Wearing a back-support exoskeleton alters lower-limb joint kinetics during single-step recovery following a forward loss of balance.

We assessed the effects of a passive, back-support exoskeleton (BSE) on lower-limb joint kinetics during the initiation and swing phases of recovery from a forward loss of balance. Sixteen (8M, 8F) young, healthy participants were released from static forward-leaning postures and attempted to recover their balance with a single-step while wearing a BSE (backXTM) with different levels of support torque and in a control condition. The BSE provided âˆ¼ 15-20 Nm of external hip extension torque on the stepping leg at the end of initiation and beginning of swing phases. Participants were unable to generate sufficient hip flexion torque, power, and work to counteract this external torque, although they sustained hip flexion torque for a more prolonged period, resulting in slightly increased hip contribution to positive leg work (compared to control). However, net positive leg work, and the net contribution of hip joint (human + BSE) to total leg work decreased with BSE use. While all participants had changes in hip joint kinetics, a significant compensatory increase in ankle contribution to positive leg work was observed only among females. Our results suggest that BSE use adversely affects reactive stepping by decreasing the stepping leg kinetic energy for forward propulsion, and that the relative contributions of lower-limb joints to total mechanical work done during balance recovery are altered by BSE use. BSEs may thus need to be implemented with caution for dynamic tasks in occupational settings, as they may impair balance recovery following a forward loss of balance.

Surgery-related anxiety regarding arthroscopic meniscectomy under general anesthesia: a retrospective observational study.

BACKGROUND: The prevalence of anxiety among patients undergoing arthroscopic surgery and its association with postoperative function has been well documented; however, the level of anxiety and anxiety-related characteristics remain unclear. As such, the present study investigated the characteristics of state anxiety in patients undergoing arthroscopic meniscectomy. METHODS: Data from 75 patients, who underwent arthroscopic partial meniscectomy under general anesthesia and completed an anxiety status questionnaire between April 2021 and March 2022, were retrospectively collected and reviewed. The State-Trait Anxiety Inventory (STAI)-X was used to measure state anxiety; a total score ≥ 52 was defined as clinically meaningful state anxiety. STAI score, main cause of preoperative anxiety, most anxious period, and most helpful factors for reducing perioperative anxiety were investigated. Patients were divided into 2 groups according to the main cause of preoperative anxiety; surgery or anesthesia (group I [n = 47]); and postoperative pain or rehabilitation (group II [n = 28]) Characteristics of state-anxiety between the two groups were compared using independent t-tests. RESULTS: The mean STAI score of the total population was 39.1 points (range, 20-60 points). The mean STAI score was significantly higher in group I than in group II (41.9 vs. 34.4 points, respectively; P < 0.001). The proportion of patients with clinically meaningful state anxiety was significantly higher in group I than in group II (23.4% vs. 3.6%, respectively, P = 0.02). Most patients (66.0% in group I and 50.0% in group II) responded that trust in medical staff was the most helpful factor in overcoming preoperative anxiety. In group I, 63.8% reported that the surgeon's explanation was the most helpful factor in reducing postoperative anxiety, whereas in group II, 71.4% reported that the natural course after surgery was the most helpful factor. CONCLUSIONS: Surgeons should be aware that anxiety related to arthroscopic meniscectomy differs according to patient characteristics, and a preoperative explanation of the postoperative process with the surgeon is important for patients who experience preoperative anxiety regarding anesthesia or the surgery itself.

Surgery-related anxiety on geriatric patients undergoing total knee arthroplasty: a retrospective observational study.

