Lower-Limb Kinematic Change during Pelvis Anterior and Posterior Tilt in Double-Limb Support in Healthy Subjects with Knee Malalignment.

This study aimed to investigate lower-limb kinematic changes during pelvic tilting in participants with knee malalignment. To define participants with lower-limb malalignment, the quadriceps angle (Q-angle) was used in this study. The sample population was divided into two groups in accordance with the Q-angle: the experimental group (ABQ) consisted of participants with an abnormal Q-angle greater than the normal range, and the control group (CON) consisted of participants with a normal Q-angle. All participants performed anterior and posterior pelvic tilts in double-limb support. Kinematic change in the lower limb was evaluated using a three-dimensional motion analysis system (Motion Analysis, Santa Rosa, CA, USA). The horizontal plane hip angle in the ABQ was significantly different compared with that in the CON in all positions (p < 0.05), and no significant difference was observed in the other lower-limb kinematic variables (p > 0.05). A significant correlation was identified only between the Q-angle and horizontal plane hip angle in all positions. Based on the results, the Q-angle was strongly related to the thigh, although it may not be related to malalignment with other segments during double-limb support.

High Quality AlN Layer Grown on Patterned Sapphire Substrates by Hydride Vapor-Phase Epitaxy: A Route for Cost Efficient AlN Templates for Deep Ultraviolet Light Devices.

We report the characteristics of AlN epilayers grown directly on cylindrical-patterned sapphire substrates (CPSS) by hydride vapor-phase epitaxy (HVPE). To evaluate the effect of CPSS, we analyzed the threading dislocation densities (TDDs) of AlN films grown simultaneously on CPSS and flat sapphire substrate (FSS) by transmission electron microscopy (TEM). The corresponding TDD is measured to be 5.69 x 108 cm-2 for the AlN sample grown on the CPSS that is almost an order of magnitude lower than the value of 3.43 × 109 cm-2 on the FSS. The CPSS contributes to reduce the TDs originated from the AlN/sapphire interface via bending the TDs by lateral growth during the coalescence process. In addition, the reduction of direct interface area between AlN and sapphire by CPSS reduce the generation of TDs.

Laparoscopic Ablation System for Complete Circumferential Renal Sympathetic Denervation.

GOAL: The catheter-based renal denervation (RDN) showed promising results for patients in lowering BP, but there were also many non-responders. One of the possible reasons was the incomplete neural ablation due to the ablation of renal nerves at random sites resulting in asymmetric innervation patterns along the renal artery. METHODS: We developed a laparoscopic ablation system that is optimized for complete RDN regardless of renal arterial innervation and size. To demonstrate its effectiveness, we evaluated the system using computational simulation and 28-day survival model using pigs. RESULTS: The ablations were focused around the tunica externa, and the ablation patterns could be predicted numerically during RDN treatment. In the animal study, the mean reduction of systolic BP and diastolic BP in the bilateral main renal arteries was 22.8 mmHg and 14.4 mmHg (P<0.001), respectively. The respond to immunostaining targeting tyrosine hydroxylase was significantly reduced at treatment site (108.2 ± 7.5 (control) vs. 63.4 ± 8.7 (treatment), P<0.001), and an increased degree of sympathetic signals interruption to kidneys was associated with the efficacy of RDN. CONCLUSION: The laparoscopic ablation system achieved complete circumferential RDN at the treatment site and could numerically predict the ablation patterns. SIGNIFICANCE: These findings clearly suggest that the proposed system can significantly improve the RDN effectiveness by reducing the variation to the percentage of injured nerves and open up a new opportunity to treat uncontrolled hypertension.

Laparoscopic Renal Denervation System for Treating Resistant Hypertension: Overcoming Limitations of Catheter-Based Approaches.

GOAL: In a pivotal clinical trial, the percutaneous catheter-based renal denervation system developed to treat resistant hypertension did not show effectiveness in reducing blood pressure because of its fundamental limitation to ablate deeper nerves present around the renal artery. METHODS: We propose a new renal denervation strategy called laparoscopicdenervation system (LDS) based-on laparoscopy procedure to ablate the renal nerves completely but inhibit the thermal arterial damage.The system has flexible electrodes to bend around the arterial wall to ablate nervesThe simulation study using validated in-silico models evaluated the heat distributionon the outer arterial wall,and an acute animal study (swine model) was conducted to demonstrate the feasibility of LDS in vivo. RESULTS: The simulation studyconfirmedthat LDS could localize the heat distributionbetween the electrode and the outer arterial wall. In the animal study, we could maximize nerve denervation by the localizing ablation energy within the renal nerves and achieve nerve denaturationand decrease in neural density by 20.78% (P < 0.001), while maintaining a constant tip temperature of 65 °C for the duration of 70 s treatment. The study confirmed intact lumen artery through histological analysis and acute reduction in systolic blood pressure by 9.55 mmHg (p < 0.001) Conclusion: The LDS presented here has potential to effectively and safely ablate the renal nerves, independent of anatomical variation and nerve distribution, to control hypertension in real clinical conditions. SIGNIFICANCE: LDS approach is innovative, inventive, and presents a novel technique totreat hypertension.

