Exploring Physical Lumbar Microvascular Geometry Through Endoscopy and Illustrations: Implications for Clinical Interpretation.

STUDY DESIGN: Retrospective Study. OBJECTIVES: Minimally invasive endoscopic spinal surgery is gaining popularity, but our understanding of the lumbar spine's microvascular geometry relies heavily on cadaver studies and textbook illustrations. Additionally, inconsistent nomenclature of vessels in the literature hampers effective communication among surgeons. This study aims to improve the clarity and comprehensibility of the lumbar spinal microvascular geometry under endoscopic view. METHODS: The study included 400 patients who underwent endoscopic spinal surgery for lumbar spinal canal stenosis and foraminal stenosis. The surgeries were performed by an experienced surgeon using either the interlaminar or transforaminal approach. Endoscopic video recordings were further analyzed to map the microvascular geometry and common bleeding foci. The observed results were cross-referenced with existing literature to reconstruct a comprehensive view of the vascular anatomy. RESULTS: The transforaminal approach commonly encounters bleeding foci originating from the major branches of the segmental lumbar artery and the emissary veins within the foramen. The interlaminar approach primarily encounters bleeding foci from the muscle vessels in the dorsal lamina, which are believed to be located near the ends of the three main branches. In the intracanal region, epidural vessels form a rotary loop above the disc, which can contribute to most of the bleeding during discectomy. CONCLUSIONS: This study provides a comprehensive understanding of the microvascular anatomy in the lumbar spine during endoscopic spinal surgery. Recognizing the geometry will help surgeons anticipate and control bleeding, reducing the risk of complications. The findings contribute to the improvement of surgical techniques and patient safety in endoscopic spinal surgery.

Enhancing endoscopic foraminal decompression in adult isthmic spondylolisthesis: the potential influence of lateral recess isthmic spur and our case series of an innovative craniocaudal interlaminar approach via unilateral biportal endoscopic spinal surgery.

BACKGROUND: The NASS guideline cannot recommend any of the surgical treatment options toward adult isthmic spondylolisthesis (AIS) since 2014. After the introduction of endoscopic decompression, instead of treating the spondylolysis itself, treatment can specifically target the refractory radicular pain developed during the degeneration progress without devastating the peripheral soft tissue. However, we noticed that endoscopic transforaminal decompression seems to be less effective in AIS compared to other types of degenerative spondylolisthesis. Thus, we came up with a novel craniocaudal interlaminar approach, utilizing the proximal adjacent interlaminar space to perform bilateral decompression and observed the pathoanatomy of pars defect directly and tried to identify the cause of decompression failure. METHODS: From January 2022 to June 2022, 13 patients with AIS underwent endoscopic decompression via the endoscopic craniocaudal interlaminar approach and were followed up for at least 6 months. Visual Analogue Scale, Oswestry Disability Index and MacNab scores were recorded to monitor patients' clinical recovery. All endoscopic procedures were recorded and reviewed to illustrate the pathoanatomy. RESULTS: Four patients required minor revision via the same technique. One of them required it due to incomplete isthmic spur resection, two due to neglected disc protrusion, and the other due to root subpedicular kinking in higher grade anterolisthesis. All patients' clinical condition improved significantly subsequently. After reviewing the endoscopic video, we have observed that the hook-like, ragged spur originating from the isthmic defect extends beyond the region around the foramen. Instead, it extends proximally into the adjacent lateral recess, resulting in impingement along the fracture edge above the index foramen and, in some cases, even in the extraforaminal area. CONCLUSIONS: The broad spanning isthmic spur extending to the proximal adjacent lateral recess might be the reason why the transforaminal approach yielded less satisfactory results due to the incomplete decompression result from approach related restriction. Our study demonstrated an optimistic outcome by applying decompression from the upper level. Therefore, we propose that the craniocaudal interlaminar approach might be a better route for decompression in adult isthmic spondylolisthesis.

An Ultrasonic Object Detection Applying the ID Based on Spread Spectrum Technique for a Vehicle.

