Safety and feasibility of optimized transcranial direct current stimulation in patients with mild cognitive impairment due to Alzheimer's disease: a multicenter study protocol for a randomized controlled trial.

Introduction: Transcranial direct current stimulation (tDCS) may effectively preserve and improve cognitive function in patients with mild cognitive impairment (MCI). Research has shown that Individual brain characteristics can influence the effects of tDCS. Computer three-dimensional brain modeling based on magnetic resonance imaging (MRI) has been suggested as an alternative for determining the most accurate tDCS electrode position based on the patients' individual brain characteristics to enhance tDCS effects. Therefore, this study aims to determine the feasibility and safety of applying tDCS treatment using optimized and personalized tDCS electrode positions in patients with Alzheimer's disease (AD)-induced MCI using computer modeling and compare the results with those of a sham group to improve cognitive function. Method: A prospective active-sham group feasibility study was set to recruit 40 participants, who will be randomized into Optimized-tDCS and Sham-tDCS groups. The parameters for tDCS will be 2 mA (disk electrodes R = 1.5 cm) for 30 min during two sets of 15 sessions (2 weeks of resting period in between), using two electrodes in pairs. Using computer modeling, the tDCS electrode positions of each participant will be personalized. Outcome measurements are going to be obtained at three points: baseline, first post-test, and second post-test. The AD assessment scale-cognitive subscale (ADAS-Cog) and the Korean version of Mini-Mental State Examination (K-MMSE), together with other secondary outcomes and safety tests will be used. Discussion: For the present study, we hypothesize that compared to a sham group, the optimized personalized tDCS application would be effective in improving the cognitive function of patients with AD-induced MCI and the participants would tolerate the tDCS intervention without any significant adverse effects.Clinical trial registration: https://cris.nih.go.kr, identifier [KCT0008918].

Fragment excision and triceps V-Y advanced reattachment using suture anchor for olecranon nonunion: A case report.

RATIONALE: The nonunion of olecranon fractures is uncommon in simple fractures, and it is challenging to treat surgically due to the disruption of the anatomy of the elbow joint. There is limited literature on surgical options, and several factors to determine the treatment, including the amount and quality of bone stock, age, and degree of articular damage. PATIENT CONCERNS: A 58-year-old man presented at the clinic with neglected olecranon fracture for 1 year (case 1). A 74-year-old man (case 2) presented with consistent pain and limited of motion after surgery for olecranon fracture. DIAGNOSIS: Both patients were diagnosed with olecranon nonunion. INTERVENTION: Both patients received the excision of nonunited fragment and reattaching with V-Y advancement of triceps. OUTCOMES: Range of motion and Mayo elbow performance score were improved after surgery. LESSONS: This technique is useful in patients who cannot undergo other surgical options due to insufficient bone quality and elbow function, and it can lead to satisfactory outcomes with an acceptable range of motion and pain relief.

Volumetric changes in temporomandibular joint space following trans-oral vertical ramus osteotomy in patients with mandibular prognathism: a one-year follow-up study.

This study measured and analyzed chronological changes in temporomandibular joint space volume by compartment following transoral vertical ramus osteotomy (TOVRO) using reconstructed 3-dimensional (3D) images of patients with mandibular prognathism. It included 70 joints of 35 patients who underwent TOVRO between January 2018 and December 2021. Computed tomography (CT) or cone-beam CT (CBCT) was performed before surgery (T0) and at 3 days (T1), 6 months (T2), and 12 months postoperatively (T3). These scans were then analyzed using 3D software. The volumes of the overall (Vjs), anterior (Vajs), posterior (Vpjs), medial (Vmjs), and lateral (Vljs) joint spaces were calculated at each time point. A linear mixed model and repeated-measures covariance pattern with unstructured covariance were used to evaluate significant changes in joint space volume over time. Vjs significantly increased to 134.54 ± 34.28 mm3 at T3 compared to T0 (p < 0.001). Vpjas and Vljs increased by 130.72 ± 10.07 mm3 and 109.98 ± 7.52 mm3 at T3 compared to T0, respectively (p < 0.001). However, no significant difference was observed between T0 and T2 in Vajs and Vmjs (p = 0.9999). The observed volume increases in Vpjs and Vljs appeared to contribute to the overall Vjs increase.

Shear-Pressure Decoupling and Accurate Perception of Shear Directions in Ionic Sensors by Analyzing the Frequency-Dependent Ionic Behavior.

