Sarcopenia is a progressive and generalized loss of skeletal muscle mass and function. The prevalence of sarcopenia was reported to be up to 29% in older persons in the community healthcare setting. Sarcopenia diagnosis is confirmed by the presence of low muscle mass plus low muscle strength or low physical performance. Sarcopenia management options include non-pharmacological and pharmacological approaches. Non-pharmacological approaches include resistance exercise and adequate nutrition. Of the two, resistance exercise is the standard non-pharmacological treatment approach for sarcopenia with significant positive evidence. Some dietary approaches such as adequate intake of protein, vitamin D, antioxidant nutrients, and long-chain polyunsaturated fatty acid have been shown to have positive effects against sarcopenia. Currently, no specific drugs have been approved by the Food and Drug Administration for the treatment of sarcopenia. However, several agents, including growth hormone, anabolic or androgenic steroids, selective androgenic receptor modulators, protein anabolic agents, appetite stimulants, myostatin inhibitors, activating II receptor drugs, β-receptor blockers, angiotensin-converting enzyme inhibitors, and troponin activators, are recommended and have been shown to have variable efficacy. Future research should focus on sarcopenia biological pathway and improved diagnostic approaches such as biomarkers for early detection, development of consistently pre-eminent treatment methods for severe sarcopenia patients, and establishing sensitive measures for predicting sarcopenia treatment response.

Purpose: This study investigated the synergistic effects of an injection of tranexamic acid and using navigation to reduce the need for blood transfusion and postoperative bleeding after total knee arthroplasty (TKA). Materials and Methods: Patients were divided into three groups and compared. Group 1 (58 cases) included those who had manual TKA with the injection of tranexamic acid in the joint. Group 2 (30 cases) was comprised of those who had navigated TKA without tranexamic acid. Group 3 (32 cases) consisted of patients who had navigated TKA with tranexamic acid. The frequency of transfusion after the operation was measured. To compare bleeding after surgery, drainage volume during 24 hours after surgery was compared and analyzed. Results: Group 1 had five cases of transfusion (8.6%), while there were 9 cases in group 2 (30%) and three cases in group 3 (9.4%). The Chi-squared test revealed a significant difference (p=0.016). An average of 343.67±165.20 ml, 452.10±197.91 ml, and 311.00±129.32 ml was drained in the 24 hours after surgery in groups 1, 2, and group 3, respectively. This difference was analyzed using ANOVA test, which showed a significant difference (p=0.003). The need for transfusion in group 2 was 3.71 times higher than that in group 1. The need for transfusion in group 2 was 4.14 times higher than that of group 3. Conclusion The combination of navigation use and injection of tranexamic acid has no synergistic effect in reducing the need for blood transfusion and post TKA bleeding. In addition, an injection of tranexamic acid in the joint is more effective in reducing blood transfusions and blood loss after TKA than navigation.

Purpose: Desmoid tumor, also known as aggressive fibromatosis, is well-characterized by abnormal Wnt/β-catenin signaling. Various therapeutic options, including imatinib, are available to treat desmoid tumor. However, the molecular mechanism of why imatinib works remains unclear. Here, we describe potential roles of NOTCH2 and HES1 in clinical response to imatinib at genome and transcriptome levels. Materials and Methods: We identified somatic mutations in coding and noncoding regions via whole-genome sequencing. To validate the genetic interaction with expression level in desmoid-tumor condition, we utilized large-scale whole-genome sequencing and transcriptome datasets from the Pan-Cancer Analysis of Whole Genomes project. RNA-sequencing was performed using prospective and retrospective cohort samples to evaluate the expressional relevance with clinical response. Results: Among 20 patients, four (20%) had a partial response and 14 (66.7%) had stable disease, 11 of which continued for ≥ 1 year. With gene-wise functional analyses, we detected a significant correlation between recurrent NOTCH2 noncoding mutations and clinical response to imatinib. Based on Pan-Cancer Analysis of Whole Genomes data analyses, NOTCH2 mutations affect expression levels particularly in the presence of CTNNB1 missense mutations. By analyzing RNA-sequencing with additional desmoid tumor samples, we found that NOTCH2 expression was significantly correlated with HES1 expression. Interestingly, NOTCH2 had no statistical power to discriminate between responders and non-responders. Instead, HES1 was differentially expressed with statistical significance between responders and non-responders. Conclusion Imatinib was effective and well tolerated for advanced desmoid tumor treatment. Our results show that HES1, regulated by NOTCH2, as an indicator of sensitivity to imatinib, and an important therapeutic consideration for desmoid tumor.

