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Given the improved accuracy of robot-assisted surgery, robotic-arm assisted functionally aligned total knee arthroplasty (RFA-TKA) aims to preserve the native pre-arthritic knee biomechanics, to achieve balanced flexion-extension gaps. The purpose of this study was to compare the accuracy of the implant position and short-term clinical outcomes of patients who underwent RFA-TKA vs. mechanically aligned total knee arthroplasty with manual technique (MA-TKA).A prospectively collected database was reviewed retrospectively for patients who underwent primary TKA. Sixty patients who underwent RFA-TKA between February 2020 and July 2020 were included in the RFA-TKA group. Sixty patients who underwent MA-TKA were included via 1:1 matching for age, sex, and body mass index based on the RFA-TKA group. For radiological evaluation, knee X-rays were used to assess the functional knee phenotype and implant position accuracy by measuring the coronal and sagittal alignment, and these measurements were compared between the two groups. Patient demographic characteristics and patient-reported outcomes including Knee Society scores, Western Ontario and McMaster Universities Arthritis Index, and forgotten joint score-12 were compared between the groups.Statistically significant differences were observed in postoperative 2-year clinical outcomes in favor of RFA-TKA group which showed greater accuracy in the tibial component sagittal alignment than MA-TKA (1.0 ± 2.3 vs. 0.7 ± 1.6, respectively; P 0.001). However, outliers in the component positions were more common in the MA-TKA group, which was statistically significant for the femoral coronal and tibial sagittal alignments (P = 0.017 and 0.015, respectively).Functional alignment in TKA could be accurately obtained with the assistance of a robotic arm, and the results showed greater 2 year postoperative patient-reported outcome and satisfaction than mechanically aligned TKA using manual instruments.III.

The transfusion rate in staged bilateral total knee arthroplasty (TKA) remains high despite the application of blood management techniques. The potential of robotic arm-assisted TKA (R-TKA) in reducing the transfusion rate in staged bilateral surgery has not yet been investigated. Therefore, we aimed to evaluate the effectiveness of R-TKA on transfusion reduction compared with conventional TKA (C-TKA) in staged bilateral surgery. This retrospective study involved two groups of patients who underwent 1-week interval staged bilateral TKA—the C-TKA group and the R-TKA group—using MAKO SmartRobotics (Stryker, Kalamazoo, MI, USA). Each group comprised 53 patients after propensity score matching and was compared in terms of nadir hemoglobin (Hb) level and transfusion rate after each stage of surgery. Both groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb level. The R-TKA group showed a significantly higher nadir Hb level than the C-TKA group after the second TKA (p = 0.002). The transfusion rate was not significantly different between the two groups after the first TKA (p = 0.558). However, the R-TKA group showed a significantly lower transfusion rate in the TKA (p = 0.030) and overall period (p = 0.023) than the C-TKA group. Patients who undergo staged bilateral R-TKA have lower transfusion rate than those who undergo C-TKA. R-TKA may be effective in minimizing unnecessary allogeneic transfusions in staged bilateral surgery.

In patients with leg length discrepancy (LLD) and consequent pelvic obliquity, either the longitudinal axis of the pelvis or a line perpendicular to the ground may be used as the longitudinal reference line for measuring the lateral center-edge angle (LCEA). We aimed to (1) systematically inspect which longitudinal reference line has been used for measuring the LCEA in previous studies; (2) evaluate the frequency of change in the radiographical classification of acetabular overcoverage or undercoverage per the longitudinal reference line; and (3) validate the trigonometric method, predicting the change in the LCEA according to the LLD.Studies investigating the LCEA published between January 1976 and July 2019 in the MEDLINE database were categorized according to the longitudinal reference line used. Further, in a retrospective analysis of 238 patients surgically treated for LLD, the LCEA was first measured on standing pelvic radiographs using the longitudinal axis of the pelvis (pLCEA) and measured again using a line perpendicular to the ground (gLCEA). Femoral head coverage was categorized as undercoverage, normal, or overcoverage based on the pLCEA and gLCEA. The theoretically calculated difference between the pLCEA and gLCEA (dLCEA) as determined using a trigonometric method was compared with the dLCEA measured on radiographs.Of 229 previous studies, 188 did not specify the longitudinal reference line. The number of patients who were diagnosed with acetabular overcoverage using the pLCEA and gLCEA was one and fourteen, respectively (P0.001). The number of patients who were diagnosed with acetabular undercoverage using the pLCEA and gLCEA was one and zero, respectively (P=1.000). There was no difference (P=0.433) between the theoretically calculated (9±5 degrees) and measured (9±5 degrees) dLCEAs.The definition of the longitudinal reference line should be clarified when measuring the LCEA. The trigonometric method can accurately predict the change in the LCEA according to LLD in concentric hips without proximal femoral and pelvic deformities.Level IV-diagnostic study.

