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Focuses on a study which proposed to replace bus and address electrodes in a large alternating current plasma display panel (PDP) with triangular protruding tips. Problems with the addressing period in PDP; Results and discussion; Conclusion.

Introduction/Purpose: Although several arthroscopic surgical techniques for the treatment of chronic ankle lateral instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear. The purpose of this study was to compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not. Methods: Between 2016 and 2018, we performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI. 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 two 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 (AOFAS) score, Foot and Ankle Outcome score (FAOS), and the Karlsson Ankle Functional 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 MRI. Results: Out of 101 patients, 19 (18.5%) were excluded based on the exclusion criteria, and 82 patients were evaluated. We identified a total of six re-tears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL re-tear 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 compared to the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups (P < 0.001). However, there were no significant differences in the clinical results and radiologic findings between the two 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Category: Ankle; Arthroscopy Introduction/Purpose: The open modified Broström-Gould procedure is widely accepted as the reference standard for lateral ankle stabilization. However, there is a lack of research comparing the outcomes of arthroscopic repair and open repair procedures for chronic ankle instability (CAI), despite the increasing number of publications on arthroscopic repair of the anterior talofibular ligament (ATFL). This study aimed to compare the clinical and radiological outcomes of arthroscopic repair and open repair of the lateral ligament complex (LLC) in patients with CAI. Methods: We prospectively randomized 64 patients who underwent ligament repair surgery for CAI into two groups: arthroscopic LLC repair (group A, 33 patients) and open modified Broström-Gould procedure (group O, 31 patients). High-demand patients, as determined by a Tegner Activity level ≥ 6, with CAI were included. Subjective outcomes were measured using the pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score. Posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic evaluations were conducted preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging (MRI). A subgroup analysis was also performed according to arthroscopic ligament quality (excellent to fair vs. poor). Results: Both groups showed significant improvements in all clinical scores, objective posturography results, and stress radiographs at 2 years postoperatively (all p < 0.05), with no significant differences between the groups in terms of preoperative and postoperative values (all p > 0.05). Additionally, we identified 5 cases of retear (7.8%) based on postoperative MRI evaluation (9.1% [3/33] in group A and 6.5% [2/31] in group O). One patient in group O experienced postoperative soft tissue infection. However, there were no significant differences between the two groups (p > 0.05). There was no difference in clinical results between each group in subgroup analysis according to ligament quality (p > 0.05). Conclusion: Arthroscopic LLC repair produced similarly favorable outcomes when compared with open lateral ankle ligament repair. In addition, arthroscopic LLC repair, as a minimally invasive technique, provide comparable outcomes to open procedure, even when the ligament tissue was poor.

Category: Sports; Arthroscopy Introduction/Purpose: Arthroscopic all-inside techniques have gained prominence in the treatment of chronic ankle instability (CAI), offering effective solutions. However, arthroscopic treatment of CAI with poor remnant ligament-tissue quality is still controversy. This study aims to evaluate the outcomes of the arthroscopic all-inside anterior talofibular ligament (ATFL) repair, according to the quality of remnant ligament. Methods: A retrospective analysis was conducted on consecutive CAI patients who underwent arthroscopic ATFL repair, with a follow-up period of at least two years. Patients were categorized into two groups based on arthroscopic ATFL grade: Group G, characterized by good to moderate tissue quality with distension or discontinuity of the ATFL; and Group P, characterized by poor tissue quality with a hypoplastic ATFL. Patients with irreparable absent ATFL were excluded. Subjective outcomes were assessed using the visual analogue scale score, Foot and Ankle Outcome Score (FAOS), and the Karlsson ankle functional score. Objective outcomes included posturographic analysis and radiological evaluations, such as stress radiographs and axial view magnetic resonance imaging (MRI). Results: Among 163 patients, 22 were excluded based on predefined criteria, leaving 141 patients for analysis (Group G, n = 77; Group P, n = 64). Patients had a mean age of 32.1 years, and the average follow-up duration was 31.6 months. Both groups exhibited postoperative improvements in subjective and objective clinical outcomes (all p < 0.05). Significantly, Group P demonstrated lower FAOS scores in the sports unit (p = 0.016), an increased fall risk as determined by posturography at the final follow-up (p = 0.019), and a higher retear rate on axial view MRI (10.9%, 7/64) compared to Group G (2.6%, 2/77) (p = 0.044). Conclusion: Arthroscopic all-inside ATFL repair is an effective treatment for CAI, regardless of the quality of the remnant ligament. However, patients with poor ligament quality showed inferior clinical outcomes, especially in sports-related activities and proprioception. Additionally, they experienced a higher retear rate. These findings highlight the significance of performing arthroscopic all-inside ATFL repair selectively for CAI, considering the patient's activity level and the quality of the remaining ligament tissue.

