Risk Factors and Clinical Outcomes of Osteotomy Plane Violation by D-Hole Screws in Medial Open Wedge High Tibial Osteotomy: A Simulation and Comparative Study.

Background and Objectives: Stable fixation is essential for successful healing after medial open wedge high tibial osteotomy (MOWHTO) to minimize the risk of non-union and correction loss. In Asians, potential complications such as D-hole screw osteotomy plane violation (D-hole violation) and inadequate plate fitting arise due to improper plate size. This study aimed to evaluate the risk factors for D-hole violation and compare the conventional anatomic (CA) plate with an individualized anatomic (IA) plate in MOWHTO procedures. Materials and Methods: A simulation study on D-hole violation using the CA plate was conducted, involving preoperative radiographs and CT scans of 64 lower extremities from 47 MOWHTO patients. Additionally, a randomized controlled study compared CA and IA plates in MOWHTO procedures with 34 patients (17 in the CA plate group; 18 in the IA plate group). Patient demographics, patient-reported outcome measures (PROMs), and radiological measures were analyzed. Results: In the simulation study, the rates of D-hole violation ranged from 20.3% to 59.4%, with an increase observed as the plate was distalized from 5 mm to 10 mm away from the joint line. Short stature was identified as an independent risk factor for D-hole violation (p < 0.001), with a cutoff value of 155.3 cm. In the randomized controlled study, no significant difference in PROMs and D-hole violation was observed between the CA plate and IA plate groups. However, the IA plate group showed better plate fitting compared to the CA plate group (p = 0.041). Conclusions: This study identified a high risk of D-hole screw osteotomy plane violations in MOWHTO procedures, particularly when the plate is positioned more distally and in individuals with a stature below 155.3 cm. It also revealed that individualized plates provide better tibial fitting compared to conventional anatomic plates, particularly in Asian populations where tibial morphology tends to be shorter than in Western populations. Therefore, evaluating patient stature and selecting tailored plates are essential to optimize plate positioning and minimize plate-related complications in MOWHTO procedures.

Application of patch stimulator for intraoperative neuromonitoring during thyroid surgery: maximizing surgeon's convenience.

BACKGROUND: Intraoperative neuromonitoring (IONM) is frequently used in thyroid surgery to reduce recurrent laryngeal nerve (RLN) injury by providing the surgeon with real-time feedback on nerve stimulation during dissection. We applied a disposable adhesive patch electrode to a dissecting instrument to transfer electrical stimulation to the dissecting instrument for IONM during thyroid surgery. This study aimed to evaluate the feasibility of using the patch stimulator approach for IONM during thyroid surgery. METHODS: We reviewed the medical records of patients who underwent thyroidectomy using both conventional stimulator and adhesive patch stimulator for IONM. The electromyography (EMG) amplitudes of the vagal and the RLNs before (V1, R1) and after thyroid resection (V2, R2) were alternatively checked with each type of stimulator at the same location of each nerve. RESULTS: Fifteen consecutive patients (4 males, 11 females) were included in this analysis, and a total of 38 nerves (19 vagus nerves and 19 RLNs) were evaluated. No statistically significant differences were seen in the mean amplitudes evoked by the patch stimulator and the conventional probe stimulator for the V1 signal (825.5±394.6 vs. 821.8±360.9 µV, P=0.954), R1 signal (1,044.8±471.2 vs. 1,039.2±507.4 µV, P=0.898), R2 signal (1,037.8±495.0 vs. 938.2±415.8 µV, P=0.948), or V2 signal (812.5±391.9 vs. 787.3±355.7 µV, P=0.975). CONCLUSIONS: The patch stimulator was safely and effectively used for IONM during thyroid surgery and provided similar nerve monitoring responses as the conventional stimulator. This approach may be used to enhance the surgeon's convenience during thyroid surgery.

Erratum to: Comparisons of Chemical Composition, Flavor and Bioactive Substances between Korean and Imported Velvet Antler Extracts.

[This corrects the article DOI: 10.5851/kosfa.2021.e4.].

Comparisons of Chemical Composition, Flavor and Bioactive Substances between Korean and Imported Velvet Antler Extracts.

