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Background: Although ABO-incompatible liver transplantation (ABOi LT) has undergone remarkable progress, the prognostic factors are poorly understood. This study aimed to elucidate the preoperative factors affecting graft survival after ABOi LT., Methods: Patients who underwent ABOi LT between January 2012 and December 2020 at a single institution in South Korea were retrospectively reviewed. A total of 146 recipients, including 34 patients with graft loss, were analyzed., Results: In the multivariate Cox proportional hazard model, recipient age (≥55 y; hazard ratio, 2.47; 95% confidence interval, 1.18-5.19; P = 0.017) and donor ABO type (donor A, hazard ratio, 3.12; 95% confidence interval, 1.33-7.33; P = 0.009) were significantly associated with an increased risk of graft loss. The most common cause of graft loss was recipient death due to bacterial infection (15/34, 44.1%). Both recipient age and donor ABO type were associated with an increased risk of recipient death due to bacterial infections. The incidence of complications after ABOi LT, including antibody-mediated rejection and diffuse intrahepatic biliary stricture, did not differ according to recipient age or donor ABO type., Conclusions: These findings suggest that recipient age and donor ABO type should be considered when preparing for ABOi LT. Careful monitoring and care after transplantation are required for recipients with preoperative risk factors., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Abnormal myocardial metabolism is a common pathophysiological process underlying ischemic heart disease and heart failure (HF). Trimetazidine is an antianginal agent with a unique mechanism of action that regulates myocardial energy metabolism and might have a beneficial effect in preventing HF in patients undergoing myocardial revascularization. We aimed to evaluate the potential benefit of trimetazidine in preventing incident hospitalization for HF after myocardial revascularization. Using the common data model, we identified patients without prior HF undergoing myocardial revascularization from 8 hospital databases in Korea. To compare clinical outcomes using trimetazidine, database-level hazard ratios (HRs) were estimated using large-scale propensity score matching for each database and pooled using a random-effects model. The primary outcome was incident hospitalization for HF. The secondary outcome of interest was major adverse cardiac events (MACEs). After propensity score matching, 6724 and 11,211 patients were allocated to trimetazidine new-users and nonusers, respectively. There was no significant difference in the incidence of hospitalization for HF between the 2 groups (HR: 1.08, 95% confidence interval [CI], 0.88-1.31; P = 0.46). The risk of MACE also did not differ between the 2 groups (HR: 1.07, 95% CI, 0.98-1.16; P = 0.15). In conclusion, the use of trimetazidine did not reduce the risk of hospitalization for HF or MACE in patients undergoing myocardial revascularization. Therefore, the role of trimetazidine in contemporary clinical practice cannot be expanded beyond its current role as an add-on treatment for symptomatic angina., Competing Interests: The authors reports no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Importance: Appropriate decision-making is critical for transfusions to prevent unnecessary adverse outcomes; however, transfusion in the emergency department (ED) can only be decided based on sparse evidence in a limited time window., Objectives: This study aimed to identify factors associated with appropriate red blood cell (RBC) transfusion in the ED by analyzing retrospective data of patients who received transfusions at a single center., Outcome Measures and Analysis: This study analyzed associations between transfusion appropriateness and sex, age, initial vital signs, an ED triage score [the Korean Triage and Acuity Scale (KTAS)], the length of stay, and the hemoglobin (Hb) concentration., Main Results: Of 10 490 transfusions, 10 109 were deemed appropriate, and 381 were considered inappropriate. A younger age ( P  < 0.001) and a KTAS level of 3-5 ( P  = 0.028) were associated with inappropriate transfusions, after adjusting for O 2 saturation and the Hb level., Conclusions: In this single-center retrospective study, younger age and higher ED triage scores were associated with the appropriateness of RBC transfusions., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

