Bursal acromial resurfacing improves shoulder biomechanics in a cadaveric model of massive rotator cuff tear.

PURPOSE: To investigate the effectiveness of bursal acromial resurfacing (acromiograft) on acromiohumeral distance, subacromial contact area, and pressure in a cadaveric model of massive rotator cuff tear. METHODS: Eight fresh-frozen cadaveric shoulders were tested using a customized shoulder testing system. Humeral head translation, subacromial contact pressure, and the subacromial contact area were evaluated across four conditions: (1) intact shoulder; (2) simulated massive rotator cuff tear; (3) 3-mm acromiograft condition; (4) 6-mm acromiograft condition. The acromiografts were simulated using Teflon and a reported technique. The values were measured at 0°, 20°, and 40° abduction and 0°, 30°, 60°, and 90° external rotation (ER) for each abduction status. RESULTS: Compared with a massive cuff tear, the 6-mm acromiograft significantly reduced the superior translation of the humeral head at all abduction/ER angles (P<0.05). The 3-mm acromiograft also decreased superior translation of the humeral head compared to massive cuff tear, but not all differences were significant. The 3- and 6-mm acromiografts significantly decreased the subacromial contact pressure and increased the subacromial contact area in almost all positions (P<0.05). The 3-mm acromiograft maintained biomechanical properties similar to the intact condition, whereas the 6-mm acromiograft increased the contact area. CONCLUSIONS: This biomechanical study demonstrated that both 3- and 6- mm acromiografts using Teflon in a cadaveric model of a massive cuff tear resulted in recentering of the superiorly migrated humeral head, increased the subacromial contact area, and decreased the subacromial contact pressure. The 3- mm graft was sufficient for achieving the intended therapeutic effects. CLINICAL RELEVANCE: The acromiograft can normalize altered biomechanics and may aid the treatment of massive cuff tears. As grafting the acromion's undersurface is new with limited clinical outcomes, further observation is crucial. Using Teflon instead of ADM allograft for bursal acromial resurfacing could yield different results, requiring careful interpretation.

Varus-valgus alignment of humeral short stem in reverse total shoulder arthroplasty: does it really matter?

BACKGROUND: The utilization of short humeral stems in reverse total shoulder arthroplasty has gained attention in recent times. However, concerns regarding the risk of misalignment during implant insertion are associated with their use. METHODS: Eight fresh-frozen cadaveric shoulders were prepared for dissection and biomechanical testing. A bespoke humeral implant was fabricated to facilitate assessment of neutral, varus, and valgus alignments using a single stem, and 10° was established as the maximum permissible angle for misalignments. Shift in humerus position and changes in deltoid length attributable to misalignments relative to the neutral position were evaluated using a Microscribe 3DLx system. The impingement-free range of motion, encompassing abduction, adduction, internal rotation, and external rotation (ER), was gauged using a digital goniometer. The capacity for abduction was evaluated at maximal abduction angles under successive loading on the middle deltoid. A specialized traction system coupled with a force transducer was employed to measure anterior dislocation forces. RESULTS: Relative to the neutral alignment, valgus alignment resulted in a more distal (10.5 ± 2.4 mm) and medial (8.3 ± 2.2 mm) translation of the humeral component, whereas the varus alignment resulted in the humerus shifting more superiorly (11.2 ± 1.3 mm) and laterally (9.9 ± 0.9 mm) at 0° abduction. The valgus alignment exhibited the highest abduction angle than neutral alignment (86.2°, P < .001). Conversely, the varus alignment demonstrated significantly higher adduction (18.4 ± 7.4°, P < .001), internal rotation (68.9 ± 15.0°, P = .014), and ER (45.2 ± 10.5°, P = .002) at 0° abduction compared to the neutral alignments. Anterior dislocation forces were considerably lower (23.8 N) in the varus group compared to the neutral group at 0°ER (P = .047). Additionally, abduction capability was markedly higher in varus alignment at low deltoid loads than the neutral alignment (5N, P = .009; 7.5 N, P = .007). CONCLUSIONS: The varus position enhances rotational range of motion (ROM) but increases instability, while the valgus position does not significantly impact ROM or instability compared to the neutral position.

Meteorological Influence on Atrial Fibrillation and Flutter: A Nationwide Observational Study in South Korea (2010-2022).

