Can we predict 1-year functional outcomes and mortality following hip fracture in middle-aged and geriatric patients at time of admission?

This study's purpose is to determine if patients treated for hip fracture at highest risk for poor functional outcomes, shorter time to death, and death within 1-year can be predicted at the time of admission. We hypothesized that the Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) tool can be used to predict risk of these variables. Between February 2019-July 2020, 544 patients ≥ 55-years-old were treated for hip fracture [AO/OTA 31A/B, 32A/C]. Each patient's demographics, functional status, and injury details were used to calculate their respective risk (STTGMA) score at time of admission. Patients were divided into risk quartiles by STTGMA score. Patients were contacted by phone to complete EuroQol-5 Dimension (EQ5D-3L) questionnaires on functional status. Comparative analyses were conducted on outcomes and EQ5D-3L questionnaire results. 439 patients (80.7%) had at least 1-year follow-up. 82 patients (18.7%) died within 1-year after hospitalization. Mean STTGMA score was 1.67% ± 4.49%. The highest-risk cohort experienced a 42x (p < 0.01) and 2.5x (p = 0.01) increased rate of 1-year mortality compared to the minimal- and low-risk groups respectively. The highest-risk cohort had the shortest time to death (p = 0.015). The highest-risk cohort had the lowest EQ5D index (p < 0.01) and VAS scores (p < 0.01) along with the highest rate of 30 day readmission (p < 0.01) and the longest length of stay (p < 0.01). The STTGMA tool provides important prognostic information for middle-aged and geriatric hip fracture patients that can help modulate care levels. This information is useful when counseling patients, their families, and caregivers on expected outcomes.

Enhanced Higher Harmonic Generation in Modified MAPbBr3-xClx Single Crystal by Additive Engineering

Mixed-halide perovskite materials (MHSCs) hold significant interest in photonics applications owing to their inherent advantages, including tunable bandgap properties, remarkable defect tolerance characteristics, and facile processability. These attributes position MHSCs as up-and-coming materials for various applications. However, the commercialization of these materials is severely affected by external factors, such as humidity and oxygen. The current work studies change in higher harmonics generation (HHG) in MAPbBr3-xClx single crystals (MHSC) with changing nitrogen-based additives. These additives act as a passivating layer and improve the nanolevel crystallinity. The additive engineering strategy impacts morphological and optical properties, depending on the additive's interaction.

Aromatic Additives Boost the Terahertz Properties of Mixed Halide Perovskite Single Crystals

Mixed halide perovskite (MHP) materials are promising candidates for photonic applications, owing to their tunable bandgap and pronounced optoelectronic properties. However, phase segregation in these materials severely impacts their scalability. The additive engineering (AE) strategy in the growth of most perovskite crystals (PSCs) has proven more effective. Current work focused toward enhancing the stability of 6.67% Cl-doped methylammonium lead(II) bromide single crystals (MHSCs) using aromatic nitrogen-based additives. Modified MHSCs showed enhanced terahertz (THz) radiation transmission and reflection. Moreover, the evidence from powder X-ray diffraction (p-XRD), X-ray photoelectron spectroscopy (XPS), and THz transmission in modified MHSCs revealed the mitigated phase segregation in modified MHSCs.

High-Order Harmonics Generation in MoS2 Transition Metal Dichalcogenides: Effect of Nickel and Carbon Nanotube Dopants

The transition metal dichalcogenides have instigated a lot of interest as harmonic generators due to their exceptional nonlinear optical properties. Here, the molybdenum disulfide (MoS2) molecular structures with dopants being in a plasma state are used to demonstrate the generation of intense high-order harmonics. The MoS2 nanoflakes and nickel-doped MoS2 nanoflakes produced stronger harmonics with higher cut-offs compared with Mo bulk and MoS2 bulk. Conversely, the MoS2 with nickel nanoparticles and carbon nanotubes (MoS2-NiCNT) produced weaker coherent XUV emissions than other materials, which is attributed to the influence of phase mismatch. The influence of heating and driving pulse intensities on the harmonic yield and cut-off energies are investigated in MoS2 molecular structures. The enhanced coherent extreme ultraviolet emission at ~32 nm (38 eV) due to the 4p-4d resonant transitions is obtained from all aforementioned molecular structures, except for MoS2-NiCNT.

Measurement of Optical Properties of CH3NH3PbX3 (X = Br, I) Single Crystals Using Terahertz Time-Domain Spectroscopy

Organometallic lead bromide and iodide perovskite single crystals (PSCs) are potential candidates for terahertz applications. Herein, we performed terahertz time-domain spectroscopy (THz-TDS) in the frequency range of 0.1-3.0 THz on different thicknesses of MAPbBr₃ (0.3, 0.6, and 0.8 mm) and MAPbI₃ (0.6, 0.8, 0.9, 1.3, and 2.3 mm). The measurements were carried out with respect to the position (along the focal area), azimuthal rotation of the PSCs, and incidence angles of the reference THz pulse on the PSCs' surface. Based on the transmitted THz pulses from PSCs from the above measurements, we calculated the real and imaginary parts of the refractive index, dielectric constants, absorption coefficients, and dark conductivity. These optical parameters tend to increase with decreases in the PSCs' thicknesses. The transmission spectra of the terahertz electric field indicate that the measured optical properties do not vary significantly with the position and orientation of PSCs. The real parts of the refractive index and dielectric constants are higher than the imaginary values for both PSCs. On the other hand, a slight blueshift in the optical phonon vibrations corresponding to Pb-Br/I-Pb and Pb-Br/I bonds is observed with an increase in thickness. Interestingly, the phonon vibrations do not vary with the incidence angle of the THz pulses on the same crystal's surface. The optical parameters based on THz-TDS reveal that the PSCs satisfy the requirement for tunable THz devices which need suitable, sensitive, and stable absorption properties between 0.1 and 3 THz.

