Publications by authors named "Jae Young Park"

210 Publications

Enterobius vermicularis Infection among Preschool Children: A 12-Year (2008-2019) Survey in Large Cities and Provinces of the Republic of Korea.

Korean J Parasitol 2021 Aug 18;59(4):421-426. Epub 2021 Aug 18.

Institute of Parasitic Diseases, Korea Association of Health Promotion (KAHP), Seoul 07649, Korea.

A 12-year nationwide survey (2008-2019) was performed to investigate the prevalence of Enterobius vermicularis infection among preschool children in Seoul, 4 large cites (Busan, Incheon, Daegu, and Ulsan), and 9 provinces (grouped into 5 localities) in the Republic of Korea (=Korea). The survey was carried out once a year by 16 regional offices of the Korea Association of Health Promotion. The cello-tape perianal swab method (1 smear per child) was applied to detect eggs of E. vermicularis and other helminths. According to the results, the egg positive rate of E. vermicularis infection in 2008-2009 was 1.8-2.0%, but it decreased gradually to 0.6% in 2019 (P<0.05). The prevalence was significantly higher in boys (0.7-5.0%, mean 1.8%) than in girls (0.5-2.8%, mean 1.3%) (P<0.05). The 2 most southern localities, Jejudo (Province) and Jeolla-do (inclusive of Jeollabuk-do and Jeollanam-do) and a mid-western province, Gyeonggi-do, revealed higher prevalences, whereas Seoul and Gangwon-do showed lower prevalences. The results indicate that a low-grade prevalence of E. vermicularis infection (less than 4%) has been maintained for the recent 12 years among preschool children in Korea. Continuous monitoring of enterobiasis in the child age group is necessary in Korea.
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http://dx.doi.org/10.3347/kjp.2021.59.4.421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413852PMC
August 2021

Prognostic factors for overall survival in patients with clear cell metastatic renal cell carcinoma: Model development and external validation with Memorial Sloan Kettering Cancer Center model and the international metastatic renal cell carcinoma database consortium model.

Medicine (Baltimore) 2021 Aug;100(31):e26826

Department of Urology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.

Abstract: To develop a new prognostic model for the overall survival of patients with clear cell metastatic renal cell carcinoma (mRCC) using Korean Renal Cancer Study Group (KRoCS) database and compared it with 2 renowned prognostic models: the Memorial Sloan Kettering Cancer Center (MSKCC) and the international metastatic renal cell carcinoma database consortium (IMDC) models.Data of 790 patients diagnosed with mRCC and receiving targeted therapy as their first-line treatment were pooled to this study. Data from 4 hospitals (n = 619) were used to develop the new model and those from other 5 hospitals (n = 171) were used for external validation. After detecting prognostic factors in multivariable Cox proportional-hazards regression analysis, patients were classified into 3 risk groups, favorable (0), intermediate (1-2), and poor (3 and more) by the number of prognostic factors.Seven variables such as more than 2 metastasis sites, no prior nephrectomy, Eastern Cooperative Oncology Group performance status ≥2, low hemoglobin, high serum corrected calcium, high neutrophil, high serum alkaline phosphatase were identified as prognostic factors for poor overall survival. Also, risk groups were categorized into 3 groups; median overall survival was 61.1 months in favorable, 26.5 months in intermediate, and 6.8 months in poor group. KRoCS ranked the first in all 3 statistical parameters including akaike information criterion (AIC), concordance index and generalized R2 among other prognostic models.We developed the KRoCS model and validated it externally with demonstrating its superiority over MSKCC and IMDC models. The KRoCS model can provide useful information for counseling patients with clear cell mRCC regarding life-expectancy.
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http://dx.doi.org/10.1097/MD.0000000000026826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341338PMC
August 2021

TGFβ1-Induced Transglutaminase-2 Triggers Catabolic Response in Osteoarthritic Chondrocytes by Modulating MMP-13.

Tissue Eng Regen Med 2021 Oct 20;18(5):831-840. Epub 2021 May 20.

Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Background: Transforming growth factor beta 1 (TGFβ1) plays an essential role in maintaining cartilage homeostasis. TGFβ1 is known to upregulate anabolic processes in articular cartilage, but the role of TGFβ1 in chondrocyte catabolism remains unclear. Thus, we examined whether TGFβ1 increases catabolic processes in the osteoarthritic joint via transglutaminase 2 (TG2). In this study, we investigated whether interplay between TGFβ1 and TG2 mediates chondrocyte catabolism and cartilage degeneration in osteoarthritis.

Methods: To investigate the role of TGFβ1 and TG2 in osteoarthritis, we performed immunostaining to measure the levels of TGFβ1 and TG2 in 6 human non-osteoarthritic and 16 osteoarthritic joints. We conducted quantitative reverse transcription polymerase chain reaction and western blot analysis to investigate the relationship between TGFβ1 and TG2 in chondrocytes and determined whether TG2 regulates the expressions of matrix metalloproteinase (MMP)-13, type II, and type X collagen. We also examined the extent of cartilage degradation after performing anterior cruciate ligament transection (ACLT) and destabilization of the medial meniscus (DMM) surgery in TG2 knock-out mice.

Results: We confirmed the overexpression of TGFβ1 and TG2 in human osteoarthritic cartilage compared with non-osteoarthritic cartilage. TGFβ1 treatment significantly increased the expression of TG2 via p38 and ERK activation. TGFβ1-induced TG2 also elevated the level of MMP-13 and type X collagen via NF-κB activation in chondrocytes. Cartilage damage after ACLT and DMM surgery was less severe in TG2 knock-out mice compared with wild-type mice.

Conclusion: TGFβ1 modulated catabolic processes in chondrocytes in a TG2-dependent manner. TGFβ1-induced TG2 might be the therapeutic target for treating cartilage degeneration and osteoarthritis.
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http://dx.doi.org/10.1007/s13770-021-00342-3DOI Listing
October 2021

The Effects of Taping Combined with Wrist Stabilization Exercise on Pain, Disability, and Quality of Life in Postpartum Women with Wrist Pain: A Randomized Controlled Pilot Study.

Int J Environ Res Public Health 2021 03 30;18(7). Epub 2021 Mar 30.

Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea.

