Mnemonic-opto-synaptic transistor for in-sensor vision system.

A mnemonic-opto-synaptic transistor (MOST) that has triple functions is demonstrated for an in-sensor vision system. It memorizes a photoresponsivity that corresponds to a synaptic weight as a memory cell, senses light as a photodetector, and performs weight updates as a synapse for machine vision with an artificial neural network (ANN). Herein the memory function added to a previous photodetecting device combined with a photodetector and a synapse provides a technical breakthrough for realizing in-sensor processing that is able to perform image sensing and signal processing in a sensor. A charge trap layer (CTL) was intercalated to gate dielectrics of a vertical pillar-shaped transistor for the memory function. Weight memorized in the CTL makes photoresponsivity tunable for real-time multiplication of the image with a memorized photoresponsivity matrix. Therefore, these multi-faceted features can allow in-sensor processing without external memory for the in-sensor vision system. In particular, the in-sensor vision system can enhance speed and energy efficiency compared to a conventional vision system due to the simultaneous preprocessing of massive data at sensor nodes prior to ANN nodes. Recognition of a simple pattern was demonstrated with full sets of the fabricated MOSTs. Furthermore, recognition of complex hand-written digits in the MNIST database was also demonstrated with software simulations.

Differences in the Prevalence of Clinical Adjacent Segment Pathology among Continents after Anterior Cervical Fusion: Meta-Analysis of Randomized Controlled Trials.

Development of adjacent segment pathology leading to secondary operation is a matter of concern after anterior cervical discectomy and fusion (ACDF). Some studies have reported anatomic difference between races, but no epidemiological data on prevalence of clinical adjacent segment pathology (cASP) among races or continents has been published. The purpose of this study was to compare the prevalence of cASP that underwent surgery after monosegmental ACDF among continents by meta-analysis. MEDLINE, EMBASE, and Cochrane Library with manual searching in key journals, reference lists, and the National Technical Information Service were searched from inception to December 2018. Twenty studies with a total of 2009 patients were included in the meta-analysis. We extracted the publication details, sample size, and prevalence of cASP that underwent surgery. A total of 15 papers from North America, three from Europe, and two from Asia met the inclusion criteria. A total number of 2009 patients underwent monosegmental ACDF, and 113 patients (5.62%) among them had cASP that underwent surgery. The rate of cASP that underwent surgery was 4.99% in the North America, 3.65% in the Europe, 6.34% in the Asia, and there were no statistically significant differences (p = 0.63). The current study using the method of meta-analysis revealed that there were no significant differences in the rate of cASP that underwent surgery after ACDF among the continents.

Bone marrow aspirate concentration provided better results in cartilage regeneration to microfracture in knee of osteoarthritic patients.

PURPOSE: To determine whether microfracture with bone marrow aspirate concentrate (BMAC) improves functional outcome and cartilage regeneration better than microfracture alone in patients undergoing high tibial osteotomy (HTO) for medial unicompartmental osteoarthritis (OA). METHODS: Among 436 patients treated with HTO for medial unicompartmental OA with varus deformity between 2010 and 2016, clinical outcomes were retrospectively compared between the microfracture alone group (group I, 43 cases) and microfracture with BMAC augmentation group (group II, 48 cases). Of these, 64 patients underwent a second-look arthroscopic assessment. Clinical outcomes were compared based on the Knee Society Score (KSS), International Knee Documentation Committee (IKDC) subjective score, and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Cartilage regeneration was assessed according to Koshino's staging system and the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. RESULTS: At the last follow-up, there were no significant intergroup differences in terms of KSS for pain and function (p > 0.05). Moreover, WOMAC scores were similar between the two groups (p > 0.05). Regarding second-look arthroscopy findings, according to Koshino's staging system, there was no significant intergroup difference in terms of defect coverage (p = 0.187). However, group II showed a significantly better mean CRA score than group I (p = 0.035). CONCLUSION: There were no significant differences in clinical outcomes and cartilage regeneration between the groups. However, the CRA score was significantly higher with BMAC augmentation and microfracture than microfracture alone. Therefore, BMAC augmentation had a synergistic effect for a better cartilage regeneration, although studies with a longer follow-up might help to confirm whether microfracture with BMAC augmentation would ensure better clinical outcomes than microfracture alone for the treatment of knee OA.

Allogeneic umbilical cord blood-derived mesenchymal stem cells combined with high tibial osteotomy: a retrospective study on safety and early results.

