Multidirectional Instability Accompanying an Inferior Labral Cyst

Paralabral cyst of the shoulder joint can be observed in 2% to 4% of the general population, particularly in men during the third and fourth decade. On average, these cysts measure 10 mm to 20 mm in diameter and are located preferentially on the postero-superior aspect of the glenoid. The MRI has increased the frequency of the diagnosis of paralabral cysts of the shoulder joint. Paralabral cysts of the shoulder joint usually develop in the proximity of the labrum. The relationship between shoulder instability and labral tears is well known, however, the association of shoulder instability with a paralabral cyst is rare. Shoulder instability may cause labral injury or labral injury may cause shoulder instability, and then injured tear develops paralabral cyst. In our patient, the inferior paralabral cyst may be associated with inferior labral tears and instability MRI

Mid-term Clinical and Radiological Outcomes of Latissimus Dorsi Tendon Transfer in Massive Rotator Cuff Tears

Background This retrospective study was undertaken to evaluate mid-term clinical and radiological outcomes of lattisimus dorsi (LD) tendon transfer in patients with irreparable massive rotator cuff tears (MRCT). We hypothesize that LD tendon transfer would provide safe and satisfactory clinical outcomes at mid-term follow-up. Methods From November 2008 to December 2016, 23 patients (57.5 ± 4.4 years; 20 male, 3 female) who underwent LD tendon transfer for massive tears, were enrolled. Inclusion criteria were irreparable MRCT. Exclusion criteria included full thickness subscapularis tear, rotator cuff arthropathy, anterosuperior rotator cuff tear, and osteoarthritis. Mean follow-up period was 4.7 ± 4.0 years (range, 2–12 years). Clinical assessment (American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA], Simple Shoulder Test [SST]) and radiographic assessment (osteoarthritis [OA], acromiohumeral distance [AHI]) were evaluated. Results ASES, UCLA and SST scores, and range of motion (ROM), except internal rotation, improved significantly at the last follow-up (p<0.05). Also, AHI was significantly improved at the last follow-up, from 6.6 mm to 8.2 mm (p=0.008). At the final follow-up, the radiologic stages of the glenohumeral osteoarthritis were determined as stage 1 in 9 patients, stage 2 in 10 patients, stage 3 in 2 patients, and stage 4 in 2 patients. Complications were observed in 21.7% cases: 3 re-tears and 2 infections were noted in our study. Conclusions LD tendon transfer for irreparable MRCT provides satisfactory clinical outcomes at mid-term follow-up. Mild degenerative osteoarthritis (stage 1, 2) of the shoulder joint are common at the mid-term follow-up. Also, complications such as tear, infection should be considered

Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population

Background To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up. Methods From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with minimum 2 years follow-up were enrolled. We evaluated the clinical and radiological outcomes, and complications at the last follow-up. In addition, we divided these patients into notching and no-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients. Results Visual analogue scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles Shoulder Scale, and Simple Shoulder Test scores improved significantly from preoperative (5.00, 3.93, 1.72, 3.94) to postoperative (1.72, 78.91, 28.34, 7.66) (p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20 of 38 patients (53%). In the comparison between notching and no-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications included three metaphyseal fractures and one inferior screw malposition. Postoperative complications included ectopic ossification, scapular neck stress fracture, humeral stem relaxation, and late infection in one case each. Conclusions BIO-RSA showed improved clinical outcomes at mid-term follow-up in Asian population. However, we observed higher scapular notching compared to the previous studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching

Surgical management of pilon fractures with large segmental bone defects using fibular strut allografts: a report of two cases

We present two patients with open pilon fractures with large bone defects treated successfully with fibular strut allografts. The patients were initially treated by massive irrigation, wound debridement, and temporary external fixation. After complete wound healing, the bone defects were managed. Because autologous iliac crest or fibular bone grafts were impossible to be harvested due to multiple fractures, the bone defects were reconstructed with fibular strut allografts. Fixation was performed with a periarticular distal tibia locking plate. At 2 months postoperatively, the patients ambulated with partial weight-bearing; at 6 months, they had full range of motion of the ankle joint and full weight-bearing

