Unveiling the Impact of Tailoring Ionic Conductor Characteristics on the Performance of Wearable Triboelectric Nanogenerators.

This work reveals the correlation between the performance of triboelectric nanogenerators (TENGs) and the characteristics of deformable solid-state ionic conductors (referred to as ionogels). For this purpose, we modify ionogel characteristics by incorporating additional plasticizers (propylene carbonate) and solid salts (lithium bis(trifluoromethylsulfonyl)imide) into the ionogels. We conclude that the high capacitance of the ionogel is crucial for achieving a high-performance TENG platform. The optimized ionogel-based TENG (i-TENG) exhibits a power density of ∼372.4 mW·m-2 (based on 95 V and 36 mA·m-2 outputs) with outstanding long-term stability over 2 weeks. Additionally, successful demonstrations of wearable nanogenerators are performed by leveraging the high stretchability (up to ∼1000%) and optical transparency (∼90%) of the ionogels. Overall, the results provide insight into the design of deformable ionic conductors for high-performance, reliable, and wearable TENGs.

Evacuation safety effects of a lightweight elevator-type evacuation device using carbon material: Focus on plantar pressure and muscle strength.

BACKGROUND: Elevator-type evacuation devices have proven to be feasible in high-rise buildings through studies on safety performance and evacuation time. However, there is a lack of research on safety using biosignal analysis in the elderly population. OBJECTIVE: A carbon material is used in this study to reduce the weight of an evacuation elevator. The impact on the human body is evaluated by conducting a satisfaction survey involving elderly and youth groups and quantitatively analyzing biological signals, including electromyography (EMG) and plantar pressure, during five repeated uses of the proposed device. METHODS: The study involves 12 healthy adults in their 20s and 20 elderly individuals with no experience in using an evacuation elevator. The EMG and left and right plantar pressures are analyzed to evaluate the physical factors affected by repeated use. RESULTS: The experiment results showed that the normalization of EMG to maximum voluntary contraction showed a significant decrease with repeated use, especially in the right tibialis anterior muscle. Moreover, plantar pressure shows a significant difference, which decreased with repetition, and the left and right balance gradually tilted to the left. CONCLUSION: This suggests that with more repeated use, muscle tension decreases owing to adaptation, resulting in lower muscle activity and plantar pressure. Particularly, the tibialis anterior muscle experiences significant muscle activity, indicating increased load, but without any apparent danger. In the future, it will be necessary to evaluate elevators for disabled individuals.

Intravascular guide wire aspiration in a patient on extracorporeal membrane oxygenation: A case report.

RATIONALE: Guide wire aspiration during central venous catheter (CVC) insertion in a patient on extracorporeal membrane oxygenation (ECMO) is a very rare but dangerous complication. A guide wire aspirated inside the ECMO can cause thrombosis, the ECMO to break down or shut off, and unnecessary ECMO replacement. PATIENT CONCERNS: A 58-year-old man was scheduled for venovenous ECMO for acute respiratory distress syndrome. After his vital signs stabilized, we inserted a CVC. During CVC insertion, the guide wire was aspirated into the ECMO venous line. INTERVENTION: After confirming the guide wire inside the ECMO venous line, we replaced the entire ECMO circuit. OUTCOMES: ECMO was maintained for 57 days, and weaning was successful but the patient died 5 days afterward. LESSONS: Care must be taken when inserting a CVC using a guide wire in ECMO patients: the guide wire should not be inserted deeply, it should be secured during insertion, the ECMO venous cannula tip requires proper positioning, and ECMO flow should be temporarily reduced.

Effect of Osteoporosis on Clinical and Radiological Outcomes Following One-Level Anterior Cervical Discectomy and Fusion.

