High-Pressure Balloon-Assisted Stretching of the Coracohumeral Ligament to Determine the Optimal Stretching Positions: A Cadaveric Study.

BACKGROUND: The coracohumeral ligament (CHL) is a thick capsular structure and markedly thickened when affected by adhesive capsulitis. Therapeutic stretching is the most commonly applied treatment for adhesive capsulitis, but optimal stretching postures for maximal therapeutic effects on the CHL have not been fully investigated. OBJECTIVE: To investigate the most effective stretching direction for the CHL by measuring the stretching intensity in 5 different directions and to determine whether the stretching intervention resulted in loosening of the ligament by comparing the changes of CHL tightness before and after stretching. DESIGN: Biomechanical cadaver study. SETTING: Academic institution cadaver laboratory. PARTICIPANTS: Nine fresh frozen cadaveric shoulders. METHODS: A high-pressure balloon catheter inserted under the CHL and intraballoon pressure was measured, to evaluate CHL tightness without ligament damage as well as to augment and monitor stretching intensity. To find the optimal stretching direction, the glenohumeral joint was stretched from the neutral position into 5 directions sequentially under pressure-monitoring: flexion, extension [EX], external rotation [ER], EX+ER, and EX+ER+adduction [AD] directions. MAIN OUTCOME MEASUREMENTS: CHL tightness was determined by a surrogate parameter, the additional pressure created by the overlying CHL. The pressure increase (ΔPstr) by a specific directional stretch was considered as the stretching intensity. RESULTS: ΔPstr by the 5 directions were mean (standard deviation) values of 0.03 ± 0.07 atm, 0.87 ± 1.31 atm, 1.13 ± 1.36 atm, 1.49 ± 1.32 atm, and 2.10 ± 1.70 atm, respectively, revealing the highest ΔPstr by the EX+ER+AD stretch (P < .05). The balloon pressure by the overlying CHL was decreased from 0.45 ± 0.35 atm to 0.18 ± 0.14 atm (P = .012) before and after the stretching manipulation. CONCLUSIONS: EX+ER+AD of the glenohumeral joint resulted in the greatest increase in balloon pressure, implying that it could be the most effective stretching direction. A series of stretching manipulations assisted with an underlying pressure balloon were capable of decreasing CHL tightness. With further development and modification, high-pressure balloon-assisted stretching can be a potential therapeutic option to release tight CHL, including the advantage of augmenting and monitoring stretching intensity. LEVEL OF EVIDENCE: II.

Cognitive and Language Function in Aphasic Patients Assessed With the Korean Version of Mini-Mental Status Examination.

OBJECTIVE: To assess the clinical usefulness of the relatively short instrument, the Korean version of the Mini-Mental State Examination (MMSE-K), for testing the association between cognition and language function in subacute post-stroke aphasia patients. METHODS: Medical charts of 111 post-stroke patients (65 men; age 69.6±10.0 years; 124.6±80.6 days post-onset) were reviewed retrospectively. All patients were assessed longitudinally for aphasia using the validated Korean version of the Western Aphasia Battery (K-WAB) and for cognition using the MMSE-K. Patients were categorized and analyzed according to 3 aphasia-severity clusters. RESULTS: All subscales of the K-WAB showed significant improvement in follow-up assessments in all groups (p<0.05 or p<0.01). Only the scores of orientation, language function, and total score of MMSE-K showed significant improvement in all groups (p<0.01). The more severely impaired group showed stronger Pearson correlation coefficients between cognition and language function. Additionally, comparisons between correlation coefficients showed that the association of improvement in orientation with that of fluency and AQ% (aphasia quotient %) was significant in the more severely impaired group. CONCLUSION: Among subacute post-stroke aphasic patients, patients with more severe aphasia showed greater impairments to cognitive function; in addition, recovery of orientation may be related to recovery of language function.

Incidence of Pneumonia After Videofluoroscopic Swallowing Study and Associated Factors.

Pneumonia after videofluoroscopic swallow study (VFSS) is sometimes considered to be caused by aspiration during VFSS; however, to our knowledge, a relationship between these events has not been clearly investigated. The aim of this study was to assess the incidence of VFSS-related pneumonia and related factors. Overall, 696 VFSS cases were retrospectively reviewed. Cases in which blood culture was performed within 3 days after VFSS due to newly developed infectious signs were considered as post-VFSS infection cases. Pneumonia was suspected when there was some evidence of respiratory infectious signs in clinical, radiological, and laboratory findings. The underlying disease, clinical signs, and VFSS findings of the pneumonia group were assessed. Among 696 cases, pneumonia was diagnosed in 15 patients. The patients in the pneumonia group tended to be older and had higher aspiration rate on VFSS than those in the non-pneumonia group. In the pneumonia group, 2 patients showed no aspiration during VFSS. In 6 patients, pneumonia developed after massive aspiration of gastric content in 5 patients and inappropriate oral feeding with risk of aspiration before VFSS in 1 patient. Only 7 patients (1.0 %) were finally determined as having VFSS-related pneumonia. In conclusion, the 72-h incidence of VFSS-related pneumonia was 1.0 %. Old age and severity of swallowing difficulty are associated with occurrence of pneumonia.

Correlates of bone mineral density and sagittal spinal balance in the aged.

