Efficacy of a novel walking assist device with auxiliary laser illuminator in stroke Patients~ a randomized control trial.

BACKGROUND/PURPOSE: Task-oriented functional walking is important in stroke patients. We aimed to investigate effects of a quad-cane with auxiliary laser illuminator (laser-cane) among stroke patients. METHODS: This was a randomized-prospective study. Patients in the experimental group (EG) received 15-min of walking training with laser-cane and 15-min of traditional physical therapy. Patients in the control group (CG) received the same rehabilitation without laser-cane. The rehabilitation lasted for 4 weeks, twice per week. Primary outcome were gait parameters. Secondary outcomes were Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and Barthel index (BI). Outcomes were measured at baseline, at the end of the rehabilitation (visit-1), and 4 weeks later (visit-2). RESULTS: Both the groups (both n = 15) showed improvement of cadence, relative stance and swing phase duration of non-paretic side, BBS, and TUG at both visits. In the intragroup comparison, the EG additionally improved at stride length, relative stance and swing phase duration of paretic side, and gait speed at both visits; temporal swing symmetry, and toe-off angle of non-paretic side at the visit-2. Intergroup comparing for changing of outcomes with the CG, stride length and gait speed increased, relative stance phase duration of the non-paretic site decreased, and the temporal swing symmetry improved at the visit-1; relative stance phase duration of the paretic side decreased and the temporal stance symmetry improved at the visit-2 in the EG. CONCLUSION: Rehabilitation with laser-cane improved the balance, activity of daily living, gait symmetry and gait parameters of stroke patients.

Pyrrole-Protected ß-Aminoalkylzinc Reagents for the Enantioselective Synthesis of Amino-Derivatives.

Chiral ß-aminoalkylzinc halides were prepared starting from optically pure commercial ß-amino-alcohols. These amino-alcohols were converted to the corresponding N-pyrrolyl-protected alkyl iodides which undergo a zinc insertion in the presence of LiCl (THF, 25 °C, 10-90 min). Subsequent Negishi cross-coupling or acylation reactions with acid chlorides produced amino-derivatives with retention of chirality. Diastereoselective CBS-reductions of some prepared N-pyrrolyl-ketones provided 1,3-subsituted N-pyrrolyl-alcohols with high diastereoselectivity. Additionally, a deprotection procedure involving an ozonolysis allowed the conversion of the pyrrole-ring into a formamide without loss of optical purity.

Pyridazino[1,6-b]quinazolinones as new anticancer scaffold: Synthesis, DNA intercalation, topoisomerase I inhibition and antitumor evaluation in vitro and in vivo.

A new anticancer N-containing heterocyclic scaffold was designed and 30 pyridazino[1,6-b]quinazolinone derivatives were synthesized and characterized. Antiproliferation evaluation in vitro against four human cancer cell lines including SK-OV-3(ovarian cell), CNE-2(nasopharyngeal cell), MGC-803(gastric cell) and NCI-H460(lung cell) indicated that most of them exhibited potent anticancer activity and the IC50 value of the most potent compound lowered to sub-µM. DNA interaction assay indicated that compounds 4e, 4g, 6o, 6p, 8o can intercalate into DNA. Compounds 6 and 8 also demonstrated potent topoisomerase I (topo I) activity. Annexin V- FITC/propidium iodide dual staining assay and cell cycle analysis indicated that 2-(4-bromophenyl)-4-((3-(diethylamino)propyl)amino) -10H-pyridazino [1,6-b]quinazolin- 10-one (8p) could induce arrest cell cycle at G2 phase and apoptosis in MGC-803 cells in a dose-dependent manner. The in vivo antitumor efficiency of compound 8p was also evaluated on MGC-803 xenograft nude mice, and the relative tumor growth inhibition was up to 55.9% at a dose of 20 mg/kg per two days. The results suggested that pyridazino[1,6-b]-quinazolinones might serve as a promising novel scaffold for the development of new antitumor agents.

Risk of osteoporotic fractures as a consequence of haemophilia: A nationwide population-based cohort study.

