Estimation of the Three Phases by Direct Cost of Care for Non-surviving Patients with Cancer: A National Population-based Patient-level Study.

Background: Determining the cost structure of medical care from diagnosis to the death of patients with cancer is crucial for establishing budgets to support patients with cancer. The breakdown of the cost estimation in distinct phases of survival is essential for optimizing the allocation of limited funds. Therefore, this study aims to examine the patterns of direct medical costs of cancer care associated with seven major cancer types and estimate cost thresholds to distinguish each phase based on the incurred cost. Methods: In this nationwide, population-based study, we used claims data from the National Health Insurance Service, Korea. Patients newly diagnosed with cancer since 2006 and who died in 2016-2017 were enrolled, and their use of medical services during cancer survival from at least 6 months up to 12 years was observed. The monthly cost exhibited a non-linear function with two unknown thresholds resembling a U-shape; therefore, we fitted three linear segment models. Individual costs were assessed by dividing the survival time into the initial, continuing, and terminal phases by estimated thresholds, and the average medical cost for each phase was calculated. Results: Based on survival durations of 12 years or less, the initial phase occurred within 1.1-4.8 months after diagnosis, while the terminal phase was observed in 1.4-4.7 months before death. The length of these two phases increased with the increased survival time of the patients. Medical costs in these phases ranged from $4067-7431 and $3127-6114 (US dollars), respectively, regardless of the variations in survival time. However, the average costs in the continuing phase were higher for patients with a short survival time. Conclusions: This study highlights the cost dynamics in cancer care through a breakdown of the phases of survival. It suggests that through a more refined definition of the initial and terminal phases, the average cost in these stages increases, indicating the significant implications of the findings for resource allocation and tailored financial support strategies for patients with cancer with varying prognoses.

Effects of Thrombin-Based Hemostatic Agent in Total Knee Arthroplasty: Meta-Analysis.

The effectiveness of Floseal, a thrombin-based hemostatic matrix, in total knee arthroplasty (TKA) in minimizing blood loss and transfusion requirements remains a topic of debate. This meta-analysis aims to evaluate the up-to-date randomized controlled trials (RCTs) on the efficacy and safety of Floseal in TKA. A comprehensive search was conducted in electronic databases to identify relevant RCTs. The methodological quality of the included studies was assessed, and data extraction was performed. The pooled effect sizes were calculated using standardized mean difference (SMD) or odds ratios (OR) with 95% confidence intervals (CIs). Eight studies involving 904 patients were included in the meta-analysis. The use of a thrombin-based hemostatic agent significantly reduced hemoglobin decline (SMD = -0.49, 95% CI: -0.92 to -0.07) and the risk of allogenic transfusion (OR = 0.45, 95% CI: 0.25 to 0.81) but showed no significant difference in the volume of drainage or total blood loss. Funnel plots showed no evidence of publication bias. This meta-analysis provides robust evidence supporting the effectiveness of Floseal in reducing hemoglobin decline and transfusion in TKA. Further well-designed RCTs with longer follow-up periods are warranted to assess long-term efficacy and safety.

Trends in treatment patterns and survival outcomes in pancreatic cancer: A nationwide population-based study in Korea.

BACKGROUND: The treatment of pancreatic cancer has evolved; however, real-world data on treatment trends remain scarce. This study investigated treatment patterns for pancreatic cancer and patient survival using a nationwide population-based study in Korea. METHODS: Using the National Health Insurance database, data from 78,920 patients diagnosed with pancreatic cancer in Korea between 2006 and 2019 were extracted. Treatment patterns and survival by age group and year of diagnosis were examined. RESULTS: Primary treatment was delivered as follows: 16,562 patients (21.0%) underwent surgery, 20,998 patients (26.6%) received chemotherapy, 1332 patients (1.7%) received chemoradiotherapy, and 40,040 patients (50.7%) received supportive care only. The proportion of patients undergoing surgery or chemotherapy increased gradually in all age groups over time. The commonly used anti-cancer drugs have changed from gemcitabine±erlotinib to gemcitabine+nab-paclitaxel and FOLFIRINOX. Survival improved mainly in patients who underwent surgery or chemotherapy. Median overall survival for all patients improved from 5.5 months in 2006-2008 to 9.8 months in 2018-2019, with greater improvement observed in younger age groups: 8.8-18.8 months, age ≤59 years, 6.8-14.6 months, age 60-69 years, 4.2-8.3 months, age 70-79 years and 2.4-3.4 months, age ≥80 years (all p < 0.0001). CONCLUSIONS: An increase in the rates of surgery and chemotherapy for pancreatic cancer was observed. Survival rates for pancreatic cancer have generally improved over the past decade and are greater in patients undergoing surgery or chemotherapy and in younger age groups.

