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Hypokalemia is a common electrolyte disturbance and is related to poor prognosis in patients with cardiovascular disease. However, the role of hypokalemia in patients with vasospastic angina (VSA) has not yet been studied. The present study enrolled 1454 patients diagnosed with VSA according to ergonovine provocation test results and available admission serum potassium data. The primary outcome was a composite of cardiac death, acute coronary syndrome, and new-onset life-threatening arrhythmia. Based on a hypokalemia definition as serum potassium concentration ≤ 3.5 mEq/L, the hypokalaemia group included 70 patients (4.8%). The median potassium levels were 3.4 mEq/L [interquartile range (IQR) 3.3–3.5] in the hypokalemia group and 4.1 mEq/L (IQR 3.9–4.3) in the no-hypokalemia group. The median follow-up duration was 764 days. Primary outcomes occurred in seven patients (10.0%) in the hypokalemia group and 51 patients (3.7%) in the no-hypokalemia group. The Kaplan–Meier analysis showed a higher cumulative incidence of primary outcomes in the hypokalemia group compared to that in the no-hypokalemia group (log-rank P  = 0.014). Multivariate Cox regression analysis also showed that hypokalemia was an independent predictor of primary outcomes. In conclusion, hypokalemia at admission was associated with adverse clinical outcomes in VSA.

Obesity is associated with a high risk of morbidity and mortality in the general population and is a major independent risk factor for cardiovascular disease. We sought to evaluate the effect of overweight/obesity on clinical outcomes of patients with vasospastic angina (VA) at 1-year follow-up. The VA-KOREA (Vasospastic Angina in Korea) registry was a cohort of 11 centers from 2010 to 2015. The primary endpoint was a composite of cardiac death (CD), new-onset arrhythmia, and acute coronary syndrome (ACS). Using the body mass index (BMI) cut-off for Asians, 517 patients with definite VA were divided into either an overweight/obese (BMI ≥ 23 kg/m 2 ) group (n = 378) or a normal weight (BMI 18.5–22.9 kg/m 2 ) group (n = 139). The overweight/obese group showed a significantly lower rate of the primary endpoint composite (2.4% vs 7.9%, p  = 0.004) and ACS (0.8% vs 4.3%, p  = 0.007) than the normal weight group in the crude population. Similarly, in propensity-score matched analysis, the overweight/obese group showed a significantly lower rate of the primary endpoint composite (2.3% vs 8.4%, p  = 0.006) and ACS (1.1% vs 4.6%, p  = 0.035) than the normal weight group. However, there were no significant differences in CD and new-onset arrhythmia between the two groups in both the crude and propensity-score matched population. Independent predictors of the primary endpoint were overweight/obesity and dyslipidemia. In patients with VA, the overweight/obese group was associated with a favorable 1-year primary endpoint and the difference was mainly driven by the lower rate of ACS compared with the normal weight group.

Background Goniometers can be used to assess shoulder ROM with reasonable accuracy, but not internal rotation. Vertebral level, as determined by the hand-behind-the-back method, is used frequently but its reproducibility is questionable. We therefore devised a new measuring tape-based method for determining vertebral level. Questions/purposes We (1) compared the accuracy of a measuring tape-based and conventional vertebral-level method; (2) determined whether BMI affects their accuracy; and (3) devised a formula for converting distances measured using a measuring tape to vertebral levels. Patients and Methods We assessed internal rotation in 61 patients with shoulder pain. An electrode was taped to the skin where the thumb reached maximally behind the back. The vertebral-level method involved determining the vertebral level of the electrode by palpating bony landmarks whereas the measuring tape method involved measuring the distance between the C7 spinous process and the electrode. True vertebral levels of the electrode were confirmed by radiography. Results In nonobese patients, the accuracies of the upper thoracic and lumbar-level measurements were better for the measuring tape method than the vertebral-level method (r = 0.861 and 0.700, respectively in upper thoracic; 0.913 and 0.710, respectively in lumbar). Patient BMI affected the accuracy of the vertebral-level method but not that of the measuring tape method. The distances obtained using the measuring tape method could be converted into vertebral-level units using the formula: estimated vertebral level = 0.031 × [distance between C7 spinous process and thumb behind back] − 0.044 × [patient height] + 7.277. Conclusions The measuring tape-based method reflected shoulder internal rotation with higher accuracy than the vertebral-level method, and unlike the vertebral-level method, the measuring tape method was not affected by obesity. Level of Evidence Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Red blood cell distribution width (RDW) is a prognostic factor in various disorders. This study aimed to assess the prognostic value of RDW in patients undergoing amputation for diabetic foot. We retrospectively analyzed data on 415 patients who underwent diabetic foot amputation between January 2009 and January 2019. After establishing an optimal cutoff value of preoperative RDW for all-cause mortality, univariable and multivariable analyses with Cox proportional hazard model for survivorship and logistic regression analysis for prolonged hospital length of stay (> 30 days) were performed to identify significant prognostic factors. A preoperative RDW of 14.5% was the optimal cutoff value for predicting all-cause mortality. RDW ≥ 14.5% was significantly associated with increased all-cause mortality (hazard ratio, 2.55; 95% confidence interval [CI], 1.55–4.19; P  < 0.001) on multivariable Cox proportional model analysis. Preoperative RDW ≥ 14.5% was also associated with a prolonged hospital length of stay after surgery (odds ratio, 2.17; 95% CI, 1.29–3.66; P  = 0.004). Higher preoperative RDW was an independent predictive factor for increased all-cause mortality and prolonged hospital length of stay after diabetic foot amputation. These results suggest that RDW may be a useful laboratory parameter for risk stratification in patients undergoing amputation for diabetic foot.