AIM: Low bone mineral density occurs more commonly in patients with haemophilia (PWH) than the general population. However, the risk of haemophilia-related osteoporotic fractures has not been well established. We aim to explore the relationship between haemophilia and the development of osteoporotic fractures following haemophilia. METHODS: This was a nationwide population-based cohort study based on the data in the Taiwan National Health Insurance Research Database (TNHIRD). Patients who were diagnosed with haemophilia were selected. A comparison cohort was formed of patients without haemophilia who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of new-onset osteoporotic fractures were calculated for both cohorts. RESULTS: The haemophilia cohort consisted of 75 patients, and the comparison cohort comprised 300 matched control patients without haemophilia. The risk of osteoporotic fractures was higher in the haemophilia cohort than in the comparison cohort (HR = 5.41, 95% confidence interval [CI] = 2.42-12.1, P < 0.001). After adjustments for age, sex, comorbidities, urbanizations and socio-economic status, PWH were 4.37 times more likely to develop osteoporotic fractures (95% CI = 1.88-10.17, P = 0.001) as compared to matched cohort. In addition, the incidence of newly diagnosed osteoporotic fractures was significantly increased after 5-year follow-up durations. CONCLUSION: Though our study by TNHIRD presented methodologic flaws by its design nature, we observed that haemophilia may increase the risk of osteoporotic fractures and the cumulative incidence was significantly higher for PWH diagnosed more than 5 years. Clinicians should pay particular attention to osteoporotic fractures following haemophilia in PWH as they age.

Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes.

BACKGROUND: Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients. OBJECTIVE: We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke. METHODS: This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age 60 . 20 ± 11 . 12 years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20 m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser. RESULTS: The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 ( p = 0 . 02 ,< 0 . 01 , and = 0 . 05 , respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser. CONCLUSION: Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.

Morita-Baylis-Hillman (MBH) Reaction Derived Nitroallylic Alcohols, Acetates and Amines as Synthons in Organocatalysis and Heterocycle Synthesis.

The Morita-Baylis-Hillman (MBH) reaction is one of the most useful and efficient protocols for constructing new carbon-carbon bonds between an activated olefin and electrophiles in the presence of a tertiary amine/phosphine. Herein, we present the use of MBH alcohols, which are obtained from the reaction of nitrostyrenes with aldehydes, as well as acetates and amines derived thereof in several organocatalytic transformations. Densely functionalised MBH adducts can also be used to synthesise substituted heteroaromatic compounds, such as furan, pyrrole, pyrazole and imidazole derivatives.

Characteristics of spatial and temporal variability in the distribution of biological soil crusts on the Loess Plateau, China.

Biological soil crust (biocrust) is widely distributed on the Loess Plateau and plays multiple roles in regulating ecosystem stability and multifunctionality. Few reports are available on the distribution characteristics of biocrust in this region, which limits the assessment of its ecological functions. Based on 388 sampling points in different precipitation zones on the Loess Plateau from 2009 to 2020, we analyzed the coverage, composition, and influencing factors of biocrust across different durations since land abandonment, precipitation levels, topography (slope aspect and position), and utilization of abandoned slopelands (shrubland, forest, and grassland). On this base, with the assistance of machine learning and spatial modeling methods, we generated a distribution map of biocrust and its composition at a resolution of 250 m × 250 m, and analyzed the spatial distribution of biocrust on the Loess Plateau. The results showed that the average biocrust coverage in the woodlands and grasslands was 47.3%, of which cyanobacterial crust accounted for 25.5%, moss crust 19.7%, and lichen crust 2.1%. There were significant temporal and spatial variations. Temporally, the coverage of biocrust in specific regions fluctuated with the extension of the abandoned durations and coverage of cyanobacterial crust, while moss crust showed a reverse pattern. In addition, the coverage of biocrust in the wet season was slightly higher than that in the dry season within a year. Spatially, the coverage of biocrusts on the sandy lands area on the Loess Plateau was higher and dominated by cyanobacterial crusts, while the coverage was lower in the hilly and gully area. Precipitation and utilization of abandoned land were the major factors driving biocrust coverage and composition, while slope direction and position did not show obvious effect. In addition, soil organic carbon content, pH, and texture were related to the distribution of biocrust. This study uncovered the spatial and temporal variability of biocrust distribution, which might provide important data support for the research and management of biocrust in the Loess Plateau region.

