S/Mo ratio and petal size controlled MoS2 nanoflowers with low temperature metal organic chemical vapor deposition and their application in solar cells.

Vertically aligned two-dimensional (2D) molybdenum disulfide nanoflowers (MoS2 NFs) have drawn considerable attention as a novel functional material with potential for next-generation applications owing to their inherently distinctive structure and extraordinary properties. We report a simple metal organic chemical vapor deposition (MOCVD) method that can grow high crystal quality, large-scale and highly homogeneous MoS2 NFs through precisely controlling the partial pressure ratio of H2S reaction gas, P SR, to Mo(CO)6 precursor, P MoP, at a substrate temperature of 250 °C. We investigate microscopically and spectroscopically that the S/Mo ratio, optical properties and orientation of the grown MoS2 NFs can be controlled by adjusting the partial pressure ratio, P SR/P MoP. It is also shown that the low temperature MOCVD (LT-MOCVD) growth method can regulate the petal size of MoS2 NFs through the growth time, thereby controlling photoluminescence intensity. More importantly, the MoS2 NFs/GaAs heterojunction flexible solar cell exhibiting a power conversion efficiency of ∼1.3% under air mass 1.5 G illumination demonstrates the utility of the LT-MOCVD method that enables the direct growth of MoS2 NFs on the flexible devices. Our work can pave the way for practical, easy-to-fabricate 2D materials integrated flexible devices in optical and photonic applications.

High conversion rate to total hip arthroplasty after hemiarthroplasty in young patients with a minimum 10 years follow-up.

BACKGROUND: This study aimed to evaluate the follow-up results of bipolar hemiarthroplasty (BHA) for more than 10 years in patients aged < 60 years and to analyze the risk factors for acetabular erosion after BHA. METHODS: This retrospective study included 114 patients who underwent BHA were followed-up for at least 10 years. The mean age was 54.1 years, and the mean follow-up duration was 13.8 years. The patients were divided into two groups according to the presence of acetabular erosion, and the preoperative parameters were compared between the two groups. Moreover, the risk factors related to acetabular erosion after BHA were analyzed using statistical comparisons. RESULTS: Reoperation was performed in 44 of the 114 patients (38.6 %). The survival rate when the end point was reoperation related to acetabular erosion was found to be significantly time-dependent: 73.2 % at 5 years, 48.8 % at 10 years, and 25.9 % at 15 years. The acetabular erosion group showed significantly younger age at the time of surgery, higher body mass index (BMI), more avascular necrosis of the femoral head, and smaller prosthetic femoral head. The final multivariate logistic regression analysis showed that young age at the time of surgery were independent risk factors for acetabular erosion after BHA in patients aged < 60 years. CONCLUSIONS: The minimum 10-year follow-up outcomes of BHA in patients aged < 60 years showed a relatively high conversion rate to total hip arthroplasty. When considering BHA in younger patients, more careful decisions should be made with respect to patient's choice, keeping in mind that long-term survival cannot be guaranteed.

The peroneal strength deficits in patients with chronic ankle instability compared to ankle sprain copers and normal individuals.

BACKGROUND: Despite a consensus regarding the correlation of peroneal strength deficit with chronic ankle instability (CAI), there are conflicting reports in regards to peroneal strength as assessed by isokinetic dynamometer in patients with CAI. The purpose of this study was to evaluate the changes of isokinetic strength in patients with CAI compared to ankle sprain copers and normal individuals. METHODS: Forty-two patients (CAI group) with chronic ankle instability who were scheduled for the modified Broström procedure met inclusion criteria. Thirty-one ankle sprain copers (ASC group) who were eligible at 6 months after acute injury and 30 controls were recruited. The muscle strength associated with four motions of the ankle were evaluated using isokinetic dynamometer. RESULTS: Peak torque for inversion and eversion at 60°/s angular velocity were significantly lower in the CAI group compared to the ASC and control group (P=.004, P<.001, respectively). Deficit ratio of peak torque for eversion at 60°/s and 120°/s in the CAI group were 33.8% and 19.8%, respectively, which indicated significant side to side differences (both P<.001). The evertor/invertor strength ratio (0.59) for eversion at 60°/s was significantly lower in the CAI group (P<.001). CONCLUSION: As compared to the ankle sprain copers and normal individuals, patients with chronic ankle instability who were scheduled for modified Broström procedure demonstrated a significant weakness of isokinetic peroneal strength. Isokinetic muscular assessment can provide the useful preoperative informations regarding functional ankle instability focusing on peroneal weakness.

