Characteristics and Treatment Strategies for Basicervical and Transcervical Shear Fractures of the Femoral Neck.

This study aimed to define basicervical and transcervical shear fractures using area classification and to determine the optimal osteosynthesis implants for them. The clinical outcomes of 1042 proximal femur fractures were investigated. A model of the proximal femur of a healthy adult was created from computed tomography images, and basicervical and transcervical shear fractures were established in the model. Osteosynthesis models were created using a short femoral nail with a single lag screw or two lag screws and a long femoral nail with a single lag screw or two lag screws. The minimum principal strains of the fracture surfaces were compared when the maximum loads during walking were applied to these models using finite element analysis software. Basicervical fractures accounted for 0.96% of all proximal femur fractures, 67% of which were treated with osteosynthesis; the failure rate was 0%. Transcervical shear fractures accounted for 9.6% of all proximal femur fractures, 24% of which were treated with osteosynthesis; the failure rate was 13%. Finite element analysis showed that transcervical shear fracture has high instability. To perform osteosynthesis, multiple screw insertions into the femoral head and careful postoperative management are required; joint replacement should be considered to achieve early mobility.

Binding events through the mutual synchronization of spintronic nano-neurons.

The brain naturally binds events from different sources in unique concepts. It is hypothesized that this process occurs through the transient mutual synchronization of neurons located in different regions of the brain when the stimulus is presented. This mechanism of 'binding through synchronization' can be directly implemented in neural networks composed of coupled oscillators. To do so, the oscillators must be able to mutually synchronize for the range of inputs corresponding to a single class, and otherwise remain desynchronized. Here we show that the outstanding ability of spintronic nano-oscillators to mutually synchronize and the possibility to precisely control the occurrence of mutual synchronization by tuning the oscillator frequencies over wide ranges allows pattern recognition. We demonstrate experimentally on a simple task that three spintronic nano-oscillators can bind consecutive events and thus recognize and distinguish temporal sequences. This work is a step forward in the construction of neural networks that exploit the non-linear dynamic properties of their components to perform brain-inspired computations.

Large voltage-induced coercivity change in Pt/Co/CoO/amorphous TiOx structure and heavy metal insertion effect.

There is urgent need for spintronics materials exhibiting a large voltage modulation effect to fulfill the great demand for high-speed, low-power-consumption information processing systems. Fcc-Co (111)-based systems are a promising option for research on the voltage effect, on account of their large perpendicular magnetic anisotropy (PMA) and high degree of freedom in structure. Aiming to observe a large voltage effect in a fcc-Co (111)-based system at room temperature, we investigated the voltage-induced coercivity (Hc) change of perpendicularly magnetized Pt/heavy metal/Co/CoO/amorphous TiOx structures. The thin CoO layer in the structure was the result of the surface oxidation of Co. We observed a large voltage-induced Hc change of 20.2 mT by applying 2 V (0.32 V/nm) to a sample without heavy metal insertion, and an Hc change of 15.4 mT by applying 1.8 V (0.29 V/nm) to an Ir-inserted sample. The relative thick Co thickness, Co surface oxidation, and large dielectric constant of TiOx layer could be related to the large voltage-induced Hc change. Furthermore, we demonstrated the separate adjustment of Hc and a voltage-induced Hc change by utilizing both upper and lower interfaces of Co.

Giant charge-to-spin conversion in ferromagnet via spin-orbit coupling.

Converting charge current into spin current via the spin Hall effect enables efficient manipulation of magnetization by electrical current. However, its geometrical restriction is a serious obstacle to device applications because it prevents switching of perpendicular magnetization in the absence of an external field. To resolve this issue, ferromagnetic materials have attracted attentions because their time reversal asymmetry induces magnetic-dependent charge-to-spin conversion that removes this restriction. Here, we achieved a large enhancement of magnetic-dependent charge-to-spin conversion by clarifying its mechanism. Through layer thickness dependence of the conversion efficiency, we revealed a coexistence of interfacial and bulk contributions to the magnetic-dependent charge-to-spin conversion. Moreover, the interfacial contribution to charge-to-spin conversion is found to be dominant and can be controlled via interfacial band engineering. The efficiency of charge-to-spin conversion in ferromagnet was found to be an order larger than that of other materials with reduced symmetry.

