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Background This study aimed to identify risk factors for chronic syndesmotic instability following syndesmotic fixation. Methods We performed a retrospective review of consecutive patients who had sustained ankle fractures requiring syndesmotic fixation. Patients available for a minimum 5 years of follow-up were classified into 2 groups according to the presence of syndesmotic instability. Statistical binary logistic regression analyses were performed to investigate the significance of various risk factors. Functional outcomes were assessed using the FAOS. Results In total, 166 patients who met the study inclusion criteria underwent analysis. The overall postoperative instability rate was 20.5%, which was significantly affected due to BMI (p = 0.018; OR 6.72), and concomitant posterior malleolar fracture (p = 0.032, OR 2.77). The mean scores in the syndesmotic instability (SI) group were significantly lower than those in the no syndesmotic instability (NSI) group (p = 0.021). Conclusions Obesity and concomitant posterior malleolar fracture were significant risk factors for postoperative syndesmotic instability.

Severe cerebral edema associated with exertional heat stroke is a major cause of death or disability. However, few studies on severe cerebral edema resulting from heat stroke have reported neuroradiological findings. Moreover, all the patients in these previous reports either died or remained severely disabled. Here, we report a case of exertional heat stroke with severe cerebral edema that probably developed or worsened due to delayed body temperature normalization. In contrast to previous reports, the patient showed complete clinical and neuroradiological recovery. This rare case suggests that severe cerebral edema could be reversed through meticulous supportive management. Moreover, it confirms the importance of rapid and effective cooling in heat stroke treatment.

Despite the low contribution of heavy ions to the total fluence in the space radiation environment, their radiobiological effect on the human body is extremely high. In this article, we investigated the radiation field which resulted from the interaction of galactic cosmic rays (GCRs), specifically some heavy ions and energies, typically encountered in space with a realistic multilayer sample of the International Space Station (ISS) Columbus module’s shielding wall. The quality factor, Q, and the normalized dose equivalent, H, derived from microdosimetric measurements for C, Ne, and Si ions behind different spacecraft wall configurations and materials are presented in this article. Particularly, carbon fiber, polyoxymethylene, and perspex with same areal density compared to currently used aluminum were investigated.

Background: Although several arthroscopic surgical techniques for the treatment of chronic ankle instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear. Purpose: To compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI between 2016 and 2018. The mean age of the patients was 35.2 years (range, 19-51 years), and the mean follow-up period was 32.6 months (range, 24-48 months). Patients were divided into 2 groups according to the surgical technique used for CAI: arthroscopic ATFL repair (group A; n = 37) and arthroscopic ATFL repair with additional IER augmentation (group R; n = 45). The pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging (MRI). Results: Out of 101 patients, 19 (18.5%) were excluded per the exclusion criteria, and 82 were evaluated. We identified 6 retears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL retear on MRI (8.1% [3/37] in group A and 6.7% [3/45] in group R) demonstrated recurrent CAI with functional discomfort and anterior displacement >3 mm as compared with the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups ( P < .001). However, there were no significant differences in the clinical results and radiologic findings between the groups. Conclusion: The clinical and radiologic outcomes of patients with CAI improved after all-inside arthroscopic ATFL repair. However, additional IER augmentation after arthroscopic ATFL repair did not guarantee better clinical outcomes.

Carbon nanotube (CNT) fibers (CNTFs) have potential for use as conducting wires in wearable electronics, but this application requires significant improvement in the mechanical and electrical prope...

In recent years, arthroscopic anterior talofibular ligament (ATFL) repair techniques have been increasingly used for chronic ankle instability. Besides permitting the treatment of several comorbidities, arthroscopic techniques are applied to minimize the need for aggressive surgery and improve the assessment of anatomic structures. We describe our surgical technique for all-arthroscopic anatomic ATFL repair using a knotless anchor, which can adjust suture tension under direct visualization using a self-locking mechanism. Thus, this technique diminishes the chance of repaired ligament separation from its attachment by obtaining the desired tension. Moreover, its knotless property allows the avoidance of some complications such as neuritis and pain related to bulky knots., Technique Video Video 1 Arthroscopic demonstration and illustration of arthroscopic anterior talofibular ligament (ATFL) repair. A medial midline portal and an accessory anterolateral portal are used as a viewing portal and working portal, respectively. A Micro SutureLasso (TFCC, Short 70° bend, Arthrex and knotless SutureTak anchor (3.0 12.7 mm; Arthrex) are used for ATFL repair.

Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group.Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n = 32) or the NO-NPO group (n = 32). After having a regular meal until midnight before surgery, the NPO group fasted until surgery, while the NO-NPO group ingested 400 mL of a carbohydrate drink at midnight and freely up to 2 hours before anesthesia. The primary outcome was the gastric antral CSA by gastric ultrasound in right lateral decubitus position (RLDP). Noninferiority was defined as a mean difference of CSA2.8 cm2. Secondary outcomes included CSA in supine position, gastric volume (GV), GV per weight (GV/kg), GV/kg1.5 mL/kg, and Perlas grade.CSA in RLDP was not different between the NPO group (6.25 ± 3.79 cm2) and the NO-NPO group (6.21 ± 2.48 cm2; P = .959). The mean difference of CSA in RLDP (NO-NPO group - NPO group) was 0.04 (95% confidence interval [CI], -1.56 to 1.64), which was within the noninferiority margin of 2.8 cm2. CSA was not different between the 2 groups (4.17 ± 2.34 cm2 in NPO group versus 4.28 ± 1.23 cm2 in NO-NPO group; P = .828). GV in NPO group (70 ± 56 mL) was not different from NO-NPO group (66 ± 36 mL; mean difference, 3.66; 95% CI, -20 to 27; P = .756). GV/kg in the NPO group (1.25 ± 1.00 mL/kg) was not different from the NO-NPO group (1.17 ± 0.67 mL/kg; P = .694). The incidence of GV/kg1.5 mL/kg was not different between NPO (31.3%) and NO-NPO group (21.9%; P = .768). The median (interquartile range) of the Perlas grade was 1 (0-1) in NPO group and 0.5 (0-1) in NO-NPO group (P = .871).Preoperative carbohydrates ingested up to 2 hours before anesthesia do not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound.

We investigated the therapeutic effect of a postoperative hospital-based systemic rehabilitation protocol on ankle function in chronic ankle instability (CAI) patients. Thirty-five patients who underwent a modified Broström procedure for CAI were recruited in this prospective randomized controlled trial. Fifty-minute sessions of hospital-based rehabilitation were performed three times weekly for 12 weeks in the intervention group. Education-based rehabilitation was conducted at home in the control group. The outcomes were evaluated at baseline (T0), 12 weeks (T1), and 16 weeks (T2). The primary outcome was the foot and ankle outcome score (FAOS). Ankle motor strength and spatiotemporal gait metrics were assessed as secondary outcomes. There were significant time and group interaction effects on the pain, symptoms, activities of daily living, sports activities, and quality of life (QOL) domains of the FAOS ( P < 0.05 , all). The patients in the intervention group showed larger improvements in all domains of the FAOS than did the control group at both T1 and T2 ( P < 0.05 , all). The time and group interaction effects on invertor and evertor strength were also significant ( P = 0.047 and P = 0.044 ). Invertor and evertor strength improved significantly more in the intervention group than in the control group at T1 and T2 ( P < 0.05 , all). The preferred walking velocity, cadence, step length on the affected side, and double stance phase duration tended to improve over time. Postoperative hospital-based rehabilitation helped improve CAI pain, symptoms, independence in activities of daily living, sports activity levels, and QOL more effectively than did conventional rehabilitation at home.