Influence of the Foaming Process on the Burning Behavior of the PET-PEN Copolymer.

The manufacturing process can modify the micromechanical structure, usefulness, and functionality of foams. Although one-step foaming is a simple process, controlling the morphology of the foams is difficult compared to the two-step processing method. In this study, we investigated the experimental differences in thermal and mechanical properties, particularly combustion behavior, between PET-PEN copolymers prepared by the two methods. With an increase in foaming temperature Tf, the PET-PEN copolymers became more fragile, and the breaking stress of the one-step PET-PEN foamed at the highest Tf was only 2.4% of that of the raw material. For the pristine PET-PEN, 24% of the mass was burned, leaving 76% as a molten sphere residue. The two-step MEG PET-PEN had only 1% of its mass remaining as a residue, whereas the one-step PET-PENs had between 41 and 55%. The actual mass burning rates were similar for all the samples except the raw material. The coefficient of thermal expansion of the one-step PET-PEN was about two orders of magnitude lower than that of the two-step SEG.

Risk of pancreatic cancer after acute pancreatitis: A population-based matched cohort study.

BACKGROUND: We investigated the short- and long-term risks of pancreatic cancer after the diagnosis of acute pancreatitis. METHODS: This population-based matched-cohort study used data from the Korean National Health Insurance Service database. Patients with acute pancreatitis (n = 25,488) were matched with the control group (n = 127,440) based on age, sex, body mass index, smoking status, and diabetes. We estimated the hazard ratios for developing pancreatic cancer in both groups using Cox regression analysis. RESULTS: During a median follow-up of 5.4 years, pancreatic cancer developed in 479 patients (1.9%) in the acute pancreatitis group and 317 patients (0.2%) in the control group. Compared with the control group, the risk of pancreatic cancer in the acute pancreatitis group was very high within the first 2 years, which gradually decreased over time. The hazard ratio for the risk of developing pancreatitis was 8.46 (95% confidence interval, 5.57-12.84) at 1-2 years, and then decreased to 3.62 (95% confidence interval, 2.26-4.91) at 2-4 years. However, even after 8-10 years, the hazard ratio was still statistically significantly increased to 2.80 (95% confidence interval, 1.42-5.53). After 10 years, there was no significant difference in the risk of pancreatic cancer between the two groups. CONCLUSIONS: The risk of pancreatic cancer increases rapidly after acute pancreatitis diagnosis, gradually declines after 2 years, and remains elevated for up to 10 years. Further studies are needed to determine the long-term effects of acute pancreatitis on the risk of pancreatic cancer.

Suspicious findings observed retrospectively on CT imaging performed before the diagnosis of pancreatic cancer.

