Electromyography Parameter Variations with Electrocardiography Noise.

Electromyograms (EMG signals) may be contaminated by electrocardiographic (ECG) signals that cannot be easily separated with traditional filters, because both signals have some overlapping spectral components. Therefore, the first challenge encountered in signal processing is to extract the ECG noise from the EMG signal. In this study, the EMG, mixed with different degrees of noise (ECG), is simulated to investigate the variations of the EMG features. Simulated data were derived from the MIT-BIH Noise Stress Test (NSTD) Database. Two EMG and four ECG data were composed with four EMG/ECG SNR to 32 simulated signals. Following Pan-Tompkins R-peak detection, four ECG removal methods were used to remove ECG with different compensation algorithms to obtain the denoised EMG signal. A total of 13 time-domain and four frequency-domain EMG features were calculated from the denoised EMG. In addition, the similarity of denoised EMG features compared to clean EMG was also evaluated. Our results showed that with the ratio EMG/ECG SNR = 10 and 20, the ECG can be almost ignored, and the similarity of EMG features is close to 1. When EMG/ECG SNR = 1 and 2, there is a large variation of EMG features. The results of our simulation study would be beneficial for understanding the variations of EMG features upon the different EMG/ECG SNR.

Bed-Exit Behavior Recognition for Real-Time Images within Limited Range.

In the context of behavior recognition, the emerging bed-exit monitoring system demands a rapid deployment in the ward to support mobility and personalization. Mobility means the system can be installed and removed as required without construction; personalization indicates human body tracking is limited to the bed region so that only the target is monitored. To satisfy the above-mentioned requirements, the behavior recognition system aims to: (1) operate in a small-size device, typically an embedded system; (2) process a series of images with narrow fields of view (NFV) to detect bed-related behaviors. In general, wide-range images are preferred to obtain a good recognition performance for diverse behaviors, while NFV images are used with abrupt activities and therefore fit single-purpose applications. This paper develops an NFV-based behavior recognition system with low complexity to realize a bed-exit monitoring application on embedded systems. To achieve effectiveness and low complexity, a queueing-based behavior classification is proposed to keep memories of object tracking information and a specific behavior can be identified from continuous object movement. The experimental results show that the developed system can recognize three bed behaviors, namely off bed, on bed and return, for NFV images with accuracy rates of 95~100%.

Delphi-based assessment of fall-related risk factors in acute rehabilitation settings according to the International Classification of Functioning, Disability and Health.

OBJECTIVE: To apply the International Classification of Functioning, Disability and Health (ICF) model to fall prevention by developing an ICF core set for fall risks in acute rehabilitation settings. DESIGN: Fall risk factors were identified based on a systematic review of the literature and linked to ICF categories. A consensus process was conducted using a Delphi-based evaluation technique. SETTING: University-based hospital. PARTICIPANTS: Multidisciplinary participants (N=20) from different institutions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A 5-point Likert-type scale was used to weigh the importance of each risk category. The level of agreement for each consensus was assessed based on Spearman rho and semi-interquartile range indices. Categories with a mean score ≥4 in the third round of evaluation were included in this ICF core set. RESULTS: The core set comprised 34 fall risk categories that were distributed as follows: 18 categories on body functions, 2 on body structures, 8 on activities and participation, 4 on environmental factors, and 2 categories on personal factors. CONCLUSIONS: An ICF core set for falls in acute rehabilitation settings was developed in this study. Further validation is required.

Nonparetic knee extensor strength is the determinant of exercise capacity of community-dwelling stroke survivors.

