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Background Although many studies have investigated iatrogenic radial nerve palsy (RNP) in humerus shaft fracture, there is inconsistent evidence on which approach leads to iatrogenic RNP. Moreover, no meta-analysis has directly compared the anterolateral and posterior approaches regarding iatrogenic RNP. Methods In this systematic review and meta-analysis, the MEDLINE, Embase, and Cochrane Library databases were searched systematically for studies published before March 30, 2021. We included studies that (1) assessed the RNP in the surgical treatment of humerus shaft fracture and (2) directly compared the anterolateral and posterior approaches regarding the RNP. We performed synthetic analyses of the incidence of iatrogenic RNP and the recovery rate of iatrogenic RNP in humerus shaft fracture between the anterolateral and posterior approaches. Results Our study enrolled nine studies, representing 1303 patients who underwent surgery for humerus shaft fracture. After exclusion of traumatic RNP, iatrogenic RNP was reported in 35 out of 678 patients in the anterolateral approach and in 69 out of 497 patients in the posterior approach. Pooled analysis revealed that the incidence of iatrogenic RNP was significantly higher in the posterior approach than in the anterolateral approach (OR = 2.72; 95% confidence interval (CI), 1.70-4.35; P Conclusion In this meta-analysis, the posterior approach showed a higher incidence of iatrogenic RNP than the anterolateral approach in the surgical treatment of humerus shaft fracture. With limited studies, it is difficult to anticipate if any particular approach favors the recovery of iatrogenic RNP.

Abstract: Background: Previous research has not investigated why and how adolescents decide to continuously engage in Taekwondo activity, which, based on self-determination theory, has positive effects on diverse (physical, psychological, social) aspects. This study examines the structural relationship between three psychological needs (autonomy, competence, relatedness), intrinsic motivation, and intentions for Taekwondo activity continuity among high-school students participating in Taekwondo training programs. Methods: High-school students (130 males, 110 females) representing multiple nationalities participated in Taekwondo lessons for one session. During the last session class, they completed three questionnaires, and the collected data were analyzed using structural equation modeling. Results: The results revealed that the satisfaction of three psychological needs was positively and directly associated with intrinsic motivation at a statistically significant level. Additionally, intrinsic motivation directly and positively contributed to intentions for Taekwondo activity continuity and mediated the relationship between the satisfaction of psychological needs and intentions to continue Taekwondo at levels of statistical significance. Discussion: The findings indicate that, if high-school students meet three psychological needs during Taekwondo classes, they are likely to internalize positive feelings such as interest, enjoyment, and satisfaction. Further, intrinsically motivated students would be highly willing to continually engage in Taekwondo activity.

Pelvic ring injuries have high mortality and morbidity rates, and they are difficult to treat because accompanying injuries to the pelvic organs, genitourinary organs, and neurovascular tissues are common. Genitourinary injuries are common comorbid injuries that have been reported to occur in 5% to 6% of all pelvic ring injuries. However, these injuries usually occur simultaneously with the pelvic ring injury, whereas relatively little research has dealt with genitourinary injuries that occur after treatment of a pelvic ring injury. To the best of our knowledge, only three cases of delayed bladder perforation due to screw loosening after symphyseal plate fixation in anterior pelvic ring injury have been reported worldwide, and no such cases have yet been reported in Korea. Since the authors experienced this very rare complication after pelvic ring surgery, we report this case along with a literature review.