OBJECTIVE: To investigate the relationship between bone mineral density (BMD) and sagittal spinal balance in the Korean elderly population. METHODS: The retrospective study included subjects aged 60 years and above, who had whole-spine lateral radiography and dual-energy X-ray absorptiometry (DEXA) within a year's gap between each other. Sagittal vertical axis (SVA) for evaluation of sagittal spinal balance and five spinopelvic parameters were measured through radiography. The presence of compression fracture was identified. Correlations of BMD T-scores with SVA and with the spinopelvic parameters were assessed using Pearson correlation coefficient (PCC). Linear regression analyses were performed between SVA and the clinical and radiologic variables. RESULTS: One hundred twenty-two subjects (42 males and 80 females; mean age, 69.93±5.5 years) were included in the study. BMD, femur or spine, was not correlated with SVA or any spinopelvic parameters in both genders (PCC<±0.2), except that spine BMD in men was associated with sacral slope. Univariate regression analysis revealed association between SVA and lumbar lordosis, pelvic tilt, and compression fractures in both genders; it was also associated with age and pelvic incidence in females and with sacral slope in males. Multivariate linear regression model showed lumbar lordosis and compression fracture as variables affecting SVA in both sexes; pelvic incidence was another factor affecting SVA in women only. CONCLUSION: BMD was not associated with sagittal spinal balance in the aged. Sagittal spinal balance was explained partly by lumbar lordosis and compression fracture. Further study is warranted to understand progression of sagittal imbalance with age.

Development of an environmental radiation analysis research capability in the UAE.

The UAE has started a nuclear energy program with the aim of having its first four units on-line between 2017 and 2020 and it is important that the country has an environmental radiation analysis capability to support this program. Khalifa University is therefore implementing a research laboratory to support both experimental analysis and radionuclide transport modeling in the aquatic and terrestrial environment. This paper outlines the development of this capability as well as the work in progress and planned for the future.

Capsule preservation improves short-term outcome of hydraulic distension in painful stiff shoulder.

The effect of intraarticular hydraulic distension (IHD) for a painful stiff shoulder (or adhesive capsulitis) has been affirmed, but whether rupturing the joint capsule during this process is beneficial remains controversial. By monitoring real-time pressure-volume (PV) profiles during IHD, we could infuse the largest possible volume without rupturing the capsule. Using the novel technique, we compared the short-term effects of IHD when the capsule was preserved versus when it was ruptured. Fifty-four patients with a painful stiff shoulder underwent IHDs intended to preserve or rupture the capsule and then classified into capsule-ruptured (n = 26) and capsule-preserved (n = 20) groups, based on the obtained PV profiles. Their profiles were triphasic or biphasic; eight with flat profiles were excluded from the comparison. Clinical outcomes were evaluated at 3-day and 1-month follow-ups, in terms of pain and range of motion (ROM). Although both groups showed significant increase in ROM and decrease in pain after IHD, the improvements were greater in the capsule-preserved group than in the ruptured group at both follow-up times, and in triphasic and biphasic cases. In conclusion, the therapeutic effects of IHD in short-term follow-ups were enhanced by preserving the capsule.

A personal thermoluminescence dosimeter using LiF:Mg,Cu,Na,Si detectors for photon fields.

A new personal thermoluminescence (TL) dosimeter for photon fields using LiF:Mg,Cu,Na,Si TL detector was developed by taking advantage of its dosimetric properties including energy dependencies. Solid pellet type LiF:Mg,Cu,Na,Si detector was developed and fabricated at Korea Atomic Energy Research Institute (KAERI) and has been studied on its dosimetric properties such as TL grow curve, dose response, energy response and reusability. Its dosimetric properties show the feasibility of application of LiF:Mg,Cu,Na,Si TL detector to personal dosimetry fields. A new dosimeter using LiF:Mg,Cu,Na,Si TL detector was designed and tested through irradiation experiments. This multi-element TL dosimeter allows the measurement of a personal dose equivalent Hp(d) in photon fields. Based on the experimental results of the proposed dosimeter, it was demonstrated that a personal TL dosimeter using sintered LiF:Mg,Cu,Na,Si TL detector is appropriate to estimate personal dose equivalent for wide range energy of photon fields.

Determination of pu isotopes in seawater by an on-line sequential injection technique with sector field inductively coupled plasma mass spectrometry.

An on-line sequential injection (SI) system combined with sector field inductively coupled plasma mass spectrometry was developed for the determination of ultratrace level 239Pu and 240Pu in seawater. The potential of this method is the substantial reduction of a sample volume and rapidity in the determination of Pu isotopes. A chemical purification and preconcentration of Pu isotopes were accomplished by the on-line SI system with two microcolumns of solid-phase extraction resins, Sr-Spec and TEVA-Spec. The MCN-6000 microconcentric nebulizer was used as a sample introduction system because of low interference effect and good sample utilization. With this method, it was possible to analyze ultratrace levels of Pu isotopes in only 5 L of surface seawater with an analysis speed of 4 h/sample. The precision of the measurement for the 239Pu and 240Pu was less than 3.4 (n = 7) and 5% (n = 7) for 5 L of seawater. The detection limits for 239Pu and 240Pu were 0.64 (1.5 microBq/mL) and 0.19 fg/mL (1.6 microBq/mL), respectively. The accuracy of this method was verified by using the reference seawater (IAEA-381) as well as by the comparison with the a-spectrometry.