OBJECTIVE: To investigate the relationship among walking speed, exercise capacity, and leg strength in community dwelling stroke subjects and to evaluate which one was the leading determinant factor of them. DESIGN: This is a descriptive, cross-sectional study. Thirty-five chronic stroke patients who were able to walk independently in their community were enrolled. Walking speed was evaluated by using the 12-meter walking test. A maximal exercise test was used to determine the stroke subjects' exercise capacity. Knee extensor strength, measured as isokinetic torque, was assessed by isokinetic dynamometer. RESULTS: The main walking speed of our subjects was 0.52 m/s. Peak oxygen uptake (VO2 peak) was 1.21 ± 0.43 L/min. Knee extensor strength, no matter whether paretic or nonparetic side, was significantly correlated to 12-meter walking speed and exercise capacity. Linear regression also showed the strength of the affected knee extensor was the determinant of walking speed and that of the nonparetic knee extensor was the determinant of exercise capacity in community dwelling stroke subjects. CONCLUSIONS: Walking speed and peak oxygen uptake were markedly decreased after stroke. Knee extensor strength of nonparetic leg was the most important determinant of exercise capacity of the community-dwelling stroke subjects. Knee extensor strengthening should be emphasized to help stroke patient to achieve optimal community living.

The effect of chinese yuanji-dance on dynamic balance and the associated attentional demands in elderly adults.

Walking performance changes with age. This has implications for the problem of falls in older adults. The aim of this study was to investigate the effects of Yuanji-Dance practice on walking balance and the associated attention demand in healthy elderly. Fifteen community-dwelling elderly (comparison group, no regular exercise habit) and fifteen Yuanji- Dance elderly (exercise group, dancing experience: 5.40 ± 1.95 years), aged 60-70 years, were included in this study. The subjects in exercise group participated in a 90-minute Yuanji-Dance practice at least three times per week and the comparison group continued their normal daily physical activity. Walking balance measures (including walking velocity, step length, step width, and percentage of time spent in double limb support, COM velocity and COM-COP inclination angles) and attentional demand tests (button reaction time and accuracy) were conducted under different conditions. Our results showed that stride lengths, walking velocities, peak A/P velocities (AP V) of the COM, medial COM-COP inclination (M angle) angles, reaction time, and accuracy decrease significantly as the dual-task (walking plus hand button pressing tasks) applied for either the comparison or exercise groups. These results demonstrated that walking performance is attenuated in our elderly participants as the cognitive tasks applied. Analysis also identified a significantly faster RT for our exercise group both in standing and walking conditions. This may indicate that physical exercise (Yuanji-Dance) may have facilitating effects on general cognitive and perceptual- motor functions. This implies that Chinese Yuanji-Dance practice for elderly adults may improve their personal safety when walking especially under the condition of multiple task demand. Key pointsThe purpose of this study was to investigate the training effects of a Chinese traditional exercise, Yuanji-Dance, on walking balance and the associated attention demand in the healthy elderly.Walking performance is attenuated in elderly participants as the cognitive tasks applied.A significantly faster reaction time for our exercise group both in standing and walking conditions.Yuanji-Dance exercise training can improve the information processing speed of elderly people and has no influence of the dynamic walking balance.

Acupuncture stimulation improves balance function in stroke patients: a single-blinded controlled, randomized study.

The disturbance of balance function is one of main etiology resulting in falling down in stroke patients. A number of studies report that acupuncture may improve the motor function of stroke patients. Therefore, the aim of the present study was to investigate the effect of acupuncture on balance function. We designed a single-blinded, controlled, randomized study. A total of 30 stroke patients were randomized into experimental and control groups. Experimental groups received acupuncture treatment accompanied by the manual twisting of needles and obtaining of qi (the subjects experienced sensations of soreness, numbness, swelling and heaviness, while the acupuncturist experienced a sensation of needle resistance), whereas the control group did not receive manual twisting of needles and without obtaining of qi. All of the subjects were first-time stroke patients; infarction location was limited to either the left or right hemisphere, and all subjects were able to walk for at least 6 meters. Acupuncture stimulation (AS) was applied to Baihui (GV 20) acupoint as well as to 4 spirit acupoints (1.5 cun anterior, posterior, left and right laterals from Baihui acupoint, respectively) for 20 min. Balance function outcome measures were: (1) the displacement area of the patient's center of gravity; (2) the time taken for a patient to stand vertically from a seated position; (3) the time taken for a patient to walk a distance of 6 meters; (4) muscle strength of both lower extremities. Results indicated that the displacement area from the center of gravity decreased in the experimental group, but not in the control group. There was greater reduction in the displacement area in the experimental group than in the control group. Following AS, the time taken to reach a standing position from a seated position, as well as the time taken to walk 6 meters was decreased equally in both the experimental and control groups. The muscle strength of the hip flexor and knee extensor were increased in the paralyzed and non-paralyzed sides of patients in the experimental group, but not in the control group. The results of the present study suggest that acupuncture stimulation may induce an immediate effect that improves balance function in stroke patients.

