Purpose: Outcome analysis of urachal cancer (UraC) is limited due to the scarcity of cases and different staging methods compared to urothelial bladder cancer (UroBC). We attempted to assess survival outcomes of UraC and compare to UroBC after stage-matched analyses. Materials and Methods: Total 203 UraC patients from a multicenter database and 373 UroBC patients in single institution from 2000 to 2018 were enrolled (median follow-up, 32 months). Sheldon stage conversion to corresponding TNM staging for UraC was conducted for head-to-head comparison to UroBC. Perioperative clinical variables and pathological results were recorded. Stage-matched analyses for survival by stage were conducted. Results: UraC patients were younger (mean age, 54 vs. 67 years; p < 0.001), with 163 patients (80.3%) receiving partial cystectomy and 23 patients (11.3%) radical cystectomy. UraC was more likely to harbor ≥ pT3a tumors (78.8% vs. 41.8%). While 5-year recurrence-free survival, cancer-specific survival (CSS) and overall survival were comparable between two groups (63.4%, 67%, and 62.1% in UraC and 61.5%, 75.9%, and 67.8% in UroBC, respectively), generally favorable prognosis for UraC in lower stages (pT1-2) but unfavorable outcomes in higher stages (pT4) compared to UroBC was observed, although only 5-year CSS in ≥ pT4 showed statistical significance (p=0.028). Body mass index (hazard ratio [HR], 0.929), diabetes mellitus (HR, 1.921), pathologic T category (HR, 3.846), and lymphovascular invasion (HR, 1.993) were predictors of CSS for all patients. Conclusion Despite differing histology, UraC has comparable prognosis to UroBC with relatively favorable outcome in low stages but worse prognosis in higher stages. The presented system may be useful for future grading and risk stratification of UraC.

Purpose: The study aimed (1) to verify the reliability and validity of the self-reported Korean version questionnaire for predicting chronic ankle instability (CAI); (2) to suggest the accuracy of questionnaires for distinguishing mechanical ankle instability (MAI) and functional ankle instability (FAI), and (3) to set a cut-off value of classification for MAI and FAI. Methods: This study involved 165 subjects (28.16±5.04 years) who consisted of 54 MAI (27 males, 27 females), and 111 FAI (72 males, 39 females). Five self-report questionnaires (Ankle Instability Instrument [AII], Cumberland Ankle Instability Tool [CAIT], Identification of Functional Ankle Instability [IdFAI], Foot and Ankle Ability Measure [FAAM], and Foot and Ankle Disability Index [FADI]) for predicting CAI were administered to all subjects twice at 2 weeks intervals. Questionnaire score was analyzed to calculate the intraclass correlation coefficient (ICC), standard error of measurement, sensitivity, specificity, positive and negative likelihood ratio, area under the curve, and cut-off values. Results: All questionnaires including FADI-Sport (ICC=0.999), FAAM-Sport (ICC=0.992), FAAM-activities of daily living (ADL) (ICC=0.991), IdFAI (ICC=0.986), AII (ICC=0.984), CAIT (ICC=0.981), FADI-ADL (ICC=0.951) showed excellent reliability (ICC＞ 0.75). Furthermore, AII (sensitivity=0.830, specificity=0.924), CAIT (sensitivity=0.915, specificity=0.915), IdFAI (sensitivity=0.809, specificity=0.924), FAAM-ADL (sensitivity=0.681, specificity=0.924), FAAM-Sport (sensitivity=0.851, specificity=0.932), FADI-Sport (sensitivity=0.915, specificity=0.924), and FADI-ADL (sensitivity=0.660, specificity=0.924) questionnaires had high sensitivity and specificity. The cut-off values for MAI and FAI for each questionnaire were 6.5 AII, 20.01 CAIT, 18.52 IdFAI, 85.71% FAAM-ADL, 69.65% FAAM-Sport, 88.53% FADI-ADL, and 79.7% FADI-Sport. Conclusion Self-report questionnaires for identifying those with CAI may help to establish FAI and MAI selection criteria in sports, clinical, and laboratory settings.