Sialolithiasis is one of the most common causes of salivary duct obstruction. In the last 20 years, minimally invasive procedures like sialendoscopy, extracorporeal lithotripsy, and basket snaring are increasingly being used for the treatment of salivary gland duct stones. Sialo-irrigation of the salivary gland is an effective procedure for treating inflammation and providing symptomatic relief. This procedure can be employed for the treatment of sialolithiasis using the back pressure of instilled saline. Sialo-irrigation under ultrasound (US) guidance allows for dynamic studies showing real-time images during diagnostic or surgical procedure and can be used for the removal of sialoliths. In addition, it can also be used to remove primitive sialoliths and microliths by washing out the ductal system, which prevents the recurrence of sialoliths. The aim of this study was to propose a minimally invasive technique for sialolithiasis using US-guided sialo-irrigation.

This paper proposes a double consequent pole changing vernier machine (DCPCVM) which adopts double consequent pole and flux modulation configuration. The proposed machine combines a vernier machine and a permanent magnet synchronous machine (PMSM) in a single topology. Therefore, the advantages of both machines can be realized in a single topology. The proposed machine provides high torque at low speed while operating in vernier mode whereas it operates in PMSM mode at high speed to avoid the disadvantages of vernier machines at high speeds such as high core losses. Parametric analysis of the proposed machine is performed to show the effect of the main variables on the electromagnetic characteristics of the machine. A finite element method (FEM) analysis is conducted, and meaningful conclusions are drawn.

The perfusion index (PI), calculated from the photoplethysmographic waveform, reflects peripheral vasomotor tone. As such, the PI serves as a surrogate for quantitative measures of drug-induced vasoconstriction or vasodilation. This study aimed to compare the effect on the PI of desflurane and sevoflurane at equi-anaesthetic concentrations in patients undergoing single-agent inhalation anaesthesia, where equi-anaesthetic dose was based on the known minimum alveolar concentration of these agents.We randomly allocated patients scheduled for arthroscopic knee surgery to receive either desflurane or sevoflurane general anaesthesia after target-controlled induction of anaesthesia with propofol. Anaesthesia was maintained at age-corrected minimum alveolar concentration 1.0, under neuromuscular block (rocuronium). The PI and haemodynamic data were recorded every minute for 35 min after induction of anaesthesia and after standardised nociceptive stimulation. The primary outcome was PI, compared between the groups over time (repeated-measures analysis of variance). Secondary outcomes included MAP and HR.Sixty-nine participants (mean [range] age: 42 yr [19-65 yr]; 49% females) were assigned to either desflurane (n=34) or sevoflurane (n=35). The PI remained higher under desflurane compared with sevoflurane, both before (mean difference [MD]: 3.3; 95% confidence intervals [CIs]: 2.0-4.7; P0.001) and after tetanic stimulation (MD: 2.8; 95% CI: 2.0-3.7; P0.001). Higher PI paralleled lower MAP in participants assigned to desflurane anaesthesia (P0.001), both before (MD: 8 mm Hg; 95% CI: 4-12) and after nociceptive stimulation (MD: 14 mm Hg; 95% CI: 7-22). HR was similar throughout.These findings suggest that at equipotent doses, desflurane exerts more potent vasodilatory properties and lowers blood pressure by a magnitude potentially associated with harm.NCT03570164.

Purpose To evaluate the results of all-arthroscopic treatment of the terrible triad of the elbow, a combination of elbow dislocation, radial head dislocation, and coronoid process fracture, and its complications. Methods We performed a retrospective review of consecutive patients with terrible triad who underwent all-arthroscopic treatment between January 2011 and December 2016. All-arthroscopic treatment was performed in the unstable elbows after manual reduction. Clinical evaluation was performed at least 2 years postoperatively. Patients with another fracture in the upper extremity and previous fracture of the affected elbow were excluded. A radial head fracture that was stable enough to reduce or involved less than 25% of the articular surface for partial excision and Regan-Morrey classification type I and type II coronoid process fractures were treated arthroscopically. Range of motion, radiologic outcomes, surgical complications, and the Mayo Elbow Performance Score were evaluated at the final follow-up. The Mann-Whitney test was used for statistical analysis. Results A total of 24 patients met the inclusion criteria, and the average age was 47.6 years. Coronoid process fractures were fixed in all patients, by use of Kirschner wires in 15 (62.5%) and pullout sutures in 9 (37.5%). Radial head fractures were treated using screw or K-wire fixation in 4 patients (16.7%); only the fragment of the fracture was resected in 11 patients (45.8%). In all 24 cases (100%), the lateral collateral ligaments were repaired. At the final follow-up, the mean flexion contracture angle was 4.8° ± 1.1° and the mean flexion angle was 132.5° ± 6.3°. Clinical scores were satisfactory, with a mean Mayo Elbow Performance Score of 93 points. However, nonunion of coronoid fractures was observed in 4 patients (16.7%). There was 1 case of pin-site irritation. Conclusions All-arthroscopic treatment for the terrible triad can provide an excellent safety profile without the need for a large incision if the indications are met. Level of Evidence Level IV, therapeutic case series.

Background and Objectives: Chronic lower back pain (LBP) is a common clinical disorder. The early identification of patients who will develop chronic LBP would help develop preventive measures and treatment. We aimed to develop machine learning models that can accurately predict the risk of chronic LBP. Materials and Methods: Data from the Sixth Korea National Health and Nutrition Examination Survey conducted in 2014 and 2015 (KNHANES VI-2, 3) were screened for selecting patients with chronic LBP. LBP lasting &gt, 30 days in the past 3 months was defined as chronic LBP in the survey. The following classification models with machine learning algorithms were developed and validated to predict chronic LBP: logistic regression (LR), k-nearest neighbors (KNN), naïve Bayes (NB), decision tree (DT), random forest (RF), gradient boosting machine (GBM), support vector machine (SVM), and artificial neural network (ANN). The performance of these models was compared with respect to the area under the receiver operating characteristic curve (AUROC). Results: A total of 6119 patients were analyzed in this study, of which 1394 had LBP. The feature selected data consisted of 13 variables. The LR, KNN, NB, DT, RF, GBM, SVM, and ANN models showed performances (in terms of AUROCs) of 0.656, 0.656, 0.712, 0.671, 0.699, 0.660, 0.707, and 0.716, respectively, with ten-fold cross-validation. Conclusions: In this study, the ANN model was identified as the best machine learning classification model for predicting the occurrence of chronic LBP. Therefore, machine learning could be effectively applied in the identification of populations at high risk of chronic LBP.

