A Case of Biliary Cast Syndrome with Cholangiocarcinoma-like Lesion in a Patient with No History of Liver Transplantation.

Background and Objectives: Biliary cast syndrome, which was first reported in 1975, is a rare disease that occurs after liver transplantation. The incidence is even lower in patients who have not undergone liver transplantation. This study reports a rare case of biliary cast syndrome with cholangiocarcinoma-like lesions in a patient who did not undergo liver transplantation. Case Report: Herein, we report a case of a 69-year-old man with right upper quadrant pain and elevated levels of alkaline phosphatase and gamma-glutamyl transferase, who had a history of total gastrectomy for gastric cancer and laparoscopic cholecystectomy for acute cholecystitis. Computed tomography (CT) revealed longitudinal bile stones in the extrahepatic and intrahepatic bile ducts and abrupt narrowing of the left main bile duct accompanied by a narrowing of the upstream bile duct in the left lobe of the liver. Based on the CT findings, the removal of the bile stones in the bile duct and additional examinations of the suspected cholangiocarcinoma were performed. The patient's symptoms improved, and examinations for suspected cholangiocarcinoma showed no abnormal findings, and he was discharged one month later. Conclusions: The purpose of this case report is to share a rare case of Biliary Cast Syndrome (BCS) occurring without liver transplantation. Additionally, the report aims to share image findings that mimic cancer in BCS, with the goal of reducing unnecessary repetitive biopsies, minimizing patient discomfort, and decreasing unnecessary costs by aiding in the diagnosis of BCS.

Risk factors of chronic subscapularis tendon tear.

BACKGROUND: Chronic subscapularis tendon tear (SBT) is a degenerative disease and a common pathologic cause of shoulder pain. Several potential risk factors for chronic SBT have been reported. Although metabolic abnormalities are common risk factors for degenerative disease, their potential etiological roles in chronic SBT remains unclear. The purpose of this study was to investigate potential risk factors for chronic SBT, with particular attention to metabolic factors. METHODS: This study evaluated single shoulders of 939 rural residents. Each subject undertook a questionnaire, physical examinations, blood tests, and simple radiographs and magnetic resonance imaging (MRI) evaluations of bilateral shoulders. Subscapularis tendon integrity was determined by MRI findings based on the thickness of the involved tendons. The association strengths of demographic, physical, social, and radiologic factors, comorbidities, severity of rotator cuff tear (RCT), and serologic parameters for SBT were evaluated using logistic regression analyses. The significance of those analyses was set at p<0.05. RESULTS: The prevalence of SBT was 32.2% (302/939). The prevalence of partial- and full-thickness tears was 23.5% (221/939) and 8.6% (81/939), respectively. The prevalence of isolated SBT was 20.2% (190/939), SBT combined with supraspinatus or infraspinatus tendon tear was 11.9% (112/939). In multivariable logistic regression analysis, dominant side involvement (p<0.001), manual labor (p=0.002), diabetes (p<0.001), metabolic syndrome (p<0.001), retraction degree of Patte tendon (p<0.001), posterosuperior RCT (p=0.010), and biceps tendon injury (p<0.001) were significantly associated with SBT. CONCLUSIONS: Metabolic syndrome is a potential risk factor for SBT, as are these factors: overuse activity, diabetes, posterosuperior RCT, increased retraction of posterosuperior rotator cuff tendon, and biceps tendon injury.

Automatic Plaque Removal Using Dual-Energy Computed Tomography Angiography: Diagnostic Accuracy and Utility in Patients with Peripheral Artery Disease.

Background and Objectives: This study aimed to evaluate the utility and accuracy of dual-energy automatic plaque removal (DE-APR) in patients with symptomatic peripheral arterial disease (PAD) using digital subtraction angiography (DSA) as the reference standard. Materials and Methods: We retrospectively analyzed 100 patients with PAD who underwent DE computed tomography angiography (DE-CTA) and DSA of the lower extremities. DE-CTA was used to generate APR subtracted images. In the three main arterial segments (aorto-iliac segment, femoro-popliteal segment, and below-the-knee segment), the presence or absence of hemodynamically significant stenosis (>50%) and calcification was assessed using the images. CTA data were analyzed using different imaging approaches (DE-standard reconstruction image (DE-SR), DE-APR maximum intensity projection image (APR), and DE-SR with APR). Results: For all segments evaluated, the sensitivity, specificity, and accuracy for detecting significant stenosis were 98.16%, 81.01%, and 89.58%, respectively, with DE-SR; 97.79%, 83.33%, and 90.56%, respectively, with APR; and 98.16%, 92.25%, and 95.20%, respectively, with DE-SR with APR. DE-SR with APR had greater accuracy than DE-SR or APR alone (p < 0.001 and p < 0.001, respectively). When analyzed based on vascular wall calcification, the accuracy of DE-SR with APR remained greater than 90% regardless of calcification severity, whereas DE-SR showed a considerable reduction in accuracy in moderate to severe calcification. In the case of APR, the degree of vascular wall calcification did not significantly influence the accuracy in the aorto-iliac and femoro-popliteal segments. DE-SR with APR achieved significantly higher diagnostic accuracy for all lower extremity segments in evaluating hemodynamically significant stenosis in patients with symptomatic PAD and transcended the impact of vascular wall calcification compared with DE-SR. Conclusions: APR demonstrated favorable diagnostic performance in the aorto-iliac and femoro-popliteal segments, exhibiting good agreement with DSA even in cases of moderate to severe vascular wall calcification.

