Background and Objectives: In acute ST-segment elevation myocardial infarction (STEMI),on-site transmission of electrocardiogram (ECG) has been shown to reduce systemic timedelay to reperfusion and improve outcomes. However, it has not been adopted in communitybasedemergency transport system in Korea. Methods: Busan Regional Cardio-cerebrovascular Center and Busan Metropolitan City Fireand Safety Headquarters (BMFSH) jointly developed and conducted a pre-hospital ECGtransmission program. Seven tertiary hospitals and 22 safety stations of BMFSH participated.Systemic time delay to reperfusion of STEMI patients in the program was compared with thatof 95 patients transported by 119 emergency medical system (EMS) before the program wasimplemented. Results: During the study period, 289 ECG transmissions were made by 119 EMS personnel,executed within 5 minutes in 88.1% of cases. Of these, 42 ECGs were interpreted as STsegmentelevation. Final diagnosis of STEMI was made in 20 patients who underwent primarypercutaneous coronary intervention. With the program, systemic time delay to reperfusion wassignificantly reduced (median [interquartile range; IQR], 76.0 [62.2–98.7] vs. 90.0 [75.0–112.0],p<0.01). Significant reduction of door-to-balloon time was also observed (median [IQR], 45.0[34.0–69.5] vs. 58.0 [51.0–68.0], p=0.03). The proportion of patients with systemic time delayshorter than 90 minutes rose (51.6% vs. 75.0%, p=0.08) with pre-hospital ECG transmission. Conclusions We developed and implemented a community-based pre-hospital ECG transmission program for expeditious triage of STEMI patients. Significant reductions ofsystemic time delay and door-to-balloon time were observed. The expanded use of prehospitalECG transmission should be encouraged to realize the full potential of this program.

OBJECTIVES: The aim of this study was to evaluate the associations of frailty with perceived neighborhood walkability and environmental pollution among community-dwelling older adults in rural areas. METHODS: The participants were 808 community-dwelling men and women aged 65 years and older in 2 rural towns. Comprehensive information, including demographics, socioeconomic status, grip strength, polypharmacy, perceived neighborhood environment (specifically, walkability and environmental pollution), and frailty, was collected from participants using face-to-face interviews conducted between June and August 2018. Perceived neighborhood walkability was measured using 20 items that were selected and revised from the Neighborhood Environment Walkability Scale, the Neighborhood Walkability Checklist from the National Heart Foundation of Australia, and the Physical Activity Neighborhood Environment Survey. The Kaigo-Yobo Checklist was used to assess participants’ frailty. RESULTS: The overall prevalence of frailty in this community-dwelling population was 35.5%. Sex, age, cohabitation status, educational attainment, employment status, grip strength, and polypharmacy were significantly associated with frailty. In the logistic regression analysis, frailty was associated with low perceived neighborhood walkability (adjusted odds ratio [aOR], 0.881; 95% confidence interval [CI], 0.833 to 0.932; p<0.001) and severe perceived neighborhood environmental pollution (aOR, 1.052; 95% CI, 1.017 to 1.087; p=0.003) after adjusting for sex, age, cohabitation status, educational attainment, employment status, monthly income, grip strength, and polypharmacy. CONCLUSIONS More studies are warranted to establish causal relationships between walkability and environmental pollution and frailty.

No abstract available.
Vulva*

A closing wedge distal femoral osteotomy is a procedure to reduce pain and delay the progression of degenerative arthritis of knee by moving the weight bearing line from the lateral compartment to the medial side while preserving the knee joint. Age, weight bearing line, and the degree of arthritis are the essential factors to be considered at the time of surgery. The indications for distal femoral osteotomy are as follows. All patients are aged less than 65 years old, normal medial compartment of the knee with normal patello femoral joint, valgus deformity with lateral degenerative arthritis, younger patients with lateral osteochondritis, congenital osteochondrosis, and recurrent patellar dislocation with genu valgum. The distal femoral osteotomy provides the advantages of rapid pain reduction and short rehabilitation in young and active patients and patients who are subjected to heavy loads on the knee.
Arthritis ; Congenital Abnormalities ; Femur* ; Genu Valgum ; Humans ; Joints ; Knee ; Knee Joint ; Osteoarthritis ; Osteochondritis ; Osteochondrosis ; Osteotomy* ; Patellar Dislocation ; Rehabilitation ; Weight-Bearing