STUDY DESIGN: Retrospective study. PURPOSE: This study aimed to evaluate how osteoporosis affected the clinical and radiological outcomes of patients who underwent anterior cervical discectomy and fusion (ACDF) with plating. OVERVIEW OF LITERATURE: The incidence of complications associated with implants is high when ACDF is performed in patients with poor bone quality. METHODS: In total, 101 patients without (T-score ≥1.0, group A) and 25 with (T-score ≤-2.5, group B) osteoporosis who underwent single-level ACDF with plating were followed up for >2 years. The clinical and radiological outcomes were compared between the two groups. The fusion rate and implant-related complications were evaluated. RESULTS: Although clinical outcomes such as visual analog scale scores for the arm (2.0±2.3 vs. 2.4±2.9, p=0.490) and neck pain (1.4±1.9 vs. 1.8±2.2, p=0.343) and neck disability index (7.7±7.1 vs. 9.9±7.5, p=0.225) were slightly higher in group B, no statistically significant difference was noted. Cage subsidence (13.9% vs. 16.0%, p=0.755) and plate migration (7.9% vs. 8.0%, p=1.000) rates did not differ between the two groups. The fusion rate at 1 year postoperatively was higher in group A than in group B (80.3% vs. 68.2%, p=0.139) and slightly increased in both groups (94.6% vs. 86.4%, p=0.178) at the final follow-up. CONCLUSIONS: Osteoporosis did not significantly affect the rate of cage subsidence or plate migration after cervical fusion. After ACDF, increased cage subsidence and implant migration rates had no significant effect on clinical outcomes.

Low-Temperature, Universal Synthetic Route for Mesoporous Metal Oxides by Exploiting Synergistic Effect of Thermal Activation and Plasma.

Mesoporous metal oxides exhibit excellent physicochemical properties and are widely used in various fields, including energy storage/conversion, catalysis, and sensors. Although several soft-template approaches are reported, high-temperature calcination for both metal oxide formation and template removal is necessary, which limits direct synthesis on a plastic substrate for flexible devices. Here, a universal synthetic approach that combines thermal activation and oxygen plasma to synthesize diverse mesoporous metal oxides (V2O5, V6O13, TiO2, Nb2O5, WO3, and MoO3) at low temperatures (150-200 °C), which can be applicable to a flexible polymeric substrate is introduced. As a demonstration, a flexible micro-supercapacitor is fabricated by directly synthesizing mesoporous V2O5 on an indium-tin oxide-coated colorless polyimide film. The energy storage performance is well maintained under severe bending conditions.

Trabecular structural difference between the superior and inferior regions of the vertebral body: a cadaveric and clinical study.

Background: Osteoporotic vertebral compression fractures commonly involve the superior vertebral body; however, their associated causes have not yet been clearly established. This study aimed to determine the trabecular structural differences between the superior and inferior regions of the vertebral body using cadaveric and clinical studies. Materials and methods: First, five vertebrae were collected from three human cadavers. The trabecular structures of the superior and inferior regions of each vertebral body were analyzed using micro-computed tomography (micro-CT), finite element analysis (FEA), and biomechanical test. Based on the results of the ex vivo study, we conducted a clinical study. Second, spine CT images were retrospectively collected. Bone volume and Hounsfield unit were analyzed for 192 vertebral bodies. Finally, after sample size calculation based on the pilot study, prospectively, 200 participants underwent dual-energy X-ray absorptiometry (DXA) of the lateral spine. The bone mineral densities (BMDs) of the superior and inferior regions of each lumbar vertebral body were measured. The paired t-test and Wilcoxon signed-rank test were used for the statistical analyses, and p-value < 0.05 was considered significant. Results: Cadaver studies revealed differences between the superior and inferior trabecular bone structures. The bone volume ratio, BMD, and various other trabecular parameters advocated for decreased strength of the superior region. Throughout the biomechanical study, the limitations of the compression force were 3.44 and 4.63 N/m2 for the superior and inferior regions, respectively. In the FEA study, the inferior region had a lower average displacement and higher von Mises stress than the superior region. In the clinical spine CT-based bone volume and BMD study, the bone volume was significantly higher in the inferior region than in the superior region. In the lateral spine DXA, the mean BMD of the superior region of vertebral bodies was significantly lower compared with that of the inferior region. Conclusion: The superior trabecular structure of the lumbar vertebral bodies possesses more biomechanical susceptibility compared with the inferior trabecular structure, confirming its dominant role in causing osteoporotic vertebral fractures. Physicians should also focus on the BMD values of the superior region of the vertebral body using lateral spine DXA to evaluate osteoporosis.