Factors Associated With Lateral Epicondylitis of the Elbow.

BACKGROUND: Metabolic factors have been linked to tendinopathies, yet few studies have investigated the association between metabolic factors and lateral epicondylitis. PURPOSE: To evaluate risk factors for lateral epicondylitis, including several metabolic factors. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We evaluated 1 elbow in each of 937 volunteers from a rural region that employs many agricultural laborers. Each participant received a questionnaire, physical examinations, blood tests, simple radiographic evaluations of both elbows, magnetic resonance imaging of bilateral shoulders, and an electrophysiological study of bilateral upper extremities. Lateral epicondylitis was diagnosed using 3 criteria: (1) pain at the lateral aspect of the elbow, (2) point tenderness over the lateral epicondyle, and (3) pain during resistive wrist dorsiflexion with the elbow in full extension. Multivariable logistic regression analysis was used to calculate the odds ratios (ORs) and 95% CIs for various demographic, physical, and social factors, including age, sex, waist circumference, dominant-side involvement, smoking habit, alcohol intake, and participation in manual labor; the comorbidities of diabetes, hypertension, thyroid dysfunction, metabolic syndrome, ipsilateral biceps tendon injury, ipsilateral rotator cuff tear, and ipsilateral carpal tunnel syndrome; and the serologic parameters of serum lipid profile, glycosylated hemoglobin A1c, level of thyroid hormone, and high-sensitivity C-reactive protein. RESULTS: The prevalence of lateral epicondylitis was 26.1% (245/937 participants). According to the multivariable logistic regression analysis, female sex (OR, 2.47; 95% CI, 1.78-3.43), dominant-side involvement (OR, 3.21; 95% CI, 2.24-4.60), manual labor (OR, 2.25; 95% CI, 1.48-3.43), and ipsilateral rotator cuff tear (OR, 2.77; 95% CI, 1.96-3.91) were significantly associated with lateral epicondylitis (P < .001 for all). No metabolic factors were significantly associated with lateral epicondylitis. CONCLUSION: Female sex, dominant-side involvement, manual labor, and ipsilateral rotator cuff tear were found to be risk factors for lateral epicondylitis. The study results suggest that overuse activity is more strongly associated with lateral epicondylitis than are metabolic factors.

Percutaneous removal of common bile duct stones using a modified balloon technique.

ABSTRACT: To evaluate the effectiveness of percutaneous removal of common bile duct (CBD) stones using a modified balloon technique (balloon catheter sphincteroplasty and expulsion of the stones using half-captured balloons within the sheath) in patients difficult to treat with endoscopy.Fifty patients underwent a modified balloon technique (balloon group), and 53 patients underwent CBD stone removal by the basket method (stone basket group) between 2016 and 2019. We compared the balloon and stone basket groups to evaluate the effectiveness of the modified balloon technique. Outcome variables such as demographics, technical success rates, procedural details, and complications were analyzed. Statistical analysis was performed using Student t test, Fisher exact test, or the χ2 test.The technical success rate in the balloon group was 66% (33/50) in 1 session, 32% (16/50) in 2 sessions, and 2% (1/50) in 3 sessions. That of the stone basket group was 45% (24/53) in 1 session, 38% (20/53) in 2 sessions, and 17% (9/53) in 3 sessions.The total procedure time was significantly shorter in the balloon group (29.5 ±â€Š15.1 minutes) than in the stone basket group (41.7 ±â€Š20.2 minutes) (P < .01), whereas the number of stones was higher in the balloon group than in the stone basket group (P = .03). Maximal stone size, balloon size, pancreatitis, and hospitalization stay did not show statistical differences between the 2 groups. Most complications (9 patients, balloon group; 8 patients, stone basket group) were mild and transient. Major complications occurred in one patient in the stone basket group, who experienced hemobilia due to arterial injury caused by percutaneous transhepatic biliary drainage, which was treated by endovascular embolization without mortality.The modified balloon technique is an effective and safe treatment method for CBD stone removal in patients presenting difficulties in the endoscopic approach.

