Comparison between Pin Fixation and Combined Screw Fixation in Proximal Chevron Metatarsal Osteotomy for Hallux Valgus Deformity Correction

Background@#Problems associated with hallux valgus deformity correction using Kirschner-wire (K-wire) fixation include pin pullout and loss of stability. These complications are pronounced in the osteopenic bone, and few reports have focused on pin versus screw fixation. We examined the use of additional screw fixation to avoid these problems. The aim of this study was to compare outcomes of K-wire fixation (KW) and a combined K-wire and screw fixation (KWS). @*Methods@#Two groups with hallux valgus deformity, who were treated with a proximal chevron metatarsal osteotomy (PCMO), were compared based on the fixation method used. The KW group included 117 feet of 98 patients, and the KWS group included 56 feet of 40 patients. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) hallux score, and patient satisfaction score were evaluated. Radiographically, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. @*Results@#The mean VAS score decreased from 6.3 preoperatively to 1.6 postoperatively in the KW group and from 5.7 preoperatively to 0.5 postoperatively in the KWS group (p < 0.001). The mean AOFAS scores of the KW and KWS groups improved from 59.4 and 58.2, respectively, to 88.9 and 95.3, respectively (p < 0.001). Eighty-five percent in the KW group and 93% in the KWS group were satisfied with surgery. Clinical differences were not significant. The mean HVAs decreased from 34.7° to 9.1° in the KW group and from 38.5° to 9.2° in the KWS group (p < 0.001). The mean IMA decreased from 14.5° (range, 11.8°–17.2°) to 6.4° (range, 2.7°–10.1°) in the KW group and from 18.0° (range, 14.8°–21.2°) to 5.3° (range, 2.5°–8.1°) in the KWS group (p < 0.001). When IMA values at the 3-month postoperative and the final follow-up were compared, the IMA was significantly increased only in the KW group (p < 0.001) and no difference was found in the KWS group (p = 0.280). @*Conclusions@#We found a statistically significant difference in the decrease in IMA between the 2 groups. We recommend the combined pin and screw fixation in PCMO to enhance fixation stability and prevent potential hallux valgus correction loss.

Usefulness of the neutrophil-to-lmphocyte ratio as a prognostic predictor in elderly patients admitted to the intensive care unit through emergency department

OBJECTIVE@#The purpose of this study was to test the hypothesis that an increase in the neutrophil-to-lymphocyte ratio (NLR) increases the risk of in-hospital density in patients aged 65 and older, who are hospitalized in intensive care through the emergency rooms.@*METHODS@#A retrospective medical record study was conducted on elderly patients who were admitted to intensive care units via the emergency room. The exclusion criteria were data loss, intensive care unit reentry, cerebrovascular accidents, hematologic disease, and trauma cases.@*RESULTS@#The study included 526 patients; the mean age was 79, and 261 (49.6%) were male. The in-hospital mortality was 18.4% (97 patients). The initial NLR was higher in the non-survivor group than the survivor group, but the difference was not statistically significant (9.82±11.02 vs. 11.48±6.11, P=0.080). In multivariate logistic analysis, the initial NLR had no statistical significance, and the odd ratio was increased from one day later. Comparing the receiver operating characteristic curve of the NLR and Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores, the NLR showed an increase in the area of under curve (AUC) value over time as well as the highest AUC with the SAPS II scores.@*CONCLUSION@#In elderly adults, early NLR was found to have weak power to predict in-hospital mortality. Over time, the NLR values more than two days after intensive care unit admission may be useful in predicting the in-hospital mortality for older patients. This may be due to the delay in the immune response and the complex medical history.

Correction to: Engineered M13 Nanofiber Accelerates Ischemic Neovascularization by Enhancing Endothelial Progenitor Cells

There is a minor spelling error in the last of name of the 9th author in the originally published article.