Hierarchical, Dual-Scale Structures of Atomically Thin MoS2 for Tunable Wetting.

Molybdenum disulfide (MoS2), a well-known solid lubricant for low friction surface coatings, has recently drawn attention as an analogue two-dimensional (2D) material beyond graphene. When patterned to produce vertically grown, nanoflower-structures, MoS2 shows promise as a functional material for hydrogen evolution catalysis systems, electrodes for alkali metal-ion batteries, and field-emission arrays. Whereas the wettability of graphene has been substantially investigated, that of MoS2 structures, especially nanoflowers, has remained relatively unexplored despite MoS2 nanoflower's potential in future applications. Here, we demonstrate that the wettability of MoS2 can be controlled by multiscale modulation of surface roughness through (1) tuning of the nanoflower structures by chemical vapor deposition synthesis and (2) tuning of microscale topography via mechanical strain. This multiscale modulation offers broadened tunability (80-155°) compared to single-scale tuning (90-130°). In addition, surface adhesion, determined from contact angle hysteresis (CAH), can also be tuned by multiscale surface roughness modulation, where the CAH is changed in range of 20-40°. Finally, the wettability of crumpled MoS2 nanoflowers can be dynamically and reversibly controlled through applied strain (∼115-150° with 0-200% strain), and remains robust over 1000 strain cycles. These studies on the tunable wettability of MoS2 will contribute to future MoS2-based applications, such as tunable wettability coatings for desalination and hydrogen evolution.

Observation of photoluminescence from large-scale layer-controlled 2D ß-Cu2S synthesized by the vapor-phase sulfurization of copper thin films.

Two-dimensional (2D) copper chalcogenides (Cu2-x X where X = S, Se, Te) have had much attention regarding various applications due to their remarkable optical and electrical properties, abundance, and environmentally friendly natures. This work indicates that highly uniform Cu2-x S (where 0 < x < 1) nanosheets can be obtained by the two-step method of Cu deposition by sputtering with precisely controlled and extremely low growth rate followed by vapor-phase sulfurization. The phase transformations of thin Cu2-x S films upon the Cu seed layer thickness are investigated. A unique thickness-constrained synthesis process using vapor-phase sulfurization is employed here, which evolves from a vertical to lateral growth mechanism based on the optimization of the Cu seed layer thickness. Atomically thin 2D ß-Cu2S film was successfully synthesized using the thinnest Cu seed film. We have systematically investigated the phase- and thickness-dependent optical properties of Cu2-x S films at room temperature. Micro-photoluminescence (PL) spectroscopy reveals that the 2D ß-Cu2S film possesses a direct band gap with an energy of 1.1 eV while the PL intensities are greatly suppressed in the multilayer Cu2-x S (where 0 ≤ x < 1).

Wafer-scale production of highly uniform two-dimensional MoS2 by metal-organic chemical vapor deposition.

Semiconducting two-dimensional (2D) materials, particularly extremely thin molybdenum disulfide (MoS2) films, are attracting considerable attention from academia and industry owing to their distinctive optical and electrical properties. Here, we present the direct growth of a MoS2 monolayer with unprecedented spatial and structural uniformity across an entire 8 inch SiO2/Si wafer. The influences of growth pressure, ambient gases (Ar, H2), and S/Mo molar flow ratio on the MoS2 layered growth were explored by considering the domain size, nucleation sites, morphology, and impurity incorporation. Monolayer MoS2-based field effect transistors achieve an electron mobility of 0.47 cm2 V-1 s-1 and on/off current ratio of 5.4 × 104. This work demonstrates the potential for reliable wafer-scale production of 2D MoS2 for practical applications in next-generation electronic and optical devices.