BACKGROUND: The prevalence of anxiety in patients undergoing total knee arthroplasty (TKA) and its association with postoperative functions are well known; however, the levels of anxiety or anxiety-related characteristics are unknown. This study aimed to investigate the prevalence of clinically significant state anxiety in geriatric patients undergoing TKA for osteoarthritis (OA) of the knee and to evaluate the anxiety-related characteristics experienced by these patients pre- and post-operatively. METHODS: This retrospective observational study recruited patients who had undergone TKA for knee OA using general anesthesia between February 2020 and August 2021. The study participants were geriatric patients older than 65 years who had moderate or severe OA. We evaluated patient characteristics including age, sex, body mass index, smoking status, hypertension, diabetes, and cancer. We assessed their levels of anxiety status using the STAI-X which comprises 20-item scales. Clinically meaningful state anxiety was defined as a total score of 52 or higher. An independent Student's t-test was used to determine differences of STAI score between subgroups in terms of patient characteristics. And patients were asked to complete questionnaires, which assessed four areas: (1) the main cause of anxiety; (2) the most helpful factor in overcoming anxiety before surgery; (3) the most helpful factor in reducing anxiety after surgery; and (4) the most anxious moment during the entire process. RESULTS: The mean STAI score of patients who underwent TKA was 43.0 points and 16.4% of patients experienced clinically significant state anxiety. The current smoking status affect STAI score and the proportion of patients with clinically meaningful state anxiety. The most common cause of preoperative anxiety was the surgery itself. Overall, 38% of patients reported that they experienced the greatest level of anxiety when the surgeon had recommended TKA in the outpatient clinic. The trust in the medical staff before surgery and the surgeon's explanations after surgery helped the most in reducing anxiety. CONCLUSIONS: One in six patients before TKA experience clinically meaningful state anxiety, and about 40% of patients experience anxiety from the time they are recommended for surgery. Patients tended to overcome anxiety before TKA through trust in the medical staff, and the surgeon's explanations after surgery was found to be helpful in reducing anxiety.

A novel approach to quantify the assistive torque profiles generated by passive back-support exoskeletons.

Industrial exoskeletons are a promising ergonomic intervention to reduce the risk of work-related musculoskeletal disorders by providing external physical support to workers. Passive exoskeletons, having no power supplies, are of particular interest given their predominance in the commercial market. Understanding the mechanical behavior of the torque generation mechanisms embedded in passive exoskeletons is, however, essential to determine the efficacy of these devices in reducing physical loads (e.g., in manual material handling tasks). We introduce a novel approach using a computerized dynamometer to quantify the assistive torque profiles of two passive back-support exoskeletons (BSEs) at different support settings and in both static and dynamic conditions. The feasibility of this approach was examined using both human subjects and a mannequin. Clear differences in assistive torque magnitudes were evident between the two BSEs, and both devices generated more assistive torques during trunk/hip flexion than extension. Assistive torques obtained from human subjects were often within similar ranges as those from the mannequin, though values were more comparable over a narrow range of flexion/extension angles due to practical limitations with the dynamometer and human subjects. Characterizing exoskeleton assistive torque profiles can help in better understanding how to select a torque profile for given task requirements and user anthropometry, and aid in predicting the potential impacts of exoskeleton use by incorporating measured torque profiles in a musculoskeletal modeling system. Future work is recommended to assess this approach for other occupational exoskeletons.

Wearing a back-support exoskeleton impairs single-step balance recovery performance following a forward loss of balance - An exploratory study.

Back-support exoskeletons (BSEs) are a promising ergonomic intervention for reducing physical demands on the low-back, but little is known regarding whether BSE use alters balance recovery following external perturbations. Hence, we investigated the effects of wearing a BSE on single-step balance recovery following a forward loss of balance. Sixteen (8 M, 8F) young, healthy participants were released from static forward-leaning postures and attempted to recover their balance with a single step while wearing a BSE (backXTM) with three different levels of support torque (i.e., no torque, low, and high) and in a control condition (no exoskeleton). Lean angle was increased until they failed in two consecutive trials to recover their balance with a single step. The maximum lean angle from which individuals could successfully recover was not significantly altered when wearing the BSE. However, wearing the BSE under all torque conditions increased reaction times. The BSE also impeded hip flexion (i.e., decrease in both peak hip flexion angle and angular velocity), resulting in decreased peak knee flexion velocity, knee range of motion, and step length. Measures of the margin of stability decreased significantly in the high-torque BSE condition. Overall, our results suggest that use of a BSE that provides external hip extension torque impairs balance recovery responses. Future work extending kinetic analyses to recovery responses, as well as a study of recovery when responding to slips and trips while walking, would offer a more complete picture of how a BSE may impact balance recovery following a loss of balance.

Minimal Surgical Manpower for Living Donor Liver Transplantation.

