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Hexagonal boron nitride (h-BN) is a key ingredient for various 2D van der Waals heterostructure devices, but the exact role of h-BN encapsulation in relation to the internal defects of 2D semiconductors remains unclear. Here, it is reported that h-BN encapsulation greatly removes the defect-related gap states by stabilizing the chemisorbed oxygen molecules onto the defects of monolayer WS2 crystals. Electron energy loss spectroscopy (EELS) combined with theoretical analysis clearly confirms that the oxygen molecules are chemisorbed onto the defects of WS2 crystals and are fixated by h-BN encapsulation, with excluding a possibility of oxygen molecules trapped in bubbles or wrinkles formed at the interface between WS2 and h-BN. Optical spectroscopic studies show that h-BN encapsulation prevents the desorption of oxygen molecules over various excitation and ambient conditions, resulting in a greatly lowered and stabilized free electron density in monolayer WS2 crystals. This suppresses the exciton annihilation processes by two orders of magnitude compared to that of bare WS2. Furthermore, the valley polarization becomes robust against the various excitation and ambient conditions in the h-BN encapsulated WS2 crystals.
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This study investigated defect formation and strain distribution in high-Mg-content Al-Mg alloys during normal rolling and cross-rolling processes. The finite element analysis (FEA) revealed the presence of wave defects and strain localization-induced zipper cracks in normal cold rolling, which were confirmed by the experimental results. The concentration of shear strain played a significant role in crack formation and propagation. However, the influence of wave defects was minimal in the cross-rolling process, which exhibited a relatively uniform strain distribution. Nonetheless, strain concentration at the edge and center regions led to the formation of zipper cracks and edge cracks, with more pronounced propagation observed in the experiments compared to FEA predictions. Furthermore, texture evolution was found to be a crucial factor affecting crack propagation, particularly with the development of the Goss texture component, which was observed via electron backscattered diffraction analysis at bending points. The Goss texture hindered crack propagation, while the Brass texture allowed cracks to pass through. This phenomenon was consistent with both FEA and experimental observations. To mitigate edge crack formation and propagation, potential strategies involve promoting the formation of the Goss texture at the edge through alloy and process conditions, as well as implementing intermediate annealing to alleviate stress accumulation. These measures can enhance the overall quality and reliability of Al-Mg alloys during cross-rolling processes. In summary, understanding the mechanisms of defect formation and strain distribution in Al-Mg alloys during rolling processes is crucial for optimizing their mechanical properties. The findings of this study provide insights into the challenges associated with wave defects, strain localization, and crack propagation. Future research and optimization efforts should focus on implementing strategies to minimize defects and improve the overall quality of Al-Mg alloys in industrial applications.
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Photo(electro)-piezo catalysis has emerged as one of the most effective strategies for sustainable environmental remediation. While various (nano)materials have been investigated for enhancing the intrinsic properties related to the interfacial band structure, increasing the efficiency by integration of materials with rational design for stress-strain applications has not yet been considered. Herein, we introduce kirigami strain engineering to photopiezo catalysts for enhancing efficiency by increasing the magnitude of applied strain and density of bends. Macroscale stretching motion is converted into localized bending by a pliable kirigami structure using similar or even lower input energy, which can be easily modulated by natural waves. The kirigami structure leads to a significant enhancement (â¼250%) in the degradation of dyes, and we discovered the significant contribution of the oxygen reduction pathway in the charge-transfer mechanism, which corresponds to the observed enhancement. The photopiezo catalytic effects of kirigami were further highlighted by the small water reservoir test, showing its feasibility in nature for self-sustainable environmental remediation that can be modulated using motions of winds, waves, and life vibrations.
