Purpose To investigate the surgical outcomes of anterior cruciate ligament (ACL) reconstruction using a low-dose irradiated tibialis anterior allograft with a fixed-loop cortical suspension device for the femur based on the graft insertion length (GIL) in the femoral tunnel. Methods Between January 2010 and January 2018, the medical records of consecutive patients who underwent arthroscopic ACL reconstruction with a tibialis anterior allograft fixed with the EndoButton CL for the femur and who had at least 2 years of follow-up were retrospectively evaluated. Patients were classified into 3 groups based on the GIL in the femoral tunnel (group 1, GIL < 15 mm; group 2, GIL of 15-20 mm; and group 3, GIL > 20 mm), and their functional scores, knee laxity, and radiographic parameters were evaluated. Results A total of 91 patients were analyzed. There were no statistically significant differences in the functional scores and knee laxity between the 3 groups at 2 years postoperatively. However, significant differences were observed in tunnel widening at 1 year postoperatively in the femur (P = .045 for absolute value and P = .004 for relative value) and the tibia (P = .014 for absolute value and P = .012 for relative value), revealing that both the femoral and tibial tunnels widened as the GIL decreased. Additional linear regression analyses were performed to identify whether the GIL independently affects tunnel widening. Consequently, the femoral tunnel depth, tunnel diameter, and GIL were found to independently influence femoral tunnel widening (P = .008, P = .019, and P < .001, respectively), whereas the tunnel diameter and GIL affected tibial tunnel widening (P < .001 and P = .004, respectively). Conclusions The GIL in the femoral tunnel during ACL reconstruction using a tibialis anterior allograft with a fixed-loop cortical suspension device for the femur has no significant association with the postoperative functional outcomes and knee laxity, but it has a negative correlation with tunnel widening in the femur and the tibia. Level of Evidence Level III, retrospective cohort study.

Nanometerand sub-nanometer-sized Ru particles were deposited on four different alkali-exchanged zeolite Y supports (H-Y, Na-Y, K-Y, and Rb-Y) by an ion-exchange method followed by a calcination treatment under vacuum. The average particle size of the Ru-based catalysts (Ru/M-Y: M = H, Na, K, and Rb) was approximately 1 nm, with the majority of Ru particles being highly monodisperse with a size in the sub-nanometer range. The oxygen-deficient environment during calcination and the well-defined repeated pore structure of zeolite are thought to have strongly affected the formation of Ru particles by restraining particle growth inside the upper/ sodalite cages of the zeolite Y matrix. X-ray absorption spectroscopic analysis revealed that the Ru particles were highly reducible at low temperatures and were low coordinated with short Ru-O bonds. The effect of surface acidity on the catalytic activity of Ru/M for ammonia decomposition was investigated. Ammonia temperature programmed desorption analysis suggested that the acidity of the alkali-exchanged zeolite Y increased (H > Na > K > Rb) with an increase in the electronegativity of the alkali cation. Among all the catalysts, H-Y exhibited the highest acidity because of the presence of strong BrOnsted acid sites. The catalytic activities of the Ru/M-Y catalysts for ammonia decomposition in the gas phase decreased in the order of Ru/Rb-Y > Ru/KY > Ru/Na-Y > Ru/H-Y, that is, the lower the acidity, the higher is the catalytic activity. This was correlated to increased electron density of the surrounding Ru active sites, which likely facilitated nitrogen desorption from the catalyst surface. Finally, the surface intermediates formed under ammonia decomposition conditions were identified by in situ diffuse reflectance infrared Fourier transform spectroscopy. NH/NH2 surface intermediates were identified in the presence of Ru with weaker N-H bonds in the case of Ru/Rb-Y compared to the case of Ru/H-Y. Overall, the high catalytic activity of the Ru/Rb-Y catalyst for ammonia decomposition was mainly because of the high basicity of the Rb-Y zeolite and the confined nanometerand sub-nanometer-sized Ru particles, which led to a high Ru dispersion, open pore structure of the zeolite, and strong metal to support interaction between the Ru active sites and the Rb-Y zeolite support.