The aim of this study was to compare the antioxidant activity, chemical composition, flavor and bioactive compounds between Korean and imported velvet antlers (VAs)-derived extracts. The Korean (KVA), Russian (RVA) and New Zealand (NZVA) VAs (n=24 each, dry form) purchased from a local supplier were used in the investigation. After extracting with water (750 g VA with 6,000 mL water) for 20 h at 95°C, the VA extracts (VAE) were then used for analysis of antioxidant activity, amino acids (AAs), flavor and bioactive compounds. Compared to the RVA and NZVA, the KVA extract showed significantly higher 2,2-diphenyl 1 picrylhydrazyl (DPPH) and 2,2'-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid (ABTS) radicals scavenging activities (p<0.05). Significantly higher Fe content was found in the KVA while, higher Mn, Zn and Ca contents were found in the RVA (p<0.05). Twenty AAs were detected in all three VAEs and some of them (e.g., glycine and alanine) were higher in the KVA (p<0.05). A higher diversity (quality and quantity) of flavor compounds was found in the KVA extract compared to the imported VAs-derived extracts. Over six hundred metabolic compounds were identified in the VAEs. Among them, 412 compounds were commonly found in all the VAE types while, 109, 107, and 84 biomarker compounds were only found in the KVA, NZVA, and RVA extracts, respectively. Based on the results obtained in this study, it may be concluded that the country of origin partly affected the antioxidant activity, chemical composition, flavor and bioactive compounds of the VAEs.

The Effect of Vitamin D Deficiency Correction on the Outcomes in Women After Carpal Tunnel Release.

PURPOSE: Studies suggest that vitamin D supplementation improves myelination and recovery after nerve injuries. The purpose of this study was to evaluate whether correction of vitamin D level leads to better surgical outcomes in women with both carpal tunnel syndrome (CTS) and vitamin D deficiency. METHODS: We retrospectively reviewed 84 vitamin D-deficient women with CTS who underwent carpal tunnel release and then received daily vitamin D supplementation of 1,000 IU vitamin D for 6 months. We also reviewed 35 control patients who were vitamin D-nondeficient at baseline and thus did not receive the supplementation. At baseline and 6 months after surgery, we measured serum vitamin D levels, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, motor conduction velocity, and grip and pinch strengths. We compared the outcomes of CTS related to vitamin D levels. We also correlated baseline and follow-up vitamin D levels with the assessed parameters. RESULTS: At 6 months, 59 patients became vitamin D-nondeficient (≥ 20 ng/mL) and 25 were still vitamin D-deficient (< 20 ng/mL). Patients who became vitamin D-nondeficient had subtle but better DASH scores than patients who were still vitamin D-deficient or the control patients. Vitamin D levels at 6 months were found to have significant correlation with the DASH score at 6 months. Vitamin D levels at 6 months did not have significant correlation with motor conduction velocity or grip and pinch strengths. CONCLUSIONS: Women with CTS and vitamin D deficiency showed subtle but better DASH scores after surgery when vitamin D deficiency was corrected by supplementation. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Learning Curve of Internal Fixation for Nondisplaced Femoral Neck Fractures: A Cumulative Sum Analysis.

BACKGROUND: The purpose of this study was to determine whether there is a learning curve for internal fixation for nondisplaced femoral neck fractures using the cumulative sum (CUSUM) technique. We applied the CUSUM technique in monitoring performance of a single surgeon in internal fixation for nondisplaced femoral neck fractures. METHODS: Fifty consecutive patients who underwent internal fixation for nondisplaced femoral neck fractures were evaluated retrospectively. Loss of fixation within 6 months postoperatively was considered as failure of treatment. Patients were stratified into the early experience group (cases 1 to 25) and the late experience group (cases 26 to 50). The CUSUM method was used to analyze the learning curve. RESULTS: There was no failure of treatment during study period. The operation time became shorter with experience. Using the CUSUM analysis to plot the learning curve, there was no significant learning curve observed for multiple pinning for nondisplaced femoral neck fractures. CONCLUSIONS: The CUSUM analysis revealed there was no obvious learning curve to become proficient at internal fixation for nondisplaced femoral neck fractures, if technical principles were followed during the procedure.

Trend in the Age-Adjusted Incidence of Hip Fractures in South Korea: Systematic Review.

BACKGROUND: The incidence of hip fractures has been reported to vary geographically, and its trend has also varied widely. However, the trend in the age-adjusted incidence of hip fractures has not been well studied in Korea. After we identified eligible studies presenting multiple age-adjusted incidences of hip fractures in the Korean population in PubMed, we evaluated changes in the absolute number of occurrence and calculated the annual percentage change (APC) of age-adjusted incidences of hip fractures. METHODS: We have searched PubMed for the original and English-language literature on the incidence of hip fractures in the Korean population published since 2000. The studies presenting multiple age-adjusted incidences of hip fractures were selected. We evaluated the change in the absolute number of hip fractures and calculated the APC of age-adjusted incidences of hip fractures for each study. RESULTS: Three eligible articles were identified. The absolute number of hip fractures for both genders increased over time in all three studies although the operational definition of hip fracture differed from one another. The APC of the age-adjusted incidence of hip fractures was positive for women and negative for men. However, the change was not statistically significant in both genders during each study period (2001-2004, 2005-2008, and 2006-2010, respectively). CONCLUSIONS: The age-adjusted incidence of hip fractures was stable among men and women, while the absolute number of hip fractures increased for both genders in Korea. Further studies with longer study periods on age-adjusted incidences are required to better determine the trend in the incidence of hip fractures in Korea.

