The function of the knee joint is determined by the anatomical integrity of ligamentous structures, however the ligaments and soft tissues which support by the knee joint are too weak to tolerate forceful stresses. The knee joint is one of the most susceptible joints to ligamentous injury. Recently, the incidence of ligamentous injuries of the knee increased because of rise in traffic accidents and participation in sports. For good results, it is very important to make an early diagnosis and to give prompt management. The authors reviewed 67 cases of ligamentous injuries in patients who were admitted and managed at the Department of Orthopaedic Surgery of Presbyterian Medical Center from March of 1976 to December of 1982. The results of the clinical study are as follows: 1. The prevalent age group is the 3rd through 5th decades, and more frequent in males (8. 6 times). 2. The traffic accident is the most common cause of injury (80. 6%) and many ligamentous injuries were associated with fracture (53. 2%). 3. The most common ruptured individual ligament was the medial collateral ligament. The isolated ligamentous rupture of anterior and posterior cruciate ligament was 3 cases each, but most of the cruciate ligaments were combined with other ligament injury. 4. The rupture sites of the individual ligaments were found to be the following: (a) The medial collateral ligament was ruptured most frequently in the mid-substance (45. 2%), with the deep layer ruptured at the femoral attachment and the superficial layer in the mid-substance; (b) The lateral collateral ligament torn at the fibular attachment (62. 5%); (c) The anterior cruciate ligament torn at the femoral and tibial (47. 6%, respectively); (d) The posterior cruciate ligament torn at the femoral attachment (40. 0%). 5. It is significant if the difference between the normal knee and the injured knee on the stress film is more than 10 or 10mm. 6. Excellent and good results were obtained in 95.2% by non-surgical management and in 93.0% by surgical management. 7. Early surgical repairs, made within 2 weeks after injury, gave much better results than late repairs.
Accidents, Traffic ; Anterior Cruciate Ligament ; Clinical Study ; Collateral Ligaments ; Early Diagnosis ; Humans ; Incidence ; Joints ; Knee Joint ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Male ; Posterior Cruciate Ligament ; Protestantism ; Rupture ; Sports

Nevoid basal cell carcinoma syndrome (NBCC syndrome) is a very rare autosomal dominant dermatopathy characterized by a primary triad with variable secondary anomalies. The chief features include nevoid basal cell carcinomas, one or more skeletal anomalies, and multiple odontogenic keratocysts of the jaw. We report a case of NBCC syndrome in a 43-year old male who had multiple nevoid basal cell carcinomas on the retroauricular area, face, chest wall, and back, which have been present since childhood. Skull x-rays revealed relatively well-circumscribed cystic, radiolucent lesions on bilateral rami of both upper and lower jaws, calcification of the falx cerebri, agenesis of the right coronoid process, and a bifid chin. The cystic lesions were histologically confirmed as keratocysts.
Child ; Male ; Female ; Humans

Objective: This study aimed at providing a critical review of the overall benefits of the chin-tuck maneuver through a systematic review of its effects when used in the treatment of dysphagia, as well as to provide basic data for a comparative analysis in future studies. Methods: To identify academic papers on the chin-tuck maneuver published from January 2000 to January 2021, a literature search on three databases was performed using keywords, including chin-tuck, dysphagia, and head flexion. Out of the 712 related papers identified, the methodological characteristics and results of 12 selected studies were reviewed. Results: Nine of the 12 studies found that the chin-tuck position not only helped in the opening of the upper esophageal sphincter (UES) but also reduced pharyngeal residues and prevented aspiration and penetration. In addition, three studies analyzed the position of the neck flexion angle and the changing angle when performing the chin-tuck maneuver. Conclusion This shows that the chin-tuck maneuver is an effective strategy in the treatment of dysphagia. In future studies, further investigation of the posture, angles, and effects of the chin-tuck maneuver, could help identify additional benefits of this treatment.