This study aimed to analyze the reproducibility and reliability of the alignment parameters measured using the EOS image system in both limbs while standing with an even weight-bearing posture. Overall, 104 lower extremities in 52 patients were analyzed retrospectively. The patients stood with an even load over both lower extremities then rotated 15° in both directions. Two EOS images were acquired and 104 pairs of lower extremities were compared according to the position of the indexed lower extremities. Then, the inter-observer reliability of the EOS system and the inter-modality reliability between EOS and computed tomography (CT) were evaluated. Femoro-tibial rotation (FTR) and tibial torsion demonstrated a significant difference between the anterior and posterior positions of the indexed lower extremity. In the inter-observer reliability analysis, all values except for FTR and tibial torsion demonstrated good or very good reliability. In the anterior position, FTR demonstrated moderate, and tibial torsion demonstrated poor reliability. In the posterior position, both FTR and tibial torsion demonstrated poor reliability. In the reliability analysis between the three-dimensional (3D) EOS model and 3D CT images, all measurements of the femur demonstrated very good reliability, but measurements of the tibia did not. For the coronal and sagittal alignment parameters measured by the EOS 3D system with rotated standing posture, except for the measurement including tibial torsion., there were no significant difference for either position of the indexed extremities with high agreement between the observers as well as with the CT 3D model.

This study comprehensively investigates hydrogen production from green ammonia reforming, including synthesis of catalysts, reactor development, process integration, and techno-economic analysis. In-house developed Ru/La-Al2O3 pellet catalyst having perovskite structure showed high catalytic activity of 2827 h(-1) at 450 degrees C and stability over 6700 h at 550 degrees C, exceeding the performance of the majority of powder catalysts reported in the literature. A scalable 12-faceted reactor adopting the as-produced catalyst was designed to enhance heat transfer, producing over 66 L min(-1) of hydrogen with state-of-the-art ammonia reforming efficiency of 83.6 %. Near-zero CO2 emission of hydrogen extraction from green ammonia was demonstrated by-product gas recirculation as a combustion heat source. A techno-economic assessment was conducted for system scales from 10 kW to 10 MW, demonstrating the effect of reduced minimum hydrogen selling prices from 7.03 USD kg(-1) at small modular scales to 3.98 USD kg(-1) at larger industrial scales. Sensitivity analyses indicate that hydrogen selling prices may reduce even further (up to 50 %). The suggested hydrogen production route from green NH3 demonstrates superior CO2 reduction ranging from 78 % to 95 % in kg CO2 (kg H-2)(-1) compared to biomass gasification and steam methane reforming. These findings can be used as a basis for following economic and policy studies to further validate the effectiveness of the suggested system and process for H-2 production from NH3.

To investigate the surgical outcomes of anatomical anterior cruciate ligament (ACL) reconstruction according to the graft isometry measured during surgery. Electrical medical records of patients who underwent an arthroscopic ACL reconstruction through the transportal technique using hamstring tendon autograft between 2012 and 2016 were retrospectively reviewed. The patients were classified into two groups based on the graft length change throughout the knee range of motion measured just before graft fixation (Group 1, graft length change ≤ 2 mm; Group 2, graft length change > 2 mm). Comparative analyses, including a non-inferiority trial, were performed regarding the clinical scores, knee laxity, and radiographic parameters between the groups. A total of 67 patients were included in the study. The total change in the length of ACL graft throughout the knee range of motion was 1.4 ± 0.4 mm in Group 1 (range, 0.2–2.0 mm), and 3.0 ± 0.7 mm in Group 2 (range, 2.2–5.0 mm). Group 1 showed a relatively high (proximal) femoral tunnel and shallow (anterior) tibial tunnel compared to Group 2 (P < 0.001 and P = 0.028, respectively), but there were no apparent differences in the macroscopic view. There were no statistically significant differences in the clinical outcomes between groups at 2 years after surgery, which satisfied the non-inferiority criterion of Group 1 in terms of clinical scores and knee laxity compared to Group 2. The surgical outcomes of anatomical ACL reconstruction in patients with non-isometric ACL graft were not inferior in terms of clinical scores and knee laxity, compared to those with nearly-isometric ACL graft. The graft tunnel placement in the isometric position during anatomical ACL reconstruction, which is technically challenging in the clinical setting, is not a crucial factor in terms of clinical outcomes. Level IV.