Control of the stochastic response of magnetization dynamics in spin-torque oscillator through radio-frequency magnetic fields.

Neuromorphic computing using spintronic devices, such as spin-torque oscillators (STOs), has been intensively studied for energy-efficient data processing. One of the critical issues in this application is stochasticity in magnetization dynamics, which limits the accuracy of computation. Such stochastic behavior, however, plays a key role in stochastic computing and machine learning. It is therefore important to develop methods for both suppressing and enhancing stochastic response in spintronic devices. We report on experimental investigations on control of stochastic quantity, such as the width of a distribution of transient time in magnetization dynamics in vortex-type STO. The spin-transfer effect can suppress stochasticity in transient dynamics from a non-oscillating to oscillating state, whereas an application of a radio-frequency magnetic field is effective in reducing stochasticity on the time evolution of the oscillating state.

Herniation of the cauda equina into the facet joint through a pseudomeningocele: A case report and literature review.

BACKGROUND: Incidental durotomy is a well-known complication of spinal surgery. It can lead to persistent cerebrospinal fluid leakage resulting in significant secondary complications. Here, we present a case in which the cauda equina herniated into a pseudomeningocele that penetrated a facet joint, leading to lower extremity radiculopathy warranting surgical correction. CASE DESCRIPTION: One year ago, a 67-year-old male underwent a partial left L4-L5 laminectomy. At surgery, a durotomy was repaired with a nylon suture and reinforced with a fat patch. He subsequently presented with severe left lower extremity radiculopathy and a partial cauda equina syndrome. On MR, the cauda equina had herniated into a pseudomeningocele that penetrated the left facet joint. Once the defect was repaired at surgery, the patient's symptoms improved. CONCLUSION: It is critical to correctly repair an intraoperative durotomy to avoid further neurological deficits that may include cauda equina herniation into pseudomeningoceles penetrating facet joints.

Preoperative medications is one of the factor affecting patient-reported outcomes after total hip arthroplasty.

Although the reported clinical outcomes of total hip arthroplasty (THA) for hip osteoarthritis are satisfactory, not all patients are completely satisfied. Thus, there is interest in predicting postoperative satisfaction before surgery. The influence of comorbidities and preoperative medications on the incidence of complications and duration of hospitalization following THA has become apparent. However, studies about the associations of preoperative medication with clinical outcomes of THA are limited. Therefore, this study aimed to clarify the relationship between preoperative medications and postoperative patient-reported outcomes. This retrospective cross-sectional multicenter study enrolled post-THA patients (79 patients, 90 hips) who were examined from February to March 2019 in eight general hospitals. Outcome measures included patient-reported outcome as Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) score. Preoperative medications were investigated from medical records. Medications were categorized, and analgesics were categorized into non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, pregabalin, duloxetine, neurotropin (an extract from inflammatory rabbit skin inoculated by vaccinia virus), and opioid. To identify the factors associated with JHEQ score, the patients were divided into lower (<55 score) and higher (≥55) JHEQ score groups. Spearman rank correlation coefficient (r) showed significant difference between the total number of preoperative medications and postoperative JHEQ movement subscale (r = -0.37, p < 0.01), mental subscale (r = -0.29, p < 0.01), and JHEQ (r = -0.30, p < 0.01) scores. In the multiple logistic regression analysis, only the total number of preoperative medications was identified as a risk factor for lower JHEQ score (p < 0.01). This study clarified an inverse correlation between the total preoperative medication count and postoperative outcomes and found that larger total count of preoperative medications is a risk factor of poor postoperative patient-reported outcomes of THA.

Step-like dependence of memory function on pulse width in spintronics reservoir computing.

Physical reservoir computing is a type of recurrent neural network that applies the dynamical response from physical systems to information processing. However, the relation between computation performance and physical parameters/phenomena still remains unclear. This study reports our progress regarding the role of current-dependent magnetic damping in the computational performance of reservoir computing. The current-dependent relaxation dynamics of a magnetic vortex core results in an asymmetric memory function with respect to binary inputs. A fast relaxation caused by a large input leads to a fast fading of the input memory, whereas a slow relaxation by a small input enables the reservoir to keep the input memory for a relatively long time. As a result, a step-like dependence is found for the short-term memory and parity-check capacities on the pulse width of input data, where the capacities remain at 1.5 for a certain range of the pulse width, and drop to 1.0 for a long pulse-width limit. Both analytical and numerical analyses clarify that the step-like behavior can be attributed to the current-dependent relaxation time of the vortex core to a limit-cycle state.

