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Background: The purpose of this study was to investigate gender differences in gait parameters, muscle activation of the lower limbs, and metabolic energy cost during walking in olderadults. Methods: Twenty-four subjectswalked on a 10mlevelwalkway as self-selected speed while barefoot. A six-camera motion capture system was used to record the gait parameters.Wireless electromyography was used for the measurement of muscle activity. Next, the subjects were equipped with a mask connected to a computerized portable metabolic system. The subjects walked on a motor-driven treadmill in two different walking speeds. Results:Walking speed was significantly higher in older men than in women. Stride length was also significantly higher in older men than older women. Older men had significantly higher step lengths the right and left sides than did olderwomen. In the stance phase, muscle activation of the external oblique and erector spinae was significantly higher for older women than for older men. The absolute value of VO2 (ml/min) of older men was significantly higher at the self-selected speed and for the 30% increased speed than those of older women. Conclusion: These gender-related differences should be considered during gait training and rehabilitation in older adults. [ABSTRACT FROM AUTHOR]

North Korea has already begun the process of transition, the patterns of which will be determined by the elites' choice. System transition in North Korea may unfold in one of two ways: gradual transition, with the maintenance of the Suryong (supreme leader) system of communist power and acceptance of the market economy for the well-being of the people; or radical transition accompanied by sudden political change, which may lead to conflict between competitive elite groups before Kim Jong-un has time to solidify his hold on leadership. Which path will North Korea follow? In the era of Kim Jong-un, everything depends on the competition between the party elite and military elite. [ABSTRACT FROM AUTHOR]

In this paper, we propose a scheme for designing a tunable pixel layer based on a Ge2Sb2Te5 (GST) alloy thin film. We show that the phase change of GST can significantly affect the reflection characteristic when the GST film is embedded into a dielectric encapsulation layer. We investigate the appropriate positions of the GST film within the dielectric layer for high diffraction efficiency, and we prove that they are antinodes of Fabry-Perot resonance inside the dielectric layer. Using the proposed scheme, we can increase the diffraction efficiency by about ten times compared to a bare GST film pixel, and 80 times for the first-to-zeroth-order diffraction power ratio. We show that the proposed scheme can be designed alternatively for a broadband or wavelength-selective type by tuning the dielectric thickness, and we discuss a multiphase example with a double-stack structure. [ABSTRACT FROM AUTHOR]

A scheme for designing a tunable pixel layer based on a Ge2Sb2Te5 (GST) alloy thin film is proposed. It is shown that the phase-change of the GST can significantly change the reflection characteristic when the GST film is embedded into a dielectric encapsulation layer. The appropriate positions of the GST film within the dielectric layer for high-diffraction efficiency are investigated, which have been proven to be antinodes of Fabri-Perot (FP) resonance inside the dielectric layer. Using the proposed scheme, the diffraction efficiency can be increased by about ten-fold compared to a bare GST film pixel, and 80-fold for the first-to-zeroth order diffraction power ratio. Herein, we show that the proposed scheme can be designed alternatively for a broadband or wavelength-selective type by tuning the dielectric thickness, and discuss a multi-phase example with a double-stack structure. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the correlation between isometric muscle strength, gross motor function, and gait parameters in patients with spastic cerebral palsy and to find which muscle groups play an important role for gait pattern in a flexed knee gait. Materials and Methods: Twenty-four ambulatory patients (mean age, 10.0 years) with spastic cerebral palsy who were scheduled for single event multilevel surgery, including distal hamstring lengthening, were included. Preoperatively, peak isometric muscle strength was measured for the hip flexor, hip extensor, knee flexor, and knee extensor muscle groups using a handheld dynamometer, and three-dimensional (3D) gait analysis and gross motor function measure (GMFM) scoring were also performed. Correlations between peak isometric strength and GMFM, gait kinematics, and gait kinetics were analyzed. Results: Peak isometric muscle strength of all muscle groups was not related to the GMFM score and the gross motor function classification system level. Peak isometric strength of the hip extensor and knee extensor was significantly correlated with the mean pelvic tilt (r=-0.588, p=0.003 and r=-0.436, p=0.033) and maximum pelvic obliquity (r=-0.450, p=0.031 and r=-0.419, p=0.041). There were significant correlations between peak isometric strength of the knee extensor and peak knee extensor moment in early stance (r=0.467, p=0.021) and in terminal stance (r=0.416, p=0.043). Conclusion: There is no correlation between muscle strength and gross motor function. However, this study showed that muscle strength, especially of the extensor muscle group of the hip and knee joints, might play a critical role in gait by stabilizing pelvic motion and decreasing energy consumption in a flexed knee gait. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to evaluate the nationwide incidence and risk factors for symptomatic deep vein thrombosis (DVT) after major lower limb orthopedic surgeries. Materials and Methods: The Korean Health Insurance Review and Assessment Service database was used to retrospectively identify International Classification of Disease-10 codes for DVT and operation codes representing hip arthroplasty, knee arthroplasty, and hip fracture surgeries. The age- and gender-adjusted annual incidence of DVT, rates of major lower limb orthopedic surgeries, and the postoperative incidence of DVT according to the surgical procedure were assessed. Results: The age- and gender-adjusted annual incidence of DVT was 70.67 per 100000 persons/ year. Compared to patients aged <49 years, the relative risk of DVT was five times higher in patients aged 50?69 and 10 times higher in patients aged >70 years (p<0.001). Females showed a greater relative risk for DVT than males (1.08; p<0.001). The incidence of postoperative DVT, according to the type of surgery, was significantly greater for knee replacement arthroplasty than for other forms of surgery (p<0.002). The relative risk of postoperative DVT was higher in females in knee replacement arthroplasty (1.47) and hip fracture surgery (2.25) groups, although relatively lower in those who underwent hip replacement arthroplasty (0.97). Conclusion: Among major lower limb surgeries, advanced age, female gender, and undergoing a knee replacement arthroplasty were found to be risk factors for developing postoperative DVT. These findings further emphasize the need for orthopedic surgeons to consider the development of DVT after surgery in high-risk patients. [ABSTRACT FROM AUTHOR]

