Daejeon Sun Hospital

ABSTRACT During host-pathogen interactions, fungal pathogens secrete effector proteins into host cells to manipulate the host immune system and facilitate infection. Although many effector genes are highly expressed during infection stages, there is limited information on the mechanisms regulating their in planta expression. Here, we characterize the promoter of MoHTR1 , a nuclear effector gene of the rice blast fungal pathogen, to elucidate its in planta -specific expression. Using promoter deletion and mutation analyses, we identified a core cis -element (TATTTCGT) within the MoHTR1 promoter, designated the in planta active (IPA) element, which is crucial for in planta -specific expression. The IPA element is responsible for the expression of not only MoHTR1 , but also other effector genes including a known effector Slp1 . Furthermore, the IPA element enables the in planta expression of MobZIP14 , a gene specifically expressed during vegetative growth. The IPA element plays a critical role in fungal virulence by enabling MoHTR1 expression and regulating host immune responses. Bioinformatic and DNA-protein interaction analyses revealed that RGS1, a transcription factor containing a winged-helix binding domain, acts as a transcriptional regulator of MoHTR1 by directly binding to the IPA element. Our findings provide new insights into the regulatory mechanisms driving the in planta -specific expression of fungal effector genes.

Recent advancements in all-inside arthroscopic techniques for chronic ankle instability have shown promising outcomes. However, the necessity and clinical benefits of inferior extensor retinaculum (IER) reinforcement in arthroscopic lateral ligament complex (LLC) repair remain unclear. To evaluate whether IER reinforcement in arthroscopic LLC repair improves clinical, radiologic, and functional outcomes as compared with isolated arthroscopic LLC repair without IER reinforcement. Randomized controlled trial; Level of evidence, 1. In this study, 59 patients who underwent arthroscopic surgery for chronic ankle instability were prospectively randomized into 2 groups: arthroscopic anterior talofibular ligament repair with (group W, n = 29) and without (group WO, n = 30) IER reinforcement. The primary outcome was the Foot and Ankle Outcome Score at the final follow-up. The visual analog scale for pain, American Orthopedic Foot & Ankle Society score, and Karlsson ankle function score were measured as subjective outcomes. Posturographic analysis, as an objective outcome, was performed with a Tetrax device. Radiologic outcome evaluations were performed preoperatively and 2 years postoperatively using stress radiographs and magnetic resonance imaging in axial view. Complications, including retears, neuralgia, and knot irritations, were recorded. No significant differences were found between groups in clinical, proprioceptive, or radiologic outcomes at the final follow-up. Three retears (5.1%) were identified on postoperative MRI (group W, 3.4% [1/29]; group WO, 6.7% [2/30]; P = .580). Complications included knot irritation in 3 patients (10.3%) of group W and superficial peroneal nerve neuralgia in 1 patient (3.3%) of group WO. No significant differences in complications were observed between the groups. Arthroscopic LLC repair yields favorable clinical outcomes, regardless of whether IER reinforcement is performed. Given the lack of additional clinical benefit, routine IER reinforcement may not be warranted. Clinical Research Information Services (CRIS), Korea - Registration No.: [KCT0004755].

Concurrent atrial septal defect (ASD) and ventricular septal defect (VSD) are rare in cats. A 7-month-old intact female Sphynx cat was presented for evaluation of respiratory distress and exercise intolerance. Thoracic radiographs showed generalized cardiomegaly and pulmonary infiltrates, consistent with cardiogenic pulmonary edema. Transthoracic echocardiography revealed an ostium secundum–type ASD and a perimembranous VSD, with structurally normal atrioventricular valves and annuli. These features supported the diagnosis of concurrent ASD and VSD, rather than an atrioventricular septal defect. Color Doppler echocardiography and agitated saline contrast studies confirmed bidirectional shunting at both defect sites. Additionally, echocardiographic findings were consistent with pulmonary hypertension. As Eisenmenger syndrome was suspected and the owner declined invasive intervention, surgical repair was not performed. Initial treatment with furosemide and supplemental oxygen led to clinical improvement. The owner later discontinued diuretics; however, the cat remained asymptomatic for several months. Cyanosis and erythrocytosis developed approximately 8 months after initial presentation. Follow-up thoracic imaging and Doppler echocardiography demonstrated reduced cardiac silhouette size without recurrent pulmonary edema, right-sided chamber enlargement with right ventricular hypertrophy, and decreased pulmonary-to-systemic flow ratio, consistent with progression of Eisenmenger physiology. Medical management with phlebotomy, sildenafil, clopidogrel, and oxygen supplementation provided temporary stabilization; however, the cat eventually died approximately 1 year after diagnosis, likely due to disease progression and inconsistent therapeutic compliance. Postmortem examination confirmed both septal defects and marked right ventricular hypertrophy, consistent with the ante-mortem imaging findings. Histopathological examination revealed pulmonary vascular remodeling and myocardial fibrosis, indicative of chronic pulmonary hypertension. This report represents the first documented case of concurrent ASD and VSD with Eisenmenger physiology in a cat, with long-term clinical follow-up and postmortem confirmation.

