Purpose: Total hip arthroplasty (THA) using dual mobility components (DMC) is a reasonable surgical option for displaced femoral neck fractures in elderly patients, resulting in lower dislocation rates and improved stability. The purpose of this study was to investigate the clinical outcomes and risk factors responsible for mortality in elderly patients who were diagnosed with a displaced femoral neck fracture and had undergone DMC-THA. Materials and Methods: Out of 147 cases of THA from December 2018 to June 2020, a total of 79 cases were enrolled in this study, with the following characteristics: (1) Garden stage III or IV, (2) over 75 years of age, and (3) over 1 year of follow-up. All the patients received DMC-THA surgery using the anterolateral approach. Results: The mean follow-up period was 15.0±8.43 months and a total of one dislocation case was observed. The mortality rate was 17.7% (14/79), and it was especially higher in patients with a past medical history of malignancy (odds ratio [OR]=7.18, p=0.03) or a cognitive disorder such as dementia (OR=5.48, p=0.03). Preoperative low initial hemoglobin levels (OR=0.65, p=0.04) and low UCLA (Uni-versity of California at Los Angeles) score (OR=0.47, p=0.02) were also associated with mortality. Conclusion When considering THA as a treatment approach in elderly patients with a displaced femoral neck fracture, a high mortality rate is expected in patients with low preoperative hemoglobin levels or a history of malignancy or cognitive disorders. Hence, thorough monitoring and management should be undertaken before and after surgery.

Purpose: This study was performed to compare the clinical results and radiological follow-up differences between intertrochanteric fractures treated with the U-blade Gamma3 nail or the Zimmer natural nail (ZNN). Materials and Methods: The medical records of 129 cases diagnosed with an intertrochanteric frac-ture (90 cases of U-blade Gamma3 nail, 39 cases of ZNN) from July 2015 to December 2018 were reviewed. Patients were assigned to a U-blade Gamma3 nail (n=39) or a ZNN (n=39) group. To reduce selective bias, groups were subjected to Propensity score matching by age, body mass index, bone mineral density, and fracture type. Patients that met the following criteria were excluded; age <65 years, non-ambulatory, high energy or pathologic fracture, and a follow-up of <6 months. Operation times, estimated blood losses, preoperative and postoperative Koval grades, Harris hip score and radiological lag screw positions in the femoral head, reduction quality, cut-out, tip-apex distance (TAD), lag screw sliding distances, and times to union were compared. Results: Clinical results were similar in the two groups, but lag screw TAD was significantly greater in Ublade Gamma3 nail group (23.4 mm vs. 21.0 mm) (p=0.042). One case of cut-out occurred in the Ublade Gamma3 nail group, but no other nail-related postoperative complication was noted. Conclusion No significant difference was observed between the outcomes of U-blade Gamma3 nail or ZNN treatments of intertrochanteric fractures. We conclude that the U-blade confers no specific advan-tage.

Purpose: This study was performed to compare the clinical results and radiological follow-up differences between intertrochanteric fractures treated with the U-blade Gamma3 nail or the Zimmer natural nail (ZNN). Materials and Methods: The medical records of 129 cases diagnosed with an intertrochanteric frac-ture (90 cases of U-blade Gamma3 nail, 39 cases of ZNN) from July 2015 to December 2018 were reviewed. Patients were assigned to a U-blade Gamma3 nail (n=39) or a ZNN (n=39) group. To reduce selective bias, groups were subjected to Propensity score matching by age, body mass index, bone mineral density, and fracture type. Patients that met the following criteria were excluded; age <65 years, non-ambulatory, high energy or pathologic fracture, and a follow-up of <6 months. Operation times, estimated blood losses, preoperative and postoperative Koval grades, Harris hip score and radiological lag screw positions in the femoral head, reduction quality, cut-out, tip-apex distance (TAD), lag screw sliding distances, and times to union were compared. Results: Clinical results were similar in the two groups, but lag screw TAD was significantly greater in Ublade Gamma3 nail group (23.4 mm vs. 21.0 mm) (p=0.042). One case of cut-out occurred in the Ublade Gamma3 nail group, but no other nail-related postoperative complication was noted. Conclusion No significant difference was observed between the outcomes of U-blade Gamma3 nail or ZNN treatments of intertrochanteric fractures. We conclude that the U-blade confers no specific advan-tage.

