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Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The composite cathode of an all-solid-state battery composed of various solid-state components requires a dense microstructure and a highly percolated solid-state interface different from that of a conventional liquid-electrolyte-based Li-ion battery. Indeed, the preparation of such a system is particularly challenging. In this study, quantitative analyses of composite cathodes by three-dimensional reconstruction analysis were performed beyond the existing qualitative analysis, and their microstructures and reaction interfaces were successfully analyzed. Interestingly, various quantitative values of structure properties (such as the volume ratio, connectivity, tortuosity, and pore formation) associated with material optimization and process development were predicted, and they were found to result in limited electrochemical charge/discharge performances. We also verified that the effective two-phase boundaries were significantly suppressed to ∼23% of the total volume because of component dispersion and packing issues.

Boosting the performance of rechargeable lithium-ion batteries (LIBs) beyond the state-of-the-art is mandatory toward meeting the future energy requirements of the consumer mass market. The replacement of conventional graphite anodes with conversion-type metal-oxide anodes is one progressive approach toward achieving this goal. Here, a LIB consisting of a highcapacity spinel NiMn 2 O 4 anode and a high-voltage spinel LiNi 0.5 Mn 1.5 O 4 cathode was proposed. Polyhedral-shaped NiMn 2 O 4 powder was prepared from a citrate precursor via the sol-gel method. Electrochemical tests showed that the NiMn 2 O 4 in a half-cell configuration could deliver reversible capacities of 750 and 303 mAh g -1 at 0.1 and 3 C rates. Integrating the NiMn 2 O 4 anode into a full-cell configuration provided an estimated energy density of 506 Wh kg -1 (vs. cathode mass) upon 100 cycles and excellent cycling performance over 150 cycles at the 0.1 C rate, which can be considered promising in terms of satisfying the demands for high energy densities in large-scale applications., (© 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

In performing neurosurgical operation on peripheral nervous system, the most important first step is to robustly hold the target nerve, since the nerve-holding stability and reliability significantly affect the result of surgical operation. However it is not straightforward to robustly hold peripheral nerve during the surgical operation, because the peripheral nerve is too flexible and slippery. In this study, we design a novel peripheral nerve-holder that can be used for the neurosurgical operation. Considering the anatomical characteristics of the peripheral nerve that small bundles of nerve fibers (i.e., fascicles) are structured inside the outermost layer of the nerve bundle (i.e., epineurium), we aim to develop a non-clamping and non-invasive type nerve-holder to protect the nerve fibers. For the aim, the negative-pressure suction method is applied to the proposed holder. And, in order to hold the nerve more robustly, micro-bump structure is fabricated on the suction surface contacting with the nerve. This paper introduces the concept, working principle, characteristics, and in-vitro experimental results on feasibility evaluation of the proposed holder.

Objective: The purpose of this study was to assess the differences between subtalar instability (STI) and lateral ankle instability (LAI) focusing on subtalar ligaments using 3-dimensional (3D) isotropic magnetic resonance imaging (MRI)., Methods: Preoperative MRIs of 10 patients with STI who failed nonoperative treatment and consequently underwent arthroscopic subtalar reconstruction were compared with preoperative MRIs of 23 patients with LAI who underwent ligament repair or reconstruction. Dimensions of anterior capsular ligament (ACL), interosseous talocalcaneal ligament (ITCL), calcaneofibular ligament (CFL), and anterior talofibular ligament (ATFL) were measured. Tears of ACL, ITCL, CFL, ATFL, cervical ligament, and inferior extensor retinaculum were analyzed., Results: Patients with subtalar instability had significantly lower ACL thickness and width than patients with LAI (thickness: 1.48 vs 2.12 mm, P = 0.045; width: 7.30 vs 8.64 mm, P = 0.029). An ACL thickness of 1.8 mm or less had sensitivity and specificity both at 75.0%, and an ACL width of 8 mm or less had sensitivity of 75.0% and specificity of 85.0% for discriminating STI from LAI. Absence or complete tear of ACL was more frequent in patients with STI than in patients with LAI (60.0% vs 13.0%, P = 0.010). The ATFL thickness was significantly greater in patients with LAI (P = 0.001). Complete tear of ATFL was more common in patients with LAI (P = 0.008). Complete tear of CFL was common in both the STI and LAI groups without significant difference (20.0% vs 21.7%). There was no significant difference in thickness and width of ITCL and in CFL thickness. Complete tear of ITCL, cervical ligament, and inferior extensor retinaculum were rare without significant difference., Conclusion: In patients with STI, the ACL is thin and narrow and more commonly absent or torn compared with patients with LAI. Complete tear of ATFL was more common in patients with LAI. Complete tear of CFL was commonly encountered in both the STI and LAI groups.

Purpose: Little is known about the arthroscopic or radiographic outcomes after arthroscopic microfracture of osteochondral lesions of the talus (OLTs). The purpose of this study was to investigate tissue growth after arthroscopic microfracture of OLTs using computed tomography arthrography (CTA) and to identify the relationship between CTA findings and clinical outcomes. We hypothesized that the morphology of the repaired tissue would be similar to that of normal anatomy and correlate with the clinical outcomes., Methods: Forty-two ankles treated using arthroscopic microfracture of OLTs between 2009 and 2014 were monitored. CTA was performed post-operatively at 6 months and at 1 and 2 years after surgery. The post-operative thickness of the repaired tissue associated with OLT (grade) and the volume of the subchondral cystic lesions were evaluated using CTA. Clinical outcomes, including the pain visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle functional scores, were evaluated and correlated with CTA., Results: The proportion of fully grown tissue (grade 3) increased over time; specifically, the rates were 12/40 (33.3%) at 6 months, 11/18 (61.1%) at 1 year, and 8/10 (80%) at 2 years after surgery (p = 0.005). The VAS pain (p < 0.001) and AOFAS scores (p < 0.001) were also improved at the final follow-up; however, they were not associated with repaired tissue thickness as shown by CTA (n.s.)., Conclusions: After microfracture of OLTs, tissue growth in the osteochondral defects was well visualized using CT arthrography and was observed in most cases. However, the CTA findings were not related to the clinical outcomes., Level of Evidence: IV.

For the realization of sodium-ion batteries (SIBs), high-performance anode materials are urgently required with the advantages of being low-cost and environment-friendly. In this work, layered-type NaVO 3 is prepared by the simple solid-state route with a rod-like morphology and used as an anode material for SIBs. The NaVO 3 electrode exhibits a high specific capacity of 196 mA h g -1 during the first cycle and retains a capacity of 125 mA h g -1 at the 80th cycle with a high Coulombic efficiency of >99%, demonstrating high reversibility. The sodium diffusion coefficient in NaVO 3 is measured using electrochemical impedance spectroscopy (1.368 × 10 -15 cm 2 s -1 ), the galvanostatic intermittent titration technique (1.15715 × 10 -13 cm 2 s -1 ), and cyclic voltammetry (2.7935 × 10 -16 cm 2 s -1 ). Furthermore, the reaction mechanism during the sodiation/desodiation process is investigated using in situ X-ray diffraction and X-ray absorption near the edge structure analysis, which suggests the formation of an amorphous-like phase and reversible redox reaction of V 4+ ↔ V 5+ , respectively.

