The Effect of Laughter therapy on Interpersonal Relations of Person's Affected by Hansen's Disease / 나학회지

This study was attempted to explore the effect of laughter therapy on Hansen people's Interpersonal Relations, certify the effect, and use that as a useful means to improve Hansen people's interpersonal ability. The research method, Hansen people receiving outpatient and admission medical examination and treatment at the research institute of Korea Hansen Welfare Association located in Euiwang-si, Gyeonggi-do, and Hansen People residing at Razaro Village, and divided 60 people approving participation at research into 30 as an experimental group and 30 as a control group, and conducted a questionnaire survey. The sex was distributed to 30 males, and 30 females, and this study conducted a laughter therapy to 30 of the experimental group over 8 times in total by 60 minutes for 2 weeks, and for the collected data, analyzed changes to interpersonal relations revealed before and after conducting the laughter therapy program using IBM/SPSS 20.0 program. The major findings of this study are as follows. Verification of effects of a laughter therapy on Hansen people' interpersonal relations indicated that the interpersonal scores of the experimental group statistically came out high, so the laughter therapy is effective in improving Hansen people' interpersonal relations. {Pre-test (M = 3.21) and post-test (M = 3.79) of the results showed a statistically significant difference (p<.001)}. It clarified that the laughter therapy is effective improving males' and females' interpersonal relations, where it has a higher effect on female Hansen people than male people. {(males : pretest (M = 2.93) and post-test (M = 3.48), females : pre-test (M = 3.45) and post-test (M = 4.07}

Gene-Smoking Interaction on Ischemic Stroke: Case-Control Study of Glutathione S-Transferase Polymorphism / 대한뇌졸중학회지

BACKGROUND: Smoking is a major risk factor of stroke, but not all smokers develop stroke. This individual difference could be explained by the variation of detoxification capacity. We investigated the relationship of smoking with the genetic polymorphism of a detoxification enzyme (glutathione S-transferase: GST). METHODS: This study was conducted as a case-control study. Conventional risk factors for stroke and 3 genetic polymorphisms of GST (GSTM1, GSTT1, and GSTP1) were studied in both 290 acute ischemic stroke patients and 290 age and sex matched controls. Smoking status was determined by urinary cotinine level. The effect of interaction of GST polymorphisms and smoking on stroke risk was investigated. RESULTS: Stroke patients had higher cotinine level compared to that of control (P<0.01). There was little difference between the patient group and control group with regard to the GST polymorphism alone, but significant interaction was noticed between the GST polymorphism and the smoking status. When we stratified the group according to the smoking status by cotinine level, stroke was significantly more frequent in GSTM1 null type and GSTT1, GSTP1 wild type of the high cotinine level group (OR and 95% CI: 2.115, 1.219-3.670; 2.620, 1.480-4.638; 2.212, 1.343-3.644 respectively). CONCLUSION: GST polymorphisms interact with the smoking and confer an increased risk of ischemic stroke, indicating that genetic polymorphism of GST might reveal smokers who are more susceptible to the ischemic stroke.

Treatment of 5th Metacarpal Neck Fracture Using Percutaneous Transverse Fixation with K-Wires

PURPOSE: To evaluate the radiologic and clinical results of percutaneous transverse fixation with K-wires for 5th metacarpal neck fracture. MATERIALS AND METHODS: Between January 2007 and September 2010, 18 patients with a 5th metacarpal neck fracture, who underwent operative treatment, were included in this study. The surgical method was percutaneous transverse fixation using K-wires. We evaluated fracture angulation in oblique radiographs preoperatively, postoperatively, and at final follow-up, and used SPSS to perform statistical analysis. We also performed clinical evaluation using the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: All of the 18 cases were completely united, and in the oblique radiographs, the angulation was corrected from 50.69degrees to 11.68degrees. The average difference between postoperative and final follow-up angulations was 0.14degrees, which was statistically insignificant. Clinically, the DASH score was 1.030 and no complications were observed. CONCLUSION: Percutaneous transverse fixation using K-wires could be one of the best ways to treat a 5th metacarpal neck fracture because of its simple method and low rate of complications.

