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Background@#Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. @*Methods@#From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. @*Results@#Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). @*Conclusion@#In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.
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Background@#and Purpose Investigating the supinator muscle (SUP) is important for diagnosing radial neuropathy or cervical radiculopathy in needle electromyography (EMG). However, different authors have proposed several locations for needle EMG placement in the SUP.This study aimed to determine the optimal needle insertion position for examining the SUP via needle EMG under ultrasonographic guidance. @*Methods@#This study included 16 male (32 upper limbs) and 15 females (30 upper limbs). In the supine position, the line connecting the midpoint of the dorsal wrist to the upper margin of the radial head (RH) (RH_WRIST line) was measured while the forearm was pronated.Under ultrasonographic guidance, the thickness of the SUP was measured at 1-cm intervals from the RH to 4 cm along the RH_WRIST line. Moreover, the horizontal distance (HD) from the RH_WRIST line to the posterior interosseous nerve (PIN) and the distance from the RH to the point where the RH_WRIST line and the PIN intersected (VD_PIN_CROSS) were measured. @*Results@#VD_PIN_CROSS was 51.25±7.0 mm (mean±SD). The muscle was the thickest at 3 cm (5.6±0.8 mm) and 4 cm (5.4±1.0 mm) from the RH. The distances from the PIN to these points were 14.1±3.9 mm and 9.0±4.3 mm, respectively. @*Conclusions@#Our findings suggest that the optimal needle placement is at 3 cm from the RH.
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Purpose@#Renal injury occurs in up to 5% of trauma cases and the kidney is the third most wounded abdominal organ. The study objective was to analyze clinical characteristics of patients with blunt renal trauma and review the treatment of high-grade blunt renal injuries. @*Methods@#The medical charts of trauma patients who visited Haeundae Paik Hospital between March 2010 and February 2020 were retrospectively analyzed. Data on demographics, injury patterns, clinical presentation, management, and outcomes were analyzed. @*Results@#A total of 68 patients with renal trauma were included in this study. The most common renal injury was Grade III (n = 27, 39.7%). Falling was the predominant mechanism of injury (n = 33, 48.5%), and 23.5% (n = 16) of patients sustained isolated renal trauma. Organ damage related to kidney injury included chest injury (57.4%, n = 39) and abdominal or pelvic content injury (48.5%, n = 33). The overall mortality rate was 2.9% (n = 2). There were 45 cases of high-grade renal trauma (AAST Kidney injury scale Grade Ш-V). There was no statistical difference in the outcomes of high-grade (n = 44, 97.8%) and low-grade (n = 23, 100%) renal trauma patients who received nonoperative treatment (p = 0.511). Variables did not differ significantly, except for the injury severity score which was statistically significantly different between low-grade and high-grade renal trauma patients (p = 0.001). @*Conclusion@#Most patients with traumatic renal injury, even those with high-grade injury, can be managed by nonoperative treatment, and have a good prognosis.
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Objective@#This study aimed to predict the injury risk to attendants by simulating and analyzing the joint moment that occurs during wheelchair transportation for five different ramp ratios and five different velocities. Method: Three-dimensional musculoskeletal models and rigid structure of a standard wheelchair were developed using the AnyBody Modeling System. The ramp ratio was set to 1：6 (the steepest), 1：8, 1：10, 1：12, and 1：14 (the gentlest). The wheelchair speeds were set to 0.4, 0.5, 0.6, 0.7, and 0.8 m/s. Both the uphill and downhill movement conditions were investigated. @*Results@#Most of the joint moments that occur in the wrist joint, elbow and shoulder while driving uphill increased or decreased proportionally to the slope and speed of the ramp. However, the external moment of the wrist occurring downhill was largely influenced by the slope, and the joint moment of the shoulder showed a dynamic pattern of change in the middle of the ramp in spite of constant driving speed. @*Conclusion@#The influence that occurs during deceleration while wheelchair driving on a ramp is primarily on the proximal shoulder joint, and the influence of the release control in the middle of driving primarily causes loads on the distal wrist and forearm. A high risk of damage exists because the moment change value of the load on the shoulder joint is relatively large and increases with inclination. The increase in wrist abduction moment for deceleration while driving downhill also suggests the possibility of damage.
