Parents' Perspectives and Clinical Effectiveness of Cranial-Molding Orthoses in Infants With Plagiocephaly

OBJECTIVE: To investigate the clinical effectiveness of and parents’ perspectives on cranial-molding orthotic treatment. METHODS: Medical charts were reviewed for 82 infants treated for plagiocephaly with cranial-molding orthoses in our clinic from April 2012 to July 2016 retrospectively. Infants who were clinically diagnosed with positional plagiocephaly and had a Cranial Vault Asymmetry Index (CVAI) of more than 3.5% were included. Pre- and post-treatment CVAI was obtained by three-dimensional head-surface laser scan. Parents’ perceptions of good outcome (satisfaction) were evaluated with the Goal Attainment Scale (GAS). The GAS score assessed how much the parent felt that his or her initial goal for correcting the skull asymmetry was achieved after the treatment. RESULTS: The compliance with cranial-molding orthoses was 90.2% (74 of 82 infants). There were 53 infants (65% of the 82 infants) who had adverse events with the cranial-molding orthoses during the study. Heat rash was found in 29 cases (35.4%) and was the most common adverse event. The mean GAS T-score was 51.9±10.2. A GAS T-score of 0 or more was identified for 71.6% of parents. The GAS T-score was significantly related to the age (p < 0.001), the initial CVAI, and the difference of CVAI during the treatment (p < 0.001). CONCLUSION: Parents’ perception of good outcome was correlated with the anthropometric improvement in cranialmolding orthotic treatment in infants with plagiocephaly. A high percentage of parents felt that the treatment met their initial goals in spite of a high occurrence of adverse events.

Short-Term Effects of Intensive Inpatient Rehabilitation in Patients with Brain Tumor: a Single-Center Experience

The objective of this study is to investigate the short-term effects of intensive inpatient rehabilitation in patients with brain tumor. Retrospective data from September 2015 to May 2017 was obtained in 65 patients with brain tumor who were transferred to the department of physical and rehabilitation medicine for comprehensive intensive inpatient rehabilitation. For comparison, data from 140 patients with subacute stroke were also obtained. To measure functional status, we collected data from the following tests: the Korean version of the Modified Barthel Index, the Motricity Index, the Korean Mini-Mental Status Examination, and the Functional Ambulatory Category. Functional efficiency of each assessment was calculated as the gain divided by the inpatient rehabilitation length of stay. Independent t-test was performed to compare functional outcomes between the brain tumor group and the subacute stroke group. There were significant improvements in all functional assessments in both the brain tumor group and the subacute stroke group (p < 0.05). In addition, there was no significant difference in the functional gain and efficiency in all assessments between the 2 groups. The results of the present study revealed that intensive inpatient rehabilitation could have potential to improve the functional levels in patients with brain tumor.

Novel treatments for inflammatory bowel disease

Increased understanding of the immunopathology of inflammatory bowel disease (IBD) has led to the development of targeted therapies and has unlocked a new era in IBD treatment. The development of treatment options aimed at a variety of pathological mechanisms offers new hope for customized therapies. Beyond anti-tumor necrosis factor agents, selective lymphocyte trafficking inhibitors have been proposed as potent drugs for IBD. Among these, vedolizumab has recently been approved for both Crohn's disease and ulcerative colitis. Numerous other agents for IBD treatment are currently under investigation, including Janus kinase inhibitors, anti-mucosal vascular addressin cell adhesion molecule-1 agents, an anti-SMAD7 antisense oligonucleotide, an anti-interleukin-12/23 monoclonal antibody, and a sphingosine-1-phosphate receptor-1 selective agonist. These agents will likely expand the treatment options available for the management of IBD patients in the future. In this review, we discuss the efficacy and safety of novel agents currently under investigation in IBD clinical trials.

Therapeutic Potential of 3D Printing Pen in Stroke Rehabilitation: Case Reports

Medical applications for 3-dimensional (3D) printing are rapidly expanding and are expected to revolutionize health care. Two patients with chronic stroke participated in a training program with the 3D printing pen (3Doodler 2.0; WobbleWorks, Inc.). This training program consisted of 12 sessions for 4 weeks. The training program consisted of a 4-step protocol. In 2 patients with chronic stroke who showed impaired visuospatial function and hand function, each function improved without any serious adverse effects after completing training. This case study suggests the therapeutic potential of the 3D printing pen to improve visual-perceptual and hand functions in stroke patients.

The Relationship between 10-Year Cardiovascular Risk Calculated Using the Pooled Cohort Equation and the Severity of Non-Alcoholic Fatty Liver Disease

BACKGROUND: We investigated the association between the severity of non-alcoholic fatty liver disease (NAFLD) and the estimated 10-year risk of cardiovascular disease (CVD) calculated by Pooled Cohort Equation (PCE) and Framingham risk score (FRS). METHODS: A total of 15,913 participants (mean age, 46.3 years) in a health screening program were selected for analysis. The presence and severity of fatty liver was assessed by abdominal ultrasonogram. Subjects who drank alcohol more than three times a week were excluded from the study. RESULTS: Among the participants, 57.6% had no NAFLD, 35.4% had grade I, 6.5% had grade II, and 0.5% had grade III NAFLD. Mean estimated 10-year CVD risk was 2.59%, 3.93%, 4.68%, and 5.23% calculated using the PCE (P for trend <0.01) and 4.55%, 6.39%, 7.33%, and 7.13% calculated using FRS, according to NAFLD severity from none to severe (P for trend <0.01). The odds ratio for ≥7.5% estimated CVD risk calculated using the PCE showed a higher correlation with increasing severity of NAFLD even after adjustment for conventional CVD risk factors (1.52, 2.56, 3.35 vs. the no NAFLD group as a reference, P<0.01) compared with calculated risk using FRS (1.65, 1.62, 1.72 vs. no NAFLD group as a reference, P<0.01). CONCLUSION: In our study of apparently healthy Korean adults, increasing severity of NAFLD showed a higher correlation with estimated 10-year CVD risk when calculated using the PCE than when calculated using FRS.