Initial Rotational Instability of the Tapered Wedge-Shaped Type Cementless Stem.

BACKGROUND: Because the tapered wedge-shaped type cementless stem has a small anteroposterior width and a low occupation rate in the medullary space, postoperative rotational instability and stem subsidence due to inadequate proximal fixation are concerns. The purpose of this study was to clarify the relationship between the rotational instability of the tapered wedge-shaped type cementless stem and femoral canal shape. METHODS: A total of 61 primary total hip arthroplasties with the tapered wedge-shaped type cementless stem Accolade® TMZF (11 males, 50 females; mean age 60 years) from January 2012 to June 2015 who underwent computed tomography before surgery and within 4 weeks and 1 year after surgery were evaluated. The preoperative femoral neck anteversion angle, preoperative femoral canal flair index, the degree of postoperative stem subsidence within 1 year after operation, and the degree of rotational change in the stem setting angle within 1 year after operation were investigated. RESULTS: The mean preoperative femoral neck anteversion angle was 32.2° ± 17.8° (0°-69°), and the mean preoperative canal flair index was 3.68 ± 0.58 (2.44-5.55). There were no stem subsidence cases within 1 year after operation. The mean degree of rotational change in the stem from immediately to 1 year after surgery was -0.4° ± 1.7° (-3°-3°). There was no significant correlation between the canal flair index and the rotational change in the stem. In addition, the mean difference between the preoperative femoral neck anteversion angle and the stem rotational angle immediately after surgery was only 1.3° ± 5.3° (-29°-15°). CONCLUSIONS: In all cases, including stove-pipe cases, the degree of rotational change in the Accolade® TMZF stem from immediately to 1 year after surgery was within 3°. In other words, regardless of femoral canal shape, the tapered wedge-shaped type cementless stem has little initial rotational instability.

Influence of flicker noise and nonlinearity on the frequency spectrum of spin torque nano-oscillators.

The correlation of phase fluctuations in any type of oscillator fundamentally defines its spectral shape. However, in nonlinear oscillators, such as spin torque nano-oscillators, the frequency spectrum can become particularly complex. This is specifically true when not only considering thermal but also colored 1/f flicker noise processes, which are crucial in the context of the oscillator's long term stability. In this study, we address the frequency spectrum of spin torque oscillators in the regime of large-amplitude steady oscillations experimentally and as well theoretically. We particularly take both thermal and flicker noise into account. We perform a series of measurements of the phase noise and the spectrum on spin torque vortex oscillators, notably varying the measurement time duration. Furthermore, we develop the modelling of thermal and flicker noise in Thiele equation based simulations. We also derive the complete phase variance in the framework of the nonlinear auto-oscillator theory and deduce the actual frequency spectrum. We investigate its dependence on the measurement time duration and compare with the experimental results. Long term stability is important in several of the recent applicative developments of spin torque oscillators. This study brings some insights on how to better address this issue.

Generation of charge current from magnetization oscillation via the inverse of voltage-controlled magnetic anisotropy effect.

It is well known that oscillating magnetization induces charge current in a circuit via Faraday's law of electromagnetic induction. New physical phenomena by which magnetization dynamics can produce charge current have gained considerable interest recently. For example, moving magnetization textures, such as domain walls, generates charge current through the spin-motive force. Here, we examine an entirely different effect, which couples magnetization and electric field at the interface between an ultrathin metallic ferromagnet and dielectric. We show that this coupling can convert magnetic energy into electrical energy. This phenomenon is the Onsager reciprocal of the voltage-controlled magnetic anisotropy effect. The effect provides a previously unexplored probe to measure the magnetization dynamics of nanomagnets.

The Differences in Imaging Findings Between Painless and Painful Osteoarthritis of the Hip.

