"Rhin sling," A Novel Type of Shoulder Sling in Post-Stroke Shoulder Subluxation: A Case Report.

This case report introduces a novel type of shoulder prosthesis in 2 patients with hemiplegic shoulder subluxation. A unique reel traction device was incorporated to allow easy traction and accurate correction of joint subluxation. X-ray images taken before and after application showed immediate correction effects that were maintained up to 2 hours after application with no change of sling position. These 2 cases support the idea that this new type of shoulder sling could be applied for therapeutic and corrective purposes in hemiplegic stroke patients with shoulder subluxation.

Effect of Hind- and Fore-Foot Eversion on Positional and Rotational Displacement of the Knee in Standing Posture.

We investigated the effects of hindfoot and forefoot eversion on the knee's positional and rotational displacement, plantar pressure, and foot discomfort in a standing posture, beyond the traditional focus on external knee adduction moments (EKAM) in lateral wedge insoles. Twenty-six healthy participants underwent hindfoot eversion from 0 to 10 degrees in 2-degree increments, and forefoot eversion from 0 degrees to the hindfoot eversion angle in 2-degree increments in a standing posture. At each eversion angle, the knee's medial displacement, EKAM's moment arm decrease, plantar pressure changes, and foot discomfort were obtained and compared across varying angles. Both hindfoot-only and entire-foot eversion led to significant medial knee displacement and the EKAM's moment arm decrease, with more pronounced effects in entire-foot eversion. At each hindfoot eversion angle, increasing forefoot eversion resulted in significant medial knee displacement and EKAM's moment arm decrease. Lower leg rotations were not significantly affected in hindfoot-only eversion but displayed significant medial tilting and internal rotation in entire-foot eversion at specific combinations. Varying eversion angles significantly influenced the forefoot pressure, with heel pressure remaining unaffected. Notably, the lateral forefoot pressure increased significantly as the forefoot eversion angle increased, particularly at higher hindfoot eversion angles. Foot discomfort increased significantly with higher eversion angles, particularly in entire-foot eversion, and also increased significantly as the forefoot eversion angle increased at higher hindfoot eversion angles. Insole configurations incorporating 6-10 degrees of hindfoot eversion and 40-60% forefoot eversion of the hindfoot angle may offer optimized biomechanical support for knee osteoarthritis patients.

Preliminary Study on an Alternative Test Method with MCTT HCETM for Ocular Irritation Test of Ophthalmic Medical Devices.

The sustained growth of the market for ophthalmic medical devices has increased the demand for alternatives to animal testing for the evaluation of eye irritation. The International Organization for Standardization has acknowledged the need to develop novel in vitro tests to replace animal testing. Here, we evaluated the applicability of an alternative method based on a human corneal model to test the safety of ophthalmic medical devices. 2-Hydroxyethyl methacrylate (HEMA) and Polymethyl methacrylate (PMMA), which are used to fabricate contact lenses, were used as base materials. These materials were blended with eye irritant and non-irritant chemicals specified in the OECD Test Guideline (TG) 492 and Globally Harmonized System (GHS) classification. Then, three GLP-certified laboratories performed three replicates using the developed method using 3D reconstructed human cornea epithelium, MCTT HCETM. OECD TG 492 describes the procedure used to evaluate the eye hazard potential of the test chemical based on its ability to induce cytotoxicity in a reconstructed human cornea-like epithelium (RhCE) tissue. Results: The within-laboratory reproducibility (WLR) and between-laboratory reproducibility (BLR) were both 100%. When a polar extraction solvent was used, the sensitivity, specificity, and accuracy were all 100% in each laboratory. When a non-polar extraction solvent was used, the sensitivity was 80%, the specificity was 100%, and the accuracy was 90%. The proposed method exhibited excellent reproducibility and predictive capacity within and between laboratories. Therefore, the proposed method using the MCTT HCETM model could be used to evaluate eye irritation caused by ophthalmic medical devices.

Efficacy and local irritation evaluation of Eriobotrya japonica leaf ethanol extract.

