Continuous Scanning and Inching in Ultrasonographic Localisation of Ulnar Neuropathy: A Comparative Study of Sensitivity.

Background: This study compares the sensitivity of continuous ultrasonographic scanning and ultrasonographic inching in the localisation of ulnar neuropathy at the elbow to diagnose the two common entrapment sites: retroepicondylar groove and cubital tunnel. Methods: The charts of 30 patients who were diagnosed with ulnar neuropathy of the elbow and underwent ultrasonographic examinations using the inching and the continuous technique between April 2015 and September 2019 were reviewed. Sensitivities of ultrasonographic inching and continuous scanning were compared. Results: A total of 34 elbows from 30 patients were examined. The sensitivities of continuous ultrasonographic scanning method and ultrasonographic inching were 85% and 71%, respectively, but this was not significant (p = 0.06). The maximum cross-sectional areas (CSAs) in continuous scanning were mainly found within the area from the medial epicondyle to the 2-cm distal point in the cubital tunnel entrapment, while a majority of the largest CSAs in ultrasonographic inching was observed at the medial epicondyle level in both entrapment sites. The mean of the maximum CSAs in continuous scanning (17.04 ± 6.75 mm2) was higher than that in ultrasonographic inching (14.13 ± 6.63 mm2), although this difference remained non-significant (p = 0.08). However, continuous scanning differed more significantly (p < 0.0001) from the cut-off value than the ultrasonographic inching (p < 0.0066). Conclusions: Continuous scanning might be more suitable than ultrasonographic inching to localise ulnar neuropathy, which inherently has variations in the cubital tunnel anatomy and its entrapment points, when selecting optimal treatment based on the entrapment site. Level of Evidence: Level III (Diagnostic).

Partial trapeziectomy for Eaton stage III thumb carpometacarpal arthritis: ligament reconstruction with tendon interposition using the entire flexor carpi radialis and interference screw fixation.

BACKGROUND: Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is currently the most popular technique for treating primary osteoarthritis of the thumb carpometacarpal joint. However, reduced trapezial height has sometimes been reported after LRTI. Longer immobilization and delayed rehabilitation times are also problematic. In this study, we evaluated the clinical and radiological outcomes of patients who underwent our modified LRTI procedure. METHODS: Retrospective study included 26 thumbs in 24 cases with advanced stages. Our modified Burton's procedure was as follows: (1) trapeziectomy was limited to distal-half, (2) the entire flexor carpi radialis (FCR) was harvested from the forearm, and (3) half-slip of the FCR tendon was stabilized by interference screw in the first metacarpal bone tunnel. RESULTS: Pain on the visual analogue scale (VAS), the quick Disabilities of the Arm Shoulder and Hand score, tip pinch strength significantly improved postoperatively. The preoperative height of the trapezial space was well-maintained at final follow-up. Magnetic resonance imaging at the one-year follow-up showed the existence of FCR tendon ball in 15 cases. Eighteen housewives resumed their daily activities after a mean period of 10 days postoperative, while another 6 patients returned to their original jobs after 3 weeks. CONCLUSIONS: Our modified LRTI method involves distal-half trapeziectomy and entire FCR interposition. A sewn FCR tendon ball always provide enough volume to fill the trapeziectomy space, which helps to prevent sinking of the metacarpal bone. Our technique produced sufficient ligamentoplasty and allowed early mobilization after surgery.

In-process measurement of a keyhole using a low-coherence interferometer with a high repetition rate.

The shape of an instance hole (keyhole) created via a high-power laser was measured using a low-coherence interferometer with the following parameters: repetition rate, 10 MHz; center wavelength, 1550 nm; absolute spatial resolution, 10 µm; and measurement range, 5 mm. The keyhole was created on a 3-mm-thick stainless-steel plate using a high-power laser with 8-kW peak power and 1070-nm center wavelength. The cross-sectional area of the keyhole was measured to be 0.42 mm × 0.78 mm (width × depth) using the interferometer, and its side dimension was 0.46 mm × 0.78 mm (width × depth).

Crystal structure of Nanoarchaeum equitans tyrosyl-tRNA synthetase and its aminoacylation activity toward tRNATyr with an extra guanosine residue at the 5'-terminus.

tRNATyr of Nanoarchaeum equitans has a remarkable feature with an extra guanosine residue at the 5'-terminus. However, the N. equitans tRNATyr mutant without extra guanosine at the 5'-end was tyrosylated by tyrosyl-tRNA synthase (TyrRS). We solved the crystal structure of N. equitans TyrRS at 2.80 Å resolution. By comparing the present solved structure with the complex structures TyrRS with tRNATyr of Thermus thermophilus and Methanocaldococcus jannaschii, an arginine substitution mutant of N. equitans TyrRS at Ile200 (I200R), which is the putative closest candidate to the 5'-phosphate of C1 of N. equitans tRNATyr, was prepared. The I200R mutant tyrosylated not only wild-type tRNATyr but also the tRNA without the G-1 residue. Further tyrosylation analysis revealed that the second base of the anticodon (U35), discriminator base (A73), and C1:G72 base pair are strong recognition sites.

