Results and Factors Affecting Clinical Efficacy of Medial Patellofemoral Ligament Reconstruction Using a Gracilis Tendon Suture Technique

Background@#This study evaluated the outcomes of medial patellofemoral ligament (MPFL) reconstruction using a gracilis tendon suture technique for patients with patellar instability. Potential factors affecting clinical efficacy were also evaluated. @*Methods@#This study included 22 patients diagnosed with patellar instability, who underwent MPFL reconstruction using a gracilis tendon. Their mean age was 21.5 years (range, 15–48 years), and the mean follow-up period was 26.8 months (range, 12–66 months). Clinical evaluation included the determination of Kujala, Lysholm, and Tegner scores. Radiographic evaluation included changes in congruence angle and arthritic changes in the patellofemoral joint. Additionally, patients were examined for any complications, including recurrent dislocation. Factors affecting clinical efficacy were also evaluated. @*Results@#All clinical scores improved at final follow-up. The mean congruence angle improved from 23.6° before surgery to –6.5° at final follow-up. Two of 15 patients developed osteoarthritic changes in the patellofemoral joint. Dislocation recurred in 2 patients with type C trochlear dysplasia, which showed a statistically significant association with recurrent dislocation when compared to type A and B dysplasia (p = 0.026). Kujala scores were significantly lower among patients with abnormal patellar tilts (p = 0.038), and Lysholm scores were significantly lower among patients with femoral internal rotation deformity (p = 0.024). @*Conclusions@#Satisfactory results were obtained after MPFL reconstruction using a gracilis tendon suture technique for patients with patellar instability. However, dislocation recurred in patients with type C trochlear dysplasia, and clinical efficacy was lower among patients with femoral internal rotation and patellar tilt.

Complete versus Incomplete Footprint Coverage in Medium-Size Full-Thickness Rotator Cuff Tears / 대한스포츠의학회지

Purpose@#This study aims to verify the preoperative factor that can affect the footprint coverage during arthroscopic rotator cuff repair in full-thickness medium-size cuff tear and the change of footprint coverage on magnetic resonance imaging (MRI) at postoperative 6 months. @*Methods@#A total of 30 medium-size full-thickness rotator cuff tears were analyzed. They were classified into complete footprint coverage group (CC, n=19) and incomplete footprint coverage group (IC, n=11) by arthroscopic findings and immediate postoperative MRI findings. MRI was performed before the operation, 1 day after the operation, and 6 months after the operation. Preoperative MRI evaluated the size of the anteroposterior tear width (cm), length of retraction (cm), fatty infiltration, and muscle atrophy. Postoperatively, footprint coverage, fatty degeneration, and muscle atrophy were evaluated. We compared healing and change of fatty degeneration between two groups. @*Results@#The healing rate was significantly increased in the CC group (complete/partial healing, 10/9) compared to the IC group (complete/partial healing, 6/5) (p＜ 0.001). Six of 11 partial coverages (54.5%) were even improved to complete coverage at postoperative 6-month follow-up. However, the difference in footprint coverage did not affect the change of fatty degeneration at postoperative 6 months. Any change of fatty degeneration (FD) and initial FD of rotator cuff tendons were not correlated with healing (p＜ 0.05). @*Conclusion@#The footprint coverage can be changed in postoperative 6 months in MRI and anteroposterior tear size, retraction, fat degeneration, and muscle atrophy do not affect footprint coverage in medium-sized full-thickness rotator cuff tears.

The best options in superior capsular reconstruction

Irreparable massive rotator cuff tears cause pain, loss of function, and a decrease in range of motion, which cause serious disturbances in daily life. Young patients, in particular, are active and have relatively high functional requirements, and their surgical options are limited. Superior capsular reconstruction (SCR) was first proposed for irreparable massive rotator cuff tears, good clinical results have been reported in short-term follow up. Since then, SCR has been used increasingly worldwide for irreparable massive rotator cuff tears, and various studies have been published on clinical outcomes, biomechanical outcomes, surgical techniques, and graft types. This article reviews the optimal graft and surgical options for improving clinical outcomes in SCR.