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Background@#and Purpose Diagnosing ulnar neuropathy at the wrist (UNW) is often challenging, and performing several short segmental studies have been suggested for achieving this. We aimed to determine the utility of ulnar nerve segmental studies at the wrist (UNSWs) in patients with suspected UNW. @*Methods@#Fourteen patients with typical symptoms of unilateral UNW were evaluated using conventional electrophysiological tests, UNSWs, and ultrasonography (US). In UNSWs, the ulnar nerve was stimulated at three sites (3 cm distal, just lateral, and 2 cm proximal to the pisiform), and recordings were made at the first dorsal interosseous (FDI) muscle and the fifth digit. Four types of UNW were identified by conventional ulnar nerve conduction studies based on motor and sensory fiber involvement. UNW was also categorized as either a proximal or distal lesion relative to the pisiform based on the UNSWs. The relationships between the conventional electrophysiological type, UNSW categorization results, and lesion location as verified by US were analyzed. @*Results@#Proximal UNW lesions were associated with involvement of the entire deep motor and the superficial sensory fibers (type I). Distal lesions were more closely related to deep motor fibers that innervated the FDI (type III). All five proximal and six distal lesions seen in US matched the lesion locations found on UNSWs. @*Conclusions@#Motor and sensory UNSW are considered useful assistive techniques for diagnosing UNW and localizing its lesion sites.
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Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have recently been established as a biomarker for MOG-antibody-associated disease (MOGAD), which is a distinct demyelinating disease of the central nervous system. Among the diverse clinical phenotypes of MOGAD, myelitis is the second-most-common presentation in adults, followed by optic neuritis. While some features overlap, there are multiple reports of distinctive clinical and radiological features of MOG-IgG-associated myelitis, which are useful for differentiating MOGAD from both multiple sclerosis and neuromyelitis optica spectrum disorder. In this review we summarize the clinical and radiographic characteristics of MOG-IgG-associated myelitis with a particular focus on adult patients.
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Purpose@#Proper use of antibiotics during emergency abdominal surgery is essential in reducing the incidence of surgical site infection. However, no studies have investigated the type of antibiotics and duration of therapy in individuals with abdominal trauma in Korea. We aimed to investigate the status of initial antibiotic therapy in patients with solitary abdominal trauma. @*Methods@#From January 2015 to December 2015, we retrospectively analyzed the medical records of patients with solitary abdominal trauma from 17 institutions including regional trauma centers in South Korea. Both blunt and penetrating abdominal injuries were included. Time from arrival to initial antibiotic therapy, rate of antibiotic use upon injury mechanism, injured organ, type, and duration of antibiotic use, and postoperative infection were investigated. @*Results@#Data of the 311 patients were collected. The use of antibiotic was initiated in 96.4% of patients with penetrating injury and 79.7% with blunt injury. Initial antibiotics therapy was provided to 78.2% of patients with solid organ injury and 97.5% with hollow viscus injury. The mean day of using antibiotics was 6 days in solid organ injuries, 6.2 days in hollow viscus. Infection within 2 weeks of admission occurred in 36 cases. Infection was related to injury severity (Abbreviated Injury Scale of >3), hollow viscus injury, operation, open abdomen, colon perforation, and RBC transfusion. There was no infection in cases with laparoscopic operation. Duration of antibiotics did not affect the infection rate. @*Conclusion@#Antibiotics are used extensively (84.2%) and for long duration (6.2 days) in patients with abdominal injury in Korea.