Poly-gamma-glutamic acid (γ-PGA), an extracellular biopolymer produced by Bacillus sp., is a non-canonical toll-like receptor 4 (TLR4) agonist. Here we show its antiviral efficacy against noroviruses. γ-PGA with a molecular mass of 2,000-kDa limited murine norovirus (MNV) replication in the macrophage cell line RAW264.7 by inducing interferon (IFN)-β and conferred resistance to viral infection-induced cell death. Additionally, γ-PGA interfered with viral entry into cells. The potent antiviral state mounted by γ-PGA was not attributed to the upregulation of TLR4 or TLR3, a sensor known to recognize norovirus RNA. γ-PGA sensing by TLR4 required the two TLR4-associated accessory factors MD2 and CD14. In ex vivo cultures of mouse ileum, γ-PGA selectively increased the expression of IFN-β in villi. In contrast, IFN-β induction was negligible in the ileal Peyer's patches (PPs) where its expression was primarily induced by the replication of MNV. Oral administration of γ-PGA, which increased serum IFN-β levels without inducing proinflammatory cytokines, reduced MNV loads in the ileum with PPs and mesenteric lymph nodes in mice. Our results disclose a γ-PGA-mediated non-conventional TLR4 signaling in the ileum, highlighting the potential use of γ-PGA as a prophylactic antiviral agent against noroviruses.

Lithium (Li) metals have been considered most promising candidates as an anode to increase the energy density of Li-ion batteries because of their ultrahigh specific capacity (3860 mA h g -1 ) and lowest redox potential (-3.040 V vs standard hydrogen electrode). However, unstable dendritic electrodeposition, low Coulombic efficiency, and infinite volume changes severely hinder their practical uses. Herein, we report that ethyl methyl carbonate (EMC)- and fluoroethylene carbonate (FEC)-based electrolytes significantly enhance the energy density and cycling stability of Li-metal batteries (LMBs). In LMBs, using commercialized Ni-rich Li[Ni 0.6 Co 0.2 Mn 0.2 ]O 2 (NCM622) and 1 M LiPF 6 in EMC/FEC = 3:1 electrolyte exhibits a high initial capacity of 1.8 mA h cm -2 with superior cycling stability and high Coulombic efficiency above 99.8% for 500 cycles while delivering a unprecedented energy density. The present work also highlights a significant improvement in scaled-up pouch-type Li/NCM622 cells. Moreover, the postmortem characterization of the cycled cathodes, separators, and Li-metal anodes collected from the pouch-type Li/NCM622 cells helped identifying the improvement or degradation mechanisms behind the observed electrochemical cycling.

The recognition of pathogen-derived ligands by pattern recognition receptors activates the innate immune response, but the potential interaction of quorum-sensing (QS) signaling molecules with host anti-viral defenses remains largely unknown. Here we show that the Vibrio vulnificus QS molecule cyclo(Phe-Pro) (cFP) inhibits interferon (IFN)-β production by interfering with retinoic-acid-inducible gene-I (RIG-I) activation. Binding of cFP to the RIG-I 2CARD domain induces a conformational change in RIG-I, preventing the TRIM25-mediated ubiquitination to abrogate IFN production. cFP enhances susceptibility to hepatitis C virus (HCV), as well as Sendai and influenza viruses, each known to be sensed by RIG-I but did not affect the melanoma-differentiation-associated gene 5 (MDA5)-recognition of norovirus. Our results reveal an inter-kingdom network between bacteria, viruses and host that dysregulates host innate responses via a microbial quorum-sensing molecule modulating the response to viral infection.

An automatic parking system is an essential part of autonomous driving, and it starts by recognizing vacant parking spaces. This paper proposes a method that can recognize various types of parking slot markings in a variety of lighting conditions including daytime, nighttime, and underground. The proposed method can readily be commercialized since it uses only those sensors already mounted on off-the-shelf vehicles: an around-view monitor (AVM) system, ultrasonic sensors, and in-vehicle motion sensors. This method first detects separating lines by extracting parallel line pairs from AVM images. Parking slot candidates are generated by pairing separating lines based on the geometric constraints of the parking slot. These candidates are confirmed by recognizing their entrance positions using line and corner features and classifying their occupancies using ultrasonic sensors. For more reliable recognition, this method uses the separating lines and parking slots not only found in the current image but also found in previous images by tracking their positions using the in-vehicle motion-sensor-based vehicle odometry. The proposed method was quantitatively evaluated using a dataset obtained during the day, night, and underground, and it outperformed previous methods by showing a 95.24% recall and a 97.64% precision., Competing Interests: The authors declare no conflict of interest.

The objective of this study was to evaluate the validity of self-reported smoking prevalence in Korean adolescents by using an improved gold standard by a combined method. Using a stratified sampling method, we selected 13 schools from among 397 high schools that participated in the 2015 Korean Youth Health Risk Behavior Web-Based Survey (KYRBS). A second survey (repeated self-reporting questionnaire and urinary cotinine test) was conducted on 1058 students who completed the KYRBS. The gold standard of current smoker was defined as those either self-reporting as a smoker in the second survey or having a urinary cotinine concentration ≥50 ng/mL. The current smoking prevalence in the first survey (KYRBS) was 7.9% (boys 16.5% and girls 1.8%), which was lower than the results based on gold standard (11.3% total, boys 21.9% and girls 3.7%). The sensitivity and specificity of self-reported smoking status was 62.5% and 99.0%, respectively. In particular, the sensitivity of girls (43.5%) was lower than that of boys (67.0%). The self-reported smoking prevalence in Korean adolescents was underestimated, particularly among girls. Careful attention should be paid to interpreting adolescents' smoking prevalence, and supplementary surveys or periodic validity tests need to be considered in Asian countries., Competing Interests: The authors declare no conflict of interest.