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Increasing wealth inequality is a significant global issue that demands attention. While the distribution of wealth varies across countries based on their economic stages, there is a universal trend observed in the distribution function. Typically, regions with lower wealth values exhibit an exponential distribution, while regions with higher wealth values demonstrate a power-law distribution. In this review, we introduce measures that effectively capture wealth inequality and examine wealth distribution functions within the wealth exchange model. Drawing inspiration from the field of econophysics, wealth exchange resulting from economic activities is likened to a kinetic model, where molecules collide and exchange energy. Within this framework, two agents exchange a specific amount of wealth. As we delve into the analysis, we investigate the impact of various factors such as tax collection, debt allowance, and savings on the wealth distribution function when wealth is exchanged. These factors play a crucial role in shaping the dynamics of wealth distribution.
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STUDY DESIGN: Retrospective case-control study. OBJECTIVES: The aim of this study was to develop a simple and reliable imaging parameter to predict postoperative ambulatory status in patients with metastatic epidural spinal cord compression (MESCC). METHODS: Sixty-three patients with MESCC underwent spine surgery because of neurologic deficits were included. On preoperative axial MRI, the cord compression ratio was analyzed for postoperative ambulatory status. The relationship between other imaging features, such as fracture of the affected vertebra and increased T2 signal intensity of the spinal cord at the compression level, and the postoperative ambulatory status were also analyzed. RESULTS: Cord compression ratio and increased T2 signal change of the spinal cord were significantly different between the postoperative ambulatory group and the non-ambulatory group. Receiver operating characteristic analysis showed that the optimal cut-off value was 0.84. In the multivariate regression analysis, only a cord compression ratio of more than 0.84 was significantly associated with postoperative ambulatory status (odds ratio = 10.80; 95% confidence interval = 2.79-41.86; P = .001). Interobserver/intraobserver agreements were strong for the cord compression ratio, however those agreements were weak for increased T2 signal intensity. CONCLUSIONS: On preoperative MRI, the cord compression ratio may predict postoperative ambulatory status in patients with MESCC. The measurement of this imaging parameter was simple and reliable. This imaging predictor may be helpful for both clinicians and patients.
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OBJECTIVE: We investigated the long-term effects of bone cement-augmented instrumentation in multilevel lumbar fusions in a retrospective cohort study. The use of cement-augmented screws is one of the techniques used to reduce early mechanical failure in treating multilevel lumbar fusion, especially in the elderly. However, little information is available regarding the long-term effects. METHODS: A total of 51 patients who had undergone ≥3 levels of lumbar fusion were divided into two groups according to the use of bone cement-augmented screw fixation involving the upper instrumented vertebra: 22 patients in the cement-augmented group (group I) and 29 patients in the non-cement-augmented group (group II). Analysis of radiographic adjacent disc segment degeneration (ASD) revealed patients with lumbosacral fusion with a similar degree of osteoporosis. Radiologic ASD was defined as progression of >2 UCLA (University of California, Los Angeles) grades at 2 years postoperatively. Other sagittal parameters and the preoperative magnetic resonance imaging Pfirrmann grades at the adjacent levels, possibly related to ASD, were also analyzed. RESULTS: No significant differences were present in the preoperative demographic and radiographic parameters between the 2 groups. However, the postoperative kyphotic changes at 3 months were greater for the non-cement-augmented group. In terms of the long-term effects, the incidence of radiologic ASD (group I, n = 20 [95.2%]; vs group II, n = 15 [53.6%]) was significantly higher in the cement-augmented group. Logistic regression analysis of radiologic ASD, including other clinical and radiologic parameters, postoperative pelvic incidence-lumbar lordosis mismatch (odds ratio, 5.201; 95% confidence interval, 1.123-24.090; P = 0.035), and cement augmentation (odds ratio, 20.193; 95% confidence interval, 2.195-185.729; P = 0.008) showed a significant correlation with the development of radiologic ASD at 2 years postoperatively. CONCLUSIONS: Although bone cement-augmented screw implantation can prevent kyphotic deformation at the proximal junction of upper instrumented vertebra in the early postoperative stages of multilevel lumbar fusion, a careful selection of patients is required because of possibly accelerated degeneration of adjacent segments.