PURPOSE: In osteoarthritis of the hip, the pain may be strong even if the deformity is mild, but the pain may be mild even if the deformity is severe. If the factors related to the pain can be identified on imaging, reducing such factors can alleviate the pain, and effective measures can be taken for cases where surgery cannot be performed. In addition, imaging findings related to the pain are also important information for determining the procedures and the timing of surgery. Thus, the purpose of this study was to identify the differences in features of osteoarthritis seen on imaging between painless and painful osteoarthritis of the hip. METHODS: The subjects were the patients with hip osteoarthritis who visited our department in 2015 and who underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI), a total of 29 patients (54 hip joints; mean age 63 years; 8 males and 21 females). The degree of osteoarthritis was determined using the Tönnis grade from the x-ray image. The cartilage morphology, intensity changes of bone marrow on MRI (subchondral bone marrow lesions [BMLs]), osteophytes, joint effusions, and paralabral cysts were scored based on the Hip Osteoarthritis MRI Scoring System (HOAMS). The cross-sectional area of the psoas major muscle at the level of the iliac crest was measured on CT, and the psoas index (PI; the cross-sectional area ratio of the psoas major muscle to the lumbar 4/5 intervertebral disc) was calculated to correct for the difference in physique. Then, the relationships between these and visual analog scale (VAS) scores of pains were evaluated. RESULTS: The average VAS was 55.4 ± 39 mm. The PI and all items of HOAMS correlated with the VAS. The average VAS of Tönnis grade 3 osteoarthritis was 75.8 ± 26 mm. When investigating only Tönnis grade 3 osteoarthritis, the differences between cases with less than average pain and those with above average pain were the BML score in the central-inferior femoral head (P = .0213), the osteophyte score of the inferomedial femoral head (P = .0325), and the PI (P = .0292). CONCLUSION: Investigation of the differences between painless and painful osteoarthritis of the hip showed that the cases with more pain have BMLs of the femoral head on MRI that extend not only to the loading area, but also to the central-inferior area. Even with the same x-ray findings, the pain was stronger in patients with severe psoas atrophy. Thus, the instability due to muscle atrophy may also play a role in the pain of hip osteoarthritis.

Voltage-Driven Magnetization Switching Controlled by Microwave Electric Field Pumping.

We study the dynamic switching properties of a nanomagnet under microwave electric field pumping. The periodic modulation of an anisotropy field induced by microwave electric field pumping efficiently excites the uniform magnetization oscillation, allowing for precise control of magnetization switching. Accurate shaping of the pumping voltage waveform also enables us to investigate the transient reaction of magnetization to the relative phase difference of the pumping signal. We demonstrate both experimentally and theoretically the existence of a dead angle in which the uniform oscillation of magnetization is inhibited even though the microwave frequency itself satisfies the conditions of parametric excitation. Our results provide an energy-efficient way of manipulating ultrafast magnetization dynamics in nanomagnetic devices.

A Comparison of the Incidences of Venous Thromboembolism after Total Hip Arthroplasty between the Direct Anterior Approach and the Direct Lateral Approach, Especially in the Early Period after Introduction of the Direct Anterior Approach.

OBJECTIVE: To compare the incidence of venous thromboembolism (VTE) after total hip arthroplasty (THA) using the direct anterior approach (DAA) with that using the direct lateral approach (DLA). In addition, patient background characteristics and the incidence of VTE were compared between the first half and the latter half of the period after introducing DAA and against DLA. METHOD: This was a retrospective, multicenter study involving 109 patients (116 hips) who had undergone primary unilateral THA. Thirty-six hips underwent THA using DAA and 80 hips underwent THA using DLA. Patient information including sex, age, and preoperative diagnosis was collected. The incidence of VTE was compared between DAA and DLA. Moreover, the patients who underwent THA using DAA were divided into 2 groups (first half and latter half groups), and sex, age, body mass index (BMI), and surgical time were compared between the 2 groups. Moreover, the incidence of VTE was compared among the 3 groups (first half of DAA, latter half of DAA, and DLA). RESULTS: The incidence of VTE in the DAA group was significantly higher than that in the DLA group (p=0.014). The incidence of VTE in the first half group was significantly higher than in the latter half group and the DLA group (p=0.035 and p=0.001, respectively), and there was no difference in the incidence of VTE between the latter half group and the DLA group (p=0.923). Surgical time was significantly longer in the first half group than in the latter half group (p=0.046). CONCLUSIONS: In the first half of the period after introducing the DAA, more VTEs occurred than in the DLA. It may be important to shorten the surgical time in the early stage of introducing the DAA, and aggressive anticoagulation therapy may be required until the surgeon becomes familiar with the procedure.

