Comparison of the nutritional indicators of critically Ill patients on extracorporeal membrane oxygen (ECMO) / 한국영양학회지

Purpose@#This study aimed at investigating the nutritional status, nutritional support, and nutritional indicators of critically ill patients on extracorporeal membrane oxygen (ECMO) in intensive care units (ICU). @*Methods@#This descriptive study obtained data from the medical records of 37 patients who were treated using ECMO at a university hospital in Korea. The patients were admitted to the Korea University Anam Hospital ICU with acute or serious damage to vital organs from January 1, 2014 to June 30, 2016. @*Results@#Although 32 patients (86.5%) were at a high risk of malnutrition, 26 patients (70.3%) were considered normal in terms of nutritional status by the nutritionist at the beginning of their ICU stay. However, after two weeks, nine patients had passed away and only one patient maintained normal status. Parenteral nutrition was started first but took 4.25 ± 6.95 days till initiation. Only eight patients (21.6%) were able to meet their requirement for both calories and protein. The group provided with adequate calorie and protein showed significantly longer use of the ECMO and respirator and longer ICU and total hospital stay than their counterparts. Normal levels of serum albumin and protein of the group at low-risk for malnutrition on the day of initiation of ECMO, which were significantly higher than the high-risk group, declined by the last day of ECMO leading to a lack of significant differences between the two groups. @*Conclusion@#Considering that the nutritional indicators of patients deteriorated as the days on ECMO increased, more aggressive nutritional management to ensure adequate nutritional support should be emphasized from the beginning and throughout the ICU stay.

The Pilot Study of Robot-Assisted Training for the Lower Extremity Rehabilitation of Burn Patients

Purpose@#Scar contracture influence the outcome of burn patients significantly. This study aims to investigate the feasibility of robot-assisted training for the lower extremity rehabilitation of burn patients. @*Methods@#This pilot study was conducted on 7 burn patients for 8 weeks between January 2019 and November 2019. Two of 7 patients withdrew from this study because one had skin abrasion on the legs which thigh fastening devices were applied on and the other was not participate in the assessment at 4 weeks after training. Final 5 patients received gait training with SUBAR Ⓡ and numeric rating scale (NRS), 6-minutes walking test, and range of motion in flexion and extension of knee and ankle joint were evaluated before training, 4 weeks and 12 weeks after training. @*Results@#The subjects had a mean age of 51.8±98 years, mean total burn surface area of 30.8±13.7%, mean duration from injury to 1 st assessment of 102.8±39.3 days. Anyone of 5 patients did not have musculoskeletal or cardiovascular side effects such as increased or decreased blood pressure or dizziness. The significant improvement in NRS, gait speed, and range of motion in knee extension and ankle plantarflexion after robotic training (all P＜0.05). @*Conclusion@#Robot-assisted training could be feasible for the rehabilitation of burn patients and it could improve muscle strength and range of motion in lower extremities, and gait function.

Wound Healing Potential of Low Temperature Plasma in Human Primary Epidermal Keratinocytes

BACKGROUND: Low temperature plasma (LTP) was recently shown to be potentially useful for biomedical applications such as bleeding cessation, cancer treatment, and wound healing, among others. Keratinocytes are a major cell type that migrates directionally into the wound bed, and their proliferation leads to complete wound closure during the cutaneous repair/regeneration process. However, the beneficial effects of LTP on human keratinocytes have not been well studied. Therefore, we investigated migration, growth factor production, and cytokine secretion in primary human keratinocytes after LTP treatment.METHODS: Primary cultured keratinocytes were obtained from human skin biopsies. Cell viability was measured with the EZ-Cytox cell viability assay, cell migration was evaluated by an in vitro wound healing assay, gene expression was analyzed by quantitative real-time polymerase chain reaction, and protein expression was measured by enzyme-linked immunosorbent assays and western blotting after LTP treatment.RESULTS: Cell migration, the secretion of several cytokines, and gene and protein levels of angiogenic growth factors increased in LTP-treated human keratinocytes without associated cell toxicity. LTP treatment also significantly induced the expression of hypoxia inducible factor-1α (HIF-1α), an upstream regulator of angiogenesis. Further, the inhibition of HIF-1α expression blocked the production of angiogenic growth factors induced by LTP in human keratinocytes.CONCLUSION: Our results suggest that LTP treatment is an effective approach to modulate wound healing-related molecules in epidermal keratinocytes and might promote angiogenesis, leading to improved wound healing.