Cadmium (Cd) is a ubiquitous environmental pollutant with an exceptionally long biological half-life. The liver is a major organ for Cd metabolism, but the toxicity of Cd is unclear. This study sought to determine whether blood Cd (BCd) level (representing recent exposure [months] to Cd) was associated with liver function in Korean adults, both cross-sectionally and longitudinally. The baseline cross-sectional study involved 2,086 adults (male: 908, female: 1,178) in 2010−2011, and 503 of them (male: 207, female: 296) were followed up in 2014−2015. BCd was measured by graphite-furnace atomic absorption spectrometry, and liver function indices (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and γ-glutamyltransferase [GGT]) were determined. Liver damage was defined as an abnormal elevation of more than one liver function index. The geometric mean of BCd (1.07 µg/L) was higher in females than in males (1.16 vs. 0.96 µg/L). Liver function indices increased significantly in a dose-dependent manner according to the BCd levels, except for ALT in males, and were higher in males than in females. BCd level was also associated with the risk of liver damage in both sexes. No significant changes in BCd were observed between baseline and follow-up. The liver function indices in 2014−2015 were comparable to those in 2010−2011 in males, while ALT and GGT were significantly increased in 2014−2015 compared to 2010−2011 in females with relatively high BCd. These findings suggest that even a low level of environmental Cd exposure, short- and long-term, may affect liver function, and females appear more susceptible than males.

Background The effect of humeral component retroversion on clinical outcomes after reverse total shoulder arthroplasty (RTSA) is unclear. Intended retroversion intraoperatively may not produce the same retroversion of the humeral component postoperatively. Methods This retrospective study was conducted on consecutive patients who received RTSA using a single product with humeral lateralization at a targeted 25° of humeral retroversion from 2014 to 2019 with minimum 1-year clinical follow-up and postoperative computed tomography (CT). Forty-five patients were enrolled, and humeral component retroversion was measured three-dimensionally. Correlation and regression analyses were conducted between humeral retroversion and postoperative isometric strength and range of motion in forward flexion (FF), external rotation (ER), and internal rotation (IR). Group comparison between a ≤25° group and a >25° group was conducted as sub-analysis to verify possible confounders. Results The actual humeral retroversion was 21.7 ± 11.9°, and it was significantly correlated with postoperative FF [Pearson's correlation coefficient (PCC) = 0.464, P= .003], ER (PCC = 0.481, P = .002), and IR (PCC = 0.471, P = .002) strengths. Multivariable regression analysis showed that humeral retroversion was significantly associated with postoperative FF (Exp(B) = 0.492, P = .003), ER (Exp(B) = 0.336, P = .002), and IR (Exp(B) = 0.578, P = .002) strengths. Two groups in sub-analysis showed no significant difference in pre- or intraoperative variables other than humeral component retroversion. Some functional outcome scores including the Constant score, American Shoulder and Elbow Surgeons score, and activity scales were significantly higher in the >25° group. Conclusion Discrepancies between intraoperatively targeted humeral retroversion angle and actual postoperative angle after RTSA should be considered by operators and researchers. Increased humeral component retroversion than recommendation can yield acceptable outcomes and might be associated with higher postoperative strength, and possibly with better functional outcome after RTSA with humeral lateralization. Level of evidence Level III; Retrospective Comparative Study

People living near abandoned mines are at increased risk of exposure to toxic metals. We surveyed 4500 inhabitants with the mean age of 68.5 years old (male: 1768, female: 2732) living near 104 abandoned metal mines from 2013 to 2017 (the 2nd phase health survey in Korea). We conducted personal interviews, blood and urine sampling, and analyzed the concentrations of lead (Pb) and cadmium (Cd) in whole blood and Cd in urine using a graphite furnace atomic absorption spectrometer. The geometric means of blood Pb, blood Cd, and urine Cd were 2.27 μg/dL, 1.42 μg/L, and 1.66 μg/g creatinine, respectively. The level of metal exposure was lower than that reported from the first phase health survey in Korea (2008‒2011) but was higher than in the general population of Korea. Blood Pb was higher in males while blood Cd and urine Cd were significantly higher in females. Blood Pb was highest in the 40‒59 age group, while blood and urine Cd levels continuously increased until age 80 or older. The Cd levels in blood and urine were affected by consumption of locally produced rice and duration of residence near abandoned mines. Furthermore, negative correlations were observed between blood Pb and blood and urine Cd levels. Additionally, 252 of the 4500 subjects exceeded the thresholds of blood Cd or urine Cd levels. Together, these findings suggest that Cd has more sustainable and adverse health effects on the abandoned mine inhabitants, who are mostly aged. Therefore, continuous biomonitoring and risk assessment to environmental health risks are necessary for environmental pollution control and health promotion.