Bose-Einstein condensation superconductivity induced by disappearance of the nematic state.

The crossover from the superconductivity of the Bardeen-Cooper-Schrieffer (BCS) regime to the Bose-Einstein condensation (BEC) regime holds a key to understanding the nature of pairing and condensation of fermions. It has been mainly studied in ultracold atoms, but in solid systems, fundamentally previously unknown insights may be obtained because multiple energy bands and coexisting electronic orders strongly affect spin and orbital degrees of freedom. Here, we provide evidence for the BCS-BEC crossover in iron-based superconductors FeSe1 - x S x from laser-excited angle-resolved photoemission spectroscopy. The system enters the BEC regime with x = 0.21, where the nematic state that breaks the orbital degeneracy is fully suppressed. The substitution dependence is opposite to the expectation for single-band superconductors, which calls for a new mechanism of BCS-BEC crossover in this system.

Massive Suppression of Proximity Pairing in Topological (Bi_{1-x}Sb_{x})_{2}Te_{3} Films on Niobium.

Interfacing bulk conducting topological Bi_{2}Se_{3} films with s-wave superconductors initiates strong superconducting order in the nontrivial surface states. However, bulk insulating topological (Bi_{1-x}Sb_{x})_{2}Te_{3} films on bulk Nb instead exhibit a giant attenuation of surface superconductivity, even for films only two layers thick. This massive suppression of proximity pairing is evidenced by ultrahigh-resolution band mappings and by contrasting quantified superconducting gaps with those of heavily n-doped topological Bi_{2}Se_{3}/Nb. The results underscore the limitations of using superconducting proximity effects to realize topological superconductivity in nearly intrinsic systems.

Combination of Extracorporeally-irradiated Autograft and Vascularized Bone Graft for Reconstruction of Malignant Musculoskeletal Tumor.

BACKGROUND: Reconstruction after wide resection of a malignant musculoskeletal tumor is challenging. We performed biological reconstruction with an extracorporeally-irradiated autograft in combination with a vascularized bone graft. PATIENTS AND METHODS: Fifteen patients who underwent curative resection of malignant musculoskeletal tumor followed by reconstruction with this method were included. Oncological outcomes, survival of the graft, radiological findings and functional outcomes were reviewed. RESULTS: No local recurrences were detected from the irradiated bones, and 93% of the vascularized bone grafts survived. The mean MSTS score was 24.8 in all cases, 22.9 in the osteoarticular cases, and 27 in the intercalary cases. The intercalary tibia cases showed excellent results with a mean MSTS score of 29.3. CONCLUSION: This method has the advantage of combining the mechanical quality of an irradiated autograft and biological quality of a vascularized bone graft. The best indication of this method is for intercalary defects of the tibia.

Unidirectional Porous ß-Tricalcium Phosphate: A New Bone Filling Substitute for Treatment of Distal Radius Fracture in the Elderly Population.

Background: A new beta-tricalcium phosphate with unidirectional pore structure (UDPTCP), Affinos® (Kurray, Okayama, Japan), has been in clinical use since 2015. To date, there have been only a few clinical studies using this material. We report here the first clinical study for distal radial fracture in the elderly population treated with UDPTCP. Methods: Consecutive patients aged 65 years or older with dorsally displaced unstable fracture of the distal radius (n = 36) were treated operatively in our department. Following reduction of the fracture site, a 7 mm size cube of UDPTCP was placed in the gap of the bony defect and the fracture stabilized with mono-axial or poly-axial type locking plates and screws. Remodeling of the UDPTCP was evaluated by plain radiograph and clinical outcomes were also assessed. Results: UDPTCP was significantly resorbed at 2 months after surgery, both at the center and periphery of the material. Complications were only observed in the post-operative period. Significant correction loss of radial alignment was seen in patients stabilized with poly-axial locking plate. The clinical outcome in all cases was excellent. Conclusions: Block UDPTCP is a safe and convenient material for the treatment of distal radius fracture and is replaced within a suitable time period after grafting into the fracture site. UDPTCP and stable internal fixation is therefore a reliable strategy for restoring and preserving anatomical position, especially in the elderly population.