Copper(I)-Catalyzed Dearomatization of Benzofurans with 2-(Chloromethyl)anilines through Radical Addition and Cyclization Cascade.

Herein, we described a copper(I)-catalyzed dearomatization of benzofurans with 2-(chloromethyl)anilines to prepare various tetrahydrobenzofuro[3,2-b]quinolines and 2-(quinolin-2-yl)phenols in good to excellent yields through radical addition and an intramolecular cyclization process. Mechanistic studies revealed that 2-(chloromethyl)anilines served as radical precursors. The present method features broad substrate scope, good functional group tolerance, quinoline scaffold diversity, and radical addition dearomatization of benzofurans.

An efficient Friedel-Crafts/oxa-Michael/aromatic annulation: rapid access to substituted naphtho[2,1-b]furan, naphtho[1,2-b]furan, and benzofuran derivatives.

Substituted naphthofurans and benzofurans are easily accessible by treatment of naphthols/substituted phenols with nitroallylic acetates through a substitution-elimination process promoted by cesium carbonate. Reactions between naphthols and aromatic/heteroaromatic-substituted nitroallylic acetates gave the desired functionalized naphthofurans in high to excellent chemical yields (14-97%). On the other hand, treatment of phenol derivatives (i.e., 3-dimethylamino-, 3-methoxy-, and 3,5-dimethoxyphenol) with various nitroallylic acetates afforded the corresponding benzofurans in moderate to good chemical yields (24-91%). The reaction proceeded through an interesting Friedel-Crafts S(N)2' process followed by intramolecular oxa-Michael cyclization and subsequent aromatization. A plot of log (k/kH) against Hammett constants σ(p) showed satisfactory linearity with a positive ρ value, indicating that the initial Friedel-Crafts-type S(N)2' process constituted the rate-determining step. This methodology has been applied to the synthesis of various novel C2 and C3 symmetric bis- and trisfurans by using catechol and phloroglucinol as the nucleophilic partners. The reactivity decreased when alkyl-substituted nitroallylic acetate systems were used. This might be related to the decreased electrophilic character of these substrates.

Intravascular laser irradiation of blood as novel migraine treatment: an observational study.

BACKGROUND: Migraine is one of four major chronic diseases that cause disability. Decreases in regional cerebral blood flow (rCBF) occur during migraine attacks. Laser therapy is extensively employed in treating other vascular diseases; nevertheless, its effectiveness in migraine management remains largely unknown. Therefore, we evaluated the effect of low-level intravascular laser irradiation of blood (ILIB) therapy in patients with migraine. METHODS: We performed an observational case-control study in 24 patients suffering from migraine. Patients were divided into an ILIB treatment group and a traditional rehabilitation group. This study performed clinical assessments and single-photon emission computed tomography (SPECT) prior to and after the treatment and 1 month later. Changes in rCBF-SPECT between groups and between timepoints were compared to clinical outcomes. RESULTS: Nine patients undergoing rehabilitation and fifteen patients undergoing ILIB were studied from baseline to 1 month follow-up. The ILIB group, visual analog scale for pain (P = 0.001), Montreal Cognitive Assessment (P = 0.003), and Athens Insomnia Scale (P < 0.001) symptom scores significantly improved after treatment. SPECT imaging showed a 1.27 ± 0.27 fold increase in rCBF after ILIB treatment, and no significant differences in the rehabilitation group. CONCLUSIONS: Low-level ILIB therapy is associated with better clinical and vascular outcomes, and may be a feasible treatment option for migraine. Although our sample size was small, our data provide a starting point for migraine laser therapy research.

4-[(3-Meth-oxy-anilino)methyl-idene]-2-phenyl-1,3-oxazol-5(4H)-one.

In the title compound, C(17)H(14)N(2)O(3), the oxazolone ring is essentially planar [maximum deviation = 0.004 (1) Å] and is oriented with respect to the phenyl and benzene rings at 10.06 (9) and 5.63 (8)°, respectively; the dihedral angle between the phenyl ring and the benzene ring is 15.69 (8)°. In the crystal, N-H⋯O hydrogen bonds link the mol-ecules into chains running along the a axis. Neighbouring chains are inter-connected by π-π stacking, the centroid-centroid distance being 3.6201 (9) Å.

