Information technology-supported integrated health service for older adults in long-term care settings.

BACKGROUND: To examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients. METHODS: We applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention. RESULTS: We screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37-4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41-8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24-3.16, p = 0.0042), and number of PIMs use (ꞵ = - 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20-1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75-2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups. CONCLUSIONS: The information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization. TRIAL REGISTRATION: Clinical Research Information Service, KCT0004360. Registered on 21 October 2019.

The reversible effect of neck flexion on the somatosensory evoked potentials in patients with Hirayama disease: a preliminary study.

The aim of this study was to examine and characterize the reversibility of the cervical somatosensory electrophysiological pathways during neutral and flexed neck positions. The parameters of somatosensory evoked potentials (SEPs) during neutral and flexed neck positions (N9, N13, and N20 SEP latencies; N9-N13 and N13-N20 inter-peak latencies; and the changes in N9-N13 and N13-N20 inter-peak latency during neutral and flexed neck positions) were measured in the patients with Hirayama disease (HD) and also in the healthy controls. In patients with HD, there was a significant difference in the mean value of N13-N20 inter-peak latency during the flexed neck position compared to that of the healthy controls (p < 0.05). In a multivariate logistic regression analysis, N13-N20 inter-peak latency during the flexed neck position significantly correlated with the presence of HD (p < 0.05). Collectively, in this cohort of patients with HD, the neck flexion of patients with HD showed a reversible effect on the SEP parameter, especially in N13-N20 inter-peak latency. Conventional diagnosis of HD is based on nerve conduction studies and electromyography along with a cervical flexion MRI, and our study suggests the possibility of an additional and cost-effective electrophysiological marker that may be helpful in the diagnosis of HD.

Are Seating Systems With a Medial Knee Support Really Helpful for Hip Displacement in Children With Spastic Cerebral Palsy GMFCS IV and V?

OBJECTIVE: To evaluate whether medial knee support (MKS) in seating systems aggravates hip displacement in children with cerebral palsy (CP). DESIGN: Retrospective chart review. SETTING: Rehabilitation department of tertiary university hospital. PARTICIPANTS: Children with CP (N=76) using seating systems (intervention group, n=42; mean age 6.86y) and using regular wheelchairs (control group, n=34; mean age 8.15y). INTERVENTIONS: The intervention group was provided with a seating system with MKS. We enrolled children who did not use a seating system in the control group, retrospectively. MAIN OUTCOME MEASURES: By radiographic images, Reimer's migration index (MI), lateral center edge angle (CEA), and femur neck shaft angle (NSA) were measured. We compared the demographic data, clinical variables, and radiographs between the 2 groups. RESULTS: In the intervention group, there was a significant deterioration in the MI, from 26.89% to 44.18% after using the system (P<.001). The progression of MI was 14.72% and 7.82% per year in the intervention and control groups, respectively (P=.016). CONCLUSION: We should consider the possibility that seating systems with MKS may exacerbate hip displacement in children with CP.

Long-term Impact of Psychological Rehabilitation on Isolated Hospitalization Patients with COVID-19: A Longitudinal Study.

OBJECTIVE: This study aimed to investigate the long-term effects of a psychological rehabilitation program that was effective on anxiety, depression, and quality of sleep in hospitalized COVID-19 patients. DESIGN: This is longitudinal study. 13 patients in the experimental group who received a psychological rehabilitation program during hospitalization and 16 patients in the control group who received conservative treatment completed the questionnaire 6 months after discharge. Questionnaires are the Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), Patient Health Questionnaire-9 (PHQ-9), Visual Analysis Scale (VAS), and the Korean version of the Insomnia Severity Index (ISI-K). RESULTS: The VAS for depression significantly improved in the experimental group compared with control group at discharge (E = -2.40, p < 0.001) and follow-up (E = -3.36, p < 0.001). The SDS and PHQ-9 scores significantly improved at discharge (E = -4.05, p = 0.01 and E = -2.29, p = 0.01) but not at follow-up (E = -4.64, p = 0.12 and E = -1.81, p = 0.22). There are no significant interactions for VAS for anxiety (E = -0.27, p = 0.79), SAS scores (E = -1.48, p = 0.51), and insomnia (E = -0.69, p = 0.63) scores during the follow-up. CONCLUSIONS: Psychological rehabilitation showed a significant long-term reduction in depression, but not in anxiety. Therefore, continuous intervention and management of mental health are required after discharge.