Cross-Shaped Bone Grafting and Locking Plate Fixation for Arthrodesis of the Trapeziometacarpal Joint: Surgical Technique and Early Mobilization.

BACKGROUND: The trapeziometacarpal joint is the second most common site of osteoarthritis in the hand and the most frequent one to require surgery. Arthrodesis of the trapeziometacarpal joint is recognized as one of the valuable technique but unfortunately there has been wide variation in the union rate. The purpose of this study was to evaluate a new arthrodesis technique involving a cross-shaped bone graft and locking plate fixation. METHODS: Eleven male patients diagnosed as Eaton's stage III osteoarthritis of the trapeziometacarpal join were treated in our institute. The mean patient age was 62 years (range 50 to 80 years). At the day after surgery, physical therapy was started and free use of the hand was permitted. RESULTS: Patients showed radiographic evidence of trapeziometacarpal joint union after an average postoperative period of 8.3 weeks (range 6-12 weeks). The VAS pain score significantly decreased from 7.2 points preoperatively to 0.4 points after surgery. Mean side pinch strength increased significantly from 3.8 kg (53% compared to unaffected side) prior to surgery to 6.2 kg (86%). The DASH score improved from 38.6 (range 34.1-43.2) preoperatively to 17.0 (6.8-22.7) postoperatively. CONCLUSIONS: These data suggested that our technique is a successful procedure for the trapeziometacarpal joint arthrodesis. Cross-shaped bone grafts have the advantages of restoring thumb length and providing internal stabilization, especially for rotational force. No complications arose at the bone harvest site of the iliac crest. The procedure seems to be technically demanding, particularly for adapting the bone graft to perfectly match the shape of the defect.

Continuous infusion of PTH1-34 delayed fracture healing in mice.

Hyperparathyroidism, which is increased parathyroid hormone (PTH) levels in the blood, could cause delayed or non-union of bone fractures. But, no study has yet demonstrated the effects of excess continuous PTH exposure, such as that seen in hyperparathyroidism, for fracture healing. Continuous human PTH1-34 (teriparatide) infusion using an osmotic pump was performed for stabilized tibial fractures in eight-week-old male mice to determine the relative bone healing process compared with saline treatment. Radiographs and micro-computed tomography showed delayed but increased calcified callus formation in the continuous PTH1-34 infusion group compared with the controls. Histology and quantitative histomorphometry confirmed that continuous PTH1-34 treatment significantly increased the bone callus area at a later time point after fracture, since delayed endochondral ossification occurred. Gene expression analyses showed that PTH1-34 resulted in sustained Col2a1 and reduced Col10a1 expression, consistent with delayed maturation of the cartilage tissue during fracture healing. In contrast, continuous PTH1-34 infusion stimulated the expression of both Bglap and Acp5 through the healing process, in accordance with bone callus formation and remodeling. Mechanical testing showed that continuously administered PTH1-34 increased the maximum load on Day 21 compared with control mice. We concluded that continuous PTH1-34 infusion resulted in a delayed fracture healing process due to delayed callus cell maturation but ultimately increased biomechanical properties.

Superconducting pairing of topological surface states in bismuth selenide films on niobium.

A topological insulator film coupled to a simple isotropic s-wave superconductor substrate can foster helical pairing of the Dirac fermions associated with the topological surface states. Experimental realization of such a system is exceedingly difficult, however using a novel "flip-chip" technique, we have prepared single-crystalline Bi2Se3 films with predetermined thicknesses in terms of quintuple layers (QLs) on top of Nb substrates fresh from in situ cleavage. Our angle-resolved photoemission spectroscopy (ARPES) measurements of the film surface disclose superconducting gaps and coherence peaks of similar magnitude for both the topological surface states and bulk states. The ARPES spectral map as a function of temperature and film thickness up to 10 QLs reveals key characteristics relevant to the mechanism of coupling between the topological surface states and the superconducting Nb substrate; the effective coupling length is found to be much larger than the decay length of the topological surface states.

Diffuse Pigmented Villonodular Synovitis Around the Ankle.