Background: The purpose of this study was to identify the risk factors for posttraumatic osteoarthritis (OA) after surgery for ankle fractures in patients aged ≤50 years. Methods: We performed a retrospective review of consecutive patients who underwent surgery for ankle fractures and were followed up for a minimum period of 5 years. The patients were assigned to 2 groups according to the presence of advanced OA at the last follow-up. Binary logistic regression was used to model the correlation between risk factors and OA. Functional outcomes were assessed using the Foot and Ankle Outcome Score. Results: The data of 332 patients who met the inclusion criteria were included in the analysis. The overall rate of posttraumatic arthritis was 27.7% (nonarthritis group: 240 patients, arthritis group: 92 patients). The arthritic change was significantly affected by BMI (95% confidence interval [CI] 1.29-19.76; adjusted odds ratio [OR] ≥ 30, 6.56), fracture-dislocation injury (CI 1.66-11.57; adjusted OR, 4.06), posterior malleolus (PM) fracture (CI 1.92-12.73, adjusted OR > 25% of the articular surface, 5.72), and postoperative articular incongruence (CI 1.52-18.10; adjusted OR, 7.21). The mean scores of the arthritis group were lower than those in the nonarthritis group ( P < .05). Conclusion: Obesity, fracture-dislocation injury, concomitant large PM fracture, and articular incongruence were risk factors of posttraumatic OA after surgery for ankle fractures. Surgeons should be aware that accurate reduction is critical in patients with ankle fractures with associated large PM fractures, especially those with obesity or severe initial injuries such as fracture-dislocation. Level of Evidence: Level III, case control study.

Background: The success rate for the production of animal models of chronic postischemia pain (CPIP) using an O-ring has yet to be improved in the study of complex regional pain syndrome-type I (CRPS-I), and producing a CPIP model is challenging, especially for mice. Objectives: We devised a new CPIP model with a higher success rate that induces ischemia for 3 hours by tying the hind limbs of mice with a rubber band, followed by reperfusion. Study Design: A randomized, controlled animal trial. Methods: Twenty-two male C57BL/6 mice were divided into a sham (n = 6), a ring (n = 8), and a tie group (n = 8). Anesthesia was induced using isoflurane. A precut O-ring was mounted on the upper left ankle in the sham group. A tight-fitting O-ring and a push-pull gauge manometer were mounted at the same location in the ring and tie groups, respectively. Reperfusion was induced 3 hours later. The thickness and circumference of the hind paws were measured before ischemia induction. Measurements were repeated 10 days after reperfusion. Mechanical allodynia was measured with a von Frey filament until 12 weeks after reperfusion. Results: The new tie model required 5 additional days until the onset of allodynia compared with the existing CPIP O-ring model. However, the successful induction rate of CPIP was higher in the tie group than in the ring group, and allodynia was maintained for over 30 days in the tie group. The ring and tie groups exhibited significantly high levels of tumor necrosis factor-alpha than those in the sham group. Limitations: First, we did not evaluate hyperalgesia, cold or heat allodynia. Second, we did not measure blood levels of inflammatory or antiinflammatory cytokines, and research on oxidative stress biomarkers such as isoprostane, 8-hydroxy-2’-deoxyguanosine (a marker of DNA oxidative damage), and malondialdehyde was not performed. Conclusions: The new CPIP tie model has a higher rate of successful induction than existing O-ring models for mice, with longer duration of mechanical allodynia. The model may reduce the number of animals sacrificed in CRPS-I research and could be useful for studying long-term effects of drugs. Key words: CPIP, mouse, O-ring, rubber band, reperfusion, allodynia, hyperalgesia

Background S1 transforaminal epidural steroid injection (S1-TFESI) results in positive clinical outcomes for the treatment of pain associated with the S1 nerve root. S1-TFESI via the transforaminal approach is commonly performed under fluoroscopic guidance. Ultrasound guidance is an alternative to mitigate radiation exposure. However, performing spinal procedures under ultrasound guidance has some limitations in confirming the position of the needle tip and vascular uptake. New techniques are therefore needed to make ultrasound and fluoroscopy complementary. Our objective was to describe a novel technique for S1-TFESI and confirm its reproducibility. Methods Records of patients with S1 radiculopathy were reviewed retrospectively; those treated using the new S1-TFESI technique were selected. Initially, ultrasound was used to distinguish anatomy of the sacral foramen and guide initial placement of the needle entry point. Fluoroscopy was subsequently used to confirm needle tip position and vascular injection. The number of times the needle required reinsertion was recorded, and ultrasound and C-arm images were stored. Results Sixty-seven S1-TFESIs were performed in 56 patients. All injections exhibited epidural spread of contrast media, not only to the S1 nerve. The cephalad angle was 16.25 ± 6.75° (range, 5–27°), the oblique angle was 2.48 ± 2.62° (range, 0–7°), and the mean number of attempts was 1.24 ± 1.25. Conclusions The new technique, involving the use of ultrasound to guide initial placement of the needle entry point, followed by confirmatory imaging and any needed adjustment with the use of fluoroscopy, can be a technique to complement the shortcomings of using ultrasound or fluoroscopy alone.

Background: Neuropathic pain (NP) is considered a clinically incurable condition despite various treatment options due to its diverse causes and complicated disease mechanisms. Since the early 2000s, multipotent human mesenchymal stem cells (hMSCs) have been used in the treatment of NP in animal models. However, the effects of hMSC injections have not been studied in chronic post-ischemia pain (CPIP) mice models. Here, we investigated whether intrathecal (IT) and intrapaw (IP) injections of hMSCs can reduce mechanical allodynia in CPIP model mice. Methods: Seventeen CPIP C57/BL6 mice were selected and randomized into four groups: IT sham (n = 4), IT stem (n = 5), IP sham (n = 4), and IP stem (n = 4). Mice in the IT sham and IT stem groups received an injection of 5 μL saline and 2 × 104 hMSCs, respectively, while mice in the IP sham and IP stem groups received an injection of 5 μL saline and 2 × 105 hMSCs, respectively. Mechanical allodynia was assessed using von Frey filaments from pre-injection to 30 days post-injection. Glial fibrillary acidic protein (GFAP) expression in the spinal cord and dorsal root ganglia were also evaluated. Results: IT and IP injections of hMSCs improved mechanical allodynia. GFAP expression was decreased on day 25 post-injection compared with the sham group. Injections of hMSCs improved allodynia and GFAP expression was decreased compared with the sham group. Conclusions: These results suggested that hMSCs may be also another treatment modality in NP model by ischemia-reperfusion.

Purpose: We aimed to determine the efficacy of cerclage wiring by comparing the clinical and radiological results between internal fixation with locking plates after distal femoral fracture reduction with or without cerclage wiring. Materials and Methods: One hundred and one patients who received open reduction internal fixation for distal femoral fractures of oblique, spiral, and spiral wedge type between 2007 and 2014 were reviewed retrospectively. Only locking plate fixation was performed in 46 patients, and locking plate fixation with additional cerclage wiring was performed in 55 patients (Group CW). Demographic, clinical, and radiologic factors were evaluated in both the groups. Age, gender, bone mineral density, bone graft, and the presence of concomitant fractures were measured as demographic factors. The range of motion of knee joint, Lysholm knee score, visual analog scale score, procedure time, and C-arm time were measured as clinical factors preoperatively and at the final followup. We also evaluated the duration of bone union and knee joint alignment radiologically. Results: There were no demographic differences between the two groups. Furthermore, there were no statistically significant differences between the two groups in terms of clinical and radiological parameters. However, the procedure time used was significantly longer in Group LP than in Group CW (108.4 vs. 95.2 min; P = 0.027). The C-arm time was longer in Group LP (2.8 vs. 1.2 s; P = 0.017). Conclusions: Open reduction and locking plate fixation with additional cerclage wiring is a useful method for the reduction of complicated distal femoral fractures, without increased complications such as nonunion. Level of Evidence: Level III, retrospective cohort design, treatment study.