BACKGROUND: Although Eriobotrya japonica leaves have been studied as a raw material for various cosmetic products, little is known about the anti-oxidant, anti-inflammatory, and anti-melanogenic activities of Eriobotrya japonica leaf ethanol extract (EJEE). METHODS: This study was conducted to evaluate the anti-oxidant, anti-inflammatory, and anti-melanogenic activities of EJEE using different in vitro models. In addition, we investigated the potential irritation of EJEE to skin and eye using animal alternative tests. RESULTS: The total content of polyphenols, one of the active constituents of EJEE, was analyzed by high-performance liquid chromatography and found to contain 88.68 mg tannic acid equivalent/g. EJEE showed a concentration-dependent 1,1-diphenyl-2-picrylhydrazyl radical scavenging activity, 2,2'-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) radical scavenging activity, and a superoxide dismutase-like activity. The anti-inflammatory effect of 0.5% (w/v) EJEE was demonstrated by a reduction in lipopolysaccharide-induced nitric oxide and tumor necrosis factor-alpha levels in RAW 264.7 cells. EJEE also significantly inhibited melanogenesis in melanocyte stimulating hormone-induced B16F1 cells. EJEE did not show any irritation in skin and eye in animal alternative test. CONCLUSIONS: These results indicate that the EJEE possesses anti-oxidant, anti-inflammatory, and anti-melanogenic activities, while it did not induce toxicity or irritation in neither skin nor eye. Therefore, EJEE can be used as a cosmetic ingredient for skin improvement.

Ultrasonography and electrophysiological study of median nerve in patients with essential tremor.

Essential tremor (ET) is a common movement disorder characterized by postural or kinetic tremor. We aimed to evaluate median nerve enlargement in patients with ET using ultrasonography (USG). Thirty-eight hands from 19 patients with ET and 24 hands from 13 controls underwent nerve conduction studies (NCS) and USG at the wrist. Tremor severity was measured using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). The median nerve cross sectional area (mCSA) in USG and NCS parameters were compared using ANCOVA. We evaluated the correlation between mCSA and NCS parameters or FTM-TRS scores using linear regression analysis. mCSA was significantly larger (p<0.001) and NCS parameters were different in two groups. Also, mCSA was negatively correlated with part B and C scores of FTM-TRS (p<0.001 and p = 0.039, respectively). In conclusion, median nerve enlargement with the changes of NCS parameters was observed and correlated with the severity of tremor in patients with ET.

Quantitative Gait Analysis in Patients with Huntington's Disease.

OBJECTIVE: Gait disturbance is the main factor contributing to a negative impact on quality of life in patients with Huntington's disease (HD). Understanding gait features in patients with HD is essential for planning a successful gait strategy. The aim of this study was to investigate temporospatial gait parameters in patients with HD compared with healthy controls. METHODS: We investigated 7 patients with HD. Diagnosis was confirmed by genetic analysis, and patients were evaluated with the Unified Huntington's Disease Rating Scale (UHDRS). Gait features were assessed with a gait analyzer. We compared the results of patients with HD to those of 7 age- and sex-matched normal controls. RESULTS: Step length and stride length were decreased and base of support was increased in the HD group compared to the control group. In addition, coefficients of variability for step and stride length were increased in the HD group. The HD group showed slower walking velocity, an increased stance/swing phase in the gait cycle and a decreased proportion of single support time compared to the control group. Cadence did not differ significantly between groups. Among the UHDRS subscores, total motor score and total behavior score were positively correlated with step length, and total behavior score was positively correlated with walking velocity in patients with HD. CONCLUSION: Increased variability in step and stride length, slower walking velocity, increased stance phase, and decreased swing phase and single support time with preserved cadence suggest that HD gait patterns are slow, ataxic and ineffective. This study suggests that quantitative gait analysis is needed to assess gait problems in HD.

Inpatient Course and Length of Hospital Stay in Patients with Brain Disorders in South Korea: A Population-based Registry Study.

OBJECTIVE: To describe inpatient course and length of hospital stay (LOS) for people who sustain brain disorders nationwide. METHOD: We interviewed 1,903 randomly selected community-dwelling patients registered as 'disabled by brain disorders' in 28 regions of South Korea. RESULTS: Seventy-seven percent were initially admitted to a Western medicine hospital, and 18% were admitted to a traditional Oriental medicine hospital. Forty-three percent were admitted to two or more hospitals. Mean LOS was 192 days. Most patients stayed in one hospital for more than 4 weeks. The transfer rate to other hospitals was 30-40%. Repeated admissions and increased LOS were related to younger onset age, higher education, non-family caregiver employment, smaller families, and more severe disability. CONCLUSION: Korean patients with brain disorders showed significantly prolonged LOS and repeated admissions. Factors increasing burden of care influenced LOS significantly.