Prognostic analysis of patients with blunt chest trauma admitted to an intensive care unit.

BACKGROUND/PURPOSE: Predictors of mortality in blunt chest trauma patients have mostly been studied by univariate analysis. This study used multivariate analysis to identify the independent predictors in these patients admitted to a surgical intensive care unit (SICU). METHODS: One hundred and twenty-seven blunt thoracic trauma patients consecutively admitted to a SICU were enrolled and evaluated by quantified injury severity scores including Acute Physiology and Chronic Health Evaluation II (APACHE II), Glasgow Coma Scale (GCS), Therapeutic Intervention Scoring System (TISS) and Injury Severity Score (ISS). Incidence of thoracic and extrathoracic injuries, transfusion and resuscitation volumes, PaO2/FIO2 ratio and the presence of shock were also evaluated. RESULTS: In the univariate analysis, clinical characteristics of survivors (n = 113) and non-survivors (n = 14) at admission were similar regarding age, gender, incidence of intrathoracic injuries and extrathoracic injuries and ISS. The following variables were higher for non-survivors: APACHE II score, 19 +/- 6 vs.12 +/- 6 (p = 0.002); TISS points, 39 +/- 13 vs. 29 +/- 15 (p = 0.019); the presence of shock, 93% vs. 42% (p < 0.001). Non-survivors also had lower GCS, 8 +/- 5 vs.14 +/- 3 (p < 0.001), and PaO2/FIO2 ratio, 211 +/- 124 vs. 340 +/- 145 (p = 0.002). Of the shock patients, they had significantly higher volumes of blood transfusions and fluid resuscitations (p < 0.001) and a higher incidence of abdominal injuries (p = 0.031) and mortality rate (p < 0.001) than non-shock patients. Multivariate logistic regression analysis identified three independent risk factors of mortality: GCS (adjusted odds ratio [OR], 0.76; 95% confidence interval [CI], 0.64-0.89; p = 0.001), PaO2/FIO2 ratio (adjusted OR, 0.75; 95% CI, 0.58-0.98; p = 0.036) and shock (adjusted OR, 3.8; 95% CI, 1.24-11.69; p = 0.020). CONCLUSION: Blunt chest trauma was usually associated with injuries of other organ systems, especially of the abdomen and head. Besides a decreased PaO2/FIO2, a lower GCS and a presence of shock were also independent prognostic predictors of mortality for these patients admitted to the ICU.

Exacerbation of symptoms of lumbar disc herniation complicated by a schwannoma: a case report.

Herniation of the lumbar disc is a common cause of low back pain. Conservative management with physiotherapy, such as lumbar spine traction, is usually effective. Although a schwannoma of the lumbar spine is relatively uncommon, the clinical manifestations are similar to those of lumbar disc herniation, making the diagnosis difficult. This case report describes a 51-year-old male who had suffered from low back pain for 3 years and who was diagnosed with L2/L3 lumbar disc herniation. The low back pain was well-controlled by conservative treatment and the symptoms improved progressively. Two months prior to our evaluation, however, the symptoms worsened acutely, and were accompanied by the onset of symptoms of cauda equina syndrome. A small tumor at the site of the L2/L3 disc herniation, observed incidentally during magnetic resonance imaging, was responsible for the symptoms of spinal stenosis at the lumbar region. The patient underwent laminectomy, tumor resection, and discectomy with near-complete resolution of symptoms. In patients with lumbar disc herniation that improves with conservative treatment, the recurrence of symptoms should prompt a thorough review of the medical history, physical examination, and imaging studies to establish the diagnosis and prevent delay in treatment.