Background: For patients with trigeminal neuralgia who do not respond to medication and for whom surgical approaches are too risky, percutaneous procedures targeting the trigeminal ganglion are the current standard treatment. Percutaneous procedures are performed via the transoval approach under radiologic guidance. Identification of the foramen ovale (FO) under fluoroscopic guidance is an important part of determining the success or failure of the procedures. Objectives: Previous studies have described how to visualize the FO under fluoroscopic guidance, but those methods are limited by poor reproducibility. In this study, we have investigated how to visualize the FO clearly and easily under fluoroscopic guidance. Study Design: Retrospective analysis. Setting: University hospital in Korea. Methods: Seventy-two 3-dimensional facial computed tomography scans without anatomic abnormalities of the skull base were analyzed for verifying the novel method. First, the mandibular angle and the occipital cortical line were overlapped and then turned by 15° oblique rotation using the software package. After these manipulations, the visualization of the FO was graded according to a 4-point scale (0: poor; 1: fair; 2: good; 3: excellent), and the inferior transfacial and oblique angles were measured. Results: This enabled clear visualization of the FO. The mean visual grade of 54 right and 46 left FO (total 100) was 2.74 (0: poor; 1: fair; 2: good; 3: excellent). All recorded FOs had at least grade 2 visibility. Limitations: This study is lacking application in clinical practice and comparative data to the submental view. Conclusions: The mandible angle and the occipital cortex line are obvious anatomic landmarks and are visible even to nonexperienced practitioners. Therefore, our method using these anatomic landmarks can improve the reproducibility and accuracy of FO visualization. Key words: Trigeminal neuralgia, foramen ovale, trigeminal ganglion, 3-dimensional (3D) facial computed tomography (CT) scans

Oleic acid (OA) is released from brain phospholipids after cerebral ischaemia; however, its role in ischaemic injury remains unknown. We hypothesised that OA has neuroprotective effects after cerebral ischaemia, which may be exerted through peroxisome proliferator-activated receptor gamma (PPAR-γ) activation, since OA is an endogenous ligand of PPAR-γ. The effects of OA administration were evaluated in rodent models of middle cerebral artery occlusion (MCAO), photothrombosis, and four-vessel occlusion (4-VO). We determined the time window of therapeutic opportunity and examined the ability of the PPAR-γ antagonist GW9662 to reverse OA’s protective effects after MCAO. We found that OA administration decreased the MCAO-induced infarct volume and functional deficits, photothrombosis-induced infarct volume, and 4-VO-induced hippocampal neuronal death. Additionally, OA was highly efficacious when administered up to 3 h after MCAO. Pre-treatment with GW9662 abolished the inhibitory effects of OA on the infarct volume and immunoreactivity of key inflammatory mediators in the ischaemic cortex. Our results indicate that OA has neuroprotective effects against transient and permanent focal cerebral ischaemia, as well as global cerebral ischaemia. It may have therapeutic value for the ischaemic stroke treatment with a clinically feasible therapeutic window. The OA-mediated neuroprotection might be attributable to its anti-inflammatory actions through PPAR-γ activation.

Previous efforts to discover new surrogate markers for the central nervous system (CNS) inflammatory demyelinating disorders have shown inconsistent results, moreover, supporting evidence is scarce. The present study investigated the IgG autoantibody responses to various viral and autoantibodies-related peptides proposed to be related to CNS inflammatory demyelinating disorders using the peptide microarray method. We customized a peptide microarray containing more than 2440 immobilized peptides representing human and viral autoantigens. Using this, we tested the sera of patients with neuromyelitis optica spectrum disorders (NMOSD seropositive, n = 6, NMOSD seronegative, n = 5), multiple sclerosis (MS, n = 5), and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD, n = 6), as well as healthy controls (HC, n = 5) and compared various peptide immunoglobulin G (IgG) responses between the groups. Among the statistically significant peptides based on the pairwise comparisons of IgG responses in each disease group to HC, cytomegalovirus (CMV)-related peptides were most clearly distinguishable among the study groups. In particular, the most significant differences in IgG response were observed for HC vs. MS and HC vs. seronegative NMOSD (p = 0.064). Relatively higher IgG responses to CMV-related peptides were observed in patients with MS and NMOSD based on analysis of the customized peptide microarray.

Total elbow arthroplasty (TEA) is associated with a relatively high incidence of chronic triceps insufficiency, but there is difficulty in treatment. This case series describes reconstruction with Achilles allografts using the keyhole technique in patients with postoperative chronic triceps insufficiency. Fourteen patients who underwent reconstruction for triceps insufficiency after TEA were included in the study. During this procedure, a keyhole-shaped osteotomy was performed on the proximal olecranon, and a fragment of the calcaneal allograft was shaped into a bone plug to fit the olecranon. The clinical outcomes were assessed in all patients 12 months after reconstruction and at last follow-up (range, 13–54 months). After 12 months, patients had a mean Mayo Elbow Performance Score of 84.3 (range, 75–100), and all achieved a marked improvement compared with before reconstruction (mean, 42.7; range, 20–75). Seven, 4, and 3 patients achieved excellent, good, and fair outcomes, respectively. The mean extension peak torque of the operated-on arm was 34.91 Nm (range, 16.3–63.9 Nm), and the percentage of extension peak torque of the operated-on arm to the opposite arm was from 14.5% preoperative to 76.2% 12 months postoperative. This case series suggests that triceps reconstruction with an Achilles tendon using the keyhole technique is a useful treatment option for triceps insufficiency after TEA. [ Orthopedics . 2021;44(4):e498–e502.]

The COVID-19 pandemic has affected the entire world, resulting in a tremendous change to people’s lifestyles. We investigated the Korean public response to COVID-19 vaccines on social media from 23 February 2021 to 22 March 2021. We collected tweets related to COVID-19 vaccines using the Korean words for “coronavirus” and “vaccines” as keywords. A topic analysis was performed to interpret and classify the tweets, and a sentiment analysis was conducted to analyze public emotions displayed within the retrieved tweets. Out of a total of 13,414 tweets, 3509 were analyzed after preprocessing. Eight topics were extracted using the Latent Dirichlet Allocation model, and the most frequently tweeted topic was vaccine hesitation, consisting of fear, flu, safety of vaccination, time course, and degree of symptoms. The sentiment analysis revealed a similar ratio of positive and negative tweets immediately before and after the commencement of vaccinations, but negative tweets were prominent after the increase in the number of confirmed COVID-19 cases. The public’s anticipation, disappointment, and fear regarding vaccinations are considered to be reflected in the tweets. However, long-term trend analysis will be needed in the future.