The best options in superior capsular reconstruction

Irreparable massive rotator cuff tears cause pain, loss of function, and a decrease in range of motion, which cause serious disturbances in daily life. Young patients, in particular, are active and have relatively high functional requirements, and their surgical options are limited. Superior capsular reconstruction (SCR) was first proposed for irreparable massive rotator cuff tears, good clinical results have been reported in short-term follow up. Since then, SCR has been used increasingly worldwide for irreparable massive rotator cuff tears, and various studies have been published on clinical outcomes, biomechanical outcomes, surgical techniques, and graft types. This article reviews the optimal graft and surgical options for improving clinical outcomes in SCR.

Molecular detection and characterization of Brucella species in raw informally marketed milk from Uganda.

This study identified and characterized Brucella species in the informal milk chain in Uganda. A total of 324 cattle bulk milk samples were screened for the genus Brucella by real-time PCR with primers targeting the bcsp31 gene and further characterized by the omp25 gene. Of the samples tested, 6.5% were positive for Brucella species. In the omp25 phylogeny, the study sequences were found to form a separate clade within the branch containing B. abortus sequences. The study shows that informally marketed cattle milk in Uganda is a likely risk factor for human brucellosis and confirms that B. abortus is present in the cattle population. This information is important for potential future control measures, such as vaccination of cattle.

The milk delivery chain and presence of Brucella spp. antibodies in bulk milk in Uganda.

This study examined the influence of informal milk delivery chains on the risk of human exposure to Brucella spp. through milk consumption in two regions of Uganda (Gulu and Soroti Districts). The work involved describing milk delivery chains, investigating brucellosis awareness amongst milk deliverers and determining the presence of Brucella spp. antibodies in cattle milk on delivery to primary collection points (boiling points and dairies). Milk samples (n = 331) were collected from deliverers at primary collection points and from street vendors at point of sale and analysed using indirect enzyme-linked immunosorbent assay (I-ELISA). A written questionnaire was used to collect data from deliverers (n = 279) on their milk delivery chains and their brucellosis awareness. The most common delivery points in Gulu District were small dairies and in Soroti District boiling points. The presence of Brucella spp. antibodies in milk samples was higher in Soroti (40 %) than in Gulu (11 %) (P < 0.0001). There are possible public health risk consequences of this finding as 42 % of deliverers in Soroti District reported drinking raw milk, compared with 15 % in Gulu District (P < 0.0001). Awareness of brucellosis was low, with 70 % of all milk deliverers reporting not having heard of the disease or the bacterium. Application of quality controls for milk (colour and odour) along the delivery chain varied depending upon supply and demand. This study provides evidence of the diversity of informal milk markets in low-income countries and of the potential public health risks of consuming unpasteurised milk. These results can be useful to those planning interventions to reduce brucellosis.

Prevalence of and factors associated with Brucella sero-positivity in cattle in urban and peri-urban Gulu and Soroti towns of Uganda.

Brucellosis is a key zoonosis of major public health, animal welfare and economic significance, and is endemic in livestock in Uganda. A cross-sectional epidemiological study was carried out to estimate the sero-prevalence of brucellosis and identify factors associated with sero-positivity in cattle in urban and peri-urban Gulu and Soroti towns of Northern and Eastern Uganda, respectively. A total of 1007 sera and data on biologically plausible risk factors from 166 herds and their spatial locations, were collected from cattle reared in urban and peri-urban Gulu and Soroti towns of Uganda. The sera were analyzed using indirect ELISA and sero-positive reactors confirmed by competitive ELISA. Multivariable models were used to investigate for risk factors. The overall animal-level and herd-level sero-prevalence was 7.5% (76/1007, 95% Confidence Interval (CI): 6.15-9.4%) and 27.1% (45/166, 95% CI: 20.9-34.3%), respectively. Herd-level sero-prevalence was significantly (P<0.001) higher in Soroti than Gulu. In Gulu town, sero-positivity increased with an increase in herd size (P=0.03) and age (P=0.002), and was higher in cattle brought in from western Uganda (P<0.0001). In Soroti town, introduction of new cattle into a herd was significantly (P=0.027) associated with herd sero-positivity. There was a geographically differential risk (clustering) of Brucella sero- positivity in herds in Soroti, while sero-positivity was homogeneously distributed in Gulu. The data highlight brucellosis occurrence and major risk factors for its transmission in cattle in urban and peri-urban areas.

