Analysis of the Factors of Wound Healing Problems After Transtibial Amputation in Diabetic Patients.

Diabetes mellitus has a global impact, necessitating surgical intervention when conservative methods fail. Transtibial amputation (TTA) is commonly performed on diabetic patients, yet surgical site complications can lead to more procedures. This study aimed to identify factors linked to wound healing issues post-TTA in diabetics.A total of 181 patients who underwent TTA between 2004 and 2021 at a single hospital were included in the study. Exclusion criteria comprised trauma, non-diabetic mellitus, follow-up duration of less than 1 year, incomplete medical records, and surgeries performed by different surgeons. The comparison focused on underlying diseases other than diabetes between the group with wound problems and the group without. Additionally, factors impacting blood flow, such as presurgery hemoglobin levels, intraoperative blood transfusion, the use of antithrombotic or anticoagulant drugs, and the presence of procedures like percutaneous transluminal angioplasty (PTA) and bypass surgery, were analyzed.Among the 181 cases, 22.1% experienced problems at the surgical site while 77.9% did not. Statistical analysis revealed that age was a significant variable affecting wound healing problems after TTA in diabetic patients (p = .007). However, there were no significant differences in wound problems based on comorbidities other than diabetes (p = .209), gender (p = .677), preoperative anemia (p = .102), intraoperative blood transfusion (p = .633), the use of antithrombotic or anticoagulant medications (p = .556), and the performance of PTA or bypass surgery (p = .6).In conclusion, this study found that age was a significant variable affecting wound healing problems after TTA in diabetic patients. Although no association was observed between underlying diseases and wound healing problems, further investigation and cautious management of factors such as preoperative anemia, intraoperative blood transfusion, the use of antithrombotic or anticoagulant drugs, and the performance of PTA or bypass surgery are warranted to prevent complications and optimize wound healing outcomes in diabetic patients undergoing TTA.

The Effects of Life Changes in Family on Engagement in Economic Activities Among Female Older Adults: A Comparative Study Between China and South Korea.

In this study, the relationship between life changes in family members and engagement in economic activities among female older adults was explored in two East Asian countries: China and South Korea. Using panel data from wave 2 (2008) to wave 6 (2016) of the Korean Longitudinal Study of Aging and wave 1 (2011) to wave 3 (2015) of the China Health and Retirement Longitudinal Study, a correlated random effects probit model was estimated. The sample included 4,412 observations from South Korea and 1,972 observations from China. The results demonstrate that life changes in family affect engagement in economic activity among female older adults in both countries. However, the influence of family members on economic activity differed between the countries. These results suggest that participation in economic activities among female older adults needs to be understood in different macro-social contexts.

Evaluation of Contact Area and Pressure After Malreduction in Isolated Medial Malleolar Fractures With 2 mm of Displacement: A Cadaveric Study.

This study was performed to evaluate the changes in contact area and pressure in the tibiotalar joint, with a 2 mm displacement after IMMF (isolated medial malleolar fracture). Ten cadavers with pairs were used to establish a situation in which IMMF occurred during ankle injury. We performed IMMF corresponding to types C and D of the Herscovici classification, and it was displaced by 2 mm. The normal group was defined as a normal tibiotalar joint, the TF (transverse fracture) group as a 2 mm transverse displacement corresponding to the Herscovici classification type C, and the OF (oblique fracture) group as a 2 mm oblique displacement corresponding to the Herscovici classification type D. We measured the contact area and pressure at the tibiotalar joint. The film was scanned and analyzed using the digital imaging software, Scion Image (Scion Crop. Frederick, MD). In normal group, the average contact area of the tibiotalar joint was 317 mm2 (IQR; interquartile range, 256; 347) and 308 mm2 (IQR, 262; 364), average pressure was 2.19 N/mm2 (IQR, 1.94; 2.27) and 2.15 N/mm2 (IQR, 2.06; 2.53). In the TF and OF groups, the average contact area of the tibiotalar joint decreased by 9% and 12%, respectively, and the average pressure increased by 8% and 14%, respectively. There was no statistical difference in peak pressure between the normal, TF, and OF groups. In the case of transverse and oblique fractures, a 2 mm displacement showed significant changes in contact area and contact pressure compared to the normal tibiotalar joint, but there were no significant changes pertaining to type, between the 2 fractures.

Differential Expression of Pax6 Following Bilateral Common Carotid Artery Occlusion.

BACKGROUND/AIM: Chronic cerebral hypoperfusion causes neuronal damage involving cognitive impairment and development of dementia. Permanent bilateral common carotid artery occlusion (BCCAO) in rat models is used to study chronic cerebral hypoperfusion. Pax6 is used as an early neurogenesis marker which affects the maturation of neuronal cells. However, the expression of PAX 6 after BCCAO is not well understood. In this study, we investigated the expression of PAX6 in the neurogenic zones after BCCAO to evaluate the effects of Pax6 on chronic hypoperfusion. MATERIALS AND METHODS: Chronic hypoperfusion was induced by BCCAO. Common carotid artery was laid parallel to the vagus nerve and separated from it. Both arteries were occluded using 4-0 silk sutures. Rats who underwent bi-common carotid artery occlusion formed in the BCCAO group, while unoperated rats served as the control group. Brain samples were obtained on days 3 and 14 after BCCAO and subjected to immunohisto-chemistry with NeuN and western blotting for Pax6 and HIF1α. RESULTS: Compared to the control, the expression of Pax6 increased three days after surgery but did not differ on day 14, while that of NeuN showed the opposite trend. The expression of HIF1α increased three days after surgery. CONCLUSION: Bilateral common carotid artery occlusion induced early neurogenesis at three days after BCCAO but this result was not maintained at fourteen days after BCCAO.

