BACKGROUND: Displaced anterior column fractures have increasingly been treated surgically by the ilioinguinal approach and fixation with lag screws and a buttress plate on the pelvic brim. However, a major disadvantage of the ilioinguinal approach is possible damage to the neurovascular bundle and the lymphatic structures in the intermediate part of the approach. This study aims to present a novel surgical technique of the less invasive anterior iliac approach and compression osteosynthesis for high anterior column fractures of the acetabulum. METHODS: In this retrospective case series, 19 patients treated operatively for isolated high anterior column fractures using the less invasive anterior iliac approach and compression osteosynthesis were included. Patient demographics, the cause of injury, associated injuries, time to surgical reconstruction, and operation time were collected from the medical records. The quality of reduction was assessed by postoperative standard radiographic views and computed tomography scans and graded according to Matta's criteria. Clinical and radiographic grades were assessed according to Matta's criteria at the last follow-up. RESULTS: This less invasive surgical technique was successful for reduction and fixation in all high anterior column fractures and provided sufficient stability to allow immediate mobilization of the patients after surgery. Twelve fractures were combined with the quadrilateral plate fracture and seven fractures did not involve the quadrilateral plate. According to Matta's criteria, anatomical reduction was obtained in 17 patients and imperfect reduction in two patients. Clinical results were excellent in 17 patients and good in two patients. Radiographic results were excellent in 17 patients and good in two patients. Ten patients had neurapraxia of the lateral femoral cutaneous nerve related to the approach, which was resolved completely in seven. One patient had deep vein thrombosis. CONCLUSIONS: Our less invasive surgical technique of the anterior iliac approach and compression osteosynthesis is a useful addition to the existing techniques in the treatment of high anterior column fractures of the acetabulum. Despite being a limited approach and fixation, this technique provides sufficient exposure for reducing and fixing the fracture and adequate stability to allow immediate mobilization of the patient after surgery.
Acetabulum* ; Demography ; Follow-Up Studies ; Humans ; Medical Records ; Retrospective Studies ; Venous Thrombosis

Background: With an aging population, the importance of treating and diagnosing osteoporosis is increasing. Osteoporosis, previously known as a resorptive change primarily related to endocrinological mechanisms, is also being approached as a phenomenon of senile change. Denosumab is gaining popularity among osteoporosis medications due to its ability to increase bone mineral density (BMD) and the economic benefit arising from the 6-month cycle. In line with previous literature, this study aimed to examine the BMD-augmenting effect of denosumab through which it reduces fracture risk in individuals aged over 80 years. Methods: We reviewed patients who received denosumab between 2018 and 2022 with a minimum clinical observation period of 12 months. BMD was measured every 12 months, and patients were classified per their period of denosumab use. Fracture risk was evaluated using the fracture risk assessment tool (FRAX) and fracture incidence during the observation period were assessed. Results: Among 155 patients, a significant increase in BMD was observed at 3 sites: the lumbar spine, femoral neck, and total hip (p<0.001, p<0.001, and p=0.001, respectively). The patients were divided according to the length of clinical follow-up they received, and similar results were found in all subgroups. Fracture risk assessment was performed using FRAX and the incidence of fracture events during follow-up. FRAX significantly decreased in all subgroups except those who received 24 months of follow-up (p=0.003, p=0.41, p=0.001 in the 12, 24, and ≥36 months groups, respectively). Conclusions Denosumab use resulted in long-term BMD increase and reduced fracture risk in individuals aged 80 and above.

STUDY DESIGN: Case report. OBJECTIVES: To report the effectiveness of open reduction and internal (screw) fixation treatment performed to treat dislocation of the first coccygeal vertebra. SUMMARY OF LITERATURE REVIEW: Most treatment methods for coccygeal dislocation were conservative treatment for acute coccygodynia and coccygectomy for chronic coccygodynia. MATERIALS AND METHODS: A 18-year-old female presented with severe coccygodynia due to a fall down the stairs. Computed tomography showed dislocation of the first coccygeal vertebra. We performed open reduction and internal fixation with a 4.0-mm shortthread cancellous screw with a washer, with no additional procedure for bone union. RESULTS: Union was achieved 10 weeks postoperatively. CONCLUSIONS: Open reduction and internal (screw) fixation can be a useful method for coccygeal vertebra dislocation.
Adolescent ; Dislocations* ; Female ; Humans ; Methods ; Spine*