Blood Pressure Reference Values for Normal Weight Korean Children and Adolescents: Data from The Korea National Health and Nutrition Examination Survey 1998-2016: The Korean Working Group of Pediatric Hypertension.

BACKGROUND AND OBJECTIVES: Hypertension is becoming one of the most common health conditions in children and adolescents due to increasing childhood obesity. We aimed to provide the auscultatory blood pressure (BP) normative reference values for Korean non-overweight children and adolescents. METHODS: BP measurements in children and adolescents aged 10 to 18 years were performed in the Korean National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016. BP was measured using a mercury sphygmomanometer. Sex-, age- and height-specific systolic BP (SBP) and diastolic BP (DBP) percentiles were calculated in the non-overweight children (n=10,442). We used the General Additive Model for Location Scale and Shape method to calculate BP percentiles. RESULTS: The 50th, 90th, 95th, and 99th percentiles of SBP and DBP tables and graphs of non-overweight children and adolescents aged 10 to 18 years were presented by age and height percentiles. We found that the SBP and DBP at the 95th percentile were well correlated with height. The BP tables presented by height contained BP values from 124 cm to 190 cm for boys and from 120 cm to 178 cm for girls. Boys had higher SBP and DBP. CONCLUSIONS: We provided the sex-, age- and height-specific auscultatory BP values using the KNHANES big data. These may be useful in diagnosis and treatment of hypertension in Korean children and adolescents.

Effects of breathing exercises on resting metabolic rate and maximal oxygen uptake.

[Purpose] The aim of the present study is to examine effects of diaphragm breathing exercise and feedback breathing exercise on maximal oxygen uptake and resting metabolic rate. [Participants and Methods] Thirty-eight healthy participants were randomly assigned to two groups; the diaphragm breathing exercise group and the feedback breathing exercise group. The diaphragm breathing exercise group was asked to perform diaphragm respiration, and the feedback breathing exercise group was asked to breathe with feedback breathing device. Maximal oxygen uptake and resting metabolic rate were measured before and after two breathing exercises. [Results] Significant difference was found in maximal oxygen uptake before and after two breathing exercises. There was also significant difference in resting metabolic rate before and after diaphragm breathing exercise. However, significant difference was not found in resting metabolic rate before and after feedback breathing exercise. There were not significant between-group differences in both maximal oxygen uptake and resting metabolic rate. [Conclusion] Diaphragm breathing exercise and feedback breathing exercise could influence maximal oxygen uptake. Diaphragm breathing exercise could influence resting metabolic rate, but feedback breathing exercise could not.

Changes in rounded shoulder posture and forward head posture according to exercise methods.

[Purpose] This study aimed to determine the effect of forward head posture-improving exercises on rounded shoulder posture when employing the self-stretch exercise, the McKenzie exercise, and the Kendall exercise as intervention methods based on previous studies that reported negative effects of unbalanced posture and musculoskeletal problems on forward head posture and rounded shoulder posture. [Subjects and Methods] The selected 28 subjects were randomly assigned into the McKenzie exercise group (n=9), the self-stretch exercise group (n=10), and the Kendall exercise group (n=9). To compare the forward head posture, the craniovertebral angle was used. To measure the rounded shoulder posture, the scapular index was used. [Results] There were significant differences in the craniovertebral angle and scapular index within the groups and no significant differences between the groups. [Conclusion] The result of this study showed that all interventions increased the craniovertebral angle and the scapular index, which revealed that the applied exercises had a positive effect on forward head posture and rounded shoulder posture.

Effect of diaphragm breathing exercise applied on the basis of overload principle.

