Effectiveness of a Culturally Responsive mHealth Gaming Application to Improve Diabetes Health Literacy in India: A Randomized Controlled Trial.

The purpose of this study was to determine the effectiveness of a culturally responsive interactive gaming mHealth educational application designed to improve diabetes health literacy among an underserved urban population in India when compared with a traditional approach of verbal education. In addition, relationships between participant sociodemographic variables and participant knowledge were assessed. A randomized controlled trial was conducted using a two-arm parallel, single-blinded intervention and control group design. The parallel groups were the mHealth Education group serving as the intervention group and the Verbal Education group serving as the control group. The mHealth application was as effective in improving diabetes health literacy as verbal education. Results for the difference in posttest and pretest score between the two groups indicated there was no statistically significant difference between groups ( P = .9306). However, there was a significant improvement in the difference in posttest and pretest scores for each group ( P < .0001), indicating that the culturally responsive type 2 diabetes educational content was effective in improving type 2 diabetes health literacy among both groups. This study answers a call by the World Health Organization that advocates for evidence-based mHealth interventions that offer unique opportunities for cost-effective informatics service delivery in low- and middle-income countries.

Cross Cultural Team Collaboration: Integrating Cultural Humility in mHealth Development and Research.

The World Health Organization called for mobile health initiatives to improve population health outcomes, particularly in limited-resource settings. The aim of our study was to reflect upon approaches embedded in cultural humility and recognize areas where improvement was needed in the social innovation collaborative development of an mHealth app to improve hypertension health literacy in India. A qualitative descriptive case study approach was employed to elicit concepts of cultural humility and areas for improvement derived from communications between project stakeholders. Overarching themes included fostering coalescence and strengthening partnerships in addition to multiple subthemes. Enveloping cultural humility in multidisciplinary, interprofessional and cross-cultural healthcare projects and processes is imperative for the development and implementation of successful culturally congruent health initiatives. Team fostering of coalescence and recognizing challenges and adapting to mitigate challenges can strengthen partnerships, a desired consequence of cultural humility.

Mobile Health to Improve Hypertension and Diabetes Health Literacy Among Asian Indian Migrants to Hong Kong.

The use of mobile technologies to improve health outcomes or mobile health is rapidly evolving, and culturally relevant resources are needed to address health disparities among vulnerable populations. Noncommunicable disease health disparities among Asian Indian migrants to Hong Kong are prevalent. A mobile health application designed to improve hypertension and type 2 diabetes mellitus health literacy was tested using a mixed-methods design to determine its impact on improving health literacy among this subpopulation. Quantitative findings indicated the mobile health application was effective in improving health literacy. Qualitative findings revealed participant perceptions about the application explored its informative nature, usability and likability of application components, and its ability to initiate intentionality for a healthier lifestyle among users. This feedback was valuable to ensure future modifications that will promote the application's scalability and sustainability.

The Results of Medial Horizontal Suture Fixation of Akin Osteotomy in Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study was to analyze the clinical results of medial horizontal suture fixation of Akin osteotomy in hallux valgus and present its advantages. MATERIALS AND METHODS: This study was based on 48 cases of 35 patients with Akin osteotomy, who underwent surgery of hallux valgus between December 2014 and July 2015, and with at least 12 months of follow-up. The mean age of patients was 46.9 years (range, 16~71 years). The mean follow-up duration was 15.9 months (range, 12~18 months). Clinical evaluations included pain visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS hallux metatarsophalangeal interphalangeal scale) score, and satisfaction score. Weightbearing anteroposterior radiographs were taken to measure the distal articular set angle (DASA) of the hallux. Radiographic bone union at 6 months follow-up was regarded as a success, while a loss of reduction and nonunion was regarded as a failure. RESULTS: The mean pre- and postoperative pain VAS scores were 4.27 and 1.67, respectively (p<0.05). The mean AOFAS score improved from 59.7 to 80.5 (p<0.05). The DASA was improved from 8.15 to –2.57 (p<0.05). There was no case of skin irritation, cortical breakage, inflammation from the knot, and infection. All patients showed union without fixation failure. CONCLUSION: The clinical and radiological evaluations in this study demonstrate reliable results without complication. The medial horizontal suture fixation of the Akin osteotomy was effective, and the advantage of this procedure was unnecessity of the material removal, preservation of the joint, and no skin irritation.

