Radius palmar plate removal without carpal tunnel release: Correlation between plate position and median nerve symptoms.

We aimed to report the clinical results of volar plate removal without carpal tunnel release in patients with late-onset median neuropathy and to evaluate the relationship between plate position and median nerve symptoms. Part I. Twelve consecutive patients with late-onset median neuropathy treated with volar plate removal without carpal tunnel release were enrolled for analysis. Pre- and post-operative Tinel sign, Phalen and Ten test, subjective rating of tingling sensation, Mayo wrist score and Disabilities of the Arm, Shoulder and Hand (DASH) score were collected. Part II. 232 consecutive patients underwent volar plating for distal radius fracture. The relationships between median nerve symptoms and volar plate prominence on the Soong classification, fracture classification, gender and age were investigated. All cases except one showed complete symptom resolution at final follow-up, with negative Tinel sign and Ten test score of 10/10. Tingling was rated 0 at final follow-up. Mean Mayo wrist and DASH scores improved to 86.7 and 23.1, respectively. The incidence of the median nerve symptoms in our cohort was 5.6%. Even though the odds ratio in Soong grade 2 was 4.0957 (95% CI, 0.93-16.9) compared to the combination of grades 0 and 1, no statistically significant relationship was found between the median nerve symptoms and volar plate prominence (p > 0.05). Plate removal without carpal tunnel release adequately relieved symptoms of late-onset median neuropathy after volar plating in patients with distal radius fracture. LEVEL OF EVIDENCE: IV; Therapeutic.

A Review of Natural Products for Prevention of Acute Kidney Injury.

BACKGROUND AND OBJECTIVES: acute kidney injury (AKI), formerly called acute renal failure (ARF), is commonly defined as an abrupt decline in renal function, clinically manifesting as a reversible acute increase in nitrogen waste products-measured by blood urea nitrogen (BUN) and serum creatinine levels-over the course of hours to weeks. AKI occurs in about 20% of all hospitalized patients and is more common in the elderly. Therefore, it is necessary to prevent the occurrence of AKI, and to detect and treat early, since it is known that a prolonged period of kidney injury increases cardiovascular complications and the risk of death. Despite advances in modern medicine, there are no consistent treatment strategies for preventing the progression to chronic kidney disease. Through many studies, the safety and efficacy of natural products have been proven, and based on this, the time and cost required for new drug development can be reduced. In addition, research results on natural products are highly anticipated in the prevention and treatment of various diseases. In relation to AKI, many papers have reported that many natural products can prevent and treat AKI. CONCLUSIONS: in this paper, the results of studies on natural products related to AKI were found and summarized, and the mechanism by which the efficacy of AKI was demonstrated was reviewed. Many natural products show that AKI can be prevented and treated, suggesting that these natural products can help to develop new drugs. In addition, we may be helpful to elucidate additional mechanisms and meta-analysis in future natural product studies.

Association Between Change in Serum Aminotransferase and Mortality: A Nationwide Cohort Study in Korea.

There is little information on how the change in serum aminotransferase affects mortality. We investigated the association between changes in serum aminotransferase levels and mortality from all causes, cardiovascular disease (CVD), and liver disease.Three percent of men from the Korean National Health Insurance database were sampled randomly at the end of 2002. After excluding patients with cancer, CVD, CVD risk factors, or liver disease, those who participated in 2 consecutive rounds of the national health screening examination were included (n = 68,431). The primary outcome was CVD mortality. Secondary outcomes were liver disease mortality and all-cause mortality. Change in metabolic profiles was analyzed based on changes in liver enzyme levels. Elevated levels of serum aminotransferase were associated with CVD, liver disease, and all-cause mortality. Men who had sustained elevation of serum aminotransferase during 2 subsequent liver enzyme tests showed a significantly higher risk of CVD mortality (adjusted hazard ratio [aHR] 1.95; 95% confidence interval [CI] 1.07-3.56, 2.29; 1.27-4.12) than the sustained normal group. In contrast, the normalization group (aHR 1.52, 95% CI 0.82-2.81 for aspartate aminotransferase [AST]; aHR 1.35, 95% CI 0.70-2.61 for alanine aminotransferase [ALT]) and the new elevation group (aHR 1.27, 0.66-2.44 for AST; aHR 0.99, 95% CI 0.49-2.20 for ALT) were not different from the sustained normal group in CVD mortality.Individuals with serum aminotransferase elevation, particularly when sustained, are at higher risk of mortality, and should receive appropriate medical attention.