Nonalcoholic fatty liver disease (NAFLD) is a condition of excess accumulation of fats in the liver. Thyroid dysfunction is commonly observed in adult populations with NAFLD. In subjects with thyroid dysfunction, phthalates, which are chemical compounds widely used to increase the flexibility of various plastic products, may increase the risk of NAFLD prevalence. Therefore, our study aimed to evaluate the relationship between the levels of urinary phthalate metabolites and the risk of NAFLD stratified by the levels of thyroid-stimulating hormone (TSH). Data (n = 2308) were obtained from the Korean National Environmental Health Survey II (2012–2014). Using the hepatic steatosis index, participants were classified into non-NAFLD (36) groups. Participants with euthyroidism were defined as 0.45–4.5 mIU/L for serum TSH and normal thyroxine (T4) levels (n = 2125). Subclinical hypothyroidism (SCH) was defined as a higher TSH level (4.5–10 mIU/L) with normal total T4 levels in the serum (n = 183). A multivariate analysis was performed to assess the association of the urinary phthalate concentration with the risk of NAFLD after stratification based on the thyroid hormone levels. The levels of phthalate metabolites in urine were not significantly associated with NAFLD in adults with euthyroidism. However, a significant increased risk of NAFLD in those with SCH was observed in the fourth quartile of mono (2-ethyl-5-hydroxyhexyl) phthalate (odds ratio (OR) 13.59, 95% confidence interval (CI) 12.13–86.44), mono (2-ethyl-5-oxohexyl) phthalate (OR 8.55, 95% CI 1.20–60.53), mono-(2-ethyl-5-carboxypentyl) phthalate (OR 9.06, 95% CI 1.78–45.96), and mono-benzyl phthalate (OR 6.05, 95% CI 1.62–22.54) compared to those of the lowest quartile after being adjusted with covariates. In conclusion, the levels of phthalate metabolites in urine are positively associated with NAFLD in adults with SCH. More experimental studies are needed to clarify the risk of NAFLD caused by phthalate exposure in cases with poor thyroid function.

In this retrospective study, 10,000 anteroposterior (AP) radiography of the knee from a single institution was used to create medical data set that are more balanced and cheaper to create. Two types of convolutional networks were used, deep convolutional GAN (DCGAN) and Style GAN Adaptive Discriminator Augmentation (StyleGAN2-ADA). To verify the quality of generated images from StyleGAN2-ADA compared to real ones, the Visual Turing test was conducted by two computer vision experts, two orthopedic surgeons, and a musculoskeletal radiologist. For quantitative analysis, the Fréchet inception distance (FID), and principal component analysis (PCA) were used. Generated images reproduced the features of osteophytes, joint space narrowing, and sclerosis. Classification accuracy of the experts was 34%, 43%, 44%, 57%, and 50%. FID between the generated images and real ones was 2.96, which is significantly smaller than another medical data set (BreCaHAD = 15.1). PCA showed that no significant difference existed between the PCs of the real and generated images (p 0.05). At least 2000 images were required to make reliable images optimally. By performing PCA in latent space, we were able to control the desired PC that show a progression of arthritis. Using a GAN, we were able to generate knee X-ray images that accurately reflected the characteristics of the arthritis progression stage, which neither human experts nor artificial intelligence could discern apart from the real images. In summary, our research opens up the potential to adopt a generative model to synthesize realistic anonymous images that can also solve data scarcity and class inequalities.

Background Abdominal aortic calcification (AAC) may overestimate lumbar bone mineral density (BMD) examined by dual-energy X-ray absorptiometry (DXA); however, the degree of effect of AAC on lumbar BMD has not been quantified. In particular, no study has quantitatively compared and analysed segmental BMD and AAC using computed tomography (CT) scan. Thus, this study aimed to quantify the effect of AAC on BMD measurements using DXA via multiple linear regression analysis. Methods This study retrospectively reviewed participants >30 years of age who underwent DXA and spinal CT scans between 2014 and 2016. Variables that significantly affected the BMD of each lumbar segment were identified. Additionally, segmental facet joint arthritis (FJA) and AAC volume were evaluated using CT. Results A total of 620 subjects (153 males and 467 females) were included. The mean age was 71.6 ± 9.1 years (range, 31–89 years). AAC had the highest prevalence in L3 (45.2%), followed by L4 (41.1%). The average volume of AAC was the highest in L4 at 213.67 ± 443.82 mm3, followed by L3 at 161.95 ± 338.09 mm3. Our regression model found that Ln (L4BMD) was significantly correlated with age, BMI, FJA, and AAC volume in female subjects. Additionally, L4 BMD might be overestimated by approximately 0.90% for every 100 mm3 increase in AAC volume. The results for Ln (L3BMD) were almost identical. However, these relationships were not observed in males. Conclusion According to this model, AAC may overestimate lumbar BMD examined by DXA in a dose-dependent manner in females.