Enhanced transmission due to antireflection coating layer at surface plasmon resonance wavelengths.

We present experiments and analysis on enhanced transmission due to dielectric layer deposited on a metal film perforated with two-dimensional periodic array of subwavelength holes. The Si3N4 overlayer is applied on the perforated gold film (PGF) fabricated on GaAs substrate in order to boost the transmission of light at the surface plasmon polariton (SPP) resonance wavelengths in the mid- and long-wave IR regions, which is used as the antireflection (AR) coating layer between two dissimilar media (air and PGF/GaAs). It is experimentally shown that the transmission through the perforated gold film with 1.8 µm (2.0 µm) pitch at the first-order (second-order) SPP resonance wavelengths can be increased up to 83% (110%) by using a 750 nm (550 nm) thick Si3N4 layer. The SPP resonance leads to a dispersive resonant effective permeability (µeff ≠ 1) and thereby the refractive index matching condition for the conventional AR coating on the surface of a dielectric material cannot be applied to the resonant PGF structure. We develop and demonstrate the concept of AR condition based on the effective parameters of PGF. In addition, the maximum transmission (zero reflection) condition is analyzed numerically by using a three-layer model and a transfer matrix method is employed to determine the total reflection and transmission. The numerically calculated total reflection agrees very well with the reflection obtained by 3D full electromagnetic simulations of the entire structure. Destructive interference conditions for amplitude and phase to get zero reflection are well satisfied.

Lateral heterostructures of WS2 and MoS2 monolayers for photo-synaptic transistor.

Von Neumann architecture-based computing, while widely successful in personal computers and embedded systems, faces inherent challenges including the von Neumann bottleneck, particularly amidst the ongoing surge of data-intensive tasks. Neuromorphic computing, designed to integrate arithmetic, logic, and memory operations, has emerged as a promising solution for improving energy efficiency and performance. This approach requires the construction of an artificial synaptic device that can simultaneously perform signal processing, learning, and memory operations. We present a photo-synaptic device with 32 analog multi-states by exploiting field-effect transistors based on the lateral heterostructures of two-dimensional (2D) WS2 and MoS2 monolayers, formed through a two-step metal-organic chemical vapor deposition process. These lateral heterostructures offer high photoresponsivity and enhanced efficiency of charge trapping at the interface between the heterostructures and SiO2 due to the presence of the WS2 monolayer with large trap densities. As a result, it enables the photo-synaptic transistor to implement synaptic behaviors of long-term plasticity and high recognition accuracy. To confirm the feasibility of the photo-synapse, we investigated its synaptic characteristics under optical and electrical stimuli, including the retention of excitatory post-synaptic currents, potentiation, habituation, nonlinearity factor, and paired-pulse facilitation. Our findings suggest the potential of versatile 2D material-synapse with a high density of device integration.

Heteronanostructured Field-Effect Transistors for Enhancing Entropy and Parameter Space in Electrical Unclonable Primitives.

Hardware security is not a new problem but is ever-growing in consumer and medical domains owing to hyperconnectivity. A physical unclonable function (PUF) offers a promising hardware security solution for cryptographic key generation, identification, and authentication. However, electrical PUFs using nanomaterials or two-dimensional (2D) transition metal dichalcogenides (TMDCs) often have limited entropy and parameter space sources, both of which increase the vulnerability to attacks and act as bottlenecks for practical applications. We report an electrical PUF with enhanced entropy as well as parameter space by incorporating 2D TMDC heteronanostructures into field-effect transistors (FETs). Lateral heteronanostructures of 2D molybdenum disulfide and tungsten disulfide serve as a potent entropy source. The variable feature of FETs is further leveraged to enhance the parameter space that provides multiple challenge-response pairs, which are essential for PUFs. This combination results in stably repeatable yet highly variable FET characteristics as alternative electrical PUFs. Comprehensive PUF performance analyses validate the bit uniformity, reproducibility, uniqueness, randomness, false rates, and encoding capacity. The 2D material heteronanostructure-driven electrical PUFs with strong FET-to-FET variability can potentially be augmented as an immediately deployable and scalable security solution for various hardware devices.