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Degeneración del Disco Intervertebral , Lordosis , Fusión Vertebral , Humanos , Anciano , Cementos para Huesos , Estudios Retrospectivos , Vértebras Lumbares/cirugía , Degeneración del Disco Intervertebral/cirugía , Lordosis/etiología , Fusión Vertebral/métodosRESUMEN
Using a catalyst-free one-pot polycondensation approach, a new donor-acceptor (D-A) based porous polyimide (PeTt-POP) photocatalyst was developed. PeTt-POP produced CH4 (125.63 ppm g-1 in 6 h) from CO2 under visible light irradiation in the gas-solid mode without the use of co-catalysts or sacrificial agents. The progress of the reaction and the corresponding intermediate species involved in the CO2 reduction were identified by operando DRIFTS experiments, from which a plausible reaction mechanism was proposed.
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Broadband omni-directional anti-reflection characteristics have been an important issue because they can maximize the optical absorption in photovoltaic devices. Here, we investigate the optical properties of ZnO nanoneedle arrays to demonstrate broadband anti-reflection, omni-directionality, and polarization insensitivity using optical simulations and experimental approaches. The results of this work clarify that the ZnO nanoneedle array plays an important role as a broadband anti-reflection layer due to its spatially graded refractive index, omni-directionality and polarization insensitivity. To take advantage of these structures, we prepared a ZnO nanoneedle array on the surface of conventional SiN x /planar Si solar cells to prove the broadband omni-directional anti-reflection for solar energy harvesting. Current density-voltage results show that SiN x /planar Si solar cells with ZnO nanoneedle arrays lead to a nearly 20% increase in power conversion efficiency compared to SiN x /planar Si solar cells, and a 9.3% enhancement in external quantum efficiency is obtained under identical conditions. Moreover, the photocurrent results of SiN x /planar Si solar cells with ZnO nanoneedle arrays clearly demonstrate the incident angle- and polarization-insensitive characteristics compared to those of typical SiN x /planar Si solar cells. Our results demonstrate the optical multi-functionality of ZnO nanoneedle arrays and pave the way for high-performance optoelectronic devices that require broadband omni-directional anti-reflection and polarization insensitivity.
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A conjugated polymer particle in an aqueous phase is covalently networked in 3D by crosslinking with azide groups, leading to significantly enhanced activity-a high photocatalytic H2 evolution rate (11 024 µmol g-1 h-1 (λ > 420 nm)) and a high apparent quantum yield (up to 0.8%). The reaction between the photoactive azide and the alkyl chains of the conjugated polymer provides more intact intermolecular polymeric interactions in the colloidal state, thus preventing physical swelling and inhibiting the recombination of photoproduced carriers. The covalent network efficiently promotes exciton diffusion, which greatly facilitates charge separation and transfer. The azide photo-crosslinking also leads to more compact and better-packed nanoparticles in the aqueous phase and efficient transfer of excitons to the outer surface of the nanoparticles, where photocatalytic reactions occur. These results show that photo-crosslinking can suppress the adverse effects of alkyl chains which inhibit photocatalytic performance. Therefore, covalent crosslinking is a promising strategy for the development of solar and hydrogen energy.