Harmonics Generation in the Laser-Induced Plasmas of Metal and Semiconductor Carbide Nanoparticles

Carbon-containing plasma is an attractive medium for generation of harmonics of laser pulses in the extreme ultraviolet range. We ablate two metal carbide (B₄C and Cr₃C₂) nanoparticles and silicon carbide (SiC) nanoparticles and generate harmonics after propagation of 35 fs pulses through the laser-induced plasmas. We analyze the spectra, spectral shifts, and splitting of harmonics from nanoparticles-contained plasmas, which demonstrate the chirp-related harmonic cut-off scaling. In addition, we present the simplified two-color pump model calculations of HHG based on the strong field approximation.

High-order harmonics generation in nanosecond-pulses-induced plasma containing Ni-doped CsPbBr3perovskite nanocrystals using chirp-free and chirped femtosecond pulses

We demonstrate high-order harmonic generation in Ni-doped CsPbBr₃perovskite nanocrystals ablated by nanosecond pulses using chirp-free 35 fs, and chirped 135 fs pulses in the case of single-color pump (800 nm) and a two-color pump (800 and 400 nm). We analyzed the spectral shift, cut-off, and intensity distribution of harmonics in the case of chirped drving pulses compared to chirp-free pulses. It is shown that the presence of Ni dopants and CsPbBr₃plasma components improves the harmonics emission. Also, we measured the third-order nonlinear optical (NLO) properties of these nanocrystals using 800 nm, 60 fs, 1 kHz pulses. The variations of measured NLO parameters of CsPbBr₃perovskite nanocrystals containing different concentrations of nickel correlate with variations of generated high-order harmonics from laser induced plasmas of studied nanocrystals in terms of harmonics intensity, cut-off, and spectral shift (in case of chirped driving pulses). The spectral shift of the harmonics generated from the Ni-doped CsPbBr₃perovskite nanocrystals can be used to form tunable extreme ultraviolet sources.

Total shoulder arthroplasty for proximal humerus fracture is associated with increased hospital charges despite a shorter length of stay

BACKGROUND

Operation choice is a complex decision in the surgical management of proximal humerus fractures. Recently, there has been an increase in the use of total shoulder arthroplasty (TSA) for complex fracture patterns.

HYPOTHESIS

Patients with proximal humerus fractures who receive TSA are more likely to have higher hospital charges and a prolonged length of stay relative to patients receiving hemiarthroplasty (HA), open reduction with internal fixation (ORIF) or closed reduction with internal fixation (CRIF).

MATERIALS AND METHODS

A statewide electronic database was used to identify 13,316 hospital admissions from 2000-2011 were a proximal humerus fracture was surgically managed in an effort to determine the effect of operation choice on cost and length of stay. A univariate analysis was preformed to examine overall trends in surgical management. Additionally, a periodic, multivariate logistic regression analysis was used to determine how operation choice affected the odds of a high cost hospital stay or a prolonged length of stay after controlling for age, comorbidity burden, gender, and insurance type.

RESULTS

After controlling for confounding factors, patients receiving total shoulder arthroplasty (TSA) were 2.25 times more likely to have high total hospital charges than patients receiving HA and 3.21 times more likely than patients receiving ORIF. Additionally, TSA was found to be a significant negative predictor of prolonged length of stay (pLOS). HA, ORIF and CRIF did not significantly predict pLOS.

DISCUSSION

The use of TSA for acute proximal humerus fractures is associated with increased hospital costs despite a shorter length of stay when compared to other operative choices. As reverse total shoulder arthroplasty becomes more popular for treatment of this injury, it is important that functional outcomes be interpreted in the context of relative cost trade-offs.

LEVEL OF EVIDENCE

Level IV.

Inflammation and bony changes at the temporomandibular joint

Cytokines help mediate the acute and chronic inflammation and associated destruction of connective tissue in arthritic temporomandibular joints (TMJ). The proinflammatory cytokines TNFalpha, IL-1beta, IL-6, IL-8, and IFN-gamma are associated with inflammation in synovial joints and connective tissue destruction. Therefore, the increased levels of these cytokines in the synovial fluid of temporomandibular disorder (TMD) patients would be expected. Conversely, IL-1ra and IL-10 acts as inhibitors to these proinflammatory cytokines. Thus, in TMD patients, low levels of IL-1ra and IL-10 might be expected. A review of studies from multiple investigators confirms that proinflammatory cytokine levels increase in TMD patients, IL-1ra levels are also increased, and IL-10 levels remain unchanged. Because IL-10 can inhibit TNFalpha, IL-1, IL-6, and IL-8, the lack of IL-10 in the TMJ in the face of the other studies showing increases in TNFalpha, IL-1beta, IL-6, and IL-8 could partially explain the exacerbation of the associated osteoarthritis. In addition, although IL-1ra levels are elevated in most of the TMD patients, the increases do not appear to be sufficient to inhibit the inflammation and connective tissue degradation associated with IL-1beta. Thus, it appears that treatment of TMD requires a delicate balance between proinflammatory cytokines and cytokine inhibitors such as IL-1ra and IL-10.