Simulational investigation of self-aligned bilayer linear grating enabling highly enhanced responsivity of MWIR InAs/GaSb type-II superlattice (T2SL) photodetector.

Linear gratings polarizers provide remarkable potential to customize the polarization properties and tailor device functionality via dimensional tuning of configurations. Here, we extensively investigate the polarization properties of single- and double-layer linear grating, mainly focusing on self-aligned bilayer linear grating (SABLG), serving as a wire grid polarizer in the mid-wavelength infrared (MWIR) region. Computational analyses revealed the polarization properties of SABLG, highlighting enhancement in TM transmission and reduction in TE transmission compared to single-layer linear gratings (SLG) due to optical cavity effects. As a result, the extinction ratio is enhanced by approximately 2724-fold in wavelength 3-6 µm. Furthermore, integrating the specially designed SABLG with an MWIR InAs/GaSb Type-II Superlattice (T2SL) photodetector yields a significantly enhanced spectral responsivity. The TM-spectral responsivity of SABLG is enhanced by around twofold than the bare device. The simulation methodology and analytical analysis presented herein provide a versatile route for designing optimized polarimetric structures integrated into infrared imaging devices, offering superior capabilities to resolve linear polarization signatures.

Effect of Abiotic Signals on the Accumulation of Saponarin in Barley Leaves in Hydroponics Under Artificial Lights.

Functional flavonoid production is a new agenda in the agricultural industry, and young barley leaves (YBL) are one of the highlighted crops due to their health-beneficial flavonoid, saponarin. For the year-round cultivation of a high saponarin content of YBL, abiotic signal effects on the biosynthesis and metabolism in YBL need to be understood clearly. In this research, the effects of reactive oxygen species (ROS)-related abiotic signals, such as light, potassium, and sodium, were investigated on the biosynthetic metabolism in YBL cultivation under artificial lights. A higher quantity of blue-rich white light (6500 K of light temperature) irradiation enhanced ROS levels and the related enzyme activities (APX and CAT), as well as photosynthesis and saponarin amount, while red-rich white light (3000 K of light temperature) increased the photosynthesis only. In addition, 1.0 g L-1 K+ treatment in water slightly reduced ROS levels and increased saponarin accumulation in YBL. These blue-rich light and K+ supplemental conditions relatively increased OGT expression and reduced 4-coumaric acid and isovitexin as saponarin precursors. Furthermore, the relative ratio of lutonarin as an oxidized product of saponarin increased in increments of light quantity. Finally, the abiotic conditions for saponarin production were optimized with the mixture solution treatment of 1.0 g L-1 Na+ and 1.0 g L-1 K+ under 500 PPFD of 6500 K light, and the saponarin amount per leaf was 219.5 µg plant-1; it was comparable amount with that under sunlight condition.

Effect of Measurement System Configuration and Operating Conditions on 2D Material-Based Gas Sensor Sensitivity.

Gas sensors applied in real-time detection of toxic gas leakage, air pollution, and respiration patterns require a reliable test platform to evaluate their characteristics, such as sensitivity and detection limits. However, securing reliable characteristics of a gas sensor is difficult, owing to the structural difference between the gas sensor measurement platform and the difference in measurement methods. This study investigates the effect of measurement conditions and system configurations on the sensitivity of two-dimensional (2D) material-based gas sensors. Herein, we developed a testbed to evaluate the response characteristics of MoS2-based gas sensors under a NO2 gas flow, which allows variations in their system configurations. Additionally, we demonstrated that the distance between the gas inlet and the sensor and gas inlet orientation influences the sensor performance. As the distance to the 2D gas sensor surface decreased from 4 to 2 mm, the sensitivity of the sensor improved to 9.20%. Furthermore, when the gas inlet orientation was perpendicular to the gas sensor surface, the sensitivity of the sensor was the maximum (4.29%). To attain the optimum operating conditions of the MoS2-based gas sensor, the effects of measurement conditions, such as gas concentration and temperature, on the sensitivity of the gas sensor were investigated.