The Efficacy of Postoperative Ultrasound-Guided Sciatic Nerve Block to Relieve Pain after Hallux Valgus Surgery / 대한족부족관절학회지

PURPOSE: Modified Mau and Akin osteotomy for hallux valgus is followed by moderate to severe postoperative pain. Ultrasound-guided sciatic nerve block can be an effective option for pain control. We attempted to evaluate the efficacy of the ultrasound-guided sciatic nerve block in controlling postoperative pain. MATERIALS AND METHODS: The charts of 59 consecutive patients were retrospectively reviewed between December 2014 and August 2015. Twenty-eight patients (the patient group) has received the ultrasound-guided sciatic nerve block after surgery, and 31 patients (the control group) has not received such procedure. The primary outcome was the satisfaction scale for postoperative pain control and postoperative visual analogue scale (VAS) score. RESULTS: The VAS score at postoperative day one was significantly lower in the patient group than in the control group. The satisfaction scale for pain control for postoperative 1 day was significantly different between the two groups. In patient group, most patients have rated positively ('strongly agree' 42.9%, 'agree' 42.9%); however, in the control group, the rating scales were distributed relatively negatively ('strongly agree' 9.7%, 'agree' 22.6%, 'neutral' 29.0%, 'disagree' 25.8%, 'strongly disagree' 12.9%). The number of postoperative rescue analgesics injection was significantly lower in the patient group than in the control group. CONCLUSION: Postoperative ultrasound-guided sciatic nerve block was effective for pain relief after hallux valgus surgery.

Phosphate glass fibres promote neurite outgrowth and early regeneration in a peripheral nerve injury model.

Three-dimensional (3D) scaffolds, which are bioactive and aid in neuronal guidance, are essential in the repair and regeneration of injured peripheral nerves. In this study, we used novel inorganic microfibres guided by phosphate glass (PG). PG fibres (PGfs) were aligned on compressed collagen that was rolled into a nerve conduit. In vitro tests confirmed that adult dorsal root ganglion (DRG) neurons showed active neurite outgrowth along the fibres, with a maximum number and length of neurites being significantly higher than those cultured on tissue culture plastic. In vivo experiments with nerve conduits that either contained PGfs (PGf/Col) or lacked them (Col) were conducted on transected sciatic nerves of rats for up to 12 weeks. One week after implantation, the PGf/Col group showed many axons extending along the scaffold, whereas the Col group showed none. Eight weeks after implantation, the PGf/Col group exhibited greater recovery of plantar muscle atrophy than the Col group. Electrophysiological studies revealed that some animals in the PGf/Col group at 6 and 7 weeks post-implantation (5.3% and 15.8%, respectively) showed compound muscle action potential. The Col group over the same period showed no response. Motor function also showed faster recovery in the PGf/Col group compared to the Col group up to 7 weeks. However, there was no significant difference in the number of axons, muscle atrophy or motor and sensory functions between the two groups at 12 weeks post-implantation. In summary, phosphate glass fibres can promote directional growth of axons in cases of peripheral nerve injury by acting as physical guides.

Medial Horizontal Suture Fixation of the Akin Osteotomy: A Technical Report / 대한족부족관절학회지

The Akin osteotomy is a complimentary procedure in hallux valgus surgery. Surgical techniques may vary depending on the operators or fixation devices. Suture fixation, for which a removal procedure is not necessary, can often be recommended. However, there is a risk of failure due to the thin cortex of the phalanx. We describe a new technique using Ethibond suture fixation in Akin osteotomy, which can lower the risk of phalangeal cortical failure and articular cartilage irritation. First, the Akin osteotomy was performed on the proximal phalanx 5 to 6 mm distal to the first metatarsophalangeal joint. Then bone holes were drilled from dorsum to plantar parallel to osteotomy with the Kirschner wire. The final procedure involved passing the Ethibond sutures connected to a straight needle through the holes and tying it. This fixation method offers an effective and easy technique for performance of Akin osteotomy.

