ABSTRACT
BACKGROUND & AIMS: The relationship between diet and health, particularly the role of carbohydrates, has been extensively studied. However, carbohydrate intake based on individual health conditions remains unclear. Here, we aimed to investigate whether the association between carbohydrate intake and all-cause mortality varied between individuals with and without diabetes mellitus (DM). METHODS: This prospective cohort study used data from the Korean Genome and Epidemiology Study (KoGES). Overall, 143,050 participants were included, with 10.1% having DM. Dietary intake was assessed using a semiquantitative food frequency questionnaire. Cox proportional hazards regression models were used to assess the association between carbohydrate intake and mortality after adjusting for confounders. RESULTS: The study showed that 5436 deaths occurred during the median follow-up period of 10.1 years. A significant interaction between carbohydrate intake and DM was observed in the study population (interaction p = 0.061). Higher carbohydrate intake proportion was associated with an increased risk of all-cause mortality among individuals with DM (adjusted hazard ratio [HR], p-value = 1.10 [1.01-1.20], p = 0.032). Conversely, no association was observed between the proportion of carbohydrate intake and all-cause mortality in participants without DM. Additionally, both total sugar and added sugar intakes were associated with an increased risk of all-cause mortality in participants with DM (adjusted HR, p-value = 1.02 [1.01-1.04], p < 0.001 and 1.18 [1.13-1.24], p < 0.001). CONCLUSIONS: High carbohydrate (%) and added sugar intake were associated with an increased mortality risk in individuals with DM. Reducing carbohydrate intake and opting for healthy carbohydrates to mitigate mortality risk may be beneficial for individuals with DM, particularly when compared with the general population.
Subject(s)
Diabetes Mellitus , Dietary Carbohydrates , Humans , Prospective Studies , Male , Female , Middle Aged , Dietary Carbohydrates/administration & dosage , Republic of Korea/epidemiology , Diabetes Mellitus/mortality , Diabetes Mellitus/epidemiology , Aged , Proportional Hazards Models , Risk Factors , Diet/statistics & numerical data , Cause of DeathABSTRACT
The evaluation of temperature-dependent drug release for solubilizing nanoformulations uses a modification of the stable isotope ultrafiltration assay (SITUA). This method is specific to parenterally administered solubilizing nanomedicines and can be used to assess drug release from the total dosage form for regulatory purposes of lot release. The principle upon which this method is based is the relationship between drug solubility and temperature in a plasma simulating media, 4.5% human serum albumin, that allows for discrimination of passing and failing lots based upon the release characteristics.
Subject(s)
Isotopes , Ultrafiltration , Humans , Drug Liberation , Temperature , SolubilityABSTRACT
BACKGRUOUND: We investigated the long-term efficacy and safety of initial triple therapy using metformin, a dipeptidyl peptidase-4 inhibitor, and a sodium-glucose cotransporter-2 inhibitor, in patients with type 2 diabetes mellitus. METHODS: We enrolled 170 drug-naïve patients with glycosylated hemoglobin (HbA1c) level >7.5% who had started triple therapy (metformin, sitagliptin, and empagliflozin). Glycemic, metabolic, and urinary parameters were measured for 24 months. RESULTS: After 24 months, HbA1c level decreased significantly from 11.0%±1.8% to 7.0%±1.7%. At 12 and 24 months, the rates of achievement of the glycemic target goal (HbA1c <7.0%) were 72.5% and 61.7%, respectively, and homeostasis model assessment of ß-cell function and insulin resistance indices improved. Whole-body fat percentage decreased by 1.08%, and whole-body muscle percentage increased by 0.97% after 24 months. Fatty liver indices and albuminuria improved significantly. The concentration of ketone bodies was elevated at the baseline but decreased after 24 months. There were no serious adverse events, including ketoacidosis. CONCLUSION: Initial triple combination therapy with metformin, sitagliptin, and empagliflozin led to achievement of the glycemic target goal, which was maintained for 24 months without severe hypoglycemia but with improved metabolic function and albuminuria. This combination therapy may be a good strategy for drug-naïve patients with type 2 diabetes mellitus.
