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Introduction A pulled elbow is a common cause of acute elbow pain that is generally managed by a reduction maneuver without radiographic examination. However, children with atypical presentation with no history of abrupt longitudinal traction should undergo elbow imaging. This study aimed to investigate plain radiography findings and determine the usefulness of ultrasonography (US) in atypical pulled elbow. Materials and methods We retrospectively reviewed the medical records and images of 37 (22 males) consecutive patients with pulled elbow who presented with an atypical history or failed reduction between April 2015 and September 2018. Mean age at presentation was 4.34 years (range, 1.25–9.5 years). Of the 37 elbows, 20 were left elbows. The injury mechanism, incidence of the posterior fat pad sign on plain radiographs, and characteristic US findings, pre- and post- reduction, were investigated. Results The original mechanisms of injury included slipping (n = 14), rolling over the arm (n = 7), vague history (n = 6), falling down (n = 6), abrupt longitudinal traction (n = 2), and direct injury (n = 2). On plain radiographs, six of the 37 elbows (16%) showed the posterior fat pad sign. Before the reduction, an entrapped supinator, a pathognomonic sign of pulled elbow, was identified on US in all cases. After reduction, the characteristic US findings showed a disentangled and swollen supinator (100%) and restored annular ligament (100%) in all successful cases. Although a click was not felt in three cases, the reductions were considered successful because the annular ligament was restored on US with free elbow motion. Conclusion Pulled elbow may be caused by atypical mechanisms of injury, such as slipping and rolling over the arm. Clinicians should be aware of the possibility of the posterior fat pad sign on plain radiographs of pulled elbow to prevent unnecessary immobilization. In such circumstances, US is a useful method for detecting an entrapped supinator and confirming adequate reduction via restoration of the annular ligament in children with atypical pulled elbow.

Background Unnecessary costs and complications can be reduced by increasing hemoglobin (Hb) levels and minimizing blood transfusions in patients who underwent total knee arthroplasty (TKA). This study aimed to determine the effects of intravenous iron monotherapy before TKA on preoperative iron deficient anemia and postoperative transfusion rates. Methods This prospective cohort study included 45 patients scheduled for TKA in the experimental group (Group I) and 221 patients who underwent TKA in 2015 and 2018 in the control group (Group C). One thousand milligrams of ferric carboxymaltose was administrated 1 month before TKA in group I. Intergroup comparison of the rate and total volume of transfusion, perioperative changes in Hb and analysis of iron metabolism variables in group I were performed. Subgroup analysis of Group I was conducted according to the response to iron monotherapy. Results Although Hb levels increased after intravenous iron monotherapy in Group I, postoperative transfusion rates in Groups I and C were 17.8% and 18.6%, respectively, without significant intergroup differences in the rate and total units of transfusion. Ferritin level and transferrin saturation were corrected in both subgroups of Group I. Only 17 patients (37.78%) showed response to iron monotherapy, with an Hb increase of 1.0 g/dL or more. Subgroup analysis showed lower proportions of coexisting chronic diseases, including chronic kidney disease in responders. Conclusion IV iron monotherapy was shown to be insufficient in successfully treating preoperative iron-deficient anemia to reduce postoperative allogenic blood transfusion in patients who underwent TKA. As preoperative anemia should be managed due to the high rates of postoperative transfusion for this surgery, clinicians should consider the complex interplay among the causal factors of anemia, apart from ID, in patients with preoperative anemia who are scheduled for TKA.

