Electric Field-Assisted Agglomeration of Trace Nanoparticle Impurities for Ultrahigh Purity Chemicals.

With the advancement of semiconductor manufacturing technology, the effects of trace impurities in industrial chemicals have grown significantly. In industrial processes, conventional purification methods, such as filtration and distillation, have reached their limits for removing nanoparticles from aqueous and acidic solutions. Especially, silicon and silicate are two fundamental byproducts in semiconductor fabrication processes. Assembly and subsequent removal of these materials at the nanoparticle level have been confronted with significant challenges. Therefore, it is imperative to develop technologies to effectively control and remove these impurities for next-generation manufacturing processes. In this study, we explored the use of electric field-assisted assembly to agglomerate silicate and silicon nanoparticles in industry-standard aqueous and acidic solutions. By applying an alternating current electric field, we induced dipole moments in the nanoparticles, which led to their agglomeration. Notably, nanoparticles smaller than 4 nm grew into significantly larger ones, with submicroparticle sizes exceeding 87 nm for silicate and reaching 130 nm for silicon. Through systematic analysis of the size distribution changes, we identified optimal agglomeration times of 10 min for silicate and 20 min for silicon, revealing effective agglomeration within the frequency range of 1-1000 kHz. The agglomerated particles were stable for 5 days. Our electric field-assisted approach to obtain assembled nanoparticles that can be subsequently removed by conventional purification processes holds promise for enhancing future microfabrication processes, such as semiconductor manufacturing, potentially improving the manufacturing yield and uniformity by reducing the number of trace particles that can act as defective sites.

Educational simulator for mastoidectomy considering mechanical properties using 3D printing and its usability evaluation.

Complex temporal bone anatomy complicates operations; thus, surgeons must engage in practice to mitigate risks, improving patient safety and outcomes. However, existing training methods often involve prohibitive costs and ethical problems. Therefore, we developed an educational mastoidectomy simulator, considering mechanical properties using 3D printing. The mastoidectomy simulator was modeled on computed tomography images of a patient undergoing a mastoidectomy. Infill was modeled for each anatomical part to provide a realistic drilling sensation. Bone and other anatomies appear in assorted colors to enhance the simulator's educational utility. The mechanical properties of the simulator were evaluated by measuring the screw insertion torque for infill specimens and cadaveric temporal bones and investigating its usability with a five-point Likert-scale questionnaire completed by five otolaryngologists. The maximum insertion torque values of the sigmoid sinus, tegmen, and semicircular canal were 1.08 ± 0.62, 0.44 ± 0.42, and 1.54 ± 0.43 N mm, displaying similar-strength infill specimens of 40%, 30%, and 50%. Otolaryngologists evaluated the quality and usability at 4.25 ± 0.81 and 4.53 ± 0.62. The mastoidectomy simulator could provide realistic bone drilling feedback for educational mastoidectomy training while reinforcing skills and comprehension of anatomical structures.

AFM Imaging Reveals MicroRNA-132 to be a Positive Regulator of Synaptic Functions.

The modification of synaptic and neural connections in adults, including the formation and removal of synapses, depends on activity-dependent synaptic and structural plasticity. MicroRNAs (miRNAs) play crucial roles in regulating these changes by targeting specific genes and regulating their expression. The fact that somatic and dendritic activity in neurons often occurs asynchronously highlights the need for spatial and dynamic regulation of protein synthesis in specific milieu and cellular loci. MicroRNAs, which can show distinct patterns of enrichment, help to establish the localized distribution of plasticity-related proteins. The recent study using atomic force microscopy (AFM)-based nanoscale imaging reveals that the abundance of miRNA(miR)-134 is inversely correlated with the functional activity of dendritic spine structures. However, the miRNAs that are selectively upregulated in potentiated synapses, and which can thereby support prospective changes in synaptic efficacy, remain largely unknown. Using AFM force imaging, significant increases in miR-132 in the dendritic regions abutting functionally-active spines is discovered. This study provides evidence for miR-132 as a novel positive miRNA regulator residing in dendritic shafts, and also suggests that activity-dependent miRNAs localized in distinct sub-compartments of neurons play bi-directional roles in controlling synaptic transmission and synaptic plasticity.

