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Muacevic A, Adler JR, Hirayu N, Kannae M, Takasu O. Systemic Capillary Leak Syndrome Induced by Influenza Type A Infection: A Case Report. Cureus 2023; 15:e34213. [PMID: 36852362 PMCID: PMC9957683 DOI: 10.7759/cureus.34213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/27/2023] Open
Abstract
Rhabdomyolysis accompanying influenza virus infection is a notable extrapulmonary complication. We experienced a case of influenza type A followed by rhabdomyolysis and systemic capillary leak syndrome (SCLS). A 57-year-old man with no significant past medical history was diagnosed as having influenza type A six hours after fever onset, and treatment with oseltamivir was started. Shock, rhabdomyolysis, and acute kidney injury (AKI) progressed rapidly. At 53 hours after starting the oral treatment, intensive care was initiated, including ventilation management. In the acute phase, a large-dose replacement was given for the SCLS and continuous renal replacement therapy for AKI; both eventually healed without sequelae.
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Affiliation(s)
- Alexander Muacevic
- Intensive Care Unit, Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, JPN
| | - John R Adler
- Intensive Care Unit, Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, JPN
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Bichon A, Bourenne J, Gainnier M, Carvelli J. Capillary leak syndrome: State of the art in 2021. Rev Med Interne 2021; 42:789-796. [PMID: 34099313 DOI: 10.1016/j.revmed.2021.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
Capillary leak syndrome (CLS) is an increasingly acknowledged multifaceted and potentially lethal disease. Initial nonspecific symptoms are followed by the intriguing CLS hallmark: the double paradox associating diffuse severe edema and hypovolemia, along with hemoconcentration and hypoalbuminemia. Spontaneous resolutive phase is often associated with poor outcome due to iatrogenic fluid overload during leak phase. CLS is mainly triggered by drugs (anti-tumoral therapies), malignancy, infections (mostly viruses) and inflammatory diseases. Its idiopathic form is named after its eponymous finder: Clarkson's disease. CLS pathophysiology involves a severe, transient and multifactorial endothelial disruption which mechanisms are still unclear. Empirical and based-on-experience treatment implies symptomatic care during the acute phase (with the eventual addition of drugs amplifying cAMP levels in the severest cases), and the prophylactic use of monthly polyvalent immunoglobulins to prevent relapses. As CLS literature is scattered, we aimed to collect and summarize the current knowledge on CLS to facilitate its diagnosis, understanding and management.
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Affiliation(s)
- A Bichon
- Service de réanimation des urgences, hôpital de la Timone, AP-HM, 264, rue Saint Pierre, 13005 Marseille, France.
| | - J Bourenne
- Service de réanimation des urgences, hôpital de la Timone, AP-HM, 264, rue Saint Pierre, 13005 Marseille, France
| | - M Gainnier
- Service de réanimation des urgences, hôpital de la Timone, AP-HM, 264, rue Saint Pierre, 13005 Marseille, France
| | - J Carvelli
- Service de réanimation des urgences, hôpital de la Timone, AP-HM, 264, rue Saint Pierre, 13005 Marseille, France
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Wu MA, Tsvirkun D, Bureau L, Boccon-Gibod I, Inglebert M, Duperray A, Bouillet L, Misbah C, Cicardi M. Paroxysmal Permeability Disorders: Development of a Microfluidic Device to Assess Endothelial Barrier Function. Front Med (Lausanne) 2019; 6:89. [PMID: 31069229 PMCID: PMC6491734 DOI: 10.3389/fmed.2019.00089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/09/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Paroxysmal Permeability Disorders (PPDs) are pathological conditions caused by periodic short lasting increase of endothelial permeability, in the absence of inflammatory, degenerative, ischemic vascular injury. PPDs include primary angioedema, idiopathic systemic capillary leak syndrome and some rare forms of localized retroperitoneal-mediastinal edema. Aim: to validate a microfluidic device to study endothelial permeability in flow conditions. Materials and Methods: we designed a microchannel network (the smallest channel is 30μm square section). Human Umbilical Vein Endothelial Cells (HUVECs) were cultured under constant shear stress in the networks. Endothelial permeability assessment was based on interaction of biotinylated fibronectin used as a matrix for HUVECs and FITC-conjugated avidin. The increase in endothelial permeability was identified as changes in fluorescence intensity detected by confocal fluorescent microscopy. Results: The microchannels were constantly perfused with a steady flow of culture medium, ensuring a physiologically relevant level of shear stress at the wall of ~0.2 Pa. Our preliminary results demonstrated that circulation of culture medium or plasma from healthy volunteers was associated with low fluorescence of fibronectin matrix. When bradykinin diluted in culture medium was perfused, an increase in average fluorescence was detected. Conclusion: Our microvasculature model is suitable to study endothelial functions in physiological flow conditions and in the presence of factors like bradykinin known as mediator of several PPDs. Therefore, it can be a promising tool to better understand the mechanisms underlying disorders of endothelial permeability.