Results of Modified Mau Osteotomy Fixed with Bioabsorbable Screws in Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study was to analyze the clinical results of application of bioabsorbable screws in hallux valgus surgery using modified Mau osteotomy. MATERIALS AND METHODS: We retrospectively reviewed medical records of 25 patients. Operations were performed between May 2013 and January 2014. We performed 33 modified Mau osteotomies and fixed using bioabsorbable screws. Mean age of patients was 52 years (range 19 to 71). Mean follow up duration was 13.2 months (range 12.3 to 18.9). The clinical evaluations included pain visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and satisfaction score. Weight bearing anteroposterior radiographs were taken for measurement of hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). All radiographs were evaluated in order to detect complications related to bioabsorbable screws such as osteolysis, cyst formation, and fixation failure. RESULTS: The mean pre- and postoperative pain VAS scores were 4.0 and 1.7 (p<0.05). The mean AOFAS score improved from 52.6 to 82.8 (p<0.05). Preoperative HVA and IMA were 31.2 and 13.9, respectively. Postoperative HVA and IMA were 5.2 and 6.2 (p<0.05). The DMAA increased from 7.8 to 9.9 (p<0.05). There was one case of superficial wound infection and one loss of correction, and no case of osteolysis, cystic formation around the screw, or deep infection. All patients showed union without fixation failure. CONCLUSION: The clinical and radiological evaluation of this study demonstrates reliable results without fixation failure or allergic reaction. The use of bioabsorbable screw appears not to be inferior to metal screw fixation in hallux valgus surgery.

First Record of Alternaria simsimi Causing Leaf Spot on Sesame (Sesamum indicum L.) in Korea.

Leaf spot disease was observed in sesame (Sesamum indicum L.) during 2009 and 2010 in Korea. The pathogen was identified as Alternaria simsimi based on morphological and cultural characteristics. The morphological identification was well supported by phylogenetic analysis of the ribosomal DNA-internal transcribed spacer region. A. simsimi isolates caused spot symptoms on leaves and stems of sesame plants 2 wk after artificial inoculation, which were similar to those observed in the field. This is the first record of leaf spot disease in Korea caused by A. simsimi.

First Record of Alternaria simsimi Causing Leaf Spot on Sesame (Sesamum indicum L.) in Korea

Leaf spot disease was observed in sesame (Sesamum indicum L.) during 2009 and 2010 in Korea. The pathogen was identified as Alternaria simsimi based on morphological and cultural characteristics. The morphological identification was well supported by phylogenetic analysis of the ribosomal DNA-internal transcribed spacer region. A. simsimi isolates caused spot symptoms on leaves and stems of sesame plants 2 wk after artificial inoculation, which were similar to those observed in the field. This is the first record of leaf spot disease in Korea caused by A. simsimi.

Penicillium daejeonium sp. nov., a new species isolated from a grape and schisandra fruit in Korea.

Two isolates of monoverticillate Penicillium species were collected from a grape and schisandra fruit in Korea. Multigene phylogenetic analyses with the nuclear ribosomal internal transcribed spacer (ITS) region and genes encoding ß-tubulin (benA) and calmodulin (cmd), as well as morphological analyses revealed that the two isolates are members of the P. sclerotiorum complex in Penicillium subgenus Aspergilloides, but different from species of the P. sclerotiorum complex. The isolates are closely related to P. cainii, P. jacksonii, and P. viticola in terms of their multigene phylogeny, but their colony and conidiophore morphologies differ from those of closely related species. The name P. daejeonium is proposed for this unclassified new species belonging to the P. sclerotiorum complex in subgenus Aspergilloides.

Diastereoselective synthesis of vicinal tertiary diols.

A strategy for the synthesis of differentiated vicinal tertiary diols is described. The key step is a high-yielding, diastereoselective LaCl3·2LiCl-mediated addition of a Grignard or organolithium reagent to ketone 2a. The reaction is believed to proceed via a 1,3-chelated intermediate. One of the adducts has been transformed into a functionalized cyclopentenone resembling the core structure of pactamycin.

PKCη Regulates the TGFß3-induced Chondevrepogenic Differentiation of Human Mesenchymal Stem Cell.

