Requirements for Universally Accessible Upper-Body Exercise Equipment: The Case of People with Spinal Cord Injuries in Korea.

Background: People with disabilities face considerable obstacles when exercising, which precludes them from the social and health benefits of physical activity. Especially for individuals with paraplegia with spinal cord injuries, it is necessary to maintain continuous participation in physical activity even after discharge, as it helps to maintain mobility and daily living activities through upper body strength. However, the participation rate of people with disabilities in physical activity in Korea is still low, mainly due to the lack of exercise equipment and facilities. Objectives: The aim of this study is to identify aspects that can be improved for better accessibility to exercise equipment for individuals with paraplegia with spinal cord injuries and to reach a consensus on possible guidelines for accessible exercise equipment. Methods: This study reviews and evaluated the usability of four existing upper-body exercise equipment for individuals with paraplegia with spinal cord injuries. To assess usability, task performance scores and time were measured, and a survey was conducted on safety and satisfaction. Based on these results, areas for improvement were identified. Through literature review, usability results, and opinions from various stakeholders, eight requirements for universal accessibility were proposed. Results: It is necessary to consider how wheelchair users access the exercise equipment. The access method to the exercise area (facility regulations, auxiliary equipment to be provided, etc.) and placement of exercise equipment should also be considered. Information such as explanations of the exercise equipment and how to use it should be located within the wheelchair user's field of vision. Considering the participation rate in sports for people with disabilities in Korea, it is necessary to explain the exact exercise equipment and exercise method. It is also necessary to consider how wheelchair users transfer from the wheelchair to the seat of the exercise equipment. Parts that require manipulation of each exercise equipment must be within the wheelchair user's range of motion. Various supports or assistive devices that provide body support according to each piece of equipment are needed. In addition to the wheelchair's own brake, it is necessary to provide a fixing device so that the wheelchair does not move during the exercise. Conclusion: For people with spinal cord injuries, the arm ergometer, aerobic exercise equipment, showed higher scores in performance, stability, and satisfaction compared to other exercise equipment. Among the strength exercise equipment, shoulder press had an effect on performance, seated lat pull-down had an effect on stability, and seated chest press had an effect on satisfaction. Therefore, when selecting exercise equipment, it is necessary to recommend aerobic and strength exercise equipment according to the preferences of people with spinal cord injuries. When developing strength exercise equipment, it is necessary to consider usability evaluation factors for individuals with spinal cord injury.

Alcohol-Incorporating Diels-Alder Dimerization of In Situ Formed ortho-Quinamine via Co-Nitrenoid Insertion.

We disclose herein a Cp*Co(III)(LX)-catalyzed dearomative Diels-Alder dimerization of 2,6-disubstituted phenyl azidoformates. Upon the postulated cobalt-nitrenoid insertion into the neighboring ortho-carbon, the key intermediate of ortho-quinamine was generated for the subsequent dimeric cycloaddition process. A series of experimental and computational studies suggested that the quinolinol ligand of the cobalt catalyst plays a crucial role in the alcoholic solvent incorporation into the o-quinamine moiety, thereby enabling the Diels-Alder dimerization to furnish the bridged tricyclic bisamidation products.

Emergent use of a King laryngeal tube for traumatic intraoral bleeding: two case reports.

Maxillofacial trauma occasionally presents a serious challenge for physicians, and an orofacial injury can be considered life-threatening. It is difficult to control the bleeding and prevent airway obstruction simultaneously with conventional treatment. Herein, we share two cases in which we managed massive orofacial bleeding using a King laryngeal tube, a supraglottic airway device equipped with an inflatable balloon. Both patients had uncontrolled orofacial bleeding. In one of the patients, endotracheal intubation was possible; however, bleeding continued, and vital signs became unstable. The second patient had failed endotracheal intubation due to uncontrolled bleeding. We deployed the King laryngeal tube in both patients and achieved bleeding control and airway maintenance. Both patients were discharged without complications after 3 to 4 weeks. The King laryngeal tube method can be considered a useful management option for addressing massive orofacial bleeding that is uncontrollable with conventional treatment.

