Dynamic knee valgus is considered a risk factor of noncontact ACL injuries. The aim of this study was to determine the association between hip and hindfoot dynamic alignment and dynamic knee valgus.This cross-sectional study involved 88 high school female basketball players (175 legs). Subjects performed single-leg squatting and drop landing which provided a hip-out distance (HOD) and a knee-in distance (KID) via 2D video images. Hip and hindfoot dynamic alignment was evaluated by a dynamic Trendelenburg test (DTT) and a heel-floor test (HFT), respectively, during squatting and landing.The DTT-positive group (dynamic hip mal-alignment with lower non-weightbearing pelvis) demonstrated greater HOD and KID values for both squatting (p＜0.001) and landing (p＜0.001) than the DTT-negative group. The HFT-positive group (5^o or greater hindfoot valgus) demonstrated greater KID values for both squatting (p＜0.01) and landing (p＜0.001), but smaller HOD value for squatting (p＜0.01) than the HFT-negative group.In conclusion, dynamic hip mal-alignment may be associated with both greater HOD and KID, but hindfoot valgus only with greater KID.

Dynamic knee valgus is considered a risk factor of non-contact anterior cruciate ligament (ACL) injury. To identify athletes at a higher risk, we developed a two-dimensional (2D) video-based screening test that determines hip abductor function as well as dynamic hindfoot and knee valgus. The purpose of this study was to validate the accuracy of the indices for dynamic knee valgus derived knee-in distance (KID) and hip-out distance (HOD) from the 2D-video.Twenty healthy university students agreed to participate in this study. Subjects were asked to step off a 30-cm box and land on one leg. This procedure was recorded simultaneously using a 2D video camera in the frontal plane and the Vicon motion capture system. Pearson's correlations examined associations between KID, KID normalized by height (KID/H), HOD, as well as HOD normalized by height (HOD/H) and 3D-valgus (knee valgus) or 3D-IR (tibial internal rotation).Significant correlations were found between the KID and 3D-valgus (r=0.72, p<0.01) and KID/H and 3D-valgus (r=0.73, p<0.01). Associations were not significant between KID and 3D-IR (r=0.08) and between KID/H and 3D-IR (r=0.03). A positive moderate correlation between HOD and 3D-valgus (r=0.46, p<0.05) and HOD/H and 3D-valgus (r=0.50, p<0.05), as well as a negative moderate correlations between HOD and 3D-IR (r=-0.52, p<0.05) and between HOD/H and 3D-IR (r=-0.51, p<0.05) were also observed.We conclude that KID is a reliable alternative for the 3D-valgus and the HOD is for the 3D-valgus and tibial external rotation.

Operations were performed 3 times on ventricular septal perforation after acute myocardial infarction which exhibited cardiogenic shock, and the patient's life was saved successfully. The case was a female aged 64. Ventricular septal perforation developed in 6 hours after onset of acute myocardial infarction, and an emergency operation was performed because the patient exhibited cardiogenic shock. Intraventricular re-shunt was observed on the postoperative 5th day, and second operation was performed on the postoperative 7th day because a trend of cardiac insufficiency was intensified. Intraventricular re-shunt was observed again on the 5th day of the second operation, but third operation with a principle that further operation is to be performed awaiting regeneration of the tissue on the perforated margin to occur since the circulatory kinetics were seen to have been stabilized. The postoperative course was favorable, and the patient was discharged on 53 rd day of the third operation with the symptom alleviated. It was considered that our policy is to have to repeat operation when the patient's movement of circulation deteriorate at re-shunt from our experience of this time.