BACKGROUND: This study evaluated the shoulder girdle muscle characteristics of elite archery athletes and provides suggestions for archery training programs.METHODS: This study enrolled 15 cases of high level archery athletes (7 males, 8 females) and 30 cases of (15 males, 15 females) sex, age-matched, healthy, non-athletic individuals. We measured peak torques of flexion (FL), extension (EX), abduction (ABD), adduction (ADD), external rotation (ER) and internal rotation (IR) of both shoulders at an angular velocity of 30°/sec, 60°/sec, and 180°/sec. The peak torques and peak torque ratios of FL/EX, ABD/ADD, and ER/IR of the two groups were compared.RESULTS: The archer group had a greater peak torque of IR and ADD, but only in the left shoulder (p < 0.05). In the same group, both shoulders had greater peak torque of EX and lower peak torque of FL. The peak torque ratios of FL/EX of both shoulders were significantly lower in the archer group at all three angular velocities (p < 0.05). The peak torque ratios of ABD/ADD were significantly greater in only the left shoulder of the archer group (p < 0.05).CONCLUSIONS: The prominent characteristics of the shoulder girdle muscles of an elite archer are stronger adductor muscles of the bow shoulder and stronger extensors of both shoulders, as compared to healthy, non-athletic individuals. These muscle groups of the shoulder probably contribute a major role in maintaining the accuracy and stability during archery shooting. Hence, a training program that selectively enhances the adductor and extensor muscles could prove helpful in enhancing the archery skills of the athlete.

Osteosynthesis is recommended for Garden I and II femoral neck fracture treatment using parallel partially threaded cannulated screws. Postoperatively, excessive femoral neck shortening (FNS) and posterior tilt of the femoral neck (PTFN) are frequently encountered and are correlated with impaired quality of life and clinical outcomes. We hypothesized that stabilization by parallel partially threaded cannulated screws replacing a posterior partially threaded screw with a fully threaded positioning screw would improve fracture healing without further FNS and PTFN in femoral neck fractures.We retrospectively reviewed Garden I and II femoral neck fractures treated by in situ fixation using parallel cannulated screws at our institution between January 2010 and November 2018. Patients with the applicable fractures were divided according to the utilization of posterior fully threaded screws: patients with partially threaded screws were included in Group C and those with posterior fully threaded screws were included in Group P. Intergroup comparisons were performed based on radiographic measurements that assessed the shortening in two vectors (the horizontal and vertical axes), FNS, and subsequent PTFN.No significant intergroup difference was found in demographics and fracture characteristics, except in the follow-up duration. The mean FNS and shortening in both vectors were significantly smaller in Group P than in Group C (FNS, 5.02 ± 1.31 vs. 8.84 ± 3.48 mm, p0.001; horizontal axis, 4.07 ± 1.06 vs. 6.18 ± 2.77 mm, p0.001; and vertical axis, 2.55 ± 1.68 vs. 5.74 ± 3.41 mm, p 0.001). The mean subsequent PTFN was significantly smaller in Group P (2.21 ± 2.99 vs. 7.56 ± 6.20 mm, p 0.001). A significantly smaller number of patients in Group P had moderate (5-10 mm) or severe (10 mm) FNS and moderate (5-10°) or severe (10°) subsequent PTFN.Parallel cannulated screws replacing a posterior partially threaded screw with a fully threaded positioning screw as a length- and angle-stable construct for Garden I or II femoral neck fracture fixation can prevent femoral neck collapse in both the coronal and axial planes.

Background This study aimed to verify the diagnostic performance of Ultrasonography (US) in the evaluation of fatty infiltration (FI) in rotator cuff muscles and to analyze the diagnostic values of each measurement component. Methods The degree of FI in 108 shoulders was assessed by magnetic resonance imaging (MRI) and US. MRI findings were graded by the Goutallier classification. US findings were graded by the Strobel method. Agreement between MRI and US findings was evaluated. The sensitivity and specificity for detecting FI and intraobserver reliabilities were also assessed. Results US grading of the infraspinatus based on short-axis architecture showed good agreement (κ = 0.62). US grading-based on architecture showed good agreement for both supraspinatus and infraspinatus in long- and short-axis scans (supraspinatus, κ = 0.63; infraspinatus, κ = 0.68), while that based on echogenicity showed moderate agreement (supraspinatus, κ = 0.51; infraspinatus, κ = 0.50). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of detecting advanced FI were significant in both axes. Conclusions US is effective for detecting advanced FI in the rotator cuff muscles. US can assess the infraspinatus more accurately than the supraspinatus, and architecture is a more decisive component of FI status than echogenicity.