Efficacy of a Topical Gelatin-Thrombin Matrix Sealant in Reducing Postoperative Drainage Following Anterior Cervical Discectomy and Fusion.

STUDY DESIGN: Retrospective fusion level(s)-, age-, and gender-matched analysis. PURPOSE: To determine whether the application of a topical gelatin-thrombin matrix sealant (Floseal) at the end of anterior cervical discectomy and fusion (ACDF) can reduce the amount of postoperative hemorrhage. OVERVIEW OF LITERATURE: The effect of the matrix sealant in decreasing postoperative hemorrhage following ACDF has not been reported. METHODS: Matrix sealant was (n=116, study group) or was not applied (n=58, control group) at the end of ACDF. Patients were selected by 1:2 matching criteria of fusion level(s), age, and gender. Seven parameters described below were compared between the two groups. RESULTS: The total drain amount for the first 24 hours (8±9 versus 27±22 mL), total drain amount until the 8-hour drainage decreased to ≤10 mL (8±10 versus 33±26 mL), and the total drain amount until 6 AM on the first postoperative day (7±8 versus 24±20 mL) were significantly lower in the study group than the control group (all p<0.001). The time for the 8-hour drainage to decrease to ≤10 mL was significantly lower in the study group (10±5 versus 26±14 hours, p<0.001). The 8-hour drainage decreased to ≤10 mL on the operation day in most patients (88%) in the study group versus mostly on the first (48%) or second (33%) postoperative day in the control group (p<0.001). The total drain amount until 6 AM on the first postoperative day was 0 mL in 43% of patients in the study group and in 7% in the control group (p<0.001). No patient in either group required hematoma evacuation. CONCLUSIONS: Application of the topical matrix sealant at the end of ACDF can significantly reduce the amount of postoperative hemorrhage.

Physicochemical Characteristics and Antioxidant Capacity of Rice Cake (Sulgitteok) Supplemented with Lyophilized Sedum sarmentosum (Dolnamul) Powder.

This study was performed to increase the availability of Sedum sarmentosum (Dolnamul) and to improve the nutraceutical value of rice cakes (sulgitteok). The contents of crude protein, mineral, dietary fiber, water holding capacity, and hardness significantly and directly increased with lyophilized sedum powder (SP). Pore ratio and expansion rate decreased in samples containing more than 10% SP compared to the control. In a sensory evaluation, a positive correlation was detected between overall acceptability and taste (R (2)=0.99, p<0.01), and color (R (2)=0.72, p<0.05). Total polyphenol contents of the SP-treated groups were significantly elevated, accompanied by an increase in radical scavenging ability estimated by the 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay. Replacing 10% of the rice powder with SP efficiently improved the antioxidant and nutritional values of sulgitteok as well as its the sensory quality.

The role of Di(2-ethylhexyl)phosphoric acid as a cosurfactant on the morphology control of mesoporous silica microspheres.

Synthesis of mesoporous silica microspheres larger than 10 microm via surfactant template approach has rarely been reported. According to the previous studies, particle morphologies were highly variable, depending on the synthesis conditions and impeller design such as impeller type, size, and agitation speed. A new robust surfactant-template synthesis strategy for the stable suspension of large silica microspheres was investigated by introducing an additional cosurfactant. Di(2-ethylhexyl)phosphoric acid (HDEHP) as a cosurfactant played a key role in suspension stabilization without distorting the spherical morphology as well as in the formation of uniform pore structures. High quality of mesoporous silica microspheres was obtained and compared with the Kosuge's silica under different conditions such as stirring rate, acid concentration, the amount of solvent in a mother liquor.

Desorption characteristics of kaolin clay contaminated with zinc from electrokinetic soil processing.

A number of bench scale laboratory column tests were carried out using a newly designed and developed electrokinetic cell to investigate the fundamental behavior of zinc-spiked kaolin clay subjected to an electric field. Laboratory investigations focused on (i) zinc migration by the combined effects of electromigration and electro-osmosis and (ii) the electrically induced desorption characteristics of zinc-contaminated kaolin that occurred during processing. The correlations of the applied voltage gradient, electro-osmotic flow rate, and the development of a pH gradient were examined and evaluated. The results showed that the removal efficiency was high during the early stage of processing due to rapid desorption by electrokinetic effects in the cathode region. However, the majority of zinc migrating from the anode was precipitated due to the high pH environment in the cathode region.