Effects of a time-use intervention in isolated patients with coronavirus disease 2019: A randomized controlled study.

OBJECTIVE: Patients with coronavirus disease experience deterioration in occupational balance and mental health. The primary objective of this study was to determine the effectiveness of a time-use intervention on the occupational balance of isolated patients with coronavirus disease. Its impact on secondary outcomes including mental health and quality of life was also assessed. METHODS: This randomized controlled clinical trial was conducted in a single community-based hospital. Forty-one patients (19 in the experimental group and 22 in the control group) with coronavirus disease were recruited between February 1, 2021, and March 19, 2021. Participants were randomly assigned to receive a time-use intervention or education on self-activity. The time-use intervention is to plan a daily routine to engage in meaningful occupations. It consisted of 4 steps: time-use analysis, occupation selection, arrangement of activities and practice, and occupational therapist intervention. The control group was educated on self-activity and spent time autonomously. OUTCOMES AND MEASURES: The primary outcome was occupational balance, evaluated using the Korean version of the Life Balance Inventory. Secondary outcomes were mental health and quality of life assessed using the Korean version of the Patient Health Questionnaire-9, Korean Form of Zung's Self-Rating Anxiety Scale, Korean version of the Insomnia Severity Index, Multidimensional State Boredom Scale-8, Fear of Coronavirus Disease: Korean version of the Fear of Coronavirus Disease Scale, and World Health Organization Quality of Life Assessment Instrument-BRIEF. Outcome measures were evaluated at admission and discharge. RESULTS: The time-use intervention significantly improved occupational balance (F = 14.12, p < .001) and all other measures of depression, anxiety, boredom, fear, and quality of life. Conversely, the control group showed a worsening pattern for all measures. CONCLUSION: The time-use intervention is effective for improving occupational balance, mental health, and quality of life in patients with coronavirus disease.

Factors associated with the mental health status of isolated COVID-19 patients in Korea.

BACKGROUND: The COVID-19 pandemic has a substantial impact on the physical and mental health status of patients with COVID-19. This study's objective was to evaluate the factors associated with mental health in patients isolated with COVID-19. METHODS: It is a retrospective, cross-sectional study. One hundred and two patients discharged from COVID-19 hospitalization in Korea were analyzed. The primary outcome was the correlation between psychological problems such as anxiety, depression, and fear of stigma and physical symptoms such as respiratory symptoms, gastrointestinal symptoms, headache, and fever. Mental and physical symptoms were ascertained using closed and multiple-choice questions. The secondary outcome was the correlation between mental issues, demographic factors, and disease severity. Hypoxia and the need for oxygen therapy, a need for remdesivir antiviral treatment, and indications of pneumonia progression on chest x-ray were confirmed through a review of medical records and used to measure disease severity. RESULTS: Patients with COVID-19 indicated feelings of depression (48.1%), anxiety (49.1%), and fear of stigma (60.45%), and some continued to experience physical symptoms even after discharge. Logistic regression revealed that gastrointestinal symptoms positively correlated with depression (p < .05) and headache positively correlated with fear of stigma (p < .05), while the other factors were not statistically significant (p > .05). CONCLUSIONS: This study showed that psychological symptoms persisted even after discharge. Gastrointestinal symptoms and headache were influential factors in predicting depression and fear of stigma. Based on this, dedicated COVID-19 hospitals should provide mental health support and preventive management.

Psychological rehabilitation for isolated patients with COVID-19 infection: A randomized controlled study.