Background: Few studies have focused on computed tomography findings before a pancreatic cancer diagnosis. We aimed to investigate the prediagnostic computed tomography findings of patients who had undergone computed tomography within the prediagnostic period of their pancreatic cancer diagnosis. Methods: Between January 2008 and December 2019, 27 patients who underwent contrast-enhanced abdominal or chest computed tomography including the pancreas within 1 year of a pancreatic cancer diagnosis were enrolled in this retrospective study. The prediagnostic computed tomography imaging findings were divided into pancreatic parenchyma and pancreatic duct findings. Results: All patients underwent computed tomography for reasons unrelated to pancreatic cancer. The pancreatic parenchyma and ducts showed normal findings in seven patients and abnormal findings in 20 patients. Hypoattenuating mass-like lesions were detected in nine patients with a median size of 1.2 cm. Six patients had focal pancreatic duct dilatations, and two patients had distal parenchymal atrophy. In three patients, two of these findings were found simultaneously. Taken together, 14 (51.9%) of 27 patients had findings suggestive of pancreatic cancer in prediagnostic computed tomography. Conclusions: In contrast-enhanced computed tomography performed for other purposes, attention should be paid to the presence of a hypoattenuating mass, focal pancreatic duct dilatation, or distal parenchymal atrophy of the pancreas. These features may be clues for an early diagnosis of pancreatic cancer.

Experience and perspectives of end-of-life care discussion and physician orders for life-sustaining treatment of Korea (POLST-K): a cross-sectional study.

BACKGROUND: This study aimed to identify the healthcare providers' experience and perspectives toward end-of-life care decisions focusing on end-of-life discussion and physician's order of life-sustaining treatment documentation in Korea which are major parts of the Life-Sustaining Treatment Act. METHODS: A cross-sectional survey was conducted using a questionnaire developed by the authors. A total of 474 subjects-94 attending physicians, 87 resident physicians, and 293 nurses-participated in the survey, and the data analysis was performed in terms of frequency, percentage, mean and standard deviation using the SPSS 24.0 program. RESULTS: Study results showed that respondents were aware of terminal illness and physician's order of life-sustaining treatment in Korea well enough except for some details. Physicians reported uncertainty in terminal state diagnosis and disease trajectory as the most challenging. Study participants regarded factors (related to relationships and communications) on the healthcare providers' side as the major impediment to end-of-life discussion. Study respondents suggested that simplification of the process and more staff are required to facilitate end-of-life discussion and documentation. CONCLUSION: Based on the study results, adequate education and training for better end-of-life discussion are required for future practice. Also, a simple and clear procedure for completing a physician's order of life-sustaining treatment in Korea should be prepared and legal and ethical advice would be required. Since the enactment of the Life-Sustaining Treatment Act, several revisions already have been made including disease categories, thus continuous education to update and support clinicians is also called for.

Evaluation of pesticide residues in vegetables and risk assessment from Incheon, Korea.

This study investigated pesticide residues to evaluate food safety caused by vegetables in Incheon. A total of 385 samples of 33 different types of vegetables mainly consumed by Koreans were collected from the Incheon market in 2021. The pesticide residues were analyzed by the multi-residue methods of the Korean Food Code for 339 different pesticides. Of the 385 vegetables, no residual pesticides were detected in 329 samples (85.5%), while 56 samples (14.5%) contained residual pesticides and 13 samples (3.4%) had residues above the maximum residue limit. A total of 34 different pesticide residues were detected and 8 pesticides exceeded maximum residue limits (MRLs). The most frequently detected pesticide residues were fluxametamide (7 samples), azoxystrobin (4 samples), chlorantraniliprole (3 samples), flubendiamide (3 samples), and procymidone (3 samples). The highest values in the risk assessment were obtained when Chinese chives were consumed with terbufos. But the values of HQ and cHI were lower than 100%. Therefore, the results showed that the detected pesticides were no potential risk from consumption of vegetables.

Detection of pesticide residues and risk assessment from the local fruits and vegetables in Incheon, Korea.

This study was conducted to investigate the pesticide residue concentrations and assess potential human health risks from fruit and vegetable consumption in Incheon. A total of 1,146 samples of 20 different types of fruits and vegetables were collected from the Incheon area in 2020. The pesticide residues were analyzed by the multi-residue method of the Korean Food Code for 400 different pesticides. Among the fruit and vegetable samples, 1,055 samples (92.1%) were free from detectable residues, while 91 samples (7.9%) contained residues and 11 samples (1.0%) had residues exceeding the Korean maximum residue limit. A total of 32 different pesticide residues were found and 8 residues exceeded MRLs. The most frequently detected pesticide residues were chlorfenapyr, procymidone, etofenprox, pendimethalin, fluopyram and azoxystrobin. The highest values of short term and long term exposure were obtained in the case of consumption of lettuce(leaves) with chlorfenpyr. For chronic dietary exposure, the cumulative hazard index (cHI) were below 100%. The results of this study showed that the detected pesticides were not exposed to potential health risks through the consumption of fruits and vegetables.

