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The long head of the biceps is an important pain generator of the shoulder joint. Pathologies of the long head of the biceps involve superior labrum anterior to posterior lesions, pulley lesions, partial tears of the biceps tendon, biceps tendonitis, and medial biceps subluxation caused by full-thickness subscapularis tendon tears. Treatment of an inflamed or injured long head of the biceps by either tenotomy or tenodesis is often mandatory during shoulder arthroscopy to avoid persisting pain and possible revision procedures. In comparison with a tenotomy of the biceps tendon, a biceps tenodesis preserves the tension, anatomy, and cosmesis of the biceps muscle. The presented technique demonstrates a single portal technique for a proximal biceps tenodesis in the bicipital groove using an all-suture anchor.

Introduction Coracoid fractures after arthroscopic treatment of acromioclavicular (AC) joint separations lead to poor clinical outcomes. In this study, different configurations of bone tunnels in the lateral clavicle and coracoid were examined concerning the amount of stress induced in the coracoid. Methods An authentic 3D finite element model of an ac joint was established. Three 2.4 mm bone tunnels were inserted in the lateral clavicle, which were situated above, medially and laterally of the coracoid. Then, two 2.4 mm bone tunnels were inserted in the latter, each simulating a proximal and a distal suture button position. Von Mises stress analyses were performed to evaluate the amount of stress caused in the coracoid process by the different configurations. Then, a clinical series of radiographs was examined, the placement of the clavicle drill hole was analyzed and the number of dangerous configurations was recorded. Results The safest configuration was a proximal tunnel in the coracoid combined with a lateral bone tunnel in the clavicle, leading to an oblique traction at the coracoid. A distal bone tunnel in the coracoid and perpendicular traction as well as a proximal tunnel in the coracoid with medial traction caused the highest stresses. Anatomical placement of the clavicle drill hole does lead to configurations with smaller stresses. Conclusion The bone tunnel placement with the smallest amount of shear stresses was found when the traction of the suture button was directed slightly lateral, towards the AC joint. Anatomical placement of the clavicle drill hole alone was not sufficient in preventing dangerous configurations., Archives of Orthopaedic and Trauma Surgery, 143 (2), ISSN:0936-8051, ISSN:0344-8444, ISSN:1434-3916

GaInP top cell current-density presently limits the performance of HVPE-grown two-junction devices, in large part due to unwanted dopant diffusion. Here, we institute mitigation strategies to lower the diffusion of dopants from both the front contact and back surface field. Successful application of these strategies resulted in a short-circuit current density of 12.1 mA/cm2 in a GaInP/GaAs cell, an improvement of 0.9 mA/cm2 over our previous best cell. The reduced Se diffusion results in a thinner unpassivated emitter, which can lead to higher series resistance. Despite the increased resistance we obtained an efficiency increase from 23.7% to 24.8%.

Objectives: We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons. Methods: EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. 892 results were obtained, 27 represented best evidence (2-Meta-analyses, 1-RCT and 24 retrospective cohort studies). Results: 474,160 operative outcomes were assessed for 434,535 CABG (431,329 on-pump vs 3206 off-pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital and 4797 thoracic procedures. 398,058 cases were performed by trainees and 75,943 by consultants. 159 cases were indeterminate. There were no statistically significant differences in the patients’ pre-operative risk scores. All studies excluded extreme high-risk patients in emergency setting, patients with poor left ventricular function and re-operation cases that were undertaken by consultants. There were no differences in CPB and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the post-operative outcomes including peri-operative myocardial infarction, resternotomy for bleeding, stroke, renal failure, ITU length of stay and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in-hospital or mid-term mortality out to five-years. Discussion: Trainees can perform cardiothoracic surgery in dedicated high-volume units with outcomes comparable to those of fully trained surgeons.