In artificial tactile sensing, to emulate the human sense of touch, independent perception of shear force and pressure is important. Decoupling the pressure and shear force is a challenging task for ensuring stable grasping manipulation for both soft and brittle objects. This study introduces a deformable ion gel-based tactile sensor that is capable of distinguishing pressure from shear force when pressurized shear force is applied in any direction. Recognition of the decoupled forces and precise shear directions is enabled by acquiring tactile data at only two frequencies (20 Hz and 10 kHz) based on the frequency-dependent ion dynamics. This study demonstrates monitoring the changes in pressure, shear force, and shear directions while performing practical robotic actions, such as pouring a water bottle, opening a water bottle cap, and picking up a book and placing it on a shelf.

Glenohumeral versus subacromial steroid injections for impingement syndrome with mild stiffness: a randomized controlled trial.

BACKGROUND: The subacromial (SA) space is a commonly used injection site for treatment of impingement syndrome. For shoulder stiffness, glenohumeral (GH) injections are commonly performed. However, in cases of impingement syndrome with mild shoulder stiffness, the optimal site of steroid injection has yet to be identified. METHODS: This prospective, randomized study compared the short-term outcomes of ultrasound-guided GH and SA steroid injections in patients who were diagnosed with impingement syndrome and mild stiffness. Each group comprised 24 patients who received either a GH or SA injection of 40 mg of triamcinolone. Range of motion and clinical scores were assessed before and 3, 7, and 13 weeks after the injection. RESULTS: GH and SA injections significantly improved the range of motion and clinical scores after 13 weeks of follow-up. Notably, targeting the GH joint resulted in an earlier gain of forward elevation, external rotation, and internal rotation in 3 weeks (P<0.001, P=0.012, and P=0.002, respectively) and of internal rotation and a Constant-Murley score in 7 weeks (P<0.001 and P=0.046). Subsequent measurements were similar between the groups and showed a steady improvement in all ranges of motion and clinical scores. CONCLUSIONS: GH injections may be more favorable than SA injections for treatment of impingement syndrome with mild stiffness, especially in improving the range of motion in the early period. However, the procedures showed similar outcomes after 3 months. Level of evidence: I.

Impact of transcranial direct current stimulation on white matter microstructure integrity in mild cognitive impairment patients according to effect modifiers as risk factors for Alzheimer's disease.

Background: Little research exists on how individual risk factors for Alzheimer's disease (AD) affect the intermediate phenotype after transcranial direct current stimulation (tDCS), despite the importance of precision medicine-based therapeutic approaches. Objective: To determine how an application of sequential tDCS (2 mA/day, left dorsolateral prefrontal cortex, 10 sessions) affects changes in white matter (WM) microstructure integrity in 63 mild cognitive impairment (MCI) patients with effect modifiers such as Aß deposition, APOE ε4 carrier status, BDNF Val66Met polymorphism status, and sex. Methods: We examined individual effect modifier-by-tDCS interactions and multiple effect modifiers-by-tDCS interactions for diffusion metrics. We also evaluated the association between baseline Aß deposition and changes in WM microstructure integrity following tDCS. Results: We found that APOE ε4 carrier status and sex had a significant interaction with tDCS, resulting in increased fractional anisotropy (FA) in the right uncinate fasciculus (UF) after stimulation. Additionally, we observed multiple effect modifiers-by-tDCS interactions on WM integrity of the right UF, leading to a more pronounced increase in FA values in APOE ε4 carriers and females with Val66 homozygotes. Finally, baseline Aß deposition was positively associated with a difference in FA of the left cingulum in the hippocampal area, which showed a positive association with the changes in the score for delayed memory. Conclusion: Our study shows the differential impact of individual AD risk factors on changes in the early intermediate phenotype after sequential tDCS in MCI patients. This research emphasizes the importance of precision medicine approaches in tDCS for the prodromal stages of AD.

Safety and therapeutic effects of personalized transcranial direct current stimulation based on electrical field simulation for prolonged disorders of consciousness: study protocol for a multi-center, double-blind, randomized controlled trial.

