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BACKGROUND: In patients with rheumatoid arthritis (RA), some problems might occur in fracture healing; however, clinical evidence is limited. Therefore, we compared the time to union and complication rate of femoral fractures between RA and non-RA patients. MATERIALS AND METHODS: This study included 42 RA patients who underwent osteosynthesis for femoral trochanter or shaft fracture. For comparison with the RA group, 126 non-RA patients were selected as a control group. The RA group was divided into the trochanteric (RA group I) and shaft fracture group (RA group II) for comparison with each control group (control groups I and II). We analyzed risk factors for nonunion or delayed union and divided patients according to whether atypical or ordinary fracture in shaft fracture. RESULTS: Time to union (p = 0.823) and complication rate (p = 0.440) did not differ significantly between RA group I and control group I. A significantly longer time to union (p = 0.001) and higher nonunion rate (p = 0.013) were observed in RA group II compared with control group II. The presence of RA (p = 0.040) and atypical femoral fracture (p = 0.006) were significant risk factors for nonunion or delayed union. CONCLUSIONS: The high prevalence of atypical femoral fracture among the femur shaft fractures in the RA patients was considered a significant risk factor for nonunion and delayed union.

The purpose of this study was to investigate the incidence of symptomatic venous thromboembolism (VTE) after chemoprophylaxis in patients with pelvic and lower-extremity fractures, and to identify risk factors for VTEs in this subgroup of patients. To detect VTE, multi-detector computed tomography (CT) angiography was performed. Of 363 patients assessed, the incidence of symptomatic VTE was 12.4% (45 patients), and the incidence of symptomatic PE was 5.2% (19 patients). For the risk-factor analysis, a higher Charlson comorbidity index (p = 0.037), and a history of external fixator application (p = 0.007) were associated with increased VTE risk. Among patients who had VTE, male sex (p = 0.017), and above-the-knee fractures (p = 0.035) were associated with increased pulmonary embolism (PE) risk. In conclusions, the incidence of VTE in post-traumatic patients is not low after chemoprophylaxis. Risk factors for VTE and PE are different among patients with pelvic and lower-extremity fractures.

This paper proposes an anti-slip traction control for electric vehicle based on torque observer. The proposed traction control consist of direct torque control and unknown input observer. The direct torque control has the performance of fast response and accuracy torque control and the unknown input observer is a proper scheme to estimate a load torque which depends on the unknown road condition. The torque command of a traction motor is compensated according to a load torque estimated by an unknown input observer. The feasibility and validity of the proposed scheme were proven by simulation results.

This paper investigates an energy-harvesting system that uses of vibration energy at a shock absorber for electric vehicles. This system mainly comprises a linear electromagnetic generator and synchronous buck converter. To obtain the electrical energy through a linear electromagnetic generator, the perturb and observe maximum power point tracking (P&O MPPT) scheme is applied at the converter. The power converter circuit is designed with a diode rectifier and synchronous buck converter. The generated electric power is able to transmit to the battery and the damping force of the shock absorber is adjusted by the controlled current of generator. The linear electromagnetic generator was designed as a single phase eight-slot eight-pole tubular permanent magnet machine. The performance of the proposed energy-harvesting system was verified through simulations and experiments.

We developed a gradient quantum dot (QD)@polyvinylpyrrolidone (PVP)-silica composite as a spectral converter to improve light harvesting of the photoactive layer in organic photovoltaic (OPV) devices. The spectral converter prepared by a simple sol–gel method served as a luminescent down-shifting (LDS) layer that absorbed ultraviolet and emitted visible light. Re-emitted light energy from the LDS layer appeared within the absorption range of the photoactive donor material of P3HT in the OPV devices. We investigated how the light harvesting ability was affected by the concentration of QD@PVP and the thickness of the LDS layer. The OPV devices with the LDS layer showed increased power conversion efficiency (PCE) from 3.38% to 3.68% compared to pristine OPV devices due to improved incident light transmittance and increased light harvesting.

Background: In Daegu, Korea, a coronavirus disease 2019 (COVID-19) outbreak occurred within a religious group. Because the hospitals in Daegu cannot afford to admit all the infected subjects with COVID-19, the Korean government has turned private dormitories and public organization-run facilities into living and treatment support centers (LTSCs) for isolation of subjects with or without mild symptoms. Methods: Data of 130 COVID-19 patients with or without mild symptoms were collected from the Jecheon LTSCs. Questionnaires about their symptoms were obtained twice per day from March 10, 2020, to April 3, 2020. Findings: A total of five subjects were transferred to general hospitals. Two cases were clearly related to COVID-19. The percentage of asymptomatic cases tended to increase over time from a minimum of 56% to a maximum of 80%. Except for the five subjects who were transferred to hospitals, asymptomatic and mildly symptomatic subjects with COVID-19 did not require specific medical treatment during the LTSC admission period. Interpretation: Subjects with COVID-19 can carry the virus for a long time. even if they are asymptomatic or mildly symptomatic, and LTSC is one good measure to prevent the spread of COVID-19 by isolating asymptomatic or mildly symptomatic subjects when a large outbreak occurs. Funding Statement: There was no funding source for this study. Declaration of Interests: The authors declare that they have no competing interests relevant to this study. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board (IRB) of National Health Insurance Ilsan Hospital (IRB number:2020-04-009). The requirement for written informed consent from patients was waived due to the retrospective nature of the study and its impracticability.