Subject(s)
Benzhydryl Compounds , Diabetes Mellitus, Type 2 , Glucosides , Metformin , Sodium-Glucose Transporter 2 Inhibitors , Humans , Diabetes Mellitus, Type 2/metabolism , Metformin/adverse effects , Sitagliptin Phosphate/adverse effects , Glycated Hemoglobin , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Albuminuria , Blood Glucose/metabolism , Treatment OutcomeABSTRACT
To date, only a few clinical studies have investigated the differences between 2-octyl cyanoacrylate and n-octyl cyanoacrylate topical skin adhesives (TSAs). This study aimed to compare the outcomes of the two TSAs for wound closure after ankle fracture surgeries. Fifty-six patients were randomized to receive either a 2-octyl or n-octyl cyanoacrylate TSA. At 3 and 6 months after surgery, wound cosmetic outcomes were assessed using the Hollander Wound Evaluation Scale (HWES), and patient satisfaction for wound cosmesis was assessed using the visual analog scale (VAS) and 5-item Likert scale. Functional outcomes at 6 months after surgery were assessed using the Olerud-Molander Ankle Score (OMAS). Fifty-five patients completed the study protocol. Within the follow-up period, no differences were found between the two groups in terms of HWES, VAS, 5-item Likert scale, and OMAS. 2-octyl cyanoacrylate TSA and n-octyl cyanoacrylate TSA were comparable options for wound closure after ankle fracture surgeries in terms of wound cosmesis, patient satisfaction, and functional outcome.
Subject(s)
Ankle Fractures , Tissue Adhesives , Humans , Tissue Adhesives/therapeutic use , Adhesives , Prospective Studies , Cyanoacrylates/therapeutic use , SuturesABSTRACT
BACKGROUND: Because ultrasound measurement of plantar fascia thickness is widely used in the diagnosis and evaluation of plantar fasciitis, it is important to understand and minimize the errors that occur with this measurement. The aim of this systematic review was to identify and synthesize studies reporting on intrarater and interrater reliability of ultrasound measurement of plantar fascia thickness. METHODS: After comprehensive searches in the MEDLINE, Embase, and Cochrane Library databases, 11 studies involving 238 healthy participants and 68 patients with pathologic foot disorders were included. RESULTS: Seven of 11 studies revealed a low risk of bias. Most of the studies reported good to excellent intrarater and interrater reliability for ultrasound measurement of plantar fascia thickness (intrarater intraclass correlation coefficient [ICC], 0.77-0.98; interrater ICC, 0.76-0.98). In addition, two studies on intrarater reliability and one study on interrater reliability showed moderate reliability (ICCs, 0.65, 0.67, and 0.59, respectively). Overall, the standard error of measurement was less than 5% and did not exceed 7%. CONCLUSIONS: The findings of this review suggest that ultrasound measurement of plantar fascia thickness is reliable in terms of both relative and absolute reliability. Reliability can be optimized by using the average of multiple measurements and an experienced operator.