Although various basal-bolus insulin therapy (BBIT) protocols have been used in the clinical environment, safer and more effective BBIT protocols are required for glucose control in hospitalized patients with type 2 diabetes (T2D). Modeling approaches could provide an evaluation environment for developing the optimal BBIT protocol prior to clinical trials at low cost and without risk of danger. In this study, an in-silico model was proposed to evaluate subcutaneous BBIT protocols in hospitalized patients with T2D. The proposed model was validated by comparing the BBIT protocol and sliding-scale insulin therapy (SSIT) protocol. The model was utilized for in-silico trials to compare the protocols of adjusting basal-insulin dose (BBIT1) versus adjusting total-daily-insulin dose (BBIT2). The model was also used to evaluate two different initial total-daily-insulin doses for various levels of renal function. The BBIT outcomes were superior to those of SSIT, which is consistent with earlier studies. BBIT2 also outperformed BBIT1, producing a decreased daily mean glucose level and longer time-in-target-range. Moreover, with a standard dose, the overall daily mean glucose levels reached the target range faster than with a reduced-dose for all degrees of renal function. The in-silico studies demonstrated several significant findings, including that the adjustment of total-daily-insulin dose is more effective than changes to basal-insulin dose alone. This research represents a first step toward the eventual development of an advanced model for evaluating various BBIT protocols.
Blood Glucose/analysis ; Diabetes Mellitus, Type 2/*drug therapy ; Hospitalization ; Humans ; Hypoglycemic Agents/*therapeutic use ; Insulin/*therapeutic use ; Models, Theoretical

Neutrophils and eosinophils, 2 prominent granulocytes, are commonly derived from myelocytic progenitors through successive stages in the bone marrow. Our previous genome-wide transcriptomic data unexpectedly showed that genes encoding a multitude of neutrophil primary granule proteins (NPGPs) were markedly downregulated during the end period of eosinophilic terminal differentiation when cord blood (CB) cluster of differentiation (CD) 34+ cells were induced to differentiate toward the eosinophil lineage during a 24-day culture period. Accordingly, this study aimed to examine whether NPGP genes were expressed on the way to eosinophil terminal differentiation stage and to compare their expression kinetics with that of genes encoding eosinophil-specific granule proteins (ESGPs). Transcripts of all NPGP genes examined, including proteinase 3, myeloperoxidase, cathepsin G (CTSG), and neutrophil elastase, reached a peak at day 12 and sharply declined thereafter, while transcript of ESGP genes including major basic protein 1 (MBP1) attained maximum expression at days 18 or 24. Growth factor independent 1 (GFI1) and CCAAT/enhancer-binding protein α (C/EBPA), transactivators for the NPGP genes, were expressed immediately before the NPGP genes, whereas expression of C/EBPA, GATA1, and GATA2 kinetically paralleled that of eosinophil granule protein genes. The expression kinetics of NPGPs and ESGPs were duplicated upon differentiation of the eosinophilic leukemia cell line (EoL-1) immature eosinophilic cells. Importantly, confocal image analysis showed that CTSG was strongly coexpressed with MBP1 in differentiating CB eosinophils at days 12 and 18 and became barely detectable at day 24 and beyond. Our results suggest for the first time the presence of an immature stage where eosinophils coexpress NPGPs and ESGPs before final maturation.
Bone Marrow ; Cathepsin G ; Cell Line ; Eosinophils* ; Fetal Blood ; Granulocytes ; Hypereosinophilic Syndrome ; Kinetics ; Leukocyte Elastase ; Myeloblastin ; Neutrophils* ; Peroxidase ; Trans-Activators

BACKGROUND: We are continually exposed to low-dose radiation (LDR) in the range 0.1 Gy from natural sources, medical devices, nuclear energy plants, and other industrial sources of ionizing radiation. There are three models for the biological mechanism of LDR: the linear no-threshold model, the hormetic model, and the threshold model. OBJECTIVE: We used keratinocytes as a model system to investigate the molecular genetic effects of LDR on epidermal cell differentiation. METHODS: To identify keratinocyte differentiation, we performed western blots using a specific antibody for involucrin, which is a precursor protein of the keratinocyte cornified envelope and a marker for keratinocyte terminal differentiation. We also performed quantitative polymerase chain reaction. We examined whether LDR induces changes in involucrin messenger RNA (mRNA) and protein levels in calcium-induced keratinocyte differentiation. RESULTS: Exposure of HaCaT cells to LDR (0.1 Gy) induced p21 expression. p21 is a key regulator that induces growth arrest and represses stemness, which accelerates keratinocyte differentiation. We correlated involucrin expression with keratinocyte differentiation, and examined the effects of LDR on involucrin levels and keratinocyte development. LDR significantly increased involucrin mRNA and protein levels during calcium-induced keratinocyte differentiation. CONCLUSION: These studies provide new evidence for the biological role of LDR, and identify the potential to utilize LDR to regulate or induce keratinocyte differentiation.
Blotting, Western ; Cell Differentiation ; Keratinocytes* ; Molecular Biology ; Nuclear Energy ; Polymerase Chain Reaction ; Radiation, Ionizing ; RNA, Messenger

