Untacted automated robotic upper-trunk- lower reciprocal locomotor training for knee osteoarthritis: A randomized controlled trial.

BACKGROUND: Although millions of people with osteoarthritis (OA) have altered biomechanical alignment, movement, and knee joint pain during gait, there are no effective and sustainable interventions. To mitigate such impairments, we developed an untacted self-automated robotic and electromyography (EMG)-augmented upper-trunk-lower reciprocal locomotor training (SRGT) intervention. OBJECTIVE: To compare the effects of SRGT and conventional treadmill gait training (CTGT) on the medial knee joint space width (JSW), hip adduction moment (HAM), knee varus deformity, pain, and physical function in community-dwelling older adults with OA. METHODS: Older adults diagnosed with medial compartment knee OA (5 men, 35 women; mean age = 78.50 ± 9.10 years) were recruited and underwent either SRGT or CTGT, 30 min a day, 3 times a week, over a 4-week period. Outcome measurements included the JSW, HAM, knee varus angle (VA), and Western Ontario McMaster Universities osteoarthritis index (WOMAC). RESULTS: Analysis of covariance (ANCOVA) showed that SRGT ed to greater changes in medial knee JSW (p= 0.00001), HAM (p= 0.00001), VA (p= 0.00001), and WOMAC (p= 0.00001) scores. CONCLUSION: This study provides the first evidence for the long-term clinical and biomechanical effects of SRGT on JSW, knee joint kinematics, kinetics, and WOMAC scores in older adults with OA. Most importantly, self-automatic robotic gait training may be an alternative, effective, and sustainable treatment for the upper-trunk-lower reciprocal locomotor training in older adults with OA.

Physiotherapeutic effects of an innovative golf swing-assist device on discomfort and mobility in amateur golfers with low back pain: A randomized controlled trial.

BACKGROUND: Although the biomechanical features of the golf swing are extremely determined, multiple joint movements with limited pelvic and thoracic rotation movement can cause injury to the golfer and are linked with low back pain (LBP). We have developed the Pulley Master machine (PM), which is designed to offer active movement evaluation and monitoring as well as repetitive and task-specific training. OBJECTIVE: The primary goal of the present research was to analyze the effects of PM and Transfer of Electricity-Capacitive and Resistive (TECAR) therapy on the lumbar pain scale and thoracic and pelvic mobility in amateur golfers with LBP. METHODS: Twenty-one amateur golfers with LBP (six females, mean age = 23.43 ± 2.36 years) were randomly assigned to either PM or TECAR groups for five days per week over one week. Clinical outcome measurements included pelvic and thoracic mobility as well as a pain rating scale. Statistical analyses were presented using the analysis of variance (ANOVA), and the statistical significance level was set at P< 0.05. RESULTS: ANOVA showed that PM outperformed TECAR in terms of pelvic and thoracic mobility as well as a pain rating scale. CONCLUSION: The results provide novel and encouraging clinical evidence that PM improves pain control and mobility in amateur golfers with LBP.

Comparative accuracy of a shoulder range motion measurement sensor and Vicon 3D motion capture for shoulder abduction in frozen shoulder.

BACKGROUND: Although patients with frozen shoulders have the range of motion (ROM) of their shoulder's abduction movements measured at hospital and the physical therapy visits, multiple visits to check for progress is often difficult. Thus, we developed an artificial intelligence-based image recognition detectable sensor (AIRDS) intended for easy use at home. OBJECTIVE: The purpose of this study was to determine the accuracy of a sensor (AIRDS) measuring shoulder abduction angle, thus offering a valid and feasible system for monitoring patients with frozen shoulder. METHODS: Ten patients with frozen shoulder (5 males, 5 females) performed shoulder joint movements while being measured with the AIRDS system and the 3-dimensional Vicon system. The measure of the outcome included the linear regression of the shoulder abduction joint kinematics. RESULTS: Linear regression analysis of the AIRDS system and the Vicon system demonstrated a significant correlation coefficient of R2= 0.9979 (P< 0.05). CONCLUSIONS: Our results provide novel, promising evidence that AIRDS can accurately measure the timing and total spatial characteristics of clinical movements. AIRDS is designed to provide real-time ROM measurements for joint mobility using artificial intelligence instead of the judgement of the physical therapist.

