Lower skeletal muscle mass is associated with diabetes and insulin resistance: A cross-sectional study.

AIMS: The association between skeletal muscle mass and diabetes incidence/insulin resistance/glycated hemoglobin (HbA1C) is unknown. The aim of this study was to investigate such association in clinically apparently healthy males and females. METHODS: A cross-sectional study of 372,399 Korean males and females who completed bioelectrical impedance analysis (BIA) in a health-screening programme was performed. Skeletal muscle index was used as an indicator of skeletal muscle mass. Skeletal muscle index (%) [appendicular skeletal muscle mass (kg)/body weight (kg)X100] was estimated using BIA. The study outcomes were diabetes incidence, homoeostasis model assessment of insulin resistance (HOMA-IR), and HbA1C. RESULTS: The mean age of study participants was 38.92 ± 8.54 years. Multiple logistic regression analysis revealed a significant negative association between Skeletal muscle index and diabetes incidence/HOMA-IR/HbA1C after adjusting for various confounding factors. Odds ratios (95% confidence interval (CI)) of diabetes incidence in Q2, Q3, and Q4 compared to the lowest quantile (Q1) were 0.95 (0.85-1.05), 0.88 (0.78-0.99), and 0.79 (0.69-0.9), respectively. Beta coefficients (95% CI) of HOMA-IR in Q2, Q3, and Q3 with Q1 were 0.05 (0.03-0.07), -0.06 (-0.09∼-0.04), and -0.19 (-0.22∼-0.16), respectively. Beta coefficients (95% CI) of HbA1C in Q2, Q3, and Q4 with Q1 were 0.02 (0.01-0.03), -0.001 (-0.01∼0.01), and -0.02 (-0.03∼-0.01), respectively. CONCLUSIONS: This study demonstrated negative associations of skeletal muscle mass with diabetes incidence, insulin resistance, and HbA1C levels in healthy adults.

Effectiveness and safety of motion-style acupuncture treatment using traction for inpatients with acute low back pain caused by a traffic accident: A randomized controlled trial.

BACKGROUND: Musculoskeletal symptoms, such as neck pain and low back pain (LBP) are common after a traffic accident (TA). While motion-style acupuncture treatment (MSAT) is effective in relieving pain, MSAT using traction (T-MSAT) has rarely been studied, and evidence for its efficacy and safety is lacking. To address this gap, this study aimed to assess the effectiveness and safety of T-MSAT for pain and functional disturbances in patients with acute LBP caused by a TA. METHODS: This two-armed, parallel, assessor blinded randomized controlled trial, conducted at Jaseng Hospital of Korean Medicine, included 100 patients with acute LBP occurring within 1 week of a TA. The participants were randomly allocated (1:1 ratio) to receive either combined T-MSAT and integrative Korean medicine treatment (IKMT) or only conventional IKMT, applied for 3 consecutive days after admission. The primary outcome was the difference between numerical rating scale (NRS) scores for LBP at baseline and after treatment completion on day 4 after admission. RESULTS: At the primary endpoint, the difference in NRS scores for LBP between the T-MSAT and control groups was 0.94 (95% confidence interval [CI] 0.40-1.48). The T-MSAT group showed a significantly lower NRS score for LBP than the control group. Differences in visual analogue scale (VAS) scores between the T-MSAT and control groups were significant at baseline and discharge. The area under the curve of the VAS score showed a significant difference (-46.86 [95% CI -85.13 to -8.59]), indicating faster pain reduction in the T-MSAT group than in the control group. Recovery (30% pain reduction) was achieved more rapidly in the T-MSAT group than in the control group (log-rank test P = .005). Meanwhile, the NRS, VAS, Oswestry disability index, and quality of life scores at discharge or at the 12-week follow-up showed no significant difference. The rates of mild adverse events (AEs) were comparable between the groups. No severe AEs were reported, and none of the AEs were associated with the clinical trial. CONCLUSIONS: T-MSAT combined with IKMT is a safe treatment that can effectively and quickly reduce initial pain in patients with LBP.

Relationship between rotator cuff posterior delamination and subscapularis tear: a large cross-sectional analysis.

