BACKGROUND: Few scales are currently available to evaluate changes in hand volume. We aimed to develop a hand grading scale for quantitative assessments of dorsal hand volume with additional consideration of changes in skin texture; to validate and prove the precision and reproducibility of the new scale; and to demonstrate the presence of clinically significant differences between grades on the scale. METHODS: Five experienced plastic surgeons developed the Hand Volume Rating Scale (HVRS) and rated 91 images. Another five plastic surgeons validated the scale using 50 randomly selected images. Intra- and inter-rater agreement was calculated using the weighted kappa statistic and intraclass correlation coefficients (ICCs). Paired images were also evaluated to verify whether the scale reflected clinical differences. RESULTS: The intra-rater agreement was 0.95 (95% confidence interval, 0.922–0.974). The interrater ICCs were excellent (first rating, 0.94; second rating, 0.94). Image pairs that differed by 1, 2, and 3 grades were considered to contain clinically relevant differences in 80%, 100%, and 100% of cases, respectively, while 84% of image pairs of the same grade were found not to show clinically relevant differences. This confirmed that the scale of the HVRS corresponded to clinically relevant distinctions. CONCLUSIONS: The scale was proven to be precise, reproducible, and reflective of clinical differences.
Asian Continental Ancestry Group ; Hand ; Humans ; Plastics ; Rejuvenation ; Skin ; Skin Aging ; Surgeons ; Weights and Measures

OBJECTIVE: To estimate the prevalence of non-adherence to rheumatoid arthritis (RA) medication and identify the associated factors for non-adherence in RA patients. METHODS: Among the KORean Observational study Network for Arthritis 3,523 patients who completed a questionnaire about the adherence to RA medication were analyzed. The patients were divided into two groups: 1) adherent group, patients who skipped medication ≤5 days within the past 2 months; and 2) non-adherent group, patients who skipped ≥6 days of medication. The baseline characteristics were compared, and multivariable regression analysis was performed to identify the associated factors for non-adherence. RESULTS: The non-adherent group had 339 patients (9.6%). The common causes of non-adherence were forgetfulness (45.8%), absence of RA symptoms (24.7%), and discomfort with RA medication (13.1%). Younger age (odds ratio [OR] 1.02, p < 0.01) and higher income (OR 1.70, p < 0.01) were associated with an increased risk of non-adherence. Whereas higher functional disability (OR 0.68, p < 0.01) and oral corticosteroid use (OR 0.73, p=0.02) were associated with a decreased risk of non-adherence. The associated factors differed according to cause of non-adherence. Having adverse events (OR 2.65, p=0.02) was associated with the risk of non-adherence due to discomfort with RA medication while a higher level of education (OR 2.37, p=0.03) was associated with the risk of non-adherence due to an absence of RA symptoms. CONCLUSION: The 9.6% of Korean RA patients were non-adherent to RA medication. The associated factors differed according to the cause of non-adherence. Therefore, an individualized approach will be needed to improve the adherence to RA medication.
Arthritis ; Arthritis, Rheumatoid ; Education ; Humans ; Medication Adherence ; Observational Study ; Prevalence

BACKGROUND/AIMS: To determine whether early diagnosis is beneficial for functional status of various disease durations in rheumatoid arthritis (RA) patients. METHODS: A total of 4,540 RA patients were enrolled as part of the Korean Observational Study Network for Arthritis (KORONA). We defined early diagnosis as a lag time between symptom onset and RA diagnosis of ≤ 12 months, whereas patients with a longer lag time comprised the delayed diagnosis group. Demographic characteristics and outcomes were compared between early and delayed diagnosis groups. Logistic regression analyses were performed to identify the impact of early diagnosis on the development of functional disability in RA patients. RESULTS: A total of 2,597 patients (57.2%) were included in the early diagnosis group. The average Health Assessment Questionnaire-Disability Index (HAQ-DI) score was higher in the delayed diagnosis group (0.64 ± 0.63 vs. 0.70 ± 0.66, p < 0.01), and the proportion of patients with no functional disability (HAQ = 0) was higher in the early diagnosis group (22.9% vs. 20.0%, p = 0.02). In multivariable analyses, early diagnosis was independently associated with no functional disability (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.01 to 1.40). In a subgroup analysis according to disease duration, early diagnosis was associated with no functional disability in patients with disease duration < 5 years (OR, 1.37; 95% CI, 1.09 to 1.72) but not in patients with longer disease duration (for 5 to 10 years: OR, 1.07; 95% CI, 0.75 to 1.52; for ≥ 10 years: OR, 0.92; 95% CI, 0.65 to 1.28). CONCLUSIONS: Early diagnosis is associated with no functional disability, especially in patients with shorter disease duration.
Arthritis ; Arthritis, Rheumatoid* ; Delayed Diagnosis ; Diagnosis ; Early Diagnosis* ; Humans ; Logistic Models ; Observational Study

Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician’s clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.
Arthritis ; Arthritis, Rheumatoid* ; Classification ; Consensus ; Fatigue ; Humans ; Judgment* ; Logistic Models ; Observational Study ; Rheumatic Diseases

This article has been retracted.