Comparative effects of different manual techniques on electromyography activity, kinematics, and muscle force in limited ankle dorsiflexion syndrome.

BACKGROUND: Although the instrument-assisted manual (IM) technique has been widely utilised to improve soft tissue and joint mobility, its therapeutic benefits and underlying neuromechanical mechanisms remain unknown compared to those of conventional static stretching (SS) and hold-relax (HR) manual techniques. OBJECTIVE: This study aimed to compare the effects of the SS, HR, and IM techniques on muscle activity, kinematics, and strength during deep squatting in limited ankle dorsiflexion (DF) syndrome. METHODS: This was a cross-sectional randomised controlled study including 39 adults divided into three groups: SS group: 13, HR group: 13, IM group: 13. Outcome measures were the tibialis anterior (TA): gastrocnemius (GCM) balance ratio and ankle, knee, hip and thoracolumbar junction angles. TA muscle strength was analysed to evaluate the limited ankle DF. Analysis of variance was performed, with P< 0.05. RESULTS: The TA:GCM balance ratio, ranges of motion of ankle DF and knee flexion, and TA muscle strength in the IM group improved significantly compared to that in either the SS group or HR group (P< 0.05). CONCLUSIONS: Our novel results demonstrated that IM was most effective in normalising TA:GCM balance, ankle DF range of motion, and TA muscle strength during deep squatting in adults with limited ankle DF.

A precision neurorehabilitation using SSEP for early detection of sensory deficit and restoration of the motor recovery in balance, gait and activities of daily living in acute stroke.

BACKGROUND: Impaired sensory in acute stroke patients results in dynamic balance, gait and activities of daily living (ADL) impairment. OBJECTIVE: The aim of present study was to examine the correlation between somatosensory-evoked potential (SSEP) parameters and motor recovery in balance, gait and ADL performance in hemiparetic stroke survivors. METHODS: One hundred and one participants with hemiparetic stroke (43 males, 58 females; mean age, 6538 ± 1222 years; post-stroke duration, 199 ± 0.74 month) participated in this study. The Electro Synergy system (Viasys Healthcare; San Diego, CA, USA) was applied to measure SSEP measurement. The 101 stroke survivors were divided into three groups consistent with their SSEP results: sensory normal group; sensory impaired group; sensory absent group. All the subject participated the inpatient rehabilitation intervention for 4 weeks. Analyses of variance (ANOVA) were used to verify the group difference among the three groups after the treatment. RESULTS: ANOVA revealed the significant difference (p< 0.01). The Scheffe test demonstrated that the sensory normal group showed greater increasement in Modified Barthel Index (MBI), Fugl-Myer Assessment (FMA), Trunk Impairment Scale (TIS), Berg Balance Scale (BBS) and Functional Ambulation Category (FAC) scores than the sensory impaired and absent group (p< 0.05). CONCLUSIONS: Our research provides therapeutic evidence that correlation of somatosensory functions on motor recovery, balance, gait, and ADL in patients with hemiplegic stroke.

Multiple pass ultrasound tightening of skin laxity of the lower face and neck.

BACKGROUND: Skin laxity is a common complaint of patients who request skin rejuvenation. Radiofrequency and infrared light are widely used for nonablative treatment of skin laxity. Intense focused ultrasound (IFUS) has been investigated as a tool for the treatment of solid benign and malignant tumors for many decades but is only now beginning to emerge as a potential noninvasive alternative to conventional nonablative therapy. OBJECTIVES: To evaluate the efficacy of IFUS for the treatment of face and neck laxity. METHODS: Twelve female volunteers were enrolled in the study, and 10 were ultimately evaluated. The device under investigation was an IFUS. Areas treated included the face and neck. For treatment, the 4-MHz, 4.5-mm probe was used first, followed by the 7-MHz, 3.0-mm probe. Two blinded, experienced clinicians evaluated paired pretreatment and post-treatment (day 90) photographs. Patient self-assessments were also obtained. RESULTS: On the first primary outcome measure, two blinded clinicians felt that 8 of 10 subjects (80%) showed clinical improvement 90 days after treatment. Nine of 10 subjects (90%) reported subjective improvement. CONCLUSIONS: IFUS has many advantages for skin tightening.