AIM Most heel pain occurs at the posterior or plantar aspect, where main entheses of the heel are located. However, simple radiographs as basic work-up tools, their features based on their association with local symptoms in the heel in ankylosing spondylitis (AS) patients, have rarely been described. METHOD Forty patients with AS and unilateral heel pain were enrolled to evaluate radiographic differences between symptomatic and asymptomatic heels. The two groups were assessed according to symptom location: posterior (group PS) or plantar (group PL). Typical abnormalities in bone and/or soft tissue on the heel due to inflammation were compared. RESULTS In group PS (20 cases), 19 (95%) symptomatic feet and 7 (35%) asymptomatic feet showed abnormal findings on the posterior heel and symptomatic feet showed 6 (30%) plantar abnormalities. Erosion of the posterior calcaneal tuberosity, obliteration of the retrocalcaneal recess (RR), and swelling shadows with increased thickness on posterior soft tissue were observed more frequently and significantly in symptomatic feet in group PS (P

To evaluate the prevalence of medial collateral ligament (MCL) injury of the knee among ankle-fracture patients and to determine the risk factors associated with MCL injury in this patient group. 303 patients (303 affected ankles) who underwent surgical treatment for an ankle fracture were assessed. Supination versus pronation injury, Danis-Weber classification, age, sex, body mass index (BMI), limb dominance, and mechanism of injury were reviewed to identify factors related to MCL injury. Prevalence of MCL injury of the knee among the total number of patients with an ankle fracture was 3.96% (12 out of 303 injuries). Multivariable logistic and linear regression analysis with adjustment of possible confounding factors confirmed that female sex and pronation injury were associated significantly (p

In this prospective, randomized, controlled trial we sought to evaluate the effectiveness of acute normovolemic hemodilution (ANH) in terms of decreasing the need for allogeneic transfusion after conventional unilateral total knee arthroplasty (TKA). TKA is often performed with an occlusive tourniquet, and thus, it could be considered ideally suited for ANH, because the chief benefit of ANH is red blood cell loss reduction and the shedding of whole blood perioperatively at lower hematocrit levels. Between January 2012 and May 2012, 40 consecutive patients scheduled to undergo elective, primary, cemented, unilateral TKA for knee osteoarthritis were enrolled. Patients were randomized to either a study (ANH) group (n = 20; Group A) or a control group (n = 20; Group B). Units of allogeneic blood transfused was considered the primary outcome. In the ANH group, less allogeneic blood transfusion (6 units in Group A versus 15 units in Group B) was required after operation. Six patients, who required a transfusion in Group A received 1 unit of allogeneic blood. In contrast, 6 of 9 patients, who required transfusion in Group B, received at least 2 units of allogeneic blood (P < 0.05). There was no complication related to the methods of the protocol. ANH is likely to reduce postoperative allogeneic transfusion requirement in patients undergoing unilateral TKA. However, adjunctive strategies are required to further reduce allogeneic blood transfusion requirements.

Although popliteal cysts are most frequently identified in patients with osteoarthritis (OA), they may occur in patients with rheumatoid arthritis (RA), in which serious complicated cases such as cyst rupture can be developed. The objective of this study was to report four patients with RA (six knees) in combination with OA with a brief review of literature of previous similar published cases. This is a retrospective review of case records of patients with refractory and/or complicated popliteal cysts, who have successfully treated with arthroscopic intervention. We suggest that arthroscopic interventions such as radical debridement, synovectomy, biomechanical valve excision, and/or cystectomy should be considered in patients with refractory and complicated popliteal cysts associated with RA or RA in combination with OA.

Non-contact anterior cruciate ligament (ACL) rupture is mostly caused by a pivot shift mechanism including valgus collapse and internal tibial rotation. In female athletes, the incidence of ACL rupture has been reported to be significantly higher than in their male counterparts. However, to date, there have been limited reports and controversy regarding sex differences underlying injury mechanisms of ACL and severity of injury. In this study, we hypothesized that 1) in patients with non-contact ACL rupture, the incidence and severity of pivot shift injury, which are determined by injury pattern on MRI, would be significantly higher in females, and 2) anatomical factors associated with pivot shift injury would be significantly associated with female sex. A total of 148 primary ACL ruptures (145 patients) caused by non-contact injury mechanisms were included in this study. Among them, 41 knees (41 patients) were female and 107 knees (104 patients) were male. The status of the osseous lesions, lateral and medial tibial slope, depth of the medial tibial plateau, collateral ligaments, and menisci were assessed by MRI and compared between sexes. The severity of osseous lesions at the lateral tibial plateau, lateral femoral condyle, medial tibial plateau, and medial femoral condyle were comparable between sexes. There were no significant differences between sexes in the location of tibial contusions (p = 0.21), femoral contusions (p = 0.23), or meniscus tears (p = 0.189). Lateral tibial slope was found to be significantly larger in females (8.95° vs. 6.82°; p

Muscle tissue is often removed during hamstring tendon graft preparation for anterior cruciate ligament (ACL) reconstruction. The purpose of the study was to test whether preservation of muscle remnants on a tendon graft is beneficial to the graft healing process following ACL reconstruction. Co-culturing of tendon-derived cells (TDCs) and muscle-derived cells (MDCs) was performed at various ratios, and their potential for cell viability and multilineage differentiation was compared to a single TDC cell group. Ligamentous and chondrogenic differentiation was most enhanced when a small population of MDCs was co-cultured with TDCs (6:2 co-culture group). Cell viability and osteogenic differentiation were proportionally enhanced with increasing MDC population size. MDCs co-cultured with TDCs possess both the ability to enhance cell viability and differentiate into other cell lineages.

We systematically investigated the effect of silver nanoparticles (Ag-NPs) on the power conversion efficiency (PCE) of perovskite solar cells (PSCs). Neat, spherical Ag-NPs at loading levels of 0.0, 0.5, 1.0, and 2.0 wt % were embedded into the titanium dioxide (TiO2) photoanode layer. The plasmonic effect of the Ag-NPs strongly enhanced the incident light absorption over a wide range of the visible wavelength region in addition to the inherent absorbance of the perovskite sensitizer. The low conduction energy level of the Ag-NPs compared to that of TiO2 provides trap sites for free charge carriers. Thus, the correlation between the enhancement of the optical absorption and the number of charge traps provided by the Ag-NPs is critical to determine the device performance, especially current density (Jsc) and PCE. This is confirmed by the quantitative comparison of the incident light absorption and the time-resolved photoluminescence decay according to the loading levels of the Ag-NPs in the TiO2 layer. The absorption enhancement from 380 to 750 nm in the UV-visible spectrum is proportional to the increase in the loading levels of the Ag-NPs. However, the Jsc increases with the device with 0.5 wt % Ag-NPs and gradually decreases with increases in the loading level above 0.5 wt % because of the different contributions to the absorbance and the charge trapping by different Ag-NP loading levels. In addition, the suppression of the surface roughness with dense packing by the Ag-NPs helps to improve the Jsc and the following PCE. Consequently, the PCE of the PSC with 0.5 wt % Ag-NPs is increased to 11.96%. These results are attributed to the balance between increased absorbance by the localized surface plasmon resonance and the decreased charge trapping as well as the decreased surface roughness of the TiO2 layer with the Ag-NPs.