Lateral Positioning for Proximal Femoral Nailing of the Intertrochanteric Fracture: Surgical Technique

In the treatment of intertrochanteric fractures, most of intramedullary nailings are performed on a fracture table in supine position. In supine position, however, soft tissue mass of the patients and drapes make it difficult to access to the piriformis fossa and to straighten the trajectory of reamer and nail insertion. To resolve these problems, we have treated twenty intertrochanteric fractures in lateral position on the general operation table with IM nail. Adjustment of the position of lag screw in femoral head was done with the technique that overlaps the shadows of the femoral head, nail and targeting guide in the lateral view. Because the entire injured limb can be moved readily, it was easy to reduce fracture and to convert to open procedure. In cases likely that the fracture table is unavailable in which patients are obese, have short stature or are amputated, and that open procedure is strongly likelihood, lateral position will be helpful technique in the treatment of intertrochanteric fractures with IM nail.

Differential oxidative stress response in young children and the elderly following exposure to PM(2.5)

<p><b>OBJECTIVES</b>The mechanism of the adverse health effects of ambient particulate matter on humans has not been well-investigated despite many epidemiologic association studies. Measurement of personal exposure to particulate pollutants and relevant biological effect markers are necessary in order to investigate the mechanism of adverse health effects, particularly in fragile populations considered to be more susceptible to the effects of pollutants.</p><p><b>METHODS</b>We measured personal exposure to PM(2.5) and examined oxidative stress using urinary malondialdehyde three times in 51 preschoolers and 38 elderly subjects. A linear mixed-effects model was used to estimate PM(2.5) effects on urinary MDA levels.</p><p><b>RESULTS</b>Average personal exposure of the children and elderly to PM(2.5) was 80.5 +/- 29.9 and 20.7 +/- 12.7 mug/m(3), respectively. Mean urinary MDA level in the children and the elderly was 3.6 +/- 1.9 and 4.0 +/- 1.6 mumol/g creatinine. For elderly subjects the PM(2.5) level was significantly associated with urinary MDA after adjusting for age, sex, BMI, passive smoking, day-care facility site, alcohol consumption, cigarette smoking, and medical history (heart disease, hypertension and bronchial asthma). However, there was no significant relationship for children.</p><p><b>CONCLUSIONS</b>The elderly were more susceptible than young children to oxidative stress as a result of ambient exposure to PM(2.5). Identification of oxidative stress induced by PM(2.5) explains the mechanism of adverse health effects such as cardiovascular or respiratory diseases, particularly in the elderly.</p>

MRI Measurement of the Distal Femur for Determining the Rotational Alignment in TKA

PURPOSE: The purpose of the current study was to investigate the relationship between the angles made by the reference axes on the axial magnetic resonance (MR) images and to provide information for determining the rotational alignment of the femoral component in total knee arthroplasty. MATERIALS AND METHODS: We analyzed 194 magnetic resonance (MR) images to measure the posterior condylar angle, the condylar twist angle and the difference between the posterior condylar angle and the condylar twist angle. We then evaluated the relationship between these angular measurements. RESULTS: The condylar twist angle averaged 6.09degrees, the posterior condylar angle averaged 2.95degrees and the difference between the posterior condylar angle and the condylar twist angle was 3.14degrees. There were no differences in these angles based on gender and age. CONCLUSION: In the cases that the center of the medial epicondyle is difficult to clearly identify during TKA, the femoral rotational resection angle can be determined by subtracting 3degrees from the condylar twist angle.

