Clinical Results after Design Modification of Lospa Total Knee Arthroplasty System: Comparison between Posterior-Stabilized (PS) and PS Plus Types.

Background: Lospa posterior-stabilized (PS) Plus type is a modified version of Lospa PS, in which the polyethylene insert shape is modified to reinforce stability and prevent patella-post impingement compared to Lospa PS. However, studies comparing the clinical and radiographic results of the two designs have not been reported yet. This study aimed to compare the clinical results of total knee arthroplasty (TKA) using the existing PS type and the modified Lospa PS Plus type. Methods: A retrospective study was performed on 558 knees of 342 patients who underwent TKA using the Lospa PS or PS Plus types and were followed up for at least 2 years. Cases were divided into two groups according to the implant used: 212 cases in the PS group and 346 cases in the PS Plus group. For clinical outcome assessment, knee range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Knee Society Score (KSS) were recorded before surgery and at the 2-year follow-up. Radiographic outcomes were evaluated according to the American Knee Society method. The incidence of postoperative complications and survival rates were compared between the two groups. Results: Both groups showed significant clinical improvement after surgery. The average KSS significantly improved from 53.4 points in the PS group and 52.3 points in the PS Plus group preoperatively to 91.3 points and 93.2 points after surgery, respectively (p < 0.001). The average WOMAC score improved from 50.4 points in the PS group and 52.3 points in the PS Plus group before surgery to 15.6 points and 14.8 points after surgery, respectively (p < 0.001). There was no significant difference between the two groups in ROM, the alignment of the lower limbs, and the implant position after surgery. The complication rates were also similar between the groups (p = 0.167). Conclusions: The Lospa PS Plus model is a modified design that improves the post structure from the previous PS type. Compared to the PS type, the PS Plus type showed similar statistical results at 2-year follow-up and good clinical results. The short-term average survival rate was over 98%, showing promising results.

Long-term outcomes of the modified Nirschl technique for lateral Epicondylitis: a retrospective study.

BACKGROUND: Although the Nirschl technique was introduced approximately 40 years ago, only limited information is available about the long-term results, especially concerning extensor power changes after surgery. The purpose of this study was to investigate long-term clinical results of surgical treatment of lateral epicondylitis using the modified Nirschl technique. The main outcome variable was muscle strength for wrist extension because the extensor origin was not reattached after removal of the degenerative extensor tendon. METHODS: Data from 99 patients who underwent surgical lateral epicondylitis treatment between 2007 to 2012 were included in the study. The mean follow-up period was 8.5 years (5 to 10, ± 1.1 years) and the mean age at surgery was 44.8 years (32 to 70, ± 9.8 years). The surgeries were performed using the modified Nirschl method and did not include extensor origin reattachment. Outcome measurements included the Visual Analogue Scale (VAS) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, the MAYO elbow performance score, and Nirschl and Pettrone's grades. Wrist extension and grip strength were analyzed using a digital handgrip dynamometer (microFET2TM system) and JAMA hand dynamometer. RESULTS: Mean time required to return to work was 2.4 months after surgery. At the last follow-up after surgery, the mean VAS score had significantly improved, from 4.9 to 1.1. Mean MAYO elbow performance scores significantly improved, from 64 to 90, and mean DASH scores improved from 50 to 13. The Nirschl and Pettrone's grades were 80% rated as 'excellent' and 16% rated as 'good'. After adjusting for power differences between the dominant and non-dominant arms, the difference between wrist extensor power of the operated elbow and the non-operated opposite elbow at the final follow-up was not statistically significant. No patients complained about wrist extension weakness. CONCLUSION: Although reattachment of the extensor origin was not performed during the modified Nirschl surgical technique, there was no significant weakness in wrist extension power and the long-term follow-up revealed favorable clinical results. LEVEL OF EVIDENCE: Level IV (case series). Retrospective study.

A case report of Multiple Symmetric Lipomatosis (MSL) in an East Asian Female.

