Changes in parents' health concerns by post-preterm birth period in South Korea: a cross-sectional study.

PURPOSE: This study aimed to examine the health concerns of parents regarding their premature infants and to identify changes in these concerns during perinatal period and after discharge. METHODS: This was a retrospective study performed at a single tertiary center that enrolled 119 premature infants who were discharged from the neonatal intensive care unit (NICU) and visited the outpatient pediatrics department between December 2018 and October 2021. Data on the concerns of 176 parents regarding enrolled premature infants' health from before birth to 1 week after NICU discharge were obtained from outpatient records. The t test and with the chi-squared test were used to analyze the data for this study. RESULTS: The consistently greatest focus of parents' health concerns was the respiratory system. The second focus of parents' health concerns before discharge was the central nervous system. However, during the first week after NICU discharge, the gastrointestinal system was the second-most frequent focus of parents' health concerns among parents of infants without diseases related to prematurity and infants with older gestational ages. CONCLUSION: The results of this study offer insights into the health concerns among parents of premature infants. Parental health concerns about premature infants vary over time, from before birth to post-discharge, necessitating supportive interventions to enhance parental understanding of their child's health status.

Trastuzumab-based palliative chemotherapy for HER2-positive gastric cancer: a single-center real-world data.

BACKGROUND: Since the results of the ToGA trial were published, trastuzumab-based chemotherapy has been used as the standard first-line treatment for HER2-positive recurrent or primary metastatic gastric cancer (RPMGC). However, the real-world data has been rarely reported. Therefore, we investigated the outcomes of trastuzumab-based chemotherapy in a single center. METHODS: This study analyzed the real-world data of 47 patients with HER2-positive RPMGC treated with trastuzumab-based chemotherapy in a single institution. RESULTS: With the median follow-up duration of 18.8 months in survivors, the median overall survival (OS) and progression-free survival were 12.8 and 6.9 months, respectively, and the overall response rate was 64%. Eastern Cooperative Oncology Group performance status 2 and massive amount of ascites were independent poor prognostic factors for OS, while surgical resection before or after chemotherapy was associated with favorable OS, in multivariate analysis. In addition, 5 patients who underwent conversion surgery after chemotherapy demonstrated an encouraging median OS of 30.8 months, all with R0 resection. CONCLUSIONS: Trastuzumab-based chemotherapy in patients with HER2-positive RPMGC in the real world demonstrated outcomes almost comparable to those of the ToGA trial. Moreover, conversion surgery can be actively considered in fit patients with a favorable response after trastuzumab-based chemotherapy.

Factors influencing the quality of nursing care as perceived by mothers of hospitalized children in South Korea.

PURPOSE: This study aimed to identify the factors affecting the quality of nursing care as perceived by mothers of hospitalized children and provide basic data for the development of nursing care quality improvement programs. METHODS: The participants consisted of 167 mothers, each of whom had a child hospitalized at a specific children's hospital. Data were collected from June 22 to August 8, 2019. RESULTS: The factors that affected how mothers perceived the quality of nursing care were the communication ability of nurses (ß=.44, p<.001) and the mother-nurse partnership (ß=.33, p=.001). The total explanatory power of these factors was 54.1%. CONCLUSION: To improve the quality of pediatric nursing care, it is necessary to improve the communication abilities of nurses and to promote partnership between nurses and the mothers of hospitalized children.

Comparative Study on the Effect of the Different Harvesting Sources of Demineralized Bone Particles on the Bone Regeneration of a Composite Gellan Gum Scaffold for Bone Tissue Engineering Applications.