When an ultrasonic sensor generates an ultrasonic wave and detects an obstacle from a reflected wave, a signal transmitted by other ultrasonic sensors would be interference. In this paper, to overcome the interference, a transducer transmits a signal with a unique ID modulated. The interference is ignored by verifying that the reflected signal includes its ID. The ID verification process uses a correlation between the received signal and the ID. Therefore, the ID is selected from orthogonal codes with good cross-correlation. Long code has the advantage of being more robust to interference. However, the reflected wave from nearby obstacles might return before the transmission ends. Therefore, the 7-bit Barker code is applied for near obstacle detection and a 31-bit Gold code is used for distant obstacle detection. The modulation technique is DQPSK, which is available in a narrow bandwidth and has a simple receiver structure. In ID recognition based on correlation, a near-far problem occurs due to a large amplitude difference between the received wave and interference. The addition of a zero-crossing detector solves this problem. The hardware is implemented based on the algorithm proposed in this paper. The simulation showed a detection rate of at least 90% and the the result of the real measurement represented a detection rate of 97.3% at 0.5 m and 94.5% at 2 m.

Dietary β-mannanase decreases cloacal temperature of broiler chickens under hot conditions without affecting growth performance / El consumo de β-mananasa disminuye la temperatura cloacal de pollos de engorde bajo condiciones de calor sin afectar su rendimiento de crecimiento / O consumo de β-mananase diminui a temperatura da cloaca do frango de corte em condições de calor sem afetar seu desempenho do crescimento

Abstract Background: High amounts of nonstarch polysaccharides in the diet may increase the amounts of fermentative materials in the hindgut, leading to an increase in fermentative heat production. Dietary β-mannanase is reported to decrease antinutritional effects of β-mannans, such as the potential increase of body heat; however, its efficacy on broiler chickens raised under hot climatic conditions has not been investigated. Objective: To investigate the effects of dietary β-mannanase on growth performance, cloacal temperature, relative lymphoid organ weight, and blood characteristics of broiler chickens raised under hot climatic conditions. Methods: A total of 1,701 1-day-old Ross 308 broiler chickens were randomly allotted to one of three dietary treatments with nine replicates. A basal diet was prepared and added with β-mannanase at 0.05 or 0.10% inclusion levels. The experiment was conducted for 30 days. Average room temperature was 28.8 ± 1.74 ˚C and average relative humidity (RH) was 76.1 ± 11.49% during the experiment. Results: Growth performance of broiler chickens raised under hot climatic conditions was not affected by β-mannanase inclusion. Cloacal temperature decreased at the end of experiment (linear, p<0.05) with increasing inclusion levels of dietary β-mannanase. Increasing inclusion levels of β-mannanase tended to increase (linear, p=0.076) the relative weight of thymus, but had no effects on the relative weight of spleen and bursa of Fabricius. Blood characteristics were not influenced by dietary β-mannanase. Conclusion: Increasing inclusion levels of β-mannanase decrease cloacal temperature; however, it does not directly influence growth performance nor alleviates the heat stress of broiler chickens raised under hot climatic conditions.

Resumen Antecedentes: Altas cantidades de carbohidratos no almidonosos en la dieta pueden aumentar la cantidad de materiales fermentativos en el intestino posterior, aumentando la producción de calor fermentativo. La β-mananasa dietaria disminuye los efectos antinutricionales de los β-mananos, tales como el potencial incremento de la producción calorica; Sin embargo, no se ha investigado su eficacia en pollos de engorde criados bajo condiciones de calor ambiental. Objetivo: Investigar los efectos de la β-mananasa en la dieta sobre el crecimiento, la temperatura cloacal, el peso relativo de los órganos linfoides y las características sanguíneas de pollos de engorde criados bajo condiciones climáticas calientes. Métodos: Un total de 1.701 pollos de engorde de 1 día de edad (Ross 308) fueron asignados al azar a uno de tres tratamientos dietarios con nueve repeticiones. A una dieta basal se le adicionó β-mananasa en niveles de inclusión de 0,05 o 0,10%. El experimento duró 30 días. La temperatura ambiente durante el experimento fue de 28,8 ± 1,74 ˚C y la humedad relativa de 76,1 ± 11,49%. Resultados: La inclusión de β-mananasa no afecto el rendimiento de los pollos. La temperatura cloacal medida al final del experimento disminuyó (lineal, p<0,05) con niveles de inclusión dietarios crecientes de β-mananasa. Niveles incrementales de β-mananasa tendieron a aumentar (lineal, p=0,076) el peso relativo del timo, pero no hubo efecto sobre el peso del bazo o la bursa de Fabricio. La β-mananasa no influenció las características de la sangre. Conclusión: Niveles incrementales de β-mananasa disminuyen la temperatura cloacal, aunque afectan el crecimiento ni alivian el estrés térmico del pollo de engorde criado bajo condiciones climáticas calientes.