[Successful Transcatheter Arterial Embolization following Diverticular Bleeding in the Third Portion of the Duodenum: A Case Report]. / 경동맥 ìƒ‰ì „ìˆ ì„ 이용한 십이지장 3부 게실 출혈의 ì„±ê³µì ì¸ 지혈: 증례 ë³´ê³ .

This is a rare case of a 73-year-old male patient who presented with hematochezia and was treated using transcatheter arterial embolization following upper gastrointestinal bleeding in the third portion of the duodenum. The cause of the bleeding was not found on gastrointestinal endoscopy and CT. On the third day of hospitalization, the hemoglobin level continued to decrease. A technetium-99m-labeled red blood cell scan revealed suspicious bleeding in the diverticulum of the third portion of the duodenum. Superior mesenteric artery angiography showed active bleeding from the posteroinferior pancreaticoduodenal artery, which was embolized with N-butyl cyanoacrylate. The patient was discharged on the seventh day after embolization without re-bleeding or complication. We report a rare case of a patient with active bleeding from a duodenal diverticulum that was difficult to diagnose using routine modalities. Herein, we report a rare case of a patient with active bleeding from a duodenal diverticulum that was difficult to diagnose using routine modalities. We also conducted a relavant literature review.

Are any radiologic parameters independently associated with degenerative postero-superior rotator cuff tears?

BACKGROUND: Several radiologic parameters representing scapular morphology have been proposed as risk factors for degenerative posterosuperior rotator cuff tear (PSRCT). The causes of PSRCT are multifactorial; many reported risk factors are compound entities. However, no determination, made after adjustment with previously reported risk factors, of which radiologic parameters are independent risk factors for degenerative PSRCT, has been reported. Therefore, this study's purpose was to determine which radiologic parameters representing scapular morphology are independent risk factors for degenerative PSRCT in a general population after adjustment with previously suggested risk factors. METHODS: This study involved 629 subjects (629 shoulders) drawn from a cohort of rural residents. PSRCT diagnoses were based on magnetic resonance imaging findings. Logistic regression analysis was used to determine the odds ratios and 95% confidence intervals for the following variables: sex, age, height, weight, waist circumference, dominant-side involvement, smoking, alcohol consumption, manual labor, diabetes, hypertension, metabolic syndrome, thyroid dysfunction, serum lipid profile, high-sensitivity C-reactive protein, and radiologic parameters. The evaluated radiologic parameters were the superior displacement of the humeral head (SDHH) and those representing the scapular morphology. The radiologic parameters representing the scapular morphology were lateral acromial angle, acromial slope, acromial tilt, acromial index, and critical shoulder angle (CSA). Univariate logistic regression analyses for all variables, as well as multivariable logistic regression analyses for variables with significant associations and clinical effect sizes in the univariate logistic regression analyses, were performed. In order to determine the cutoff value for significant radiologic parameters, each pair of candidate cutoff values was obtained as follows: 1 candidate, as the lowest significant ordinal value in a univariate analysis, and the other candidate, according to a receiver operating characteristic curve analysis. Then, the cutoff values were determined by selecting the value in each candidate pair that had the larger area under the receiver operating characteristic curve, using the DeLong test. RESULTS: In the multivariable analyses, CSA was significantly associated with degenerative PSRCT after controlling for the following factors: age, waist circumference, dominant-side involvement, manual labor, diabetes, metabolic syndrome, hypo-high-density lipoproteinemia, and SDHH (P ≤ .033). CSA (odds ratio, 1.58 [95% confidence interval, 1.45-1.72]; P < .001) was the only significantly associated radiologic parameter among the studied radiologic parameters representing scapular morphology. CONCLUSION: CSA (≥35°) is an independent associated factor for degenerative PSRCT after adjustment for the following suggested risk factors: age, waist circumference, dominant-side involvement, manual labor, diabetes, metabolic syndrome, hypo-high-density lipoproteinemia, and SDHH.

Low pectoralis muscle index, cavitary nodule or mass and segmental to lobar consolidation as predictors of primary multidrug-resistant tuberculosis: A comparison with primary drug sensitive tuberculosis.

