Can manipulation under anesthesia alone provide clinical outcomes similar to arthroscopic circumferential capsular release in primary frozen shoulder (FS)?: the necessity of arthroscopic capsular release in primary FS

Background We evaluated the need for arthroscopic capsular release (ACR) in refractory primary frozen shoulder (FS) by comparing clinical outcomes of patients treated with ACR and manipulation under anesthesia (MUA). Methods We assessed patients with refractory primary FS, 57 patients (group A) who were treated with MUA and 22 patients (group B) who were treated with ACR. In group A, manipulation including a backside arm-curl maneuver was performed under interscalene brachial block. In group B, manipulation was performed only to release the inferior capsule before arthroscopic circumferential capsular release, which was carried out for the unreleased capsule after manipulation. Pain, range of shoulder motion, and American Shoulder and Elbow Surgeons score were recorded at 1 week, 3 months, 6 months, and 1 year after surgery. We compared outcome variables between treatment groups and between diabetics and non-diabetics and also evaluated the numbers of patients receiving additional intra-articular steroid injection. Results Outcome variables at 3 months after surgery and improvements in outcome variables did not differ between groups. Group A showed significantly better results than group B in the evaluation of pain and range of motion at 1 week. Diabetics showed comparable outcomes to non-diabetics for most variables. Eleven patients required additional steroid injections between 8 to 16 weeks after surgery: 12.2% in group A, 18.2% in group B. Additional injections were given three times more often in diabetics compared to non-diabetics. Conclusions MUA alone can yield similar clinical outcomes to ACR in refractory FS

A hybrid decision support model to discover informative knowledge in diagnosing acute appendicitis

BACKGROUND: The aim of this study is to develop a simple and reliable hybrid decision support model by combining statistical analysis and decision tree algorithms to ensure high accuracy of early diagnosis in patients with suspected acute appendicitis and to identify useful decision rules. METHODS: We enrolled 326 patients who attended an emergency medical center complaining mainly of acute abdominal pain. Statistical analysis approaches were used as a feature selection process in the design of decision support models, including the Chi-square test, Fisher's exact test, the Mann-Whitney U-test (p < 0.01), and Wald forward logistic regression (entry and removal criteria of 0.01 and 0.05, or 0.05 and 0.10, respectively). The final decision support models were constructed using the C5.0 decision tree algorithm of Clementine 12.0 after pre-processing. RESULTS: Of 55 variables, two subsets were found to be indispensable for early diagnostic knowledge discovery in acute appendicitis. The two subsets were as follows: (1) lymphocytes, urine glucose, total bilirubin, total amylase, chloride, red blood cell, neutrophils, eosinophils, white blood cell, complaints, basophils, glucose, monocytes, activated partial thromboplastin time, urine ketone, and direct bilirubin in the univariate analysis-based model; and (2) neutrophils, complaints, total bilirubin, urine glucose, and lipase in the multivariate analysis-based model. The experimental results showed that the model with univariate analysis (80.2%, 82.4%, 78.3%, 76.8%, 83.5%, and 80.3%) outperformed models using multivariate analysis (71.6%, 69.3%, 73.7%, 69.7%, 73.3%, and 71.5% with entry and removal criteria of 0.01 and 0.05; 73.5%, 66.0%, 80.0%, 74.3%, 72.9%, and 73.0% with entry and removal criteria of 0.05 and 0.10) in terms of accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under ROC curve, during a 10-fold cross validation. A statistically significant difference was detected in the pairwise comparison of ROC curves (p < 0.01, 95% CI, 3.13-14.5; p < 0.05, 95% CI, 1.54-13.1). The larger induced decision model was more effective for identifying acute appendicitis in patients with acute abdominal pain, whereas the smaller induced decision tree was less accurate with the test data. CONCLUSIONS: The decision model developed in this study can be applied as an aid in the initial decision making of clinicians to increase vigilance in cases of suspected acute appendicitis

Two distinct red giant branch populations in the globular cluster NGC 2419 as tracers of a merger event in the Milky Way