Femoral head fracture is a rare type of fracture commonly associated with hip dislocation. Femoral head fracture treatments include conservative treatment, fragment excision, open reduction, internal fixation, and arthroplasty. In cases of young patients, open reduction and internal fixation are preferred over arthroplasty. Pipkin type 2 fractures are treated with open reduction and internal fixation in most cases because the fracture line extends upward of the fovea and includes the femoral head-acetabular weight-bearing joint surface. However, if the fracture is severely comminuted or crushed, good results are difficult to obtain with open reduction and internal fixation.A 23-years-old male patient presented to the emergency room with right hip pain after 4-m fall.In initial image work up, he was diagnosed with right posterior hip dislocation and a Pipkin type 2 femoral head fracture with an ipsilateral superior ramus fracture. After manual reduction, simple radiography and computed tomography showed reduction of the hip joint and a large osteochondral defect of approximately 6 cm2 in the weight-bearing area on the superomedial side of the femoral head.This was treated with a novel surgery named autologous osteochondral transplantation (repositionplasty), devised by the authors.The congruent reduction was confirmed by radiography and computed tomography immediately after the surgery. At 5 years postoperatively, the Harris Hip Score was 100 points and no discomfort, femoral head collapse, osteonecrosis, or traumatic arthritis were observed on follow-up radiographs.We think this method "repositionplasty" will be a good treatment method for young patients with a large defect in the weight-bearing part of the femoral head who cannot undergo open reduction and internal fixation.

Preoperative patient analysis for oral cancer involves multiple considerations that are based on multiple factors; these include TNM stages, histopathologic findings, and adjacent anatomical structures. Once the decision is made to excise the lesion, the margin of dissection and its extent should be considered along with the best form of reconstruction and airway management. Treatment methods include surgical resection, radiotherapy, and chemotherapy. Although the combined method of treatment is controversial, surgical resection is considered predominantly, and immediate reconstruction after surgical resection follows. The choice of treatment is dictated by the anticipated functional and esthetic results of treatment and also by the availability of a surgeon with the required expertise. Segmental mandibulectomy with primary reconstruction has been shown to have advantages in both functional and esthetic results. A 52-year-old male patient with basaloid squamous cell carcinoma of the floor of the mouth, and the anterior portion of the mandible was treated with surgical procedures that included segmental mandibulectomy with both supraomohyoid neck dissection (SOHND) at Levels I-III and mandible reconstruction with a left fibula free flap. A 55-year-old male patient with clear cell odontogenic carcinoma of the oral cavity underwent segmental mandibulectomy with both SOHND at Levels I-III and mandible reconstruction with a left fibula free flap. The purpose of this study was to review the anatomic and functional results of patients after immediate reconstruction with a fibula free flap following resection of carcinoma in the anterior portion of the mandible and floor of the mouth.

최근 코로나19의 영향으로 관광산업 현장에서 근무하는 직원들의 상황이 좋지 않다. 특히 호텔기업은 인적자원을 바탕으로 영업하는 기업이기 때문에 상황이 더욱더 어려운 실정이다. 이에 본 연구에서는 호텔기업의 인적자원에 대한 관리의 중요성을 인식하고, 호텔직원의 감성지능이 혁신행동과 조직신뢰 및 업무성과에 미치는 영향 관계를 파악하여 호텔기업의 발전과 성장을 위한 시사점을 제시하고자 하였다. 자료는 한국의 다양한 등급 10개 호텔에서 근무하고 있는 직원들로부터 수집하였다. 각 호텔에 40부씩, 총 400부를 배포하였고, 그 중 380부를 회수하였다. 회수된 설문지 중에서 5부의 설문지를 제외하고, 총 375부의 설문지들을 이용해 분석하였다. 분석 결과는 첫째, 호텔 직원들이 인식하는 감성지능은 혁신행동에 유의미한 영향을 미치는 것으로 나타났다. 특히 감성조절 요인이 혁신행동에 정(+)의 영향을 미치는 것으로 나타났고, 나머지 요인들은 혁신행동에 부(-)의 영향을 미치는 것으로 나타났다. 둘째, 호텔직원들이 인식하는 혁신행동은 조직신뢰와 업무성과에 모두 정(+)의 영향을 미치는 것으로 나타났다. 셋째, 호텔직원들의 조직신뢰는 업무성과에 정(+)의 영향을 미치는 것으로 나타났다. 연구결과를 해석해보면, 최근 코로나19의 영향으로 호텔직원들이 심리적으로 어려운 상황에 처하게 되었다. 그렇기 때문에 강한 정신력을 의미하는 감성조절 요인이 혁신행동에 정(+)의 영향을 미친것이라고 해석할 수 있다. 본 연구는 호텔직원들의 감성지능이 혁신행동과 조직신뢰 및 업무성과에 미치는 인과관계를 분석함으로써, 호텔기업의 인적자원관리에 도움을 주고 지속가능한 성장과 발전을 위한 시사점을 제시하였다는데 의의가 있다.