BACKGROUND: The loss of muscle mass in primary multidrug-resistant tuberculosis (MDR-TB) has not been examined in previous studies. This study aimed to investigate that low pectoralis muscle index and characteristic CT features can help differentiate patients with primary MDR-TB from those with drug-sensitive tuberculosis (DS-TB). MATERIAL AND METHODS: From 2010 to 2016, we retrospectively enrolled 90 patients with primary MDR-TB and 90 age- and sex-matched patients with primary DS-TB. The pectoralis muscle mass was quantitatively measured on axial CT images using density histogram analysis. The pectoralis muscle index (PMI) was defined as the pectoralis muscle mass divided by body mass index. We compared the PMI and characteristic CT features of pulmonary tuberculosis between the two groups. RESULTS: Low PMI, segmental to lobar consolidation, cavity in consolidation, cavitary nodule or mass, and bilateral involvement were more frequently observed in patients with MDR-TB than in those with DS-TB. In stepwise multivariate logistic regression analysis, low PMI (odds ratio, 2.776; 95% confidence interval, 1.450-5.314; p = 0.002), segmental or lobar consolidation (odds ratio, 3.123; 95% confidence interval, 1.629-5.987; p = 0.001), and cavitary nodule or mass (odds ratio, 2.790; 95% confidence interval, 1.348-5.176; p = 0.002) were significant factors for MDR-TB. CONCLUSION: Low pectoralis muscle index, segmental to lobar consolidation and cavitary nodule or mass can help differentiate primary MDR-TB from DS-TB.

Percutaneous intervention for salvage of non-maturing arteriovenous fistulas: Which is the better approach, arterial or venous?

OBJECTIVES: To evaluate the efficacy and long-term patency of endovascular treatment for non-maturing native arteriovenous fistulas according to the approach route (arterial vs. venous). METHODS: Eighty-five patients underwent percutaneous transluminal angioplasty for non-maturing fistulas (63 radiocephalic and 22 brachiocephalic) between 2010 and 2019. Outcome variables such as procedural success, complications, and primary and secondary patency rates were analyzed from the patients' demographic, angiographic, clinical, and hemodialysis records according to the approach route (venous access group, n = 53 and arterial access group, n = 32). The Kaplan-Meier method was used to analyze the patency rates. RESULTS: The mean duration from fistula creation to fistulography was 78.4±51.4 days (range, 1-180 days). The anatomical and clinical success rates were 98.8% and 83.5%, respectively. Lesions were most commonly located at the juxta-anastomosis (55.3%). Accessory cephalic veins were observed in 16 patients. The primary patency rates were 83.9%, 71.9%, and 66.3% and the secondary patency rates were 98.6%, 95.9%, and 94.2% at 3 months, 6 months, and 1 year, respectively. The degree of hypertension (P = 0.023), minimal preoperative vein size (P = 0.041), and increment in postoperative vein diameter were higher in the venous access group than in the arterial access group (P<0.01). The frequency of using cutting balloons (P = 0.026) and complication rate were higher in the arterial access group than in the venous access group (arterial access: 1 major, 8 minor; venous access: 4 minor; P = 0.015). CONCLUSIONS: Aggressive evaluation and endovascular therapy can salvage most non-maturing fistulas. Transradial and distal radial approaches can be effective even for challenging lesions.

Transcatheter arterial embolization for gastrointestinal bleeding related to pancreatic adenocarcinoma: clinical efficacy and predictors of clinical outcome.

PURPOSE: To evaluate the clinical efficacy of transcatheter arterial embolization (TAE) for managing pancreatic adenocarcinoma-related gastrointestinal (GI) bleeding, and to determine the factors associated with clinical outcomes. METHOD: From 2001-2017, this retrospective study included 58 patients who underwent TAE for pancreatic adenocarcinoma-related GI bleeding. The technical and clinical success of TAE, clinical factors including patient characteristics and embolization details, complications, and the 30-day mortality were evaluated. Univariate analyses were performed to determine the factors related to the clinical outcomes. RESULTS: On angiography, bleeding foci were detected in 47 patients (81%), while the other 11 patients showed tumor staining. Technical success rate was 98%, and first session and overall clinical success rates were 79% and 88%, respectively. N-butyl cyanoacrylate (NBCA) was the most commonly used embolic agent (53%). Stent-related bleeding was shown in 22 patients with characteristic angiogram such as arterial cut-off (13/22) and arteriobiliary fistula (5/22), with comparable clinical success rate (82%). Bleeding from the superior mesenteric artery (n = 3) at the first session of angiography and complications (n = 2), such as ischemic hepatitis and small bowel infarction, were all associated with a 30-day mortality. The overall 30-day mortality rate was 22%. Univariate analysis showed that massive transfusion and TNM stage 4 were related to clinical failure (P = 0.035 and 0.038, respectively). CONCLUSIONS: TAE was effective and safe for pancreatic adenocarcinoma-related GI bleeding. Stent-related bleeding was not uncommon, and associated with vascular abnormality amenable to TAE. Massive transfusion and TNM stage 4 were related to clinical failure.