Background: Disorders of consciousness (DOC) resulting from acquired brain injury (ABI) increase the mortality rate of patients, complicate rehabilitation, and increase the physical and economic burden that DOC imposes on patients and their families. Thus, treatment to promote early awakening from DOC is vital. Transcranial direct current stimulation (tDCS) has shown great potential for promoting neuro-electrochemical activity. However, previous tDCS studies did not consider structural damage or head and brain lesions, so the applicability of the results to all DOC patients was limited. In this study, to establish a patient-specific tDCS treatment plan considering the brain lesions of and damage sustained by DOC patients, we considered the electric field calculated by a the "finite electric" three-dimensional brain model based on magnetic resonance images. This protocol was developed to aid tDCS treatment of actual patients, and to verify its safety and effectiveness. Methods/design: Twenty-four patients with DOC after ABI will be enrolled in this cross-over trial. All participants will receive typical rehabilitation combined with sham tDCS and typical rehabilitation plus personalized tDCS (P-tDCS). Each interventional period will last 2 weeks (30 min/day, 5 days/week). The primary outcome [score on the Korean version of the Coma Recovery Scale-Revised (K-CRS-R)] will be assessed at baseline and the end of the first day of the intervention. Secondary outcomes (K-CRS-R at 1 week and 2 weeks after experimental session and quantitative EEG changes quantitative electroencephalography changes) will be measured at baseline and the end of week 4. Adverse events will be recorded during each treatment session. Discussion: For patients with neurological disorders, tDCS has served as a painless, non-invasive, easily applied, and effective therapy for several decades, and there is some evidence that it can improve the level of consciousness of patients with DOC. However, variability in the effects on consciousness among subjects have been reported and personalized strategies are lacking. This protocol is for a randomized controlled trial designed to validate the effectiveness and safety of P-tDCS combined with typical rehabilitation for DOC. Clinical trial registration: https://cris.nih.go.kr, identifier KCT0007157.

Prescription Patterns of Topical Medications in Patients with Atopic Dermatitis: An Investigative Review Using Big Data from the National Health Insurance Corporation.

BACKGROUND: Topical medications play a crucial role in the treatment of atopic dermatitis (AD). Topical corticosteroids (TCSs) remain the main treatment of choice and topical antibiotics have also been used. However, with the new topical calcineurin inhibitors (TCIs), the prescription patterns of topical agents have changed over time. OBJECTIVE: To characterize the prescription patterns of topical medications in Korean patients with AD. METHODS: We investigated topical medications prescribed to Korean patients with AD using the National Health Insurance Sharing System (NHISS) database over a 14-year period (2002~2015). Additionally, the potency of prescribed TCSs was compared with AD and psoriasis patients. RESULTS: The annual prescription of TCSs showed a slightly decreasing trend without significant change. In particular, in terms of steroid class, prescription of moderate-to-low potency TCSs were increased and the use of high potency TCSs were decreased. TCSs were the most commonly prescribed topical medications for AD. Tertiary hospitals had a higher prescription rate for TCIs than secondary or primary hospitals (16.2%, 3.1%, and 1.9%, respectively). Additionally, dermatologists prescribed TCIs more frequently than pediatricians and internists (4.3%, 1.2%, and 0.6%, respectively). Among TCSs, Class 5 was prescribed the most (40.6%) followed by Class 7, 6, 4, 3, 1, and 2. When we compared the potency of TCSs prescribed for AD with psoriasis patients, moderate-to-low-potency TCSs were more commonly prescribed in AD. CONCLUSION: Prescription patterns of topical medications had changed from 2002 to 2015 and differed according to the type of institution and specialty of the physician.

Biohybrid 3D Printing of a Tissue-Sensor Platform for Wireless, Real-Time, and Continuous Monitoring of Drug-Induced Cardiotoxicity.

Drug-induced cardiotoxicity is regarded as a major hurdle in the early stages of drug development. Although there are various methods for preclinical cardiotoxicity tests, they cannot completely predict the cardiotoxic potential of a compound due to the lack of physiological relevance. Recently, 3D engineered heart tissue (EHT) has been used to investigate cardiac muscle functions as well as pharmacological effects by exhibiting physiological auxotonic contractions. However, there is still no adequate platform for continuous monitoring to test acute and chronic pharmacological effects in vitro. Here, a biohybrid 3D printing method for fabricating a tissue-sensor platform, composed of a bipillar-grafted strain gauge sensor and EHT, is first introduced. Two pillars are three-dimensionally printed as grafts onto a strain gauge-embedded substrate to promote the EHT contractility and guide the self-assembly of the EHTs along with the strain gauge. In addition, the integration of a wireless multi-channel electronic system allows for continuous monitoring of the EHT contractile force by the tissue-sensor platform and, ultimately, for the observation of the acute and chronic drug effects of cardiotoxicants. In summary, biohybrid 3D printing technology is expected to be a potential fabrication method to provide a next-generation tissue-sensor platform for an effective drug development process.