Bilateral anterior shoulder dislocation as a result of manipulation: A case report.

RATIONALE: Bilateral anterior shoulder dislocation is clinically rare and has been reported to be related to high-speed sports. PATIENT CONCERNS: A 76-year-old woman presented with bilateral shoulders pain after traditional Chinese manipulation. DIAGNOSES: She was diagnosed with bilateral anterior dislocations, and a closed reduction was immediately performed. INTERVENTION: The patient was referred for rehabilitation 3 days later, and bilateral rotator cuff injuries were identified from musculoskeletal ultrasound. After 4 weeks of physical therapy, the patient's shoulder pain had reduced and the passive ROM was nearly full. OUTCOMES: At 1-year follow-up, only mild intermittent shoulder pain was noted, and there was no limitation of shoulder ROM. LESSONS: This case illustrates that patients with acute shoulder injuries who receive proper diagnosis and treatment can achieve good outcomes. Therefore, patients with musculoskeletal disorders should seek qualified specialists for accurate diagnosis and appropriate management.

Gait asymmetry, ankle spasticity, and depression as independent predictors of falls in ambulatory stroke patients.

BACKGROUND: Falls are the leading cause of injury in stroke patients. However, the cause of a fall is complicated, and several types of risk factors are involved. Therefore, a comprehensive model to predict falls with high sensitivity and specificity is needed. METHODS: This study was a prospective study of 112 inpatients in a rehabilitation ward with follow-up interviews in patients' homes. Evaluations were performed 1 month after stroke and included the following factors: (1) status of cognition, depression, fear of fall and limb spasticity; (2) functional assessments [walking velocity and the Functional Independence Measure (FIM)]; and (3) objective, computerized gait and balance analyses. The outcome variable was the number of accidental falls during the 6-month follow-up period after baseline measurements. RESULTS: The non-faller group exhibited significantly better walking velocity and FIM scale compared to the faller group (P < .001). The faller group exhibited higher levels of spasticity in the affected limbs, asymmetry of gait parameters in single support (P < .001), double support (P = .027), and step time (P = .003), and lower stability of center of gravity in the medial-lateral direction (P = .008). Psychological assessments revealed that the faller group exhibited more severe depression and lower confidence without falling. A multivariate logistic regression model identified three independent predictors of falls with high sensitivity (82.6%) and specificity (86.5%): the asymmetry ratio of single support [adjusted odds ratio, aOR = 2.2, 95% CI (1.2-3.8)], the level of spasticity in the gastrocnemius [aOR = 3.2 (1.4-7.3)], and the degree of depression [aOR = 1.4 (1.2-1.8)]. CONCLUSIONS: This study revealed depression, in additional to gait asymmetry and spasticity, as another independent factor for predicting falls. These results suggest that appropriate gait training, reduction of ankle spasticity, and aggressive management of depression may be critical to prevent falls in stroke patients.

Recurrent Bacille Calmette-Guérin osteomyelitis with ankle joint involvement in a toddler: gait analysis and rehabilitation experience.

Bacille Calmette-Guérin (BCG) osteomyelitis is a rare complication after vaccination. This article reports on a 1-year-old immunocompetent boy with recurrent BCG osteomyelitis involving the distal tibia who presented with a limping gait from the beginning of toddling. The lesion was located in the metaphysis and crossed the growth plate to the epiphysis, causing concern for ambulation. After surgery, he was initiated on an individualized, intense rehabilitation program and achieved a good functional recovery. Rehabilitation programs with gait analyses provide effective therapeutic and monitoring methods for toddlers recovering from BCG osteomyelitis.

The outcome of early pressure-controlled inverse ratio ventilation on patients with severe acute respiratory distress syndrome in surgical intensive care unit.

