Effects of Kinesio Taping on Balance and Gait in Patients withStroke: A Systematic Review and Meta-Analysis of Studies inKorea

Purpose@#The objective of this study was to investigate the effects of Kinesio taping (KT) for balance and gait in patients with stroke through meta-analysis of studies conducted in Korea. @*Methods@#RISS, Science on, and DBPia were the three databases used to collect articles on KT. Keywords such as “Stroke,” “Kinesio taping,” “Elasticity taping,” and “Taping” were used to search for published articles. We systematically searched from the inception of each database to November 2020. Interventions and comparisons were KT and without KT. Outcome measures were the timed up and go (TUG) and 10-meter walking tests (10MWT). Consequently, six studies were selected for the second screening using meta-analyses. @*Results@#Based on the results of the meta-analysis, comparison between patients with and without KT showed that KT was effective for TUG (ES: 2.51, 95% CI: 2.12 to 2.90); however, it was not effective for 10MWT (ES: 0.79, 95% CI: -0.04 to 1.62). @*Conclusion@#The current evidence suggests that KT is more effective than without KT interventions for balance function in post-strokepatients. However, more well-conducted randomized controlled trials are required in the future.

Effects of Kinesio Taping on Balance and Gait in Patients withStroke: A Systematic Review and Meta-Analysis of Studies inKorea

Purpose@#The objective of this study was to investigate the effects of Kinesio taping (KT) for balance and gait in patients with stroke through meta-analysis of studies conducted in Korea. @*Methods@#RISS, Science on, and DBPia were the three databases used to collect articles on KT. Keywords such as “Stroke,” “Kinesio taping,” “Elasticity taping,” and “Taping” were used to search for published articles. We systematically searched from the inception of each database to November 2020. Interventions and comparisons were KT and without KT. Outcome measures were the timed up and go (TUG) and 10-meter walking tests (10MWT). Consequently, six studies were selected for the second screening using meta-analyses. @*Results@#Based on the results of the meta-analysis, comparison between patients with and without KT showed that KT was effective for TUG (ES: 2.51, 95% CI: 2.12 to 2.90); however, it was not effective for 10MWT (ES: 0.79, 95% CI: -0.04 to 1.62). @*Conclusion@#The current evidence suggests that KT is more effective than without KT interventions for balance function in post-strokepatients. However, more well-conducted randomized controlled trials are required in the future.

Efficacy and Safety of Voglibose Plus Metformin in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial

BACKGROUND: Combination of metformin to reduce the fasting plasma glucose level and an α-glucosidase inhibitor to decrease the postprandial glucose level is expected to generate a complementary effect. We compared the efficacy and safety of a fixed-dose combination of voglibose plus metformin (vogmet) with metformin monotherapy in drug-naïve newly-diagnosed type 2 diabetes mellitus. METHODS: A total of 187 eligible patients aged 20 to 70 years, with a glycosylated hemoglobin (HbA1c) level of 7.0% to 11.0%, were randomized into either vogmet or metformin treatments for 24 weeks. A change in the HbA1c level from baseline was measured at week 24. RESULTS: The reduction in the levels of HbA1c was −1.62%±0.07% in the vogmet group and −1.31%±0.07% in the metformin group (P=0.003), and significantly more vogmet-treated patients achieved the target HbA1c levels of <6.5% (P=0.002) or <7% (P=0.039). Glycemic variability was also significantly improved with vogmet treatment, estimated by M-values (P=0.004). Gastrointestinal adverse events and hypoglycemia (%) were numerically lower in the vogmet-treated group. Moreover, a significant weight loss was observed with vogmet treatment compared with metformin (−1.63 kg vs. −0.86 kg, P=0.039). CONCLUSION: Vogmet is a safe antihyperglycemic agent that controls blood glucose level effectively, yields weight loss, and is superior to metformin in terms of various key glycemic parameters without increasing the risk of hypoglycemia.