Platform business models as AppStore, SNS (social network service) and online marketplace are creating new markets and providing opportunities to dominate. And they are considered as a blueprint for future business. Trying to create or enter a new business area, the more interested companies and consumers can be induced to minimize the risk. Platform could maximize the profitability of private companies, as well as provide various improved citizen services with minimum cost in public sector. Platform's ability to link multiple public agencies are capable of keystone. Therefore, designing the platform service model in public sector, setting an R&R (role and responsibility) of each related agency for platform governance to be considered in the perspective of national innovation system (NIS, National Innovation System).

Purpose To assess the effect of a preoperative virtual reality (VR) experience of 3-dimensional (3D) reconstructed magnetic resonance images (MRIs) on anxiety reduction in patients undergoing arthroscopic knee surgery. Methods Patients in the VR group watched a 3D model of their own MRI through a VR headset describing the anatomy of the knee as well as their own lesion of interest for an arthroscopic procedure. Patients in the non-VR (NR) group received standard preoperative information about their MRI. The primary outcome for analysis was the Amsterdam Preoperative Anxiety and Information Scale score to measure level of anxiety and the need for information in patients undergoing arthroscopic knee surgery. Secondary outcomes were rated with visual analog scale (VAS) scores measuring patient pain, preparedness, satisfaction, and stress. Results Regarding the Amsterdam Preoperative Anxiety and Information Scale score, the sum S (surgery-related anxiety) and sum C (combined anxiety component) subscales showed significantly better outcomes in the VR group (median [interquartile range] for sum S = 2.0 [2.0-4.0], median [quartile 1-quartile 3] sum C = 4.0 [4.0-8.5]) than in the NR group (median [interquartile range] for sum S = 4.9 [3.0-5.0], median [quartile 1-quartile 3] sum C = 8.0 [5.3-9.8]) (P = .014 and P = .005, respectively). Regarding VAS scores, preoperative measures showed significantly better outcomes in satisfaction among VR group patients (95 [90.0-100.0]) in comparison to NR group patients (85 [70.0-96.0]) (P = .010). For postoperative VAS measures, the VR group (satisfaction score = 95 [90.0-100.0], stress score = 15 [2.5-37.5]) showed significantly better outcomes in satisfaction and stress in comparison to the NR group (satisfaction score = 85 [70.0-97.5], stress score = 30 [30.0-50.0]). Conclusions Application of preoperative VR experience of 3D reconstructed knee MRIs in patients undergoing arthroscopic knee surgery reduces anxiety around surgical encounters. The VR patient group was more satisfied overall and less stressed postoperatively. However, perioperative pain and preparedness were not affected by VR exposure. Level of Evidence Level I, randomized controlled trial.

The purpose of this study was to determine and compare the prevalence of anterolateral ligament abnormality and associated injuries among patients with complete and partial anterior cruciate ligament tears. In addition, the prevalence of associated injuries with anterolateral ligament abnormality was further analyzed. Of the 158 patients diagnosed with acute anterior cruciate ligament tear, 82 patients were diagnosed with acute complete anterior cruciate ligament confirmed by magnetic resonance imaging (MRI) and arthroscopic procedures (Group C), and 74 patients were diagnosed with acute partial anterior cruciate ligament tears confirmed by MRI (Group P). The status of the anterolateral ligament, collateral ligaments, menisci, and osseous lesions was assessed. There was a significantly higher prevalence of anterolateral ligament abnormalities in Group C than Group P (36.6 vs. 4.1%, p

The purpose of this study was to determine the prognostic factors related to the outcome of lavage surgery in patients with septic arthritis of the knee. A total of 55 patients with acute septic arthritis who underwent arthroscopic lavage were enrolled in the study. Host factors, including age, medical comorbidities, and medication use, were evaluated according to the Musculoskeletal Infection Society staging system, and patients were then stratified into 3 types: type A, no compromising factors; type B, 1 to 2 compromising factors; and type C, more than 2 compromising factors. Routes of infection were classified. Causative organisms were classified as gram positive, gram negative, mixed, or culture negative. Multivariable analysis confirmed that type C hosts showed more than 16 times the risk for failure of a single arthroscopic lavage than type A hosts. Type B hosts showed no significant differences from either type A or type C hosts. Patients with gram-positive cultures had more than 13 times the risk for failure than patients who were culture negative. Patients with gram-negative and mixed cultures showed no significant differences from the other groups. The sex of the patient and the route of infection were not related to the success of a single arthroscopic lavage surgery. Patients in poor health (ie, very medically ill) and with gram-positive cultures should be counselled regarding potential failure after a single arthroscopic debridement procedure. [ Orthopedics. 2018; 41(2):e184–e188.]

The purpose of this study was to compare the revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) with primary TKA through a review of previously published studies. The hypothesis was that the revised UKA group would need additional operative procedures, including the use of stems and augments, resulting in poorer clinical outcomes than those of the primary TKA group. A literature search of online register databases was performed to identify clinical trials that compared revised UKA to TKA with primary TKA. An electronic literature search was performed using the Medline, Embase, Cochrane Library, Web of Science, and Scopus databases. No language or date restrictions were applied. A total of 2034 articles were identified from a keyword search, of which 11 studies were determined as eligible. They were all retrospective comparative studies. The revised UKA to TKA group had longer operation times resulting from additional procedures such as bone grafting and use of stems and augments, higher reoperation rates, and worse postoperative clinical outcomes based on the Western Ontario and McMaster Universities Osteoarthritis Index and Oxford Knee Score than the primary TKA group, with the differences being statistically significant. UKA should not be considered an alternative procedure to TKA. Therapeutic Level III.

