Comparison of corticocancellous bone graft from the anterolateral metaphysis of the distal radius versus iliac crest for the treatment of unstable scaphoid nonunion with humpback deformity.

BACKGROUND: Corticocancellous bone grafting from the iliac crest is acceptable treatment for unstable scaphoid nonunion with a viable proximal pole. However, harvesting graft from the iliac crest is associated with donor site morbidity and the requirement of general anesthesia. Thus, bone grafting from the anterolateral metaphysis of the distal radius (DR) can be a treatment option. However, no study has compared the clinical effect between the two grafting techniques. METHODS: From 2014 to 2019, patients with unstable scaphoid nonunion with humpback deformity underwent corticocancellous bone grafting from the anterolateral metaphysis of the DR (group DR) or iliac crest (group IC). Humpback deformity was determined by evaluating the scapholunate angle (SLA) ≥ 60°, intrascaphoid angle (ISA) ≥ 45°, and radiolunate angle (RLA) ≥ 15° from preoperative radiographs and computed tomography scans. The SLA, ISA, and RLA served to gauge carpal alignment. The operative time, grip strength, active range of motion (ROM), the Modified Mayo Wrist score (MMWS), and Disabilities of Arm, Shoulder, and Hand (DASH) score were assessed postoperatively. RESULTS: Thirty-eight patients qualified for the study (group DR, 15; group IC, 23). Union rates did not differ by patient subset (group DR, 100%; group IC, 95.7%; P = .827), and grip strength, ROM, MWS, and DASH score were similar between groups at the last follow-up. The operative time (minutes) was significantly shorter in group DR (median, 98; quartiles, 80, 114) than in group IC (median, 125; quartiles, 105, 150, P < .001). The ISA, RLA, and SLA improved postoperatively in both groups (P < 0.001). The degree of restoring carpal alignment, as evaluated by SLA, showed superior correction capability in group DR (median, 25.3% quartiles, 21.1, 35.3, P < 0.05). Donor site complications were not significantly different between the groups. CONCLUSIONS: Corticocancellous bone graft from the anterolateral metaphysis of the DR for unstable scaphoid nonunion is associated with a shorter operation time and comparable results with that from the iliac crest in regard to union, restoration of carpal alignment, and wrist function. LEVEL OF EVIDENCE: Level III.

Minimum four-year clinical outcomes after on-table reconstruction technique for Dubberley type III in coronal shear fractures of the capitellum and trochlea: a report of 10 patients.

PURPOSE: Comminuted coronal shear fractures of the distal humerus represent rare injuries and are difficult to treat, especially comminuted capitellum and trochlear fractures (Dubberley Type III). The on-table reconstruction technique of comminuted articular fractures may be an option, although it has not been reported in the coronal shear fracture of the distal humerus. The aim of the present case series is to determine the functional and radiological outcomes of on-table reconstructed Dubberley III fractures. METHODS: A retrospective review was conducted of 10 patients with Dubberley type III fractures in coronal shear fractures of the capitellum and trochlea who underwent an 'on-table' reconstruction technique between January 2009 and October 2019. All patients were evaluated using the disabilities of the arm, shoulder, and hand (DASH) score, American Shoulder and Elbow Surgeons(ASES) score, Mayo Elbow Score Performance Index (MEPI) score and at least 4 years later. RESULTS: All cases achieved union. At the final follow-up, the mean range of elbow motion was 11.5°of flexion contracture and 131.9° of further flexion. The mean DASH score was 21.2 (5.7) points (range 13.3-32.5). The mean ASES score was 88.6 ± 7.4 (range, 77 to 100). The mean MEPI score was 87 (10) points (range 70-100). In complication, partial osteonecrosis of capitellum is developed in one patient. One patient had heterotopic ossification without functional impairment. CONCLUSION: The on-table reconstruction technique can be a reliable option in the surgical treatment of complex distal humerus fractures. This technique allows anatomical reduction of comminuted capitellum and trochlea, with a low risk of avascular necrosis over 4 years of follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Discrimination of Explosive Residues by Standoff Sensing Using Anodic Aluminum Oxide Microcantilever Laser Absorption Spectroscopy with Kernel-Based Machine Learning.