Effects of Fast Treadmill Training on Spinal Alignment and Muscles Thickness

PURPOSE: This study examined the effects of fast walking training on a treadmill on the spinal alignment and muscle thickness of normal adults. METHODS: A total of 36 college students in their twenties participated in the study for eight weeks, and they were divided into the normal walking, fast walking, and speed change groups. All the groups were measured in a pre-test before training. The subjects performed exercise three times per week for six weeks. A post-test was conducted six weeks after training began, and a follow-up test was done two weeks after the training ended.Trunk and pelvic tilts were measured in Formetric 4D for the spinal alignment of the subjects. The muscle thickness was examined in the trunk with an ultrasound test. Repeated-measures ANOVA was conducted to test the main effects and interactions among the measurement variables according to time and group. RESULTS: ignificant differences were observed in the pelvic tilt according to time. There were significant differences in the external oblique, internal oblique, transverse abdominal muscle according to time. The post-test results showed significant differences in the left external oblique, internal oblique muscles between before training, six weeks into training, and two weeks after the completion of training. There were significant interactions in the left oblique muscles according to the time and group. CONCLUSION: These findings have some value for patient rehabilitation and clinical applications and interventions through walking training.

Effect of Kettle Bell Swing Exercise on the Body Composition and Lower Limb Muscular Activity

PURPOSE: This study examined the effect of Kettle bell swing exercise on the body composition and lower limb muscular activity. METHODS: As subjects, 26 normal adults in their twenties were divided randomly into the experiment group (n=13), in which Kettle bell exercise was applied, and the control group (n=13), in which bar exercise was applied. Both groups participated in the interventions for eight weeks with three sessions per week. Each group was assessed before training and four and eight weeks into the training to determine the effects of training intervention within and between the groups. The body composition was measured with a body composition analyzer. The changes in muscle activity were measured with a surface electromyography. An independent t-test was conducted to test the significance between the groups according to the measurement points and Repeated measured ANOVA was performed to compare the groups according to the periods with the statistical significance level set to α=0.05. RESULTS: No significant changes to the main effects of time and the interactions of time according to the measurement points were observed in the Kettle bell and control groups in the body composition (p>0.05). The muscular activity of both muscles were significantly different between the Kettle bell and control groups according to the measurement points with the exception of the right lateral gastrocnemius muscle (p<0.05). CONCLUSION: These findings suggest that Kettle bell swing exercise can have positive effects on the development of lower limb muscles.

Early Management of Scars Using a 532-nm Nd:YAG Laser

BACKGROUND: Laser therapy is generally postponed until scar maturation. We speculated that the use of laser therapy at the beginning of the wound healing process might minimize discomfort and problems at an early stage. METHODS: From January 2013 to May 2014, we conducted a study of 50 patients who underwent primary closure or scar revision procedures due to facial scarring. Within 1 to 2 weeks after the removal of all stitches, we performed laser treatments with a 532-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser. To assess the improvement of the scars, we evaluated the scars using the Vancouver Scar Scale (VSS) and conducted a photo analysis using a computer graphics program. RESULTS: The mean score on the VSS decreased from 5.99 to 1.49 after the laser treatment. The score for each evaluation item decreased, meaning that the scars improved. The differences showed statistical significance. In the photo analysis that was conducted using Adobe Photoshop, the mean brightness of the pixels located within the scar territory increased from 61.54% to 69.42% after laser treatment, and the mean chroma decreased from 50.65% to 43.12%. These changes were statistically significant. CONCLUSIONS: We used a 532-nm Nd:YAG laser at an early stage of scar formation and confirmed improvements in the redness, hyperpigmentation, and hypertrophy of the scars shortly after treatment.

Comparison of the Amount of Drainage in 3 Acellular Dermal Matrices in Implant-Based Breast Reconstruction: A Retrospective Study