OBJECTIVE: To improve the mental health of isolated patients with COVID-19 by face-to-face psychological rehabilitation program. DESIGN: Randomized controlled study. SETTING: Single community-based hospital. PARTICIPANTS: 109 patients (52 in experimental group, 57 in control group) with COVID-19 were recruited from May 27 to September 17, 2021. INTERVENTIONS: A psychological rehabilitation program that consists of education, craft, and physical activity. The activity program was provided by a multidisciplinary rehabilitation team of doctors, nurses, occupational therapists, and physical therapists. The purpose of the education was to provide accurate information about COVID-19, and craft and physical activity were for improving physical health, occupational balance, participation in activities, and reducing boredom. MAIN OUTCOME MEASURES: The primary outcome was degree of anxiety assessed using the Zung Self-Rating Anxiety Scale (SAS). Secondary outcomes were severity of depression, and quality of sleep assessed using the Zung Self-Rating Depression Scale (SDS), Patient Health Questionnaire-9 (PHQ-9), Visual Analysis Scale (VAS), and the Korean version of the Insomnia Severity Index (ISI-K). RESULTS: Isolated patients complained of anxiety, depression, and insomnia the most in the early stages of hospitalization and isolation. In addition, the psychological rehabilitation program significantly improved mental health scale, including scores of SAS (F = 12.46, p = .001), SDS (F = 6.76, p = .01), and ISI-K (F = 4.41, p = .04). CONCLUSIONS: The psychological rehabilitation program is effective for improving anxiety, depression, and quality of sleep for isolated patients with COVID-19.

Factors associated with anticholinergic burden among older patients in long-term care hospitals in Korea.

BACKGROUND/AIMS: Drugs with anticholinergic properties (DAPs) are associated with adverse health outcomes in older patients. The objective of this study was to evaluate the factors that determine the prescribing of more DAPs in long-term care hospitals (LTCHs) in Korea. In addition, the current patterns of DAP prescription were explored using a novel platform, which can collect data from LTCHs. METHODS: This was a Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) sub-study, which is a pragmatic, cluster-randomized, controlled trial. The Health-RESPECT platform was used to collect prescribed medication data of 466 patients (aged ≥ 65 years) from seven LTCHs. DAPs were identified using the Korean Anticholinergic Burden Scale (KABS). Physical frailty, cognitive function, functional status, and quality of life were evaluated. RESULTS: Among 466 LTCH patients, 88.8% (n = 414) were prescribed DAPs, and the prevalence of high KABS (≥ 3) was 70.4% (n = 328). The drugs that contributed most to the total KABS were quetiapine (20.7%), chlorpheniramine (19.5%), tramadol (9.8%), cimetidine (5.8%), and furosemide (3.6%). Polypharmacy, higher body mass index, less dependence, better communication and cognitive functions, and poorer quality of life were associated with high KABS. CONCLUSION: Although the patients with a high burden of DAPs were less dependent and had better cognitive and communication functions, they had poorer quality of life. DAP use in LTCH patients should be monitored carefully, and the risk/ benefit relationship for their use should be considered.

Effect of Communication and Education within the Rehabilitation Team: Therapists' and Nurses' Views.

BACKGROUND: To improve the rehabilitation team's awareness of patient mobility and participation by enhancing communication between therapists and nurses and conducting patient education. METHODS: This study used a non-equivalent control group with a non-synchronized design. To facilitate communication between therapists and nurses, we used a manual for mobility management to improve the sharing of information on the functional status of patients. We also implemented patient education to improve their awareness of mobility and participation. Finally, we conducted newly devised surveys related to patient functional status and awareness that were applied by therapists and nurses. RESULTS: The nurses reported significantly lower functional levels of patients compared to those assessed by therapists. After the intervention, the kappa values representing the concordance between therapists and nurses improved to almost perfect agreement for transfer ability (κ=0.836), mobility (κ=0.664), and toileting (κ=1.000). We also observed a statistically significant increase in questionnaire scores with respect to nurses' awareness (p<0.05). CONCLUSION: Improving communication among the rehabilitation team, including nurses through the use of a continuous education program, was effective in promoting the mobility and functional level of patients in the inpatient ward.

Electromyographic activation patterns during swallowing in older adults.

