Vitamin D and Resilience in Acutely Admitted Patients with Bipolar Disorder / 생물치료정신의학

Objectives@#：The purpose of this study was to investigate the relationship between serum vitamin D concentration and resilience in patients hospitalized with bipolar disorder. @*Methods@#：Serum vitamin D levels were measured on day 1 of hospitalization in 64 patients with bipolar disorder, who were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. The ConnorDavidson Resilience Scale and the Korean version of the Inventory for Depressive Symptomatology (KIDS) were administered to these patients, and symptoms of mania were evaluated using the Young Mania Rating Scale (YMRS). Patients were then categorized into vitamin D sufficient and deficient groups based on a serum vitamin D cut-off of 20 ng/ mL. Analysis of covariance (ANCOVA) was performed to compare the resilience between the two groups, and multiple linear regression was performed to determine the association between serum vitamin D levels and resilience. @*Results@#：The vitamin D deficiency group had more depressive episodes than the sufficient group (p<0.05). ANCOVA showed that the vitamin D deficient group had significantly lower resilience scores than the sufficient group (p= 0.034). Moreover, multiple regression analyses conducted by controlling age, sex, body mass index, season of blood sampling, KIDS scores, and YMRS scores, showed a significant association between serum vitamin D concentration and resilience in patients with bipolar disorder (p=0.001). @*Conclusions@#：This study suggested that vitamin D deficiency is associated with resilience as a protective factor against stress and trauma in patients with bipolar disorder. Further research is warranted to determine the causal relationship between vitamin D levels and resilience.

Measurement Uncertainty in Spine Bone Mineral Density by Dual Energy X-ray Absorptiometry

BACKGROUND: The purpose of this study was to calculate the measurement uncertainty of the process of bone mineral density (BMD) analysis using dual energy X-ray absorptiometry with traceability. METHODS: Between March 2015 and October 2016, among healthy participants in their 20s and 30s, the study included those who had not taken calcium, vitamin D supplements and steroids and were without a history of osteoporosis, osteopenia and diseases related to osteoporosis. Relational expression of the model was established based on Guide to the Expression of Uncertainty in Measurements and Eurachem and the uncertainty from each factor was evaluated. RESULTS: The combined standard uncertainty was 0.015, while the expanded uncertainty was 0.0298. The factor-specific standard uncertainties that occurred in the process of measuring BMD were 0.72% for the calibration curve, 0.9% for the internal quality control (IQC) using Aluminum Spine Phantom, 0.58% for European Spine Phantom (ESP), and 0.9% for the inspector precision (IP). CONCLUSIONS: The combined standard uncertainty of the spine BMD corrected with ESP was 0.015 when measured at one time and targeting one participant. The uncertainties of the accuracy of the IQC and the IP were higher than that of the other factors. Therefore, there will be a need for establishment of protocols to lower these uncertainties.

The Usefulness of Poller Screw with Antegrade Nailing in the Initial Treatment of Infraisthmal Femur Shaft Fracture

PURPOSE: The purpose of this study was to evaluate the radiologic and clinical outcomes after intramedullary nailing with Poller screw insertion at initial stage in infraisthmal femur shaft fractures. MATERIALS AND METHODS: Seven consecutive patients (7 femurs) treated with antegrade intramedullary nailing with Poller screw insertion for the infraisthmal femur shaft fracture were reviewed retrospectively. There were 4 male and 3 female patients. Mean age was 46.1 years (20-72 years). Operative time including Poller screw insertion, time for union, malalignment, and range of motion were evaluated. RESULTS: All 7 cases had primarily healed successfully. Mean time for radiologic union was 19.1 weeks (16-24 weeks) postoperatively. One case had 5 degree valgus malalignment. One case of 15 mm shortening was reported and he required shoe lift orthosis. All cases had a full range of motion in hip and knee joint. CONCLUSION: Antegrade intramedullary nailing with Poller screw insertion is useful in the initial treatment of infraisthmal femur shaft fracture, because it could provide additional stability. An additional 20 minutes were required but a Poller screw should be considered according to the anatomic location of a femur shaft fracture.