The purpose of this study was to evaluate the effects of wrist stabilization exercise combined with taping on wrist pain, disability, and quality of life in postpartum women with wrist pain. Forty-five patients with wrist pain were recruited and randomly divided into three groups: wrist stabilization exercise + taping therapy (WSE + TT) group (n = 15), wrist stabilization exercise (WSE) group (n = 15), and control group (n = 15). The WSE + TT and WSE groups performed wrist stabilization exercises for 40 min (once a day, five times a week for eight weeks), and the control group performed passive range of motion (P-ROM) exercise for the same amount of time. Additionally, the WSE + TT group attached taping to the wrist and forearm during the training period. The visual analogue scale (VAS) was used to assess pain level of the wrist. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Short Form-36 (SF-36) were used to evaluate the degree of wrist disability and quality of life, respectively. The WSE + TT group showed a significant decrease in wrist pain and functional disability compared to two groups ( < 0.05). Significant improvement in the SF-36 score was observed in the WSE + TT and WSE groups compared to that in the control group ( < 0.05). However, there was no significant difference between the WSE + TT and WSE groups in the SF-36. Our findings indicate that wrist stabilization exercise combined with taping is beneficial and effective in managing wrist pain and disability in postpartum women with wrist pain.
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http://dx.doi.org/10.3390/ijerph18073564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037921PMC
March 2021

Comparable Clinical and Radiologic Outcomes Between an Anatomic Tunnel and a Low Tibial Tunnel in Remnant-Preserving Posterior Cruciate Ligament Reconstruction.

Orthop J Sports Med 2021 Feb 23;9(2):2325967120985153. Epub 2021 Feb 23.

Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, Gyeongki-do, Republic of Korea.

Background: There is currently no consensus on the optimal placement of the tibial tunnel for remnant-preserving posterior cruciate ligament (PCL) reconstruction.

Purpose/hypothesis: The purpose of this study was to compare the clinical and radiologic outcomes of remnant-preserving PCL reconstruction using anatomic versus low tibial tunnels. We hypothesized that the outcomes of low tibial tunnel placement would be superior to those of anatomic tibial tunnel placement at the 2-year follow-up after remnant-preserving PCL reconstruction.

Study Design: Cohort study; Level of evidence, 3.

Methods: We retrospectively reviewed the data for patients who underwent remnant-preserving PCL reconstruction between March 2011 and January 2018 with a minimum follow-up of 2 years (N = 63). On the basis of the tibial tunnel position on postoperative computed tomography, the patients were divided into those with anatomic placement (group A; n = 31) and those with low tunnel placement (group L; n = 32). Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity level), range of motion, complications, and stability test outcomes at follow-up were compared between the 2 groups. Graft signal on 1-year follow-up magnetic resonance imaging scans was compared between 22 patients in group A and 17 patients in group L.

Results: There were no significant differences between groups regarding clinical scores or incidence of complications, no between-group differences in posterior drawer test results, and no side-to-side difference on Telos stress radiographs (5.2 ± 2.9 mm in group A vs 5.1 ± 2.8 mm in group L; = .900). Postoperative 1-year follow-up magnetic resonance imaging scans showed excellent graft healing in both groups, with no significant difference between them.

Conclusion: The clinical and radiologic outcomes and complication rate were comparable between anatomic tunnel placement and low tibial tunnel placement at 2-year follow-up after remnant-preserving PCL reconstruction. The findings of this study suggest that both tibial tunnel positions are clinically feasible for remnant-preserving PCL reconstruction.
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http://dx.doi.org/10.1177/2325967120985153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907546PMC
February 2021

Targeted therapy response in early versus late recurrence of renal cell carcinoma after surgical treatment: A propensity score-matched study using the Korean Renal Cancer Study Group database.

Int J Urol 2021 04 1;28(4):417-423. Epub 2021 Feb 1.

Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

Objectives: To investigate the clinicopathological features and outcomes of targeted therapy in patients with recurrence of renal cell carcinoma in <5 years or ≥5 years after the surgical treatment for renal cell carcinoma.

Methods: Patients with metastatic renal cell carcinoma treated with targeted therapy in a multicenter database were retrospectively characterized according to time from surgery to recurrence. Early recurrence was defined as recurrence within 5 years after surgery, and late recurrence was defined as occurring ≥5 years after surgery. The propensity scores for recurrence status were calculated, and patients with late recurrence were matched to patients with early recurrence at a 1:3 ratio. The oncological outcomes of targeted therapy in both groups were compared.

Results: Among 716 patients, 512 (71.5%) experienced early recurrence and 204 (28.5%) experienced late recurrence. The patients with late recurrence presented with younger age at surgery, lower tumor stages and Fuhrman grade, and fewer sarcomatoid features and lymphovascular invasion (all P < 0.005). All differences in clinicopathological characteristics before targeted therapy disappeared after matching. Patients with late recurrence had significantly longer median overall survival (56 months vs 36 months; P < 0.0001) and median first-line progression-free survival (12 months vs 8 months; P = 0.031). The early recurrence status was a significantly worse predictor for overall survival and first-line progression-free survival (hazard ratio 1.30, P = 0.007; and hazard ratio 1.76, P < 0.001, respectively).

Conclusions: Late recurrence might have prognostic value in terms of oncological outcomes in metastatic renal cell carcinoma treated with targeted therapy.
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http://dx.doi.org/10.1111/iju.14485DOI Listing
April 2021

WITHDRAWN:Current Status of Benign Prostatic Hyperplasia Prescription in Korea Based on the Clinician's Urology Specialty Using Nationwide Healthcare System Data.

Int Neurourol J 2021 01 19. Epub 2021 Jan 19.

Department of Urology, Korea University Hospital, Korea University College of Medicine, Seoul, Korea.

Ahead of Print article withdrawn by Editorial Board.
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http://dx.doi.org/10.5213/inj.2040270.135DOI Listing
January 2021

Awakening from Sleep with Numbness and Indescribable Odd Feeling: Nocturnal Panic Attack or Sleep-Related Epilepsy?

Brain Sci 2021 Jan 21;11(2). Epub 2021 Jan 21.

Veterans Health Service Medical Center, Department of Neurology, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Korea.

Paroxysmal events during sleep can be classified into parasomnias, sleep-related movements, psychiatric events, neurologic events, or medically related events. Diagnosis can be difficult because of the frequent overlap of clinical descriptors and lack of diurnal findings. We report a case of a 68-year-old man who presented to the hospital complaining of awakening from sleep with numbness, which was followed by an indescribable odd feeling. We discuss overlapping clinical features of nocturnal panic and sleep-related epilepsy.
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http://dx.doi.org/10.3390/brainsci11020137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911585PMC
January 2021

Health-related quality of life after radical cystectomy.

Transl Androl Urol 2020 Dec;9(6):2997-3006

Department of Urology, Korea University Medical Center, Korea University School of Medicine, Ansan, Korea.