Cellular cardiomyoplasty has recently emerged as a potential new treatment of ischemic heart disease. Combining cellular cardiomyoplasty with gene therapy using myogenic transcription factor might facilitate myocardial regeneration. In this study, we engineered H9c2, L6 using plasmid vector to overexpress the transcription factor MEF2c, Nkx2.5 involved in cardiomyogenesis. We investigated 1) formation of intercellular junction in mono-culture and co-culture with cardiomyocyte for functional and structural synchronous contraction after transplantation, 2) differentiation into cardiomyocyte, 3) resistance to hypoxic condition. Each cell overexpressing MEF2 and Nkx2.5 was generated by gene transfection and clonal selection. CO-culture was performed that each cell line added over cultured cardiomyocyte. H9c2-MEF2c and H9c2-Nkx2.5 became long, spindle shape like cardiomyocyte. Troponin T, cardiac specific marker, was found spot-like pattern in H9c2-Nkx2.5. However, co-culture with cardiomyocyte did not induce differentiation all kinds of cells into cardiomyocyte. Connexin43, which is gap junction marker was increased in H9c2-MEF2c, H9c2-Nkx2.5, L6-MEF2c and L6-Nkx2.5. Especially, co-culture with cardiomyocyte resulted in elevation of connexin43 levels more than monoculture. Ultrastructurally, formations of gap junction and desmosome were found apparently in L6-Nkx2.5. Long-standing, strong, regular and more frequent contraction were observed in cardiomyocyte co-cultured with H9c2-MEF2c, H9c2-Nkx2.5, L6-MEF2c, L6-Nkx2.5, respectively. Neverthless, any cell did not have active contraction itself, but passive movement except cardiomyocyte. H9c2-MEF2c, L6-MEF2c and L6-Nkx2.5 had resistance to hypoxia compared with other groups. These results suggested that co-culture and overexpressions of MEF2c and Nkx2.5 induced differentiation into cardiomyocyte and played an important role on intercellular junction formation and hypoxic resistance. This would be a promising source of cellular cardiomyoplasty. Therefore, much more research would be essential for clinical application of cellular cardiomyoplasty and this study would be a basic source for further study of MEF2c and Nkx2.5 in cellular cardiomyoplasty.
Animals ; Anoxia ; Cardiomyoplasty ; Cell Line ; Cell Transplantation ; Coculture Techniques* ; Connexin 43 ; Desmosomes ; Gap Junctions ; Genetic Therapy ; Intercellular Junctions ; Myoblasts ; Myoblasts, Cardiac* ; Myocardial Ischemia ; Myocytes, Cardiac* ; Plasmids ; Rats* ; Regeneration ; Transcription Factors ; Transfection ; Troponin T

BACKGROUND: It is unclear whether impaired pulmonary function serves as a risk factor for decreased renal function. This study investigated the association between the forced vital capacity (FVC) and chronic kidney disease (CKD) in middle-aged and elderly men.METHODS: We investigated the association between FVC and CKD in 412 Korean men aged ≥50 years, without diabetes, who have not received treatment for chronic lung disease. CKD was defined based on evidence of renal tissue damage or reduced renal function indicated by estimated glomerular filtration rate < 60 mL/min/1.73 m² or proteinuria level ≥1+. We assessed the association between FVC and CKD using multivariate logistic regression analysis after adjusting for confounders.RESULTS: The overall prevalence of CKD was 29.2% in the study population. Multivariate logistic regression analysis showed that the odds ratio with a 95% confidence interval for CKD was 0.96 (0.92–0.99) with a 1% increment in FVC after adjusting for age, body mass index, smoking status, alcohol intake, regular exercise, systolic and diastolic blood pressures, fasting plasma glucose, triglyceride, and high-density lipoprotein-cholesterol levels, as well as antihypertensive and antidyslipidemic medications.CONCLUSION: We observed that FVC was independently and inversely associated with CKD. This finding suggests that careful monitoring of renal function is necessary to evaluate possible kidney dysfunction in patients with decreased FVC.
Aged ; Blood Glucose ; Body Mass Index ; Fasting ; Glomerular Filtration Rate ; Humans ; Kidney ; Logistic Models ; Lung Diseases ; Male ; Odds Ratio ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic ; Respiratory Function Tests ; Risk Factors ; Smoke ; Smoking ; Triglycerides ; Vital Capacity