Extracorporeal Shock Wave Therapy For Treatment of Intractable Stump Pain

Amputation stump pains can be developed in amputation sites after high voltage electrical burn injuries. We experienced one case of these severe stump pains in an upper extremity amputation patient. A 35-year-old man had a 38% total body surface area high voltage electrical burn. The patient underwent skin grafting and left shoulder disarticulation. During the rehabilitation period, he complained about severe stump area pains and phantom pains. We injected 0.5% Bupivacaine and Triamcinolone on the stump neuroma site but the pain sustained. After extracorporeal shock wave therapy (ESWT,) the pain subsided and did not recur. The patient was satisfied with functional and pain outcomes, so we report this case.

Comparison of Awareness of Symptoms and Illness Between Patients with Obstructive Sleep Apnea and Simple Snoring / 수면정신생리

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is often undiagnosed but is an important risk factor affecting the health of an individual. The level of awareness of the illness among patients with OSA is low and is not correlated with severity of the illness. This study was conducted to compare awareness of OSA symptoms and illness between patients with OSA and simple snorers. MATERIALS AND METHODS: Two hundred eighty-two patients who were suspected of having OSA participated in this study. All subjects underwent overnight polysomnography. Those with an apnea-hypopnea index (AHI) ≥ 5 were classified as the OSA group, while those with an AHI < 5 were classified as the simple snoring group. A sleep questionnaire, which included items on awareness of the illness, OSA, and sleep symptoms, was administered to all subjects and their bed-partners. RESULTS: Simple snorers were much more aware of their symptoms such as snoring, irregular breathing, and apnea than were patients with OSA. Bed-partners of simple snorers were also more aware of the participants' sleep symptoms than were partners of patients with OSA. However, the duration of OSA symptoms was longer in the OSA group. In the correlation analysis, the level of awareness of OSA symptoms was negatively correlated with AHI, age, body mass index, and Epworth Sleepiness Scale score. Among the sleep questionnaire and polysomnography results, only Pittsburgh Sleep Quality Index was positively correlated with level of awareness of OSA symptoms. The minority of the respondents had heard about the treatment methods of continuous positive airway pressure and oral appliance and preferred them as treatment options. CONCLUSION: This study suggests that simple snorers are more aware of their symptoms than are patients with OSA. A higher severity of OSA, represented by a higher AHI, is correlated with lower awareness of one's OSA symptoms.

Vitamin C and D Insufficiency in Burn Patients Undergoing Rehabilitative Therapy-Preliminary Result

PURPOSE: The burn increase the requirement for the antioxidative vitamin C and decrease the plasma concentration of vitamin D due to the loss of skin body surface area. We investigated the vitamin C and D status and the prevalence of vitamin C and D insufficiency in adult burn patients undergoing rehabilitative therapy. METHODS: 256 burn patients admitted to the department of rehabilitation medicine from April 2013 to September 2014 were tested for the plasma level of vitamin C and D[25(OH)D]. Vitamin C insufficiency was considered as or =20%, mean plasma concentration of vitamin C and vitamin D[25(OH)D] were significantly lower (P=0.023, P<0.001). With adjusting for potential confounder such as age, sex, burn type, mean serum 25 (OH)D levels was significantly decreased 0.07 ng/ml per one percent of burned surface area (beta=-0.07, P<0.001), but with adjusting for age, sex, burn type, length of ICU stay and duration from burn injury to sampling, vitamin C and vitamin D[25(OH)D] were not significantly decreased (P=0.221, P=0.142). CONCLUSION: Vitamin C and D insufficiency were common nutrient problems in burn patients undergoing rehabilitative therapy. Further studies will be needed to establish the effective way to improve vitamin C and D status and prevent nutritional complications.