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Background@#and Purpose A major concern with ocular myasthenia gravis (MG) is the potential conversion to generalized MG. This study was conducted to determine if the repetitive nerve stimulation (RNS) test could predict the conversion from ocular to generalized MG. @*Methods@#The RNS test was conducted in a consistent manner on five muscles in the face and limbs in every patient. Subjects were divided into those who remained as ocular MG (ROMG group) and those who experienced conversion to generalized MG during follow-up (GOMG group). @*Results@#Conversion to generalized MG occurred in 24 (21.4%) of 112 MG patients with ocular onset. The proportion of patients displaying abnormal decreases in responses in the trapezius, abductor digiti minimi, or flexor carpi ulnaris muscles on the RNS test was higher in the GOMG group (p<0.001,p=0.002, and p<0.001, respectively). The Cox proportional-hazards model revealed that an abnormal result on the RNS test was significantly associated with conversion to generalized MG [hazard ratio (HR)=3.13, 95% confidence interval (CI)=1.18– 8.32]. Notably, the HR was higher for abnormal results on the RNS test for the limb muscles, at 5.19 (95% CI=2.09–12.90). @*Conclusions@#An abnormal result on the RNS test, especially in the limb muscles, is an independent predictor of the conversion from ocular to generalized MG. Applying the RNS test to limb muscles could be useful for predicting the conversion to generalized MG in patients with ocular onset.
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Background@#and Purpose A major concern with ocular myasthenia gravis (MG) is the potential conversion to generalized MG. This study was conducted to determine if the repetitive nerve stimulation (RNS) test could predict the conversion from ocular to generalized MG. @*Methods@#The RNS test was conducted in a consistent manner on five muscles in the face and limbs in every patient. Subjects were divided into those who remained as ocular MG (ROMG group) and those who experienced conversion to generalized MG during follow-up (GOMG group). @*Results@#Conversion to generalized MG occurred in 24 (21.4%) of 112 MG patients with ocular onset. The proportion of patients displaying abnormal decreases in responses in the trapezius, abductor digiti minimi, or flexor carpi ulnaris muscles on the RNS test was higher in the GOMG group (p<0.001,p=0.002, and p<0.001, respectively). The Cox proportional-hazards model revealed that an abnormal result on the RNS test was significantly associated with conversion to generalized MG [hazard ratio (HR)=3.13, 95% confidence interval (CI)=1.18– 8.32]. Notably, the HR was higher for abnormal results on the RNS test for the limb muscles, at 5.19 (95% CI=2.09–12.90). @*Conclusions@#An abnormal result on the RNS test, especially in the limb muscles, is an independent predictor of the conversion from ocular to generalized MG. Applying the RNS test to limb muscles could be useful for predicting the conversion to generalized MG in patients with ocular onset.
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Purpose@#This study aimed to independently analyze pediatric trauma characteristics from a single institution in Korea to gain a better understanding of pediatric injury. @*Methods@#A retrospective review was conducted at a single, non-regional trauma center using data from 303 children (< 8 years) who presented at the emergency department (March 2010 to December 2018), to determine the frequency and details of admissions. Demographic variables [sex, age, mechanism of injury, regions of trauma on the body, score of the injury (abbreviated injury scale)] location where the trauma occurred, injury severity score, history of surgery, mortality, and cumulative length of hospital stay], were used to evaluate the severity of the trauma. @*Results@#The frequency of admissions was typically high for all seasons except winter. The most common mechanism of injury was due to falls; however, this was not the case for 1-, 2-, and 4-yearolds. The most common location where trauma occurred was at home for the age group 1-3 years, and outside the home for children aged 4 years or older. The most common area of injury was the extremities (65.7%). The median injury severity score was 4 (range, 4-4), and the median hospital stay was 4 days (range, 2-6). The overall mortality rate was 0.3%. @*Conclusion@#Although mortality from trauma is low among pediatric patients, we must continue to improve treatment outcomes. Hospitals lack sufficient resources for pediatric trauma specialists, however to improve patient outcome, it is necessary to recognize age-specific trauma characteristics.