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OBJECTIVE: The most catastrophic symptom of proximal junctional failure (PJF) following long instrumented fusion surgery for adult spinal deformity (ASD) is neurological deficits. Although previous reports have shown that PJF usually developed during the early postoperative period, some patients showed late neurological deficits. The aim of this study was to report the incidence, characteristics, and surgical outcomes of PJF with late neurological deficits. METHODS: Patients surgically treated for ASD at a single institution were retrospectively reviewed. Among them, the patients requiring revision surgery for newly developed neurological deficits at least 6 months after the initial surgery were included. Patient demographic, radiographic, surgical, and clinical data were investigated. Neurological status was assessed using the Frankel grading system. RESULTS: PJF with late neurological deficits developed in 18 of 385 patients (4.7%). The mean age at the onset of neurological deficits was 72.0 ± 6.0 years, and the median time from the initial surgery was 4.5 years. The most common pathology of PJF was adjacent disc degeneration and subsequent canal stenosis (11 patients). Five patients showed disc degeneration with aseptic bone destruction. Fractures at the upper instrumented vertebra (UIV), UIV + 1, and UIV + 2 occurred in 2, 3, and 2 patients, respectively. Ossification of the yellow ligament, which had not been found at the first surgery, was identified in 6 patients. Eight patients showed improvement of their neurological deficits and 10 patients showed no improvement by the final follow-up. Perioperative major complications occurred in 8 of 18 patients. CONCLUSIONS: The incidence of PJF with late neurological deficits following ASD surgery was 4.7% in this cohort. The patients showed several morphological features. After revision surgery, perioperative complications were common and the prognosis for improved neurological status was not favorable.
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The workability of Al-xMg alloys with a high Mg content (Al-6Mg, Al-8Mg, Al-9Mg) was evaluated by investigating the microstructure and processing map. Hot torsion tests were conducted in the range of 350-500 °C between 0.1 and 1 s-1. Constitutive equations were derived from various effective stress-strain curves, and the thermal activation energies for deformation obtained were 171 kJ/mol at Al-6Mg, 195 kJ/mol at Al-8Mg, and 220 kJ/mol at Al-9Mg. In the case of the processing map, the instability region, which widened with increasing Mg content, was due mainly to the influence of the Mg solute, which activated grain boundary cracking and flow localization.
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STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to investigate proximal junctional kyphosis (PJK) after lumbosacral long fusion according to preoperative Roussouly and lumbar degenerative kyphosis (LDK) types. SUMMARY OF BACKGROUND DATA: Although previous studies have suggested some risk factors for PJK, the effects of preoperative grade of sagittal imbalance and paraspinal muscles degeneration on PJK remain unclear. METHODS: Eighty-seven patients who had undergone lumbosacral fusion more than five levels with available clinical and radiological data were enrolled. The presence of PJK defined as sagittal Cobb angle ≥20° between the uppermost instrumented vertebra (UIV) and two supra-adjacent vertebrae at postoperative 2-year radiographs was recorded. Its occurrence was compared according to preoperative Roussouly and LDK types (Takemistu type) and the degree of paraspinal muscle degeneration at the upper level of UIV. Other sagittal radiographic parameters were also measured. RESULTS: In this series, 28 patients (group I, 32.2%) showed radiological PJK, whereas 59 patients did not show radiological PJK (non-PJK patients, group II, 67.8%) at postoperative 2 years. PJK presented more prevalence in type III and type IV of LDK types (26/27, 96.3%). However, Roussouly types did not show any significant difference in PJK prevalence. In radiological parameters, a larger preoperative SVA (Pâ=â0.018) and PI-LL (Pâ=â0.015) were associated with PJK. Also, smaller quantity and lower quality of paraspinal muscles at T12-L1 level showed significant (Pâ<â0.001) relationship with PJK. On multivariate logistic regression, higher LDK type (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.24-3.56), smaller quantity (OR: 1.03, 95% CI: 1.00-1.07), and higher degree of paraspinal muscle degeneration (OR: 1.46, 95% CI: 0.92-2.31) were independent predictors of postoperative PJK. CONCLUSION: Although various factors are related to PJK following long segment fusion, preoperative conditions such as LDK types and degree of paraspinal muscle degeneration might be related to the development of PJK.Level of Evidence: 3.