Outcomes of Ultrasound-Guided Extracorporeal Shock Wave Therapy for Painful Stump Neuroma

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma. METHODS: Thirty patients with stump neuroma at the distal end of an amputation site were assigned randomly to the ESWT group (n=15) and the transcutaneous electrical nerve stimulation (TENS)+desensitization+pharmacological treatment group (n=15). For 3 weeks, the ESWT group received a weekly session involving 1,500 pulses at 0.10 mJ/mm2, while the control group was treated 10 times each, 40 minutes per day with TENS and desensitization treatment, and daily medication for 3 weeks. ESWT stimulation was given by focusing on the area at the neuroma site clearly identified by ultrasound. RESULTS: The changes in the McGill pain questionnaire were 38.8+/-9.0 prior to treatment and 11.8+/-3.1 following the treatment. The corresponding values for the control group were 37.2+/-7.7 and 28.5+/-10.3. The changes between groups were significantly different (p=0.035). The change in visual analog scale prior to and after treatment was 7.0+/-1.5 and 2.8+/-0.8 in the ESWT group, respectively, and 7.2+/-1.4 and 5.8+/-2.0 in the control group. These changes between the groups were also significantly different (p=0.010). The outcome in the pain rating scale also showed significant differences between groups (p0.05). CONCLUSION: The study findings imply that ESWT for stump neuroma is superior to conventional therapy.

The Effect of Extracorporeal Shock Wave Therapy on the Scar Pain of Burn Patients: A Case Report

PURPOSE: Many burn patients are troubled with pain and paresthesia from healed wounds. Extracorporeal Shock Wave Therapy (ESWT) in various musculoskeletal disease and wounds is reported that it reduces the pain and promotes regenerating of tendon and healing of the wound. Therefore we investigated the effect of ESWT on the scar pain of burn patients. METHODS: On February 2014, three patients admitted to the department of rehabilitation medicine of Hangang Sacred Heart Hospital Burn Center underwent ESWT. One low-energy ESWT (0.05~0.12 mJ/mm2) a week was provided to them for 3 weeks in total. Numerical rating scale (NRS), Nirschl pain phase system, 70-point scoring system, Roles and Maudsley score were evaluated before ESWT, after first and third ESWT. RESULTS: In all three patients, the NRS score was decreased and total scores of Nirschl pain phase system and 70-point scoring system were improved after ESWT compared to before ESWT. Roles and Maudsley scores was poor in all three patients at before ESWT but was acceptable in two patients and good in one patient after third ESWT. CONCLUSION: Extracorporeal shockwave therapy (ESWT) is non-invasive, feasible and effective modality on the scar pain of burn patients.

Comparison between Isokinetic Method and Electromyographic Method in Muscle Power Measurement of Lumbar Muscles

OBJECTIVE: The purpose of this study was to analyze the relationship between isokinetic measurement and electromyographic method in muscle power measurement of lumbar muscles. METHOD: The subjects were 23 chronic lower back pain patients and 17 normal adult. Isokinetic lumbar extensor strength test was performed at specific speeds (120degrees/sec, 180degrees/sec) with Cybex 770 and automatic turn/amplitude analysis of electromyogram (EMG) was performed with Viking EMG system. RESULTS: The relationship between the parameters of isokinetic test and turn/sec of EMG study was not significantly correlated. The relationship between the parameters of isokinetic test and amplitude of EMG study was significantly correlated. The relationship between the parameters of isokinetic test and ratio of turns to mean amplitude of EMG was not correlated significantly. The mean amplitude in 120degrees/sec speed test and the ratio of turns to mean amplitude in 120degrees/sec and 180degrees/sec speed test were significantly lower in chronic lower back pain patients than that of normal controls. CONCLUSION: Turn/amplitude analysis of EMG method if performed with isometric or isokinetic muscle test will be clinically useful in muscle power measurement of lumbar muscles.