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Pyometra is a rare condition that is defined as the accumulation of purulent material in the uterine cavity caused by an occlusion to the natural drainage of the uterus. Pyometra cases are seldom reported. The symptoms of pyometra may be non-specific, resulting in a delay or misdiagnosis that may subsequently increase the risk of perforation of the pyometra. Once a pyometra ruptures, the patient develops acute abdominal and generalized peritonitis. This case report describes diffuse peritonitis caused by the spontaneous perforation of a pyometra in a woman who was diagnosed preoperatively and treated successfully by emergency laparotomy.
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Purpose@#This study aimed to independently analyze pediatric trauma characteristics from a single institution in Korea to gain a better understanding of pediatric injury. @*Methods@#A retrospective review was conducted at a single, non-regional trauma center using data from 303 children (< 8 years) who presented at the emergency department (March 2010 to December 2018), to determine the frequency and details of admissions. Demographic variables [sex, age, mechanism of injury, regions of trauma on the body, score of the injury (abbreviated injury scale)] location where the trauma occurred, injury severity score, history of surgery, mortality, and cumulative length of hospital stay], were used to evaluate the severity of the trauma. @*Results@#The frequency of admissions was typically high for all seasons except winter. The most common mechanism of injury was due to falls; however, this was not the case for 1-, 2-, and 4-yearolds. The most common location where trauma occurred was at home for the age group 1-3 years, and outside the home for children aged 4 years or older. The most common area of injury was the extremities (65.7%). The median injury severity score was 4 (range, 4-4), and the median hospital stay was 4 days (range, 2-6). The overall mortality rate was 0.3%. @*Conclusion@#Although mortality from trauma is low among pediatric patients, we must continue to improve treatment outcomes. Hospitals lack sufficient resources for pediatric trauma specialists, however to improve patient outcome, it is necessary to recognize age-specific trauma characteristics.
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Pyometra is a rare condition that is defined as the accumulation of purulent material in the uterine cavity caused by an occlusion to the natural drainage of the uterus. Pyometra cases are seldom reported. The symptoms of pyometra may be non-specific, resulting in a delay or misdiagnosis that may subsequently increase the risk of perforation of the pyometra. Once a pyometra ruptures, the patient develops acute abdominal and generalized peritonitis. This case report describes diffuse peritonitis caused by the spontaneous perforation of a pyometra in a woman who was diagnosed preoperatively and treated successfully by emergency laparotomy.
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Extracellular vesicles (EVs) are nano-sized particles secreted by almost all cell types, and they mediate various biological processes via cell-to-cell communication. Compared with parental cells for therapeutic purposes, stem cell-derived EVs have several advantages such as reduced risk of rejection, less oncogenic potential, ease of long-term storage, lower chance of thromboembolism, and readiness for immediate use. Recent studies have demonstrated that EVs from stem cells, mostly from mesenchymal stem cells (MSCs) from various tissues, have anti-inflammatory, anti-oxidative, anti-apoptotic, and proliferative role in injured organs including osteoarthritic lesions. Herein, we provide a review about the up-to-date studies in preclinical application of stem cell-derived EVs in osteoarthritis animal arthritis models.