Herein, we review the assessment of quality-of-life (QoL) in radical cystectomy (RC) patients, summarize the result of studies for different surgical approaches, and provide an overview of patient management, as well as other considerations. In this review article, we reviewed the QoL research and research tools for patients undergoing RC, including urinary diversion methods, gender differences, and surgical methods (open surgery robotic surgery). This narrative review focused primarily on articles indexed in PubMed, Embase, Scopus, and Google Scholar databases. We did not used formal search strategy and meta-analysis was not performed.
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http://dx.doi.org/10.21037/tau.2020.02.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807323PMC
December 2020

Influences of pregravid liver enzyme levels on the development of gestational diabetes mellitus.

Liver Int 2021 04 15;41(4):743-753. Epub 2021 Jan 15.

Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Background & Aims: Elevated liver enzymes are associated with later development of type 2 diabetes mellitus. The objective of this study was to assess the association between prepregnancy liver enzyme levels and subsequent risk of gestational diabetes mellitus.

Methods: Data from a total of 236,109 women who participated in the National Health Screening Examination between 2011 and 2015 was analysed. Multivariate logistic regression analyses were performed to estimate the risk of developing gestational diabetes mellitus in relation to pregravid liver enzyme levels. Subgroup analyses were performed according to pregravid obesity and metabolic syndrome (MetS).

Results: Approximately 5.7% and 1.1% of women developed gestational diabetes mellitus with and without insulin treatment requirement respectively. Pregravid gamma-glutamyl transferase and alanine aminotransferase levels with greater than or equal to the 4th quartile were associated with significantly increased risks of gestational diabetes mellitus requiring insulin treatment in women with obesity and with MetS, (odds ratios [ORs] with 6.228 and 9.505, respectively, P < .001 for both). In women without obesity and without MetS, the risks of gestational diabetes mellitus requiring insulin treatment were also significant (ORs with 2.837 and 3.029, respectively, P < .001 for both). The elevated pregravid liver enzymes were associated with gestational diabetes mellitus without insulin treatment requirement, but minimally.

Conclusions/interpretation: The elevated pregravid liver enzyme levels were significantly associated with the subsequent risk of gestational diabetes mellitus, especially gestational diabetes mellitus requiring insulin treatment, not only in women with obesity or MetS, but also in women without obesity or MetS.
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http://dx.doi.org/10.1111/liv.14759DOI Listing
April 2021

Metastatic renal cell carcinoma to the pancreas: Clinical features and treatment outcome.

J Surg Oncol 2021 Jan 12;123(1):204-213. Epub 2020 Oct 12.

Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Background And Objectives: Metastatic renal cell carcinoma to the pancreas (PM-RCC) is infrequent; we sought to describe the characteristics of PM-RCC and analyze the outcome following treatment.

Methods: Data of 3107 mRCC patients treated between 1992 and 2007 from the Korean Renal Cancer Study Group database were obtained to identify 300 (9.7%) PM-RCC patients. Characteristics and survival were analyzed and compared to the rest of the mRCC, according to the timing of metastasis and surgical treatments received.

Results: PM-RCC was younger at initial diagnosis (55.0 vs. 58.2 years), more frequently in women (30.3% vs. 22.3%), and metachronous (65.3% vs. 41.9%) with a longer disease-free period (82.0 vs. 33.0 months). Overall survival (OS) was significantly better in PM-RCC but pancreas metastasectomy was associated with improved OS only among metachronous PM-RCC. In the 132 metachronous PM-RCC with pancreas metastasectomy, median recurrence-free survival was 17.2 months and we found Heng risk group (hazard ratio [HR] = 2.384, 95% confidence interval [CI] = 1.213-4.684), younger age (HR = 0.965, 95% CI = 0.945-0.987), shorter interval to pancreas metastasis (HR = 0.993, 95% CI = 0.986-0.999), and Eastern Cooperative Oncology Group performance status to be predictive of early progression following pancreas metastasectomy.

Conclusion: Compared to the other mRCC, PM-RCC demonstrated a favorable prognosis. Pancreas metastasectomy was associated with prolonged survival in the metachronous PM-RCC with a long progression-free period.
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http://dx.doi.org/10.1002/jso.26251DOI Listing
January 2021

Comparable clinical and radiological outcomes between anatomical and high femoral tunnels in posterior cruciate ligament reconstruction.

Knee Surg Sports Traumatol Arthrosc 2021 Jun 10;29(6):1936-1943. Epub 2020 Sep 10.

Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeongki-do, Republic of Korea.

Purpose: To compare clinical and radiological outcomes and failure rates between anatomical and high femoral tunnels in remnant-preserving single-bundle posterior cruciate ligament (PCL) reconstruction.

Methods: 63 patients who underwent remnant-preserving single-bundle PCL reconstruction between 2011 and 2018 with a minimum 2-year follow-up were retrospectively reviewed. Patients were divided into two groups according to the femoral tunnel position: group A (33 patients with anatomical femoral tunnel) and group H (30 patients with high femoral tunnels). The femoral tunnel was positioned at the center (group A) or upper margin (group H) of the remnant anterolateral bundle. The position of the femoral tunnel was evaluated using the grid method on three-dimensional computed tomography. Clinical and radiological outcomes and failure rates were compared between the groups at the 2-year follow-up.

Results: The position of the femoral tunnel was significantly high in group H than in group A (87.4% ± 4.2% versus 76.1% ± 3.7%, p < 0.001). Clinical outcomes were not significantly different between the two groups in terms of the clinical scores (International Knee Documentation Committee subjective, Lysholm, and Tegner activity scores), range of motion, and posterior drawer test. Radiological outcomes also showed no intergroup differences in the side-to-side differences of posterior tibial translation and osteoarthritis progression. Side-to-side difference on the Telos stress radiograph was 5.2 ± 2.9 mm in group A and 5.2 ± 2.7 mm in group H (n.s.). There were four failures in group A (12.1%) and one in group H (3.3%). The differences between the groups were not statistically significant.

Conclusion: The clinical and radiological outcomes and failure rates of the high femoral tunnels were comparable with those of the anatomical femoral tunnels at the 2-year follow-up after remnant-preserving single-bundle PCL reconstruction. The findings of this study suggest that high femoral tunnels can be considered an alternative in remnant-preserving single-bundle PCL reconstruction.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-020-06266-0DOI Listing
June 2021

Optimal dose of topical tranexamic acid considering efficacy and safety in total knee arthroplasty: a randomized controlled study.

Knee Surg Sports Traumatol Arthrosc 2020 Aug 31. Epub 2020 Aug 31.

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.

Purpose: This study aimed to evaluate the optimal dosage of topical tranexamic acid (TXA) considering the efficacy and safety for controlling bleeding after total knee arthroplasty (TKA).