Rare Normal Variation Between Biceps Anchor and Superior Labrum: A Case Report

PURPOSE: Labral lesions and its anatomic variants have been studied by several authors in the last decade. Buford complex and sublabral recess are most common variants. Their recognition is important in order to distinguish them from superior and anterior labral tear. MATERIALS AND METHODS: We report one case of a 19-year-old female who was mistaken SLAP lesion for normal variant and was treated with arthroscopic surgery. RESULTS: The arthroscopic finding shows rare normal variant of biceps anchor and superior labrum. The biceps long head tendon was inserted at superior labrum and supraspinatus tendon area. This finding was mistaken to SLAP lesion. CONCLUSION: We report rare normal variant of biceps anchor and superior labrum that was observed during arthroscopic surgery for SLAP lesion.

Early Dislocation Rate with Large Femoral Heads in Primary Total Hip Arthroplasty

PURPOSE: To compare the incidence of early dislocation in a series of a small femoral heads with a series of larger femoral heads. MATERIALS AND METHODS: This study analyzed 84 primary total hip arthroplasties, which were performed between January 2002 and January 2006 and were followed more than 6 months. The cases were divided into two groups, a smaller head group (28 & 32 mm) and a larger head group (36 mm). The incidence of dislocation was recorded for both groups during the first 3 months after surgery. The probability that the incidence of dislocation between both groups was significantly different from the expected dislocation rate was assessed based on the assumed risk of an early dislocation of 2%. The two groups were compared with regard to the size of the acetabular cup. RESULTS: There were 6 early dislocations in the smaller head group, while no dislocations occurred in the larger head group. The incidence of expected dislocation, assuming a 2% dislocation rate, was similar for the smaller head group but different for the larger head group. The size of the acetabular cup was similar in both groups. CONCLUSION: These results highlight the advantage of a larger femoral head in reducing the early dislocation rates.

Delayed Posterolateral Rotatory Instability of the Elbow after Cubitus Varus : A Case Report / 대한정형외과학회잡지

Cubitus varus deformity of the elbow may not only cause cosmetic problems, but delayed functional deficiencies also. This case report demonstrated delayed posterolateral rotatory instability due to lateral collateral ligament complex avulsion long after posttraumatic cubitus varus. Satisfactory results were obtained using cubitus varus correction and reattachment of the lateral collateral ligament complex to the lateral epicondyle of the humerus.

The Fractures of Humerus Shaft and Medial Epicondyle by Arm Wrestling

PURPOSE: To evaluate the mechanism of the humeral fractures induced by arm wrestling and the clinical results of its treatment. MATERIALS AND METHOD: We reviewed 7 humeral fractures induced by arm wrestling; 3 humeral shaft fractures, 4 humeral medial epicondyle fractures. The mechanism of the fractures and the clinical results were assessed by history and radiographs. RESULTS: Shaft fractures were produced by twist and axial compression force. Humeral medial epicondyle fractures were the avulsion fractures by excessive contraction of flexor muscles and developed in young age. We operated 6 of them and in all cases, we could obtain fracture healings without complication. CONCLUSION: The humeral fractures induced by arm wrestling have the differences in the ages and mechanisms as to the locations of the fractures and if the proper treatment is performed, the clinical results are satisfactory.

GSTM1 and GSTP1 Polymorphisms as Potential Factors for Modifying the Effect of Smoking on Inflammatory Response

Inflammation has been known to be an important underlying condition for development of various diseases including cancer. The aims of this study were to investigate whether tobacco smoke exposure increases the level of inflammation biomarkers and the GSTM1 and GSTP1 gene polymorphisms are associated with inflam matory response due to tobacco smoke exposure. We measured urinary cotinine level in 300 healthy university students. Total serum TNF-alpha levels and blood WBC counts were determined to evaluate inflammatory response. Allelic loss of the GSTM1 and the GSTP1 (Ile105Val) polymorphism were determined by PCR and RFLP. Tobacco smoke exposure was found to be associated with increase of both TNF-alpha level and WBC count. Particularly, smokers with combination of GSTM1 null and GSTP1 AG or GG genotypes showed higher TNF-alpha level than those with the other genotype combinations (p=0.07). This result suggests that smoking may induce inflammation measured as TNF-alpha level or WBC count and combinations of the GSTM1 and GSTP1 polymorphisms may modify the effect of smoking on serum TNF-alpha level.