Effect of optimized transcranial direct current stimulation on motor cortex activation in patients with sub-acute or chronic stroke: a study protocol for a single-blinded cross-over randomized control trial.

Introduction: Transcranial direct current stimulation (tDCS) has shown positive but inconsistent results in stroke rehabilitation. This could be attributed to inter-individual variations in brain characteristics and stroke lesions, which limit the use of a single tDCS protocol for all post-stroke patients. Optimizing the electrode location in tDCS for each individual using magnetic resonance imaging (MRI) to generate three-dimensional computer models and calculate the electric field (E-field) induced by tDCS at a specific target point in the primary motor cortex may help reduce these inconsistencies. In stroke rehabilitation, locating the optimal position that generates a high E-field in a target area can influence motor recovery. Therefore, this study was designed to determine the effect of personalized tDCS electrode positions on hand-knob activation in post-stroke patients. Method: This is a crossover study with a sample size of 50 participants, who will be randomly assigned to one of six groups and will receive one session of either optimized-active, conventional-active, or sham tDCS, with 24 h between sessions. The tDCS parameters will be 1 mA (5 × 5 cm electrodes) for 20 min. The motor-evoked potential (MEP) will be recorded before and after each session over the target area (motor cortex hand-knob) and the MEP hotspot. The MEP amplitude at the target location will be the primary outcome. Discussion: We hypothesize that the optimized-active tDCS session would show a greater increase in MEP amplitude over the target area in patients with subacute and chronic stroke than conventional and sham tDCS sessions.Clinical trial registration: https://cris.nih.go.kr, identifier KCT0007536.

Regional nerve blocks for relieving postoperative pain in arthroscopic rotator cuff repair.

Rotator cuff tear is the most common cause of shoulder pain in middle-age and older people. Arthroscopic rotator cuff repair (ARCR) is the most common treatment method for rotator cuff tear. Early postoperative pain after ARCR is the primary concern for surgeons and patients and can affect postoperative rehabilitation, satisfaction, recovery, and hospital day. There are numerous methods for controlling postoperative pain including patient-controlled analgesia, opioid, interscalene block, and local anesthesia. Regional blocks including interscalene nerve block, suprascapular nerve block, and axillary nerve block have been successfully and commonly used. There is no difference between interscalene brachial plexus block (ISB) and suprascapular nerve block (SSNB) in pain control and opioid consumption. However, SSNB has fewer complications and can be more easily applied than ISB. Combination of axillary nerve block with SSNB has a stronger analgesic effect than SSNB alone. These regional blocks can be helpful for postoperative pain control within 48 hours after ARCR surgery.

Pathological validation of the Japanese Renal Pathology Society classification and challenges in predicting renal prognosis in patients with diabetic nephropathy.

BACKGROUND: Diabetic nephropathy (DN) accounts for approximately half of all cases of chronic kidney disease (CKD) and end-stage kidney disease worldwide. The Renal Pathology Society (RPS) classification has been used to predict the renal prognosis in DN. In 2018, the Japanese Renal Pathology Society (JRPS) proposed a comprehensive classification system that included pathological changes in the kidney. The clinical significance of the JRPS classification system was comparatively evaluated in the present study. METHODS: A total of 93 cases diagnosed with DN from 2009 to 2019 were enrolled. JRPS scores (J-scores) were calculated by scoring the pathological factors in the JRPS classification system and comparing them with clinical parameters. RESULTS: Most pathological factors constituting the J-score were significantly correlated with clinical factors. Laminated nodules were inversely correlated with estimated glomerular filtration rate. After adjusting for age, sex, body mass index, hemoglobin A1c, diabetes duration, and hypertension, CKD stage was significantly correlated with JRPS grade, nodular lesions, and exudative lesions in the multivariate logistic regression analysis. However, receiver operating characteristic curve analysis revealed that the J-score (area under the curve [AUC] = 0.639) had lower clinical significance than the traditional RPS classification system (AUC = 0.675). CONCLUSION: The JRPS classification can more comprehensively reflect renal changes than the RPS classification and is correlated with renal survival. When creating a new pathological classification, arteriolar hyalinosis should not be included, whereas laminated nodules should be included.