BACKGROUND: Cartilage repair performed as a single-stage procedure is an important advancement in the treatment of full-thickness cartilage injury and has potential for widespread clinical use. PURPOSE: To investigate the short-term outcomes and cartilage regeneration after implantation of allogeneic human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) in patients who received high tibial osteotomy (HTO) for symptomatic medial knee osteoarthritis. METHODS: Patients underwent treatment of full-thickness chondral injury in the osteoarthritic knee with HTO and implantation of hUCB-MSCs and were followed prospectively for a minimum of one year. Ninety-three patients were followed for a mean 1.7 years (range, 1.0-3.5). Median cartilage lesion size was 6.5 cm2 (range, 2.0-12.8). Clinical outcomes were examined with patient-reported scoring instruments that consisted of the International Knee Documentation Committee (IKDC) subjective score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS), and Hospital for Special Surgery (HSS) score. Cartilage regeneration was evaluated using the International Cartilage Repair Society (ICRS) cartilage repair assessment grading (CRA) system and the Koshino regeneration staging system in 49 patients who underwent second look arthroscopic assessment when their HTO plates were removed. RESULTS: At final follow-up, the median IKDC subjective score had significantly improved from 39.0 to 71.3; the WOMAC score from 44.5 to 11.0; the KSS pain and function scores from 29.8 to 43.2 and 61.0 to 81.2, respectively; and the HSS from 61.6 to 82.7 (p < 0.05). Pre-operative examination showed ICRS grade IV cartilage injury in all knees, and cartilage regeneration at 2nd look arthroscopy showed improvements (8.2% of patients improved to ICRS grade I, 69.3% to grade II, and 22.5% to grade III). Moreover, Koshino stage was B in 24.5% and C in 75.5% of patients (p < 0.05). CONCLUSION: Allogeneic hUCB-MSC implantation combined with HTO for medial knee osteoarthritis was safe and showed signs of cartilage status improvement. Furthermore, randomized controlled studies with a control group are necessary to determine the real effectiveness and indications of this new combined procedure for patients with osteoarthritis.

Treatment of instability with scapular notching and glenoid component loosing by partial mixed different implant revision.

In general, reverse shoulder arthroplasty revision is performed using the same implant for both the humerus and glenoid components. However, the authors of the present case used different implants from what was used previously for treating instability with scapular notching and glenoid aseptic loosening and report the case.

Additional fixation using a metal plate with bioresorbable screws and wires for robinson type 2B clavicle fracture.

Simple clavicle fractures can achieve satisfactory results through conservative treatment, and the less frequency of nonunion. Non-union or malunion can occur in displaced clavicle fractures or comminuted shaft fractures. Treatment of displaced comminuted clavicle shaft fractures is performed by holding together the free fragments with interfragmentary screws or wires and fixing them to the clavicle with a plate. Therefore, we performed interfragmentary fixation using open reduction and internal fixation with bioresorbable screws (Mg-Ca alloy, Resomet bioresorbable bone screw; U&I Corp.) and bioresorbable wires (Mg-Ca alloy, Resomet bioresorbable K-wire and pin, U&I Corp.) for displaced comminuted clavicle fractures (Robinson type 2B) and additionally used a metal plate. We expected decreased irritation and infection due to absorption after surgery. We report four cases that were treated in this way.

Subscapular and Pectoralis Major Sparing Deltopectoral Approach for Reverse Total Shoulder Arthroplasty.

In reverse ball shoulder replacement, surgery is usually performed using a deltopectoral approach or an anterosuperior transdeltoid approach. The deltopectoral approach is to incise the pectoralis major to upper 1/3 to 1/2, and subscapularis tendon should be removed at the lesser tuberosity of the humerus. This approach has the problem of breaking the shoulder deltoid instead of incising the rotator cuff. Therefore, we report a detailed procedure of reverse ball shoulder replacement using approach without incision of the pectoralis major muscle and subscapularis muscle.

[A case of nodular regenerative hyperplasia of liver that mimicked primary biliary cirrhosis].

Nodular regenerative hyperplasia (NRH) of the liver is a rare disease that is characterized by multiple regenerative nodules in the hepatic parenchyma without fibrosis. The exact pathogenesis of NRH has not been established, but it's been suggested that obliteration of portal veins may initiate the nodular transformation. It is also known that this disease is associated with autoimmune disease, myeloproliferative disease, lymphoproliferative disease, primary biliary cirrhosis, and some chemotherapy agents. The patients with NRH are usually asymptomatic, yet if they have symptoms, the most common clinical manifestations are those of portal hypertension, including splenomegaly and esophageal varices with or without bleeding. We report a case of nodular regenerative hyperplasia that presented with clinical manifestations similar to those of primary biliary cirrhosis.