BACKGROUND: Pressure-controlled inverse ratio ventilation (PC-IRV) was used in patients with acute respiratory distress syndrome (ARDS) after failed volume-cycled conventional ratio ventilation (VC-CRV). The aim of this study was to evaluate the outcome of early PC-IRV in severe ARDS. METHODS: Twenty patients with severe ARDS were switched from VC-CRV to PC-IRV if they failed to maintain SaO(2) >90% by the following criteria: peak inspiratory pressure (PIP) >35 cm H(2)O, FIO(2) = 60%, and positive end-expiratory pressure (PEEP) 10 cm H(2)O. RESULTS: The values of PIP, mean airway pressure, minute volumes, and lung injury score in VC-CRV were 43.9 +/- 8.0 cm H(2)O, 19.5 +/- 6.4 cm H(2)O, 11.0 +/- 2.1 L/min, and 2.8 +/- 0.2 respectively. In PC-IRV, the corresponding data were 31.8 +/- 5.1 cm H(2)O, 25.4 +/- 4.6 cm H(2)O, 8.3 +/- 0.9 L/min, and 2.5 +/- 0.4. All of these parameters were significantly different. Fifteen patients (75%) survived their intensive care unit stay. CONCLUSIONS: Early PC-IRV in severe ARDS improves oxygenation, facilitates tapering of high fraction of inspiratory oxygen, and decreases high PEEP or PIP, and then results in the improvement of the patient's outcome.

Successful complex decongestive physiotherapy for lymphedema and lymphocutaneous reflux of the female external genitalia after radiation therapy.

Development of secondary lower extremity lymphedema after cervical cancer is common. However, severe lymphedema of the female genitalia and vesicular cutaneous lymphatic reflux without lower limb lymphedema after treatment of cervical cancer is rare. We report successful complex decongestive physiotherapy (CDP) in a 53-year-old female who developed recurrent folliculitis, lymphocutaneous reflux, warty change of the right labium majora, and lymphedema involving the external genitalia after receiving hysterectomy, pelvic lymph node dissection, and radiation. CDP included skin care, manual lymphatic drainage, exercise, and use of a hip spica bandage and panty girdle garment. Oral antibiotics were prescribed to control the skin infection. Lymphatic discharge and folliculitis were markedly improved after a 3-week course of treatment. Traditional conservative treatment with pneumatic compression and massage is ineffective and not suitable in controlling lymphedema of the external genitalia. Use of CDP may help to relieve the symptoms and recurrent infection in patients with this condition.

Complex decongestive physiotherapy for patients with chronic cancer-associated lymphedema.

BACKGROUND AND PURPOSE: Lymphedema of the limbs after cancer therapy is the most common cause of lymphedema in developed countries. There is no cure for chronic cancer-associated lymphedema. Multidisciplinary complex decongestive physiotherapy (CDP) is commonly used as a primary treatment. This prospective study assessed the efficacy of intensive CDP treatment in chronic cancer-associated lymphedema. METHODS: Thirty women who had unilateral upper or lower limb chronic lymphedema after breast or pelvic cancer therapy were enrolled in the study. All patients received CDP once per day, in consecutive full treatment sessions, which took place between 4 and 21 times. Assessment of the results of therapy included measuring the circumference, calculated volume, and edema ratio (excess volume/unaffected side volume) of the limb volume. The main outcome measure was the percentage reduction in excess limb volume. RESULTS: The pretreatment edema ratio demonstrated a high correlation with the patient's age (r = 0.508, p = 0.004) and the duration of the lymphedema (r = 0.634, p < 0.000). After the intensive CDP, the limb circumference, calculated volume, and edema ratio were significantly reduced compared with their pretreatment values (p < 0.000). The mean percentage reduction of excess volume was 67.8 +/- 33.2% in all patients. CONCLUSIONS: Intensive CDP was effectively able to reduce the limb volume of patients with chronic cancer-associated lymphedema. Further follow-up study is needed to confirm the effectiveness of CDP in the maintenance phase, and its long-term effectiveness in Taiwanese.

Potential risk of malposition of nasogastric tube using nose-ear-xiphoid measurement.