High-Voltage Pulse-Assisted Operation of Single-Layer Electrochromic Systems for High Performance and Reliability.

A single-layer electrochromic device (SL-ECD) based on ionic conductors containing EC chromophores provides a very simple platform that can be readily fabricated by sandwiching the EC layer between two electrodes. The operation of SL-ECDs is governed by the diffusion of redox species due to their SL structure, which causes a relatively slow dynamic response. In this study, we propose an effective high-voltage pulse injection strategy to improve the performance of SL-ECDs. Applying a programmed voltage wave composed of DC and high-voltage pulses promotes coloration/bleaching switching without degrading device stability, which is more advantageous than applying high DC voltages. We modified the input voltage profile by considering fundamental parameters, such as the amplitude and duty ratio of additional voltage pulses. The coloration and bleaching dynamic responses with the optimized voltage wave are ∼62 and ∼20% faster, respectively, compared with those with the simple DC input. Furthermore, the additionally injected pulse aids in increasing the coloration efficiency from ∼95.3 to ∼168.6 cm2 C-1. Another notable feature of this system is that the device operates stably when a programmed voltage wave is used. These results indicate that the concept of high-voltage pulse-assisted operation of SL-ECDs is a straightforward but effective method for improving device performance without changing the EC chromophore or device structure.

Multimodal Wearable Ionoskins Enabling Independent Recognition of External Stimuli Without Crosstalk.

Wearable ionoskins are one of the representative examples of the many useful applications offered by deformable stimuli-responsive sensory platforms. Herein, ionotronic thermo-mechano-multimodal response sensors are proposed, which can independently detect changes in temperature and mechanical stimuli without crosstalk. For this purpose, mechanically robust, thermo-responsive ion gels composed of poly(styrene-ran-n-butyl methacrylate) (PS-r-PnBMA, copolymer gelator) and 1-butyl-3-methylimidazolium bis(trifluoromethyl sulfonyl)imide ([BMI][TFSI], ionic liquid) are prepared. The optical transmittance change arising from the lower critical solution temperature (LCST) phenomenon between PnBMA and [BMI][TFSI] is exploited to track the external temperature, creating a new concept of the temperature coefficient of transmittance (TCT). The TCT of this system (-11.5% °C-1 ) is observed to be more sensitive to temperature fluctuations than the conventional metric of temperature coefficient of resistance. The tailoring molecular characteristics of gelators selectively improved the mechanical robustness of the gel, providing an additional application opportunity for strain sensors. This functional sensory platform, which is attached to a robot finger, can successfully detect thermal and mechanical environmental changes through variations in the optical (transmittance) and electrical (resistance) properties of the ion gel, respectively, indicating the high practicality of on-skin multimodal wearable sensors.

Dynamic Metal-Ligand Coordination-Assisted Ionogels for Deformable Alternating Current Electroluminescent Devices.

Overcoming the trade-off between the mechanical robustness and conductivity of ionic conductors is a crucial challenge for deformable ionotronics. In this work, we propose a simple but effective gelation strategy for selectively improving the mechanical robustness of ionogels without compromising their ionic conductivity. To achieve this, we introduce dynamic metal-ligand coordination chemistry into the ionic liquid (IL)-insoluble domains of a physically crosslinked ionogel network structure. As a result, the overall mechanical property is remarkably improved with the aid of additional chemical crosslinking. This strategy does not require any additional heat/light (UV) treatments to induce chemical crosslinking. The homogeneous physically/chemically dual crosslinked ionogel films can be readily obtained by simply casting a solution containing Ni2+ sources, copolymer gelators, and ILs. The effects of adjusting fundamental parameters on the ionogel properties are investigated systematically. The optimized mechanically robust and highly conductive ionogels are successfully employed as deformable ionic electrodes in alternating-current electroluminescent displays, indicating their high practicality. Overall, these results validate that exploiting metal-ligand coordination dynamic bonding is an extremely straightforward strategy for selectively improving the mechanical characteristics of conductive ionogels, which are promising platforms for deformable ionotronics.