In most prior research on training and development, employees’ attitudes toward their organization have been viewed as consequences of training interventions rather than as antecedents. This study asserts that affective organizational commitment and organizational identification are performance predictors of training designed to directly address the collective interests of the organization. Additionally, we expected that organizational identification has a stronger positive effect on training performance than does organizational commitment. To test these hypotheses, the independent variables were measured in 149 trainees prior to the beginning of the training program. Observers’ ratings of behavioral performance were evaluated as the training outcome using an assessment center method. The analysis showed that organizational identification significantly predicts training performance, whereas organizational commitment does not.

OBJECTIVE The aims of this prospective study were to determine the prevalence of posttraumatic stress disorder (PTSD) in a population of young male military conscripts who experienced an extremity long-bone fracture, and to evaluate whether injury-related variables are associated with the development of PTSD. DESIGN Prospective, nonrandomized comparative study. SETTING Level 1 trauma center. PATIENTS AND METHODS A total of 148 men (age older than 18 years) who had 1 or more acute long-bone extremity fractures within 12 months and were seen at the Seoul Regional Military Manpower Center for examination of military conscripts from March 2013 to March 2014, were enrolled. The Korean version of the posttraumatic disorder scale was used to identify aspects of PTSD. The injury-related variables assessed included injury mechanism, fracture location and multiplicity, fracture severity, and the occurrence of joint ankylosis and secondary osteoarthritis. RESULTS Of the 148 participants, 40 (27.0%) met the criteria for the diagnosis of PTSD. Multivariate logistic linear analysis confirmed that lower extremity fracture, multiple fractures, and a higher pain visual analog scale score were significantly (P = 0.042, P = 0.043 and P < 0.001, respectively) related to the occurrence of PTSD. CONCLUSIONS Lower extremity fracture, multiple extremity fractures, and higher pain visual analog scale scores were significantly related to the occurrence of PTSD. To achieve an optimal recovery after orthopaedic injury, clinicians must address both physical and psychologic needs of their patients. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

We sought to compare a group (Group L) (n=21) of patients that underwent total knee arthroplasty and received a single preoperative dose of pregabalin combined with a COX-2 inhibitor with a control group (Group C) (n=20) that only received a COX-2 inhibitor in terms of (1) acute postoperative pain intensity, (2) analgesic consumption, and (3) functional recovery. Mean cumulative fentanyl consumption during the first 48 hours was lower in Group L than in Group C (P

The clinical and radiological outcomes of proximal tibia fractures involving the meta-diaphyseal junction treated with unilateral 3.5-mm locking precontoured anatomical plates are reported. Thirty-nine patients (41 proximal tibia fractures) who had proximal tibia fractures with complete meta-diaphyseal dissociation were enrolled in the study. For all patients, immediate postoperative and final follow-up simple radiographs were evaluated to determine the quality of the reduction by assessing coronal and sagittal alignment. In cases of intra-articular involvement, articular reduction quality and condylar width were additionally assessed. Clinical outcomes were assessed by knee range of motion and Lysholm knee score at final follow-up. Immediate postoperative radiographs showed satisfactory results: medial proximal tibial angle within 87°±5° in 87.8% (36 of 41), posterior tibia slope within 9°±5° in 85.4% (35 of 41), less than 2-mm articular step or gap in 79.3% (23 of 29), and a condylar width difference within 5 mm compared with the femoral condyles in 93.1% (27 of 29). All reductions but 1 were found to have satisfactory maintenance of the initial reduction. At final follow-up, the mean knee range of motion and Lysholm knee score were 122.5° (range, 100°–135°) and 75.8 (range, 50–100), respectively. A single lateral 3.5-mm plate fixation for proximal tibia fractures involving the meta-diaphyseal junction offers mechanically stable fixation with satisfactory clinical and radiological outcomes. [ Orthopedics . 2018; 41(6):e777–e782.]

Controversy exists regarding percutaneous balloon kyphoplasty (PBK) in patients with a very severe osteoporotic vertebral compression fracture (vsOVCF).The study was conducted to investigate the clinical and radiological outcomes of PBK for the treatment of vsOVCF compared with those of non-vsOVCF.This is a retrospective, case-control study.A total of 167 consecutive patients (210 vertebral bodies) who underwent PBK for OVCF between March 2010 and January 2015 were assessed.Visual analog scale (VAS) scores for back pain, Korean Oswestry disability index (K-ODI) scores, vertebral body height variations, and kyphotic angles were evaluated preoperatively, postoperatively, and 1 year after treatment.Patients in the non-vsOVCF group (anterior vertebral compression of more than two-thirds on plain radiograph) who had undergone PBK where compared with those in the non-vsOVCF group (compression between 30% and two-thirds). Clinical and radiological outcomes were compared. In addition, complications were evaluated.In total, 31 patients (33 vertebrae) in the vsOVCF group and 136 patients (177 vertebrae) in the non-vsOVCF group were treated with PBK. Both groups had significant postoperative improvements in the clinical and radiological outcomes (VAS score, K-ODI score, vertebral body height variation, and kyphotic angle). There was no difference regarding the VAS score and the K-ODI score between the two groups at the final follow-up (p.05). The cement leakage occurred frequently in the vsOVCF group (26 vertebrae, 78.8%) than in the non-vsOVCF group (92 vertebrae, 52.0%), the difference was statistically significant (p.05). But there was no case that showed neurologic complication or pulmonary embolism caused by cement leakage. The incidence of recollapse was significantly higher in the vsOVCF group (five vertebrae, 15.2%) than in the non-vsOVCF group (seven vertebrae, 4.0%) (p.05). The incidence of an adjacent segment fracture (vsOVCF group, 6 vertebrae, 18.2%; non-vsOVCF group, 21 vertebrae, 11.9%) was not significantly different (p=.320).Percutaneous balloon kyphoplasty is a safe and effective procedure for the treatment of vsOVCF.