BACKGROUND: Multiple Symmetric Lipomatosis (MSL) is a rare disorder related to fat metabolism and lipid storage. The condition results in characteristic depositions of fat, especially around the cephalic, cervical, and upper thoracic subcutaneous. It is much more common in adult males who live in the Mediterranean region and has only rarely been reported in Asian females. In this report, we present a case of an Asian female with MSL and also review the clinical features of the condition, including radiological and histological findings required for proper diagnosis and management. CASE PRESENTATION: A 59-year-old Korean female came in with a chief complaint of palpable mass present in shoulder and upper back regions. Images showed diffuse non-encapsulated adipose tissue in the subcutaneous layer of the suboccipital, posterior neck area. The patient wanted to remove the mass for cosmetic reasons and discomfort. Excisional biopsy was planned. Preoperative blood analyses showed deteriorated liver function, and the computed tomography findings were consistent with liver cirrhosis. Detailed history taking revealed that she consumed highly levels of alcohol. Lipectomy was performed and the histological findings demonstrated large dystrophic adipocyte morphology. The patient was recovered uneventfully. CONCLUSION: When patients have multiple symmetric lipomatous lesions, clinicians should suspect MSL and survey possible associated conditions, such as alcoholism, liver cirrhosis, dyspnea, and neuropathy in detail.

Risk Factors of Carpal Tunnel Syndrome for Male Patient Undergoing Carpal Tunnel Release.

INTRODUCTION: Although the major cause of carpal tunnel syndrome (CTS) remains idiopathic, many male CTS patients are clinically different from female patients and often have specific risk factors associated with their conditions. An accurate analysis of such propensity has yet to be established. The purpose of this study is to compare male and female patients by analyzing the risk factors associated with CTS patients who underwent surgical treatment, with focus on their occupation. PATIENTS/MATERIAL AND METHODS: retrospective chart review of 818 patients with CTS was performed to identify the associated risk factors. Patients were stratified by gender: female (n = 707, 86.4 %) and male (n = 111, 13.6 %). The mean patient age was 54.5 (range: 16-85 yr.) for all groups. The medical history and risk factors of each patient was thoroughly reviewed by medical charts and telephone survey. We categorized the risk factors of CTS into 7 categories: anatomic, neuropathic, inflammatory, alteration of fluid balance, distal radius fracture associated, occupational risk factor related, and idiopathic. Occupations of CTS patients were divided into high risk occupations (vibratory tools, assembly jobs, and food processing and packaging jobs, and other occupations of repetitive wrist motion and forceful gripping) and nonrisk occupations. All variables were analyzed with chi-square or Fisher's exact test for differences between men and women. RESULTS: The number of individuals with known risk factors of CTS was greater in male, compared to that of female patients; 97 (87.4 %) male patients had the risk factors of CTS, while 361 (51.1 %) female patients (p < 0.001) did. In subgroup analysis of risk factors, male patients had frequent risk factors in neuropathic, inflammatory, and alteration of fluid balance (p < 0.001). Occupational risk was strongly associated with male gender (p < 0.001). CONCLUSION: Male CTS patients who underwent surgery are more likely to have a reason and have many occupational risk factors than women.

Intra-articular Large Ossicle Associated to Osgood-Schlatter Disease.

Osgood-Schlatter disease (OSD) is known as a self-limiting condition but surgical excision of the ossicles may be required in adults resistant to conservative treatments. The ossicle associated to OSD is generally small and located outside the joint near the tibial tubercle; however, large or intra-articular ossicle has been reported rarely. Here, we report an unusual case of OSD with a separated, large-sized ossicle that protruded into the knee joint and treated by arthroscopy-assisted excision of the ossicle.

The effects of graft shrinkage and extrusion on early clinical outcomes after meniscal allograft transplantation.

