Background: Glyphosate and glufosinate use widely used as herbicide ingredients. There have been several reported cases of chemical burns caused by dermal exposure to glyphosatecontaining herbicide, and patients in these cases were discharged without fatal complications.There were no cases of severe symptoms due to non-oral exposure of glufosinate-containing herbicides. Here, we report a case of fatality accompanied with severe chemical burns in an 81-year-old man who did not wash his skin for more than 48 hours after dermal exposure to herbicide containing glyphosate and glufosinate with surfactant (HGlyGluS).Case presentation: An 81-year-old male with no underlying disease was admitted to the emergency department (ED). He had sprayed HGlyGluS with a manual knapsack sprayer 3 days ago and had not wash away the herbicide. On arrival, he was drowsy and had multiple severe corrosive skin lesions. Skin necrosis (10 × 15 cm) on the right shoulder and skin lesions with subcutaneous fat exposure (15 × 20 cm) on the right thigh were observed. Although he was treated including continuous renal replacement therapy, antibiotic apply, debridement operations, and so on, he was unable to recover and expired. Conclusions We suggest that prolonged dermal exposure to HGlyGluS induces fatality.Further studies including prolonged dermal exposure and ingredients of surfactants should be carried out. Also, it is necessary to educate farmers that it is very important to wash immediately after dermal exposure to pesticide.

Background: Glyphosate and glufosinate use widely used as herbicide ingredients. There have been several reported cases of chemical burns caused by dermal exposure to glyphosatecontaining herbicide, and patients in these cases were discharged without fatal complications.There were no cases of severe symptoms due to non-oral exposure of glufosinate-containing herbicides. Here, we report a case of fatality accompanied with severe chemical burns in an 81-year-old man who did not wash his skin for more than 48 hours after dermal exposure to herbicide containing glyphosate and glufosinate with surfactant (HGlyGluS).Case presentation: An 81-year-old male with no underlying disease was admitted to the emergency department (ED). He had sprayed HGlyGluS with a manual knapsack sprayer 3 days ago and had not wash away the herbicide. On arrival, he was drowsy and had multiple severe corrosive skin lesions. Skin necrosis (10 × 15 cm) on the right shoulder and skin lesions with subcutaneous fat exposure (15 × 20 cm) on the right thigh were observed. Although he was treated including continuous renal replacement therapy, antibiotic apply, debridement operations, and so on, he was unable to recover and expired. Conclusions We suggest that prolonged dermal exposure to HGlyGluS induces fatality.Further studies including prolonged dermal exposure and ingredients of surfactants should be carried out. Also, it is necessary to educate farmers that it is very important to wash immediately after dermal exposure to pesticide.

Background and Objectives: Ambient particulate matter (PM) in real urban air pollution (RUA) is an environmental health risk factor associated with increased cardiac events. This study investigated the threshold level to induce arrhythmia, as well as arrhythmogenic mechanism of RUA that mainly consisted of PM <2.5 μm in aerodynamic diameter close to ultrafine particles. Methods: RUA was artificially produced by a lately developed pyrolysis based RUA generator.C57BL/6 mice were divided into 4 groups: a control group (control, n=12) and three groups with exposure to RUA with the concentration of 200 µg/㎥ (n=12), 400 µg/㎥ (n=12), and 800 µg/㎥ (n=12). Mice were exposed to RUA at each concentration for 8 hr/day and 5 day/week to mimic ordinary human activity during 3 weeks. Results: The QRS and QTc intervals, as well as intracellular Ca2+ duration, apicobasal action potential duration (APD) gradient, fibrosis, and inflammation of left ventricle of mouse hearts were increased dose-dependently with the increase of RUA concentration, and significantly increased at RUA concentration of 400 µg/㎥ compared to control (all p<0.001). In mice exposed to RUA concentration of 800 µg/㎥ , spontaneous ventricular arrhythmia was observed in 42%, with significant increase of inflammatory markers, phosphorylated Ca2+ /calmodulindependent protein kinase II (CaMKII), and phospholamban (PLB) compared to control. Conclusions RUA could induce electrophysiological changes such as APD and QT prolongation, fibrosis, and inflammation dose-dependently, with significant increase of ventricular arrhythmia at the concentration of 400 µg/㎥ . RUA concentration of 800 µg/㎥ increased phosphorylation of CaMKII and PLB.