In this study, we investigate the performance of the Gunma University Heavy Ion Medical Center’s ion computed tomography (CT) system, which measures the residual range of a carbon-ion beam using a fluoroscopy screen, a charge-coupled-device camera, and a moving wedge absorber and collects CT reconstruction images from each projection angle. Each 2D image was obtained by changing the polymethyl methacrylate (PMMA) thickness, such that all images for one projection could be expressed as the depth distribution in PMMA. The residual range as a function of PMMA depth was related to the range in water through a calibration factor, which was determined by comparing the PMMA-equivalent thickness measured by the ion CT system to the water-equivalent thickness measured by a water column. Aluminium, graphite, PMMA, and five biological phantoms were placed in a sample holder, and the residual range for each was quantified simultaneously. A novel method of CT reconstruction to correct for the angular deflection of incident carbon ions in the heterogeneous region utilising the Bragg peak reduction (BPR) is also introduced in this paper, and its performance is compared with other methods present in the literature such as the decomposition and differential methods. Stopping power ratio values derived with the BPR method from carbon-ion CT images matched closely with the true water-equivalent length values obtained from the validation slab experiment. [ABSTRACT FROM AUTHOR]

Category: Sports; Arthroscopy Introduction/Purpose: Although Modified Broström Technique is still gold standard procedure for chronic ankle instability (CAI), the effect of inferior extensor retinaculum (IER) augmentation remains unclear. Recently, as several arthroscopic surgical techniques for CAI have been introduced, the issue on additional IER augmentation has been controversial in the arthroscopic field as well. The purpose of this study was to compare the clinical and radiological outcomes between all-inside arthroscopic anterior talofibular ligament (ATFL) repair with and without IER augmentation. Methods: We prospectively randomized 59 patients who underwent arthroscopic surgery for CAI into 2 groups: arthroscopic ATFL repair with IER augmentation (group W, 29 patients) and without IER augmentation (group WO, 30 patients). 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. Results: All clinical scores, objective posturography, and stress radiographs improved significantly at 2 years postoperatively in both groups (all, p< 0.05), with no significant differences between the groups with respect to the preoperative and postoperative values (all, p>0.05). In addition, we identified 3 retear (5.1%) based on postoperative MRI evaluation (3.4% [1/29] in group W and 6.7% [2/30] in group WO). However, there was no significant differences between 2 groups (p>0.05). One patient in group WO had neuralgia of the superficial peroneal nerve; 2 patients in group W had knot irritation causing mild discomfort. Conclusion: Arthroscopic ATFL repair represent good postoperative functional and radiologic outcomes, regardless IER augmentation. Additional IER augmentation after arthroscopic ATFL repair is not promise better clinical outcomes.

Category: Sports; Other Introduction/Purpose: We investigated the therapeutic effect of a postoperative hospital-based systemic rehabilitation protocol on ankle function in chronic ankle instability (CAI) patients. Methods: 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. Results: There were 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. Conclusion: 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.

