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Purpose Posterior cruciate ligament (PCL) deficiency is considered to be a contraindication for unicompartmental knee replacement (UKR); however, there is no evidence to support or contradict this. There are occasional circumstances where UKR in PCL deficient patients have been performed where the patient otherwise satisfies the indications for UKR. The aim of this paper is to describe the outcome of UKR in PCL deficient patients. Methods A retrospective study of patients with painful medial compartment osteoarthritis and PCL deficiency treated with Oxford UKR between 2006 and 2015 was undertaken. Clinical records from a prospectively recorded database were reviewed and outcomes were assessed based on revision rate, Oxford Knee Score (OKS), American Knee Society score and Tegner Activity Score. Results Nine patients were identified. The median age at surgery was 51 years (range 42–80) and median follow-up was 6 years (range 1–10). There was one bearing dislocation requiring open exchange. The outcome of seven patients was excellent (OKS > 41). Two patients, who were both elderly, had good outcomes (OKS 41 and 39). One patient had a poor outcome, but it is not clear if this was related to the knee as she had a learning disability and examination and radiographs of the knee were satisfactory. Conclusion The results of this small series suggest that excellent results can be achieved with UKR for selected patients with medial osteoarthritis in a PCL deficient knee that was functioning well before the osteoarthritis developed. On the basis of this a larger study should be undertaken. Until more results are available PCL deficiency should be considered a relative contra-indication to UKR. Level of evidence IV.

Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.

We report the synthesis of sodium ion-conducting polymer-blend electrolyte (NIPBE) thin films prepared by a standard solution-casting technique based on polyvinylpyrrolidone (PVP)/polyvinyl alcohol (PVA) and sodium bicarbonate (NaHCO 3 ). The as-synthesized NIPBE thin films were flexible, free-standing and displayed good mechanical stability. The prepared films were characterized using various experimental techniques including scanning electron microscopy (SEM), X-ray diffraction (XRD), differential scanning calorimetry (DSC), AC impedance spectroscopy, linear sweep voltammetry (LSV), cyclic voltammetry (CV), Fourier transform infrared spectroscopy (FTIR) and UV–visible spectroscopy. The SEM, XRD and DSC studies revealed a reduction in the crystallinity of the polymer-blend electrolyte with an increase in the content of NaHCO 3 due to the plasticization effect of Na-salts. The FTIR spectra show the complexation behavior of our as-prepared NIPBEs. The optical properties (i.e., direct and indirect optical energy bandgaps, optical absorption edge) were estimated using UV–visible spectroscopy studies. The dynamic ion behavior of all the as-prepared samples was assessed by the frequency-dependent AC conductivity of the NIPBEs. Also, the dielectric constant and dielectric loss ( ε ′ and ε ″), and electric modulus ( M ′ and M ″) vs. frequency plots at different concentrations and at room temperatures, were reported. The relaxation frequency ( τ s ) of the NIPBE films was determined from the loss tangent spectra (tan δ ). The ionic conductivity of NIPBE films was found to increase with sodium salt concentration, with maximum conductivity of the order of ∼10 −5 S/cm at 30 °C. CV measurements showed good electrochemical stability of the sample containing a high concentration of Na salts. The optimized NIPBEs showed ionic conductivity and electrochemical voltage stability which is good for application in energy storage devices.

Polymer blend electrolyte films based on polyvinyl alcohol (PVA)–polyethylene glycol (PEG) with dopant sodium nitrate (NaNO 3 ) salt were successfully synthesized by the standard solution casting technique. These blend electrolytes were characterized by XRD, DSC/TGA, FTIR, FE-SEM, UV–Vis, ionic conductivity, Raman spectroscopic study and electrochemical measurements to optimize their structural, thermal, optical, ionic transport and electrochemical properties. XRD and DSC studies showed that the crystalline phase of the PVA–PEG blend polymer matrix decreases significantly with the content of NaNO 3 salt, which favours highly flexible polymer backbone and hence providing high ionic conductivity of the polymer blend electrolyte films. The maximum ionic conductivity is found to be 1.53 × 10 −5  S cm −1 at room temperature (~ 30 °C) for the blend electrolyte film PB30. The ionic transference numbers of these polymeric blend electrolytes are estimated in the range of 0.94–0.97, which showed that ion conduction is purely ionic in nature. The Raman and FTIR spectroscopic analysis confirms the complexation of the cation of dopant salt (Na + ) with the backbone of the blend polymer matrix via Lewis acid–base interactions. The UV–visible analysis showed that optical band gap (direct and indirect band gap), absorption edge, and refractive index of the pristine polymeric blend change significantly with the concentration of dopant NaNO 3 salt, and these effects are more noticeable at the higher loading. The electrochemical stability window of the blend polymer electrolytes is observed 3.9 V for the PB 30 films, which confirm their utility as a separator membrane in the high-performance flexible solid-state electrochemical devices.

