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Purpose: The purpose of this study was to assess the clinical and radiographic results of a total hip arthroplasty with the double tapered Mallory-Head system.Methods: The clinical and radiographic results of a consecutive series of 81 total hip replacements in 75 patients were reviewed 10-15 years (average 11.4 years) postoperatively. The patients' underlying conditions were avascular necrosis in 46 hips (57 %), osteoarthritis in 12 hips (15 %), RA in nine hips (11 %), and others. Clinical results were evaluated based on the modified Harris hip score and modified Merle d'Aubigné-Postel score. A radiographic analysis was performed.Results: The average modified Harris hip score improved from a preoperative score of 56 points to a postoperative 92 points. The average modified Merle d'Aubigné-Postel score was 15 points at the latest follow up, and 55 hips (68 %) were classified as the clinical grades of excellent or good results. One acetabular component was revised because of loosening, and one was revised for recurrent dislocation.Conclusion: The clinical and radiological evaluations of the total hip replacements using the Mallory-Head system showed good results. [ABSTRACT FROM AUTHOR]

Background: Cytosine arabinoside-based chemotherapy coupled with anthracycline is currently the first-line treatment for acute myeloid leukaemia (AML), but diverse responses to the regimen constitute obstacles to successful treatment. Therefore, outcome prediction to chemotherapy at diagnosis is believed to be a critical consideration.Methods: The mRNA expression of 12 genes closely involved in the actions of cytosine arabinoside and anthracycline was evaluated by real-time reverse transcriptase PCR (RT-PCR), in 54 diagnostic bone marrow specimens of M2-subtype AML.Results: Low expression levels of ribonucleotide reductase M2 (RRM2) and high expression levels of topoisomerase 2 beta (TOP2B) were correlated with longer survival in a univariate analysis. Another interesting finding is that high ratios of TOP2B/RRM2 and TOP2B/TOP2 alpha (TOP2A) in a combined analysis were also shown to have a prognostic impact for longer survival with improved accuracy. Among the four markers, when adjusted for the influence of other clinical factors in multivariate analysis, the TOP2B/TOP2A ratio was significantly correlated with treatment outcomes; patients with high ratios trended toward longer disease-free survival (HR, 0.24; P=0.002) and overall survival (HR, 0.29; P=0.005).Conclusion: Genes with distinct expression profiles such as TOP2B/TOP2A expression ratio at diagnosis can be employed for outcome prediction after the treatment with standard regimens in AML patients with M2 subtype. [ABSTRACT FROM AUTHOR]

Purpose: Bacteremia is an important clinical condition in febrile neutropenia that can cause clinical failure of antimicrobial therapy. The purpose of this study was to investigate the clinical factors predictive of bacteremia in low-risk febrile neutropenia at initial patient evaluation.Methods: We performed a retrospective cohort study in a university hospital in Seoul, Korea, between May 1995 and May 2007. Patients who met the criteria of low-risk febrile neutropenia at the time of visit to emergency department after anti-cancer chemotherapy were included in the analysis.Results: During the study period, 102 episodes of bacteremia were documented among the 993 episodes of low-risk febrile neutropenia. Single gram-negative bacteremia was most frequent. In multivariate regression analysis, initial body temperature ≥39°C, initial hypotension, presence of clinical sites of infection, presence of central venous catheter, initial absolute neutrophil count <50/mm(3), and the CRP ≥10 mg/dL were statistically significant predictors for bacteremia. A scoring system using these variables was derived and the likelihood of bacteremia was well correlated with the score points with AUC under ROC curve of 0.785. Patients with low score points had low rate of bacteremia, thus, would be candidates for outpatient-based or oral antibiotic therapy.Conclusions: We identified major clinical factors that can predict bacteremia in low-risk febrile neutropenia. [ABSTRACT FROM AUTHOR]