Resumo Antecedentes: Altas quantidades de polissacáridos não amiláceos na dieta podem aumentar as quantidades de materiais fermentativos no intestino posterior, levando a um aumento na produção de calor fermentativo. A β-mananase dietética é relatada para diminuir os efeitos antinutricionais da β-manana, tal como o possível aumento da produção de calor; Entretanto, não tem sido investigada a eficácia de la em frangos de corte criados em condições climáticas quentes. Objetivo: Investigar os efeitos da β-mananase na dieta sobre o desempenho do crescimento, a temperatura cloacal, o peso relativo dos órgãos linfóides e as características de sanguíneas de frangos de corte criados em condições climáticas quentes. Métodos: Um total de 1.701 frangos de corte de um dia de idade (Ross 308) foram distribuídos aleatoriamente em um dos três tratamentos dietéticos com nove repetições. A dieta basal foi preparada e a β-mananase foi adicionada à dieta basal com níveis de inclusão de 0,05 ou 0,10%. O experimento foi conduzido durante 30 dias. A temperatura ambiente média foi de 28,8 temperatura ahumidade relativa (HR) média foi de 76,1 ± 11,49% durante o experimento. Resultados: O desempenho de crescimento dos frangos de corte criados em condições climáticas quentes não foi afetado pelos níveis de inclusão de β-mananase. A temperatura cloacal medida no final do experimento foi diminuída (linear, p<0,05) com níveis crescentes de inclusão de β-mananase na dieta. O aumento dos níveis de inclusão da β-mananase tendeu a aumentar (linear, p=0,076) o peso relativo do timo, mas não teve efeitos sobre o peso relativo do baço e da bursa de Fabricius. As características do sangue não foram influenciadas pela β-mananase dietética. Conclusão: Os níveis crescentes de inclusão de β-mananase diminuem a temperatura cloacal; entretanto, isso não influencia diretamente o desempenho do crescimento e alivia o estresse térmico dos frangos de corte criados em condições climáticas quentes.

Risk Factors of Postoperative Spinal Epidural Hematoma After Biportal Endoscopic Spinal Surgery.

BACKGROUND: Although postoperative spinal epidural hematoma is a rare complication, it can cause severe neurologic complications. Studies regarding biportal endoscopic spinal surgery, a type of minimally invasive spinal surgery technique, have been recently reported. The purpose of our study is to report the incidence and risk factors of postoperative hematoma after biportal endoscopic spinal surgery. METHODS: The subjects included 310 patients that underwent biportal endoscopic spinal surgery from 2015 to 2017. Magnetic resonance imaging (MRI) was performed in all patients before surgery, and also after surgery to identify epidural hematoma. Using electronic medical records, perioperative factors such as age, sex, operation name, operation level, water infusion pump usage, thrombin-containing hemostatic agent, and anticoagulant medication were statistically analyzed in the aspect of postoperative hematoma. RESULTS: The overall occurrence rate of postoperative hematoma was 23.6% (n = 94). A total of 304 levels (76.4%) were without hematoma according to the postoperative MRI among the total 398 levels. Six patients underwent revision surgery of hematoma evacuation. Female sex, old age (>70 years), preoperative anticoagulation medication, and usage of intraoperative water infusion pump were significantly correlated to the occurrence of postoperative hematoma. CONCLUSIONS: Although symptomatic postoperative hematoma was extremely rare at 1.9%, radiologic hematoma confirmed by postoperative MRI was higher at 23.6%. The perioperative risk factors of postoperative hematoma after biportal endoscopic spinal surgery include female sex, older age (>70 years), preoperative anticoagulation medication, usage of intraoperative water infusion pump, and surgery requiring more bone work (laminectomy or interbody fusion).

Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis.

Biportal endoscopic spinal surgery (BESS) is a minimally invasive spinal surgery, which is basically similar to microscopic spinal surgery in terms of the use of floating technique and technically similar to conventional percutaneous endoscopic spinal surgery in terms of the use of endoscopic or arthroscopic instruments. Using two independent portals (viewing and working) and maintaining a certain distance from the bony and neural structures allow closer access to the target lesion through a panoramic view by free handling of the scope and instruments rather than through a fixed view by docking into the Kambin's triangle. Minimally invasive surgery allows for reduced dissection and inevitable muscle injury, preserving stability and reducing risks of restabilization. The purpose of fusion surgery is the same as that of the three surgical techniques stated above. Its wider range of view helps to overcome limitations of conventional endoscopic spinal surgery and to supplement the weak points of microscopic spinal surgery, such as limited working space in a tubular retractor and difficulty in accessing the contralateral area. This technique provides an alternative to unilateral or bilateral decompression of lumbar central spinal stenosis, foraminal stenosis, low-grade spondylolisthesis, and adjacent segment degeneration. Early clinical outcomes are promising despite potential for complications, such as dural tearing and postoperative epidural hematoma, similar to other procedures. Merits of BESS include decreased postoperative infection rate due to continuous irrigation throughout the procedure and decreased need for fusion surgery for one- or two-level lumbar stenosis by wide sublaminar and foraminal decompression with minimal sacrifice of stabilizing structures.

Factors Affecting Adherence to Antihypertensive Medication.

BACKGROUND: Hypertension is a major contributor to the global disease burden of cardiovascular and cerebrovascular disease. The aim of this study was to determine demographic and clinical factors associated with adherence to antihypertensive medication. METHODS: From August 2012 to February 2015, we recruited 1,523 Korean patients with hypertension who visited family physicians. The study was conducted in 24 facilities located in urban and metropolitan areas. Of these facilities, two were primary care clinics and 22 were level 2 or 3 hospitals. Adherence was assessed using the pill count method; a cut-off value of 80% was used as the criterion for good adherence. Sociodemographic and lifestyle factors were compared between the adherent and nonadherent groups using the chi-square test for categorical variables and t-test for continuous variables. Binary logistic regression analysis was performed with medication adherence as the outcome variable. RESULTS: Of the 1,523 patients, 1,245 (81.7%) showed good adherence to antihypertensive medication. In the multivariate logistic analysis, age ≥65 years, exercise, treatment in a metropolitan-located hospital, being on ≥2 classes of antihypertensive medication and concomitant medication for diabetes, and a family history of hypertension or cardiovascular diseases were associated with good adherence. Patients who had a habit of high salt intake were less adherent to medication. CONCLUSION: Multiple classes of antihypertensive medications, concomitant medication, and exercise were associated with good adherence to antihypertensive medication, and high salt intake was associated with poor adherence to antihypertensive medication. These factors should be considered to improve hypertension control.

Reference values for hand grip strength in the South Korean population.

OBJECTIVE: To establish reference values for hand grip strength (HGS) in a healthy Korean population and to identify the dependent anthropometric variables that affect HGS. METHODS: Based on the sixth Korea National Health and Nutrition Examination Survey from 2014 to 2015, we analyzed the HGS data of 7,969 South Koreans. Individuals with specific chronic diseases and who reported poor subjective health status were excluded to ensure a healthy population sample. Means with standard deviations (SDs) and 95% confidence intervals were calculated for each 5-year interval starting from 10 years of age. To determine the relationship between HGS and anthropometric variables, we performed correlation analyses between HGS and height, weight, and body mass index (BMI). Additionally, based on these findings, the cut-off value for low HGS was presented by deriving -2SD values of healthy young adults as recommended by the European Working Group on Sarcopenia in Older People. RESULTS: The mean age and BMI of men and women were 38.3 and 38.2 years and 23.8 and 22.4 kg/m2, respectively. Mean HGS of the dominant hand in men and women was 39.5 and 24.2 kg, respectively. The peak in HGS was at 35-39 years of age, after which HGS decreased in both sexes. HGS was significantly correlated with height, weight, and BMI. The cut-off values for weak HGS were < 28.9 and < 16.8 kg in men and women, respectively. CONCLUSION: These results provide useful reference values to assess HGS in patients who undergo hand surgery or who have various diseases that affect HGS. Moreover, a cut-off value for low HGS may help in defining sarcopenia among the Korean population.