BACKGROUND: Graft shrinkage or radial extrusion is a reported complication after meniscus allograft transplantation (MAT). Whether shrinkage or extrusion progress after surgery and whether they are associated with the clinical outcome of MAT remain debatable. In this study, graft shrinkage and extrusion were measured in the coronal and sagittal planes using serial postoperative magnetic resonance imaging (MRI). The purpose of this study was to evaluate if graft shrinkage or extrusion is correlated to the clinical outcome of MAT. METHODS: MRIs acquired at 3 and 12 months postoperatively in 30 patients (21 men and 9 women) who underwent MAT (6 medial and 24 lateral menisci) from 2010 to 2016 were analyzed. Two orthopedic surgeons and two musculoskeletal specialized radiologists each performed the MRI measurements. Allograft shrinkage was measured by the width and thickness of the graft at the coronal and sagittal planes. To determine the graft extrusion, distances between the proximal tibia cartilage margin and the extruded graft margin were measured in both coronal (either lateral or medial) and sagittal (both anterior and posterior) plane and relative percentage of extrusion (RPE) were calculated. Subjective International Knee Documentation Committee (IKDC) scores at 12 months were evaluated as a clinical outcome measurement, and correlations between shrinkage or extrusion of allograft and IKDC score were analyzed. RESULTS: In the coronal plane, radial RPE averaged 43.6% at postoperative 3 months, but there was no significant progression of extrusion at 12 months (average 42.0%) (P = 0.728). In the sagittal plane, there were no significant progressions of anterior and posterior RPE (P = 0.487 and 0.166, respectively) between postoperative 3 and 12 months. Shrinkage was calculated by multiplying the width and height of the three sections and summing these values. There was no significant progression of shrinkage between postoperative 3 and 12 months (P = 0.150). RPE in the radial (R = 0.147, P = 0.525), anterior (R = 0.249, P = 0.264), and posterior (R = 0.230, P = 0.315) directions and shrinkage (R = 0.176, P = 0.435) were not correlated to IKDC score at postoperative 12 months. CONCLUSIONS: In the coronal and sagittal planes, extrusion and shrinkage did not progress from 3 months to 1 year. Extrusion and shrinkage had no correlation with early clinical outcomes. This finding suggests that graft extrusion or shrinkage may be not a great concern especially in early postoperative period of MAT, and multiple, serial MRI may be not necessary.

Comparison of Bone Mineral Density and Appendicular Lean Body Mass between Osteoporotic Distal Radius Fracture and Degenerative Rotator Cuff Tear in Women Patients.

BACKGROUND: Authors assessed lean body mass (fat free tissue), upper and lower, and bone mineral density (BMD) in patients of osteoporotic bone distal radius fracture (DRF) and degenerative rotator cuff tear (RCT) patients of shoulder. We predict inferior muscle mass and osteoporosis are more frequent in DRF group than RCT group. METHODS: Between January 2016 and June 2017, overall 38 of DRF and 30 of RCT were eligible for this retrospective comparison study after excluding of patients with compounding factors. BMD and other body composition, fat and lean body mass, were assessed with a single dual energy X-ray absorptiometry in one hospital. RESULTS: T-score of spine were -2.2 and -1.6 in DRF and RCT patients with significant difference (P=0.040). Final BMD score, lower score of patient between spine and femoral score, of both group also presented difference with significance, -2.4 of DRF and -1.9 of RCT patients (P=0.047). Diagnosis of osteoporosis was confirmed in 19 patients (50%) from DRF compared with 9 patients (30%) from RCT. The mean lean soft tissue mass of the arm was 3.7 kg and 3.8 kg in the DRF and RCT, respectively, without significant difference (P=0.882). The mean lean body mass of the leg was 11.0 kg and 10.5 kg in the DRF and RCT, respectively, without significant difference (P=0.189). The relative overall appendicular lean mass was not significantly different between groups. CONCLUSIONS: Even though BMD difference, we did not find muscle mass difference between DRF and RCT patients.

Effect of Sub- and Super-critical Water Treatment on Physicochemical Properties of Porcine Skin.

Super- and sub-critical water treatments have been of interest as novel methods for protein hydrolysis. In the present study, we studied the effect of sub-critical water (Sub-H2O, 300℃, 80 bar) treatment as well as super-critical water (Super-H2O, 400℃, 280 bar) treatment on the physicochemical properties of porcine skin (PS), which has abundant collagen. Porcine skin was subjected to pre-thermal treatment by immersion in water at 70℃, and then treated with sub- or super-critical water. Physicochemical properties of the hydrolysates, such as molecular weight distribution, free amino acid content, amino acid profile, pH, color, and water content were determined. For the molecular weight distribution analysis, 1 kDa hydrolyzed porcine skin (H-PS) was produced by Super-H2O or Sub-H2O treatment. The free amino acid content was 57.18 mM and 30.13 mM after Sub-H2O and Super-H2O treatment, respectively. Determination of amino acid profile revealed that the content of Glu (22.5%) and Pro (30%) was higher after Super-H2O treatment than after Sub-H2O treatment, whereas the content of Gly (28%) and Ala (13.1%) was higher after Sub-H2O treatment. Super-H2O or Sub-H2O treatment affected the pH of PS, which changed from 7.29 (Raw) to 9.22 (after Sub-H2O treatment) and 9.49 (after Super-H2O treatment). Taken together, these results showed that Sub-H2O treatment was slightly more effective for hydrolysis than Super-H2O was. However, both Sub-H2O and Super-H2O treatments were effective processing methods for hydrolysis of PS collagen in a short time and can be regarded as a green chemistry technology.