We aimed to investigate the progression of patella alta (PA) in patients with cerebral palsy (CP) using the Koshino-Sugimoto (KS) index and assess associated risk factors. Participants in our retrospective study met the following inclusion criteria: patients with CP who visited our institute from May 2003 to December 2019, were ≤18 years of age, were followed up for >2 years and had at least two lateral knee radiographs. KS indices of both knee radiographs were measured for each patient. A linear mixed model was implemented. Our participants included 222 CP patients. KS index values were measured via 652 knee radiographs. Reference values of the KS index for those between 4 and 18 years of age were determined according to Gross Motor Function Classification System (GMFCS) levels. In all GMFCS levels, the KS index decreased with patients' ages (P < 0.0001). In groups where the KS index increased, GMFCS levels IV (P = 0.0045) and V (P = 0.0040) were statistically significant. Change in the KS index values indicates that PA improves as patients age within all GMFCS levels. However, in patients with GMFCS levels of IV and V, progressive PA is expected., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Identifying risk factors associated with developmental dysplasia of the hip (DDH) is essential for early diagnosis and treatment. Breech presentation is a major DDH risk factor, possibly because of crowding of the fetus within the uterus. In multifetal pregnancy, fetuses are generally smaller than singletons, which may obscure the effect of breech presentation on fetal hips. Only a few studies have investigated the occurrence of DDH in multifetal pregnancies. In this study, we aimed to evaluate whether the breech presentation is a major risk factor of DDH in twin pregnancies., Methods: This retrospective study included 491 consecutive live births (after 23+0 weeks gestation) delivered through cesarean section with at least 1 baby with noncephalic presentation in single or twin pregnancies from April 2013 to October 2018. We analyzed the incidence of DDH and its associated factors, including sex, breech, and multifetal pregnancy, with a generalized linear mixed model., Results: The incidence of DDH was 12.5% in singleton with breech presentation, 9.8% in twin-breech presentation, and 0.7% in twin-cephalic presentation. Multivariate analysis showed that singleton-breech presentation (P=0.003), twin-breech presentation (P=0.003), and female sex (P=0.008) were independent risk factors for DDH., Conclusion: Breech presentation is an independent risk factor for DDH in twin pregnancies, although twin pregnancy itself is not an independent risk factor for DDH., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: There has been no study evaluating the change of limb alignment for patients with genu valgum. The purpose of this study was to investigate the change of limb alignments in children and adolescents with idiopathic genu valgum through evaluating distal femur, proximal tibia, and knee joint line.Consecutive children and adolescents, under the age of 18, with genu valgum were included. Mechanical tibiofemoral angle, mechanical lateral distal femoral angle, mechanical medial proximal tibia angle, and joint line convergence angle were measured. The rate of changes for each radiographic measurement were analyzed using a linear mixed model.A total of 1539 teleroentgenograms from 518 limbs of 273 individuals were included in this study. Linear mixed model showed that the change of limb alignment was significantly associated with age, but not associated with gender and laterality. The mechanical tibiofemoral angle was most valgus initially, decreasing until reaching its lowest value of 2.8° at 10 years old. The mechanical lateral distal femoral angle decreases from initial neutral alignment and increases in valgus continuously. The mechanical medial proximal tibia angle decreases from initial valgus and progresses to be neutral at around the age of 10. The joint line convergence angle decreases sharply from initial valgus alignment to 0° at the age of 5.Valgus alignment in children with idiopathic genu valgum decreases until approximately the age of 10. In younger children, the tibia and joint line contribute most to overall valgus alignment; in older children, the femur contributes the most. Based on our results, we recommend monitoring patient limb alignment until it stabilizes around the age of 10, and then carefully planning and performing corrective surgery with complete consideration of the changing bony alignment., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: This study investigated the effect of screw configuration on the rate of correction of coronal angular deformity of the knee joint in children who underwent guided growth using the tension-band plate., Methods: Consecutive patients (76 