Factors associated with Achilles tendon re-rupture following operative fixation.

Aims: Achilles tendon re-rupture (ATRR) poses a significant risk of postoperative complication, even after a successful initial surgical repair. This study aimed to identify risk factors associated with Achilles tendon re-rupture following operative fixation. Methods: This retrospective cohort study analyzed a total of 43,287 patients from national health claims data spanning 2008 to 2018, focusing on patients who underwent surgical treatment for primary Achilles tendon rupture. Short-term ATRR was defined as cases that required revision surgery occurring between six weeks and one year after the initial surgical repair, while omitting cases with simultaneous infection or skin necrosis. Variables such as age, sex, the presence of Achilles tendinopathy, and comorbidities were systematically collected for the analysis. We employed multivariate stepwise logistic regression to identify potential risk factors associated with short-term ATRR. Results: From 2009 to 2018, the short-term re-rupture rate for Achilles tendon surgeries was 2.14%. Risk factors included male sex, younger age, and the presence of Achilles tendinopathy. Conclusion: This large-scale, big-data study reaffirmed known risk factors for short-term Achilles tendon re-rupture, specifically identifying male sex and younger age. Moreover, this study discovered that a prior history of Achilles tendinopathy emerges as an independent risk factor for re-rupture, even following initial operative fixation.

Reliability and validity testing of automated scoring in obstructive sleep apnea diagnosis with the Embletta X100.

OBJECTIVES/HYPOTHESIS: To verify the reliability and validity of automated scoring and compare it to that of manual scoring for diagnosing obstructive sleep apnea using an Embletta X100 level 2 portable device. STUDY DESIGN: Retrospective study. METHODS: A total of 116 patients with suspected obstructive sleep apnea who had successfully received portable polysomnography with the Embletta X100 were examined. All polysomnography data were analyzed by automated and manual methods. Manual scoring was performed according to the revised American Academy of Sleep Medicine 2012 criteria. Automated scoring was analyzed using the automatic algorithm, which was updated with the American Academy of Sleep Medicine 2012 criteria. All parameters were evaluated statistically using correlation analysis and paired t tests. RESULTS: The apnea-hypopnea index for automated scoring and manual scoring with the Embletta X100 were moderately correlated (r = 0.76, P < .001). However, there was poor agreement (Bland-Altman plot, κ = 0.34, 0.33, and 0.26; cutoff value = 5, 15, and 30), and the apnea-hypopnea index data were generally excessively underestimated based on diagnostic agreement and disagreement criteria. Furthermore, the apnea-hypopnea index severity (Kendall tau-b = 0.62) between automated and manual scoring lacked good concordance. CONCLUSIONS: Automated scoring using the Embletta X100 was statistically moderately related to the manual scoring results. However, automated scoring tended to excessively underestimate the apnea-hypopnea index data compared to manual scoring. Thus, manual scoring by a sleep expert is essential for obstructive sleep apnea diagnosis with the Embletta X100. LEVEL OF EVIDENCE: 4.

Effect of the Pillar implant on snoring and mild obstructive sleep apnea: A multicenter study in Korea.