Avascular necrosis (AVN) of the talus is a rare but debilitating condition that can lead to joint collapse and significant functional impairment. In advanced stages, joint-preserving surgical options are limited. This study aimed to develop a lightweight, patient-specific 3D-printed total talar implant and evaluate short-term clinical and radiographic outcomes in patients with idiopathic talar necrosis. A total of eight patients were approved for inclusion in this prospective clinical trial under the rare-disease framework established by the Ministry of Food and Drug Safety (MFDS) of Republic of Korea. Six patients underwent total talar arthroplasty starting in July 2023. As of this interim analysis, three patients had completed both the 6-week and 3-month postoperative follow-up assessments and were included in the analysis. The mean follow-up duration was 16 weeks. Radiographs were obtained at each follow-up visit to assess implant positioning and structural integrity. Clinical outcomes were evaluated using the visual analog scale (VAS), the Foot and Ankle Outcome Score (FAOS), and ankle range of motion (ROM). Preoperatively, all three patients reported VAS scores ranging from 7 to 10, which decreased by 3 to 7 points postoperatively. The median final FAOS improved from 48.0 [IQR: 17–76] to 61.0 [IQR: 48–72] at 3 months. Improvements were observed in pain and daily living function subscales, while lower gains were noted in sports and recreational activities. ROM was generally maintained or improved postoperatively, with plantarflexion increasing from a median of 40° [IQR: 0–45] to 40° [IQR: 35–55], and dorsiflexion maintained at a median of 10°. These preliminary findings suggest that total talar replacement using a patient-specific implant may preserve joint function and improve early clinical outcomes in selected patients with advanced talar AVN. Ongoing follow-up is required to assess mid- and long-term safety and implant durability. Clinical trial registration : Ministry of Food and Drug Safety (MFDS), approval number 2,023,000,218 / Approval date April 12, 2023.

Inertial measurement unit (IMU)-based gait analysis can be used to quantitatively analyze the bilateral coordination and gait asymmetry (GA). The purpose of this study was to investigate changes in bilateral coordination and GA due to gait speed using an IMU based gait analysis and identify spatiotemporal factors affecting bilateral coordination and GA. Eighty healthy adults (40 men and 40 women) participated in the study. The mean age was 26.2 years, and the mean body mass index was 22.8 kg/m2. Three different walking speeds (80%, 100%, and 120% of preferred walking speed) on a treadmill were applied for 1 min of continuous level walking using a shoe-type IMU-based gait analysis system. The phase coordination index (PCI) and GA were calculated on three different walking speeds. Several variables (gait speed, height, body mass index, cadence, and step length) were analyzed as possible factors affecting the PCI and GA. Bilateral coordination and GA improved during fast walking (p = 0.005 and p = 0.019, respectively) and deteriorated during slow walking (p<0.001 and p = 0.008, respectively), compared with the participants' preferred walking speeds. The correlation analysis revealed that PCI was negatively correlated with step length at each walking condition and lower gait speed was negatively correlated with PCI and GA during slow walking. Both bilateral coordination and GA had a negative linear relationship with gait speed, showing an improvement in the fast walking condition and deterioration in the slow walking condition. Step length was the factor associated with the change in the bilateral coordination.