Background Critical bone defects remain challenges for clinicians, which cannot heal spontaneously and require medical intervention. Following the development of three-dimensional (3D) printing technology is widely used in bone tissue engineering for its outstanding customizability. The 3D printed scaffolds were usually accompanied with growth factors, such as bone morphometric protein 2 (BMP-2), whose effects have been widely investigated on bone regeneration. We previously fabricated and investigated the effect of a polylactic acid (PLA) cage/Biogel scaffold as a carrier of BMP-2. In this study, we furtherly investigated the effect of another shape of PLA cage/Biogel scaffold as a carrier of BMP-2 in a rat calvaria defect model and an ectopic ossification (EO) model. Method The PLA scaffold was printed with a basic commercial 3D printer, and the PLA scaffold was combined with gelatin and alginate-based Biogel and BMP-2 to induce bone regeneration. The experimental groups were divided into PLA scaffold, PLA scaffold with Biogel, PLA scaffold filled with BMP-2, and PLA scaffold with Biogel and BMP-2 and were tested both in vitro and in vivo. One-way ANOVA with Bonferroni post-hoc analysis was used to determine whether statistically significant difference exists between groups. Result The in vitro results showed the cage/Biogel scaffold released BMP-2 with an initial burst release and followed by a sustained slow-release pattern. The released BMP-2 maintained its osteoinductivity for at least 14 days. The in vivo results showed the cage/Biogel/BMP-2 group had the highest bone regeneration in the rat calvarial defect model and EO model. Especially, the bone regenerated more regularly in the EO model at the implanted sites, which indicated the cage/Biogel had an outstanding ability to control the shape of regenerated bone. Conclusion In conclusion, the 3D printed PLA cage/Biogel scaffold system was proved to be a proper carrier for BMP-2 that induced significant bone regeneration and induced bone formation following the designed shape.

Arsenic is a human carcinogen. Data on urinary arsenic species analyses of Koreans is limited. This study evaluated the arsenic exposure level, contributing factors, and health effects in Korean adults. Dietary intake information and urine samples were obtained from 2,044 participants. Arsenic exposure was assessed based on urinary concentrations of arsenic species, such as inorganic arsenic, As(III) and As(V), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), and arsenobetaine (AsB), using high-performance liquid chromatography with inductively coupled plasma mass spectrometry, followed by determination of biomarkers, malondialdehyde and c-peptide. The geometric mean concentrations were 30.9 ㎍/L for the sum of inorganic arsenic and their metabolites, and 84.7 ㎍/L for the total sum of arsenic measured. Urinary concentrations of arsenic species were influenced by age, inhabitant area (inland or coastal), and seafood intake, which was positively correlated with inorganic arsenic, DMA, and AsB. Rice intake was positively correlated with inorganic arsenic and its metabolites but not with AsB. Additionally, malondialdehyde and c-peptide levels were significantly associated with urinary concentrations of various arsenic species. Seafood and rice are major sources of organic/inorganic arsenic exposure in Korean adults; however, it is necessary to evaluate whether their overconsumption could have a potentially detrimental effect on human health.

Purpose This cross-sectional study aimed to assess the effect of environmental cadmium (Cd) exposure and essential metal imbalance on renal tubular damage and oxidative stress in 979 adults living in a Cd-polluted area near an abandoned copper (Cu) refinery. Methods We analyzed urinary Cd concentrations, renal tubular damage and oxidative stress markers, such as beta-2 microglobulin (β2-MG) and N-acetyl-β-d-glucosaminidase (NAG) activity and urine malondialdehyde (MDA) levels. The serum copper-to-zinc ratio (CZR) was used as an essential metal imbalance indicator. We divided the subjects into two Cd exposure groups based on the reference level of urinary Cd for renal dysfunction (2 μg/g creatinine). Results The geometric mean concentration of urinary Cd in all subjects was 2.25 μg/g creatinine. In both low and high Cd exposure groups, urinary Cd levels were positively correlated with urinary NAG activity, but not with serum CZR. After multivariate adjustment, serum CZR was strongly associated with urinary β2-MG levels in the low Cd exposure group (β = 1.360, P = 0.019) and was significantly associated with urinary MDA levels, regardless of Cd exposure level. In addition, the risk of renal tubular damage was significantly associated with urinary Cd level, particularly in the lowest or highest CZR tertile groups. Conclusions Essential metal imbalance may be a determinant of oxidative stress and renal tubular damage in a chronically Cd-exposed population, and proper zinc supplementation will be effective in preventing adverse health effects due to Cd exposure.

Background After the global epidemic of coronavirus disease 2019 (COVID-19), lifestyle changes to curb the spread of COVID-19 (e.g., wearing a mask, hand washing, and social distancing) have also affected the outbreak of other infectious diseases. However, few studies have been conducted on whether the incidence of gastrointestinal infections has changed over the past year with COVID-19. In this study, we examined how the incidence of gastrointestinal infections has changed since COVID-19 outbreak through open data. Methods We summarized the data on the several viruses and bacteria that cause gastrointestinal infections from the open data of the Korea Disease Control and Prevention Agency for 3 years from March 2018 to February 2021 (from Spring 2018 to Winter 2020). Moreover, we confirmed three most common legal gastrointestinal infectious pathogens from March 2016. Results From March 2020, when the COVID-19 epidemic was in full swing and social distancing and personal hygiene management were heavily emphasized, the incidence of infection from each virus was drastically decreased. The reduction rates compared to the averages of the last 2 years were as follows: total viruses 31.9%, norovirus 40.2%, group A rotavirus 31.8%, enteric adenovirus 13.4%, astrovirus 7.0%, and sapovirus 12.2%. Among bacterial pathogens, the infection rates of Campylobacter and Clostridium perfringens did not decrease but rather increased in some periods when compared to the average of the last two years. The incidence of nontyphoidal Salmonella, Staphylococcus aureus, or enteropathogenic Escherichia coli somewhat decreased but not significantly compared to the previous two years. Conclusion The incidence of infection from gastrointestinal viruses, which are mainly caused by the fecal-to-oral route and require direct contact among people, was significantly reduced, whereas the incidence of bacterial pathogens, which have food-mediated transmission as the main cause of infection, did not decrease significantly., Graphical Abstract