BACKGROUND: Pigmented villonodular synovitis (PVNS) is a rare disorder around the ankle joint. The optimal treatment for diffuse-type PVNS is still controversial because of the high incidence of recurrence. We present the clinical features of our patients and review the current diagnostic and treatment modalities. METHODS: Five patients with PVNS located around the ankle were surgically treated. In three patients, diffuse PVNS arose from the ankle joint, and in the other two it arose from the calcaneocuboid and intercuneiform joints. The average follow-up time after surgery was 2.9 years (range, 2-4.6 years). RESULTS: The average time between onset of pain and diagnosis of PVNS was 6.4 years (range, 4-10 years). Arthrotomic tumor resection was performed in all of the patients. In the three patients with ankle joint PVNS, both medial and lateral approaches were used. One patient experienced mild infection at the surgical site, but this healed conservatively. No tumor recurrences had occurred after minimum follow-up of 2 years, although mild pain persisted in the three patients with ankle PVNS. CONCLUSIONS: Diagnosis of diffuse PVNS is frequently delayed due to vague symptoms and variable growth patterns. Orthopedic clinicians should be aware of the existence of this lesion, and it should be suspected in patients with persistent ankle swelling. To prevent tumor recurrence, accurate evaluation of tumor location and careful operative planning are mandatory. A combined surgical approach involving medial and lateral incision is necessary to expose the entire joint cavity.

Observation of topological superconductivity on the surface of an iron-based superconductor.

Topological superconductors are predicted to host exotic Majorana states that obey non-Abelian statistics and can be used to implement a topological quantum computer. Most of the proposed topological superconductors are realized in difficult-to-fabricate heterostructures at very low temperatures. By using high-resolution spin-resolved and angle-resolved photoelectron spectroscopy, we find that the iron-based superconductor FeTe1-x Se x (x = 0.45; superconducting transition temperature Tc = 14.5 kelvin) hosts Dirac-cone-type spin-helical surface states at the Fermi level; the surface states exhibit an s-wave superconducting gap below Tc Our study shows that the surface states of FeTe0.55Se0.45 are topologically superconducting, providing a simple and possibly high-temperature platform for realizing Majorana states.

Ulnar nerve palsy caused by synovial protrusion in synovial chondromatosis of the elbow: a case report and literature review.

We describe an unusual case of ulnar nerve compression (cubital tunnel syndrome) caused by synovial protrusion in primary synovial chondromatosis of the elbow in a 59-year-old man. Magnetic resonance imaging is a useful tool for diagnosing this rare condition. Surgical excision of the intra-articular multiple loose bodies and ulnar nerve decompression were performed. The clinician should be aware of primary synovial chondromatosis as one of the causative factors of cubital tunnel syndrome.

Superconducting gap anisotropy sensitive to nematic domains in FeSe.

The structure of the superconducting gap in unconventional superconductors holds a key to understand the momentum-dependent pairing interactions. In superconducting FeSe, there have been controversial results reporting nodal and nodeless gap structures, raising a fundamental issue of pairing mechanisms of iron-based superconductivity. Here, by utilizing polarization-dependent laser-excited angle-resolved photoemission spectroscopy, we report a detailed momentum dependence of the gap in single- and multi-domain regions of orthorhombic FeSe crystals. We confirm that the superconducting gap has a twofold in-plane anisotropy, associated with the nematicity due to orbital ordering. In twinned regions, we clearly find finite gap minima near the vertices of the major axis of the elliptical zone-centered Fermi surface, indicating a nodeless state. In contrast, the single-domain gap drops steeply to zero in a narrow angle range, evidencing for nascent nodes. Such unusual node lifting in multi-domain regions can be explained by the nematicity-induced time-reversal symmetry breaking near the twin boundaries.

Preliminary Study of PGA Fabric for Seromas at Latissimus Dorsi Flap Donor Sites.

BACKGROUND: Seroma formation is a major complication following latissimus dorsi (LD) flap transfer for breast reconstruction. We implanted a nonwoven polyglycolic acid (PGA) fabric-a biodegradable polymer-in the LD flap donor site and examined its effect on postoperative seroma formation and resolution in a comparative study on 38 patients undergoing primary 1-stage breast reconstruction by LD flap. METHOD: A PGA treatment group had a PGA fabric placed in the donor wound (PGA group, n = 20), whereas a second group was treated with standard donor site closure (control group, n = 18). The incidence of seromas was comparable between the groups. RESULT: There was a significant reduction in aspiration volume by needle aspiration after drain removal (P < 0.05) and in the time until seroma resolution (P < 0.01) in the PGA group compared with the control group. CONCLUSION: These results indicate that application of PGA at the LD donor site is useful in controlling postoperative seromas.

Image analysis of the inferior rectus muscle in orbital floor fracture using cine mode magnetic resonance imaging.