BACKGROUND AND OBJECTIVE: Even though they are identified on the basis of their induction by elevated temperatures, heat shock proteins are induced by various stimuli. Such inducers include viral infection, exposure to ethanol, sodium arsenite, steroid hormones and heavy metals. They become involved under pathological conditions, such as anoxia/ischemia, reperfusion injury and oxidative stress in the heart. In this research, the cellular damages and changes of Hsp25 and alphaB crytallin were investigated under oxidative stress induced H2O2 treatment in a cultured cardiomyoblast cell line, H9c2. MATERIALS AND METHODS: The morphological changes of the H9c2, and the distributions of Hsp25 and alphaB crytallin, were examined with phase-contrast, confocal and electron microscopy. The levels of Hsp25 and alphaB crytallin expressions within the cells were also checked. RESULTS: After exposure to a low concentration (10 micrometer) of H2O2, the amounts of Hsp25 and alphaB crytallin were increased more than in the control and heat shock groups. They were particularly localized in the perinuclear region and along the actin filament. When exposed to a high concentration (more than 100 micrometer) of H2O2, many cells developed apoptotic features, such as vacuolization, blebbing and apoptotic body formations. The amounts of Hsp25 and alphaB crytallin were decreased more than in the control group. However, a weak reaction in the perinuclear region and along the actin filaments still remained when observed under confocal microscopy. CONCLUSION: These results suggest that the elevation of the expressions of Hsp25 and alphaB crytallin were dependent on the concentration of H2O2. Additionally, the redistribution of these small Hsps is closely associated with the actin filaments, as well as the nuclei. Therefore, much more research will be essential for the elucidation of roles of Hsp25 and alphaB crytallin in oxidative stress, such as ischemia or ischemic-reperfusion injury.
Actin Cytoskeleton ; Actins* ; Blister ; Cell Line* ; Ethanol ; Heart ; Heat-Shock Proteins* ; Hot Temperature* ; Ischemia ; Metals, Heavy ; Microscopy, Confocal ; Microscopy, Electron ; Oxidative Stress ; Reperfusion Injury ; Shock ; Sodium

Objectives: This study aims to suggest ways to improve the oral care competencies of caregivers by strengthening oral care services for the elderly with mobility difficulties in long-term care facilities. Methods: Through a web survey, 215 caregivers were invited, their actual situation was identified, and necessary educational tasks were listed. We developed 16 types of card news, two types of songs, and four types of video clips that can be used in the field for the listed educational topics. Several meetings with expert developers resulted in developing the components and design of an oral health management platform for caregivers in long-term care facilities. Results: As a result of the web survey, many caregivers in long-term care facilities needed education or information on oral care methods, and many people felt difficulties in oral care for the elderly. About 40% of the caregivers had no experience in oral health education, and many learned how to care through unsystematic apprenticeships. Most of the education content that caregivers prioritized were brushing teeth and denture management, but there were also needs such as management of dementia and bedridden patients, non-cooperative oral care, nutrition management, and oral auxiliary products use. Conclusions In conclusion, this study reviewed and suggested digital platforms such as strengthening caregivers’ competency in long-term care facilities, providing customized educational information, discovering oral problems of the elderly, and reporting oral difficulties to experts.