Methods: This prospective randomized double-blinded placebo-controlled comparative study included 325 patients scheduled to undergo TKA, who were randomly assigned to five groups based on the topical TXA injection (n = 65 per group): control; group 1, 0.5 g TXA; group 2, 1.0 g TXA; group 3, 2.0 g TXA; and group 4, 3.0 g TXA. The primary outcome was decrease in postoperative hemoglobin levels. The secondary outcomes were blood loss calculated using Good's method, drainage volume, frequency of transfusion, and range of motion (ROM). Plasma TXA levels and complications were also evaluated.

Results: Significant differences were noted in the decrease in hemoglobin levels between the control group and groups 2 (p = 0.0027), 3 (p = 0.005), and 4 (p = 0.001). No significant differences were shown among the experimental groups. Significant differences in total blood loss and frequency of transfusion were noted between the control group and groups 2 (p = 0.004, 0.002, respectively), 3 (p = 0.007, 0.001, respectively), and 4 (p = 0.001, 0.009, respectively) without showing significant differences among the experimental groups. With respect to drainage volume, no significant differences were observed among the groups. The serum TXA levels increased proportionally with the applied dose of topical TXA immediately and at 3 and 6 h postoperatively. Symptomatic deep vein thrombosis or pulmonary embolism was not observed in any group. Other complications related to TXA administration were not detected.

Conclusion: Topical application of 1.0 g or more of TXA shows significant bleeding control without a dose-response relationship. Blood TXA levels increase with the TXA dose following topical TXA application. Therefore, to prevent overdosing and reduce potential complications with ensuring the effectiveness, 1.0 g of TXA is recommended as a topical application.

Level Of Evidence: I.
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http://dx.doi.org/10.1007/s00167-020-06241-9DOI Listing
August 2020

Elastic pneumatic tourniquet cuff can reduce postoperative thigh pain after total knee arthroplasty: a prospective randomized trial.

BMC Musculoskelet Disord 2020 Aug 21;21(1):565. Epub 2020 Aug 21.

Department of Orthopedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Background: Tourniquet use is associated with complications such as thigh pain, skin problems, and deep vein thrombosis (DVT). This prospective study aimed to evaluate the efficacy and safety of the pneumatic tourniquet system using an elastic cuff and limb occlusion pressure (LOP) in total knee arthroplasty (TKA). The hypothesis of this study was that an elastic cuff tourniquet would result in less postoperative thigh pain after TKA.

Methods: This prospective randomized controlled trial involved a total of 98 patients who underwent primary TKA. They were randomized into two groups: tourniquet system using an elastic cuff and LOP group (Group E) and tourniquet system using a conventional-cuff and LOP group (Group C). Outcomes including postoperative thigh pain assessed using a visual analog scale (VAS), serum muscle enzymes, recommended tourniquet pressure (RTP), bloodlessness of surgical field, surgical time, incidence of DVT, and the frequency of rescue analgesic use after surgery, were compared between groups.

Results: Patients in Group E experienced significantly less thigh pain compared to those in Group C on postoperative day 4 (P = 0.01) and day 7 (P = 0.04). The difference between RTP and systolic blood pressure was significantly lower in Group E (P = 0.045). One case of thigh DVT was found in Group E, while no such cases were found in Group C. One and two cases of poor bloodless surgical fields were observed in Group E and Group C, respectively. There was no significant difference in surgical time, levels of serum muscle enzymes, and the frequency of rescue analgesic use between the two groups.

Conclusions: The pneumatic tourniquet system using an elastic cuff and LOP reduced early postoperative thigh pain more effectively than did the tourniquet system using a conventional cuff and LOP.

Trial Registration: # KCT0003149 . Registered August 17, 2018 - Retrospectively registered.
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http://dx.doi.org/10.1186/s12891-020-03579-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442977PMC
August 2020

The platelet-to-lymphocyte ratio as a significant prognostic factor to predict survival outcomes in patients with synchronous metastatic renal cell carcinoma.

Investig Clin Urol 2020 09 23;61(5):475-481. Epub 2020 Jul 23.

Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.

Purpose: The clinical impact of the platelet-to-lymphocyte ratio (PLR) on the prognosis of patients with metastatic renal cell carcinoma (mRCC) remains controversial. We investigated the associations between elevation of the PLR and disease prognosis in patients with synchronous mRCC.

Materials And Methods: The data of 1,505 patients with synchronous mRCC were retrospectively analyzed. The entire cohort was stratified into two subgroups according to PLR. Kaplan-Meier and Cox proportional analyses were performed to investigate the possible associations between the PLR and disease prognosis.

Results: There were 921 patients with a high PLR and 584 patients with a low PLR by use of the cutoff of 146. The patients with a high PLR had worse clinical characteristics in terms of advanced clinical stage (p<0.001) and rate of lymph node invasion (p=0.036). The Kaplan-Meier analysis showed that patients with a high PLR had significantly shorter overall survival (OS) (p<0.001) and cancer-specific survival (CSS) (p<0.001). The multivariate Cox analysis revealed that the PLR was an independent predictor for shorter OS (hazard ratio [HR], 1.345; 95% confidence interval [CI], 1.183-1.530; p<0.001) and CSS (HR, 1.318; 95% CI, 1.156-1.502; p<0.001). In the subgroup analyses, the PLR showed a significant association with survival outcomes in the subgroup with clear cell type (all p<0.05) but not in the subgroup with the non-clear cell type.

Conclusions: The PLR was an independent prognostic factor for survival outcomes in patients with mRCC. However, the association was statistically significant only in patients with clear cell type mRCC.
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http://dx.doi.org/10.4111/icu.20200002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458873PMC
September 2020

Indirect pathological indicators for cardiac sarcoidosis on endomyocardial biopsy.

J Pathol Transl Med 2020 Sep 29;54(5):396-410. Epub 2020 Jul 29.

Department of Pathology, Sejong Hospital, Bucheon, Korea.

Background: The definitive pathologic diagnosis of cardiac sarcoidosis requires observation of a granuloma in the myocardial tissue. It is common, however, to receive a "negative" report for a clinically probable case. We would like to advise pathologists and clinicians on how to interpret "negative" biopsies.

Methods: Our study samples were 27 endomyocardial biopsies from 25 patients, three cardiac transplantation and an autopsied heart with suspected cardiac sarcoidosis. Pathologic, radiologic, and clinical features were compared.