Subject(s)
Fasciitis, Plantar , Foot , Humans , Reproducibility of Results , Ultrasonography , Foot/diagnostic imaging , Foot/pathology , Muscle, Skeletal , Fasciitis, Plantar/diagnostic imaging , Fascia/diagnostic imaging , Fascia/pathologyABSTRACT
OBJECTIVE: Although the incidence of contralateral Achilles tendon in patients with Achilles tendon rupture is higher than in the general population, there are no studies evaluating the status of the contralateral Achilles tendon. The aim of this study was to investigate the status of the contralateral Achilles tendon in patients with acute Achilles tendon rupture. DESIGN: Prospective observational cohort study. SETTING: University hospital foot and ankle clinic. PARTICIPANTS: Seventy-five patients with acute Achilles tendon rupture who met the inclusion criteria. INTERVENTION: Ultrasonography performed by an orthopedic surgeon who had 8 years of experience in musculoskeletal ultrasonography. MAIN OUTCOME MEASURES: Ultrasonographic abnormalities of the contralateral Achilles tendon at the time of diagnosis of acute Achilles tendon rupture. Abnormalities were categorized as intratendinous lesions, peritendinous lesions, changes in retrocalcaneal bursa, and Achilles tendon thickening. RESULTS: The maximal Achilles tendon thickness had a mean of 4.8 ± 1.0 mm. Nine patients (12%) showed ultrasonographic abnormalities on the contralateral Achilles tendon, and the presence of exertional pain was the sole associating variable with ultrasonographic abnormalities. CONCLUSION: The prevalence of ultrasonographic abnormalities in the contralateral Achilles tendon shown in this study was not higher than that reported in healthy or asymptomatic Achilles tendon. Therefore, routine evaluation of the contralateral Achilles tendon is unnecessary at the time of acute Achilles tendon rupture.
Subject(s)
Achilles Tendon , Tendon Injuries , Humans , Achilles Tendon/diagnostic imaging , Achilles Tendon/pathology , Prospective Studies , Tendon Injuries/diagnostic imaging , Tendon Injuries/surgery , Rupture/diagnostic imaging , Rupture/surgery , Treatment OutcomeABSTRACT
Serum tryptase is a biomarker used to aid in the identification of certain myeloid neoplasms, most notably systemic mastocytosis, where basal serum tryptase (BST) levels >20 ng/mL are a minor criterion for diagnosis. Although clonal myeloid neoplasms are rare, the common cause for elevated BST levels is the genetic trait hereditary α-tryptasemia (HαT) caused by increased germline TPSAB1 copy number. To date, the precise structural variation and mechanism(s) underlying elevated BST in HαT and the general clinical utility of tryptase genotyping, remain undefined. Through cloning, long-read sequencing, and assembling of the human tryptase locus from an individual with HαT, and validating our findings in vitro and in silico, we demonstrate that BST elevations arise from overexpression of replicated TPSAB1 loci encoding canonical α-tryptase protein owing to coinheritance of a linked overactive promoter element. Modeling BST levels based on TPSAB1 replication number, we generate new individualized clinical reference values for the upper limit of normal. Using this personalized laboratory medicine approach, we demonstrate the clinical utility of tryptase genotyping, finding that in the absence of HαT, BST levels >11.4 ng/mL frequently identify indolent clonal mast cell disease. Moreover, substantial BST elevations (eg, >100 ng/mL), which would ordinarily prompt bone marrow biopsy, can result from TPSAB1 replications alone and thus be within normal limits for certain individuals with HαT.
Subject(s)
Mastocytosis , Myeloproliferative Disorders , Humans , Tryptases/genetics , Mast Cells , Reference Values , Unnecessary Procedures , Mastocytosis/diagnosis , Myeloproliferative Disorders/pathologyABSTRACT
INTRODUCTION: It remains unclear whether computed tomography (CT) is superior to plain radiography in detecting lateral hinge fractures after medial opening-wedge supramalleolar osteotomy (SMO) of the ankle joint. This study aimed to evaluate the disparity between postoperative plain radiography and CT in detecting lateral hinge fractures after medial opening-wedge SMO and to identify the predictive factors of lateral hinge fractures. MATERIALS AND METHODS: This retrospective study included 39 patients who underwent medial opening-wedge SMO. The immediate postoperative plain radiography and CT scan images were retrieved, and the presence of lateral hinge fractures was independently determined. Depending on the fracture gap, the lateral hinge fractures were subclassified as stable (gap < 2 mm) or unstable (gap ≥ 2 mm) fractures. To investigate the predictive factors, the cases were divided based on diagnostic tools such as plain radiography and CT. RESULTS: The incidence of lateral hinge fractures was 48.7% (19/39) on plain radiographs and 61.5% (24/39) on CT scans. Five cases of lateral hinge fractures additionally detected on CT scans were stable fractures, and all had been classified as no fracture on plain radiographs. The unstable fractures that had been subclassified based on plain radiographs did not change on CT scans. None of the variables were associated with the presence of lateral hinge fractures on plain radiographs and CT scans. CONCLUSIONS: Postoperative CT after medial opening-wedge SMO has no additional diagnostic value if the lateral hinge fracture has already been diagnosed on plain radiography. Therefore, postoperative CT is only recommended when lateral hinge fractures are not visible on plain radiographs.