Cobalt-Nitrenoid Insertion-Mediated Amidative Carbon Rearrangement via Alkyl-Walking on Arenes.

We herein disclose the Cp*Co(III)(LX)-catalyzed amidative alkyl migration using 2,6-disubstituted phenyl azidoformates. Upon the cobalt-nitrenoid insertion toward the substituted ortho carbon, an arenium cationic species bearing a quaternary carbon is generated, and a subsequent alkyl migration process is suggested to occur through an unforeseen alkyl-walking mechanism. A quinolinol ligand of the cobalt catalyst system is proposed to facilitate the final product-releasing rearomatization process by serving as an internal base. This new mechanistic mode enabled both [1,2]- and [1,4]-alkyl rearrangements to allow the structural variation of N-heterocyclic compounds.

Management of intractable oronasal bleeding using Sengstaken-Blakemore tubes in patients with facial trauma: a case series and technical notes.

OBJECTIVE: Intractable massive oronasal bleeding can become a life-threatening condition. The success rate of conventional bleeding control methods other than transarterial embolization (TAE) is not expected to be high. We investigated the efficacy of Sengstaken-Blakemore tube (SBT) balloon tamponade in patients with sustained and intractable oronasal bleeding secondary to facial injury. METHODS: This study is a retrospective chart review from traumatic patients with sustained and intractable oronasal bleeding who were admitted to the emergency center of Ajou University Hospital and Soonchunhyang University Bucheon Hospital from January 2014 to December 2016. RESULTS: Twelve patients were included in the study, of whom nine (75%) were male. The median age was 31 years (range, 20-73 years). Bleeding was controlled in 11 of the 12 patients (91.7%) either temporarily or definitively. One patient without hemostasis underwent TAE. TAE was performed in an additional three patients out of the 11 patients with hemostasis who experienced continued nasal bleeding after the removal of SBTs. There were no complications from performing the procedure. CONCLUSION: Using SBTs as a hemostatic tool will aid patients with life-threatening intractable oronasal bleeding. Furthermore, this method may be used in patients with continual and intractable oronasal bleeding after facial trauma as a bridging procedure from the emergency department or the intensive care unit to the interventional radiology.

In situ immobilization of YVO4:Eu phosphor particles on a film of vertically oriented Y2(OH)5Cl·nH2O nanosheets.

A heterostructured photoluminescence 'turn-off' film was developed using vertically oriented LYH:Eu nanosheets as a partial sacrificial layer for isolated YVO4:Eu3+ nanophosphor layers and was used for the convenient detection and removal of Cu2+ ions with excellent sensitivity and recyclability.

The difference of subcutaneous digital nerve block method efficacy according to injection location.

INTRODUCTION: Finger injuries are commonly attended to in the emergency department, and digital nerve block is a frequently performed procedure for such injuries. This study compared the efficacy levels of the subcutaneous method according to the different injection sites. METHOD: This was a simulation study for medical students who rendered medical service at the emergency department. One group performed subcutaneous injection of lidocaine at the volar side of the metacarpophalangeal (MCP) joint, while another group injected at the volar side of the proximal interphalangeal (PIP) joint. The time to anesthesia was measured at 30-s intervals. Pain at the injection site was measured using the numeric rating scale (NRS), while the length from the fingertip to the injection site and the circumference of the injection site were measured. RESULTS: A total of 82 participants were included, with 41 under the MCP joint group and the rest under the PIP joint group. The mean length from the fingertip to the needling point was 3.62 ±â€¯0.63 cm in the PIP joint group and 5.90 ±â€¯0.65 cm in the MCP joint group, while the mean circumference of the needling point was 4.93 ±â€¯0.51 and 5.61 ±â€¯0.58 cm, and the mean time to anesthesia was 2.55 ±â€¯1.11 and 3.79 ±â€¯1.28 min (p-value < 0.001), respectively. The median value of NRS was 4 in both groups (p-value = 0.921). Length was correlated with the time to anesthesia (p-value = 0.018). CONCLUSION: Injection into the PIP joint showed the same anesthetic effect as injection into the MCP joint, but this effect occurred faster in the former.