Results: The presence of micro-granulomas or increased histiocytic infiltration was always (6/6 or 100%) associated with fatty infiltration and confluent fibrosis, and they showed radiological features of sarcoidosis. Three of five cases (60%) with fatty change and confluent fibrosis were probable for cardiac sarcoidosis on radiology. When either confluent fibrosis or fatty change was present, one-third (3/9) were radiologically probable for cardiac sarcoidosis. We interpreted cases with micro-granuloma as positive for cardiac sarcoidosis (five of 25, 20%). Cases with both confluent fibrosis and fatty change were interpreted as probable for cardiac sarcoidosis (seven of 25, 28%). Another 13 cases, including eight cases with either confluent fibrosis or fatty change, were interpreted as low probability based on endomyocardial biopsy.

Conclusions: The presence of micro-granuloma could be an evidence for positive diagnosis of cardiac sarcoidosis. Presence of both confluent fibrosis and fatty change is necessary for probable cardiac sarcoidosis in the absence of granuloma. Either of confluent fibrosis or fatty change may be an indirect pathological evidence but they are interpreted as nonspecific findings.
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http://dx.doi.org/10.4132/jptm.2020.06.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483025PMC
September 2020

The amount of displacement can determine non-operative treatment in posterior cruciate ligament avulsion fracture.

Knee Surg Sports Traumatol Arthrosc 2021 Apr 25;29(4):1269-1275. Epub 2020 Jul 25.

Department of Orthopedic Surgery, Kyung-Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.

Purpose: It is generally agreed that surgical treatment is warranted for acute posterior cruciate ligament (PCL) avulsion fracture with displacement. However, the amount of displacement that warrants surgical treatment has not been defined. The purpose of this study was to determine the optimal cut-off value for displacement of posterior cruciate ligament avulsion fracture in determining non-operative treatment and to compare the results of non-operative treatment in acute isolated PCL avulsion fractures with non-operative treatment of acute PCL injury.

Methods: Between 2007 and 2017, 30 consecutive patients with acute isolated PCL avulsion fractures and 70 consecutive patients with acute isolated PCL injuries, all of whom underwent non-operative treatment (cast immobilization with > 2 years of follow-up) were retrospectively analyzed. Clinical scores including the International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score, as well as side-to-side differences on stress radiographs, were compared between the PCL avulsion fracture and PCL injury groups at the final follow-up. The failure rates of non-operative treatment were also compared. The predictive value of the amount of fracture displacement for successful non-operative treatment was calculated using area under the receiver operating characteristic curve (AUROC). The optimal cut-off of the amount of fracture displacement to determine non-operative treatment was based on the maximal sum of sensitivity and specificity.

Results: The two groups exhibited comparable clinical scores and mean side-to-side differences on stress radiographs. There were 5 (16.6%) failures of non-operative treatment in the PCL avulsion fracture group and 19 (27.1%) failures in the PCL injury group. (n.s) There was a significant positive correlation between the amount of initial avulsion fracture displacement and side-to-side difference in posterior stress radiographs at final follow up (P < 0.001). The optimal cut-off value for the amount of fracture displacement in PCL avulsion fracture to predict failure of non-operative treatment was 6.7 mm (AUROC = 1.0).

Conclusion: The outcomes of non-operative treatment of acute isolated PCL avulsion fractures were comparable to those of patients with acute isolated PCL injuries. Acute PCL avulsion injuries with displacement of less than 6.7 mm should be considered for non-operative treatment.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-020-06175-2DOI Listing
April 2021

Meniscal Allograft Transplantation After Anterior Cruciate Ligament Reconstruction Can Improve Knee Stability: A Comparison of Medial and Lateral Procedures.

Am J Sports Med 2020 08 21;48(10):2370-2375. Epub 2020 Jul 21.

Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea.

Background: The purpose of this study was to evaluate the clinical score and stability after meniscal allograft transplantation (MAT) after a previous anterior cruciate ligament (ACL) reconstruction.

Hypothesis: Medial MAT would improve anteroposterior stability, and lateral MAT would improve rotational stability.

Study Design: Cohort study; Level of evidence, 3.

Method: We retrospectively investigated 31 cases of MAT after a previous total or nearly total meniscectomy and ACL reconstruction between November 2008 and June 2017. Cases were divided into medial (16 cases) and lateral (15 cases) MAT groups. The patients were assessed preoperatively and at the 2-year follow-up.

Results: In the medial MAT group, the International Knee Documentation Committee, Lysholm, Lysholm instability, and Tegner scores improved significantly at the 2-year follow-up, and there were also significant improvements in the anterior drawer, Lachman, and pivot-shift tests. In the lateral MAT group, the Lysholm and Tegner scores improved significantly at the 2-year follow-up, as had the anterior drawer and Lachman tests but not the pivot-shift test. The medial MAT group showed significant improvement in side-to-side difference on Telos stress radiographs, from 6.5 mm (preoperatively) to 3.6 mm (2-year follow-up) ( = .001), while the lateral MAT group showed no significant change. There was no progression of arthritis in either group.

Conclusion: Medial MAT improved not only anteroposterior stability but also rotational stability in the meniscus-deficient ACL-reconstructed knee. Lateral MAT showed improvements in the anterior drawer and Lachman tests but not in the pivot-shift test or side-to-side difference on Telos stress radiographs in meniscus-deficient ACL-reconstructed knees. Instability and pain are indications for MAT in meniscus-deficient ACL-reconstructed knees.
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http://dx.doi.org/10.1177/0363546520938771DOI Listing
August 2020

Driving-Related Adverse Events in the Elderly Men: A Population-Based Prospective Cohort Study.

Psychiatry Investig 2020 Aug 21;17(8):744-750. Epub 2020 Jul 21.

Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.

Objective: This study estimated the incidence of driving-related adverse events and examined the association of cognitive function with the risk of future driving-related adverse events in the elderly Korean male population.

Methods: We analyzed 1,172 male drivers aged 60 years or older in the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD). Using the data from Korean National Police Agency, we classified the participants into three groups: safe driving (drove for 2 years after baseline without a traffic accident or repeated violations), driving cessation (stopped driving), and risky driving (one or more traffic accidents or repeated violations). We estimated the incidences of driving cessation and risky driving, and examined the effect of cognitive function on their risks.

Results: The incidence of driving cessation and risky driving in the Korean male drivers aged 60 years or older was 19.3 and 69.9 per 1,000 person-years respectively and increased in the late 80s. Drivers with better baseline Word List Memory Test scores showed less risky driving (OR=0.94, p=0.039).

Conclusion: Driving-related adverse events increased in late 80s, and better memory function was protective against these events.
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http://dx.doi.org/10.30773/pi.2019.0219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449837PMC
August 2020

Predicting outcome of repair of medial meniscus posterior root tear with early osteoarthritis using bone single-photon emission computed tomography/computed tomography.

