Ankle and toe weakness caused by calcified ligamentum flavum cyst: A case report.

BACKGROUND: Ligamentum flavum cysts, which are most common in mobile junctional levels of the spine, can be a rare cause of spinal stenosis. There have been several case reports of ligamentum flavum cysts. However, there is yet to be a documented case report of a calcified ligamentum flavum cyst. Herein, we report the first case of a calcified ligamentum flavum cyst causing ankle and toe weakness. CASE SUMMARY: A 66-year-old male visited our hospital complaining of claudication as well as thigh and calf pain in his left leg, all beginning two weeks prior. Physical examination revealed motor weakness of the left ankle dorsiflexion and great toe dorsiflexion. Lumbar spinal computed tomography scans showed spinal stenosis combined with a calcified mass at the left side of the L4-5 level. Magnetic resonance imaging showed dural sac compression caused by the calcified mass at the left ligamentum flavum of the L4-5 level. We performed decompressive laminectomy and excision of the calcified mass combined with posterior lumbar interbody fusion at the L4-5 level. Intra-operatively, we found a firm and nodule like mass originating from the ventral surface of ligamentum flavum. Pathological examination suggested a calcified pseudocyst without a capsular lining. After the operation, the patient's motor weakness in the ankle and great toe improved gradually. CONCLUSION: The patient's ankle and great toe weakness were improved successfully after surgical removal of the calcified cyst.

Application of Escherichia coli-Derived Recombinant Human Bone Morphogenic Protein-2 to Unstable Spinal Fractures.

(1) Background: Recently, Escherichia coli-derived recombinant human bone morphogenetic protein-2 (E. coli-derived rhBMP-2) has been increasingly applied to different types of spinal surgeries and reported to achieve successful fusion. This pilot study aimed to evaluate the clinical efficacy and safety of rhBMP-2 in patients undergoing posterior instrumented fusions for unstable spinal fractures. (2) Methods: This study included ten consecutive patients undergoing spinal surgery using E. coli-derived rhBMP-2 with more than one year of follow-up. Radiologic outcomes were compared, including the average fracture healing period, local kyphosis correction, and clinical outcomes between preoperative and the last follow-up. (3) Results: The average time of radiographic union was 99.9 ± 45.4 (62-192) days, with an average use of 5.2 ± 3.9 months of anabolic agents. Radiologic parameters such as anterior vertebral height and vertebral wedge angle were significantly corrected postoperatively and at the last follow-up. Clinical outcomes other than leg pain were significantly improved after the surgery. In addition, four patients with preoperative neurologic deficits showed improved neurologic status. (4) Conclusions: Combined with the anabolic agents, applying E. coli-derived rhBMP-2 to the fractured vertebral body could be an effective surgical treatment for unstable spinal fractures. Further trials are needed to validate this result.

Sequentially Coated Wavy Nanowire Composite Transparent Electrode for Stretchable Solar Cells.

Recent advances in fabricating stretchable and transparent electrodes have led to various techniques for establishing next-generation form-factor optoelectronic devices. Wavy Ag nanowire networks with large curvature radii are promising platforms as stretchable and transparent electrodes due to their high electrical conductivity and stretchability even at very high transparency. However, there are disadvantages such as intrinsic nonregular conductivity, large surface roughness, and nanowire oxidation in air. Here, we introduce electrically synergistic but mechanically independent composite electrodes by sequentially introducing conducting polymers and ionic liquids into the wavy Ag nanowire network to maintain the superior performance of the stretchable transparent electrode while ensuring overall conductivity, lower roughness, and long-term stability. In particular, plenty of ionic liquids can be incorporated into the uniformly coated conducting polymer so that the elastic modulus can be significantly lowered and sliding can occur at the nanowire interface, thereby obtaining the high mechanical stretchability of the composite electrode. Finally, as a result of applying the composite film as the stretchable transparent electrode of stretchable organic solar cells, the organic solar cell exhibits a high power conversion efficiency of 11.3% and 89% compared to the initial efficiency even at 20% tensile strain, demonstrating excellent stretching stability.

Effect of Lumbar Spinal Stenosis on Treatment of Osteoporosis: Comparison of Three Oral Bisphosphonate Therapies.