Subtalar Arthroereisis Using Kalix® Sinus Tarsi Implant for Pediatric Flexible Flatfoot / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the radiographic and clinical outcomes of subtalar arthroereisis as a method of treatment for pediatric flexible flatfoot. MATERIALS AND METHODS: We retrospectively investigated 14 feet among 10 patients with flexible flatfoot, who were treated with a subtalar arthroereisis using a sinus tarsi implant between March 2007 and June 2012. Radiographically, the talo-1st metatarsal angle, talar declination, and calcaneal pitch angle have all been measured on lateral radiographs. The talo-navicular coverage angle and talo-1st metatarsal angle was measured on anteroposterior (AP) radiographs and tibio-calcaneal angle was assessed by hindfoot alignment view. Visual analogue scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used for clinical evaluation. RESULTS: The mean follow-up was 48.7 months (16–98 months), and the mean age was 11.6 years (6–19 years). Radiographically, the mean pre-operative and postoperative values measured by the lateral foot radiograph were −25.1° and −7.5° for talo-1st metatarsal angle, 37.4° and 23.2° for talar declination, and 8.3° and 15.0° for calcaneal pitch angle, respectively. The mean preoperative and postoperative values measured by foot AP radiograph were 23.0° and 11.9° for talo-navicular coverage angle and 17.2° and 9.0° for talo-1st metatarsal angle, respectively. Moreover, tibio-calcaneal angle improved from valgus 17.4° on average to 4.5° on average. Clinically, the VAS score and AOFAS score was improved from 5.8 to 1.5 and from 61.8 to 90.4, respectively. Complication was sinus tarsi pain that occurred in 5 cases (35.7%). CONCLUSION: We achieved a satisfactory correction of pediatric flexible flatfoot deformities via subtalar arthroereisis, using a sinus tarsi implant with favorable radiographic and clinical measures. However, high potential complication rate of postoperative sinus tarsi pain on weight-bearing should carefully be considered.

Engineered M13 Nanofiber Accelerates Ischemic Neovascularization by Enhancing Endothelial Progenitor Cells

Dysfunction or loss of blood vessel causes several ischemic diseases. Although endothelial progenitor cells (EPCs) are a promising source for cell-based therapy, ischemia-induced pathophysiological condition limits the recovery rate by causing drastic cell death. To overcome this issue, we attempted to develop a cell-targeted peptide delivery and priming system to enhance EPCbased neovascularization using an engineered M13 bacteriophage harboring nanofibrous tubes displaying ∼ 2700 multiple functional motifs. The M13 nanofiber was modified by displaying RGD, which is an integrin-docking peptide, on the minor coat protein, and bymutilayering SDKPmotifs,which are the key active sites for thymosin b4, on themajor coat protein. The engineered M13 nanofiber dramatically enhanced ischemic neovascularization by activating intracellular and extracellular processes such as proliferation, migration, and tube formation in the EPCs. Furthermore, transplantation of the primed EPCs with the M13 nanofiber harboring RGD and SDKP facilitated functional recovery and neovascularization in a murine hindlimb ischemia model. Overall, this study demonstrates the effectiveness of theM13 nanofiber-based novel peptide deliveryandprimingstrategy inpromotingEPC bioactivity and neovessel regeneration. To our knowledge, this is first report onM13 nanofibers harboring dual functional motifs, the use of which might be a novel strategy for stem and progenitor cell therapy against cardiovascular ischemic diseases.

The Relation between Coagulation Profile Test and Outcome in Survivors who were Treated with Therapeutic Hypothermia after Cardiopulmonary Resuscitation

PURPOSE: The purpose of this study is to clarify the clinical significance of coagulation factor as a prognostic tool in patients with cardiac arrest treated with therapeutic hypothermia (TH). METHODS: We designed a retrospective case review study in one university hospital. All adult patients who suffered cardiac arrest from December 2011 to February 2014 were considered for inclusion in the study. Patients who did not undergo TH were excluded from the analysis. Patients with any hematologic disorder were also excluded. Patients were divided into two groups, the good outcome group and the poor outcome group depending on the final cerebral performance category (CPC). Serum D-dimer, FDP, PT, aPTT, anti-thrombin III, fibrinogen, Troponin T, CK-MB, Troponin-I, DIC score, NSE, and S-100 were taken within one hour after ROSC. Logistic regression was used for multivariable analysis. RESULTS: A total of 92 patients were included; 22 in the good outcome group, 70 in the poor outcome group. The median serum PT, aPTT, FDP, fibrinogen, and D-dimer levels were grossly elevated in the poor outcome group. Only serum PT, D-dimer level showed significant association with poor outcome (PT: OR=1.577; 95% CI=1.08-17.49, D-dimer: OR=1.577; 95% CI=1.06-2.33). The area under the receiver operating characteristic (AUC) of PT, D-dimer, and S-100 for prediction of poor outcome was 0.822 (95% CI=0.72-0.89), 0.68 (95% CI=0.57-0.77), and 0.811 (95% CI=0.70-0.89), respectively. Other factors were not associated with prognosis. CONCLUSION: Increased PT and D-dimer levels are significantly associated with poor outcome. PT and D-dimer values have potential for use as new prognostic predictors along with the current prognostic factor, S-100 protein.