[Purpose] The purpose of this study was to examine effects of diaphragm breathing exercise applied on the basis overload principle on respiratory function. [Subjects and Methods] The subjects of this study were 35 normal adults. They were randomly assigned to two group; the maneuver-diaphragm exercise group and self-diaphragm exercise group. The respiratory function was evaluated using the CardioTouch 3000S (BIONET, Korea) as a pulmometry device. [Results] The maneuver-diaphragm exercise was more effective on functional vital capacity and forced expiratory volume at one second when compared to the self-diaphragm exercise. [Conclusion] According to the results of this study, although the self-diaphragm exercise did not show effects as much as the maneuver one, but the self-diaphragm exercise had a similar effects as the maneuver-diaphragm exercise. The self-diaphragmatic respiration applied on the basis of overload principle may be used as an effective respiratory exercise as a part of home respiration program.

Multicenter, Single-Arm, Phase IV Study of Combined Aspirin and High-Dose "IVIG-SN" Therapy for Pediatric Patients with Kawasaki Disease.

BACKGROUND AND OBJECTIVES: Intravenous immunoglobulin-SN (IVIG-SN) is a new human immunoglobulin product. Its safety is ensured by pathogen-elimination steps comprising solvent/detergent treatment and a nanofiltration process. This multicenter clinical study was designed to evaluate the efficacy and safety of combined aspirin and high-dose IVIG-SN therapy in pediatric patients with Kawasaki disease (KD). SUBJECTS AND METHODS: We evaluated coronary artery lesions (CALs) at 2 and 7 weeks after administering IVIG-SN; total fever duration; and variations in erythrocyte sedimentation rate, N-terminal pro B-type natriuretic peptide or B-type natriuretic peptide, and creatine kinase-myocardial band level before and after treatment with IVIG-SN (2 g/kg). Adverse events were monitored. RESULTS: Forty-five patients were enrolled, three of whom were excluded according to the exclusion criteria; the other 42 completed the study. The male:female ratio was 0.91:1, and the mean age was 29.11±17.23 months. The mean fever duration before IVIG-SN treatment was 6.45±1.30 days. Although most patients had complete KD (40 patients, 90.91%), four had atypical KD (9.09%). After IVIG-SN treatment, one patient (2.38%) had CALs, which was significantly lower than the incidence reported previously (15%) (p=0.022), but not significantly different from recent data (5%). There were no serious adverse events, though 28 patients (63.64%) had mild adverse events. Three adverse drug reactions occurred in 2 patients (eczema, anemia, and increased eosinophil count), all of which were transient. CONCLUSION: IVIG-SN treatment in patients with KD was safe and effective.

Effects of diaphragm breathing exercise and feedback breathing exercise on pulmonary function in healthy adults.

[Purpose] The present study investigated effects of diaphragm breathing exercise and feedback breathing exercise on respiratory function. [Subjects and Methods] Thirty-one subjects were randomly assigned to two groups; the feedback breathing exercise group and the maneuver-diaphragm exercise group. The feedback breathing exercise group was asked to breathe with feedback breathing device, and the maneuver-diaphragm exercise group was asked to perform diaphragm respiration. Respiratory function was evaluated when a subject sat on a chair comfortably. [Results] There was a significant difference in the functional vital capacity and slow vital capacity before and after all breathing exercises. There was a significant between-group difference in functional vital capacity. However, no between-group difference was found in slow vital capacity. [Conclusion] Diaphragm breathing exercise and feedback breathing exercise can affect respiratory function.

Correlation between head posture and proprioceptive function in the cervical region.

[Purpose] The aim of the present study was to investigate correlation between head posture and proprioceptive function in the cervical region. [Subjects and Methods] Seventy-two subjects (35 males and 37 females) participated in this study. For measurement of head posture, the craniovertebral angle was calculated based on the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7. The joint position sense was evaluated using a dual digital inclinometer (Acumar, Lafayette Instrument, Lafayette, IN, USA), which was used to measure the joint position error for cervical flexion and extension. [Results] A significant negative correlation was observed between the craniovertebral angle and position sense error for flexion and extension. [Conclusion] Forward head posture is correlated with greater repositioning error than a more upright posture, and further research is needed to determine whether correction of forward head posture has any impact on repositioning error.

Effects of Kinesio taping on joint position sense of the ankle.