Category: Ankle; Trauma Introduction/Purpose: The fundamental concept of open reduction and internal fixation (ORIF) of unstable ankle fractures was anatomical reduction and firm fixation that allow early mobilization and rehabilitation. On the other hand, ORIF of ankle fractures is associated with complications including wound dehiscence, necrosis and infection, prominent hardware and failure. Closed reduction and intramedullary fixation (CRIF) using fibula nail was emerged as additional surgical option for unstable ankle fractures especially in elderly and medical high-risk patients. We hypothesized that fibula nailing for unstable ankle fractures would have similar functional outcomes to standard ORIF. The purpose of this study is to perform a prospective randomized study to compare clinical outcomes, bone union, and postoperative complications between ORIF and CRIF using fibula nail. Methods: A total of 59 patients (32 men, 27 women) with the mean age of 50.2 years were prospectively randomized to undergo standard ORIF or fibular nailing for unstable ankle fractures: those who underwent ORIF (31 patients 14 men, 17 women) and those who underwent CRIF using fibula nail (29 patients; 18 men and 11women). Exclusion criteria of fracture characteristics were open fracture and highly comminuted fibula fractures. Functional scoring including VAS, AOFAS and FAOS were evaluated at minimum postoperative 2 years follow up. In addition, union period, reduction status of fracture and ankle mortise at postoperative CT scan, complications including wound problem and posttraumatic arthritis were evaluated. Results: The VAS, AOFAS, and all FAOS subscales were not significantly different between two group at 2 years postoperatively (all, p>0.05). Significantly fewer infections and wound complication occurred in the fibula nail group. (p < 0.05; ORIF group (12.9%), fibula nail group (0%)). Postoperative at fracture site of fibula was high in fibula nail group (p < 0.05; ORIF group (0%), fibula nail group (13.7%)), but there were no significant differences in the status of mortise and the rate of posttraumatic arthritis (all, p>0.05). Conclusion: We concluded that the fibula nail allows acceptable reduction and secure fixation of unstable ankle fracture, with low soft tissue complication rate than ORIF. Considering the property closed reduction, the fibula nail would be an excellent treatment option for patients with unstable ankle fractures when indications is well selected

Macrodystrophia lipomatosa (MDL) is a rare disorder characterized by overgrowth of mesenchymal cells, resulting in gigantism of one or more digit. We report a case of a woman in her late 60s who presented with abnormal enlargement of the right second toe. By debulking the pathological tissue while preserving the shape of the toe as much as possible without amputation of the entire phalanx, debulking surgery not only helps walking, but also allows wearing shoes of the same size on both feet and achieves cosmetic satisfaction for patients. The functional and cosmetic improvement obtained through debulking surgery in this case resulted in no recurrence of disease 5 years postoperatively and provided a desirable alternative to amputation. Therefore, through this case, we demonstrated that debulking surgery can be a reasonable option for MDL patients.

Background and Objectives: Supine-to-prone hypotension is caused by increased intrathoracic pressure and decreased venous return in the prone position. Dynamic arterial elastance (Eadyn) indicates fluid responsiveness and can be used to predict hypotension. This study aimed to investigate whether Eadyn can predict supine-to-prone hypotension. Materials and Methods: In this prospective, observational study, 47 patients who underwent elective spine surgery in the prone position were enrolled. Supine-to-prone hypotension is defined as a decrease in Mean Arterial Pressure (MAP) by more than 20% in the prone position compared to the supine position. Hemodynamic parameters, including systolic blood pressure (SAP), diastolic blood pressure, MAP, stroke volume variation (SVV), pulse pressure variation (PPV), stroke volume index, cardiac index, dP/dt, and hypotension prediction index (HPI), were collected in the supine and prone positions. Supine-to-prone hypotension was also assessed using two different definitions: MAPprone < 65 mmHg and SAPprone < 100 mmHg. Hemodynamic parameters were analyzed to determine the predictability of supine-to-prone hypotension. Results: Supine-to-prone hypotension occurred in 13 (27.7%) patients. Eadyn did not predict supine-to-prone hypotension [Area under the curve (AUC), 0.569; p = 0.440]. SAPsupine > 139 mmHg (AUC, 0.760; p = 0.003) and dP/dtsupine > 981 mmHg/s (AUC, 0.765; p = 0.002) predicted supine-to-prone hypotension. MAPsupine, SAPsupine, PPVsupine, and HPIsupine predicted MAPprone supine, SAPsupine, SVVsupine, PPVsupine, and HPIsupine predicted SAPprone < 100 mm Hg. Conclusions: Dynamic arterial elastance did not predict supine-to-prone hypotension in patients undergoing spine surgery. Systolic arterial pressure > 139 mmHg and dP/dt > 981 mmHg/s in the supine position were predictors for supine-to-prone hypotension. When different definitions were employed (mean arterial pressure < 65 mmHg in the prone position or systolic arterial pressure < 100 mmHg in the prone position), low blood pressures in the supine position were related to supine-to-prone hypotension.