Combined treatment (image-guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia: Clinical efficacy and outcomes.

OBJECTIVES: To evaluate the effectiveness and safety of combined treatment (image guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia. METHODS: From 2009 to 2017, 52 patients (44 men, eight women, mean 67.2 years) underwent combined treatment for acute thrombotic occlusion of lower extremity arteries. The patients presented with acute limb ischemia and we selectively perform combined treatment in the cases with challenging clinical considerations (e.g. various spectrum of thrombus, underlying atherosclerotic lesions). Combined treatment included cutdown of common femoral artery, thrombectomy using a Fogarty balloon catheter, balloon angioplasty, stenting, and catheter-introduced thrombus fragmentation and aspiration. Patients' medical records were retrospectively reviewed and follow-up data were collected. The technical and clinical success rates and limb salvage were assessed. The Kaplan-Meier method was used to analyze primary patency rates and overall survival rates. Univariate analyses were performed to determine the factors related to clinical outcomes. RESULTS: Technical and clinical success rate was 90.4% and 80.8%, respectively. The mean follow-up duration was 26.5 ± 25.8 months. Primary patency was 91.4%, 86.1%, and 74.6% at six months, 1-, and 2-year, respectively. Limb salvage without amputation was 88.5% (46/52). The overall survival rates at six months, 1-, and 3-year were 82.6%, 80.2, and 56.9%, respectively. The 30-day mortality was 5.8% (3/52). Univariate analysis showed that percutaneous transluminal angioplasty (PTA) type (balloon versus stent) was related to clinical failure. CONCLUSIONS: Combined treatment can be effective and safe for ALI patients even under challenging clinical conditions.

Prevalence of Upper Extremity Musculoskeletal Diseases and Disability among Fruit Tree Farmers in Korea: Cross-Sectional Study.

PURPOSE: The aim of this study was to examine the prevalence of upper extremity musculoskeletal (MSK) diseases and to identify factors influencing disability among fruit tree farmers in Korea. MATERIALS AND METHODS: Of the 1150 subjects of the Namgaram study, 460 fruit tree farmers completed a questionnaire and underwent clinical evaluations, including physical assessments, laboratory tests, simple radiographic examinations, and magnetic resonance imaging studies of the upper extremities. Disability was assessed using the Disabilities of the Arm, Shoulder, and Hand outcome measure. Data were analyzed with descriptive statistics and regression analyses using SPSS Win 24.0. RESULTS: The prevalences of upper extremity MSK diseases were 60.4% for rotator cuff tear, 20.9% for golf elbow, 40.9% for tennis elbow, and 58.0% for hand osteoarthritis. Disability in fruit farmers was associated with female sex (B=-4.47, p<0.001), smoking (B=-4.00, p=0.026), depression (B=2.83, p<0.001), working hours (B=0.96, p=0.001), injuries of the arms (B=10.78, p<0.001) and shoulders (B=6.75, p<0.001), and numbers of upper extremity MSK diseases (B=2.02, p=0.001), with 26.5% of the variance explained (R²=0.265, Durbin-Watson test=1.81, p<0.001). CONCLUSION: Fruit tree farmers remain at risk for MSK diseases of the upper extremities. Disability tended to worsen with more MSK diseases. It is necessary to not only educate farmers about prevention strategies, but also to develop an effective management system for agricultural work-related MSK diseases and a surveillance system at the government level for the health problems of farmers.

Adverse effect of smoking on cross-sectional area of small pulmonary vessel and arterial stiffness in healthy smokers without COPD.