Cost Effectiveness of Allogeneic Umbilical Cord Blood-Derived Mesenchymal Stem Cells in Patients with Knee Osteoarthritis.

OBJECTIVES: The aim of this study was to assess the cost effectiveness of allogeneic umbilical cord blood-derived mesenchymal stem cells with sodium hyaluronate (hUCB-MSC) compared with microfracture in patients with knee cartilage defects caused by osteoarthritis (OA) in South Korea. METHODS: A partitioned survival model approach was taken consisting of five mutually exclusive health states: excellent, good, fair, poor, and death over a 20-year time horizon. Utility values were obtained from a randomized clinical trial. Cost data were extracted from a database provided by the Health Insurance Review & Assessment Service, and the utilization of healthcare services was estimated from an expert panel of orthopedic surgeons using a structured questionnaire. The incremental cost-effectiveness ratio (ICER) in terms of quality-adjusted life-years (QALY) was calculated. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: In the base case, the incremental costs of US$14,410 for hUCB-MSC therapy along with its associated QALY gain of 0.857 resulted in an ICER of US$16,812 (₩18,790,773) per QALY (95% confidence interval [CI] US$13,408-US$20,828) when compared with microfracture treatment from a healthcare payer perspective. From a societal perspective, the ICER was US$268 (₩299,255) per QALY (95% CI -US$2915 to US$3784). When using a willingness-to-pay threshold of US$22,367/QALY, the probability of hUCB being cost effectiveness compared with microfracture was 99% from the healthcare payer perspective and 100% from the societal perspective. CONCLUSIONS: The study demonstrated that hUCB-MSC therapy was cost effective compared with microfracture when treating patients with knee OA. These findings should inform health policy decision makers about considerations for cost-effective therapy for treating knee OA to ultimately enhance population health.

Comparison of bispectral index and phase lag entropy during general anesthesia: Sevoflurane or propofol anesthesia.

BACKGROUND: Phase-lag entropy (PLE) based on functional connectivity between different regions of the brain may be superior to conventional depth of anesthesia (DoA) methods for monitoring changes in consciousness. However, few studies have compared the PLE and bispectral index (BIS) methods for monitoring consciousness during clinical anesthesia, such as total intravenous anesthesia (TIVA) or anesthesia via inhalation. Therefore, we evaluated differences between the PLE and BIS methods in clinical anesthesia, including TIVA using propofol and anesthesia with sevoflurane. METHODS: The observational trial included 60 patients scheduled for elective surgery under general anesthesia. The BIS and PLE electrodes were placed together on the left temporal-frontal area of all patients. During anesthesia, anesthetic levels were adjusted using the BIS values, which are generally used to monitor the DoA; the level of anesthesia was maintained at between 40 and 60. BIS- and PLE-derived values were recorded continuously. Anesthetic events, the concentration of each anesthetic, and standard monitoring values were recorded. The patients included were divided into 2 groups, the TIVA and sevoflurane groups, with 30 patients in each. For the TIVA group, anesthesia was induced and maintained using propofol and remifentanil target-controlled infusion. For the sevoflurane group, anesthesia was induced using propofol and maintained using sevoflurane and remifentanil. RESULTS: From loss of consciousness until the anesthetic maintenance period, PLE values were higher than BIS values at several time points. During the recovery period, BIS values were higher than PLE values (all P < .001). Spaghetti plots showed that there was more variation among the BIS values than among the PLE values. CONCLUSIONS: For monitoring DoA during general anesthesia and surgery, PLE values vary less than BIS values; thus, PLE may be more reliable for monitoring changes in consciousness. However, further studies are needed to evaluate the clinical application of these methods in general anesthesia.

A biomimetic ocular prosthesis system: emulating autonomic pupil and corneal reflections.