No association between PAWR gene polymorphisms and tardive dyskinesia in schizophrenia patients.

Tardive dyskinesia (TD) is a hyperkinetic movement disorder associated with the prolonged use of antipsychotic drugs. Since prostate apoptosis response 4 (Par-4) is a key ligand of the dopamine D2 receptor, the Par-4 gene (PAWR) is a good candidate gene to study in the context of TD susceptibility. We examined the association between PAWR gene polymorphisms and TD. Three single nucleotide polymorphisms of PAWR were selected for the analysis: rs7979987, rs4842318, and rs17005769. Two hundred and eighty unrelated Korean schizophrenic patients participated in this study (105 TD and 175 non-TD patients). Genotype/allele-wise and haplotype-wise analyses were performed. There were no significant differences in genotype and allele frequencies between the two groups. Haplotype analysis also did not reveal a difference between the two groups. Within the limitations imposed by the size of the clinical sample, these findings suggest that PAWR gene variants do not significantly contribute to an increased risk of TD.

Association of the 4 g/5 g polymorphism of plasminogen activator inhibitor-1 gene with sudden sensorineural hearing loss. A case control study.

BACKGROUND: The 5 G/5 G genotype of PAI-1 polymorphism is linked to decreased plasminogen activator inhibitor-1 (PAI-1) levels and it has been suggested that lower PAI-1 levels may provide protective effects on inflammation, local microcirculatory disturbance, and fibrotic changes, which are likely associated with development of sudden sensorineural hearing loss (SSNHL). METHODS: The association of the 4 G/5 G PAI-1 polymorphism with the development and clinical outcome of SSNHL is evaluated via a case control study. 103 patients with SSNHL and 113 age and sex-matched controls were enrolled at University of Ferrara, Italy and hearing loss outcome was measured at least 3 months after the onset of hearing loss. DNA was isolated from peripheral blood using the QIAamp kit and the 4 G/5 G polymorphism in the -675 promoter region was genotyped with an allele-specific PCR. Genotype distribution was tested in patients and compared to controls by chi-square and odd-ratio analysis. The codominant and recessive models were used for the multiple logistic regression analyses of the PAI-1 gene allele. RESULTS: In this population, 5 G/5 G genotype had a two-time lower frequency in SSNHL patients compared to healthy controls (15.5% vs 30.1%) and was associated with decreased odds compared to 4 G/5 G genotype (OR 0.37, 95% CI 0.19-0.75, p = 0.005). In addition, the patients with 5 G/5 G genotype showed a trend of more than 2 times higher ratio of hearing recovery (> 20 dB) after systemic corticosteroid treatment compared to 4 G/5 G genotype (OR 2.3, 95% CI 0.32 - 16.83, p = 0.39), suggesting a better clinical outcome. CONCLUSIONS: The 5 G/5 G genotype of PAI-1 may be associated with a reduced risk of SSNHL in the Italian population.

Morphometric analysis of the Korean mandibular ramus for distraction osteogenesis using micro-computed tomography.

When performing distraction osteogenesis, the osteotomy is normally applied to the cortical bone posterior to the mandibular second molar. We measured the topographic thickness of the cortical and trabecular bone of the mandibular ramus and at the mandibular canal (MC) to provide crucial anatomic data aimed at minimizing complications and elucidating the most appropriate site for placing the distractor. Forty sides of the mandibles were prepared from 20 Korean cadavers (10 men and 10 women with a mean age of 68 years). The specimens were scanned and reconstructed into three-dimensional images using a micro-computed tomography system. Coronal and horizontal sectional images of the mandibular ramus were taken at thickness intervals of 2 mm from the reconstructed three-dimensional images. Image analysis software was used to measure the thicknesses of the cortical and trabecular bone and to identify the locations of the MC within the body and the mandibular ramus on each section. The mean thicknesses of the buccal cortical plate, trabecular bone, and lingual cortical plate were 2.9 mm (men, 3.0 mm; women, 2.8 mm), 9.1 mm (men, 9.8 mm; women, 8.5 mm), and 2.2 mm (men, 2.3 mm; women, 2.1 mm), respectively. The distance from the buccal surface of the mandible to the MC increased from 5.3 to 10.0 mm (men, 5.3-10.0 mm; women, 5.3-9.1 mm) when moving progressively anterosuperior from the mandibular angle region. Morphometric analyses of the mandibular ramus can provide crucial data when performing mandibular osteotomy and locating an appropriate placement site for a distractor device during the distraction-osteogenesis procedure.