Effect of dietary ß-mannanase on productive performance, egg quality, and utilization of dietary energy and nutrients in aged laying hens raised under hot climatic conditions.

OBJECTIVE: The objective of this experiment was to investigate the effect of dietary ß-mannanase on productive performance, egg quality, and utilization of dietary energy and nutrients in aged laying hens raised under hot climatic conditions. METHODS: A total of 320 84-wk-old Hy-line Brown aged laying hens were allotted to one of four treatments with eight replicates in a completely randomized design. Two dietary treatments with high energy (HE; 2,800 kcal/kg nitrogen-corrected apparent metabolizable energy [AMEn]) and low energy (LE; 2,700 kcal/kg AMEn) were formulated. Two additional diets were prepared by adding 0.04% (MN4) or 0.08% ß-mannanase (MN8) to LE treatment diets. The feeding trial was conducted for 28 d, covering a period from July to August in South Korea. The average daily room temperature and relative humidity were 29.2°C and 83%, respectively. RESULTS: Productive performance, egg quality, and cloacal temperature were not influenced by dietary treatments. The measured AMEn values for MN8 diets were similar to those for HE diets, which were greater (p<0.05) than those for LE and MN4 diets. However, the AMEn values for MN8 diets did not differ from those for LE and MN4 diets. CONCLUSION: The addition of ß-mannanase to low energy diets increases energy values for diets fed to aged laying hens. However, this increase has little positive impacts on performance and egg quality. These results indicate that dietary ß-mannanase does not mitigate the heat stress of aged laying hens raised under hot climatic conditions.

Impact of night-shift work on the prevalence of erosive esophagitis in shipyard male workers.

PURPOSE: Whether night-shift work is a risk factor for gastroesophageal reflux disease is controversial. The aim of this study was to investigate the association between night-shift work and other factors, and erosive esophagitis. METHODS: A cross-sectional study with 6040 male shipyard workers was performed. Esophagogastroduodenoscopic examination and a survey about night-shift work status, lifestyle, medical history, educational status, and marital status were conducted in all workers. The odds ratios of erosive esophagitis according to night-shift work status were calculated by using the logistic regression model. RESULTS: The prevalence of erosive esophagitis increased in the night-shift workers [odds ratio, 95 % confidence interval: 1.41 (1.03-1.94)]. According to multiple logistic regression models, night-shift work, obesity, smoking, and alcohol consumption of ≥140 g/week were significant risk factors for erosive esophagitis. By contrast, Helicobacter pylori infection was negatively associated with erosive esophagitis. CONCLUSION: Night-shift work is suggested to be a risk factor for erosive esophagitis. Avoidance of night-shift work and lifestyle modification should be considered for prevention and management of gastroesophageal reflux disease.

The ACC/AHA 2013 pooled cohort equations compared to a Korean Risk Prediction Model for atherosclerotic cardiovascular disease.

BACKGROUND AND AIMS: To evaluate the performance of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Pooled Cohort Equations in the Korean Heart Study (KHS) population and to develop a Korean Risk Prediction Model (KRPM) for atherosclerotic cardiovascular disease (ASCVD) events. METHODS: The KHS cohort included 200,010 Korean adults aged 40-79 years who were free from ASCVD at baseline. Discrimination, calibration, and recalibration of the ACC/AHA Equations in predicting 10-year ASCVD risk in the KHS cohort were evaluated. The KRPM was derived using Cox model coefficients, mean risk factor values, and mean incidences from the KHS cohort. RESULTS: In the discriminatory analysis, the ACC/AHA Equations' White and African-American (AA) models moderately distinguished cases from non-cases, and were similar to the KRPM: For men, the area under the receiver operating characteristic curve (AUROCs) were 0.727 (White model), 0.725 (AA model), and 0.741 (KRPM); for women, the corresponding AUROCs were 0.738, 0.739, and 0.745. Absolute 10-year ASCVD risk for men in the KHS cohort was overestimated by 56.5% (White model) and 74.1% (AA model), while the risk for women was underestimated by 27.9% (White model) and overestimated by 29.1% (AA model). Recalibration of the ACC/AHA Equations did not affect discriminatory ability but improved calibration substantially, especially in men in the White model. Of the three ASCVD risk prediction models, the KRPM showed best calibration. CONCLUSIONS: The ACC/AHA Equations should not be directly applied for ASCVD risk prediction in a Korean population. The KRPM showed best predictive ability for ASCVD risk.