BACKGROUND: Correct placement of nasogastric tubes provide proper functionality and maximize benefit and minimize risk. The Nose-Ear-Xiphoid (NEX) body surface estimate method is a long-lasting technique, and this study was conducted to evaluate the correlation between NEX method and the secure insertion depth of nasogastric tube. MATERIALS AND METHODS: Thirty patients with nasogastric tube insertion who received whole body positron emission tomography with computerized tomography scan (PET-CT) were recruited. All data were gathered in the image center, which included Nose-Ear (NE), Ear-Xiphoid (EX), Nose-Ear-Xiphoid (NEX), glabella-xiphoid (GX) and glabella-umbilicus (GU) lengths. The distances of the inserted portion of the nasogastric tube between the cardiac and the nostril were measured by multiplanar reconstruction algorithm. RESULTS: Only one patient successfully placed all side-holes into the stomach while using NEX method to estimate inserting depth. Twenty-nine patients (96.7%) failed to place correctly. Fourteen participants had one or more side-holes in both the esophagus and the stomach sides. Fifteen patients could not pass through any side-hole across the gastroesophageal junction. They had shorter EX distances (p = 0.02), but no difference among the NE distances. Body height had the highest statistical correlation with nasogastric tube length (adjusted R(2) = 0.459), as compared with the NEX, GX and GU body surface methods. CONCLUSION: This study suggests that NEX method is inappropriate for adult patients to estimate the ideal inserting length of nasogastric tube. Physicians should realize these underinsertions with any side-hole above the gastroesophageal junctions may increase the potential risk of complications.

The effectiveness of multimedia visual perceptual training groups for the preschool children with developmental delay.

This study compared the effectiveness of three approaches to improving visual perception among preschool children 4-6 years old with developmental delays: multimedia visual perceptual group training, multimedia visual perceptual individual training, and paper visual perceptual group training. A control group received no special training. This study employed a pretest-posttest control group of true experimental design. A total of 64 children 4-6 years old with developmental delays were randomized into four groups: (1) multimedia visual perceptual group training (15 subjects); (2) multimedia visual perceptual individual training group (15 subjects); paper visual perceptual group training (19 subjects); and (4) a control group (15 subjects) with no visual perceptual training. Forty minute training sessions were conducted once a week for 14 weeks. The Test of Visual Perception Skills, third edition, was used to evaluate the effectiveness of the intervention. Paired-samples t-test showed significant differences pre- and post-test among the three groups, but no significant difference was found between the pre-test and post-test scores among the control group. ANOVA results showed significant differences in improvement levels among the four study groups. Scheffe post hoc test results showed significant differences between: group 1 and group 2; group 1 and group 3; group 1 and the control group; and group 2 and the control group. No significant differences were reported between group 2 and group 3, and group 3 and the control group. The results showed all three therapeutic programs produced significant differences between pretest and posttest scores. The training effect on the multimedia visual perceptual group program and the individual program was greater than the developmental effect Both the multimedia visual perceptual group training program and the multimedia visual perceptual individual training program produced significant effects on visual perception. The multimedia visual perceptual group training program was more effective for improving visual perception than was multimedia visual perceptual individual training program. The multimedia visual perceptual group training program was more effective than was the paper visual perceptual group training program.

The effect of long-term conventional physical therapy and independent predictive factors analysis in children with cerebral palsy.

OBJECTIVES: This study evaluated the effect of long-term conventional physical therapy (PT) on cerebral palsy (CP) children and to identify the predictors of therapy's response. METHODS: We performed a retrospective review of CP children treated with PT, and their motor function was assessed every 3 months between 2008 and 2011. RESULTS: Fifty-six children with a mean age of 4.2 ± 2.8 years, gross motor function classification system (GMFCS) levels were level I (n = 14), level II (n = 20), level III (n = 5), level IV (n = 8), and level V (n = 9). In the generalized estimating equations model, there was a significant improvement in the Gross Motor Function Measure (GMFM-66) score (p < 0.001); the improvement was different in five GMFCS levels (p < 0.001) and GMFCS level II had faster progression. The younger CP children had better PT efficacy, and the GMFM-66 score continued improving until 8.4 years old in the older group. CONCLUSION: The long-term conventional PT is effective even in older CP children, and PT was most efficient in younger children and GMFCS level II.