Development of antisynthetase syndrome in a patient with rheumatoid arthritis.

Rheumatoid arthritis (RA) and antisynthetase syndrome (ASS) are distinct clinical syndromes, and their co-occurrence is rarely encountered. The authors report the case of a 56-year-old female patient with RA of 3 years duration who suddenly developed ASS, and include a review of the literature. The patient was diagnosed with ASS based on; positivity for anti-histidyl-tRNA synthetase (Jo-1) antibody, interstitial lung disease, polyarthritis, and mechanic's hands. High-dose corticosteroid and pulse intravenous cyclophosphamide were used to control the ASS. This case demonstrates that ASS should be considered during clinical presentations due to its potential overlap with RA.

Surgical removal of endovascular stent after migration to the right ventricle following right subclavian vein deployment for treatment of central venous stenosis.

Central venous stenosis or occlusion occurs in 11-50% of hemodialysis patients with prior subclavian vein cannulation and ipsilateral fistula or shunt. Most patients are asymptomatic but some require treatment to reduce the risk of thrombosis and improve inadequate hemodialysis pressure. In these cases, endovascular intervention, including ballooning and stenting, is a feasible strategy for selected patents. We report an unusual case of a 40-year-old man on hemodialysis that underwent endovascular stenting to treat right subclavian vein stenosis and experienced stent migration to the right ventricle, requiring surgical removal.

Influence of aging on movement of the hyoid bone and epiglottis during normal swallowing: a motion analysis.

BACKGROUND: The age-related effects on various aspects of swallowing have been reported in studies on the temporal relationship between hyolaryngeal movement and bolus location, as well as the extent of hyolaryngeal movement. However, few studies have described the temporal and spatial relationships concurrently. OBJECTIVE: The main purpose of this study was to define the kinematics of the hyoid bone and epiglottis, during swallowing, on the temporal and spatial relationships concurrently in healthy subjects, and to investigate the influence of aging on hyolaryngeal movement. METHODS: We performed a two-dimensional motion analysis of the hyoid bone and epiglottis using videofluoroscopy images in 69 normal subjects. The trajectories of the hyolaryngeal movement and passage of a bolus were superimposed to form one plot. Temporal measurements included initiation and duration of the hyoid bone and epiglottis movement compared to their movement with the bolus. The spatial measurements included vertical and horizontal excursion of the hyoid bone, and the rotational angle of the epiglottis. RESULTS: The duration of supraglottis closure, and the maximal vertical excursion of the hyoid bone were increased in older subjects, more than 65 years of age, compared to younger subjects (p<0.05). Other temporal and spatial measurements were not statistically significant in the comparisons among the age groups. The vertical distance of the cervical vertebra was related to vertical excursion of the hyoid bone (p=0.002), and the horizontal distance from the chin to the cervical vertebra was related to the horizontal excursion of the hyoid bone (p=0.003). CONCLUSION: This paper describes a method for assessing temporal and spatial relationships of hyolaryngeal movement, and the passage of a bolus during swallowing. The two-dimensional kinematic swallowing motion analyses that were developed provided useful data that changed with age.

Effect of electroacupuncture on motor recovery in a rat stroke model during the early recovery stage.