Purpose: The purpose is to estimate the degree of normalization of C-reactive protein (CRP) at 2 weeks and 4 weeks after uncomplicated total knee arthroplasty (TKA) using computer navigation. We also wish to determine whether the degree of normalization of CRP at 2 and 4 weeks differs after TKA performed in one knee and after TKA performed sequentially in both knees. We also want to analyze the patient factors that may influence the normalization of CRP. Methods: We studied 400 knees who underwent primary computer-navigated TKA for treatment of advanced osteoarthritis: the TKAs were all performed by the same surgeon. We retrospectively analyzed CRP levels during the preoperative period, the early postoperative period (5–7 days), the 2-week postoperative period (12–14 days), and the 4-week postoperative period (25–30 days). We have assumed gender, age, body mass index (BMI), staged bilateral TKA, and preoperative CRP as the potential patient factors associated with CRP normalization. Results: In unilateral TKA, CRP was normalized in 94 cases (34.3%) and in 219 cases (81.4%) within 2 weeks and 4 weeks after surgery, respectively. In second-knee, staged bilateral TKA, CRP was normalized in 46 cases (35.1%) and in 104 cases (79.4%) within 2 weeks and 4 weeks after surgery, respectively. There were no statistical differences between unilateral TKA and second-knee, staged bilateral TKA during the 2-week postoperative and the 4-week postoperative period. Compared to women, men were 1.99 times less likely to have normalized CRP at 2 weeks after surgery (P = 0.02). Conclusion CRP was less likely to normalize during the 2-week postoperative period in men than it is in women, while there was no difference between men and women in the normalization of CRP during the 4-week postoperative period. There were no statistical differences in the course of CRP levels after unilateral TKA and staged bilateral TKA during the 2-week postoperative and the 4-week postoperative period.

Purpose: The purpose is to estimate the degree of normalization of C-reactive protein (CRP) at 2 weeks and 4 weeks after uncomplicated total knee arthroplasty (TKA) using computer navigation. We also wish to determine whether the degree of normalization of CRP at 2 and 4 weeks differs after TKA performed in one knee and after TKA performed sequentially in both knees. We also want to analyze the patient factors that may influence the normalization of CRP. Methods: We studied 400 knees who underwent primary computer-navigated TKA for treatment of advanced osteoarthritis: the TKAs were all performed by the same surgeon. We retrospectively analyzed CRP levels during the preoperative period, the early postoperative period (5–7 days), the 2-week postoperative period (12–14 days), and the 4-week postoperative period (25–30 days). We have assumed gender, age, body mass index (BMI), staged bilateral TKA, and preoperative CRP as the potential patient factors associated with CRP normalization. Results: In unilateral TKA, CRP was normalized in 94 cases (34.3%) and in 219 cases (81.4%) within 2 weeks and 4 weeks after surgery, respectively. In second-knee, staged bilateral TKA, CRP was normalized in 46 cases (35.1%) and in 104 cases (79.4%) within 2 weeks and 4 weeks after surgery, respectively. There were no statistical differences between unilateral TKA and second-knee, staged bilateral TKA during the 2-week postoperative and the 4-week postoperative period. Compared to women, men were 1.99 times less likely to have normalized CRP at 2 weeks after surgery (P = 0.02). Conclusion CRP was less likely to normalize during the 2-week postoperative period in men than it is in women, while there was no difference between men and women in the normalization of CRP during the 4-week postoperative period. There were no statistical differences in the course of CRP levels after unilateral TKA and staged bilateral TKA during the 2-week postoperative and the 4-week postoperative period.

