Effect of Bone Marrow Stimulation on Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis.

Background: Arthroscopic rotator cuff repair (RCR) is a common orthopaedic procedure, but it has a high rate of retears that can negatively affect the functional outcomes. Bone marrow stimulation (BMS) has been suggested as an additional treatment to improve the outcomes of RCR. Purpose: To compare the effectiveness of the BMS procedure during RCR with conventional RCR. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic literature search was conducted in MEDLINE/PubMed, Embase, Cochrane Library, and Scopus, on March 1, 2023, for studies comparing postoperative retear rates and functional outcomes between patients who underwent primary arthroscopic RCR with and without the BMS procedure. Only level 1 and 2 randomized controlled trials with a minimum 12-month follow-up were included. The primary outcomes were retear rates and functional outcomes as measured by the Constant; American Shoulder and Elbow Surgeons (ASES); and University of California, Los Angeles (UCLA) scores and by postoperative range of motion. Subgroup analyses were performed based on repair technique (single-row repair vs double-row or suture-bridge repair). The standardized mean difference (SMD) and odds ratio (OR) were utilized to synthesize continuous and dichotomous outcomes, respectively. Homogeneity was evaluated using the chi-square test and I2 statistic. Results: The literature search yielded 661 articles, of which 6 studies (522 patients; 261 with BMS, 261 without BMS) met the eligibility criteria. The combined analysis showed no significant decrease in retear rates with the utilization of the BMS procedure during RCR (OR, 0.60; 95% CI, 0.35 to 1.03; P = .07; I2 = 24%). There was no significant intergroup difference in functional outcomes (Constant score: SMD, 0.13; 95% CI, -0.04 to 0.31; P = .13; I2 = 0%; ASES score: SMD, 0.04; 95% CI, -0.20 to 0.28; P = .73; I2 = 0%; UCLA score: SMD, -0.13; 95% CI, -0.50 to 0.23; P = .47; I2 = 0%). Subgroup analyses revealed no significant differences in postoperative retear risk or total Constant score according to the repair technique. Conclusion: Based on the available evidence, this systematic review did not find a significant benefit of the BMS procedure at the footprint during arthroscopic RCR compared with conventional RCR in terms of retear rates and functional outcomes at short-term follow-up.

Changes in Thermal Stress in Korea Using Climate-Based Indicators: Present-Day and Future Projections from 1 km High Resolution Scenarios.

Among the various thermal stress indices, apparent temperature (AT) is closely related to public health indicators, and consequently is widely used by weather agencies around the world. Therefore, in this paper we estimate the changes in AT and contributing components in Korea as a whole and in five major cities (Seoul, Gwanju, Daegu, Daejeon, and Busan) using national standard climate scenarios based on the coupled model inter-comparison project (CMIP6). In the present day, high AT occurs in major cities due to high temperature (TAS) and relative humidity (RH). Our findings reveal that even when TAS is relatively low, large AT occurs with higher humidity. Notably, in future warmer climate conditions, high AT may first appear in the five major cities and then extend to the surrounding areas. An increase in TAS and RH during the pre-hot season (March to June) may lead to earlier occurrence of thermal risks in future warmer climate conditions and more frequent occurrence of high thermal stress events. Our study can serve as a reference for future information on thermal risk changes in Korea. Considering those who have not adapted to high temperature environments, our findings imply that thermal risks will become more serious and that heat adaptation strategies will be needed during the pre-hot season under future warmer climate conditions.

Impact of Chronic Obstructive Pulmonary Disease on Outcomes After Total Joint Arthroplasty: A Meta-analysis and Systematic Review.