Development of acute megakaryoblastic leukemia with isochromosome (12p) after a primary mediastinal germ cell tumor in Korea.

The association of hematological malignancies with a mediastinal germ cell tumor (GCT) is very rare. We report one case of a young adult male with primary mediastinal GCT who subsequently developed acute megakaryoblastic leukemia involving isochromosome (12p). A 25-yr-old man had been diagnosed with a mediastinal GCT and underwent surgical resection and adjuvant chemotherapy. At 1 week after the last cycle of chemotherapy, his peripheral blood showed leukocytosis with blasts. A bone marrow study confirmed the acute megakaryoblastic leukemia. A cytogenetic study revealed a complex karyotype with i(12p). Although additional chemotherapy was administered, the patient could not attain remission and died of septic shock. This case was definitely distinct from therapy-related secondary leukemia in terms of clinical, morphologic, and cytogenetic features. To our knowledge, this is the first case report of a patient with mediastinal GCT subsequently developing acute megakaryoblastic leukemia involving i(12p) in Korea.

The implementation and effects of a clinical laboratory accreditation program in Korea from 1999 to 2006.

BACKGROUND: The Korean Laboratory Accreditation Program (KLAP) by the Korean Society of Laboratory Medicine (KSLM) was started in 1999. We summarized history and achievement of KLAP for the last 8 yr. METHODS: We analyzed 8 yr data (1999-2006) of historical events, trends of participating laboratories, and scores according to the impact of the question to the outcome of the tests. Inspection check lists are for 'laboratory management', 'clinical chemistry', 'diagnostic hematology', 'clinical microbiology', 'diagnostic immunology', 'transfusion medicine', 'cytogenetics', 'molecular genetics', 'histocompatibility', 'flow cytometry', and 'comprehensive laboratory test verification report'. The laboratories with score 90 or higher got 2-yr certificate and laboratories with score between 60 and 89 got 1-yr certificate. The laboratories with score below 60 failed accreditation. RESULTS: The number of accredited laboratories was 2.4 times higher in 2006 (n=227) than in 1999 (n=96). Inspection check lists have been revised 5 times till 2006. The average accreditation rate was 99.6% during these periods and the 2-yr accreditation rate was 32.4% in 2000, 45.6% in 2001, 53.3% in 2002, 47.3% in 2003, 68.5% in 2004, 37.7% in 2005, and 47.7% in 2006. Number of participants in inspector training workshops increased from 89 in 2000 to 766 in 2006. CONCLUSIONS: The KLAP has been in place successfully and stabilized over the past 8 yr. It seemed to enhance the laboratory quality. Efforts for improvement of quality control and inspector training workshops appeared to be in the main contributing factors.

[Current status of external quality assessment of syphilis test in Korea].