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Cifosis/clasificación , Cifosis/cirugía , Vértebras Lumbares/cirugía , Músculos Paraespinales/patología , Adulto , Anciano , Femenino , Humanos , Cifosis/epidemiología , Región Lumbosacra/cirugía , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Prevalencia , Radiografía , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The purpose of this study was to report the characteristics of SIFs after ILSF and discuss its management focusing on pelvic deformation. We retrospectively reviewed all consecutive patients who underwent ILSF for degenerative disc diseases during the period between 2000 and 2017 and were diagnosed as SIF at our institute. The clinical and radiographic data were reviewed on their medical charts. Treatment outcomes for SIF were also investigated. Eight patients (all females) were included in this study. Mean age at SIF diagnosis was 72 years, and the mean follow-up period was 3.8 years (range 1-7 years). SIF developed average 7.5 years (range 1 month-17 years) after the index ILSF. Fracture patterns were unilateral vertical in four, bilateral vertical in three, and horizontal in 1 patient. Unlike patients with unilateral vertical SIF, patients with bilateral vertical or horizontal SIF showed a marked increase of pelvic incidence (PI) by mean 17.0°±5.0° and sagittal vertical axis (SVA) by mean 4.5 ± 2.2 cm, compared to the respective values before the onset of abrupt pain. All patients with unilateral vertical SIF were treated favorably by conservative management, however sacropelvic fixation was inevitable in patients with bilateral vertical or horizontal SIF. Bilateral vertical or horizontal SIF showed marked changes on sagittal radiographic parameters including PI and SVA. Although unilateral vertical SIF has benign courses that responded well to conservative management, bilateral vertical or horizontal SIF is likely to need surgical treatment. Treatment plan should be determined depending on fracture pattern and pelvic deformation.
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Fracturas por Estrés/etiología , Vértebras Lumbares/cirugía , Fracturas de la Columna Vertebral , Fusión Vertebral/efectos adversos , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sacro/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: More caudal osteotomy is believed to lead to greater sagittal correction; however, the osteotomy level and whether or not to use iliac screw fixation (ISF) are topics of on-going debate. The aim of this study was to compare clinical and radiographic outcomes after revisional lumbar pedicle subtraction osteotomy (PSO) for fixed sagittal imbalance (FSI) according to the osteotomy level and ISF. METHODS: All consecutive patients who underwent revisional PSO (at L3 or L4) for FSI in a single institute from July 2006 to January 2014 were investigated retrospectively. Thirty-eight patients with at least 2-year follow-up were finally included. Clinical outcomes including the visual analogue scale (VAS) and Oswestry Disability Index (ODI) were investigated. Radiographic spinopelvic parameters were analyzed according to the level of PSO, the degree of correction, and the use of ISF. RESULTS: The mean number of fused segments after PSO was 6.6 ± 1.8. Sagittal vertical axis (SVA) was restored after the surgery (12, 2.5, and 5.2 cm at preoperative, postoperative, and the last follow-up, respectively). PSO was performed at L3 in 16 patients and at L4 in 22 patients. The osteotomy level was not associated with any changes of spinopelvic parameters (pelvic tilt [PT] or lumbar lordosis) or sagittal alignment (T1-pelvic angle [TPA] or SVA). However, better TPA restoration was achieved with more osteotomy resection angle (P = 0.031). ISF group showed significant improvement in postoperative pelvic orientation (PT and ratio of PT to pelvic incidence) which was maintained until the last follow-up. CONCLUSIONS: Although postoperative sagittal alignment was different in FSI patients according to the osteotomy level, pelvic orientation improved in ISF group. Also, the degree of correction showed significant associations with sagittal alignment. When performing revisional PSO for FSI, spine surgeon should carefully consider how to correct rather than where to do the osteotomy, and the role of ISF.