Purpose: Although previous studies have focused on risk factors for osteoarthritis, there is some debate on this issue. Furthermore, associated factors with arthritic symptom (arthralgia) have not been sufficiently investigated, despite its clinical importance in the management of osteoarthritis. This study was performed to examine the risk factors for osteoarthritis and the contributing factors to current arthritic pain in older adults. Materials and Methods: The Fourth Korean National Health and Nutrition Examination Surveys was conducted in 2009. Therein, 720 males and 1008 females aged 65 years and older were included. Comprehensive data on habitual, socioeconomic, medical, nutritional, and psychological factors were collected along with the presence of osteoarthritis and arthritic pain. After univariate analysis, binary logistic regression analysis was performed to identify risk factors for osteoarthritis and contributing factors to current arthritic pain. Results: Age (p=0.005), female gender (p<0.001), higher body mass index (BMI) (p<0.001), and osteoporosis (p<0.001) were significant risk factors for osteoarthritis, while higher education level (p=0.025) was a protective factor for osteoarthritis. Higher BMI (p=0.047), lack of weekly moderate intensity activity (p<0.001), and unfavorable subjective health status (p<0.001) were significant factors contributing to current arthritic pain among subjects with osteoarthritis. Both osteoarthritis and current arthritic pain adversely affected health related quality of life. Conclusion: Higher BMI, lack of weekly moderate intensity activity, and unfavorable subjective health status were significant factors contributing to current arthritic pain. More attention needs to be paid to psychiatric effects on osteoarthritis and joint related pain. [ABSTRACT FROM AUTHOR]

Purpose: To determine the 1-year survival rate, 1-year amputation-free survival rate and the risk factors of amputation for patients with diabetic foot ulcers. Materials and Methods: One hundred seventy-three patients with diabetic foot ulcers were included in our study. Mean patient age was 67.5 (range, 29 to 87, SD ±11.4) years. 74% of the patients were male. Time from study entry to amputation and time to death were evaluated separately as censored event times by Kaplan-Meier curves and log-rank tests. A multivariate Cox proportional hazards regression analysis was carried out for determining the risk factors of amputation. Results: The survival rate and amputation-free survival rate were 96.5% (n=167), 65.9% (n=114), respectively, over one year study period. Severity of ulcer was the strongest significant risk factor of amputation [hazard ratio (HR): 7.99; confidence interval (CI): 3.12 to 20.47]. Peripheral artery disease was also independent risk factor of amputation (HR: 2.64; CI: 1.52 to 4.59). Conclusion: In assessing the prognosis of diabetic foot ulcers, clinicians should consider the severity of ulcer and presence of peripheral artery disease. Our study provides important insights into clinical practice and supplementary information for both physicians and patients. [ABSTRACT FROM AUTHOR]

Background: This study was performed to investigate anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in patients with residual poliomyelitis and to investigate whether the severity of preoperative equinus deformity affected the occurrence of symptomatic anterior impingement. Methods: Twenty-seven consecutive patients (mean age, 43.8 ± 9.4 years) with residual poliomyelitis who underwent tendo-Achilles lengthening for equinus foot deformity were included. On lateral foot-ankle weight-bearing radiographs, the tibiocalcaneal angle, plantigrade angle, and McDermott grade were measured and the presence of anterior blocking spur was evaluated. Results: Eleven patients (40.7%) had anterior ankle impingement on radiographic findings preoperatively and 24 patients (88.9%) at latest follow-up. There was a significant difference in McDermott grade between preoperative and latest follow-up (P < .001). There were significant differences in tibiocalcaneal angle and plantigrade angle between the patients with anterior ankle pain and without anterior ankle pain (P = .006 and .011, respectively) and between the patients with anterior blocking spur and without anterior blocking spur (P = .005 and .010, respectively). Conclusions: Most patients with residual poliomyelitis had anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity, and the presence of symptomatic anterior ankle impingement was significantly associated with the severity of the equinus deformity. Therefore, for residual poliomyelitis patients with severe long-standing equinus deformity, surgeons should consider the possibility of a subsequent anterior procedure for anterior impingement after tendo-Achilles lengthening. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

The article reports on an increase which has been seen in the use of ankle arthroscopy and discuses challenges which orthopedic surgeons encounter while performing ankle arthroscopy. A discussion of a technique which surgeons can use when performing a three-portal ankle arthroscopy in a patient in a prone position with the patient's ankle suspended is presented.

The article provides information on a study which examined the clinical and radiological results with a modified technique of osteotomy. The results of the study are highlighted, which prove that a modified technique of distal metatarsal osteotomy is stable and accurate in terms of correcting the deformity in the 77 cases under study. An end-to-end contact of the dorsal metatarsal cortex was also used to maintain the stability and length.