Recent spectroscopic observations of the outer halo globular cluster (GC) NGC 2419 show that it is unique among GCs, in terms of chemical abundance patterns, and some suggest that it was originated in the nucleus of a dwarf galaxy. Here we show, from the Subaru narrow-band photometry employing a calcium filter, that the red giant-branch (RGB) of this GC is split into two distinct subpopulations. Comparison with spectroscopy has confirmed that the redder RGB stars in the $hk$[=(Ca$-b)-(b-y)$] index are enhanced in [Ca/H] by $\sim$0.2 dex compared to the bluer RGB stars. Our population model further indicates that the calcium-rich second generation stars are also enhanced in helium abundance by a large amount ($\Delta$Y = 0.19). Our photometry, together with the results for other massive GCs (e.g., $\omega$ Cen, M22, and NGC 1851), suggests that the discrete distribution of RGB stars in the $hk$ index might be a universal characteristic of this growing group of peculiar GCs. The planned narrow-band calcium photometry for the Local Group dwarf galaxies would help to establish an empirical connection between these GCs and the primordial building blocks in the hierarchical merging paradigm of galaxy formation.Comment: 4 pages, 4 figures, 1 table, accepted for the publication in ApJ

Fabrication of double-ceramic-layer TBCs by suspension plasma spray

Rare-earth zirconates, such as La2Zr2O7 and Gd2Zr2O7, have been investigated as one of the candidates for replacing conventional yttria-stabilized zirconia (YSZ) for thermal barrier coating (TBC) applications at higher turbine inlet temperatures. Rare-earth zirconate oxides exhibit little phase transformation upon heating up to melting temperature as well as low thermal conductivity, where as their mechanical properties is inferior to those of YSZ TBCs. Double-ceramic-layer (DCL) TBCs have been investigated in order to take advantage of beneficial characteristics of both YSZ and rare-earth zirconate. In this study, the fabrication of DCL-TBCs with YSZ layer and rare-earth-zirconate top layer by using suspension plasma spray are reported. Microstructure, compositional profile, thermal conductivity, and thermal durability of DCL-TBCs are characterized. The usefulness of these DCL-TBCs is also discussed

Monitoring daily evapotranspiration in Northeast Asia using MODIS and a regional Land Data Assimilation System

We applied an approach for daily estimation and monitoring of evapotranspiration (ET) over the Northeast Asia monsoon region using satellite remote sensing observations from the Moderate Resolution Imaging Spectroradiometer (MODIS). Frequent cloud cover results in a substantial loss of remote sensing information, limiting the capability of continuous ET monitoring for the monsoon region. Accordingly, we applied and evaluated a stand-alone MODIS ET algorithm for representative regional ecosystem types and an alternative algorithm to facilitate continuous regional ET estimates using surface meteorological inputs from the Korea Land Data Assimilation System (KLDAS) in addition to MODIS land products. The resulting ET calculations showed generally favorable agreement (root-mean-square error  \u3c 1.3 mm d−1) with respect to in situ measurements from eight regional flux tower sites. The estimated mean annual ET for 3 years (2006 to 2008) was approximately 362.0 ± 161.5 mm yr−1 over the Northeast Asia domain. In general, the MODIS and KLDAS-based ET (MODIS-KLDAS ET) results showed favorable performance when compared to tower observations, though the results were overestimated for a forest site by approximately 39.5% and underestimated for a cropland site in South Korea by 0.8%. The MODIS-KLDAS ET data were generally underestimated relative to the MODIS (MOD16) operational global terrestrial ET product for various biome types, excluding cropland; however, MODIS-KLDAS ET showed better agreement than MOD16 ET for forest and cropland sites in South Korea. Our results indicate that MODIS ET estimates are feasible but are limited by satellite optical-infrared remote sensing constraints over cloudy regions, whereas alternative ET estimates using continuous meteorological inputs from operational regional climate systems (e.g., KLDAS) provide accurate ET results and continuous monitoring capability under all-sky conditions

Early Surgical Repair of Acute Complete Rupture of the Proximal Hamstring Tendons

Hamstring injuries are common forms of muscle strains in athletes but a complete rupture of a proximal hamstring origin is rare. Often there is a considerable delay in diagnosis and stringent treatment because of its rarity, difficulty in clinical diagnosis, and initial attempts of conservative care. We report two cases of acute complete rupture of the proximal hamstring tendons treated with early surgical repair. The diagnosis and treatment of this unusual injury are discussed