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Affiliation(s)
- Maddalena Alessandra Wu
- Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Daria Tsvirkun
- Univ. Grenoble Alpes, LIPHY, Grenoble, France.,CNRS, LIPHY, Grenoble, France.,Belozersky Institute of Physico-chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Lionel Bureau
- Univ. Grenoble Alpes, LIPHY, Grenoble, France.,CNRS, LIPHY, Grenoble, France
| | - Isabelle Boccon-Gibod
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | | | - Alain Duperray
- Univ. Grenoble Alpes, IAB, Grenoble, France.,INSERM, IAB, Grenoble, France
| | - Laurence Bouillet
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Chaouqi Misbah
- Univ. Grenoble Alpes, LIPHY, Grenoble, France.,CNRS, LIPHY, Grenoble, France
| | - Marco Cicardi
- IRCCS-Istituti Clinici Scientifici Maugeri, University of Milan, Milan, Italy
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Raith EP, Ihle JF, Jamieson J, Kalff A, Bosco J. Idiopathic systemic capillary leak syndrome presenting as septic shock: A case report. Heart Lung 2018; 47:425-428. [PMID: 29779703 DOI: 10.1016/j.hrtlng.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/18/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Idiopathic capillary leak syndrome (Clarkson's Disease) is a rare angiopathy with a heterogenous phenotype that may present as distributive shock refractory to resuscitative management. OBJECTIVE We report a case of idiopathic systemic capillary leak syndrome presenting as septic shock. METHODS Structured case report and review of the literature. RESULTS A 27-year old man admitted to our institution with coryzal symptoms rapidly deteriorated with presumed sepsis, leading to intensive care unit admission. Following further deterioration, Idiopathic systemic capillary leak syndrome was considered and intravenous immunoglobulin administered, resulting in rapid improvement in the patient's clinical status. CONCLUSIONS Idiopathic systemic capillary leak syndrome is a rare and potentially life-threatening angiopathy that may present as, and should be considered in, refractory distributive shock. Administration of intravenous immunglobulin resulted in rapid recovery in this patient, and has been associated with positive outcomes in previous cases.
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Affiliation(s)
- Eamon P Raith
- Department of Intensive Care Medicine, The Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Discipline of Acute Care Medicine, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
| | - Joshua F Ihle
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Road, Prahran, Melbourne, VIC 3181, Australia
| | - Jennifer Jamieson
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Road, Prahran, Melbourne, VIC 3181, Australia
| | - Anna Kalff
- Department of Clinical Haematology, The Alfred Hospital, Commercial Road, Prahran, Melbourne, VIC 3181, Australia
| | - Julian Bosco
- Department of Allergy, Immunology, Respiratory Medicine, The Alfred Hospital, Commercial Road, Prahran, Melbourne, VIC 3181, Australia
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Siddall E, Khatri M, Radhakrishnan J. Capillary leak syndrome: etiologies, pathophysiology, and management. Kidney Int 2017; 92:37-46. [PMID: 28318633 DOI: 10.1016/j.kint.2016.11.029] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/25/2016] [Accepted: 11/15/2016] [Indexed: 02/06/2023]
Abstract
In various human diseases, an increase in capillary permeability to proteins leads to the loss of protein-rich fluid from the intravascular to the interstitial space. Although sepsis is the disease most commonly associated with this phenomenon, many other diseases can lead to a "sepsis-like" syndrome with manifestations of diffuse pitting edema, exudative serous cavity effusions, noncardiogenic pulmonary edema, hypotension, and, in some cases, hypovolemic shock with multiple-organ failure. The term capillary leak syndrome has been used to describe this constellation of disease manifestations associated with an increased capillary permeability to proteins. Diseases other than sepsis that can result in capillary leak syndrome include the idiopathic systemic capillary leak syndrome or Clarkson's disease, engraftment syndrome, differentiation syndrome, the ovarian hyperstimulation syndrome, hemophagocytic lymphohistiocytosis, viral hemorrhagic fevers, autoimmune diseases, snakebite envenomation, and ricin poisoning. Drugs including some interleukins, some monoclonal antibodies, and gemcitabine can also cause capillary leak syndrome. Acute kidney injury is commonly seen in all of these diseases. In addition to hypotension, cytokines are likely to be important in the pathophysiology of acute kidney injury in capillary leak syndrome. Fluid management is a critical part of the treatment of capillary leak syndrome; hypovolemia and hypotension can cause organ injury, whereas capillary leakage of administered fluid can worsen organ edema leading to progressive organ injury. The purpose of this article is to discuss the diseases other than sepsis that produce capillary leak and review their collective pathophysiology and treatment.
