Search

Background: Despite numerous studies identifying risk factors for proximal junctional failure (PJF), risk factors for recurrent PJF (R-PJF) are still not well established. Therefore, we aimed to identify the risk factors for R-PJF following adult spinal deformity (ASD) surgery. Methods: Among 479 patients who underwent ≥5-level fusion surgery for ASD, the focus was on those who experienced R-PJF at any time or did not experience R-PJF during a follow-up duration of ≥1 year. PJF was defined as a proximal junctional angle (PJA) ≥28° plus a difference in PJA ≥22° or performance of revision surgery regardless of PJA degree. The patients were divided into 2 groups according to R-PJF development: no R-PJF and R-PJF groups. Risk factors were evaluated focusing on patient, surgical, and radiographic factors at the index surgery as well as at the revision surgery. Results: Of the 60 patients in the final study cohort, 24 (40%) experienced R-PJF. Significant risk factors included greater postoperative sagittal vertical axis (OR = 1.044), overcorrection relative to age-adjusted pelvic incidence-lumbar lordosis (PI- LL; OR = 7.794) at the index surgery, a greater total sum of the proximal junctional kyphosis severity scale (OR = 1.145), and no use of the upper instrumented vertebra cement (OR = 5.494) at the revision surgery. Conclusions: We revealed that the greater postoperative sagittal vertical axis and overcorrection relative to age-adjusted pelvic incidence-lumbar lordosis at the index surgery, a greater proximal junctional kyphosis severity scale score, and no use of upper instrumented vertebra cement at the revision surgery were significant risk factors for R-PJF. Clinical Relevance: To reduce the risk of R-PJF after ASD surgery, avoiding under- and overcorrection during the initial surgery is recommended. Additionally, close assessment of the severity of PJF with timely intervention is crucial, and cement augmentation should be considered during revision surgery. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: The clinical implications of myelin oligodendrocyte glycoprotein autoantibodies (MOG-Abs) are increasing. Establishing MOG-Ab assays is essential for effectively treating patients with MOG-Abs. We established an in-house cell-based assay (CBA) to detect MOG-Abs to identify correlations with patients' clinical characteristics. Methods: We established the CBA using HEK 293 cells transiently overexpressing fulllength human MOG, tested it against 166 samples from a multicenter registry of central nervous system (CNS) inflammatory disorders, and compared the results with those of the Oxford MOG-Ab-based CBA and a commercial MOG-Ab CBA kit. We recruited additional patients with MOG-Abs and compared the clinical characteristics of MOG-Ab-associated disease (MOGAD) with those of neuromyelitis optica spectrum disorder (NMOSD). Results: Of 166 samples tested, 10 tested positive for MOG-Abs, with optic neuritis (ON) being the most common manifestation (4/15, 26.7%). The in-house and Oxford MOG-Ab CBAs agreed for 164/166 (98.8%) samples (?=0.883, P <0.001); two patients (2/166, 1.2%) were only positive in our in-house CBA, and the CBA scores of the two laboratories correlated well (r=0.663, P <0.001). The commercial MOG-Ab CBA kit showed one falsenegative and three false-positive results. The clinical presentation at disease onset differed between MOGAD and NMOSD; ON was the most frequent manifestation in MOGAD, and transverse myelitis was most frequent in NMOSD. Conclusions: The in-house CBA for MOG-Abs demonstrated reliable results and can potentially be used to evaluate CNS inflammatory disorders. A comprehensive, long-term study with a large patient population would clarify the clinical significance of MOG-Abs. [ABSTRACT FROM AUTHOR]

Objective: To introduce a new sagittal parameter, uppermost instrumented vertebra-pelvic tilt angle (UIVPTA), and to determine the effects on the proximal junctional kyphosis (PJK) development in adult spinal deformity (ASD) surgery. Methods: Patients ≥ 60 years with ASD who underwent low thoracic spine to pelvis fusion with a minimum of 2-years of follow-up were included in this study. Two groups were created according to PJK development. Various clinical and radiographic factors were compared between PJK and non-PJK groups to identify the risk factors for PJK. Cutoff value of UIVPTA for PJK development was calculated using receiver operating characteristic curve according to different pelvic incidence groups. Linear regression analysis was performed to identify factors to affect UIVPTA. Results: One hundred fifity-one patients were included in this study. There were 135 female patients (89.4%). Mean age was 70.5 years. PJK developed in 65 patients (43.0%). Multivariate analysis showed that overcorrection relative to age-adjusted pelvic incidence (PI) minus lumbar lordosis (LL) (PI–LL) target and lower UIVPTA were independent risk factors for PJK. The cutoff value of UIVPTA for PJK development was calculated as 4.0° in patients with PI less than 45°, 9.5° in patients with PI between 45° and 60°, and 13.0° in patients with PI greater than 60°. Linear regression analysis showed that UIVPTA was positively affected by postoperative values of LL (coefficient = 0.505), PI–LL (coefficient = 0.674), and pelvic tilt (coefficient = 0.286). Conclusion: Optimal correction within the age-adjusted PI–LL combined with keeping UIVPTA within optimal range is suggested for the prevention of PJK. [ABSTRACT FROM AUTHOR]