Medicine (Baltimore) 2020 Jul;99(27):e21047

Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.

Repair of medial meniscus posterior root tear (MMPRT) is considered as an effective early intervention strategy for osteoarthritis. We aimed at evaluating whether or not single-photon emission computed tomography/computed tomography (SPECT/CT) could predict the treatment outcome.Eleven patients with MMPRT who underwent preoperative SPECT/CT were retrospectively enrolled. Clinical symptoms were evaluated based on the knee injury and osteoarthritis outcome score (KOOS) and visual analogue scale (VAS) for pain. The uptake pattern of the medial tibial plateau (MTP) on SPECT/CT was visually assessed. Additionally, the maximum lesion-to-cortical counts ratio (LCRmax) for the anterior and posterior aspects of MTP and anterior-posterior MTP ratio (APR) were quantitatively assessed. Spearman correlation analyses were performed between the change in clinical symptom scores and preoperative SPECT/CT patterns.All patients showed increased radiotracer uptake in MTP. Among them, 8 (73%) showed dominant uptake in the anterior aspect of MTP. The rest 3 (27%) showed posterior-dominant uptake. Patients with anterior-dominant patterns tended to show better outcomes in terms of the postoperative KOOS score (P = .07). Anterior MTP LCRmax showed a negative correlation with the change in VAS (ρ = -0.664, P < .03). APR showed a correlation with the change in the KOOS score (ρ = 0.655, P < .03).Patients with MMPRT with relatively higher uptake in the anterior aspect of MTP could have better clinical outcomes after the repair. The preoperative SPECT/CT pattern may have a predictive value in selecting patients with good postoperative outcomes.
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http://dx.doi.org/10.1097/MD.0000000000021047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337403PMC
July 2020

Centralized anterior bone plug results in less graft extrusion in patients undergoing medial meniscus allograft transplantation following anterior cruciate ligament reconstruction.

Knee 2020 Jun;27(3):884-890

Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea. Electronic address:

Purpose: This study was performed to analyze the effect of anterior bone plug positioning on clinical and radiological outcomes in patients undergoing medial meniscus allograft transplantation (M-MAT) following anterior cruciate ligament reconstruction (ACLR).

Methods: Data from 24 patients who underwent M-MAT following meniscectomy and ACLR from November 2008 to June 2017 were retrospectively investigated. Patients were divided into either the centrally positioned group (group C) or the medially positioned group (group M) based on the location of the anterior bone plug for M-MAT. Clinical and radiographic follow-up was performed at two years postoperatively. International Cartilage Repair Society (ICRS) grades of chondral lesion, graft extrusion, and meniscus signal intensity were evaluated by magnetic resonance imaging (MRI) at one year postoperatively.

Results: There were no significant differences in demographics including follow-up time of two years between the two groups. There were no significant differences in postoperative subjective International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores between groups. Furthermore, there were no significant differences in osteoarthritis progression or ICRS grade on MRI. However, group C showed significantly less absolute graft extrusion (P = .008) and relative graft extrusion (P < .0001) on one-year follow-up MRI, relative to group M. Meniscus signal intensity tended to be better in group C, although this difference was not statistically significant (P = .092).

Conclusion: The centrally positioned group showed significantly less graft extrusion on MRI compared to the medially positioned group; however, there were no statistically significant differences in clinical outcomes between the two groups.
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http://dx.doi.org/10.1016/j.knee.2020.02.014DOI Listing
June 2020

Influence of Posterior Tibial Slope on Clinical Outcomes and Survivorship After Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts: A Minimum of 10-Year Follow-Up.

Arthroscopy 2020 10 15;36(10):2718-2727. Epub 2020 Jun 15.

Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, Gyeongki-do, Republic of Korea. Electronic address:

Purpose: To investigate the influence of medial and lateral posterior tibial slope (PTS) on long-term clinical outcomes and survivorship after anterior cruciate ligament (ACL) reconstruction using hamstring autografts.

Methods: A total of 232 patients (mean age, 28.2 ± 8.9 years) who underwent primary ACL reconstruction from October 2002 to July 2007 were retrospectively reviewed. Patients with multiple ligament reconstruction, total meniscectomy, contralateral knee surgery before ACL reconstruction, open growth plate, and less than 10-year follow-up were excluded in the study. The medial and lateral PTS were measured from preoperative magnetic resonance imaging. Based on Li et al.'s previous study, the patients were divided into 2 groups according to their medial PTS (≤5.6° vs >5.6°) and lateral PTS (≤3.8° vs >3.8°), respectively. Clinical outcomes (clinical scores, stability tests and failure rate) were compared between the groups at the last follow-up. Furthermore, survival analysis was performed using the Kaplan-Meier method.

Results: All clinical scores (International Knee Documentation Committee subjective, Lysholm, and Tegner activity scores) and stability tests (physical examinations and side-to-side difference in Telos stress radiographs) were insignificantly different between the 2 groups classified based on medial or lateral PTS. However, the failure rate was significantly higher in patients with medial PTS >5.6° (16.1% vs 5.1%, P = .01) or lateral PTS >3.8° (14.5% vs 4.7%; P = .01). The odds ratios of graft failure due to increased medial and lateral PTS were 3.18 (95% confidence interval, 1.22-8.28; P = .02) and 3.43 (95% confidence interval, 1.29-9.09; P = .01), respectively. In addition, the 10-year survivorship was significantly lower in patients with medial PTS >5.6° (83.9% vs 94.9%, P = .01) or lateral PTS >3.8° (85.5% vs 96.0%; P = .01).

Conclusions: Increased medial (>5.6°) and lateral (>3.8°) PTS were associated with higher failure rate and lower survivorship at a minimum of 10-year follow-up after primary ACL reconstruction using hamstring autografts.

Level Of Evidence: Level III, retrospective comparative trial.
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http://dx.doi.org/10.1016/j.arthro.2020.06.011DOI Listing
October 2020

Clinical Outcomes and the Failure Rate of Revision Anterior Cruciate Ligament Reconstruction Were Comparable Between Patients Younger Than 40 Years and Patients Older Than 40 Years: A Minimum 2-Year Follow-Up Study.

Arthroscopy 2020 09 15;36(9):2513-2522. Epub 2020 Jun 15.

Department of Orthopedic Surgery, Korea University Ansan Hospital, Gyeongki-do, Korea. Electronic address:

Purpose: To compare the clinical outcomes and failure rates of revision anterior cruciate ligament reconstruction (ACLR) between young and middle-aged surgery patients.