PCA-based sub-surface structure and defect analysis for germanium-on-nothing using nanoscale surface topography.

Empty space in germanium (ESG) or germanium-on-nothing (GON) are unique self-assembled germanium structures with multiscale cavities of various morphologies. Due to their simple fabrication process and high-quality crystallinity after self-assembly, they can be applied in various fields including micro-/nanoelectronics, optoelectronics, and precision sensors, to name a few. In contrast to their simple fabrication, inspection is intrinsically difficult due to buried structures. Today, ultrasonic atomic force microscopy and interferometry are some prevalent non-destructive 3-D imaging methods that are used to inspect the underlying ESG structures. However, these non-destructive characterization methods suffer from low throughput due to slow measurement speed and limited measurable thickness. To overcome these limitations, this work proposes a new methodology to construct a principal-component-analysis based database that correlates surface images with empirically determined sub-surface structures. Then, from this database, the morphology of buried sub-surface structure is determined only using surface topography. Since the acquisition rate of a single nanoscale surface micrograph is up to a few orders faster than a thorough 3-D sub-surface analysis, the proposed methodology benefits from improved throughput compared to current inspection methods. Also, an empirical destructive test essentially resolves the measurable thickness limitation. We also demonstrate the practicality of the proposed methodology by applying it to GON devices to selectively detect and quantitatively analyze surface defects. Compared to state-of-the-art deep learning-based defect detection schemes, our method is much effortlessly finetunable for specific applications. In terms of sub-surface analysis, this work proposes a fast, robust, and high-resolution methodology which could potentially replace the conventional exhaustive sub-surface inspection schemes.

Dynamic tactility by position-encoded spike spectrum.

In fast and transient somatosensory processing, the relative timing of the selected spikes is more important than the spike frequency because the ensemble of the first spikes in the spike trains encodes the dynamic tactile information. Here, inspired by the functional effectiveness of the selected spikes, we propose an artificial dynamic sensory system based on position-encoded spike spectrum. We use a mixed ion-electron conductor to generate a potential spike signal. We design artificial receptors that have different ion relaxation times (τ); thus, a sequence of the spikes from the receptors creates a spike spectrum, providing the spatial information (position and motion trace) and the temporal information (speed and dynamic contact area). The artificial receptors can be incorporated by as much as 132/square centimeters by using only two global signal addressing lines for sensor operation. Structural simplicity of the device opens the possibility of scalable fabrication with dense receptor integration. With computational decoding of the position-encoded spike spectrum, the artificial sensory system can recognize complicated dynamic motions in real time. The high-resolution spatiotemporal tactile perception in the ionic artificial sensory system enables the real-time dynamic robotic manipulation.

Impact of Transcranial Direct Current Stimulation on Cognitive Function, Brain Functional Segregation, and Integration in Patients with Mild Cognitive Impairment According to Amyloid-Beta Deposition and APOE ε4-Allele: A Pilot Study.

Anodal transcranial direct current stimulation (anodal-tDCS) is known to improve cognition and normalize abnormal network configuration during resting-state functional magnetic resonance imaging (fMRI) in patients with mild cognitive impairment (MCI). We aimed to evaluate the impact of sequential anodal-tDCS on cognitive functions, functional segregation, and integration parameters in patients with MCI, according to high-risk factors for Alzheimer's disease (AD): amyloid-beta (Aß) deposition and APOE ε4-allele status. In 32 patients with MCI ([18 F] flutemetamol-: n = 10, [18 F] flutemetamol+: n = 22; APOE ε4-: n = 13, APOE ε4+: n = 19), we delivered anodal-tDCS (2 mA/day, five times/week, for 2 weeks) over the left dorsolateral prefrontal cortex and assessed the neuropsychological test battery and resting-state fMRI measurements before and after 2 weeks stimulation. We observed a non-significant impact of an anodal-tDCS on changes in neuropsychological battery scores between MCI patients with and without high-risk factors of AD, Aß retention and APOE ε4-allele. However, there was a significant difference in brain functional segregation and integration parameters between MCI patients with and without AD high-risk factors. We also found a significant effect of tDCS-by-APOE ε4-allele interaction on changes in the functional segregation parameter of the temporal pole. In addition, baseline Aß deposition significantly associated negatively with change in global functional integrity of hippocampal formation. Anodal-tDCS might help to enhance restorative and compensatory intrinsic functional changes in MCI patients, modulated by the presence of Aß retention and the APOE ε4-allele.