This study examined a room temperature operative, highly sensitive, stable, and selective PANI ammonia (NH 3 ) gas sensor using multiwalled carbon nanotubes (MWCNTs) and copper nanocomposites (Cu). The silicon substrate was coated with the sensing materials using the drop casting technique. To synthesize PANI, PANI@Cu@MWCNT nanocomposites chemical polymerisation method and ultrasonication techniques were used. In comparison to three PANI nano-composite sensor, which demonstrated sensing responses of 18%, 28%, and 43%, respectively, the PANI@Cu 3 @MWCNT 3 -based sensor demonstrated a greater sensing response of 116% under the room temperature conditions of NH 3 (100 ppm). The resistance variation of all the sensors is 62 kΩ, 78 kΩ, 89 kΩ, and 90 kΩ respectively. The PANI@Cu 3 @MWCNT 3 based sensor exhibited excellent results in term of resistance (90 kΩ). The stability, response time (10 s), and recovery time (13 s) of PANI@Cu 2 @MWCNT 2 is measured and has better results in terms of time than all other sensors. Pure PANI nano-composite sensor has shown the sensing response of 18%, resistance variation of 62 kΩ, response time (45 s), recovery time (48 s) respectively. The sensing materials were characterized using FTIR, XRD, EDX, and FESEM techniques. PANI and PANI@Cu@MWCNT nanocomposites’ gas sensing capabilities were examined using a Keithley 6514 multimeter.

Erosive bony lesions are radiographic findings where localized bone resorption and cortical line breakage occurs. One less common cause of bone erosions is arteriovenous malformations (AVMs). This should always be included in the differentials for foot pain.A 33-year-old gentleman presented with a 5-year history of chronic left foot pain. Clinical examination was unremarkable. Magnetic resonance imaging (MRI) and computerized tomography demonstrated erosive bone changes in the navicular, the intermediate and lateral cuneiforms bones and their corresponding metatarsal bases. An ultrasound and magnetic resonance angiogram demonstrated high signal showing the abnormal communication between metatarsal artery and vein at the site of most pain confirming the AVM. This was subsequently successfully treated with sclerotherapy.Clinicians should be aware of the history, symptoms and signs of AVMs and consider the use of MRI with or without digital subtraction angiography in making a definitive diagnosis.

Blend polymer composite electrolyte (BPCE) films consisting of Polyvinyl alcohol (PVA)-Polyethylene glycol (PEG) with Sodium nitrate (NaNO 3 ) and different weight percent of reduced graphene-oxide (rGO) were prepared by standard solution cast technique. The structural properties were analysed by the X-ray diffraction of the nanocomposite shows the uniform distribution of rGO in the polymer matrix and confirms the amorphous nature of the polymer blend composite films. FTIR studies clearly shows the confirmation of strong interaction between polymer, rGO (nanofillers) and Na-ion. The chemical bond formation spectrum or structure is analyzed by Raman spectroscopy to understand the chemical variation of the polymer composite, which confirm the presence of rGO in the composites. Thermal analysis DSC / TGA results show that the amount of rGO in the blend polymer matrix has a significantly improved the thermal stability of blend polymer composite films. The surface morphology of the as prepared films was analysed by field emission scanning electron microscope. The electrical properties of as prepared films show the highest ionic conductivity σ ∼ 10 –6 S cm −1 in 30 wt.% based BPCE films (at 323 K). The dielectric properties of blend polymer composites films were measured over a wide frequency range of 10 –1 to 10 7  Hz at two different temperatures, which illustrates the increment in a.c conductivity and dielectric permittivity of blend polymer composite films by adding the rGO contents. The performance of the electrochemical stability window was found up to ( ∼ 4.15 V vs.Na + /Na) and ionic transference numbers found ∼ 0.91 at room temperature. Ion transport mechanism is the key parameter and reveals better ion transportation in electrolytes during electrochemical analysis.