Standoff laser absorption spectroscopy (LAS) has attracted considerable interest across many applications for environmental safety. Herein, we propose an anodic aluminum oxide (AAO) microcantilever LAS combined with machine learning (ML) for sensitive and selective standoff discrimination of explosive residues. A nanoporous AAO microcantilever with a thickness of <1 µm was fabricated using a micromachining process; its spring constant (18.95 mN/m) was approximately one-third of that of a typical Si microcantilever (53.41 mN/m) with the same dimensions. The standoff infrared (IR) spectra of pentaerythritol tetranitrate, cyclotrimethylene trinitramine, and trinitrotoluene were measured using our AAO microcantilever LAS over a wide range of wavelengths, and they closely matched the spectra obtained using standard Fourier transform infrared spectroscopy. The standoff IR spectra were fed into ML models, such as kernel extreme learning machines (KELMs), support vector machines (SVMs), random forest (RF), and backpropagation neural networks (BPNNs). Among these four ML models, the kernel-based ML models (KELM and SVM) were found to be efficient learning models able to satisfy both a high prediction accuracy (KELM: 94.4%, SVM: 95.8%) and short hyperparameter optimization time (KELM: 5.9 s, SVM: 7.6 s). Thus, the AAO microcantilever LAS with kernel-based learners could emerge as an efficient sensing method for safety monitoring.

Attention Mechanism-Based Glaucoma Classification Model Using Retinal Fundus Images.

This paper presents a classification model for eye diseases utilizing attention mechanisms to learn features from fundus images and structures. The study focuses on diagnosing glaucoma by extracting retinal vessels and the optic disc from fundus images using a ResU-Net-based segmentation model and Hough Circle Transform, respectively. The extracted structures and preprocessed images were inputted into a CNN-based multi-input model for training. Comparative evaluations demonstrated that our model outperformed other research models in classifying glaucoma, even with a smaller dataset. Ablation studies confirmed that using attention mechanisms to learn fundus structures significantly enhanced performance. The study also highlighted the challenges in normal case classification due to potential feature degradation during structure extraction. Future research will focus on incorporating additional fundus structures such as the macula, refining extraction algorithms, and expanding the types of classified eye diseases.

A phase 2 multicenter study of docetaxel-PM and trastuzumab-pkrb combination therapy in recurrent or metastatic salivary gland carcinomas.

BACKGROUND: Salivary duct carcinoma (SDC) is uncommon but is the most aggressive subtype of salivary gland carcinomas. The high positivity rate for human epidermal growth factor receptor 2 (HER2) led to an investigation of the efficacy of HER2-targeted agents. Docetaxel-PM (polymeric micelle) is a low-molecular-weight, nontoxic, biodegradable, and docetaxel-loaded micellar formulation. Trastuzumab-pkrb is a biosimilar to trastuzumab. METHODS: This was a multicenter, single-arm, open-label phase 2 study. Patients with HER2-positive (immunohistochemistry [IHC] score of ≥2+ and/or HER2/chromosome enumeration probe 17 [CEP17] ratio of ≥2.0) advanced SDCs were enrolled. Patients received docetaxel-PM (75 mg/m2 ) and trastuzumab-pkrb (8 mg/kg in the first cycle and 6 mg/kg in subsequent cycles) every 3 weeks. Primary end point was objective response rate (ORR). RESULTS: A total of 43 patients were enrolled. The best objective responses were partial response in 30 (69.8%) patients and stable disease in 10 (23.3%) patients, leading to an ORR of 69.8% (95% confidence interval [CI], 53.9-82.8) and a disease control rate of 93.0% (80.9-98.5). Median progression-free survival, duration of response, and overall survival were 7.9 (6.3-9.5), 6.7 (5.1-8.4), and 23.3 (19.9-26.7) months, respectively. Patients with HER2 IHC score of 3+ or HER2/CEP17 ratio ≥2.0 demonstrated better efficacies compared to those with HER2 IHC score of 2+. Thirty-eight (88.4%) patients experienced treatment-related adverse events (TRAE). Because of TRAE, nine (20.9%), 14 (32.6%), and 19 (44.2%) patients required temporary discontinuation, permanent discontinuation, or dose reduction, respectively. CONCLUSIONS: The combination of docetaxel-PM and trastuzumab-pkrb demonstrated promising antitumor activity with a manageable toxicity profile in HER2-positive advanced SDC. PLAIN LANGUAGE SUMMARY: Salivary duct carcinoma (SDC) is uncommon but is the most aggressive subtype of salivary gland carcinomas. SDC shares morphological and histological similarities with invasive ductal carcinoma of breast, which led to an investigation of hormonal receptor and human epidermal growth factor receptor 2 (HER2)/neu expression status in SDC. In this study, patients with HER2-positive SDC were enrolled and treated with combination of docetaxel-polymeric micelle and trastuzumab-pkrb. Promising antitumor activities were shown with objective response rate of 69.8%, disease control rate of 93.0%, median progression-free survival of 7.9 months, median duration of response of 6.7 months, and median overall survival of 23.3 months.