The objective of this study is to assess the safety and efficacy of repeated intra-articular injection of high molecular weight hyaluronic acid (LBSA0103) at a 26-week interval, in patients with osteoarthritis of the knee. The study was an open-label, single arm, multicentre prospective trial conducted in patients with symptomatic knee osteoarthritis. The intervention consisted of two intra-articular injections of LBSA0103, with the second injection performed 26 weeks after the first injection. The primary outcome was the incidence of adverse drug reactions related to each injection. Assessment of efficacy of repeated injections in terms of maintenance of pain relief was a secondary objective of this study. Of the 185 patients screened, 174 patients received the first injection and 153 patients received both injections of LBSA0103. Nine adverse drug reactions occurred in seven patients (4.02%) after the first injection, while only one adverse drug reaction occurred (0.65%) after the second injection. As a secondary outcome measure, the improvements in the efficacy parameters including total WOMAC score and weight-bearing pain were all significant at both week 13 and 39 compared to the baseline value (P

Previous approaches for utilizing automatic test equipment (ATE) vector repeat are based on identifying runs of repeated scan data and directly generating that data using ATE vector repeat. Each run requires a separate vector repeat instruc- tion, so the amount of compression is limited by the amount of ATE instruction memory available and the length of the runs (which typically will be much shorter than the length of a scan vector). In this paper, a new and more efficient approach is pro- posed for utilizing ATE vector repeat. The scan vector sequence is partitioned and decomposed into a common sequence which is the same for an entire cluster of test cubes and a unique sequence that is different for each test cube. The common sequence can be generated very efficiently using ATE vector repeat. Experimental results demonstrate that the proposed approach can achieve much greater compression while using many fewer vector repeat instructions compared with previous methods.

ObjectivesTo identify the effects of two years’ oral bisphosphonate (alendronate) treatment in patients who underwent total knee arthroplasty (TKA); to determine whether significant responses seen after the first year of treatment changed during the second year. Additionally, the study tried to identify factors relating to bone mineral density (BMD) changes.MethodsThis was a prospective 2-year follow-up study of a previous 1-year report of postmenopausal women with knee osteoarthritis who underwent primary unilateral or staged bilateral TKA, after which they received 70 mg alendronate orally once-weekly. BMD was measured using quantitative computed tomography (QCT) on lumbar vertebrae at baseline (pre-TKA) and at 12 and 24 months. Factors associated with BMD changes were determined by regression analysis.ResultsSixty-one patients entered the second year and continued treatment for ≥24 months. Mean vertebral QCT BMDs at baseline and after 12 and 24 months’ alendronate treatment were 71.8 mg/ml (41.9–97.5 mg/ml), 69.3 mg/ml (31.4–103.9 mg/ml), and 72.7 mg/ml (33.1–136.1 mg/ml), respectively. Patients undergoing bilateral TKA and who had more severe OA at baseline (bilateral severe [grade 4] OA) had a lower BMD response after 2 years’ bisphosphonate treatment, compared with patients with less severe unilateral knee OA who underwent unilateral TKA. Improvements were, however, seen compared with year 1 levels. Low BMI was associated with BMD nonresponse.ConclusionsPatients with bilateral severe OA (grade 4) requiring bilateral knee replacement are at greater risk of nonresponse after 2 years’ oral alendronate treatment. A longer duration of treatment may be necessary in these patients.

Legacy constrained condylar knee (LCCK) components are designed in the way that they can also be used in conjunction with a posterior-stabilized (PS) polyethylene insert, when adequate collateral stability is present. This study comprised 27 revision total knee arthroplasties (TKA) treated using an LCCK prosthesis and a PS polyethylene insert. Substantial range of motion and Knee Society score improvements were achieved in all subjects. Radiolucent lines between the block-cement were noted in 6 of 27 knees, but not significant. During TKA requiring the use of a femoral augment or stem extension, the design offering least constraint can be chosen, and an LCCK prosthesis with a PS polyethylene insert could be a satisfactory option.

Background The purpose of this study was to evaluate the joint gap kinematics in posterior-stabilized total knee arthroplasty (PS TKA). Methods Between January 2010 and April 2011, 44 consecutive patients (55 knees) who underwent primary PS TKA using the navigation system were assessed. There were 37 women and 7 men with a mean age at operation of 63 years (range; 58–73 years). After fixation of all components with cement and insertion of polyethylene trial insert, medial and lateral joint gap measurements were carried out without distraction force and separately using a navigation system on each flexion angles. The joint gaps were measured before and after deflation of tourniquet, first with patella everted and then reduced. Results Deflation of tourniquet did not effect on gap. In patellofemoral joint reduction situation, the medial gap relatively maintained throughout the range of knee motion, but the lateral gap is gradually decreasing with knee flexion from 30° to 120° flexion. However, in patellar eversion situation, the medial gap showed a significant increase and also statistically significantly increased compared with patellar reduced position over 90° knee flexion status, but the lateral gaps are decreased compared with patellofemoral reduction situation throughout the range of knee motion except full flexion status. In more physiologic status that is patella reduced and tourniquet deflated status, the average medial joint gap change was 2.30 ± 1.64 mm and the average lateral joint gap change was 2.90 ± 1.53 mm throughout the range of motion. Conclusions Medial and lateral joint gaps showed different patterns with patellar eversion and patellofemoral joint reduction. However, such changes occurred within 3 mm in average throughout whole range of knee motion even with multi-radius femoral component.