OBJECTIVES: The purpose of this study was to explore the influence of high school students' mental health on their academic achievement and school dropout rate by using longitudinal data. METHODS: For this study, 153 high schools were randomly sampled on a nationwide scale. The descriptive data was collected from a school information internet site which is organized by the Korean Ministry of Education. We used the schools' mean scores on the Adolescent Mental Health Problem-Behavior Questionnaire-II (AMPQ-II) scale which was used for estimating students' mental health in the 2013 school-based mental health screening test. The data analysis was conducted by using hierarchical regression analysis. RESULTS: The results of this study showed that the AMPQ-II scale's mean scores have significant effects on the following year's academic achievement and annual dropout rates. Especially, the AMPQ-II scale's mean scores tend to increase the school dropout rate in vocational schools. CONCLUSION: The finding of this study is that Korean high school students' mental health states significantly influence their academic achievement and school dropout rate.
Adolescent ; Education ; Humans ; Internet ; Mass Screening ; Mental Health* ; Statistics as Topic ; Student Dropouts*

BACKGROUND: The purpose of this study was to evaluate the cost-effectiveness of screening tests (AFP and US) for early detection of primary hepatocellular carcinoma (HCC) and its optimal screening interval in Korean hepatitis B virus carriers. METHODS: Data relating to tumor incidence, efficacy of screening tests, tumour growth times and various cost for detecting HCC were obtained from reviews of Korean literature. Decision analysis technique was used to calculate the efficacy of these screening tests and screening interval. RESULTS: When the doubling time of HCC was 6 months, the most cost-effective screening interval of each AFP and US was 6 months, respectively. The optimal screening intervals of AFP and US were 3 and 5 months for each, respectively, and 7 months for both when a detection rate of 80% was expected. These results were significantly altered when the different tumour growth times reported in other literatures were applied. CONCLUSION: If the doubling time of HCC was 6 months, the optimal screening interval was 7 months on using both tests. Because the tumour doubling time alters the optimal screening interval, further evaluation on the doubling time of Korean hepatoma is needed.
Carcinoma, Hepatocellular ; Decision Support Techniques ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Incidence ; Mass Screening*

BACKGROUND: Beers criteria are used to identify the potentially inappropriate medications (PIMs) in elderly patients. However, the criteria have limitations such as lacking consideration of drug-drug and duplicated prescriptions. The aim of this study is to compare the efficacy of newly developed screening tool of older person's prescriptions (STOPP) with Beers criteria in identifying PIMs and adverse drug events (ADEs) in elderly patients. METHODS: We included 115 elderly patients older than 65 years who visited the outpatients' clinic or have been hospitalized for medical illness. Comprehensive geriatric assessments including medication review by the pharmacists were performed by the multidisciplinary team. Beers criteria and STOPP were used to find out PIMs. The association between PIMs defined by both criteria with ADEs was also evaluated. RESULTS: A total of 59 patients (50.4%) by Beers criteria and 76 patients (65.0%) by STOPP had been prescribed with PIMs. Compared with Beers criteria, STOPP had advantage in identifying more PIMs. In addition, STOPP could identify more ADEs related medications than Beers criteria. STOPP was also useful to detect duplicate drug class prescription and nonsteroidal anti-inflammatory drugs for renal impaired patients. CONCLUSION: STOPP criteria PIMs can detect more duplicated prescription and are significantly associated with avoidable ADEs in older individuals compared with that of Beers criteria PIMs.
Aged ; Beer ; Drug Toxicity ; Geriatric Assessment ; Humans ; Imidazoles ; Mass Screening ; Nitro Compounds ; Pharmacists ; Prescriptions

Arteriovenous malformation of the female pelvis is a rare condition, and its diagnosis, classification, and treatment are still sources of considerable confusion. Now, multidisciplinary and individualized approaches with the use of modern interventional radiologic technology are stressed and play an important role in the management of female pelvic arteriovenous malformation. We experienced a patient, 28-year0old woman with a uterine arteriovenous malformation presenting with irregular vaginal bleeding. At physical examination the slightly enlarged uterus was found, but no other abdominal or cardiopulmonary abnormalities were found. Diagnosis was established by angiography and contrast-enhanced CT/MRI scan. The patient underwent preoperative intra-arterial embolization to decrease operative morbidity and facilitate complete removal. Hysterectomy and resection of surrounding tissue was done successfully. Pathologic examination showed that the uterine myometrium was involved by the arteriovenous malformation and it was composed of fat and fibrous tissues with shick-walled and dilated blood vessels of various diameter. Now we report a case of arteriovenous malformation with a brief review.
Angiography ; Animals ; Arteriovenous Malformations* ; Blood Vessels ; Classification ; Diagnosis ; Female ; Humans ; Hysterectomy ; Mice ; Myometrium ; Pelvis ; Physical Examination ; Technology, Radiologic ; Uterine Hemorrhage ; Uterus