Medial Meniscus Posterior Root Repair Restores Contact Pressure and Contact Area to Its Native State Even After Opening-Wedge High Tibial Osteotomy: A Cadaveric Biomechanical Study.

PURPOSE: To elucidate the effect of medial meniscus posterior root (MMPR) repair during opening-wedge high tibial osteotomy (OWHTO) in terms of contact pressure (CP) and contact area (CA). METHODS: Nine fresh-frozen human cadaveric knee specimens were included. Each specimen was tested under 9 conditions comprising 3 different degrees of correction during OWHTO (neutral, 5° of valgus, and 10° of valgus) and 3 different types of MMPR conditions (intact, torn, and repaired). The prepared specimens were attached to a customized tibiofemoral jig in a fully extended state. The CP and CA generated by a tibiofemoral axial load of 650 N was recorded using the Tekscan sensor's pressure mapping software. Statistical analysis was performed using a repeated measures analysis of variance. RESULTS: The increased CP and decreased CA in torn MMPR was decreased and increased, respectively, to the intact MMPR after repairing, irrespective of whether OWHTO was performed. The mean CP at a correction angle of 5° of valgus was 0.4067 ± 0.0768 MPa for intact MMPR, which increased to 0.7340 ± 0.1593 MPa for the torn MMPR and decreased to 0.3614 ± 0.0639 MPa for the repaired MMPR. In addition, the proportion of decrease in CP and increase in CA after MMPR repair was constant, compared with the torn MMPR, irrespective of the degree of correction during OWHTO. CONCLUSIONS: MMPR repair decreases CP and increases CA, irrespective of whether OWHTO is performed. The biomechanical advantage of repairing torn MMPR is maintained, regardless of the degree of correction during OWHTO. CLINICAL RELEVANCE: Both OWHTO and MMPR repair are known to protect the medial compartment of the knee. However, there are concerns in performing 2 procedures simultaneously. Results of our study showed that concurrent repair of the MMPR during OWHTO is useful for protecting the medial compartment of the knee with respect to tibiofemoral contact biomechanics.

Characterization of Clofazimine as a Potential Substrate of Drug Transporter.