Patient dose for computed tomography examination: dose reference levels and effective doses based on a national survey of 2013 in Korea.

14,620 sets of patient dose data were obtained for 31 different models of computed tomography (CT) equipment (total 73) with 18 types of CT examination in Korea. Specific diagnostic reference levels (DRLs) for this study in terms of third quartile volumetric CT dose index in mGy [and dose-length product (DLP) in mGy.cm] are as follows: head, 53 (910); neck, 20 (770); chest, 14 (710); abdomen, 14 (1000); stomach, 14 (1000); liver, 14 (1700); pancreas, 14 (1700); kidney, 14 (2100); cervical spine, 30 (600); lumbar spine, 25 (760); hip, 17 (600); cardiac CT angiography, 45 (1250); head CT angiography, 43 (1900); liver CT angiography, 14 (1400) and thoraco-abdominal CT angiography, 16 (2000). In the present study, DRLs in terms of volumetric CT dose index were below previously published reference levels, partly because the newer CT equipments have improved technology that facilitates lower patient dose. Meanwhile, DRLs in terms of DLP were higher, because multi-phase scanning protocols with prolonged scan coverage have been widely used.

A coronary heart disease prediction model: the Korean Heart Study.

OBJECTIVE: The objectives of this study were to develop a coronary heart disease (CHD) risk model among the Korean Heart Study (KHS) population and compare it with the Framingham CHD risk score. DESIGN: A prospective cohort study within a national insurance system. SETTING: 18 health promotion centres nationwide between 1996 and 2001 in Korea. PARTICIPANTS: 268 315 Koreans between the ages of 30 and 74 years without CHD at baseline. OUTCOME MEASURE: Non-fatal or fatal CHD events between 1997 and 2011. During an 11.6-year median follow-up, 2596 CHD events (1903 non-fatal and 693 fatal) occurred in the cohort. The optimal CHD model was created by adding high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides to the basic CHD model, evaluating using the area under the receiver operating characteristic curve (ROC) and continuous net reclassification index (NRI). RESULTS: The optimal CHD models for men and women included HDL-cholesterol (NRI=0.284) and triglycerides (NRI=0.207) from the basic CHD model, respectively. The discrimination using the CHD model in the Korean cohort was high: the areas under ROC were 0.764 (95% CI 0.752 to 0.774) for men and 0.815 (95% CI 0.795 to 0.835) for women. The Framingham risk function predicted 3-6 times as many CHD events than observed. Recalibration of the Framingham function using the mean values of risk factors and mean CHD incidence rates of the KHS cohort substantially improved the performance of the Framingham functions in the KHS cohort. CONCLUSIONS: The present study provides the first evidence that the Framingham risk function overestimates the risk of CHD in the Korean population where CHD incidence is low. The Korean CHD risk model is well-calculated alternations which can be used to predict an individual's risk of CHD and provides a useful guide to identify the groups at high risk for CHD among Koreans.

Association between Hepatitis B Surface Antigen Seropositivity and Metabolic Syndrome.