INTRODUCTION: Because it induces systemic inflammation, smoking is a risk factor of atherosclerosis and pulmonary hypertension. The brachial-ankle pulse wave velocity (baPWV) and cross-sectional area (CSA) of small pulmonary vessels can be useful markers to assess early changes of arterial stiffness and pulmonary vascular alteration in smokers. OBJECTIVES: This study aimed to explore association between the CSA of small pulmonary vessel and arterial stiffness in healthy male smokers. METHODS: We enrolled 90 male non-smokers and 90 male smokers (age: 51.5 ± 9.7 years and 52.1 ± 7.9 years, respectively). All subjects underwent chest computed tomography (CT), pulmonary function test and baPWV measurement. We evaluated the total CSAs less than 5 mm2 using ImageJ software and divided by the total lung area (%CSA<5). We compared the association between baPWV and %CSA<5 in two groups as well as correlations among the amount of smoking, baPWV and %CSA<5. Multiple linear regression analysis using %CSA<5 as the dependent variable was also performed. RESULTS: The mean baPWV and mean %CSA<5 were significantly different between the smokers and non-smokers. The pack-years was significantly correlated with %CSA<5 (r = -0.631, P < 0.001) and baPWV (r = 0.534, P < 0.001) in smokers. In multiple linear regression analysis, age, pack-years, FEV1 /FVC and baPWV were associated with %CSA<5, regardless of body mass index, blood pressure and heart rate. CONCLUSIONS: There is a dose-response relationship between cigarette smoking and the CSA of small pulmonary vessels and arterial stiffness, respectively. Arterial stiffness, age, pack-years and mild airflow impairment are independent predictors of small pulmonary vascular destruction in smokers.

Factors Associated with Atraumatic Posterosuperior Rotator Cuff Tears.

BACKGROUND: Certain metabolic factors have been proposed as risk factors for a posterosuperior rotator cuff tear. Although metabolic syndrome is of increasing concern in industrialized societies, little information exists regarding its association with posterosuperior rotator cuff tears. The purpose of this study was to determine the risk factors for an atraumatic posterosuperior rotator cuff tear, including metabolic factors and metabolic syndrome. METHODS: This study involved 634 subjects (634 shoulders) drawn from a cohort of rural residents. Posterosuperior rotator cuff tear diagnoses were based on magnetic resonance imaging (MRI) findings. Logistic regression analysis was used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for various demographic, physical, and social factors, including age, sex, dominant-side involvement, body mass index (BMI), and participation in manual labor; the comorbidities of diabetes, hypertension, dyslipidemia, thyroid dysfunction, ipsilateral carpal tunnel syndrome, and metabolic syndrome; and the serum metabolic parameters of serum lipid profile, glycosylated hemoglobin A1c, and level of thyroid hormone. Two multivariable analyses were performed: the first excluded metabolic syndrome while including diabetes, hypertension, BMI, and hypo-high-density lipoproteinemia (hypo-HDLemia), and the second included metabolic syndrome while excluding the formerly included variables. RESULTS: Age, BMI, waist circumference, dominant-side involvement, manual labor, diabetes, hypertension, metabolic syndrome, ipsilateral carpel tunnel syndrome, HDL (high-density lipoprotein), and hypo-HDLemia were significantly associated with posterosuperior rotator cuff tears in univariate analyses (p ≤ 0.035). In the first multivariable analysis, age (OR. 1.86 [95% CI, 1.47 to 2.35]), BMI (OR, 1.09 [95% CI, 1.02 to 1.18]), dominant-side involvement (OR, 2.04 [95% CI, 1.38 to 3.01]), manual labor (OR, 9.48 [95% CI, 5.13 to 17.51]), diabetes (OR, 3.38 [95% CI, 1.98 to 5.77]), and hypo-HDLemia (OR, 2.07 [95% CI, 1.30 to 3.29]) were significantly associated with posterosuperior rotator cuff tears (p ≤ 0.019). In the second multivariable analysis, age (OR, 1.85 [95% CI, 1.48 to 2.31]), dominant-side involvement (OR, 1.83 [95% CI, 1.26 to 2.67]), manual labor (OR, 7.71 [95% CI, 4.33 to 13.73]), and metabolic syndrome (OR, 1.98 [95% CI, 1.35 to 2.91]) were significantly associated with posterosuperior rotator cuff tears (p ≤ 0.002). CONCLUSIONS: The metabolic factors of diabetes, BMI, hypo-HDLemia, and metabolic syndrome were significant independent factors associated with the development of posterosuperior rotator cuff tears. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas.