Broncholith is a calcified lymph node which partially or completely erodes into the bronchial lumen and broncholithiasis is a relatively rare condition which related to late tissue response to healing granulomatous pulmonary infections, most commonly histoplasmosis or tuberculosis. The prominent symptoms of broncholithiasis are coughing followed by hemoptysis and symptoms related to bronchial obstruction. The complications include bronchoesophageal fistula and aortotracheal fistula. We report one case of broncholithiasis caused by Aspergillus. The case was a 53 year-old house wife whose chief complaints were recurrent fever, chill and malaise. The chest film revealed an ovoid hazziness on the right middle lobe and chest CT scan showed consolidation of lateral segment of right middle lobe with calcified small low attenuated lesion in right middle lobe bronchus. Aspergillosis confirmed by pathology after bronchoscopic removal of impacted Aspergillus containing muddy plug from lateral segmental branch of right middle lobe bronchus.
Aspergillosis ; Aspergillus* ; Bronchi ; Cough ; Cytochrome P-450 CYP1A1 ; Fever ; Fistula ; Hemoptysis ; Histoplasmosis ; Humans ; Lymph Nodes ; Middle Aged ; Pathology ; Spouses ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis

Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory condition presenting with painful, deep-seated abscesses and sinus tracts in multifocal locations. Rarely, longstanding inflammation in HS may lead to serious complications, such as cutaneous squamous cell carcinoma (SCC) (also termed Marjolin ulcer). Herein, we report a case of invasive cutaneous SCC arising from chronic ulcers of a HS patient. A 40-year old Korean male, a current smoker with 20 pack-year history, presented with a history of painful, recurrent, deep-seated abscesses and ulcers on the buttocks since his late teens, thus classified as Hurley stage III. A large purulent ulcer developed on the right buttock several months ago. Initial treatment was focused on controlling infection and facilitating wound healing. The lesion showed 50% reduction of size in 6 weeks, but also developed foul odor and showed fungating margins. Multiple skin biopsies were consistent with invasive SCC. Magnetic resonance imaging revealed a few enlarged lymph nodes on the right inguinal area, which was confirmed as metastasis on frozen biopsy.Slow Mohs micrographic surgery and radical right inguinal lymph node dissection was done. Incidence rates of SCC aris-ing from HS have been reported up to 4.6%. To our knowledge, this is the first report of cutaneous SCC arising from HS in Korea. Our case emphasizes that the diagnosis of cutaneous SCC in HS should not be delayed, and early surgical intervention is crucial for better outcomes.

To examine individual variation in drug metabolism catalyzed by flavin-containing monooxygenase (FMO), 179 Korean volunteers' urinary molar concentration ratio of theobromine (TB) and caffeine (CA) was determined. Their urine was collected for 1 hr (between 4 and 5 hrs) after they drank a cup of coffee containing 115 mg CA and analyzed by an HPLC system. The lowest TB/CA ratio obtained was 0.40, the highest ratio was 15.17 (38-fold difference), and the median ratio for all subjects was 1.87. The mean was 2.66 with 2.36 S.D.. In 134 nonsmokers, the mean ratio was 2.35 +/- 1.93, that of 51 males was 2.30 +/- 2.26 and 83 females was 2.37 +/- 1.85, respectively. There was no significant gender difference in the obtained TB/CA ratio (Mann-Whitney test; p=0.518). There were no smokers among the 83 female volunteers. In the remaining 96 male subjects, the ratio obtained in 51 nonsmokers was 2.30 +/- 2.06 and that of 45 smokers was 3.62 +/- 3.19. This indicated that the TB/CA ratio was increased significantly in smokers (p=0.007). However, when the TB/CA ratios (FMO activity) obtained in all 179 Korean volunteers are compared with the urinary concentration ratios of paraxanthine (PX) plus 1,7-dimethylurate (17U) to CA (CYP1A2 activity), there was a weak but significant correlation (Pearson's correlation coefficient test; r2=0.28, p<0.0001). This indicates that, although the urinary TB/CA ratio mostly represents FMO activity, minor contribution by CYP1A2 activity cannot be ignored. In conclusion, the FMO activity measured by taking the urinary TB/CA ratio from normal healthy Korean volunteers shows marked individual variations without significant gender differences and the increased TB/CA ratio observed in cigarette smokers may have been caused by the increased CYP1A2 activity.
Caffeine* ; Chromatography, High Pressure Liquid ; Coffee* ; Cytochrome P-450 CYP1A2 ; Drinking* ; Ethanol ; Female ; Humans ; Male ; Metabolism ; Molar ; Theobromine* ; Tobacco Products ; Volunteers