Ultrastrong coupling in Super Yellow polymer microcavities and development of highly efficient polariton light-emitting diodes and light-emitting transistors.

We present detailed studies on exciton-photon coupling and polariton emission based on a poly(1,4-phenylenevinylene) copolymer, Super Yellow (SY), in a series of optical microcavities and optoelectronic devices, including light-emitting diode (LED) and light-emitting transistor (LET). We show that sufficiently thick SY microcavities can generate ultrastrong coupling with Rabi splitting energies exceeding 1 eV and exhibit spectrally narrow, nearly angle-independent photoluminescence following lower polariton (LP) mode dispersion. When the microcavity is designed with matched LP low-energy state and exciton emission peak for radiative pumping, the conversion efficiency from exciton to polariton emission can reach up to 80%. By introducing appropriate injection layers in a SY microcavity and optimizing the cavity design, we further demonstrate a high-performance ultrastrongly coupled SY LED with weakly dispersive electroluminescence along LP mode and a maximum external quantum efficiency (EQE) of 2.8%. Finally, we realize an ultrastrongly coupled LET based on vertical integration of a high-mobility ZnO transistor and a SY LED in a microcavity, which enables a large switching ratio, uniform emission in the ZnO pattern, and LP mode emission with a maximum EQE of 2.4%. This vertical LET addresses the difficulties of achieving high emission performance and precisely defining the emission area in typical planar LETs, and opens up the possibility of applying various strongly coupled emitters for advanced polariton devices and high-resolution applications.

Status and clinical influencing factors of involuntary admission in chinese patients with schizophrenia.

BACKGROUND: Though controversial for its various disadvantages, involuntary admission (IA) is necessary in providing mental health care for patients suffering from schizophrenia in China. This article examines the IA rate in a representative sample, and under which circumstances are these patients more likely to be admitted involuntarily. METHODS: Adult patients consecutively admitted to two typical hospitals in Shanghai between 2013 and 2014 with a diagnosis of ICD-10 schizophrenia were included. 2167 patients were included in this study. Sociodemographic and clinical data, as well as personal information of psychiatrists who made risk assessment, were collected. The whole sample was divided into voluntary and involuntary admission groups. Group comparisons were performed with SPSS 17.0, using one-way ANOVA, Wilcoxon rank sum test, Chi-squares and Logistic regression. RESULTS: Among 2167 inpatients, the majority (2003, 92.4%) were involuntarily admitted. Clinical features, including age of patients (p < 0.001, OR = 1.037), lacking of insight (p < 0.001, OR = 3.691), were statistically significant for IA. Psychiatrist's age (p < 0.001, OR = 1.042) was independently associated with IA. However, risk behaviors had dramatically affected patients' admission status, of which the strongest predictor of IA was noncompliance with treatment (p < 0.001, OR = 3.597). The areas under the curve of the ROC and accuracy for the regression model were 0.815 and 0.927, respectively. CONCLUSION: IA patients account for a major proportion of all those hospitalized with schizophrenia in China. Insights and risk behaviors contributed the most reasons for admission status of patients. This research shed light on necessity of further qualitative studies learning detailed evaluation processes of IA and high-quality interventional studies aiming to limit the performance of IA among patients with schizophrenia.

Risk assessment and its influencing factors of involuntary admission in patients with mental disorders in Shanghai, China.

BACKGROUND: The 'risk criterion' for involuntary admission (IA) has been adopted by Mental Health Law of the People's Republic of China since 2013. How the new legal regulation influences daily practices in psychiatric institutes are still unclear. AIMS: The present study sought to explore the application of risk criterion in IA cases; especially risk assessed by psychiatrists at admission and its influencing factors. METHOD: Socio-demographic and clinical data including risk assessment for admission of 3,529 involuntary admitted patients from two typical hospitals in Shanghai from 2013 to 2014 were consecutively collected. Personal information of psychiatrists who made admission assessment was collected separately. RESULTS: Among the 3,529 cases, 1,890 (53.6%) were admitted because of actual harmful behaviors to self or others, while 1,639 (46.4%) were admitted with some kinds of risk, but 265 (7.5%) were admitted without any records on risk assessment checklists. Patients who were unemployed, of younger age, single status, diagnosed with schizophrenia were more likely to be admitted without any records on the checklist. Male gender, older age, and lower professional title are influencing factors that psychiatrists made no risk assessment records. CONCLUSIONS: The vast majority (92.5%) of risk assessment in IA patients were qualified in our study. In order to protect the legal rights of patients better, operational and reasonable procedures of risk assessment should be developed, such include more detailed rules to IA, systematic training of psychiatrists on IA assessment, mechanism improving doctor-patient relationship, and alternative mental health services for patients and so on.

CRISPR/dCas9-Mediated Parkin Inhibition Impairs Mitophagy and Aggravates Apoptosis of Rat Nucleus Pulposus Cells Under Oxidative Stress.