Heatwaves are gaining in importance due to increasing climatic changes. They can impair health and increase mortality. A comparison of studies is difficult because of differences in the definition of a heatwave used and/or different populations studied. In this study, morbidity data were collected using the web-based IVENA system. This system registers hospital admissions with diagnosis by the emergency medical services. We analysed hospital admissions in Frankfurt/Main during June-August of 2014-2016. These periods included a heatwave in July 2015 (per definition>32°C for at least 5 days/more than 4 days). On days with "heatwave", there was a 22% increase in hospital admissions of patients brought in by the emergency services (excess morbidity). Considering only "heat-related diagnosis", the increase was 300%. In addition to the increase in hospital admissions on "heatwave" days, there was also a direct correlation between temperature and hospital admissions over the summer days. Using the data on hospital admission of patients brought in by the emergency services turned out to be a valid marker for "heat morbidity"., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Although smoking is known to be harmful to the musculoskeletal system, no studies have investigated its effects on the outcomes of ankle ligament surgery. We determined the effects of smoking on the clinical and radiological outcomes of lateral ankle ligament reconstruction using tendon allografts according to smoking status., Methods: From among 105 patients with chronic ankle instability who were treated with anatomical reconstruction of the anterior talofibular ligament and the calcaneofibular ligament using semitendinosus tendon allografts and bio-tenodesis screws, 70 ankles, from 23 smokers and 47 non-smokers, were analyzed. Visual analog scale (VAS) pain scores, American Orthopedic Foot and Ankle Society ankle-hindfoot scores, Karlsson scores and complications were routinely determined at each follow-up visit. Anterior translation and the talar tilt angle on radiographic stress views were also assessed., Results: The mean follow-up period was 21.8 months (12-68 months). No significant differences were observed between the two groups with respect to age, gender, body mass index, or the duration of preoperative symptoms. The mean preoperative pain VAS scores were 5.8 and 5.3 among non-smokers and smokers, respectively. Postoperatively, the mean pain VAS score improved to 1.4 in both groups (p < 0.001). Clinical and radiographic measures did not show significant changes according to the presence of smoking after surgery. However, two wound complications, 1 delayed healing and 1 superficial necrosis, occurred in non-smokers, whereas five, 2 delayed healing, 2 superficial infections and 1 superficial necrosis in smokers (p = 0.035)., Conclusion: The radiographic outcomes of smokers were comparable to those of non-smokers in the short term, whereas wound complications were more common in the smoker group., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Li-O 2 batteries have received much attention due to their extremely large theoretical energy density. However, the high overpotentials required for charging Li-O 2 batteries lower their energy efficiency and degrade the electrolytes and carbon electrodes. This problem is one of the main obstacles in developing practical Li-O 2 batteries. To solve this problem, it is important to facilitate the oxidation of Li 2 O 2 upon charging by using effective electrocatalysis. Using solid catalysts is not too effective for oxidizing the electronically isolating Li-peroxide layers. In turn, for soluble catalysts, red-ox mediators (RMs) are homogeneously dissolved in the electrolyte solutions and can effectively oxidize all of the Li 2 O 2 precipitated during discharge. RMs can decompose solid Li 2 O 2 species no matter their size, morphology, or thickness and thus dramatically increase energy efficiency. However, some negative side effects, such as the shuttle reactions of RMs and deterioration of the Li-metal occur. Therefore, it is necessary to study the activity and stability of RMs in Li-O 2 batteries in detail. Herein, recent studies related to redox mediators are reviewed and the mechanisms of redox reactions are illustrated. The development opportunities of RMs for this important battery technology are discussed and future directions are suggested., (© 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: The aim of this study was to evaluate the clinical and radiologic outcomes of medial compartment ankle osteoarthritis after supramalleolar osteotomy (SMO) without the bone marrow stimulation procedure and confirm cartilage recovery by second-look arthroscopy., Methods: Twenty-two ankles that were followed for more than 1 year after SMO were retrospectively reviewed. Visual analog scale pain scores and American Orthopaedic Foot & Ankle Society ankle-hindfoot scores were used for functional evaluations. The tibial anterior surface angle and tibial lateral surface angle were measured on radiographs, and ankle osteoarthritis was classified by Takakura stage. Among the 22 patients, 21 underwent ankle arthroscopy prior to SMO, and second-look arthroscopy was performed in 16 patients 1 year postoperatively. Tibiotalar cartilage regeneration was evaluated according to the modified Outerbridge classification for the 14 patients who had undergone SMO without the bone marrow stimulation procedure., Results: The mean visual analog scale and American Orthopaedic Foot & Ankle Society scores significantly improved from 6.5 preoperatively to 1.1 postoperatively and from 60.7 preoperatively to 87.1 postoperatively, respectively ( P < .05). The mean tibial anterior surface and tibial lateral surface angles significantly improved from 83.5° and 76.9° preoperatively to 93.8° and 80.2° postoperatively, respectively ( P < .05). All preoperative Takakura stage IIIa cases and IIIb case improved to postoperative stage II. On second-look arthroscopy, cartilage regeneration of the medial compartment of the tibiotalar joint was observed in 12 of 14 patients (85%), whereas cartilage deterioration was not observed in any patient., Conclusions: SMO without the bone marrow stimulation procedure for medial ankle osteoarthritis demonstrated cartilage regeneration in the medial tibiotalar joint in most patients by second-look arthroscopy, as well as satisfactory clinical and radiologic outcomes., Level of Evidence: Level IV, case series.

Background: MRI analysis of subtalar ligaments in the tarsal sinus has not been well performed. We retrospectively investigated the appearance of subtalar ligaments using 3D isotropic MRI and compared imaging findings of subtalar ligaments between patients with subtalar instability (STI) and controls., Methods: Preoperative MRIs of 23 STI patients treated with arthroscopic subtalar reconstruction were compared to MRIs of 23 age- and sex-matched control subjects without STI. Thickness and width of anterior capsular ligament (ACL) and interosseous talocalcaneal ligament (ITCL) as well as thickness of calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) were measured. Abnormalities in ACL, ITCL, CFL, ATFL, cervical ligament, and inferior extensor retinaculum were analyzed., Results: STI patients had significantly smaller ACL thickness and ACL width than controls (ACL thickness: 1.73 mm vs. 2.22 mm, p = 0.007; ACL width: 7.21 mm vs. 8.80 mm, p = 0.004). ACL thickness of ≤2.1 mm had a sensitivity of 66.7% and a specificity of 66.7% for diagnosis of STI. ACL width of ≤7.9 mm had a sensitivity of 80.0% and a specificity of 76.2% for the diagnosis of STI. However, thickness and width of ITCL, thickness of CFL, or thickness of ATFL was not significantly different between the two groups. Absence or complete tear of ACL was significantly more frequent in STI patients than that in controls (34.8% vs. 8.7%, p = 0.035). Complete tear of CFL and ATFL was more common in STI patients than that in controls, although the difference between the two groups was not statistically significant. Abnormalities of ITCL, cervical ligament, or inferior extensor retinaculum were not significantly different between the two groups., Conclusions: MRI features of thin or narrow ACLs may suggest STI. Absence or complete tear of ACL was significantly more common in STI patients than that in controls.

Despite its highest theoretical capacity, the practical applications of the silicon anode are still limited by severe capacity fading, which is due to pulverization of the Si particles through volume change during charge and discharge. In this study, silicon nanoparticles are embedded in micron-sized porous carbon spheres (Si-MCS) via a facile hydrothermal process in order to provide a stiff carbon framework that functions as a cage to hold the pulverized silicon pieces. The carbon framework subsequently allows these silicon pieces to rearrange themselves in restricted domains within the sphere. Unlike current carbon coating methods, the Si-MCS electrode is immune to delamination. Hence, it demonstrates unprecedented excellent cyclability (capacity retention: 93.5% after 500 cycles at 0.8 A g -1 ), high rate capability (with a specific capacity of 880 mAh g -1 at the high discharge current density of 40 A g -1 ), and high volumetric capacity (814.8 mAh cm -3 ) on account of increased tap density. The lithium-ion battery using the new Si-MCS anode and commercial LiNi 0.6 Co 0.2 Mn 0.2 O 2 cathode shows a high specific energy density above 300 Wh kg -1 , which is considerably higher than that of commercial graphite anodes.