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Purpose@#Adenocarcinoma is an extremely rare malignancy in the pediatric population. Research regarding pediatric adenocarcinoma is very rare in Korea. This study aimed to investigate the clinical features of pediatric adenocarcinomas of various primary organ sites in Korea. @*Materials and Methods@#Pediatric patients under 18 years, diagnosed with adenocarcinoma of various sites between January 1995 and December 2016, were included. We retrospectively reviewed patient and tumor characteristics and calculated survival estimates, reported as 5-year survival rate and 95% confidence interval. @*Results@#Of 80 patients (median age, 15 years; range, 10 to 17 years), 37 (46.3%) were men, and 24 (30%) had a family history of cancer or underlying disease relevant to malignancy. The cancer locations were the colon and rectum (n=32), ovaries (n=18), stomach (n=15), lung (n=4), small bowel (n=1), and other sites (n=10). Totally, 54.8% patients (42/77) had stage 3 or 4 disease. The median follow-up period was 2.0 years (range, 0 to 20.4). The 5-year overall survival estimate for all patients, and for those with stomach, colorectal, ovarian, and other cancer sites were 57.9%±11.5%, 58.2%±25.7%, 41.5%±18.2%, 87.5%±16.2%, and 64.0%±34.4%, respectively. The 5-year survival rate differed significantly between categories of adenocarcinomas into gastrointestinal (GI) (44.7%) and non-GI adenocarcinomas (78.8%) (p=0.007). The 5-year survival rate also differed significantly according to carcinoembryonic antigen level (69.3% in 3 ng/mL; p < 0.001). @*Conclusion@#In pediatric patients, adenocarcinomas arise from various organs and are often diagnosed at advanced stages. Large, prospective studies for their accurate clinical characteristics and prognostic factors are needed.
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PURPOSE: Adrenal gland injuries in trauma are rare and usually misdiagnosed or underestimated in an emergency setting because they are asymptomatic and associated with severe abdominal injuries. This paper reviews the clinical characteristics of adrenal injuries. METHODS: A retrospective analysis of trauma patients who visited the authors' emergency center was performed from March, 2010 to December, 2017. The patient demographic data, injury mechanism & associated injuries, injury severity score, hospital stay, and mortality were retrieved and analyzed. RESULTS: Adrenal gland injuries were found in 52 patients: 73.1% (n=38) were males and the mean age was 43.6 years. Of the patients, 84.6% (n=44) had ISS ≥15. Right adrenal gland injuries occurred in 82.7% (n=43). The mechanism of injury was falls in 30.8% (n=16), motor vehicle accidents in 25.0% (n=13), and pedestrian accidents in 23.1% (n=12). Associated injures were liver injury (58.5%), rib fracture (52.8%), kidney injury (24.5%), pelvic bone fracture (20.8%), spine fracture (28.3%), and spleen injury (13.2%). The mean hospital stay was 34.2 days, and the intensive care unit stay was 9 days. The mortality rate was 3.8% (n=2). CONCLUSION: Adrenal gland injuries are common in males and frequent in the right side. Falls are the leading cause of injury. Most injuries have an associated injury at the abdominal or thoracic region. Adrenal injury is accompanied by high injury severity but showed a good prognosis.
Subject(s)
Humans , Male , Abdominal Injuries , Accidental Falls , Adrenal Glands , Emergencies , Injury Severity Score , Intensive Care Units , Kidney , Length of Stay , Liver , Mortality , Motor Vehicles , Pelvic Bones , Prognosis , Retrospective Studies , Rib Fractures , Spine , SpleenABSTRACT
OBJECTIVE: To present the branching patterns and anatomical course of the common fibular nerve (CFN) and its relationship with fibular head (FH).METHODS: A total of 21 limbs from 12 fresh cadavers were dissected. The FH width (FH_width), distance between the FH and CFN (FH_CFN), and thickness of the nerve were measured. The ratio of the FH_CFN to FH_width was calculated as follows: < 1, cross type and ≥1, posterior type. Angle between the CFN and vertical line of the lower limb 5 cm proximal to the tip of the FH was measured. Branching patterns of the lateral cutaneous nerve of the calf (LCNC) were classified into four types according to its origin and direction as follows: type 1a, lateral margin of the CFN; type 1b, medial margin of the CFN; type 2, lateral sural cutaneous nerve (LSCN); and type 3, CFN and LSCN.RESULTS: In the cross type (15 cases, 71.4%), the ratio of FH_CFN/FH_width was 0.83 and the angle was 13.0°. In the posterior type (6 cases, 28.6%), the ratio was 1.04 and the angle was 11.0°. In the branching patterns of LCNC, type 2 was the most common (10 cases), followed by types 1a and 1b (both, 5 cases).CONCLUSION: Location of the CFN around the FH might be related to the development of its neuropathy, especially in the cross type of CFN. The LCNC showed various branching patterns and direction, which could be associated with difficulties of electrophysiologic testing.
