Surgical Procedures for Chronic Lateral Ankle Instability / 대한족부족관절학회지

Surgical treatments for chronic lateral ankle instability include anatomic repair, anatomic reconstruction using an auto or allograft, nonanatomic reconstruction, and arthroscopic repair. Open anatomic repair using the native ligament with or without reinforcement of the inferior extensor retinaculum is commonly performed in patients with sufficient ligament quality. Non-anatomical reconstruction using the adjacent peroneus brevis tendon is typically used only in patients with poor-quality ligament remnants or when previous repair failed. Anatomical reconstruction can be considered in patients in whom anatomical repair is expected to fail and when performed using auto or allografts can provide good to excellent short-term results, although the long-term outcomes of these methods remain unclear. Arthroscopic repair can provide good to excellent short-term clinical outcomes, but evidence supporting this technique is limited.The advantages and disadvantages of various surgical methods should be compared, and appropriate treatment should be implemented based on patient characteristics.

An MRI-Based Quantification for Correlation of Imaging Biomarker and Clinical Performance in Chronic Phase of Carbon Monoxide Poisoning

PURPOSE: The purpose of this study was to determine the relation between quantitative magnetic resonance imaging biomarkers, and clinical performances in chronic phase of carbon monoxide intoxication. MATERIALS AND METHODS: Eighteen magnetic resonance scans and cognitive evaluations were performed, on patients with carbon monoxide intoxication in chronic phase. Apparent diffusion coefficient (ADC) ratios of affected versus unaffected centrum semiovale, and corpus callosum were obtained. Signal intensity (SI) ratios between affected centrum semiovale, and normal pons in T2-FLAIR (fluid-attenuated inversion recovery) images were obtained. The Mini-Mental State Exam, and clinical outcome scores were assessed. Correlation coefficients were calculated, between MRI and clinical markers. Patients were further classified into poor-outcome and good-outcome groups based on clinical performance, and imaging parameters were compared. T2-SI ratio of centrum semiovale was compared, with that of 18 sex-matched and age-matched controls. RESULTS: T2-SI ratio of centrum semiovale was significantly higher in the poor-outcome group, than that in the good-outcome group and was strongly inversely correlated, with results from the Mini-Mental State Exam. ADC ratios of centrum semiovale were significantly lower in the poor outcome group than in the good outcome group, and were moderately correlated with the Mini-Mental State Exam score. CONCLUSION: A higher T2-SI and a lower ratio of ADC values in the centrum semiovale, may indicate presence of more severe white matter injury and clinical impairment. T2-SI ratio and ADC values in the centrum semiovale, are useful quantitative imaging biomarkers for correlation with clinical performance in individuals with carbon monoxide intoxication.

Peroneal Tendon Repair in Sports Injury / 대한족부족관절학회지

PURPOSE: This study examined the clinical outcomes and assessed the average time to return to play following a peroneal tendon repair in Korean athletes. MATERIALS AND METHODS: Between March 2004 and February 2017, a total of 30 athletes underwent peroneal tendon repair for a peroneal tendon tear. The indications of surgical treatment were chronic pain or intractable symptoms after a previous ankle sprain affecting sports activity refractory to conservative treatment for at least six months. The patient underwent tubulization for a longitudinal tendon rupture. Peroneus longus to peroneus brevis tenodesis was performed when tendon repair was impossible due to total rupture or multiple longitudinal rupture. RESULTS: Twenty patients not included in this study were as follows: insufficient follow-up, previous surgery, and additional bone surgery. All 10 patients had a previous ankle sprain history, tenderness and swelling on the retromalleolar area. In the 10 patient population, there were five peroneus brevis tendon tears, three peroneus longus tendon tears, one peroneus longus and brevis tendon tear, and one peroneus brevis and superior peroneal retinaculum tear. In the 10 patients, six cases of peroneal brevis tendon repair and four cases of peroneal longus to brevis tenodesis were performed. The preoperative American Orthopaedic Foot and Ankle Society score was improved from a mean of 60.6 (standard deviation [SD], 8.64) to a mean of 90.2, postoperatively (SD, 4.4; p<0.012). The preoperative visual analogue scale was improved from a mean of 5.43 (SD, 1.2) to 0.5 (SD, 0.16), postoperatively (p<0.023). The mean length of time to return to play was 12.2 weeks (range, 8~16 weeks). CONCLUSION: Peroneal tendon tear can occur due to sports injuries. If there is tenderness at the retromalleolar area, the surgeon should consider a peroneal tendon lesion. Surgical repair of the peroneal tendon can be an effective treatment to help athletes to return to play.