PURPOSE: Upper extremity musculoskeletal disorders (UEMDs), such as rotator cuff tear, epicondylitis, and hand osteoarthritis, have a negative impact on quality of life (QOL). In this study, we evaluated the prevalence of rotator cuff tear, lateral and medial epicondylitis, and hand osteoarthritis in the dominant side and the impact of these UEMDs on the disabilities of the arm, shoulder, and hand (DASH) outcome measure, which assesses upper extremity-related QOL. MATERIALS AND METHODS: In 2013-2015, 987 participants from rural areas completed a questionnaire and underwent physical examinations, laboratory tests, simple radiographic evaluations of bilateral upper extremities, and magnetic resonance imaging studies of bilateral shoulders. Based on data from these participants, researchers evaluated DASH and performed a functional assessment of each region of the dominant side and related UEMDs. RESULTS: The prevalences of epicondylitis, rotator cuff tear, and hand osteoarthritis were 33.7%, 53.4%, and 44.6%, respectively. Univariate regression analysis results revealed that epicondylitis, epicondylitis+rotator cuff tear, epicondylitis+hand osteoarthritis, and epicondylitis+rotator cuff tear+hand osteoarthritis were significantly associated with DASH score. Multiple regression analysis, including DASH, UEMD, and regional functional assessments, showed that only epicondylitis and epicondylitis+rotator cuff tear were associated with DASH score. CONCLUSION: Epicondylitis significantly affected QOL, while other UEMDs, such as hand osteoarthritis and rotator cuff tear, had no significant impact. When a patient's QOL is affected by a UEMD, there is an increased possibility of the simultaneous presence of other UEMDs.

Outcomes of Arthroscopic Rotator Cuff Repair in Patients Who Are 70 Years of Age or Older Versus Under 70 Years of Age: A Sex- and Tear Size-Matched Case-Control Study.

PURPOSE: To compare the structural and clinical outcomes after arthroscopic rotator cuff repair (ARCR) of a case group aged 70 and above with those of a control group younger than 70, with the 2 groups matched for sex and tear size. METHODS: The case group, comprising 53 patients 70 or older, and the control group, comprising 159 patients younger than 70, all received ARCR to 1 shoulder with symptomatic full-thickness rotator cuff tear. The case and the control subjects, who were matched for sex and tear size to minimize bias related to tendon healing, received ARCR during the same period. The mean age was 71.8 ± 2.6 years in the case group and 59.3 ± 7.1 years in the control group. The minimum follow-up period was 1 year in both groups. Cuff integrity was evaluated using ultrasonography. Structural and clinical outcomes of the 2 groups were compared. RESULTS: Regarding structural outcomes, the complete healing, partial-thickness retear, and full-thickness retear rates were 66% (35/53), 15% (8/53), and 19% (10/53) in the case group, and 68% (108/159), 19% (30/159), and 13% (21/159), respectively, in the control group. The 2 groups had no significantly different retear rates (P = .52). Regarding clinical outcomes, the mean improvements in range of motion, pain, muscle strength, and age- and sex-matched Constant scores were not significantly different between the 2 groups (P > .37). The preoperative tear size was significantly associated with retear in both studied groups (P = .02). CONCLUSIONS: The clinical and structural outcomes of ARCR in patients 70 or older with symptomatic full-thickness rotator cuff tear are comparable with those in patients younger than 70 with at least 1-year follow-up. Preoperative tear size, a biological factor, is a strong predictor for retear. LEVEL OF EVIDENCE: Level III, a retrospective comparative (case-control) study.

Direct binding of Copine3 with Jab1 activates downstream ErbB2 signaling and motility in SKBr3 breast cancer cells.

Copine3, a known calcium-dependent membrane binding protein, contains two tandem C2 domains and an A domain. This protein has been shown to interact with receptor tyrosine kinase 2 (ErbB2), but little is known concerning the physiological function of Copine3. To better understand its cellular function, we carried out a yeast two-hybrid screen to find Copine3 binding partners. Among the identified proteins, Jun activation domain-binding protein 1 (Jab1) appears to directly interact with Copine3. This physical interaction between Copine3 and Jab1 as well as the specific binding regions of both proteins were confirmed in vitro and in vivo. Our results also demonstrate that binding of Copine3 to ErbB2 is increased when Jab1 is overexpressed in SKBr3 breast cancer cells. Furthermore, two ErbB2 downstream signaling proteins [phosphatidylinositol 3 (PI3) kinase and protein kinase B (AKT)] were also activated by Jab1 overexpression in these cells. These data suggest that binding of Copine3 and Jab1 regulates, at least to some extent, the ErbB2 signaling pathway. Moreover, overexpression of both Copine3 and Jab1 in SKBr3 cells effectively increased cellular migration. Collectively, our findings indicating that Jab1 enhances the ErbB2 binding ability of Copine3, further activating the ErbB2 signaling pathways involved in breast cancer cell pathogenesis.