Bis[µ-N'-(adamantan-1-ylcarbon-yl)-2-oxidobenzohydrazidato(3-)]tetra-pyridine-trinickel(II) dimethyl-formamide monosolvate monohydrate.

In the title trinuclear Ni(II) compound, [Ni(3)(C(18)H(19)N(2)O(3))(2)(C(5)H(5)N)(4)]·C(3)H(7)NO·H(2)O, three Ni(II) cations are bridged by two N'-(adamantan-1-ylcarbon-yl)-2-oxidobenzohydrazidate trianions. The central Ni(II) cation has a distorted octa-hedral N(4)O(2) coordination environment where a reverse torsion occurs between the two bridging ligands, whereas the two Ni(II) cations on the sides each adopt an N(2)O(2) square-planar coordination. Weak intra-molecular C-H⋯O and C-H⋯N inter-actions help to stabilize the mol-ecular structure. In the crystal, the lattice water mol-ecule links with the Ni(II) complex and dimethyl-formamide solvent mol-ecule via O-H⋯O hydrogen bonding.

Effect of high intensity laser therapy in the treatment of acute atlantoaxial rotatory subluxation: A case report.

BACKGROUND: Sudden onset of acute torticollis in children is rare and is usually diagnosed as atlantoaxial rotatory subluxation (AARS). The common treatment for acute AARS without neurological symptoms is halter traction in conjunction with muscle relaxant and sedative agents, followed by cervicothoracic orthotic immobilization. To the best of our knowledge, a case of acute AARS treatment with high-intensity laser therapy (HILT) has not yet been reported so far. OBJECTIVE: We aimed to report a case of acute AARS treatment with HILT successfully and to discuss about the clinical effect of HILT in AARS. METHODS: We reported a 9-year-old girl with acute onset of torticollis visiting the rehabilitation outpatient department. RESULS: The physical examination revealed a typical cock robin position without neurological symptoms. A series of evaluations, including open-mouth odontoid radiograph and soft tissue sonography, confirmed the diagnosis of acute AARS. The patient received HILT over the left suboccipital and upper back muscle groups, which started on the day of the first rehabilitation clinic visit, once a week, for four weeks. Torticollis and neck pain improved gradually with each session of HILT, and the symptoms resolved completely after the fourth session. Dynamic computed tomography (CT) of the cervical spine showed no evidence of obvious AARS after the treatment. CONCLUSIONS: The patient had no complaints after HILT in a case of acute AARS resulting from a mechanical factor. Due to its pain-relief and muscle-release characteristics, HILT indicates the probable benefit of relaxation of spastic muscles for patients with AARS.

[2,2'-(1,1'-Binaphthyl-2,2'-diyldiimino)-diethanol-κN,N',O]dichloridocopper(II).

In the title complex, [CuCl(2)(C(24)H(24)N(2)O(2))], the Cu(II) cation is N,N',O-chelated by a 2,2'-(1,1'-binaphthyl-2,2'-diyldiimino)-diethanol ligand and coordinated by two chloride anions in a distorted square-pyramidal geometry. In the diethanol ligand, the two naphthalene ring systems are twisted with respect to each other at a dihedral angle of 68.30 (9)°. The uncoord-inated hy-droxy group links with a coordinated chloride anion via an intra-molecular O-H⋯Cl hydrogen bond. Inter-molecular N-H⋯O and N-H⋯Cl hydrogen bonds occur in the crystal structure.

Physiotherapist' job performance, impression management and organizational citizenship behaviors: An analysis of hierarchical linear modeling.