BACKGROUND:Increased varus alignment of the lower extremity is known to be a poor prognostic factor for the surgical repair for a medial meniscus root tear (MMRT). However, given the concept of constitutional varus, which is present in a substantial portion of the normal population, the generally accepted surgical indication for MMRT concerning a varus alignment of 5° may be unnecessarily narrow.PURPOSE:To compare the surgical outcomes of arthroscopic transtibial pullout repair of MMRT according to the degree of varus alignment of the lower extremity.STUDY DESIGN:Cohort study; Level of evidence, 3.METHODS:Patients who underwent isolated arthroscopic transtibial pullout repair of MMRT between January 2010 and July 2017 at one institution and had a minimum follow-up of 2 years were included in this study. Patients were classified into 1 of 2 groups: the experimental group (n = 22) included patients with a preoperative hip-knee-ankle angle between 5° and 10° varus (mild to moderate varus alignment) and the control group (n = 51) included those with a preoperative hip-knee-ankle angle <5° varus (neutral alignment). Clinical scores and radiographic parameters were compared between the groups to assess surgical outcomes, which were statistically matched for potential confounders (age, body mass index, the severity of cartilage lesion) by use of the inverse probability of treatment weighting. A noninferiority trial was performed comparing the experimental and control groups in terms of subjective outcomes (International Knee Documentation Committee subjective and Lysholm scores) and objective outcomes (postoperative medial meniscal extrusion and the rate of osteoarthritis progression).RESULTS:There were no statistically significant differences in surgical outcomes between the groups in subjective and objective aspects, which were consistent before and after inverse probability of treatment weighting. Apart from the clinical improvement observed in both groups, overall degenerative changes in the knee were found, although progression rates did not differ between the groups. In terms of the noninferiority trial, the overall surgical outcomes in the experimental group were not inferior to those in the control group.CONCLUSION:The short-term surgical outcomes of arthroscopic transtibial pullout repair for MMRT of patients with mild to moderate varus alignment were not inferior to but rather comparable with those with neutral alignment in terms of subjective and objective aspects. Therefore, it would be inappropriate to exclude patients with a diagnosis of MMRT from being indicated for the surgery simply because of mild to moderate varus alignment.

We developed a 32 kB embedded nonvolatile memory (NVM) intellectual property (IP) using 2T-SONOS cells. Although SONOS cells possess intrinsic defect immunity, we discovered abnormal memory cell failure during the probe test of the IP. The major failed items are checkerboard (CKBD), inverse CKBD, and gate-with-source (G-S) disturbance at the erased state. The threshold voltage distributions and electrical failure analysis (FA) reveal that all major failures occurred because of an abnormally weak G-S disturbance immunity. In addition, the temperature dependency of the G-S disturbance implies that the failure mechanism is related to Co-spike rather than midgap trap-induced junction leakage. Although abnormal defects are not detected through physical FA, by using simple failure modeling and a process split test, we verified the root cause of a new type of erratic failure. The single-bit disturbance failure can be explained as electrons generated in the floating junction area being accelerated in the G-S stress mode, resulting in soft programming by the channel hot electron (CHE) injection mechanism.

