Changes in Parameters after High Tibial Osteotomy: Comparison of EOS System and Computed Tomographic Analysis.

Unintended rotation of the distal tibia occurs during medial open-wedge high tibial osteotomy (MOWHTO). Computed tomography (CT) is the standard method of measuring lower limb alignment; however, the new low-dose EOS system allows three-dimensional limb modeling with automated measurements of lower limb alignment. This study investigated the differences between the changes in lower limb alignment profiles obtained using the EOS system and CT in patients who underwent MOWHTO. We investigated whether any factors contributed to the degree of deformation. Thirty patients were prospectively enrolled between October 2019 and February 2023. Changes in femoral and tibial torsion, femorotibial rotation, and posterior tibial slope were measured using pre- and post-MOWHTO CT and EOS images. We found no significant difference in pre- and postoperative tibial torsion or posterior tibial slope between CT and EOS. No variables showed a significant correlation with changes in the tibial torsion or posterior tibial slope. This study confirmed the possibility that the EOS system could replace CT in measuring changes in several parameters pre- and postoperatively. Furthermore, we confirmed that the distal tibia tended to be internally rotated after MOWHTO; however, we found no significantly related parameters related to deformation caused by MOWHTO.

Effects and Mechanism of Particulate Matter on Tendon Healing Based on Integrated Analysis of DNA Methylation and RNA Sequencing Data in a Rat Model.

Exposure to particulate matter (PM) has been linked with the severity of various diseases. To date, there is no study on the relationship between PM exposure and tendon healing. Open Achilles tenotomy of 20 rats was performed. The animals were divided into two groups according to exposure to PM: a PM group and a non-PM group. After 6 weeks of PM exposure, the harvest and investigations of lungs, blood samples, and Achilles tendons were performed. Compared to the non-PM group, the white blood cell count and tumor necrosis factor-alpha expression in the PM group were significantly higher. The Achilles tendons in PM group showed significantly increased inflammatory outcomes. A TEM analysis showed reduced collagen fibrils in the PM group. A biomechanical analysis demonstrated that the load to failure value was lower in the PM group. An upregulation of the gene encoding cyclic AMP response element-binding protein (CREB) was detected in the PM group by an integrated analysis of DNA methylation and RNA sequencing data, as confirmed via a Western blot analysis showing significantly elevated levels of phosphorylated CREB. In summary, PM exposure caused a deleterious effect on tendon healing. The molecular data indicate that the action mechanism of PM may be associated with upregulated CREB signaling.

Epidemiology and postoperative complications of hip fracture during COVID-19 pandemic.

Objectives: This study aims to analyze the changes in epidemiology and the postoperative outcomes in patients with hip fractures during the COVID-19 pandemic compared to non-pandemic period. Methods: According to the date of declaration of "mandatory social distance", we separated patients into 2 groups over a 1-year period: Period A and period B. We assessed the overall time to surgery, delay in surgery (> 24 hours, > 36 hours, and > 48 hours), reason of delay, length of hospital stay, type of surgery, and postoperative complications. Results: The number of operated hip fractures and other trauma decreased in period B compared with period A by 17%, and 23%, respectively. The number of patients with delay in surgery by > 24 hours and > 36 hours was significantly higher in period B compared to that in period A (P = 0.035, P = 0.012, respectively). However, no significant difference in the number of delay in surgery > 48 hours and mean overall time to surgery between the 2 groups was observed (P = 0.856, P = 0.399, respectively). There was no difference in the duration of hospital stay, type of surgery, and postoperative complications between periods A and B. Conclusions: During the COVID-19 pandemic, the decrease in hip fractures was relatively fewer compared to the decrease in orthopedic trauma. Although hip fracture surgeries were delayed for over 24 hours and 36 hours, there was no increase in delay for over 48 hours and postoperative complications.

Bilateral congenital absence of the anterior cruciate ligament associated with bilateral knee and hip osteoarthritis: Case report.

INTRODUCTION: Congenital absence of the cruciate ligaments is very rare condition. Its association with congenital abnormalities of the spine, knee and hip, has been rarely reported. Most of the case reports were mostly reported before adolescence, so reports of the progression of this congenital disease at old age were extremely rare. PRESENTATION OF CASE: A 65-year-old woman had a 7-year history of both knee and hip pain. On physical examination, valgus and varus instability on both knees and painful limitation of motion in both hip joints were observed. Radiography and magnetic resonance imaging showed the absence of the anterior cruciate ligament with osteoarthritis on both knees and hip osteoarthritis. Total knee and hip arthroplasties were performed on both knee joints and total hip arthroplasty. The pain and instability of both knees and hips were lost for follow up of more than a year, and the patient is doing well in daily life. DISCUSSION: Congenital absence of cruciate ligament may progress to osteoarthritis, do early detection and proper management is needed. In the treatment of older aged patients. Reports of treatment for this disorder are also very rare in older age. In old age, arthroplasty can be a useful treatment when the severe osteoarthritis is accompanied by instability. CONCLUSION: Since the congenital absence of the ACL in old age could lead to hip and knee osteoarthritis, periodic follow-up is necessary and arthroplasty can be a useful treatment when the severe osteoarthritis is accompanied by instability.