(1) Background: Lumbar spinal stenosis (LSS) causes uncomfortable neuropathic symptoms, which can negatively affect osteoporosis. The aim of this study was to investigate the effect of LSS on bone mineral density (BMD) in patients treated with one of three oral bisphosphonates (ibandronate, alendronate and risedronate) for initially diagnosed osteoporosis. (2) Methods: We included 346 patients treated with oral bisphosphonates for three years. We compared annual BMD T-scores and BMD increases between the two groups according to symptomatic LSS. The therapeutic efficacies of the three oral bisphosphonates in each group were also evaluated. (3) Results: Annual and total increases in BMD were significantly greater in group I (osteoporosis) compared to group II (osteoporosis + LSS). The total increase in BMD for three years was significantly greater in the ibandronate and alendronate subgroups than that in the risedronate subgroup (0.49 vs. 0.45 vs. 0.25, p < 0.001). Ibandronate showed a significantly greater increase in BMD than that of risedronate in group II (0.36 vs. 0.13, p = 0.018). (4) Conclusions: Symptomatic LSS may interfere with the increase in BMD. Ibandronate and alendronate were more effective in treating osteoporosis than risedronate. In particular, ibandronate was more effective than risedronate in patients with both osteoporosis and LSS.

Intrinsically Stretchable, Highly Efficient Organic Solar Cells Enabled by Polymer Donors Featuring Hydrogen-Bonding Spacers.

Intrinsically stretchable organic solar cells (IS-OSCs), consisting of all stretchable layers, are attracting significant attention as a future power source for wearable electronics. However, most of the efficient active layers for OSCs are mechanically brittle due to their rigid molecular structures designed for high electrical and optical properties. Here, a series of new polymer donors (PD s, PhAmX) featuring phenyl amide (N1 ,N3 -bis((5-bromothiophen-2-yl)methyl)isophthalamide, PhAm)-based flexible spacer (FS) inducing hydrogen-bonding (H-bonding) interactions is developed. These PD s enable IS-OSCs with a high power conversion efficiency (PCE) of 12.73% and excellent stretchability (PCE retention of >80% of the initial value at 32% strain), representing the best performances among the reported IS-OSCs to date. The incorporation of PhAm-based FS enhances the molecular ordering of PD s as well as their interactions with a Y7 acceptor, enhancing the mechanical stretchability and electrical properties simultaneously. It is also found that in rigid OSCs, the PhAm5:Y7 blend achieves a much higher PCE of 17.5% compared to that of the reference PM6:Y7 blend. The impact of the PhAm-FS linker on the mechanical and photovoltaic properties of OSCs is thoroughly investigated.

Material Design and Device Fabrication Strategies for Stretchable Organic Solar Cells.

Recent advances in the power conversion efficiency (PCE) of organic solar cells (OSCs) have greatly enhanced their commercial viability. Considering the technical standards (e.g., mechanical robustness) required for wearable electronics, which are promising application platforms for OSCs, the development of fully stretchable OSCs (f-SOSCs) should be accelerated. Here, a comprehensive overview of f-SOSCs, which are aimed to reliably operate under various forms of mechanical stress, including bending and multidirectional stretching, is provided. First, the mechanical requirements of f-SOSCs, in terms of tensile and cohesion/adhesion properties, are summarized along with the experimental methods to evaluate those properties. Second, essential studies to make each layer of f-SOSCs stretchable and efficient are discussed, emphasizing strategies to simultaneously enhance the photovoltaic and mechanical properties of the active layer, ranging from material design to fabrication control. Key improvements to the other components/layers (i.e., substrate, electrodes, and interlayers) are also covered. Lastly, considering that f-SOSC research is in its infancy, the current challenges and future prospects are explored.

Impact of Chlorination Patterns of Naphthalenediimide-Based Polymers on Aggregated Structure, Crystallinity, and Device Performance of All-Polymer Solar Cells and Organic Transistors.