In this study, we explored clofazimine (CFZ) as a potential substrate of uptake and efflux transporters that might be involved in CFZ disposition, using transporter gene overexpressing cell lines in vitro. The intracellular concentrations of CFZ were significantly increased in the presence of selective inhibitors of P-gp and BCRP, which include verapamil, cyclosporine-A, PSC-833, quinidine, Ko143, and daunorubicin. In a bidirectional transport assay using transwell cultures of cell lines overexpressing P-gp and BCRP, the mean efflux ratios of CFZ were found to be 4.17 ± 0.63 and 3.37 ± 1.2, respectively. The Km and maximum rate of uptake (Vmax) were estimated to be 223.3 ± 14.73 µM and 548.8 ± 87.15 pmol/min/mg protein for P-gp and 381.9 ± 25.07 µM and 5.8 ± 1.22 pmol/min/mg protein for BCRP, respectively. Among the uptake transporters screened, the CFZ uptake rate was increased 1.93 and 3.09-fold in HEK293 cell lines overexpressing OAT1 and OAT3, respectively, compared to the control cell lines, but no significant uptake was observed in cell lines overexpressing OCT1, OCT2, OATP1B1, OATP1B3, OATP2B1, or NTCP. Both OAT1- and OAT3-mediated uptake was inhibited by the selective inhibitors diclofenac, probenecid, and butanesulfonic acid. The Km and Vmax values of CFZ were estimated to be 0.63 ± 0.15 µM and 8.23 ± 1.03 pmol/min/mg protein, respectively, for OAT1 and 0.47 ± 0.1 µM and 17.81 ± 2.19 pmol/min/mg protein, respectively, for OAT3. These findings suggest that CFZ is a novel substrate of BCRP, OAT1, and OAT3 and a known substrate of P-gp in vitro.

Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex Improved the Clinical Outcomes in Patients With Persistent Symptomatic Distal Radio-Ulnar Joint Instability After Plate Fixation of Distal Radius Fractures: Minimum 2-Year Follow-Up.

PURPOSE: To investigate the longitudinal trend of symptomatic distal radioulnar joint (DRUJ) instability after plate fixation for distal radius fractures (DRFs), determine which factors are associated with persistent symptomatic DRUJ instability, and evaluate the postoperative outcomes of arthroscopic foveal repair of the triangular fibrocartilage complex (TFCC) in patients with persistent symptomatic DRUJ instability after plate fixation for DRF. METHODS: All consecutive patients who underwent plate fixation for DRF between January 2014 and December 2017 and were followed up for a minimum of 1 year were included in this retrospective study. DRUJ instability was evaluated by subjective ulnar wrist pain and physical examination that included foveal sign and ballottement testing every 2 months after surgery. In patients with persistent symptomatic DRUJ instability lasting >6 months, arthroscopic transosseous foveal repair was performed with consent. Clinical outcomes were evaluated at a minimum of 2 years after surgery. The Generalized Estimating Equation model was used to analyze the incidence rate trend of symptomatic DRUJ instability. RESULTS: Overall, 204 patients were included. The incidence of symptomatic DRUJ instability decreased gradually with time after fixation for DRF until 6 months and was maintained thereafter. Thirty-four of 204 patients (16.6%) had persistent symptomatic DRUJ instability. In multivariable analysis, only high-energy injury was an independent risk factor for persistent symptomatic DRUJ instability (P = .003; odds ratio = 3.599). Seventeen patients underwent arthroscopic foveal repair. The mean follow-up period thereafter was 28.6 months. All clinical outcomes improved significantly compared with preoperative values, and no patient had residual DRUJ instability. CONCLUSION: In patients who had persistent symptomatic DRUJ instability for >6 months after plate fixation for DRFs, arthroscopic foveal repair of the TFCC is considered as a treatment option. Arthroscopic foveal repair of the TFCC to stabilize the DRUJ provided satisfactory clinical and functional outcomes and decreased ulnar-side pain. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Kinematically aligned total knee arthroplasty restores more native medial collateral ligament strain than mechanically aligned total knee arthroplasty.