Association between Muscle Loss and Urinary Incontinence in Elderly Korean Women.

BACKGROUND: Incontinence and muscle loss are important senior health issues. Nevertheless, there are no available domestic or international studies on the association between urinary incontinence and muscle loss. The aim of this study was to investigate the association between muscle loss and urinary incontinence in elderly Korean woman. METHODS: Korean women (1,313) ≥65 years of age whose complete body composition data were collected using dual X-ray absorptiometry were analyzed from the Fourth Korean National Health and Nutritional Examination Surveys. Class I and II losses of the appendicular, truncal, and total muscle mass were defined using adjustments for weight and height. Each participant's incontinence status was collected using constructed questionnaires. Multiple logistic regression was performed to examine the association between muscle loss and incontinence. RESULTS: On the basis of physician-diagnosed incontinence, weight- and height-adjusted muscle loss showed no association with urinary incontinence (weight-adjusted muscle loss: class I adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.34 to 1.73; class II aOR, 1.37; 95% CI, 0.59 to 3.18; height-adjusted muscle loss: class I aOR, 0.51; 95% CI, 0.18 to 1.51; class II aOR, 1.86; 95% CI, 0.22 to 15.79). Similar results were observed for truncal muscle and total muscle mass as well as self-reported urinary incontinence. CONCLUSION: Our study found no association between urinary incontinence and appendicular, truncal, and total muscle loss in elderly Korean women.

Obesity explains gender differences in the association between education level and metabolic syndrome in South Korea: the results from the Korean National Health and Nutrition Examination Survey 2010.

This study aimed to examine the association of educational level with metabolic syndrome (MS) and its risk factors by gender in South Korea. A total of 6178 participants aged 20 years or older from The Fifth Korean National Health and Nutrition Examination Survey were included in this study. A generalized linear model and adjusted proportion were used to identify educational disparities in MS, its components, and its risk factors (smoking, high-risk alcohol consumption, obesity, and stress). In women, a clearly inverse association between education level and MS were observed with significant trend, and the decreasing trends of all risk factors across education quartiles were in line with the inverse association. However, the association between education level and MS was not observed with a significant trend among men. An opposite trend of risk factors across education levels was shown in men, with an increasing trend for obesity and decreasing trends for smoking and high-risk alcohol consumption. These findings demonstrate that obesity can explain gender differences in the association between education level and MS in South Korea.

Optical coordinate tracking system using afocal optics for image-guided surgery.

PURPOSE: Image-guided surgery using medical robots supports surgeons by providing critical real-time feedback information, such as surgical instrument tracking, patient-specific models, and the use of surgery robots. An image-guided surgery system based on afocal optics was developed to overcome the problems associated with conventional optical tracking systems. METHOD: An optical tracking system was developed that utilizes afocal optics. Instead of using geometrically specified marker spheres as tracking targets, the proposed system uses a marker with a lens and a micro-engraved data-coded pattern. A position and orientation-tracking algorithm was developed to utilize the observed afocal images of the marker patterns. The marker used in this tracking system can be manufactured in a smaller size than traditional optical tracker markers, and the accuracy of the proposed tracking system has significant potential for improvement due to its focused and highly magnified image. The system was tested in vitro on an optical bench with position and orientation measurement experiments using a commercial optical tracker, Polaris Vicra (NDI Corp.) for comparison. RESULTS: The afocal optical system provided accuracy in position and orientation that was equal or better than a commercial optical tracker system, and provided a high degree of consistency during in vitro testing. The position error was 21µ m, and the orientation error was 0.093°. CONCLUSION: An afocal optical tracker is feasible and potentially advantageous for surgical navigation, as it is expected to have fewer occlusions and provide greater efficiency for coordinate matching and tracking of patient-specific models, surgical instruments, and surgery robots. This promising new system requires in vivo testing.

Shared decision-making on the use of hormone therapy: a nationwide survey in the Republic of Korea.