University students in the international regions show reduced physical activity levels compared to previous generations. Lack of physical activity in college population is a growing problem of modern society because over half of the population is faced with serious health problems, such as obesity, diabetes, and high blood pressure. An emphasis point of physical activity research is to get detailed information of motivational process for engaging in physical activity. This study tested a serial path model that the relationship between autonomous motivation and after school physical activity was proposed to be mediated by behavioral intention and the existence of action planning. A total of 203 students participating in physical education classes of two universities located at a metropolitan city in South Korea were selected. The participants completed four well-validated questionnaires at the end of the classes in one semester. The results of data analyzed using a structural equation modeling revealed that after school physical activity could be positively advanced by the sequential mediation effects of behavioral intention and action planning if students were internalized with autonomous motivation in the physical education classes. The findings highlighted that the action planning played as an effective strategy in leading to engagement in after school physical activity and provided useful information for university physical educators to increase physical activity levels of university students during out of school hours.

A 74-year-old woman presented with multiple rib fractures, hemothorax, spleen rupture, and right shoulder dislocation. Shoulder joint reduction was performed using the traction-countertraction method. An injury to the descending aorta, caused by the seventh rib, was confirmed.The authors encountered an aortic injury, a rare complication of shoulder joint reduction, in a patient with a posterior rib fracture. When managing patients with posterior fractures of the fourth to ninth ribs on the left side, the reduction method should be carefully selected depending on the status of the patient to avoid aortic injuries.

Surgical outcomes of the paratricipital approach (PT) and olecranon osteotomy (OO) for the treatment of distal humerus intra-articular fracture have been reported. However, there is no consensus regarding which approach is better in terms of functional outcomes and complications. This study aimed to compare the operation time, functional outcomes, and complications of OO and PT.The databases of MEDLINE, Embase, and Cochrane Library were systematically searched for studies published before June 1, 2021. We performed synthetic analysis of the operation time, functional outcomes, and incidence of complication after the conduct of OO group or PT group in patients with distal humerus intra-articular fractures.Five studies were included representing a total of 243 patients who underwent surgery for distal humerus intra-articular fractures. A pooled analysis showed that there was a longer operation time in the OO group compared with the PT group (mean difference [MD] = 13.32, 95% CI: 3.78-22.87; P = .006). There was no significant difference between the functional outcomes of the OO and PT groups (elbow flexion: MD = 2.4, 95% CI: -0.82 to 5.79, P = .14; elbow extension: MD = 0.36, 95% CI: -2.20 to 2.92, P = .78; elbow arc of motion: MD = 0.40, 95% CI: -4.05 to 4.84, P = .86; Mayo Elbow Performance score: MD = -1.37, 95% CI: -4.73 to 1.98, P = .42). The incidence of infection was significantly higher in the OO group compared with that of the PT group (odds ratio [OR] = 3.82, 95% CI: 1.03-14.16, P = .04). There was no significant difference between the 2 groups in terms of the heterotopic ossification and ulnar neuropathy (OR = 1.85, 95% CI: 0.51-6.71, P = .35 and OR = 2.74, 95% CI: 0.60-12.48, P = .19, respectively).Since the choice of surgical approach does not influence outcomes, surgeons can base their choice of approach on the basis of their own experience and familiarity with the procedure and the need to visualize the entire articular surface in complex intra-articular fracture patterns.

