The Development of a Universally Accepted Sacral Fracture Classification: A Survey of AOSpine and AOTrauma Members.

Study Design Survey study. Objective To determine the global perspective on controversial aspects of sacral fracture classifications. Methods While developing the AOSpine Sacral Injury Classification System, a survey was sent to all members of AOSpine and AOTrauma. The survey asked four yes-or-no questions to help determine the best way to handle controversial aspects of sacral fractures in future classifications. Chi-square tests were initially used to compare surgeons\u27 answers to the four key questions of the survey, and then the data was modeled through multivariable logistic regression analysis. Results A total of 474 surgeons answered all questions in the survey. Overall 86.9% of respondents felt that the proposed hierarchical nature of injuries was appropriate, and 77.8% of respondents agreed that that the risk of neurologic injury is highest in a vertical fracture through the foramen. Almost 80% of respondents felt that the separation of injuries based on the integrity of L5-S1 facet was appropriate, and 83.8% of surgeons agreed that a nondisplaced sacral U fracture is a clinically relevant entity. Conclusion This study determines the global perspective on controversial areas in the injury patterns of sacral fractures and demonstrates that the development of a comprehensive and universally accepted sacral classification is possible

Real-Gas Effects and Phase Separation in Underexpanded Jets at Engine-Relevant Conditions

A numerical framework implemented in the open-source tool OpenFOAM is presented in this work combining a hybrid, pressure-based solver with a vapor-liquid equilibrium model based on the cubic equation of state. This framework is used in the present work to investigate underexpanded jets at engine-relevant conditions where real-gas effects and mixture induced phase separation are probable to occur. A thorough validation and discussion of the applied vapor-liquid equilibrium model is conducted by means of general thermodynamic relations and measurement data available in the literature. Engine-relevant simulation cases for two different fuels were defined. Analyses of the flow field show that the used fuel has a first order effect on the occurrence of phase separation. In the case of phase separation two different effects could be revealed causing the single-phase instability, namely the strong expansion and the mixing of the fuel with the chamber gas. A comparison of single-phase and two-phase jets disclosed that the phase separation leads to a completely different penetration depth in contrast to single-phase injection and therefore commonly used analytical approaches fail to predict the penetration depth.Comment: Preprint submitted to AIAA Scitech 2018, Kissimmee, Florid

Sacral Fractures and Associated Injuries.

STUDY DESIGN: Literature review. OBJECTIVE: The aim of this review is to describe the injuries associated with sacral fractures and to analyze their impact on patient outcome. METHODS: A comprehensive narrative review of the literature was performed to identify the injuries associated with sacral fractures. RESULTS: Sacral fractures are uncommon injuries that result from high-energy trauma, and that, due to their rarity, are frequently underdiagnosed and mistreated. Only 5% of sacral fractures occur in isolation. Injuries most often associated with sacral fractures include neurologic injuries (present in up to 50% of sacral fractures), pelvic ring disruptions, hip and lumbar spine fractures, active pelvic/ abdominal bleeding and the presence of an open fracture or significant soft tissue injury. Diagnosis of pelvic ring fractures and fractures extending to the lumbar spine are key factors for the appropriate management of sacral fractures. Importantly, associated systemic (cranial, thoracic, and abdominopelvic) or musculoskeletal injuries should be promptly assessed and addressed. These associated injuries often dictate the management and eventual outcome of sacral fractures and, therefore, any treatment algorithm should take them into consideration. CONCLUSIONS: Sacral fractures are complex in nature and often associated with other often-missed injuries. This review summarizes the most relevant associated injuries in sacral fractures and discusses on their appropriate management

Preoperative assessment of meningioma aggressiveness by Thallium-201 brain SPECT

Introduction: Meningioma is usually a benign brain tumor, but sometimes with aggressive course. The aim of this study was to assess the ability of 201Tl Brain SPECT to differentiate the pathologic grade of meningioma preoperatively. Methods: Thirty lesions in 28 patients were evaluated in this study. Early (20 minutes) and late (3 hours) brain SPECT images were performed and early uptake ratio (EUR), late uptake ratio (LUR) and retention index (RI) were calculated. All patients were operated and pathologic grade of tumors were defined according to World Health Organization grading system. Results: SPECT results were compared in different pathologic groups. Data analysis clarified no significant difference of EUR in benign and aggressive meningioma (P=0.2). However LUR and RI were significantly higher in aggressive tumors (P=0.001 and P=0.02, respectively). Conclusion: According to our data Tl-201 Brain SPECT with early and late imaging has 80 sensitivity and specificity to differentiate malignant from benign meningioma

Influence of plasmon excitations on atomic‑resolution quantitative 4D scanning transmission electron microscopy

Scanning transmission electron microscopy (STEM) allows to gain quantitative information on the atomic‑scale structure and composition of materials, satisfying one of todays major needs in the development of novel nanoscale devices. The aim of this study is to quantify the impact of inelastic, i.e. plasmon excitations (PE), on the angular dependence of STEM intensities and answer the question whether these excitations are responsible for a drastic mismatch between experiments and contemporary image simulations observed at scattering angles below∼40 mrad. For the two materials silicon and platinum, the angular dependencies of elastic and inelastic scattering are investigated. We utilize energy filtering in two complementary microscopes, which are representative for the systems used for quantitative STEM, to form position‑averaged diffraction patterns as well as atomically resolved 4D STEM data sets for different energy ranges. The resulting five‑dimensional data are used to elucidate the distinct features in real and momentum space for different energy losses. We find different angular distributions for the elastic and inelastic scattering, resulting in an increased low‑angle intensity (∼10–40 mrad). The ratio of inelastic/elastic scattering increases with rising sample thickness, while the general shape of the angular dependency is maintained. Moreover, the ratio increases with the distance to an atomic column in the low‑angle regime. Since PE are usually neglected in image simulations, consequently the experimental intensity is underestimated at these angles, which especially affects bright field or low‑angle annular dark field imaging. The high‑angle regime, however, is unaffected. In addition, we find negligible impact of inelastic scattering on first‑ moment imaging in momentum‑resolved STEM, which is important for STEM techniques to measure internal electric fields in functional nanostructures. To resolve the discrepancies between experiment and simulation, we present an adopted simulation scheme including PE. This study highlights the necessity to take into account PE to achieve quantitative agreement between simulation and experiment. Besides solving the fundamental question of missing physics in established simulations, this finally allows for the quantitative evaluation of low‑angle scattering, which contains valuable information about the material investigated

Concepts of patients with alopecia areata about their disease

BACKGROUND: Alopecia areata (AA) is a common and chronic skin disease with an unknown etiology. It may significantly affect the patient quality of life. This study was designed to evaluate the illness perception in patients with AA. METHODS: A questionnaire consisting of 25 questions about causes, timeline, consequences and control of disease were given to 80 patients with AA attending a skin clinic in Tehran, Iran. The impact of age, gender, duration of disease, education, extent of disease and family history of AA were also assessed. RESULTS: Eighty patients (38 male and 42 female) with a mean age of 27.5 years (SD = 9.3) and disease duration of 7.8 years (SD = 7.7) completed the questionnaire. 76.9% of the patients believed that the role of stress was the cause of disease. 17.1 % believed genetic background to be the main cause, this found to be more frequent in patients with positive family history of AA. More than half of patients believed that their illness had major consequences on their lives and 40% of patients believed that their illness would be likely to be permanent rather than temporary, more in patients with longer duration of disease. Only 57.5% of patients considered their treatments to be effective. CONCLUSION: AA may considerably affect various aspects of patients' lives. The patient knowledge about the causes and course of this disease is limited