Transferring learning from faculty development to the classroom.

This study's purpose was to better understand the transfer of learning by uncovering how various factors supported the integration of health information technology knowledge and skills gleaned from the Health Resources and Services Administration­funded faculty development programs into nursing education curricula. Through interviews with 20 participants from four programs, this study confirmed the importance of findings related to faculty, program, and work environment characteristics for supporting successful transfer of learning and substantiates a variety of other transfer-of-learning research. New or seldom discussed supportive individual characteristics were found, including leadership abilities, lifelong learning, ability to recognize limitations, persistence, creativity, and risk taking. The importance of networking, diversity of perspectives, postconference support, and teams in program designs were found to positively influence transfer. The variety of supportive factors and barriers in the participants' work environments strengthens the assertions that transfer may be context dependent. Findings provided insight for recommendations to improve learning transfer.

Common themes in clinical education partnerships.

The concurrent nursing and faculty shortages continue to be critical issues for the nation's health care system. As academic nursing programs struggle with maintaining and increasing enrollment in the midst of a faculty shortage, one solution is to expand the faculty's capacity through innovative academic-service partnerships. Schools and clinical partners identified as having implemented innovative partnerships were invited to participate in this descriptive study. Site visitations to schools in Florida and Texas were conducted to gain in-depth knowledge of the clinical education model, the academic-service partnership, and the strengths and challenges associated with planning, implementing, and sustaining programs. Four underlying features were common across the successful implementation: supportive relationships, goodness of fit, flexibility, and communication. Consideration of the four features will be useful as nursing programs and their clinical partners are developing, implementing, and evaluating new models for increasing educational capacity and lessening the nursing shortage.

A Case of Early Developed Secondary Renal Amyloidosis in a Patient with Rheumatoid Arthritis (RA) / 대한신장학회잡지

We experienced a case of secondary renal amyloidosis diagnosed by renal biopsy in a patient who had been diagnosed as RA two years ago. A 62-year old man was admitted to neurology departement because of right hemiplegia. During conservative care at neurology department, he was consulted to us because of aggravated generalized edema and proteinuria. He was diagnosed as rheumatoid arthritis and ulcerative colitis two years ago, and then he had taken prednisolone, methotrexate, mesalazine regularly. At physical examination, there was no abnormal finding except pretibial pitting edema and right hemiplegia. In urinalysis, specific gravity was 1.025, pH was 5.5, protein was 4+ and RBC 0-1/ HPF and WBC 0-1/HPF. Total protein of 24 hour's urine was 5.5 g/day. The blood BUN and creatinine level were 16.4 mg/dL, 0.4 mg/dL and cholesterol level were 154 mg/dL, total protein and albumin were 4.4 g/dL and 1.9 g/dL. Serum RA factor and CRP showed high level as 94.90 IU/mL and 118.00 mg/L. On urine electrophoresis, albuminuria was dominant but M-spike was not founded. On urinalysis taken at the time of first diagnosis of rheumatoid arthritis two years ago, proteinuria was negative and serum albumin levels was 3.6 g/dL. At that time, there was no evidence of nephropathy. In renal biopsy, electron microscope showed heavy nonbranching amyloid fibrils accumulated in mesangium and polarized light microscopy after Congo-red staining revealed apple-green birefringent amyloid deposits in glomeruli and blood. So we diagnosed renal amyloidosis associated with RA.