GSTM1 and GSTP1 Polymorphisms as Potential Factors for Modifying the Effect of Smoking on Inflammatory Response

Inflammation has been known to be an important underlying condition for development of various diseases including cancer. The aims of this study were to investigate whether tobacco smoke exposure increases the level of inflammation biomarkers and the GSTM1 and GSTP1 gene polymorphisms are associated with inflam matory response due to tobacco smoke exposure. We measured urinary cotinine level in 300 healthy university students. Total serum TNF-alpha levels and blood WBC counts were determined to evaluate inflammatory response. Allelic loss of the GSTM1 and the GSTP1 (Ile105Val) polymorphism were determined by PCR and RFLP. Tobacco smoke exposure was found to be associated with increase of both TNF-alpha level and WBC count. Particularly, smokers with combination of GSTM1 null and GSTP1 AG or GG genotypes showed higher TNF-alpha level than those with the other genotype combinations (p=0.07). This result suggests that smoking may induce inflammation measured as TNF-alpha level or WBC count and combinations of the GSTM1 and GSTP1 polymorphisms may modify the effect of smoking on serum TNF-alpha level.

Treatment of Complex Tibial Plateau Fractures: A Modified Patient Positioning for the Combined Anterior and Posterior Approaches

We have treated thirteen complex plateau fractures involving both condyles with one of the following conditions with the use of the combined anterior and posterior approaches in a modified supine position. Associated PCL avulsion fracture, displacement of major fracture plane dominantly at the back, large coronal fracture fragment involving medial or lateral condyles. A patient is placed on an operation table in supine position with a bump under the contralateral buttock. The well leg is placed in a lithotomy position and the injured leg is placed over a sterilized Mayo stand separately. For the posterior approach the table was tilt toward the injured side with the hip abducted and rotated externally. With a modified patient's positioning we were able to use combined anterior and posterior approaches simultaneously for the management of certain complex plateau fractures without changing the draping.

Effects of Air Pollutants on Childhood Asthma

Epidemiologic studies have suggested the association between environmental exposure to volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) and the increased risk of incurring asthma. Yet there is little data regarding the relationship between personal exposure to air pollution and the incidence of asthma in children. This study was designed to evaluate the effect of exposure to air pollution on children with asthma by using exposure biomarkers. We assessed the exposure level to VOCs by measuring urinary concentrations of hippuric acid and muconic acid, and PAHs by 1-OH pyrene and 2-naphthol in 30 children with asthma and 30 children without asthma (control). The mean level of hippuric acid was 0.158+/-0.169micromol/mol creatinine in the asthma group and 0.148+/-0.249micromol/mol creatinine in the control group, with no statistical significance noted (p=0.30). The mean concentration of muconic acid was higher in the asthma group than in the control group (7.630+/-8.915micromol/mol creatinine vs. 3.390+/-4.526micromol/mol creatinine p=0.01). The mean level of urinary 1-OHP was higher in the asthma group (0.430+/-0.343micromol/mol creatinine) than the control group (0.239+/-0.175micromol/mol creatinine), which was statistically significant (p=0.03). There was no difference in the mean concentration of 2-NAP between the two groups (9.864+/-10.037micromol/mol in the asthma group vs. 9.157+/-9.640micromol/mol in the control group, p=0.96). In conclusion, this study suggests that VOCs and PAHs have some role in asthma.