Bisphosphonates are the most commonly used drugs for osteoporosis and long-term use of bisphosphonates may affect fusion rate after spinal fusion surgery. There was significant delayed union after 6 months in long-term bisphosphonates users; however, there were no significant difference in fusion rate of long-term bisphosphonate users. Therefore, spinal fusion surgery should not be hesitated in long-term bisphosphonates users.Bisphosphonates (BPs) are the most popular class of drugs for treatment of postmenopausal osteoporosis. Long-term use of BPs may also inhibit the spinal fusion process after posterior lumbar interbody fusion (PLIF). We compared bone fusion rates of long-term BPs users and non-users after undergoing spinal fusion surgery.A total of 97 postmenopausal women who were candidates for single-level PLIF were recruited from 2015 to 2016. Participants were divided into two groups, with 63 patients in a long-term BPs user group and 34 patients in a non-user group. Serum C-terminal cross-linking telopeptide (CTX) levels were checked for bone resorption markers. Bone fusion rates were calculated at 6 months and 1 and 2 years after the surgery. Clinical outcomes were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS).Serum CTX level was dramatically decreased in the long-term BPs user group (p 0.05). Fusion rates at 6 months after surgery were 42% in the non-user group and 26% in the long-term BPs user group (p = 0.035). However, fusion rates were 82% in the long-term BPs user group and 87% in the non-user group at 2 years after surgery (p 0.05). There was no significant difference between the two groups in ODI or VAS.Even though there was significant delayed union after 6 months in long-term BPs users, at the 2-year postoperative follow-up, there was no significant difference in bone fusion rate between the two groups. Long-term BPs users showed fusion rates greater than 80% and clinical outcome improvements that were comparable to those in non-users. No significant effect on fusion rate after PLIF was found in long-term BPs users.

In order to suppress the malfunction caused by the shift of the threshold voltage (VTH) of oxide thin film transistors (TFTs) to a negative value, double-gate TFTs are used in the shift register of the gate driving system to control VTH by adjusting the top gate bias. The proposed circuit detects the current consumption of the shift register and adjusts VTH so that the current consumption of the shift register is regulated within the desired value. The system includes a compensation algorithm, which can search for an optimized top gate bias in various circumstances such as process fluctuations and ambient temperature change. The proposed system provides a stable operation compared with a conventional structure especially at high temperature. Experimental results show that, in the conventional system without compensation, the output voltage of the shift register deteriorates at $80\, {}^{\circ} {\rm C}$ and above, and the power consumption increases from 1.15 to 2.14 mW after 21600 s of continuous operation at $60\, {}^{\circ} {\rm C}$ . On the other hand, the proposed system provides a stable gate output up to $100\, {}^{\circ} {\rm C}$ and keeps the power consumption below 1.10 mW by adjusting the top gate bias responding to environment changes.

In order to suppress the malfunction caused by the negative Vth of oxide TFTs the shift register consists of double gate TFTs to control the Vth by adjusting top gate bias. The proposed circuit can detect the current consumption of the shift register so that we can hold the current consumption of the shift-register with accordance with the desired current consumptions in the shift-register. The system includes the compensation algorithm which can search an optimized top gate bias in the various circumstances, such as the process fluctuation and ambient temperature. The proposed system provided more stable operation than conventional one at high temperature. Experimental results showed that an output voltage of the shift-register was deteriorated at 80 °C and power consumption doubled during 6 hours at 60 °C in the conventional system. On the other hand, the proposed system can provide the stable gate output up to 100 °C and kept the initial power consumption by adjusting the top gate bias.