OBJECTIVE: The aim of this study is to explore the role of Parkin in intervertebral disk degeneration (IDD) and its mitophagy regulation mechanism. STUDY DESIGN AND METHODS: Rat nucleus pulposus (NP) cells were stimulated with hydrogen peroxide (H2O2) to a mimic pathological condition. Apoptosis and mitophagy were assessed by Western blot, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay, and immunofluorescence staining. The CRISPR-dCas9-KRAB system was used to silence the expression of Parkin. RESULT: In this study, we found that Parkin was downregulated in rat NP cells under oxidative stress. In addition, treatment with H2O2 resulted in mitochondrial dysfunction, autophagy inhibition, and a significant increase in the rate of apoptosis of NP cells. Meanwhile, mitophagy inhibition enhanced H2O2-induced apoptosis. Furthermore, repression of Parkin significantly attenuated mitophagy and exacerbated apoptosis. CONCLUSION: These results suggested that Parkin may play a protective role in alleviating the apoptosis of NP cells via mitophagy, and that targeting Parkin may provide a promising therapeutic strategy for the prevention of IDD.

Horizontal Rafting Plate for Treatment of the Tibial Plateau Fracture.

OBJECTIVE: This study aimed to investigate the value of a horizontal rafting plate in treating tibial plateau fractures. METHODS: The data of 24 patients in whom a horizontal rafting plate was used to treat a tibial plateau fracture between October 2014 and January 2018 were retrospectively analyzed, including 16 males and 8 females, aged 21-63 years old, with an average of 40 ± 14.68 years. The fractures included 13 in the left knee and 11 in the right knee. The places where the horizontal rafting plate were used included the anterior margin of tibia, anterolateral tibia, and posterolateral tibia. All cases were followed up for 12-24 months, with an average follow-up of 17.5 ± 5.0 months. At the last follow-up, the Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation. The knee joint function was evaluated using the Rasmussen functional score. Computed tomography (CT) scanning and three-dimensional reconstruction were performed preoperatively and postoperatively, with the quality of reduction of the fractured articular surface clarified by the final follow-up. The flexion and extension abilities of the knee joint were also measured in the postoperative follow-up. RESULTS: Preoperative CT scanning showed that the gap of the tibial plateau was 8.00 ± 1.40 (5-24) mm. The heights of the fracture of the articular surface at all three sites during the final follow-ups were significantly different from the height before the surgery (P < 0.05). The vertical distance between the articular line and the highest point of the articular surface after reduction was 0.17 ± 0.05 mm. Anatomic reductions were obtained in 24 patients. The Rasmussen functional score after surgeries was 27.25 ± 0.94 points. Bony union was achieved in all the patients. According to the Rasmussen radiological criteria, the scores during the last follow-up were as follows: the total score was 13-18 points, with an average of 16.00 ± 1.72 points; the scores were excellent in 17 cases and good in seven cases. Therefore, 100% of results were excellent or good. No infection or fracture nonunion was found. CONCLUSION: Using a horizontal plate can be an effective method for treating special types of fractures of the tibial plateau, including the anterior margin and anterolateral and posterolateral tibial plateau, with satisfactory treatment efficacy.

Surgical Treatment of Lateral Tibial Plateau Fractures Involving the Posterolateral Column.

OBJECTIVE: To summarize the indications and the clinical effects of a transfibular neck osteotomy approach and a combined anterolateral and posterolateral approach in the treatment of fractures of the lateral tibial plateau involving the posterolateral column. METHODS: Eleven patients with lateral tibial plateau fractures were included in the present study. The fractures were Schatzker type II or lateral platform fractures involving posterolateral column. The anterolateral combined posterolateral approach (lateral + posterolateral locking plate fixation) was applied in 7 patients and 4 patients underwent transfibular neck osteotomy (lateral + posterolateral locking plate fixation + 1/4 tubular plate edge fixation, fibular osteotomy with Kirschner wire tension band fixation, and hollow nail fixation for upper tibiofibular joint). All cases were followed up for 12-24 months, with an average follow-up of 17.5 ± 5.0 months. At the last followup, the Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation. The knee joint function was evaluated using the knee function evaluation criteria of the Hospital for Special Surgery (HSS). The Lachman test and the pivot-shift test were used to evaluate the anterior and posterior and rotational stability of the knee joint. The range of knee motion was recorded. RESULTS: Bone healing was achieved in all patients with fractures treated with a transfibular neck osteotomy approach and a combined anterolateral and posterolateral approach. At the last follow-up, both the Lachman test and the pivot-shift test results were negative. All patients had complete knee extension. For the combined anterolateral and posterolateral approach, the knee flexion angle was 110°-130°, with an average of 122.86° ± 7.56°. For the transfibular neck osteotomy approach, the knee flexion angle was 115°-130°, with an average of 120.00° ± 7.07°. For the patients in which the combined anterolateral and posterolateral approach was used, the Rasmussen score was 12-18 points, with an average of 16.00 ± 2.56 points. The results were excellent in 4 cases and good in 3 cases; therefore, 100% of results were excellent or good. For patients in which the transfibular neck osteotomy approach was used, the Rasmussen score was 10-18 points, with an average of 15.25 ± 3.77 points. The results were excellent in 2 cases, good in 1 case, and acceptable in 1 case; therefore, 75% of results were excellent or good. The HSS score for the combined anterolateral and posterolateral approach was 76-98 points, with an average of 88.43 ± 7.55 points. The results were excellent in 5 cases and good in 2 cases; therefore, 100% of results were excellent or good. The HSS score for the transfibular neck osteotomy approach was 74-96 points, with an average of 87.25 ± 9.43 points. The results were excellent in 3 cases and good in 1 case; therefore, 100% of results were excellent or good. There were no significant differences in operation time, surgical blood loss, fracture healing time, postoperative imaging score, and knee function evaluation between the two approaches. One patient who underwent transfibular neck osteotomy had a 3-mm step that gradually appeared, but no significant abnormalities were found in the width of the platform and the lower limb force line. One patient in whom the combined anterolateral and posterolateral approach was used showed numbness in the common peroneal nerve. No common peroneal nerve injury occurred through the transfibular neck osteotomy approach. CONCLUSIONS: The anterolateral combined posterolateral approach and the transfibular neck osteotomy approach are effective in the surgical treatment of lateral tibial plateau fractures involving the posterolateral column. However, the transfibular neck osteotomy approach is more suitable for the posterolateral plateau articular surface damaged with bone separation and displacement, deep collapse, cases involving a large range of the posterolateral column, especially fractures of the lateral tibial plateau in the upper tibiofibular syndesmosis area of the line connecting the anterior and posterior margin of the fibular head to the midpoint of the plateau.