Adequacy of Videos for Adult Basic Life Support in a Portal Site of Korea

PURPOSE: Prompt initiation of effective cardiopulmonary resuscitation (CPR) and defibrillation is underlined in the guideline. Many people search health-related information on the internet. The objective of this study was to evaluate the content and quality of videos for adult basic life support (BLS) on the internet. METHODS: We searched 'Daum' for the term 'CPR' in Korean. Videos dealing with BLS over 5 sequences were included. Videos inserted in the news and drama or used for advertisement or entertainment, or which only contained pediatric BLS were excluded. Two emergency physicians analyzed videos using a standardized checklist. RESULTS: Of 1,600 videos, 32 met the inclusion criteria, except for duplicate videos. More than 90% of videos showed appropriate demonstration for check response, activate emergency response system, correct hand placement, minimize interruptions in chest compression, 30:2 compression to ventilation ratio, open airway, and deliver rescue breath; 13 (40.6%) and 12 (37.5%) videos demonstrated 'call for automated external defibrillator (AED)' and 'apply AED', respectively; 25 (78.1%), 23 (71.9%), and 27 (84.4%) videos showed correct demonstration for chest compression rate and depth, and complete chest recoil, respectively; 6 (18.8%) and 10 (31.3%) videos contained instructions for 'complete chest recoil' and 'minimize interruptions in chest compression', respectively. Only 2 (6.3%) videos dealt with hands-only CPR. CONCLUSION: A large proportion of educational videos for adult BLS contained basic sequence of BLS, except for 'call for AED' and 'apply AED'. There is a lack of instruction for high-quality CPR, particularly for minimizing interruptions in chest compression and complete chest recoil, and hands-only CPR.

The Characteristics and Outcomes of Foreign Body Aspiration and Ingestion in Pediatric Patients who Visit an Emergency Department

PURPOSE: Many children visit an emergency department with aspiration or ingestion of a foreign body (FB). As little study based on Korean domestic data has been reported, we conducted a retrospective study in order to investigate the characteristics and outcomes in pediatric patients with FB. METHODS: A retrospective chart review of children with FB aspiration or ingestion who visited one of three emergency departments between January 2009 and December 2012 was conducted. Demographic data including age and sex, time of accident, whether the event was witnessed, time to visit, symptoms, radioopacity, diagnostic and therapeutic modalities, and category of FB were recorded. Stepwise forward logistic regression was performed in order to verify the association between variables and confirmation of FB. RESULTS: A total of 1508 pediatric patients presented to the emergency departments with FB aspiration or ingestion 739(49%) patients were 0 to 3 years old; 922(61.1%) patients visited with food itself or food-related materials, including fishbone. A total of 534(35.4%) patients were finally confirmed as having FB. Of those, the Odds ratio of positive radiologic test in patients presenting with a certain sign or symptom was 1.412(95% Confidence interval, 1.133 to 1.759). The proportion of those witnessed was significantly higher in those confirmed with FB than in those not confirmed (p<0.001). CONCLUSION: An emergency physician should take a detailed history, including whether there is a witness, and perform a careful examination in order to make a decision regarding the need for diagnostic and therapeutic modality when a pediatric patient is under three years old, and has no symptom or positive radiologic finding.

The Characteristics and Outcomes of Foreign Body Aspiration and Ingestion in Pediatric Patients who Visit an Emergency Department

PURPOSE: Many children visit an emergency department with aspiration or ingestion of a foreign body (FB). As little study based on Korean domestic data has been reported, we conducted a retrospective study in order to investigate the characteristics and outcomes in pediatric patients with FB. METHODS: A retrospective chart review of children with FB aspiration or ingestion who visited one of three emergency departments between January 2009 and December 2012 was conducted. Demographic data including age and sex, time of accident, whether the event was witnessed, time to visit, symptoms, radioopacity, diagnostic and therapeutic modalities, and category of FB were recorded. Stepwise forward logistic regression was performed in order to verify the association between variables and confirmation of FB. RESULTS: A total of 1508 pediatric patients presented to the emergency departments with FB aspiration or ingestion 739(49%) patients were 0 to 3 years old; 922(61.1%) patients visited with food itself or food-related materials, including fishbone. A total of 534(35.4%) patients were finally confirmed as having FB. Of those, the Odds ratio of positive radiologic test in patients presenting with a certain sign or symptom was 1.412(95% Confidence interval, 1.133 to 1.759). The proportion of those witnessed was significantly higher in those confirmed with FB than in those not confirmed (p<0.001). CONCLUSION: An emergency physician should take a detailed history, including whether there is a witness, and perform a careful examination in order to make a decision regarding the need for diagnostic and therapeutic modality when a pediatric patient is under three years old, and has no symptom or positive radiologic finding.