Objective: Neuronata-R® (lenzumestrocel) is an autologous bone marrowderived mesenchymal stem cell (BM-MSC) product, which was conditionally approved by the Korean Ministry of Food and Drug Safety (KMFDS, Republic of Korea) in 2013 for the treatment of amyotrophic lateral sclerosis (ALS). In the present study, we aimed to investigate the long-term survival benefits of treatment with intrathecal lenzumestrocel. Methods: A total of 157 participants who received lenzumestrocel and whose symptom duration was less than 2 years were included in the analysis (BM-MSC group). The survival data of placebo participants from the Pooled-Resource Open-Access ALS Clinical Trials (PROACT) database were used as the external control, and propensity score matching (PSM) was used to reduce confounding biases in baseline characteristics. Adverse events were recorded during the entire follow-up period after the first treatment. Results: Survival probability was significantly higher in the BM-MSC group compared to the external control group from the PROACT database (log-rank, p < 0.001). Multivariate Cox proportional hazard analysis showed a significantly lower hazard ratio for death in the BM-MSC group and indicated that multiple injections were more effective. Additionally, there were no serious adverse drug reactions found during the safety assessment, lasting a year after the first administration. Conclusion: The results of the present study showed that lenzumestrocel treatment had a long-term survival benefit in real-world ALS patients. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the relationship between sarcopenia and change in bone mineral density (BMD) and functional outcome in hip arthroplasty patients. Methods: Among the 221 patients who had undergone hip arthroplasty, 147 patients were enrolled. All patients were divided into 2 groups according to presence of sarcopenia. Bone mineral density (BMD) at hospitalization and 1-year after surgery and Barthel index was measured at the time of before injury, hospitalization, 3 months and 1-year after surgery. Results: BMD at hospitalization showed .627 ± .082 (g/cm²) in Sarcopenia and .726 ± .059 (g/cm²) in Non-sarcopenia at femur (total) site (P < .001), .531 ± .085 (g/cm²) vs .629 ± .057 (g/cm²) at femur neck site (P=.002), .715 ± .084 (g/cm²) vs .807 ± .058 (g/cm²) at lumbar (L1-L4) site (P < .001). BMD at 1-year follow-up period, Sarcopenia showed .626 ± .082 (g/cm²) and Non-sarcopenia showed .725 ± .060 (g/cm²) at femur (total) site (P < .001), .530 ± .085 (g/cm²) vs .629 ± .058 (g/cm²) at femur neck site (P < .001), .715 ± .084 (g/cm²) vs .806 ± .058 (g/cm²) at lumbar (L1-L4) site (P < .001). Change of BMD showed -.01 ± .25% for Sarcopenia and -.15 ± .47% for Non-sarcopenia in femur (total) site (P=.089), -.08 ± .63% vs -.01 ± 1.01% in femur neck site (P = .058), .00 ± .09% vs -.12 ± .33% for each group in lumbar (L1-L4) site (P = .052). Barthel index score showed 79.94 ± 5.66 for Sarcopenia and 84.74 ± 5.36 for Non-sarcopenia at pre-injury status (P < .001), 33.89 ± 4.94 vs 33.87 ± 5.36 at the time of hospitalization (P = .977), 57.42 ± 7.19 vs 60.06 ± 5.39 at 3 months follow up (P = .015), 73.86 ± 5.94 vs 80.71 ± 4.81 for each group at 1-year follow up (P < .001). Conclusions: Our study found that the sarcopenia showed lower BMD than the non-sarcopenia, but there was no significant difference of BMD change in the follow-up period. In addition, the sarcopenia showed poor functional results at all points except at the time of hospitalization. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the prevalence of musculoskeletal disorders in the hands and wrists of fishermen working as oyster shuckers, and to identify the risk factors associated with oyster shucking.Material and Methods: A total of 590 fishery workers including those working as oyster shuckers in 2015-2017 were included in the study analysis. Hand osteoarthritis (OA), carpal tunnel syndrome (CTS), and ulnar impaction syndrome were diagnosed using X-ray, magnetic resonance imaging, and physical examinations according to each diagnostic criterion. The Rapid Entire Body Assessment was used as a measurement tool for analyzing the occupation-related burden factors.Results: The prevalence of hand OA, CTS, and ulnar impaction syndrome was higher in oyster shuckers than in aquaculture/offshore fishery workers. The prevalence of upper limb disease was higher in oyster shuckers than in other fishery workers, even in the prevalence of exposure to occupational burden factors. In oyster shuckers, the incidence of hand and wrist OA was 84%, that of CTS was 72%, and that of ulnar impaction syndrome was 41%. In addition, oyster shuckers were more likely to be exposed to occupational burden factors than were other types of fishermen.Conclusions: The prevalence of hand OA, CTS, and ulnar impaction syndrome was higher in oyster shuckers. Therefore, proper stretching or exercises for rest and musculoskeletal relaxation, along with health-care education and promotion, will be needed for the fishermen's repeated posture and impact work. Int J Occup Med Environ Health. 2021;34(5):603-15. [ABSTRACT FROM AUTHOR]