Low-Voltage Hydrogen Production via Hydrogen Peroxide Oxidation Facilitated by Oxo Ligand Axially Coordinated to Cobalt in Phthalocyanine Moiety.

A cobalt phthalocyanine having an electron-poor CoN4 (+δ) in its phthalocyanine moiety was presented as an electrocatalyst for hydrogen peroxide oxidation reaction (HPOR). We suggested that hydrogen peroxide as an electrolysis medium for hydrogen production and therefore as a hydrogen carrier, demonstrating that the electrocatalyst guaranteed high hydrogen production rate by hydrogen peroxide splitting. The electron deficiency of cobalt allows CoN4 to have the highly HPOR-active monovalent oxidation state and facilitates HPOR at small overpotentials range around the onset potential. The strong interaction between the electron-deficient cobalt and oxygen of peroxide adsorbates in Co─OOH- encourages an axially coordinated cobalt oxo complex (O═CoN4 ) to form, the O═CoN4 facilitating the HPOR efficiently at high overpotentials. Low-voltage oxygen evolution reaction guaranteeing low-voltage hydrogen production is successfully demonstrated in the presence of the metal-oxo complex having electron-deficient CoN4 . Hydrogen production by 391 mA cm-2 at 1 V and 870 mA cm-2 at 1.5 V is obtained. Also, the techno-economic benefit of hydrogen peroxide as a hydrogen carrier is evaluated by comparing hydrogen peroxide with other hydrogen carriers such as ammonia and liquid organic hydrogen carriers.

2D Amorphous GaOX Gate Dielectric for ß-Ga2O3 Field-Effect Transistors.

Appropriate gate dielectrics must be identified to fabricate metal-insulator-semiconductor field-effect transistors (MISFETs); however, this has been challenging for compound semiconductors owing to the absence of high-quality native oxides. This study uses the liquid-gallium squeezing technique to fabricate 2D amorphous gallium oxide (GaOX) with a high dielectric constant, where its thickness is precisely controlled at the atomic scale (monolayer, ∼4.5 nm; bilayer, ∼8.5 nm). Beta-phase gallium oxide (ß-Ga2O3) with an ultrawide energy bandgap (4.5-4.9 eV) has emerged as a next-generation power semiconductor material and is presented here as the channel material. The 2D amorphous GaOX dielectric is combined with a ß-Ga2O3 conducting nanolayer, and the resulting ß-Ga2O3 MISFET is stable up to 250 °C. The 2D amorphous GaOX is oxygen-deficient, and a high-quality interface with excellent uniformity and scalability forms between the 2D amorphous GaOX and ß-Ga2O3. The fabricated MISFET exhibits a wide gate-voltage swing of approximately +5 V, a high current on/off ratio, moderate field-effect carrier mobility, and a decent three-terminal breakdown voltage (∼138 V). The carrier transport of the Ni/GaOX/ß-Ga2O3 metal-insulator-semiconductor (MIS) structure displays a combination of Schottky emission and Fowler-Nordheim (F-N) tunneling in the high-gate-bias region at 25 °C, whereas at elevated temperatures it shows Schottky emission and F-N tunneling in the low- and high-gate-bias regions, respectively. This study demonstrates that a 2D GaOX gate dielectric layer can be produced and incorporated into an active channel layer to form an MIS structure at room temperature (∼25 °C), which enables the facile fabrication of MISFET devices.

Layer-Controlled Perovskite 2D Nanosheet Interlayer for the Energy Storage Performance of Nanocomposites.