PURPOSE: Kinematically aligned total knee arthroplasty (KA TKA) targets restoration of patient-specific alignment and soft tissue laxity. However, whether KA TKA reproduces native soft tissue strain remains unclear. This cadaveric study tested the hypothesis that KA TKA would better restore the quantitative strain and strain distribution of medial collateral ligament (MCL) to the native healthy knee compared to mechanically aligned (MA) TKA. METHODS: Twenty-four fresh-frozen cadaver knees (12 pairs) were mounted on a customized knee squatting simulator to measure MCL strain during flexion. For each pair, one knee was assigned to KA TKA and the other to MA TKA. During KA TKA, the amount of femur and tibia resected was equivalent to implant thickness without MCL release using the calipered measuring technique. MA TKA was performed using conventional measured resection techniques. MCL strain was measured using a video extensometer (Mercury® RT RealTime tracking system, Sobriety s.r.o, Czech Republic). MCL strain and strain distribution during knee flexion were measured, and the measurements compared between native and post-TKA conditions. RESULTS: Mean and peak MCL strain were similar between KA TKA and native knees at all flexion angles (p > 0.1 at all flexion angles) while mean strain at all flexion angles and peak strain at ≥ 60º of MA TKA were approximately twice those of the native knees (p < 0.05 at ≥ 60º of flexion). In addition, greater MCL strain was observed in 4 of 12 regions of interest (ROI) after MA TKA (M1, M2, P1 and P2) compared to the native knee, whereas after KA TKA, MCL strain measurements were similar at all but 1 ROI (P2). CONCLUSIONS: KA TKA restored a more native amount and distribution of MCL strain compared to MA TKA. These findings provide clues for understanding why patients may experience better performance and more normal knee sensations after KA TKA compared to MA TKA. LEVEL OF EVIDENCE: Therapeutic study, Level I.

Classification between Normal and Cancerous Human Urothelial Cells by Using Micro-Dimensional Electrochemical Impedance Spectroscopy Combined with Machine Learning.

Although the high incidence and recurrence rates of urothelial cancer of the bladder (UCB) are heavy burdens, a noninvasive tool for effectively detecting UCB as an alternative to voided urine cytology, which has low sensitivity, is yet to be reported. Herein, we propose an intelligent discrimination method between normal (SV-HUC-1) and cancerous (TCCSUP) urothelial cells by using a combination of micro-dimensional electrochemical impedance spectroscopy (µEIS) with machine learning (ML) for a noninvasive and high-accuracy UCB diagnostic tool. We developed a unique valved flow cytometry, equipped with a pneumatic valve to increase sensitivity without cell clogging. Since contact between a cell and electrodes is tight with a high volume fraction, the electric field can be effectively confined to the cell. This enables the proposed sensor to highly discriminate different cell types at frequencies of 10, 50, 100, 500 kHz, and 1 MHz. A total of 236 impedance spectra were applied to six ML models, and systematic comparisons of the ML models were carried out. The hyperparameters were estimated by conducting a grid search or Bayesian optimization. Among the ML models, random forest strongly discriminated between SV-HUC-1 and TCCSUP, with an accuracy of 91.7%, sensitivity of 92.9%, precision of 92.9%, specificity of 90%, and F1-score of 93.8%.

Guided-Motion Bicruciate-Stabilized Total Knee Arthroplasty Reproduces Native Medial Collateral Ligament Strain.

Background and Objectives: Guided-motion bicruciate-stabilized (BCS) total knee arthroplasty (TKA) includes a dual cam-post mechanism with an asymmetric bearing geometry that promotes normal knee kinematics and enhances anterior-posterior stability. However, it is unclear whether the improved biomechanics after guided-motion BCS TKA reproduce soft tissue strain similar to the strain generated by native knees. The purpose of this cadaveric study was to compare medial collateral ligament (MCL) strain between native and guided-motion BCS TKA knees using a video extensometer. Materials and Methods: Eight cadaver knees were mounted onto a customized knee squatting simulator to measure MCL strain during flexion in both native and guided-motion BCS TKA knees (Journey II-BCS; Smith & Nephew, Memphis, TN, USA). MCL strain was measured using a video extensometer (Mercury® RT RealTime tracking system, Sobriety s.r.o, Kurim, Czech Republic). MCL strain level and strain distribution during knee flexion were compared between the native and guided-motion BCS TKA conditions. Results: The mean and peak MCL strain were similar between native and guided-motion BCS TKA knees at all flexion angles (p > 0.1). MCL strain distribution was similar between native and BCS TKA knees at 8 of 9 regions of interest (ROIs), while higher MCL strain was observed after BCS TKA than in the native knee at 1 ROI in the mid portion of the MCL at early flexion angles (p < 0.05 at ≤30° of flexion). Conclusions: Guided-motion BCS TKA restored the amount and distribution of MCL strain to the values observed on native knees.

