Association Between Initiation of Rehabilitation and Length of Hospital Stay for Workers with Moderate to Severe Work-Related Traumatic Brain Injury

Background@#In workers with moderate to severe work-related traumatic brain injury (wrTBI), this study aimed to investigate the effect of the timing of rehabilitation therapy initiation on the length of hospital stay and the factors that can influence this timing. @*Methods@#We used data obtained from the Republic of Korea's nationwide Workers' Compensation Insurance. In the Republic of Korea, between the years 2010 and 2019, a total of 26,324 workers filed a claim for compensation for moderate to severe wrTBI. Multiple regression modeling was performed to compare the length of hospital stay according to the timing of rehabilitation therapy initiation following wrTBI. According to the timing of the initiation of rehabilitation therapy following TBI, the proportions of healthcare institutions that provided medical care during each admission step were compared. @*Results@#The length of hospital stay for workers who started rehabilitation therapy within 90 days was significantly shorter than that for workers who started rehabilitationment were first admitted to tertiary hospitals. Approximately 39% of patients who received delayed rehabilitation treatment were first admitted to general hospitals, and 28.5% were first admitted to primary hospitals. @*Conclusions@#Our findings demonstrate the importance of early rehabilitation initiation and that the type of healthcare institution that the patient is first admitted to after wrTBI may influence the timing of rehabilitation initiation. The results of this study also emphasize the need to establish a Worker’s Compensation Insurance–specialized rehabilitation healthcare delivery system.

Comparison of Trends in the Incidence of Traumatic Spinal Cord Injury in Daily Life, Automobile Accidents, and Industrial Accidents: A National Multi-Insurance Study in Korea

Background@#To examine the incidence of traumatic spinal cord injury (TSCI) from all etiologies, we measured and compared the incidence of TSCI from three national or quasinational databases in South Korea, namely, the National Health Insurance Service (NHIS), automobile insurance (AUI), and Industrial Accident Compensation Insurance (IACI). @*Methods@#We reviewed patients with TSCI reported in the NHIS database between 2009 and 2018, and in the AUI and IACI databases between 2014 and 2018. TSCI patients were defined as those first admitted to the hospital with a diagnosis of TSCI according to the International Classification of Diseases (10th revision) criteria. Age-adjusted incidence was calculated using direct standardization using the 2005 South Korean population or the 2000 US population as the standard population. The annual percentage changes (APC) of TSCI incidence were calculated. The Cochrane–Armitage trend test was performed according to the injured body region. @*Results@#In the NHIS database, age-adjusted TSCI incidence using the Korean standard population increased significantly from 2009 to 2018 (from 33.73 per million in 2009 to 38.14 per million in 2018, APC = 1.2%, P = 0.014). Contrarily, age-adjusted incidence in the AUI database significantly decreased from 13.88 per million in 2014 to 11.57 per million in 2018 (APC = – 5.1%, P = 0.009). In the IACI database, the age-adjusted incidence showed no significant difference, while crude incidence showed a significant increase (from 22.02 per million in 2014 to 28.92 per million in 2018, APC = 6.1%, P = 0.038). According to the age group, all the three databases showed high incidences of TSCI in those in their 60s and 70s or older. Among those in their 70s or older, the incidence of TSCI increased dramatically in the NHIS and IACI databases, while no significant trend was found in AUI database. In 2018, the number of TSCI patients was the highest among those over 70 years of age in the NHIS, whereas among those in their 50s were the highest in both AUI and IACI. The proportion of patients with cervical spinal cord injury was the most common in all these databases. @*Conclusions@#The differences in trends in the incidence of TSCI may be due to the different etiologies and different characteristics of subjects depending on insurance type. These results imply the need for tailored medical strategies for the different injury mechanisms represented by three national insurance services in South Korea.