Polymer-based nanocomposites are desirable materials for next-generation dielectric capacitors. 2D dielectric nanosheets have received significant attention as a filler. However, randomly spreading the 2D filler causes residual stresses and agglomerated defect sites in the polymer matrix, which leads to the growth of an electric tree, resulting in a more premature breakdown than expected. Therefore, realizing a well-aligned 2D nanosheet layer with a small amount is a key challenge; it can inhibit the growth of conduction paths without degrading the performance of the material. Here, an ultrathin Sr1.8 Bi0.2 Nb3 O10 (SBNO) nanosheet filler is added as a layer into poly(vinylidene fluoride) (PVDF) films via the Langmuir-Blodgett method. The structural properties, breakdown strength, and energy storage capacity of a PVDF and multilayer PVDF/SBNO/PVDF composites as a function of the thickness-controlled SBNO layer are examined. The seven-layered (only 14 nm) SBNO nanosheets thin film can sufficiently prevent the electrical path in the PVDF/SBNO/PVDF composite and shows a high energy density of 12.8 J cm-3 at 508 MV m-1 , which is significantly higher than that of the bare PVDF film (9.2 J cm-3 at 439 MV m-1 ). At present, this composite has the highest energy density among the polymer-based nanocomposites under the filler of thin thickness.

Autonomous Resonance-Tuning Mechanism for Environmental Adaptive Energy Harvesting.

An innovative autonomous resonance-tuning (ART) energy harvester is reported that utilizes adaptive clamping systems driven by intrinsic mechanical mechanisms without outsourcing additional energy. The adaptive clamping system modulates the natural frequency of the harvester's main beam (MB) by adjusting the clamping position of the MB. The pulling force induced by the resonance vibration of the tuning beam (TB) provides the driving force for operating the adaptive clamp. The ART mechanism is possible by matching the natural frequencies of the TB and clamped MB. Detailed evaluations are conducted on the optimization of the adaptive clamp tolerance and TB design to increase the pulling force. The energy harvester exhibits an ultrawide resonance bandwidth of over 30 Hz in the commonly accessible low vibration frequency range (<100 Hz) owing to the ART function. The practical feasibility is demonstrated by evaluating the ART performance under both frequency and acceleration-variant conditions and powering a location tracking sensor.

Quantification of a Neurological Protein in a Single Cell Without Amplification.

Proteins are key biomolecules that not only play various roles in the living body but also are used as biomarkers. If these proteins can be quantified at the level of a single cell, understanding the role of proteins will be deepened and diagnosing diseases and abnormality will be further upgraded. In this study, we quantified a neurological protein in a single cell using atomic force microscopy (AFM). After capturing specifically disrupted-in-schizophrenia 1 (DISC1) in a single cell onto a microspot immobilizing the corresponding antibody on the surface, force mapping with AFM was followed to visualize individual DISC1. Although a large variation of the number of DISC1 in a cell was observed, the average number is 4.38 × 103, and the number agrees with the ensemble-averaged value. The current AFM approach for the quantitative analysis of proteins in a single cell should be useful to study molecular behavior of proteins in depth and to follow physiological change of individual cells in response to external stimuli.

SalfMix: A Novel Single Image-Based Data Augmentation Technique Using a Saliency Map.

Modern data augmentation strategies such as Cutout, Mixup, and CutMix, have achieved good performance in image recognition tasks. Particularly, the data augmentation approaches, such as Mixup and CutMix, that mix two images to generate a mixed training image, could generalize convolutional neural networks better than single image-based data augmentation approaches such as Cutout. We focus on the fact that the mixed image can improve generalization ability, and we wondered if it would be effective to apply it to a single image. Consequently, we propose a new data augmentation method to produce a self-mixed image based on a saliency map, called SalfMix. Furthermore, we combined SalfMix with state-of-the-art two images-based approaches, such as Mixup, SaliencyMix, and CutMix, to increase the performance, called HybridMix. The proposed SalfMix achieved better accuracies than Cutout, and HybridMix achieved state-of-the-art performance on three classification datasets: CIFAR-10, CIFAR-100, and TinyImageNet-200. Furthermore, HybridMix achieved the best accuracy in object detection tasks on the VOC dataset, in terms of mean average precision.