Assesment of safety analysis code on integral effect test with SNUF

Paper presented at the 9th International Conference on Heat Transfer, Fluid Mechanics and Thermodynamics, Malta, 16-18 July, 2012.A Safety and Performance Analysis CodE (SPACE) is a thermal-hydraulics computer code under development of South Korea for analysis of complicated phenomena in the nuclear power plants including anticipated transients and postulated accidents. This study assessed the SPACE code capability for prediction of the direct vessel injection (DVI) system, which is adopted as a key safety system in the APR1400 reactor. This study mainly focused on the DVI line break accident, one of the postulated SBLOCA accidents that might result in loss of main coolant water and a quarter of safety injection water simultaneously, for assessment of the code. In order to evaluate the code prediction capability on the phenomena associated with the downcomer seal clearing at the DVI line break, this study selected the SNUF DVI break experiment as the experimental benchmark. This experiment is a reduced-height and reduced-pressure (RHRP) integral test facility designed for simulation of the primary loop of APR1400 designed in Korea. As a result, the SPACE showed reliable agreement with the experimental data on seal clearing phenomena well predicting both the start point of downcomer seal clearance and loop seal clearance. In the DVI system, downcomer seal clearing appears to be more important than loop seal clearing because the vapor generated from core flows through downcomer to broken DVI line. Therefore, the core collapsed level increases as the vapor pressure decreases in the coredc201

Diagnosis and Prognosis Using Machine Learning Trained on Brain Morphometry and White Matter Connectomes

Accurate, reliable prediction of risk for Alzheimer’s disease (AD) is essential for early, diseasemodifying therapeutics. Multimodal MRI, such as structural and diffusion MRI, is likely to contain complementary information of neurodegenerative processes in AD. Here we tested the utility of commonly available multimodal MRI (T1-weighted structure and diffusion MRI), combined with high-throughput brain phenotyping—morphometry and connectomics—and machine learning, as a diagnostic tool for AD. We used, firstly, a clinical cohort at a dementia clinic (study 1: Ilsan Dementia Cohort; N=211; 110 AD, 64 mild cognitive impairment [MCI], and 37 subjective memory complaints [SMC]) to test and validate the diagnostic models; and, secondly, Alzheimer’s Disease Neuroimaging Initiative (ADNI)-2 (study 2) to test the generalizability of the approach and the prognostic models with longitudinal follow up data. Our machine learning models trained on the morphometric and connectome estimates (number of features=34,646) showed optimal classification accuracy (AD/SMC: 97% accuracy, MCI/SMC: 83% accuracy; AD/MCI: 97% accuracy) with iterative nested cross-validation in a single-site study, outperforming the benchmark model (FLAIR-based white matter hyperintensity volumes). In a generalizability study using ADNI-2, the combined connectome and morphometry model showed similar or superior accuracies (AD/HC: 96%; MCI/HC: 70%; AD/MCI: 75% accuracy) as CSF biomarker model (t-tau, p-tau, and Amyloid β, and ratios). We also predicted MCI to AD progression with 69% accuracy, compared with the 70% accuracy using CSF biomarker model. The optimal classification accuracy in a single-site dataset and the reproduced results in multisite dataset show the feasibility of the high-throughput imaging analysis of multimodal MRI and data-driven machine learning for predictive modeling in AD

SUCCESSFUL FACTORS OF 540° DWIHURYEOCHAGI IN TAEKWONDO

The purpose of our study was to provide fundamental information about success factors of 540° Dwihuryeochagi in Taekwondo. Twenty Taekwondo athletes who participated in the 2012 Taekwondo Kyukpa Wang (breaking king) championship: ten successful athletes (S, age: 23.1±1.6 yrs, height: 171.0±3.5 cm, body mass: 66.4±7.1 kg) and ten failed athletes (F, age: 22.3±1.8 yrs, height: 172.1±5.4 cm, body mass: 64.4±4.2 kg) were selected. Three-dimensional motion analysis using a system of 3 video cameras with a sampling of 60 fields/s was performed during the competition of 540 ° Dwihuryeochagi. Based on the findings, it is concluded that success factors of 540° Dwihuryeochagi were horizontal velocity of COM during P1, vertical velocity of COM during P2, and the time, kick distance, velocity and angle of lower extremities of P3-P4