patients with 154 physes; mean age: 11.8±2.2 y) who underwent guided growth using the tension-band plate for coronal angular deformity (genu varum or genu valgum) were included. The mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and screw angle were measured from the teleroentgenograms of preoperative and postoperative periodic follow-up visits., Results: The mean initial screw angle and the mean rate of correction were 16.7±10.5 degrees and 6.5±5.3 degrees per year, respectively. The rate of correction was significantly affected by age at surgery, sex, physis treated, severity of deformity, and rate of change in screw angle (all P<0.001). However, the initial screw angle and type of deformity did not affect the rate of correction. The rate of correction per year was 3.6 degrees higher in boys than in girls and 2.8 degrees higher in the distal femur than in the proximal tibia. A 1 degree increase in the rate of change in screw angle was associated with a 0.5 degree increase in the correction rate. Screw angle significantly increased with follow-up duration (P<0.001) and the change in screw angle was significantly affected by age, sex, and physis treated (all P<0.001)., Conclusions: This study demonstrated that screw configuration did not affect the correction rate of coronal angular deformity for guided growth using the tension-band plate. Therefore, surgeons only need to insert the screws according to anatomic restriction, not considering the screw configuration when using the tension-band plate for guided growth in children., Level of Evidence: Prognostic level III., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Although papillary thyroid cancers are known to have a relatively low risk of recurrence, several factors are associated with a higher risk of recurrence, such as extrathyroidal extension, nodal metastasis, and BRAF gene mutation. However, predicting disease recurrence and prognosis in patients undergoing thyroidectomy is clinically difficult. To detect new algorithms that predict recurrence, inductive logic programming was used in this study.A total of 785 thyroid cancer patients who underwent bilateral total thyroidectomy and were treated with radioiodine were selected for our study. Of those, 624 (79.5%) cases were used to create algorithms that would detect recurrence. Furthermore, 161 (20.5%) cases were analyzed to validate the created rules. DELMIA Process Rules Discovery was used to conduct the analysis.Of the 624 cases, 43 (6.9%) cases experienced recurrence. Three rules that could predict recurrence were identified, with postoperative thyroglobulin level being the most powerful variable that correlated with recurrence. The rules identified in our study, when applied to the 161 cases for validation, were able to predict 71.4% (10 of 14) of the recurrences.Our study highlights that inductive logic programming could have a useful application in predicting recurrence among thyroid patients., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study aims to investigate the real indications for low-dose tamsulosin monotherapy for initial treatment.A cross-sectional study was conducted in a total of 1643 patients with lower urinary tract symptoms (LUTS) and with initial low-dose tamsulosin. Initial pretreatment data including the International Prostate Symptoms Score (IPSS), prostate volume, and uroflowmetry data were reviewed. After 8 weeks of treatment, post-treatment IPSS and satisfaction was assessed. Logistic regression analysis was conducted to investigate the pretreatment factors influencing post-treatment satisfaction.Overall satisfaction rate with low-dose tamsulosin as an initial treatment medication was 88.7%. Multivariate analysis revealed that symptom durations, IPSS voiding score, IPSS storage score, and quality of life (QoL) were determinant factors for patient satisfaction. ROC analysis revealed that a urinary score > 10 and symptom duration > 3 years showed satisfaction with a sensitivity of 85.8% and 90.6%, respectively, and specificity of 43.5% and 39.8%, respectively. Whereas, ROC analysis revealed that a storage score > 5 and QoL > 3 showed nonsatisfaction with sensitivity of 84.2% and 39.5%, respectively, and specificity of 43.5% and 45.7%, respectively. Multivariate regression analysis demonstrated that voiding score and storage score had a significant relationship with QoL (unstandardized coefficients: 0.073, 0.145, respectively; P-value: < .001, < .001, respectively).The patient with higher storage scores and higher QoL before treatment could have a higher change of non-satisfaction. Combining treatment with anticholinergics could be considered in these patients.