OBJECTIVE: This study aims to assess the current status of shared decision-making on instituting postmenopausal hormone therapy (HT). METHODS: Two cross-sectional nationwide surveys of postmenopausal women and primary care physicians in the Republic of Korea were conducted in 2012 via face-to-face interviews. A total of 685 women (aged 50-69 y) who with natural menopause and 250 primary care physicians were included. RESULTS: Only 56.8% of primary care physicians reported that they explain the benefits and risks of HT and leave the decision to postmenopausal women. The others usually recommended using or not using HT. Of those postmenopausal women who had discussed such therapy with physicians (147 of 685; 21.5%), not all were aware of breast cancer or cardiovascular risks (only 65.3% and 38.8% were informed, respectively). Although most physicians perceived HT as beneficial for menopausal symptom control (99.6%) and acknowledged the related risk of breast cancer (84.8%), nearly half had the impression that HT was preventive of cardiovascular diseases. The interviewed women were less informed of the benefits and risks of HT than were the physician respondents. The awareness levels of the treated and untreated women did not differ. CONCLUSIONS: Participation of postmenopausal women in deciding whether to use HT is not prevalent. Physician-woman information transfer is suboptimal, and treatment decisions often are not based on the best available evidence. The current status of shared decision-making in this setting is clearly in need of improvement.

A case of acute aortic dissection presenting with chest pain relieved by sublingual nitroglycerin.

Acute aortic dissection is an uncommon disorder which can have fatal results in the event of treatment delay or misdiagnosis. This case examines a 77-year-old woman presenting with chest pain relieved by nitroglycerin. She was referred to the emergency room with clinical suspicion of acute coronary syndrome (ACS). However, she was later diagnosed with acute aortic dissection and an emergency operation was performed with successful recovery. Aortic dissection may manifest in various ways depending on the site involved and may mimic other disorders such as ACS or pulmonary embolism. Therefore, clinicians must always be aware of aortic dissection and its different clinical manifestations must be understood.

The role of androgen in the adipose tissue of males.

Adipose tissue, where various metabolic hormones are secreted, plays a role in metabolizing different substances including androgen. Within fat tissue, enzymes such as aromatase and aldo-keto reductase 1C are responsible for metabolizing testosterone into estrogen and 5-dihydrotestosterone into inactive metabolites. Adipose tissue can also affect the secretion of gonadotropin, which influences the formation of androgen in the testes. At the same time, androgen has an impact on the distribution and proliferation of adipose tissue. The adrenoreceptors for catecholamines, which have been proven to play an essential role in controlling lipolysis, function by being up-regulated by androgens. Furthermore, androgens regulate the activity of lipoprotein lipase, a key enzyme involved in intracellular esterification of adipose tissue.

Antidepressant use and diabetes mellitus risk: a meta-analysis.

BACKGROUND: Epidemiologic studies have reported inconsistent findings regarding the association between the use of antidepressants and type 2 diabetes mellitus (DM) risk. We performed a meta-analysis to systematically assess the association between antidepressants and type 2 DM risk. METHODS: We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library (through Dec 31, 2011), including references of qualifying articles. Studies concerning the use of tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), or other antidepressants and the associated risk of diabetes mellitus were included. RESULTS: Out of 2,934 screened articles, 3 case-control studies, 9 cohort studies, and no clinical trials were included in the final analyses. When all studies were pooled, use of antidepressants was significantly associated with an increased risk of DM in a random effect model (relative risk [RR], 1.49; 95% confidence interval [CI], 1.29 to 1.71). In subgroup analyses, the risk of DM increased among both SSRI users (RR, 1.35; 95% CI, 1.15 to 1.58) and TCA users (RR, 1.57; 95% CI, 1.26 to 1.96). The subgroup analyses were consistent with overall results regardless of study type, information source, country, duration of medication, or study quality. The subgroup results considering body weight, depression severity, and physical activity also showed a positive association (RR, 1.14; 95% CI, 1.01 to 1.28). A publication bias was observed in the selected studies (Egger's test, P for bias = 0.09). CONCLUSION: Our results suggest that the use of antidepressants is associated with an increased risk of DM.

Mental health of people with retinitis pigmentosa.

PURPOSE: The purpose of this study was to evaluate and compare the mental health of patients with retinitis pigmentosa (RP) with that of the general population of Korea. METHODS: Online surveys were completed by patients registered with the KRPS (Korean Retinitis Pigmentosa Society), an online organization that promotes research on RP and provides advocacy and online and offline support and information for patients with RP. Control population was selected from the fourth round of the KNHANES (Korean National Health and Nutrition Examination Survey). One hundred eighty-seven patients with RP were matched with the control population using the propensity-score method to optimize comparative analysis. RESULTS: Stress was reported in 51.9% of RP patients and 29.4% of controls (p < 0.001). Depressive mood of at least 2 weeks' duration in the previous year was reported by 34.8 and 17.1% of patients and controls, respectively (p < 0.001). Suicidal thoughts were reported by 38.5 and 12.9% of patients and controls, respectively (p < 0.001), although there was no significant difference in the number of suicide attempts between the groups (2.1 vs. 1.6%, p = 0.703). In multivariate analysis, disability rating was significantly associated with stress (adjusted odds ratio, 0.46; 95% confidence interval, 0.24 to 0.88). CONCLUSIONS: People with RP had poorer mental health than the general population. Further investigations are warranted on the mental health of RP patients, and appropriate welfare services are needed to decrease the impact of mental illness in this population.