Studies on physiotherapists are generally focused on clinical professionalism, with very few examining job performance from a management standpoint. To address this gap, this study sought to investigate the relationship between impression management and organizational citizenship behavior and job performance. This study targeted medical institutions offering rehabilitation and physiotherapy services and conducted a questionnaire survey based on scales developed by domestic and foreign scholars. A total of 600 questionnaires were distributed and 523 valid ones collected. The data was tested and verified using regression analysis and hierarchical linear modeling (HLM). In the survey, the Impression Management Scale, Organizational Citizenship Behavior Scale, and Job Performance Scale indicated that at the individual level, the impression management of physiotherapists is significantly related to their organizational citizenship behaviors and job performance. The organizational citizenship behaviors were also found to have a mediating effect between impression management and job performance. At the group level, impression management had a conditioning effect on organizational citizenship behaviors and job performance. In terms of statistical methods, group-level variables act as moderators, which affects the power of individual-level explanatory variables on outcome variables, i.e., the influence of the slope. The job behaviors of physiotherapists entail direct service and their performance is closely related to organizational development. Impression management gives people certain purposes and behaviors while organizational citizenship behaviors are a type of non-self-seeking, selfless dedication behaviors. Therefore, the motivation of physiotherapists who demonstrate organizational citizenship behaviors should be further explored.

Efficacy of lateral stair walking training in patients with chronic stroke: A pilot randomized controlled study.

BACKGROUND: Patients with chronic stroke have reduced capacity for performing activities of daily living (ADLs) and are at increased risk for falls during walking due to long-term changes to muscle tone and force, as well as movement control. RESEARCH QUESTION: To investigate the efficacy of lateral stair walking training on muscle strength of affected lower extremities, balance, ADLs, and gait ability in patients with chronic stroke. METHODS: The experimental group received 15 min of lateral stair walking exercise along with 15 min of traditional physiotherapy, whereas the control group received only traditional physiotherapy for 30 min. Both groups received the intervention once a week for 12 weeks. Outcome measurements included muscle strength, postural assessment scale for stroke patients (PASS), Fugal-Meyer assessment for lower extremity (FMA-LE), Barthel index (BI), timed up and go test (TUG), and the gait parameters which were determined by the Reha-Watch system. RESULTS: A total of 24 participants completed the study. The experimental group showed significant improvements in hip extensor, flexor, and abductor strength of the affected limb, FMA-LE, BI, TUG, and gait parameters of stride length, velocity, and cadence. Significant differences in affected limb ankle plantar strength (p = 0.024), PASS (p = 0.017), BI (p = 0.039), TUG (p = 0.049), and gait velocity (p < 0.001) were observed between the 2 groups. SIGNIFICANCE: Lateral stair walking training alongside physical therapy resulted in significant improvements in hip muscle strength and gait parameters in patients with chronic stroke. Our results support the incorporation of lateral stair walking training into clinical rehabilitation programs. Lateral stair walking training in patients with chronic stroke can be used as an effective treatment to improve gait, balance performance, and ADLs.

Decreased passive muscle stiffness of vastus medialis is associated with poorer quadriceps strength and knee function after anterior cruciate ligament reconstruction.

BACKGROUND: Muscle deficits of the quadriceps and hamstrings are common after anterior cruciate ligament reconstruction, and increase the risk of knee reinjury. Muscle stiffness is an important factor for dynamic joint stability. However, the changes in quadriceps and hamstring muscle stiffness and its influence after anterior cruciate ligament reconstruction remain unclear. METHOD: Twenty-five male subjects with anterior cruciate ligament reconstruction and twenty-one matched healthy subjects participated in this study. The passive muscle stiffness of the quadriceps and hamstrings was assessed by shear modulus using ultrasound shear wave elastography. The isokinetic muscle strengths of the quadriceps and hamstrings were tested. Knee function was evaluated by the International Knee Documentation Committee and Lysholm score. Muscle stiffness was compared between limbs via non-parametric tests. Correlation analysis was used to detect the relationship between muscle stiffness, isokinetic muscle strength and knee functional scores. FINDINGS: The involved limb exhibited significantly decreased shear modulus in the vastus medialis compared to the dominant limbs(z = -3.585;P = 0.001;ES = 1.13) and non-dominant limbs(z = -3.551;P = 0.002;ES = 1.24) of healthy controls. The shear modulus of ST was also significantly lower in the involved limb when compared with the contralateral limbs(z = -3.996;P < 0.001;ES = 1.33), dominant limbs(z = -4.477;P < 0.001;ES = 1.65) and non-dominant limbs(z = -4.234;P = 0.001;ES = 1.43) of healthy controls. The shear modulus of the vastus medialis was associated with quadriceps peak torque at 60°/s(r = 0.470; p < 0.001) and knee functional score(r = 0.459; p = 0.021). INTERPRETATION: The passive muscle stiffness of the vastus medialis decreased after anterior cruciate ligament reconstruction, which is associated with poorer quadriceps strength and knee function. The effect of modulation of muscle stiffness on improving knee function warrants future investigation.

