Association of Change in Smoking Status and Subsequent Weight Change with Risk of Nonalcoholic Fatty Liver Disease

Background/Aims@#Smoking is considered a risk factor for the development of nonalcoholic fatty liver disease (NAFLD). However, the association of a weight change after a change in smoking status and the risk of NAFLD remains undetermined. @*Methods@#This study used the Korean National Health Insurance Service-National Sample Cohort. Based on the first (2009 to 2010) and second (2011 to 2012) health examination periods, 139,180 adults aged at least 40 years were divided into nonsmoking, smoking cessation, smoking relapse, and sustained smoking groups. NAFLD was operationally defined using the fatty liver index. The adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated using multivariable-adjusted logistic regression. @*Results@#Compared to nonsmoking with no body mass index (BMI) change, the risk of NAFLD was significantly increased among subjects with BMI gain and nonsmoking (aOR, 4.07; 95% CI, 3.77 to 4.39), smoking cessation (aOR, 5.52; 95% CI, 4.12 to 7.40), smoking relapse (aOR, 7.51; 95% CI, 4.81 to 11.72), and sustained smoking (aOR, 6.65; 95% CI, 5.33 to 8.29), whereas the risk of NAFLD was reduced among participants with BMI loss in all smoking status groups. In addition, smoking cessation (aOR, 1.76; 95% CI, 1.35 to 2.29) and sustained smoking (aOR, 1.64; 95% CI, 1.39 to 1.94) were associated with higher risk of NAFLD among participants with no BMI change.The liver enzyme levels were higher among participants with smoking cessation and BMI gain. @*Conclusions@#Monitoring and management of weight change after a change in smoking status may be a promising approach to reducing NAFLD.

Exercise Frequency Reduction Is Associated With Higher Risk of Infection in Newly Diagnosed Diabetes: A Nationally Representative Cohort Study

Background@#Exercise is an important method to control the progression of diabetes. Since diabetes compromises immune function and increases the risk of infectious diseases, we hypothesized that exercise may affect the risk of infection by its immunoprotective effects.However, population-based cohort studies regarding the association between exercise and the risk of infection are limited, especially regarding changes in exercise frequency. The aim of this study was to determine the association between the change in exercise frequency and the risk of infection among patients with newly diagnosed diabetes. @*Methods@#Data of 10,023 patients with newly diagnosed diabetes were extracted from the Korean National Health Insurance Service-Health Screening Cohort. Self-reported questionnaires for moderate-to-vigorous physical activity (MVPA) were used to classify changes in exercise frequency between two consecutive two-year periods of health screenings (2009–2010 and 2011–2012). The association between changes in exercise frequency and the risk of infection was evaluated using multivariable Cox proportional-hazards regression. @*Results@#Compared with engaging in ≥ 5 times of MVPA/week during both periods, a radical decrease in MVPA (from ≥ 5 times of MVPA/week to physical inactivity) was associated with a higher risk of pneumonia (adjusted hazard ratio [aHR], 1.60; 95% confidence interval [CI], 1.03–2.48) and upper respiratory tract infection (aHR, 1.15; 95% CI, 1.01–1.31). In addition, a reduction of MVPA from ≥ 5 to < 5 times of MVPA/week was associated with a higher risk of pneumonia (aHR, 1.52; 95% CI, 1.02–2.27), whereas the risk of upper respiratory tract infection was not higher. @*Conclusion@#Among patients with newly diagnosed diabetes, a reduction in exercise frequency was related to an increase in the risk of pneumonia. For patients with diabetes, a modest level of physical activity may need to be maintained to reduce the risk of pneumonia.

Result of a Long-Term Follow-Up of Arthroscopic Partial Repair for Massive Irreparable Rotator Cuff Tears Using a Biceps Long Head Auto Graft / 대한정형외과학회잡지

Purpose@#This paper presents the long term follow-up results of arthroscopic partial repair for massive irreparable rotator cuff tears using a biceps long head auto graft. @*Materials and Methods@#Forty-one patients with massive irreparable rotator cuff tear, who underwent arthroscopic repair, were reviewed retrospectively. Patients who underwent arthroscopic partial repair using a biceps long head auto graft were assigned to group 1, and patients in group 2 underwent arthroscopic partial repair alone. Patients with a less than 50% partial tear of the long head biceps tendon were included in this study. The clinical scores were measured using a visual analogue pain scale (VAS) for pain, range of motion (ROM), The University of California, Los Angeles shoulder score (UCLA), American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Korean Shoulder Scoring System (KSS) scores preoperatively and at the final follow-up. The acromiohumeral interval (AHI) was measured using plain radiographs taken preoperatively and at the final follow-up, and re-tear was evaluated using postoperative ultrasound or magnetic resonance imaging at the last follow-up. @*Results@#The mean age of the patients was 62.1±12.7 years, and the mean follow-up period was 90.3±16.8 months. No significant differences in the VAS and ROM (forward flexion, external rotation, internal rotation) were found between the two groups (p=0.179, p=0.129, p=0.098, p=0.155, respectively). The UCLA (p=0.041), ASES (p=0.023), and KSS (p=0.019) scores showed functional improvements in group 1 compared to group 2. At the last follow-up, the measured AHI values were 9.46±0.41 mm and 6.86±0.64 mm in group 1 and 2, respectively (p=0.032). Re-tear was observed in six out of 21 cases (28.6%) in group 1 and nine out of 20 cases (45.0%) in group 2; the retear rate was significantly lower in group 1 than in group 2 (p=0.011). @*Conclusion@#Arthroscopic partial repair for a massive irreparable rotator cuff tear using a biceps long head auto graft has significant clinical usefulness in functional recovery and decreases the re-tear rates after surgery than arthroscopic partial repair alone, showing favorable results after a long-term follow-up.