Correlation between Psoas Muscle Index and Degeneration of Spinal Back Muscle in Patients with Back Pain.

Sarcopenia is characterized by a decline in systemic muscle mass and physical performance. Disc degeneration also causes back muscle atrophy. Therefore, we aimed to evaluate the influence of systemic muscle mass decline on back muscle atrophy and fatty infiltration compared to disc degeneration. We included 127 patients (65.54 ± 14.93 years) with back pain who underwent lumbar spine magnetic resonance imaging (MRI). Axial T2-weighted MRI data of the L4-5 and L5-S1 levels were used to measure the cross-sectional area (CSA) of the psoas and spinal muscles. The psoas index (cm2/m2) was used as a surrogate for systemic muscle mass. The Pfirrmann grading system was used to evaluate intervertebral disc degeneration. The functional area of the back muscles was calculated by subtracting the fat infiltration area from the CSA; the functional CSA ratio was calculated by dividing the functional CSA by the CSA. Image-processing software (ImageJ; National Institutes of Health, Bethesda, MD, USA) was used for analysis. Psoas index and aging significantly affected CSA and the ratio of functional CSA of the back muscles and multifidi. Disc degeneration did not significantly affect the back muscles beyond aging in patients with back pain. Males showed substantially higher CSA of the back muscles and multifidi than females; however, sex did not affect the functional CSA ratio of these muscles. Systemic muscle mass decline showed a more powerful influence on back muscle atrophy and fatty infiltration than disc degeneration. Therefore, proper evaluation of sarcopenia is needed for patients with chronic back pain and back muscle degeneration.

Natural History of Isolated Below-Knee Vein Thrombosis in Patients with Spinal Cord Injury.

In the general population, serial imaging is recommended over anticoagulant therapy for below-knee deep vein thrombosis (BKDVT). However, no clinical trial in Asian patients with spinal cord injury and BKDVT has been performed. Therefore, we evaluated the natural course of BKDVT in patients with acute spinal cord injury. We retrospectively analyzed inpatients with spinal cord injury with BKDVT between 2016 and 2020. All patients underwent inpatient rehabilitation treatment and duplex ultrasonographic examination of both the lower extremities at follow-up. After screening 172 patients with acute spinal cord injury for deep vein thrombosis using duplex ultrasound, 27 patients with below-the-knee deep vein thrombosis were included in this study. The mean lower-extremity motor score (median, interquartile range) was 66.0, 54.0-74.5. Sixteen patients received a non-vitamin K antagonist oral anticoagulant (NOAC) for anticoagulation. None of the patients had proximal propagation according to the follow-up duplex ultrasonography. BKDVT disappearance was not significantly different between the NOAC treatment and non-treatment groups. Asian patients with spinal cord injury have a low incidence of venous thromboembolism and favorable natural history of BKDVT. We recommend serial imaging over anticoagulant therapy for BKDVT in these patients.

The Findings of SPECT/CT Concerning Bypass Lymph Circulation in Lymphedema Following Breast Cancer Surgery.