Transforming growth factor (TGF) family is well known to induce the chondevrepogenic differentiation of mesenchymal stem cells (MSC). However, the precise signal transduction pathways and underlying factors are not well known. Thus the present study aims to evaluate the possible role of C2 domain in the chondevrepogenic differentiation of human mesenchymal stem cells. To this end, 145 C2 domains in the adenovirus were individually transfected to hMSC, and morphological changes were examined. Among 145 C2 domains, C2 domain of protein kinase C eta (PKCη) was selected as a possible chondevrepogenic differentiation factor for hMSC. To confirm this possibility, we treated TGFß3, a well known chondevrepogenic differentiation factor of hMSC, and examined the increased-expression of glycosaminoglycan (GAG), collagen type II (COL II) as well as PKCη using PT-PCR, immunocytochemistry and Western blot analysis. To further evaluation of C2 domain of PKCη, we examined morphological changes, expressions of GAG and COL II after transfection of PKCη -C2 domain in hMSC. Overexpression of PKCη-C2 domain induced morphological change and increased GAG and COL II expressions. The present results demonstrate that PKCη involves in the TGF-ß3-induced chondevrepogenic differentiation of hMSC, and C2 domain of PKCη has important role in this process.

Hallux Valgus and Cartilage Erosion in First Metatarsal Head: Correlation between Intraoperative Cartilage Erosion and Preoperative Parameters / 대한족부족관절학회지

PURPOSE: To analyze relation between age or parameters measured before operation and cartilage erosion of the first metatarsal head measured during operation. MATERIALS AND METHODS: The study was targeted at 56 patients and 79 feet, who underwent Scarf osteotomy or Scarf and Akin osteotomy from November 2009 through November 2010, and whose cartilage lesion of the first metatarsal head referred to the cartilage grade III or IV of the International Cartilage Repair Society. The measurement parameters were age, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle. The cartilage erosion of the first metatarsal head was measured by one surgeon using cellophane. Occupancy rate and frequent involved sites of the cartilage erosion were recorded using AutoCAD(R) and adobe Illustrator CS4 program. SPSS correlation test and T-test were used for statistical analysis of the parameters and the cartilage erosion. RESULTS: The cartilage erosion was incurred frequently in the sagittal groove and the site where subluxation or dislocation of the tibial sesamoild bone occurred but frequent involved sites had no statistical significance with cartilage erosion. The age showed a statistical significance with the cartilage erosion in the correlation test (p=0.003). Especially, the group of over 51 year old patients was turned out to have association with the cartilage erosion, compared to the group of below 51 (p=0.007). But, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle were no statistical significance with the cartilage erosion. CONCLUSION: We found the more the age of patients increased (especially above 51), the more cartilage erosion increased. And it is thought that we pay attention to reduce tibial sesamoid bone.

Incomplete Reduction that Influence Reduction of Sesamoid as a Cause for Recurrence of Hallux Valgus / 대한족부족관절학회지

PURPOSE: The incomplete reduction of the sesamoid has lately been issued as cause for recurrence. In this study, we analysed factors that may influence reduction of sesamoid. MATERIALS AND METHODS: The study consists of 50 cases operated by single surgeon. Eighteen cases were done by proximal chevron osteotomy, and 32 cases were done by scarf osteotomy. Hallux valgus (HV) angle and intermetatarsal (IM) angle were measured before and three months after the surgery. Sesamoid position (SP) was classified according to Hardy and Clapham grade system. RESULTS: After the proximal chevron osteotomy, the correction of the mean HV angle was 19.5degrees, and IM angle was 6.2degrees. SP was changed from 5.6 to 3.4 grade. After the Scarf osteotomy, the correction of the mean HV angle was 25 degree, and IM angle was 9degrees. SP was changed from 5.5 to 2.8 grade. There was difference of sesamoid's correction between two different method of surgery (p=0.127). However, better correction of sesamoid was witnessed with bigger correction angle regardless of method of surgery (p=0.002, 0.001). CONCLUSION: We believe surgical method do not effect sesamoid's correction but more correction angle can result in better correction of sesamoid position.

