Purpose: Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs) are frequently employed to counteract the detrimental effects of proteinuria on glomerular diseases. However, the effects of ARBs remain poorly examined in pediatric patients with immunoglobulin A (IgA) nephropathy. Herein, we evaluated the efficacy and safety of losartan, an ARB, in pediatric IgA nephropathy with proteinuria. Methods: This prospective, single-arm, multicenter study included children with IgA nephropathy exhibiting proteinuria. Changes in proteinuria, blood pressure, and kidney function were prospectively evaluated before and 4 and 24 weeks after losartan administration. The primary endpoint was the difference in proteinuria between baseline and 24 weeks. Results: In total, 29 patients were enrolled and received losartan treatment. The full analysis set included 28 patients who received losartan at least once and had pre- and post-urinary protein to creatinine ratio measurements (n=28). The per-protocol analysis group included 22 patients who completed all scheduled visits without any serious violations during the study period. In both groups, the mean log (urine protein to creatinine ratio) value decreased significantly at 6 months. After 24 weeks, the urinary protein to creatinine ratio decreased by more than 50% in approximately 40% of the patients. The glomerular filtration rate was not significantly altered during the observation period. Conclusions Losartan decreased proteinuria without decreasing kidney function in patients with IgA nephropathy over 24 weeks. Losartan could be safely employed to reduce proteinuria in this patient population. ClinicalTrials.gov trial registration (NCT0223277)

Background: Most previous studies have evaluated flexion strength to assess recovery after arthroscopic rotator cuff (RC) repair.However, limited data are available regarding peak torque at the initial angle (iPT) because most studies have measured flexion strength for peak torque (PT), particularly in small- and medium-sized supraspinatus tears. The purpose of this study was to compare conventional PT and iPT to evaluate supraspinatus muscle strength after arthroscopic RC repair in patients with small- and medium-sized supraspinatus tears. Methods: Isokinetic muscle performance testing was performed in 42 patients with small tears and in 47 patients with medium-sized tears. PT and iPT were evaluated before and 1 year after surgery and were recorded at an angular velocity of 60°/sec and 180°/sec with an isokinetic test. Results: PT and iPT were significantly lower in the involved-side shoulders than in the uninvolved-side shoulders (PT: small tear, p < 0.001; medium tear, p < 0.001; iPT: small tear, p < 0.001; medium tear, p < 0.001) in both groups, preoperatively. However, postoperatively, in the involved-side shoulders, PTs were not different in both small- and medium-sized tears (all p > 0.05), but iPTs were significantly lower in the involved-side shoulders (small tear, p < 0.001; medium tear, p < 0.001). iPT was significantly lower in the involved side shoulders in the medium-sized tear group than in the small-sized tear group before and after surgery (p < 0.05). In the smalland medium-sized tear groups, tear size was significantly correlated with preoperative iPT in the involved-side shoulders (small tear: r = –0.304, p = 0.046; medium tear: r = –0.323, p= 0.027). However, pain visual analog scale was significantly correlated with preoperative (small tear: r = –0.455,p = 0.002; medium tear: r = –0.286, p = 0.044) and postoperative (small tear: r = –0.430, p = 0.005; medium tear: r = –0.354, p = 0.021) iPT in the involved-side shoulders. Furthermore, fatty infiltration grade of the supraspinatus muscle and global fatty degeneration index were not associated with preoperative and postoperative PT and iPT in each group (all p > 0.05). Conclusions iPT is as important as conventional PT in isokinetic testing to assess supraspinatus muscle strength before and after RC repair.