BACKGROUND: Infection with hepatitis B virus (HBV) may be a risk factor for cardiovascular disease. We investigated the relationship between HBV infection and metabolic syndrome. METHODS: We performed a cross-sectional study of 9,474 Korean men and women who were at least 20 years old and who underwent a routine health check-up at Ulsan University Hospital in Ulsan, South Korea between March 2008 and February 2009. The associations of hepatitis B surface antigen (HBsAg) seropositivity with the presence of metabolic syndrome and its components were investigated by logistic regression analysis. Data were analyzed separately for males and females. RESULTS: HBsAg seropositivity was significantly negatively associated with hypertriglyceridemia and metabolic syndrome in men (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.29 to 0.50; P < 0.001 and OR, 0.75; 95% CI, 0.57 to 0.98, P = 0.033). In women, HBsAg seropositivity was also significantly negatively associated with hypertriglyceridemia, but not with metabolic syndrome (OR, 0.40; 95% CI, 0.17 to 0.91; P = 0.029 and OR, 0.80; 95% CI, 0.38 to 1.66, P = 0.545). CONCLUSION: HBV infection was significantly negatively associated with hypertriglyceridemia and metabolic syndrome in men and hypertriglyceridemia in women.

Can unilateral-approach minimally invasive transforaminal lumbar interbody fusion attain indirect contralateral decompression? A preliminary report of 66 MRI analysis.

PURPOSE: Few studies have measured the amount of indirect decompression at the contralateral neural foramen after unilateral-approach minimally invasive transforaminal lumbar interbody fusion (MITLIF). This study examined the amount of intraoperative indirect decompression at the contralateral neural foramen after a unilateral-approach MITLIF in patients with bilateral foraminal stenosis. METHODS: From February 2009 to October 2012, 66 consecutive patients with bilateral foraminal stenosis underwent unilateral-approach MITLIF and postoperative magnetic resonance imaging (MRI). Direct decompression was performed at the central canal and approach-side neural foramen, while indirect decompression using cage distraction was pursued at the contralateral neural foramen. Qualitative parameters of the central canal (dural sac morphology) and neural foramen (foramen morphology) were analyzed using pre- and post-operative MRI. Quantitative measurement on the central canal (dural sac cross-sectional area) and neural foramen (foramen height and width) were also measured. RESULTS: A total of 69 intervertebral levels in the 66 patients were analyzed. Qualitative parameters of the central canal and contralateral neural foramen improved significantly after unilateral-approach MITLIF (both P < 0.001). The mean dural sac cross-sectional area increased from 51.1 ± 28.8 to 84.8 ± 30.2 mm(2) (P < 0.001). The mean preoperative contralateral foramen height, maximum foramen width, and minimum foramen width were 11.8 ± 2.0, 4.9 ± 1.5, and 1.5 ± 0.7 mm, respectively, and these values increased postoperatively to 14.7 ± 2.5, 6.5 ± 1.8, and 2.4 ± 1.0 mm, respectively (all P < 0.001). CONCLUSION: Quantitative and qualitative parameters of the central canal and contralateral neural foramen increased significantly after unilateral-approach MITLIF.

The Korean Heart Study: rationale, objectives, protocol, and preliminary results for a new prospective cohort study of 430,920 men and women.

BACKGROUND: To describe the rationale, objectives, protocol, and preliminary results for a new prospective cohort study of cardiovascular disease (CVD) risk factors in South Korea. METHODS: Study members were recruited from participants in routine health assessments at health promotion centres across South Korea. Established and emerging CVD risk factors were measured. Eighteen centres holding electronic health records agreed to linkage of participants' records to future health insurance claims for monitoring of disease events. The recruitment of 430,920 participants (266,782 men, 164,138 women), aged 30-74 years, provides broad geographical reach across South Korea. RESULTS: Risk factor prevalence was more favourable in women than men, and, in general, in the younger rather than older study members. There was also close similarity between the characteristics of the present sample and the Korean National Health and Nutrition Examination Survey. The expected associations between risk factors and both CVD and death were also apparent. CONCLUSIONS: Data from the present sample, based on data linkage, show close agreement with South Korea-wide surveys (for risk factor prevalence) and the extant literature (for risk factor associations). These findings gives confidence in future results anticipated from this cohort study of east Asians - a group that has been traditionally under-researched.

Radiation exposure in multidetector CT: dose comparison between late 1990s and early 2010s in Korea.