The efficacy of complex decongestive physiotherapy (CDP) and predictive factors of lymphedema severity and response to CDP in breast cancer-related lymphedema (BCRL).

BCRL is the most common morbidity in women with breast cancer. We performed a retrospective analysis of 107 BCRL patients to identify the efficacy of CDP and the predictors of lymphedema severity and response to CDP. The patients received 12 sessions of CDP, the duration of lymphedema was 22.4 months, and 56% of BCRL occurred within 2 years after surgery. Lymphedema severity, baseline and post-CDP percentage of excess volume (PEV), was 27.7% and 14.9%. The baseline PEV was correlated with the duration of lymphedema. The CDP efficacy, percentage reduction of excess volume (PREV), was 50.5%, and was correlated with PEV, duration of lymphedema and age. Baseline lymphedema severity was the most important predictive factor for CDP efficacy. The breast cancer therapy characteristics did not affect PEV or PREV. This study showed the effectiveness of an intensive CDP interventions. The key to predicting successful lymphedema treatment is the baseline PEV.

Feasibility of a novel two-piece nasogastric feeding tube for patients with dysphagia.

INTRODUCTION: The exposed section of a traditional nasogastric (NG) tube can interfere with patients' social activities and thereby result in distress. This study was conducted to evaluate the feasibility and safety of a novel two-piece NG tube for patients with dysphagia. METHODS: Ten patients with dysphagia were recruited between November 2011 and May 2012. Patients who were unconscious or in critical condition, had a traditional NG tube < 50 cm or > 60 cm in fixed length, or were unable to follow instructions or sign consent forms were excluded. The two-piece NG tube, which was placed in the patients for one week, comprised a removable external tube that can be joined to an internal tube via a T-connector, which was placed close to the naris. Events related to safety (e.g. nasal pressure sores, number of unplanned extubation, displacement and spontaneous migration of the NG tube, other unpredictable injuries) and effectiveness (e.g. liquid food spills, tube obstruction, perfusion rate, other adverse circumstances) were assessed daily. RESULTS: All patients received feeding without complication using the two-piece NG tube and none experienced premature removal of the tube. No serious NG tube complications or malfunctions were observed. CONCLUSION: The results of this study indicate that the two-piece NG feeding tube is a feasible option for patients with dysphagia. Future improvements to the connector may help enhance its performance. A rigorous randomised controlled trial to examine the effects of the two-piece NG tube on patients' quality of life and quality of medical care is being planned.

Vertebral osteomyelitis complicated by iliopsoas muscle abscess in an immunocompetent adolescent: successful conservative treatment.

Vertebral osteomyelitis is rare in children. The lumbar spine is the most commonly involved region. Vertebral osteomyelitis occurs more frequently in the vertebral body, and involvement of posterior element is rare. Vertebral osteomyelitis results from hematogenous seeding, spread from contiguous infections, and direct inoculation from spinal surgery. Initial symptoms include low back pain, difficulty standing, limping gait, and fever. Blood cultures should be obtained for children with vertebral osteomyelitis because it is the definite guide for providing accurate treatment. Computed tomographyi-guided abscess aspiration should be considered for patients with negative blood cultures. Staphylococcus aureus is the most common microorganism in vertebral osteomyelitis, and the incidence of methicillin-resistant S aureus has increased in recent years. Plain radiographs, bone scintigraphy, and magnetic resonance imaging are useful for making the diagnosis. Antimicrobial therapy for 6 weeks is usually successful, and an early transition to oral form does not increase the risk of treatment failure. Debridement with implant removal is required, especially for late-onset infections associated with previous spinal surgery. Vertebral osteomyelitis can cause motor weakness and paralysis. Because of the involvement of spinal development, spinal deformities, including scoliosis and loss of normal lumbar lordosis, should be a concern in pediatric patients. Early diagnosis and adequate treatment for vertebral osteomyelitis are important to prevent severe complications and lifelong disabilities.This article describes the case of a 14-year-old boy with spontaneous lumbar vertebral osteomyelitis who initially presented with low back pain and was successfully treated nonoperatively.