Background and rationale The impact of meteorological factors, including atmospheric temperature, humidity, and wind speed, on the incidence of atrial fibrillation and flutter (AF) has been the subject of several studies, but the findings have been inconsistent. Given the complex and multifaceted nature of this relationship, a larger-scale study was necessary to provide sufficient statistical power and elucidate potential associations between them. The aim of this study was, thus, to investigate the potential associations between meteorological factors and the incidence of AF. Methods The South Korean government provides open access to national health insurance and weather data for its citizens; the data was available from January 2010 to July 2022. The national health insurance data includes the monthly number of patients diagnosed with a specific condition, reflecting the incidence and prevalence of the condition. Pearson correlation analyses were performed using the statistical analysis software, SAS® OnDemand for Academics (SAS Institute Inc., Cary, North Carolina, United States), to examine the association between each month's national average climate data and the number of patients diagnosed with AF. Results The number of patients diagnosed with AF in the total population showed a statistically significant correlation only with average wind speed (correlation coefficient (r)=-0.42, 95%CI -0.55 to -0.28, p<0.001) and sunshine duration (r=0.27, 95%CI 0.12 to 0.41, p<0.001). Among females aged 20-24 years, there was a statistically significant association with other variables, including average temperature, precipitation, humidity, and atmospheric pressure (p<0.05). Diurnal temperature variation showed inconsistent associations across different age and sex groups. Conclusion The number of patients diagnosed with AF is negatively correlated with average wind speed and positively correlated with sunshine duration in the general population, particularly among the elderly. There was no significant association between the number of patients diagnosed with AF and average temperature, precipitation, or humidity, except for females aged 20-24 years, who exhibited a significant association with these variables. However, it is important to note that these correlations do not establish causality.

Development of Pinaceae and Cupressaceae Essential Oils from Forest Waste in South Korea.

The growing awareness of environmental issues has garnered increasing interest in the use of waste material in a wide variety of applications. From this viewpoint, developing essential oils from forest waste can bring new cost opportunities for the effective and sustainable management of unused forestry biomass. However, better knowledge of the production, chemical constituents, and application of essential oils is necessary. Among the species considered to be of interest from the point of view of their essential oils and forest biomass, Pinaceae and Cupressaceae were selected in this study as potential candidates for commercial essential oils based on previous studies. This current study focuses on investigating Pinaceae (Larix kaempferi, Pinus densiflora, and Pinus koraiensis) and Cupressaceae (Chamaecyparis obtusa and Chamaecyparis pisifera) essential oils extracted from various parts from the perspective of their bioactive compounds and potential applications. This is followed by an overview of the essential oils industry in South Korea, with particular attention being paid to utilising unused forest biomass. Therefore, this is a comprehensive review suggesting that Pinaceae and Cupressaceae essential oils extracted from various parts of forest waste could be utilised in various industries, adding value to the aspect of sustainable industry. Furthermore, our study contributes towards capturing the value of forest resources through the utilisation of native essential oils in South Korea.

Synergistic Effect of Calcination and Sintering on the Reduction of Grain Boundary Resistance of LATP Solid Electrolyte.

The NASICON-type Li1.4Al0.4Ti1.6(PO4)3 (LATP) solid electrolyte is a promising candidate for next-generation lithium-ion batteries due to its high stability in air and moisture, as well as high bulk ion conductivity. However, the grain boundary resistance of LATP limits its overall ionic conductivity, which remains a major obstacle to the commercialization of all-solid-state batteries. In this study, we made efforts to solve the problem by promoting the minimization of voids and the formation of well-defined grain boundaries by controlling the temperature of two heat treatments during the synthesis process. The crystallization temperature was confirmed through thermogravimetric analysis/DTA analysis, and the degree of crystallization was confirmed using XRD analysis. The formation of grain boundaries and the presence of voids were evaluated by cross-sectional SEM images after sintering. After sintering, the LA_900 °C sample, characterized by a high degree of crystallization and well-formed grain boundaries without voids, demonstrated a low bulk and grain boundary resistance, which was confirmed by electrochemical impedance spectroscopy analysis. The result was an ionic conductivity of 1.72 × 10-4 S/cm. These results provide valuable insights into the facile synthesis of LATP.

Development of Native Essential Oils from Forestry Resources in South Korea.