Ultraviolet (UV) radiation has adverse effects on extracellular matrix (ECM) proteins, leading to formation of wrinkles a hallmark of premature skin aging. The adverse effects of UV radiation are associated with induction of matrix metalloproteinases (MMPs) expression and degradation of collagen and elastin. The present study investigated anti-wrinkle effects of chlorogenic acid (CGA), pyrocatechol (PC) and 3,4,5-tricaffeoyl quinic acid (TCQ), isolated from beans of Coffea arabica, against UV-B stimulated mouse fibroblast cells (CCRF) by measuring expression levels of MMP-1, 3, 9, and type-I procollagen. The three compounds were isolated and purified from coffee grounds using column chromatography and structural examination was evaluated by nuclear magnetic resonance (NMR) analysis. Among the three isolated compounds, CGA effectively suppressed the expression of the MMP-1, 3, and 9 and increased synthesis of type-I procollagen as compared UV-B-stimulated CCRF cells. In addition, CGA dose-dependently inhibited intracellular reactive oxygen species (ROS) production in CCRF cells stimulated by UV radiation. Moreover, CGA displayed a good sun protection factor (SPF) and in vitro DNA damage protection together with inhibition of enzyme xanthine oxidase. The enzyme inhibitory kinetic behavior of CGA was determined by Lineweaver-Burk plot, displayed a mixed type enzyme inhibition with 260.3±4.5μM, K i value. The results indicate that CGA has potential to be used as a preventive agent against premature skin aging induced by UV radiation., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To propose a new scale, the Feeding and Swallowing Scale for Premature Infants (FSSPI), based on videofluoroscopic swallowing study (VFSS) findings and to verify the reliability and validity of the FSSPI., Methods: One hundred thirty preterm infants who had undergone VFSS were enrolled in this retrospective study. The FSSPI was developed by referring to the Baby Regulated Organization of Subsystems and Sucking approach. The FSSPI score for each VFSS video was evaluated by a physiatrist as well as by three experienced speech-language pathologists. To verify the reliability of the FSSPI, the inter-evaluator and intra-evaluator associations for the FSSPI scores were analyzed. To verify the validity of the FSSPI, the association between FSSPI scores and clinical characteristics including prognosis-related factors was analyzed., Results: The mean gestational age was 27.3±2.8 weeks. The FSSPI showed a high degree of both intra-rater reliability and inter-rater reliability. Also, there was a significant negative correlation between the FSSPI score and corrected age (CA) at the time of performing VFSS. Further, a significant positive correlation was observed between the FSSPI score and CA at the time of achieving full oral feeding. A significant negative correlation was observed between the FSSPI score and weight gain, between the 1st and 2nd month after birth, and between the 2nd and 3rd month after birth, respectively., Conclusion: In this study, we proposed a new clinical scale using VFSS to reflect the development of feeding and swallowing skills in preterm infants. Further, we verified the reliability and validity of the scale., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Background: Studies regarding magnetic resonance imaging (MRI) findings of the lateral ankle ligaments in chronic lateral ankle instability and their clinical relevance for surgery are lacking. This study classified the lateral ankle ligament MRI findings of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in chronic lateral ankle instability (CLAI) and correlated these findings with ankle stress radiographs., Methods: We included 132 ankles with CLAI that underwent ligament reconstructions from 2006 to 2013. The distributions of the ATFL and CFL morphologies were evaluated using the following categories: (1) the amount of thickness: normal/thickened/attenuated/non-visualized, (2) the presence of discontinuity, (3) wavy or irregular contour, and (4) increased signal intensity on T2-weighted images. The relationships between the ligament morphologies and stress radiographs were analyzed., Results: The ATFL was normal in 5 (4%) ankles, thickened in 35 (27%), attenuated in 76 (58%), and non-visualized in 16 (12%), while the CFL was normal in 39 (30%) ankles, thickened in 42 (32%), attenuated in 44 (33%), and non-visualized in 7 (5%). Discontinuity of the ATFL or CFL was observed in 46 (35%) ankles. Wavy or irregular contours were observed in 55 (42%) ATFLs and 37 (28%) CFLs, and signal intensity of both ligaments was increased in 19 (14%) ankles. ATFL ( P < .001) and CFL thickness ( P = .007) correlated with the talar tilt angle., Conclusions: The MRI findings of CLAI showed several morphologies and specific incidences for each morphology. Attenuated, wavy appearance was the most frequent MRI pattern. Thickness was related to the degree of instability., Level of Evidence: Level IV, retrospective case series.

Nickel ferrite (NiFe 2 O 4 ) has been previously shown to have a promising electrochemical performance for lithium-ion batteries (LIBs) as an anode material. However, associated electrochemical processes, along with structural changes, during conversion reactions are hardly studied. Nanocrystalline NiFe 2 O 4 was synthesized with the aid of a simple citric acid assisted sol-gel method and tested as a negative electrode for LIBs. After 100 cycles at a constant current density of 0.5 A g -1 (about a 0.5 C-rate), the synthesized NiFe 2 O 4 electrode provided a stable reversible capacity of 786 mAh g -1 with a capacity retention greater than 85%. The NiFe 2 O 4 electrode achieved a specific capacity of 365 mAh g -1 when cycled at a current density of 10 A g -1 (about a 10 C-rate). At such a high current density, this is an outstanding capacity for NiFe 2 O 4 nanoparticles as an anode. Ex-situ X-ray diffraction (XRD) and X-ray absorption spectroscopy (XAS) were employed at different potential states during the cell operation to elucidate the conversion process of a NiFe 2 O 4 anode and the capacity contribution from either Ni or Fe. Investigation reveals that the lithium extraction reaction does not fully agree with the previously reported one and is found to be a hindered oxidation of metallic nickel to nickel oxide in the applied potential window. Our findings suggest that iron is participating in an electrochemical reaction with full reversibility and forms iron oxide in the fully charged state, while nickel is found to be the cause of partial irreversible capacity where it exists in both metallic nickel and nickel oxide phases.

Background: Moderate to severe midfoot-forefoot varus deformities are commonly found in several conditions. However, few techniques are available to correct these deformities. So, we evaluated the clinical and radiological outcomes of patients who underwent midfoot derotational osteotomy to achieve plantigrade foot., Methods: From 2006 to 2014, 6 patients (7 feet) underwent midfoot derotational osteotomy. A visual analog scale (VAS) pain and the American Orthopedic Foot & Ankle Society (AOFAS) functional score were evaluated. Radiographic parameters, including tibiocalcaneal angle (TCA) and navicular height (NH), were assessed., Results: The mean patient age at surgery was 48.0 years (37-58). From before the operation to the final follow-up, the mean VAS score decreased from 6.5 (2-9) to 1.3 (0-4) and the mean AOFAS score improved from 42.7 (34-58) to 77 (68-87). All patients were satisfied with outcomes. The mean TCA significantly improved from 33.8° (9.9-66.7) to 12.7 (5.1-27.6) (p = 0.018)and the mean NH decreased from 46.7 mm (32.8-67) to42.6 (30.1-60.8) (p = 0.018)., Conclusion: Severe midfoot-forefoot varus deformities can be efficiently corrected by midfoot derotational osteotomy resulting in favorable clinical and radiological outcomes and high patient satisfaction., Level of Evidence: IV, case series., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

The growing demand for lithium-ion batteries (LIBs) requires investigation of high-performance electrode materials with the advantages of being environmentally friendly and cost-effective. In this study, a nanocomposite of open-pyrochlore-structured FeF 3 ·0.5H 2 O and reduced graphene oxide (RGO) is synthesized for use as a high-performance cathode in LIBs, where RGO provides high electrical conductivity to the composite material. The morphology of the composite shows that FeF 3 ·0.5H 2 O spheres are embedded into RGO layers and high-resolution TEM image shows that those spheres are composed of primary nanoparticles with a size of ~5 nm. The cycling performance indicates that the composite electrode delivers an initial high discharge capacity of 223 mAh g -1 at 0.05 C, a rate capability up to a high C-rate of 10 C (47 mAh g -1 ) and stable cycle performance at 0.05 C (145 mAh g -1 after 100 cycles) and 0.2 C (93 mAh g -1 after 100 cycles) while maintaining high electrochemical reversibility. Furthermore, the responsible electrochemical reaction is investigated using in-situ XRD and synchrotron-based X-ray absorption spectroscopy (XAS), and the XRD results show that FeF 3 ·0.5H 2 O transitions to an amorphous-like phase through a lithiation process. However, a reversible oxidation change of Fe 3+  ↔ Fe 2+ is identified by the XAS results., Competing Interests: The authors declare no competing financial interests.