Background: Comorbid chronic obstructive pulmonary disease (COPD) is increasingly common and may have an adverse impact on outcomes in patients undergoing total joint arthroplasty (TJA) of lower extremity. The purpose of this meta-analysis is to compare the postoperative complications between COPD and non-COPD patients undergoing primary TJA including total hip and knee arthroplasty. Methods: PubMed, EMBASE, and Cochrane Library were systematically searched for relevant studies published before December 2021. Postoperative outcomes were compared between patients with COPD versus those without COPD as controls. The outcomes were mortality, re-admission, pulmonary, cardiac, renal, thromboembolic complications, surgical site infection (SSI), periprosthetic joint infection (PJI), and sepsis. Results: A total of 1,002,779 patients from nine studies were finally included in this meta-analysis. Patients with COPD had an increased risk of mortality (OR [odds ratio] = 1.69, 95% confidence interval [CI] 1.42-2.02), re-admission (OR = 1.54, 95% CI 1.38-1.71), pulmonary complications (OR = 2.73, 95% CI 2.26-3.30), cardiac complications (OR = 1.40, 95% CI 1.15-1.69), thromboembolic complications (OR = 1.21, 95% CI 1.15-1.28), renal complications (OR = 1.50, 95% CI 1.14-1.26), SSI (OR = 1.23, 95% CI 1.18-1.30), PJI (OR = 1.26, 95% CI 1.15-1.38), and sepsis (OR = 1.36, 95% CI 1.22-1.52). Conclusion: Patients with comorbid COPD showed an increased risk of mortality and postoperative complications following TJA compared with patients without COPD. Therefore, orthopedic surgeons can use the study to adequately educate these potential complications when obtaining informed consent. Furthermore, preoperative evaluation and medical optimization are crucial to minimizing postoperative complications from arising in this difficult-to-treat population. Level of evidence: Level III. Registration: None. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00794-2.

Intrapancreatic fat deposition and visceral fat volume are associated with the presence of diabetes after acute pancreatitis.

Ectopic fat and abdominal adiposity phenotypes have never been studied holistically in individuals after acute pancreatitis (AP). The aim of the study was to investigate phenotypical differences in ectopic fat and abdominal fat between individuals after AP (with and without diabetes) and to determine the role of pancreatitis-related factors. Eighty-four individuals were studied cross-sectionally after a median of 21.5 mo since last episode of AP and were categorized into "diabetes" and "no diabetes" groups. Twenty-eight healthy volunteers were also recruited. With the use of magnetic resonance imaging, intrapancreatic fat percentage, liver fat percentage, visceral fat volume (VFV), subcutaneous fat volume, and visceral-to-subcutaneous (V/S) fat volume ratio were quantified. Analysis of variance was used to investigate the differences in these phenotypes between the groups. All analyses were adjusted for age and sex. Linear regression analysis was used to investigate the association between pancreatitis-related factors and the studied phenotypes. Intrapancreatic fat percentage was significantly higher in the diabetes group (10.2 ± 1.2%) compared with the no diabetes (9.2 ± 1.7%) and healthy volunteers (7.9 ± 1.9%) groups (P < 0.001). VFV was significantly higher in the diabetes (2,715.3 ±1,077.6 cm3) compared with no diabetes (1,983.2 ± 1,092.4 cm3) and healthy volunteer (1,126.2 ± 740.4 cm3) groups (P < 0.001). V/S fat volume ratio was significantly higher in the diabetes (0.97 ± 0.27) compared with no diabetes (0.68 ± 0.42) and healthy volunteer (0.52 ± 0.34) groups (P = 0.001). Biliary AP was associated with significantly higher intrapancreatic fat percentage (ß = 0.67; 95% CI, 0.01, 1.33; P = 0.047). C-reactive protein levels during hospitalization for AP were associated with significantly higher VFV (ß = 3.32; 95% CI, 1.68, 4.96; P < 0.001). In conclusion, individuals with diabetes after AP have higher intrapancreatic fat percentage, VFV, and V/S fat volume ratio. Levels of C-reactive protein during AP are significantly associated with VFV, whereas biliary AP is significantly associated with intrapancreatic fat percentage. NEW & NOTEWORTHY Individuals with diabetes after acute pancreatitis have significantly higher intrapancreatic fat percentage and visceral fat volume compared with individuals without diabetes after acute pancreatitis and healthy controls. C-reactive protein levels during hospitalization for acute pancreatitis and biliary etiology of acute pancreatitis are associated with significantly larger visceral fat and pancreatic fat depots, respectively.

Comparison of orbicularis oris muscle strength and endurance in young and elderly adults.

[Purpose] The purpose of this study was to compare the strength and endurance of the orbicularis oris muscle in healthy Korean (young vs. elderly adults). [Participants and Methods] A total of 60 participants (30 young adults and 30 elderly adults) were recruited. The Iowa Oral Performance Instrument was used to measure orbicularis oris muscle maximal strength and endurance. [Results] Elderly adults showed significantly lower orbicularis oris muscle strength and endurance than younger adults. [Conclusion] This study confirmed a significant age-related decrease in orbicularis oris muscle strength and endurance. The data collected will be useful as a basis for future on speech and swallowing therapy.

Oropharyngeal swallowing function in patients with presbyphagia.