Introduction: With minimal systemic toxicity, an analgesic effect of regional nerve block (RNB) has been proved in hip fracture cases. Analgesia was expected to reduce delirium by controlling pain, a known predisposing factor for delirium. We performed a meta-analysis to investigate the effect of RNB on delirium after hip fracture surgery in elderly patients. We aimed to answer the question: Can regional nerve block reduce postoperative delirium in hip fracture patients?. Hypothesis: Our hypothesis was that RNB could reduce postoperative delirium after hip fracture surgery in elderly patients. Patients and Methods: MEDLINE, Embase, and Cochrane Library databases were searched systematically for studies published before September 9, 2020, investigating the effect of RNB on perioperative delirium after hip fracture in elderly patients. We performed synthetic analyses for overall RNB compared to a control group both in 1) overall elderly patients, including the cognitively impaired, and 2) for patients without cognitive impairment (CoI). Also, we performed subgroup analyses for each of the block techniques, such as fascia-iliac block (FIB) and femoral nerve block (FNB). Results: Eight randomized controlled trials compared the incidence of perioperative delirium between the RNB and control groups. A pooled analysis showed no differences in delirium incidence between the RNB and control groups (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.36–1.22; P = 0.18; I2 = 58%) in overall elderly patients. However, there was a significant reduction of delirium in the RNB group in patients without CoI (OR, 0.44; 95% CI, 0.21–0.94; P = 0.03; I2 = 51%). In the subgroup analyses, we were unable to discern any differences in delirium incidence between the groups for FIB (OR, 0.89; 95% CI, 0.19–4.19; P = 0.88; I2 = 78%) and FNB (OR 0.61; 95% CI, 0.31–1.20, P = 0.15, I2 = 47%). Conclusions: In cases of hip fracture in elderly, RNB demonstrated a preventive effect on perioperative delirium for patients without preoperative CoI. No significant reduction in perioperative delirium was observed when cognitively impaired patients were included.

In this paper, we show that a connected graph with smallest eigenvalue at least −3 and large enough minimal degree is 2-integrable. This result generalizes a 1977 result of Hoffman for connected graphs with smallest eigenvalue at least −2.

Inadvertent intra-arterial drug injection occurs rarely, but it can cause very serious clinical complications, and thus, awareness of inadvertent intra-arterial drug injection is needed. The complications mainly result from iatrogenic reasons and can occur because of vascular variations in the arteries, under circumstances where normal intravenous injection is difficult, or in drug abusers who perform self-injection. The adverse effect associated with intra-arterial drug injection is serious and may lead to necrosis, requiring amputation of the affected extremity, infection, pseudoaneurysm, rhabdomyolysis, compartment syndrome, and permanent disability. However, the etiology of such adverse effects has not been clearly identified and treatment methods have not yet been established. We encountered a patient who developed necrosis of the thumb after an inadvertent injection of diclofenac sodium in the radial artery due to variations in the forearm arteries. Here, we report the prevention and treatment of, and precautions against, the dangers of intra-arterial drug injection.

Background The active involvement of anesthesiologists in chronic pain management has been associated with an increase in the number of related medical dispute cases. Methods Using the Korean Society of Anesthesiologists Legislation Committee database covering case files from July 2009 to June 2016, we explored injuries and liability characteristics in a subset of cases involving chronic pain management. Results During the study period, 58 cases were eligible for final analysis. There were 27 cases related to complex regional pain syndrome (CRPS), many of them involving problems with financial compensation (24/27, 88.9%). The CRPS cases showed male dominance (22 males, 5 females). In a disproportionately large number of these cases, the causative injury occurred during military training (n = 5). Two cases were associated with noninvasive pain managements, and 29 cases with invasive procedures. Of the latter group, procedures involving the spine (both neuraxial and non-neuraxial procedures) resulted in more severe complications than other procedures (P = 0.007). Seven of the patients who underwent invasive procedures died. The most common type of invasive procedures were lumbosacral procedures (16/29, 55.2%). More specifically, the most common damaging events were inadvertent intravascular or intrathecal injection of local anesthetics (n = 6). Conclusions Several characteristics of medical disputes related to chronic pain management were identified: the prevalence of injury benefit claims in CRPS patients, higher severity of complications in procedures performed at the spine or cervical region, and the preventability of inadvertent intravascular or intrathecal injection of local anesthetics.