Calcaneal lengthening (CL) is one of the treatment options for planovalgus deformity in patients with cerebral palsy (CP). However, its indication still needs to be clarified according to the functional status of CP. The aim of this study was to investigate the radiographic outcome after CL in patients with CP and to evaluate the risk factors causing undercorrection of planovalgus deformities. We included consecutive patients with CP who underwent CL for planovalgus deformity, were followed for more than 2 years, and had preoperative and postoperative weight-bearing anteroposterior (AP) and lateral foot radiographs. Six radiographic indices were used to assess the radiographic outcome. The patient age, sex, and Gross Motor Function Classification System (GMFCS) level were evaluated as possible risk factors, and we controlled for the interaction of potentially confounding variables using multivariate analysis. A total of 44 (77 feet) patients were included in this study. The mean age of the patients at the time of surgery was 10.5±4.0 years and the mean follow-up was 5.1±2.2 years. Patients with GMFCS III/IV achieved less correction than those with GMFCS I/II in the AP talus-first metatarsal angle (P=0.001), lateral talocalcaneal angle (P=0.028), and the lateral talus-first metatarsal angle (P<0.001). The rate of undercorrection in the GMFCS III/IV group was 1.6 times higher than that in the GMFCS I/II group in the AP talus-first metatarsal angle (odds ratios: 1.6; 95% confidence interval: 1.2-2.0; P<0.001) and 1.6 times higher in the lateral talus-first metatarsal angle (odds ratios: 1.6; 95% confidence interval: 1.3-1.9; P<0.001). In GMFCS I/II patients with CP, we found CL to be an effective procedure for the correction of planovalgus foot deformities. However, in GMFCS III/IV patients with planovalgus deformities, CL appears to be insufficient on the basis of the high rate of undercorrection in these patients. For patients with GMFCS level III/IV, additional or alternative procedures should be considered to correct the deformity and maintain the correction achieved., Level of Evidence: Level III, therapeutic study.

Proximal femoral osteotomy has been used in cerebral palsy, Perthes disease, hip dysplasia, idiopathic femoral anteversion, and various hip diseases in children and adolescents. Conventionally, a blade plate (BP) has been used. However, the pediatric locking compression plate (LCP) has recently been applied widely. We compared the hardware-related complications of the BP and the LCP as well as the factors influencing these complications in patients who have undergone a proximal femoral osteotomy in children and adolescents. We enrolled consecutive patients aged less than or equal to 20 years who had undergone proximal femoral osteotomy with BP or LCP between May 2003 and December 2014, and who were followed up until 6 months after hardware removal. Following consensus building, hardware-related complications were identified from the patients' medical records and hip radiographs. Patient age, sex, type of plate, and Gross Motor Function Classification System (GMFCS) level in cerebral palsy patients were evaluated as possible risk factors, and a generalized estimating equation was used to assess the risk factors for hardware-related complications. A total of 417 hips from 251 patients were finally included in this study. Seven losses of fixation around the plate (five patients, 3.0%) occurred in the BP, three implant-related fractures (three patients, 3.6%) occurred in the LCP, and there was no significant difference (P=0.74). All hardware-related complications occurred in cerebral palsy patients, and the implant-related fractures occurred in patients with GMFCS IV/V. The risk of complications increased with age (P=0.002). The risk of loss of fixation around the BP is a well-known complication. However, LCP is not without hardware-related complications. The LCP provides strong stability of fixation. However, it is speculated that the LCP is related to implant-related fractures because of the stress shielding effect. Therefore, care should be exercised when using a locking plate in patients with osteoporosis, such as cerebral palsy with GMFCS IV/V., Level of Evidence: Therapeutic Level III.

This study investigated the radiologic results of a stepwise surgical approach to equinocavovarus in 24 patients with cerebral palsy and determined the extent to which each procedure affected radiographic parameters using a linear mixed model. The anteroposterior talus-first metatarsal and anteroposterior talonavicular coverage angles were improved. The calcaneal pitch angle, tibiocalcaneal angle, lateral talus-first metatarsal angle, and naviculocuboid overlap were also improved. The Dwyer sliding osteotomy affected the tibiocalcaneal angle, whereas first metatarsal dorsal wedge osteotomy improved the calcaneal pitch angle and lateral first metatarsal angle. The stepwise surgical approach is effective for correction of equinocavovarus in cerebral palsy patients.