The effect of Smoking and Residential environment on Urinary 2-naphthol / 대한산업의학회지

OBJECTIVES: To evaluate the association of urinary 2-naphthol level and air pollution caused by exposure to smoking, traffic and residential factors. METHODS: The study subjects consisted of 300 university students in Incheon. The questionnaires concerning subject characteristics, smoking amount, traffic, distance between housing and main road, heating and cooking fuel including urinary cotinine levels were checked. RESULTS: There was not any significant association between urinary 2-naphthol level and age, sex, body mass index, distance from mainroad, traffic, heating and cooking fuel. The urinary 2-naphthol level was higher in smokers or high urinary cotinine level group(p=0.0001)than in nonsmokers or low urinary cotinine group. After adjusting for age, sex, and body mass index in the basic model, the 2-naphthol level was also higher in the smokers or high urinary cotinine level group, too(p<0.0005). The model included both traffic and residential variables and it had a good fitness as compared to other models. CONCLUSIONS: It has been known that as one of PAH metabolites, urinary 2-naphthol is a respiration-selective biological marker. We showed that tabacco smoking has a much stronger effects on urinary 2-naphthol levels than when subjects were exposed to air pollution, such as traffic, and other residential factors at the same time.

Total Knee Arthroplasty Without Patellar Resurfacing / 대한정형외과학회잡지

PURPOSE: To Analyze the Clinical Results of the Total Knee Arthroplasty without Patellar Resurfacing. MATERIALS AND METHODS: One hundred and eight Total Knee Arthroplasties (Nexgen(R), Zimmer, USA) without resurfacing of the patella, were performed between February 1995 and September 1999, and 89 cases followed up for more than 36 months were analyzed in this study. The follow up period ranged from 36 to 70 months (average 52 months). The diagnosis was degenerative joint disease in 83 cases (93%), rheumatoid arthritis in 5 cases (6%) and avascular necrosis of medial femoral condyle in 1 case (1%). The clinical results were evaluated according to Knee Society Clinical Rating System. RESULTS: The mean preoperative knee score was 34 points (range 5-63 points) according to the Knee Society Clinical Rating System, and the mean preoperative functional score was 38 points (range, 10-61 points). The mean postoperative knee score was 91 points (range 65-98 points) and the mean postoperative functional score 89 points (range, 63-100 points). The current study shows that patellar complications associated with unresurfacing did not occur, with the exception of 2 cases of persistent peripatellar pain, which resolved by a postoperative 6 months with conservative treatment. The patellofemoral joint space was also well preserved even at the 3 and 5 year follow-ups. CONCLUSION: Complications of total knee arthroplasty, such as patellar dislocation or subluxation, rupture of the patellar tendon, and fracture of the patella, can be avoided by not resurfacing the patella. On the basis of our results, there is little evidence to support routine patellar resurfacing in total knee arthroplasty.

Exposure Assessment of PCDD/Fs and Monitoring of Health Effects on Workers and Residents near the Waste Incinerators in Korea / 예방의학회지

OBJECTIVES: In this study, the exposure status of the hazardous substances from incinerators, such as polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs), were studied, and the relationship between the exposure of these hazardous substances and their heath effects on the workers and residents near municipal solid waste (MSW) incinerators and an industrial incinerator investigated. METHODS: Between July 2001 and June 2002, 13 workers at two MSW incinerators, 16 residents from the area around the two MSW incinerators, 6 residents from the control area, and further 10 residents near an industrial incinerator, estimated to emit higher levels of hazardous substances, were interviewed. Information, including sociodemographic information, personal habits, and work history, detailed gynecologic and other medical history were collected through interviews. Blood samples were also collected from 45 subjects, and analyzed for PCDD/DFs, by high resolution gas chromatography - high resolution mass spectrometry, using the US EPA 1613 method. In addition to the questionnaire survey, urinary concentrations of 8-hydroxydeoxyguanosine (8-OH-dG) and malondialdehyde (MDA) were measured as oxidative injury biomarkers. The urinary concentrations of 8-OH-dG were determined by in vitro ELISA, and the MDA by HPLC, using an adduct with thiobarbituric acid. RESULTS: The PCDD/DFs concentrations in the residents near the industrial incinerator were higher than those in the controls, workers and residents near the MSW incinerators. The average TEQ (Toxic Equivalencies) concentrations of the PCDD/DFs in residents near the industrial incinerator were 53.4pg I-TEQs/g lipid. The estimated daily intakes were within the tolerable daily intake range (1-4 pg I-TEQ/Kg bw/day) suggested by WHO (1997) in only 30% to the people near the industrial incinerator. Animal studies have already shown that even a low body burden of PCDD/DFs, such as 10ng TEQ/kg bw, can cause oxidative damage in laboratory animals. Our study also showed that the same body burden of PCDD/DFs can cause oxidative damage to humans. CONCLUSIONS: The exposures to PCDD/DFs and the oxidative stress of residents near the industrial incinerator, were higher than those in the controls, workers and residents near the MSW incinerators. Proper protection strategies against these hazardous chemicals are needed. Because a lower body burden of PCDD/Fs, such as 10ng TEQ/kg bw, can cause oxidative damage, the tolerable daily intake range should be restrictedly limited to 1pg I-TEQ/kg bw/day.