Subject(s)
Fractures, Bone , Osteoarthritis, Knee , Humans , Retrospective Studies , Tibia/surgery , Osteoarthritis, Knee/surgery , Tomography, X-Ray Computed , Osteotomy/methodsABSTRACT
Although conventional topical approaches for treating psoriasis have been offered as an alternative, there are still unmet medical needs such as low skin-penetrating efficacy and off-target adverse effects. A hyaluronic acid nanoparticle (HA-NP) formed by self-assembly of HA-hydrophobic moiety conjugates has been broadly studied as a nanocarrier for long-term and target-specific delivery of drugs, owing to their excellent physicochemical and biological characteristics. Here, we identify HA-NPs as topical therapeutics for treating psoriasis using in vivo skin penetration studies and psoriasis animal models. Transcutaneously administered HA-NPs were found to be accumulated and associated with pro-inflammatory macrophages in the inflamed dermis of a psoriasis mouse model. Importantly, HA-NP exerted potent therapeutic efficacy against psoriasis-like skin dermatitis in a size-dependent manner by suppressing innate immune responses and restoring skin barrier function without overt toxicity signs. The therapeutic efficacy of HA-NPs on psoriasis-like skin dermatitis was due to the outermost hydrophilic HA shell layer of HA-NPs, independent of the molecular weight of HA and hydrophobic moiety, and comparable with that of other conventional psoriasis therapeutics widely used in the clinical settings. Overall, HA-NPs have the potential as a topical nanomedicine for treating psoriasis effectively and safely.
Subject(s)
Dermatitis , Nanoparticles , Psoriasis , Mice , Animals , Hyaluronic Acid/chemistry , Psoriasis/drug therapy , Skin , Nanoparticles/chemistryABSTRACT
No previous study has demonstrated the relationship between the ankle position and radiographic diagnosis of acute Achilles tendon rupture. The purpose of this study was to investigate the influence of ankle position in the presence of diagnostic radiographic signs in acute Achilles tendon rupture. A retrospective review of 154 ankle lateral radiographs of acute Achilles tendon rupture was performed. Ankle position was classified as dorsiflexion, neutral, or plantar flexion by measurement of the tibiotalar angle. Kager's triangle, Toygar's angle, Arner's sign, and thickening of the Achilles tendon were assessed as diagnostic radiographic signs, and their relations to ankle position were analyzed. Interobserver reliabilities of radiographic signs were moderate to substantial (kappa value, range 0.41-0.68). All 4 signs were significantly more visible in ankle plantar flexion than dorsiflexion. The presence of Toygar's angle and positive Arner's sign were significantly increased in ankle plantar flexion compared to neutral, while the presence of Kager's triangle, and thickening of the Achilles tendon did not differ according to ankle position. The diagnostic radiographic signs of acute Achilles tendon rupture were better presented in ankle plantar flexion position than neutral and dorsiflexion positions. Neutral and dorsiflexion ankle positions should be avoided when performing lateral radiographs of patients with suspected acute Achilles tendon rupture.