Evaluation of MARK BTM for Quantitative Measurement of Three Tumor Markers: Prostate Specific Antigen, Alpha Fetoprotein, and Carcinoembryonic Antigen.

BACKGROUND: Tumor marker assays have played a crucial role for screening cancers and monitoring cancer patients, as they reflect the status and prognosis of patients. Alpha fetoprotein (AFP), prostate specific antigen (PSA), and carcinoembryonic antigen (CEA) are the most commonly used tumor marker proteins. The MARK BTM immunoassay system is a novel platform based on magnetic nanoparticles and electrochemical immunoassay. METHODS: The analytical performance of MARK BTM immunoassay system for determination of AFP, PSA, and CEA are evaluated. Comparisons of methods are also conducted by comparing the assay results of MARK BTM immunoassay system to that of cobas e 801 system. RESULTS: The MARK BTM immunoassay system provides within-run, between-run, and between-day precisions for the three tumor markers, ranging from 1.13 - 7.46%. Data measured by the MARK BTM immunoassay system show high correlation with that of the cobas e 801 system, with a linear slope ranging from 0.966 to 1.042 and a correlation coefficient of r > 0.996 for the three markers. CONCLUSIONS: These results show that the MARK BTM immunoassay system can be used for the quantitative measurements of AFP, PSA, and CEA in clinical practice.

MESIA: Magnetic force-assisted electrochemical sandwich immunoassays for quantification of prostate-specific antigen in human serum.

We propose a new immunoassay technique, called magnetic-force assisted electrochemical sandwich immunoassay (MESIA), where serum biomarkers can be determined by magnetic actuation and electrochemical detection of gold-coated iron oxide nanoparticles as probes for immunocomplex formation. In MESIA, neither washing buffer nor fluidic parts are necessary, because the formation of immunocomplexes and the removal of unbound probes are controlled by magnetic forces. Electrochemical pretreatment and measurement of the gold-coated magnetic probes allows highly sensitive, precise, and robust system for quantification of target analytes. Using MESIA, the concentration of prostate-specific antigen (PSA) in 10 µl of human serum is determined within 5 min. The limit of detection is 0.085 ng/mL, and the average coefficient of variance is 8.85% for five different PSA concentrations ranging from 0 to 25 ng/mL. This method shows good precision and reproducibility (<10%) and high correlation with cobas e 801 (r = 0.997) for clinical patient samples. We believe this technique to be useful in the development of a point-of-care testing platform for diagnosis and prognosis of various diseases, such as cancer, based on quantification of biomarkers in a drop of blood.

Ketamine infusion therapy for chronic pain management in South Korea: A national survey for pain physicians with a narrative review.

Although ketamine infusion therapy (KIT) has been used extensively for the treatment of chronic persistent pain, there remains high heterogeneity in the administration protocols. The aim of this study was to assess the current clinical use and the infusion protocols of KIT in South Korea and to compare the protocol details with previous relevant studies.In the first phase, an online survey about KIT, including protocol information, was distributed to pain physicians managing chronic pain patients at 47 teaching hospitals registered in the Korean Pain Society. In the second phase, a review of the KIT protocols in previous clinical studies was conducted and compared with the survey results.Among 47 institutions, 35 replied; among them, 25 institutions performed KIT on an outpatient basis. The administration protocol for KIT varied greatly among institutions: the total infusion dose of ketamine ranged from 3.5 to 140 mg/70 kg, with a mode of 70 mg [interquartile range (IQR): 62.0; 8.0-70.0 mg] administered in 1 to 3 hours. In 10 previous studies of outpatient KIT, the total dose of ketamine ranged from 12.6 to 98 mg/70 kg, with a mode of 35 mg [IQR: 40 mg; 23-63 mg] given in 1 to 4 hours, which was significantly lower than in our results (P = .01). In the survey, physicians listed hallucination as the most frequent side effect.Although KIT is used in Korean pain centers, there is wide variation regarding the specific infusion protocols. The total dose of ketamine used in South Korea is significantly higher than the general recommendations for outpatient management and may compromise patient safety. The results of this survey reinforce the need for specific guidelines for KIT in managing chronic pain that counterbalance its risks and benefits.

Magnetic force assisted electrochemical sensor for the detection of thrombin with aptamer-antibody sandwich formation.

A magnetic force assisted electrochemical aptamer-antibody sandwich assay (MESA) was developed for the detection of thrombin as a model protein in serum samples. The MESA using the formation of sandwich complexes on the electrochemical sensor probe for reaction and the removal of unbound bioconjugates from the sensor surface without washing are controlled by a magnetic field. Thrombin was determined by the cathodic currents of a toluidine blue O (TBO) attached with thrombin antibody modified magnetic nanoparticle (MNP) at the sensor surface. To detect thrombin in a serum sample, we applied a thrombin-specific aptamer as the capture molecule bound to the functionalized conducting polymer layer (poly-(2,2´:5´,5″-terthiophene-3´-p-benzoic acid) (pTBA)), and streptavidin and starch coated-MNP was conjugated with biotinylated thrombin antibodies (Ab) and TBO as the bioconjugate (MNP@Ab-TBO). The characterization of MNP@Ab-TBO and sensor probe was performed using voltammetry, impedance spectroscopy, XPS, and UV-VIS spectroscopy. The experimental conditions were optimized in terms of pH, binding time, removal time of unbound bioconjugates, and applied potential. The dynamic ranges of thrombin were from 1.0 to 500 nM with detection limit of 0.49 ( ±â€¯0.06) nM. The recovery test demonstrates the reliability of the proposed sensing system for a handheld device.