Long-term Comparison of Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Propensity Score-weighted Analysis of 2084 Consecutive Patients.

OBJECTIVE: To compare long-term outcomes between robotic and LG approaches using propensity score weighting based on a generalized boosted method to control for selection bias. SUMMARY OF BACKGROUND DATA: Minimally invasive surgical approaches for GC are increasing, yet limited evidence exists for long-term outcomes of robotic gastrectomy (RG). METHODS: Patients (n = 2084) with GC stages I-III who underwent LG or RG between 2009 and 2017 were analyzed. Generalized boosted method was used to estimate a propensity score derived from all available preoperative characteristics. Long-term outcomes were compared using the adjusted Kaplan-Meier method and the weighted Cox proportional hazards regression model. RESULTS: After propensity score weighting, the population was balanced. Patients who underwent RG showed reduced blood loss (16 mL less, P = 0.025), sufficient lymph node harvest from the initial period, and no changes in surgical outcomes over time. With 52-month median follow-up, no difference was noted in 5-year overall survival in unweighted [91.5% in LG vs 94% in RG; hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.46-1.1; P = 0.126] and weighted populations (94.2% in LG vs 93.2% in RG; HR, 0.88; 95% CI, 0.52-1.48; P = 0.636). There were no differences in 5-year recurrence-free survival (RFS), with unweighted 5-year RFS of 95.4% for LG and 95.2% for RG (HR, 0.95; 95% CI, 0.55-1.64; P = 0.845) and weighted 5-year RFS of 96.3% for LG and 95.3% for RG (HR, 1.24; 95% CI, 0.66-2.33; P = 0.498). CONCLUSIONS: After balancing covariates, RG demonstrated reliable surgical outcomes from the beginning. Long-term survival after RG and LG for GC was similar.

Prediction of Survival Outcomes Based on Preoperative Clinical Parameters in Gastric Cancer.

BACKGROUND: Few current preoperative risk assessment tools provide essential, optimized treatment for gastric cancer. The purpose of this study was to develop and validate a nomogram that uses preoperative data to predict survival and risk assessments. METHODS: A survival prediction model was constructed using data from a developmental cohort of 1251 patients with stage I to III gastric cancer who underwent curative resection between January 2005 and December 2008 at Ajou University Hospital, Korea. The model was internally validated for discrimination and calibrated using bootstrap resampling. To externally validate the model, data from a validation cohort of 2012 patients with stage I to III gastric cancer who underwent surgery at multiple centers in Korea between January 2001 and June 2006 were analyzed. Analyses included the model's discrimination index (C-index), calibration plots, and decision curve that predict overall survival. RESULTS: Eight independent predictors, including age, sex, clinical tumor size, macroscopic features, body mass index, histology, clinical stages, and tumor location, were considered for developing the nomogram. The discrimination index was 0.816 (adjusted C-index) in the developmental cohort and 0.781 (adjusted C-index) in the external validation cohort. Additionally, in both the developmental and validation datasets, age and tumor size were significantly correlated with each other and were independent indicators for survival (P < 0.05). CONCLUSIONS: We developed a new nomogram by using the most common and significant preoperative parameters that can help to identify high-risk patients before treatment and help clinicians to make appropriate decisions for patients with stage I to III gastric cancer.

How I do it? Extraforaminal lumbar interbody fusion assisted with biportal endoscopic technique.

BACKGROUND: The biportal endoscope-assisted unilateral foraminal approach is an option for various foraminal pathologies. Lumbar interbody fusion is the standard treatment for foraminal stenosis because both direct and indirect neural decompressions can be obtained. METHOD: We used the biportal endoscopic technique for extraforaminal lumbar interbody fusion (BE-EFLIF) and have described the steps, with discussion regarding the indications, advantages, possible complications, and ways to overcome complications. CONCLUSION: BE-EFLIF achieves direct neural decompression of lateral spinal canal under endoscopic visualization. It achieves indirect neural decompression using a large footprint lordotic interbody cage, while preserving the lumbar posterior arch as much as possible.