Segmental fractures of the clavicle are very rare. Therefore, to date, there has not been a clear, standardized method of management of segmental clavicle fractures. Herein, two patients with a segmental fracture are described: One patient was treated conservatively, while another patient was treated operatively. Both patients showed excellent results. We discuss the various management options with a literature review.
Clavicle* ; Humans ; Methods*

PURPOSE: To report the clinical results from surgical treatment for clavicle shaft fracture by percutaneous intramedullary fixation with Steinmann pins. MATERIALS AND METHODS: Between January 2004 and June 2014, the medical records of 135 patients who underwent percutaneous intramedullary fixation with Steinmann pins were reviewed. The mean follow-up periods were 15 months. The functional results were evaluated with The Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant score. The clinical results were evaluated with the shortened length of the clavicle, length of surgical wound, operation time and Kang's criteria. RESULTS: The mean bone union period was 11.6 weeks (8–16 weeks). The mean DASH score was 11.8. The mean Constant score was 91.2. The mean shortened length of the clavicle was less than 20 mm. The mean length of surgical wound was 1.2 cm (0.7–1.5 cm). The mean operation time was 18 minutes (10–35 minutes). Using Kang's criteria, 131 out of 135 patients (97.0%) showed good results. Complications included were 3 pin migrations and 2 non-unions. CONCLUSION: Percutaneous intramedullary fixation with Steinmann pins showed good results for treating clavicle shaft fracture.
Arm ; Clavicle* ; Follow-Up Studies ; Hand ; Humans ; Medical Records ; Shoulder ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: Previous studies have evaluated atrial electromechanical delays (AEMDs) with a number of different definitions to discriminate patients with paroxysmal atrial fibrillation (PAF) from controls without PAF. However, their discriminative values for PAF have not previously been directly compared. SUBJECTS AND METHODS: A total of 65 PAF patients and 130 control subjects matched for age, sex, history of hypertension, and diabetes mellitus were selected. The AEMDi and AEMDp were defined as the time intervals from the initiation of the P wave on the surface electrocardiogram to the initiation and peak of the late diastolic transmitral inflow on pulsed wave Doppler images, respectively. The AEMDim and AEMDpm were defined as the time intervals from the initiation of the P wave on the surface electrocardiogram to the initiation and peak of the late diastolic lateral mitral annular motion on tissue Doppler images, respectively. RESULTS: There were no significant differences in the clinical characteristics between the two groups. All 4 AEMDs were consistently longer in the PAF group, and proven effective to differentiate the PAF patients from the controls. The AEMDi measurement had a larger area under the curve (AUC) than the other AEMDs, left atrial volume index, and P wave amplitude. However, the AEMDp, AEMDim, and AEMDpm measurements had AUCs similar to those of the left atrial volume index and P wave amplitude. CONCLUSION: The findings suggest that the AEMDi is better than the other AEMDs for the discrimination of PAF patients from the controls.
Area Under Curve ; Atrial Fibrillation* ; Diabetes Mellitus ; Discrimination (Psychology)* ; Echocardiography ; Electrocardiography ; Humans ; Hypertension