Enhanced Recovery After Cardiac Surgery (ERACS) is a multidisciplinary and multiprofessional treatment approach in cardiac surgery. Recently, a transfer and adaptation of enhanced recovery after surgery (ERAS) protocols from other disciplines, such as colorectal surgery, to cardiac surgery has been performed in different settings. First, prehabilitation programs have been established and investigated to improve patients' physical, psychological and nutritional status including treatment of preoperative anemia. Second, intraoperative therapeutic steps are described, such as infection reduction bundles, rigid sternal closure and guidance of perioperative anesthesia. For this, the use of short-acting agents, goal-directed fluid management and multimodal anesthesia are among the important measures. Third, early recovery and restoration of patient autonomy are achieved with early extubation and mobilization, efficient postoperative analgesia and diagnosis and treatment of delirium.The introduction of an ERACS protocol is a team effort requiring a protocol adapted to the institutional conditions and a willingness to perform a shift of culture in perioperative care. So far, the successful establishment of ERACS protocols in minimally invasive cardiac surgery has been reported and encourages the development of protocols of specific patient groups, such as pediatric cardiac surgery or left ventricular assist device implantation.Enhanced Recovery After Cardiac Surgery (ERACS) ist ein interdisziplinärer und interprofessioneller Behandlungsansatz für kardiochirurgische Patienten. Etablierte Enhanced-recovery-after-surgery(ERAS)-Protokolle anderer Fachdisziplinen (z. B. aus der kolorektalen Chirurgie) wurden in den letzten 3 Jahren in die Kardioanästhesie übertragen und angepasst. Als erste ERACS-Säule wurden Programme zur Prähabilitation eingeführt und erste wissenschaftliche Untersuchungen zu deren Einfluss auf den physischen und psychischen Zustand des Patienten sowie den Ernährungszustand durchgeführt. Hierzu gehört auch die Behandlung einer präoperativen Anämie. Die zweite ERACS-Säule umfasst intraoperative Behandlungsstrategien zur Reduktion von Infektionen, den rigiden Sternumverschluss und die Anästhesieführung. Hierbei sind die Verwendung kurz wirksamer Anästhetika sowie eine zielgerichtete Flüssigkeitstherapie und ein multimodales Schmerzkonzept bedeutsam. Als dritte ERACS-Säule wird eine zeitnahe Erholung und Wiederherstellung der Patientenautonomie durch frühe Extubation und Mobilisierung, effektive postoperative Analgesie und Delirmanagement angestrebt.Die Einführung eines ERACS-Protokolls ist eine Herausforderung für das gesamte Team und benötigt neben einem für die eigene Klinik adaptierten Protokoll auch die Bereitschaft, diesen „Kulturwandel“ in der perioperativen Medizin durchzuführen. Vielerorts sind ERACS-Protokolle für die minimal-invasive Kardiochirurgie eingeführt worden und haben den Anstoß gegeben, derartige Protokolle auch für spezielle kardiochirurgische Patientenkollektive, wie Kinder oder Patienten zur linksventrikulären Assist-Device-Implantation, zu entwickeln.

We analyze the effect of growth on non-(100) surfaces resulting from incomplete planarization of spalled GaAs wafers on the defect structure of GaAs solar cell layers grown by hydride vapor phase epitaxy (HVPE). Controlled spalling of (100)-oriented GaAs has the potential to reduce substrate costs for III-V epitaxy; however, it creates regularly faceted surfaces that may complicate the growth of high-quality III-V optoelectronic devices. We leverage the anisotropic growth rate of HVPE to planarize these faceted GaAs substrates, reducing the surface roughness and degree of faceting. We observe degraded solar cell performance and material quality in sample areas where facets are not completely removed. We used dark lock-in thermography and photoluminescence to identify recombination in areas that were not fully planarized. We used cathodoluminescence to identify the presence of extended defects in these regions, which are correlated with bandgap fluctuations in the material. We hypothesize that these defects were created by strain from compositional fluctuations in ternary alloys grown on the faceted surfaces. This work elucidates the potential issues of solar cells grown on faceted surfaces and builds understanding toward realizing high performance III-V photovoltaics with the cost-reduction potential of controlled spalling.