Objective: Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are considered substitutes for each other for evaluating Crohn’s disease (CD). However, the adequacy of mixing them for routine periodic follow-up for CD has not been established. This study aimed to compare MRE alone with the mixed use of CTE and MRE for the periodic follow-up of small bowel inflammation in patients with CD. Materials and Methods: We retrospectively compared two non-randomized groups, each comprising 96 patients with CD. One group underwent CTE and MRE (MRE followed by CTE or vice versa) for the follow-up of CD (interval, 13–27 months [median, 22 months]), and the other group underwent MRE alone (interval, 15–26 months [median, 21 months]). However, these two groups were similar in clinical characteristics. Three independent readers from three different institutions determined whether inflammation had decreased, remained unchanged, or increased within the entire small bowel and the terminal ileum based on sequential enterography of the patients after appropriate blinding. We compared the two groups for inter-reader agreement and accuracy (terminal ileum only) using endoscopy as the reference standard for enterographic interpretation. Results: The inter-reader agreement was greater in the MRE alone group for the entire small bowel (intraclass correlation coefficient [ICC]: 0.683 vs. 0.473; p = 0.005) and the terminal ileum (ICC: 0.656 vs. 0.490; p = 0.030). The interpretation accuracy was higher in the MRE alone group without statistical significance (70.9%–74.5% vs. 57.9%–64.9% in individual readers; adjusted odds ratio = 3.21; p = 0.077). Conclusion The mixed use of CTE and MRE was inferior to MRE alone in terms of inter-reader reliability and could probably be less accurate than MRE alone for routine monitoring of small bowel inflammation in patients with CD. Therefore, the consistent use of MRE is favored for this purpose.

Purpose: Anterior cruciate ligament reconstruction (ACLR) is one of the most common procedures in sports medicine.It is important for patients to determine whether or not to return to the pre-operative state after the ACRL. This study is to evaluate the objective and subjective analysis of the knee joint function and to compare between injured knee and non-injured knee in those with ACLR.Methods: This cross-sectional study recruited 15 individuals with ACLR using autograft (age, 27.87±4.10 years; height, 172.56±4.81 cm; weight, 75.51±13.03 kg; time to surgery, 27.11±14.03 months). International Knee Document Committee subjective knee evaluation form and Lower Extremity Assessment Protocol (LEAP) including muscle strength, static and dynamic postural control, functional task was used to assess the knee joint function. Deficit ratio between injured knee and non-injured knee and independent t-test were used for analysis. Results: Injured knee has significantly decreased isokinetic extension strength (90º/sec), isometric flexion strength and one-leg hopping distance (p＜ 0.05). Conclusion Although individuals who successfully returned to play (RTP) did not experience subjective dysfunction and pain, there are items of LEAP that indicates deficit ratio between injured knee and non-injured knee. Therefore, when considered whether and when to RTP, it is very important to assess not only subjective dysfunction and pain but also whether the patient has recovered to a level similar to that of the non-injured knee in various aspects of the knee joint.

PURPOSE: To investigate the alteration of lower extremity movement during maintaining balance test with their eyes closed in chronic ankle instability (CAI) patients compared to healthy group with and without plantar cutaneous sensation. METHODS: Ten healthy volunteers (age, 23.40±2.22 years; height, 165.42±6.67 cm; weight, 60.93±13.42 kg) and 10 CAI patients (age, 23.90±2.56 years; height, 166.89±10.50 cm; weight, 67.43±12.96 kg), were recruited. Subjects immersed both feet in an ice water for 10 minutes and performed three trials of a single-leg stance balance test with their eyes closed while standing on a force plate for 10 seconds. RESULTS: CAI group showed increased knee flexion, reduced knee external rotation, and hip internal rotation compared to the healthy group from single-limb stance with eyes closed after diminished plantar cutaneous sensation. However, there was no significant interaction between group and time. CONCLUSION: These findings indicate that the postural kinematic analyses revealed that individuals with CAI used different strategy of controlling their lower extremities, which alters transverse plane motion of hip and knee compared to the healthy group in order to compensate for their ankle deficits after freezing the plantar cutaneous.
Ankle ; Foot ; Freezing ; Healthy Volunteers ; Hip ; Humans ; Ice ; Knee ; Lower Extremity ; Sensation ; Water