BACKGROUND: Current status of external quality assessment (EQA) of laboratory tests for syphilis in Korea was analyzed to find out the problems that should be improved in the future. METHODS: Based on the data from the external quality assessment program performed twice a year by the Immunoserology Subcommittee of the Korean Association of Quality Assurance for Clinical Laboratory from the year 2004 to 2006, discordance rates were analyzed according to the test method and commercial kit used. RESULTS: Among the laboratories participating in the EQA program for syphilis test, about 90% of them used non-treponemal tests and about 55% treponemal tests. The non-treponemal tests included RPR (rapid plasma reagin) and VDRL tests used in 88% (363/412) and 11% (45/412), respectively, of the laboratories. The discordance rates were 2.2% for RPR test and 3.6% for VDRL. For the treponemal tests, Treponema pallidum hemagglutination assay (TPHA) was used in 60-76% and Immunochromatography assay (ICA) in about 30% of the laboratories in 2006. A high discordance rate of over 10% was reported in both TPHA and in ICA methods, possibly due to a low titer (1:1 in VDRL) of EQA samples in 2005. Analysis of the accumulated data from year 2004 to 2006 showed that the discordance rates of TPHA, ICA, and FTA-ABS were 4.6%, 3.7%, and 2.7%, respectively. CONCLUSIONS: For syphilis tests, RPR test, TPHA, and ICA are mainly used in Korea. A high discordance rate is still reported in TPHA and ICA, especially when testing samples with a low titer. Further analysis of data and education of laboratory personnel are needed for the improvement of the EQA program.

Differential effects of homocysteine on porcine endothelial and vascular smooth muscle cells.

High concentrations of homocysteine damage endothelial cells and lower concentrations increase vascular smooth muscle cell (VSMC) growth. This study investigated the effects of various concentrations of homocysteine on endothelial cells (VECs) and VSMCs in terms of cell survival, proliferation, and function. VECs and VSMCs from porcine thoracic aorta were studied. These cells were exposed to homocysteine in concentrations of 20 microM, 400 microM, and 1 mM every 8 h for 24 h, and its effect on cell survival, proliferation, and function were studied using methylthiazoletetrazolium assay, [3H]-thymidine incorporation test, and 6-keto-prostaglandin F1alpha enzyme-linked immunosorbent assay for VECs, and platelet-derived growth factor (PDGF) enzyme-linked immunosorbent assay for VSMCs, respectively. In VECs, 20 microM of homocysteine reduced the viable cell count to 95 +/- 31%, 400 microM reduced it to 89 +/- 35%, 1,000 microM reduced it to *58 +/- 29% (control = 100 +/- 30%, n = 18, *p < 0.05). In VSMCs, 20 microM of homocysteine slightly increased the viable cell count to 106 +/- 30%, but there was no statistical significance; 400 microM of homocysteine reduced the viable cell count to *74 +/- 29%, 1,000 microM to *50 +/- 24% (control = 100 +/- 28%, n = 18, *p < 0.05). In VECs, 20 microM of homocysteine reduced [3H]-thymidine uptake by 98 +/- 14%, 400 microM reduced it by *82 +/- 17%, 1,000 microM reduced it by *66 +/- 17% (control = 100 +/- 12, n = 6, *p < 0.05), respectively. But in VSMCs, 20 microM of homocysteine significantly increased [3H]-thymidine uptake (*131 +/- 16%), and thereafter, homocysteine decreased VSMCs [3H]-thymidine uptake, 400 microM by *24 +/- 7%, 1,000 microM by *29 +/- 10% (control = 100 +/- 16, n = 6, *p < 0.05), respectively. Homocysteine decreased VEC prostacyclin secretion in a dose-dependent manner, 20 microM by 105 +/- 0.65 pg/100 microl, 400 microM by *100 +/- 2.37 pg/100 microl, 1,000 microM by *93 +/- 2.54 pg/100 microl (control = 107 +/- 1.26 pg/100 microl, n = 6, *p = 0.007). In VSMCs, 20 microM of homocysteine slightly increased PDGF secretion by 62.2 +/- 20.7 pg/100 microl, but there was little statistical significance (p = 0.13); 400 microM of homocysteine reduced PDGF secretion by *28.9 +/- 10.7 pg/100 microl, and 1,000 microM reduced it by *21.3 +/- 4.7 pg/100 microl (control = 54.5 +/- 9.3 pg/100 microl, n = 6, *p < 0.05). High concentrations of homocysteine damaged both VECs and VSMCs with respect to cell survival, proliferation, and function. By increasing exposure to homocysteine, it was shown that physiologic high concentrations of homocysteine enhanced VSMC proliferation.