The effect of horse simulator riding on visual analogue scale, body composition and trunk strength in the patients with chronic low back pain.

BACKGROUND: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders, and thus effective treatments are required. Recently, real horseback riding has been reported to be beneficial for the patients. However, it has some limitations, such as limited approaches and safety issues. OBJECTIVE: The purpose of this study was to investigate the effect of horse simulator riding on back pain, body composition and trunk strength in the patients with CLBP. PARTICIPANTS: Forty-seven men with CLBP (mean age 20.55 ± 1.38 years) were randomly divided into a control group (n = 23) and a horse simulator riding group (n = 24), and visual analogue scale (VAS), body composition and isokinetic trunk strength were measured after 8 weeks for which subjects in a horse simulator riding group had performed the horse simulator exercise (HSE). RESULTS: Horse simulator exercise significantly reduced pain scores of VAS and enhanced isokinetic torques of trunk at 30 and 90°/s. There were also significantly increased muscle mass and decreased fat mass in horse simulator riding group. CONCLUSION: It can be inferred that HSE may be helpful in relief of back pain and recovery of back function through developing trunk strength and balancing the ratio of trunk flexor/extensor muscles.

Short term rehabilitation and ankle instability.

Chronic ankle instability (CAI) after ankle sprains has been shown to cause foot and ankle disability. Although rehabilitation programs for patients with CAI have been performed in related studies, few researchers have studied overall performance including pain, balance, and isokinetic torque. The purpose of this study was to determine if a short-term rehabilitation program that addressed range of motion (ROM), functional muscular performance, and neuromuscular control, can improve the foot/ankle disability index (FADI), FADI-Sport, ROM, star excursion balance test (SEBT), and isokinetic torque for patients with CAI. Prior to the experiment, we investigated the principal injury site through an administered questionnaire on 236 potential participants, and selected 18 male subjects aged between 21 and 23 years. 9 subjects (rehabilitation group, RG) with unilateral CAI took part in the rehabilitation program for 4 weeks, whereas 9 subjects (control group, CG) did not participate in that program. The results were as follows; the RG significantly increased FADI, FADI-Sport scores, and ROM on the injured limb compared with the CG. Also, the RG had greater SEBT reaches and improvements in isokinetic torque compared with the CG. In conclusion, these results demonstrate that a short-term rehabilitation program can improve functional limitations in patients with CAI.

Safety of extended endoscopic mucosal resection and endoscopic submucosal dissection following the Japanese Gastric Cancer Association treatment guidelines.

BACKGROUND: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely performed. Indications for these procedures have been extended in Korea and Japan. The aim was to evaluate whether these extended indications are safe. METHODS: All patients who had surgery for early gastric cancer at Seoul National University Bundang Hospital between May 2003 and December 2007 were identified from a prospective database. Lymph node status was examined in patients who met extended indications for EMR and had undergone surgical resection. RESULTS: Of patients with mucosal cancers, 129 met extended indications for EMR or ESD and three (2.3 per cent) had lymph node metastasis. Of the 52 submucosal cancers meeting extended indications for EMR or ESD, two (4 per cent) had lymph node metastasis. Differentiated mucosal cancers without ulcer formation did not have lymph node metastasis, irrespective of size. CONCLUSION: Extending the indications for EMR and ESD according to the Japanese Gastric Cancer Association guidelines carries an increased risk of lymph node metastasis. For cancers meeting these criteria, treatment by gastric resection with lymph node dissection should still be considered. A well differentiated mucosal cancer of any size without ulceration may be considered as an extended indication for EMR or ESD.

Effect of GM-CSF and IL-2 co-expression on the anti-tumor immune response.

