Background: Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS.Additionally, we analyzed factors associated with complications arising from these procedures. Methods: Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean followup period was 33.2 months (range, 12–85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9–55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed. Results: Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12–35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65–100) and 95.5 (range, 74–100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs. Conclusions A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.

Background: Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS.Additionally, we analyzed factors associated with complications arising from these procedures. Methods: Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean followup period was 33.2 months (range, 12–85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9–55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed. Results: Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12–35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65–100) and 95.5 (range, 74–100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs. Conclusions A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.

Background: Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS.Additionally, we analyzed factors associated with complications arising from these procedures. Methods: Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean followup period was 33.2 months (range, 12–85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9–55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed. Results: Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12–35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65–100) and 95.5 (range, 74–100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs. Conclusions A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.

Background: Staged operations are commonly employed in the management of high-energy tibial plateau fractures (TPF) complicated by acute compartment syndrome (ACS); however, complications, such as nonunion, deep wound infection, and traumatic arthritis, often occur due to severe bone and soft-tissue damage. We aimed to report the radiological and clinical outcomes of staged surgical interventions performed following complete closure of the fasciotomy wound for the treatment of TPF complicated by ACS.Additionally, we analyzed factors associated with complications arising from these procedures. Methods: Thirty patients with TPF and ACS were included (23 men and 7 women; average age, 59.7 years). The mean followup period was 33.2 months (range, 12–85 months). An external fixator was initially applied with emergency fasciotomy, and open reduction and plate fixation were performed after complete closure of the fasciotomy wound and soft-tissue stabilization (mean, 31 days; range, 9–55 days). Radiological evaluation of bone union and alignment was conducted, functional evaluation of the knee and ankle joints was performed using the Knee Society and American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications and related factors were analyzed. Results: Primary bone union was achieved in 29 of the 30 cases (96.7%) at an average of 20.8 weeks (range, 12–35 weeks). Malalignment was not observed in any case. At the final follow-up examination, the mean Knee Society and AOFAS scores were 92.5 (range, 65–100) and 95.5 (range, 74–100), respectively. Complications included 1 case of nonunion (3.3%), 2 cases of deep wound infection (6.7%), and 5 cases of traumatic arthritis (16.7%). A statistically significant correlation was noted between complications and patients who underwent dual approaches for the fixation of bicondylar TPFs. Conclusions A staged operation coupled with sufficient soft-tissue healing can achieve excellent bone union and functional outcomes in patients with TPF and ACS. However, complications may occur more often in patients undergoing dual approaches for bicondylar TPFs, necessitating vigilant monitoring and management.

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disease characterized by spiking fever, arthralgia, skin rashes, and hyperferritinemia. The rash is usually salmon-colored, non-itchy, accompanied by fever, and disappears with an improvement of fever. However, in some cases, the rash persisted regardless of fever. Here, we present a case of AOSD with an atypical persistent rash that showed histological findings resembling those of neutrophilic urticarial dermatosis. The patient was a 60-year-old woman with high fever, arthralgia, and a persistent flagellated skin rash. Despite systemic steroid treatment, the patient developed a serious complication: macrophage activation syndrome. Since this case presented with an atypical persistent rash with histological resemblance to neutrophilic urticarial dermatosis, we report its contribution to the further study of AOSD.

Background/Aims: A relationship between fatty liver and lung function impairment has been identified, and both are independently associated with metabolic dysfunction. However, the temporal relationship between changes in fatty liver status and lung function and their genome-wide association remain unclear. Methods: This longitudinal cohort consisted of subjects who received serial health check-ups, including liver ultrasonography and spirometry, for ≥3 years between 2003 and 2015. Lung func-tion decline rates were classified as “slow” and “accelerated” and compared among four different sonographic changes in steatosis status: “normal,” “improved,” “worsened,” and “persistent.” A genome-wide association study was conducted between the two groups: normal/improved steatosis with a slow decline in lung function versus worsened/persistent steatosis with an accelerated decline in lung function. Results: Among 6,149 individuals, the annual rates of decline in forced vital capacity (FVC) and forced expiratory volume measured in the first second of exhalation (FEV 1 ) were higher in the worsened/persistent steatosis group than in the normal/improved steatosis group. In multivariable analysis, persistent or worsened status of fatty liver was significantly associated with accelerated declines in FVC (persistent status, odds ratio [OR]=1.22, 95% confidence interval [CI]=1.04–1.44; worsened status, OR=1.30, 95% CI=1.12–1.50), while improved status of fatty liver was significantly associated with slow declines in FEV 1 (OR=0.77, 95% CI=0.64–0.92). The PNPLA3 risk gene was most strongly associated with steatosis status change and accelerated declines in FVC (rs12483959, p=2.61×10 -7 ) and FEV 1(rs2294433, p=3.69×10 -8 ). Conclusions Regression of fatty liver is related to lung function decline. Continuing efforts to improve fatty liver may preserve lung function, especially for subjects with a high genetic risk.