Subject(s)
Achilles Tendon , Ankle Injuries , Tendon Injuries , Achilles Tendon/diagnostic imaging , Achilles Tendon/surgery , Acute Disease , Ankle , Ankle Injuries/diagnostic imaging , Ankle Injuries/surgery , Ankle Joint/diagnostic imaging , Humans , Posture , Rupture/diagnostic imaging , Rupture/surgery , Tendon Injuries/diagnostic imaging , Tendon Injuries/surgeryABSTRACT
Metabolic syndrome is one factor known to contribute to the development of tendinopathies. The aim of this study was to compare the clinical outcomes of eccentric calf-muscle exercise for treatment of chronic insertional Achilles tendinopathy in patients with or without metabolic syndrome. Twenty-eight patients with chronic insertional Achilles tendinopathy and metabolic syndrome who performed eccentric calf-muscle exercise were retrospectively compared with 28 age- and sex-matched controls without metabolic syndrome. Comparisons between the 2 groups were made by evaluating the Visual Analog Scale for pain, patient satisfaction, and amount of pain medications needed during 3 months of follow-up. Two-way analysis of variance with repeated measures showed that the pain scales in the metabolic syndrome group were higher than those in the control group during the follow-up period (F[1,54] = 24.45, p < .001). The patient satisfaction ratings were lower and the amount of required pain medication was higher in the metabolic syndrome group (p < .001 and p < .001, respectively). Eccentric calf-muscle exercises for chronic insertional Achilles tendinopathy were less effective in patients with metabolic syndrome. Therefore, these patients should be managed with a combination of other treatment modalities rather than eccentric exercise alone.
Subject(s)
Achilles Tendon , Metabolic Syndrome , Tendinopathy , Exercise Therapy , Humans , Metabolic Syndrome/complications , Metabolic Syndrome/therapy , Pain , Retrospective Studies , Tendinopathy/therapy , Treatment OutcomeABSTRACT
INTRODUCTION: Knowledge on the learning curve for the repair of Achilles tendon rupture is limited. The aim of this study was to quantify the learning curve for the Krackow suture technique for the repair of Achilles tendon rupture and to identify the correlation between the cumulative volume of cases and clinical outcome measures. MATERIALS AND METHODS: A total of 226 cases of Achilles tendon repair using the Krackow suture technique were reviewed. Each surgery was independently performed by four surgeons who started a foot and ankle specialty career after fellowship training. After logarithmic transformation of the operative time and cumulative volume of cases, a linear regression analysis was performed to determine the best-fit linear equations to predict the required time for the Krackow suture technique according to the cumulative volume of cases. The correlation between the cumulative volume of cases and clinical outcome measures was analyzed using Pearson correlation coefficients. Receiver operating characteristic curves were constructed to determine the minimum number of cases with an operative time shorter than the average in the first 30 cases. RESULTS: In all four surgeons, significant log-linear correlations were observed between the operative time and cumulative volume of cases. The best-fit linear equations showed estimated learning rates of 90%, 87%, 92%, and 86% for each of the four surgeons, indicating that the necessary operative time decreased by 10%, 13%, 8%, and 14%, respectively, when the cumulative volume of cases had doubled. The minimum number of cases with an operative time shorter than the average was 9 (91% sensitivity and 59% specificity). The clinical outcome measures at 6 and 12 months postoperatively were available for one surgeon; however, no correlation was found with the cumulative volume of cases. CONCLUSION: The learning rate for the Krackow suture technique for the repair of Achilles tendon rupture was approximately 89%, indicating that the required operative time can decrease by up to 11% when the cumulative volume of cases doubles. Therefore, it is important to rapidly accumulate surgical experience during the early phase of training.