Backgroud Open reduction and internal fixation is the standard treatment for a displaced medial malleolus fracture (MMFx), achieving ankle stability and bony union to prevent post-traumatic arthritis. Previous fixation techniques including tension band wiring and unicortical screw fixation are not optimal for fixation of small fragments in MMFx due to their small size and poor manipulability. Here, we describe a novel surgical method using mini-screws only for fixation of small fragments in MMFx. Methods We conducted a retrospective consecutive study of patients who underwent surgery using mini-screws for small fragment MMFx between April 2013 and March 2018. We reviewed the patients' clinical characteristics and assessed the fracture features radiographically. Clinical outcomes were assessed by measuring the range of motion of both ankle joints and investigating symptomatic implants. We reviewed the radiographic outcomes of the medial malleolus and the functional outcomes using the Foot and Ankle Outcome Score (FAOS) at the last follow-up. Results Nine patients were included in the study. The minimal follow-up period was 27 months. There was no incidental bone breakage during the procedure. All MMFx healed without reduction loss, nonunion, or implant failure at the last follow-up. Two patients had mild osteoarthritic changes of the ankle joint. The mean FAOS score of the patients was 80.99 (range, 65.44-98.42). No patients required removal of the hardware. Conclusions Fixation of comminuted fractures of the medial malleolus using mini-screws for young adult patients is a straightforward and simple technique. Safe fixation of the anterior and posterior colliculi reduces the risk of implant irritation symptoms that necessitate implant removal.

The aims of this study were to examine the relationship between Internet gaming disorder (IGD) and gaming disorder (GD) and the degree of concordance between treatment seeking for gaming and IGD/GD. One hundred gamers who sought treatment for their gaming were compared with one hundred gamers who never sought treatment and gamers who met IGD and/or GD criteria were compared with those who did not meet these criteria, regardless of their treatment-seeking status. These comparisons were made using semi-structured diagnostic interviews and self-report psychopathology and symptom measures. There was only a partial concordance between treatment seeking and IGD/GD because 61% of treatment-seeking gamers met the diagnostic criteria for IGD and 36% met the diagnostic criteria for GD. GD criteria were found to reflect a more intense, pathological pattern of gaming, associated with high rates of attention deficit/hyperactivity disorder (ADHD) and coping as the main reason for gaming. IGD criteria were found to refer to a broad, heterogeneous entity that encompasses a "spectrum" of gaming from risky/hazardous to pathological. These findings suggest that gamers may seek treatment for IGD/GD, a diagnostically subthreshold, risky gaming pattern (i.e., hazardous gaming) or for a gaming pattern that seems normal. A partial overlap between IGD and GD indicates that the two disorders as conceptualized by their respective criteria, should not be considered interchangeably. The relationship and extent of the conceptual overlap between ADHD and a gaming-related disorder, especially GD, merit further study.

Background: Although a few studies have reported the incidence of deep vein thrombosis (DVT) after opening-wedge high tibial osteotomy (OWHTO), previous studies focused only on symptomatic DVT. Information is lacking regarding the overall incidence of DVT after OWHTO, thrombus location, and the relationship between DVT and clinical outcome. Purpose: To determine the overall incidence of DVT and classify the location of DVT after OWHTO. We also determined whether significant differences in clinical improvement exist in patients with and without DVT at 6 months and at 2 years after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included 46 patients (47 knees) who underwent OWHTO. All patients were instructed to perform knee range of motion exercises and partial weightbearing after drain removal. None of the patients received a chemoprophylaxis for DVT except intermittent pneumatic compression. DVT was diagnosed using 128-row multidetector computed tomography performed before discharge on the fourth postoperative day. The location was classified into 6 segments in the distal portion (muscular and axial veins) and proximal portion (popliteal, femoral, and common femoral veins and veins located above the iliac vein). International Knee Documentation Committee (IKDC) score was assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years using a linear mixed model. Results: Although the incidence of symptomatic DVT was 8.5% (n = 4), the overall incidence of early DVT was 44.7% (n = 21). All DVTs were located in the distal portion of the lower extremity vein, and 76.2% of the DVTs were located in an axial vein. The IKDC scores were 33.6 ± 7.2 and 35.3 ± 9.1 ( P = .910) preoperatively, 38.1 ± 5.6 and 40.6 ± 8.4 ( P = .531) at 6 months after surgery, and 44.8 ± 6.9 and 45.9 ± 11.4 ( P = .786) at 2 years after surgery in patients without and those with DVT, respectively. Conclusion: The overall incidence of early DVT after OWHTO was 44.7%. DVT after OWHTO was found particularly around the osteotomy site (76.2%). Patients with DVT did not have inferior short-term clinical outcomes after surgery.