Incomplete Reduction that Influence Reduction of Sesamoid as a Cause for Recurrence of Hallux Valgus / 대한족부족관절학회지

PURPOSE: The incomplete reduction of the sesamoid has lately been issued as cause for recurrence. In this study, we analysed factors that may influence reduction of sesamoid. MATERIALS AND METHODS: The study consists of 50 cases operated by single surgeon. Eighteen cases were done by proximal chevron osteotomy, and 32 cases were done by scarf osteotomy. Hallux valgus (HV) angle and intermetatarsal (IM) angle were measured before and three months after the surgery. Sesamoid position (SP) was classified according to Hardy and Clapham grade system. RESULTS: After the proximal chevron osteotomy, the correction of the mean HV angle was 19.5degrees, and IM angle was 6.2degrees. SP was changed from 5.6 to 3.4 grade. After the Scarf osteotomy, the correction of the mean HV angle was 25 degree, and IM angle was 9degrees. SP was changed from 5.5 to 2.8 grade. There was difference of sesamoid's correction between two different method of surgery (p=0.127). However, better correction of sesamoid was witnessed with bigger correction angle regardless of method of surgery (p=0.002, 0.001). CONCLUSION: We believe surgical method do not effect sesamoid's correction but more correction angle can result in better correction of sesamoid position.

A case of postcardiac injury syndrome presenting as acute mediastinitis.

A 41-year-old man sought evaluation at the emergency department for pain in the anterior chest that had been ongoing for approximately 35 hours. The electrocardiogram showed marked ST segment elevation in the precordial leads. Cardiac biomarker levels were elevated. He subsequently underwent coronary angioplasty and stenting of the left anterior descending artery using two sirolimus-eluting stents. The following day, the patient complained of severe pain in his chest and shoulders. Computed tomography (CT) of the chest showed small gas bubbles around the aortic wall and mild pericardial thickening with subtle air densities, suggesting acute mediastinitis. With an impression of postcardiac injury syndrome and acute mediastinitis, he was treated with intravenous antibiotics and oral ibuprofen. Two days later, the patient had subjective improvement and the friction rub was no longer heard.

A Case of Postcardiac Injury Syndrome Presenting as Acute Mediastinitis

A 41-year-old man sought evaluation at the emergency department for pain in the anterior chest that had been ongoing for approximately 35 hours. The electrocardiogram showed marked ST segment elevation in the precordial leads. Cardiac biomarker levels were elevated. He subsequently underwent coronary angioplasty and stenting of the left anterior descending artery using two sirolimus-eluting stents. The following day, the patient complained of severe pain in his chest and shoulders. Computed tomography (CT) of the chest showed small gas bubbles around the aortic wall and mild pericardial thickening with subtle air densities, suggesting acute mediastinitis. With an impression of postcardiac injury syndrome and acute mediastinitis, he was treated with intravenous antibiotics and oral ibuprofen. Two days later, the patient had subjective improvement and the friction rub was no longer heard.

Posterior Approach to Total Hip Joint Replacement Arthroplasty

This paper was written to review the posterior approach for total hip arthroplasty and to introduce the modified short external rotator muscle saving posterior approach for enhancing the hip stability after total hip replacement arthroplasty. After total hip replacement arthroplasty, dislocation is the most commom early complication. Especially with using the posterior approach, dislocation is more common than that for the anterior or lateral approach to the hip. We report here that saving or meticulously repairing the short rotator could reduce the incidence of posterior hip dislocation after total hip replacement arthroplasty. Along with a brief review of the posterior approach to the hip, we introduce the short external rotator muscle saving modified posterior approach to total hip arthroplasty.

Risk Factors for Osteonecrosis of the Femoral Head in Patients with Heamatologic diseases

PURPOSE: We aimed to clarify the risk factors associated with the development of ONFH by comparing patients with hematologic diseases and osteonecrosis of the femur head (ONFH) to those patients without ONFH and who have hematologic diseases MATERIALS AND METHODS: The study population was limited to the patients admitted to our Hematology-Oncology department from 1 January 1994 to 31 May 2007. The patients were divided into 2 groups (those with ONFH, 54 patients and those without ONFH, 54 patients) and the risk factors for ONFH were evaluated by a comparative analysis. We analyzed the effect of a history of bone marrow transplantation (BMT), graft-versus-host disease (GVHD), total body radiation (TBI) and the amount of steroid used as the risk factors for ONFH. RESULTS: On the multiple logistic regression analysis, a total steroid use of >g/BMI was statistically identified as a significant risk factor for ONFH. The history of BMT and TBI were not statistically correlated with the development of ONFH. Among the patients with BMT, allogenic BMT and a history of GVHD were not statistically correlated with the development of ONFH on the multiple logistic regression analysis. CONCLUSION: Patients with hematologic diseases and who have used steroid >1.5g/BMI should carefully observed because they are more likely to develop ONFH.