Background: This study investigated the prevalence of adrenal insufficiency among patients admitted for total knee arthroplasty (TKA) due to osteoarthritis and identified factors contributing to adrenal insufficiency. Methods: We divided the patients into two groups based on the results of preoperative standard-dose short synchronous stimulation tests: group 1 (adrenal insufficiency) and group 2 (normal adrenal function). We also assessed the prevalence of adrenal insufficiency and compared the numbers of patients who received oral steroids, the frequency of previous steroid injection use, and the frequency of systemic symptoms of steroid depletion such as fatigue and loss of appetite between the two groups. Multiple regression analysis was performed to identify factors related to adrenal insufficiency. Results: The prevalence of adrenal insufficiency was 60.0% (120/200). Group 1 had higher numbers of previous steroid injections (12.8±10.2 vs. 6.8±7.9) and patients taking oral steroids (18/120 vs. 3/80) (p<0.001 and p=0.011, respectively). The frequency of systemic symptoms of steroid depletion, such as fatigue and loss of appetite, was also higher in group 1 (94/120 vs. 42/80, p<0.001). Recent steroid injections and loss of appetite were associated with adrenal insufficiency (p=0.002 and p=0.009, respectively). Conclusions The results of this study revealed a high prevalence of adrenal insufficiency in Korean patients hospitalized for TKA due to end-stage osteoarthritis. Recent steroid injections were causally related to the development of adrenal insufficiency. Therefore, adrenal function should be assessed preoperatively to prevent postoperative complications related to adrenal insufficiency.

Purpose: The purpose of this study is to analyze the clinical results of patients with basicervical fractureundergoing cephalomedullary nailing (CMN) with an additional cannulated screw fixation compared to only performing CMN. We hypothesized that a difference may exist in the clinical outcomes if an ad-ditional screw is fixed with CMN compared to only performing CMN in basicervical fracture. Materials and Methods: A total of 28 consecutive patients who underwent CMN for basicervical fracture were included. In 9 cases, only CMN was conducted, and in 19 cases, an additional cannulated screw fixation was performed with CMN. Bone union, sliding distance, reduction status, and fixation failure were evaluated by postoperative radiography, and ambulatory ability was evaluated by functional results. These findings were compared between a group of CMN and a group of CMN with an additional cannulated screw. Results: There were 4 males and 24 females with a mean age of 84 years (range, 69–100 years). No significant difference was found in postoperative reduction, tip-apex distance, bone union, and walking function recovery after surgery between the two groups, but in the sliding distance of the lag screw, the CMN group demonstrated more sliding (6.2 mm [range, 2.5–13.4 mm] vs 3.5 mm [range, 0.1– 9.2 mm]; p=0.045). Among the two groups, only one case of fixation failure at the postoperative four months was observed in the CMN group (p=0.321), and hemiarthroplasty with nail construct removal was performed. Conclusion CMN with additional cannulated screw fixation is a safe and reliable surgical option in basicervical fracture. It provided favorable clinical outcomes and may be a good alternative for treating basicervical fracture.

Most cystic lesions of the liver are found incidentally in imaging studies because they are not symptomatic, and generally do not require treatment. Rarely, however, symptomatic hepatic cysts may develop complications and require treatment. Here, we describe a case of a 77-year-old woman who developed biliary obstruction with abdominal pain due to compression of the bile duct by a simple hepatic cyst. We confirmed the diagnosis based on symptoms and imaging studies. The patient's symptoms improved after simple cyst ablation by sclerotherapy.
Abdominal Pain ; Aged ; Bile Ducts ; Cholestasis ; Diagnosis ; Female ; Humans ; Liver* ; Sclerotherapy