This study aimed to determine whether bypass circulation was present in lymphedema and its effect. This was a retrospective, cross-sectional study. Patients who underwent unilateral breast cancer surgery with axillary lymph node dissection were recruited and underwent single-photon emission tomography/computed tomography (SPECT/CT). SPECT/CT was performed to detect the three-dimensional locations of radio-activated lymph nodes. Patients with radioactivity in anatomical locations other than axillary lymph nodes were classified into a positive group. All patients received complete decongestive therapy (CDT). Exclusion criteria were as follows: History of bilateral breast cancer surgery, cervical lymph node dissection history, and upper extremity amputation. The difference in the upper extremity circumference (cm) was measured at four points: Mid-point of the upper arm, elbow, and 10 and 15 cm below the elbow. Twenty-nine patients were included in this study. Fifteen patients (51.7%) had bypass lymphatic systems on the affected side, six (20.7%) had a bypass lymphatic system with axillary lymph nodes on the unaffected side, and 11 (37.9%) showed new lymphatic drainage. The positive group showed significantly less swelling than the negative group at the mid-arm, elbow, and 15 cm below the elbow. Bypass lymphatic circulation had two patterns: Infraclavicular lymph nodes and supraclavicular and/or cervical lymph nodes. Changes in lymph drainage caused by surgery triggered the activation of the superficial lymphatic drainage system to relieve lymphedema. Superficial lymphatic drainage has a connection through the deltopectoral groove.

Visual question answering based on local-scene-aware referring expression generation.

Visual question answering requires a deep understanding of both images and natural language. However, most methods mainly focus on visual concept; such as the relationships between various objects. The limited use of object categories combined with their relationships or simple question embedding is insufficient for representing complex scenes and explaining decisions. To address this limitation, we propose the use of text expressions generated for images, because such expressions have few structural constraints and can provide richer descriptions of images. The generated expressions can be incorporated with visual features and question embedding to obtain the question-relevant answer. A joint-embedding multi-head attention network is also proposed to model three different information modalities with co-attention. We quantitatively and qualitatively evaluated the proposed method on the VQA v2 dataset and compared it with state-of-the-art methods in terms of answer prediction. The quality of the generated expressions was also evaluated on the RefCOCO, RefCOCO+, and RefCOCOg datasets. Experimental results demonstrate the effectiveness of the proposed method and reveal that it outperformed all of the competing methods in terms of both quantitative and qualitative results.

Piezoelectric Energy Harvesting Design Principles for Materials and Structures: Material Figure-of-Merit and Self-Resonance Tuning.

Piezoelectric energy harvesters (PEHs) aim to generate sufficient power to operate targeting device from the limited ambient energy. PEH includes mechanical-to-mechanical, mechanical-to-electrical, and electrical-to-electrical energy conversions, which are related to PEH structures, materials, and circuits, respectively; these should be efficient for increasing the total power. This critical review focuses on PEH structures and materials associated with the two major energy conversions to improve PEH performance. First, the resonance tuning mechanisms for PEH structures maintaining continuous resonance, regardless of a change in the vibration frequency, are presented. Based on the manual tuning technique, the electrically- and mechanically-driven self-resonance tuning (SRT) techniques are introduced in detail. The representative SRT harvesters are summarized in terms of tunability, power consumption, and net power. Second, the figure-of-merits of the piezoelectric materials for output power are summarized based on the operating conditions, and optimal piezoelectric materials are suggested. Piezoelectric materials with large kij , dij , and gij values are suitable for most PEHs, whereas those with large kij and Qm values should be used for on-resonance conditions, wherein the mechanical energy is directly supplied to the piezoelectric material. This comprehensive review provides insights for designing efficient structures and selection of proper piezoelectric materials for PEHs.

Enhanced microbial fuel cell (MFC) power outputs through Membrane Permeabilization using a branched polyethyleneimine.

This study demonstrates the impact outer membrane permeability has on the power densities generated by E. coli-based microbial fuel cells with neutral red as the mediator, and how increasing the permeability improves the current generation. Experiments performed with several lipopolysaccharide (LPS) mutants (ΔwaaC, ΔwaaF and ΔwaaG) of E. coli BW25113 that increase the outer membrane permeability found the power generated by two of the truncated LPS mutants, i.e., ΔwaaC and ΔwaaF, to be significantly higher (5.6 and 6.9 mW/m2, respectively) than that of the wild-type E. coli BW25113 (2.6 mW/m2). Branched polyethyleneimine (BPEI, 400 mg/L), a strong chemical permeabilizer, was more effective, however, increasing the power output from E. coli BW25113 cultures to as much as 29.7 mW/m2, or approximately 11-fold higher than the control MFC. BPEI also increased the activities of the mutant strains (to between 10.6 and 16.3 mW/m2), as well as when benzyl viologen was the mediator. Additional tests found BPEI not only enhanced membrane permeability but also increased the zeta potential of the bacterial cells from a value of -43.4 mV to -21.0 mV. This led to a significant increase in auto-aggregation of the bacterial cells and, consequently, better adherence of the cells to the anode electrode, as was demonstrated using scanning electron microscopy. In conclusion, our study demonstrates the importance of outer membrane permeabilities on MFC performances and defines two benefits that BPEI offers when used within MFCs as an outer membrane permeabilizer.

