Osteochondritis dissecans of the knee occurs twice as often in males as in females. The peak incidence is about fifteen years of age, and most patients are first diagnosed before the age of eighteen. The etiology of osteochondritis dissecans is still unknown, but the most accepted theories are trauma, ischemia, abnormal ossification within the physes, constitutional or genetic predisposition, and a combination of these. Osteochondritis dissecans of the knee associated with gout was first reported by Carrabba in 1969. And no additional case has been reported. The purpose of this paper is to present an unusual case of osteochondritis dissecans of the knee associated with gout.
Female ; Genetic Predisposition to Disease ; Gout* ; Humans ; Incidence ; Ischemia ; Knee* ; Male ; Osteochondritis Dissecans* ; Osteochondritis*

Kaempferol exerts cardioprotective actions through incompletely understood mechanisms. This study investigated the molecular mechanisms underlying the cardioprotective effects of kaempferol in sinus node dysfunction (SND) heart. Here, we demonstrate that angiotensin II (Ang II) infusion causes SND through oxidized calmodulin kinase II (CaMKII). In contrast to this, kaempferol protects sinus node against Ang II-induced SND. Ang II evoked apoptosis with caspase-3 activation in sinus nodal cells. However, kaempferol lowered the CaMKII oxidization and the sinus nodal cell death. To block the CaMKII oxidization, gene of p47phox, a cytosolic subunit of NADPH oxidase, was deleted using Cas9 KO plasmid. In the absence of p47phox, sinus nodal cells were highly resistance to Ang II-induced apoptosis, suggesting that oxidized-CaMKII contributed to sinus nodal cell death. In Langendorff heart from Ang II infused mice, kaempferol preserved normal impulse formation at right atrium. These data suggested that kaempferol protects sinus node via inhibition of CaMKII oxidization and may be useful for preventing SND in high risk patients.
Angiotensin II ; Animals ; Apoptosis ; Calcium-Calmodulin-Dependent Protein Kinase Type 2* ; Calcium-Calmodulin-Dependent Protein Kinases ; Caspase 3 ; Cell Death ; Cytosol ; Heart ; Heart Atria ; Humans ; Mice ; NADPH Oxidase ; Plasmids ; Sick Sinus Syndrome* ; Sinoatrial Node*

PURPOSE: The purpose of this study was to identify the effects of heating on the non-affected hand on blood flow velocity, wound healing, and pain for hand microsurgery patients. METHODS: This study was designed using the nonequivalent control group pretest-posttest design. Thirty-nine patients were assigned either to the experimental group (20 patients) or control group (19 patients). Data were analyzed with chi2-test, Fisher's exact test, t-test, and repeated measure ANOVA using SPSS/WIN 17.0 program. RESULTS: After treatment in this program, blood flow velocity (F=5.13, p=.008) and wound healing (F=4.11, p=.020) improved significantly in the experimental group compared to the control group. But there was no significant improvement in pain in the experimental group compared to the control group (F=2.40, p=.097). CONCLUSION: Based upon these results, the non-affected side hand heating was recommended as an independent nursing intervention for the patients who need improvement in blood flow velocity and wound healing such as patients who have microsurgery. As the heating was effective even when applied on the non-affected side, it is the applicable to patients who cannot tolerate any therapy on affected side.
Adult ; Blood Flow Velocity/*physiology ; Female ; Hand Injuries/surgery/*therapy ; Humans ; Hyperthermia, Induced ; Male ; *Pain Measurement ; Time Factors ; Wound Healing/*physiology

PURPOSE: This study aimed to examine influence of cognitive function, disease severity and disability on ability to perform activity of daily living (ADL) after ischemic stroke. METHODS: A total of 88 patients with ischemic stroke were recruited from January 1, 2008 to December 31, 2012 and assessed with the standardized cognitive test battery and self-reports about disease severity, disability, and ADL. To analyze the data, ANOVA, Pearson correlation coefficients and multiple regression were conducted using SPSS/WIN program. RESULTS: Significant correlations were found between ADL and visuospatial function, visual memory, executive function, and disability (r=.29~.38). Executive function and disability explained 17.3% of total variability in ADL performance after ischemic stroke. CONCLUSION: Executive function may be a promising target for cognitive rehabilitation after ischemic stroke. Thus, effective therapeutic interventions such as cognitive training for stroke patients should be considered to improve their ability to perform ADL.
Activities of Daily Living* ; Cognition ; Executive Function ; Humans ; Memory ; Rehabilitation ; Severity of Illness Index ; Stroke*