Objectives: This study aims to explore the experience of caregivers in oral health care of the elderly in long-term care facilities, identify the problems, and collect opinions, and to seek improvement directions for strengthening competency and improving services of oral health care for the elderly. Methods: Data on the experience in oral health care of the elderly were collected through focus group interviews (FGI) targeting caregivers in long-term care facilities. The grounded theory method was used. The interview content was categorized by open coding, and a paradigm model was presented by identifying the relationship between the categories through axial coding. Selective coding found core categories. Results: As a result of categorizing the caregivers’ oral care experience of the elderly, 15 categories, 40 sub-categories, and 125 concept/phenomena codes were derived. The central phenomenon was the difficulty of implementing sustainable oral health care. The deterioration of the mental and physical functions of the elderly, the work characteristics of caregivers, and the lack of linkage with internal and external resources of the facility acted as causal conditions for the central phenomenon. The caregiver’s oral health education experience acted as an intervening condition. In an effort to improve the problem, an interaction strategy was derived. Conclusions It is possible to seek delivery of sustainable oral health care services by caregivers by improving the quality of oral health education and establishing an oral health care service system for the elderly.

Objective: This study evaluated the deep learning (DL) algorithm performance to detect lesions that suggest pneumonia in chest X-rays (CXR) of suspected coronavirus disease 2019 (COVID-19) patients. Methods: This retrospective study included consecutive patients who visited a screening clinic in Daegu, and were suspected to be afflicted with the COVID-19 during the COVID-19 epidemic. CXR were analyzed using the commercial artificial intelligence product that provides free online DL algorithms to the public for COVID-19. Computerized tomography was used as the standard reference. Performance of the DL algorithm was evaluated by the sensitivity and specificity, and results were compared to the CXR records of emergency physicians (EP) in charge of the actual screening triage clinic during the COVID-19 epidemic. Results: Totally, 114 patients were evaluated, of which 38 patients were positive for COVID-19. In 85 CXRs examined (36 COVID-19 and 49 non-COVID-19) with findings of pneumonia in computerized tomography, the DL algorithm showed significantly higher sensitivity as compared to the EP (DL, 98.8% [93.6%-99.9%] vs. EP, 85.9% [76.6%-92.5%]; P<0.01). Moreover, the DL algorithm showed significantly higher sensitivity for detecting CXRs with COVID-19 pneumonia, as compared to the EP (DL, 100.0% [90.3%-100%] vs. EP, 91.7% [77.5%-98.3%]; P=0.08). Conclusion We conclude that for examining the CXR of patients with suspected COVID-19, sensitivity of the DL algorithm is superior than the EP for detecting lesions suggesting pneumonia. Thus, the application of the DL algorithm is potentially useful in screening triage clinics to detect COVID-19 pneumonia.

Objective: This study evaluated the deep learning (DL) algorithm performance to detect lesions that suggest pneumonia in chest X-rays (CXR) of suspected coronavirus disease 2019 (COVID-19) patients. Methods: This retrospective study included consecutive patients who visited a screening clinic in Daegu, and were suspected to be afflicted with the COVID-19 during the COVID-19 epidemic. CXR were analyzed using the commercial artificial intelligence product that provides free online DL algorithms to the public for COVID-19. Computerized tomography was used as the standard reference. Performance of the DL algorithm was evaluated by the sensitivity and specificity, and results were compared to the CXR records of emergency physicians (EP) in charge of the actual screening triage clinic during the COVID-19 epidemic. Results: Totally, 114 patients were evaluated, of which 38 patients were positive for COVID-19. In 85 CXRs examined (36 COVID-19 and 49 non-COVID-19) with findings of pneumonia in computerized tomography, the DL algorithm showed significantly higher sensitivity as compared to the EP (DL, 98.8% [93.6%-99.9%] vs. EP, 85.9% [76.6%-92.5%]; P<0.01). Moreover, the DL algorithm showed significantly higher sensitivity for detecting CXRs with COVID-19 pneumonia, as compared to the EP (DL, 100.0% [90.3%-100%] vs. EP, 91.7% [77.5%-98.3%]; P=0.08). Conclusion We conclude that for examining the CXR of patients with suspected COVID-19, sensitivity of the DL algorithm is superior than the EP for detecting lesions suggesting pneumonia. Thus, the application of the DL algorithm is potentially useful in screening triage clinics to detect COVID-19 pneumonia.