PURPOSE: We investigated the association between aging-induced apoptosis and cell proliferation in the anterior cruciate ligament (ACL) of aged patients. MATERIALS AND METHODS: Twenty patients with osteoarthritis who underwent total knee replacement arthroplasty were enrolled in the study. They were divided into three groups according to age: group A (< or =65 years), group B (66-75 years), and group C (> or =76 years). The ACL tissue was obtained intraoperatively and subjected to terminal deoxynucleotidyl transferase dUTP nick-end labeling staining and immunohistochemistry to quantify the apoptosis and cell proliferation indices. RESULTS: Apoptosis occurred in all groups, with the highest apoptosis index found in group C, followed by that in groups B and A. A statistically significant positive linear correlation was observed, with a 1-year increase in age resulting in an average increase of 1.49 in the apoptotic index. The lowest cell proliferation index was observed in group C, followed by that in group B and group A, with a 1-year increase in age resulting in an average decrease of 1.0 in the cell proliferation index, which was a statistically significant negative linear correlation. Consequently, a statistically significant negative correlation was confirmed between the apoptosis and cell proliferation indices, whereby an increase of 1.0 in the apoptosis index was concurrent with a decrease of 0.45 in the cell proliferation index. CONCLUSION: Apoptosis occurred in the ACL of human knee joint. With increasing age, apoptosis increased and cell proliferation decreased.
Aged ; Aging* ; Anterior Cruciate Ligament* ; Apoptosis* ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Cell Proliferation* ; DNA Nucleotidylexotransferase ; Humans* ; Immunohistochemistry ; Knee Joint* ; Knee* ; Osteoarthritis

BACKGROUND/AIMS: The purpose of this study was to compare changes in primary percutaneous coronary artery intervention (PCI) outcomes after starting the government-directed Busan-Ulsan Regional Cardiocerebrovascular Center Project. METHODS: Patients with ST segment elevation myocardial infarction (STEMI) who visited the Busan-Ulsan Regional Cardiocerebrovascular Center from 1 June 2009 to 30 May 2011 were selected. Their medical records were retrospectively reviewed. Clinical and survival outcomes before and after starting the project were compared. RESULTS: A total of 122 patients (mean age, 63 +/- 13 years; male, 74%) with STEMI were selected for analysis. There were no significant differences in patients' baseline characteristics. After starting the Busan-Ulsan Regional Cardiocerebrovascular Center Project, the door-to-balloon time decreased from 72 +/- 30 to 59 +/- 22 minutes (p = 0.011). The door-to-balloon time when the PCI team did not stay in the hospital also decreased from 80 +/- 30 to 62 +/- 12 minutes (p = 0.005). However, there was no significant change in the total ischemic time (339 +/- 293 vs. 304 +/- 287 minutes, p = 0.514), survival discharge rate (94% vs. 93%, p = 1.000), or 1-year survival rate (89% vs. 91%, p = 0.996). CONCLUSIONS: After starting the government-directed Busan-Ulsan Regional Cardiocerebrovascular Center Project, the door-to-balloon time was significantly reduced. However, the total ischemic time and short-term survival remained unchanged.
Coronary Vessels ; Humans ; Male ; Medical Records ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Retrospective Studies ; Survival Rate

STUDY DESIGN: A prospective analysis of an adaptive change of the spinopelvic alignment after total knee arthroplasty. PURPOSE: To evaluate the effect of correction of the contractured knee in flexion on the spinopelvic alignment by total knee arthroplasty. OVERVIEW OF LITERATURE: Flexion contracture of the knee joint may affect the body posture and precipitate the symptoms in the lumbar spine, which is known as the 'knee-spine syndrome'. METHODS: Fifteen patients who could be followed at least over 12 months were used in this study. Neutral whole spine lateral standing radiograms taken at certain intervals were analyzed. The subjects were divided into two groups (group A, the patients who obtained over 10degrees correction; group B, the others). The sacral slope, the pelvic tilt and the pelvic incidence were measured preoperatively and at 12 months and thereafter postoperatively in all the patients. Also, the thoracic kyphosis, lumbar lordosis, and lumbosacral angle were measured, including the spinal sagittal balance, S1 overhang and spino-sacral angle. RESULTS: The average correction of the contractured knee in flexion were 13.8degrees in group A and 2.7degrees in group B. The median of changes of the sacral slope were 4.2degrees in group A and -0.4degrees in group B. These results revealed that there was a significant increase of the sacral slope for group A (p=0.001). However, there were no significant differences between the other parameters. CONCLUSIONS: The sacral slope appears to be affected by the change of the flexion contracture after total knee arthroplasty.
Arthroplasty ; Contracture ; Humans ; Knee ; Knee Joint ; Kyphosis ; Lordosis ; Pelvis ; Posture ; Prospective Studies ; Spine