BACKGROUND: Living donor liver transplantation (LDLT) is widely performed with good outcomes in the current era of improved surgical techniques. However, few studies have addressed how many human resources are required in the surgery itself. This study aimed to introduce how to perform LDLT with minimal manpower and evaluate the outcomes in adult patients. METHODS: The main surgical procedures of donor and recipient operations of LDLT were performed by a single specialist surgeon who led a team of minimal manpower that only included one fellow, one resident, one intern, and three nurses. He also provided postsurgical care and followed up all the patients as a primary care physician. The outcomes were analyzed from the standpoints of the feasibility and acceptability. RESULTS: Between November 2018 and February 2020, a total of 47 patients underwent LDLT. Ten patients had ABO-incompatible donors. The median age of the overall recipients was 57 years old (36-71); 37 patients (78.7%) were male. The MELD score was 10 (6-40), and the main etiologies were hepatic malignancy (38 patients or 80.9%) and liver failure (9 patients or 19.1%). The median age of the overall donors was 34 years old (19-62); 22 patients (46.8%) were male. All the graft types were right liver except for one case of extended right liver with middle hepatic vein. All donors had an uneventful recovery with no complications. There was one intraoperative mortality due to cardiac arrest after reperfusion in one recipient. Hepatic artery thrombosis was developed in 5 (10.6%) recipients. An acute rejection episode occurred in one patient. The median follow-up period for all the patients was 32.9 months (range, 24.7-39.8). Biliary complications were developed in 11 (23.4%) recipients. In total, 7 (15%) patients died, including 1 intraoperative mortality, 5 from cancer recurrence, and 1 from intracranial hemorrhage. The 1-, 2-, and 3-year overall survival rates in the recipient group were 91.5%, 87.2%, and 85.1%, respectively. CONCLUSIONS: LDLT with minimal surgical manpower is feasible under the supervision of a single expert surgeon who has the capacity for all the main surgical procedures in both donor and recipient operations without compromising the outcomes in the present era of advanced surgical management.

Effects of Back-Support Exoskeleton Use on Lower Limb Joint Kinematics and Kinetics During Level Walking.

We assessed the effects of using a passive back-support exoskeleton (BSE) on lower limb joint kinematics and kinetics during level walking. Twenty young, healthy participants completed level walking trials while wearing a BSE (backXTM) with three different levels of hip-extension support torque (i.e., no torque, low, and high) and in a control condition (no-BSE). When hip extension torques were required for gait-initial 0-10% and final 75-100% of the gait cycle-the BSE with high supportive torque provided ~ 10 Nm of external hip extension torque at each hip, resulting in beneficial changes in participants' gait patterns. Specifically, there was a ~ 10% reduction in muscle-generated hip extension torque and ~ 15-20% reduction in extensor power. During the stance-swing transition, however, BSE use produced undesirable changes in lower limb kinematics (e.g., 5-20% increase in ankle joint velocity) and kinetics (e.g., ~ 10% increase in hip flexor, knee extensor, and ankle plantarflexor powers). These latter changes likely stemmed from the need to increase mechanical energy for propelling the leg into the swing phase. BSE use may thus increase the metabolic cost of walking. Whether such use also leads to muscle fatigue and/or postural instability in long-distance walking needs to be confirmed in future work.

Effects of back-support exoskeleton use on gait performance and stability during level walking.

BACKGROUND: Back-support exoskeletons (BSEs) are a promising intervention to mitigate physical demands at work. Although growing evidence indicates that BSEs can reduce low-back physical demands, there is limited understanding of potential unintended consequences of BSE use, including the risk of falls. RESEARCH QUESTION: Does using a BSE adversely affect gait performance and stability, and are such effects dependent on specific BSE external torque characteristics? METHODS: Twenty participants (10 M, 10 F) completed five level over-ground walking trials and a five-minute treadmill walking trial while wearing a BSE (backX™) with three different levels of external torque (i.e., no torque, low torque, and high torque) and in a control (no-exoskeleton) condition. Spatiotemporal gait patterns, stride-to-stride gait variability measures, required coefficient-of-friction (RCoF), and minimum foot clearance (MFC) were determined, to assess gait performance. Gait stability was quantified using the maximum Lyapunov exponent (MLE) of trunk kinematics and the margin-of-stability (MoS). RESULTS: Using the backX™ with high supportive torque decreased slip risk (7% decrease in RCoF) and slightly improved trunk stability (3% decrease in MLE). However, it also decreased step length (1%), increased step width (10%) and increased gait variability (8-19%). Changes in MoS were complex: while MoS at heel strike decreased in the AP direction, it increased in the ML direction. There was a rather large decrease in MoS (26%) in the ML direction during the swing phase. SIGNIFICANCE: This is the first study to quantify the effects of wearing a passive BSE with multiple supportive torque levels on gait performance and stability during level walking. Our results, showing that the external torque of the BSE may adversely affect gait step width, variability, and dynamic stability, can contribute to better design and practice guidelines to facilitate the safe adoption of BSEs in the workplace.