Diospyros kaki (DK) contains an abundance of flavonoids and has been used in folk medicine in Korea for centuries. Here, we report for the first time the anti-inflammatory activities of Quercetin (QCT) and Quercetin 3-O-β-("2"-galloyl)-glucopyranoside (Q32G) isolated from DK. We have determine the no cytotoxicity of Q32G and QCT against RAW 264.7 cells up to concentration of 50 μM. QCT and Q32G demonstrated potent anti-inflammatory activities by reducing expression of nitric oxide (NO), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6 inducible NO synthase (iNOS), cyclooxygenase (COX)-2, and mitogen-activated protein kinase (MAPKs) in mouse RAW 264.7 macrophages activated with lipopolysaccharide (LPS). Both QCT or Q32G could decrease cellular protein levels of COX-2 and iNOS as well as secreted protein levels of NO, PGE 2 , and cytokines (TNF-α, IL-1β, and IL-6) in culture medium of LPS-stimulated RAW 264.7 macrophages. Immunoblot analysis showed that QCT and Q32G suppressed LPS-induced MAP kinase pathway proteins p-p38, ERK, and JNK. This study revealed that QCT and Q32G have anti-inflammatory potential, however Q32G possess comparable activity as that of QCT and could be use as adjuvant to treat inflammatory diseases., (© 2016 Institute of Food Technologists®.)

Background: Recently, as total ankle arthroplasty (TAA) has been widely performed, its outcomes and complications have been reported. Heterotopic ossification (HO) after TAA has been reported in the posterior compartment of the ankle. We report on a series of HOs that developed in the anterior compartment of the ankle at the talar neck region after TAA., Methods: TAA was performed using the Hintegra and the Mobility in 54 ankles (Hintegra, 21 ankles; Mobility, 33 ankles) from 2004 to 2012. The outcome was assessed by visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, patient satisfaction, and radiographic evaluation. The HO was confirmed on the lateral ankle view. HO in the anterior compartment of the ankle was classified based on a modification of the Brooker classification., Results: After TAA, 13 HOs developed in 12 of the 54 ankles. Six HOs developed in the anterior compartment, and 7 HOs developed in the posterior compartment. The majority of the anterior compartment HO (5/6) was observed in the Mobility group. There was no significant relationship between HO and the clinical outcomes (VAS score, P = .62; AOFAS score, P = .31; ankle range of motion, P = .31)., Conclusions: Besides the posterior ankle, the anterior compartment of the ankle in the talar neck region was demonstrated to be another potential area for HO after TAA. The development of anterior HO was strongly related to the wide exposure of the cancellous bony surface at the talar neck and therefore occurred more often with the Mobility than with the Hintegra prosthesis., Level of Evidence: Level III, retrospective comparative case series., (© The Author(s) 2016.)

Background: Deltoid ligament insufficiency can cause arthritic changes with various symptoms in the ankle joint. However, reconstruction procedures of the medial collateral and deltoid ligaments have drawn less attention than those of the lateral ankle ligaments. Few techniques for reconstructing deltoid ligaments are available, and those that are can be complex., Objective: We introduce a new surgical method for reconstructing superficial deltoid ligaments that is simple and straightforward., Conclusion: With this method, the tibionavicular and tibiocalcaneal ligaments can be reconstructed efficiently and easily., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The indications and clinical necessity for routine hardware removal after treating ankle or distal tibia fracture with open reduction and internal fixation are disputed even when hardware-related pain is insignificant. Thus, we determined the clinical effects of routine hardware removal irrespective of the degree of hardware-related pain, especially in the perspective of patients' daily activities. This study was conducted on 80 consecutive cases (78 patients) treated by surgery and hardware removal after bony union. There were 56 ankle and 24 distal tibia fractures. The hardware-related pain, ankle joint stiffness, discomfort on ambulation, and patient satisfaction were evaluated before and at least 6 months after hardware removal. Pain score before hardware removal was 3.4 (range 0 to 6) and decreased to 1.3 (range 0 to 6) after removal. 58 (72.5%) patients experienced improved ankle stiffness and 65 (81.3%) less discomfort while walking on uneven ground and 63 (80.8%) patients were satisfied with hardware removal. These results suggest that routine hardware removal after ankle or distal tibia fracture could ameliorate hardware-related pain and improves daily activities and patient satisfaction even when the hardware-related pain is minimal.

In this study, the effect of purified quercetin-3-O-β-d-glucopyranosyl-(1 → 6)-β-d-glucopyranosid (QCGG) on melanogenesis was investigated. QCGG was isolated from the calyx of a traditional Korean medicinal herb, Persimmon (Diospyros kaki). The hypopigmentation effects of QCGG were determined by examination of cellular melanin contents, tyrosinase activity assay, cAMP assay, and Western blotting of α-MSH-stimulated B16F10 mouse melanoma cells. Our results showed that QCGG inhibited both melanin synthesis and tyrosinase activity in a concentration-dependent manner as well as significantly reduced the expression of melanogenic proteins such as microphthalmia-associated transcription factor (MITF), tyrosinase-related protein-1, tyrosinase-related protein-2, and tyrosinase. Moreover, QCGG inhibited intracellular cAMP levels, cAMP response element-binding protein (CREB), and p38 MAPK expression in α-MSH-stimulated B16F10 cells. Taken together, the suppressive effects of QCGG on melanogenesis may involve down-regulation of MITF and its downstream signaling pathway via phosphorylation of p38 MAPK and CREB along with reduced cAMP levels. These results indicate that QCGG reduced melanin synthesis by reducing expression of tyrosine and tyrosine-related proteins via extracellular signal-related protein kinase (ERK) activation, followed by down-regulation of CREB, p38, and MITF.

Study Design: A prospective sonographic study., Purpose: To verify the effectiveness of simultaneous application of two landmarks, Doppler image of the vertebral artery and shape of the transverse tubercle of the seventh cervical (C7) vertebra., Overview of Literature: Counting upwards from the C7 vertebra which only has a posterior tubercle of the transverse process is a commonly used method for ultrasound-guided cervical nerve root block. However, each transverse process has a different shape., Methods: Sonograms of 20 volunteers were examined. At first, we identified the C7 transverse process based on the presence of the vertebral artery without the anterior tubercle. The C5 and C6 transverse processes were identified based on the presence of anterior tubercle without the vertebral artery. Subsequently, we placed needles on the C5, C6, and C7 transverse processes and the location and direction of needles were confirmed by fluoroscopy., Results: In the 120 segments, 93.3% of needles were placed correctly as desired; 97.5% of needles were placed on the 5C transverse process; 97.5% of needles were placed on the C6 transverse process; and 85.0% of needles were placed on the C7 transverse process, respectively. Both sides showed the same accuracy of 93.3%., Conclusions: Simultaneous application of Doppler image of the vertebral artery and shape of the C7 transverse tubercle showed 93.3% accuracy in identifying the target cervical level. Therefore, Doppler image of the vertebral artery can be considered to be a useful landmark for ultrasound-guided cervical nerve root block.