Bone is the rigid tissue that constitutes the skeleton. The material for bone regeneration has to provide the mechanical stability by maintaining the mechanical loads both in the rest conditions and during the body movements. Bone is dynamic tissue constantly reshaped by the action of cells (osteoblasts and osteoclasts). This activity is normally enough to heal bone injuries; however, in several conditions, when bone is subjected to fatal damages, self-renewal is difficult, if not even impossible, and a medical treatment is required. The transplantation of a biomaterial is one of the common surgical procedures to overcome critical injuries. In this study, we exploited the effect of the use of different sources of demineralized bone powder (DBP) in combination with gellan gum (GG) to form a GG-DBP hydrogel scaffold with the purpose of regenerating the bone tissue. DBP was extracted from the femurs of two typologies of Gallus gallus domesticus (the Yeonsan Ogye, a traditional and rare black chicken from Korea, and the Cornish cross, the most common breeds for industrial meat production) and the Pekin duck. The composite scaffold has been tested both in vitro and in vivo. In vitro studies using rat bone marrow-derived mesenchymal stem cells (rBMSCs) confirmed the cellular suitability of bone-specific gene expression for seeded GG-DBP scaffolds, differentiation capacity, and marked upregulation. The scaffold containing a DBP derived from the Yeonsan Ogye (YO) bone showed higher levels of cell proliferation and osteogenic differentiation in comparison with the scaffold with the DBP obtained from the other studied sources. These results have been related with the higher amount of melanin, studied by fluorescence, of the YO DBP compared to Cornish cross and Pekin duck. Overall, this study clearly shows the use of YO DBP as a promising material in bone tissue regeneration.

Factors Influencing Compassion Fatigue among Hospice and Palliative Care Unit Nurses.

Purpose: This descriptive study aimed to explore nursing workplace spirituality, end-of-life care stress, and resilience as factors influencing compassion fatigue among nurses working in hospice and palliative care units. Methods: Data were collected using a self-report questionnaire completed by 146 nurses at 14 hospice and palliative care institutions across South Korea who had worked in a hospice and palliative care institution for at least 6 months and had experience providing end-of-life care. Data were collected from February 25, 2019 to April 12, 2019, and analyzed using SPSS for Windows version 18.0. As appropriate, descriptive statistics, the t-test, analysis of variance, the Scheffé test, Pearson correlation coefficients, and stepwise multiple regression were used. Results: The survey results showed that factors influencing compassion fatigue were resilience, subjective health status, current satisfaction with the hospice ward, and end-of-life care stress. Higher levels of resilience, a subjective health status of "healthy", high levels of current satisfaction with the hospice ward, and lower levels of end-of-life care stress were associated with lower levels of compassion fatigue, explaining 42.9% of the total variance. Conclusion: The results of this study suggest that resilience is an important factor mitigating compassion fatigue among nurses at hospice and palliative care institutions. Therefore, intervention programs should be developed to reduce compassion fatigue.

A case of foreign bodies self-inserted into the paranasal sinus via an oroantral fistula.

Foreign bodies in the nasal cavity are rarely seen in adults, and most cases are traumatic in origin. Multiple foreign bodies in adults are particularly rare. Foreign bodies induce pain, bleeding, and infection but are easily removed in most cases. A patient presented with multiple toothpick foreign bodies in the nasal cavity, which were introduced intentionally through an oroantral fistula. We report an adult case with 37 toothpicks in the nasal cavity, which were removed successfully with a nasal endoscope. Oroantral fistula closure was achieved through oral surgery. Voluntary insertion of foreign bodies into the body by patients with mental illnesses is relatively difficult to identify. Evaluating and managing the psychiatric problems of such patients during treatment planning are necessary.

Development of fluorescein isothiocyanate conjugated gellan gum for application of bioimaging for biomedical application.

Herein, gellan gum (GG), a nature-derived polysaccharide, was applied to combine fluorescein isothiocyanate (FITC) to fabricate a bio-imaging material. The synthesis process of the FITC grafted GG (GG-F) and manufacturing method of GG-F scaffolds are presented. Chemical, physicochemical, and mechanical properties were characterized. In vitro study and in vivo study by implanting the GG-F scaffolds under the subcutaneous area of the nude mice were carried out to verify biocompatibility and safety of the material. The emission of the FITC was confirmed with high-resolution confocal laser scanning microscope (SR CLMS) and fluorescence in vivo imaging (FOBI). The results exhibited well-synthesized GG-F and the manufactured GG-F scaffolds showed similar property of GG scaffolds which confirms that the chemical modification does not affect the property of GG scaffolds. The in vitro and in vivo study exhibited biocompatibility of the GG-F material. Overall, the properly blended GG-F in GG did not influence the characteristics of the pristine GG except for the chemical property. Therefore, the GG-F can be applied for the future analysis in verifying the mechanism of GG characters and can be a promising candidate for bio-imaging.