One of fundamental limitations of renewable energy is intermittent nature of its energy source. To make up the weak points means such as thermal energy storage system (TES) can be utilized. The stored thermal energy can be converted to electricity via power conversion system stably. There are various options to store the thermal energy [1]. Representatively, an energy storage tank can take advantage of sensible heat, latent heat, and phase change heat of materials filled in the tank [1]. Number of tanks are generally one or two. One tank is favorable economically but a little complicated. System using two tanks for hot and cold tank is simple but not competitive with respect to expense. Thermal energy storage system is connected to power conversion system for which general steam Rankine cycle can be applied or challenging supercritical CO2(SCO2) Brayton cycle can be employed [2]. In this study, a conceptual design of thermal energy storage and utilization system was considered for which sensible heat storage option with two tanks and S-CO2 Brayton cycle was chosen. For the storage system, sodium is used to have advantages of wide range operability of working temperature over general molten salt and high conductivity feature. By the way, thermal energy storage system can be used to store the energy from any source including nuclear power plant. For heat exchanger from the sodium side to the CO2 side, compact printed circuit heat exchanger (PCHE) is employed [3]. To design a lumped PCHE design code had been developed [4,5] but varying properties of working fluids on temperature may require more refined design approach. Therefore, the lumped PCHE design code was upgraded to have option of discretization capability along the flow directions of both tube sides. In this study, methodology of the 1D PCHE design code is introduced in brief and the upgraded code is validated compared to the lumped code. The validated code is utilized to design Na-CO2 PCHEs for thermal energy storage and utilization system based on a given plant heat balance [6].

Right ventricular (RV) pacing-induced dyssynchrony may precipitate heart failure (HF) with impaired left ventricle (LV) systolic function in susceptible patients. LV pacing via coronary sinus or endocardially via transseptal approach has its limitations due to anatomy and requirement for long term anticoagulation respectively. His pacing is promising, as it engages the natural conduction system. However, in patients with LBBB, His pacing may be able to normalize LBBB in about 50% of patients. Pacing the LBB area via the right ventricle has rapidly evolved however engaging the LBB can be challenging due to restrictive short active fixation helix. An alternative is to engage the Purkinje network in the LV septum via the membranous septum from the right atrium (RA) to LV. We sought to determine the anatomic dimensions that could safely guide placement of this RA-LV lead bounded by COMiT (boundaries: Coronary sinus(CS), left ventricular outflow tract (LVOT), Mitral annulus (MA), Tricuspid annulus (TA)).

For catalytic reactions involving H2 extraction, the membrane reactor is an attractive option for enhancing the equilibrium and kinetics while eliminating excessive purification steps. In this study, a steam carrier adopted composite membrane reactor system is developed to produce pure H2 (>99.99%) from ammonia with high H2 productivity (>0.35 mol-H2 gcat−1 h−1) and ammonia conversion (>99%) at a significantly reduced operating temperature (<723 K). Coupling of a custom developed palladium/tantalum composite metallic membrane and ruthenium on lanthanum-doped alumina catalysts allowed stable operation of the membrane system with significant mass transfer enhancement. Various reactor assemblies involving as-fabricated membranes and catalysts are experimentally compared to suggest the optimal configuration and operating conditions for future applications. Steam is adopted as a sweep gas, presenting efficient H2 recovery (>91%) while replacing conventionally utilized noble carrier gases that require additional gas separation processes. The steam carrier presents similar membrane reactor performance to that of noble gases, and the water reservoir used for steam generation acts as an ammonia buffer via scrubbing effects. Finally, electricity generation is demonstrated using a commercial fuel cell along with process simulation, substantiating potential of the proposed membrane system in practical applications for H2 production from ammonia and on-site power generation.

Network isolation is a critical modern Internet service. To date, network operators have created a logical network of distributed systems to provide communication isolation between different parties. However, the current network isolation is limited in scalability and flexibility. It limits the number of virtual networks and it only supports isolation at host (or virtualmachine) granularity. In this paper, we introduce Scalable Virtual Local Area Networking (SVLAN) that scales to a large number of distributed systems and offers improved flexibility in providing secure network isolation. With the notion of destination-driven reachability and packet-carrying forwarding state, SVLAN not only offers communication isolation but isolation can be specified at different granularities, e.g., per-application or per-process. Our proof-of-concept SVLAN implementation demonstrates its feasibility and practicality for real-world applications.