Mobile diagnostics: next-generation technologies for in vitro diagnostics.

The emergence of a wide range of applications of smartphones along with advances in 'liquid biopsy' has significantly propelled medical research particularly in the field of in vitro diagnostics (IVD). Herein, we have presented a detailed analysis of IVD, its associated critical concerns and probable solutions. It also demonstrates the transition in terms of analytes from minimally invasive (blood) to non-invasive (urine, saliva and sweat) and depicts how the different features of a smartphone can be integrated for specific diagnostic purposes. This review basically highlights recent advances in the applications of smartphone-based biosensors in IVD taking into account the following factors: accuracy and portability; quantitative and qualitative analysis; and centralization and decentralization tests. Furthermore, the critical concerns and future direction of diagnostics based on smartphones are also discussed.

Anaphylaxis following atropine administration during general anesthesia: a case report.

Anaphylaxis is an acute, potentially lethal, multisystem syndrome resulting from the sudden release of mast-cell- and basophile-derived mediators into the circulation. Common manifestations of anaphylactic reactions include urticaria, angioedema, nausea, vomiting, hypotension and cardiovascular collapse. Cardiovascular collapse is the first detected manifestation in up to 50% of cases in perioperative anaphylaxis, because patients are anesthetized and unable to report symptoms. A 25-year-old male presented with severe hypotension and erythema after intravenous atropine administration during general anesthesia. Postoperative laboratory findings demonstrated elevated serum tryptase and total immunoglobulin E. An intradermal test showed atropine sensitivity. Although atropine is used widely as a perioperative anticholinergic agent, it is a potential risk factor for a severe anaphylactic reaction. Therefore, prompt recognition and adequate therapeutic measures are necessary to avoid fatal consequences.

Breast cancer diagnosis using a microfluidic multiplexed immunohistochemistry platform.

BACKGROUND: Biomarkers play a key role in risk assessment, assessing treatment response, and detecting recurrence and the investigation of multiple biomarkers may also prove useful in accurate prediction and prognosis of cancers. Immunohistochemistry (IHC) has been a major diagnostic tool to identify therapeutic biomarkers and to subclassify breast cancer patients. However, there is no suitable IHC platform for multiplex assay toward personalized cancer therapy. Here, we report a microfluidics-based multiplexed IHC (MMIHC) platform that significantly improves IHC performance in reduction of time and tissue consumption, quantification, consistency, sensitivity, specificity and cost-effectiveness. METHODOLOGY/PRINCIPAL FINDINGS: By creating a simple and robust interface between the device and human breast tissue samples, we not only applied conventional thin-section tissues into on-chip without any additional modification process, but also attained perfect fluid control for various solutions, without any leakage, bubble formation, or cross-contamination. Four biomarkers, estrogen receptor (ER), human epidermal growth factor receptor 2 (HER2), progesterone receptor (PR) and Ki-67, were examined simultaneously on breast cancer cells and human breast cancer tissues. The MMIHC method improved immunoreaction, reducing time and reagent consumption. Moreover, it showed the availability of semi-quantitative analysis by comparing Western blot. Concordance study proved strong consensus between conventional whole-section analysis and MMIHC (n = 105, lowest Kendall's coefficient of concordance, 0.90). To demonstrate the suitability of MMIHC for scarce samples, it was also applied successfully to tissues from needle biopsies. CONCLUSIONS/SIGNIFICANCE: The microfluidic system, for the first time, was successfully applied to human clinical tissue samples and histopathological diagnosis was realized for breast cancers. Our results showing substantial agreement indicate that several cancer-related proteins can be simultaneously investigated on a single tumor section, giving clear advantages and technical advances over standard immunohistochemical method. This novel concept will enable histopathological diagnosis using numerous specific biomarkers at a time even for small-sized specimens, thus facilitating the individualization of cancer therapy.

Microdevice for analyzing the effect of electrochemotherapy on cancer cells.

A microfabricated cell-based testing device for electrochemotherapy (ECT) has been developed; it mimics a clinical electroporator with a circular needle array and maintains a similar electric field strength distribution. Until now, the performance between electroporators having two- and six-needle circular array electrodes, which are the general needle-type clinical electroporators for ECT, has not been evaluated systemically, although many studies have investigated the efficacy of ECT on cancer cells. In this study, the cell-based performance on the newly developed ECT testing device was analyzed in two- and six-electrode modes using propidium iodide and bleomycin, and the electroporation characteristics were characterized. With on-chip fluorescence-based assays, the proposed device offers time- and cost-effective experimental procedures compared with conventional assays, and the results can reflect the electric characteristics of clinical electroporators.