Osteochondral and bone tissue engineering scaffold prepared from Gallus var domesticus derived demineralized bone powder combined with gellan gum for medical application.

Osteochondral (OC) lesions can occur in the knee and ankle. Such lesions induce a fracture in the cartilage protecting the bone joints. Cartilage tissue shows limited self-regeneration ability, hence the tissue is avascular and lack of vascular innervation, while the bone is a unique organ with the capacity to self-repair of small defects. In this present study, we have prepared a scaffold using demineralized bone powder (DBP) extracted from Gallus gallus var domesticus (GD), and Gellan gum (GG) for OC tissue regeneration. They were characterized for their chemical, physical, mechanical and biological properties using different available techniques, in vitro bioactivity was performed in simulated body fluid for 14 days confirming the formation of bone-like apatite. The in vitro biocompatibility was analyzed using chondrocyte cells and osteogenic and chondrogenic marker gene expression using RT-PCR, in vivo experiments performed by implanting scaffold in rabbit and characterized by histology and immunofluorescent stainings. The obtained results indicated that the prepared pores scaffold was biocompatible, and promote OC regeneration and integration of newly formed tissues with the host tissues in a rabbit. The prepared 1% DBP/GG scaffold can be used as a potential and promising alternate material for OC regeneration.

[Structural Equation Modeling of Job Engagement in Pediatric Nurses Based on the Job Crafting Model]. / 잡 í¬ëž˜í”„íŒ ëª¨ë¸ì— 근거한 아동간호사의 직무열의 구조모형.

PURPOSE: The goal of this study was to construct a structural equation model of job engagement in pediatric nurses based on Tims and Bakker's job crafting model. METHODS: In total, 203 pediatric nurses participated in this study, which was conducted to analyze the relationships among the concepts of job demands, job resources, person-job fit, job crafting and job engagement. Data were collected from July 24 to August 30, 2017, and analyzed using SPSS 20.0 and AMOS 21.0. RESULTS: The hypothetical model appeared to fit the data. Six of the nine hypotheses selected for the hypothetical model were statistically significant. The job engagement model showed significant direct effects for job crafting, person-job fit and job resources, which collectively explained 61.5% of the variation in pediatric nurses' job engagement. CONCLUSION: Based on the findings of this study, a strategy will be needed to improve job resources and person-job fit in order to promote job engagement among pediatric nurses. Job crafting was affected by the factors of job resources and person-job fit, which should be addressed in job crafting promotion programs.

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus.

BACKGROUND: Fixation of proximal chevron metatarsal osteotomy has been accomplished using K-wires traditionally and with a locking plate recently. However, both methods have many disadvantages. Hence, we developed an intramedullary fixation technique using headless cannulated screws and conducted a biomechanical study to evaluate the superiority of the technique to K-wire and locking plate fixations. METHODS: Proximal chevron metatarsal osteotomy was performed on 30 synthetic metatarsal models using three fixation techniques. Specimens in group I were fixated with K-wires (1.6 mm × 2) and in group II with headless cannulated screws (3.0 mm × 2) distally through the intramedullary canal. Specimens in group III were fixated with a locking X-shaped plate (1.3-mm thick) and screws (2.5 mm × 4). Eight metatarsal specimens were selected from each group for walking fatigue test. Bending stiffness and dorsal angulation were measured by 1,000 repetitions of a cantilever bending protocol in a plantar to dorsal direction. The remaining two samples from each group were subjected to 5 mm per minute axial loading to assess the maximal loading tolerance. RESULTS: All samples in group I failed walking fatigue test while group II and group III tolerated the walking fatigue test. Group II showed greater resistance to bending force and smaller dorsal angulation than group III (p = 0.001). On the axial loading test, group I and group II demonstrated superior maximum tolerance to group III (54.8 N vs. 47.2 N vs. 28.3 N). CONCLUSIONS: Authors have demonstrated proximal chevron metatarsal osteotomy with intramedullary screw fixation provides superior biomechanical stability to locking plate and K-wire fixations. The new technique using intramedullary screw fixation can offer robust fixation and may lead to better outcomes in surgical treatment of hallux valgus.