Methods: Patients who underwent revision ACLRs between January 2008 and June 2017 with a minimum 2-year follow-up were retrospectively evaluated. Patients were divided into 2 groups according to age: ≥40 years (group A) and <40 years (group B). Detailed patient demographic data, preoperative radiographic data, and concurrent meniscal and chondral lesion were reviewed. Clinical scores, laxity tests results, and graft failures were compared between groups at the final follow-up.

Results: Eighty-six patients (group A, n = 24, 46.6 ± 4.5 years; group B, n = 62, 26.2 ± 6.3 years) were included in this study. Demographic data showed that the time interval from primary to revision ACLR was longer in group A than in group B (96.2 ± 80.9 vs. 52.0 ± 42.1 months, P = .011). Group A had a higher prevalence of chondral defects of the trochlea (P = .016). No significant differences were identified in the prevalence and severity of meniscal lesions. At the final follow-up, all clinical scores were improved postoperatively but did not differ significantly between the groups. No significant differences were identified in side-to-side difference on Telos stress radiographs (group A, 6.3 ± 5.0 mm; group B, 5.6 ± 3.8 mm; P = .403) and graft failure rate (group A, 33.3%; group B, 30.6%; P = .358) at the final follow-up.

Conclusions: The current study showed that the clinical outcomes of revision ACLRs in patients improved significantly in patients younger than 40 years and were comparable to those observed in patients older than 40 years at a minimum 2-year follow-up.

Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.arthro.2020.06.012DOI Listing
September 2020

Clinical Outcomes and the Failure Rate of Revision Anterior Cruciate Ligament Reconstruction Were Comparable Between Patients Younger Than 40 Years and Patients Older Than 40 Years: A Minimum 2-Year Follow-Up Study.

Arthroscopy 2020 09 15;36(9):2513-2522. Epub 2020 Jun 15.

Department of Orthopedic Surgery, Korea University Ansan Hospital, Gyeongki-do, Korea. Electronic address:

Purpose: To compare the clinical outcomes and failure rates of revision anterior cruciate ligament reconstruction (ACLR) between young and middle-aged surgery patients.

Methods: Patients who underwent revision ACLRs between January 2008 and June 2017 with a minimum 2-year follow-up were retrospectively evaluated. Patients were divided into 2 groups according to age: ≥40 years (group A) and <40 years (group B). Detailed patient demographic data, preoperative radiographic data, and concurrent meniscal and chondral lesion were reviewed. Clinical scores, laxity tests results, and graft failures were compared between groups at the final follow-up.

Results: Eighty-six patients (group A, n = 24, 46.6 ± 4.5 years; group B, n = 62, 26.2 ± 6.3 years) were included in this study. Demographic data showed that the time interval from primary to revision ACLR was longer in group A than in group B (96.2 ± 80.9 vs. 52.0 ± 42.1 months, P = .011). Group A had a higher prevalence of chondral defects of the trochlea (P = .016). No significant differences were identified in the prevalence and severity of meniscal lesions. At the final follow-up, all clinical scores were improved postoperatively but did not differ significantly between the groups. No significant differences were identified in side-to-side difference on Telos stress radiographs (group A, 6.3 ± 5.0 mm; group B, 5.6 ± 3.8 mm; P = .403) and graft failure rate (group A, 33.3%; group B, 30.6%; P = .358) at the final follow-up.

Conclusions: The current study showed that the clinical outcomes of revision ACLRs in patients improved significantly in patients younger than 40 years and were comparable to those observed in patients older than 40 years at a minimum 2-year follow-up.

Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.arthro.2020.06.012DOI Listing
September 2020

Costal Chondrocyte-Derived Pellet-Type Autologous Chondrocyte Implantation versus Microfracture for Repair of Articular Cartilage Defects: A Prospective Randomized Trial.

Cartilage 2020 Jun 1:1947603520921448. Epub 2020 Jun 1.

Department of Orthopaedic Surgery, Kyung-Hee University Hospital, Seoul, Republic of Korea.

Objective: To compare the efficacy and safety of costal chondrocyte-derived pellet-type autologous chondrocyte implantation (CCP-ACI) with microfracture (MFx) for repair of articular cartilage defects of the knee.

Design: Thirty subjects with an International Cartilage Repair Society (ICRS) grade 3 to 4 chondral defect (2-10 cm in area; ≤4 cm in volume) were randomized at a ratio of 2:1 (CCP-ACI:MFx). Twenty patients were allocated in the CCP-ACI group and 10 patients in the MFx group. CCP-ACI was performed by harvesting costal cartilage at least 4 weeks before surgery. Implantation was performed without any marrow stimulation. Efficacy and safety were assessed at weeks 8, 24, and 48 after surgery according to the magnetic resonance observation of cartilage repair tissue (MOCART) score and clinical outcomes.

Results: MOCART scores improved from baseline to 24 and 48 weeks postoperatively in both treatment groups. The improvement in MOCART scores in the CCP-ACI group was significantly greater than that in the MFx group at 24 and 48 weeks (39.1 vs 21.8 and 43.0 vs 24.8, respectively). The proportions of complete defect repair and complete integration were significantly higher in the CCP-ACI group than the MFx group at 48 weeks. Improvement in Lysholm score and KOOS subscores, including Function (Sports and Recreational Activity) and knee-related quality of life was significantly greater in the CCP-ACI group than the MFx group at 48 weeks (35.4 vs 31.5, 35.7 vs 28.5, and 27.9 vs 11.6, respectively).

Conclusion: Treatment of cartilage defects with CCP-ACI yielded satisfactory cartilage tissue repair outcomes, with good structural integration with native cartilage tissue shown by magnetic resonance imaging at 24 and 48 weeks after surgery.

Level Of Evidence: Level 1: Randomized controlled study.
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http://dx.doi.org/10.1177/1947603520921448DOI Listing
June 2020

The utility of hip arthroscopy for patients with painful borderline hip dysplasia.

J Orthop Surg (Hong Kong) 2020 Jan-Apr;28(2):2309499020923162

Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea.

Purpose: We measured the width of the acetabular labra in, and the clinical outcomes of, patients with borderline hip dysplasia (HD) who underwent arthroscopy.

Methods: A total of 1436 patients who underwent hip arthroscopy to treat symptomatic, acetabular labral tears were enrolled. From this cohort, we extracted a borderline HD group (162 cases). Lateral labral widths were evaluated using preoperative magnetic resonance imaging scans. Clinical data including the modified Harris hip score (mHHS), non-arthritic hip score (NAHS), hip outcome score-activity of daily living (HOS-ADL) score, visual analog scale (VAS) pain score, and Tönnis grade were collected. In addition, patient satisfaction with arthroscopy outcomes was rated. All complications and reoperations were noted.