Health risk associated with pesticide residues in vegetables from Incheon region of Korea.

This study was conducted to investigate the pesticide residue concentrations and assess potential human health risks from vegetable consumption in Incheon. A total of 960 samples were collected from the Incheon areas of Korea in 2019. The pesticide residues were analyzed by the multi-residue method of the Korean Food Code for 373 different pesticides using GC-MS/MS, LC-MS/MS, GC-ECD/NPD, and HPLC-UVD. Among the vegetable samples, 869 samples (90.5%) were free from detectable residues, while 91 samples (9.5%) contained residues, and 16 samples (1.7%) had residues exceeding the Korean maximum residue limit (MRLs). A total of 33 different pesticide residues were found, and 11 residues exceeded MRLs. The most frequently detected pesticide residues were chlorfenapyr, fludioxonil, pyridalyl, hexaconazole, and procymidone. Samples exceeding the MRLs were found in aster scaber, coastal hog fennel, lettuce (leaves), mustard green, mustard leaf, perilla leaves, Pimpinella brachycarpa, radish leaves, shepherd' purse, spinach, and winter-grown cabbage. The potential health risk assessment of pesticides was estimated by calculating the estimated daily intake (EDI) and the acceptable daily intake (ADI). The range of HQs was 0.002-90.621%, which was below 100%. Therefore, the results of this study show that the detected pesticide could not be considered a serious public health problem through the consumption of vegetables.

Lifestyle, body mass index, diabetes, and the risk of pancreatic cancer in a nationwide population-based cohort study with 7.4 million Korean subjects.

BACKGROUND: Large-scale epidemiological studies on pancreatic cancer in non-Western populations are insufficient. We investigated the risk factors for pancreatic cancer. METHODS: Using the Korean National Health Insurance database, subjects who participated in the health examination program between 2005 and 2006 were identified and followed up until 2017. Adjusted hazard ratios (HRs) for pancreatic cancer risk were estimated using a Cox proportional hazards model. RESULTS: During 11.5 years follow-up, 22,543 of 7,445,947 participants were newly diagnosed with pancreatic cancer. Compared with normal-weight subjects, pancreatic cancer risk was increased in those with severe obesity (BMI ≥ 28 kg/m2) (HR = 1.16; 95% CI, 1.11-1.23). Subjects with diabetes had an increased risk compared with those without diabetes (HR = 1.48; 95% CI, 1.43-1.53). Current smokers had a higher risk than never smokers (HR = 1.43; 95% CI, 1.38-1.48). Current smoking combined with diabetes increased the risk compared with never smokers without diabetes (HR = 2.13; 95% CI, 2.00-2.28). Current smoking combined with BMI ≥ 25 kg/m2 had an increased risk compared with never smokers with BMI < 23 kg/m2 (HR = 1.55; 95% CI, 1.46-1.65). CONCLUSION: Smoking, obesity, and diabetes are significant risk factors for pancreatic cancer in Koreans. Lifestyle modifications for smoking and obesity would be beneficial for pancreatic cancer prevention.

Risk factors associated with surveillance loss after endoscopic submucosal dissection in patients with gastric neoplasm.