The effective dose under ordinary clinical computed tomography (CT) protocols using three kinds of 64-channel and a 40-channel CT ranged from 0.6 to 15.5 mSv in early 2010s. And the organ dose ranged from 1.6 to 130.4 mGy: orbital and brain doses for brain stroke CT were the highest. For the comparison of the effective dose between late 1990s and early 2010s, multidetector CT (MDCT) for high-resolution lung CT was 2.4 times higher than that of single-detector CT (SDCT) and the ratio was the highest. However, the effective dose at MDCT was 20 % lower than that of SDCT in chest CT due to applying dose-saving techniques. In organ dose comparisons, high-resolution lung CT at MDCT was 3.5-4.5 times higher than that of SDCT, and showed 1.1-1.5 times higher than that of SDCT in the head and chest CT. For the abdomen CT, the primary organ dose at MDCT was ∼30 % lower than that of SDCT.

Subsidence of polyetheretherketone cage after minimally invasive transforaminal lumbar interbody fusion.

STUDY DESIGN: A retrospective case series. OBJECTIVE: The aim of this study was to determine the rate of cage subsidence after minimally invasive transforaminal lumbar interbody fusion (MITLIF) conducted using a polyetheretherketone (PEEK) cage, and to identify associated risk factors. SUMMARY OF BACKGROUND DATA: Although various rates of cage subsidence after lumbar interbody fusion have been reported, few studies have addressed subsidence rate after MITLIF using PEEK cage. METHODS: A total of 104 consecutive patients who had undergone MITLIF using a PEEK cage with a minimum follow-up of 2 years were included in this study. Cage subsidence was defined to have occurred when a cage was observed to sink into an adjacent vertebral body by ≥2 mm on the postoperative or serial follow-up lateral radiographs. The demographic variables considered to affect cage subsidence were the following: age, sex, body mass index, bone mineral density, diagnosis, number of fusion segment, and the quality/quantity of back muscle, and the cage-related variables considered were: level of fusion, intervertebral angle, cage size, cage position, and postoperative distraction of disc height. Logistic regression analysis was conducted to explore relations between these variables and cage subsidence. RESULTS: : For the 122 cages inserted, the rate of cage subsidence was 14.8% (18 cages), and cage subsidence occurred within 7.2±8.5 (1-25) months of surgery. The odds ratios for factors found to significantly increase the risk of cage subsidence were; 1.950 (95% confidence interval, 1.002-4.224) for L5-S1 level, and 1.018 (95% confidence interval, 1.000-1.066) for anterior cage position. CONCLUSIONS: The rate of PEEK cage subsidence after MITLIF was relatively low. End-plate manipulation and cage insertion during MITLIF were not influenced by a small operation window.

Chronic pure radiculopathy in patient with organizing epidural hematoma around C8 nerve root.

Spontaneously occurring spinal epidural hematomas are uncommon clinical findings, and the chronic form is the rarest and its most frequent location is the lumbar spine. Pure radicular involvement is far less frequent than myelopathy. We report a case of progressive radiculopathy in a 52-year-old man with spontaneously occurring cervical epidural hematoma (SCEH). The patient had left hand weakness and numbness for 4 months. MRI scan showed small space-occupying lesion around left 8th cervical nerve root. After surgery we confirmed chronic organizing epidural hematoma. To the best of our knowledge, this is the second reported case in the worldwide literature of pure radiculopathy in a patient with chronic SCEH.

MONW phenotype is associated with advanced colorectal adenoma in Korean men.

The aim of this study was to investigate whether there was a relationship between colorectal adenoma and metabolically obese but normal weight (MONW) among Korean men and women. The MONW phenotype is defined as a BMI <25, but fulfilling the metabolic syndrome (MS) criteria with a modified waist circumference (≥90 cm for men and ≥85 cm for women) appropriate for Korean. A total of 3,430 subjects (2,263 men and 1,167 women; 23-75 years old) were included in the study. Colorectal adenomas were diagnosed in 775 men and 199 women. The rate of advanced adenomas in males was 24.3% and in females 21.1%. A significant association between MONW and advanced colorectal adenoma was found in men (age-adjusted odds ratio (OR) = 1.92, 95% confidence interval (CI): 1.06-3.47) but not in women (age-adjusted OR = 1.80, 95% CI: 0.50-6.45). The findings suggest that men with MONW may have an increased risk of developing advanced colorectal adenoma whereas this does not seem true for females.