BACKGROUND: The oral minimal model is a simple, useful tool for the assessment of β-cell function and insulin sensitivity across the spectrum of glucose tolerance, including normal glucose tolerance (NGT), prediabetes, and type 2 diabetes mellitus (T2DM) in humans. METHODS: Plasma glucose, insulin, and C-peptide levels were measured during a 180-minute, 75-g oral glucose tolerance test in 24 Korean subjects with NGT (n=10) and T2DM (n=14). The parameters in the computational model were estimated, and the indexes for insulin sensitivity and β-cell function were compared between the NGT and T2DM groups. RESULTS: The insulin sensitivity index was lower in the T2DM group than the NGT group. The basal index of β-cell responsivity, basal hepatic insulin extraction ratio, and post-glucose challenge hepatic insulin extraction ratio were not different between the NGT and T2DM groups. The dynamic, static, and total β-cell responsivity indexes were significantly lower in the T2DM group than the NGT group. The dynamic, static, and total disposition indexes were also significantly lower in the T2DM group than the NGT group. CONCLUSION: The oral minimal model can be reproducibly applied to evaluate β-cell function and insulin sensitivity in Koreans.
Blood Glucose ; C-Peptide ; Diabetes Mellitus, Type 2* ; Glucose Tolerance Test ; Glucose* ; Humans ; Insulin ; Insulin Resistance ; Prediabetic State

BACKGROUND AND OBJECTIVES: The aim of this study was to analyze the summating potential (SP)/action potential (AP) ratio of electrocochleography (ECoG) recorded from the position of SP peak. We compared the SP/AP ratios of negative polarity and positive polarity graphs from the same ECoG of each patient by assuming different the position of SP peak. In addition, we attempted to evaluate the utility of two different manners of recording the ECoG graph in the diagnosis of Meniere's disease. SUBJECTS AND METHOD: Retrospectively, we analyzed the results of ECoG in 67 patients with unilateral definite Meniere's disease. ECoG was analyzed in two different manners. From the AP peak, the SP peak was determined close when positioned in the negative polarity; on the other hand, SP peak was considered distant when positioned in the positive polarity. The SP/AP ratio was interpreted with reference to the base line value. The ratio of two different ECoG values from each patient of Meniere's disease was calculated. RESULTS: In the abnormal side, the negative polarity ECoG showed significantly greater value of SP/AP ratio (mean: 0.334±0.10) than the positive polarity ECoG (mean: 0.283±0.09) (p<0.001). In the normal side, the negative polarity ECoG, showed significantly greater value of SP/AP ratio (mean: 0.250±0.09) than the positive polarity ECoG (mean: 0.204±0.06), as well as in the abnormal cases (p<0.001). CONCLUSION: The standard SP/AP ratio for the diagnosis of Meniere's disease can be variable according to the manner of determining the SP peak.
Action Potentials ; Audiometry, Evoked Response* ; Diagnosis ; Evoked Potentials ; Hand ; Humans ; Meniere Disease ; Methods ; Retrospective Studies

The incretin effect, which is a unique stimulus of insulin secretion in response to oral ingestion of nutrients, is calculated by the difference in insulin secretory responses from an oral glucose tolerance test (OGTT) and a corresponding isoglycemic intravenous glucose infusion (IIGI) study. The OGTT model of this study, which is individualized by fitting the glucose profiles during an OGTT, was developed to predict the glucose profile during an IIGI study in the same subject. Also, the model predicts the insulin and incretin profiles during both studies. The incretin effect, estimated by simulation, was compared with that measured by physiologic studies from eight human subjects with normal glucose tolerance, and the result exhibited a good correlation (r > 0.8); the incretin effect from the simulation was 56.5% +/- 10.6% while the one from the measured data was 52.5% +/- 19.6%. In conclusion, the parameters of the OGTT model have been successfully estimated to predict the profiles of both OGTTs and IIGI studies. Therefore, with glucose data from the OGTT alone, this model could control and predict the physiologic responses, including insulin secretion during OGTTs and IIGI studies, which could eventually eliminate the need for complex and cumbersome IIGI studies in incretin research.
Administration, Oral ; Adult ; Area Under Curve ; Blood Glucose/analysis ; *Computer Simulation ; Female ; Glucose/metabolism/pharmacology ; Glucose Tolerance Test ; Humans ; Incretins/*blood ; Insulin/blood ; Liver/drug effects ; Middle Aged ; *Models, Theoretical ; ROC Curve

An 18-year-old male with a Fontan circulation underwent excision of a pheochromocytoma after conversion from laparoscopic surgery. The pneumoperitoneum established for laparoscopic surgery may have adverse effects on the Fontan circulation, because it increases the intra-abdominal pressure (IAP), intra-thoracic pressure, pulmonary vascular resistance, and systemic vascular resistance (SVR), and decreases cardiac preload and cardiac output. Meticulous monitoring is also required during carbon dioxide exsufflation, because a rapid decrease in IAP can provoke hemodynamic deterioration by decreasing venous return and SVR. Furthermore, catecholamines released by the pheochromocytoma can worsen the hemodynamic status of Fontan circulation during surgery. Therefore, sophisticated intraoperative anesthetic care is required during laparoscopic pheochromocytoma excision in patients with a Fontan circulation.
Adolescent ; Anesthesia, General ; Carbon Dioxide ; Cardiac Output ; Catecholamines ; Fontan Procedure ; Hemodynamics ; Humans ; Laparoscopy ; Male ; Pheochromocytoma* ; Pneumoperitoneum ; Vascular Resistance