Although rare, antihistamines can cause adverse effects, including drug-induced eruptions or anaphylaxis. A 4-year-old child visited the pediatric department of a hospital for skin eruptions after administration of antihistamines, (e.g., ucerax [hydroxyzine] or leptizine [levocetirizine]), for cholinergic rashes; he did not have pruritus. Skin prick, intradermal, and drug provocation tests were performed to determine the relationship between the antihistamines and eruptions. Levocetirizine induced wheals in the skin prick test and a rash in the oral drug provocation test. In contrast, ketotifen induced no reaction in the skin prick test but showed a positive reaction in the oral provocation test. Our case report highlights that children can experience the same types of adverse reactions as seen in adults, and cross-reactivity between various antihistamines can occur. [ABSTRACT FROM AUTHOR]

Mycoplasma pneumoniae is a respiratory pathogen responsible for various upper and lower respiratory tract diseases. This also induces extra-pulmonary manifestations, with encephalitis being the most frequent and critical manifestation in pediatric populations. This report describes an 8-year-old boy who presented with repetitive motions in both hands, agitation, muttering and increased appetite after seizure. He had started treatment with antibiotics for M. pneumoniae infection 14 days prior to this event. Electroencephalography (EEG) showed slow and disorganized background rhythms and polymorphic slowing on both frontal areas, whereas brain magnetic resonance imaging was normal. He was diagnosed with M. pneumo niae -related encephalitis and treated with intravenous immunoglobulin (500 mg/ kg/day for 4 days). After 3 days, his impulsive behaviors disappeared and, after 4 days, his EEG became normal. Abrupt hyperactive behavior in children may be a sign of M. pneumoniae - related encephalitis. [ABSTRACT FROM AUTHOR]

Procyanidins can inhibit cell proliferation and tumorigenesis and induce apoptosis in human skin, breast and prostate carcinoma cell lines. Squamous cell carcinoma (SCC) of the skin is a common form of keratinocytic or non-melanoma skin cancer and is a deadly disease with a poor prognosis due to the ineffectiveness of therapy. The present study aimed to determine whether grape seed proanthocyanidin (GSP) may regulate different modes of cell death in the human SCC12 cell line. The present study found that the treatment of SCC12 cells with GSP inhibited proliferation in a dose-dependent manner and reduced the motility and invasiveness of SCC12 cells through suppression of matrix metalloproteinase-2/9 expression. GSP treatment also resulted in induction of apoptosis and autophagy via generation of reactive oxygen species. The inhibition of autophagy by 3-methyladenine decreased GSP-induced cell death, which suggested that GSP-induced autophagy can promote cell death. The results of the present study suggested that autophagy functions as a death mechanism in SCC and provided a rationale for the use of GSP in combination with autophagy activators for treating cancers such as SCC. [ABSTRACT FROM AUTHOR]