Highly Sensitive and Cost-Effective Polymeric-Sulfur-Based Mid-Wavelength Infrared Linear Polarizers with Tailored Fabry-Pérot Resonance.

Inverse-vulcanized polymeric sulfur has received considerable attention for application in waste-based infrared (IR) polarizers with high polarization sensitivities, owing to its high transmittance in the IR region and thermal processability. However, there have been few reports on highly sensitive polymeric sulfur-based polarizers by replication of pre-simulated dimensions to achieve a high transmission of the transverse magnetic field (TTM ) and extinction ratio (ER). Herein, a 400-nanometer-pitch mid-wavelength infrared bilayer linear polarizer with self-aligned metal gratings is introduced on polymeric sulfur gratings integrated with a spacer layer (SM-polarizer). The dimensions of the SM-polarizer can be closely replicated using pre-simulated dimensions via a systematic investigation of thermal nanoimprinting conditions. Spacer thickness is tailored from 40 to 5100 nm by adjusting the concentration of polymeric sulfur solution during spin-coating. A tailored spacer thickness can maximize TTM in the broadband MWIR region by satisfying Fabry-Pérot resonance. The SM-polarizer yields TTM of 0.65, 0.59, and 0.43 and ER of 3.12 × 103 , 5.19 × 103 , and 5.81 × 103 at 4 µm for spacer thicknesses of 90, 338, and 572 nm, respectively. This demonstration of a highly sensitive and cost-effective SM-polarizer opens up exciting avenues for infrared polarimetric imaging and for applications in polarization manipulation.

De novo asymmetric synthesis of all-D-, all-L-, and D-/L-oligosaccharides using atom-less protecting groups.

Oligosaccharide synthesis is hindered by the need for multiple steps as well as numerous selective protections and deprotections. Herein we report a highly efficient de novo route to various oligosaccharide motifs, of use for biological and medicinal structure activity studies. The key to the overall efficiency is the judicious use of asymmetric catalysis and synthetic design. These green principles include the bidirectional use of highly stereoselective catalysis (Pd(0)-catalyzed glycosylation/post-glycosylation). In addition, the chemoselective use of C-C and C-O π-bond functionality, as atom-less protecting groups as well as an anomeric directing group (via a Pd-π-allyl), highlights the atom-economical aspects of the route to a divergent set of natural and unnatural oligosaccharides (i.e., various d-/l-diastereomers of oligosaccharides as well as deoxysugars which lack C-2 anomeric directing groups). For example, in only 12 steps, the construction of a highly branched heptasaccharide with 35 stereocenters was accomplished from an achiral acylfuran.

Development and calibration of differential mobility analyzer for 20 to 80 nm particles under low pressure conditions.

The vienna-type differential mobility analyzer (DMA) was developed for the measurement of wide-range nm-sized particles under low-pressure conditions (2.9-8 kPa) with the faraday cup electrometer (FCE). The length, inner and outer diameter of DMA are calculated as a function of flow rate, applied voltage, pressure, and particle diameter to avoide breakdown in DMA. The algorithm for the diffusion transfer function of the DMA was successfully developed and verified by comparing the numerical and experimental results. The DMA was calibrated via the tandem DMA (TDMA) method which using two DMA in parallel. The inversion algorithm was applied to the size distribution obtained from the current of the FCE. The calibration experiment was performed with 1% NaCl particles under atmospheric and low-pressure conditions. The calibration result showed that the development of the DMA was successful as it was able to measure 20- to 80-nm paricles under low-pressure conditions with various flow rates (0.1-0.5 l/min).

