the molecular spin and create delicate many-body states. Unlike graphene, semiconducting graphene nanoribbons do not have free electrons due to their large bandgaps, and thus they should electronically decouple molecules from the metal substrate. Here, we observe unusually well-defined Kondo resonances in magnetic molecules separated from a gold surface by graphene nanoribbons in vertically stacked heterostructures. Surprisingly, the strengths of Kondo resonances for the molecules on graphene nanoribbons appear nearly identical to those directly adsorbed on the top, bridge and threefold hollow sites of Au(111). This unexpectedly strong spin-coupling effect is further confirmed by density functional calculations that reveal no spin-electron interactions at this molecule-gold substrate separation if the graphene nanoribbons are absent. Our findings suggest graphene nanoribbons mediate effective spin coupling, opening a way for potential applications in spintronics.Semiconducting graphene nanoribbon provides a platform for band-gap engineering desired for electronic and optoelectronic applications. Here, Li et al. show that graphene nanoribbon can effectively mediate the interaction of molecular magnetic moment and electronic spin in underlying metallic substrates.

Cervical cancer: A global health crisis.

Cervical cancer is the fourth most common malignancy diagnosed in women worldwide. Nearly all cases of cervical cancer result from infection with the human papillomavirus, and the prevention of cervical cancer includes screening and vaccination. Primary treatment options for patients with cervical cancer may include surgery or a concurrent chemoradiotherapy regimen consisting of cisplatin-based chemotherapy with external beam radiotherapy and brachytherapy. Cervical cancer causes more than one quarter of a million deaths per year as a result of grossly deficient treatments in many developing countries. This warrants a concerted global effort to counter the shocking loss of life and suffering that largely goes unreported. This article provides a review of the biology, prevention, and treatment of cervical cancer, and discusses the global cervical cancer crisis and efforts to improve the prevention and treatment of the disease in underdeveloped countries. Cancer 2017;123:2404-12. © 2017 American Cancer Society.

Cervix Cancer Research Network (CCRN): Improving Access to Cervix Cancer Trials on a Global Scale.

Eighty-seven percent of cervix cancer occurs in less-developed regions of the world, and there is up to an 18-fold difference in mortality rate for cervix cancer depending on the region of the world. The Cervix Cancer Research Network (CCRN) was founded through the Gynecologic Cancer InterGroup with the aim of improving access to clinical trials in cervix cancer worldwide, and in so doing improving standards of care. The CCRN recently held its first international educational symposium in Bangkok. Sixty-two participants attended from 16 different countries including Pakistan, India, Bangladesh, Thailand, Malaysia, Singapore, Philippines, Taiwan, China, Vietnam, Korea, Japan, Columbia, Brazil, Canada, and the United States. The focus of this symposium was to evaluate progress, to promote new clinical trials for the CCRN, and to provide education regarding the role of brachytherapy in the treatment of cervical cancer.