Erratum: Immune Disorders and Its Correlation with Gut Microbiome

The authors requested a correction in the authorship as JS Hwang to be the sole first author based on their careful re-evaluation of the authors' contribution. This correction does not affect any of the content of the article.

Estimation of Diastolic Filling Pressure with Cardiac CT in Comparison with Echocardiography Using Tissue Doppler Imaging: Determination of Optimal CT Reconstruction Parameters

OBJECTIVE: To determine the optimal CT image reconstruction parameters for the measurement of early transmitral peak velocity (E), early peak mitral septal tissue velocity (E′), and E / E′. MATERIALS AND METHODS: Forty-six patients underwent simultaneous cardiac CT and echocardiography on the same day. Four CT datasets were reconstructed with a slice thickness/interval of 0.9/0.9 mm or 3/3 mm at 10 (10% RR-interval) or 20 (5% RR-interval) RR-intervals. The E was calculated by dividing the peak transmitral flow (mL/s) by the corresponding mitral valve area (cm²). E′ was calculated from the changes in the left ventricular length per cardiac phase. E / E′ was then estimated and compared with that from echocardiography. RESULTS: For assessment of E / E′, CT and echocardiography were more strongly correlated (p < 0.05) with a slice thickness of 0.9 mm and 5% RR-interval (r = 0.77) than with 3 mm or 10% RR-interval. The diagnostic accuracy of predicting elevated filling pressure (E / E′≥ 13, n = 14) was better with a slice thickness of 0.9 mm and 5% RR-interval (87.0%) than with 0.9 mm and 10% RR-interval (71.7%) (p = 0.123) and significantly higher than that with a slice thickness of 3 mm with 5% (67.4%) and 10% RR-interval (63.0%), (p < 0.05), respectively. CONCLUSION: Data reconstruction with a slice thickness of 0.9 mm at 5% RR-interval is superior to that with a slice thickness of 3 mm or 10% RR-interval in terms of the correlation of E / E′ between CT and echocardiography. Thin slices and frequent sampling also allow for more accurate prediction of elevated filling pressure.

Immune Disorders and Its Correlation with Gut Microbiome

Allergic disorders such as atopic dermatitis and asthma are common hyper-immune disorders in industrialized countries. Along with genetic association, environmental factors and gut microbiota have been suggested as major triggering factors for the development of atopic dermatitis. Numerous studies support the association of hygiene hypothesis in allergic immune disorders that a lack of early childhood exposure to diverse microorganism increases susceptibility to allergic diseases. Among the symbiotic microorganisms (e.g. gut flora or probiotics), probiotics confer health benefits through multiple action mechanisms including modification of immune response in gut associated lymphoid tissue (GALT). Although many human clinical trials and mouse studies demonstrated the beneficial effects of probiotics in diverse immune disorders, this effect is strain specific and needs to apply specific probiotics for specific allergic diseases. Herein, we briefly review the diverse functions and regulation mechanisms of probiotics in diverse disorders.

Probiotics as an Immune Modulator for Allergic Disorders / 소아알레르기및호흡기학회지

Allergic disorders such as atopic dermatitis and asthma are common hyperimmune disorders in industrialized countries. Although the exact etiology is unclear, several factors may trigger the disease onset. These include susceptible genetic background, environmental factors and an aberrant gut microbiota with a shift of the Th1/Th2 balance towards a Th2 response. Probiotics confer health benefits through multiple action mechanisms including modification of immune system in both systemic immune system and gut associated lymphoid tissue. Although many human clinical trials and mouse studies demonstrated the beneficial effects of probiotics in diverse allergic disorders, therapeutic efficacy is quite diverse depending on administration dose and types of strains or their mixture. To properly modulate allergic diseases, administration of tailor made probiotics with immune tolerance activity is required. Human clinical trials demonstrate a limited benefit of probiotics in atopic dermatitis in a preventive as well as a therapeutic capacity. In addition, beneficial effect of probiotics treatment is limited in the treatment of bronchial asthma. Identification of specific probiotics that has immune modulating activity and elucidation of the underlying mechanism of action will lead to develop probiotics as an as immune modulator targeting allergic disorders. Herein, we briefly review the diverse functions and regulation mechanisms of probiotics in allergic disorders including atopic dermatitis and asthma.