Background: Rotator cuff posterior delamination and subscapularis tear are commonly observed in rotator cuff injuries. However, there are very few studies on the relationship between posterior delamination and subscapularis tendon tear. This study aimed to investigate the relationship between posterior delamination and subscapularis tendon tear. Methods: The study was conducted from March 2018 to June 2021 with 553 patients who underwent rotator cuff repairs at two institutions. The age and gender, size of rotator cuff tear, duration of symptoms, range of motion of shoulder joint, visual analog scale score, Korean Shoulder Scale score, gap and width of rotator cuff tear, and fatty degeneration of the supraspinatus and infraspinatus muscles were compared to confirm the differences between a delaminated and nondelaminated rotator cuff tear. Moreover, the proportions of the subscapular tendon rupture and subscapularis tendon rupture according to the size of the rotator cuff tear were analyzed in both the delaminated and nondelaminated rotator cuff tear groups. Results: Compared to the nondelaminated rotator cuff tear group, the age of the delaminated rotator cuff tear group was significantly higher, and as the size of the rotator cuff tear increased, the proportion of delaminated tear increased (P < .001). Furthermore, the duration of symptoms was longer, visual analog scale score was higher, Korean Shoulder Scale score was lower, gap and width of rotator cuff as well as fatty degeneration of the supraspinatus and infraspinatus were more severe in the group with posterior delamination than that without. In the nondelaminated rotator cuff tear group, 212 subjects (84.46%) had no subscapularis tear, and 39 subjects (15.54%) had subscapularis tear. In the delaminated rotator cuff tear group, 103 subjects (34.11%) had no subscapular tendon tear while 199 subjects (65.89%) had a subscapular tendon tear (P < .001). Furthermore, as the size of the rotator cuff tear increased, the rate of subscapular tendon tear increased in both the delaminated and nondelaminated rotator cuff tear groups. Conclusions: The results suggest that there is a high probability of concomitant rupture of the subscapularis tendon in the patient group with posterior delamination tear. Therefore, it should be noted that if a posterior delamination is confirmed during surgery, it is necessary to carefully check for rupture of the scapular tendon.

A study on the relationship between the rate of vertebral body height loss before balloon kyphoplasty and early adjacent vertebral fracture.

BACKGROUND: The number of patients with an osteoporotic vertebral compression fracture, which is often accompanied by lower back pain and restrained activities, is growing. Balloon kyphoplasty involves the inflation of a balloon to restore height and reduce kyphotic deformity before stabilization with polymethylmethacrylate. However, there is a great deal of debate about whether balloon kyphoplasty also increases fracture morbidity by either inducing or facilitating subsequent adjacent vertebral fractures. OBJECTIVE: To evaluate the relationship between the rate of vertebral body height loss before balloon kyphoplasty and the etiology of early adjacent vertebral fracture after augmentation. METHODS: A total of 59 patients with osteoporotic vertebral compression fractures who underwent kyphoplasty were enrolled. This study defined early adjacent segmental fractures as new fractures occurring within three months after surgery. This study included the rate of vertebral body height loss. RESULTS: Early adjacent vertebral fractures were diagnosed in nine (15%) of the 59 patients. The patients were divided into two groups, with and without adjacent vertebral fractures. There was no significant difference in terms of age, body mass index, bone mineral density, local kyphotic angle, Cobb's angle, cement volume, cement leakage, and percent height restored between the groups with fractures and without fractures. There was a statistically significant difference between the two groups in the rate of vertebral body height loss. The rate of vertebral body height loss was significantly higher in the fracture group than in the without fracture group. CONCLUSIONS: A high rate of vertebral body height loss increased the risk of early adjacent vertebral fractures after balloon kyphoplasty.

Association between clinical parameters and size of three-dimensionally reconstructed anatomical abnormalities in patients with lateral epicondylitis: a cross-sectional study.

BACKGROUND: The association of the severity of clinical symptoms and level of functional performance with the degree of magnetic resonance imaging abnormalities in patients with lateral epicondylitis has not been fully elucidated. This study aimed to investigate the association between the degree of anatomical abnormalities by evaluating three-dimensional magnetic resonance imaging models of the common extensor tendon and clinical parameters in patients with lateral epicondylitis. MATERIALS AND METHODS: A total of 61 patients (24 men and 37 women) with lateral epicondylitis were included in this study. 3-Tesla magnetic resonance imaging was performed for all patients, and clinical parameters, including pain visual analog scale score, Quick Disabilities of Arm, Shoulder and Hand questionnaire score, elbow range of motion, and demographic factors, were evaluated. The proportion of lesion volume of common extensor tendon was adopted for three-dimensional model analysis. To determine the factors associated with clinical parameters, univariate, and multivariate linear regression analyses were performed. RESULTS: The proportion of lesion volume of common extensor tendon was not associated with clinical parameters. Gender and muscle edema were independently associated with pain visual analog scale scores. However, demographic factors and magnetic resonance imaging abnormalities were not associated with the Quick Disabilities of Arm, Shoulder, and Hand questionnaire score or elbow range of motion. CONCLUSIONS: The three-dimensional volumetric lesion size of common extensor tendon was not associated with clinical symptoms and functional performance in patients with lateral epicondylitis. The clinical parameters of lateral epicondylitis may be influenced by several factors.