Changes in hindfoot alignment after total knee arthroplasty in knee osteoarthritic patients with varus deformity.

PURPOSE: Hindfoot alignment can affect the weight-bearing kinematics of the knee joint in patients undergoing total knee arthroplasty (TKA). This study evaluated the change in hindfoot alignment after TKA by prospectively analysing the correlation between the knee joint and the hindfoot deformity, the post-operative improvement in the hindfoot deformity, and the long-term post-operative changes in hindfoot alignment. METHODS: This study included 195 knees from 117 patients with osteoarthritis who underwent TKA between 2012 and 2013. The mechanical alignment angle of the knee joint and the hindfoot alignment angle were measured preoperatively and 6 weeks, 1, and 2 years post-operatively. The patients were divided into two groups according to the severity of the preoperative knee joint deformity: <10° varus (group 1, N = 81) and ≥10° varus (group 2, N = 114). The preoperative and post-operative radiologic parameters of the axis of the knee joint and hindfoot were evaluated, and the results were compared. A Spearman correlation analysis was used to assess the differences in both the mechanical alignment and the hindfoot alignment pre- and post-operatively. RESULTS: After TKA, the hindfoot valgus deformity improved from 5.2° (±3.8) valgus to 2.1° (±3.9) valgus. At 6 weeks post-operatively, the hindfoot alignment angle was 1.4° (±3.5) valgus and 2.5° (±4.1) valgus in group 1 and group 2, respectively; the difference between the two groups was not statistically significant. Hindfoot alignment showed greater valgus with increasing varus of the mechanical alignment of the knee joint preoperatively (-0.484, p < 0.001) and post-operatively (-0.147, p = 0.040). The post-operative 1- and 2-year hindfoot alignment angles were 2.2° (±4.2) valgus and 2.2° (±4.1) valgus, respectively. None of the differences between the post-operative hindfoot alignment angles were statistically significant. CONCLUSIONS: The stable improvement in the hindfoot deformity after TKA demonstrates that a valgus deformity of the hindfoot in a patient with a varus knee joint deformity does not require preoperative correction. In patients with a residual hindfoot deformity and pain 6 weeks after TKA, active treatment should be considered because no further improvement can be expected. LEVEL OF EVIDENCE: Prospective cohort study, Level II.

Effectiveness of Headless Bioabsorbable Screws for Fixation of the Scarf Osteotomy.

BACKGROUND: Scarf osteotomy has been used in hallux valgus surgery due to its large fixation surface for screws and low postoperative complications. However, screws may cause skin irritation from their head, which may require an additional surgical procedure to remove. METHODS: This study included 115 patients (106 females and 9 males, 115 feet) who underwent hallux valgus correction with a scarf osteotomy using bioabsorbable screws between September 2010 and September 2012. Preoperative and postoperative 1-month and 1-year radiographic measurements, including intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA), and lateral translational distance (LTD), were obtained. American Orthopaedic Foot & Ankle Society (AOFAS) hallux/forefoot scores were used for patient satisfaction. RESULTS: Preoperative mean values of HVA, IMA, and PPA of 32.8 degrees, 14.6 degrees, and 7.52 degrees, respectively, improved to 10.7 degrees, 6.0 degrees, and 4.6 degrees, respectively at 1-year follow up (P < .05). The difference in LTD between the 1-month and 1-year follow-up was not statistically significant. AOFAS hallux/forefoot score improved from 69.1 to 96.1 at the 1-year follow up (P < .001). Complete screw absorption was not seen radiographically. Sixteen feet had complications reported. One patient complained of skin irritation over a small protrusion of the screw, and another patient had a foreign body reaction. There were 3 patients with neurologic injury from a popliteal block and 3 patients with dorsal cutaneous nerve symptoms. Four feet had metatarsal fracture during surgery. CONCLUSION: We found the scarf osteotomy using bioabsorbable screws to have satisfactory clinical and radiographic results with a low complication rate. LEVEL OF EVIDENCE: Level IV, case series.

Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas.

BACKGROUND: The talus has a very complex anatomical morphology and is mainly fractured by a major force caused by a fall or a traffic accident. Therefore, a talus fracture is not common. However, many recent reports have shown that minor injuries, such as sprains and slips during sports activities, can induce a talar fracture especially in the lateral or posterior process. Still, fractures to the main parts of the talus (neck and body) after ankle sprains have not been reported as occult fractures. METHODS: Of the total 102 cases from January 2005 to December 2012, 7 patients had confirmed cases of missed/delayed diagnosis of a talus body or neck fracture and were included in the study population. If available, medical records, X-rays, computed tomography scans, and magnetic resonance imaging of the confirmed cases were retrospectively reviewed and analyzed. RESULTS: In the 7-patient population, there were 3 talar neck fractures and 4 talar body fractures (coronal shearing type). The mechanisms of injuries were all low energy trauma episodes. The causes of the injuries included twisting of the ankle during climbing (n = 2), jumping to the ground from a 1-m high wall (n = 2), and twisting of the ankle during daily activities (n = 3). CONCLUSIONS: A talar body fracture and a talar neck fracture should be considered in the differential diagnosis of patients with acute and chronic ankle pain after a minor ankle injury.

Cascade regulation of PPARγ(2) and C/EBPα signaling pathways by celastrol impairs adipocyte differentiation and stimulates lipolysis in 3T3-L1 adipocytes.

OBJECTIVE: Celastrol, a triterpene from the root bark of the Chinese medicinal plant Tripterygium wilfordii, has been shown to exhibit anti-oxidant, anti-inflammatory, anti-cancer and insecticidal activities. Also, it has been demonstrated that celastrol has obesity-controlling effects in diet-induced obesity mice. However, direct evidence that celastrol contributes to the development of adipocyte differentiation and lipolysis has not been fully elucidated. Moreover, no previous studies have evaluated whether celastrol may regulate adipogenic transcriptional markers in adipocytes. MATERIALS/METHODS: In order to address the questions above, we extended previous observations and investigated in vitro celastrol signaling study whether celastrol may regulate differentiation, lipolysis and key adipogenic transcriptional pathways in 3T3-L1 adipocytes. RESULTS: Treatment of celastrol not only inhibited adipocyte differentiation (lipid accumulation, glyceraldehyde-3-phosphate dehydrogenase activity and triglyceride content) but also increased lipolysis (glycerol release and free fatty acid release) in 3T3-L1 adipocytes. In addition, all celastrol-regulated functional activities were controlled by PPARγ(2) and C/EBPα signaling pathways in duration of celastrol's treatment in 3T3-L1 adipocytes. CONCLUSION: Our initial data from in vitro celastrol signaling studies suggest novel insights into the role of PPARγ(2) and C/EBPα as probable mediators of the action of celastrol in regulating adipocyte differentiation and lipolysis in 3T3-L1 adipocytes.

Mediating Effect of School Nurses' Self Efficacy between Multicultural Attitude and Cultural Sensitivity in Korean Elementary Schools.