The effect of acupuncture on motor recovery after stroke continues to be debated. This animal study was designed to determine whether acupuncture improves motor function following experimentally induced cerebral ischemia. In addition, we studied whether the outcome of motor function was associated with the expression of BDNF (brain derived neurotrophic factor), trkB (receptor, trkB) and infarct volume. Cerebral ischemia was induced by permanent middle cerebral artery occlusion (MCAO) or MCAO plus bilateral vertebral artery occlusion in Sprague-Dawley rats. The groups studied were a control, treadmill exercise, electroacupuncture and a combined treatment group with both treadmill exercise and electroacupuncture (ExEA). On postoperative day 16, Western blot analysis for BDNF and trkB and estimation of infarct volume were performed. The motor behavior scores were measured 2 and 16-days postoperatively. Comparison of the motor scores among the groups showed that the motor scores in the exercise only group and ExEA group were higher than in the control group on postoperative day 16. No statistical significance was found among the groups in the Western blot analysis and the infarct volume. This study demonstrates no significant additional effect of electroacupuncture on the motor recovery in rats following mild cerebral ischemia during the early recovery stage. Further studies in a rat model with moderate to severe cerebral ischemia, assessment and reassessment for more extended periods after the cerebral ischemia will be required.

Coupling of semiconductor nanowires with neurons and their interfacial structure.

We report on the compatibility of various nanowires with hippocampal neurons and the structural study of the neuron-nanowire interface. Si, Ge, SiGe, and GaN nanowires are compatible with hippocampal neurons due to their native oxide, but ZnO nanowires are toxic to neuron due to a release of Zn ion. The interfaces of fixed Si nanowire and hippocampal neuron, cross-sectional samples, were prepared by focused ion beam and observed by transmission electron microscopy. The results showed that the processes of neuron were adhered well on the nanowire without cleft.

Platinum assisted vapor-liquid-solid growth of er-si nanowires and their optical properties.

We report the optical activation of erbium coated silicon nanowires (Er-SiNWs) grown with the assist of platinum (Pt) and gold (Au), respectively. The NWs were grown on Si substrates by using a chemical vapor transport process using SiCl4 and ErCl4 as precursors. Pt as well as Au worked successfully as vapor-liquid-solid (VLS) catalysts for growing SiNWs with diameters of ~100 nm and length of several micrometers, respectively. The SiNWs have core-shell structures where the Er-crystalline layer is sandwiched between silica layers. Photoluminescence spectra analyses showed the optical activity of SiNWs from both Pt and Au. A stronger Er3+ luminescence of 1,534 nm was observed from the SiNWs with Pt at room- and low-temperature (25 K) using the 488- and/or 477-nm line of an Ar laser that may be due to the uniform incorporation of more Er ions into NWs with the exclusion of the formation of catalyst-induced deep levels in the band-gap. Pt would be used as a VLS catalyst for high performance optically active Er-SiNWs.

Magnetic stimulation of the quadriceps femoris muscle: comparison of pain with electrical stimulation.

OBJECTIVE: The objective of this study was to compare pain induced by magnetic stimulation of the quadriceps femoris (QF) muscle with that induced by transcutaneous neuromuscular electrical stimulation (NMES). DESIGN: Magnetic stimulation and transcutaneous NMES were applied to QF muscles of 17 normal volunteers. The intensity of each mode of stimulation was increased in a stepwise manner. Peak torque values of isometric contractions of QF muscles and visual analog scale (VAS) scores were recorded at each intensity level. The VAS scores of the two stimulating modalities were compared at the intensity-generating same peak torque values. RESULTS: The median VAS scores for electrical and magnetic stimulation were 5.7 and 0.3, respectively. The median difference between the VAS scores for electrical and magnetic stimulation was 3.7 (range, 1.7-8.5). The mean of the maximum peak torque obtained from each subject was higher in magnetic stimulation than in electrical stimulation (9.5 +/- 4.8 vs. 4.4 +/- 2.9 Nm). CONCLUSIONS: Magnetic stimulation of the QF muscle produced less pain at the same level of isometric peak torque than did transcutaneous NMES. Magnetic stimulation is a potential alternative to transcutaneous NMES, especially for persons with intact or residual sensory function.

Influence of mastication and salivation on swallowing in stroke patients.