Polymorpshisms of XPC Gene and Risk of Primary Lung Cancer in Koreans / 결핵

BACKGROUND: DNA repair plays a crucial role in protection from cancer-causing agents. Therefore, a reduced DNA repair capacity can increase the susceptibility to lung cancer. The XPC gene contains 15 exons and encodes a 940 amino acid protein that plays a central role in DNA damage recognition of the nucleotide excision repair pathway, which is a major DNA repair mechanism removing the bulky-helix distorting DNA lesions caused by smoking. Recently several polymorphisms in the XPC gene were identified. In addition, it is possible that these polymorphisms may affect the DNA repair capacity, which modulate cancer susceptibility. The relationship between codon 499 and 939 polymorphisms, and a poly(AT) insertion/deletion polymorphism in the XPC gene, and the lung cancer risk were investigated. METHOD: The genotypes were determined using either PCR or PCR-RFLP analysis in 219 male lung cancer patients and 150 healthy males controls. RESULTS: The frequencies of the genotypes (Val499Ala, PAT and Lys939Gln) among the cases were not significantly different from those of the controls. There was no significant associantion between these polymorphism and the lung cancer risk when the analyses were stratified according to age, smoking status and the pack-years of smoking. Moreover, the genotypes had no apparent relationship with any of the histological types of lung cancer. There was a linkage disequilibrium among the Val499Ala, PAT and Lys939Gln polymorphisms. The PAT polymorphism had a strong linkage disequilibrium with the Lys939Gln polymorphism (kappa value=0.87). The XPC haplotypes showed no significant association with the lung cancer risk. CONCLUSION: These results suggest that XPC Val499Ala, PAT and Lys939Gln polymorphisms are not major contributors to the individual lung cancer susceptibility in Koreans.

Ser326Cys Polymorphism of hOGG1 Gene and Risk of Primary Lung Cancer in Koreans / 결핵

BACKGROUND: DNA repair plays a crucial role in protecting the genome from cancer-causing agents. Therefore, a reduced DNA repair capacity can increase the susceptibility to cancer. The human OGG1 (hOGG1) gene encod es DNA glycosylase/apurinic lyase and excise 8-hydroxyguanine, one of the major premutagenic DNA lesions, which is produced by oxygen radical forming agents including smoking. Recently several polymorphisms in the hOGG1 gene were identified, and it is possible that these polymorphisms may affect the DNA repair capacity and thus modulate cancer susceptibility. The relationship between the codon 326 polymorphism (Ser to Cys) in the hOGG1 gene and lung cancer risk was investigated. MATERIALS AND METHOD: The Ser326Cys genotypes were determined using PCR-RFLP analysis in 299 primary lung cancer patients and 186 healthy controls who were frequency (case:control=3:2) matched according to age and sex. RESULT: The frequencies of the Ser326Cys genotypes (Ser/Ser, Ser/Cys and Cys/Cys) among cases (23.4%, 51.8%, and 24.7%, respectively) were not significantly different from those among the controls (22.6%, 52.1% and 25.3%, respectively). When the analyses were stratified according to age, sex, smoking status and pack-years of smoking, no significant association between this polymorphism and lung cancer risk was found. Moreover, the Ser326Cys genotype showed no apparent relationship with any of the histological types of lung cancer. CONCLUSION: These result suggest that the hOGG1 Ser326Cys polymorphism is not a major contributor to individual lung cancer susceptibility in Koreans.

Polymorphisms of GSTM1 and CYP1A1, and Susceptibility to Primary Lung Cancer in Korean Males / 결핵

BACKGROUND: Lung cancer is frequently cited as an example of a disease caused solely by exposure to environmental caricinogens. However, there is a growing realization that the genetic constitution is also important in determining individual's susceptibility to lung cancer. This genetic susceptibility may result from functional polymorphims of the genes involved in carcinogen metabolism. In this study, the association between GSTM1 and CYP1A1 polymorphisms and the lung cancer risk in Korean males was investigated. MATERIALS AND METHOD: The study population consisted of 153 male lung cancer patients and 143 healthy male controls. The GSTM1 and CYP1A1 genotypes were determined by multiplex PCR and PCR-RELP analysis. RESULT: The were no significant differences in the frequency of the GSTM1 null genotype between the cases and the controls. When the cases were categorized by their histologic type, the frequency of the GSTM1 null genotype in the small cell carcinoma group was higher than those of the controls(67.2% vs 55.9%), but the difference was not statistically significant(OR=1.772 ; 95% CI=0.723-4.340). The distribution of the CYP1A1 MspI genotypes among the cases were similar to those among the controls. When the cases were grouped by their histologic type, the m1/m1, m1/m2, m2/m2 genotypes frequencies among the small cell carcinomas(23.0%, 38.5%, and 38.5%, respectively) were significantly different from those of the controls(36.4%, 46.2%, and 17.4%, respectively, p<0.05). When the m1/m1 genotype was used as a reference, the m1/m2 and m2/m2 genotypes were associated with an increased risk for small cell lung cancer(m1/m2 genotype : OR=1.337, 95% CI=0.453-3.947 ; m2/m2 genotype : OR=3.374, 95% CI=1.092-10.421). CONCLUSION: These results suggest that the GSTM1 and CYP1A1 genotypes may be a genetic determinant of the risk for lung cancer, particlulary small cell carcinoma. Further investigation is needed to confirm these results.