Metal@SiO2 Core-Shells with Self-Arrested Migrating Core.

Developing easy and customizable strategies for the directional structure modulation of multicomponent nanosystems to influence and optimize their properties are a paramount but challenging task in nanoscience. Here, we demonstrate highly controlled eccentric off-center positioning of metal-core in metal@silica core-shells by utilizing an in situ generated biphasic silica-based intraparticle solid-solid interface. In the synthetic strategy, by including Ca2+-ions in silica-shell and successive oxidative and reductive annealing at high temperature, a unique hairline-biphasic interface is evolved via the heat-induced concentric radial segregation of calcium silicate phase at the interior and normal silica phase at the exterior of core-shell, which can effectively arrest the outwardly migrating metal-core within rubbery calcium silicate phase, affording various eccentric core-shells, where core-positions are flexibly controlled by the annealing time and amounts of initially added Ca2+-ions. In the structure-property correlation study, the strategy allows fine-tuning of dipolar interaction-based blocking temperatures and magnetic anisotropies of different eccentric core-shells as the function of variable off-center distance of magnetic core without changing the overall size of nanoparticles. This work demonstrates the discovery and potential application of biphasic solid-solid media interface in controlling the heat-induced migration of metal nanocrystals and opens the avenues for exploiting the rarely studied high-temperature solid-state nanocrystal conversion chemistry and migratory behavior for directional nanostructure engineering.

Analysis of Migration Patterns of Disk Fragments and Contributing Factors in Extruded Lumbar Disk Herniation.

BACKGROUND: The exact location of migrated extruded lumbar disk fragments is an important consideration in selecting a treatment plan. However, few descriptive reports of the migration pattern of extruded lumbar disk fragments are available. OBJECTIVE: To examine the distribution of disk fragments and possible contributing factors that affect their migration. DESIGN: Retrospective descriptive study. SETTING: Tertiary university outpatient and inpatient clinic. PATIENTS: A total of 164 patients diagnosed with a symptomatic extruded lumbar disk from January 2011 to December 2012. METHODS: Lumbar spine magnetic resonance imaging scans of patients were retrospectively reviewed. The term "migration" was defined as the horizontal and vertical displacement of extruded material away from the opening in the annulus through which the material has extruded. Migration of the disk material was recorded in both the horizontal and vertical plane. In the horizontal plane, migration was recorded as central, paracentral, subarticular, or foraminal. In the vertical plane, migration was recorded as rostral or caudal. MAIN OUTCOME MEASUREMENTS: The pattern of migration and the associated factors (age and the level of herniation) were analyzed. RESULTS: Rostral and caudal migration was observed in 27% (95% confidence interval [CI], 21%-35%) and 73% (95% CI, 66%-79%) of the patients. Central, paracentral, subarticular, and foraminal migration was observed in 6% (95% CI, 3%-11%), 67% (95% CI, 60%-74%), 18% (95% CI, 13%-25%), and 9% (95% CI, 5%-14%) of the patients, respectively. A significant increase was observed in the incidence of rostral migration with increasing age (P = .048). A significant association was also noted between migration in the horizontal plane and increasing age (P = .01). A significant increase occurred in the incidence of foraminal extrusion with increasing age (P = .01). A significant association was found between migration in the vertical plane and horizontal plane; in patients with foraminal herniations, migration was always rostral (P < .001). CONCLUSION: The migration of extruded lumbar disk materials follows some general patterns. The results of this study may help spine interventionists and surgeons choose appropriate treatments for patients who have radiculopathy associated with lumbar disk extrusions. LEVEL OF EVIDENCE: IV.