[Purpose] The purpose of this study was to examine the effect of Kinesio taping on the joint position sense of the ankle. [Subjects and Methods] The subjects of this study were 26 nomal adults who had experienced ankle sprain. Kinesio taping was applied over the ankle medial ligament and ankle lateral ligament with eight pattern reinforcement taping. Joint position sense was measured using isokinetic equipment (Biodex System 4 pro dynamometer, Biodex Medical systems Inc., USA) during dorsiflexion/plantarflexion and inversion/eversion, before and after taping. Statistical analyses were performed using SPSS 21.0 for Windows. [Results] Joint position sense after Kinesio taping was improved in the dorsiflexion and inversion positions. [Conclusion] According to the results of this study, Kinesio taping of the ankle is effective for the prevention of ankle sprain.

Effects of increased standing balance on pain in patients with knee osteoarthritis.

[Purpose] The purpose of this study was to examine the relationship between standing balance increased through muscle-strengthening exercises and pain in knee osteoarthritis patients. [Subjects and Methods] Thirty knee osteoarthritis patients were equally divided into a strengthening exercise group and an unstable exercise group. Before and after the six-week experiment, the visual analogue scale was measured, and bilateral one-leg standing tests were performed. [Results] In both the strengthening exercise group and unstable exercise group, the bilateral one-leg standing time significantly increased after the six-week experiment. Regarding the visual analogue scale, a pain measurement scale, the strengthening exercise group had significantly decreased pain. The unstable exercise group also had decreased pain, but the decrease was not statistically significant. [Conclusion] In knee osteoarthritis patients, exercises using an unstable base of support and knee-extensor strengthening exercises with gradually increased loads had a positive effect on improving balance ability and decreasing pain.

The effect of cervical stabilization exercise on active joint position sense: A randomized controlled trial.

We attempted to investigate the effect of cervical stabilization exercise for a period of 5 weeks on active joint position sense in healthy young adults. Twenty-four subjects were randomly assigned to either the exercise group or the control group. The exercise group performed cervical stabilization exercise during the 5-week period. Cervical active joint position sense was measured using the head repositioning accuracy test. The result showed a positive interaction between time and group in the left and right rotation, flexion, and extension. Cervical stabilization exercise significantly improved the sense for four position senses in the exercise group (p< 0.05). However, there was no difference in the four position senses in the control group (p> 0.05). In conclusion, we suggested that cervical stabilization exercise leads to improvement in accuracy of the joint position sense.

Effects of craniocervical flexion exercise on upper-limb postural stability during a goal-directed pointing task.

[Purpose] This study investigated the effects of craniocervical flexion exercise on upper-limb postural stability by measuring upper-limb postural tremor during a goal-directed pointing task. [Subjects and Methods] Twenty-four subjects were randomly assigned to the exercise or control group. The exercise group performed craniocervical flexion exercise four days per week for five weeks. Upper-limb postural tremor was measured by using a three-dimensional electromagnetic motion tracking system (trakSTAR™, Ascension Technology Corporation, Burlington, VT, USA) during a goal-directed pointing task. [Results] In the exercise group, the range and velocity of the trajectories of the shoulder, wrist, and finger in the lateral direction improved significantly. However, no significant changes were observed in the control group. [Conclusion] Craniocervical flexion exercise reduces the range and velocity of upper-limb postural tremor, thereby increasing postural stability.

Effects of the ankle angle of an ankle foot orthosis on foot pressure during the gait in healthy adults.

[Purpose] The purpose of this study was to investigate the effects of the ankle angle of an ankle foot orthosis (AFO) on foot pressure during the gait in healthy adults. [Subjects] Sixteen healthy males with neither orthopedic nor neurological problems participated in this study. [Methods] Subjects walked on a walkway at a self-selected pace with an AFO set at four different ankle angles (-5°, 0°, 5°, and 10°). Foot pressure was measured randomly according to the ankle angle of the AFO using an F-scan system. Three trials were measured and averaged for data analysis. [Results] The peak foot pressure of the hallux, 2nd-5th toes, 2nd and 3rd metatarsal heads, 4th and 5th metatarsal heads, and the heel showed significant differences among the AFO ankle angles: angles of 0° and -5° increased the foot pressure of the lateral legions, and the peak foot pressure of the heel at an AFO ankle angle of 10° was significantly greater than those of the other angles. [Conclusion] The ankle angle of the AFO affected foot pressure and gait patterns during gait. The results suggest that the appropriate angle for an AFO is between 5° and 10° when AFOs are prescribed by clinicians.

Characteristics of cervical position sense in subjects with forward head posture.