Specimen Storage and Analysis for Genomic Epidemiology / 예방의학회지

Because of advances of technologies in the field of genomic epidemiology in the recent years, specimen collection, storage and analysis became an essential part of research methodologies. DNA is now being used in epidemiologic studies to evaluate genetic risk factors and specimens other than the fresh whole blood can be used for PCR. Therefore, All nucleated cells, such as buccal swabs and urine specimens, are suitable for DNA analysis. For an unlimited source of genomic DNA, EBV transformation of lymphocytes can be used for immortalization. However, the type of specimen collected in genomic epidemiologic studies will depend on the study where the epidemiologist play a leading role for the design. We also briefly described various kinds of analysis for SNP that is an essential part of the genomic epidemiology.

Benzoapyrene-Induced DNA-Protein Crosslinks in Cultured Human Lymphocytes and the Role of the GSTM1 and GSTT1 Genotypes

We investigated the influence of glutathione S-transferase M1 (GSTM1) and glutathione S-transferase T1 (GSTT1) polymorphisms upon DNA-protein crosslinks (DPC) induced by benzo[a]pyrene (B[a]P) in cultured human lymphocytes. Lymphocyte samples were collected from 30 healthy nonsmoking hospital administrative workers. DPC was detected with KCl-SDS assay and the distributions of GSTM1 and GSTT1 were determined by polymerase chain reaction. B[a]P was found to induce a significant dose-responsive increase in cytotoxicity and DPC regardless of the genotypes (p0.05). In terms of the genes examined, the level of cytotoxicity and DPC formation were found to be highest in the GSTM1-null and GSTT1-null cells. In conclusion, B[a]P induced a significant increase in the cytotoxicity and the level of DPC formation in cultured human lymphocytes. Our findings suggest that DPC could be used as a biomarker of B[a]P exposure.

A Case of Streptococcal Toxic Shock Syndrome with Myonecrosis / 감염

Invasive infections by group A streptococci have reemerged as a global public health problem since the middle of the 1980s. Streptococcal toxic shock syndrome (StrepTSS) is one manifestation of invasive streptococcal infections, and it is characterized by necrotic infection of soft tissue. Myonecrosis can occur in StrepTSS, but the clinical features of this subset of StrepTSS are not clearly defined. A previously healthy 38-year-old woman was hospitalized because of pain and edema of both legs, which had developed one day prior to admission. Six hours after admission, the swelling of the patient's left leg became more severe and areas of well-demarcated violescent discoloration of the skin and hemorrhagic bullae developed. A further ten hours later, she was in shock and exhibited signs of disseminated intravascular coagulation and multiple organ failure. Gram stain of an aspirate from the bulla revealed short chains of gram-positive cocci. Streptococcus pyogenes was isolated from blood culture and the presence of streptococcal exotoxins (speA gene) and M-protein type 3 were confirmed using the polymerase chain reaction. Muscle biopsy showed extensive myonecrosis and hemorrhage without infiltration of leukocytes. Despite intensive treatment with antibiotics (including clindamycin), debridement, and intravenous gamma globulin, the patient died four days after admission to the hospital.