BACKGROUND: Acellular dermal matrix (ADM)-assisted breast reconstruction has gained popularity because it has several advantages. Some studies have reported that the use of ADM was strongly associated with postoperative complications, especially seroma formation. We performed direct-to-implant breast reconstruction using 3 types of human allograft products (CGDerm®, AlloDerm®, and MegaDerm®). The purpose of this study was to obtain information useful for the selection of an ADM product by comparing the amount of collected serum and the maintenance period of the drain. METHODS: Seventy-three patients with breast cancer who underwent ADM-assisted implant breast reconstruction between March 2011 and January 2016 were included in this study. The patients were divided into 3 groups based on the type of ADM that was used. The demographic characteristics collected were: age, body mass index (BMI), breast reconstruction location, smoking history, axillary dissection, comorbidities (such as hypertension and diabetes mellitus [DM]), breast implant size, breast implant type, amount of ADM, the total amount of serum that was collected in the drain, and the maintenance period of the drain. RESULTS: We obtained significant results after adjusting for variables including age, BMI, DM, axillary dissection, ADM amount, and breast implant size. Compared to AlloDerm, MegaDerm showed a significantly smaller amount of total drained serum and a significantly shorter drain maintenance period. CONCLUSIONS: The use of MegaDerm led to smaller amounts of drained serum and a shorter drain maintenance period than when AlloDerm was used. In contrast, no significant differences were found between CGDerm and AlloDerm, or between CGDerm and MegaDerm.

Early Management of Scars Using a 532-nm Nd:YAG Laser

BACKGROUND: Laser therapy is generally postponed until scar maturation. We speculated that the use of laser therapy at the beginning of the wound healing process might minimize discomfort and problems at an early stage. METHODS: From January 2013 to May 2014, we conducted a study of 50 patients who underwent primary closure or scar revision procedures due to facial scarring. Within 1 to 2 weeks after the removal of all stitches, we performed laser treatments with a 532-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser. To assess the improvement of the scars, we evaluated the scars using the Vancouver Scar Scale (VSS) and conducted a photo analysis using a computer graphics program. RESULTS: The mean score on the VSS decreased from 5.99 to 1.49 after the laser treatment. The score for each evaluation item decreased, meaning that the scars improved. The differences showed statistical significance. In the photo analysis that was conducted using Adobe Photoshop, the mean brightness of the pixels located within the scar territory increased from 61.54% to 69.42% after laser treatment, and the mean chroma decreased from 50.65% to 43.12%. These changes were statistically significant. CONCLUSIONS: We used a 532-nm Nd:YAG laser at an early stage of scar formation and confirmed improvements in the redness, hyperpigmentation, and hypertrophy of the scars shortly after treatment.

Comparison of the Amount of Drainage in 3 Acellular Dermal Matrices in Implant-Based Breast Reconstruction: A Retrospective Study

BACKGROUND: Acellular dermal matrix (ADM)-assisted breast reconstruction has gained popularity because it has several advantages. Some studies have reported that the use of ADM was strongly associated with postoperative complications, especially seroma formation. We performed direct-to-implant breast reconstruction using 3 types of human allograft products (CGDerm®, AlloDerm®, and MegaDerm®). The purpose of this study was to obtain information useful for the selection of an ADM product by comparing the amount of collected serum and the maintenance period of the drain. METHODS: Seventy-three patients with breast cancer who underwent ADM-assisted implant breast reconstruction between March 2011 and January 2016 were included in this study. The patients were divided into 3 groups based on the type of ADM that was used. The demographic characteristics collected were: age, body mass index (BMI), breast reconstruction location, smoking history, axillary dissection, comorbidities (such as hypertension and diabetes mellitus [DM]), breast implant size, breast implant type, amount of ADM, the total amount of serum that was collected in the drain, and the maintenance period of the drain. RESULTS: We obtained significant results after adjusting for variables including age, BMI, DM, axillary dissection, ADM amount, and breast implant size. Compared to AlloDerm, MegaDerm showed a significantly smaller amount of total drained serum and a significantly shorter drain maintenance period. CONCLUSIONS: The use of MegaDerm led to smaller amounts of drained serum and a shorter drain maintenance period than when AlloDerm was used. In contrast, no significant differences were found between CGDerm and AlloDerm, or between CGDerm and MegaDerm.