The human light modulation response allows humans to perceive objects clearly by receiving the appropriate amount of light from the environment. This paper proposes a biomimetic ocular prosthesis system that mimics the human light modulation response capable of pupil and corneal reflections. First, photoinduced synaptic properties of the quantum dot embedded photonic synapse and its biosimilar signal transmission is confirmed. Subsequently, the pupillary light reflex is emulated by incorporating the quantum dot embedded photonic synapse, electrochromic device, and CMOS components. Moreover, a solenoid-based eyelid is connected to the pupillary light reflex system to emulate the corneal reflex. The proposed ocular prosthesis system represents a platform for biomimetic prosthesis that can accommodate an appropriate amount of stimulus by self-regulating the intensity of external stimuli.

Recent progress in electrochromic energy storage materials and devices: a minireview.

Integration of several functionalities into one isolated electrochemical body is necessary to realize compact and tiny smart electronics. Recently, two different technologies, electrochromic (EC) materials and energy storage, were combined to create a single system that supports and drives both functions simultaneously. In EC energy storage devices, the characteristic feature of EC materials, their optical modulation depending on the applied voltage, is used to visually identify the stored energy level in real time. Moreover, combining energy-harvesting and EC storage systems by sharing one electrode facilitates the realization of further compact multifunction systems. In this minireview, we highlight recent groundbreaking achievements in EC multifunction systems where the stored energy levels can be visualized using the color of the device.

Soft Template-Assisted Fabrication of Mesoporous Graphenes for High-Performance Energy Storage Systems.

Graphene is a promising active material for electric double layer supercapacitors (EDLCs) due to its high electric conductivity and lightweight nature. However, for practical uses as a power source of electronic devices, a porous structure is advantageous to maximize specific energy density. Here, we propose a facile fabrication approach of mesoporous graphene (m-G), in which self-assembled mesoporous structures of poly(styrene)-block-poly(2-vinylpyridine) copolymer (PS-b-P2VP) are exploited as both mesostructured catalytic template and a carbon source. Notably, the mesostructured catalytic template is sufficient to act as a rigid support without structural collapse, while PS-b-P2VP converts to graphene, generating m-G with a pore diameter of ca. 3.5 nm and high specific surface area of 186 m2/g. When the EDLCs were prepared using the obtained m-G and ionic liquids, excellent electrochemical behaviors were achieved even at high operation voltages (0 ∼ 3.5 V), including a large specific capacitance (130.2 F/g at 0.2 A/g), high-energy density of 55.4 W h/kg at power density of 350 W/kg, and excellent cycle stability (>10,000 cycles). This study demonstrates that m-G is a promising material for high-performance energy storage devices.

Surgical Management of an Isolated Huge Innominate Artery Aneurysm Causing Tracheal Compression: A Case Report.

The innominate artery is an uncommon site for an aneurysm, and tracheal compression caused by an innominate artery aneurysm is a very rare occurrence. An innominate artery aneurysm can cause catastrophic complications, such as rupture or thromboembolism. The most common surgical approach for open repair is median sternotomy with cardiopulmonary bypass, but cerebral ischemic injury and thromboembolism can occur during surgery. We present the case of a male patient who had an isolated giant innominate artery aneurysm causing tracheal compression, which was successfully managed by surgical repair.

Binary Co-Gelator Strategy: Toward Highly Deformable Ionic Conductors for Wearable Ionoskins.

Stretchable ionic conductors have been actively developed due to the increasing demand for wearable electrochemical platforms. Herein, we propose a convenient and effective strategy for tailoring the mechanical deformability of ionic conductors. The mixing of poly(methyl methacrylate) (PMMA, polymer gelator) and 1-butyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide ([BMI][TFSI], ionic liquid) produces mechanically stiff ionic conductors. To reduce the chain entanglement of polymer gelators and induce effective dissipation of applied stresses, flexible poly(butyl acrylate) (PBA) with a low glass-transition temperature is additionally doped into the ionic conductor. An extremely stretchable (∼1500%) homogeneous ternary ionic conductor is obtained without a notable change in electrochemical characteristics, unless the content of PBA exceeds the macrophase separation limit of 3 wt %. In addition, the mechanical elasticity (1.8 × 105 Pa) and durability (e.g., recovery ratio of ∼86.3% after 1000 stretching/releasing cycles) of the conductor further support its suitability as a strain sensory platform. In contrast to conventional ionoskins that have to fit the area of target body parts, even a small piece of the ternary ionic conductor successfully monitors human motion over large areas by taking advantage of its superior deformability.