Background: Denosumab (DEN) and zoledronic acid (ZOL) currently represent the most potent antiresorptive agents for the treatment of osteoporosis. Despite similar effects on bone resorption, these agents have distinct mechanisms of action. The objective of this study was to compare the effect of DEN and ZOL after two-year administration on bone mineral density (BMD), trabecular bone score (TBS), bone turnover markers, and persistence. Methods: A total of 585 postmenopausal women with osteoporosis who did not use osteoporosis medications were retrospectively reviewed. 290 patients were administered 60 mg DEN subcutaneously every 6 months from 2017 to 2018, and 295 patients were treated with 5 mg ZOL intravenously yearly from 2015 to 2017. BMD, TBS, and C-terminal crosslinking telopeptide of type 1 collagen (CTX) measurements were obtained at baseline and two-year after DEN injection or ZOL infusion. Results: After two-year follow-up, 188 patients in the DEN group and 183 patients in the ZOL group were compared. BMD change from baseline at two years was significantly greater in the DEN group compared with the ZOL group (P < 0.001). The changes of TBS in the DEN group were statistically significant compared with baseline (P < 0.001) and the ZOL group (P < 0.001). The DEN group led to significantly greater reduction of CTX compared with ZOL group (P = 0.041). Conclusion In postmenopausal women with osteoporosis, DEN was associated with greater BMD increase at all measured skeletal sites, greater increase of TBS, and greater inhibition of bone remodeling compared with ZOL.

Background: Posterior inferior capsule (PIC) tightness in the shoulder joint, a known risk factor for shoulder injury, can be assessed using shear-wave ultrasound elastography (SWE). However, to date, the correlation between PIC elasticity and shoulder rotator muscle performance in college baseball players with glenohumeral internal rotation deficit (GIRD) has not been reported. This study aimed to analyze the differences in PIC elasticity measured using SWE and shoulder rotator muscle performance between male college baseball players with and without GIRD. Methods: Twenty-four male college baseball players participated in this study: 10 with GIRD (G group) vs. 14 without GIRD (NG group). PIC elasticity was measured using SWE in the lateral decubitus position. Shoulder rotator muscle performance tests were performed for the internal rotators (IRs) and external rotators (ERs) at an angular velocity of 180°/sec with 90° shoulder abduction using an isokinetic test device. Results: Mean PIC elasticity was significantly greater in the throwing shoulders of the G group than in those of the NG group (4.8 ± 1.2 kPa vs. 3.7 ± 1.2 kPa, p= 0.036). In the throwing shoulders of the G group, compared with those of the NG-group, the ER/IR ratio was significantly lower (35.7% ± 5.0% vs. 55.5% ± 6.2%, p < 0.001) and IR muscle strength was significantly greater (75.0 ± 7.6 Nm kg −1 × 100 vs. 55.7 ± 6.4 Nm kg −1 × 100, p = 0.002). The mean elasticity of the PIC showed a significant negative correlation with the ER/IR ratio in the throwing shoulders of the G group (r = −0.640, p = 0.046). Conclusions Among the male college baseball players with GIRD, SWE could quantitatively assess PIC tightness, and an imbalance in shoulder rotator muscle strength was found in these baseball players. Therefore, clinicians and therapists need to focus on the restoration of shoulder rotator muscle imbalance in addition to improving internal rotation in these players.

MRI has the advantages of having excellent soft-tissue contrast and providing functional information without any harmful ionizing radiation. Although previous technical limitations restricted the use of chest MRI, recent technological advances and expansion of insurance coverage are increasing the demand for chest MRI. Recognizing the need for guidelines on appropriate use of chest MRI in Korean clinical settings, the Korean Society of Radiology has composed a development committee, working committee, and advisory committee to develop Korean chest MRI justification guidelines. Five key questions were selected and recommendations have been made with the evidence-based clinical imaging guideline adaptation methodology.Recommendations are as follows. Chest MRI can be considered in the following circumstances:for patients with incidentally found anterior mediastinal masses to exclude non-neoplastic conditions, for pneumoconiosis patients with lung masses to differentiate progressive massive fibrosis from lung cancer, and when invasion of the chest wall, vertebrae, diaphragm, or major vessels by malignant pleural mesothelioma or non-small cell lung cancer is suspected. Chest MRI without contrast enhancement or with minimal dose low-risk contrast media can be considered for pregnant women with suspected pulmonary embolism. Lastly, chest MRI is recommended for patients with pancoast tumors planned for radical surgery.