Subject(s)
Achilles Tendon , Ankle Injuries , Tendon Injuries , Humans , Achilles Tendon/surgery , Rupture/surgery , Learning Curve , Tendon Injuries/surgery , Suture Techniques , Ankle Injuries/surgeryABSTRACT
OBJECTIVE: Identifying the risk factors for persistent pain despite proper conservative treatment in adult symptomatic accessory navicular may reduce the need for surgical treatment. The aim of this study was to identify any such risk factors. DESIGN: Cohort study. SETTING: University hospital foot and ankle clinic. PATIENTS: A retrospective review of 313 patients who presented with adult symptomatic accessory navicular was performed. ASSESSMENT OF RISK FACTORS: Potential risk factors were identified via medical records and foot radiographs. The possible risk factors included age, gender, body mass index, smoking status, occurrence/cause of symptoms, occupation, type of accessory navicular, and radiographic foot parameters. MAIN OUTCOME MEASURES: Predictors that relate to persistent pain requiring surgical treatment in adult accessory navicular were analyzed using logistic regression analysis. RESULTS: Of the 313 patients included, 30 (9.6%) underwent surgical treatment due to failure of conservative treatment. The odds of needing surgical treatment decreased by 0.96 per year of age at symptom onset (P = 0.030), but those odds were 8.52 times higher in patients who had a type IIB accessory navicular (P = 0.001). Other variables did not reach statistical significance. CONCLUSIONS: Younger age at symptom onset and type IIB were the risk factors for persistent pain requiring surgical treatment in adult symptomatic accessory navicular.
Subject(s)
Tarsal Bones , Adult , Cohort Studies , Foot Diseases , Humans , Pain/etiology , Risk Factors , Tarsal Bones/abnormalities , Tarsal Bones/diagnostic imaging , Tarsal Bones/surgeryABSTRACT
INTRODUCTION: To date, there has been no prospective randomized trial supporting the rationale of the use of headless compression screw (HCS) compared to conventional fixation methods for medial malleolar fractures. This study aimed to prospectively compare the outcomes of the HCS and tension band wire (TBW) for the fixation of medial malleolar fractures. MATERIAL AND METHODS: Sixty patients were randomized to receive either an HCS or a TBW for the fixation of a medial malleolar fracture. Clinical outcomes were assessed using the Olerud-Molander ankle score (OMAS), EuroQoL five-dimensional instrument (EQ-5D) score, visual analog scale (VAS) score, patient satisfaction with implant-related symptoms, operative time, and incision length. Radiographic outcomes were assessed using the presence of nonunion, delayed union, and articular incongruity. Clinical and radiographic assessments were performed at 2 and 6 weeks and 3, 6, and 12 months postoperatively. RESULTS: The OMAS, EQ-5D score, VAS score, and operative time did not differ between the HCS and TBW groups; however, the HCS group had greater satisfaction with implant-related symptoms and smaller incision than the TBW group. There was no difference in the presence of nonunion, delayed union, and articular incongruity. CONCLUSION: HCS fixation for medial malleolar fractures is not inferior to TBW fixation, while reducing implant-related symptoms. These findings suggest that HCS is a viable alternative for the fixation of medial malleolar fractures.
Subject(s)
Ankle Fractures , Ankle Fractures/diagnostic imaging , Ankle Fractures/surgery , Ankle Joint/surgery , Bone Screws , Bone Wires , Fracture Fixation, Internal/methods , HumansABSTRACT
INTRODUCTION: To date, only few studies have been performed on the accuracy of manual angle manipulation during orthopedic surgery. This cadaver study was aimed at quantitatively assessing the accuracy of manual angle manipulation performed by orthopedic surgeons according to their surgical experience and comparing it with manipulation performed with the assistance of a digital goniometer. MATERIALS AND METHODS: Six lower-leg specimens of fresh-frozen human cadavers were subjected to angle manipulation performed via Kirschner wire (K-wire) insertion. K-wires were inserted manually and with the assistance of a digital goniometer at target angles of 0°, 30°, and 60° by three operators who had different levels of experience in orthopedic surgery. The accuracy of the insertion angles at the target angles was evaluated using computed tomography. RESULTS: The mean angle error in the manual angle manipulation was 8.8° (standard deviation [SD] 6.0). When the target angles were set to 0°, 30°, and 60°, the identified angle errors were 6.1° (SD 4.3), 8.8° (SD 6.6), and 11.7° (SD 5.6), respectively, and each value did not show any significant difference among the operators. With the assistance of a digital goniometer, the mean (SD) angle error was significantly improved to 2.1° (1.1°) (p < 0.001). The amount of improvement in accuracy significantly increased as the target angle increased (p = 0.01). CONCLUSION: This cadaver study quantified the inaccuracy of manual angle manipulation in orthopedic surgery and showed that these inaccuracies ââcan be improved using an assistive device. These results support the need to develop a device that can compensate manual angle manipulation in orthopedic surgery.