Background & aimsFentanyl buccal tablets (FBTs) are a rapid-onset opioid indicated for breakthrough cancer pain (BTcP) and FBT titration is needed to optimize BTcP management. We aimed to predict which patients could tolerate a high dose of FBT (400 μg or more at a time).MethodsA retrospective analysis was performed to assess the final FBT dose. The final FBT doses were compared according to the clinical features. The prediction accuracy of patients tolerant of 400 μg or higher FBT was compared using the area under the receiver operating characteristic (ROC) curves. A risk scoring model based on the odds ratio (OR) was developed from the final multivariable model, and patients were assigned into two groups: low tolerance (0-1 point) and high tolerance (2-3 points).ResultsAmong 131 patients, the most frequently effective dose of FBT was 200 μg (54%), followed by 100 μg (30%). The median value of morphine equivalent daily doses (MEDD) was 60 mg/day, and the most common daily use was 3-4 times/day. In multivariable analysis, male sex, younger age, and use of FBTs three or more times per day were independently associated with high-dose FBT. According to the risk scoring model, the patients with a final FBT of 400 μg or higher were significantly more in the high tolerance group (17%) compared to the low tolerance group (3%; p = 0.023).ConclusionsAccording to the dose relationship between the final FBT dose and the clinical features, three factors (sex, age, daily use of FBT) were independently associated with the final dose of FBT. Our risk score model could help predict tolerance to high-dose FBT and guide the titration plan for BTcP.

This study was conducted to suggest the necessity of regulated stand density control in order to maintain the ratio of height to diameter at breast height (H/D ratio) of Hinoki cypress (Chamaecyparis obtusa) and Japanese cedar (Cryptomeria japonica) in South Korea. A total of 2,000 (1,000 each) Hinoki cypress and Japanese cedar were cut from various regions of South Korea, and their diameter at breast height (DBH), height and clear length were measured. The two species’ regional means of H/D ratio and crown ratio were then computed and compared to find the relationship with tree growth. The result of analyzing the relationship between the H/D ratio and tree growth by DBH class is as follows, 77.0% for small DBH class, 62.5% for medium DBH class, and 45.9% for large DBH class, with overall mean of 61.8%. The annual means of DBH growth were 4.6 mm, 7.4 mm, and 8.2 mm respectively for small, medium, and large DBH classes. As the DBH class went up, the H/D ratio decreased, showing a negative correlation (p

Abstract 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.

Background Intra-articular distal humeral fractures can be surgically challenging. It remains under discussion whether open reduction and internal fixation (ORIF) or total elbow arthroplasty (TEA) is more beneficial for treatment of the elderly. This study aimed to compare the clinical and functional outcomes of ORIF and TEA for managing intra-articular distal humerus fractures in patients aged 65 years or older. Methods Patients who underwent ORIF (n=28) or TEA (n=43) for in intra-articular distal humerus fracture between May 2008 and December 2018 were reviewed. Range of motion, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiologic outcomes, and surgical complications were evaluated at the final follow-up visit. Results The ORIF and TEA groups showed a mean arc of flexion–extension of 97°±21° and 101°±12°, respectively. The mean MEPS and DASH scores were 94±15 and 27±12 points, respectively, in the ORIF group and 81±27 and 47±28 points in the TEA group. This difference was statistically significant. The incidence of total complications was similar between the groups. Conclusions In patients older than 65 years with intra-articular distal humerus fracture, ORIF had better outcomes than TEA.