Usefulness of Ultrasound Examination in Evaluation of Breast Cancer-Related Lymphedema

OBJECTIVE: To evaluate the usefulness of ultrasound examination as an adjunctive measurement tool in breast cancer-related lymphedema. METHOD: Twenty healthy volunteers and 20 women who had been treated for unilateral breast cancer and had subsequently developed lymphedema were recruited. Examiners measured the volume of both arm with volumeter and the circumference of both forearm and upper arm with tape measure. Then the thickness of the skin and subcutis on the ventral aspect of forearm and upper arm were measured by ultrasonography. These results were compared with each other. RESULTS: The ICCs for interrater reliability of ultrasound examination was high (mostly>0.98). The volume of the swollen arm (2,308 ml) was larger than contralateral arm (1,873 ml). The circumference of swollen forearm (24.50 cm) and upper arm (30.81 cm) were larger than contralateral forearm (21.54 cm) and upper arm (27.60 cm). In the swollen side, average thickness of the forearm skin, forearm subcutis, upper arm skin and upper arm subcutis were 0.23 mm, 1.03 mm, 0.19 mm and 0.95 mm respectively. In the contralateral side, average thickness of the forearm skin, forearm subcutis, upper arm skin and upper arm subcutis were 0.12 mm, 0.69 mm, 0.13 mm, 0.73 mm respectively. The degree of increase in mid-forearm skin thickness were correlated with the degree of swelling calculated with volumeter (r=0.651, p=0.002). CONCLUSION: Ultrasonography is able to give valuable information on the extent of edema and fibrosis of skin and subcutis. It will be a useful tool to follow the results of lymphedema treatment and its progression over time.

Relationship between Physical Examinations and Two-Dimensional Computed Tomographic Findings in Children with Intoeing Gait

OBJECTIVE: To evaluate the validity of physical examinations by assessment of correlation between physical examinations and CT measurements in children with intoeing gait and the causes of intoeing gait by age using CT measurements. METHOD: Twenty-six children with intoeing gait participated in this study. The internal and external hip rotation, thigh-foot angle and transmalleolar angle were measured. In addition, femoral anteversion and tibial torsion of the subjects were assessed using a CT scan. The measurements of torsional angles were performed twice by two raters. The correlation coefficients between physical examinations and CT measurements were calculated using Pearson correlation. The data was analyzed statistically using SPSS v12.0. RESULTS: The correlation coefficients between physical examinations and CT measurements were not high. Before 5 years of age, intoeing gait was caused by femoral anteversion in 17.86%, tibial torsion in 32.29% and the combination of causes in 35.71% of cases. After 6 years of age, the contributions changed to 29.17%, 8.33% and 45.83%, respectively. CONCLUSION: Before 5 years of age, the common cause of an intoeing gait was tibial torsion, whereas after 6 years of age it was femoral anteversion. Regardless of age, the most common cause of intoeing gait was a combination of causes. This study shows poor correlation between physical examinations and CT. Therefore, it is limiting to use physical examination only for evaluating the cause of intoeing gait in clinical practice.

Measurement of Proprioception of the Knee in Hemiplegic Patients Using an Isokinetic Dynamometer

OBJECTIVE: To measure knee joint proprioception quantitatively in hemiplegic patients after brain injury using an isokinetic dynamometer. METHOD: Thirty healthy subjects and 24 hemiplegic patients participated in this study. Joint position sense was evaluated with passive angle reproduction of 30degrees and 60degrees of knee flexion and kinesthesia was evaluated with the threshold for detection of passive movementfrom 45degrees of knee flexion. We used toe-"up or down"-test for conventional clinical method. RESULTS: Significant proprioceptive deficit was observed not only in paretic knees of both right and left hemiplegic patients (p0.05). CONCLUSION: The quantitative test using an isokinetic dynamometer is a reliable method to measure knee proprioception, and it is possible to detect proprioceptive deficit in hemiplegic patients. Conventional clinical assessments are poor for predicting the results of the quantitative measure in the nonparetic knee. This quantitative method may be useful in diagnosis and follow-up of knee proprioception of hemiplegic patients after brain injury.

The Effect of Cognitive-behavioral Characteristics on Depression of Caregivers in Brain-injured Patients

OBJECTIVE: To evaluate the relationship between depression and cognitive-behavioral characteristics of caregivers using social problem solving inventory (SPSI), social support or conflict scale (SSS or SCS) and somatic symptoms (SS). METHOD: Fifty five couples of brain-injured patients and caregivers participated in this study. We conducted a questionnaire survey of caregivers with Beck depression index (BDI), SPSI, SSS, SCS and SS for cognitive-behavioral characteristics. And also we studied demographic factors of patients and caregivers, clinical features of brain-injured patients, care- giving duration and time per day through interview and review of medical records. The statistical analyses were performed by independent t-test, one-way ANOVA, Pearson correlation test and linear regression analysis-stepwise method. RESULTS: BDI of the caregivers showed a negative correlation with SPSI, SSS, patients' MMSE and caregivers' education level, also a positive correlation with SCS, SS and patients' GDS (p<0.05). And married caregivers showed more depressive mood (p<0.05). Of these factors, the most influencing factors on BDI were GDS and SCS through linear regression analysis (p<0.01). CONCLUSION: MMSE, GDS and education level as cognitive- mental factors rather than physical and economic strain had a statistical correlation with depression of caregivers. Especially, SPSI, SSS and SCS as cognitive-behavioral characteristics should be considered on evaluation of depression of caregivers and will be helpful for successful rehabilitation for patients and caregivers.