No abstract available.
Absorption* ; Hysteroscopy*

Insulin sensitizers, while effective in glucose-lowering for diabetes control, are linked to an increased risk of heart disease through mechanisms that are not well understood. In this study, we investigated the molecular mechanisms underlying the effects of insulin sensitization on cardiac sinus node dysfunction. We used pharmacologic or genetic approaches to enhance insulin sensitivity, by treating with pioglitazone or rosiglitazone, or through phosphatase and tensin homolog (PTEN) deletion in cardiomyocytes respectively. We employed an angiotensin II (Ang II)-induced hypertensive animal model which causes sinus node dysfunction and accumulation of oxidized calcium/calmodulin-dependent protein kinase II (CaMKII), which also serves as a biomarker for this defect. While neither PTEN deficiency nor insulin sensitizers caused sinus node dysfunction in normotensive mice, both accelerated the onset of sinus node dysfunction and CaMKII oxidation in hypertensive mice.These abnormalities were accompanied by a significant defect in autophagy as revealed by unc-51 like autophagy activating kinase 1 (ULK1) signaling. Indeed, mice deficient in ulk1 in cardiomyocytes and the sinus node also showed early onset of slow atrial impulse conduction with frequent sinus pauses and upregulated CaMKII oxidation following Ang II infusion similar to that seen with PTEN deficiency, or treatment with insulin sensitizers. To further elucidate the role of autophagy in sinus node dysfunction, we treated mice with a peptide D-Tat-beclin1 that enhanced autophagy, which significantly abrogated the frequent sinus pauses and accumulation of oxidized CaMKII induced by insulin sensitizers treatment, or PTEN deficiency in hypertensive animals. Together, these findings provide clear evidence of the detrimental cardiac effects of insulin sensitization that occurs through failure of autophagy-mediated proteolytic clearance.

OBJECTIVES: We examined whether pericardial adipose tissue (PAT) is predictive of prediabetes and type 2 diabetes over time. METHODS: In total, 2,570 adults without prediabetes/diabetes from the Coronary Artery Risk Development in Young Adults Study were followed up over 15 years. PAT volume was measured by computed tomography scans, and the new onset of prediabetes/diabetes was examined 5 years, 10 years, and 15 years after the PAT measurements. Multivariable Cox regression models were used to examine the association between the tertile of PAT and incident prediabetes/diabetes up to 15 years later. The predictive ability of PAT (vs. waist circumference [WC], body mass index [BMI], waist-to-height ratio [WHtR]) for prediabetes/diabetes was examined by comparing the area under the receiver operating characteristic curve (AUC). RESULTS: The highest tertile of PAT was associated with a 1.56 times (95% confidence interval [CI], 1.03 to 2.34) higher rate of diabetes than the lowest tertile; however, no association was found between the highest tertile of PAT and prediabetes in the fully adjusted models, including additional adjustment for BMI or WC. In the fully adjusted models, the AUCs of WC, BMI, WHtR, and PAT for predicting diabetes were not significantly different, whereas the AUC of WC for predicting prediabetes was higher than that of PAT. CONCLUSIONS PAT may be a significant predictor of hyperglycemia, but this association might depend on the effect of BMI or WC. Additional work is warranted to examine whether novel adiposity indicators can suggest advanced and optimal information to supplement the established diagnosis for prediabetes/diabetes.