A 2-month-old girl had been urgently seen on postnatal day 10 due to poor weight gain and tachypnea. Echocardiography showed congenital valvular aortic stenosis (AS), ventricular septal defect (VSD), atrial septal defect (ASD), and aortic valve dysplasia, but no cyst image was seen at the aortic valve level. Aortography revealed a dysplastic aortic valve along with coarctation of aorta (CoA) and patent ductus arterious (PDA). Balloon aortic valvotomy (BAV) was performed on day 53. Ballooning was satisfactory, but there was no change in gradient. Operation was performed on day 70 under a diagnosis of congenital AS and CoA complex. After cardiopulmonary bypass was established, the ascending aorta was transected. The blood cyst originated from the center of the anterior leaflet and was resected. The pressure gradient at the aortic valve decreased to 22.5mmHg. The patient was discharged 25 days after surgery.

We experienced the coronary artery bypass grafting (CABG) with essential thrombocythemia (ET). A case is a man of 73 years old. As for him, 3 vessel disease including left main trunk was recognized on coronary angiography, and it was planned CABG. However, we recognized blood cell aberration in blood examination, and it was diagnosed as ET. ET is classed as a chronic myeloproliferative disorder. It has two opposite tendencies, a bleeding tendency and thrombus tendency. Ischemic heart disease to merge ET is acute myocardial infarction by thrombus in case of most, and there are a few cases to need blood circulation reconstruction of coronary artery for angina pectoris. Perioperative hemorrhage and postoperative graft closure become a problem in CABG with ET. With the hydroxycarbamide which is DNA synthesis inhibitor of a platelet count, a function controlled it, and enforced CABG. He doesn't have any cardiac events and complications due to ET for 7 years post CABG. We report this case with a review of the literature.

We report a patient displaying several symptoms of myelitis associated with atopic dermatitis. The patient, a 35-year-old female, initially suffered from gait titubation that gradually developed into motor disturbance. She underwent many tests (blood, cerebrospinal fluid, electromyography, and brain, cervical, and lumbar spinal cord and muscle MRIs) at several hospitals, including a university institution, over the course of two years until she finally came to our hospital. However, her disease was never identified by these tests, and she was referred to our hospital to start rehabilitation for her disability which was believed to be caused by disuse syndrome. On first examination, muscle hypertonia of both legs, hypoesthesia of all extremities, difficulty sitting, and a low performance level of ADL were observed. Judging by the factors (e.g. age, neurological symptoms), we considered that the patient was not suffering disuse syndrome, and recommended that she attend another medical college hospital for a thorough investigation. The disease was finally diagnosed as atopic myelitis, as indicated by the test results (e.g. hyperIgEemia). She could sit without a back rest and undertake gait training between parallel bars after steroid pulse therapy at the hospital. While she undertook rehabilitation at our hospital, we applied some approaches to adapt to her fluctuating symptoms (e.g. making short leg braces for both legs, injection of botulinum toxin A (BOTOX^®) in the leg). We recognized we should gather as much information as possible given the rarity of the disease.

Preservation is essential for successful cell transplantation. 1) Control group (n=13); Cells isolated from human right atrial tissues were cultured for 15 days. 2) Cell-cryopreservation (C. P.) group (n=23), Tissue-C. P. group (n=29); Human heart cells and minced tissues were cryopreserved in freezing medium containing 70% IMDM, 20% FBS, and 10% DMSO at a rate of 1°C/min. to -80°C by a programmed freezer and stored in liquid nitrogen (-196°C) for 1 week. After cryapreservation, the tissues and cells were thawed rapidly at 37°C. The cells, cryopreserved cells and cells isolated from cryopreserved tissues were cultured as passage 1, 2, and 3 for 15 days each. Cell proliferation was compared with a control group by determining growth curves, and 2-day proliferation rates. A growth factor, biochemical features and cell cycle were measured pre and post-cryopreservation. The cryopreserved group proliferated much more than the control group within 15 days at passage 1, 2, and 3 (1.7, 2.1, and 3.1 times, p<0.0001) respectively. The 2-day proliferation rates of cryopreservation group were higher than the control group in 15 days (p<0.05). The bFGF release after cryopreservation was on average 46.8 and 6.8 times greater than before cryopreservation for the Cell-C. P. and Tissue-C. P. groups, respectively. The TGF-β1 release was also accelerated by cryopreservation (Cell-C.P. group: 1.78 times, Tissue-C. P. group: 1.45 times in average) after cryopreservation. The cell cycle of human heart cells shifted to G2+M from the G1+G0 period by cryopreservation. Human atrial tissues and cells can be cultured and cryopreserved. The cryopreserved cells and cells isolated from cryopreserved tissue proliferate much more than non-cryopreserved cells at all cell ages. Cryopreservation enables human tissues and cells to proliferate more because of the greater release of growth factors and changing cell cycle.