Comparison of arthroscopy-assisted vs. open reduction and fixation of coronoid fractures of the ulna.

PURPOSE: The purpose of this study was to compare clinical and radiographic outcomes and complications for arthroscopy-assisted vs. open reduction and fixation of coronoid fractures in patients with complex elbow fracture-dislocations. METHODS: This retrospective study analyzed patients with complex elbow fracture-dislocations who underwent surgical fixation for coronoid fractures of the ulna from March 2009 to January 2016. Subjects included those who received either arthroscopy-assisted (group A) or open surgery (group O) for coronoid fractures and concurrent reconstruction of the lateral column (radial head and/or lateral ulnar collateral ligament) with follow-up for at least 2 years. Clinical outcomes were assessed using the visual analog scale for pain, range of motion, Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder, and Hand score at 2 years after surgery. For radiographic assessment, union of the coronoid, development of heterotopic ossification, and arthritic changes were evaluated. We also reviewed surgery-related complications. RESULTS: Twenty-five patients (mean age, 40.0 ± 12.4 years) were enrolled in this study (group A, 15 patients; group O, 10 patients), and there were no statistical differences in baseline data between the 2 groups. Clinical outcomes did not differ between the 2 groups. All fractures were united and that the prevalence of heterotopic ossification and arthritic changes were similar between the 2 groups. However, operation-related complications were more common in group O than in group A (group A, 13.3%; group O, 40.0%), including 1 patient who underwent ulnar nerve neurolysis and anterior transposition at 3 months after the initial operation. CONCLUSIONS: Eliciting fewer complications, arthroscopy-assisted reduction and fixation of coronoid fractures shows union rates and clinical results comparable to open fixation in patients with complex elbow fracture-dislocation.

Full-Color-Tunable Nanophotonic Device Using Electrochromic Tungsten Trioxide Thin Film.

Color generation based on strategically designed plasmonic nanostructures is a promising approach for display applications with unprecedented high-resolution. However, it is disadvantageous in that the optical response is fixed once the structure is determined. Therefore, obtaining high modulation depth with reversible optical properties while maintaining its fixed nanostructure is a great challenge in nanophotonics. In this work, dynamic color tuning and switching using tungsten trioxide (WO3), a representative electrochromic material, are demonstrated with reflection-type and transmission-type optical devices. Thin WO3 films incorporated in simple stacked configurations undergo dynamic color change by the adjustment of their dielectric constant through the electrochromic principle. A large resonance wavelength shift up to 107 nm under an electrochemical bias of 3.2 V could be achieved by the reflection-type device. For the transmission-type device, on/off switchable color pixels with improved purity are demonstrated of which transmittance is modulated by up to 4.04:1.

Overseas Air Medical Repatriation of National Soccer Players Infected With Coronavirus Disease 2019 and Contacted Staff From Austria to South Korea.

Korea rarely has a system to transport patients from abroad. However, single-patient transfers are steadily being performed, and there was an experience of transferring a large number of personnel regardless of whether they were confirmed or not due to coronavirus disease 2019. Recently, a national soccer game was held abroad, and a total of 8 players and staff were infected. A total of 15 people were transported through a charter fully equipped with quarantine equipment by a medical response team with experience in air transport.

Arthroscopic treatment of a one-fourth anteroinferior glenoid comminuted fracture-dislocation with concomitant three-part complex proximal humerus fracture in a middle-aged man: a case report.

INTRODUCTION: Proximal humeral fracture-dislocations can occur in high-energy traumas. This injury can be accompanied by a glenoid fracture; however, it is a rare type of complex injury in patients aged under 60 years. MATERIALS AND METHODS: A 53-year-old man presented with a three-part fracture-dislocation of the proximal humerus and a severely comminuted glenoid fracture. For the glenohumeral dislocation and proximal humeral fracture, we performed closed reduction using a threaded Steinman pin and fixation with percutaneous cannulated screws. Using arthroscopy, while maintaining humeral traction with the Steinman pin, the intra-articular glenoid fragments were reduced and then fixed with a buttressing headless screw and one suture anchor. After a 6-week immobilization with a shoulder spica cast, rehabilitation was initiated. RESULTS: We confirmed bony union of the fracture sites after 6 months post-surgery. The patient showed excellent clinical outcomes with a nearly full range of motion without instability CONCLUSIONS: We reported a successful outcome for a complex proximal humeral fracture involving the glenoid using closed reduction and fixation for the proximal humeral fracture and arthroscopic reduction and fixation for the comminuted anteroinferior glenoid fracture.