Light detection and ranging (LIDAR) is one of solutions to extract 3D depth image of objects. Especially, as fabrication process of silicon image sensor has been progressed, amplitude-modulated continuous wave (AMCW) time-of-flight (ToF) cameras have been widely used due to their relatively cheap price and high measurement accuracy. However, to estimate ToF, reflected laser signal should be sequentially demodulated using optoelectronic device such as demodulation pixel, which induces relatively long integration and processing times. Additionally, due to the limitation of demodulation contrast and optical fill factor of demodulation pixel, depth measurement accuracy is also limited. To cope with such shortcomings of conventional ToF cameras, a novel AMCW method based on parallel phase-demodulation and related scanning LIDAR prototype are demonstrated in this paper. This scanning AMCW LIDAR prototype has enabled scanning object in extremely short integration time with adaptable field of view (FoV) and resolution to extract precise 3D depth images.

A development project for hypo-fractionated multi-ion therapy has been initiated at the National Institute of Radiological Sciences in Japan. In the treatment, helium, carbon, oxygen, and neon ions will be used as primary beams with pencil beam scanning. A ripple filter (RiFi), consisting of a thin plastic or aluminum plate with a fine periodic ridge and groove structure, has been used to broaden the Bragg peak of heavy-ion beams in the beam direction. To sufficiently broaden the Bragg peak of helium-, carbon-, oxygen-, and neon-ion beams with suppressed lateral scattering and surface dose inhomogeneity, in this study, we tested a plate made of a lung substitute material, Gammex LN300, as the RiFi. The planar integrated dose distribution of a 183.5 MeV u−1 neon-ion beam was measured behind a 3 cm thick LN300 plate in water. The Bragg peak of the pristine beam was broadened following the normal distribution with the standard deviation σ value of 1.29 mm, while the range of the beam was reduced by 8.8 mm by the plate. To verify the LN300 performance as the RiFi in multi-ion therapy, we measured the pencil beam data of helium-, carbon-, oxygen- and neon-ion beams penetrating the 3 cm thick LN300 plate. The data were then modeled and used in a treatment planning system to achieve a uniform 10% survival of human undifferentiated carcinoma cells within a cuboid target by the beam for each of the different ion species. The measured survival fractions were reasonably reproduced by the planned ones for all the ion species. No surface dose inhomogeneity was observed for any ion species even when the plate was placed close to the phantom surface. The plate made of lung substitute material, Gammex LN300, is applicable as the RiFi in multi-ion therapy with helium-, carbon-, oxygen- and neon-ion beams.

Many predictive tools have been reported for assessing osteoporosis risk. The development and validation of osteoporosis risk prediction models were supported by machine learning. Osteoporosis is a silent disease until it results in fragility fractures. However, early diagnosis of osteoporosis provides an opportunity to detect and prevent fractures. We aimed to develop machine learning approaches to achieve high predictive ability for osteoporosis risk that could help primary care providers identify which women are at increased risk of osteoporosis and should therefore undergo further testing with bone densitometry. We included all postmenopausal Korean women from the Korea National Health and Nutrition Examination Surveys (KNHANES V-1, V-2) conducted in 2010 and 2011. Machine learning models using methods such as the k-nearest neighbors (KNN), decision tree (DT), random forest (RF), gradient boosting machine (GBM), support vector machine (SVM), artificial neural networks (ANN), and logistic regression (LR) were developed to predict osteoporosis risk. We analyzed the effect of applying the machine learning algorithms to the raw data and featuring the selected data only where the statistically significant variables were included as model inputs. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were used to evaluate performance among the seven models. A total of 1792 patients were included in this study, of which 613 had osteoporosis. The raw data consisted of 19 variables and achieved performances (in terms of AUROCs) of 0.712, 0.684, 0.727, 0.652, 0.724, 0.741, and 0.726 for KNN, DT, RF, GBM, SVM, ANN, and LR with fivefold cross-validation, respectively. The feature selected data consisted of nine variables and achieved performances (in terms of AUROCs) of 0.713, 0.685, 0.734, 0.728, 0.728, 0.743, and 0.727 for KNN, DT, RF, GBM, SVM, ANN, and LR with fivefold cross-validation, respectively. In this study, we developed and compared seven machine learning models to accurately predict osteoporosis risk. The ANN model performed best when compared to the other models, having the highest AUROC value. Applying the ANN model in the clinical environment could help primary care providers stratify osteoporosis patients and improve the prevention, detection, and early treatment of osteoporosis.

Category: Trauma; Arthroscopy Introduction/Purpose: One of the factors contributing to outcome of posterior malleolar (PM) fractures is the development of osteoarthritis. Previous studies suggested that fragment size of PM and postoperative articular congruency were influenced on generative ankle arthritis. Haraguchi et al. classify PM fractures according to pathoanatomy of injury. However, there was no study to investigate possible risk factors including the type of PM fracture for degenerative arthritis in ankle fractures including PM. The purpose of this study was to identify the risk factors for degenerative arthritis in ankle fractures including PM. We hypothesized that risk factors for posttraumatic arthritis could be identified from patient demographic and the extent of the pathologic condition associated with fractures. Methods: We performed a retrospective review between 2004 and 2015 of consecutive patients who underwent operation with ankle fractures and available at minimum 5 years of follow up. The exclusion criteria included diabetic neuropathy, skeletal immaturity, tibial pilon fractures, polytrauma, open fracture. Patients were sorted into 2 groups according to the presence of arthritis change more than grade 2 at last follow up. Furthermore, the statistical analysis by binary logistic regression analysis included the significance of various risk factors including age at surgery, sex, diabetes, smoking, body mass index (BMI), dominant side, time interval between the trauma and surgery, type of PM fracture, PM fragment size and postoperative joint congruency, The functional outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Results: A total 332 patients with mean follow up of 8.2+-2.4 years met the study inclusion criteria and underwent analysis. The overall rate of posttraumatic arthritic change was 31.3% (non-arthritis group: 228 patients, arthritis group: 104). It was significantly affected by the BMI (p=0.021; adjusted odds ratio, OR, >= 30, 7.23), Mason classification type 3 PM fracture (p=0.031, adjusted OR 4.23), >25% of articular surface of PM, and postoperative articular incongruence (p=0.029, adjusted OR 5.13). The other variables were not found to be significant risk factors. The mean scores in the group with arthritis were significantly lower than those in the group without arthritis (p=0.001) Conclusion: The overall results suggest that articular congruency should be considered during surgery along with meticulous attention to anatomic reduction of large fragment posterior malleolar fracture, especially in obese patients.

Objective This study was performed to compare two different shapes of stylets, 60° and J-shaped stylets, for intubation using the McGrath MAC® video laryngoscope (MVL). Methods Two hundred twenty-two patients undergoing surgery under general anesthesia were randomly allocated to Group J (n = 111) or Group 60° (n = 111) and intubated using the MVL with the stylet bent into the allocated shape. The time to intubation (TTI) and other intubating profiles were compared between the groups. Multivariate regression analysis was used to determine the relationship between factors related to difficult intubation and TTI. Results The TTI was not different between the two groups. There were also no differences in the intubating profiles between the two groups. In both groups, the TTI was longer with a modified Mallampati score (mMS) of ≥3 and percentage of glottic opening (POGO) score of 2. Conclusion The TTI during tracheal intubation with the MVL was not different between the two groups. The TTI was longer with an mMS of ≥3 and POGO score of 2.