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Lordosis , Vértebras Lumbares , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Osteotomía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
We prepared MoS2 monolayers on Au nanodot (ND) and nanohole (NH) arrays. Both these sample arrays exhibited enhanced photoluminescence intensity compared with that of a bare SiO2/Si substrate. The reflectance spectra of MoS2/ND and MoS2/NH had clear features originating from excitation of localized surface plasmon and propagating surface plasmon polaritons. Notably, the surface photovoltages (SPV) of these hybrid plasmonic nanostructures had opposite polarities, indicating negative and positive charging at MoS2/ND and MoS2/NH, respectively. Surface potential maps, obtained by Kelvin probe force microscopy, suggested that the potential gradient led to a distinct spatial distribution of photo-generated charges in these two samples under illumination. Furthermore, the local density of photo-generated excitons, as predicted from optical simulations, explained the SPV spectra of MoS2/ND and MoS2/NH. We show that the geometric configuration of the plasmonic nanostructures modified the polarity of photo-generated excess charges in MoS2. These findings point to a useful means of optimizing optoelectronic characteristics and improving the performance of MoS2-based plasmonic devices.
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Lumbar interbody fusion (LIF) is an effective and popular surgical procedure for the management of various spinal pathologies, especially degenerative diseases. Currently, LIF can be performed with posterior, transforaminal, anterior, and lateral approaches by open surgery or minimally invasive surgery (MIS). Each technique has its own advantages and disadvantages. In general, posterior LIF is a well-established procedure with good fusion rates and low complication rates but is limited by the possibility of iatrogenic injury to the neural structures and paraspinal muscles. Transforaminal LIF is frequently performed using an MIS technique and has an advantage of reducing these iatrogenic injuries. Anterior LIF (ALIF) can restore the disk height and sagittal alignment but has inherent approach-related challenges such as visceral and vascular complications. Lateral LIF and oblique LIF are performed using an MIS technique and have shown postoperative outcomes similar to ALIF; however, these approaches carry a risk of injury to psoas, lumbar plexus, and vascular structures. Herein, we provide a detailed description of the surgical procedures of each LIF technique. We shall then consider the pearls and pitfalls, as well as propose surgical indications and contraindications based on the available evidence in the literatures.
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STUDY DESIGN: Retrospective case-control study. OBJECTIVE: To investigate the effects of postoperative sagittal alignment on radiographic adjacent segment degeneration (ASD) after lumbar fusion surgery. SUMMARY OF BACKGROUND DATA: ASD is one of inherent problems with fusion surgery. Many confounding factors are related to the development of ASD. Recently, sagittal alignment has been emphasized for its significance on ASD. METHODS: Seventy-three patients who underwent four-level lumbar fusion surgery (L2-S1) were divided into two groups according to postoperative sagittal alignment (pelvic incidence-lumbar lordosis [PI-LL] ≥ or <9°): 44 patients (matched group, including 10 patients who underwent pedicle subtraction osteotomy [PSO] at L4) and 29 patients (mismatched group). The general demographics, radiographic parameters, and clinical outcomes were recorded. Preoperative disc degeneration at L1-2 was evaluated by Pfirrmann grade and Kellgren-Lawrence (K-L) grade. Disc degeneration at L1-2 was evaluated by the K-L grade on 2-year postoperative X-rays. RESULTS: The incidence of radiographic ASD (11 [25%] vs. 16 patients [55%], Pâ=â0.02) and Oswestry Disability Index (ODI) scores (36.9â±â19.9 vs. 49.4â±â20.7, Pâ=â0.015) at postoperative 2 years were significantly higher in the mismatched group. There were no significant differences in other demographic and radiographic parameters between the two groups. On subgroup analysis between 10 PSO patients and the mismatched group, the mismatched group showed a higher incidence of radiographic ASD (16 [55%] vs. 1 patient [10%], Pâ=â0.041) and worse ODI scores (49.7â±â20.5 vs. 39.0â±â20.7, Pâ=â0.040). Preoperative Pfirrmann grade at L1-2 (odds ratio [OR]â=â4.191, 95% confidence interval [CI]: 1.754-10.013, Pâ=â0.001) and postoperative PI-LL mismatch (ORâ=â4.890, 95% CI: 1.550-15.427, Pâ=â0.007) showed significant relationships with the development of radiographic ASD at postoperative 2 years. CONCLUSION: The restoration of optimal sagittal alignment, even with PSO, may provide a protective effect on the development of radiographic ASD, although the preoperative disc degeneration grade was a risk factor for radiographic ASD. LEVEL OF EVIDENCE: 3.