Background: Lateral ankle instability is one of the most common musculoskeletal disorders and can result in ankle damage. This study reports on the results of the anatomical reconstruction of ligaments using semitendinosus tendon allograft and bioabsorbable tenodesis screws for chronic lateral ankle instability, as well as the functional and radiological results of this procedure., Methods: From February 2007 to January 2013, 70 patients (72 ankles) underwent this procedure. Six patients were lost to follow-up, and ultimately 64 patients (66 ankles) were evaluated. Visual Analog Scale (VAS) pain scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, Karlsson-Peterson ankle scores, and patient satisfaction were evaluated at a mean of 22.1 months (range, 12-68 months) postoperatively. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. The mean patient age at surgery was 30.1 years (range, 16-59 years)., Results: The mean VAS pain score decreased from 5.5 to 1.3 (P < .05), and the mean AOFAS improved from 71.0 to 90.9 (P < .05). The mean Karlsson-Peterson score improved from 55.1 to 90.3, whereas talar tilt decreased from 14.8 degrees to 3.9 degrees. There was no significant difference in clinical outcomes between the pretensioned and nonpretensioned groups., Conclusion: This procedure yielded successful results, including satisfactory ankle stability and clinical outcomes, in ankles with poor lateral ligament tissues., Level of Evidence: Level IV, case series., (© The Author(s) 2015.)

Purpose: Subtalar instability (STI) has often been obscured by lateral ankle instability. Moreover, although there have been several reports of techniques for reconstructing STI, no clinical outcome results are known to have been published. The authors report the clinical and radiographic outcomes of the ligament reconstruction of STI with a recently reported novel technique utilising a semitendinosus tendon allograft and interference screws., Methods: This study is based on 20 ankles that underwent ligament reconstruction for STI between 2009 and 2013. The average follow-up period was 15.0 ± 5 months, and the average age at surgery was 28.1 ± 10.8 years old. Visual analogue (VAS) pain scores, American Orthopedic Foot and Ankle Society (AOFAS) and Karlsson-Peterson ankle scores as well as patient satisfaction were evaluated. Radiographic evaluation of medial translations of calcaneus and subtalar tilt angles was preformed with ankle and Broden's stress radiographs., Results: The VAS pain score decreased from 6.1 ± 1.1 preoperatively to 1.8 ± 1.2 post-operatively (p < 0.05). The AOFAS score improved from 66.0 ± 12.2 preoperatively to 89.6 ± 6.7 post-operatively, and the Karlsson-Peterson score improved from 57.0 ± 13.5 to 91.1 ± 6.8 (p < 0.05). There were no complications such as recurred STI or subtalar joint stiffness. All of the patients were satisfied with the surgery. Subtalar tilt angle decreased from 11.5° preoperatively to 3.0° post-operatively, and the calcaneal medial translations decreased from 7.4 to 3.9 mm., Conclusion: This is the first report on the comprehensive clinical and radiographic outcomes of STI reconstruction using a semitendinosus tendon allograft and interference screws. The novel technique of STI reconstruction was found to show encouraging clinical outcomes with high patient satisfaction., Levels of Evidence: IV.

Among many challenges present in Li-air batteries, one of the main reasons of low efficiency is the high charge overpotential due to the slow oxygen evolution reaction (OER). Here, we present systematic evaluation of Pt, Pd, and Ru nanoparticles supported on rGO as OER electrocatalysts in Li-air cell cathodes with LiCF3SO3-tetra(ethylene glycol) dimethyl ether (TEGDME) salt-electrolyte system. All of the noble metals explored could lower the charge overpotentials, and among them, Ru-rGO hybrids exhibited the most stable cycling performance and the lowest charge overpotentials. Role of Ru nanoparticles in boosting oxidation kinetics of the discharge products were investigated. Apparent behavior of Ru nanoparticles was different from the conventional electrocatalysts that lower activation barrier through electron transfer, because the major contribution of Ru nanoparticles in lowering charge overpotential is to control the nature of the discharge products. Ru nanoparticles facilitated thin film-like or nanoparticulate Li2O2 formation during oxygen reduction reaction (ORR), which decomposes at lower potentials during charge, although the conventional role as electrocatalysts during OER cannot be ruled out. Pt-and Pd-rGO hybrids showed fluctuating potential profiles during the cycling. Although Pt- and Pd-rGO decomposed the electrolyte after electrochemical cycling, no electrolyte instability was observed with Ru-rGO hybrids. This study provides the possibility of screening selective electrocatalysts for Li-air cells while maintaining electrolyte stability.

Purpose: To report the risk factors and clinical effects of an opaque bubble layer (OBL) during creation of a laser in situ keratomileusis (LASIK) flap with the Visumax 500 kHz femtosecond laser., Setting: HanGil Eye Hospital, Incheon, South Korea., Design: Retrospective comparative study., Methods: Visual acuity, manifest refraction, intraocular pressure, corneal curvature, corneal thickness, and optical quality were evaluated. To prove a previous hypothesis that the harder a surgeon applanates during flap creation (hard-docking technique), the higher the incidence of OBL, the area of the meniscus on the cornea to which pressure was applied by the patient interface was calculated. Eyes were separated into 2 groups; that is, OBL-occurrence group and OBL-free group. Clinical outcomes in the 2 groups were compared to measure the risk factors and clinical effects of an OBL., Results: The study included 827 myopic eyes. The incidence of OBL was 5.0% (41 eyes). The mean flat keratometry was steeper and the preoperative cornea thicker in the OBL-occurrence group. The OBL-occurrence group had harder applanation (ie, a larger area of meniscus) than the OBL-free group. The incidence of OBL was higher in the hard-docking technique. Clinical outcomes, including refractive error, visual acuity, and optical quality, in the 2 groups were not statistically significantly different 1 month after LASIK., Conclusions: The incidence of OBL was 5.0%. A steep, thick cornea and a hard-docking technique could be risk factors for an OBL. The OBL did not appear to affect optical quality or visual outcomes., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To develop a novel, simplified method for correcting the ischemic index of nonperfused areas in diabetic retinopathy (DR)., Methods: We performed a retrospective review of 103 eyes with naive DR that underwent ultra-widefield angiography (UWFA) over a year. UWFAs were graded according to the quantity of retinal non-perfusion, and uncorrected ischemic index (UII) and corrected ischemic index (CII) were calculated using a simplified, novel method., Results: The average differences between UII and CII in the non-proliferative DR group and the proliferative DR group were 0.7 ± 0.9% in the <25% CII group, 3.0 ± 0.9% in the 25% to 49.9% CII group, and 3.6 ± 0.6% in the >50% CII group, respectively. A CII >25% was critical for determining DR progression (p < 0.001)., Conclusions: Distortion created by UWFA needs to be corrected because the difference between UII and CII in DR increases with the ischemic index.

Background: Total ankle arthroplasty (TAA) with the use of third generation implants has demonstrated favorable clinical results and improved survival. However, few studies have compared the different types of implants. The purpose of this study was to perform a retrospective evaluation of patient outcomes and complications by comparing TAA procedures performed with HINTEGRA versus MOBILITY systems., Methods: Fifty-two consecutively enrolled patients (28 men and 24 women; mean age 64.8 years) underwent TAA using HINTEGRA (21 ankles) or MOBILITY (33 ankles) between September 2004 and July 2012. Visual analog scale (VAS) pain scores and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores were determined at each follow-up visit. The radiographs were reviewed to assess component positioning, radiolucency, heterotopic ossification, and other factors. The mean follow-up period was 28.3 months in the HINTEGRA group and 32.5 months in the MOBILITY group., Results: VAS decreased from 8.3 to 2.0 for the HINTEGRA group and from 7.9 to 2.7 for the MOBILITY group. The AOFAS score increased from 43.8 to 87.3 for the HINTEGRA group and from 46.6 to 83.7 for the MOBILITY group. Intra- and postoperative malleolar fractures were not noted in the HINTEGRA group, whereas 5 ankles (15.2%) in the MOBILITY group sustained this injury (P = .144). Ankle impingement syndrome was noted in 8 ankles (38.1%) in the HINTEGRA group and 3 (9.1%) in the MOBILITY group (P = .015). However, no significant differences in postoperative osteolysis and neuralgia were noted between the groups., Conclusions: Both implants exhibited favorable clinical outcome without significant differences. However, in terms of complications, ankle impingement syndrome was significantly more common in the HINTEGRA group, while intraoperative malleolar fracture was observed only in the MOBILITY group., Level of Evidence: Level III, comparative series., (© The Author(s) 2015.)