Efficient light harvesting is essential for the realization of high energy conversion efficiency in dye-sensitized solar cells (DSCs). State-of-the-art mesoporous TiO2 photoanodes fall short for collection of long-wavelength visible light photons, and thus there have been efforts on introduction of scattering nanoparticles. Herein, we report the synthesis of wrinkled silica/titania nanoparticles with tunable interwrinkle distances as scattering materials for enhanced light harvesting in DSCs. These particles with more than 20 times larger specific surface area (>400 m2/g) compared to the spherical scattering particles (2/g) of the similar sizes gave rise to the dye-loading amounts, causing significant improvements in photocurrent density and efficiency. Moreover, dependence of spectral scattering properties of wrinkled particles on interwrinkle distances, which was originated from difference in overall refractive indices, was observed.

In total knee arthroplasty (TKA), the position of the patellar component can affect patellar tracking. However, the patellar component cannot always replicate the original high point of the patella because of anatomical variance. This study investigated whether altering the highest point of the patella can affect outcomes of primary TKA, especially in patients having a patella with a far-medialized median ridge.A retrospective review was performed for 177 knees (143 patients) treated with primary TKA between July 2011 and March 2014. Group 1 (34 knees) had the patellar component displaced over three millimeters from the median ridge, while Group 2 (143 knees) had the patellar component placed on the original median ridge position. The one-year follow-up outcomes were reviewed, including: patellar tilt angle, Knee Society Score, Feller Patellar Score, and modified Kujala Anterior Knee Pain Score.Mean (±standard deviation) displacement of the patellar component in Group 1 was 3.97±0.97mm lateral to the original position of the median ridge, with a significant decrease in lateral patellar tilt angle (P0.001). Lateral patellar tilt showed a positive correlation with the medialization of the patellar component (P0.001, r=0.401). Ability to rise from a chair was better in Group 1 (P=0.025). There were no other between-group differences in other clinical outcomes.There should be no need for the patellar component to replicate the original highest point of the native patella in primary TKA.

Bone is a dynamic tissue that undergoes renewal throughout life in a process whereby osteoclasts resorb worn bone and osteoblasts synthesize new bone. Imbalances in bone turnover lead to bone loss and development of osteoporosis and ultimately fracture, a debilitating condition with high morbidity and mortality. Silica is a ubiquitous biocontaminant that is considered to have high biocompatibility. The authors report that silica nanoparticles (NPs) mediate potent inhibitory effects on osteoclasts and stimulatory effects on osteoblasts in vitro. The mechanism of bioactivity is a consequence of an intrinsic capacity to antagonize activation of NF-κB, a signal transduction pathway required for osteoclastic bone resorption but inhibitory to osteoblastic bone formation. We further demonstrate that silica NPs promote a significant enhancement of bone mineral density (BMD) in mice in vivo, providing a proof of principle for the potential application of silica NPs as a pharmacological agent to enhance BMD and protect against bone fracture. From the Clinical Editor In this paper, silicate nanoparticles are utilized in an animal model to stimulate bone growth by inhibiting osteoclasts while enhancing the activity of osteoblasts. This result may have important ramification in future applications to a variety of bone diseases, including but not limited to osteoporosis, pathological fractures, metastatic bone lesions, different types of bone cancer, etc.

Bone mineral density (BMD) declined in more than half (53.7%) of post-total knee arthroplasty (TKA) patients (44 of the 82) after 1 year of oral bisphosphonate treatment, and that this decline was significant in bilateral TKA patients. TKA has proven to be an extremely successful procedure in terms of improving ambulatory function. However, the effects of such improvements in ambulatory function and of bisphosphonate on axial BMD have not been established. The purpose of this study was to determine the effect of 1 year of oral bisphosphonate in postmenopausal patients that have undergone TKA and to identify factors related to BMD changes using lumbar spine quantitative computed tomography (QCT). Eighty-two postmenopausal women that underwent primary TKA for knee osteoarthritis and who received once-weekly oral alendronate 70 mg for 12 months after TKA were enrolled. The effect of 1 year of oral bisphosphonate treatment post-TKA and the factors related to general lumbar spine BMD changes by using QCT were determined. Some 53.7% of patients (44 of the 82) experienced an average lumbar spine QCT BMD decline of −6 mg/ml (range −15 to −0.5 mg/ml) after 1 year of oral bisphosphonate treatment, whereas the remaining 38 patients (46.3%) experienced an average increase of 6.8 mg/ml (range 0.6 to 15.7 mg/ml). Logistic and linear regression analysis showed that bilateral TKA was significantly related to a BMD decline (p

We synthesize the TiO2 nanowire electrodes via hydrothermal process without addition of any surfactant as a function of reaction time. The short-circuit current density and cell efficiency of the TiO2 nanowire electrodes in DSSC increase with decreasing reaction time. In particular, the rutile nanowire electrodes show an improved open-circuit voltage due to an increased electron lifetime in one-dimensional electrode.

During warm forging, materials are formed in the temperature range of . In this temperature range, the friction between the forging die and the material is very high and has a negative effect on the forming process causing severe die wear and possible defects in the component because of stick-slip. Thus, lubrication characteristics are a very important factor for productivity during warm forging. In this paper, ring compression experiments were conducted to estimate the friction factor between the die and the materials as the main factor in characterizing the lubricant. Also, ring tests using normal graphite power as a lubricant coating system were compared with tests using nano graphite powder. The results confirm that the nano graphite is superior to the normal graphite in view of its lubricating effect. In addition, the friction factor (m) was estimated with respect to the amount of the nano graphite content in the lubricant. With 10 % nano graphite the friction factor had the lowest value as compared to other amounts. It can be concluded that the amount of the nano graphite in the coating system can be optimized to obtain the best lubrication condition between the die and the material using ring test experiments.