PURPOSE: This study examined the mediating effect of school nurses' self efficacy, which is one of the significant cognitive factors influencing cultural sensitivity, on the mutual relationships between multicultural attitude and cultural sensitivity in Korean elementary schools. METHODS: A cross-sectional descriptive survey design was used. Participants were 157 school nurses in elementary schools located in Gyeonggi-do, South Korea. The survey instruments included Teacher Multicultural Attitude Survey, Teacher Efficacy Scale, and Multicultural Sensitivity Scale. Data were analyzed using three regression equations to test the mediation model. RESULTS: The mean score of the school nurses' cultural sensitivity was relatively low. A positive correlation among multicultural attitude, self efficacy, and cultural sensitivity was noted. Self efficacy of school nurses showed a significant mediating effect on the relationships between multicultural attitude and cultural sensitivity. CONCLUSIONS: Given the meaningful influence of positive multicultural attitude on cultural sensitivity and significant mediator effect of self efficacy as a school nurse between the two variables, the strategies to cultivate a positive multicultural attitude and enhance school nurses' self efficacy in their unique role should be considered in a training program. School nurses' health care services will benefit from the improvement of cultural sensitivity toward young children from multicultural families.

Stent Compression in Iliac Vein Compression Syndrome Associated with Acute Ilio-Femoral Deep Vein Thrombosis.

OBJECTIVE: This study was conducted to evaluate stent compression in iliac vein compression syndrome (IVCS) and to identify its association with stent patency. MATERIALS AND METHODS: Between May 2005 and June 2014, after stent placement for the treatment of IVCS with acute ilio-femoral deep vein thrombosis, follow-up CT venography was performed in 48 patients (35 women, 13 men; age range 23-87 years; median age 56 years). Using follow-up CT venography, the degree of the stent compression was calculated and used to divide patients into two groups. Possible factors associated with stent compression and patency were evaluated. The cumulative degree of stent compression and patency rate were analyzed. RESULTS: All of the stents used were laser-cut nitinol stents. The proportion of limbs showing significant stent compression was 33%. Fifty-six percent of limbs in the significant stent compression group developed stent occlusion. On the other hand, only 9% of limbs in the insignificant stent compression group developed stent occlusion. Significant stent compression was inversely correlated with stent patency (p < 0.001). The median patency period evaluated with Kaplan-Meier analysis was 20.0 months for patients with significant stent compression. Other factors including gender, age, and type of stent were not correlated with stent patency. Significant stent compression occurred most frequently (87.5%) at the upper end of the stent (ilio-caval junction). CONCLUSION: Significant compression of nitinol stents placed in IVCS highly affects stent patency. Therefore, in order to prevent stent compression in IVCS, nitinol stents with higher radial resistive force may be required.

Concomitant Syndesmotic Instability and Medial Ankle Instability Are Risk Factors for Unsatisfactory Outcomes in Patients With Chronic Ankle Instability.

PURPOSE: To determine whether concomitant chronic syndesmotic injury or chronic medial ankle instability is associated with unsatisfactory outcomes in patients with chronic lateral ankle instability (CAI). METHODS: We conducted a retrospective review of prospectively collected data from 276 male military patients with CAI who had undergone a modified Broström procedure between May 2007 and March 2010 and had been followed up for a mean of 26.7 months (range, 22 to 41 months). We evaluated clinical outcomes using American Orthopaedic Foot & Ankle Society ankle-hindfoot, visual analog scale, and ankle functional satisfactory scale scores. Possible associations with concomitant instability were reconstructed and investigated using the Pearson correlation coefficient and multivariate logistic regression analysis. RESULTS: Of the 236 patients with satisfactory outcomes, 19 (8%) had medial ankle instability and 13 (6%) had syndesmotic instability; in contrast, of the 40 patients with unsatisfactory outcomes, 14 (35%) had medial ankle instability and 12 (30%) had syndesmotic instability. The mean American Orthopaedic Foot & Ankle Society scores for patients with satisfactory and unsatisfactory outcomes increased from 68.1 to 92.8 (P < .001) and from 65.9 to 76.8 (P < .001), respectively. The mean visual analog scale scores for the groups with satisfactory and unsatisfactory outcomes decreased from 5.8 to 2.1 (P < .001) and from 6.2 to 4.8 (P < .001), respectively. The mean ankle satisfaction score was 27.8 for patients with satisfactory outcomes and 18.7 for those with unsatisfactory outcomes (P < .001). Multivariate logistic regression analysis showed a 4-fold higher risk of dissatisfaction (95% confidence interval [CI], 0.81 to 20.07; P = .0880) with CAI and syndesmotic instability, a 3.8-fold higher risk (95% CI, 0.96 to 15.07; P = .0576) with CAI and medial ankle instability, and an 11.7-fold higher risk (95% CI, 2.60 to 52.70; P = .0014) with CAI and both syndesmotic and medial ankle instability. CONCLUSIONS: Chronic syndesmotic instability and chronic medial ankle instability are significantly associated with unsatisfactory outcomes in patients with CAI. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