Nitrogen-doped carbon is coated on lithium titanate (Li4Ti5O12, LTO) via a simple chemical refluxing process, using ethylenediamine (EDA) as the carbon and nitrogen source. The process incorporates a carbon coating doped with a relatively high amount of nitrogen to form a conducting network on the LTO matrix. The introduction of N dopants in the carbon matrix leads to a higher density of C vacancies, resulting in improved lithium-ion diffusion. The uniform coating of nitrogen-doped carbon on Li4Ti5O12 (CN-LTO) enhances the electronic conductivity of a CN-LTO electrode and the corresponding electrochemical properties of the cell employing the electrode. The results of our study demonstrate that the CN-LTO anode exhibits higher rate capability and cycling performance over 100 cycles. From the electrochemical tests performed, the specific capacity of CN-LTO electrode at higher rates of 20 and 50 C are found to be 140.7 and 82.3 mAh g(-1), respectively. In addition, the CN-Li4Ti5O12 anode attained higher capacity retention of 100% at 1 C rate after 100 cycles and 92.9% at 10 C rate after 300 cycles.

Athletes usually complain of an ongoing or chronic pain over the Achilles tendon, but recently even non-athletes are experiencing the same kind of pain which affects their daily activities. Achilles tendinosis refers to a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation. Treatment is based on whether to stimulate or prevent neovascularization. Thus, until now, there is no consensus as to the best treatment for this condition. This paper aims to review the common ways of treating this condition from the conservative to the surgical options.

Study Design: Retrospective study., Purpose: To determine the prevalence of high risk patient with osteopenia requiring pharmacologic treatment and investigate the difference of 10-year fracture probability whether bone mineral density (BMD) include or not in Korean FRAX model., Overview of Literature: Many people with the fracture have osteopenia rather than osteoporosis, and BMD alone could be considered as a chance to prevent fracture., Methods: Three hundred sixty-nine patients who was diagnosed as osteopenia were divided into two groups according to age (group 1, under 65 years; group 2, over 65 years), and 10-year fracture probabilities were calculated by FRAX algorithm with and without femur neck T-score., Results: The high risk patients of the fracture who had above 3% of 10-year hip fracture probability were 15 cases in group 1 and 121 cases in group 2. In 193 patients of group 1, the mean 10-year fracture probability with BMD was significantly higher than the results without BMD (hip fracture: p=0.04, major osteoporotic fracture: p=0.01). Unlike the results of the group 1, the mean 10-year fracture probability without BMD was significantly higher than the results with BMD in 176 patients of group 2 (hip fracture: p=0.01, major osteoporotic fracture: p=0.01)., Conclusions: Total of 136 cases (36.8%) as a high risk of the fracture with osteopenia could be overlooked treatment eligibility in Korean. The Korean FRAX model without BMD could be effective in predicting fracture risk especially in the individuals who were over 65 years.

Ultraviolet (UV) exposure is well-known to induce premature aging, which is mediated by matrix metalloproteinase-1 (MMP-1) activity. A 9-mer peptide, CopA3 (CopA3) was synthesized from a natural peptide, coprisin, which is isolated from the dung beetle Copris tripartitus. As part of our continuing search for novel bioactive natural products, CopA3 was investigated for its in vitro anti-skin photoaging activity. UV-induced inhibition of type-I procollagen and induction of MMP-1 were partially prevented in human skin fibroblasts by CopA3 peptide in a dose-dependent manner. At a concentration of 25 μM, CopA3 nearly completely inhibited MMP-1 expression. These results suggest that CopA3, an insect peptide, is a potential candidate for the prevention and treatment of skin aging.

Background: Scarring on the dorsal first web space after lateral soft tissue release can be a major contributor to patient dissatisfaction following hallux valgus surgery. We hypothesized that performing distal soft tissue procedure (DSTP), proximal reverse chevron metatarsal osteotomy (PCMO), and Akin osteotomy through a single medial incision would provide better clinical and radiographic results with improved patient satisfaction compared with bunion corrections performed through 2 incisions., Methods: The study included 117 feet (of 98 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, first MTP joint range of motion (ROM), and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), hallux valgus interphalangeal angle (HIA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery., Results: The mean AOFAS hallux score improved from 56.3 preoperatively to 90.6 at the final follow-up, and the mean VAS pain score decreased from 6.8 preoperatively to 1.5 at the final follow-up (P < .001). Ninety-five percent of the patients were satisfied with the surgery. Radiographically, the mean HVA decreased from 36.1 degrees (range, 16.0 to 44.0 degrees) preoperatively to 5.4 degrees (range, -12.4 to 29.7 degrees) at the final follow-up (P < .001), and the mean IMA decreased from 19.0 degrees (range, 9.0 to 28.0 degrees) preoperatively to 4.5 degrees (range, -5.0 to 14.2 degrees) at the final follow-up (P < .001). The mean 1-5MTW also decreased by 16% (16 mm) from 97.3 mm (range, 85.0 to 110.0 mm) preoperatively to 81.3 mm (range, 70.0 to 95.0 mm) at the final follow-up (P < .001)., Conclusion: We achieved very favorable clinical and radiographic outcomes with minimal complications in patients with moderate to severe hallux valgus, by treating hallux valgus using DSTP, PCMO, and Akin osteotomy through a single medial incision. The single medial incision scar improved the cosmetic results by avoiding the formation of a disfiguring dorsal first web space scar., Level of Evidence: Level IV, retrospective case series.