Clay-Shoveler's Fracture in an 18-Year-Old Cheerleader: A Case Report

Clay-Shoveler's fracture refers to a fracture that is solely developed on the spinous process of the cervical spine or the thoracic vertebrae. This fracture rarely occurs during sporting activities. In this case, an 18-year-old female developed the fracture on the spinous process of the 7th cervical spine and 1st thoracic vertebrae due to the repetitive practice of cheerleading. The patient's pain was improved by wearing a support device and taking an anti-inflammatory analgesic drug and muscle relaxant. Her case is being followed-up at the outpatient department.

Differential Diagnosis and Treatment of Cervical Spondylotic Myelopathy Mimicking Myelitis in an Adolescent Patient: A Case Report

STUDY DESIGN: Case report OBJECTIVES: This study introduces an interesting case of adolescent cervical myelopathy with atypical cervical magnetic resonance imaging (MRI) findings. A differential diagnosis was made, followed by successful surgical treatment. SUMMARY OF LITERATURE REVIEW: A careful differential diagnosis of high signal intensity on T2-weighted cervical MRI is necessary if there is no evidence of cervical stenosis. Recent reports have suggested that the differential diagnosis should be based on a comprehensive analysis of data, including brain MRI, a cerebrospinal fluid examination, and empirical steroid treatment. MATERIALS AND METHODS: A 17-year-old male patient complained of upper extremity weakness, gait disturbance, and decreased sensation in the upper extremity. Cervical spine MRI findings suggested C3/4 disc herniation, moderate cervical stenosis, and high signal intensity in the spinal cord. A differential diagnosis was made between cervical myelopathy and myelitis. RESULTS: Decompression and posterolateral fusion of C3/4 were performed in a 17-year-old patient with cervical myelopathy without significant cervical stenosis. Postoperatively, upper extremity sensation and weakness and gait disturbance showed improvement, and the Japanese Orthopedic Association score improved to 17 points at 6 months after surgery. CONCLUSIONS: In patients with cervical myelopathy showing high signal intensity on T2-weighted imaging without evident spinal stenosis, a differential diagnosis should be made between cervical myelopathy and myelitis; surgical decompression can be an effective treatment choice upon the diagnosis of cervical myelopathy.

Management of Hair Line Using Skin Graft after Tissue Expansion for the Auricular Reconstruction of Microtia

Reconstructing the ear with autogenous rib cartilage is one of the most preferred methods for microtic ear reconstruction. Sometimes, when using this method, the skin envelope size is not large enough for the cartilage framework. With tissue expansion, a more adequately sized hairless skin envelope can be developed. Usually we recommend that canaloplasty be delayed after external ear reconstruction. But when the external ear canal has been reconstructed before external ear reconstruction, the remaining hairless skin for an envelope is so deficient that even though using tissue expansion, it is nearly impossible to develop well-qualified hairless skin envelope. From January, 1996 to December, 1998, we reconstructed auricles using tissue expansion, followed by excision of hair-bearing skin and grafting of full-thickness skin in five microtic patients whose external ear canals had been reconstructed before external ear reconstruction. The skin donor area was the contralateral postauricular area. Two to three weeks after the skin graft, autogenous cartilage grafts followed. No graft was lost. Color and texture was well matched, and the hair-bearing tissue portions were almost completely removed. Our method has several advantages: 1) it uses local tissue maximally; 2) it leaves the capsule intact, which can improve flap circulation; 3) it may thin the flap as much as it can be, which can reveal well defined cartilage framework; 4) it allows easy removal of hair-bearing tissue portions; 5) it provides a well-vascularized bed for graft survival and preserves the temporoparietal fascia, which can be used for secondary reconstruction if necessary; 6) Tissue expansion can reduce the amount of hair-bearing portion which should be removed.

Le Fort III Advancement for the Correction of Crouzon's Disease

Crouzon's disease, first described by Crouzon in 1912, is characterized by craniosynostosis, exorbitism and midface hypoplasia. As well, it has been known to be transmitted as an autosomal dominant trait. Clinically, Crouzon's disease not only has aesthetic problems, but also many functional disabilities, such as increased intracranial pressure, hydrocephalus, visual disturbance. difficulty in nasal breathing and malocclusion. The surgical correction of Crouzon's disease includes: 1) frontal bone advancement and release of the craniosynostosis; 2) correction of the midface retrusion; and 3) other ancillary procedures for better aesthetic results. The authors performed Le Fort III advancement for the correction of midface retrusion in 5 cases of Crouzon's disease. These advancements were performed at about the age of 15 in consideration of facial bone growth disturbance, psychosocial effects, and the recurrence of class III malocclusion after operation. The average advancement of the midface was 9. 2 mm. We experienced favorable aesthetic and functional results without severe complication in all cases or relapse of the advanced segment.