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Affiliation(s)
- Eric Siddall
- Columbia University Medical Center, New York, New York, USA
| | - Minesh Khatri
- Winthrop University Hospital, Mineola, New York, USA
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Duan CY, Zhang J, Wu HL, Li T, Liu LM. Regulatory mechanisms, prophylaxis and treatment of vascular leakage following severe trauma and shock. Mil Med Res 2017; 4:11. [PMID: 28361006 PMCID: PMC5370457 DOI: 10.1186/s40779-017-0117-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/06/2017] [Indexed: 02/08/2023] Open
Abstract
Vascular leakage, or increased vascular permeability, is a common but important pathological process for various critical diseases, including severe trauma, shock, sepsis, and multiple organ dysfunction syndrome (MODS), and has become one of the most important causes of death for intensive care units (ICU) patients. Currently, although there has been some progress in knowledge of the pathogenesis of these vascular disorders, the detailed mechanisms remain unclear, and effective prophylaxis and treatment are still lacking. In this study, we aimed to provide a review of the literature regarding the regulatory mechanisms and prophylaxis as well as the treatment of vascular leakage in critical diseases such as severe trauma and shock, which could be beneficial for the overall clinical treatment of vascular leakage disorders.
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Affiliation(s)
- Chen-Yang Duan
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Jie Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Hui-Ling Wu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Tao Li
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
| | - Liang-Ming Liu
- State Key Laboratory of Trauma, Burns and Combined Injury, Second Department of Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, 400042 China
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Yardimci B, Kazancioglu R. Idiopathic Systemic Capillary Leak Syndrome: A Case Report. Iran Red Crescent Med J 2016; 18:e29249. [PMID: 27195144 PMCID: PMC4867362 DOI: 10.5812/ircmj.29249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/19/2015] [Accepted: 06/04/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Idiopathic systemic capillary leak syndrome (ISCLS) is rarely seen, and presents with recurrent episodes of hypotension, shock, hemoconcentration, and hypoproteinemia. The main pathology is the dysfunction of the vascular endothelium, and it is characterized by an increase of capillary permeability that is accompanied by the loss of intravascular fluid and protein. CASE PRESENTATION We present a 58-year-old female who presented with peripheral edema, leg pain, and syncope at the emergency department. Interestingly demyemilising neuropathy, which is a rare finding, ensued on day 4. She is still being treated using intravenous immunoglobulin therapy. CONCLUSIONS The early signs and symptoms of ISCLS may be subtle; therefore the diagnosis can easily be missed and prompt treatment of the syndrome may be postponed. Thus, the clinician must consider ISCLS in differential diagnosis in cases of hypotension, hemoconcentration, and hypoalbuminemia.
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Affiliation(s)
- Bulent Yardimci
- Department of Internal Medicine, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
- Corresponding Author: Bulent Yardimci, Department of Internal Medicine, Istanbul Florence Nightingale Hospital, Istanbul, Turkey. Tel: +90-2123756565, Fax: +90-2122244982, E-mail:
| | - Rumeyza Kazancioglu
- Department of Nephrology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
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Prete M, Urso L, Fatone MC, Pinto V, Perosa F. Antiphospholipids Syndrome Complicated by a Systemic Capillary Leak-Like Syndrome Treated With Steroids and Intravenous Immunoglobulins: A Case Report. Medicine (Baltimore) 2016; 95:e2648. [PMID: 26844485 PMCID: PMC4748902 DOI: 10.1097/md.0000000000002648] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This report describes the onset of systemic capillary leak (SCL)-like syndrome in a 30-year-old woman with antiphospholipids syndrome (APS) during puerperium.Twelve hours after a cesarean section, she presented a sudden fever and abdominal pains followed by dyspnea, severe edema of the limbs and pelvis.Computer tomography shows congestion of interstitial pulmonary parenchyma, pericardial and pleural effusion, edema of intestinal wall and of perivisceral adipose tissue, and periportal lymphedema. Laboratory tests showed neutrophilic leukocytosis, hypoalbuminemia, and an increase of erythrocyte sedimentation rate and C-reactive protein. Because fever and raised inflammation parameters are not observed in idiopathic capillary leak syndrome (SCLS; Clarkson disease), a diagnosis of SCL-like syndrome was made.Albumin solution, high-dose methylprednisolone and intravenous immunoglobulins (IVIG) infusion were administered with a rapid improvement of her clinical condition.The prompt treatment with steroids and IVIG likely prevented the life-threatening shock syndrome that can occur in SCLS, with acute hypotensive attacks, and severe limbs edema requiring fasciotomy.All clinical and laboratory findings supported autoinflammation as the underlying pathogenic mechanism of the syndrome. The data indicate that SCL-like syndrome can be considered a novel clinical syndrome, which can complicate APS.