Prolonged stay in the emergency department is an independent risk factor for hospital-acquired pressure ulcer.

It is not easy to ensure optimal prevention of hospital-acquired pressure ulcer (HAPU) in crowded emergency departments (EDs). We hypothesised that a prolonged ED length of stay (LOS) is associated with an increased risk of HAPU. This is a single-centre observational study. Prospectively collected HAPU surveillance data were analysed. Adult (aged ≥20 years) patients admitted through the ED from April 1, 2013 to December 31, 2016 were included. The primary outcome was the development of HAPU within a month. Covariates included demographics, comorbidities, conditions at triage, initial laboratory results, primary ED diagnosis, critical ED interventions, and ED dispositions. The association between ED LOS and HAPU was modelled using logistic and extended Cox regression. A total of 48 641 admissions were analysed. The crude odds ratio (OR) and hazard ratio (HR) for HAPU were increased to 1.44 (95% CI, 1.20-1.72) and 1.21 (95% CI, 1.02-1.45), respectively, in ED LOS ≥24 hours relative to ED LOS <6 hours. In multivariable logistic regression, ED LOS ≥12 and ≥24 hours were associated with higher risk of HAPU, with ORs of 1.30 (95% CI, 1.05-1.60) and 1.80 (95% CI, 1.45-2.23) relative to ED LOS <6 hours, respectively. The extended Cox regression showed that the risk lasted up to a week, with HRs of 1.42 (95% CI, 1.07-1.88) and 1.92 (95% CI, 1.44-2.57) relative to ED LOS <6 hours, respectively. In conclusion, Prolonged ED LOS is independently associated with HAPU. Shorter ED LOS should be pursued as a goal in a multifaceted solution for HAPU.

Effects of the Computer Desk Level on the Musculoskeletal Discomfort of Neck and Upper Extremities and EMG Activities in Patients with Spinal Cord Injuries.

BACKGROUND: Computers are used as a means of social communication, for work and other purposes. However, patients with spinal cord injuries may have a higher risk than normal individuals with musculoskeletal problems when using computers owing to their inability to control respective postures due to problems in motor and sensory functioning. OBJECTIVES: This study is aimed at identifying the effect of computer desk heights on musculoskeletal discomforts of the neck and upper extremities and EMG activities in patients with spinal cord (C6) and upper thoracic spinal cord injuries. METHODS: Participants of the present study were the patients diagnosed with ASIA A or B. The patients were divided into two groups according to their spinal cord injuries: C6 group and T2-T6 group. The level of the desk was set at 5 cm below the elbow, at the elbow level, and 5 cm above the elbow level. Electromyography was used to measure the duration of typing task EMG(%RVC) of the cervical erector spinae, upper trapezius, anterior deltoid, and wrist extensor. Subjective musculoskeletal discomfort (Borg-RPE) was measured at the end of the experiment. RESULTS: The two groups showed differences in terms of RPE corresponding to each level of the computer desk (p < .05). Postanalysis revealed the C6 group had decreased RPE as the level of computer desk increased, whereas the subjects in the T2-T6 group had decreased RPE values in accordance with the decreasing level of computer desk (p < .05). In EMG, both groups had no significant differences (p > .05). However, in terms of the interaction between the muscles and the level of computer desk in both groups, the differences in the interactions of the upper trapezius and wrist extensor with each level of the desk were found (p < .05). CONCLUSION: This study is meaningful in that it confirms computer work posture and preference of spinal cord-injured individuals.

Comparison of internal jugular vein dilation between Valsalva maneuver and proximal internal jugular vein compression.