Background/aim The local control rate of chondrosarcomas treated with carbon-ion radiotherapy (CIRT) worsens as tumour size increases, possibly because of the intra-tumoural linear energy transfer (LET) distribution. This study aimed to evaluate the relationship between local recurrence and intra-tumoural LET distribution in chondrosarcomas treated with CIRT. Patients and methods Thirty patients treated with CIRT for grade 2 chondrosarcoma were included. Dose-averaged LET (LETd) distribution was calculated by the treatment planning system, and the relationship between LETd distribution in the planning tumour volume (PTV) and local control was evaluated. Results The mean LETd value in PTV was similar between cases with and without recurrence. Recurrence was not observed in cases where the effective minimum LETd value exceeded 40 keV/μm. Conclusion LETd distribution in PTV is associated with local control in chondrosarcomas and patients treated with ion beams of higher LETd may have an improved local control rate for unresectable chondrosarcomas.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is a commonly performed minimally invasive procedure that has led to lower levels of pain, as well as procedure-related mortality and morbidity. However, VATS requires analgesia that blocks both visceral and somatic nerve fibers for more effective pain control. This randomized controlled trial evaluated the effect of erector spinae plane block (ESPB) in the postoperative analgesia management of patients undergoing VATS. METHODS: We performed a prospective, randomized, single-center study between December 2018 and December 2019. Fifty-four patients were recruited to two equal groups (ESPB and control group). Following exclusion, 46 patients were included in the final analysis. Patients were randomly assigned to receive preoperative ultrasound-guided ESPB with either ropivacaine or saline. The primary outcome was the numeric rating scale (NRS) score, assessed 12 hours postoperatively. Secondary outcomes were the Riker Sedation-Agitation Scale (SAS) score for emergence agitation, postoperative cumulative opioid consumption, length of post-anesthesia care unit (PACU) stay, incidence of postoperative nausea and vomiting (PONV) and dizziness, and ESPB-related adverse events. RESULTS: The NRS in the ESPB group during the postoperative period immediately after PACU admission was significantly lower than that in the control group (5.96±1.68 and 7.59±1.18, respectively; P

BACKGROUND Pre-administration of remifentanil in target-controlled propofol and remifentanil anaesthesia could prolong the time of onset of muscle relaxation owing to haemodynamic effects, thereby prolonging the time to tracheal intubation. Although the sympatholytic effects of remifentanil result in bradycardia and hypotension, these responses can be attenuated by the administration of atropine. Therefore, we investigated whether prophylactic administration of atropine could prevent the prolongation of the time to tracheal intubation. METHODS Sixty-four patients were included in this study. They were randomised into Group A (atropine 0.5 mg, n = 32) and Group S (saline 0.9%, n = 32), immediately before the pre-administration of remifentanil. The primary outcome was the time to tracheal intubation and the secondary outcomes were rocuronium onset time, time to loss of consciousness (LOC), time to reach a value of 60 on the bispectral index (BIS) and haemodynamic variables. RESULTS The median [Interquartile range] of the time to tracheal intubation was 240 [214, 288]s in Group S and 190 [176, 212]s in Group A(median difference: 50 s, 95% confidence interval: 27-80 s, P = .001). Rocuronium onset time was significantly decreased in Group A compared to that in Group S (129 [110, 156] vs 172 [154, 200], P = .001). The times to LOC and reach 60 on the BIS were not significantly different between the two groups. Cardiac output(CO) and heart rate were less decreased in Group A than in Group S (P = .02, P

Background: Immunofluorescence analyses of anterior cruciate ligament (ACL) allografts following remnant-preserving ACL reconstruction using Achilles tendon allografts have provided evidence for the presence of neural elements. In this study, we aimed to examine the expression of neural elements and quantify the presence of neural cells in ACL remnants and Achilles allografts using nerve growth factor (NGF) therapy after remnant-preserving ACL reconstruction.Methods: Experiments were conducted on 5 pairs of rats (approximately 8 weeks old and weighing 320 g at the time of surgery). Longitudinally split Achilles tendons from the paired rats were freshly frozen and later defrosted with warm saline and allografted onto the right ACL of the other rat that was partially detached at the femoral attachment site. A sham operation was conducted on the left knee to be used as a control. NGF was injected into both knee joints every week for 6 weeks after surgery. The presence of neural cells in the ACL of the sham-operated knee, allografted Achilles tendon, and ACL remnant was examined 6 weeks post-surgery using H and E and immunofluorescent staining.Results: H and E staining did not reveal neural cells in any of the three groups. However, immunofluorescence analysis showed the presence of nestin-positive neural elements in the normal ACL tissues as well as ACL remnants. Additionally, neural elements were examined in 7 of the 8 (87.5%) allograft tissues. Quantitative analysis showed no difference in the number or area of nuclei among the three groups. However, the number and area of neural cells in the Achilles allografts were significantly lower than those in the other two groups (p=0.000 and p=0.001, respectively).Conclusion: Our observations indicate that ACL remnants promote the new ingrowth and persistence of neural cells. We suggest that the ingrowth of neural elements can support the persistence and new ingrowth of mechanoreceptors, thereby enhancing the functional stability of knee joints. Moreover, the expression of neural cells in the Achilles allografts was lower than that in normal ACL tissues and ACL remnants in the quantitative evaluation, thereby confirming the essential role of ACL remnants in knee joint functionalization.

The National Institute of Radiological Sciences has investigated multiple-ion therapy using energetic beams of helium, carbon, oxygen, and neon ions, to improve treatment outcomes of refractory cancer. For this therapy, it is necessary to ensure the helium-ion beam purity to avoid irradiation by unwanted ions. Here, we develop a measurement method for monitoring beam purity. This method can measure the charge number of the ions in a high-purity beam using an ionization chamber and Faraday cup. In addition, it can be used to detect the contamination of the clinical helium-ion beam. We perform beam experiments to evaluate our beam-purity monitoring method and predict that our method is capable of detecting contamination below 1%.

BACKGROUND: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved < 50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation.METHODS: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving < 50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery.RESULTS: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms.CONCLUSIONS: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving < 50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

Background Sevoflurane and desflurane are widely used in balanced anaesthesia in combination with opioid analgesics. The opioid remifentanil is frequently chosen because of its extremely rapid pharmacokinetics. However, intraoperative high-dose remifentanil is associated with increased postoperative pain and rescue analgesic use owing to acute tolerance and opioid-induced hyperalgesia. This study aimed to compare intraoperative remifentanil requirements during equi-minimum alveolar concentration (MAC) sevoflurane and desflurane anaesthesia via surgical pleth index-guided remifentanil administration. Methods Eighty-two subjects undergoing laparoscopic cholecystectomy were randomly allocated to two groups receiving either sevoflurane (n=40) or desflurane (n=42). Anaesthesia was maintained with the assigned inhaled anaesthetics and remifentanil. End-tidal anaesthetic concentration was maintained at age-corrected 1.0 MAC, and remifentanil infusion was continuously adjusted to achieve a surgical pleth index of 20–50. Mean remifentanil infusion rate, which was the primary outcome of the study, was calculated as the total infused remifentanil dose per kg body weight per minute of total operative time. Results Mean remifentanil infusion rate [mean (standard deviation)] was significantly higher in the sevoflurane group than in the desflurane group [0.192 (0.064) vs. 0.099 (0.033) μg kg−1 min−1; difference, 0.093 (95% confidence interval, 0.071–0.115); P Conclusions During equi-MAC anaesthesia of 1.0 MAC, sevoflurane and desflurane did not show similar intraoperative remifentanil consumption under surgical pleth index-guided opioid administration. Further studies using other monitors with different measuring mechanisms are warranted to determine the cause of this difference. Clinical trial registration NCT02830243 ( ClinicalTrials.gov ).