BACKGROUND AND OBJECTIVES: Proficient differentiation of human pluripotent stem cells (hPSCs) into specific lineages is required for applications in regenerative medicine. A growing amount of evidences had implicated hormones and hormone-like molecules as critical regulators of proliferation and lineage specification during in vivo development. Therefore, a deeper understanding of the hormones and hormone-like molecules involved in cell fate decisions is critical for efficient and controlled differentiation of hPSCs into specific lineages. Thus, we functionally and quantitatively compared the effects of diverse hormones (estradiol 17-β (E2), progesterone (P4), and dexamethasone (DM)) and a hormone-like molecule (retinoic acid (RA)) on the regulation of hematopoietic and neural lineage specification. METHODS AND RESULTS: We used 10 nM E2, 3 μM P4, 10 nM DM, and 10 nM RA based on their functional in vivo developmental potential. The sex hormone E2 enhanced functional activity of hematopoietic progenitors compared to P4 and DM, whereas RA impaired hematopoietic differentiation. In addition, E2 increased CD34⁺CD45⁺ cells with progenitor functions, even in the CD43⁻ population, a well-known hemogenic marker. RA exhibited lineage-biased potential, preferentially committing hPSCs toward the neural lineage while restricting the hematopoietic fate decision. CONCLUSIONS: Our findings reveal unique cell fate potentials of E2 and RA treatment and provide valuable differentiation information that is essential for hPSC applications.
Dexamethasone ; Humans ; Induced Pluripotent Stem Cells ; Pluripotent Stem Cells ; Progesterone ; Regenerative Medicine ; Tretinoin

BACKGROUND: Sleep is an essential restorative physiologic phenomenon. Impaired sleep results in significant negative effect to the health. Symptoms like sleep initiation difficulty, frequent awakening, severe snoring have related to poor sleep quality. We studied frequency and compared the characteristics of common sleep disorders at family practice. METHODS: We surveyed patients over 18 years of age and their guardians who visited 16 familial practices for 6 days. We investigated sleep characteristics, frequency of sleep disorder and associated factors by questionnaires and analyzed by frequency analysis, Spearman's correlation coefficient, multiple logistic regression. RESULTS: We enrolled 1,117 participants. Older participants were more likely to report early sleep onset and off time, short sleep duration. Mean number of awakening during a typical night is 1.69. Female complained difficulties in initiation and maintenance of sleep more than male. A total of 32.5% had these insomnia symptoms and related to hypertension, stroke, stress, arthralgia, depression, urological disorder. 31.1% had excessive daytime sleepiness, related to stress, arthralgia, depression. Loud snoring and gasp for breath showed positive correlation between male, high BMI. Disrupted sleep over 3 times was related to old age, female, diabetes, hypertension, stroke, stress, arthralgia, depression. Restless leg syndrome were high in elderly, high BMI, stress, arthralgia and depression. CONCLUSION: About one in three who visit in primary medical practice have sleep disorder symptoms like insomnia, daytime fatigue, snoring. 3% of them have gasp for breath, 8% have restless leg syndrome.
Aged ; Arthralgia ; Depression ; Family Practice ; Fatigue ; Female ; Humans ; Hypertension ; Leg ; Male ; Prevalence ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Snoring ; Stroke

PURPOSE: Aspirin-intolerant asthma (AIA) is characterized by moderate to severe asthma that is aggravated by aspirin or other non-steroidal anti-inflammatory drugs. Affected patients frequently have chronic rhinosinusitis and nasal polyposis due to persistent upper and lower airway inflammation with marked eosinophilia. IL-13 plays a crucial role in the development of allergic asthma by inducing airway eosinophilia and hyper-reactivity and it has been correlated with an increased eosinophil count. METHODS: Two promoter polymorphisms of the IL-13 gene (-1510 A>C and -1055C>T) and one coding nonsynonymus Arg110Gln (110G>A) polymorphism were genotyped using primer extension methods in 162 patients with AIA, 301 patients with aspirin-tolerant asthma (ATA), and 430 normal healthy controls (NC). RESULTS: There was no significant difference in the genotype, allele, and haplotype frequencies of the three polymorphisms among the three groups. AIA patients with the AA genotype -1510A>C (P=0.012) and CC genotype -1055C>T (P<0.001) had a significantly higher frequency of rhinosinusitis, as compared to those with the minor alleles of these two single nucleotide polymorphisms. AIA patients with the GG genotype had a higher peripheral eosinophil count (P=0.025) and a higher serum eotaxin-1 level (P=0.044), as compared to patients with the AA genotype IL-13 Arg110Gln (110G>A). CONCLUSIONS: These findings suggest that the IL-13 polymorphisms at -1510A>C and 1055C>T are associated with the development of rhinosinusitis in AIA patients. IL-13 Arg110Gln may be associated with an increased eosinophil count and eotaxin-1 level and could increase eosinophilic inflammation in the upper and lower airways of patients with AIA.
Alleles ; Aspirin ; Asthma ; Chemokine CCL11 ; Clinical Coding ; Eosinophilia ; Eosinophils ; Genotype ; Haplotypes ; Humans ; Inflammation ; Interleukin-13 ; Polymorphism, Single Nucleotide