A New Measure of Tibial Sesamoid Position in Hallux Valgus in Relation to the Coronal Rotation of the First Metatarsal in CT Scans.

BACKGROUND: We aimed to find a new radiographic measurement for evaluating first metatarsal pronation and sesamoid position in hallux valgus (HV) deformity. METHODS: Data from a clinical study of 19 control patients (19 feet) with no HV deformity were compared with preoperative data of 138 patients (166 feet) with HV deformities. Using a weightbearing plain radiograph in anteroposterior (AP) view, the intermetatarsal angles (IMAs) and the hallux valgus angles (HVAs) of the control and study groups were measured. Using a semi-weightbearing coronal computed tomography (CT) axial view, the α angle was measured in the control and study groups. In addition, the tibial sesamoid grades in plain radiograph tangential view and the CT axial view were measured. The tibial sesamoid position in an AP view was checked preoperatively. Based on these measurements, 4 types of HV deformities were defined. RESULTS: The mean values of the α angle in the control and HV deformity groups (control group µ = 13.8 degrees, study group µ = 21.9 degrees) was significantly different. Among 166 HV feet, 145 feet (87.3%) had an α angle of more than 15.8 degrees, which is the upper value of the 95% confidence interval of the control group, indicating the existence of abnormal first metatarsal pronation in HV deformity. Four types of HV deformities were defined based on their α angles and tibial sesamoid grades in CT axial view (CT 4 position). Among 25.9% (43/166) of the study group, abnormal first metatarsal pronation with an absence of sesamoid deviation from its articular facet was observed. The prominent characteristic of this group was that they had high grades in the AP 7 position (≥5); however, in the CT 4 position, their grade was 0. This group was defined as the "pseudo-sesamoid subluxation" group. CONCLUSIONS: Patients with HV deformities had a more pronated first metatarsal than the control group, with a greater α angle. Pseudo-subluxation of the sesamoids existed in 25.9% of our study group. From our results, we suggest that the use of the CT axial view in assessments of HV deformity may benefit surgeons when they make operative choices to correct these deformities. With regard to the pseudo-sesamoid subluxation group, the use of the distal soft tissue procedure is not surgically recommended. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Paratrooper's ankle fracture: posterior malleolar fracture.

BACKGROUND: We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. METHODS: Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. RESULTS: The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. CONCLUSIONS: Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to undergo surgical repairs.

Anger, Anger Expression Types, Problem Behaviors, and Suicide Probability in Adolescent Women using Cluster Analysis.

PURPOSE: This cross-sectional study was designed to identify anger-expression types of adolescent women and investigate the relationship between the identified anger-expression types and their problem behaviors and suicide probability. METHODS: The participants were 942 students at two female high school located in Gwangju. The data were analyzed using descriptive statistics, cluster analysis, t-test, ANOVA, and Scheffe multiple comparison test. RESULTS: Cluster analysis revealed 4 distinct anger expression types; Anger-out, Low anger expression, Anger-control, and Anger-in/out types. Female adolescent women had a higher level of trait anger or who frequently used the anger-in/out type reported internalized-externalized problem behaviors and suicide probability more frequently compared to those who frequently used the other three types of anger expression. CONCLUSION: Female adolescent women who had the low anger expression type and anger control type managed anger most effectively. The findings suggest the necessity of a development of the program for lowering the trait anger level and controlling the unfavorable anger expression types such as the anger-in/out.