Effect of Pitavastatin Treatment on ApoB-48 and Lp-PLA2 in Patients with Metabolic Syndrome: Substudy of PROspective Comparative Clinical Study Evaluating the Efficacy and Safety of PITavastatin in Patients with Metabolic Syndrome

BACKGROUND: Apolipoprotein (Apo) B-48 is an intestinally derived lipoprotein that is expected to be a marker for cardiovascular disease (CVD). Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a vascular-specific inflammatory marker and important risk predictor of CVD. The aim of this study was to explore the effect of pitavastatin treatment and life style modification (LSM) on ApoB-48 and Lp-PLA2 levels in metabolic syndrome (MS) patients at relatively low risk for CVD, as a sub-analysis of a previous multi-center prospective study. METHODS: We enrolled 75 patients with MS from the PROPIT study and randomized them into two treatment groups: 2 mg pitavastatin daily+intensive LSM or intensive LSM only. We measured the change of lipid profiles, ApoB-48 and Lp-PLA2 for 48 weeks. RESULTS: Total cholesterol, low density lipoprotein cholesterol, non-high density lipoprotein cholesterol, and ApoB-100/A1 ratio were significantly improved in the pitavastatin+LSM group compared to the LSM only group (P≤0.001). Pitavastatin+LSM did not change the level of ApoB-48 in subjects overall, but the level of ApoB-48 was significantly lower in the higher mean baseline value group of ApoB-48. The change in Lp-PLA2 was not significant after intervention in either group after treatment with pitavastatin for 1 year. CONCLUSION: Pitavastatin treatment and LSM significantly improved lipid profiles, ApoB-100/A1 ratio, and reduced ApoB-48 levels in the higher mean baseline value group of ApoB-48, but did not significantly alter the Lp-PLA2 levels.

Metabolic Health Is More Important than Obesity in the Development of Nonalcoholic Fatty Liver Disease: A 4-Year Retrospective Study

BACKGROUND: The aim of this study is to compare the risk for future development of nonalcoholic fatty liver disease (NAFLD) according to different status of metabolic health and obesity. METHODS: A total of 3,045 subjects without NAFLD and diabetes at baseline were followed for 4 years. Subjects were categorized into four groups according to the following baseline metabolic health and obesity statuses: metabolically healthy, non-obese (MHNO); metabolically healthy, obese (MHO); metabolically unhealthy, non-obese (MUHNO); and metabolically unhealthy, obese (MUHO). Being metabolically healthy was defined as having fewer than two of the following five components: high blood pressure, high fasting blood glucose, high triglyceride, low high density lipoprotein cholesterol, and being in the highest decile of the homeostasis model assessment-insulin resistance index. Obesity was defined as a body mass index >25 kg/m2. The presence of NAFLD was assessed by ultrasonography. RESULTS: The proportions of subjects included in the MHNO, MHO, MUHNO, and MUHO groups were 71.4%, 9.8%, 13.0%, and 5.8%, respectively. The proportions of subjects who developed NAFLD were 10.5%, 31.4%, 23.2%, and 42% in the MHNO, MHO, MUHNO, and MUHO groups, respectively. The risk for developing NAFLD was highest in subjects who were metabolically unhealthy both at baseline and after 4 years compared with subjects who were consistently metabolically healthy during the follow-up period (odds ratio, 2.862). Using the MHNO group as reference, the odds ratios for the MHO, MUHNO, and MUHO groups were 1.731, 1.877, and 2.501, respectively. CONCLUSION: The risk for NAFLD was lower in MHO subjects than in MUNO subjects.

A Study on Usage of Classroom Desks and Chairs by Teenagers

OBJECTIVES: To evaluate the compatability of high school students' desks and chairs to the fittness of their physique, to examine the factors related the posture and pain while they use the classroom desks and chairs, and to analyze the curvature of spine in sitting position. METHOD: Measurements of the dimensions of desks and chairs and a written survey to question students' habits regarding to the usage of classroom desks and chairs along with the physical examinations of spine including the analysis of spine curvature in sitting position with an electrogoniometer. RESULTS: Seven hundred forty nine among 831 male students, and 1,017 among 1,074 female students, complained of discomforts associated with the usage of classroom desks and chiairs. An examination of spine in sitting position using an electrogoniometer showed that both male and female subjects displayed the spine curvatures in the order of thoracic kyphosis, lumbar lordosis, and scoliosis. All subjects displayed pain in the order of low back(38.8%), posterior neck(23.9%), shoulder and elbow joints(15.8%), and buttock(15.7%). CONCLUSION: The study revealed an urgent need for the adaptation of classroom desks and chairs according to the growing physique of the adolescents. A majority of the teenaged subjects experienced the discomfort from the use of improper funiture and a poor posture. Authors highly recommend a formal education to the students regarding the importance of proper posture and the usage of adjustable desks and chairs.