OBJECTIVES/HYPOTHESIS: The effect of the Pillar implant on mild sleep-disordered breathing (SDB) has been assessed in various studies. However, most of these were conducted among a non-Asian population at a single institution. Therefore, the aim of this study was to prospectively evaluate the efficacy of the Pillar implant in Asian patients with simple snoring and mild obstructive sleep apnea (OSA) at multiple centers. STUDY DESIGN: Multicenter prospective clinical trials. METHODS: This study included consecutive subjects with simple snoring or mild OSA. We examined subjective symptoms (snoring intensity, frequency, witnessed apnea, and daytime sleepiness) and objective snoring and respiratory parameters (snoring duration [proportion of sleep while snoring louder than 50 dB], snoring loudness, apnea-hypopnea index, respiratory disturbance index, minimum arterial oxygen saturation, and oxygen desaturation index ≥ 4%) at 3 to 6 months after surgery. Adverse events were also investigated. RESULTS: Twenty-nine subjects with mild SDB completed the study. Whole group analysis found significant improvements in various subjective symptoms, but not in the objective snoring and respiratory parameters. A subgroup analysis of subjects with mild OSA (n = 11) found significant alleviation in various subjective symptoms, apnea-hypopnea index, respiratory disturbance index, and oxygen desaturation index ≥ 4%. No major complication related to surgery was observed, and most minor adverse effects were resolved without morbidity. CONCLUSIONS: In selected Korean patients, the Pillar implant significantly improved not only subjective symptoms of mild SDB but also respiratory disturbances in mild OSA. LEVEL OF EVIDENCE: 2b.

Periodic array of polyelectrolyte-gated organic transistors from electrospun poly(3-hexylthiophene) nanofibers.

High-performance organic field-effect transistors (OFETs) based on polyelectrolyte gate dielectric and electrospun poly(3-hexylthiophene) (P3HT) nanofibers were fabricated on a flexible polymer substrate. The use of UV-crosslinked hydrogel including ionic liquids for the insulating layer enabled fast and large-area fabrication of transistor arrays. The P3HT nanofibers were directly deposited on the methacrylated polymer substrate. During UV irradiation through a patterned mask, the methacrylate groups formed covalent bonds with the patterned polyelectrolyte dielectric layer, which provides mechanical stability to the devices. The OFETs operate at voltages of less than 2 V. The average field-effect mobility and on/off ratio were approximately 2 cm(2)/(Vs) and 10(5), respectively.

Influence of the CYP3A5 and MDR1 genetic polymorphisms on the pharmacokinetics of tacrolimus in healthy Korean subjects.

AIMS: To determine the frequencies of the genotypes of CYP3A5 and MDR1 and to examine the influence of the polymorphisms of these genes on tacrolimus pharmacokinetics in the Korean population. METHODS: Twenty-nine healthy Koreans who participated in the previous tacrolimus pharmacokinetic study were genotyped for CYP3A4*1B, CYP3A5*3, MDR1 c.1236C-->T, MDR1 c.2677G-->A/T and MDR1 c.3435C-->T. The relationship between the genotypes so obtained and tacrolimus pharmacokinetics observed in the previous study was examined. RESULTS: No subject in this study had the CYP3A4*1B variant. The observed frequencies of CYP3A5*1/*1, *1/*3, and *3/*3 were 0.069 [confidence interval (CI) -0.023, 0.161], 0.483 (CI 0.301, 0.665) and 0.448 (CI 0.267, 0.629), respectively. AUC(0-infinity) for the CYP3A5*1/*1 or *1/*3 genotype was 131.5 +/- 44.8 ng h ml(-1) (CI 109.6, 153.5), which was much lower compared with the CYP3A5*3/*3 genotype of 323.8 +/- 129.3 ng h ml(-1) (CI 253.5, 394.1) (P = 2.063E-07). Similarly, C(max) for the CYP3A5*1/*1 or *1/*3 genotype was 11.8 +/- 3.4 ng ml(-1) (CI 10.1, 13.5), which was also much lower compared with the CYP3A5*3/*3 genotype of 24.4 +/- 12.3 ng ml(-1) (CI 17.8, 31.1) (P = 0.0001). However, there was no significant difference in tacrolimus pharmacokinetics among the MDR1 diplotypes of CGC-CGC, CGC-TTT, CGC-TGC, TTT-TGC or TTT-TTT (P = 0.2486). CONCLUSIONS: This study shows that the CYP3A5*3 genetic polymorphisms may be associated with the individual difference in tacrolimus pharmacokinetics. An individualized dosage regimen design incorporating such genetic information would help increase clinical efficacy of the drug while reducing adverse drug reactions.