A Case of Adult Acute Myeloid Leukemia Presenting with Musculoskeletal Manifestations / 대한류마티스학회지

Leukemia is a heterogenous group of neoplasms that arise from the malignant transformation of hematopoietic cells. The usual presentation is one of lethargy, pallor, fever, purpura, bleeding, etc, and all this is secondary to a decrease in the production of normal blood components. However, leukemia often manifests with musculoskeletal symptoms without a systemic presentation. Musculoskeletal symptoms that precede the recognition of leukemia are much less frequent in adults as compared to those in children, and this causes diagnostic confusion and a delayed diagnosis. We describe here a case of adult acute myeloid leukemia in which pain and weakness of the limbs were the main manifestations and these were suspected as being symptoms of musculoskeletal disease.

Association of rOAT1 with Caveolin-1 in Rat Kidney / 대한신장학회지

PURPOSE: A family of organic anion transporters (OAT) has been identified, and several isoforms have been reported. The regulatory mechanisms of OATs functions, however, still remain to be elucidated. The rat OAT1 contributes to move a number of negatively-charged organic compounds between cells and their extracellular milieu. Caveolin (Cav) also plays a role in membrane transport. To address this issue, we investigated the protein-protein interaction between rOAT1 and Cav-1. METHODS: The expressions of rOAT1 and Cav-1 (mRNA and protein) were evaluated using RT-PCR and Western blot analysis. The localization of rOAT1 and Cav-1 was determined in the caveolae-rich membrane fraction isolated by sucrose density gradient ultra-centrifugation. For the direct binding between the rOAT1 and Cav-1 proteins, the immuno-precipitation method and confocal microscopy were employed. To perform functional analysis, a Xenopus oocytes expression system with the antisense oligonucleotides (ODN) technique was used. RESULTS: The expressions of rOAT1 and Cav-1 were detected in the kidney. The caveolae-rich membranous fractions from the kidney contained both rOAT1 and Cav-1 in the same fractions. The immuno-precipitation experiments showed the formation of a complex between the rOAT1 and Cav-1. The confocal microscopy using primary cultured renal proximal epithelial cells also supported the co-localization of rOAT1 and Cav-1 at the plasma membrane. The uptake function of rOAT1, as assessed by using a Xenopus oocytes expression system, was inhibited by the Xenopus Cav-1 antisense ODN. CONCLUSION: rOAT1 co-localizes with caveolin-1 in the caveolae, and caveolin-1 plays an important role in regulating the function of rOAT1.

Identification of a kidney-specific mouse organic cation transporter like-1 (mOCTL1)

Organic ion transporters are expressed in various tissues that transport endogenous and exogenous compounds including their metabolites. There are organic anion transporter (OAT), organic cation transporter (OCT), organic anion transporter like protein (OATLP) and organic cation transporter like (OCTL). Considering the variety of charged organic ionic compounds, the existence of numerous isoforms of organic ion transporters can be assumed. In the present study, we have searched for a new isoform in the expressed sequence tag (EST) database using human organic anion transporter 4 (hOAT4) amino acid sequence as a "query". We found a candidate clone (BC021449) from the mouse kidney cDNA library. This clone was identified as an ortholog of ORCTL3 or OCTL-1. The mOCTL1 cDNA consists of 2016 base pairs encoding 551 amino acid residues with 12 putative transmembrane domains. The deduced amino acid sequence of mOCTL1 showed 35 to 40% identity to those of the other members of the OATs and OCTs. According to the tissue distribution, examined by Northern blot analysis, about a 2.4-kb transcript of mOCTL1 was observed in the kidney. About a 90-kDa band was detected when Western blot analysis in the mouse kidney was done by using antibody against synthesized oligopeptide of mOCTL1. The immunohistochemical result showed that mOCTL1 was stained at the glomerulus (the parietal epithelial cells and podocytes), pars recta of proximal tubule, distal convoluted tubules, connecting tubules and collecting tubules. From these results, we conclude that mOCTL1 may be a candidate for an organic ion transporter isoform in the mouse kidney.