Future Scenarios of the Data-Driven Healthcare Economy in South Korea.

Although data-based healthcare innovation has been spotlighted in South Korea in recent years, previous studies have made little effort to systematically predict various possible future outcomes in the data-driven healthcare economy. This study investigated possible future such scenarios in South Korea by conducting a general morphological analysis (GMA). Seven key factors were identified that will drive the data-driven healthcare economy: the acceptability of data utilization, the level of data literacy, the status of healthcare data regulation, the healthcare data system, medical costs, the convergence of ICT and biotechnology, and the utilization of data in medical services. The main findings are as follows: Four possible scenarios for the data-driven healthcare economy in South Korea were identified. The first scenario suggested mostly optimistic prospects and close associations between factorial values on the various spectra. The second scenario was similar to the first one, except for medical costs. However, the third scenario contrasted with the first, as it entailed relatively pessimistic factorial values. Finally, most of the elements of the current healthcare status quo were maintained in the fourth scenario. This study makes not only an academic contribution, but also has policy implications based on the four scenarios.

Predicting Ischemic Stroke in Patients with Atrial Fibrillation Using Machine Learning.

BACKGROUND: Atrial fibrillation (AF) is a well-known risk factor for stroke. Predicting the risk is important to prevent the first and secondary attacks of cerebrovascular diseases by determining early treatment. This study aimed to predict the ischemic stroke in AF patients based on the massive and complex Korean National Health Insurance (KNHIS) data through a machine learning approach. METHODS: We extracted 65-dimensional features, including demographics, health examination, and medical history information, of 754,949 patients with AF from KNHIS. Logistic regression was used to determine whether the extracted features had a statistically significant association with ischemic stroke occurrence. Then, we constructed the ischemic stroke prediction model using an attention-based deep neural network. The extracted features were used as input, and the occurrence of ischemic stroke after the diagnosis of AF was the output used to train the model. RESULTS: We found 48 features significantly associated with ischemic stroke occurrence through regression analysis (p-value < 0.001). When the proposed deep learning model was applied to 150,989 AF patients, it was confirmed that the occurrence ischemic stroke was predicted to be higher AUROC (AUROC = 0.727 ± 0.003) compared to CHA2DS2-VASc score (AUROC = 0.651 ± 0.007) and other machine learning methods. CONCLUSIONS: As part of preventive medicine, this study could help AF patients prepare for ischemic stroke prevention based on predicted stoke associated features and risk scores.

Arthroscopic Deltoid Repair: A Technical Tip.

Deltoid ligament repair can be challenging, and implementation of an arthroscopic method can be useful in terms of minimizing morbidity associated with open dissection, as long as the repair is effective and durable. In this brief report, we describe a method of arthroscopic deltoid ligament repair that we have found to be useful.

Prediction of Cochlear Implant Outcomes in Patients With Prelingual Deafness.

OBJECTIVES: To evaluate the factors that limit post-cochlear implantation (CI) speech perception in prelingually deaf children. METHODS: Patients with CI were divided into two groups according to Category of Auditory Performance (CAP) scores 3 years post-CI: the poor performance group (poor performance group, CAP scores≤4, n=41) and the good performance group (good performance group, CAP scores≥5, n=85). The distribution and contribution of the potential limiting factors related to post-CI speech perception was compared. RESULTS: Perinatal problems, inner ear anomalies, narrow bony cochlear nerve canal (BCNC), and intraoperative problems was significantly higher in the poor performance group than the good performance group (P=0.010, P=0.003, P=0.001, and P=0.045, respectively). The mean number of limiting factors was significantly higher in the poor performance group (1.98±1.04) than the good performance group (1.25±1.11, P=0.001). The odds ratios for perinatal problems and narrow bony cochlear nerve canal in the poor performance group in comparison with the good performance group were 4.878 (95% confidence interval, 0.067 to 0.625; P=0.005) and 4.785 (95% confidence interval, 0.045 to 0.972; P=0.046). CONCLUSION: This study highlights the comprehensive prediction of speech perception after CI and provides otologic surgeons with useful information for individualized preoperative counseling of CI candidates.

Comprehension of Patient-Physician Interaction through Analysis of Relationships between Domains in Clinical Performance Examination.

PURPOSE: This research investigated the psychometric properties of the patient-physician interaction (PPI) domain in the clinical performance examination (CPX). This research aimed to understand the PPI domain in the CPX through a psychometric and relationship analysis between the domains. METHODS: Data were drawn from 1,302 examinees on a set of 6 common CPX cases and 1,066 on a 'bad news delivery' case. All cases included 7 PPI items, among which we calculated internal consistency reliability. Correlations were made between PPI and the other domains. Analyses using the structural equation model (SEM) were conducted to assess the relationships between latent factors and controlled measurement errors. To calculate the disparity between colleges, we performed a multi-level analysis. Also, we conducted t-tests to investigate the consistency of the PPI and information sharing (IS) scores in the 'bad news delivery' case. RESULTS: Correlation between the mean PPI score and the total CPX score was high (0.707). The correlations between PPI and other domains were; 0.904 for the patient's overall satisfaction, 0.41 for history taking, and 0.327 for patient education. In SEM, these correlations between latent variables increased. The proportion of level-2 (between-school component) variance in PPI was 4.1%. For 'bad news delivery', the group that checked 'yes' on the IS items had higher PPI scores (mostly p<0.01). CONCLUSION: PPI is an influential domain of the CPX and is highly related with the patient's overall satisfaction, clinical courtesy, and history taking. Disparities between schools in PPI are relatively small, such that the PPI could be due to individual factors rather than the school.