Study design Retrospective case-control study. Objective A cost-effectiveness analysis was performed by comparing patients who received extension revision operations for adjacent segment disease (ASD) reusing the pedicle screws extracted from fused segments with patients who received conventional surgery. Summary of background data ASD often required extension revision surgery, and during extension surgery, pedicle screws may be reused by extracting from the fused segments of primary surgery. Methods Study examined 37 patients who received extension revision surgery for ASD from January 2003 to December 2013. For the fixation of extended segments during revision operation, in 16 cases the pedicle screws extracted from fused segments were reused (group R), and in 21 cases new pedicle screws were used (group C) as a conventional method. Clinical outcomes were evaluated by means of visual analog scale scores for lumbago and leg pain, and the Korean Oswestry Disability Index. Radiologic outcomes were evaluated from the extent of bone union. The total operating costs in the two groups were compared. Results Visual analog scale scores for lumbago and leg pain, and the Korean Oswestry Disability Index measured at final follow-up averaged 3.6 and 3.8, and 19.9 in group R, and 3.8 and 3.1, and 21.1 in group C, respectively (P = 0.280, P = 0.387, P = 0.751). For radiologic outcomes, there was one case of nonunion in each group. The cost of surgery was 5332 US dollars in group R, and 6109 US dollars in group C, respectively (P = 0.036). Conclusion Reusing pedicle screws extracted from the fused segments during extension revision operation for ASD can reduce the cost of surgery, and achieves clinical and radiological results similar to those of the conventional operation. Level of evidence 4.

Background We sought to evaluate the long-term outcomes of long-level instrumented posterolateral fusion (PLF) directly compared to those with short level instrumented PLF for degenerative spinal stenosis. Methods From 1987–2002, patients who underwent instrumented PLF with wide decompression for degenerative spinal stenosis were reviewed. A total of 295 patients were available for follow-up over 10 years (mean, 14 years). These patients were divided into Group 1 (fusion of 1 or 2 levels) and Group 2 (fusion of three or more levels). Clinical and radiological outcomes were evaluated. Results On clinical outcomes, Group 1 showed better results than Group 2 based on the Katz’s Activities Daily Living index (p = 0.024), Kirkaldy-Willis criteria (p = 0.001) and the Korean version of the Oswestry disability index (p = 0.01). However, excellent and good outcome was noted in more than 64.5 % in Group 2. For radiological outcomes, overall fusion rate was higher in Group 1 compared with Group 2, but not significantly different (p = 0.35). However, the metal problems and surgical complications were more developed in Group 2 (p

Background context Spinal neurocysticercosis (NCC) is a very rare clinical entity. Signs and symptoms may include myelopathy, radiculopathy, or cauda equina syndrome, depending on location of the cyst, and it may mimic more common neuropathology. When the patient does not come from an endemic region and serologic tests fail to yield evidence of the presence of parasites, the diagnosis may only become apparent at surgery. Purpose To report a case of NCC of lumbar spine with spinal root symptoms, which had only become apparent at surgery. Study design Case report. Methods A 72-year-old man presented with progressive lower-extremity weakness and diminished sensation in his left lower extremity. Laboratory evaluation, including serologic tests, was nonspecific. Magnetic resonance imaging revealed a large eccentric mass lesion at lumbar subarachnoid space. Result Diagnosis was confirmed after surgical excision, and cysticercosis was found to be the etiologic factor. Conclusion Even when the patient does not come from endemic region and serologic tests fail to yield evidence of the presence of parasites, spinal NCC should be considered in the differential diagnosis with symptoms suggestive of spinal mass lesion.

Study design The incidence and risk factors of postoperative delirium were retrospectively examined in patients who had spine surgery for degenerative lumbar disease. Objective The aim of this study is to examine the incidence, pre- and postoperative risk factors and clinical results of postoperative delirium after spine surgery. Summary of background data Postoperative delirium is of great concern in older patients. Patients with postoperative delirium tend to have delay in functional restoration and difficulty in postoperative care. But to author's knowledge this is the first report to postoperative delirium after spine surgery in South Korean population. Methods Eighty-one patients over 70 years of age, who underwent spinal fusion for degenerative lumbar disease from November 2000 and March 2007 were selected. We analyzed the relation between postoperative delirium and such variables as operation time, intraoperative blood loss and transfusion, fusion level, comorbidity and laboratory data checked before surgery and at 1 day after surgery. Results Postoperative delirium was found in 11 patients (13.6%). There were significant relationships between postoperative delirium and comorbidity such as cerebral vascular disease and gastric ulcer. Hemoglobin and hematocrit levels at 1 day after surgery and albumin level before surgery was significantly lower than in control group. Oswestry disability index was improved from 50.4% to 27.6% in delirium group and from 48.5% to 24.9% in control group. Hospitalization period was significantly longer in delirium group. Conclusion History of cerebral vascular disease, low hemoglobin and hematocrit levels at 1 day after surgery, and bad nutritional status were risk factors for delirium. As it is of great concern in older patients, careful observation is necessary for the management of patients with risk factors for delirium.

Lithium-ion polymer batteries of aluminium-laminated packaging structure have advantages in terms of thermal characteristics and safety but have a weak configuration with respect to external forces compared with other types of cells such as cylindrical and prismatic cells. Thus it is important to protect the batteries of the aluminium-laminated packaging structure under the severe conditions encountered in vehicle operation where excessive mechanical impacts and vibrations may affect the battery system. In this work, an energy storage system for a hybrid electric vehicle (HEV) has been developed using lithium-ion polymer battery cells with an aluminium-laminated packaging structure and has been tested for structural and electrical durabilities. The test results of combined accelerated vibration and charge discharge cycling are presented to prove that the battery pack has the durability to satisfy vehicle standards. Three different types of test method have been applied to evaluate the mechanical and electrical durabilities. It was observed that the HEV battery pack satisfied the durability standards required for vehicle applications. The results imply that an aluminium-laminated cell packaging structure can be a competitive option for physical configuration of cells for vehicle applications.

Novel hot chamber rheo-diecasting process has been successfully developed. It requires no additional processing equipment except commonly used hot chamber diecasting machine, no molten metal control like grain refinement procedure and no additional cycling time to produce slurry-on-demand. Additionally, it could lower molten metal temperature in a furnace. Process concept of novel hot chamber rheo-diecasting is simply based on the paradigm shift from HOW to WHERE for producing slurry-on-demand. This paper will demonstrate the possibility to achieve slurry-on-demand by novel hot chamber rheo-diecasting and the advantages for 3Cs applications.