[Purpose] This study investigated the characteristics of oropharyngeal swallowing function in patients with presbyphagia. [Participants and Methods] Data for 25 patients with presbyphagia were retrospectively analyzed. The oropharyngeal swallowing function was evaluated using VDS based on videofluoroscopic swallowing study. [Results] Lip closure, mastication, laryngeal elevation, and aspiration showed a relative decrease in function. [Conclusion] This study showed a reduction in oropharyngeal swallowing in patients with presbyphagia. Our results may help in the diagnosis and treatment of presbyphagia.

Lumbar Intradiscal Invaginated Inferior Vena Cava Aneurysm.

The objective of this study is to present a rare case of an invaginated inferior vena cava (IVC) aneurysm in the lumbar intradiscal space. A 73-year-old woman with lower back pain and bilateral lower extremity swelling presented to the clinic. She had undergone spinal surgery performed thrice at the same site (L4-L5) in another hospital and a separate posterolateral fusion surgery procedure 3 years previously. On plain radiography, pseudarthrosis was observed at L4-L5 segment. Contrast computed tomography (CT) imaging revealed a dilatation of the IVC in the intradiscal space of L4-L5. On the anterior side, anterior discectomy was performed. Following insertion of the allograft bone chip and cage, the invaginated IVC aneurysm was repositioned. Implant removal and screw fixation were performed posteriorly. Post-surgery, the patient's lower back pain improved, and the start of anticoagulation treatment after vascular evaluation was planned. Although there have been numerous case reports of patients with intradiscal cysts or gas requiring surgical treatment, there have not yet been any reports of those with invaginated IVC in an intradiscal space. It is important to provide the appropriate treatment based on a thorough prior understanding of the patient's anatomy.

Analysis of the incidence and risk factors for the progression of proximal junctional kyphosis following surgical treatment for lumbar degenerative kyphosis: minimum 2-year follow-up.

BACKGROUND CONTEXT. Proximal junctional kyphosis (PJK) following surgical treatment of lumbar degenerative kyphosis (LDK) is one of the critical complications leading to the failure of instrumentation and additional extensive surgery. However, most previous studies have focused on idiopathic scoliosis resulting from variable surgical techniques. LDK usually differ from other scoliotic deformities in terms of patient characteristics and disease mechanisms. PURPOSE. Identification of the prevalence of PJK after the surgical treatment of LDK and searching for the predictable value for the progression of PJK. Study design. Retrospective comparative study. Patient sample (must be included in clinical studies). Forty-seven consecutive patients who underwent surgical correction of a sagittal imbalance due to LDK, from January 2005 to December 2008 in a single spine clinic, were evaluated with a minimum 2 years follow-up (mean 3.8 years). METHODS. Patients were divided into 2 groups: with or without the occurrence of PJK, and three categorized factors according to patient characteristics, surgical variables, and the radiographic spinopelvic parameters were evaluated. RESULTS. PJK had occurred in 29 of 47 patients (61.7%). Among variable factors, old age, upper-instrumented vertebra below L2, lumbar lordosis to PI ratio, and the sum of lumbar lordosis, and the sacral slope related to PI were found to be statistically significant. CONCLUSIONS. The overall incidence of PJK following surgical treatment of LDK patients was higher than expected. Spinal biomechanics may be changed after long instrumented fusion surgery. Thorough consideration of these factors is needed in the treatment strategy of LDK patients. A long-term follow-up study should be conducted.

Radiological analysis of lumbar degenerative kyphosis in relation to pelvic incidence.