Background and Objectives: Ambient particulate matter (PM) in real urban air pollution (RUA) is an environmental health risk factor associated with increased cardiac events. This study investigated the threshold level to induce arrhythmia, as well as arrhythmogenic mechanism of RUA that mainly consisted of PM <2.5 μm in aerodynamic diameter close to ultrafine particles. Methods: RUA was artificially produced by a lately developed pyrolysis based RUA generator.C57BL/6 mice were divided into 4 groups: a control group (control, n=12) and three groups with exposure to RUA with the concentration of 200 µg/㎥ (n=12), 400 µg/㎥ (n=12), and 800 µg/㎥ (n=12). Mice were exposed to RUA at each concentration for 8 hr/day and 5 day/week to mimic ordinary human activity during 3 weeks. Results: The QRS and QTc intervals, as well as intracellular Ca2+ duration, apicobasal action potential duration (APD) gradient, fibrosis, and inflammation of left ventricle of mouse hearts were increased dose-dependently with the increase of RUA concentration, and significantly increased at RUA concentration of 400 µg/㎥ compared to control (all p<0.001). In mice exposed to RUA concentration of 800 µg/㎥ , spontaneous ventricular arrhythmia was observed in 42%, with significant increase of inflammatory markers, phosphorylated Ca2+ /calmodulindependent protein kinase II (CaMKII), and phospholamban (PLB) compared to control. Conclusions RUA could induce electrophysiological changes such as APD and QT prolongation, fibrosis, and inflammation dose-dependently, with significant increase of ventricular arrhythmia at the concentration of 400 µg/㎥ . RUA concentration of 800 µg/㎥ increased phosphorylation of CaMKII and PLB.

BACKGROUND:This study was designed to evaluate the efficacy of subcutaneous Botulinum toxin type A (BoNT-A) injection for treating chronic medial knee pain with osteoarthritis. METHODS:A randomized, double-blind, placebo-controlled clinical trial was conducted at a university hospital in Korea.The subjects suffering from chronic medial knee pain with osteoarthritis were randomly allocated to either the BoNT-A (treatment, n = 23) group or the normal saline (placebo, n = 27) group.Injections were given to 10 points per unilateral knee along the course of the saphenous nerve.A total of 90 units of BoNT-A (60 units at baseline and 30 units after 1 week) was given for treating unilateral knee pain and a total of 180 units of BoNT-A was given for treating bilateral knee pain.The placebo group received the same volume of normal saline. RESULTS:The Visual Analog Scale (VAS) pain score was significantly decreased in both the BoNT-A and normal saline groups 1, 4 and 12 weeks after injection.After adjusting for covariates, BoNT-A had a 0.788 times higher effect to decrease the VAS score than did normal saline, but the effect was marginally significant (P = 0.050). CONCLUSIONS:Subcutaneous injection along the course of the saphenous nerve significantly reduces chronic medial knee pain. The pain reduction effect of BoNT-A is higher than that of placebo, but the effect is marginally significant
Botulinum Toxins ; Botulinum Toxins, Type A ; Knee ; Osteoarthritis ; Stress, Psychological

BACKGROUND:This study was designed to evaluate the efficacy of subcutaneous Botulinum toxin type A (BoNT-A) injection for treating chronic medial knee pain with osteoarthritis. METHODS:A randomized, double-blind, placebo-controlled clinical trial was conducted at a university hospital in Korea.The subjects suffering from chronic medial knee pain with osteoarthritis were randomly allocated to either the BoNT-A (treatment, n = 23) group or the normal saline (placebo, n = 27) group.Injections were given to 10 points per unilateral knee along the course of the saphenous nerve.A total of 90 units of BoNT-A (60 units at baseline and 30 units after 1 week) was given for treating unilateral knee pain and a total of 180 units of BoNT-A was given for treating bilateral knee pain.The placebo group received the same volume of normal saline. RESULTS:The Visual Analog Scale (VAS) pain score was significantly decreased in both the BoNT-A and normal saline groups 1, 4 and 12 weeks after injection.After adjusting for covariates, BoNT-A had a 0.788 times higher effect to decrease the VAS score than did normal saline, but the effect was marginally significant (P = 0.050). CONCLUSIONS:Subcutaneous injection along the course of the saphenous nerve significantly reduces chronic medial knee pain. The pain reduction effect of BoNT-A is higher than that of placebo, but the effect is marginally significant
Botulinum Toxins ; Botulinum Toxins, Type A ; Knee ; Osteoarthritis ; Stress, Psychological

PURPOSE: Bone defects in revision TKA were classified according to AORI (Anderson Orthopedic Research Institute) system and results of the treatment are reported according to this classification. MATERIALS AND METHODS: The results of 24 revision TKAs operated from Mar. 1991 to Apr. 1999 were analysed. Fourteen knees had type 1 tibial defects, four knees had type 2 and six knees had type 3. On the femoral side, twelve knees had type 1, four knees had type 2 and seven knees had type 3 defects. Cement and chip bone grafts were mainly used to fill bone defects in type 1, wedges or blocks in type 2 and structural allograft combined with the other methods in type 3. Results were evaluated using the knee and functional scores of the American knee society. RESULTS: The analysis of the results according to the method of treatment- cement filling, chip bone graft, structural bone graft, wedge or blocks and custom made prosthesis- revealed improvements of knee scores in all groups except for custom made prosthesis. CONCLUSION: Satisfactory clinical results were obtained for the management of bone defects according to the AORI classification system in revision total knee arthroplasty.
Allografts ; Arthroplasty* ; Classification ; Knee* ; Orthopedics ; Prostheses and Implants ; Transplants