BACKGROUND/AIMS: Noninvasive liver fibrosis evaluation was performed in patients with nonalcoholic fatty liver disease (NAFLD). We used a quantitative method based on the hepatic volume acquired from gadoxetate disodium-enhanced (Gd-EOB-DTPA-enhanced) magnetic resonance imaging (MRI) for diagnosing advanced fibrosis in patients with NAFLD. METHODS: A total of 130 patients who were diagnosed with NAFLD and underwent Gd-EOB-DTPA-enhanced MRI were retrospectively included. Histological data were available for 118 patients. Hepatic volumetric parameters, including the left hepatic lobe to right hepatic lobe volume ratio (L/R ratio), were measured. The usefulness of the L/R ratio for diagnosing fibrosis ≥F3–4 and F4 was assessed using the area under the receiver operating characteristic (AUROC) curve. Multiple regression analysis was performed to identify variables (age, body mass index, serum fibrosis markers, and histological features) that were associated with the L/R ratio. RESULTS: The L/R ratio demonstrated good performance in differentiating advanced fibrosis (AUROC, 0.80; 95% confidence interval, 0.72 to 0.88) from cirrhosis (AUROC, 0.87; 95% confidence interval, 0.75 to 0.99). Multiple regression analysis showed that only fibrosis was significantly associated with the L/R ratio (coefficient, 0.121; p<0.0001). CONCLUSIONS: The L/R ratio, which is not influenced by pathological parameters other than fibrosis, is useful for diagnosing cirrhosis in patients with NAFLD.
Body Mass Index ; Fibrosis* ; Humans ; Liver Cirrhosis ; Magnetic Resonance Imaging ; Methods ; Non-alcoholic Fatty Liver Disease* ; Retrospective Studies ; ROC Curve

Background/Aims: Intestinal Behçet disease is typically associated with ileocecal punched-out ulcers and significant morbidity and mortality. Intestinal ultrasound is a noninvasive imaging technique for disease monitoring. However, no previous reports have compared intestinal ultrasound with endoscopic ulcer activity or histopathological findings for intestinal Behçet disease. We evaluated the usefulness of intestinal ultrasound for assessing the activity of ileocecal ulcers in intestinal Behçet disease. Methods: We retrospectively compared intestinal ultrasound findings with 73 corresponding endoscopic images and 6 resected specimens. The intestinal ultrasound findings were assessed for 7 parameters (bowel wall thickness, vascularity [evaluated using the modified Limberg score with color Doppler], bowel wall stratification, white-plaque sign [strong hyperechogenic lines or spots], mesenteric lymphadenopathy, extramural phlegmons, and fistulas), and endoscopic ulcer activity was classified into active, healing, and scar stages. Histopathological findings were evaluated by consensus among experienced pathologists. Results: Bowel wall thickness (P< 0.001), vascularity (P< 0.001), loss of bowel wall stratification (P= 0.015), and white-plague sign (P= 0.013) were significantly exacerbated in the endoscopic active ulcer stage. Receiver operating characteristic curve analysis revealed that a bowel wall thickness of > 5.5 mm (sensitivity 89.7%, specificity 85.3%) was potentially useful for detecting active lesions. When compared with histopathological findings, an increase in bowel wall thickness reflected the ulcer marginal ridge, and the white-plaque sign reflected the ulcer bottom. Conclusions Intestinal ultrasound is useful for monitoring intestinal ulcer activity in intestinal Behçet disease.