Results: The mean follow-up time was 87.4 months. The lateral labral width was 7.64 mm in those with normal hips and 7.73 mm in borderline HD patients, respectively ( = 0.870). The Tönnis grade progressed mildly from 0.46 to 0.76 ( = 0.227). At the last follow-up, clinical outcome scores (mHHS, NAHS, and HOS-ADL scores) and the VAS score were improved ( < 0.001). The mean patient satisfaction was scored at 8.2. The reoperation rate was higher in those who underwent labral debridement (25.6%) than labral repair (4.1%).

Conclusions: The lateral labral width did not differ significantly between the borderline HD group and the nondysplastic control group. Arthroscopy relieved the symptoms of painful borderline HD and did not accelerate osteoarthritis. Therefore, if such patients do not respond to conservative treatment, hip arthroscopy can be considered for further treatment.
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http://dx.doi.org/10.1177/2309499020923162DOI Listing
February 2021

Development of the clinical calculator for mortality of patients with metastatic clear cell type renal cell carcinoma: An analysis of patients from Korean Renal Cancer Study Group database.

Investig Clin Urol 2020 05 10;61(3):260-268. Epub 2020 Mar 10.

Anesthesia Consultants of Indianapolis, Indianapolis, IN, USA.

Purpose: To develop the clinical calculator for mortality of patients with metastatic renal cell carcinoma (mRCC) using Korean Renal Cancer Study Group (KRoCS) database.

Materials And Methods: Data from 1,115 patients with mRCC treated in 4 hospitals joining KRoCS between 1993 and 2016 were pooled. Five-year survival rates were calculated using Kaplan-Meier curve. A clinical calculator for 5-year mortality was developed using multivariable logistic regression analysis and validated externally using dataset including 916 patients from 4 other hospitals.

Results: Overall survival rates and cancer specific survival rate at 5 years were 28.5% and 29.4%, respectively. Among baseline factors, increased neutrophil-lymphocyte ratio (≥4), synchronous metastasis, low albumin (<3.0 g/dL), and low hemoglobin (
Conclusions: A clinical calculator has been developed to quantify the risk of death for individual patients after treatment of mRCC. This tool may be useful for patients or their guardians who want to know their prognosis and to identify patients requiring aggressive therapy and additional supportive measures during and after treatment.
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http://dx.doi.org/10.4111/icu.2020.61.3.260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189103PMC
May 2020

The number of metabolic features as a significant prognostic factor in patients with metastatic renal cell carcinoma.

Sci Rep 2020 04 24;10(1):6967. Epub 2020 Apr 24.

Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.

The effect of metabolic characteristics on the prognosis of patients with metastatic renal cell carcinoma remains controversial. We investigated the associations between metabolic features of each individual and disease prognosis in patients with metastatic renal cell carcinoma. Data of 1,584 patients with metastatic renal cell carcinoma from a multi-institutional database were retrospectively analyzed. The entire cohort was stratified into three subgroups according to how many patients had abnormal metabolic features (hypertension, diabetes mellitus, and low body mass index). The Kaplan-Meier and Cox proportional analyses were performed to investigate the associations between abnormal metabolic features and disease prognosis. mThere were 465 subjects without any metabolic features, 995 with one or two, and 124 with three. When the survival outcomes were compared according to the number of metabolic features, patients with higher numbers of metabolic features had significantly shorter overall and cancer-specific survival than those with fewer metabolic features (all p values <0.05). The multivariate Cox analysis showed that the number of metabolic features was an independent predictor for shorter cancer-specific and overall survival (all p values < 0.05). When performing subgroup analysis according to the cellular type, significant results were only obtained among the clear cell subtype subgroup, with the association not being significant in the non-clear cell subtype cohort. Patients with more metabolic features had significantly worse survival outcomes than those with fewer metabolic features. However, the association was only statistically significant in patients with clear cell-type metastatic renal cell carcinoma.
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http://dx.doi.org/10.1038/s41598-020-63816-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181597PMC
April 2020

Costal Chondrocyte-Derived Pellet-Type Autologous Chondrocyte Implantation for Treatment of Articular Cartilage Defect.

Am J Sports Med 2020 04 3;48(5):1236-1245. Epub 2020 Mar 3.

Department of Orthopaedics, Kyung-Hee University Hospital, Seoul, Republic of Korea.

Background: Because articular chondrocyte-based autologous chondrocyte implantations (ACIs) have restrictively restored articular cartilage defects, alternative cell sources as a new therapeutic option for cartilage repair have been introduced.

Purpose: To assess whether implantation of a costal chondrocyte-derived pellet-type (CCP) ACI allows safe, functional, and structural restoration of full-thickness cartilage defects in the knee.

Study Design: Case series; Level of evidence, 4.

Methods: In this first-in-human study, 7 patients with symptomatic, full-thickness cartilage lesions were enrolled. The chondrocytes isolated from the patients' costal cartilage were expanded, followed by 3-dimensional pellet culture to prepare the CCP-ACI. Implantation of the pellets was performed via minimal arthrotomy and secured with a fibrin sealant. Clinical scores, including the International Knee Documentation Committee (IKDC) subjective, Lysholm, and Tegner activity scores, were estimated preoperatively and at 1, 2, and 5 years postoperatively. High-resolution magnetic resonance imaging was also performed to evaluate cartilage repair as well as to calculate the MOCART (magnetic resonance observation of cartilage repair tissue) score.

Results: The costal chondrocytes of all patients formed homogeneous-sized pellets, which showed the characteristics of the hyaline cartilaginous tissue with lacunae-occupied chondrocytes surrounded by glycosaminoglycan and type II collagen-rich extracellular matrix. There were no treatment-related serious adverse events during the 5-year follow-up period. Significant improvements were seen in all clinical scores from preoperative baseline to the 5-year follow-up (IKDC subjective score, 34.67 to 75.86; Lysholm score, 34.00 to 85.33; Tegner activity score, 1.17 to 4.67; and MOCART score, 28.33 to 83.33). Two patients had complete defect filling on magnetic resonance imaging evaluation at 1 year. Moreover, at 5 years postoperatively, complete defect filling was observed in 4 patients, and hypertrophy or incomplete defect filling (50%-100%) was observed in 2 patients.

Conclusion: The overall results of this clinical study suggest that CCP-ACI can emerge as a promising therapeutic option for articular cartilage repair with good clinical outcomes and structural regeneration and with stable results at midterm follow-up.

Registration: NCT03517046 ( ClinicalTrials.gov identifier).
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http://dx.doi.org/10.1177/0363546520905565DOI Listing
April 2020
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