Ion-cluster-mediated ultrafast self-healable ionoconductors for reconfigurable electronics.

Implementing self-healing capabilities in a deformable platform is one of the critical challenges for achieving future wearable electronics with high durability and reliability. Conventional systems are mostly based on polymeric materials, so their self-healing usually proceeds at elevated temperatures to promote chain flexibility and reduce healing time. Here, we propose an ion-cluster-driven self-healable ionoconductor composed of rationally designed copolymers and ionic liquids. After complete cleavage, the ionoconductor can be repaired with high efficiency (∼90.3%) within 1 min even at 25 °C, which is mainly attributed to the dynamic formation of ion clusters between the charged moieties in copolymers and ionic liquids. By taking advantages of the superior self-healing performance, stretchability (∼1130%), non-volatility (over 6 months), and ability to be easily shaped as desired through cutting and re-assembly protocol, reconfigurable, deformable light-emitting electroluminescent displays are successfully demonstrated as promising electronic platforms for future applications.

DNA Optoelectronics: Versatile Systems for On-Demand Functional Electrochemical Applications.

Herein, we propose innovative deoxyribonucleic acid (DNA)-based gels and their applications in diverse optoelectronics. We prepared the optoelectronic DNA-based gels (OpDNA Gel) through molecular complexation, that is, groove binding and ionic interactions of DNA and 1,1'-diheptyl-4,4'-bipyridinium (DHV). This process is feasible even with sequence-nonspecific DNA extracted from nature (e.g., salmon testes), resulting in the expansion of the application scope of DNA-based gels. OpDNA Gel possessed good mechanical characteristics (e.g., high compressibility, thermoplasticity, and outstanding viscoelastic properties) that have not been observed in typical DNA hydrogels. Moreover, the electrochromic (EC) characteristics of DHV were not lost when combined with OpDNA Gel. By taking advantage of the facile moldability, voltage-tunable EC behavior, and biocompatibility/biodegradability of OpDNA Gel, we successfully demonstrated its applicability in a variety of functional electrochemical systems, including on-demand information coding systems, user-customized EC displays, and microorganism monitoring systems. The OpDNA Gel is a promising platform for the application of DNA-based biomaterials in electrochemical optoelectronics.

Significance of Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Vertebral body sliding osteotomy (VBSO) has previously been reported as a technique to decompress ossification of the posterior longitudinal ligament (OPLL) by translating the vertebral body anteriorly. This study aimed to evaluate the radiological and clinical efficacies of VBSO and clarify the surgical indications of VBSO for treating myelopathy caused by OPLL. METHODS: Ninety-seven patients with symptomatic OPLL-induced cervical myelopathy treated with VBSO or laminoplasty who were followed up for more than 2 years were retrospectively reviewed. Cervical alignment, range of motion, fusion, modified K-line (mK-line) status, and minimum interval between ossified mass and mK-line (INT(min)), and the Japanese Orthopaedic Association (JOA) score were assessed. Patients in the VBSO group were compared with those who underwent laminoplasty. RESULTS: Cervical lordosis and INT(min) significantly increased in the VBSO group. All patients in the VBSO group assessed as mK-line (-) preoperatively were assessed as mK-line (+) postoperatively. However, in the LMP group, the mK-line status changed from (+) preoperatively to (-) postoperatively in 3 patients. Final JOA score (p = 0.02) and JOA score improvement (p = 0.01) were significantly higher in the VBSO group. JOA recovery ratio (p = 0.03) and proportion of patients with a recovery rate ≥50% were significantly higher in the VBSO group (p < 0.01). CONCLUSIONS: VBSO is an effective surgical option for OPLL-induced myelopathy, demonstrating favorable neurological recovery and lordosis restoration with low complication rates. It is best indicated for kyphotic alignment, OPLL with a high space-occupying ratio, and OPLL involving ≤3 segments.