Age-related weakness due to atrophy and fatty infiltration in oropharyngeal muscles may be related to dysphagia in older adults. However, little is known about changes in the oropharyngeal muscle activation pattern in older adults. This was a prospective and experimental study. Forty healthy participants (20 older [> 60 years] and 20 young [< 60 years] adults) were enrolled. Six channel surface electrodes were placed over the bilateral suprahyoid (SH), bilateral retrohyoid (RH), thyrohyoid (TH), and sternothyroid (StH) muscles. Electromyography signals were then recorded twice for each patient during swallowing of 2 cc of water, 5 cc of water, and 5 cc of a highly viscous fluid. Latency, duration, and peak amplitude were measured. The activation patterns were the same, in the order of SH, TH, and StH, in both groups. The muscle activation patterns were classified as type I and II; the type I pattern was characterized by a monophasic shape, and the type II comprised a pre-reflex phase and a main phase. The oropharyngeal muscles and SH muscles were found to develop a pre-reflex phase specifically with increasing volume and viscosity of the swallowed fluid. Type I showed a different response to the highly viscous fluid in the older group compared to that in the younger group. However, type II showed concordant changes in the groups. Therefore, healthy older people were found to compensate for swallowing with a pre-reflex phase of muscle activation in response to increased liquid volume and viscosity, to adjust for age-related muscle weakness.

Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis.

There have been many studies on adolescent idiopathic scoliosis related abnormal muscle contractions of the spine. However, previous studies using surface electromyography to investigate paraspinal muscle asymmetry are controversial, lacking in clarity of results, and hindered by methodological limitations. The purpose of this study was to investigate the relationship between imbalance factors including surface electromyography activity according to the scoliosis curve type and leg length discrepancy and adolescent idiopathic scoliosis curve types. Seventy-nine patients with scoliosis were prospectively enrolled and were divided into five types: single thoracic, thoracolumbar, lumbar, double thoracic, and double major. Cobb angle and structural variables were measured. Surface electromyography examinations were conducted at the 7th, 12th thoracic erector spinae, 3rd lumbar erector spinae, and multifidus muscles during the superman position keeping prone spinal extension to lift the arms and legs off the floor. Whole spine radiographs were obtained to measure the Cobb angle, coronal imbalance, pelvic height and angle, and femoral head height. In the double major, thoracolumbar, and lumbar types, the mean root mean squared (RMS) EMG amplitudes were significantly higher on the convex side than the concave side (P < 0.005). In the DM type, the mean RMS EMG amplitudes of EST7 and ESL3 where the apex was located were significantly higher at the convex side than those of the concave side (P < 0.005, effect size (Cohen's d) for EST7/ESL3: 0.517/0.573). The TL and L types showed a similar pattern. The mean RMS EMG amplitudes of the EST12 concave side and MuL3 and ESL3 concave sides were significantly lower than those of the convex side in the TL and L types, respectively (P < 0.008, effect size (Cohen's d) for EST12/MuL3/ESL3: 0.960/0.264/0.448). Conversely, there were no significant differences in the single thoracic and double thoracic types. All structural variables (coronal imbalance, pelvic height and angle, and femur head height) were higher in the lumbar type, but only coronal imbalance was significantly different (P < 0.05). Different patterns of asymmetry of paraspinal muscles and structural variables were described based on the curvature of the spine. L type showed that EMG activity was asymmetric in the paraspinalis muscles where the apex was located and that structural asymmetry, such as coronal imbalance was significantly greater than other types. DM type showed similar paraspinalis asymmetry pattern to the ST type but there was no structural asymmetry in DM and ST types. TL type has the features of both thoracic and lumbar origins. Understanding these could contribute to the management in correcting scoliosis.

3D-printed tablets using a single-step hot-melt pneumatic process for poorly soluble drugs.

Main purpose was to evaluate the applicability of a 3D-printer equipped with a hot-melt pneumatic dispenser as a single-step process to prepare tablet dosage forms. Dutasteride, a poorly water-soluble drug, was selected as a model drug. Soluplus®, Kollidon® VA 64, Eudragit® E PO, and hydroxypropyl cellulose (HPC) were premixed as bulking agents prior to printing. Differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), and thermogravimetric analysis (TGA) were utilized to evaluate the physicochemical properties of the 3D-printed tablets. Moreover, different geometries were designed to correlate the surface area/volume (SA/V) of the tablets with respect to their release profiles. As a result, printed dutasteride was confirmed to be in an amorphous state and not recrystallized even after the accelerated storage stability. Out of the four bulking agents, Kollidon® VA 64, enhanced the dissolution of the printed dutasteride, reaching above 80% within 15 min. These results suggest that the hot-melt pneumatic dispenser was efficient in converting the solid state into an amorphous state, which significantly enhanced the dissolution. On the other hand, the tube-shaped 3D-printed tablet exhibited the fastest drug dissolution profile, which had the highest SA/V ratio in comparison to the cube, hemisphere, and pyramid shapes. These results confirm the dependency of the drug dissolution rate not only on its crystallinity but also on the surface area of the 3D-printed tablet. Therefore, a 3D-printer equipped with a hot-melt pneumatic dispenser possesses useful applicability in enhancing drug dissolution, especially for poorly water-soluble drugs, in a single-step process.