South Korea's forests occupy approximately 70% of the mainland, therefore, there is considerable potential for waste coming from the forest. Extracting essential oils from underutilised biomass is an economic and sustainable method for the production of high-added-value products. These days, countries' ownership of domestic natural resources is becoming vital, so there is an urgent need for developing the essential oils from native plants. To increase the value of native essential oils in South Korea, the National Institute of Forest Science (NiFoS) established the to develop the native essential oils as well as develop more research infrastructure by sharing information on native essential oils and enhancing their value. We review the selected essential oils which are listed in the from the literature on major chemical constituents, biological activity, and potential uses of essential oils. Those utilising forest resources for commercial essential oil production need to consider the stable supply of plant material in terms of forest management and conservation. Therefore, Pinaceae (Larix kaempferi, Pinus densiflora, Pinus koraiensis) and Cupressaceae (Chamaecyparis obtusa and Chamaecyparis pisifera) could be potential candidates for commercial essential oil as their waste materials are easily obtained from the plantation after forest management. With their unique fragrance and the bioactive compounds in their oils, potential candidates can be utilised in various industry sectors.

The Effect of the Height of Coppicing and Harvest Season on the Yield and Quality of the Essential Oil of Kunzea ambigua.

Kunzea ambigua is a small shrub belonging to the Myrtaceae family and the leaves are steam-distilled to produce a therapeutically active essential oil. With production moving from wild-harvested to orchardised stands, there is a need for harvest management of kunzea oil. This study compared the regrowth, essential oil content and composition of kunzea plants after harvesting vegetative material to a depth of 0.2 m above ground level (shallow-cut), relative to plants cut to a depth of 0.1 m above ground level (deep-cut) over the 2018/2019 growing season. Increased vegetative biomass accounted for the increased oil yield and was caused by consistently higher growth rates of 50 to 60% across all seasons in shallow-cut crops relative to those subject to deep-cut. Total soluble sugar concentrations were higher in the leaves and lower in the roots of deep-cut treated plants compared to the other treatments, indicating defoliated K. ambigua responds by mobilising sugars into above-ground biomass. The overall essential oil content of leaves was constant regardless of season, though the oil yield for shallow-cut was 1.9-fold higher at 11.79 ± 0.23 g/m2 compared to deep-cut (6.24 ± 0.18 g/m2). An interactive effect of harvest intensity with season was recorded for all major components except for a non-significant effect of season on terpinen-4-ol. Bicyclogermacrene and α-pinene were elevated in both shallow- and deep-cut treatments relative to control (un-cut) in spring, possibly due to the plant defense response after de-foliation. The highest percentage of bioactive compounds (1,8-cineole and viridiflorol) were present in autumn. Therefore, the recovery of biomass post-harvest is optimised by shallow-cut harvests, and the profile of kunzea oil can be manipulated to elevate levels of specific bioactive components by selecting to crop in autumn/spring.

Small Interfering RNA-Mediated Suppression of Fas Modulate Apoptosis and Proliferation in Rat Intervertebral Disc Cells.

STUDY DESIGN: In vitro cell culture model. PURPOSE: To investigate the effect of small interfering RNA (siRNA) on Fas expression, apoptosis, and proliferation in serum-deprived rat disc cells. OVERVIEW OF LITERATURE: Synthetic siRNA can trigger an RNA interference (RNAi) response in mammalian cells and precipitate the inhibition of specific gene expression. However, the potential utility of siRNA technology in downregulation of specific genes associated with disc cell apoptosis remains unclear. METHODS: Rat disc cells were isolated and cultured in the presence of either 10% fetal bovine serum (FBS) (normal control) or 0% FBS (serum deprivation to induce apoptosis) for 48 hours. Fas expression, apoptosis, and proliferation were determined. Additionally, siRNA oligonucleotides against Fas (Fas siRNA) were transfected into rat disc cells to suppress Fas expression. Changes in Fas expression were assessed by reverse transcription-polymerase chain reaction and semiquantitatively analyzed using densitometry. The effect of Fas siRNA on apoptosis and proliferation of rat disc cells were also determined. Negative siRNA and transfection agent alone (Mock) were used as controls. RESULTS: Serum deprivation increased apoptosis by 40.3% (p<0.001), decreased proliferation by 45.3% (p<0.001), and upregulated Fas expression. Additionally, Fas siRNA suppressed Fas expression in serum-deprived cultures, with 68.5% reduction at the mRNA level compared to the control cultures (p<0.001). Finally, Fas siRNA-mediated suppression of Fas expression significantly inhibited apoptosis by 9.3% and increased proliferation by 21% in serum-deprived cultures (p<0.05 for both). CONCLUSIONS: The observed dual positive effect of Fas siRNA might be a powerful therapeutic approach for disc degeneration by suppression of harmful gene expression.