Interleukin-23 (IL-23) is a novel pro-inflammatory cytokine which has been implicated to play a pathogenic role in rheumatoid arthritis (RA). This study was undertaken to investigate the IL-23 inductive activity of the proinflammatory cytokine IL-17, IL-1 beta and tumor necrosis factor (TNF-alpha) in RA synovial fluid mononuclear cells (SFMC). Expression of IL-23p19, IL-17, IL-1 beta and TNF-alpha in joint was examined by immunohistochemistry (IHC) of patients with RA and osteoarthritis (OA). The effects of IL-17 and IL-1 beta on expression of IL-23p19 in human SFMC from RA patients were determined by reverse transcriptase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). IL-23p19 was expressed in the RA fibroblast like synoviocyte (FLS), but not from OA FLS. Similar to the protein expression, IL-23p19 mRNA could be detected by RT-PCR in RA SFMC. IL-17 and IL-1 beta could induce RA SFMC to produce the IL-23p19. The effects of IL-17 were much stronger than IL-1 beta or TNF-alpha. These responses were observed in a dose- responsive manner. In addition, IL-17 or IL-1 beta neutralizing antibody down-regulated the expression of IL-23p19 induced by LPS in RA-SFMC. Our results demonstrate that IL-23p19 is overexpressed in RA synovium and IL-17 and IL-1 beta appears to upregulate the expression of IL-23p19 in RA-SFMC.
Antibodies, Neutralizing ; Arthritis, Rheumatoid ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Humans ; Immunohistochemistry ; Interleukin-17 ; Interleukin-1beta ; Interleukin-23 ; Interleukin-23 Subunit p19 ; Joints ; Osteoarthritis ; RNA, Messenger ; RNA-Directed DNA Polymerase ; Synovial Fluid ; Synovial Membrane ; Tumor Necrosis Factor-alpha

Interleukin-23 (IL-23) is a novel pro-inflammatory cytokine which has been implicated to play a pathogenic role in rheumatoid arthritis (RA). This study was undertaken to investigate the IL-23 inductive activity of the proinflammatory cytokine IL-17, IL-1 beta and tumor necrosis factor (TNF-alpha) in RA synovial fluid mononuclear cells (SFMC). Expression of IL-23p19, IL-17, IL-1 beta and TNF-alpha in joint was examined by immunohistochemistry (IHC) of patients with RA and osteoarthritis (OA). The effects of IL-17 and IL-1 beta on expression of IL-23p19 in human SFMC from RA patients were determined by reverse transcriptase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). IL-23p19 was expressed in the RA fibroblast like synoviocyte (FLS), but not from OA FLS. Similar to the protein expression, IL-23p19 mRNA could be detected by RT-PCR in RA SFMC. IL-17 and IL-1 beta could induce RA SFMC to produce the IL-23p19. The effects of IL-17 were much stronger than IL-1 beta or TNF-alpha. These responses were observed in a dose- responsive manner. In addition, IL-17 or IL-1 beta neutralizing antibody down-regulated the expression of IL-23p19 induced by LPS in RA-SFMC. Our results demonstrate that IL-23p19 is overexpressed in RA synovium and IL-17 and IL-1 beta appears to upregulate the expression of IL-23p19 in RA-SFMC.
Antibodies, Neutralizing ; Arthritis, Rheumatoid ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Humans ; Immunohistochemistry ; Interleukin-17 ; Interleukin-1beta ; Interleukin-23 ; Interleukin-23 Subunit p19 ; Joints ; Osteoarthritis ; RNA, Messenger ; RNA-Directed DNA Polymerase ; Synovial Fluid ; Synovial Membrane ; Tumor Necrosis Factor-alpha

The acute tumor lysis syndrome is an acute illness caused by massive cell lysis after chemotherapies. This syndrome is characterized by hyperuricemia, hyperphosphatemia with hypocalcemia and hyperkalemia. Among these electrolyte abnormalities, the most serious complication is the severe hyperphosphatemia (greater than 14mg/dL) that could result in sudden cardiac arrest or respiratory failure. In order to correct the severe hyperphosphatemia, hemodialysis has been used commonly as the renal replacement therapy . However the hemodialysis can make posthemodialysis serum phosphate rebounded unless the patient take this treatment for more than 6 hours. Therefore it is not sufficient to use hemodialysis treatment alone. To solve this problem, hemodialysis has been used with or replaced by the uninterrupted dialysis technique such as CRRT (continuous renal replacement therapy). We report a 33-year-old man with Burkitt lymphoma who showed severe hyperphosphatemia (peak phosphate value was 18.6mg/dL) during the course of chemotherapy. used with 5 day CAVH (continuous arteriovenous hemofiltration) his phosphate level could be maintained without any rebound. Therefore we concluded that CAVH in conjunction with hemodialysis would be a successful way to control severe hyperphosphatemia associated with tumor lysis syndrome.
Adult ; Burkitt Lymphoma ; Death, Sudden, Cardiac ; Dialysis ; Drug Therapy ; Hemofiltration* ; Humans ; Hyperkalemia ; Hyperphosphatemia* ; Hyperuricemia ; Hypocalcemia ; Renal Dialysis* ; Renal Replacement Therapy ; Respiratory Insufficiency ; Tumor Lysis Syndrome*