BACKGROUND: To evaluate oral anticoagulant (OAC) utilization in patients with atrial fibrillation after the changes in the health insurance coverage policy in July 2015. METHODS: We used the Health Insurance Review and Assessment Service-National Patient Samples (HIRA-NPS) between 2014 and 2016. The HIRA-NPS, including approximately 1.4 million individuals, is a stratified random sample of 3% of the entire Korean population using 16 age groups and 2 sex groups. The HIRA-NPS comprises personal and medical information such as surgical or medical treatment provided, diagnoses, age, sex, region of medical institution, and clinician characteristics. The studied drugs included non-vitamin K antagonist OACs (NOACs) such as apixaban, dabigatran, edoxaban, and rivaroxaban, and were compared with warfarin. We analyzed drug utilization pattern under three aspects: person, time, and place. RESULTS: The number of patients with atrial fibrillation who were prescribed OACs was 3,114, 3,954, and 4,828; and the proportions of prescribed NOACs to total OACs were 5.1%, 36.2%, and 60.8% in 2014, 2015, and 2016, respectively. The growth rate of OACs prescription increased from 61.4 patients/quarter before June 2015 to 147.7 patients/quarter thereafter. These changes were predominantly in elderly individuals aged more than 70 years. The proportion of NOACs to OACs showed significant regional difference. CONCLUSION: The change of health insurance coverage policy substantially influenced OACs prescription pattern in whole Korean region. But the impact has been significantly different among regions and age groups, which provides the evidence for developing standard clinical practice guideline on OACs use.
Aged ; Anticoagulants ; Atrial Fibrillation* ; Dabigatran ; Drug Utilization ; Drug Utilization Review ; Humans ; Insurance, Health* ; Korea* ; Prescriptions* ; Rivaroxaban ; Warfarin

Objective: : The percutaneous thread transection technique is a surgical dissecting method using a dissecting thread inserted through a needle under ultrasound guidance without skin incision. As the new dissecting threads were developed domestically, this cadaver study was conducted to compare the effectiveness and safety between the new threads (ultra V sswire and smartwire-01) and a pre-existing commercial dissecting thread (loop & shear) by demonstrating a modified looped thread cubital tunnel release. Methods: : The percutaneous cubital tunnel release procedure was performed on 29 fresh cadaveric upper extremities. The preexisting commercial thread was used in 5 upper extremities. The two newly developed threads were used in 24 upper extremities. Two practitioners performed the procedures separately. After the modified looped thread cubital release, anatomical and histological analyses were performed by a blinded anatomist. The presence of the dissected cubital tunnel and damaged adjacent soft tissue was assessed. Results: : Out of the 29 cadaveric upper extremities, 27 specimens showed complete dissection of the Osborne ligament and the proximal fascia of the flexor carpi ulnaris muscle. One specimen was incompletely dissected in each of the ultra V sswire and smartwire-01 groups. There were no injuries of adjacent structures including the ulnar nerve, ulnar artery, medial antebrachial cutaneous nerve, or flexor tendon with either the commercial thread or the newly developed threads. The anatomical analysis revealed clear and sharp incisional margins of the cubital tunnel in the Smartwire-01 and loop & shear groups. All three kinds of threads maintained proper linear elasticity for easy handling during the procedure. The smartwire-01 provided higher visibility in ultrasound than the other threads. Conclusion : The newly developed threads were effective and safe for use in the thread cubital tunnel release procedure.

Objective: To examine the usefulness and feasibility of modified thread carpal tunnel release (TCTR) by comparing the results of using pre-existing commercial thread with those of a newly developed thread (Smartwire-01). Methods: A total of 17 cadaveric wrists were used in the study. The modified TCTR method was practiced by two different experts. Pre-existing commercial surgical dissecting thread (Loop&ShearTM) was used for five wrists and the newly developed Smartwire-01 was used for twelve wrists. The gross and microanatomy of the specimens were evaluated by a blinded anatomist. Results: Both types of thread were able to cut the TCL similarly. Gross anatomy and histologic findings showed that there was no significant difference between the two types of threads. However, the practitioners felt that it was easier to cut the TCL using the newly-developed thread. Conclusion TCTR using Smartwire-01 was as effective as pre-existing Loop&ShearTM, with better user experiences.