Altered Resting-State Functional Connectivity in Wernicke's Encephalopathy With Vestibular Impairment

Objectives: To reveal the neural basis of Wernicke's encephalopathy (WE) with impaired vestibulo-ocular reflex (VOR), we evaluated resting-state functional connectivity (rs-fc) in the vestibular processing brain regions. Methods: Rs-fc between the vestibular regions and the rest of the brain were compared with neurotological features including the head-impulse tests (vHIT) and caloric responses in patients with WE (n = 5, mean age 53.4 ± 10 years) and healthy controls (n = 20, mean age 55.0 ± 9.2 years). Rs-fc analyses employed a region of interest (ROI)-based approach using regions selected a priori that participate in vestibular processing including the cerebellar vermis, insula, parietal operculum, and calcarine cortex. Results: The main neurologic findings for patients with WE were mental changes; gait ataxia; spontaneous and gaze-evoked nystagmus (GEN); and bilaterally positive HIT for the horizontal canals. Video HIT documented bilateral horizontal canal dysfunction with decreased gain and corrective saccades. Caloric irrigation and rotation chair testing revealed prominent bilateral horizontal canal paresis. Patients with WE also had decreased spatial memory, which substantially recovered after treatments. Functional connections at the predefined seed regions, including the insular cortex and parietal operculum, were attenuated in the WE group compared to healthy controls. Conclusions: WE is related to impaired VOR and visuospatial dysfunction, and fMRI documented changes in the rs-fc of multisensory vestibular processing regions including the insula, parietal operculum, and superior temporal gyrus, which participate in integration of vestibular perception

Long-term Results of Primary Total Knee Arthroplasty with and without Patellar Resurfacing

Among patients that underwent total knee arthroplasty from June, 1990 to January, 1999, 61 cases (44 patients) that could be followed for more than 10 years were included in this study. The patients were divided into a patellar retention group and a patellar resurfacing group, and were compared with regard to their clinical and radiological outcomes. In patients undergoing primary TKA, a selective patellar resurfacing protocol was used. The indications for patellar retention were a small patella, nearly normal articular cartilage, minimal preoperative patellofemoral pain, poor patellar bone quality, and young patient age. When patellar retention was performed, osteophytes of the patella were removed and marginal electrocauterization was carried out. There were 25 cases (20 patients) in the patellar retention group and 36 cases (29 patients) in the patellar resurfacing group. The mean follow-up period was 140.7 months in the patellar retention group and 149.0 months in the patellar resurfacing group. The selective patellar resurfacing with total knee arthroplasty had a favorable outcome;there were a significant difference noted between the 2 groups in the functional scores, which showed better outcomes in the patellar resurfacing group than in the patellar retention group

THREE DIMENSIONAL ATOM PROBE STUDY OF NI-BASE ALLOY/LOW ALLOY STEEL DISSIMILAR METAL WELD INTERFACES

Three dimensional atom probe tomography (3D APT) is applied to characterize the dissimilar metal joint which was welded between the Ni-based alloy, Alloy 690 and the low alloy steel, A533 Gr. B, with Alloy 152 filler metal. While there is some difficulty in preparing the specimen for the analysis, the 3D APT has a truly quantitative analytical capability to characterize nanometer scale particles in metallic materials, thus its application to the microstructural analysis in multicomponent metallic materials provides critical information on the mechanism of nanoscale microstructural evolution. In this study, the procedure for 3D APT specimen preparation was established, and those for dissimilar metal weld interface were prepared near the fusion boundary by a focused ion beam. The result of the analysis in this study showed the precipitation of chromium carbides near the fusion boundary between A533 Gr. B and Alloy 152.close3