The aim of this study was to assess changes in bone mineral density (BMD) and cadmium (Cd) levels in blood and urine in individuals living in a Cd-contaminated area according to the type of osteoporosis medication over a three-year period. This follow-up study included 204 residents living in the vicinity of a closed copper refinery, who had been found to have elevated urinary or blood Cd levels. Cd levels in the blood and urine, as well as BMD, were measured every 6 months. After the first BMD measurement, individuals were prescribed antiresorptives such as alendronate or vitamin D and calcium, according to their BMD. Subjects were classified according to the type of medicine provided over the previous 6 months. General linear models controlling for other factors were used to evaluate the effects of each type of medication on the participants' Cd levels and BMD. Spinal BMD showed a significant increase in the antiresorptive group compared to the nontreatment group. Significant decreases in blood Cd levels were found in the vitamin D and calcium group, in comparison to the nontreatment group, as well as a marginally significant decrease in the antiresorptive group. The vitamin D and calcium group showed a significantly greater decrease in urinary Cd levels than the nontreatment group. In contrast, antiresorptive medication was found to have a negative effect on urinary Cd excretion. These results suggest that vitamin D and calcium treatment for osteoporosis lowers blood Cd levels more effectively and improves urinary Cd excretion.

Neuropsychiatric symptoms have been well documented after subthalamic nucleus deep brain stimulation (STN-DBS), but those following a subthalamic lesion have been rarely reported. Herein, we present a 43-year-old woman with sudden-onset dramatic psychiatric and behavioral symptoms with hemiballism. Brain magnetic resonance imaging (MRI) with fluid attenuated inversion recovery (FLAIR) sequence during the acute phase demonstrated extensive hyperintensity in the left STN and adjacent regions. Contrast-enhanced MRI showed no abnormal areas of enhancement. Magnetic resonance venography (MRV) was normal. Routine blood and cerebrospinal fluid (CSF) tests were not remarkable. Autoimmune antibodies showed no significant results. A gradual recovery of both psychiatric and behavioral symptoms and hemiballism was observed with steroid and symptomatic treatment. Our case is unique in dramatic neuropsychiatric symptoms following a subthalamic lesion. We would like to point out that severe neuropsychiatric symptoms can occur in the patients with subthalamic lesions, and can be a troubling feature in their management.

Purpose Cerebral small vessel disease (SVD) is known to be associated with ischemic stroke, intracerebral hemorrhage (ICH), and cognitive impairment. In this retrospective observational study, we explored SVD markers on MRI relevant to spontaneous ICH. Materials and methods The ICH group consisted of 150 consecutive patients with a first primary parenchymal ICH, and the control group consisted of 271 age- and sex-matched individuals who underwent brain MRI in a health care center. We compared cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular space (EPVS), and lacunae in the ICH and control groups. Results A total of 1278 CMB lesions were identified in 121 of the 150 patients in the ICH group (80.6%), while 77 CMB lesions were found in 32 of the 271 individuals in the control group (11.8%). WMH and EPVS were more severe and lacunae were more frequent in the ICH patients than in the control group. When receiver operating characteristic (ROC) curves were plotted, number of CMBs most significantly predicted ICH. All imaging markers were significantly associated with ICH in every age group. The location of CMBs coincided with the location of ICH, and ICH volume correlated with CMB count. Conclusion All MRI markers for SVD were worse in ICH patients than in healthy controls, and these markers were prominent even in young ICH patients. Lacunae, WMH, EPVS, and CMB should be considered as factors related with spontaneous ICH.

In this study, we aimed to provide the recommended occupational exposure limits (OELs) for multi-walled carbon nanotubes (MWCNTs) and graphene nanomaterials based on data from a subchronic inhalation toxicity study using a lung dosimetry model. We used a no observed adverse effect level (NOAEL) of 0.98 mg m(–3) and 3.02 mg m(–3) in rats for MWCNTs and graphene, respectively. The NOAELs were obtained from a 13-week inhalation study in rats. The deposition fractions of MWCNTs and graphene in the respiratory tract of rats and humans were calculated by using the multi-path particle dosimetry model (MPPD model, v3.04). The deposition fraction in the alveolar region was 0.0527 and 0.0984 for MWCNTs and 0.0569 and 0.1043 for graphene in rats and human lungs, respectively. Then, the human equivalent exposure concentrations (HECs) of MWCNTs and graphene were calculated according to the method by the National Institute for Occupational Safety and Health (NIOSH). The HEC was estimated to be 0.17 mg m(–3) for MWCNTs and to be 0.54 mg m(–3) for graphene, which was relevant to the rat NOAEL of 0.98 mg m(–3) and 3.02 mg m(–3) for MWCNTs and graphene, respectively. Finally, we estimated the recommended OELs by applying uncertainty factors (UFs) to the HEC as follows: an UF of 3 for species differences (rats to humans), 2 for an experimental duration (subchronic to chronic), and 5 for inter-individual variations among workers. Thus, the OEL was estimated to be 6 μg m(–3) for MWCNTs and 18 μg m(–3) for graphene. These values could be useful in preventing the adverse health effects of nanoparticles in workers.