Vertically aligned carbon nanotubes having the advanced atomic configuration, structural properties, and electronic conductivity, which makes the CNTs as an eminent candidate for the electron field emission. In the present work, we have altered the morphology of the vertically aligned - CNT field emitters for improving the electron field emission parameters and temporal stability. The structural tuning and alteration of CNT field emitters was performed in the electron cyclotron resonance based chemical vapor deposition system via generating a dense resonating plasma of NH 3 gas. The as-synthesized pristine and resonating plasma treated VA-CNT field emitters were characterized by field emission scanning electron microscope for study the morphology, and Raman spectroscopy for the analysis of quality and structural defects. The horn type protrusions were formed after resonating plasma treatment. The electron field emission properties were drastically influenced by the time-based resonating plasma treatment. In terms of the reduction in the turn-on E to and threshold E th electric fields, improvement in the emission current density J , increment in the conventional characteristics field enhancement factor γ , and excellent temporal emission stability due to the incorporation of nitrogen species in the graphitic sheet of nanotubes, reduction in the screening effect, edge effect enhanced, and formation of defects in the graphitic sheet of VA-CNT. The calculated scaled barrier field values belong in the acceptable range and hence, orthodox emission hypothesis test qualified.

Foot fractures vary in severity with complex midfoot fractures having poor morbidity rates and high amputation rates. Complex midfoot fractures are rarely reported since they are uncommon and only treated in specialist centres. Given the important role of the midfoot in foot function, reconstruction is preferable. Soft tissue management on the dorsal aspect of the foot poses further challenges to reconstructive surgeons. We report a case of a 55-year-old woman who sustained an open 3C Gustilo–Anderson fracture that was initially treated with open reduction internal fixation and free flap. She subsequently developed flap and internal fixation failure with osteomyelitis of the talus. We report a good outcome using primary limb shortening with a talectomy, tibiocalcaneal arthrodesis using external fixation and a combination of vancomycin-loaded calcium sulphate and intravenous antibiotics in our patient.

Background Urgent referral for suspected central nervous system (CNS) cancer is recommended, but little analysis of the referral criteria diagnostic performance has been conducted. New 2015 NICE guidance recommends direct brain imaging for patients with symptoms with positive predictive values (PPV) of 3 %, but further guidance is needed. Methods A 12-month retrospective evaluation of 393 patients referred under previous 2005 NICE 2-week rule criteria was conducted. Analysis was based on the three groups of symptoms forming the referral criteria, (1) CNS symptoms, (2) recent onset headaches, (3) rapidly progressive subacute focal deficit/cognitive/behavioural/personality change. Comparison was made with neuroimaging findings. Results Twelve (3.1 %) of 383 patients who attended clinic had CNS cancer suggesting the combination of clinical judgement and application of 2005 criteria matched the 2015 guideline’s PPV threshold. PPVs for the three groups of symptoms were (1) 4.1 % (95 % CIs 2.0 to 7.4 %), (2) 1.2 % (0.1 to 4.3 %) and (3) 3.7 % (0.1 to 19.0 %). Sensitivities were (1) 83.3 % (95 % CIs 51.6 to 97.9 %), (2) 16.7 % (2.1 to 48.4 %), and (3) 8.3 % (0.2 to 38.5 %); specificities were (1) 37.2 % (32.3 to 42.3 %), (2) 55.5 % (50.3 to 60.7 %) and (3) 93.0 % (89.9 to 95.4 %). Of 288 patients who underwent neuroimaging, 59 (20.5 %) had incidental findings, most commonly cerebrovascular disease. Conclusions The 2015 guidance is less prescriptive than previous criteria making clinical judgement more important. CNS symptoms had greatest sensitivity, while PPVs for CNS symptoms and rapidly progressive subacute deficit/cognitive/behavioural/personality change were closest to 3 %. Recent onset headaches had the lowest sensitivity and PPV.