Greater Tuberosity Bone Mineral Density and Rotator Cuff Tear Size Are Independent Factors Associated With Cutting-Through in Arthroscopic Suture-Bridge Rotator Cuff Repair.

PURPOSE: To evaluate the correlation between cutting-through at the greater tuberosity (GT) in arthroscopic suture-bridge rotator cuff repair and the bone mineral density (BMD) of the lumbar spine, hip, and ipsilateral GT of the proximal humerus and to evaluate factors and clinical outcomes related to cutting-through. METHODS: This study prospectively enrolled patients who underwent arthroscopic knotted suture-bridge rotator cuff repair for full-thickness rotator cuff tears between June 2014 and October 2015 and who had undergone dual-energy X-ray absorptiometry cans within 1 month before surgery with a minimum 2-year follow-up. Cutting-through was defined as the occurrence of cortical breakage of the GT just medial to the lateral knotless anchor hole due to the tension of the sutures from the medial anchor, and it was assessed. Clinical and radiologic data were analyzed. Univariate and regression analyses were performed to evaluate factors related to cutting-through. RESULTS: A total of 78 patients were analyzed. Patients were divided into 2 groups: patients who had cutting-through (46, group I) and patients who did not (32, group II). In an analysis of lumbar spine, hip, and GT BMD, GT BMD was the most effective for predicting cutting-through (area under the receiver operating characteristic curve = 0.94, 95% confidence interval 0.89-0.99). GT BMD (P < .001) and tear size (P = .004) were independent factors for cutting-through. Although a significant difference was found between the 2 groups in terms of age, sex, lumbar spine and hip BMD, fatty infiltration of the supraspinatus and infraspinatus, and atrophy of the supraspinatus, these variables were not independent factors. Clinical and structural outcomes showed no significant difference between the 2 groups, and anchor failure was not identified intraoperatively. CONCLUSIONS: GT BMD and rotator cuff tear size are independent factors associated with cutting-through at the GT. A dual-energy X-ray absorptiometry scan of the proximal humerus is useful for predicting bone quality before arthroscopic suture-bridge rotator cuff repair. LEVEL OF EVIDENCE: Level II, Prospective cohort study.

PHILOS plate fixation with polymethyl methacrylate cement augmentation of an osteoporotic proximal humerus fracture.

PHILOS plate fixation in osteoporotic proximal humerus fracture of old age is well-known for high complication rate, especially metal failure, providing various augmentation techniques, such as calcium phosphate cement, allogenous or autologous bone graft. We report a case of polymethyl methacrylate augmentation to provide appropriate reduction with a significant mechanical support. This can be a treatment option for displaced unstable osteoporotic proximal humerus fracture with marked bony defect.

A Cadaveric Study of the Distal Biceps Femoris Muscle in relation to the Normal and Variant Course of the Common Peroneal Nerve: A Possible Cause of Common Peroneal Entrapment Neuropathy.

The most frequent mononeuropathy in the lower extremity has been reported as the common peroneal nerve entrapment neuropathy (CPNe) around the head and neck of the fibula, although the mechanism of the neuropathy in this area cannot be fully explained. Therefore, the aim of this cadaveric study was to evaluate the relationship between morphologic variations of the distal biceps femoris muscle (BFM) and the course of the common peroneal nerve (CPN) and to investigate the incidence and morphological characteristics of anatomical variations in the BFM associated with CPNe. The popliteal region and the thigh were dissected in 115 formalin-fixed lower limbs. We evaluated consensus for (1) normal anatomy of the distal BFM, (2) anatomic variations of this muscle, and (3) the relationship of the muscle to the CPN. Measurements of the distal extents of the short and long heads of the BFM from insertion (fibular head) were performed. Two anatomic patterns were seen. First, in 93 knees (80.8%), the CPN ran obliquely along the lateral side of the BFM and then superficial to the lateral head of the gastrocnemius muscle. Second, in 22 cases (19.2%), the CPN coursed within a tunnel between the biceps femoris and lateral head of the gastrocnemius muscle (LGCM). There was a positive correlation between the distal extents of the short heads of the biceps femoris muscle (SHBFM) and the presence of the tunnel. The "popliteal intermuscular tunnel" in which the CPN travels can be produced between the more distal extension variant of the SHBFM and the LGCM. This anatomical variation of BFM may have a clinical significance as an entrapment area of the CPN in the patients in which the mechanism of CPNe around the fibula head and neck is not understood.