Background: The coronavirus disease 2019 (COVID-19) pandemic has impeded the treatment of elective shoulder patients all over the world. Owing to the constraints in personnel and operation theater capacities, many patients who should undergo planned surgeries could not receive medical care. In our study, we examined the status quo of elective shoulder arthroscopy during the pandemic in Germany. Methods: Using a nonprofit database, 40 shoulder units that performed the most arthroscopic rotator cuff repairs in Germany in 2018 were identified. Following a standardized protocol, the web pages of these units were screened, and their strategy for elective procedures during the COVID-19 pandemic was analyzed. Special emphasis was put on the use of new digital technologies. Results: At the time of the study, no unit had stopped scheduling appointments for elective shoulder patients because of the pandemic. Almost all units (97.5%) offered explicit information about COVID-19 and their strategies toward it. The possibilities of visiting patients in shoulder units varied owing to local restrictions. Two units (5%) offered digital consultations. Conclusion: At the time of the study, elective shoulder procedures could be planned and carried out at the largest centers in Germany. Local restrictions had a great influence on the organization of the procedure and hospital stay during the COVID-19 pandemic. Digital consultations were not available in every unit.

Purpose Transforaminal lumbar interbody fusion (TLIF) is a widely accepted surgical procedure for degenerative disk disease. While numerous studies have analyzed complication rates and risk factors this study investigates the extent to which complications after TLIF spondylodesis alter the clinical outcome regarding pain and physical function. Methods A prospective clinical two-center study was conducted, including 157 patients undergoing TLIF spondylodesis with 12-month follow-up (FU). Our study classified complications into three subgroups: none (I), minor (IIa), and major complications (IIb). Complications were considered “major” if revision surgery was required or new permanent physical impairment ensued. Clinical outcome was assessed using visual analog scales for back (VAS-B) and leg pain (VAS-L), and Oswestry Disability Index (ODI). Results Thirty-nine of 157 patients (24.8%) had at least one complication during follow-up. At FU, significant improvement was seen for group I (n = 118) in VAS-B (–50%), VAS-L (–54%), and ODI (–48%) and for group IIa (n = 27) in VAS-B (–40%), VAS-L (–64%), and ODI (–47%). In group IIb (n = 12), VAS-B (–22%, P = 0.089) and ODI (–33%, P = 0.056) improved not significantly, while VAS-L dropped significantly less (–32%, P = 0.013) compared to both other groups. Conclusion Our results suggest that major complications with need of revision surgery after TLIF spondylodesis lead to a significantly worse clinical outcome (VAS-B, VAS-L, and ODI) compared to no or minor complications. It is therefore vitally important to raise the surgeon´s awareness of consequences of major complications, and the topic should be given high priority in clinical work.

Objective In this study, we hypothesized that standing and supine X‐rays lead to different preoperative planning results. Methods The present study included 168 pictures from 81 patients who were treated surgically with high tibial osteotomy (HTO) for varus deformity between January 2017 and February 2018. Each patient underwent whole leg X‐ray examinations in both standing and supine position. On both images, the following parameters were measured: degree of axis deviation (DAD), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), width of medial (MJS) and lateral joint space (LJS), and the correction angle (CA). The results were correlated with the patients’ age and body mass index (BMI). To analyze intra‐observer reliability, the same researcher, blinded to the previous measurements, remeasured all X‐rays from 10 patients 8 weeks after the initial measurements were carried out. Results While mLDFA (P = 0.075), mMPTA (P = 0.435), and MJS (P = 0.119) did not show any differences between the two modalities, LJS (P = 0.016) and DAD (P, In this study, we hypothesized that standing and supine X‐rays lead to different preoperative planning results in high tibial osteotomies. Indeed, we did find an influence of the imaging modality on planning results; however, these results were not influenced by body mass and age.