The diversity of autologous cells being used and investigated for cancer therapy continues to increase. Mast cells (MCs) are tissue cells that contain a unique set of anti-cancer mediators and are found in and around tumors. We sought to exploit the anti-tumor mediators in MC granules to selectively target them to tumor cells using tumor specific immunoglobin E (IgE) and controllably trigger release of anti-tumor mediators upon tumor cell engagement. We used a human HER2/neu-specific IgE to arm human MCs through the high affinity IgE receptor (FcεRI). The ability of MCs to bind to and induce apoptosis of HER2/neu-positive cancer cells in vitro and in vivo was assessed. The interactions between MCs and cancer cells were investigated in real time using confocal microscopy. The mechanism of action using cytotoxic MCs was examined using gene array profiling. Genetically manipulating autologous MC to assess the effects of MC-specific mediators have on apoptosis of tumor cells was developed using siRNA. We found that HER2/neu tumor-specific IgE-sensitized MCs bound, penetrated, and killed HER2/neu-positive tumor masses in vitro. Tunneling nanotubes formed between MCs and tumor cells are described that parallel tumor cell apoptosis. In solid tumor, human breast cancer (BC) xenograft mouse models, infusion of HER2/neu IgE-sensitized human MCs co-localized to BC cells, decreased tumor burden, and prolonged overall survival without indications of toxicity. Gene microarray of tumor cells suggests a dependence on TNF and TGFβ signaling pathways leading to apoptosis. Knocking down MC-released tryptase did not affect apoptosis of cancer cells. These studies suggest MCs can be polarized from Type I hypersensitivity-mediating cells to cytotoxic cells that selectively target tumor cells and specifically triggered to release anti-tumor mediators. A strategy to investigate which MC mediators are responsible for the observed tumor killing is described so that rational decisions can be made in the future when selecting which mediators to target for deletion or those that could further polarize them to cytotoxic MC by adding other known anti-tumor agents. Using autologous human MC may provide further options for cancer therapeutics that offers a unique anti-cancer mechanism of action using tumor targeted IgE’s.

Objective: To investigate if intentional pesticide intake could have different clinical outcomes compared to unintentional poisoning, and whether acute alcohol consumption correlated with intentional poisoning. Method: The retrospective observational study was conducted in South Korea and comprised data from the Emergency Department-based Injury In-depth Surveillance Registry of all adults with pesticide poisoning from 2009 to 2017. The primary outcome was overall mortality. Adjusted odds ratios with 95% confidence intervals of the exposures on clinical outcomes were calculated. Data was analysed using SAS 9.4. Results: Among the 7,320 patients, intentional poisoning had higher odds of overall mortality (adjusted odds ratio: 1.88; 95% confidence interval: 1.56-2.25) and major adverse outcomes (adjusted odds ratio: 2.64; 95% confidence interval: 2.32-2.99), while acute alcohol consumption showed a higher incidence of intentional poisoning (adjusted odds ratio: 2.43; 95% confidence interval: 2.11-2.80). Conclusion: Intentional poisoning showed higher mortality rate and major adverse outcomes. It is important to consider host factors before poisoning, such as acute alcohol consumption, which may contribute to the clinical outcomes of pesticide poisoning cases. Key Words: Pesticide, Poisoning, Intentionality, Alcohol.