Cryptococcal Osteomyelitis of the First Metatarsal Head in an Immunocompetent Patient.

Most fungal infections primarily occur in immunocompromised patients. We describe a case of osteomyelitis involving the first metatarsal head due to Cryptococcus neoformans in a previously healthy immunocompetent patient. She was treated with surgical debridement combined with antifungal drug therapy for 6 months. At 5-year follow-up, she remained symptom free with full range of motion of the first metatarsophalangeal joint. Fungal osteomyelitis should be considered as a possible cause in osteolytic lesions in the metatarsal bone.

Level of surgical experience is associated with change in hip center of rotation following cementless total hip arthroplasty: A radiographic assessment.

OBJECTIVES: After total hip arthroplasty (THA), restoration of hip center of rotation (COR) is essential to ensure stability of the prosthetic hip and longevity of the prosthesis. Our aim was to determine whether, and how, the COR changed postoperatively compared to the native COR following implantation of a cementless acetabular component in anatomical position and to compare the accuracy of cup placement between two surgeons with different levels of surgical experience. MATERIALS AND METHODS: We evaluated 145 patients (145 hips) who underwent unilateral primary THA, who had no distorted acetabulum on the affected hip and a normal contralateral hip. Hip reconstruction was radiologically and clinically assessed at a minimum 2-year follow-up. Perioperative change in COR, initial cup position, offset, leg-length discrepancy (LLD), radiographic cup orientation, Harris Hip Score (HHS), component loosening, and dislocations were compared between the highly experienced surgeon and less-experienced surgeon groups. RESULTS: The COR was significantly displaced in the superior and medial directions postoperatively. Significant differences were identified in the vertical COR change, initial cup position, LLD, cup inclination, and cups within safe zones, but not in the horizontal COR change, offset parameters, cup anteversion, or HHS. There were no radiographic evidence of component loosening in both groups, but three dislocations (7%) only in the group operated on by the less-experienced surgeon (p = 0.027). CONCLUSIONS: We found that the postoperative COR tended to be displaced in the superior and medial directions, and that the level of surgical experience strongly affected the accuracy and consistency of cup placement, particularly in COR position and cup inclination.

Ultrasonographic examination of plantar fasciitis: a comparison of patient positions during examination.

BACKGROUND: Musculoskeletal ultrasound is a non-invasive and low-cost modality for real-time visualisation of the plantar fascia. Ultrasound examination for plantar fasciitis is generally performed with the patient in a prone position, although the rational for using a prone position has not been validated. The aim of the study was to investigate if ultrasound examination in a supine position, which is more comfortable than the prone position, is valid. METHODS: We conducted a prospective study of 30 participants with plantar fasciitis, 8 men (27 %) and 22 women (73 %), with a mean age of 53.9 ± 12.6 (range, 32 to 77) years, and an equal distribution of left and right feet. The plantar heel was divided into three portions for ultrasound examination: medial, central and lateral. Two measurements of plantar fascia thickness were obtained for each portion, with participants in 2 positions (supine and prone) and for 2 ankle postures (neutral and 15° of plantarflexion). Mean measurements of plantar fascia thickness were compared between the two positions (Wilcoxon signed rank tests for non-normally distributed data and paired t-tests for normally distributed data). Participants were asked to report their preferred position for examination, supine or prone. RESULTS: The measured thickness was comparable for both supine and prone positions, for both ankle postures, neutral and 15° of plantarflexion (p > 0.05). A specific self-reported preferred position was not identified. CONCLUSIONS: Ultrasound examination of plantar fasciitis can be performed in the supine position without any significant difference in measurement compared to examination in the conventional prone position. TRIAL REGISTRATION: The Catholic Medical Center Office of Human Research Protection Program (CMC-OHRP)/Institutional Review Board approved the current study (Approval No. KC12DISI0338), and all participants provided their written informed consent for participation and publication.