Slippage theory and the flanker paradigm: an early-selection account of selective attention failures.

In the flanker paradigm, participants identify a target letter while attempting to ignore an irrelevant flanker. When the identity of this flanker mismatches the target, target identification is slowed (called the flanker compatibility effect). Interestingly, reducing the array set size greatly increases flanker compatibility effects. This finding inspired 2 prominent explanations: perceptual load (mandatory capacity spillover) and dilution (visual interference). However, an alternative explanation, based on early selection theory and attention capture research, can also explain the data pattern. According to this "slippage" account, observers sometimes accidentally allocate spatial attention to the flanker (see Lachter, Forster, & Ruthruff, 2004), especially when the flanker has the property used to find the target (cf. contingent capture). In Experiments 1 through 4, deterring slippage to the flanker nearly eliminated flanker compatibility effects, even at the low set size. In Experiment 5, promoting slippage to the flanker dramatically enhanced compatibility effects, even at the high set size. Thus, slippage strongly modulates flanker effects and can, by itself, readily explain the impact of set size. The perceptual load and dilution accounts are, at best, incomplete, and, at worst, not needed.

Effects of Concentration and Reaction Time of Trypsin, Pepsin, and Chymotrypsin on the Hydrolysis Efficiency of Porcine Placenta.

This study investigated the effects of three proteases (trypsin, pepsin and chymotrypsin) on the hydrolysis efficiency of porcine placenta and the molecular weight (Mw) distributions of the placental hydrolysates. Because placenta was made up of insoluble collagen, the placenta was gelatinized by applying thermal treatment at 90 ℃ for 1 h and used as the sample. The placental hydrolyzing activities of the enzymes at varying concentrations and incubation times were determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and gel permeation chromatography (GPC). Based on the SDS-PAGE, the best placental hydrolysis efficiency was observed in trypsin treatments where all peptide bands disappeared after 1 h of incubation as compared to 6 h of chymotrypsin. Pepsin hardly hydrolyzed the placenta as compared to the other two enzymes. The Mw distribution revealed that the trypsin produced placental peptides with Mw of 106 and 500 Da. Peptides produced by chymotrypsin exhibited broad ranges of Mw distribution (1-20 kDa), while the pepsin treatment showed Mw greater than 7 kDa. For comparisons of pre-treatments, the subcritical water processing (37.5 MPa and 200 ℃ of raw placenta improved the efficiency of tryptic digestions to a greater level than that of a preheating treatment (90 ℃ for 1 h). Consequently, subcritical water processing followed by enzymatic digestions has the potential of an advanced collagen hydrolysis technique.

Automatic identification of familiar faces.

Much research has suggested that facial identification has some characteristics of automaticity, in that it is rapid, nonconscious, and mandatory. However, little research has tested whether it can occur even if attention is already devoted to the demanding central processes of another task. In the present study, we addressed this type of automaticity using the psychological refractory period paradigm. In Experiments 1 and 2, participants successfully identified familiar faces, even while they were engaged with another task, indicating the automaticity of familiar-face identification. In Experiments 3 and 4, however, participants could not identify unfamiliar faces as automatically as they could identify the familiar faces. We concluded that automatic face identification is possible, but dependent on prior familiarity.

Breaking through the attentional window: capture by abrupt onsets versus color singletons.

Theeuwes (Psychonomic Bulletin & Review 11:65-70, 2004) proposed that stimulus-driven capture occurs primarily for salient stimuli that fall within the observer's attentional window, such as when performing a parallel search. This proposal, which is supported by some studies, can explain many seemingly discrepant results in the literature. The present study tested this proposal using a modified precuing paradigm. Search mode was manipulated via target-distractor similarity in color space. In the parallel search condition, the orange target "popped out" from a set of distantly colored distractors (blue and green). In the serial search condition, the orange target was more difficult to find amongst a set of similarly colored distractors (yellow and red). In Experiments 1 and 2, cue validity effects for irrelevant-color singleton cues were greater under parallel than under serial search, at least partially replicating previous studies favoring the attentional-window account (e.g., Belopolsky, Zwaan, Theeuwes, & Kramer, Psychonomic Bulletin & Review 14:934-938, 2007). We found the opposite pattern, however, for capture by abrupt onsets (Experiments 3 and 4), in which case capture effects were actually greater under serial search. In sum, parallel search appears to facilitate capture by color singletons, yet to inhibit capture by abrupt onsets.