2-Styryl-4-aminoquinazoline derivatives as potent DNA-cleavage, p53-activation and in vivo effective anticancer agents.

Forty-eight analogues of CP-31398, an antitumor agent modulated the mutant p53 gene were synthesized and their cytotoxicities against four cancer cell lines with different p-53 status including bladder cell T24 (w-p53), gastric cell MGC-803 (m-p53), prostate cell DU145 (m-p53), prostate cell PC-3 (null-p53), lung cell A549 (w-p53) and normal liver cell line HL-7702 (w-p53) were examined. (E)-2-(4-Nitrostyryl)-4-(3-dimethylaminopropyl)-aminoquinazoline (10ah) was identified as the most potent compound in anti-proliferation against MGC-803 cells, with IC50 lowed to 1.73 µM, far potency than that of CP-31398. Molecular mechanism study revealed that 10ah and CP-31398 differ greatly in mechanism to exert their antitumor properties. 10ah could intercalate into DNA and resulted in significant DNA double-strand break. 10ah-treatment in MGC-803 cells increased the expression of p53, phosphorylated p53 (p-p53), CDK4, p21 to cause cell cycle arrest at G2/M phase, significantly up-regulated the levels of pro-apoptosis proteins Bak, Bax, Bim while down-regulated the anti-apoptosis proteins Bcl-2, Bcl-xL and the levels of cyclin B1, fluctuated the intracellular reactive oxygen species (ROS), Ca2+ and mitochondrial membrane potential, activated Caspase-9 and Caspase-3 to induce apoptosis. 10ah also displayed potent anticancer efficiency against MGC-803 xenograft tumors models, with tumor growth inhibition (TGI) up to 61.8% at 20 mg/kg without obvious toxicity.

(Z)-Isobutyl 2-benzamido-3-(4-chloro-phen-yl)acrylate.

The title compound, C(20)H(20)ClNO(3), is a α-amino acid derivative which displays a Z configuration about the C=C double bond. The dihedral angle betwen the aromatic rings is 87.75 (12)°. The mol-ecular conformation is stabilized by an intra-molecular C-H⋯N hydrogen bond. In the crystal structure, centrosymmetrically related mol-ecules inter-act through inter-molecular C-H⋯O hydrogen-bond inter-actions, forming dimers. The dimers are further linked into chains parallel to the a axis by N-H⋯O hydrogen bonds. The methyl groups of the isopropyl group are disordered over two positions with occupancy factors of 0.5.

Factors influencing the occupational injuries of physical therapists in Taiwan: A hierarchical linear model approach.

BACKGROUND: The evidence literature suggests that physical therapy practitioners are subjected to a high probability of acquiring work-related injuries, but only a few studies have specifically investigated Taiwanese physical therapy practitioners. OBJECTIVE: This study was conducted to determine the relationships among individual and group hospital-level factors that contribute to the medical expenses for the occupational injuries of physical therapy practitioners in Taiwan. PARTICIPANTS: Physical therapy practitioners in Taiwan with occupational injuries were selected from the 2013 National Health Insurance Research Databases (NHIRD). METHODS: The age, gender, job title, hospitals attributes, and outpatient data of physical therapy practitioners who sustained an occupational injury in 2013 were obtained with SAS 9.3. SPSS 20.0 and HLM 7.01 were used to conduct descriptive and hierarchical linear model analyses, respectively. RESULTS: The job title of physical therapy practitioners at the individual level and the hospital type at the group level exert positive effects on per person medical expenses. Hospital hierarchy moderates the individual-level relationships of age and job title with the per person medical expenses. CONCLUSION: Considering that age, job title, and hospital hierarchy affect medical expenses for the occupational injuries of physical therapy practitioners, we suggest strengthening related safety education and training and elevating the self-awareness of the risk of occupational injuries of physical therapy practitioners to reduce and prevent the occurrence of such injuries.