MRI has the advantages of having excellent soft-tissue contrast and providing functional information without any harmful ionizing radiation. Although previous technical limitations restricted the use of chest MRI, recent technological advances and expansion of insurance coverage are increasing the demand for chest MRI. Recognizing the need for guidelines on appropriate use of chest MRI in Korean clinical settings, the Korean Society of Radiology has composed a development committee, working committee, and advisory committee to develop Korean chest MRI justification guidelines. Five key questions were selected and recommendations have been made with the evidence-based clinical imaging guideline adaptation methodology.Recommendations are as follows. Chest MRI can be considered in the following circumstances:for patients with incidentally found anterior mediastinal masses to exclude non-neoplastic conditions, for pneumoconiosis patients with lung masses to differentiate progressive massive fibrosis from lung cancer, and when invasion of the chest wall, vertebrae, diaphragm, or major vessels by malignant pleural mesothelioma or non-small cell lung cancer is suspected. Chest MRI without contrast enhancement or with minimal dose low-risk contrast media can be considered for pregnant women with suspected pulmonary embolism. Lastly, chest MRI is recommended for patients with pancoast tumors planned for radical surgery.

Background: The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods: This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results: Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53%) and infection (44%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

As the elderly population increases, the incidence of lumbar fusion is increasing, and there has been increasing interest in rapid rehabilitation and functional recovery after surgery. Enhanced recovery after surgery program and multimodal pain control methods can reduce the complications and allow rapid recovery. Various methods have been used to increase the fusion.

PURPOSE: We previously demonstrated that CD44v9 and Ki-67 played an important role in predicting poor prognosis of early gastric cancer (EGC). However, little is known about combined use of both biomarkers as prognostic biomarker. The present study was performed to investigate the significance of CD44v9 and Ki-67 expression as a combination biomarker for EGC. MATERIALS AND METHODS: With tissue microarray for 158 EGC tissues, we performed immunohistochemical staining for CD44v9 and Ki-67. The whole patients were divided into three groups (group A, CD44v9-negative/Ki-67–low; group B, neither group A or C; and group C, CD44v9-positive/Ki-67–high). Its clinical significance was re-analyzed with adjustment via propensity score matching (PSM). For validation, we performed bootstrap resampling. RESULTS: The median follow-up duration was 90.4 months (range, 3.7 to 120.4 months). In the comparison according to CD44v9/Ki-67 expression, the combined use of the two biomarker clearly separated the three groups by 5-year survival rates (5-YSR, 96.3%, 89.8%, and 76.8% in group A, B, and C, respectively; p=0.009). After PSM, 5-YSR were 97.7% and 76.8% in group A+B and group C, respectively (p=0.002). Multivariable analysis demonstrated that group C had independently poor prognosis (hazard ratio, 9.137; 95% confidence interval, 1.187 to 70.366; p=0.034) compared with group A. Bootstrap resampling internally validated this result (p=0.016). CONCLUSION: This study suggests that both positive CD44v9 and high Ki-67 expression are associated with poor prognosis in EGC, and the combined use of these markers provides better prognostic stratification than the single use of them.
Biomarkers ; Follow-Up Studies ; Humans ; Ki-67 Antigen ; Prognosis ; Propensity Score ; Stomach Neoplasms ; Survival Rate

Lumbar decompressive surgery is a standard surgery for lumbar spinal stenosis. Many surgical techniques have been introduced, ranging from open surgery to percutaneous procedures. Minimally invasive techniques are preferred because of the less postoperative pain and shorter hospital stay. Uniportal percutaneous endoscopic decompression has technical difficulties due to the narrow field. Biportal percutaneous endoscopic decompression is a satisfactory technique that can compensate for the shortcomings and provide sufficient decompression.
Decompression ; Endoscopy ; Ion Transport ; Length of Stay ; Minimally Invasive Surgical Procedures ; Pain, Postoperative ; Spinal Stenosis