BackgroundPostoperative nausea and vomiting (PONV) is a still highly relevant problem and is known to be a distressing side effect in patients. The aim of this study was to develop a machine learning model to predict PONV up to 24 h with fentanyl-based intravenous patient-controlled analgesia (IV-PCA).MethodsFrom July 2019 and July 2020, data from 2,149 patients who received fentanyl-based IV-PCA for analgesia after non-cardiac surgery under general anesthesia were applied to develop predictive models. The rates of PONV at 1 day after surgery were measured according to patient characteristics as well as anesthetic, surgical, or PCA-related factors. All statistical analyses and computations were performed using the R software.ResultsA total of 2,149 patients were enrolled in this study, 337 of whom (15.7%) experienced PONV. After applying the machine-learning algorithm and Apfel model to the test dataset to predict PONV, we found that the area under the receiver operating characteristic curve using logistic regression was 0.576 (95% confidence interval [CI], 0.520-0.633), k-nearest neighbor was 0.597 (95% CI, 0.537-0.656), decision tree was 0.561 (95% CI, 0.498-0.625), random forest was 0.610 (95% CI, 0.552-0.668), gradient boosting machine was 0.580 (95% CI, 0.520-0.639), support vector machine was 0.649 (95% CI, 0.592-0.707), artificial neural network was 0.686 (95% CI, 0.630-0.742), and Apfel model was 0.643 (95% CI, 0.596-0.690).ConclusionsWe developed and validated machine learning models for predicting PONV in the first 24 h. The machine learning model showed better performance than the Apfel model in predicting PONV.

Studies in rats, monkeys, and humans have found action-value signals in multiple regions of the brain. These findings suggest that action-value signals encoded in these brain structures bias choices toward higher expected rewards. However, previous estimates of actionvalue signals might have been inflated by serial correlations in neural activity and also by activity related to other decision variables. Here, we applied several statistical tests based on permutation and surrogate data to analyze neural activity recorded from the striatum, frontal cortex, and hippocampus. The results show that previously identified action-value signals in these brain areas cannot be entirely accounted for by concurrent serial correlations in neural activity and action value. We also found that neural activity related to action value is intermixed with signals related to other decision variables. Our findings provide strong evidence for broadly distributed neural signals related to action value throughout the brain. [ABSTRACT FROM AUTHOR]

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.

Experimental microdosimetry along with the microdosimetric kinetic (MK) model can be utilized to predict the biological effects of ions. To predict the relative biological effectiveness (RBE) of ions and the survival fraction (SF) of human salivary gland tumour (HSGc-C5) cells, microdosimetric quantities measured by a silicon-on-insulator (SOI) MicroPlus-mushroom microdosimeter along the spread-out Bragg peak (SOBP) delivered by pencil beam scanning of 4He, 12C, 16O, and 20Ne ions were used. The MK model parameters of HSGc-C5 cells were obtained from the best fit of the calculated SF for the different linear energy transfer (LET) of these ions and the formerly reported in vitro SF for the same LET and ions used for calculations. For a cube-shaped target of 10 × 10 × 6 cm3, treatment plans for 4He, 12C, 16O, and 20Ne ions were produced with proprietary treatment planning software (TPS) aiming for 10% SF of HSGc-C5 cells over the target volume and were delivered to a polymethyl methacrylate (PMMA) phantom. Afterwards, the saturation-corrected dose-mean lineal energy derived based on the measured microdosimetry spectra, along with the physical dose at various depths in PMMA phantoms, was used for the estimation of the SF, RBE, and RBE-weighted dose using the MK model. The predicted SF, RBE, and the RBE-weighted dose agreed with what was planned by the TPS within 3% at most depths for these ions.

ObjectiveTo construct a prediction model for optimal tracheal tube depth in pediatric patients using machine learning.MethodsPediatric patients aged ResultsFor 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.ConclusionsIn 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.

ObjectivesThe 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.MethodsAmong 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.ResultsThe 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.ConclusionsIncreased 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.