Table S1. The distribution of modified Rankin Scale scores according to the development of acute kidney injury in patients with good neurological outcomes at discharge. Table S2. The distribution of modified Rankin Scale scores according to the recovery from acute kidney injury in patients with good neurological outcomes at discharge. Table S3. The distribution of modified Rankin Scale scores according to renal replacement therapy in patients with good neurological outcomes at discharge. Table S4. Baseline characteristics of the study population according to the recovery of acute kidney injury after excluding patients who died within 48â h since return of spontaneous circulation. Table S5. Factors associated with survival discharge in multivariate analysis after excluding patients who died within 48â h since return of spontaneous circulation. Table S6. Factors associated with good neurological outcome in multivariate analysis after excluding patients who died within 48â h since return of spontaneous circulation. (DOCX 22 kb)

Objective To date, data regarding the efficacy of acetylcholinesterase inhibitors in preventing postoperative delirium (POD) are inconsistent and conflicting. Older individuals with cognitive dysfunction are thought to show POD more frequently. Our aim was to study the effectiveness of rivastigmine prophylaxis on the incidence, severity, and risk factors for POD in older patients with cognitive impairment undergoing hip fracture surgery. Methods Of 62 older patients with cognitive impairment about to undergo surgery after a hip fracture, 31 were randomly assigned to receive a rivastigmine patch from 3 days before to 7 days after the operation (Group I), and the other 31 did not receive a rivastigmine patch (Group II). The two groups were compared with regard to incidence and severity of delirium on postoperative days 2 or 3 and 7. Multivariate logistic regression analysis was performed to assess factors associated with POD. Results Postoperative delirium occurred in five Group I patients and 14 Group II patients (p = 0.013). The mean severity of delirium in the two groups as determined by the Delirium Rating Scale was 2.2 and 6.2 respectively (p = 0.033). The odds ratio for POD was 0.259 (95% CI: 0.074–0.905, p = 0.034) after adjusting for American Society of Anesthesiologists score (p = 0.058), age (p = 0.203), and gender (p = 0.560). There were no rivastigmine-related perioperative complications. Conclusion Perioperative rivastigmine patch application could reduce the occurrence of POD in older patients with low cognitive status. Copyright © 2016 John Wiley & Sons, Ltd.

This study was performed to select single nucleotide polymorphisms (SNPs) related to the body burden of heavy metals in Koreans, to provide Korean allele frequencies of selected SNPs, and to assess the difference in allele frequencies with other ethnicities. The candidate-gene approach method and genome-wide association screening were used to select SNPs related to the body burden of heavy metals. Genotyping analysis of the final 192 SNPs selected was performed on 1,483 subjects using the VeraCode Goldengate assay. Allele frequencies differences and genetic differentiations between the Korean population and Chinese (CHB), Japanese (JPT), Caucasian (CEU), and African (YIR) populations were tested by Fisher’s exact test and fixation index (FST), respectively. The Korean population was genetically similar to the CHB and JPT populations (FST < 0.05, for all SNPs in both populations). However, a significant difference in the allele frequencies between the Korean and CEU and YIR populations were observed in 99 SNPs (60.7%) and 120 SNPs (73.6%), respectively. Ten (6.1%) and 26 (16.0%) SNPs had genetic differentiation (FST > 0.05) among the Korean-CEU and Korean-YIR comparisons, respectively. The SNP with the largest FST value between the Korean and African populations was cystathionine-β-synthase rs234709 (FST: KOR-YIR, 0.309; KOR-CEU, 0.064). Our study suggests that interethnic differences exist in SNPs associated with heavy metals of Koreans, and it should be considered in future studies that address ethnic differences in heavy-metal concentrations in the body and genetic susceptibility to the body burden of heavy metals.

The purpose of this study is to classify main risk factors on a construction phase of a plant project and analyze importance by the risk factors. Plant Industry is continuing boom and the increase in overseas plant orders in 2014 has showed a performance increase of 61% of the total orders, as the plant industry are risk factors for the construction phase, safety management target recognition and variety of accident prevention and safety factors by importance, etc. a situation that requires the development and introduction of management. So, it is performed that collected disaster conditions data on a construction phase of a plant project, is questioned by plant construction professional and is classified by 4M. Then, it is performed that is questioned by plant construction and safety professional in order to apply AHP method, and is presented from analyzing the risk factors, which are results of the survey, by importance and priority. This study will recognize from identifying the main risk factors in advance and will be utilized as a basic data is to prevent the risk factors.