Oxygen Transfer Capacity of Pseudobrookite Particles Derived from Ilmenite Mineral (x wt.%CuO/y wt.%red Mud-z wt.%ilmenite).

The minerals have a somewhat slower than other transition metals at critical reduction rates in their ability to deliver oxygen. Thus, single minerals alone do not exhibit a higher oxygen transfer capacity than metal oxide oxygen carriers. In this study, we try to solve the problem of single mineral ilmenite (FeTiO3) by combining it with Fe-based red mud and Cu oxide. When the ilmenite was used without calcination, the CH4-CO/air redox cycle showed rapid decayed. However, when ilmenite was calcined, the CH4-CO/air redox cycle became stable, and the oxygen transfer rate increased to 4.2%. This is because the FeTiO3 structure was converted to the pseudobrookite (Fe2TiO5) structure through the calcination process. That is, the Fe2+ ion in the ilmenite structure was converted into an Fe3+ ion. When 30 wt.% of red mud was added to the Fe ion, it reacted with the rutile-type titania mixed with pseudobrookite-typed Fe2TiO5, producing an almost perfect pseudobrookite crystal. This resulted in a slight increase in the capacity of oxygen transfer to 4.9%. When 15 wt.% of Cu oxide was added, the oxygen transfer capacity increased to 6.0%. This performance was indicated by the cyclic voltammetry curve that remained constant even after 200 cycles. Here, we argue that if low-cost minerals as a base material are used in appropriate amounts, the production of a lowest-cost oxygen carrier can be achieved.

Technical variation of trans-articular sacroiliac joint (SIJ) fusion using three screws considering the effects of sacral dysplasia in patients with non-traumatic SIJ pain.

BACKGROUND: This study evaluated the technical adequacy of trans-articular sacroiliac joint (SIJ) fusion using three screws for non-traumatic SIJ pain, considering different grades of sacral dysplasia. METHODS: Cadaveric CT data of unilateral sacropelvic complexes for 72 individuals (53.4 ± 8.4 years) were selected. A 3D model was reformatted into the plain lateral radiograph to mark the articular surface of the SIJ. Subjects were classified into dysplastic (DYS) and non-dysplastic sacrum (NDS) groups. Proximal (PS), middle (MS), and distal screws (DS) with 10-mm diameter were virtually introduced to the iliac bone and the SIJ on the lateral image with a 5-mm safety margin. On a corresponding axial image, each screw was advanced vertically to the sagittal plane with the same safety margin. The entry points for each screw to the endplate of S1 (S2) and to the corresponding anterior sacral margin on the lateral image were measured, along with the maximal screw lengths on the axial image. Whether each screw passed through the SIJ was determined. Different types of sacral dysplasia and screws were compared statistically. RESULTS: Thirty-eight (26.4%) cases were DYS, and 106 (73.6%) were NDS. The entry points of all screws were significantly more distal in DYS than in NDS groups. The PS and MS screw lengths differed significantly between the 2 groups. Incidences of short sacral fixation (< 10 mm) were significantly higher for the DS in both NDS (38.7%) and DYS (39.5%) groups. Incidences of screw pass were lowest for the MS in both NDS (43.4%) and DYS (47.4%) groups. CONCLUSIONS: Sacral dysplasia locates the SIJ more distally and therefore affects the entry point locations and screw lengths for all screws in trans-articular SIJ fusion, compared with a non-dysplastic sacrum. Moreover, three-screw fixation risks the development of unstable DS fixation and a high extra-articular fixation rate in MS.