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Affiliation(s)
- Marcella Prete
- From the Department of Biomedical Science and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit (MP, LU, MCF, FP); and Second Unit of Obstetrics and Gynecology, University of Bari Medical School (VP), Bari, Italy
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Xie Z, Chan EC, Long LM, Nelson C, Druey KM. High-dose intravenous immunoglobulin therapy for systemic capillary leak syndrome (Clarkson disease). Am J Med 2015; 128:91-5. [PMID: 25193271 DOI: 10.1016/j.amjmed.2014.08.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 08/11/2014] [Accepted: 08/11/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Systemic capillary leak syndrome is a highly rare disorder of unknown cause. The disease is characterized by episodes of transient vascular collapse, which leads to hypotensive shock and anasarca. Previous treatment of this potentially devastating condition has been largely ineffective. We evaluated intravenous immunoglobulin prophylactic therapy in a cohort of 29 patients with systemic capillary leak syndrome in a longitudinal follow-up study. METHODS All patients received treatments at the discretion of their primary providers and retrospectively via questionnaire-recorded symptoms beginning with their first documented episode of systemic capillary leak syndrome to May 31, 2014. RESULTS A total of 22 of 29 patients responded to the questionnaire, and 18 of the 22 respondents received monthly prophylaxis with intravenous immunoglobulin during the study period for a median interval of 32 months. The median annual attack frequency was 2.6 per patient before intravenous immunoglobulin therapy and 0 per patient after initiation of intravenous immunoglobulin prophylaxis (P = .0001). A total of 15 of 18 subjects with a history of 1 or more acute systemic capillary leak syndrome episodes experienced no further symptoms while taking intravenous immunoglobulin therapy. CONCLUSIONS Intravenous immunoglobulin prophylaxis is associated with a dramatic reduction in the occurrence of systemic capillary leak syndrome attacks in most patients, with minimal side effects. A prospective, randomized trial may be necessary to fully assess the benefits of intravenous immunoglobulin for systemic capillary leak syndrome and to determine the optimal dosage and duration of therapy.
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Kang KW, Heo ST, Han SH, Park YG, Park HS. Systemic capillary leak syndrome induced by influenza type A infection. Clin Exp Emerg Med 2014; 1:126-129. [PMID: 27752564 PMCID: PMC5052828 DOI: 10.15441/ceem.14.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 01/05/2023] Open
Abstract
A 42-year-old man visited the emergency department complaining of lower extremity swelling and myalgia. His influenza A antigen test was positive, and he was admitted for supportive care of severe myalgia. On the first hospital day, the swelling in his lower legs was aggravated with intolerable pain, and his creatine phosphokinase and hemoglobin levels were elevated. He was treated with massive hydration, albumin replacement, continuous venovenous hemofiltration, phlebotomy, and oseltamivir. The swelling and pain in his extremities were decreased without renal dysfunction, even though peripheral neuropathy and muscular complication persisted. Systemic capillary leak syndrome is a rare but life-threatening condition. The diagnosis is made clinically based on a classic triad of hypotension, hypoalbuminemia, and hemoconcentration. In our case, the influenza A infection was related to the capillary leakage.
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Affiliation(s)
- Kyeong Won Kang
- Department of Emergency Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Taek Heo
- Division of Infectious Diseases, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Hoon Han
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Yong-Geun Park
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Hyun Soo Park
- Department of Emergency Medicine, Jeju National University School of Medicine, Jeju, Korea
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