We evaluated the effect of potential therapeutic genes, GM-CSF and IL-2 respectively, or in combination of both cytokines, on the activation of systemic antitumor responses. CT26 tumor cells were modified to secrete GM-CSF and/or IL-2. The growth rate of the modified tumor cells versus the parental CT26 cells did not show any difference. When we implanted the CT26 tumor cells which secrete either GM-CSF or IL-2, delayed and suppressed tumorigenicity was observed. However, another CT26 cell line which expresses both GM-CSF and IL-2 (CT26/GMCSF/IL-2) did not form any tumor mass in the immunocompetent syngeneic Balb/c mice, showing the potential immune responses. Immunohistochemical examination of the modified tumor masses implanted with the cells expressing GM-CSF or IL-2 showed increased necrosis and infiltration of NK (CD56+) lineage cells and macrophage/monocytes. In the vaccination model, the growth of rechallenged wild-type CT26 was more suppressed int he mice which were injected with GM-CSF or IL-2, however, the wild-type CT26 tumor formed normal tumor mass in the mice vaccinated with CT26/GM-CSF/IL-2 showing acute non-T-cell mediated immune response. As a treatment, we injected those modified tumor cells into the established tumor. There we could find tumor growth suppression by the injection of cytokine-modified CT26 cells, especially by the CT26/GM-CSF/IL-2. In the present study we could induce the eradication of tumorigenicity by the transfection of both GM-CSF and IL-2 genes and a potent role in the growth suppression of an established tumor.

Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome.

There are few consistent guidelines in choosing anesthesia for cesarean section for a parturient with placenta previa. This prospective randomized trial was organized to compare the maternal hemodynamics, blood loss and neonatal outcome of general versus epidural anesthesia for cesarean section with the diagnosis of grade 4 placenta previa. After giving informed consent, 12 patients received general anesthesia and 13 received epidural. Intraoperative blood pressures demonstrated a more stable course in the epidural group than in the general group. Blood loss did not differ significantly between the groups (1622 +/- 775 mL vs. 1418 +/- 996 mL). General anesthesia resulted in lower immediate postoperative hematocrit level (28.1 +/- 3.5% vs. 32.5 +/- 5.0%, P < 0.05). The patients in the general group received a significantly larger transfusion than the epidural group (1.08 +/- 1.6 vs. 0.38 +/- 0.9 units, P < 0.05). The Apgar scores at 1 and 5 min were similar in the two groups (8 [4-9] vs. 8 [7-9] and 10 [6-10] vs. 9 [9-10], respectively). We concluded that epidural anesthesia is superior to general anesthesia in elective cesarean section for grade 4 placenta previa with regard to maternal hemodynamics and blood loss. There was no difference in neonatal outcome.

Effects of remifentanil on propofol requirements for loss of consciousness in target-controlled infusion.

BACKGROUND: We evaluated the effects of various doses of target-controlled remifentanil on the propofol requirements for the loss of consciousness (LOC) and the consequent hemodynamic changes on the induction of intravenous anesthesia in day-case surgery. METHODS: Eighty infertile female patients scheduled for diagnostic laparoscopy were randomly allocated to 1 of 4 groups (20 in each) to receive a target concentration of 1 ng x mL(-1) (Remi-1 group), 2 ng x mL(-1) (Remi-2 group), 3 ng x mL(-1) (Remi-3 group), or 4 ng x mL(-1) remifentanil (Remi-4 group). After equilibrium of remifentanil, propofol was administered with initial target concentration of 2 microg x mL(-1) and with 1 microg x mL(-1) increments. The response to call was assessed every 15 s until a LOC was achieved. RESULTS: The effect site concentration of propofol (Ce), the total propofol dose, and the time for LOC were significantly decreased with increasing remifentanil concentrations. There was a moderate correlation between the effect of remifentanil and the effect site concentration of propofol at the LOC (r(2) = 0.353, P < 0.05). There was also a moderate correlation between the remifentanil concentration and the time to LOC (r(2) = 0.442, P < 0.05). There were no significant differences in the hemodynamics among the groups, although the decreases in blood pressure after propofol administration in all groups were significant compared with baseline. CONCLUSION: The effect of altering the target-controlled remifentanil concentration during propofol induction was found to be dose-dependent. There was no significant difference in the cardiovascular response with the studied range of concentrations of remifentanil and propofol.