Quantification of Fewer than Ten Copies of a DNA Biomarker without Amplification or Labeling.

Polymerase chain reaction (PCR) is a highly sensitive diagnosis technique for detection of nucleic acids and for monitoring residual disease; however, PCR can be unreliable for samples containing very few target molecules. Here, we describe a quantification method, using force-distance (FD) curve based atomic force microscopy (AFM) to detect a target DNA bound to small (1.4-1.9 µm diameter) probe DNA spots, allowing mapping of entire spots to nanometer resolution. Using a synthetic BCR-ABL fusion gene sequence target, we examined samples containing between one and 10 target copies. A high degree of correlation (r(2) = 0.994) between numbers of target copies and detected probe clusters was observed, and the approach could detect the BCR-ABL biomarker when only a single copy was present, although multiple screens were required. Our results clearly demonstrate that FD curve-based imaging is suitable for quantitative analysis of fewer than 10 copies of DNA biomarkers without amplification, modification, or labeling.

SH2 Domains Serve as Lipid-Binding Modules for pTyr-Signaling Proteins.

The Src-homology 2 (SH2) domain is a protein interaction domain that directs myriad phosphotyrosine (pY)-signaling pathways. Genome-wide screening of human SH2 domains reveals that ∼90% of SH2 domains bind plasma membrane lipids and many have high phosphoinositide specificity. They bind lipids using surface cationic patches separate from pY-binding pockets, thus binding lipids and the pY motif independently. The patches form grooves for specific lipid headgroup recognition or flat surfaces for non-specific membrane binding and both types of interaction are important for cellular function and regulation of SH2 domain-containing proteins. Cellular studies with ZAP70 showed that multiple lipids bind its C-terminal SH2 domain in a spatiotemporally specific manner and thereby exert exquisite spatiotemporal control over its protein binding and signaling activities in T cells. Collectively, this study reveals how lipids control SH2 domain-mediated cellular protein-protein interaction networks and suggest a new strategy for therapeutic modulation of pY-signaling pathways.

Proper site of corticosteroid injection for the treatment of idiopathic frozen shoulder: Results from a randomized trial.

OBJECTIVE: The objective is to determine whether corticosteroid injection into the subacromial space was not inferior to intra-articular injection in patients with idiopathic frozen shoulder (FS), and whether combined injections had an additive effect. METHODS: Patients with idiopathic FS (n=126) were randomly assigned to receive ultrasound-guided intra-articular (IA group), subacromial (SA group), or combined IA and subacromial injections (IA+SA group). All groups received a total dose of 40mg triamcinolone acetonide. The outcome measures included the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon (ASES) shoulder score, subjective shoulder value (SSV), and passive range of motion before and at 3, 6, and 12 weeks after treatment. RESULTS: There was significant effect of time on all measurements such that all measures improved in all groups (P<0.001) during the 12 weeks after treatment. Group-by-time interactions were significant for ASES (P=0.006), VAS (P<0.001), SSV (P=0.03), and internal rotation (P=0.014). Between-group comparisons revealed a significant improvement in the IA (P<0.001) and IA+SA (P<0.001) groups as compared to the SA group. The IA+SA group demonstrated significant improvement in internal rotation as compared to the IA group (P=0.046). CONCLUSION: The efficacy of corticosteroid injection into the SA space in idiopathic FS was inferior to IA injection up to 12 weeks; however, combination injections had an additive effect on increasing the internal rotation angle. These results indicate that although the glenohumeral joint is a major site in the pathogenesis of idiopathic FS, the SA space may be a contributing site.