Study Design: Measurement of radiation dose from C-arm fluoroscopy during a simulated intraoperative use in spine surgery., Objective: To assess how the radiation dose is affected by changes in the types of thyroid shields used and by the arrangements or ways in which they are worn during the intraoperative use of C-arm fluoroscopy., Summary of Background Data: Although the danger to the thyroid from exposure to radiation is well known, there are no guidelines for the proper use of thyroid shields., Methods: Two photoluminescence dosimeters were used to measure the dose of scattered radiation arriving at the location of the thyroid in a whole-body phantom in the position of the surgeon. On an operating table beside this setup was an anthropomorphic chest phantom representing a patient for which treatment with C-arm fluoroscopy was simulated. Radiation doses were measured using 3 different arrangements of the thyroid shield: worn tightly, worn loosely, and worn loosely with a bismuth masking reagent. The same tests were performed using 2 kinds of thyroid shield: lead and lead-equivalent., Results: For the lead-shield group, radiation doses were measured in 3 arrangements; worn tightly, worn loosely, and worn loosely with a bismuth masking reagent, for which the results were 1.91 ± 0.13, 2.35 ± 0.22, and 1.86 ± 0.13 μSv/min, respectively. Wearing the shield tight against the throat and wearing it loose with a bismuth masking reagent led to lower radiation exposure levels than by simply wearing the shield loosely (P ≤ 0.001). For the lead-equivalent shield group, doses were measured for the same 3 arrangements, for which the results were 1.79 ± 0.12, 1.82 ± 0.11, and 1.74 ± 0.12 μSv/min. Lower scattered radiation doses were delivered to the thyroid in the lead-equivalent thyroid shield group compared with the lead thyroid shield group (P ≤ 0.001). The unshielded thyroid group received a radiation dose of 16.32 ± 0.48 μSv/min., Conclusion: The use of some form of thyroid shield is essential during the use of C-arm fluoroscopy. It was found that the best way to reduce scattered radiation exposure to the thyroid was wearing the thyroid shield tightly or wearing it loosely in combination with a bismuth masking reagent., Level of Evidence: 2.

Purpose: To compare choroidal thicknesses among eyes with early age-related maculopathy (ARM), neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, and central serous chorioretinopathy., Methods: Patients with age-related maculopathy (37 eyes), neovascular age-related macular degeneration (24 eyes), polypoidal choroidal vasculopathy (12 eyes), and central serous chorioretinopathy (31 eyes) underwent spectral-domain optical coherence tomography evaluations using a choroid scanning protocol. A horizontal linear section comprising 50 averaged scans was obtained of each macula. The choroidal thickness was measured from the outer border of the retinal pigment epithelium to the inner scleral border. Twenty-nine subjects with healthy eyes served as a control group. Analysis of covariance tests were performed to evaluate the effects of various diagnoses on choroidal thickness after removal of variance (covariates = gender, age, and refractive error)., Results: Among the different covariates, age was associated with choroidal thickness (fovea: F = 12.067, P = 0.001). After controlling for age differences, the choroid was thicker in polypoidal choroidal vasculopathy (319.92 ± 68.66 μm) and central serous chorioretinopathy (367.81 ± 105.56 μm) patients than in controls (241.97 ± 66.37 μm) and age-related maculopathy patients (186.62 ± 64.02 μm). However, there were no significant differences in mean choroidal thickness between neovascular age-related macular degeneration (226.46 ± 102.87 μm) and any of the other diagnoses., Conclusion: The choroid was thicker in eyes with polypoidal choroidal vasculopathy or central serous chorioretinopathy than in control or age-related maculopathy groups.

A 20-year-old man with rapid refractory pulmonary infiltrates, fever, and chill was admitted to our hospital. Microscopic examination showed focal necrosis of the lung tissue, arterial thromboembolism, and alveolar hemorrhage. He tested positive for anticardiolipin IgG antibodies. Because of the absence of underlying diseases, the possibility of secondary antiphospholipid antibody syndrome was excluded. Follow-up chest CT after 2 years revealed pulmonary arterial aneurysms with diffuse ground-glass opacities. The aneurysms were occluded by coil embolization.