Background: The aim of this study was to evaluate the difference between the planned and verified actual values in total knee arthroplasty (TKA) performed using a navigation system. Methods: Sixty patients who underwent primary TKA for knee pain from March 2018 to July 2018 were included in this study.All patients underwent TKA using the latest version of a computer navigation system (Kick ver. 2.6). All TKA procedures were performed by the same surgeon. The appropriateness of the use of navigation system in each of the several steps during the operation was investigated. Implant size was assessed using a preoperative template and after registration of landmarks with the navigation system. Intraoperative measurement was conducted using a femoral sizing implant apparatus. The difference between the planned value based on the navigation system and the actual cutting value was investigated. Intraoperatively confirmed hip-knee-ankle angle was also compared to the angle measured at postoperative 3 months. Results: The average time spent on the registration process was 242 seconds (range, 205–345 seconds). Intraoperative femoral component size tended to be smaller than the size recommended by the navigation system. A significant difference between the planned distal femoral cutting level (9.08 ± 0.40 mm) and the verified actual cutting level (9.87 ± 1.39 mm) was identified (p < 0.05).The difference between the planned lateral and medial tibial resection levels (10.12 ± 0.34 mm and 4.47 ± 2.17 mm, respectively) and the verified actual lateral and medial tibial resection levels (9.07 ± 1.45 mm and 3.48 ± 2.00 mm, respectively) was statistically significant. Distal femoral cutting angle in sagittal plane was significantly different but femoral and tibial cutting angles showed no significant difference between the planned and verified values. At full extension, the average coronal alignment of the implant recorded after insertion of the actual implant using the navigation system was 0.23° ± 0.51° varus and showed no significant difference from the alignment measured at postoperative 3 months (0.45° ± 0.58°). Conclusions When performing navigation-assisted TKA, surgeons should aware that frequent errors can occur on the femoral cutting level, tibial cutting level, and implant sizing despite its reported advantage in defining the mechanical limb axis.

Purpose: Post-fracture sleeping disorders can lead to a deterioration of mental and physical health and delay recovery to pre-fracture status. Here, an analysis was conducted to determine if sleep disturbance is a risk factor for delirium in patients older than 60 years of age with surgically treated proximal femoral fractures. Materials and Methods: This retrospective study included 316 patients with surgically treated proximal femoral fractures between January 2014 and December 2016; 33 patients were removed from analysis due to exclusion criteria. Confirmation of delirium was made by a neurologist upon consultation for cognitive impairment and sleeping disorders were confirmed by a doctor or nurse based on the Pittsburgh sleep quality index. Potential risk factors other than a sleep disorder (e.g., history of cognitive impairment, medical illness, preoperational levels of albumin and hemoglobin, transfusion) were also analyzed as variables for the development of delirium. Results: The sensitivity and specificity of a sleeping disorder as a risk factor for the development of delirium were 0.75 and 0.76, respectively; the positive and negative predictive values were 0.64 and 0.93, respectively. A sleeping disorder was significantly related to the development of the delirium (odds ratio adjusted for age, sex and body mass index was 5.78, P<0.01). In those with a history of cognitive impairment, the adjusted odds ratio for the development of delirium was 6.03 (P<0.01). Conclusion Sleeping disorders occurring after a surgically repaired proximal femoral fracture in patients 60 years of age or older could be an independent predictive factor of delirium.

Background: Seroprevalence studies of coronavirus disease 2019 (COVID-19) from many countries have shown that the number of undiagnosed missing cases is much larger than that of confirmed cases, irrespective of seroprevalence levels. Considering the strategy of Korea entailing massive testing and contact tracing from the beginning of epidemic, the number of undiagnosed missing cases in Korea may be negligible. This study was conducted to estimate the seroprevalence of COVID-19 among individuals who were never diagnosed with COVID-19 in Daegu, the epicenter of COVID-19 epidemic in Korea. Methods: Serologic testing for immunoglobulin G antibody based on immunochromatographic assay was conducted in 103 patients and 95 guardians aged 18 to 82 years without any history of COVID-19 diagnosis, who visited outpatient clinics of a single university-affiliated hospital from May 25 to June 5, 2020. Results: The estimated seroprevalence was 7.6% (95% confidence interval, 4.3%–12.2%) with 15 positive cases. Among them, only one had a polymerase chain reaction (PCR)-confirmed case among their close contacts and 13 did not experience COVID-19-related symptoms. Seroprevalence was similar between patients and guardians. Based on this figure, the number of undiagnosed missing cases in Daegu was estimated to be a dozen times more than the number of confirmed cases based on PCR testing. Conclusion Despite the limitation of a small and unrepresentative sample, this is the first study on seroprevalence of COVID-19 in Korea. Our study suggested that the number of undiagnosed missing cases was substantial even with the stringent strategy adopted in Korea, similar to that of other countries.