Kinematic Gait Analysis in Children with Hemiplegic Spastic Cerebral Palsy

OBJECTIVE: The purpose of this study is to evaluate gait characteristics using kinematic analysis in children with hemiplegic spastic cerebral palsy. METHOD: Fifty-seven non-operated spastic hemiplegic children who were able to walk independently without any walking aid were recruited as subjects. Three-dimensional kinematic gait analysis using a motion analyzer (Vicon 370 M. A. with 6 infrared cameras) were performed in all patients. Changes in joint angle of hip, knee and ankle in sagittal plane were evaluated to classify gait pattern and also the temporospatial values were measured to determine any differences between groups. RESULTS: Gait patterns were able to be classified into 6 groups. Group I had a minimal gait disturbance, a drop foot pattern. Group II showed hip and knee flexed, with normal ankle range. Group III showed hip, knee, and ankle flexed. Group IV showed genu recurvatum with tibia progression, Group V showed genu recurvatum with tibia arrest. Group VI showed stiff crouch gait. However, the temporospatial values between groups were not significantly different. CONCLUSION: This classification system would be useful for converting the vast quantitative information of gait analysis into descriptive and clinically relevant patterns. Therefore, it would be helpful for the clinician to understand underlying pathology and plan appropriate treatment.

Concentric and Eccentric Isokinetic Trunk Muscle Evaluation in Chronic Low Back Pain

OBJECTIVE: The purpose of this study is to evaluate concentric and eccentric trunk muscle strength in patients with chronic low back pain and compare it with healthy controls to determine the role of trunk muscle in chronic low back pain METHOD: Subjects were 20 chronic low back pain patients with the duration at least 6 months and 20 normal adults. Concentric and eccentric isokinetic trunk muscle test was performed at specific speeds (30degrees, 60degrees, 120degrees/sec) with Cybex 770 machine in back pain patients and healthy control. RESULTS: The strength of trunk flexor and extensor muscles of chronic low back pain patients was significantly weaker than that of normal controls. Eccentric peak torque was significantly higher than concentric peak torque in both patients and healthy control. A concentric and eccentric ratio of patients was lower than that of normal controls. The correlation between concentric and eccentric variables was high. Our results show that concentric peak torque has the highest correlation with eccentric peak torque. CONCLUSION: Isokinetic evaluations of the trunk muscle offer objective and quantitative data of patients with chronic low back pain and will be clinically useful in muscle power measurement of lumbar muscles.

The effect of electrical stimulation on the trunk control in young children with spastic diplegic cerebral palsy

This study was designed to determine the effectiveness of electrical stimulation over the trunk in improving sitting balance in young children with spastic diplegic cerebral palsy who displayed poor trunk control. The subjects ranged in age from 8 to 16 months and were randomly assigned to two groups. Both group had physical therapy for 6 weeks. Electrical stimulation (ES) group had additional electrical stimulation over the abdomen and posterior back muscles. Radiographic studies were carried out on the whole spine while they were sitting before and after treatment. Kyphotic angle, Cobb's angle and lumbo-sacral angle were measured. Additionally, sitting score-Gross Motor Function Measure (GMFM) was also evaluated. There was no difference of these values at initial evaluation between the two groups. Following 6 weeks of intensive therapy, the changes of kyphotic angle and sitting score-GMFM were significantly higher in ES group statistically when compared with those of the control group. The Cobb's angle following treatment was improved in ES group, but not statistically compared with that of control group. This study suggests that electrical stimulation over the trunk become a beneficial therapeutic technique in improving the sitting posture and trunk control in young children with spastic diplegic cerebral palsy.