[Purpose] The purpose of this study was to investigate the effect of forward head posture (FHP) on proprioception by determining the cervical position-reposition error. [Subjects and Methods] A sample population was divided into two groups in accordance with the craniovertebral angle: the FHP group and the control group. We measured the craniovertebral angle, which is defined as the angle between a horizontal line passing through C7 and a line extending from the tragus of the ear to C7. The error value of the cervical position sense after cervical flexion, extension, and rotation was evaluated using the head repositioning accuracy test. [Results] There were significant differences in the error value of the joint position sense (cervical flexion, extension, and rotation) between the FHP and control groups. In addition, there was an inverse correlation between the craniovertebral angle and error value of the joint position sense. [Conclusion] FHP is associated with reduced proprioception. This result implies that the change in the muscle length caused by FHP decreases the joint position sense. Also, proprioception becomes worse as FHP becomes more severe.

The influence of exercise on an unstable surface on the physical function and muscle strength of patients with osteoarthritis of the knee.

[Purpose] This study investigated the influence of exercise on an unstable surface on ROM of the knee, muscle strength and the physical function of patients with osteoarthritis of the knee. [Subjects] The subjects were 30 patients diagnosed with degenerative osteoarthritis of the knee, they were divided into an experimental group (n=15) and a control group (n=15). [Methods] The experimental group performed exercise using an aero step XL (TOGU, Germany) 3 times a week, for 6 weeks. A control group performed the same exercise on a stable surface and without aero step XL. [Results] After the intervention, the experimental group showed statistically significant improvements in active knee flexion, knee joint manual muscle test (MMT), knee joint MMT hamstring and WOMAC score. [Conclusion] Exercise on the unstable surface improved the symptoms of patient with osteoarthritis. Exercise on an unstable surface might be helpful for improving the muscle strength and alignment of lower extremities as well as improving physical function related to the knee joint.

Interleukin-21 receptor gene polymorphisms in kawasaki disease.

BACKGROUND AND OBJECTIVES: Interleukin-21 receptor (IL-21R) gene polymorphism is related with the development of systemic vasculitis. In this study, we investigated the polymorphisms of IL-21R gene in patients with Kawasaki disease (KD). SUBJECTS AND METHODS: We genotyped the promoter region of IL-21R gene (-2500 bp to +1 bp) in 100 patients with KD and 100 healthy controls. All study subjects were Korean. We designed five pairs of primers and performed polymerase chain reaction (PCR) and direct sequencing. We analyzed whole promoter sequences of 200 individuals with comparison to reference sequences of IL-21R gene (NG_012222.1/NC_000016.9). RESULTS: We found five single nucleotide polymorphisms (SNPs) of which minor allele frequency (MAF) >0.01 in the promoter region of IL-21R gene. Those are -1681 G>T (chromosome site 27411802), -379 G>A (27413104), -332 G>C (27413151, rs2214537), -237 A>T (27413246), and -53 G>A (27413430). There is no significant difference in MAF of each SNP between patients with KD and healthy controls except -237 A>T. Twenty five patients with KD had more than 1 SNP in contrast to only seven healthy controls had. The patients with KD have significantly more IL-21R gene polymorphisms than controls (odds ratio: 3.0, 95% confidence interval: 1.6-5.6, p=0.0005). There was no significant correlation between IL-21R gene polymorphisms and the serum level of IL-21. The serum level of total IgE was not significantly correlated with the presence of IL-21R gene polymorphisms. CONCLUSION: Our data suggest that the genetic susceptibility profile for KD may include IL-21R gene.

Analysis for Sit-to-Stand Performance According to the Angle of Knee Flexion in Individuals with Hemiparesis.

[Purpose] Sit-to-stand (STS) is one of the important functional tasks people perform throughout the day. This study investigated whether varying angles of knee flexion affect STS patterns in individuals with hemiparesis by using a foot plantar pressure measurement system. [Methods] Fifteen stroke patients with hemiparesis participated for this study. They performed sit-to-stand with three angles of knee flexion (70°, 90°, and 110°). We measured the trajectory of the center of pressure, peak plantar pressure, and symmetry index using a Mat-scan system (Tekscan, South Boston, MA, USA). [Results] As a result, we found that there were significant differences among the three angle conditions (trajectory of center of pressure, peak plantar pressure on the affected side, and symmetry index). However, there was no significant difference in peak pressure according to the knee flexion on the unaffected side. [Conclusion] In the current study, we found that stroke patients with hemiparesis had a compensated STS pattern according to knee flexion angles. This indicates that the peak value of plantar pressure increased and that the trajectory of the center of pressure widened as the angle of knee flexion increased. We also suggest that hemiparesis patients should be more concerned about proper knee angle for symmetrical STS pattern.