PURPOSE: The main cause of diplopia induced by orbital floor fracture is strangulation or damage of the extraocular muscles, and the outcome varies depending on the severity of trauma. In this study, we evaluated the dynamics of the eyeball and inferior rectus muscle based on cine magnetic resonance (MR) images acquired before surgery. The preoperative images and outcomes were retrospectively investigated. MATERIAL AND METHODS: The subjects were 20 patients with orbital floor fracture. The patients repeated upgaze and downgaze, and images of these were acquired using cine mode magnetic resonance imaging (MRI). Image series were obtained in the sagittal direction including the eyeball and long axis of the optic nerve. The eyeball rotation angle, strangulation, and morphology of the inferior rectus muscle were evaluated in each phase. RESULTS: On cine mode MRI, the outcome was poor in cases with a maximal inferior rectus muscle thickness of 5 mm or greater on extension (two or more times thicker than on the healthy side). CONCLUSIONS: Our results suggest that the development of sequelae can be predicted by preoperative image analysis using cine MRI, which may be beneficial to help surgeons understand the mechanism of contracture.

What Is the Best Way to Handle the Involutional Blepharoptosis Repair?

There are many different operations to correct involutional blepharoptosis (IB); however, the outcome of the corrective surgery is rather unpredictable, regardless of the procedure employed. A reasonably predictable outcome can be achieved with careful intraoperative evaluation of the condition, with measuring of the margin reflex distance-1 (MRD-1) in supine position of the patients. With these prepositions, we collected data that indicated that our approach can achieve a predictable outcome. This was a prospective study of 21 consecutive patients (8 men and 13 women) involving 42 eyelids with IB. IB was defined as an MRD-1 of <2  mm. All 21 patients were informed of the purposes of the study, and underwent levator aponeurosis advancement. The MRD-1 was measured intraoperatively with the patients in a supine position and in the 3-month postoperative inspection with the patients in a sitting position. Statistical analyses using paired t-tests were performed. From intraoperative measurement, mean MRD-1 values were 4.31  mm on the right side (range 3.0-4.5) and 4.29  mm on the left side (range 3.5-5.0). Three months after the operations, mean MRD-1 values were 3.07  mm on the right side (range 1.5-4.0) and 3.07  mm on the left side (range 2.0-4.0). Compared with the intraoperative MRD-1 measurements, those of the postoperatives were significantly 1.2  mm reduced (right: P < 0.01, left: P < 0.01). The intraoperative measurement of MRD-1 without changing position of patients could result in successful outcome of the operation.

Surgical treatment of metastatic femoral fractures: achieving an improved quality of life for cancer patients.

BACKGROUND: The femur is the most common long bone affected by metastatic carcinoma. We report our experience regarding treatment of metastatic femoral fracture using femoral head prosthesis (FHP) or intramedullary nailing (IM nail) with augmentation by polymethylmethacrylate (PMMA). PATIENTS AND METHODS: Thirty-five complete fractures in 33 patients were treated surgically. Metastatic lesions were present in the femoral head to neck region (n=9), trochanteric to shaft region (n=23) and supracondular region (n=3). RESULTS: Eight out of 9 patients with proximal femoral metastasis reconstructed by FHP were later able to walk outdoors. For the 11 patients with trochanteric metastasis, the short type of gamma nail was used for bony fixation. In two patients the inserted IM nails were broken. All other cases showed excellent clinical outcomes. For the 12 patients with femoral shaft metastasis, the long type of gamma nail was inserted. Nine cases showed excellent clinical outcomes without any serious complications. CONCLUSION: FHP is indicated for metastases in the femoral head to neck region. IM nailing is best indicated when the lesion is located in the proximal to mid shaft and the patient's life expectancy is <6 month.

Efficacy and feasibility of the submuscular implantation technique for an implantable cardiac electrical device.

BACKGROUND: A common complication associated with implantable cardiac electrical device implantation compromises skin lesions caused by overstretching just above a buried device that is relatively large in size. Apart from affecting the cosmetic appearance in some patients, a compromised blood supply to the skin may also lead to ischemic necrosis, which is an important complication. We describe a novel procedure for the implantation of implantable cardiac electrical devices generators under the pectoralis major muscle to avoid such skin-related complications. METHODS: Twenty-one patients were referred to plastic surgeon for surgical support for the secondary replacement of implantable cardiac electrical devices. In all cases, the leads and devices had been implanted under the skin. We decided to perform device implantation under the pectoralis major muscle, which was highly recommended in all these patients. RESULTS: In Japan, leanness is determined on the basis of body mass index less than 18.5, and 11 patients out of 21 (52%) were considered to be lean. The surgeon's participation in the procedure for implantable cardiac electrical device implantation did not exceed 5 minutes in total. CONCLUSIONS: We consider that the novel method of sub-pectoralis major muscle device implantation described here minimizes the risk of the skin breakdown and improves the patient's quality of life.