Scarring, particularly the atrophic type, is one of the most distressing consequences of acne. Despite the availability of various treatment options, no single best treatment option has been recognized. To compare the efficacy of carbon dioxide (CO 2 ) pinhole method and needleless microsubcision with hyaluronic acid (HA) to identify a more effective treatment option for acne atrophic scars. A 4-week prospective, single-center, evaluator-blinded, randomized, split-face study was conducted. Clinical evaluation using the VISIA imaging tool, reflectance confocal microscopy (RCM), and histopathologic analysis was performed a month after a single-treatment session. Microsubcision with HA improved scarring depth and postacne erythema more than CO 2 pinhole method, although the differences were not statistically significant. Histopathologic analysis revealed that microsubcision with HA induced diffuse soft tissue remodeling and evenly distributed fine collagen fibers. In addition, RCM analysis revealed evenly distributed hyper-reflective collagen fibers in the dermis and regular honeycomb patterns in the epidermis. No serious adverse effects were observed. This study demonstrated that needleless microsubcision with HA shows a nonsignificant trend toward superiority than CO 2 pinhole method in treating atrophic acne scars.

Background/Objectives: Despite a substantial duration of recovery following the modified Broström procedure (MBP), many individuals do not entirely recover their preinjury sports performance. Return to sports (RTS) can be affected by multiple elements apart from a patient’s motivation. This study aimed to investigate the factors influencing RTS after anatomical ligament repair for chronic ankle instability. Methods: Sixty-two patients aged under 35 who underwent the MBP were regularly monitored for up to 3 years. Of these, 51 patients (82.3%) returned to their preinjury level of sports activity (return group), while 11 patients (17.7%) complained of partial or significant limitations (non-return group). Clinical outcomes were measured by the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). Mechanical stability was examined through physical examination and stress radiography. Peroneal strength was evaluated with an isokinetic dynamometer. Static and dynamic postural control abilities were tested using Biodex posturography. Results: Significant group differences were found in FAOS pain (94.7 points in the return group vs. 85.1 points in the non-return group; p = 0.004) and sports (91.2 vs. 78.8 points; p < 0.001) subscales. In the FAAM, the sports activity subscale also showed significant disparities (90.5 vs. 77.4 points, p < 0.001). Mechanical instability recurred in 2 patients (3.9%) in the return group and 4 patients (36.4%) in the non-return group, indicating a significant difference (p < 0.001). No notable differences were identified in stress radiography values or peroneal strength measurements. Posturographic evaluation showed that static postural control ability (overall stability index) did not differ significantly between the groups (1.22 in the return group vs. 1.43 in the non-return group); however, dynamic postural control ability differed substantially (1.41 vs. 2.33, p = 0.002). Conclusions: Residual pain, recurrence of mechanical instability, and insufficient recovery of dynamic postural control ability were associated with the return to preinjury level of sports activity after the MBP. Comprehensive rehabilitation protocols should address these factors to facilitate optimal postoperative sports participation.

Abstract Purpose The use of fixation and arthroplasty in treating elderly patients with nondisplaced femoral neck fracture (FNF) remains controversial. The femoral neck system (FNS) is known to have relatively stronger axial and rotational stability compared with cancellous screw fixation. This study aimed to evaluate how effective internal fixation using a FNS is for non-displaced FNF in elderly patients. Methods All patients with nondisplaced (Garden I and II) FNF between July 2019 and November 2023 were eligible for osteosynthesis surgery at three institutions. Ninety-five patients (50 under 75 years of age and 45 over 75 years of age) who were treated with FNS with a follow-up period of more than 1 year were included. Clinical data (age, sex, direction, body mass index, injury mechanism, bone mineral density (BMD), and time to operation) were extracted from patient records. Institutional imaging software was used for radiographic analysis to evaluate surgical site complications at 1 year. Multivariate logistic regression analysis was performed to identify independent risk factors for reoperation. Results The mean age of the younger group was 61.0 years, whereas that of the elderly group was 81.2 years. No significant differences were observed between the two groups except for BMD and time to operation. Three reoperations were observed in the younger group (6%), and four cases were observed in the elderly group (8.9%) (p = 0.894), and no significant difference in other surgical complications was observed between the two groups. BMD was identified as an independent risk factor for reoperation. Conclusion FNS may be used as an alternative to elderly and younger patients with nondisplaced FNFs. However, the reoperation rate may increase in severe osteoporosis patients with very low hip BMD.