OBJECTIVE: To determine differences of the oral swallowing functions between stroke and normal subjects and to identify those factors affecting dysphagia of stroke patients. DESIGN: Case-control study. SETTING: University hospital. PARTICIPANTS: Ten stroke and 10 healthy subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Resting saliva flow rate, the total number of chews, and the duration of the oral phase until onset of pharyngeal swallow, and food viscosities both before and after the oral phase using diluted barium, pudding, thick rice gruel, and curd type yogurt. RESULTS: The viscosity of all test foods was significantly reduced after the oral phase in both groups (P<.01). Resting saliva flow rate and the viscosity of thick rice gruel after the oral phase in the stroke group were significantly lower than in the control group (P<.01). However, there were no differences in the viscosities of the other foods between both groups. And a longer oral phase and a greater number of chews prior to pharyngeal swallow were revealed in the stroke group than in the control group (P<.01). CONCLUSIONS: This study shows that the food requiring mastication demands a longer oral phase and a greater number of chews, and has more altered rheologic characteristics during the oral phase in stroke patients. These findings suggest that masticatory function is impaired in stroke patients, which may contribute to their swallowing dysfunction.

Systemic transforming growth factor-beta1 gene therapy induces Foxp3+ regulatory cells, restores self-tolerance, and facilitates regeneration of beta cell function in overtly diabetic nonobese diabetic mice.

BACKGROUND: Type 1 diabetes results from auto-aggressive T-cell-mediated destruction of beta cells of the pancreas. Recent data suggest that restoration of self-tolerance may facilitate islet-cell regeneration/recovery. In view of the immunoregulatory activity of transforming growth factor (TGF)-beta1, we investigated whether systemic TGF-beta1 gene therapy blocks islet destructive autoimmunity and facilitates regeneration of beta-cell function in overtly diabetic nonobese diabetic (NOD) mice. METHODS: We used site-directed mutagenesis to create cysteine to serine mutation at sites 224 and 226 and constructed a replication deficient adenovirus (Ad) vector encoding active form of human TGF-beta1 (Ad-hTGF-beta1). Overtly diabetic NOD mice received intravenous injection of Ad-hTGF-beta1. Seven to 14 days after the injection, the mice received transplants with 500 syngeneic islets under the kidney capsule. Islet-graft survival and regeneration of endogenous beta-cell function were examined. RESULTS: Syngeneic islet grafts failed by day 17 in all untreated mice, whereas Ad-hTGF-beta1 therapy prolonged survival of islet grafts. Islet grafts from treated mice showed well-preserved islets with a peri-islet infiltrate primarily of CD4+ T cells and expression of CD25 and Foxp3. Systemic TGF-beta1 gene therapy was associated with islet regeneration in the native pancreas. Native pancreas of treated mice revealed islets staining strongly for insulin. Similar to what was found in the syngeneic islet graft, there were well-demarcated peri-islet infiltrates that were positive for CD4, TGF-beta1, and Foxp3. CONCLUSIONS: Our data demonstrate that systemic TGF-beta1 gene therapy blocks islet destructive autoimmunity, facilitates islet regeneration, and cures diabetes in diabetic NOD mice.

Association of IL-1beta, IL-1ra, and TNF-alpha gene polymorphisms in childhood nephrotic syndrome.

We investigated the association between IL-1beta, IL-1ra, and TNF-alpha gene polymorphisms and childhood nephrotic syndrome (NS). We analyzed the genetic polymorphism of IL-1beta, IL-1ra, and TNF-alpha genes in 152 patients with childhood NS and 292 healthy adult controls. The C to T exchange at position -511 of IL-1beta and the G to A at -308 of the TNF-alpha gene were genotyped. Five alleles of the IL-1ra gene were identified and designated as IL1RN*1, IL1RN*2, IL1RN*3, IL1RN*4, and IL1RN*5, according to the variable number of tandem repeats in intron 2. The allele frequencies of IL-1beta1 (-511C), IL-1beta2 (-511T), TNF1 (-308G), and TNF2 (-308A) were 53.0, 47.0, 92.1, and 7.9%, respectively, in the childhood NS group. This was not significantly different from normal controls. In the childhood NS group, the allele frequencies of IL1RN*1, IL1RN*2, IL1RN*3, IL1RN*4, and IL1RN*5 were 90.8, 7.6, 1.6, 0, and 0% [IL1RN*1 odds ratio (OR)=0.296, P=0.0001, IL1RN*2 OR=3.902, P=0.0002]. A high allele frequency of IL1RN*2 and a lower allele frequency of IL1RN*1 were found in childhood NS, although there was no association with IL-1beta and TNF-alpha. A high allele frequency of the IL1RN*2 allele may affect disease susceptibility in childhood NS.