Transforming Impossible into Possible (TIP) for SUD recovery: A promising practice innovation to combat the opioid crisis.

The purpose of this study is to examine the psychological self-sufficiency (PSS) process among low-income individuals participating in the Transforming Impossible into Possible (TIP) program and explore the implications of TIP as a SUD recovery intervention. A sample of 622 individuals from 9 local job training programs in a large Midwestern city was used to examine the group differences in substance abuse barrier and employment hope as they relates to economic self-sufficiency (ESS). Individuals in the TIP program (n = 315) had statistically significant path coefficients between substance abuse barriers, employment hope and ESS while the non-TIP counterpart (n = 307) showed a significant path only between employment hope and ESS. Also, the time difference score in substance abuse barrier and ESS was greater for the TIP group compared to the non-TIP comparison group. Results provide implications for social work practice among persons with SUDs. While the traditional employment programs focused only on the interview and job skills, TIP allowed participants to discover their resources to address the inner obstacles that have been holding them back. TIP could serve as a promising model to treat SUDs and support the recovery process.

The effects of prolonged sitting, standing, and an alternating sit-stand pattern on trunk mechanical stiffness, trunk muscle activation and low back discomfort.

Sit-stand desks continue to be a popular intervention for office work. While previous studies have reported changes in subjective measures, there is limited understanding of how sit-stand work differs from prolonged sitting or standing work, from a biomechanical standpoint. The objective of this study was to investigate the effects of prolonged sitting, prolonged standing, and a sit-stand paradigm on changes in trunk stiffness, low back discomfort, and trunk muscle activation. Twelve healthy participants performed 2 h of computer-based tasks in each protocol, on three different days. The sit-stand protocol was associated with a significant increase in trunk stiffness and a decrease in muscle activation of lumbar multifidus and longissimus thoracis pars thoracis, compared to both prolonged sitting and standing. Both sitting and standing were associated with increased low back discomfort. These findings may be worth exploring in more detail, for why alternating sit-stand patterns may help alleviate low back pain. Practitioner summary: We explored changes in objective and subjective measures related to low back discomfort following prolonged sitting, standing, and alternating sit-stand patterns. Alternating sit-stand pattern was associated with increased trunk stiffness and decreased back muscle activity. Hence, sit-stand desks may have benefits in terms of preventing/mitigating low back pain. Abbreviations: DOF: degree of freedom; EMG: electromyogram; ILL: iliocostalis lumborum pars lumborum; LTL: longissimus thoracis pars lumborum; LTT: longissimus thoracis pars thoracis; LBP: low back pain; LM: lumbar multifidus; MVEs: maximum isometric voluntary exertions; RANOVA: repeated-measure analysis of variance; RMS: root mean square.

Effects of two passive back-support exoskeletons on postural balance during quiet stance and functional limits of stability.

While occupational back-support exoskeletons (BSEs) are considered as potential workplace interventions, BSE use may compromise postural control. Thus, we investigated the effects of passive BSEs on postural balance during quiet upright stance and functional limits of stability. Twenty healthy adults completed trials of quiet upright stance with differing levels of difficulty (bipedal and unipedal stance; each with eyes open and closed), and executed maximal voluntary leans. Trials were done while wearing two different BSEs (SuitX™, Laevo™) and in a control (no-BSE) condition. BSE use significantly increased center-of-pressure (COP) median frequency and mean velocity during bipedal stance. In unipedal stance, using the Laevo™ was associated with a significant improvement in postural balance, especially among males, as indicated by smaller COP displacement and sway area, and a longer time to contact the stability boundary. BSE use may affect postural balance, through translation of the human + BSE center-of-mass, restricted motion, and added supportive torques. Furthermore, larger effects of BSEs on postural balance were evident among males. Future work should further investigate the gender-specificity of BSE effects on postural balance and consider the effects of BSEs on dynamic stability.