Efficacy and Safety of 1,064 nm Q-switched Nd:YAG Laser Treatment for Removing Melanocytic Nevi

BACKGROUND: Until recently, the removal of melanocytic nevi has been performed with a CO2 laser or Er:YAG laser. These lasers have been useful for removing affected spots. However, enlargement of spots or some sequelae, including depressed or hypertrophic scars, could develop as unwanted results. The Q-switched Nd:YAG laser has been used to remove deep-seated melanocytes, such as Ota nevus or tattoos. However, there have been no previous experiments performed to test the efficacy and safety of this laser treatment for melanocytic nevi. OBJECTIVE: The objective of this study was to investigate the efficacy and safety of the 1,064 nm Q-switched Nd:YAG laser for removing melanocytic nevi, including congenital nevomelanocytic and acquired nevomelanocytic nevi. METHODS: Two thousand and sixty four Korean patients with small melanocytic nevi were treated with a Q-switched Nd:YAG laser from 2005 to 2009. High-resolution photographs were taken in identical lighting and positions before and after the six weeks of treatment to observe the procedural efficacy. RESULTS: About 70% of the nevi treated using a 1,064 nm Q-switched Nd:YAG laser were completely removed after one session. The other 30% were completely treated within three sessions. The appearance of sequelae such as hollow scars noticeably decreased compared to the results seen in CO2 or Er:YAG laser treatments. CONCLUSION: Use of the 1,064 nm Q-switched Nd:YAG laser is a safe and effective treatment modality for melanocytic nevi.

Cryptococcal Tenosynovitis of the Hand in a Patient with Rheumatiod Arthritis: A Case Report

Cryptococcosis is a fungal infection caused by Cryptococcus neoformans which is frequently occurred in the immunosuppressed host. Any organ or tissue may become infected, however, tendon sheath infection is extremely rare. We report a case of primary cryptococcal tenosynovitis after direct skin injury in a patient with rheumatoid arthritis who has been treated with methotrexate and leflunomide.

Distal Intersection Syndrome of the Wrist: Three Cases Report

Distal intersection syndrome indicates simultaneous tenosynovitis or tendinosis of the second and third extensor compartment where extensor pollicis longus cross with the tendons of the second extensor compartment. We report three cases of distal intersection syndrome which differ from usual intersection syndrome.

Superficial Peroneal Nerve Injury Following Ankle Sprain / 대한스포츠의학회지

Lateral ankle sprains are one of the most common injuries to the lower extremity. Most of them well respond to conservative treatments. However, simultaneous peroneal nerve injuries may occur rarely following lateral ankle ligamentous injuries. We report a case presents superficial peroneal nerve injury with dorsal foot pain lasting for more than 2 months after lateral ankle sprain and review the literature.

A case of intracranial abscess following the tubo-ovarian abscess / 대한산부인과학회지

Cases of intracranial complication following infections of head and neck have been reported rarely, but the case of intracranial complication following tubo-ovarian abscess has not been reported yet. In this case, the 35-year-old women patient with lower abdominal pain and mild headache that was diagnosed as pelvic inflammatory disease was admitted to our hospital and was cared. In the course of admission, headache was aggravated and lateral deviation of eyeballs occurred. She was diagnosed as intracranial abscess following tubo-ovarian abscess in the result of neurological surgery department consultation. So we report it with brief review of literatures.

A case of intracranial abscess following the tubo-ovarian abscess / 대한산부인과학회지

Cases of intracranial complication following infections of head and neck have been reported rarely, but the case of intracranial complication following tubo-ovarian abscess has not been reported yet. In this case, the 35-year-old women patient with lower abdominal pain and mild headache that was diagnosed as pelvic inflammatory disease was admitted to our hospital and was cared. In the course of admission, headache was aggravated and lateral deviation of eyeballs occurred. She was diagnosed as intracranial abscess following tubo-ovarian abscess in the result of neurological surgery department consultation. So we report it with brief review of literatures.