BACKGROUND: The clinical presentation and course of Langerhans cell histiocytosis (LCH) are variable, ranging from an isolated, spontaneously remitting bone lesion to multisystem disease with risk organ involvement. Treatment of LCH ranges from a wait-and-see attitude to intensive multidrug therapy and, in some cases, bone marrow transplantation. It is necessary to develop an objective score for assessing disease activity in patients with LCH. We propose a new clinical scoring system to evaluate disease activity at diagnosis that can predict the clinical outcomes of LCH and correlate it with clinical courses. METHODS: Clinical data, obtained from children diagnosed with LCH at Asan Medical Center and Hanyang University Hospital between March 1998 and February 2009, were studied retrospectively. The scoring system was developed according to the basic biological data, radiological findings, and physical findings and applied to a database containing information on 133 patients. RESULTS: The median age of the 133 patients (74 male, 59 female) was 52 months (range, 0.6-178 months), and LCH was diagnosed based on CD1a positivity. At diagnosis, the score distributions were highly asymmetrical: the score was between 1 and 2 in 75.9% of cases, 3-6 in 15.8%, and greater than 6 in 8.3%. Initial scores above 6 were highly predictive of reactivation and late complications. CONCLUSION: This new LCH disease activity score provides an objective tool for assessing disease severity, both at diagnosis and during follow-up.
Bone Marrow Transplantation ; Child ; Follow-Up Studies ; Histiocytosis ; Histiocytosis, Langerhans-Cell ; Humans ; Langerhans Cells ; Male ; Retrospective Studies

Paragangliomas of the urinary bladder are very rare tumors of the paraganglion system that arise from chromaffin cells in or near the sympathetic ganglia. Only approximately 15% of them develop from extra-adrenal chromaffin tissue. Most of these tumors are hormonally active and secrete mainly noradrenaline (rarely adrenaline), calcitonin, and adrenocorticotropic hormone. Paragangliomas are generally benign tumors, with less than 10% being malignant. Here we report a case of a paraganglioma arising in a urinary bladder with a bladder stone.
Adrenocorticotropic Hormone ; Calcitonin ; Chromaffin Cells ; Ganglia, Sympathetic ; Norepinephrine ; Paraganglioma ; Urinary Bladder ; Urinary Bladder Calculi

PURPOSE: The purpose of this study was to evaluate the clinical results of intraoperative periarticular injection for osteoarthritic patients who are treated with total knee arthroplasty (TKA). MATERIALS AND METHODS: Forty patients (2 males and 38 females) who underwent TKA under general anesthesia from January 2007 to May 2007 were enrolled in this study. We classified 20 cases to the injection group and 20 cases to the control group. For the injection group, we injected ropivacaine 40 mg, ketolocac tromethamine 2 mg, epinephrine 0.5 cc and morphine 0.8 cc to the periarticular soft tissue before inserting the prosthesis, and the same amount of saline was injected in the control group. We assessed the clinical results according to preoperative and postoperative range of motion (ROM), the visual analogue scale (VAS), and the dosage of the patient controlled anesthesia (PCA) in both groups. RESULTS: There was no significant difference in preoperative ROM and VAS between the groups (p>0.05). However, significant differences between the groups were reported for the postoperative ROM at 6 and 12 hour. In terms of the VAS, it showed significant differences between the groups at 6 and 12 hours and at the first and second days after operation. The dosage of PCA was significantly lower at postoperative 6 and 12 hours. CONCLUSION: For the patients treated with TKA, periarticular injection to the operation site is supposed to be an effective method at the early stage for recovery of the ROM, the postoperative pain control and to decrease of the PCA dosage.
Amides ; Anesthesia ; Anesthesia, General ; Arthroplasty ; Epinephrine ; Humans ; Knee ; Male ; Morphine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Prostheses and Implants ; Range of Motion, Articular ; Tromethamine

Satisfactory results of unicondylar knee arthroplasty (UKA) have been reported since minimally invasive UKA had been introduced. However, several stress fractures of the tibial plateau, related to instrumentation design, have been reported. We report two cases of periprosthetic stress fractures of the tibial plateau after navigation-assisted unicondylar knee arthroplasties.
Arthroplasty* ; Fractures, Stress* ; Knee*

BACKGROUND: Glomerular endothelial cells should participate in the process of glomerular disease by expressions of HLA antigens and adhesion molecules. However, few have been known about the regulation of the expression of these molecules in human glomerular endothelial cells(HGEC). The aim of this study was to evaluate the expressions of VCAM-1, ICAM-1 and HLA-DR to see if there are any cytokine-dependent or time-dependent differences. METHODS: HGEC were isolated and cultured from the normal portion of the kidneys removed due to renal cell carcinoma, which was confirmed by factor VIII and fluorescent-labeled acetylated LDL. The effects of cytokine on the cell surface expression of VCAM-1, ICAM-1 and HLA-DR were measured by ELISA. RESULTS: ICAM-1 was increased by IL-1 beta, TNF-alpha and IFN-gamma. VCAM-1 was increased by IL-1 beta and TNF-alpha, not by IFN-gamma. IFN-gamma only increased expression of HLA-DR. Basal expression of ICAM-1 was higher than VCAM-1 and HLA-DR. The time course of expression was different according to adhesion molecule. CONCLUSIONS: These data showed that the expression of adhesion molecules and HLA-DR in HGEC were regulated differentially by inflammatory and immune-regulatory cytokines.
Carcinoma, Renal Cell ; Cytokines ; Endothelial Cells* ; Enzyme-Linked Immunosorbent Assay ; Factor VIII ; HLA Antigens ; HLA-DR Antigens* ; Humans* ; Intercellular Adhesion Molecule-1 ; Interleukin-1beta ; Kidney ; Tumor Necrosis Factor-alpha ; Vascular Cell Adhesion Molecule-1