Subluxation of the Extensor Carpi Ulnaris Tendon Associated with the Extensor Digitorum Tendon Subluxation of the Long Finger

A twenty-year-old male visited our clinic with wrist and long finger metacarpophalangeal (MP) joint pain. Dynamic ultrasonography revealed sagittal band (SB) ulnar subluxation and extensor carpi ulnaris (ECU) volar subluxation. Magnetic resonance imaging showed longitudinal splitting and dislocation of the volar half slip of the ECU tendon. The redundant radial SB was augmented and ECU sheath was advanced to the periosteum using suture anchors. He was able to perform his previous activities at the last follow-up. We encountered a case of "simulateous" ECU dislocation with extensor tendon subluxation of the long finger at the MP joint. Therefore, we report this case with a review of the relevant literature.

A Clinical Result of Pedicle Screw Fixation in Osteoporotic Spine: Complications and Prevention

STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze the clinical results of patients who were treated by pedicle screw fixation in osteoporotic spine and suggest the methods for preventing a loss of fixation strength. SUMMARY OF THE LITERATURE REVIEW: There are some methods to decrease failure rate and increase fixation strength in the osteoporotic spine: use bicortical screw, cement augmentation and supporting anterior column by interbody fusion using cages. MATERIALS AND METHODS: Forty-four patients treated by spinal instrumentation using pedicle screw from 2004 to 2011 were followed for at least 12 months. Five men and 39 women were diagnosed as osteoporotic spine (T score <-3.0). Two hundred forty eight pedicle screws were included and statistically analyzed the correlation between the use of bicortical screw, cement augmentation, anterior column support and fixation loss of the pedicle screw. Radiologic results were evaluated to find out the mechanical complications, like loosening of the screw, fixation failure, and nonunion. RESULTS: There were 9 complications associated with mechanical strength, loosening of pedicle screws in 7, sinking down of cage in 4, and nonunion in 4 cases. Using bicortical pedicle screw, cement augmentation and anterior column support were significantly correlated with the increasing fixation strength (P=0.001, P=0.047, P=0.014). In addition, these three factors contribute to stabilize the instrumentation (Linear by linear association, P=0.012). CONCLUSIONS: These 3 methods, using bicortical pedicle screw, cement augmentation and supporting anterior column, are effective to enhance the fixation strength and prevent loss of holding power in the osteoporotic spine.

The Association of Eosinophilic Airway Inflammation in Mycoplasma pneumonia and Asthma / 소아알레르기및호흡기학회지

PURPOSE:To investigate whether airway eosinophilic degranulation develops in Mycoplasma pneumonia (M. pneumonia), and to elucidate the association between M. pneumonia and asthma. METHODS:Forty patients with M. pneumonia, 20 stable asthma patients (stable asthma) and 20 normal controls were recruited from October 2005 to February 2007. In the M. pneumonia, blood and induced sputum sampling were collected at admission (acute stage) and 6 to 8 weeks later (convalescent stage). Eosinophil-derived neurotoxin (EDN) and eosinophil cationic protein (ECP) levels in sputum and serum were measured in all 3 groups. RESULTS:Serum levels of EDN and ECP in the acute stage of M. pneumonia were comparable to those in the stable asthma group. However, in the convalescent stage of M. pneumonia, EDN and ECP levels were significantly lower than in the stable asthma (P<0.01 and P<0.05, respectively). Sputum levels of EDN and ECP levels in the acute stage of M. pneumonia were comparable to those in the stable asthma. Sputum EDN levels in the convalescent stage of M. pneumonia were significantly lower than those in the stable asthma (P<0.05), and sputum ECP levels were lower than those in the stable asthma, which was not statistically significant. CONCLUSION:Eosinophilic degranulation may play an important role in the pathogenesis of M. pneumonia, which suggests the association between M. pneumonia and asthma.

A Case of Gonococcal Conjunctivitis in Adult

The authors have experienced a case of gonococcal conjunctivitis in 19 year-old male, who showed bilateral lid edema and copious yellowish conjunctival discharge which progress rapidly for four days. A stain of the conjunctival exudate appeared gram-negative intraCellular diplococci. This patient was treated with topical and systemic antibiotics for 7 days and topical antibiotics and corticosteroids for 12 days, with almost complete resolution. Involvement of corneal epithelium and residual punctate corneal opacity were remained slightly.