This study was aimed to examine the association the blood/urinary concentration of toxic metal (Hg, Pb, and Cd) with children’s dietary patterns. This cross-sectional study included 1026 school children aged 8–17 years. Dietary patterns were defined using factor loading scores for 108 foods from a Semi-Quantitative Food Frequency Questionnaire. A high blood Hg level was found in boys with a high score in the ‘fish’ pattern (p = 0.02), and in girls with a high score in ‘fruit’ pattern (p = 0.04). The concentration of Pb was related to the ‘imprudent’ pattern in high school boys (p = 0.02). The effect of the ‘vegetable’ pattern on high excretion of urinary Cd was observed in low grade elementary (p = 0.04) and middle school students (p

Highly degraded human DNA is commonly encountered in the forensic studies. Despite many efforts, the poor quality and quantity of the DNA often result in unsuccessful DNA analysis. There has been no extensive evaluation of DNA polymerase performance for the successful PCR of highly degraded DNA samples. We evaluated the most efficient DNA polymerases, based on real-time PCR and agarose gel electrophoresis analyses for a single copy gene amplification, with 200 ancient DNA (aDNA) samples of various origins. Nine commercially available DNA polymerases were tested, which included enzymes that are reportedly effective for PCR-inhibitory samples. The first screening test for the polymerases with 20 aDNA samples showed that Pico Maxx HF, FastStart Taq, and Ex Taq HS DNA polymerases were the most effective. Further tests with 180 aDNA samples showed that AmpliTaq Gold (control) amplified PCR products from 52 aDNA samples, PicoMaxx HF from 62, FastStart Taq from 64, and Ex Taq HS from 65. The use of two or more of Ex Taq HS, FastStart Taq, and PicoMaxx HF resulted in a significantly higher success rate than that of AmpliTaq Gold alone. With 37 positive samples tested in duplicate, Ex Taq HS showed the highest reproducibility (13 samples) and AmpliTaq Gold, the lowest (four samples); this difference was significant. The data also showed preferential amplification by the enzymes; Ex Taq HS exclusively produced amplification from two samples, FastStart Taq from one, and PicoMaxx HF from one. We suggest that the initial use of these three DNA polymerases will increase the probability of successfully amplifying DNA from highly degraded human DNA samples.

Cadmium (Cd) is a metal that is toxic to renal tubules. If renal tubules are damaged by Cd, urinary excretion of N-acetyl-β-D-glucosaminidase (NAG) and beta 2-microglobulin (β2-MG) increases. The aim of this study was to describe the changing patterns of urinary Cd, NAG, and β2-MG levels over a 3-year period in individuals living in a Cd-contaminated area. This follow-up study included 191 residents (65.6±9.3 years) who were living in the vicinity of a copper refinery. Urinary levels of Cd, NAG activity, and β2-MG levels were measured, and their determinants and changing patterns were analyzed statistically. The natural logarithm of urinary Cd levels decreased significantly over time. Sex and intake of locally cultivated rice were significant determinants of urinary Cd concentration. Urinary NAG activity decreased over time. Age and urinary Cd concentration were significant determinants of urinary NAG activity in subjects with urinary Cd concentrations5μg/g creatinine. In subjects whose urinary Cd concentrations were2μg/g creatinine, diabetes was found to be a significant risk factor for high urinary NAG activity. The slope for temporal changes in urinary β2-MG levels was negative in subjects whose urinary Cd levels were2μg/g creatinine but was positive in those whose urinary Cd levels were 2-5μg/g creatinine or5μg/g creatinine. The urinary β2-MG levels found in individuals whose urinary Cd levels were2μg/g creatinine suggest that previous Cd-induced renal tubular damage had occurred.

Background Lead (Pb), mercury (Hg), and cadmium (Cd) are well-known environmental pollutants. They are unnecessary in the biological processes of humans. This study was performed to estimate the representative background exposure levels to the metals by measuring concentrations in whole blood of the Korean general population. Methods This population-based cross-sectional study included 4,000 subjects (1,886 males and 2,114 females) 0–83 years of age in 2010 and 2011. Adult subjects (≥ 19 years of age) were collected by sex- and age-stratified probability method, and preschool- and school-aged subjects were recruited by a cluster sampling method. Written consent was provided prior to blood sampling. Pb and Cd blood concentrations were determined by a flameless atomic absorption spectrophotometry, and blood Hg was analyzed by a direct Hg analyzer. Results The geometric mean, median and 95th percentile of blood Pb was 1.82 µg/dL, 1.83 µg/dL, and 3.78 µg/dL, respectively. The respective values were 2.92 µg/L, 2.87 µg/L, 9.12 µg/L for Hg, and 0.56 µg/L, 0.59 µg/L, 2.20 µg/L for Cd. Blood Pb and Hg were higher in males than in females, but no sex difference was observed, respectively, in subjects 0–4 years of age for Pb and in subjects less than 20 years for Hg. However, blood Cd was higher in females than in males and no sex difference was observed in subjects < 30 years of age. Conclusion This study provides representative data of human exposure to Pb, Hg, and Cd covering whole age groups of the general population in Korea., Graphical Abstract