To identify the risk factors for recurrent instability after arthroscopic Bankart repair and evaluate the recurrence rate and functional outcomes.A retrospective review was performed of patients with anterior-inferior shoulder instability who underwent arthroscopic Bankart repair between 2008 and 2014. Patients below 30 years of age who were available for follow-up at least for 2 years were sorted into 2 groups according to the presence of recurrent instability. Furthermore, statistical analysis by binary logistic regression analysis included the significance of various risk factors including gender, demographic factors, number of preoperative dislocations, time interval between the first dislocation and the surgery (shorter than 6 months or not), generalized hyperlaxity, concomitant injury, bony Bankart, and off-track lesion. The functional outcomes were assessed with the Rowe and Walch-Duplay scores.A total of 170 shoulders were included (without-recurrence group: 138, recurrent group: 32). The overall postoperative recurrent instability rate was 18.8%. SLAP repair, interval closure, and capsular plication were performed when necessary. However, these additional procedures were not influenced by recurrence (P = .37). The 2 groups showed significant differences in the number of preoperative dislocations (P = .048; adjusted odds ratio [OR] 2-5 times, 6.41; more than 5 times, 8.77), time interval between the first dislocation and surgery (P = .003, adjusted OR 5.62), and off-track Hill-Sachs lesion (P = .04, adjusted OR 4.31). There was significant improvement in the mean Rowe and Walch-Duplay scores at 2 years postoperatively (P.001 in both cases), but the mean scores were lower in the group with recurrence than in the group without (P = .021 and .014, respectively).The overall results suggest that surgery within 6 months of the first dislocation should be considered, with meticulous attention in patients with a high number of preoperative dislocations or off-track Hill-Sachs lesions.Level III, retrospective case-control study.

A novel hybrid single chamber microbial fuel cell is described in which a TiO2 nanotube array (TNT) photoanode is coupled with a conventional bioanode to achieve simultaneous degradation of methylene blue (MB) dye with improved power generation. As compared to a conventional microbial fuel cell (MFC), the described hybrid-MFC exhibits enhanced power density (14%), current density (33%), and voltage (4%) while simultaneously degrading MB dye, 82.79% after 3.5 h of operation under simulated solar light illumination. The key factor attributed to the enhanced performance is the addition of photogenerated electrons to the MFC external circuit. The effect of various design configurations is also investigated, such as the presence of an air cathode, anode type, and illumination. The hybrid-MFC strategy provides new directions for productive and economical utilization of microbial fuel cells.

Background We report the successful use of allograft–prosthesis composite (APC) and structural femoral head allografting in the bilateral reconstruction of large femoral and tibial uncontained defects during revision total knee arthroplasty (RTKA). Case presentation A 67-year-old female with degenerative arthritis underwent bilateral total knee arthroplasty (TKA) using the Press Fit Condylar (PFC) modular knee system at our clinic in March, 1996. At 8 years postoperatively, the patient presented with painful, bilateral varus knees, with swelling, limited passive range of motion (ROM), and severe instability. We treated to reconstruct both knee using a femoral head allograft at the tibial site, a structural distal femoral allograft at the femoral site, and a varus-valgus constrained (VVC) prosthesis with cement. At the 10-year follow up, we found no infection, graft failure, loosening of implants, in spite of using massive bilateral structural femoral head allografts in RTKA. Conclusion The use of APC enabled a stable and durable reconstruction in this uncommon presentation with large femoral bone deficiencies encountered during a RTKA. Electronic supplementary material The online version of this article (10.1186/s12891-018-1981-2) contains supplementary material, which is available to authorized users.

Objectives The occurrence of postoperative neurocognitive deficits(POND)after major cardiac surgery is associated with an increase in perioperative mortality and morbidity. Oxidative stress caused by oxygen can affect neuronal damage, which can lead to POND. Whether the intraoperative rSO2 value reflects oxidative stress and the associated incidence of POND is unknown. Methods Among 3482 patients undergoing cardiac surgery, 976 patients were allocated for this retrospective study. Of these, 230 patients (32.5%) were observed to have postoperative neurologic symptoms. After propensity score 1:2 ratio matching, a total of 690 patients were included in the analysis. Recorded data on the occurrence of POND from the postoperative period to predischarge were collected from the electronic records. Results The mean baseline rSO2 value was higher in the POND (–) group than in the POND (+) group. The mean overall minimum rSO2 value was lower in the POND (+) group (52.2 ± 8.3 vs 48.3 ± 10.5, P < 0.001). The mean overall maximum rSO2 values were not significantly different between the two groups (72.7 ± 8.3 vs 73.2 ± 9.2, P = 0.526). However, there was a greater increase in the overall maximum rSO2 values as compared with baseline in the POND (+) group (10.9 ± 8.2 vs 17.9 ± 10.2, P < 0.001). The degree of increase in the maximum rSO2 value was a risk factor affecting the occurrence of POND (adjusted odds ratio, 1.08; 95% confidence interval [CI], 1.04–1.11; P < 0.001). The areas under the receiver-operating characteristic curve for delta values of minimal and maximal compared with baseline values were 0.60 and 0.71, respectively. Conclusions Increased cerebral oximeter levels during cardiac surgery may also be a risk factor for POND. This is considered to reflect the possibility of oxidative neuronal damage, and further studies are needed in the future.

Background To evaluate the effects of Huang Bai (Phellodendron amurense) on growth and maturation in adolescent female rats. Methods Female Sprague–Dawley rats (28 days old; n = 72) were divided into six daily treatment groups: control (distilled water), Huang Bai (100 and 300 mg/kg), recombinant human GH (rhGH; 20 μg/kg), estradiol (1 μg/kg), and triptorelin (100 μg). Body weight, food intake, and vaginal opening were measured daily from postnatal day (PND) 28 to PND 43. Tetracycline (20 mg/kg) was injected on PND 41. After sacrifice on PND 43, the ovaries and uterus were weighed, and the tibias were fixed in 4% paraformaldehyde. Decalcified and dehydrated tibias were sectioned at a thickness of 40 μm, and sectioned tissues were examined with a fluorescence microscope. Insulin-like growth factor (IGF)-1 and bone morphogenetic protein (BMP)-2 were detected using immunohistochemistry. Results Relative to controls, body weight was higher in the triptorelin group. Bone growth rate increased in the Huang Bai 100 mg/kg (354.00 ± 31.1 μm/day), rhGH (367.10 ± 27.11 μm/day), and triptorelin (374.50 ± 25.37 μm/day) groups. Expression of IGF-1 and BMP-2 in the hypertrophic zone was higher in all experimental groups. Vaginal opening occurred earlier in the estradiol group (PND 33.58 ± 1.62) than in controls and later in the triptorelin group (PND > 43). Ovarian and uterine weights were lower in the oestradiol and triptorelin groups. However, Huang Bai had nonsignificant effects on vaginal opening and the weights of ovaries and the uterus. Conclusions Huang Bai stimulated bone growth by upregulating IGF-1 and BMP-2 in the growth plate. However, it had no effect on pubertal development. Electronic supplementary material The online version of this article (10.1186/s13020-017-0156-7) contains supplementary material, which is available to authorized users.