Polyneuropathy in Patients with Chronic Obstructive Pulmonary Disease / 결핵

The incidence, type arid distribution of polyneuropathy in patients with chronic obstructive pulmonary disease (COPD) were assessed and also analyzed the causative factors. Forty-four patients, mean age 66.1 years (42 male, 2 female), have been investigated with arterial gas analysis, pulmonary function test, clinical and electrodiagnostic studies. None of them had conditions known to affect the peripheral nervous system such as metabolic disorders or drugs. In a selected group of 44 patients, electrophysiological findings of polyneuropathy were found in 22 patients(50%), clinical polyneurtpathy were diagnosed in 13 patients(9 patients were diagnosed by electrophysiological studies, 4 patients were normal by electrophysiological studies). These findings indicate that subclinical polyneuropathy( 13 patisnts, 30%) more conimorily occurs than clinical polyneuropathy( 9 patients, 20%) in associated with COPD. In the patients with polyneuropathy, the lesions were predominant axonal degeneration, the changes were more involved in leg than arm, more frequently affected sensory fibers. We could not find etiologic factor to cause polyneuropathy in COPD patients.

Changes in Plasma Concentration of Catechloamine during Sodium Nitroprusside-induced Hypotension / 대한마취과학회지

Sodium nitroprusside is used to induce hypotension to decrease bleeding in operation site, Sodium nitroprusside decrease vascular resistance by directly relax arteriolar and venous smooth muscle, to a lesser extent. Hypotension stimulate baroreceptors and increase sympatho-adrenal activity. The function of sympatho-adrenal mdullary system may be monitored by the changes of plasma cancentrations of epinephrine and norepinephrine. To study the relationship between induced hypotension and the catecholamine release, the plasma epinephrine and norepinephrine concentration were measured before, during and after infusion of aodium nitropruaside to rabbits The results were as follows: 1) The mean arterial blood pressure decreased significantly after SNP infusion (5.0 ug/kg/minute) from the control value of 98.1+/-11.9 mmHg to 66.3+/-16.2, 57.9+/-17.9 mmHg in 10 and 20 minutes after SNP infusion (P<0.01) and 78.8+/-12.5 mmHg after discontinuation of SNP infusion. 2) The heart rate increased significantly after SNP infusion from the control value of 149.8+/-12.8 beat/minute to 166.5+/-10.8, 190.4+/-17.6 beats/minute in 10 and 20 minutes after SNP infusion (P<0.05, P<0.01) and the heart rate increased after discontinuation of SNP infusion. 3) The plasma epinephrine concentration increased significantly after SNP infusion from the control value of 181.2+/-91.9 pg/ml to 547.5+/-163.2, 837.5+/-253.6 pg/ml in 10 and 20 minutes after SNP infusion and continued to increase of epinephrine after discontinuation of SNP infusion. 4) The plasma norepinephrine concentration increased significantly after SNP infusion from the control value of 566.2+/-92.6 pg/ml to 1131.3+/-424.7, 1432.5+/-479.2 pg/ml 10 and 20 minutes after SNP infusion and continued to increase after discontinuation of SNP infusion. There was a highly significant correlation between decrease in mean arterial pressure and increase in plasma epinephrine and norepinephrine concentrations.

Baekward Dislocation of Temporomandibular Joint during Induction of Anesthesia / 대한마취과학회지

Dislocation of the temporomandibular joint(TMJ) is fairly frequent but backward dislocation of TMJ during induction of anesthesia is rarely reported. The causes include congenital weakness of the capsule or malformation of the condyles of both. The physical causes are as follows ; The joint may be strained or injured during general anesthesia, 1) possible straing or injureyto the joint, 2) yawning, 3) attempts by children to insert large objects into the mouth, 4) and positional pressures during sleep. Acase of backward dislocation of TMJ occureed during induction of anesthesia and treated with nanual reduction and subsequent intermaxillary fixation.