The Lazy S Design: A Novel Skin Closure Design in Skin-Sparing Mastectomy for Implant-Based Breast Reconstruction

Preservation of the breast skin envelope during immediate implant-based breast reconstruction is important for producing symmetrical and natural-looking breasts. We propose the lazy S design for the closure of round-shaped wounds with the hope of improving the aesthetic outcomes and reducing the tension on the wound by preserving the skin. Additionally, the direction of tension is dispersed due to the shape of this design. Patients undergoing implant reconstruction after skin-sparing mastectomy may benefit from the lazy S design.

Serum Chemerin Levels Are Associated with Abdominal Visceral Fat in Type 2 Diabetes

Chemerin is a recently identified adipokine suggested to play a role in obesity and its metabolic complications. The relationship between visceral obesity and serum chemerin levels in type 2 diabetes (T2DM) is unknown and may differ from that of subjects without diabetes. Therefore, we evaluated whether serum chemerin was associated with visceral abdominal obesity in patients with T2DM. A total of 218 Korean patients with T2DM were enrolled and metabolic parameters, abdominal visceral and subcutaneous fat areas, and serum chemerin levels were measured. Serum chemerin level showed positive correlation with fasting insulin, HOMA-IR, serum triglyceride, serum creatinine, urine albumin/creatinine ratio, high-sensitivity C-reactive protein (hsCRP), fibrinogen, abdominal visceral fat area, visceral to subcutaneous fat area ratio, and negatively correlation with high density lipoprotein cholesterol and creatinine clearance (CCr) after adjusting for age, gender and body mass index. Multiple linear stepwise regression analysis showed that abdominal visceral fat area (β = 0.001, P < 0.001), serum triglyceride (β = 0.001, P < 0.001), CCr (β = -0.003, P = 0.001), hsCRP (β = 0.157, P = 0.001), fibrinogen (β = 0.001, P < 0.001) and BMI (β = 0.02, P = 0.008) independently affected log transformed serum chemerin levels. Higher serum chemerin level was associated with higher level of abdominal visceral fat area, serum triglyceride, hsCRP and fibrinogen and lower level of CCr in patients with T2DM. Serum chemerin may be used as a biomarker of visceral adiposity and chemerin may play a role in inflammation, decreased renal function, and increased cardiovascular risk in T2DM.

Two Cases of Phlegmonous Esophagogastritis in New Onset Type 2 Diabetes / 임상당뇨병

Phlegmonous esophagogastritis is a rare bacterial infection that has been reported to result in mortality. The pathophysiology of phlegmonous gastrointestinal infection is unclear, but some predisposing factors are reported. Those include immunocompromised status, alcohol abuse, malignancy and uncontrolled diabetes mellitus. We report two cases of phlegmonous esophagogastritis with newly diagnosed diabetes mellitus. A 26-year-old woman and a 56-year-old woman individually visited our hospital for sore throat, neck pain and fever. The laboratory findings of both patients demonstrated leukocytosis, and elevated serum glucose levels. HbA1c of both patients was above 11%. Enhanced computed tomography of young woman showed submucosal edema with intramural abscess along the esophagus and stomach, and that of older woman showed the same defined to esophagus. In both cases, empirical antibiotic therapy with intravenous third generation cephalosporin and metronidazole were started. Later, we identified Klebsiella pneumonia through pus culture in both cases. The symptoms of case 1 improved with conservative management with antibiotics only. However, case 2 required surgical drainage and esophagectomy. Early radiologic diagnosis of this disease and accurate identification of pathogens are important factors for good prognosis. Therefore, we emphasize suspicion of such a rare disease is needed, especially when the patient has risk factors such as diabetes mellitus.

Change of Bone Mineral Density and Biochemical Markers of Bone Turnover in Patients on Suppressive Levothyroxine Therapy for Differentiated Thyroid Carcinoma