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Vértebras Lumbares/cirugía , Región Lumbosacra/cirugía , Fusión Vertebral/métodos , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Degeneración del Disco Intervertebral/cirugía , Lordosis/cirugía , Masculino , Persona de Mediana Edad , Osteotomía , Periodo Posoperatorio , Radiografía , Estudios Retrospectivos , Factores de RiesgoRESUMEN
We fabricated plasmonic hybrid nanostructures consisting of MoS2 monolayer flakes and Au nanogratings with a period of 500 nm. The angle-resolved reflectance and photoluminescence spectra of the hybrid nanostructures clearly indicated a coupling between surface plasmon polaritons (SPPs) and incoming photons. The surface photovoltage (SPV) maps could visualize the spatial distribution of net charges while shining light on the sample. Considerable polarization and wavelength dependence of the SPV signals suggested that the SPP mode enhanced the light-matter interaction and resulting exciton generation in the MoS2 monolayer. From the photoluminescence spectra and the morphology of the suspended MoS2 region, it could be noted that light irradiation did not much raise the temperature of the MoS2 monolayers on the nanogratings. Nanoscopic SPV and surface topography measurements could reveal the local optoelectronic and mechanical properties of MoS2 monolayers. This work provided us insights into the proposal of a high-performance MoS2/metal optoelectronic devices, based on the understanding of the SPP-photon and SPP-exciton coupling.
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TTo evaluate the clinical and radiological results of the treatment of complex tibial shaft fracture (AO/OTA type 42-C) with minimally invasive plate osteosynthesis(MIPO). Twenty patients diagnosed with complex tibial shaft fracture without extension to the articular surface and treated with MIPO, including 9 cases of AO/OTA type 42-C2 and 11 cases of AO/OTA type 42-C3, 6 of which were open fractures. External fixation was used for open fractures until the soft tissue damage had healed; then, 2nd stage operation with MIPO was performed to stabilize the fracture. Each patient was followed up for a minimum of 12 months. The mean time to union was 20.1 weeks. Delayed union was observed in 4 cases. Angular deformity, length shortening and non-union were not observed. Severely comminuted and open fractures of the tibial shaft may benefit from temporary external fixation prior to performing MIPO.
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Placas Óseas , Fijación Interna de Fracturas/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Tibia/cirugía , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Curación de Fractura/fisiología , Humanos , Masculino , Persona de Mediana Edad , Tibia/diagnóstico por imagen , Resultado del Tratamiento , Adulto JovenRESUMEN
Although remote ischemic preconditioning (RIPC) is an organ-protective maneuver from subsequent ischemia reperfusion injury (IRI) by application of brief ischemia and reperfusion to other organs, its mechanism remains unclear. However, it is known that RIPC reduces the heart, brain, and liver IRI, and that nitric oxide (NO) is involved in the mechanism of this effect. To identify the role of NO in the protective effect of RIPC in renal IRI, this study examined renal function, oxidative status, and histopathological changes using N-nitro-L-arginine methyl ester (L-NAME), an NO synthase inhibitor. Remote ischemic preconditioning was produced by 3 cycles of 5 minutes ischemia and 5 minutes reperfusion. Blood urea nitrogen, creatinine (Cr), and renal tissue malondialdehyde levels were lower, histopathological damage was less severe, and superoxide dismutase level was higher in the RIPC + IRI group than in the IRI group. The renoprotective effect was reversed by L-NAME. Obtained results suggest that RIPC before renal IRI contributes to improvement of renal function, increases antioxidative marker levels, and decreases oxidative stress marker levels and histopathological damage. Moreover, NO is likely to play an important role in this protective effect of RIPC on renal IRI.