BACKGROUND CONTEXT: Lumbar degenerative kyphosis (LDK) is characterized by sagittal imbalance resulting from a loss of lumbar lordosis (LL). The pelvic incidence (PI) regulates the sagittal alignment of the spine and pelvis. PURPOSE: The purpose of this study is to evaluate the spinopelvic parameters in patients with LDK and to compare them with those of a normal population. STUDY DESIGN/SETTING: A cross-sectional study. PATIENT SAMPLE: The selected patients showed characteristic clinical features of LDK. As control group, asymptomatic volunteers without spinal pathology were recruited. OUTCOME MEASURES: Full-length radiographs of the spine in the anteroposterior and lateral planes were taken, extending from the base of the skull to the proximal femur. Pelvic incidence, sacral slope (SS), pelvic tilt (PT), main thoracic kyphosis (TK), thoracolumbar junction (TLJ), LL, and sagittal vertical axis (SVA) were evaluated. METHODS: In terms of PI, the patient and control groups were divided into three groups: low (PI≤45°), middle (45°60°). All the spinopelvic parameters were compared between each group and between the patient and control groups in each group. The correlations between each of the parameters were analyzed. RESULTS: We evaluated 172 patients with symptomatic LDK and 39 healthy volunteers. The number of LDK patients with low, middle, and high PI groups were 44 (25.6%), 72 (44.8%), and 51 (29.6%), respectively. In the control group, the number of low, average, and high PI patients were 18 (46.2%), 15 (38.5%), and 6 (15.4%), respectively. In the control group, PI determined all spinopelvic parameters except SVA. In the LDK group, PI also determined spinopelvic parameters except for TK and SVA. Lumbar degenerative kyphosis with low PI was associated with pronounced kyphosis in LL and TLJ; LDK with a high PI was associated with relatively preserved lordosis in LL with a flat or lordotic TLJ. In terms of pelvic parameters, low PI showed flattened SS and low PT, whereas high PI showed steep SS and high PT. CONCLUSIONS: The results of this study suggest the importance of the key anatomical parameter, PI, in the determination of sagittal contour in symptomatic LDK patients and normal population. Spinopelvic parameters and pelvic compensatory mechanisms in LDK patients differ according to PI. Identifying the spinopelvic parameters is useful when correcting deformities.

A comparison study on the change in lumbar lordosis when standing, sitting on a chair, and sitting on the floor in normal individuals.

OBJECTIVE: To compare radiographic analysis on the sagittal lumbar curve when standing, sitting on a chair, and sitting on the floor. METHODS: Thirty asymptomatic volunteers without a history of spinal pathology were recruited. The study population comprised 11 women and 19 men with a mean age of 29.8 years. An independent observer assessed whole lumbar lordosis (WL) and segmental lordosis (SL) between L1 and S1 using the Cobb's angle on lateral radiographs of the lumbar spine obtained from normal individuals when standing, sitting on a chair, and sitting on the floor. WL and SL at each segment were compared for each position. RESULTS: WL when sitting on the floor was reduced by 72.9% than the average of that in the standing position. Of the total decrease in WL, 78% occurred between L4 to S1. There were significant decreases in SL at all lumbar spinal levels, except L1-2, when sitting on the floor as compared to when standing and sitting on a chair. Changes in WL between the positions when sitting on a chair and when sitting on the floor were mostly contributed by the loss of SL at the L4-5 and L5-S1 levels. CONCLUSION: When sitting on the floor, WL is relatively low; this is mostly because of decreasing lordosis at the L4-5 and L5-S1 levels. In the case of lower lumbar fusion, hyperflexion is expected at the adjacent segment when sitting on the floor. To avoid this, sitting with a lordotic lumbar curve is important. Surgeons should remember to create sufficient lordosis when performing lower lumbar fusion surgery in patients with an oriental life style.

Delayed neurological insufficiency caused by transverse sacral fracture after minor trauma in elderly patients.

Sacral fractures in elderly patients with associated lumbosacral lesions can be overlooked easily because of vague symptoms and delayed neurological insufficiency. A 70-year-old female and a 73-year-old female presented with delayed neurological insufficiency caused by transverse sacral fracture after minor trauma. Both patients had suffered from lower extremity symptoms with dysuresia and dyschezia for more than a month. Coexisting lumbosacral pathological lesions may confuse the correct diagnosis for sacral fractures. Decompressive sacral laminectomy was performed, and the patients showed relatively favorable outcomes.

Differences between experts and novices in kinematics and accuracy of golf putting.

In this study, golf-putting movements were examined under three goal distances (short, 1.7m; middle, 3.25m; long, 6m), two different putter weights (500g, 750g), and two levels of expertise (5 experts, 5 novices). The study's aim was to identify differences in kinematics and accuracy between expert and novice golfers. The results demonstrated that experts achieved higher accuracy with lower impact velocity than novices. In addition, while novices showed symmetrical movements, experts exhibited asymmetrical movements, which were achieved by modulating their movement time and amplitude differently from novices. These results demonstrated differences in relative timing, relative amplitude and velocity, but no difference in time-to-contact between novices and experts. The results reaffirmed the role of prior learning and supported the hypothesis of Manoel and Connolly (1995) that motor learning is a hierarchical process organized at both macroscopic and microscopic levels.

Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy.