BACKGROUND: After endoscopic submucosal dissection of gastric neoplasms, surveillance endoscopy is required for patients with synchronous or metachronous neoplasms. We aimed to evaluate the risk factors associated with surveillance loss in patients who underwent endoscopic submucosal dissection. METHODS: Ninety-five patients treated with endoscopic submucosal dissection for gastric neoplasms between May 2015 and June 2016 were retrospectively reviewed. Clinicopathologic factors, sociodemographic factors, psychiatric measures, and associated risk factors for surveillance loss were evaluated. The chi-square or Fisher exact test, t-test, and logistic regression analysis were used in data analysis. RESULTS: Twenty-five (26.3%) patients were identified as having surveillance loss. Compared to the surveillance group, the surveillance loss group was old and had dysplasia, and a healthy American Society of Anesthesiologists physical status. Similarly, surveillance loss was related to low symptom perception, low incidence of alexithymia, mindful awareness, and high trait forgiveness. Logistic regression analysis showed that dysplasia (odds ratio, 15.23; 95% CI, 1.56-149.09, P=0.019), old age (odds ratio, 7.14; 95% CI, 1.90-26.88, P=0.004), and American Society of Anesthesiologists physical status 1 (odds ratio, 3.99; 95% CI, 1.09-14.60, P=0.037) were associated with surveillance loss. CONCLUSIONS: Dysplasia, old age, and the American Society of Anesthesiologists physical status 1 were associated with surveillance loss in patients who underwent gastric endoscopic submucosal dissection. It could be helpful to proactively monitor patients with such conditions after gastric endoscopic submucosal dissection.

A population-based epidemiology of Wilson's disease in South Korea between 2010 and 2016.

Very few population-based studies have examined the epidemiology of Wilson's disease (WD). We investigated the epidemiology of WD using the National Health Insurance Service (NHIS) database in South Korea. We analyzed not only the statistical variables of WD, but also those of WD-related diseases. WD patients were identified with the relevant International Classification of Diseases-10 code out of 50.5 million people. We used the NHIS database from 2009 to 2016 and analyzed the incidence rate, prevalence, and clinical symptoms of WD. A total of 1,333 patients were identified. The average annual incidence rate was 3.8 per million person-years. The prevalence was 38.7 per million people. The mean diagnostic age was 26.1 ± 17.2 with earlier diagnosis in men (P = 0.0003). Among the patients, 988 (74.1%) had hepatic symptoms, 510 (38.3%) had neurologic symptoms, and 601 (45.1%) had psychiatric symptoms. Before the diagnosis of WD, 350 (26.3%) had neurologic symptoms, and 427 (32%) had psychiatric symptoms. The annual mortality rate was 0.7%. Age, liver cirrhosis, and liver failure correlated with a fatal prognosis (P < 0.05). Many patients showed neurologic and psychiatric symptoms before they were diagnosed with WD. Prognosis correlated with age, liver cirrhosis, and liver failure.

Carbohydrate antigen 19-9 elevation without evidence of malignant or pancreatobiliary diseases.

Although carbohydrate antigen 19-9 (CA 19-9) may be elevated in benign diseases, elevated CA 19-9 may cause a fear of cancer and unnecessary follow-up studies. Research on how to approach systematically in this case is very limited. The purpose of this study was to analyze the clinical features and the causes of CA 19-9 elevation without evidence of malignant or pancreatobiliary diseases. We retrospectively reviewed the medical records of patients who had CA 19-9 elevation (≥80 U/mL) and were found to be unrelated to cancer after follow-up. After exclusion, 192 patients were included in this study. The median level of CA 19-9 was 136.5 U/mL. The causes of CA 19-9 elevation were determined in 147 (76.6%) patients, and that was unknown in 45 (23.4%). The estimated causative diseases were hepatic diseases in 63 patients, pulmonary diseases in 32, gynecologic diseases in 38, endocrine diseases in 13, and spleen disease in 1. Of 45 patients with unknown cause, 35 had normalization of CA 19-9 and 10 had persistently elevated CA 19-9. In conclusion, CA 19-9 elevation without malignancies or pancreatobiliary diseases should be systematically evaluated and followed up. We suggest an algorithm to investigate the causes and follow up these patients.

Nationwide validation study of diagnostic algorithms for inflammatory bowel disease in Korean National Health Insurance Service database.