OBJECTIVE: The Valsalva maneuver is recognized as an effective method to dilate the internal jugular vein (IJV). However, this maneuver cannot be performed in many cases, such as children and unconscious patients. The aim of this study was to evaluate the effectiveness of proximal IJV compression, which can easily be performed, regardless of patient cooperation. METHODS: Healthy adult volunteers were recruited from tertiary hospital employees. Basic anatomic and physiologic data were collected. The subjects lay down as if they were undergoing IJV catheter insertion, in the supine position with their necks turned 30 degrees to the left. The main outcome was the cross-sectional area (CSA) of the distal IJV as measured by ultrasound in four stages. The first stage was sham without any maneuver. The second was Valsalva maneuver, the third was digital IJV compression, and the fourth was digital compression accompanied by simultaneous Valsalva maneuver. RESULTS: A total of 41 volunteers were enrolled. Twenty-six (63.41%) were male with an average age of 28.15±2.85 years. Mean height was 170.74±8.66 cm and mean neck circumference was 35.28±3.87 cm. The mean CSA-IJV was 1.06±0.36 cm2 without any maneuver. It increased to 1.34±0.45 cm2 with Valsalva maneuver (P<0.001), to 1.26±0.41 cm2 with digital compression (P<0.001), and to 1.41±0.47 cm2 with the two maneuvers combined (P=0.01). CONCLUSION: Digital proximal IJV compression effectively dilates the distal IJV. When performed simultaneously with the Valsalva maneuver, the effect was enhanced.

Effectiveness of a compressive device in controlling hemorrhage following radial artery catheterization.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of a compressive device in controlling hemorrhage following radial artery catheterization. METHODS: A prospective randomized trial was conducted on subjects receiving the standard taping method (group S) compared to a compressive device method (group C) after removal of the cannula in radial artery catheterization. Primary outcomes were the success rate of hemostasis and complication rate after cannula removal. Secondary outcomes were the cost of compression and the level of convenience. RESULTS: A total of 250 subjects were enrolled in this study. Hemostasis after removal was successful in 122 of 125 (97.6%) subjects in group S and 116 of 125 (92.8%) subjects in group C (P=0.18). Complication rates in group S and group C were 55.2% (69/125) and 48% (60/125), respectively (P=0.35). The cost of compression for group C (approximately 6,740 Korean won) was approximately two times cheaper than for group S (approximately 14,140 Korean won). The level of convenience was significantly higher in group C than in group S (7.4±2.1 vs. 3.7±1.9, p < 0.001). CONCLUSION: These findings suggest that hemostasis using a compressive device may be a suitable alternative method to the standard taping method in controlling hemorrhage following radial artery cannulation.

One-pot synthesis of 3-azido- and 3-aminopiperidines by intramolecular cyclization of unsaturated amines.

A highly efficient one-pot synthesis of 3-azidopiperidines has been achieved by an intramolecular cyclization of unsaturated amines that allows for the nucleophilic installation of an azide moiety. This method unlocks the versatile employment of the azide functionality in the preparation and biological studies of piperidine-containing structures. This strategy has been expanded for the direct incorporation of a variety of nitrogen nucleophiles, and thus it provides a rapid and modular synthesis of 3-amino and 3-amidopiperidines of important pharmaceutical and biological relevance. Particularly noteworthy is that the regioselectivity of this transformation enables the formation of the anti-Markovnikov-type adduct, complementing Markovnikov-based olefin amino functionalization methods.

Injuries associated with the 580 km university student grand voluntary road march: focus on foot injuries.

College student volunteers (n = 142) completed a 580 km road march for 21 consecutive days. Each volunteer carried a backpack that weighed 14.1 ± 1.4 kg on the average. We investigated the incidence and location of blisters associated with the road march using a foot map along with other injuries. Overall, 95.1% of the subjects (135 of 142) sustained one or more injuries. All injured subjects had foot blisters, and 18% had other foot injuries. The most common locations of blister development were the right 5th toe (61%) and the left 5th toe (57%). The little toes seem to have been subjected to the greatest friction and shearing forces. March-related injuries, excluding foot injuries, were ankle pain (12.7%), knee pain (12.7%) and Achilles tendon pain (7.7%). Six subjects (4.2%) needed extra medical treatment for more than 2 weeks prior to returning to their daily lives after completion of the march due to associated injuries. The present study observed a very high incidence rate of injuries (95.1%) associated with the 580 km university students grand road march. These injuries posed an obstacle against completion of the road march and against returning to daily life. Active preventive interventions such as physical therapy and customized reinforced shoes and education program are recommended for reducing incidence rate and severity of injuries.