The location of the fracture determines the better solution, osteosynthesis or revision, in periprosthetic femoral fractures.

PURPOSE: Periprosthetic femoral fractures are difficult to treat, but few reports have included many periprosthetic femoral fractures. The purpose of this study was to investigate the trends and characteristics of a large number of periprosthetic femoral fractures and to determine the best treatment strategy for such fractures. METHODS: The fracture type according to the Vancouver classification, the stem fixation style of previous surgery, the elapsed time from previous surgery, and the treatment method for periprosthetic fractures of 51 patients with periprosthetic femoral fractures who were seen between 2006 and 2018 were investigated. RESULTS: The types of fractures according to the Vancouver classification were: type A 5.9%, type B1 47%, type B2 20%, type B3 2.0%, and type C 25%. Of the previous surgeries, 76% were cementless fixation, and 24% were cemented fixation. The mean duration from previous surgery to periprosthetic femoral fracture was 8 years and 7 months (1-358 months), and injury within 1 year from previous surgery was most commonly observed (24%). As treatment for periprosthetic femoral fractures, conservative treatment was performed in 8%, and surgery was performed in 92%. Of the surgery cases, 53% underwent osteosynthesis, and 39% underwent revision surgery. Of type B1 surgery cases, 58% were treated with osteosynthesis, and 33% underwent revision surgery, although type B1 had no stem loosening. CONCLUSION: Many periprosthetic femoral fractures occurred within 1 year after the previous surgery. Therefore, preventive measures for periprosthetic femoral fractures should be started immediately after total hip replacement. In addition, revision surgery was performed even if the stem was not loosened in cases where it was judged that sufficient osteosynthesis could not be performed.

Role of non-linear data processing on speech recognition task in the framework of reservoir computing.

The reservoir computing neural network architecture is widely used to test hardware systems for neuromorphic computing. One of the preferred tasks for bench-marking such devices is automatic speech recognition. This task requires acoustic transformations from sound waveforms with varying amplitudes to frequency domain maps that can be seen as feature extraction techniques. Depending on the conversion method, these transformations sometimes obscure the contribution of the neuromorphic hardware to the overall speech recognition performance. Here, we quantify and separate the contributions of the acoustic transformations and the neuromorphic hardware to the speech recognition success rate. We show that the non-linearity in the acoustic transformation plays a critical role in feature extraction. We compute the gain in word success rate provided by a reservoir computing device compared to the acoustic transformation only, and show that it is an appropriate bench-mark for comparing different hardware. Finally, we experimentally and numerically quantify the impact of the different acoustic transformations for neuromorphic hardware based on magnetic nano-oscillators.

Treatment of Atypical Fracture of the Ulnar Diaphysis by Open Reduction and Internal Fixation with Teriparatide.

Atypical fractures commonly arise in the subtrochanteric region or the femoral shaft, whereas those of the upper extremities are rare. Only 15 fractures in 13 patients have been described in the English literature. The management of such fractures has not been established. We describe a patient with an atypical fracture of the ulnar diaphysis, which required revision surgery to achieve the union of the fracture site. Teriparatide together with low-intensity pulsed ultrasound contributed to bone healing. Further studies are needed to determine the optimal strategy for treating atypical fractures of the ulna.

The Status of Assessments and Treatments for Osteoporosis in Patients 5 Years after Total Hip Arthroplasty: A Cross-Sectional Survey of 194 Post-THA Patients.