Background: A nationwide Rehabilitation at Home Care Pilot Program for patients undergoing lower extremity orthopedic surgeries has been ongoing since 2020. The program was designed to improve clinical outcomes through early mobilization and rehabilitation after discharge. This study aimed to analyze the interim data to assess its effectiveness and suggest improvements, particularly for older patients who are more vulnerable compared to younger patients. Methods: We analyzed the data of 872 patients from seven hospitals. Patients were divided into an older-age group (OG; ≥60 years) and younger-age group (YG; <60 years). The Berg Balance Scale (BBS) and Numeric Rating Scale (NRS) scores for pain were the main outcomes. Results: Participants were categorized into OG (n=801) and YG (n=71). The most common surgeries were knee joint replacement (63.7%) in OG and hip joint replacement in YG (77.5%). It took more days to enroll in the pilot program in OG (4.4 days) than YG (3.2 days). OG showed less improvement in BBS than YG for all surgeries (23.3 vs. 31.9) and hip joint surgery (19.8 vs. 33.5). In patients with hip joint replacement in OG, those with a higher number of comorbidities (≥3) showed less BBS improvement than those with fewer comorbidities (<3). In the pain domain, NRS scores decreased in both groups. Conclusion The postoperative rehabilitation education program appeared to be effective in improving physical function and reducing pain severity, though the improvement was less obvious in older patients who may require a more comprehensive approach compared to younger patients.

Background: A nationwide Rehabilitation at Home Care Pilot Program for patients undergoing lower extremity orthopedic surgeries has been ongoing since 2020. The program was designed to improve clinical outcomes through early mobilization and rehabilitation after discharge. This study aimed to analyze the interim data to assess its effectiveness and suggest improvements, particularly for older patients who are more vulnerable compared to younger patients. Methods: We analyzed the data of 872 patients from seven hospitals. Patients were divided into an older-age group (OG; ≥60 years) and younger-age group (YG; <60 years). The Berg Balance Scale (BBS) and Numeric Rating Scale (NRS) scores for pain were the main outcomes. Results: Participants were categorized into OG (n=801) and YG (n=71). The most common surgeries were knee joint replacement (63.7%) in OG and hip joint replacement in YG (77.5%). It took more days to enroll in the pilot program in OG (4.4 days) than YG (3.2 days). OG showed less improvement in BBS than YG for all surgeries (23.3 vs. 31.9) and hip joint surgery (19.8 vs. 33.5). In patients with hip joint replacement in OG, those with a higher number of comorbidities (≥3) showed less BBS improvement than those with fewer comorbidities (<3). In the pain domain, NRS scores decreased in both groups. Conclusion The postoperative rehabilitation education program appeared to be effective in improving physical function and reducing pain severity, though the improvement was less obvious in older patients who may require a more comprehensive approach compared to younger patients.

Background: A nationwide Rehabilitation at Home Care Pilot Program for patients undergoing lower extremity orthopedic surgeries has been ongoing since 2020. The program was designed to improve clinical outcomes through early mobilization and rehabilitation after discharge. This study aimed to analyze the interim data to assess its effectiveness and suggest improvements, particularly for older patients who are more vulnerable compared to younger patients. Methods: We analyzed the data of 872 patients from seven hospitals. Patients were divided into an older-age group (OG; ≥60 years) and younger-age group (YG; <60 years). The Berg Balance Scale (BBS) and Numeric Rating Scale (NRS) scores for pain were the main outcomes. Results: Participants were categorized into OG (n=801) and YG (n=71). The most common surgeries were knee joint replacement (63.7%) in OG and hip joint replacement in YG (77.5%). It took more days to enroll in the pilot program in OG (4.4 days) than YG (3.2 days). OG showed less improvement in BBS than YG for all surgeries (23.3 vs. 31.9) and hip joint surgery (19.8 vs. 33.5). In patients with hip joint replacement in OG, those with a higher number of comorbidities (≥3) showed less BBS improvement than those with fewer comorbidities (<3). In the pain domain, NRS scores decreased in both groups. Conclusion The postoperative rehabilitation education program appeared to be effective in improving physical function and reducing pain severity, though the improvement was less obvious in older patients who may require a more comprehensive approach compared to younger patients.