The aggregation properties of conjugated polymers can play a crucial role in their thin film structures and performance of electronic devices. Control of these aggregated structures is particularly important in producing efficient all-polymer solar cells (all-PSCs), considering that strong demixing of the polymer donor and polymer acceptor typically occurs during film formation because of the low entropic contribution to the thermodynamics of the system. Here, three naphthalenediimide (NDI)-based polymer acceptors with different backbone chlorination patterns are developed to investigate the effect of the chlorination patterns on the aggregation tendencies of the polymer acceptors, which greatly influence their crystalline structures, electrical properties, and device performances of the resultant all-PSCs and organic field-effect transistors (OFETs). The counterparts of NDI units, dichlorinated bithiophene (Cl2T2), monochlorinated bithiophene (ClT2), and dichlorinated thienylene-vinylene-thienylene (Cl2TVT), are employed to synthesize a series of P(NDIOD-Cl2T2), P(NDIOD-ClT2), and P(NDIOD-Cl2TVT) polymers. The P(NDIOD-Cl2T2) polymer takes advantage of strong noncovalent bonding induced by its chlorine substituents, resulting in the formation of optimal face-on oriented crystalline structures which are suitable for efficient all-PSC devices. In comparison, the P(NDIOD-Cl2TVT) polymer forms bimodal crystalline structures in thin films to yield optimal performances in the resultant OFETs. When the three chlorinated polymers are applied to all-PSCs with the PBDTTTPD polymer donor, P(NDIOD-Cl2T2) achieves a maximum power conversion efficiency (PCE) of 7.22% with an appropriate blend morphology and high fill factor, outperforming P(NDIOD-ClT2) (PCE = 4.80%) and P(NDIOD-Cl2TVT) (PCE = 5.78%). Our observations highlight the effectiveness of the chlorination strategy for developing efficient polymer acceptors and demonstrate the important role of polymer aggregation in modulating the blend morphology and all-PSC performance.

Spinal Surgery for Parkinson Disease With Camptocormia: Propensity Score-Matched Cohort Study With Degenerative Sagittal Imbalance (DSI).

STUDY DESIGN: A propensity score-matched cohort study. OBJECTIVE: The objective of this study was to compare the radiologic and clinical outcomes of camptocormia in Parkinson disease (PD) with degenerative sagittal imbalance (DSI) patients. SUMMARY OF BACKGROUND DATA: Camptocormia in PD and DSI could be characterized by a dynamic deformity. However, no study has directly evaluated the outcomes of patients with camptocormia and DSI. METHODS: Thirteen consecutive PD patients undergoing surgical correction for camptocormia were matched in a 1-to-2 format with 26 patients in the DSI group by propensity score-matching. Radiologic outcomes, including paravertebral muscle changes, and clinical outcomes were compared between the 2 groups. The rate of proximal junctional problems and reoperations were assessed. RESULTS: PD patients with camptocormia had significantly greater preoperative coronal and sagittal malalignments (29.9 vs. 16.9 mm, P=0.019; 142.8 vs. 64.4 mm, P=0.0001, respectively) and weakness of paravertebral muscles compared with the DSI patients. Regarding the clinical outcomes, reoperations were significantly higher in the camptocormia group, compared with the DSI group (53.8% vs. 7.7%, P=0.001). Moreover, proximal junctional failure was developed in 8 patients in the camptocormia group, while 1 patient in the DSI group (61.5% vs. 3.8%, P=0.0001). In subgroup analysis, independent risk factors for the proximal junctional failure were the total fusion levels (hazard ratio=0.26, P=0.018) and the degree of fatty changes of the paravertebral muscles (hazard ratio=1.15, P=0.048). CONCLUSIONS: PD patients undergoing spinal surgery for camptocormia had global malalignment and higher rates of complications compared with DSI patients. Patients should be appropriately counseled regarding the increased risk of operative complications and closely followed for incipient failure.

Recent Advances, Design Guidelines, and Prospects of All-Polymer Solar Cells.

All-polymer solar cells (all-PSCs) consisting of polymer donors (PDs) and polymer acceptors (PAs) have drawn tremendous research interest in recent years. It is due to not only their tunable optical, electrochemical, and structural properties, but also many superior features that are not readily available in conventional polymer-fullerene solar cells (fullerene-PSCs) including long-term stability, synthetic accessibility, and excellent film-forming properties suitable for large-scale manufacturing. Recent breakthroughs in material design and device engineering have driven the power conversion efficiencies (PCEs) of all-PSCs exceeding 11%, which is comparable to the performance of fullerene-PSCs. Furthermore, outstanding mechanical durability and stretchability have been reported for all-PSCs, which make them stand out from the other small molecule-based PSCs as a promising power supplier for wearable electronic devices. This review provides a comprehensive overview of the important work in all-PSCs, in which pertinent examples are deliberately chosen. First, we describe the key components that enabled the recent progresses of all-PSCs including rational design rules for efficient PDs and PAs, blend morphology control, and light harvesting engineering. We also review the recent work on the understanding of the stability of all-PSCs under various external conditions, which highlights the importance of all-PSCs for future implementation and commercialization. Finally, because all-PSCs have not yet achieved their full potential and are still undergoing rapid development, we offer our views on the current challenges and future prospects.