Subject(s)
Cadaver , Extremities , Fibula , Head , Lower Extremity , Peroneal NerveABSTRACT
Ulnar neuropathy at the wrist is an uncommon disease and pure ulnar sensory neuropathy at the wrist is even rarer. It is difficult to diagnose pure ulnar sensory neuropathy at the wrist by conventional methods. We report a case of pure ulnar sensory neuropathy at the hypothenar area. The lesion was localized between 3 cm and 5 cm distal to pisiform using orthodromic inching test of ulnar sensory nerve to stimulate at three points around the hypothenar area. Ultrasonographic examination confirmed compression of superficial sensory branch of the ulnar nerve. Further, surgical exploration reconfirmed compression of the ulnar nerve. This case report demonstrates the utility of orthodromic ulnar sensory inching test.
Subject(s)
Diagnosis , Electrodiagnosis , Neural Conduction , Ulnar Nerve , Ulnar Nerve Compression Syndromes , Ulnar Neuropathies , WristABSTRACT
Unverricht-Lundborg disease (ULD) is a form of progressive myoclonus epilepsy characterized by stimulation-induced myoclonus and seizures. This disease is an autosomal recessive disorder, and the gene CSTB, which encodes cystatin B, a cysteine protease inhibitor, is the only gene known to be associated with ULD. Although the prevalence of ULD is higher in the Baltic region of Europe and the Mediterranean, sporadic cases have occasionally been diagnosed worldwide. The patient described in the current report showed only abnormally enlarged restriction fragments of 62 dodecamer repeats, confirming ULD, that were transmitted from both her father and mother who carried the abnormally enlarged restriction fragment as heterozygotes with normal-sized fragments. We report the first case of a genetically confirmed patient with ULD in Korea.
Subject(s)
Humans , Blotting, Southern , Cystatin B , Cysteine Proteases , Diagnosis , Europe , Fathers , Heterozygote , Korea , Mothers , Myoclonic Epilepsies, Progressive , Myoclonus , Prevalence , Seizures , Unverricht-Lundborg SyndromeABSTRACT
OBJECTIVE: To identify the center of extensor indicis (EI) muscle through cadaver dissection and compare the accuracy of different techniques for needle electromyography (EMG) electrode insertion. METHODS: Eighteen upper limbs of 10 adult cadavers were dissected. The center of trigonal EI muscle was defined as the point where the three medians of the triangle intersect. Three different needle electrode insertion techniques were introduced: M1, 2.5 cm above the lower border of ulnar styloid process (USP), lateral aspect of the ulna; M2, 2 finger breadths (FB) proximal to USP, lateral aspect of the ulna; and M3, distal fourth of the forearm, lateral aspect of the ulna. The distance from USP to the center (X) parallel to the line between radial head to USP, and from medial border of ulna to the center (Y) were measured. The distances between 3 different points (M1– M3) and the center were measured (marked as D1, D2, and D3, respectively). RESULTS: The median value of X was 48.3 mm and that of Y was 7.2 mm. The median values of D1, D2 and D3 were 23.3 mm, 13.3 mm and 9.0 mm, respectively. CONCLUSION: The center of EI muscle is located approximately 4.8 cm proximal to USP level and 7.2 mm lateral to the medial border of the ulna. Among the three methods, the technique placing the needle electrode at distal fourth of the forearm and lateral to the radial side of the ulna bone (M3) is the most accurate and closest to the center of the EI muscle.