Meta-analysis: selective serotonin reuptake inhibitors and colon cancer.

OBJECTIVE: To perform meta-analyses using observational studies to assess the association between the use of selective serotonin reuptake inhibitors (SSRIs) and the risk of colorectal cancer. METHODS: A systematic search of relevant studies published through February 2012 was carried out using the Medline (PubMed), Embase, and Cochrane Library databases. We reviewed the observational studies that were associated with our subject and carried out a meta-analysis. RESULTS: Out of 324 screened articles, six observational studies were included in the final analyses. According to this meta-analysis, the use of SSRIs was not associated with an increased risk of colorectal cancer in pooled analyses (adjusted odds ratio 0.89, 95% confidence interval 0.79-1.01). This finding was consistently observed in subgroup analyses of study area, location of colorectal cancer, duration of SSRI use, study quality, adjustment for NSAID use, and the prevalence of overweight. CONCLUSION: Our research shows that the use of SSRIs does not increase the risk of colorectal cancer. Further studies are needed to confirm the association between SSRIs and colorectal cancer.

Use of selective serotonin reuptake inhibitors and risk of fracture: a systematic review and meta-analysis.

Previous studies have reported inconsistent findings regarding the association between the use of selective serotonin reuptake inhibitors (SSRIs) and the risk of fracture. We identified relevant studies by searching three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) from their inception to October 20, 2010. Two evaluators independently extracted data. Because of heterogeneity, we used random-effects meta-analysis to obtain pooled estimates of effect. We identified 12 studies: seven case-control studies and five cohort studies. A meta-analysis of these 12 observational studies showed that the overall risk of fracture was higher among people using SSRIs (adjusted odds ratio [OR] = 1.69, 95% confidence interval [CI] 1.51-1.90, I(2 ) = 89.9%). Subgroup analysis by adjusted number of key risk factors for osteoporotic fracture showed a greater increased fracture risk in those adjusted for fewer than four variables (adjusted OR = 1.83, 95% CI 1.57-2.13, I(2) = 88.0%) than those adjusted for four or more variables (adjusted OR = 1.38, 95% CI 1.27-1.49, I(2) = 46.1%). The pooled ORs anatomical site of fracture in the hip/femur, spine, and wrist/forearm were 2.06 (95% CI 1.84-2.30, I(2 ) = 62.3%), 1.34 (95% CI 1.13-1.59, I(2 ) = 48.5%), and 1.51 (95% CI 1.26-1.82, I(2 ) = 76.6%), respectively. Subgroup analysis by exposure duration revealed that the strength of the association decreased with a longer window of SSRI administration before the index date. The risk of fracture was greater within 6 weeks before the index date (adjusted OR = 3.83, 95% CI 1.96-7.49, I(2 ) = 41.5%) than 6 weeks or more (adjusted OR = 1.60, 95% CI 0.93-2.76, I(2 ) = 63.1%). Fracture risk associated with SSRI use may have a significant clinical impact. Clinicians should carefully consider bone mineral density screening before prescribing SSRIs and proper management for high-risk populations.

[A case of acute hepatitis a complicated by Guillain-Barré syndrome].

We report here a case of acute hepatitis A, which was complicated by Guillain-Barré syndrome (GBS). A 32-year old male admitted to our hospital with the symptoms of acute hepatitis and was diagnosed to have acute hepatitis A with positive IgM anti hepatitis A virus antibody. On 9th day after the onset of jaundice, acute progressive, ascending, symmetric motor paralysis were developed and eventually respiratory failure ensued. Cerebrospinal fluid analysis showed albumino-cytologic dissociation and nerve conduction velocity test suggested a polyradiculopathy. He was diagnosed to have GBS and treated with intravenous immunoglobulin and required a ventilatory support. After 90 hospital days, he recovered in ambulatory condition with the aid of crutches. The clinical course, prognosis and the outcome of neuropathic symptoms of GBS following acute hepatitis A were relatively poor in our case.