The Effectiveness and safety of T-MSAT on inpatients with acute low back pain caused by traffic accidents: A protocol for randomized controlled trial.

BACKGROUND: Presentation of musculoskeletal symptoms, such as pain, discomfort, or disability, caused by a traffic accident (TA) is a common occurrence. However, studies on treatment and management of sudden low back pain (LBP) caused by a TA are very scarce, while studies on the effectiveness of motion style acupuncture therapy (MSAT) used on such patients are also rare. Accordingly, a randomized controlled trial (RCT) is planned to assess the effectiveness and safety of MSAT using traction (T-MSAT) for the treatment of pain and functional problems in patients with acute LBP caused by a TA. METHODS: This study will be conducted at Jaseng Hospital of Korean Medicine in South Korea, using a two-armed, parallel, assessor-blinded RCT design. The study population will consist of 100 participants who will be randomly assigned in a 1:1 ratio to either the T-MSAT+integrative Korean medicine therapy (IKMT) group or IKMT control group. The treatment will be applied continuously for 3 days after admission. The primary outcome will be the difference between the numeric rating scale (NRS) scores at admission and immediately after treatment on the fourth day of admission. Secondary outcomes will include visual analogue scale (VAS) for LBP and radiating leg pain; NRS for radiating leg pain; lumbar active range of motion; Oswestry Disability Index (ODI); Patient Global Impression of Change (PGIC); the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5-K); and 12-item short-form health survey (SF-12). DISCUSSION: This study is a RCT to assess the effectiveness and safety of T-MSAT for acute LBP caused by a TA. The findings could be used by healthcare-related policy makers and clinicians in primary care institutions, which are frequently visited by patients suffering from LBP caused by a TA.

Novel amides and esters prodrugs of olmesartan: Synthesis, bioconversion, and pharmacokinetic evaluation.

Synthesis of novel amides and esters prodrugs of olmesartan is described. Their in vitro stability in rat plasma was tested. The results showed that the ester derivative IIa with n-octyl substituted dioxolone moiety was rapidly converted into olmesartan within 30 min. The pharmacokinetic parameters of IIa were studied and compared with those of olmesartan medoxomil. Compound IIa is proposed to be a promising prodrug of olmesartan.

Comparison of hip subregion bone mineral density to the type of proximal femur fracture.

Beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group. These results can be used to increase the awareness of proximal hip fracture among physicians and improve treatments and outcomes. PURPOSE: To compare the BMD of the femoral neck region and the intertrochanteric region between the femoral neck fracture group and the intertrochanteric fracture group. METHODS: We did a retrospective review of radiographs of the proximal femoral fractures in patients registered from 2010 to 2017. A total of 329 patients were classified into the femoral neck fracture group (group A, n = 162) and the femur intertrochanteric fracture group (group B, n = 167). We did intergroup comparisons of age, sex, BMI (body mass index), and bone mineral density (BMD) of the neck and intertrochanteric region, adjusting for age. We did multiple logistic regression analysis among these parameters. RESULTS: The BMD of the femoral neck and intertrochanteric was statistically significantly different between the two groups (p < 0.001), and the BMD of the femur intertrochanteric was also significantly different between the two groups (p < 0.001). BMD of both regions in the intertrochanteric fracture group was lower than that of the femoral neck fracture group. In linear regression analysis, the beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group. CONCLUSION: In linear regression analysis, the beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group.

Correction to: Comparison of hip subregion bone mineral density to the type of proximal femur fracture.

The original version of this article, published on 05 August 2020, unfortunately contained a mistake.

Synthesis of pyrrolo[2,3-d]pyrimidine derivatives and their antiproliferative activity against melanoma cell line.

Synthesis of a new series of diarylureas and amides having pyrrolo[2,3-d]pyrimidine scaffold is described. Their in vitro antiproliferative activities against A375 human melanoma cell line and HS 27 fibroblast cell line were tested and the effect of substituents on pyrrolo[2,3-d]pyrimidine was investigated. The newly synthesized compounds, except N-acetyl derivatives (Id, Ie, and Im), generally showed superior or similar activity against A375 to Sorafenib. Among all of these derivatives, compounds Iq and Ir having imidazole and morpholine moieties, respectively, showed the most potent antiproliferative activity against A375.