Incidental detection of a retained left atrial catheter via intraoperative transesophageal echocardiography in a patient undergoing tricuspid valve replacement: A case report.

RATIONALE: A cardiac foreign body can cause thrombosis or infection, but sometimes it may not cause any symptoms in a patient. The diagnosis is mainly performed using a radiological examination. Especially, ultrasound is useful not only for detecting the foreign body but also for hemodynamic findings. However, the disadvantage of ultrasound is that it cannot be used where shadows are generated because of poor permeability. The transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) for identifying posterior cardiac structures because the probe is located in the esophagus behind the heart. Here, we report on the incidental finding of a foreign body in the left atrium through TEE during cardiac surgery. It did not cause any symptoms or signs for 20 years. PATIENT CONCERNS: A 75-year-old female patient with severe tricuspid regurgitation underwent tricuspid valve replacement (TVR) under general anesthesia. She had a history of mitral valve replacement (MVR) and tricuspid annuloplasty surgery 20 years ago. DIAGNOSIS: A hyper-echoic floating intracardiac foreign body was observed in the left atrium during TEE examination. It was not detected in the preoperative imaging studies such as X-ray, computed tomography, TTE. INTERVENTIONS: The cardiac foreign body found using TEE was visually confirmed through an incision in the left atrium. A long and thin foreign body was located in the right upper pulmonary vein to the left atrium, which was considered to be a left atrial catheter used during the MVR surgery performed 20 years ago. After removing the foreign body, the planned TVR operation proceeded. OUTCOMES: After removing the intracardiac foreign body and TVR, the patient was admitted into the intensive care unit followed by the general ward as planned, and discharged without any complications. LESSONS: TEE was very useful for diagnosing a foreign body in the posterior part of the heart. TEE performed during the perioperative period should be performed beyond the level of re-confirming the findings of TEE performed prior to surgery. If a retained catheter is detected, it may be appropriate to remove it considering the risk of complications.

Effectiveness of Simulated Horseback Riding for Patients With Chronic Low Back Pain: A Randomized Controlled Trial.

CONTEXT: A simulated horseback riding (SHR) exercise is effective for improvement of pain and functional disability, but its comparative effectiveness with the other is unknown. OBJECTIVE: The authors aimed to demonstrate the effect of a SHR exercise in people with chronic low back pain. DESIGN: A randomized controlled trial. SETTINGS: Community and university campus. PARTICIPANTS: A total of 48 participants with chronic low back pain were divided into 2 groups, and SHR exercises (n = 24) or stabilization (STB) exercises (n = 24) were performed. INTERVENTIONS: The exercises were performed for 30 minutes, 2 days per week for 8 weeks. MAIN OUTCOME MEASURES: Numeric rating scale, functional disabilities (Oswestry disability index and Roland-Morris disability), and fear-avoidance beliefs questionnaire (FABQ) scores were measured at baseline and at 4 weeks, 8 weeks, and 6 months. RESULTS: A 2-way repeated analysis of variance identified that between-group comparisons showed significant differences in the FABQ related to work scale (F = 21.422; P = .01). There were no significant differences in the numeric rating scale (F = 1.696; P = .21), Oswestry disability index (F = 1.848; P = .20), Roland-Morris disability (F = 0.069; P = .80), and FABQ related to physical scale (F = 1.579; P = .24). In within-group comparisons, both groups presented significant differences in numeric rating scale (both SHR and STB after 4 wk), Oswestry disability index (both SHR and STB after 6 mo), and Roland-Morris disability (SHR after 6 mo and STB after 8 wk) compared with baseline values. In FABQ-related physical (SHR after 4 wk) and work scales (SHR after 6 mo), there were only significant differences in the SHR compared with baseline values. CONCLUSIONS: SHR exercise for 8 weeks had a greater effect than STB exercise for reducing work-related FABQ. The SHR exercise performed in a seated position could substantially decrease pain-related fear disability in young adults with chronic low back pain.