OBJECTIVES Fetal surgery for repair of open neural tube defect (ONTD) typically results in decreased need for a ventriculoperitoneal shunt (VPS). Our objectives were to determine the trend in ventricle size (VS) during pregnancy and whether VS and change in VS, as assessed by ultrasound, were predictive of the need for VPS in pregnancy with ONTD. METHODS This was a retrospective analysis of prospectively collected data of consecutive pregnancies with ONTD, evaluated in a single center from January 2012 to May 2018. Two groups were identified: the first consisted of pregnancies that underwent in-utero repair (IUR) and the second those that had postnatal repair (PNR). Penalized B splines were used to determine the trend in VS, across 2-week gestational-age (GA) epochs, between 24 and 36 weeks of gestation. VS at each GA epoch and the change in VS between each GA epoch were compared between the IUR and PNR groups. To determine whether VS at any GA was predictive of VPS, receiver-operating-characteristics (ROC) curves were used and the optimal cut-off at each GA epoch was identified. Univariate analysis and multiple logistic regression were used for further analysis. RESULTS ONTD was diagnosed in 110 fetuses, of whom 69 underwent IUR and 41 had PNR. Fetuses in the IUR group were more likely to have Chiari II malformation (100.0% vs 82.9%; P

This study analyzes the atmospheric variability that caused the largest floods affecting the town of Tortosa, Spain, in the mouth of the Ebro River (northeast Iberian Peninsula). The Tortosa flood database and flood marks in the nearby town of Xerta are used to define the more relevant flooding episodes (discharges >2900 m3 s−1) of the 1600–2005 period. We explore the atmospheric variability based on low-frequency patterns and synoptic types applying a multivariable analysis to grids at sea level pressure and geopotential at 500 hPa provided by the twentieth-century V3 Reanalysis Project for the instrumental period (since 1836). Output from the Last Millennium Ensemble Project was used to analyze the sea level pressure over the pre-instrumental period (before 1836). Our analysis includes 33 flood episodes. Four synoptic types are related to floods in Tortosa since 1836, characterized by low pressure systems that interact with the Mediterranean warm air mass and promote atmospheric destabilization. Flooding in Tortosa is related to relative high values of solar activity, positive Northern Hemisphere temperature anomalies, and NAO in positive phase. This result indicates that the major floods are related to zonal atmospheric circulations (west-to-east cyclone transfer). During winter, the main impact of the floods is located at the western part of the basin, and the Pyrenean subbasins are affected during autumn. The major finding is that similar flood behavior is detected since 1600, improving our understanding of past climates, enhancing the knowledge base for some aspects and impacts of climate change, and reducing uncertainty about future outcomes. Significance Statement A total of 33 large floods (>2900 m3 s−1) were registered since 1600 in Tortosa, Spain, located at the mouth of the Ebro River (northeast Iberian Peninsula). They occur associated with low pressure systems that interact with the Mediterranean warm air mass promoting atmospheric destabilization. The floods in Tortosa are also associated with other important processes occurring at significantly longer time scales: high values of solar activity, positive Northern Hemisphere temperature anomalies, and NAO in positive phase, indicating that the major floods are related to zonal atmospheric circulations. The major finding is that we detect similar flood behaviors since 1600, improving our understanding of past climates, enhancing the knowledge base for some aspects and impacts of climate change, and reducing uncertainty about future outcomes.

Recent developments in optogenetics allow for quick and minimally-invasive methods of studying functional brain organization in animal models. DeepLabCut (DLC), a toolbox for markerless pose estimation, offers the ability to track user-defined features in 3-dimensions with human level accuracy. We demonstrate a hybrid method utilizing DLC and optogenetic motor mapping to localize the movements of multiple modalities to the mouse cortex. We outline a pipeline to map and characterize multiple motor representations in anesthetized and awake mice. Furthermore, we identify behaviorally-relevant motor movements of multiple limbs reside in overlapping cortical representations of the respective limbs.