Subject(s)
Orthopedic Procedures , Surgeons , Bone Wires , Cadaver , Humans , Tomography, X-Ray Computed/methodsABSTRACT
Although the use of topical skin adhesives has increased as an alternative to conventional skin closure methods, studies on the incidence and risk factors of allergic contact dermatitis (ACD) to topical skin adhesives have been limited. The purpose of this study was to investigate the incidence and risk factors of ACD after the use of 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives. We retrospectively reviewed 1145 patients (739 patients with 2-octyl cyanoacrylate and 406 patients with n-butyl cyanoacrylate) who underwent skin closure with topical skin adhesives. Variables suspected to correlate with ACD were retrieved from medical records and analyzed to determine risk factors. The incidence of ACD from the use of 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives was 2.7% and 2.2%, respectively. There was no statistically significant difference in the incidence between the two ingredients. In logistic regression analysis, none of the variables were found to increase the risk of ACD in both 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives. As ACD occurs without risk factors in 2-3% of patients who used 2-octyl cyanoacrylate or n-butyl cyanoacrylate topical skin adhesives, clinicians and patients should be aware of these facts before using topical skin adhesives.
Subject(s)
Cyanoacrylates/adverse effects , Dermatitis, Allergic Contact/epidemiology , Dermatitis, Allergic Contact/etiology , Enbucrilate/adverse effects , Tissue Adhesives/adverse effects , Adult , Aged , Cyanoacrylates/administration & dosage , Dermatitis, Allergic Contact/diagnosis , Disease Susceptibility , Drug Hypersensitivity/epidemiology , Drug Hypersensitivity/etiology , Enbucrilate/administration & dosage , Female , Health Care Surveys , Humans , Incidence , Male , Middle Aged , Risk Factors , Skin/pathology , Tissue Adhesives/administration & dosageABSTRACT
BACKGROUND: The Achilles tendon Total Rupture Score (ATRS) is a widely used patient-reported outcome measure to assess clinical outcomes of Achilles tendon rupture, but it has not been validated in Korean yet. The purpose of this study was to translate the ATRS into Korean and evaluate its reliability and validity in a Korean population. METHODS: The ATRS was translated into Korean according to recommended guidelines for forward-backward translation. Thirty-eight patients who underwent surgical treatment for Achilles tendon rupture from 2017 to 2019 were enrolled. Reliability was evaluated by the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Construct validity was assessed with Spearman rank correlations with the Korean version of the Foot and Ankle Outcome Score (FAOS) and Numeric Rating Scale (NRS) for pain in daily activity. RESULTS: The Korean translation of the ATRS had excellent test-retest reliability (ICC = 0.84) and acceptable internal consistency (Cronbach's alpha = 0.84). The SEM was 6.61, and the MDC was 18.32 at the individual level and 2.97 at the group level. The Korean translation of the ATRS was strongly correlated with the FASO (r = 0.88). Correlation with the NRS in daily activity (r = - 0.66) was moderate. CONCLUSION: The Korean translation of the ATRS showed sufficient reliability and validity for use in the Korean population. LEVEL OF EVIDENCE: II.