Although over 60% of Korean acute care hospitals are small- or medium-sized, their ability to address sexual harassment may differ from larger hospitals due to differences in resources, policies, and organizational culture. This study aims to identify sexual harassment experience, coping, and awareness among nurses working in small- and medium-sized hospitals. This is a descriptive cross-sectional study that collected data from 462 nurses working in nine small- and medium-sized acute care hospitals in two cities in Korea. The study utilized self-report questionnaires, including the coping with sexual harassment questionnaire, perception of sexual, and experience of sexual harassment. Data were analyzed using descriptive statistics, t-tests, and one-way analysis of variance. Most nurses receive sexual harassment prevention education in the workplace every year, but only 77% of them are accurately aware of sexual harassment behavior. Among the types of sexual harassment experienced by the participants, verbal sexual harassment was the most common. Only 192 out of 462 nurses responded to the timing of their sexual harassment experience. Of those, more than 50% reported experiencing sexual harassment within the first year of employment and over 80% within 3 years. The most common perpetrators of sexual harassment were patients, followed by doctors. The more times the nurses received sexual harassment prevention education, the better they were at coping with sexual harassment. To prevent sexual harassment in the workplace, training content should be tailored because attitudes and perceptions vary based on the perpetrator's characteristics. This ensures relevance, addresses risks, and clarifies legal responsibilities. To create a healthy and safe working environment for nurses, institutions and managers should implement methods to raise awareness of sexual harassment. This may include providing anonymous hotlines, online reporting systems, regular audits, and establishing anonymous peer counseling platforms.

Purpose Emerging evidence has suggested that prior or concurrent antibiotic (ATB) use may be associated with a poor response to immune checkpoint inhibitors (ICIs) in patients with some solid tumors. This study examined the effects of ATB use on the oncological outcomes of patients receiving ICIs for mUC. Materials and Methods Patients receiving ICIs for mUC between 2018 and 2020 were assessed retrospectively. Those with over three cycles of atezolizumab or pembrolizumab were included. ATB use, defined as ≥ three days within 60 days before or three months after ICI administration, was compared between groups for oncological outcomes. Results Thirty-one patients were examined. The ATB-use and no-ATB-use groups consisted of 15 (48.4%) and 16 patients (51.6%), respectively. The ATB-use group showed a lower disease control rate (56.3% vs. 13.3%, p=0.023) than the no-ATB-use group. The objective response rate in the ATB-use group was lower than the no-ATB-use group, but the difference was statistically insignificant (43.7% vs. 13.3%, p=0.113). The ATB-use group had shorter progression-free survival (median three vs. six months, log-rank p=0.045) and shorter overall survival (median three vs. 14 months, log-rank p=0.023) than the no-ATB-use group. The most commonly used antibiotics were fluoroquinolones (46.7%), cephalosporins (40.0%), non-cephalosporin beta-lactams (6.7%), and nitrofurantoin (6.7%). Conclusions ATB may be associated with poorer oncological outcomes in patients with mUC who received ICI therapy. Hence, further research will be needed to understand the relationship between the modulation of ATB-related dysbiosis and gut microbiota composition with the oncological outcomes in patients with mUC.

Background and Objectives: Currently, only patients with osteonecrosis of the femoral head (ONFH), who had bone defects involving 30–33.3% of the remaining femoral head, are indicated in hip resurfacing arthroplasty (HRA). In an experimental cadaver model of ONFH involving up to 50% of the remaining femoral head, the initial stability of the femoral head implant (FHI) at the interface between the implant and the remaining femoral head was measured. Materials and Methods: The ten specimens and the remaining ten served as the experimental group and the control group, respectively. We examined the degree of the displacement of the FHI, the bonding strength between the FHI and the retained bone and that at the interface between the FHI and bone cement. Results: Changes in the degree of displacement at the final phase from the initial phase were calculated as 0.089 ± 0.036 mm in the experimental group and 0.083 ± 0.056 mm in the control group. However, this difference reached no statistical significance (p = 0.7789). Overall, there was an increase in the degree of displacement due to the loading stress, with increased loading cycles in both groups. In cycles of up to 6000 times, there was a steep increase. After cycles of 8000 times, however, there was a gradual increase. Moreover, in cycles of up to 8000 times, there was an increase in the difference in the degree of displacement due to the loading stress between the two groups. After cycles of 8000 times, however, such difference remained almost unchanged. Conclusions: In conclusion, orthopedic surgeons could consider performing the HRA in patients with ONFH where the bone defects involved up to 50% of the remaining femoral head, without involving the femoral head–neck junction in the anterior and superior area of the femoral head. However, more evidence-based studies are warranted to justify our results.

The use of commercial products such as a cup and liner for total hip arthroplasty for patients with severe bone defects has a high probability of failure. In these patients the cup alone cannot cover the bone defect, and thus, an additional augment or cage is required. In this study, we designed three-dimensional (3D) printable bone augments as an alternative to surgeries using reinforcement cages. Thirty-five sharp-edged bone augments of various sizes were 3D printed. A biporous structure was designed to reduce the weight of the augment and to facilitate bone ingrowth. Two types of frames were used to prevent damage to the augment’s porous structure and maintain its stability during printing. Furthermore, two types of holes were provided for easy augment fixation at various angles. Fatigue tests were performed on a combination of worst-case sizes derived using finite element analysis. The test results confirmed the structural stability of the specimens at a load of 5340 N. Although the porosity of the specimens was measured to be 63.70%, it cannot be said that the porous nature was uniformly distributed because porosity tests were performed locally and randomly. In summary, 3D-printable biporous bone augments capable of bonding from various angles and bidirectionally through angulation and bottom-plane screw holes are proposed. The mechanical results with bone augments indicate good structural safety in patients. However, further research is necessary to study the clinical applications of the proposed bone augment.Graphic abstract