Focal Outerbridge grade IV cartilage defects of the proximal humerus may lead to pain and an impaired shoulder function. In cases of failed operative or conservative treatment options such as intraarticular injections or arthroscopic microfracturing of the subchondral bone, partial arthroplasty of the humeral may restore the articular surface of the humeral head without altering the anatomy. This study evaluates mid-term results of open and arthroscopic partial resurfacing of the humeral head in the context of focal grade IV cartilage defects. Eighteen patients (f = 3, m = 15, mean age = 57.7 years) out of 22 patients were available for follow-up after 65 (24–116) months. Thirteen patients were treated with a partial humeral head prosthesis in an open technique and five patients received a partial humeral head prosthesis in an arthroscopic technique. The patients were followed-up clinically using the Constant-Score, the ASES Score as well as the range of motion. Plain radiographs (anterior–posterior and axial view) were carried out for radiologic assessment. At follow-up the mean CS rated 79.5. The mean ASES Score was 85.8 points. Mean active forward flexion measured 163.8°, while mean active abduction was 160.0°. The average pain level on a visual analogue scale (VAS) made out 0.7 out of 10. Patients treated with an arthroscopically implanted prosthesis achieved a mean CS of 88.8 points and a mean ASES Score of 92.6 points. The patients with openly implanted prosthesis had a CS of 75.3 points and an ASES Score of 83 points. There were no intraoperative or immediate postoperative complications. Until the final follow-up one patient needed to be converted to total shoulder arthroplasty due to progressive glenohumeral osteoarthritis. Nine patients (50%) showed progressive glenohumeral osteoarthritis. Aseptic loosening of the implants was not observed. Partial arthroscopic or open arthroplasty of the humeral head is related to good functional results after mid-term follow-up. Resurfacing of the humeral head is a safe procedure without any implant-related complications. There is a risk for progression of glenohumeral osteoarthritis, which may require surgical revision with conversion to anatomic shoulder arthroplasty. Level IV (retrospective study).

Single-junction flat-plate terrestrial solar cells are fundamentally limited to about 30% solar-to-electricity conversion efficiency, but multiple junctions and concentrated light make much higher efficiencies practically achievable. Until now, four-junction III–V concentrator solar cells have demonstrated the highest solar conversion efficiencies. Here, we demonstrate 47.1% solar conversion efficiency using a monolithic, series-connected, six-junction inverted metamorphic structure operated under the direct spectrum at 143 Suns concentration. When tuned to the global spectrum, a variation of this structure achieves a 1-Sun global efficiency of 39.2%. Nearly optimal bandgaps for six junctions were fabricated using alloys of III–V semiconductors. To develop these junctions, it was necessary to minimize threading dislocations in lattice-mismatched III–V alloys, prevent phase segregation in metastable quaternary III–V alloys and understand dopant diffusion in complex structures. Further reduction of the series resistance within this structure could realistically enable efficiencies over 50%. Stacking multiple junctions with different bandgaps and operating under concentrated light allows solar cells to reach efficiencies beyond the limits of standard devices. Geisz et al. present a six-junction solar cell based on III–V materials with a 47.1% efficiency—the highest reported to date.

Purpose The aim of this study was to assess the biomechanical properties of intact vertebra augmented using a local osteo-enhancement procedure to inject a triphasic calcium sulfate/calcium phosphate implant material. Methods Twenty-one fresh frozen human cadaver vertebra (Th11–L2) were randomized into three groups: treatment, sham, and control (n = 7 each). Treatment included vertebral body access, saline lavage to displace soft tissue and marrow elements, and injection of the implant material to fill approximately 20% of the vertebral body by volume. The sham group included all treatment steps, but without injection of the implant material. The control group consisted of untreated intact osteoporotic vertebra. Load at failure and displacement at failure for each of the three groups were measured in axial compression loading. Results The mean failure load of treated vertebra (4118 N) was significantly higher than either control (2841 N) or sham (2186 N) vertebra (p p Conclusions This biomechanical study shows that a local osteo-enhancement procedure using a triphasic implant material significantly increases the load at failure and displacement at failure in cadaveric osteoporotic vertebra.

Compositionally graded buffers (CGBs) are essential components of high-efficiency III–V inverted metamorphic solar cells, and high-quality CGBs with low defect densities are a requirement for high device efficiencies. In this article, we use plan-view and cross-sectional cathodoluminescence spectrum imaging (CLSI) to investigate the effect of growth conditions on the microstructure of Al y Ga1- x - y In x As CGBs with x In > 0.30. CLSI reveals significant compositional fluctuation in these materials that correlates with the distribution of threading dislocations in the CGBs. Threading dislocations are observed to collect in regions between abrupt transitions in emission energy, implying that concomitant strain fluctuations in these regions restrict dislocation motion. Thus, the compositional fluctuation leads to elevated threading dislocation densities that degrade CGB quality. We also correlate compositional fluctuation in the CGB with compositional fluctuation in subsequently grown device layers. The effectiveness of specific growth conditions at suppressing compositional fluctuation and limiting threading dislocation density is evaluated. CGBs grown at high temperatures with high Al content exhibit the lowest defect densities. The use of a high V/III ratio suppresses compositional fluctuation and defect density. These insights lead directly to improvements in the efficiency of metamorphic Ga1- x In x As solar cells grown on Al y Ga1- x - y In x As CGBs.

