PURPOSE: The study aimed to assess the average time to return to play following surgery for chronic lateral ankle instability in athletes.METHODS: A literature search was conducted (1976 to 2019) by two independent reviewers using the Medline, Embase, and Cochrane library databases. Articles were retrieved by an electronic search using individual keywords (“lateral ankle instability,” “surgery,” “operation,” “return to sport,” “return to play”) and their combinations. Studies that met the inclusion criteria were assessed for pertinent data.RESULTS: Six randomized controlled trials were included in this analysis. The mean follow-up period was 44.8 months (range, 31.8–58.1 months) in 219 patients (male, 126; female, 113). The mean age was 23.2 years (range, 18.2–28.2 years). Different criteria for returning to sports were used in each paper. In the papers included in this study, different methods and definitions were used for the postoperative recovery method for lateral ankle instability injury. The average time until return to play was 16.53 weeks.CONCLUSION: There are limitations to the application of different surgical techniques and data from different athletes for chronic lateral ankle instability. However, these results suggest that sports physicians evaluate the surgical outcome and may be utilized as reference data for informing the athletes about their time until return.
Ankle Injuries ; Ankle ; Athletes ; Female ; Follow-Up Studies ; Humans ; Methods ; Return to Sport ; Sports

In this report, a case of a black meniscus with underlying ochronosis is described. Further analysis by laboratory findings showed that the patient had underlying alkaptonuria, which was previously undiagnosed. The patient's symptoms showed improvement after arthroscopic treatment.
Alkaptonuria ; Arthroscopy ; Humans ; Knee ; Ochronosis

Telmisartan is an angiotensin-II receptor blocker and acts as a selective modulator of peroxisome proliferator-activated receptor gamma (PPARγ). Several studies have demonstrated that telmisartan ameliorates depression and memory dysfunction and reduces brain inflammation. We hypothesized that the beneficial effects of telmisartan on brain could be due to modulation of the blood-brain barrier (BBB) function. Here, we examined the effect of telmisartan on tumor necrosis factor alpha (TNF-α)-induced expression of intercellular adhesion molecule 1 (ICAM-1) which plays an important role in leukocyte transcytosis through the BBB. Telmisartan blocked TNF-α-induced ICAM-1 expression and leukocyte adhesion in U87MG human glioma cells but showed no effect on human brain microvascular endothelial cells. In U87MG cells, a PPAR antagonist, GW9662 did not block the effect of telmisartan on ICAM1 expression but rather potentiated. Moreover, GW9662 caused no change in TNF-α-induced ICAM-1 expression, suggesting no implication of PPARγ in the telmisartan effect. Further studies showed that telmisartan blocked TNF-α-induced activation of c-Jun N-terminal kinase (JNK), extracellular signal-regulated kinase 1/2 (ERK1/2), p38, and nuclear factorkappa B (NF-κB). In contrast, inhibitors of JNK, ERK1/2 and NF-κB but not p38, blocked ICAM-1 expression induced by TNF-α.Thus, our findings suggest that the beneficial effect of telmisartan is likely due to the reduction of astrocytic ICAM1 expression and leukocytes adhesion to astrocytes, and that this response was mediated by the inhibition of JNK/ERK1/2/NF-κB activation and in the PPAR-independent manner. In conclusion, this study enhances our understanding of the mechanism by which telmisartan exerts the beneficial brain function.

Digoxin, a cardiac glycoside, is commonly prescribed to treat heart failure and atrial fibrillation. Because digoxin acts as a substrate of P-glycoprotein (P-gp), its blood concentration may be reduced by P-gp inducers such as rifampin. To assess the real-world implications of this drug-drug interaction, a retrospective analysis was carried out on the Clinical Data Warehouse at Seoul National University Hospital between 2012 and 2017. Eleven patients who received both digoxin and rifampin with satisfying the inclusion/exclusion criteria were identified. The C trough values of digoxin monotherapy were compared to those of the combination therapy with rifampin. Results demonstrated that the systemic exposure of orally administered digoxin decreased by 40% with the concurrent use of rifampin. Clinicians should be aware of potential drug interactions between digoxin and rifampin, as adjustments to digoxin dosage might be necessary for patients receiving rifampin or other P-gp inducer drugs.

Cushing's syndrome is characterized by central obesity, fatigability, weakness, amenorrhea, hirsutism, edema, hypertension, impaired glucose tolerance, and osteoporosis due to excessive production of steroids. Cushing's syndrome is an important cause of secondary osteoporosis. Patients with Cushing's syndrome have a high incidence of osteoporotic fractures. At least, 30-50% of patients with Cushing's syndrome experience fractures, particularly in the vertebral body. And it is consistent with the 50% prevalence of osteoporosis in patients with Cushing's syndrome. However, reports of multiple pathological fractures in young patients with Cushing's syndrome are rare. Thus, we describe the case of a 26-year-old woman with Cushing's syndrome accompanied with recurrent multiple osteoporotic fractures and being treated by parathyroid hormone. Careful consideration for the possibility of Cushing's syndrome will be necessary in case of young patients with a spontaneous multiple compression fractures in spine.
Adult ; Amenorrhea ; Cushing Syndrome ; Edema ; Female ; Fractures, Compression ; Fractures, Spontaneous ; Glucose ; Hirsutism ; Humans ; Hypertension ; Incidence ; Obesity, Abdominal ; Osteoporosis ; Osteoporotic Fractures ; Parathyroid Hormone ; Prevalence ; Spine ; Steroids