Subject(s)
Achilles Tendon , Achilles Tendon/surgery , Cross-Cultural Comparison , Humans , Psychometrics , Reproducibility of Results , Republic of Korea/epidemiology , Rupture/surgery , Surveys and Questionnaires , TranslationsABSTRACT
BACKGROUND: Systemic mastocytosis (SM), a clonal expansion of mast cells affecting multiple organs including the skeletal system, puts patients at risk for osteoporosis and fractures. Various aspects of skeletal disease in SM have been reported among European cohorts. OBJECTIVE: To determine fracture prevalence and risk predictors in SM in a North American (NA) cohort and compare findings with studies of other populations. METHODS: Fifty patients, aged 25-74 years, were grouped based on fracture type and history. Data collected included laboratory findings and radiographic markers such as serum tryptase, bone turnover markers, dual-energy x-ray absorptiometry images, and trabecular bone scores. We performed univariate and multivariate analyses of these findings. RESULTS: Fracture history was found in 74% of patients. Significantly different median age, body mass index, dual-energy x-ray absorptiometry scores, and alkaline phosphatase levels were observed between fracture groups, consistent with French and Dutch studies. Significant findings included the difference in trabecular bone scores among fracture groups, the association between alkaline phosphatase and fracture type and occurrence, and the model for predicting fracture risk based on DXA spine T-scores, alkaline phosphatase, and age (81.3% accuracy and 77.1% sensitivity). CONCLUSIONS: Our findings in an NA cohort are in overall agreement with those reported in European studies of skeletal disease and fracture risk for individuals with SM. We include an interactive calculator designed from a predictive model based on the NA cohort, which may be used for improved screening for fracture risk.
Subject(s)
Mastocytosis , Osteoporosis , Absorptiometry, Photon , Bone Density , Humans , North America/epidemiology , Osteoporosis/diagnosis , Osteoporosis/epidemiology , Risk AssessmentABSTRACT
BACKGROUND: The association between ankle fractures in elderly patients and low bone mineral density (BMD) has recently been recognized, but the effect of BMD on the postoperative outcome of these fractures is unknown. The aim of this study was to investigate the effect of BMD on the postoperative outcome of ankle fractures in elderly patients to evaluate the need for BMD screening. METHODS: We retrospectively reviewed 48 patients aged 65 years or older who had ankle fractures and underwent dual-energy x-ray absorptiometry to assess BMD after surgical treatment of the fracture. Postoperative outcomes were assessed using the Olerud-Molander Ankle Score (OMAS), visual analog scale (VAS) score for pain, Kellgren and Lawrence (K&L) grading scale score, and quality of fracture reduction. The correlation between the BMD and the outcome measures at 12 months after surgery was analyzed using the Pearson correlation coefficient. RESULTS: The mean absolute value of BMD was 0.6 ± 0.1 g/cm2 (T-score, -1.5 ± 1.2) at the femoral neck and 0.8 ± 0.2 g/cm2 (T-score, -1.2 ± 1.5) at the lumbar spine. Osteoporosis was present in 33% of female patients and in 11% of male patients. At 12 months after surgery, the OMAS was 70 ± 17 and the VAS score for pain was 18 ± 17. Of the patients, 20, 21, 5, 1, and 1 had K&L grades of 0, 1, 2, 3, and 4, respectively. None of the clinical and radiographic outcome measures were correlated with the BMD values of the patients. CONCLUSION: The postoperative outcome of the ankle fractures in elderly patients at 12 months after surgery showed no correlation with femoral neck or lumbar spine BMD at the time of fracture. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
Subject(s)
Ankle Fractures , Bone Density , Absorptiometry, Photon , Aged , Ankle , Ankle Fractures/diagnostic imaging , Ankle Fractures/surgery , Female , Humans , Male , Retrospective StudiesABSTRACT
A 34-year-old female recreational badminton player presented with left ankle pain 1 week after a recreational badminton game. She reported experiencing a similar pattern of pain in her right ankle 4 months before that had persisted for 3 months. On plain radiography, callus formation was evident on the right distal fibula, and a subtle lesion was observed on the left side. Ultrasound was performed with the clinical suspicion of bilateral, nonsimultaneous, distal fibular stress fracture. Focal hyperechoic thickening of the periosteum with irregularity and hypoechoic periosteal edema over the left distal fibula were identified. These findings were consistent with stress fracture, and an early phase of distal fibular stress fracture was diagnosed. This case report highlights that ultrasound can be an alternative modality to magnetic resonance imaging or bone scan scintigraphy for the early diagnosis of stress fracture.