We demonstrate hydride vapor phase epitaxy (HVPE) of AlxGa1–xAs, AlxIn1–xP, and AlxGayIn1–x–yP using an AlCl3 precursor. We study the growth of the AlxGa1–xAs alloy system to elucidate the effects ...

The publication rate of presented abstracts is an important parameter to assess the scientific quality of medical congresses. It has been investigated for many congresses in orthopaedics and traumatology, but until now, it has not been studied for the congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT). The aims of this study were to determine: (1) the publication rate of the EFORT congress, (2) factors that favour publication of abstracts presented at the EFORT congress, (3) the consistency between the congress abstract and publication in relation to authorship.There are factors that favour publication of abstracts presented at the EFORT congress and there is a high consistency between the congress abstract and publication in relation to authorship.All 1624 abstracts presented at the EFORT congress in 2011 were included in this study, to allow a 5-year period for publication after the congress. The characteristics of the abstracts presented were studied and the publication rate in peer-reviewed journals was determined using a Medline search.The publication rate for studies presented at the 2011 EFORT congress was 42% (677/1624 abstracts), with a mean of 16 months (-56 to 60 months) between congress and publication. The mean impact factor of the publications was 1.8 (0-7.6). A significantly higher publication rate was found for: oral presentations (52%; 322/617) versus posters (35%; 355/1007) (p0.01), experimental studies (53%; 110/208) versus clinical studies (40%; 507/1254) (p0.01), and studies with higher levels of evidence of I or II (59%; 144/244) versus studies with lower levels of evidence of III or IV (36%; 362/1005) (p0.01). A new author was added in 59% (403/677) of the publications.Factors that favour publication of abstracts presented at the EFORT congress are oral presentation, experimental study, and a study with a higher level of evidence of I or II. It is common that a new author is added in the publication. Nevertheless, a high percentage of congress abstracts (58%; 947/1624) remains unpublished.IV, retrospective study.

The aim of this study was to investigate the effect of radial extracorporeal shockwave therapy (rESWT) primarily on acute lumbar back pain (aLBP), and secondarily on physical function and quality of life. This randomized, placebo-controlled, single-blinded trial with 12-week follow-up (FU) randomized 63 patients with aLBP 1:1 into two groups receiving either rESWT (intervention) or sham rESWT (placebo) with a manipulated shockwave head not delivering any shockwaves. Both, rESWT and sham procedure were carried out eight times for four weeks. Both groups received additional analgesics and physiotherapy twice a week. Primary patient-reported outcome measure (PROM) was the visual analogue scale for aLBP (VAS-LBP). Secondary PROMs included the Oswestry disability index (ODI), Roland and Morris Disability Questionnaire (RDQ), EuroQol EQ-5D-3L, and the Beck Depression Index (BDI-II). Primary endpoint was a between-arm comparison of mean changes in VAS-LBP from baseline to final FU. At randomization, there were no differences between the two groups in relation to age and PROMs. Both groups showed significant improvement in all PROMs at final FU. VAS-LBP declined by 60.7% (p < 0.001) in the intervention and by 86.4% (p < 0.001) in the sham group. The intervention group showed significantly less pain relief after 4 and 12 weeks. The EQ-5D submodality pain showed significantly inferior results for the intervention (1.5 (0.58)) compared to the sham group (1.1 (0.33)) (p < 0.014) after eight weeks. No significant intergroup differences were observed for RDQ, ODI or BDI-II. Additional rESWT alongside conventional guideline therapy in aLBP does not have any significant effects on pain intensity, physical function, or quality of life. To the best of our knowledge, this is the first study with a high level of evidence reporting the efficacy of rESWT in aLBP treatment and will be a future basis for decision-making.