The incidence of achilles tendon rupture varies by gender, age, and seasonal variation. However, there has been no study as yet linking achilles tendon rupture to daily fluctuations in outdoor temperature. The purpose of this study was to investigate the association between outdoor temperature and achilles tendon rupture using a Korea Meteorological Administration database and a Korean National Health Insurance Service-National Sample Cohort database. Between 2002 and 2015, all instances of achilles tendon repair were retrieved from the National Health Insurance Service-National Sample Cohort database to examine sociodemographic factors, specifically sex, age, residential area, and income level. Minimum age requirement was 20 years. Outdoor temperatures recorded at 16 observation points in South Korea were also acquired from the Korea Meteorological Administration data center for analysis. Overall, 850 (0.119%) of 713,456 individuals in the National Health Insurance Service-National Sample Cohort database underwent achilles tendon repair between 2002 and 2015. Yearly procedural totals increased with advancing age, peaking at ages 30–39 years (14.6 per 100,000 persons) and declining thereafter. Minimum, median, and maximum outdoor temperatures were associated with achilles tendon repair ( p <0.05), as did household income. In multivariate logistic regression analysis, outdoor temperatures, sex, age, and household income emerged as factors significantly associated with achilles tendon repair. Outcomes of this study confirm an association between incidence of achilles tendon repair and outdoor temperature, the latter denoting a novel index and likely surrogate measure of vigorous physical activity afforded by warmer weather.

Angle measurement methods for measuring pes planus may lose consistency by errors between observers. If the feature points for angle measurement can be provided in advance with the algorithm developed through the deep learning method, it is thought that the error between the observers can be reduced. A total of 300 weightbearing lateral radiographs were used for the development of the deep learning-based algorithm, and a total of 95 radiographs were collected for the clinical validation test set. Meary angle (MA) and calcaneal pitch (CP) were selected as measurement methods and measured twice by three less-experienced physicians with the algorithm-based tool and twice without. The intra- and inter-observer agreements of MA and CP measures were assessed via intra-class correlation coefficient. In addition, verification of the improvement of measurement performance by the algorithm was performed. Interobserver agreements for MA and CP measurements with algorithm were more improved than without algorithm. As for agreement with reference standard, combining the results of all readers, both MA and CP with algorithm were greater than those without algorithm. The deep learning algorithm tool is expected to improve the reproducibility of radiographic measurements for pes planus, especially by improving inter-observer agreement.

The authors describe two cases of subacromial impingement syndrome of the shoulder secondary to scapular dyskinesia caused by a tumor in young adults. The two tumors, an osteochondroma and a ganglion, were located in the scapulothoracic joint and inhibited normal kinesis of the scapula during arm motion.

Beta-2 microglobulin (β2m) is a component of the major histocompatibility complex class I (MHC-I) playing a crucial role in the immune system on cell surface, but it can be separated from the MHC-I and exist in biological fluid independently. Numerous reports have shown that β2m is a systemic pro-aging factor impairing cognitive function, and that it is increased in the blood and CSF of patients with Alzheimer's disease (AD). While β2m in the body fluid has been recognized as a potential factor in AD and aging, the development of therapeutic agents, especially those directly targeting β2m using antibodies, may face challenges. As β2m is a protein normally expressed in most nucleated cells as heterodimer bound to MHC-I, targeting β2m may indeed carry a risk of compromising immune responses and leading to side effects by inhibiting MHC-I. To develop monoclonal antibody against free β2m, not complexed to MHC-I, the hybridoma clones were obtained from mice injected with peptides containing epitopes targeting the adjacent region where β2m binds to heavy chain, another subunit of MHC-I. One of these antibody clones, termed ADEL-Y03, was selected by characterizing its binding affinity and specificity for free β2m, and mass-produced for in vivo efficacy study against AD. The ADEL-Y03 exhibit high affinity and specificity for free β2m, but not to β2m complexed with MHC- I. The in vivo activity of ADEL-Y03 in blocking free β2m was validated by recovering β2m-induced cognitive deficit in wild type mice. In addition, intraperitoneal injection of ADEL-Y03 reduced free β2m levels in the brain and plasma, leading to a decrease of beta-amyloid and inflammation, hallmarks of AD pathology, in 5XFAD mice brain. In vitro study demonstrates the role of free β2m in AD pathology, and these effects were ameliorated by ADEL-Y03. Specific targeting free β2m using ADEL-Y03 antibody may be a promising approach to developing new therapies for AD without deleterious effects such as downregulating immune function of MHC-I.