State-Anxiety in Geriatric Patients Undergoing Surgical Treatment for Femoral Neck or Intertrochanteric Fractures.

INTRODUCTION: Geriatric patients with hip fractures often experience unexpected falls and they may have unfamiliar and unpleasant experiences within a brief period. This study aimed to investigate the prevalence and levels of preoperative anxiety in patients undergoing surgical treatment for hip fractures, and to determine the anxiety-related characteristics experienced by patients during the period before and after surgery. MATERIALS AND METHODS: We recruited a total of 75 geriatric patients who underwent surgical treatment for hip fractures and returned complete questionnaires. We used the State-Trait Anxiety Inventory (STAI)-X type to measure state-anxiety and defined a total score of 52 or higher as clinically meaningful state-anxiety. And, we investigated main cause of anxiety, moment of the highest level of anxiety, and the most helpful factor in overcoming anxiety before surgery and in reducing anxiety after surgery. RESULTS: The mean STAI score was 47.2 points and one-third of the patients experienced various levels of clinically meaningful state-anxiety. The most common cause of preoperative anxiety was the surgery itself and patients experienced the greatest level of anxiety from the night preceding the surgery to the day of the surgery. Further, patients' trust in the medical staff prior to surgery and the surgeon's explanation after the surgery were the most key factors in overcoming anxiety. CONCLUSION: This study investigates the state-anxiety of geriatric patients undergoing surgery for hip fractures and presents important findings which can help in developing evidence-based interventions to improve the experience of patients undergoing hip surgeries.

Postural balance effects from exposure to multi-axial whole-body vibration in mining vehicle operation.

Twenty participants (18 males and 2 females) completed postural stability assessments before and after 4-h exposure to whole body vibration (WBV) in four experimental conditions: (a) vertical-dominant WBV with vertical passive air suspension, (b) multi-axial WBV with vertical passive air suspension, (c) multi-axial WBV with multi-axial active suspension, and (d) no WBV condition. Center of pressure (COP)-based postural sway measures significantly increased following multi-axial WBV exposure. Increase in COP velocity and displacement following multi-axial WBV was significantly higher than the increase in all the other exposure conditions. However, no significant differences between the WBV conditions were observed in functional limits of stability and anticipatory postural adjustments. While our results show standing balance to be impaired following the multi-axial WBV exposure of off-road mining vehicles, dynamic stability across a broader range of conditions needs to be understood to causally link postural stability decrements to increased fall-risks associated with off-road vehicle operators.

Examining Psychological Self-Sufficiency among African American Low-Income Jobseekers in a Health Profession Career Pathways Program.

The aim of this study was to explore the experiences and perceptions of low-income African American jobseekers participating in the Health Profession Opportunity Grants (HPOG) program by employing a mixed method (Qual-Quant) approach. For qualitative data, two in-depth focus groups were conducted with a total of 12 participants who either completed one program or graduated from the HPOG program. With quantitative data, amediation path analysis was conducted using Model 4 of the PROCESS macro (3.1) with a total of 386 participants. The qualitative content analysis of the focus groups generated an overarching theme of the relationship influence on generating hope that included four phenomenological categories: (a) staff and instructors' approach to engagement and support with on-going accessibility and close follow-up; (b) experience-based career motivation; (c) hope as the core driver to overcoming perceived barriers; and (d) supportive relationships as key to instilling hope. In addition, the quantitative analysis confirmed a full mediation model with the path from perceived employment barriers to economic self-sufficiency being mediated by employment hope. The model suggested that the psychological self-sufficiency (PSS) process is key to increasing the economic self-sufficiency (ESS) outcome. Findings supported the importance ofa relationship-based, culturally competent practice to strengthen the PSS process in health profession workforce development among low-income African American jobseekers.