A 2.3 kDa of antimicrobial peptide was purified from an acidified liver extract of skipjack tuna, Katsuwonus pelamis, by preparative acid-urea-polyacrylamide gel electrophoresis and C18 reversed-phase HPLC. A comparison of the amino acid sequence of the purified peptide with those of other known polypeptides revealed high homology with the C-terminus of hemoglobin β-chain; thus, this peptide was designated as the Skipjack Hemoglobin β chain-related Antimicrobial Peptide (SHβAP). SHβAP showed potent antimicrobial activity against Gram-positive bacteria, such as Bacillus subtilis, Staphylococcus aureus, and Streptococcus iniae (minimal effective concentrations [MECs], 6.5-57.0 μg/mL), Gram-negative bacteria, such as Escherichia coli D31, Pseudomonas aeruginosa, Salmonella enterica, Shigella sonnei, and two Vibrio parahaemolyticus species (MECs, 2.0-19.0 μg/mL), and against Candida albicans (MEC; 12.0 μg/mL) without significant hemolytic activity. Antimicrobial activity of this peptide was heatstable and pH resistant but is sensitive to proteases and salt. SHβAP did not show membrane permeabilization and killing ability. The secondary structural prediction and the homology modeling expected that this peptide formed an amphipathic α-helical structure. This is the first report the purification of a novel antimicrobial peptide related to the C-terminus of hemoglobin β-chain from marine fish., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Open ankle fracture, including compound loss of the lateral malleolus, lateral ankle ligaments, and overlying skin, is a severe injury and can result in ankle instability and permanent disability. Treatment of this injury is challenging and requires bone grafting and soft tissue reconstruction. In the present report, we describe a unique reconstruction technique for compound loss of the lateral malleolus, lateral ankle ligaments, and the overlying skin using a double-bundle Achilles tendon-bone allograft combined with a reverse sural fasciocutaneous flap. The patient obtained a stable ankle with nearly full range of motion and displayed satisfactory function during the follow-up period., (Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Stromal cell-derived factor 1 (SDF-1) is a chemokine that is involved in the bone-destructive process in rheumatoid arthritis (RA) and bony metastasis in malignancy. This study was undertaken to determine the role and mechanism of SDF-1 in RA-associated osteoclastogenesis., Methods: The expression of SDF-1, tumor necrosis factor α (TNFα), and RANKL in RA synovial tissue was analyzed using confocal microscopy. After synovial fibroblasts and CD4+ T cells were treated with SDF-1, RANKL messenger RNA expression was determined by real-time and reverse transcription polymerase chain reaction. Osteoclastogenesis was assessed by counting tartrate-resistant acid phosphatase-positive multinucleated cells in CD14+ monocytes cultured with SDF-1 in the presence of anticytokine antibodies or signal inhibitors and in monocytes cocultured with SDF-1-pretreated synovial fibroblasts and CD4+ T cells., Results: RANKL, TNFα, and SDF-1 were coexpressed in the lining and sublining of RA synovium. SDF-1 stimulated RANKL expression in RA synovial fibroblasts and CD4+ T cells, and TNFα inhibition reduced this stimulation. When monocytes isolated from human peripheral blood were cultured with SDF-1, they were differentiated into osteoclasts in the absence of RANKL. Monocytes were also differentiated into osteoclasts when they were cocultured with SDF-1-pretreated synovial fibroblasts or CD4+T cells; however, this osteoclastogenesis was reduced by TNFα inhibition., Conclusion: Our findings indicate that SDF-1 induces osteoclastogenesis directly and indirectly via up-regulating RANKL expression in RA synovial fibroblasts and CD4+ T cells, and that this is mediated by TNFα. The axis of SDF-1 and RANKL is a potential therapeutic target for RA-associated bone destruction., (Copyright © 2014 by the American College of Rheumatology.)

Objective: We investigated the clinical outcome of percutaneous transluminal angioplasty (PTA) which has not been fully established in diabetic patients with critical limb Ischaemia (CLI) compared with non-diabetics., Design and Patients: A total of 73 limbs of 52 patients (50 limbs of 34 diabetic patients and 23 limbs of 18 non-diabetics) who underwent PTA for CLI (Rutherford-Becker category 4, 5 or 6) were enrolled. Rates of amputation and restenosis, and ankle brachial index (ABI), were assessed before and after PTA during a 36-month follow-up period., Results: Diabetic patients had a higher rate of major amputations after PTA (10 vs. 0%, P<0.05); however, total amputation (12.0 vs. 8.7%, P=0.62) and restenosis rates (4.0 vs. 8.7%, P=0.38) were not significantly different compared with non-diabetic patients. ABI at 3 months after PTA was significantly improved in both diabetic and non-diabetic patients (0.70±0.20 vs. 0.93±0.19, P<0.01 in diabetic patients; 0.69±0.25 vs. 0.92±0.17, P<0.01 in non-diabetics). Improved ABI was maintained for 36 months in both groups and did not show a significant difference (0.88±0.21 vs. 0.89±0.20, P=0.89)., Conclusion: Our results, showing that the outcome of PTA in diabetic patients is not inferior to that in non-diabetics, suggest the potential benefit of primary PTA, instead of bypass surgery, for CLI in diabetic patients who are at high risk of perioperative complications., (© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.)

This study proposes a method for manufacturing high-performance electrode materials in which controlling the shape of the current collector and electrode material for a Li-ion capacitor (LIC). In particular, the proposed LIC manufacturing method maintains the high voltage of a cell by using a microdome-patterned electrode material, allowing for reversible reactions between the Li-ion and the active material for an extended period of time. As a result, the LICs exhibit initial capacities of approximately 42 F g⁻¹, even at 60 A g⁻¹. The LICs also exhibit good cycle performance up to approximately 15,000 cycles. In addition, these advancements allow for a considerably higher energy density than other existing capacitor systems. The energy density of the proposed LICs is approximately nine, two, and 1.5 times higher than those of the electrochemical double layer capacitor (EDLC), AC/LiMn₂O₄ hybrid capacitor, and intrinsic Si/AC LIC, respectively.

Adult cavovarus deformity patients present with rigid cavovarus deformity, where the correction can no longer be obtained using soft tissue procedures alone, and corrective arthrodesis or osteotomy must be performed to realign the deformity. Reconstructive surgeries for cavovarus foot deformities are variable and include hindfoot or midfoot osteotomy or arthrodesis, soft tissue release or lengthening, and tendon transfers. Recently adult cavovarus foot deformities have been more commonly addressed with joint preservation osteotomies and adjunctive soft tissue surgeries and less with triple arthrodesis. Clinical and radiographic outcomes are overall favorable., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Diabetes mellitus tends to have the greatest impact on the smaller vessels and contributes significantly to occlusive disease from the popliteal artery distally., Purpose: To evaluate the clinical outcomes after a balloon angioplasty with or without stent placement in diabetic patients with critical limb ischemia (CLI) by chronic total occlusion (CTO) limited to below-the-knee (BTK) arteries., Material and Methods: From August 2005, patients who presented CLI and CTO limited to the BTK arteries, and who underwent endovascular treatment, were included in this study. The primary endpoints evaluated were technical success, limb salvage, and primary patency. The secondary endpoints evaluated were 30-day access site, intervention site, and systemic complications. Patency and limb salvage were evaluated using the Kaplan-Meier method and compared using Fisher's exact test., Results: The BTK endovascular treatment (EVT) was performed on 64 limbs. Technical success rate was 93.8% and limb salvage rate was 90.6%. Three of four limbs with technical failure and three of 60 limbs with technical success underwent BTK amputation and the comparison of these rates were significantly different (75% vs. 5%, P = 0.002). Primary patency rates for the limbs were 75% and 59.1% at 6-month and 12-month follow-up, respectively. Minor complications disappeared through the follow-up periods and there was no 30-day complication or systemic adverse events for the treated vessel., Conclusion: Even though EVT for CLI in patients with diabetes and CTO in isolated BTK arteries does not have comparable primary patency, it can lead to a very high rate of limb salvage. This result can accentuate the importance of more blood flow to the foot by means of successful revascularization using EVT rather than long-term patency in CTO of isolated BTK arteries.

Purpose: To evaluate the optical quality after laser in situ keratomileusis (LASIK) or serial photorefractive keratectomy (PRK) using a double-pass system and to follow the recovery of optical quality after laser vision correction., Methods: This study measured the visual acuity, manifest refraction and optical quality before and one day, one week, one month, and three months after laser vision correction. Optical quality parameters including the modulation transfer function, Strehl ratio and intraocular scattering were evaluated with a double-pass system., Results: This study included 51 eyes that underwent LASIK and 57 that underwent PRK. The optical quality three months post-surgery did not differ significantly between these laser vision correction techniques. Furthermore, the preoperative and postoperative optical quality did not differ significantly in either group. Optical quality recovered within one week after LASIK but took between one and three months to recover after PRK. The optical quality of patients in the PRK group seemed to recover slightly more slowly than their uncorrected distance visual acuity., Conclusions: Optical quality recovers to the preoperative level after laser vision correction, so laser vision correction is efficacious for correcting myopia. The double-pass system is a useful tool for clinical assessment of optical quality.