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

The Centre for Medical Radiation Physics introduced the concept of Silicon On Insulator (SOI) microdosimeters with 3-Dimensional (3D) cylindrical sensitive volumes (SVs) mimicking the dimensions of cells in an array. Several designs of high-definition 3D SVs fabricated using 3D MEMS technology were implemented. 3D SVs were fabricated in different sizes and configurations with diameters between 18 and 30 µm, thicknesses of 2–50 µm and at a pitch of 50 µm in matrices with volumes of 20 × 20 and 50 × 50. SVs were segmented into sub-arrays to reduce capacitance and avoid pile up in high-dose rate pencil beam scanning applications. Detailed TCAD simulations and charge collection studies in individual SVs have been performed. The microdosimetry probe (MicroPlus) is composed of the silicon microdosimeter and low-noise front–end readout electronics housed in a PMMA waterproof sheath that allows measurements of lineal energies as low as 0.4 keV/µm in water or PMMA. Microdosimetric quantities measured with SOI microdosimeters and the MicroPlus probe were used to evaluate the relative biological effectiveness (RBE) of heavy ions and protons delivered by pencil-beam scanning and passive scattering systems in different particle therapy centres. The 3D detectors and MicroPlus probe developed for microdosimetry have the potential to provide confidence in the delivery of RBE optimized particle therapy when introduced into routine clinical practice.

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 >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.

Abstract 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.

The two-parameter-fitting method (PFM) is commonly used to calculate the stopping-power ratio (SPR). This study proposes a new formalism: a three-PFM, which can be used in multiple spectral computed tomography (CT). Using a photon-counting CT system, seven rod-shaped samples of aluminium, graphite, and poly(methyl methacrylate) (PMMA), and four types of biological phantom materials were placed in a water-filled sample holder. The X-ray tube voltage and current were set at 150 kV and 40 μμA respectively, and four CT images were obtained at four threshold settings. A semi-empirical correction method that corrects the difference between the CT values from the photon-counting CT images and theoretical values in each spectral region was also introduced. Both the two- and three-PFMs were used to calculate the effective atomic number and electron density from multiple CT numbers. The mean excitation energy was calculated via parameterisation with the effective atomic number, and the SPR was then calculated from the calculated electron density and mean excitation energy. Then, the SPRs from both methods were compared with the theoretical values. To estimate the noise level of the CT numbers obtained from the photon-counting CT, CT numbers, including noise, were simulated to evaluate the robustness of the aforementioned PFMs. For the aluminium and graphite, the maximum relative errors for the SPRs calculated using the two-PFM and three-PFM were 17.1% and 7.1%, respectively. For the PMMA and biological phantom materials, the maximum relative errors for the SPRs calculated using the two-PFM and three-PFM were 5.5% and 2.0%, respectively. It was concluded that the three-PFM, compared with the two-PFM, can yield SPRs that are closer to the theoretical values and is less affected by noise.

Allium macrostemon (AM) may affect bone growth by regulating bone formation and resorption. To examine the effect of AM on bone growth, 48 rats were divided into four administration groups in which either distilled water, AM (100 and 300 mg/kg), or recombinant human growth hormone (rhGH; 20 μg/kg) was administered for 10 days. On day 9, all animals were intraperitoneally injected with tetracycline hydrochloride (20 mg/kg), and 48 h after the injection, the rats were sacrificed. Their tibial sections were photographed to measure bone growth. Antigen-specific immunohistochemistry was performed to detect insulin-like growth factor-1 (IGF-1) and bone morphogenetic protein-2 (BMP-2). The food intake of the AM 100 mg/kg group was higher; however, the food intake of the AM 300 mg/kg group was less than that of the control group. The rhGH and AM 100 mg/kg groups showed greater rates of bone growth (359.0 ± 23.7 and 373.1 ± 28.0 μm/day, respectively) compared with the control group. IGF-1 and BMP-2 in the AM and rhGH groups were highly expressed. Indigestion at higher doses of AM led to nonsignificant bone growth in spite of increased IGF-1 and BMP-2 expression. Therefore, a suitable amount of AM could increase bone growth.