Clinical Outcomes and Radiologic Changes After Microsurgical Bilateral Decompression by a Unilateral Approach in Patients With Lumbar Spinal Stenosis and Grade I Degenerative Spondylolisthesis With a Minimum 3-Year Follow-Up.

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the clinical outcomes and radiologic changes after microsurgical bilateral decompression via a unilateral approach in patients with lumbar spinal stenosis (LSS) and degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA: Satisfactory short-term results have been observed after minimally invasive decompressive procedures, but intermediate-term and long-term outcomes have not been assessed. It is not yet clear whether decompressive laminectomy with concomitant fusion is the optimal surgical treatment for spinal stenosis combined with mild DS. We, therefore, evaluated minimum 3-year clinical outcomes and radiologic changes in patients with LSS and grade 1 DS, who underwent microsurgical bilateral decompression via a unilateral approach, without fusion. METHODS: We assessed 21 consecutive patients who underwent surgery conducted by a single surgeon of our hospital, between 2005 and 2007. The Oswestry Disability Index was determined preoperatively, just before discharge, and at last follow-up. Plain dynamic x-rays were used to determine slip percentages. RESULTS: Average patient age and clinical and radiologic follow-up periods were 67 years, 49.3 months, and 18 months, respectively. Preoperative, immediate postoperative, and last follow-up average Oswestry Disability Indices were 59.52±9.00, 50.19±7.23, and 26.19±12.42, respectively. However, 1 patient experienced aggravated symptoms and later underwent a fusion procedure. Of the 22 levels with spondylolisthesis, 15 had no sagittal motion as the difference in slip percentage on dynamic x-rays, but 7 showed sagittal motion. Average slip percentages increased from 13.90±5.41% to 14.60±5.78% for levels without sagittal motion on dynamic x-ray, and from 13.12±3.48% to 18.58±4.55% for levels with sagittal motion. CONCLUSIONS: Despite small case series with retrospective design and the absence of a control group, our study suggests that bilateral decompression via a unilateral approach in patients with LSS and grade 1 DS showed good mid-term clinical outcomes, despite an increase in slip percentage.However, more marked increases in slippage were observed in patients with sagittal motion in spondylolisthesis levels on preoperative dynamic x-ray, than in patients without sagittal motion. Therefore, bilateral decompression via a unilateral approach can aggravate symptoms related to instability in patients with preoperative sagittal motion on dynamic x-ray, and needs a longer term follow-up than in our study.

Does plate profile affect postoperative dysphagia following anterior cervical spine surgery?

Dysphagia following anterior cervical spine surgery is a significant problem. The risk factors for such dysphagia have not been established. We examined whether plate profile affected the incidence of dysphagia. This study enrolled 50 consecutive patients undergoing one-level corpectomy or one- or two-level discectomies with plate fixation performed by the same surgeon from 2004 to 2009. The anterior cervical plates used were either the Codman (Johnson and Johnson Professional Inc., Raynham, MA, USA; width 17.58 mm, thickness 2.69 mm; 27 patients) or the Zephir (Medtronic Sofamor Danek Inc., Memphis, TN, USA; width 15 mm, thickness 1.6 mm; 23 patients). Dysphagia was assessed via telephone interviews, and was classified as short-term (occurring within 6 months postoperatively) or persistent (persisting beyond 6 months postoperatively). The overall short-term and persistent dysphagia rates were 20% and 14%, respectively. The short-term and persistent dysphagia rates were 26% and 13% for the Zephir plate, and 14.8% and 14.8% for the Codman plate, and analysis showed that the rates were similar for both types of plate. Age and sex were not found to correlate with dysphagia. In patients undergoing anterior cervical spine surgery with plate fixation, we found that postoperative dysphagia did not correlate with plate profile up to a plate size of 17.58 mm wide and 2.69 mm thick. Dysphagia occurred at the same incidence in patients with a smaller plate that was 15 mm wide and 1.6 mm thick.

New imidazo[2,1-b]thiazole derivatives: synthesis, in vitro anticancer evaluation, and in silico studies.

A series of 18 new imidazo[2,1-b]thiazole derivatives was synthesized. Their in vitro antiproliferative activities against A375P human melanoma cell line and NCI-60 cell line panel were tested. Compounds 15, 16, 18, 22, 26-28, and 31 showed superior potency against A375P to sorafenib. In addition, compounds 26 and 27 showed selectivity toward melanoma cell lines than for other cancer types. Both compounds exerted sub-micromolar IC(50) values over 7 (including A375P) and 6 melanoma cell lines, respectively. In silico studies are also reported. ADME profiling, in silico toxicity, drug-likeness, and drug-score data of compounds 26 and 27 are promising.