A bio-available microbubble, liposome, and Fe3+ chelated melanin nanoparticle complex with a dual ultrasound and T1-w magnetic resonance imaging modality has been synthesized for the specific targeting of cancer cells.

Thixoextrusion, one of the thixoforming processes, has advantages of high productivity, reduction of the extrusion pressure, extension of the die life, and cost saving owing to its low energy consumption compared with the conventional extrusion processes. Especially, thixoextrusion process is expected to be very effective for hard-to-form materials with high strength. The present study focuses on 7075 Al wrought alloy to investigate the potential industrial applications of the thixoextrusion process. The microstructural evolution of 7075 Al wrought alloy for thixoextrusion was investigated with respect to isothermal holding temperature and time in the partially remelted semisolid state. The results showed that the liquid fraction increased with increasing isothermal holding temperature and time while the average grain size was inversely proportional to isothermal holding temperature and time up to 5min. However, there was no big change of liquid fraction and average grain size with respect to isothermal holding temperature and time. The important fact that the liquid fraction and average grain size were almost uniform after 5 min holding time is considered very useful for thixoextrusion in terms of process control.

A novel metal–semiconductor and/or heterodimensional nanohybrid material (CdS–MoS2) is synthesized by hybridizing catalytically important materials (i.e., zero-dimensional CdS quantum dots and two-dimensional, unilamellar MoS2 sheets). According to our high-resolution transmission electron microscopic (HRTEM) analyses on the present nanohybrid, ca. 6.5 nm CdS quantum dots are successfully immobilized in the interlayer space of MoS2 sheets. The microscopic internal structure of the CdS–MoS2 nanohybrid is mainly characterized as a “house of cards” structure. Such a microscopic evolution is further demonstrated by BET specific surface area analyses. The BET surface area (∼84 m2 g−1) of the present nanohybrid sample is nearly two orders of magnitude larger than that of the pristine material (2H-MoS2), suggesting that the CdS quantum dots are rather loosely packed in the interlayer space of MoS2 platelets to create many voids. We suggest, from the observed microscopic evolution and the increased BET surface area, that the present nanohybrid material can be successfully applied as a high performance catalyst in hydrodesulfurization (HDS) and/or visible light harvesting photocatalyst.

Although postoperative delirium is a complicated disorder in elderly individuals, no study has been examined the risk factors associated with perioperative comorbidities and clinical laboratory data while specifically focusing on only total knee arthroplasty (TKA). In the present retrospective study, we aimed to evaluate the incidence and perioperative risk factors of postoperative delirium after TKA. Between April 2009 and May 2013, 287 patients (365 knees) aged >65 years who had undergone primary TKA were enrolled. These patients were assigned to the delirium group of 11 patients (11 knees) or the non-delirium group of 276 patients (354 knees). The incidence of delirium among the patients was 3.1% (11/365). Univariate logistic regression analysis indicated that a history of dementia, older age, lower body mass index (BMI) level, and a postoperative day 3 blood urea nitrogen (BUN) level of >14.9 mg/dL were risk factors. However, multivariate logistic regression analysis indicated that a history of dementia (adjusted odds ratio [AOR]: 10.4, [1.09, 100]), older age (AOR: 1.15, [1.01, 1.31]), and a postoperative day 3 BUN level of >14.9 mg/dL (AOR: 4.76, [1.15, 19.7]) were independent risk factors. Based on our findings, we believe that the surgeons should be careful to avoid the postoperative delirium and ensure the appropriate management for patients who have these risk factors.

Severe uncontained tibial bone defects occurring during total knee arthroplasty are challenging, and which treatment method is the best remains unknown. In this study, clinical and radiographic outcomes of double metal blocks augmentation were examined. Between 2004 and 2012, double metal blocks augmentation was carried out in 17 patients with severe asymmetric uncontained tibial bone defects. The first block was attached to the tibial tray with screws, and then the second block was cemented to the first block. Out of 17 patients, 13 (8 primary, 5 revision) were available for final follow-up at a median of 69 months (range 24–99). For clinical assessment, range of motion and Knee Society score were evaluated preoperatively and annually thereafter. At the final follow-up, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford knee, Short Form-36, Lower extremity functional scale, and Lower extremity activity scale scores were evaluated. Radiographic assessment for radiolucent lines at the block–cement–bone interfaces and signs of failure was performed annually using fluoroscopy and standard radiographs. Range of motion and Knee Society score were significantly improved post-operatively. Other clinical outcomes were favourable. Radiolucent lines were seen on fluoroscopy in three knees, but no sign of failure, such as loosening, collapse, or instability, was observed at the final follow-up. Double metal blocks augmentation is a favourable and useful method, which does not cause mechanical failure or protrusion of the prosthetic because of its modularity, to manage severe asymmetric uncontained proximal tibial bone defects >15 mm in total knee arthroplasty. Case series, Level IV.

Recently, in proportion to the increase of earthquake occurrence-frequency and its strength in the countries within the circum-pan Pacific earthquake belt, a concept of earthquake-proof design for huge structures containing liquid has been growing up. This study deals with the refinement of classical numerical approaches for the free vibration analysis of separated structure and liquid motions. According to the liquid-structure interaction, LNG-storage tanks exhibit two distinguished eigenmodes, the sloshing mode and the bulging mode. For the sloshing-more analysis, we refine the classical rigid-tank model by reflecting the container flexibility. While, for the bulging-mode analysis, we refine the classical uncoupled structural vibration system by taking the liquid free-surface fluctuation into consideration. We first construct the refined dynamic models for both problems, and present the refined numerical procedures. Furthermore, in order for the efficient treatment of large-scale matrices, we employ the Lanczos iteration scheme and the frontal-solver for our test FEM program. With the developed program we carry out numerical experiments illustrating the theoretical results.