The development of cerebral venous thrombosis (CVT) as a secondary complication of Crohn's disease (CD) seems to be rare, but it is generally accepted that the disease activity of CD contributes to the establishment of a hypercoagulable state. Here, we describe a case of CVT that developed outside the active phase of CD. A 17-year-old male visited the emergency room because of a sudden onset of right-sided weakness and right-sided hypesthesia. He had been diagnosed with CD 1 year before and was on a maintenance regimen of mesalazine and azathioprine. He did not exhibit any symptoms indicating a CD flare-up (bloody stools, abdominal pain, complications, or weight loss). A brain MRI scan revealed an acute infarction of the left frontal cortex and a cortical subarachnoid hemorrhage. Additionally, a magnetic resonance venography revealed a segmental filling defect in the superior sagittal sinus and also the non-visualizability of some bilateral cortical veins. The characteristics of the present case suggest that the risk of CVT is most likely related to CD per se rather than disease activity associated with CD.

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.

BackgroundAcute liver failure (ALF) is a rapidly progressing and fatal disease for which liver transplantation (LT) is the only treatment. Posttransplant mechanical ventilation tends to be more prolonged in patients with ALF than in other LT patients. The present study examined the clinical effects of prolonged posttransplant mechanical ventilation (PMV), and identified risk factors for PMV following LT for ALF.MethodsWe reviewed data of patients undergoing LT for ALF between January 2005 and June 2011. After grouping patients according to administration of PMV (≥ 24 h), donor and recipient perioperative variables were compared between the groups with and without PMV. Potentially significant factors (P < 0.1) from the univariate intergroup comparison were entered into a multivariate logistic regression to establish a predictive model for PMV.ResultsTwenty-four (25.3%) of 95 patients with ALF who received PMV had a higher mortality rate (29.2% vs 11.3%, P = 0.038) and longer intensive care unit stay (12.9 ± 10.4 vs 7.1 ± 2.7 days, P = 0.012) than patients without PMV. The intergroup comparisons revealed worse preoperative hepatic conditions, more supportive therapy, and more intraoperative fluctuations in vital signs and less urine output in the with- compared with the without-PMV group. The multivariate analysis revealed that preoperative hepatic encephalopathy (≥ grade III), intraoperative blood pressure fluctuation, and oliguria (< 0.5 ml/kg/h) were independent risk factors for PMV.ConclusionsPMV was associated with deleterious outcomes. Besides care for known risk factors including hepatic encephalopathy, meticulous attention to managing intraoperative hemodynamic circulatory status is required to avoid PMV and improve the posttransplant prognosis in ALF patients.

Spontaneous cervical epidural hematoma (SCEH) is a rare condition that causes paraparesis or quadriparesis. As spontaneous resolution is seldom expected, it usually requires surgical treatment for relieve symptoms. Even if spontaneous resolution occurs, relief from symptoms usually requires several hours to days. In contrast, hemiparesis is the most common symptom of a transient ischemic attack (TIA), and usually resolves over minutes to hours. We report here two patients with SCEH who presented with hemiparesis with severe neck pain. Both patients were taking antiplatelet drugs. Their neurological symptoms recovered spontaneously over a very short time. They were initially misdiagnosed as TIA. These cases show that patients with transient hemiparesis may have SCEH if there is severe neck pain and no cranial nerve involvement. [ABSTRACT FROM AUTHOR]

Bilateral Moyamoya disease manifesting as ischemic stroke in a patient with Williams syndrome has not been previously reported. Williams syndrome is a genetic disorder characterized by infantile hypercalcemia, elfin facial features, an outgoing personality, and cardiovascular abnormalities. It has been found to be related to elastin gene defect. Cerebrovascular abnormalities with associated strokes in Williams syndrome have been described only recently and rarely. Moyamoya disease is a cerebrovascular disorder characterized by progressive occlusion of the supraclinoid internal carotid artery. The pathogenesis of Moyamoya disease is unclear. Only a single report of Moyamoya disease associated with Williams syndrome manifesting as an intracerebral hemorrhage has been published. We report the first case of bilateral Moyamoya disease manifesting as ischemic stroke in a patient with Williams syndrome. We propose that inherited moyamoya disease is also related to elastin gene defect. [ABSTRACT FROM AUTHOR]