Untreated hyperthyroidism and high-dose thyroid hormone are associated with osteoporosis, and increased bone mineral density (BMD) has been demonstrated in postmenopausal females with hypoparathyroidism. Studies on the effect of suppressive levothyroxine (LT4) therapy on BMD and bone metabolism after total thyroidectomy in patients with differentiated thyroid carcinoma have presented conflicting results, and few studies in relation to the status of hypoparathyroidism have been studied. One hundred postmenopausal women and 24 premenopausal women on LT4 suppression therapy were included in this study. BMD of lumbar spine and femur and bone turnover markers were measured at the baseline and during the follow-up period up to 18 months using dual energy X-ray absorptiometry. Biochemical marker of bone resorption was measured by urine deoxypyridinoline and bone formation by serum osteocalcin. The age ranged from 36 to 64 years old. Thyroid stimulating hormone (TSH) was suppressed during the study. The results showed that BMD of femur and lumbar spine were not significantly changed in both pre- and postmenopausal women except femur neck in postmenopausal women without hypoparathyroidism. Patients with hypoparathyroidism had higher BMD gain than those without hypoparathyroidism in total hip (1.25 vs. -1.18%, P=0.015). Biochemical markers of bone turnover, serum osteocalcin, and urine deoxypyridinoline did not show significant change. In conclusion, patients with well differentiated thyroid carcinoma are not at a great risk of bone loss after LT4 suppressive therapy. The state of hypoparathyroidism is associated with increased BMD, particularly in postmenopausal women.

Metformin-Associated Lactic Acidosis: Predisposing Factors and Outcome

BACKGROUND: Metformin is considered the first choice oral treatment for type 2 diabetes patients in the absence of contraindications. Rarely, life-threatening complications associated with metformin treatment are seen in some patients with underlying diseases. The aim of this study was to further investigate the clinical profiles and risk factors for metformin-associated lactic acidosis (MALA) and the treatment modalities according to survival. METHODS: To identify MALA, we performed a retrospective study in seven diabetic patients who were taking metformin and had been diagnosed with lactic acidosis at Inha University Hospital between 1995 and 2012. For each patient, we recorded the age, sex, daily metformin dosage, laboratory test results, admission diagnosis, and risk factors. Also, concurrent conditions, treatment modalities, and outcomes were evaluated. RESULTS: Six patients had risk factors for lactic acidosis before admission. All patients had renal impairment on admission as a precipitating risk factor. Five patients survived and two patients died despite early renal replacement therapy. Older patients tended to have a poorer prognosis. CONCLUSION: Renal function must be monitored in elderly type 2 diabetes mellitus patients with underlying diseases and conditions causing renal impairment who begin metformin treatment. Accurate recognition of MALA and initiation of renal replacement are essential for treatment.

A Case of Functioning Paraganglioma Mimicking Anaphylactic Shock: A Case Report / 대한구급학회지

Paraganglioma is a tumor originating from the extra-adrenal chromaffin cells, and functional paraganglioma causes paroxysmal hypertension, headache and tachycardia, due to excess excretion of catecholamine. However, rarely, ARDS, acute myocardial infarction, heart failure, arrhythmia, and pulmonary edema are also seen in patients with paraganglioma and clinical manifestations are depending on the patient's intravascular volume status. Seventy one-years-old male was presented with hypotension and pulmonary edema after intravenous midazolam injection during colonoscopy under conscious sedation. The patient was initially suspected with anaphylactic shock, due to midazolam injection. However, later, he was diagnosed with paraganglioma, and blood pressure was successfully controlled with alpha adrenergic blockade. We suggest that when we encounter heart failure, pulmonary edema and shock of unknown origin, pheochromocytoma must be taken into consideration.

Case of concurrent Riedel's thyroiditis, acute suppurative thyroiditis, and micropapillary carcinoma

Riedel's thyroiditis (RT) is a rare chronic inflammatory disease of the thyroid gland. It is characterized by a fibroinflammatory process that partially destroys the gland and extends into adjacent neck structures. Its clinical manifestation can mask an accompanying thyroid neoplasm and can mimic invasive thyroid carcinoma. Therefore, diagnosis can be difficult prior to surgical removal of the thyroid, and histopathologic examination of the thyroid is necessary for a definite diagnosis. The concurrent presence of RT and other thyroid diseases has been reported. However, to our knowledge, the association of RT with acute suppurative thyroiditis and micropapillary carcinoma has not been reported. We report a rare case of concurrent RT, acute suppurative thyroiditis, and micropapillary carcinoma in a 48-year-old patient.