Practical Application of Semiquantitative Procalcitonin Test in Emergency Department

PURPOSE: Procalcitonin (PCT) is a good marker of infection but is still not routinely used. Here, we assessed the usefulness of a semi-quantitative procalcitonin test kit (PCT-Q(R)), a rapid and simple test for evaluating sepsis in the emergency department. METHODS: We recruited 80 patients who visited the emergency center and with systemic inflammatory response syndrome (SIRS). Patients were classified into 4 groups according to PCT levels using PCT-Q[Ed-Trademark signs only have to be given one time in a document]. Mortality rate, bacteremia, severity score, and severity of sepsis (SIRS/sepsis/severe sepsis/septic shock) were assessed with the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. We calculated a receiver operating characteristic curve (ROC curve), cut-off value, and the related diagnostic parameters of each cut-off value. RESULTS: Higher PCT levels were significantly associated with increased mortality, bacteremia, and severity scores. PCT levels could discriminate between sepsis and severe sepsis at a threshold of 2 ng/ml. CONCLUSION: PCT-Q is a prognostic marker of infectious disease, but low levels do not always indicate a good prognosis. PCT levels increase with aggravation of sepsis, especially at values greater than 2 ng/ml for severe sepsis.

Sulindac Prevents Esophageal Adenocarcinomas Induced by Gastroduodenal Reflux in Rats

PURPOSE: It is known that cyclooxygenase (COX)-2 expression is increased in Barrett's esophagus and esophageal adenocarcinomas. We studied COX-2 expression and the effect sulindac has on the genesis of Barrett's esophagus and adenocarcinoma in rats undergoing esophagogastroduodenal anastomosis (EGDA). MATERIALS AND METHODS: Fifty-one rats were divided into a control group (n=27), a 500ppm sulindac-treated group (n=15) and 1000 ppm sulindac-treated group (n=9). Randomly selected rats were killed by diethyl ether inhalation at 20 and 40 weeks after surgery. RESULTS: At 40 weeks, rats treated with 1000 ppm sulindac showed narrower esophageal diameter and milder inflammation than the control rats. At 40 weeks, the incidence of Barrett's esophagus was similar between control and sulindac-treated groups, but the incidence of adenocarcinoma was significantly lower in the 1000ppm sulindac-treated group than either the control or 500 ppm sulindac-treated groups. COX-2 was significantly increased in the lower esophagus of control rats killed at 40 weeks. Cyclin D1 expression was negligible in the sulindac- treated group compared with the control group. CONCLUSION: We suggest that the chemopreventive effect of sulindac is related to decreased COX-2 and cyclin D1 expression, which may be influenced by reduced inflammation.

A Case of Post-total hysterectomy with bilat. salpingooophorectomy Retroperitoneal Endometrial Stromal Sarcoma / 대한산부인과학회지

Endometrial stromal sarcoma (ESS) is a relatively rare form of uterine sarcoma. Endometrial stromal sarcoma (ESS) of the myometrium compose just 0.2% of uterine malignant tumors. Low-grade stromal sarcoma has extended beyond the uterus in 40% of cases at the time of diagnosis, but the extra-uterine spread is confined to the pelvis in two thirds of the cases. A few cases of extra-uterine endometrial stromal sarcoma have been reported in literature concerning the ovary and pelvis. We have experienced a Post-total hysterectomy with bilateral salpingooophorectomy retroperitoneal endometrial stromal sarcoma, so we report this case with a brief review of literature.

A Study of correlation of fetal and maternal serum interleukin-1beta and interleukin-6 with histologic placental inflammation / 대한산부인과학회지

OBJECTIVE: This study was to determine if placental histologic acute inflammation is related to maternal and fetal serum cytokine levels in preterm labor. METHODS: In 2003-2004, 32 consecutive patients at 20-36 weeks with progressive labor and tocolytic failure were recruited. Maternal serum sampled during the labor, and fetal serum of umbilical vein were assayed by ELISA for levels of soluble interleukin-1beta and interleukin-6. Acute placental inflammation was scored by two groups blinded to clinical data, and the average scores analyzed for relationships to serum cytokine levels. RESULTS: Fetal level of interleukin-1beta was higher with grade 3-4 acute amnionitis than with grade 0-2 (p=0.022 and p=0.023). Fetal levels of both cytokine were higher in grade 3-4 umbilical vasculitis (interleukin-1beta p=0.008 and interleukin-6 p=0.03). In contrast, maternal serum interleukin levels were not associated with presence or severity of histologic evidence of acute placental inflammation. CONCLUSION: We conclude that fetal serum, but not maternal serum interleukin levels, was correlated with histologic evidence of acute placental inflammation. This result may be used to detect acute placental inflammation as an indirect indicator.

A Case of Congenital Intramural Cyst of Uterus / 대한산부인과학회지

I experienced a case of a congenital intramural cyst of the uterine fundus. It was composed of a single layer of non-ciliated low cuboidal epithelium without associated with endometrial stroma and was found to be derived from the mesonephric duct. This case is presented with a brief review of the literature.