Closure of Persistent, Small, Posterior Elbow Soft Tissue Defects Using a Rotation Flap: A Retrospective Study.

Treating soft tissue defects occurring over the posterior elbow is challenging. PURPOSE: This study aimed to evaluate the long-term outcomes of using rotation flaps for soft tissue defects over the posterior elbow. METHODS: A retrospective study was conducted among patients who had sustained posterior elbow defects and underwent rotation flap under local anesthesia between January 2, 2011, and December 31, 2014. Patient inclusion criteria stipulated the soft tissue defect had to be small (<12 cm2), was the result of wound dehiscence following posterior approach surgery immediately following trauma, and had failed to heal using nonsurgical treatment or primary closure. Patients with an active infection, malignancies, a defect of any etiology other than trauma, or incomplete operative data were excluded. Patient demographics, medical history, operative reports, and outcomes were abstracted. Flap failure and surgical complications were monitored for a minimum of 2 years after surgery. Range of motion (ROM; 0˚ to normal 130˚) and Mayo Elbow Performance Scores (MEPS) were evaluated and recorded before surgery and after 2 years' follow-up and included evaluating pain, ROM, stability, and daily function. Patient, wound, surgical, and wound healing variables were compared between the flap survival and flap failure/complication groups using Mann-Whitney U and chi-squared tests. The Wilcoxon signed-rank test was used to compare pre- and postoperative MEPS and elbow ROM. RESULTS: Thirty (30) patients (13 male, 17 female; mean age 55 ± 15.6 [range 19-74] years) had complete records. Eighteen (18) flaps were created using the transolecranon approach, and 12 rotation flaps involved an olecranon fracture; 24 flaps survived and 6 patients experienced flap failure/complications (wound dehiscence or infection). Mean procedure duration was 25.6 ± 10.1 minutes. All defects were located over the olecranon with exposed bone or hardware. Mean defect size was 7.4 cm2 ± 2.9 cm2, the average defect duration was 60.4 (range 31-89) days, average time to wound healing was 21.9 ± 11.5 days, and mean follow-up time was 29.4 (range 24-56) months. All flaps successfully survived without recurrence. Mean pre- and postoperative MEPS were significantly different (56.4 vs. 90.2 points; P <.001). ROM did not differ significantly between mean preoperative range (extension 9.8˚ ± 3.2˚ and flexion 116.7˚ ± 10.2˚) and mean final follow-up range (extension 9.6˚ ± 2.6˚ and flexion 118.5˚ ± 11.3˚; P = .459). CONCLUSION: Rotation flap surgery performed under local anesthesia may offer a simple and safe option in the treatment of small (<12 cm2) trauma-related defects over the posterior elbow. More research is needed to develop evidence-based guidelines for optimal approaches to posterior elbow soft tissue defect closure techniques.

In idiopathic cubital tunnel syndrome, ulnar nerve excursion and instability can be reduced by repairing Osborne's ligament after simple decompression.

Osborne's modified decompression involves repairing Osborne's ligament beneath the ulnar nerve after simple decompression for idiopathic cubital tunnel syndrome. In this retrospective interrupted time series, 31 patients underwent modified simple decompression and 20 patients underwent conventional simple decompression. In the modified simple decompression group, the ulnar nerve length was measured at operation in full elbow flexion and extension before and after repair of Osborne's ligament. Ulnar nerve instability during elbow motion was measured using ultrasonography before operation and at 12 months after operation. In patients treated by modified simple decompression, the ulnar nerve length in full elbow flexion reduced significantly after repair of Osborne's ligament. At 12 months after surgery, the grade of ulnar nerve instability was lower in the modified simple decompression group than in the conventional simple decompression group. The clinical outcomes did not differ significantly between the groups at 24 months after operation. Level of evidence: III.

Three-dimensional measurement of the course of the radial nerve at the posterior humeral shaft: An in vivo anatomical study.