The shift register of display panel employing double-gate oxide thin-film transistors (TFTs) to compensate the severe degradation of the threshold voltage (V TH) is proposed. In double-gate TFTs, V TH is controlled by adjusting top-gate bias, so that V TH degradation can be stabilised by top-gate bias control. However, an optimum top-gate voltage varies from product to product due to process–voltage–temperature variation. To overcome this variation, a feedback system is designed and fabricated in a 0.18 μm BCDMOS process. The system consists of the shift register current sensing and the searching algorithm for finding optimal top-gate bias of double-gate TFTs. It is verified that proposed system successfully stabilised the operation of the shift register up to 80°C.

The Ultra high Definition (3840times2160) resolution, 70″ LCD TV with 240Hz frame rate has been developed. A cost effective single bank driving architecture with multi-chip structure is realized by adopting a vertical quarter partitioned (VQP) and overlap data exchange (ODX) driving scheme. Even though half-gate two-data line design (hG-2D) is adopted to overcome the charging time limitation, scan line overlapping driving scheme has also been implemented to enhance the actual pixel charging performance. The 240Hz frame rate driving technology makes 3-dimensional display through temporal division such as 3D display of active shutter glass possible. Furthermore, a novel up-scaling algorithm with inventive single-frame super-resolution methodologies has been invented to cope with input display data of FHD resolution.

Postpartum sacral fracture is relatively rare, and its diagnosis is often delayed. We herein report such a case of a 28-year-old patient who presented with an insidious-onset lower back pain, left buttock pain, and radicular symptoms mimicking lumbar radiculopathy. Laboratory tests showed a decreased 25-hydroxy vitamin D level, and the bone mineral densitometry of both femurs was below the expected range. Plain radiographs of the lumbar spine and pelvis showed no definite abnormality, but lumbosacral spinal magnetic resonance imaging identified a left sacral fracture. Symptoms were alleviated with rest and oral analgesic treatment.

Objective To explore the effect of visual and haptic vertical stimulation on standing balance in post-stroke patients. Methods Twenty-five post-stroke patients were recruited. We measured left/right standing pressure differences and the center of pressure (COP) parameters for each patient under three different conditions: no stimulation, visual, and haptic stimulated conditions. First, patients stood on a posturography platform with their eyes blindfolded. After a rest period, the patients stood on the same platform with their eyes fixed to a 1.5-m luminous rod, which was placed at a vertical position in front of the patients. After another rest period, the patients again stood touching a vertically placed long rod in their non-hemiplegic hand with their eyes blindfolded. We collected the signals from the feet in each condition and obtained the balance indices. Results Compared with the no stimulation condition, significant improvements were observed for most of the COP parameters including COP area, length, and velocity for both the visual and haptic vertical stimulation conditions (p0.01). Conclusion Both visual and haptic vertical stimulation improved standing steadiness of post-stroke patients. Notably, visual vertical stimulation was more effective than haptic stimulation.

DC–DC converters integrated into a panel are proposed for mobile display applications using indium gallium zinc oxide (IGZO) thin film transistors (TFTs). The proposed positive DC–DC converter uses cross-coupled and diode-connected structures for a high output voltage and a high power efficiency, while the proposed negative DC–DC converter uses also a cross-coupled structure but with separated pumping capacitors for a negative output voltage and a high power efficiency. The simulated results show that the output voltage and power efficiency are 21.3 V and 69.5% for the positive DC–DC converter and -5.1 V and 56.1% for the negative DC–DC converter, respectively, at a supply voltage of 10 V and a load current of 250 µA. The measured results show that the output voltage and power efficiency of the proposed positive DC–DC converter are 20.8 V and 66.6%, respectively, under the same conditions as those for the simulated results.

An efficient two-stage frequency-domain equalisation (TS-FDE) is proposed, in order to mitigate the effect of multiple access interference (MAI) in code division multiple access (CDMA) systems having no cyclic-prefix (CP). In TS-FDE, the first stage performs channel equalisation and signal detection. Utilising the detected signal and a channel response, the second stage constructs the circularity of a channel matrix for a received signal, and then it performs once more the channel equalisation like an FDE using the CP. The MAI mitigating capability of the TS-FDE is evaluated in a mobile channel.