PURPOSE: To compare the outcomes of navigation-assisted total knee replacement conducted by a skilled surgeon and novice surgeon, as well as to evaluate the usefulness of the navigation assistance to a novice surgeon. MATERIALS AND METHODS: We retrospectively made a comparison between 60 total knee replacement surgeries conducted by skilled surgeon and 60 total knee replacement surgeries by a novice surgeon during the 2015. Scanograms were taken both preoperatively and at 3-month postoperatively to measure the accuracy of bone cutting and alignment. As for external rotation of the femur, we checked the values of the distal femur surgical epicondyle axis, and the posterior condyle axis displaced by the navigator after bone registration for both novice and skilled groups. For postoperative functional examination, Knee Society Score (KSS) were evaluated at 1-year follow-up. RESULTS: Forty-nine knees in the skilled group, and 51 knees in the novice group achieved coronal axis alignment of hip knee ankle values of 0°±3°. The mean external rotation degree of the femoral epicondyle axis against the posterior condyle axis, measured by the navigator, was 3.8°±2.9° in skilled group, and 1.2°±3.0° in novice group. When regarding femoral epicondyle axis, which showed a more internal rotation than the posterior condylar axis as an outlier, six cases were outlier in skilled group, while, 18 cases were outlier in novice group. After revising external rotation value of femoral implants comparing values navigation displaced and values using 3° external rotation manual jig against femoral posterior condylar axis, the skilled group showed 0 case of outlier and the novice group showed 10 cases of outlier. The mean KSS knee assessed at 1 year postoperatively was 83.2±6.8 in skilled group, and 83.1±7.0 in novice group, with no statistically significant difference. CONCLUSION: Navigation provides advantages to novice surgeon to achieve stabilized coronal plane axis, as well as accurate resection of the femur and tibia. However, the navigation does not provide any advantages in achieving the aimed amount of femoral external rotation to novice surgeons.
Ankle ; Arthroplasty, Replacement, Knee* ; Femur ; Follow-Up Studies ; Hip ; Knee ; Retrospective Studies ; Surgeons ; Tibia

OBJECTIVE: It was proposed that the ability to recognize facial emotions is closely related to complex neurocognitive processes and/or skills related to theory of mind (ToM). This study examines whether ToM skills mediate the relationship between higher neurocognitive functions, such as reasoning ability, and facial emotion recognition. METHODS: A total of 200 healthy subjects (101 males, 99 females) were recruited. Facial emotion recognition was measured through the use of 64 facial emotional stimuli that were selected from photographs from the Korean Facial Expressions of Emotion (KOFEE). Participants were requested to complete the Theory of Mind Picture Stories task and Standard Progressive Matrices (SPM). RESULTS: Multiple regression analysis showed that the SPM score (t=3.19, p=0.002, beta=0.22) and the overall ToM score (t=2.56, p=0.011, beta=0.18) were primarily associated with a total hit rate (%) of the emotion recognition task. Hierarchical regression analysis through a three-step mediation model showed that ToM may partially mediate the relationship between SPM and performance on facial emotion recognition. CONCLUSION: These findings imply that higher neurocognitive functioning, inclusive of reasoning, may not only directly contribute towards facial emotion recognition but also influence ToM, which in turn, influences facial emotion recognition. These findings are particularly true for healthy young people.
Facial Expression ; Humans ; Male ; Negotiating ; Theory of Mind*