The comparison of recovery patterns between ischemic spinal cord injury and traumatic spinal cord injury from acute to chronic phase.

Objective: To investigate the neurological and functional recovery patterns of ischemic spinal cord injury (ISCI) compared with traumatic spinal cord injury (TSCI) in the acute to chronic phase.Design: Retrospective cohort study.Settings: Department of Neurology, Neurosurgery, Rehabilitation Medicine at a tertiary hospital.Participants: Fifty-four patients with ISCI and 86 patients with TSCI.Interventions: Not applicable.Outcome measures: MRI findings, American Spinal Injury Association Impairment Scale (AIS), modified Rankin Scale (mRS), Korean Spinal Cord Independence Measure (KSCIM), ambulatory status, and bladder status were reviewed. The functional outcomes were measured at admission, discharge, and >6 months after discharge.Results: AIS classification did not significantly change after 6 months in both ISCI and TSCI groups. Between admission and discharge, the proportion of patients needing a wheelchair or assistive device to ambulate decreased more in the ISCI group compared with the TSCI group [odds ratio (OR) 0.40, P = 0.04]. In addition, the proportion of catheterized voiding in the ISCI group was significantly higher than in the TSCI group at all time points (OR 5.12, P < 0.001). Lastly, both groups showed that functional improvement was the greatest between admission and discharge. In addition, the proportion of catheterized voiding decreased (Diff = -0.12, P = 0.019) and mRS score decreased (Diff=-0.48, P < 0.001) significantly in the ISCI group at >6 months post discharge.Conclusion: The ISCI group showed better recovery of mobility during inpatient rehabilitation period and worse recovery of bladder function as demonstrated by higher number of patients requiring bladder catheterization at all time points when compared with the TSCI group.

Development of Health-RESPECT: An Integrated Service Model for Older Long-Term Care Hospital/Nursing Home Patients Using Information and Communication Technology.

BACKGROUND: Korea, as one of the fastest-aging countries worldwide, requires an improved healthcare service model for older adults. We evaluated the current healthcare system and developed a service model based on information and communication technologies (ICT) for use in older patients in long-term care facilities (LTCF). METHODS: We conducted a qualitative literature review, focus group interviews (FGIs), and structured survey to identify the current technology use and status of healthcare systems. We then developed a web-based platform with necessary, high-priority, and usable content for the care of older patients in LTCF. RESULTS: We reviewed 60 (23 hypertension, 18 diabetes, and 19 heart failure) articles on information and communication technologies (ICT)-based disease management for clinical effectiveness and improved patient satisfaction. FGIs and structured surveys were used to evaluate the inconvenience in patient and medical information transfer between hospitals and cost and time required for its process. Accordingly, we confirmed the unmet need for an ICT-based service model for management, monitoring, and consultation among older patients and developed the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT), a service platform for older patients residing in LTCF. The medical information exchange system was used to transfer medical information. Health-RESPECT includes an established algorithm for evidence-based comprehensive geriatric assessment and customized management; chronic disease management; management of potentially inappropriate medications; rehabilitation; and consultation and videoconferencing. CONCLUSION: This study identified the current status and unmet needs of healthcare systems for older adults. We developed an ICT-based system to manage older institutionalized patients. However, the Health-RESPECT service model requires further validation.

Validation of an integrated service model, Health-RESPECT, for older patients in long-term care institution using information and communication technologies: protocol of a cluster randomised controlled trial.