The value of diagnostic ultrasonography in the assessment of a glomus tumor of the subcutaneous layer of the forearm mimicking a hemangioma: a case report.

INTRODUCTION: A glomus tumor is a rare, benign tumor with atypical clinical symptoms. Because of its small size, it is difficult to diagnose and treat early; therefore, it leads to poor quality of life. Glomus tumors are known to commonly affect the hand and rarely manifest in other areas. Because they simulate neuromas, hemangiomas, and neurofibromatosis, the differential diagnosis is difficult. We performed marginal resection of a solitary forearm mass previously suspected to be a hemangioma or glomus tumor on the basis of ultrasound findings and histologically diagnosed to be a glomus tumor afterward. We report this case to demonstrate the good prognosis of the procedure we used, and we review the relevant literature. CASE PRESENTATION: A 68-year-old Asian man without a particular medical history visited our hospital with a mass with focal tenderness in his left distal forearm that had developed 8 years earlier. The tumor was observed with suspicion of being a hemangioma or glomus tumor based on the location, clinical symptoms, and ultrasound findings taken into consideration together. The biopsy results led us to conclude that the lesion was a glomus tumor. CONCLUSIONS: A glomus tumor located in the forearm is very rare. It is often clinically overlooked and is likely to be misdiagnosed as another disease. The patient's quality of life deteriorates, and, though the disease is rare, it has serious sequelae. Therefore, a quick diagnosis and appropriate treatment must be conducted early. If a mass occurs with serious pain in subcutaneous soft tissue of not the hands but the limbs, it is important to conduct examinations with suspicion of a glomus tumor. Ultrasonography performed quickly may be useful for making the differential diagnosis.

Monostotic fibrous dysplasia in the proximal tibial epiphysis: a case report.

INTRODUCTION: Fibrous dysplasia is one of many well-known disorders in which there is a defect in the remodeling process of immature bone to mature into lamellar bone, and it often exists in metaphyseal and diaphyseal parts of the long bone. In this report, we describe a rare case where fibrous dysplasia was found only in the proximal part of the epiphysis of the tibia without other bony lesions. CASE PRESENTATION: A 14-year-old Asian girl was referred to our hospital after slipping down with pain on the left knee. A radiograph showed an abnormal finding of a central radiolucent lesion with a marginal sclerotic border near the proximal tibial spine. A magnetic resonance image showed the lesion at low signal intensity on a T1-weighted image and at high signal intensity on a T2-weighted image. The biopsy results led us to conclude that the lesion was a fibrous dysplasia. CONCLUSION: If an abnormal lesion on the epiphysis, especially in long bones, is detected on a radiograph, several differential diagnoses can be made. Although fibrous dysplasia is usually not encountered as an epiphyseal lesion, it is important to incorporate all the clinical, radiographic and pathologic features to diagnose monostotic fibrous dysplasia when the lesion is located at the epiphyseal location.

Mass and fat infiltration of intercostal muscles measured by CT histogram analysis and their correlations with COPD severity.

RATIONALE AND OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is characterized by progressive respiratory function impairment and respiratory muscle dysfunction. We hypothesized that the mass and fat infiltration of respiratory muscles correlates with COPD severity and emphysema extent. MATERIALS AND METHODS: Ninety-eight male patients with COPD underwent chest computed tomography (CT) and spirometry. The mass and fat infiltrations of intercostal and latissimus muscles were quantified as the cross-sectional area (CSA) and attenuation of these muscles using CT histogram analysis. Intercostal index and latissimus index were defined as intercostal CSAs and latissimus CSAs divided by body mass index. The emphysema extent was measured as the ratio of the emphysematous lung volume to the total lung volume using a density-mask technique. Pearson correlation analyses were performed to evaluate the relationships between these parameters. Multiple regression analysis was performed using forced expiratory volume in 1 second (FEV1) as the dependent parameter and the clinical and CT data as the independent parameters. RESULTS: FEV1 was significantly correlated with intercostal index (r = 0.57), latissimus index (r = 0.34), intercostal attenuation (r = 0.62), and latissimus attenuation (r = 0.38). Emphysema extent was significantly correlated with intercostal index (r = -0.36) and intercostal attenuation (r = -0.50). Multiple regression analysis showed that FEV1 was predicted by intercostal attenuation (B = 0.40), intercostal CSA (B = 0.23), emphysema extent (B = -0.23), and age (B = -0.21, R(2) = 0.64, P < .001). CONCLUSIONS: A decrease in intercostal mass and an increase in intercostal fat are associated with worsening of COPD severity.