In the present study, we tried to examine whether oleanolic acid regulates the activity, secretion and gene expression of matrix metalloproteinase-3 (MMP-3) in primary cultured rabbit articular chondrocytes, as well as the production of MMP-3 in the knee joint of rat to evaluate the potential chondroprotective effect of oleanolic acid. Rabbit articular chondrocytes were cultured in a monolayer, and reverse transcription-polymerase chain reaction (RT-PCR) was used to measure interleukin-1ß (IL-1ß)-induced gene expression of MMP-3, MMP-1, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4), ADAMTS-5 and type II collagen. In rabbit articular chondrocytes, the effects of oleanolic acid on IL-1ß-induced secretion and proteolytic activity of MMP-3 were investigated using western blot analysis and casein zymography, respectively. The effect of oleanolic acid on in vivo MMP-3 protein production was also examined, after intra-articular injection to the knee joint of rat. The results were as follows: (1) oleanolic acid inhibited the gene expression of MMP-3, MMP-1, MMP-13, ADAMTS-4, and ADAMTS-5, but increased the gene expression of type II collagen; (2) oleanolic acid reduced the secretion and proteolytic activity of MMP-3; (3) oleanolic acid suppressed the production of MMP-3 protein in vivo. These results suggest that oleanolic acid can regulate the activity, secretion and gene expression of MMP-3, by directly acting on articular chondrocytes. [ABSTRACT FROM AUTHOR]

The article discusses the treatment of patients with lateral collateral ligament (LCL) complex with posterolateral rotatory instability after an unstable elbow dislocation, with or without an intra-articular fracture is arthroscopy. It highlights the procedure including Magnetic Resonance Imaging (MRI) and preoperative planning, positioning patients, and diagnostic arthroscopy.

The article discusses the neuralgic amyotrophy (NA), an uncommon disease with symptoms include acute shoulder pain and profound weakness of the upper extremities. Topics include the case study of a 59-year-old man with acute shoulder pain and asymmetric arm weakness, the unremarkable laboratory tests which exclude autoimmune and infectious causes and the cardiac echocardiography.

Introduction: A glomus tumor is a rare, benign tumor with atypical clinical symptoms. Because of its small size, it is difficult to diagnose and treat early; therefore, it leads to poor quality of life. Glomus tumors are known to commonly affect the hand and rarely manifest in other areas. Because they simulate neuromas, hemangiomas, and neurofibromatosis, the differential diagnosis is difficult. We performed marginal resection of a solitary forearm mass previously suspected to be a hemangioma or glomus tumor on the basis of ultrasound findings and histologically diagnosed to be a glomus tumor afterward. We report this case to demonstrate the good prognosis of the procedure we used, and we review the relevant literature.Case Presentation: A 68-year-old Asian man without a particular medical history visited our hospital with a mass with focal tenderness in his left distal forearm that had developed 8 years earlier. The tumor was observed with suspicion of being a hemangioma or glomus tumor based on the location, clinical symptoms, and ultrasound findings taken into consideration together. The biopsy results led us to conclude that the lesion was a glomus tumor.Conclusions: A glomus tumor located in the forearm is very rare. It is often clinically overlooked and is likely to be misdiagnosed as another disease. The patient's quality of life deteriorates, and, though the disease is rare, it has serious sequelae. Therefore, a quick diagnosis and appropriate treatment must be conducted early. If a mass occurs with serious pain in subcutaneous soft tissue of not the hands but the limbs, it is important to conduct examinations with suspicion of a glomus tumor. Ultrasonography performed quickly may be useful for making the differential diagnosis. [ABSTRACT FROM AUTHOR]

Recently, several new techniques for anatomic posterior cruciate ligament reconstruction (PCLR) have emerged and are believed to restore the normal anatomy of the posterior cruciate ligament more accurately. Despite the latest trend, the optimal methods for anatomic PCLR remain controversial. The purpose of this research is to review surgical techniques for PCLR in cadaver studies and suggest consistent and reproducible technical criteria. For the review of the literature, MEDLINE and EMBASE were screened for articles on anatomic PCLR. Only basic science studies on PCLR performed on human cadavers and written in English were included. Seventeen studies were included in this systematic review. Only the tunnel positions, graft types, and surgical techniques were reported in the majority of the studies. There were many variations of the reported tunnel positions, graft types, and surgical techniques among the studies. In most studies, surgical techniques for consistent and reproducible anatomic PCLR were not explained clearly. Therefore, high level medical research should be encouraged in order to establish standard surgical techniques for anatomic PCLR [ABSTRACT FROM AUTHOR]