OBJECT: The purpose of this study was to demonstrate the clinical characteristics of postoperative retroperitoneal hematoma (RPH) following transforaminal percutaneous endoscopic lumbar discectomy (PELD) and to discuss how to prevent the complication of unintended hemorrhage. METHODS: The medical records of 412 consecutive patients treated with transforaminal PELD between January 2005 and May 2007 were reviewed. A total of 4 patients (0.97%) experienced symptomatic postoperative RPH. The clinical outcomes were evaluated using the visual analog scale and the Oswestry Disability Index. RESULTS: The common symptom in all patients with a hematoma was inguinal pain. The mean hematoma volume was 527.9 ml (range 53.3-1274.1 ml). Two patients with massive diffuse-type RPHs compressing the intraabdominal structures required open hematoma evacuation performed by general surgeons, and the other 2 patients with small, localized RPHs of < 100 ml were treated conservatively. The mean follow-up period was 21.3 months (range 13-29 months). The mean visual analog scale score for radicular leg pain improved from 7.6 to 1.8 and that for back pain improved from 4.3 to 2. The mean Oswestry Disability Index improved from 58.8 to 9.1%. The preoperative symptoms improved after the second treatment without significant neurological sequelae in all patients. CONCLUSIONS: Although transforaminal PELD is a minimally invasive and safe procedure, the possibility of RPH should be kept in mind. Adequate technical and anatomical considerations are important to avoid this unusual hemorrhagic complication, especially in the patient with underlying medical problems or previous operative scarring. A high index of suspicion and early detection is also important to avoid the progression of the hematoma.

Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration.

BACKGROUND: Compared with lower lumbar disc herniations, upper lumbar disc herniations at L1-L2 and L2-L3 have specific characteristics that result in different surgical outcomes after conventional open discectomy. There are no published studies on the feasibility of percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation. The purpose of this study was to assess the clinical outcome, prognostic factors and the technical pitfalls of PELD for upper lumbar disc herniation. METHOD: Forty-five patients with a soft disc herniation at L1-L2 or L2-L3 underwent percutaneous endoscopic discectomy. Posterolateral transforaminal endoscopic laser-assisted disc removal was performed under local anesthesia. Clinical outcomes was assessed using the Prolo scale. The prognostic factors associated with outcome were then analyzed. FINDINGS: The mean follow-up was 38.8 months (range, 25-52 months). The outcome of the 45 patients was excellent in 21 (46.7%), good in 14 patients (31.1%), fair in six patients (13.3%), and poor in four patients (8.9%). Four patients with a poor outcome underwent further open surgery. Mean scores on a visual analog scale decreased from 8.38 to 2.36 (P < 0.0001). Age less than 45 years and a lateral disc herniation were independently associated with an excellent outcome (P < 0.05). CONCLUSIONS: Patient selection and an anatomically modified surgical technique promote a more successful outcome after percutaneous endoscopic discectomy for upper lumbar disc herniation.

Extraforaminal lumbar synovial cyst causing sudden foot drop: case report.

A 52-year-old female presented with extraforaminal lumbar synovial cyst at the L4-5 level causing sudden foot drop on the right. Computed tomography, magnetic resonance (MR) imaging, and coronal MR myelography source images identified the cystic mass in the extraforaminal zone. The patient underwent microdecompression via a lateral transmuscular route, and the extraforaminal cyst compressing L4 ganglion was successfully removed. The histological diagnosis was synovial cyst. This unique case of surgically proven extraforaminal lumbar synovial cyst causing sudden foot drop indicates that extraforaminal synovial cyst should be included in the differential diagnosis of patients presenting with sudden foot drop.

Discrepancies between primary physician practice and treatment guidelines for Helicobacter pylori infection in Korea.

AIM: To evaluate the attitude of primary care physicians in the diagnosis and treatment of Helicobacter pylori (H. pylori) infection. METHODS: Primary care physicians in the Seoul metropolitan area answered self-administered questionnaire from January to March 2003. RESULTS: One hundred and eight doctors responded to the questionnaire. The most frequent reasons for testing H. pylori infection were gastric and duodenal ulcers (93.5% and 88.9%, respectively). For patients with H. pylori positive dyspepsia, 28.7% of doctors always tried to eradicate the worm and 34.4% treated selectively. A large proportion (28.7%) of primary care physicians treated H. pylori on a patient's request basis. Only 9.3% of primary care physicians always conducted follow-up testing after treating H. pylori infection. When H. pylori was not cleared by the first treatment, 40.7% of doctors reused the same regimen, 16.7% changed to another triple regimen and 25% to a quadruple regimen. CONCLUSION: It has been well documented that the issuance of guidelines alone has little impact on practice. Communication between primary care physicians and gastroenterologists in the form of continuous medical education is required.