BACKGROUND AND AIM: We conducted a nationwide validation study of diagnostic algorithms to identify cases of inflammatory bowel disease (IBD) within the Korea National Health Insurance System (NHIS) database. METHOD: Using the NHIS dataset, we developed 44 algorithms combining the International Classification of Diseases (ICD)-10 codes, codes for Rare and Intractable Diseases (RID) registration and claims data for health care encounters, and pharmaceutical prescriptions for IBD-specific drugs. For each algorithm, we compared the case identification results from electronic medical records data with the gold standard (chart-based diagnosis). A multiple sampling test verified the validation results from the entire study population. RESULTS: A random nationwide sample of 1697 patients (848 potential cases and 849 negative control cases) from 17 hospitals were included for validation. A combination of the ICD-10 code, ≥ 1 claims for health care encounters, and ≥ 1 prescription claims (reference algorithm) achieved excellent performance (sensitivity, 93.1% [95% confidence interval 91-94.7]; specificity, 98.1% [96.9-98.8]; positive predictive value, 97.5% [96.1-98.5]; negative predictive value, 94.5% [92.8-95.8]) with the lowest error rate (4.2% [3.3-5.3]). The multiple sampling test confirmed that the reference algorithm achieves the best performance regarding IBD diagnosis. Algorithms including the RID registration codes exhibited poorer performance compared with that of the reference algorithm, particularly for the diagnosis of patients affiliated with secondary hospitals. The performance of the reference algorithm showed no statistical difference depending on the hospital volume or IBD type, with P-value < 0.05. CONCLUSIONS: We strongly recommend the reference algorithm as a uniform standard operational definition for future studies using the NHIS database.

A cadaveric study for the volar needle approach to the pronator quadratus using the palmaris longus tendon landmark.

INTRODUCTION: Our aim in this work was to determine the safety and accuracy of the volar approach to the pronator quadratus (PQ) through cadaver dissection. METHODS: Twenty upper limbs from 10 fresh cadavers were investigated. At the level 3 cm proximal to the ulnar styloid process (USP), a needle was inserted just medial to the palmaris longus (PL) tendon. Distances of the median nerve (MN) and ulnar artery (UA) from the needle insertion point (IP) were measured using ultrasonography and cadaver dissection. RESULTS: The PQ was located at a depth of 10.8-19.9 mm from the skin and had a median thickness of 9.1 mm, measured 3 cm proximal to the USP. The median distances of the MN and UA from the IP were 7.6 and 13.4 mm, respectively. DISCUSSION: A needle insertion for the volar approach to the PQ was safe at 3 cm proximal to the USP, just medial to the PL tendon.

Solid-State Foaming of Acrylonitrile-Butadiene-Styrene/Recycled Polyethylene Terephthalate Using Carbon Dioxide as a Blowing Agent.

In this study, a single paragraph of acrylonitrile-butadiene-styrene (ABS)/recycled polyethylene terephthalate (R-PET) polymeric foams is prepared using CO2 as a blowing agent. First, the sorption kinetics of subcritical and supercritical CO2 are first studied at saturation temperatures from -20 to 40 °C and a pressure of 10 MPa, in order to estimate the diffusion coefficient and the sorption amount. As the sorption temperature increases, the diffusion coefficient of CO2 increases while the sorption amount decreases. Then, a series of two-step solid-state foaming experiments are conducted. In this process, a specimen is saturated with liquid CO2 and foamed by dipping the sample in a high-temperature medium at 60 to 120 °C. The effects of foaming temperature and depressurization rate on the morphology and structure of ABS/R-PET microcellular foams are examined. The mean cell size and the variation of the cell size distribution increases as the foaming temperature and the depressurization rate increases.

Delamination Does Not Affect Outcomes After Arthroscopic Rotator Cuff Repair as Compared With Nondelaminated Rotator Cuff Tears: A Study of 1043 Consecutive Cases.