Safety and Efficacy of Modern Insulin Analogues

BACKGROUND: A1chieve(R) was a noninterventional study evaluating the clinical safety and efficacy of biphasic insulin aspart 30, insulin detemir, and insulin aspart. METHODS: Korean type 2 diabetes patients who have not been treated with the study insulin or have started it within 4 weeks before enrollment were eligible for the study. The patient selection and the choice of regimen were at the discretion of the physician. The safety and efficacy information was collected from the subjects at baseline, week 12, and week 24. The number of serious adverse drug reactions (SADRs) was the primary endpoint. The changes of clinical diabetic markers at week 12 and/or at week 24 compared to baseline were the secondary endpoints. RESULTS: Out of 4,058 exposed patients, 3,003 completed the study. During the study period, three SADRs were reported in three patients (0.1%). No major hypoglycemic episodes were observed and the rate of minor hypoglycemic episodes marginally decreased during 24 weeks (from 2.77 to 2.42 events per patient-year). The overall quality of life score improved (from 66.7+/-15.9 to 72.5+/-13.5) while the mean body weight was slightly increased (0.6+/-3.0 kg). The 24-week reductions in glycated hemoglobin, fasting plasma glucose and postprandial plasma glucose were 1.6%+/-2.2%, 2.5+/-4.7 mmol/L, and 4.0+/-6.4 mmol/L, respectively. CONCLUSION: The studied regimens showed improvements in glycemic control with low incidence of SADRs, including no incidence of major hypoglycemic episodes in Korean patients with type 2 diabetes.

A Case of Hyperglycemic Hyperosmolar Syndrome in a Patient with Central Diabetes Insipidus and Type 2 Diabetes Mellitus / 대한내과학회지

Diabetes insipidus is a disorder caused by complete or partial deficiency or unresponsiveness to antidiuretic hormone. Both diabetes mellitus and diabetes insipidus are well-known causes of polyuria and polydipsia. Although Wolfram Syndrome, which is characterized by the concurrence of diabetes mellitus and diabetes insipidus along with optic atrophy and ataxia, is frequently reported, the concurrence of diabetes insipidus and type 2 diabetes mellitus without optic atrophy and deafness is rare. We report a 31-year-old woman presenting with hyperglycemic hyperosmolar syndrome caused by type 2 diabetes mellitus complicated with concurrent central diabetes insipidus.

A Case of Cushing Syndrome Diagnosed by Recurrent Pathologic Fractures in a Young Woman

Cushing's syndrome is characterized by central obesity, fatigability, weakness, amenorrhea, hirsutism, edema, hypertension, impaired glucose tolerance, and osteoporosis due to excessive production of steroids. Cushing's syndrome is an important cause of secondary osteoporosis. Patients with Cushing's syndrome have a high incidence of osteoporotic fractures. At least, 30-50% of patients with Cushing's syndrome experience fractures, particularly in the vertebral body. And it is consistent with the 50% prevalence of osteoporosis in patients with Cushing's syndrome. However, reports of multiple pathological fractures in young patients with Cushing's syndrome are rare. Thus, we describe the case of a 26-year-old woman with Cushing's syndrome accompanied with recurrent multiple osteoporotic fractures and being treated by parathyroid hormone. Careful consideration for the possibility of Cushing's syndrome will be necessary in case of young patients with a spontaneous multiple compression fractures in spine.

A Case of Hyperglycemic Hyperosmolar Syndrome in a Patient with Central Diabetes Insipidus and Type 2 Diabetes Mellitus / 대한내과학회지

Diabetes insipidus is a disorder caused by complete or partial deficiency or unresponsiveness to antidiuretic hormone. Both diabetes mellitus and diabetes insipidus are well-known causes of polyuria and polydipsia. Although Wolfram Syndrome, which is characterized by the concurrence of diabetes mellitus and diabetes insipidus along with optic atrophy and ataxia, is frequently reported, the concurrence of diabetes insipidus and type 2 diabetes mellitus without optic atrophy and deafness is rare. We report a 31-year-old woman presenting with hyperglycemic hyperosmolar syndrome caused by type 2 diabetes mellitus complicated with concurrent central diabetes insipidus.