INTRODUCTION: There is an increased healthcare need to manage institutionalised older patients owing to the ageing population. To overcome substantial future challenges, the Health-RESPECT (caRE Systems for Patients/Elderly with Coordinated care using icT), a new information and communication technologies based integrated management service model, was developed to provide effective management, enable consultation with distant professionals and share medical information between acute care hospitals and long-term care institutions. METHODS AND ANALYSIS: A cluster randomised controlled trial will be conducted to examine the effectiveness of the Health-RESPECT in older patients with chronic diseases and their medical staff in charge. Intervention involves registration with simple comprehensive geriatric assessment, establishment of an individualised care plan for three chronic diseases (hypertension, diabetes and heart failure), medication and rehabilitation management, periodic video-conference and in-system assessment after intervention period. Primary outcomes are control levels of the three chronic diseases, adequacy of drug management and overall functional status. Patients will be assessed at before and after study period and 3 months after study ended. Analysis will be carried out with an intention-to-treat principle. In addition to evaluate intervention effects, clinical usability and economic evaluation will be assessed. ETHICS AND DISSEMINATION: The study protocol was reviewed and approved by the Seoul National University Bundang Hospital Institutional Review Board. Study findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: KCT0004360.

A novel de novo mutation in MYH7 gene in a patient with early onset muscular weakness and severe kyphoscoliosis: A case report.

INTRODUCTION: Various phenotypes have been identified for MYH7 gene mutation-related myopathy. Here, we describe a patient with severe muscular weakness and skeletal deformity with de novo heterozygous MYH7 gene mutation. PATIENT CONCERNS: A 33-year-old woman presented with early onset of muscular weakness, with delayed motor development during infancy. At age 8 years, she was unable to walk, with signs of skeletal deformity, including the progression of kyphoscoliosis. At age 31 years, she developed dyspnea. DIAGNOSIS: She diagnosed with esophageal hiatal hernia with abdominal CT. In electromyography, short duration, small amplitude motor unit action potential (MUAP), and early recruitment patterns were observed in the involved proximal muscles, suggesting myopathy. Muscle histopathology showed fiber-type disproportion. INTERVENTIONS: Next-generation sequencing study revealed a heterozygous in-frame deletion variation in the exon 14 of the MYH7 gene (c.1498_1500del/p.Glu500del), which is a novel variation confirmed by conventional Sanger sequencing. Compared with the parental test, this variant was concluded as de novo. OUTCOMES: She received laparoscopic hiatal hernia repair and Nissen fundoplication for esophageal hiatal hernia. After surgery, her postural dyspnea improved. As there is no fundamental treatment for MYH7-related myopathies, she continued conservative treatment for her symptoms. CONCLUSION: Here, we presented a rare case of de novo mutation of the myosin head domain in the MYH7 gene. This report broadens both the phenotypic and genotypic spectra of MYH7-related myopathies.

The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial.

BACKGROUND: Various exercises have been proposed to mitigate chronic low back pain (LBP). However, to date, no one particular exercise has been shown to be superior. Hence, the aim of this study was to compare the efficiency between 2 exercises: the individualized graded lumbar stabilization exercise (IGLSE) and walking exercise (WE). METHODS: A randomized controlled trial was conducted in 48 participants with chronic LBP. After screening, participants were randomized to 1 of 4 groups: flexibility exercise, WE, stabilization exercise (SE), and stabilization with WE (SWE) groups. Participants underwent each exercise for 6 weeks. The primary outcome was visual analog scale (VAS) of LBP during rest and physical activity. Secondary outcomes were as follows: VAS of radiating pain measured during rest and physical activity; frequency of medication use (number of times/day); Oswestry disability index; Beck depression inventory; endurances of specific posture; and strength of lumbar extensor muscles. RESULTS: LBP during physical activity was significantly decreased in all 4 groups. Exercise frequency was significantly increased in the SE and WE groups; exercise time was significantly increased in the SE group. The endurance of supine, side lying, and prone posture were significantly improved in the WE and SWE groups. CONCLUSIONS: Lumbar SE and WE can be recommended for patients with chronic LBP because they not only relieve back pain but also prevent chronic back pain through improving muscle endurance.

The Mechanism of Hip Dislocation Related to the Use of Abduction Bar and Hip Compression Bandage in Patients With Spastic Cerebral Palsy.