PURPOSE: Iatrogenic radial nerve injury caused by surgical exposure of the humerus is a serious complication. We aimed to describe the course of the radial nerve at the posterior humeral shaft using a three-dimensional (3D) reconstruction technique by utilizing computed tomography (CT) images of living subjects. We hypothesized that the course of the radial nerve in the posterior aspect of the humeral shaft would be reliably established using this technique and the measurements would have satisfactory intraobserver/interobserver reliabilities. METHODS: This in vivo anatomical study utilized 652 upper extremity CT angiography images from 326 patients. A 3D modeling of the humerus and radial nerve was performed. We evaluated the segment of the radial nerve that lays directly on the posterior aspect of the humeral shaft and measured its proximal point, mid, and distal points. The shortest distances from the olecranon fossa to these points were defined as R1, R2, and R3, respectively. The relationships between these parameters and humeral length (HL) and transcondylar length (TL) were evaluated, and the intraobserver/interobserver reliabilities of these parameters were measured. RESULTS: The HL was 293.6 mm, and TL was 58.64 mm on average. The R1 measured 159.2 (range 127.1-198.2) mm, R2 was 136.6 (105.7-182.5), and R3 was 112.8 (76.8-150.0) mm on average (p < .001). The intraobserver/interobserver reliabilities ranged from 0.90 to 0.98. CONCLUSION: The course of the radial nerve at the posterior aspect of the humeral shaft can be reliably established using the 3D reconstruction technique, and all measurements had excellent intraobserver/interobserver reliability.

Skin graft using MatriDerm® for plantar defects after excision of skin cancer.

Skin cancer should be excised with sufficient margin to reduce recurrence rate. However, the surgeon always has to worry about the reconstruction method of skin defects after excision. In particular, defects in the plantar surface of the foot are difficult to reconstruct due to their position and structure, and various methods are applied by each surgeon. Surgeons think which methods are easier to apply to patients and less morbidity. To alleviate these concerns, we applied artificial dermal substitute to skin defects after skin cancer. Bowen's disease (squamous cell carcinoma in situ) and melanoma in situ on the plantar surface of the foot were subjected to wide excision with sufficient margin. After excision, a skin defect with exposed plantar fascia was applied with a matrix defect and vacuum. A granulation tissue (dermal matrix) was formed and a split-thickness skin graft was performed. Both patients had good functional results and no problems with skin donor sites. Thus, we report a skin graft method that is relatively easy to apply after skin cancer excision on the plantar surface of the foot.

Evaluation of Inferior Capsular Laxity in Patients with Atraumatic Multidirectional Shoulder Instability with Magnetic Resonance Arthrography.

OBJECTIVE: To compare inferior capsular redundancy by using magnetic resonance arthrography (MRA) images in patients with multidirectional instability (MDI) of the shoulder and control subjects without instability and thereby develop a screening method to identify the presence of shoulder MDI. MATERIALS AND METHODS: The MRA images of patients with MDI of the shoulder (n = 65, 57 men, 8 women; mean age, 24.5 years; age range, 18-42 years) treated over an eight-year period were retrospectively reviewed; a control group (n = 65, 57 men, 8 women; mean age, 27.4 years; age range, 18-45 years) without instability was also selected. The inferior capsular redundancy was measured using a new method we named the glenocapsular (GC) ratio method. MRA images of both groups were randomly mixed together, and two orthopedic surgeon reviewers measured the cross-sectional areas (CSAs) and sagittal capsule-head ratios on oblique sagittal images, as well as the axial capsule-head ratios on axial images and GC ratios on oblique coronal images. RESULTS: The CSAs and GC ratios were significantly higher in patients than in controls (both, p < 0.001); however, the sagittal capsule-head ratios and axial capsule-head ratios were not significantly different (p = 0.317, p = 0.053, respectively). In addition, GC ratios determined the presence of MDI more sensitively and specifically than did CSAs. A GC ratio of > 1.42 was found to be most suggestive of MDI of the shoulder, owing to its high sensitivity (92.3%) and specificity (89.2%). CONCLUSION: GC ratio can be easily measured and used to accurately screen for MDI of the shoulder.