Background. Rotator cuff tendinopathy is a primary cause of shoulder pain and dysfunction. Several effective nonsurgical treatment methods have been described for chronic rotator cuff tendinopathy. Prolotherapy with polydeoxyribonucleotide (PDRN), which consists of active deoxyribonucleotide polymers that stimulate tissue repair, is a nonsurgical regenerative injection that may be a viable treatment option. The objective of this study was to assess the efficacy of PDRN in the treatment of chronic rotator cuff tendinopathy. Method. The records of patients with chronic rotator cuff tendinopathy (n=131) were reviewed retrospectively, and the patients treated with PDRN prolotherapy (n=32) were selected. We measured the main outcome of the shoulder pain and disability index score on a numerical rating scale of average shoulder pain. Results. Compared with baseline data, significant improvements in the shoulder pain and disability index and pain visual analog scale scores were demonstrated at one week after the end of treatment, and at one month and three months later. Conclusions. PDRN prolotherapy may improve the conservative treatment of painful rotator cuff tendinopathy for a specific subset of patients.

Background: Preoperative carbohydrate loading enhances postoperative recovery and reduces patient discomfort. However, gastric emptying of liquids can be delayed in elderly populations. Therefore, this study aimed to evaluate the gastric emptying of 400 mL of a carbohydrate drink ingested 2 hours before surgery in elderly patients. Methods: In this prospective, randomized controlled study, patients aged >65 years were allocated to either fast from midnight (nil per os [NPO] group, n = 29) or drink 400 mL of a carbohydrate drink 2 hours before surgery (carbohydrate group, n = 29). The gastric antrum was assessed using ultrasonography in the supine position, followed by the right lateral decubitus (RLD) position. The gastric antrum was graded as grade 0 (fluid not seen in both positions), grade 1 (fluid only seen in the RLD position), and grade 2 (fluid seen in both positions). The gastric antral cross-sectional area (CSA) and aspirated residual gastric volume were measured. Results: In 58 patients, the incidence of grade 2 stomach was 13.8% in NPO group and 17.2% in carbohydrate group (P = .790). The gastric antral CSA in the supine position was larger in carbohydrate group than in NPO group (4.42 [3.72–5.18] cm2 vs 5.31 [4.35–6.92] cm2, P = .018). The gastric antral CSA in the RLD position was not different in NPO and carbohydrate groups (P = .120). There was no difference in gastric volume (2 [0–7.5] vs 3 [0–13.4], P = .331) in NPO group versus carbohydrate group. Conclusion: The incidence of grade 2 stomach was not different between NPO group and carbohydrate group in elderly patients.

Objective To construct a prediction model for optimal tracheal tube depth in pediatric patients using machine learning. Methods Pediatric patients aged Results For each method, the percentage with optimal tracheal tube depth predictions in the test set was calculated as follows: 79.0 (95% confidence interval [CI], 73.5 to 83.6) for random forest, 77.4 (95% CI, 71.8 to 82.2; P = 0.719) for elastic net, 77.0 (95% CI, 71.4 to 81.8; P = 0.486) for support vector machine, 76.6 (95% CI, 71.0 to 81.5; P = 1.0) for artificial neural network, 66.9 (95% CI, 60.9 to 72.5; P < 0.001) for the age-based formula, 58.5 (95% CI, 52.3 to 64.4; P< 0.001) for the tube ID-based formula, and 44.4 (95% CI, 38.3 to 50.6; P < 0.001) for the height-based formula. Conclusions In this study, the machine learning models predicted the optimal tracheal tube tip location for pediatric patients more accurately than the formula-based methods. Machine learning models using biometric variables may help clinicians make decisions regarding optimal tracheal tube depth in pediatric patients.

This study aimed to evaluate the clinical outcomes and persistent infection rate of two-stage revision of infected shoulder arthroplasty. We enrolled 12 patients who developed an infection after undergoing shoulder arthroplasty between January 2009 and January 2014. They underwent a two-stage revision with PROSTALAC implantation and shoulder re-implantation in the first- and second-stage surgery, respectively. The mean follow-up period was 40.88 months (range, 36–52 months). After the second-stage re-implantation, clinical scores, erythrocyte sedimentation rate, as well as C-reactive protein level were evaluated, and the presence of re-infection and complications were analyzed. Infection was improved in all the cases after PROSTALAC insertion. The mean range of motion of forward elevation, external rotation, and internal rotation at the final follow-up after the second-stage re-implantation were 81.67°, 40.42°, and 16.67° (vertebral level), respectively. The mean visual analog scale score improved from 7.08 points before surgery to 2.33 points after surgery. The Modified American Shoulder and Elbow Surgeons score improved from 32.25 before surgery to 64.17 after surgery (P

Background The purpose of this study is to analyze clinical and radiological outcomes of patients (with a minimum of 14 years of follow-up) who underwent cruciate-retaining (CR) total knee arthroplasty (TKA) using a NexGen®-CR, comparing a patellar resurfacing group with a patellar retention group. Methods From June 1996 to April 2002, 116 cases of TKA using a NexGen®-CR who had at least 14 years of follow-up were enrolled in this study. Among them, 68 cases had patellar resurfacing and 48 had patellar retention. The average follow-up period was 14.8 years (14.1–18.7). Clinical scores and range of motion (ROM) were evaluated preoperatively and at the last follow-up in all patients. The Hospital for Special Surgery (HSS) score, Knee Society Score (KSS), Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) score, and a new patellar score were assessed. Radiological evaluations are done by analyzing the tibiofemoral angle, loosening, and a radiolucent line on the radiograph by American Knee Society Roentgen Graphic Evaluation. Results The average HSS score of both the patellar resurfacing group and retention group increased from 42.3 and 41.2 preoperatively to 90.2 and 90.8 at the last follow-up, respectively. The KSS, WOMAC score, patellar score, and knee joint ROM also improved significantly in both groups. However, there were no significant differences in clinical results between the two groups. On the radiological evaluation, the tibiofemoral angle in both groups had improved from varus 7.8° and 7.2° preoperative to valgus 4.9° and 4.8°, respectively. The average angles of α, β, γ, and δ were 94.1°, 90.4°, 3.2°, and 87.8° in the patellar resurfacing group and 94.4°, 89.8°, 3.3°, and 88.1° in the patellar retention group, respectively. A radiolucent line shown on radiograph was noted in a total of seven cases, three in the patellar resurfacing group and four in the patellar retention group. In the patellar resurfacing group, among the seven zones on the tibia radiograph, all cases were located at the medial side of tibia and two cases were in zone 1 and one case in zone 2, and in the patellar retention group, three cases were in zone 1 and 1 case was in zone 2, also located on the same side. Conclusions We achieved satisfactory clinical and radiological outcomes on long-term follow-up when performing TKAs with a NexGen®-CR. There was no significant difference in clinical or radiological results between the patellar resurfacing and retention groups in our study.