Objectives: This study aimed to explore factors influencing satisfaction with medical services among medically underserved populations at the free medical clinic, providing data to improve free medical services for these populations. Methods: We employed a descriptive correlational study design involving 112 individuals (aged 19 years and older) from medically underserved populations who visited the clinic. Data were collected through face-to-face surveys from September to October 2023, and statistical analyses (t-tests, analysis of variance, Pearson correlation, and hierarchical multiple regression) were used to identify key predictors of satisfaction. Results: Perceived support from healthcare providers emerged as the strongest predictor ofsatisfaction with medical services, demonstrating a significant positive association. While socialsupport was positively correlated with perceived support from healthcare providers, it did not independently predict satisfaction. Conclusion These findings underscore the importance of healthcare provider and social supportin increasing satisfaction with medical services among medically underserved populations.Developing tailored healthcare programs and specialized healthcare provider training are essential strategies to improve healthcare access and outcomes for these vulnerable groups.

Objectives: This study aimed to explore factors influencing satisfaction with medical services among medically underserved populations at the free medical clinic, providing data to improve free medical services for these populations. Methods: We employed a descriptive correlational study design involving 112 individuals (aged 19 years and older) from medically underserved populations who visited the clinic. Data were collected through face-to-face surveys from September to October 2023, and statistical analyses (t-tests, analysis of variance, Pearson correlation, and hierarchical multiple regression) were used to identify key predictors of satisfaction. Results: Perceived support from healthcare providers emerged as the strongest predictor ofsatisfaction with medical services, demonstrating a significant positive association. While socialsupport was positively correlated with perceived support from healthcare providers, it did not independently predict satisfaction. Conclusion These findings underscore the importance of healthcare provider and social supportin increasing satisfaction with medical services among medically underserved populations.Developing tailored healthcare programs and specialized healthcare provider training are essential strategies to improve healthcare access and outcomes for these vulnerable groups.

Objectives: This study aimed to explore factors influencing satisfaction with medical services among medically underserved populations at the free medical clinic, providing data to improve free medical services for these populations. Methods: We employed a descriptive correlational study design involving 112 individuals (aged 19 years and older) from medically underserved populations who visited the clinic. Data were collected through face-to-face surveys from September to October 2023, and statistical analyses (t-tests, analysis of variance, Pearson correlation, and hierarchical multiple regression) were used to identify key predictors of satisfaction. Results: Perceived support from healthcare providers emerged as the strongest predictor ofsatisfaction with medical services, demonstrating a significant positive association. While socialsupport was positively correlated with perceived support from healthcare providers, it did not independently predict satisfaction. Conclusion These findings underscore the importance of healthcare provider and social supportin increasing satisfaction with medical services among medically underserved populations.Developing tailored healthcare programs and specialized healthcare provider training are essential strategies to improve healthcare access and outcomes for these vulnerable groups.

Objectives: This study aimed to explore factors influencing satisfaction with medical services among medically underserved populations at the free medical clinic, providing data to improve free medical services for these populations. Methods: We employed a descriptive correlational study design involving 112 individuals (aged 19 years and older) from medically underserved populations who visited the clinic. Data were collected through face-to-face surveys from September to October 2023, and statistical analyses (t-tests, analysis of variance, Pearson correlation, and hierarchical multiple regression) were used to identify key predictors of satisfaction. Results: Perceived support from healthcare providers emerged as the strongest predictor ofsatisfaction with medical services, demonstrating a significant positive association. While socialsupport was positively correlated with perceived support from healthcare providers, it did not independently predict satisfaction. Conclusion These findings underscore the importance of healthcare provider and social supportin increasing satisfaction with medical services among medically underserved populations.Developing tailored healthcare programs and specialized healthcare provider training are essential strategies to improve healthcare access and outcomes for these vulnerable groups.