OBJECTIVE: The aims of the study were to identify the differences of forces in the hip adductors between with or without the abduction bar and to evaluate the effect of hip compression bandage on the spasticity of the adductor muscles. DESIGN: Thirty-three patients with cerebral palsy (Gross Motor Functional Classification System IV and V) were prospectively included. Surface electromyography was taken by attaching electromyography on the adductor and abductor muscles. Theraband was used as hip compression bandage. Surface electromyography were taken when spasticity provoked with and without abduction bar, as well as with both abduction bar and hip compression bandage. Root mean square values were measured. RESULTS: Root mean square values were significantly increased with abduction bar in the adductor longus, adductor magnus, and tensor fascia lata muscles. Adductor Sum and Net Adduction Index showed significant increases after the use of abduction bar. After applying hip compression bandage, the Net Adduction Index was significantly decreased. CONCLUSIONS: Our results showed significant changes in the adductor muscles' amplitude, Adduction Sum, and Net Adduction Index. These results indicate that forces that worsen hip dislocation may develop, and therefore, abduction bar should either not be used for spastic cerebral palsy patients or should only be used with hip compression wrapping in place as well.

Minimalism in fabrication of self-organized nanogels holding both anti-cancer drug and targeting moiety.

Recent researches to develop nano-carrier systems in anti-cancer drug delivery have focused on more complicated design to improve therapeutic efficacy and to reduce side effects. Although such efforts have great impact to biomedical science and engineering, the complexity has been a huddle because of clinical and economic problems. In order to overcome the problems, a simplest strategy to fabricate nano-carriers to deliver doxorubicin (DOX) was proposed in the present study. Two significant subjects (i) formation of nanoparticles loading and releasing DOX and (ii) binding specificity of them to cells, were examined. Folic acid (FA) was directly coupled with pullulan (Pul) backbone by ester linkage (FA/Pul conjugate) and the degree of substitution (DS) was varied, which were confirmed by 1H NMR and UV spectrophotometry. Light scattering results revealed that the nanogels possessed two major size distributions around 70 and 270 nm in an aqueous solution. Their critical aggregation concentrations (CACs) were less than 10 microg/mL, which are lower than general critical micelle concentrations (CMCs) of low-molecular-weight surfactants. Transmission electron microscopy (TEM) images showed well-dispersed nanogel morphology in a dried state. Depending on the DS, the nanogels showed different DOX-loading and releasing profiles. The DOX release rate from FA8/Pul (with the highest DS) for 24h was slower than that from FA4/or FA6/Pul, indicating that the FA worked as a hydrophobic moiety for drug holding. Cellular uptake of the nanogels (KB cells) was also monitored by confocal microscopy. All nanogels were internalized regardless of the DS of FA. Based on the results, the objectives of this study, to suggest a new method overcoming the complications in the drug carrier design, were successfully verified.

Proposal of a new exercise protocol for idiopathic scoliosis: A preliminary study.

In clinical practice, we found a unilateral instability in patients with right thoracic scoliosis during asymmetric spinal stabilization exercise (ASSE), which can be an important clue to identify the pathophysiology of idiopathic scoliosis (IS).We investigated the relationship between unilateral postural instability and weakness of paraspinal muscles according to curve pattern. And finally, we propose the new exercise method based on the curve pattern.Combined use of prospective and retrospective clinical trials.Fifteen participants without IS and 10 patients with IS in 1 tertiary referral hospital.In 15 participants without IS, surface electromyography (sEMG) was used to evaluate the muscular activation patterns in the bilateral erector spinae (ES), rectus abdominis (RA), and external oblique (EO) muscles during ASSE. In addition, to assess the clinical effect of ASSE, Cobb angle and rotation grade were measured from 10 patients with IS.The most significant findings from the sEMG data were the increased activities of ipsilateral 7th thoracic ES during hand-up motion, ipsilateral 3rd lumbar ES during leg-up motion, and 12th thoracic and 3rd lumbar ES during side-bridging. In a radiographic analysis, specific components of ASSE that activates the concave side muscles were found to be effective for IS.The paraspinal muscle strengthening of the concave side using ASSE can improve the severity of scoliosis. Based on this research, we could propose a new exercise protocol that can be personalized according to the curve pattern.