BACKGROUND: Limited information is available regarding the characteristics of delaminated rotator cuff tears as compared with nondelaminated tears. Furthermore, there is conflicting information regarding the effects of delamination on the anatomic healing of repaired cuffs. PURPOSE: To evaluate the characteristics and anatomic outcomes of delaminated rotator cuff tears in comparison with nondelaminated tears to determine whether delamination is a negative prognostic factor affecting rotator cuff repair outcomes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between 2010 and 2014, 1043 patients were enrolled in the study to assess the prevalence of delamination. Among them, the findings from 531 patients who underwent magnetic resonance imaging or computed tomographic arthrography at least 1 year after surgery were included to determine whether delamination was a negative prognostic factor affecting the anatomic outcomes of arthroscopic rotator cuff repair. Delamination was assessed intraoperatively and defined by distinguishable edge cleavage tearing or interstitial horizontal gap between the articular and bursal surfaces of the torn tendon. One of 3 repair techniques (modified Mason Allen, single row, or double row) was used according to tear configuration and tendon mobilization. The authors evaluated visual analog scale scores for pain and satisfaction and American Shoulder and Elbow Surgeons scores to quantify clinical outcomes. RESULTS: The incidence of delamination was 42.9% (447 of 1043). As compared with those with nondelaminated tears, patients with delaminated tears were older ( P < .001) and had longer symptom duration ( P = .019), larger tear sizes and retractions ( P < .001 for both), higher grades of fatty infiltration of the rotator cuff muscles (all P < .001), and poorer tendon quality ( P < .001). The overall healing failure rate was 19.0% (101 of 531). In univariate analysis, the rate of healing failure for the repaired cuffs was significantly higher in the delaminated group (delaminated tears, 60 of 238, 25.2%; nondelaminated tears, 41 of 293, 14.0%; P = .001). However, results of subgroup and multivariate analyses showed that the presence of delamination was ultimately not an independent risk factor for the failure of cuff healing. Between the delaminated and nondelaminated groups, there was no significant difference in postoperative functional outcomes. CONCLUSION: The results suggest that delaminated rotator cuff tears might represent chronic degenerative tears of longer symptom duration, with larger tear sizes and higher grades of fatty infiltration in older patients. It appears that delamination could be a confounding factor, not an independent prognostic factor, affecting rotator cuff healing.

Pulmonary Extraintestinal Manifestation of Crohn's Disease Treated Successfully with Adalimumab.

Pulmonary extraintestinal manifestation is rare in Crohn's disease and has been reported in only a few cases. Despite the presence of pulmonary abnormalities in a significant proportion of patients with inflammatory bowel disease, there are only few case reports, due to complicated diagnosis and low recognition by clinicians. Currently, treatment guidelines for pulmonary Crohn's disease have not been established. There are some case reports of pulmonary Crohn's disease that achieved remission after infliximab treatment. Clinical and radiological remission of pulmonary extraintestinal involvement in Crohn's disease after adalimumab therapy has not been reported yet. Here, we report one case of lung involvement of Crohn's disease, which shows radiological and clinical remission after adalimumab treatment.

Fabrication and Characterization of Multiscale PLA Structures Using Integrated Rapid Prototyping and Gas Foaming Technologies.

Multiscale structured polymers have been considered as a promising category of functional materials with unique properties. We combined rapid prototyping and gas foaming technologies to fabricate multiscale functional materials of superior mechanical and thermal insulation properties. Through scanning electron microscope based morphological characterization, formation of multiscale porous structure with nanoscale cellular pores was confirmed. Improvement in mechanical strength is attributed to rearrangement of crystals within CO2 saturated grid sample. It is also shown that a post-foaming temperature higher than the glass transition temperature deteriorates mechanical strength, providing process guidelines. Thermal decomposition of filament material sets the upper limit of temperature for 3D printed features, characterized by simultaneous differential scanning calorimetry and thermogravimetric analysis. Porosity of the fabricated 3D structured polylactic acid (PLA) foam is controllable by suitable tuning of foaming conditions. The fabricated multiscale 3D structures have potential for thermal insulation applications with lightweight and reasonable mechanical strength.