Development of post-disaster psychosocial evaluation and intervention for children: Results of a South Korean delphi panel survey.

OBJECTIVE: This study aimed to administer a Delphi panel survey and provide evidence for the development of a psychological intervention protocol for use after disasters in South Korea. METHOD: A three-round Delphi survey was conducted. In all rounds, respondents answered open- or closed-ended questions regarding their views on i) the concept of disaster, ii) evaluation, iii) intervention, and iv) considerations in a disaster. Data from Round 1 were subjected to content analysis. In Round 2, items with content validity ratios (CVRs) greater than 0.49 were included, and in Round 3, items with a CVR≥0.38 were accepted. RESULTS: The response rates for the Delphi survey were high: 83% (n = 15, Round 1), 80% (n = 16, Round 2), and 86% (n = 24, Round 3). The data collected during this survey showed a need for a support system for children; for preventive strategies, including disaster readiness plans; for the protection of children's safety; and for the development of post-disaster psychosocial care. CONCLUSIONS: The panel experts reached a consensus regarding the steps they considered critical in post-disaster evaluation and intervention. The findings suggest a unified model for advancing the development of the Korean version of an intervention protocol for children and adolescents exposed to traumatic events.

Cognitive Function and Neuropsychological Comorbidities in Children with Newly Diagnosed Idiopathic Epilepsy.

BACKGROUND: In this study, we aimed to identify cognitive function and neuropsychological comorbidities in children with newly diagnosed idiopathic epilepsy. METHODS: We retrospectively reviewed the records of 97 antiepileptic drug-naïve children (9.7 ± 2.9 years; 54 males and 43 females) with newly diagnosed idiopathic epilepsy, all of whom underwent a neuropsychological battery. The battery consisted of the Korean Wechsler Intelligence Scale, Attention Deficit Hyperactivity Disorder (ADHD) Rating Scale, ADHD Diagnostic System, Children's Depression Inventory, and State-Trait Anxiety Inventory for Children. We investigated association between scores of the neuropsychological battery and epilepsy classification, lateralization of interictal epileptiform discharges (IEDs) on electroencephalography (EEG), and variables related to seizures. RESULTS: Thirteen patients (14.3%) had ADHD symptoms. Three patients (4.1%) had depressive symptoms, and 9 (12.3%) had anxiety symptoms. Patients with idiopathic generalized epilepsy (IGE) had significantly lower full-scale intelligence and performance intelligence quotient scores than patients with idiopathic localization-related epilepsy (ILRE) (89.0 ± 17.6 vs. 96.3 ± 14.8; P = 0.030 and 88.9 ± 16.3 vs. 97.0 ± 16.4; P = 0.016, respectively). Patients with ILRE having unilateral IEDs had significantly higher full-scale intelligence quotient scores than patients with ILRE having bilateral IEDs and patients with IGE (99.9 ± 12.2 vs. 93.7 ± 16.1 vs. 89.0 ± 17.6; P = 0.039, respectively). CONCLUSION: Our results suggest that idiopathic epilepsy may be accompanied by various neuropsychological comorbidities even at initial diagnosis. Patients with IGE and ILRE having bilateral IEDs on EEG appear more likely to be at high risk of decreased cognitive function.

Psychiatric Symptoms in Teachers from Danwon High School after Exposure to the Sinking of the Motor Vessel Sewol.

OBJECTIVE: The goal of this study was to describe the psychiatric symptoms in the teachers from Danwon High School who were exposed to the sinking of the Motor Vessel Sewol. METHODS: Data were collected from 32 teachers who underwent psychiatric interventions by 16 volunteer psychiatrists for 3 months after the sinking of the Motor Vessel Sewol. RESULTS: The most commonly diagnosed clinical diagnosis in the teachers were normal reaction, acute stress disorder and adjustment disorder. Psychiatric symptoms including anxiety, depressed mood and sleep disturbances were also observed. CONCLUSION: In the acute aftermath of the Sewol Ferry sinking on April 16, 2014, psychiatrists volunteered to provide professional psychiatric interventions to Danwon High School teachers. These results suggest the importance of crisis intervention focused on the teachers who are exposed to disasters. The implications for future research and interventions are discussed.