BACKGROUND: Assessments for osteoporosis in patients who have undergone total hip arthroplasty (THA) are very important with respect to the clinical results. However, few studies have investigated the status of the assessments and treatments for osteoporosis in post-THA patients. The purpose of this multicenter study was to investigate the status of assessments and treatments for osteoporosis in post-THA patients. METHODS: The results of a self-report questionnaire and the medical records of 194 post-THA patients over 40 years of age who visited the outpatient departments of the five hospitals participating in the study were analyzed. RESULTS: A total of 125 patients (64.4%) had been examined for osteoporosis, and 69 patients (35.6%) had never been assessed for osteoporosis. It was assumed, based on the questionnaire results, that 50 (40%) of the 125 patients should have been receiving treatment for osteoporosis. Forty-five (90%) of these 50 patients were actually taking medication for osteoporosis at the time of the investigation. Overall, a total of 58 (29.9%) patients were receiving treatment for osteoporosis. CONCLUSIONS: The present survey revealed that 64.4% of post-THA patients had been evaluated for osteoporosis. Moreover, while 40% of post-THA patients over 40 years of age may require treatment for osteoporosis, only 29.9% were actually receiving treatment.

Incidence and Clinical Outcomes of Hip Fractures Involving Both the Subcapital Area and the Trochanteric or Subtrochanteric Area.

PURPOSE: Proximal femoral fractures involving both the subcapital area and the trochanteric or subtrochanteric area have rarely been reported, but they are not uncommon. However, few studies have reported the incidence or clinical outcomes of such fractures. This study investigated such fractures. METHODS: In area classification, the proximal femur is divided into 4 areas by 3 boundary planes: the first plane is the center of femoral neck; the second plane is the border between femoral neck and femoral trochanter; and the third plane links the inferior borders of greater and lesser trochanters. A fracture only in the first area is classified as a Type 1 fracture; one in the first and second areas is classified as a Type 1-2 fracture. Therefore, proximal femoral fractures involving both the subcapital area and the trochanteric area are classified as Type 1-2-3, and those involving both the subcapital area and the subtrochanteric area are classified as Type 1-2-3-4. In this study, a total of 1042 femoral proximal fractures were classified by area classification, and the treatment methods and the failure rates were investigated only for Types 1-2-3 and 1-2-3-4 cases. The failure rate was defined as the incidence of internal fixator cut-out or telescoping >10 mm. RESULTS: Types 1-2-3 and 1-2-3-4 fractures accounted for 1.72%. Surgical treatment was performed for 89%. Of these, 56% underwent osteosynthesis, but the failure rate was 33%. The other patients (44%) underwent prosthetic replacement. Fracture lines of all these fractures were present along trochanteric fossa to intertrochanteric fossa in posterior aspect and just below the femoral head in anterior aspect. CONCLUSION: Fracture involving the subcapital area to the trochanteric or subtrochanteric area was found in approximately 2%. In patients for whom prosthetic replacement was selected, good results were obtained. However, 1/3 of patients who underwent osteosynthesis had poor results.

Microwave amplification in a magnetic tunnel junction induced by heat-to-spin conversion at the nanoscale.

Heat-driven engines are hard to realize in nanoscale machines because of efficient heat dissipation1. However, in the realm of spintronics, heat has been employed successfully-for example, heat current has been converted into a spin current in a NiFe|Pt bilayer system2, and Joule heating has enabled selective writing in magnetic memory arrays3. Here, we use Joule heating in nanoscale magnetic tunnel junctions to create a giant spin torque due to a magnetic anisotropy change. Efficient conversion from heat dynamics to spin dynamics is obtained because of a large interfacial thermal resistance at an FeB|MgO interface. The heat-driven spin torque is equivalent to a voltage-controlled magnetic anisotropy4,5 of approximately 300 fJ V-1 m-1, which is more than twice the value reported in a (Co)FeB|MgO system6,7. We demonstrate an electric microwave amplification gain of 20% in a d.c. biased magnetic tunnel junction as a result of this spin torque. While electric d.c. power amplification in spintronic devices has been realized previously8, the microwave amplification was limited to relatively small amplification gains (G = radiofrequency output voltage/radiofrequency input voltage) and has never exceeded 1 (refs 9-13). A magnetic tunnel junction driven by radiofrequency spin transfer torque using ferromagnetic resonance enabled a relatively large gain of G ≈ 0.55 (ref. 12). Furthermore, radiofrequency spin waves were tuned by the spin transfer effect14,15. The heat-driven giant spin torque in the FeB|MgO16,17 magnetic tunnel junction, which shows a large magnetization precession and resistance oscillation under a d.c. bias, overcomes the above limitations and provides a gain larger than 1.