Morphological changes of focal choroidal excavation.

PURPOSE: To investigate morphological changes of focal choroidal excavation (FCE). METHODS: The medical records of 18 FCE patients (25 eyes) were retrospectively reviewed. Clinical features as well as images of ocular fundus, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and spectral domain optical coherence tomography (OCT) were analyzed. OCT images were employed as a major criterion to evaluate the changes which occurred during the follow-up. RESULT: Of the 18 patients, 9 were male and 9 were female. The mean age was 41 ± 13.5 years. The follow-up period was 38.5 ± 24.7 (7-92) months. Thirteen patients were myopic. FCE appeared from slight pigment irregularity to yellowish white plaque. FFA revealed window defects corresponding to the lesions. Early-phase ICGA images showed hypofluorescence and medium to large choroidal blood vessels. Plaque- or dot-like hyperfluorescence was seen on late-phase images. OCT scans showed that 11 patients had unilateral FCE and 7 patients were bilaterally affected. Twenty-three eyes had a single FCE and the other two eyes had 2 excavations. FCE presented as confirming type in 21 eyes and non-confirming type in 3 eyes. Discontinuity of the interdigitation zone, ellipsoid zone, and retinal pigment epithelium/Bruch's complex zone was found. The average subfoveal choroidal thickness was 312.06 ± 66.12 µm in FCE eyes. During the follow-up, choroidal neovascularization developed in 4 patients and retinal pigment epithelium discontinuity was aggravated in one eye. No remarkable changes were found in the other eyes on B scan of the OCT images, but the volume of FCE might have changed a little. CONCLUSION: FCE, both confirming type and non-confirming type, may keep stable during a long period of time. Choroidal neovascularization may develop at the site of FCE.

Comparison Between Posterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases: A Systematic Review and Meta-Analysis.

OBJECTIVE: To compare the efficacy and safety in the management of lumbar diseases performed by either posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). Interbody fusion is considered the "gold standard" in the treatment of lumbar degenerative diseases. Both PLIF and TLIF have been advocated, and it remains controversial as to the best operative technique. METHODS: The electronic databases including Embase, PubMed, and Cochrane library were searched to identify relevant studies up to September 2017. The primary outcomes were fusion rate, complications, and clinical satisfaction. The secondary outcomes were length of hospitalization, operation time, blood loss, postoperative visual analog scale, Oswestry Disability Index, and Japanese Orthopaedic Association Score. Data analysis was conducted with RevMan 5.3 software. RESULTS: A total of 16 studies involving 1502 patients (805 patients in PLIF group and 697 in TLIF group) were included in the meta-analysis. The pooled analysis showed that there was no significant difference in terms of fusion rate (P > 0.05) and clinical satisfaction (P > 0.05) between the 2 groups. TLIF was superior to PLIF with significantly lower incidence of nerve root injury (P < 0.05) and dural tear (P < 0.05). However, there was no significant difference regarding wound infection (P > 0.05) and graft malposition (P > 0.05). PLIF required significant longer operation time (P < 0.05) and was associated with more blood loss (P < 0.05). Although TLIF was associated with better postoperative visual analog scale, Oswestry Disability Index, and Japanese Orthopaedic Association Score than PLIF, there was no statistical difference regarding these results. CONCLUSIONS: The available evidence suggests that both TLIF and PLIF could achieve similar clinical satisfaction and fusion rate in the management of degenerative lumbar diseases. However, TLIF was superior to PLIF with shorter operation time, less blood loss, and lower incidence of nerve root injury and dural tear. There is no significant difference between both groups regarding wound infection and graft malposition.