Is Preexisting Cervical Disk Degeneration a Prognostic Factor in Whiplash-associated Disorders?

STUDY DESIGN: This is a retrospective control study. OBJECTIVE: We aimed to determine whether preexisting cervical disk degeneration is a prognostic factor in Whiplash-associated disorder (WAD). SUMMARY OF BACKGROUND DATA: WAD is a common injury of traffic accident and has a broad range of prognoses. Although numerous studies have investigated prognostic factors in WAD, few have evaluated the effect of preexisting disk degeneration. MATERIALS AND METHODS: This study involved 45 consecutive patients with grade I or II WAD having advanced disk degeneration (at least 1 disk of Miyazaki grade≥III on magnetic resonance imaging) and a control cohort of 52 patients with no or mild disk degeneration (all disks having Miyazaki grades≤II). Clinical assessment included pain severity (assessed by the visual analog scale), neck pain-related disability (assessed by the neck disability index), and physical and mental health condition [assessed by the short-form 36 (SF-36) physical composite score and SF-36 mental composite score, respectively]. Changes in each parameter were evaluated at baseline and at 3-month, 6-month, and 1-year follow-ups and compared between the 2 groups. RESULTS: There were no differences between the 2 groups regarding demographics and baseline outcome parameters (all P>0.05). There were also no differences in improvement in visual analog scale for neck pain, neck disability index, SF-36 physical composite score, or SF-36 mental composite score between the 2 groups (all P>0.05) for each visit. The number of claim closures was significantly lower among patients with advanced degeneration than among controls at 6-month and 1-year follow-ups (P=0.004 and 0.006, respectively). CONCLUSIONS: In the present study, the clinical presentation and prognosis of WAD were not affected by preexisting disk degeneration. However, claim closure was delayed in patients with preexisting disk degeneration. These results suggest that misunderstanding of disk degeneration on magnetic resonance imaging may create persistent illness and lead to continued compensation in WAD.

Charles Bonnet Syndrome Following Trans-Sphenoidal Adenomectomy without Optic Nerve Atrophy.

Charles Bonnet syndrome (CBS) can develop after trans-sphenoidal adenomectomy (TSA); however, the neural mechanisms remain unknown. Sensory deprivation and releasing phenomenon are both hypothetical explanations for this condition; however, there is no definite evidence that strongly supports either supposition. We report the first case of CBS after TSA without optic nerve atrophy. Postoperatively, the patient's vision seemed to be relatively well preserved, apart from the left-side hemianopsia in the right eye. Distinctive visual hallucinations only appeared when his eyes were closed, and these responded to quetiapine in a dose-dependent manner. Dose dependent change in colors and formation of hallucination was reported. Two weeks after quetiapine initiation, the patient's CBS was completely resolved. This unique case suggests that blocking sensory input from the periphery is more critical than neural damage of the bottom-up connection to the visual association cortex. In addition, quetiapine should be considered as a specific treatment for CBS.

Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas.

BACKGROUND: The talus has a very complex anatomical morphology and is mainly fractured by a major force caused by a fall or a traffic accident. Therefore, a talus fracture is not common. However, many recent reports have shown that minor injuries, such as sprains and slips during sports activities, can induce a talar fracture especially in the lateral or posterior process. Still, fractures to the main parts of the talus (neck and body) after ankle sprains have not been reported as occult fractures. METHODS: Of the total 102 cases from January 2005 to December 2012, 7 patients had confirmed cases of missed/delayed diagnosis of a talus body or neck fracture and were included in the study population. If available, medical records, X-rays, computed tomography scans, and magnetic resonance imaging of the confirmed cases were retrospectively reviewed and analyzed. RESULTS: In the 7-patient population, there were 3 talar neck fractures and 4 talar body fractures (coronal shearing type). The mechanisms of injuries were all low energy trauma episodes. The causes of the injuries included twisting of the ankle during climbing (n = 2), jumping to the ground from a 1-m high wall (n = 2), and twisting of the ankle during daily activities (n = 3). CONCLUSIONS: A talar body fracture and a talar neck fracture should be considered in the differential diagnosis of patients with acute and chronic ankle pain after a minor ankle injury.