Requirement of CD4 help for induction of CD8 T cell response specific for virally derived h60.

CD40-CD40L-mediated help from CD4 T cells is essential to induce primary CD8 T cell responses specific to the non-inflammatory cell-based antigen H60. In this study, using H60 as a model antigen, we generated recombinant vaccinia viruses (rVVs) expressing the H60 CD8 epitope and investigated whether CD4 help was required to activate the CD8 T cell response specific to the virally expressed H60. The immune response after infection with rVVs expressing H60 was similar to that after immunization with H60 congenic splenocytes, with a peak frequency of H60-specific CD8 T cells detected in the blood on day 10 post-infection. A CD8 T cell response specific for virally derived H60 was not induced in CD4-depleted mice, but was in CD40-deficient mice. These results provide insights into the characterization of the CD8 T cell response specifically for antigens originating from cellular sources compared to viral sources.

In vivo imaging of differences in early donor cell proliferation in graft-versus-host disease hosts with different pre-conditioning doses.

Graft-versus-host disease (GVHD) results from immunemediated attacks on recipient tissues by donor-originated cells through the recognition of incompatible antigens expressed on host cells. The pre-conditioning irradiation dose is a risk factor influencing GVHD severity. In this study, using newly generated luciferase transgenic mice on a B6 background (B6.Luc(Tg)) as bone marrow and splenocyte donors, we explored the effects of irradiation doses on donor cell dynamics in major histocompatibility complex (MHC)-matched allogeneic GVHD hosts via bioluminescence imaging (BLI). Results from BLI of GVHD hosts showed higher emission intensities of luminescence signals from hosts irradiated with 900 cGy as compared with those irradiated with 400 cGy. In particular, BLI signals from target organs, such as the spleen, liver, and lung, and several different lymph nodes fluctuated with similar time kinetics soon after transplantation, reflecting the synchronous proliferation of donor cells in the different organs in hosts irradiated with 900 cGy. The kinetic curves of the BLI signals were not synchronized between the target organs and the secondary organs in hosts irradiated with 400 cGy. These results demonstrate that pre-conditioning doses influence the kinetics and degree of proliferation in the target organs soon after transplantation. The results from this study are the first describing donor cell dynamics in MHC-matched allogeneic GVHD hosts and the influence of irradiation doses on proliferation dynamics, and will provide spatiotemporal information to help understand GVHD pathophysiology.

Comparative genomic analysis of the whale (Pseudorca crassidens) PRNP locus.

There have been many studies of the morphology, behavioral audiograms, and population structure of the false killer whale (Pseudorca crassidens), but sequencing, mapping, and functional and comparative genomics studies are still largely unknown. In this paper, we sequenced three novel BAC clones corresponding to a total length of 308 kb and spanning the PRNP, PRND, and RASSF2 loci, and conducted comparative genomic analysis to examine the genomic structure of the false killer whale PRNP locus. We determined that the three genes show a high degree of conservation in their syntenic regions with respect to gene order, gene orientation, and the predicted coding sequence (CDS) between human and whale, whereas PRNT was not detected in whale. Interestingly, the predicted CDS in whale PRNP contained a novel type of 4-copy octarepeat resulting from a 24 bp deletion when compared with the human sequence. In addition, we identified a novel 1869 bp repeat unit in a region that is non-syntenic to human and cow sequences and is therefore considered to be whale-specific sequence. Our results will provide novel insights into the genomic changes that have occurred during evolution of mammalian PRNP loci, and may also have implications for research into prion disease.