Objective: The number of people with metabolic syndrome is increasing worldwide, and changes in socioenvironmental factors contribute to this increase. Therefore, investigation of changes in metabolic syndrome and its components in South Korea, where rapid socioenvironmental changes have occurred in recent years, would be foundational in setting up an effective strategy for reducing this increasing trend.Research Design and Methods: We compared the prevalence and pattern of metabolic syndrome among participants in the Korean National Health and Nutrition Examination Surveys for 1998, 2001, 2005, and 2007. In each survey, stratified, multistage, probability-sampling designs and weighting adjustments were conducted to represent the entire Korean population. The revised National Cholesterol Education Program criteria were used as the definition of metabolic syndrome. All biochemical parameters were measured in a central laboratory.Results: A total of 6,907 (mean ± SE age 45.0 ± 0.2 years), 4,536 (45.5 ± 0.2), 5,373 (47.1 ± 0.2), and 2,890 (49.9 ± 0.3) Koreans over 20 years of age have participated in the studies in 1998, 2001, 2005, and 2007, respectively. The age-adjusted prevalence of metabolic syndrome increased significantly from 24.9% in 1998, 29.2% in 2001, and 30.4% in 2005 to 31.3% in 2007. Among the five components, the level of low HDL cholesterol increased the most, by 13.8% over the 10 years. Abdominal obesity and hypertriglyceridemia followed, with 8.7 and 4.9% increases, respectively.Conclusions: Because dyslipidemia and abdominal obesity were major factors in increasing the prevalence of metabolic syndrome in Koreans for the past 10 years, lifestyle interventions should be conducted at the national level to reduce the burden and consequences of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective review. Objective: To analyze the changes of fusion process and radiological parameters during the postoperative period after anterior cervical discectomy and fusion with cage and plate construct (ACDF-CPC). Summary Of Background Data: Because of its well-reported efficacy, plate augmentation has been performed to avoid the various complications associated with the cage-alone procedure. The radiological changes at the fusion site after ACDF-CPC have yet to be fully explored. Methods: Seventy-eight patients (122 fusion sites) who underwent ACDF-CPC were observed at 6 weeks and at 3, 6, 12, and 24 months postoperatively. Fusion status was classified into 3 categories: Type I (pseudoarthrosis), Type II (borderline), and Type III (fusion). Changes at the fusion site were described through radiological parameters at each follow-up time point. In addition, the ability of the radiological parameters to predict fusion rates was analyzed. Results: The fusion process after ACDF-CPC progresses slower when compared with the standard procedure utilizing autograft. Fusion between bone graft chips begins at 6 weeks post surgery. At 3 months, initial bone bridging between graft and host bones begins to form. Anterior spur formation occurs at 3 to 6 months, and "kissing" lesions form at 6 to 12 months. Bony incorporation is achieved at 1 to 2 years. Persistent or newly developed Type I at the 1-year follow-up exhibited significantly higher pseudoarthrosis rates in comparison with rates determined at the 3- and 6-month time points. Among 29 subsidence cases, 9 of the 16 (56.3%) cases that exhibited anterior spur formation eventually achieved fusion, whereas 2 of the 13 (15.4%) cases that did not exhibit anterior spur formation eventually achieved fusion. In cases that demonstrated anterior spur formation, the fusion rate was significantly higher than in cases without it (P = 0.016). Conclusion: The fusion process after ACDF-CPC progresses slower than the standard procedure utilizing autograft. Cage subsidence of greater than 2 mm, a radiolucent defect, or a halo sign are poor prognostic signs indicating a high probability for pseudoarthrosis when detected radiographically after 1 year postoperatively. The anterior spur formation sign and "kissing" lesion, on the contrary, represent signs for eventual successful fusion. [ABSTRACT FROM AUTHOR]

This study was performed to evaluate the impact of extended-spectrum β-lactamase (ESBL)-producing bacteremia on outcome in patients with hematologic malignancy. We collected and analyzed data on 156 hematologic malignancy patients with Escherichia coli or Klebsiella pneumoniae bacteremia from the database of nationwide surveillance studies for bacteremia. Thirty-seven of the 156 patients (23.7%) harbored ESBL-producing bacteremia. No significant differences in underlying diseases were found in either group. The multivariate analysis showed that significant factors associated with ESBL-producing bacteremia were ICU care (OR = 7.03, 95% CI = 1.79-27.6) and nosocomial acquisition (OR = 5.66, 95% CI = 1.60-20.23). There was an association between prior receipt of cephalosporins and ESBL-producing bacteremia, although this association was not statistically significant (OR = 2.27, 95% CI = 0.99-5.23). The overall 30-day mortality rate of the study population was 20.4% (29/142), and the 30-day mortality rate for the ESBL group was significantly higher than that for the non-ESBL group (44.8% vs. 14.2%, P < 0.001). Multivariate analysis showed that ESBL-producing bacteremia was the most important risk factor associated with 30-day mortality (OR, 5.64; 95% CI, 1.91-16.67), along with ICU care (OR = 4.35, 95% CI = 1.16-16.26) and higher Pitt bacteremia score (per 1-point increment) (OR = 1.50, 95% CI = 1.18-1.92). In conclusion, ESBL-producing bacteremia was the most important risk factor associated with 30-day mortality in patients with hematologic malignancy, along with ICU care and higher Pitt bacteremia score. Our data suggest that determining the optimal empiric antimicrobial therapy in patients with hematologic malignancy is now becoming a challenge for clinicians in the era of multidrug-resistant Gram-negative bacilli. [ABSTRACT FROM AUTHOR]

We report a rare case of radial tears in the roots of the posterior horns of both the medial and lateral menisci associated with a chronic anterior cruciate ligament tear. Treatment included an arthroscopic pullout suture combined with anterior cruciate ligament reconstruction. At the 3-year postoperative follow-up, a second-look arthroscopic examination showed the posterior horns of both menisci to be well healed on the tibia. Manual knee laxity tests were negative and no side-to-side difference was detected by a KT-1000 arthrometer. The patient was able to perform outdoor activities without residual symptoms. [ABSTRACT FROM AUTHOR]

We investigated the inhibitory pathways that mediate the antinociceptive effects of heterotopic electro-acupuncture (EA) on formalin injection-induced pain in rats. EA (2 ms, 10 Hz, 3 mA) was delivered to heterotopic acupoints HT(7) and PC(7) for 30 min; this was followed immediately by subcutaneous injection of formalin into the left hind paw of rats. Naltrexone (10 mg/kg, i.p.), an opioid receptor antagonist, was administered to evaluate the involvement of endogenous opioids. The dorsolateral funiculus (DLF), which is a descending pathway that inhibits pain, was transected at the ipsilateral T10-11 level of the thoracic spinal cord. EA inhibited behavioral responses to formalin injection-induced pain and prevented the pain-induced increase in cFos expression in the lumbar spinal cord. Pretreatment with naltrexone did not inhibit the antinociceptive effects of EA on formalin injection-induced pain. Transection of the DLF ipsilateral to the acupuncture site eliminated the antinociceptive effects of EA. These results suggest that the antinociceptive effects of heterotopic EA are mediated by the DLF and not by endogenous opioids. [ABSTRACT FROM AUTHOR]