Let $\lambda\geq2$ be an integer. For strongly regular graphs with parameters $(v, k, a,c)$ and smallest eigenvalue $-\lambda$, Neumaier gave two bounds on $c$ by using algebraic property of strongly regular graphs. In this paper, we will study a new class of regular graphs called sesqui-regular graphs, which contains strongly regular graphs as a subclass, and prove that for a sesqui-regular graph with parameters $(v,k,c)$ and smallest eigenvalue at least $-\lambda$, if $k$ is very large, then either $c \leq \lambda^2(\lambda -1)$ or $v-k-1 \leq \frac{(\lambda-1)^2}{4} + 1$ holds.

Erythromelalgia is often refractory and resistant to many forms of treatment. Numerous therapeutic options have been tried, but effective treatment remains elusive. The sympathetic nervous system has been involved in various painful conditions of neuropathic, vascular, and visceral origin. Sympathetic block is helpful in making a diagnosis and managing pain. We report a case of excellent pain relief after lumbar sympathetic pulsed radiofrequency treatment in a patient with primary erythromelalgia of the lower extremities. This case suggests the viability of pulsed radiofrequency treatment in patients with erythromelalgia.

In this paper, we will give a structure theory for graphs with fixed smallest eigenvalue. In order to do this, the concept of Hoffman graph (as introduced by Woo and Neumaier) is used. Our main result states that for fixed positive integer λ and any graph G with smallest eigenvalue at least −λ, there exist dense induced subgraphs Q 1 , … , Q c in G such that each vertex lies in at most λ Q i 's and almost all edges of G lie in at least one of the Q i 's.

The purpose of this study is to classify types of the eaves structure of buildings with the Jusimpo-type structure and to analyze the characteristics of each eaves structure. For this objective, forty buildings were selected and investigated. The results of analysis are summarized as follows. First, the main members of framework which handle a load burden on the long-rafter(長椽) are classified as the Jusim-dori(柱心道里) and the Oemok-dori(外目道里). Based on the method of handling a load, the eaves structure is classified into three types; the Jusim-processing-type(柱心中心形), the Oemok-processing-type(外目中 心形), and the Oemok-processing-variant-type(外目中心變異形). The Jusim-processing-type is the set where the internal length of a long-rafter is longer than the length of the eaves on the basis of the center of a column. The Oemok-processing-type is the set where the external length of a long-rafter is longer than the internal length of it. And the Oemok-processing-variant-type is the set where the internal length of a long-rafter is longer than the external length of it, but it is shorter than the length of the eaves which includes the extruded length of a Buyeon(浮椽). Second, the Jusim-processing-type had been generally adopted in the Jusimpo-type structure of the Goryeo Dynasty. But since the 17th century, the Oemok-processing-type had the highest application rate. Third, the change from the Jusimdori-processing-structure to the Oemokdori-processing-structure means that the long-rafter is moved to the direction of outside of the building, and thus the Jung-dori(中道里) is gradually moved to the column center. And, the change of the eaves with the Jusimpo-type structure was not a process for increasing the length of the eaves but a process for adopting the advantages of the Dapo-type structure by changing the arrangement of purlin. Fourth, the change from the Jusimpo-type structure to the Dapo-type structure could be understood as a process for moving the main point for handling a load from the Jusim-dori to the Oemok-dori.