Antibacterial properties of dental resin incorporated with nano-silver doped silica in accordance with exposure of visible light / 대한치과재료학회지

This study investigated reduction of the bandgap of silica by applying nano-silver doping technique and possible application of such silica as a filler in dental resin. Due to reduce band gap, newly fabricated nano-silver doped silica was able to release ROS in accordance with exposure of visible light. Nano-silver doped silica was composed of below 20 nm size crystal silver nanoparticle and 100~500 nm size amorphous silica. These two components were chemically attached to each other (Si-O-Ag). The reduced bandgap was 2.10 eV, which the value could be interpreted as occurrence of surface plasmon resonance generating ROS in visible light exposure conditions. When such nano-silver doped silica was used as a filler in dental resin, increased antibacterial property of nano-silver ion was observed which was related to releasing of ROS when exposed in visible light. The antibacterial properties were statistically significant following exposure to visible light when 0.7 to 1.5 wt% of nano-silver doped silica were incorporated into resin. When the contents of nano-silver doped silica were below 0.7 wt%, minimal ROS release resulted in no significant increase in antibacterial properties as there would be less exposed nano-silver doped silica on the resin surface by visible light. Meanwhile, more than 1.5 wt% of nano-silver doped silica also resulted no significant increase in antibacterial properties following exposure to visible light as the antibacterial effects from nano-silver ion itself were greater than effects from released ROS. Hence, it was concluded that dental resin containing 0.7 to 1.5 wt% of nano-silver doped silica would provide antibacterial properties when exposed to visible light, significantly greater than in dark conditions.

Knee Extensor Strength Measurement in Patients With Limited Physical Activity Using a Supine Dynamometer Anchoring Frame

Objective@#To investigate the reliability of knee extensor strength measurements using a supine hand-held dynamometer (HHD) anchoring frame in patients with limited physical activity. Although an HHD is suitable for bedside use, its inter-rater reliability is low because measurements can be influenced by tester strength. @*Methods@#Maximal knee extensor isometric strength was measured using an HHD anchored to the supine frame. Three trials of three maximal contractions were assessed by two raters. @*Results@#A total of 33 inpatients who were non-ambulatory due to acute illness participated in the study. The intraclass correlation coefficients were 0.974 (inter-rater) and 0.959 (intra-rater). The minimal detectable changes in intra- and inter-observer measurements were 29.46 N (24.10%) and 36.73 N (29.26%), respectively. The limits of agreement ranged from -19.79% to 24.81% for intra-rater agreement and from -21.45% to 37.07% for inter-rater agreement. @*Conclusion@#The portable dynamometer anchoring system can measure the isometric strength of the knee extensor reliably in the supine position, and could be used for measurements in patients who have difficulty visiting the laboratory and maintaining a seated posture.

Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients With Loss of Cervical Lordosis and Neck Pain

Objective@#To explore if the modified cervical and shoulder retraction exercise program restores cervical lordosis and reduces neck pain in patients with loss of cervical lordosis. @*Methods@#This study was a retrospective analysis of prospectively collected data. Eighty-three patients with loss of cervical lordosis were eligible. The eligible patients were trained to perform the modified cervical and shoulder retraction exercise program by a physiatrist, and were scheduled for a follow-up 6 to 8 weeks later to check the post-exercise pain intensity and lateral radiograph of the cervical spine in a comfortable position. The parameters of cervical alignment (4-line Cobb’s angle, posterior tangent method, and sagittal vertical axis) were measured from the lateral radiograph. @*Results@#Forty-seven patients were included. The mean age was 48.29±14.47 years. Cervical alignment and neck pain significantly improved after undergoing the modified cervical and shoulder retraction exercise program (p≤0.001). The upper cervical lordotic angle also significantly improved (p=0.001). In a subgroup analysis, which involved dividing the patients into two age groups (<50 years and ≥50 years), the change of the sagittal vertical axis was significantly greater in the <50 years group (p=0.021). @*Conclusion@#The modified cervical and shoulder retraction exercise program tends to improve cervical lordosis and neck pain in patients with loss of cervical lordosis.

Knee Extensor Strength Measurement in Patients With Limited Physical Activity Using a Supine Dynamometer Anchoring Frame

Objective@#To investigate the reliability of knee extensor strength measurements using a supine hand-held dynamometer (HHD) anchoring frame in patients with limited physical activity. Although an HHD is suitable for bedside use, its inter-rater reliability is low because measurements can be influenced by tester strength. @*Methods@#Maximal knee extensor isometric strength was measured using an HHD anchored to the supine frame. Three trials of three maximal contractions were assessed by two raters. @*Results@#A total of 33 inpatients who were non-ambulatory due to acute illness participated in the study. The intraclass correlation coefficients were 0.974 (inter-rater) and 0.959 (intra-rater). The minimal detectable changes in intra- and inter-observer measurements were 29.46 N (24.10%) and 36.73 N (29.26%), respectively. The limits of agreement ranged from -19.79% to 24.81% for intra-rater agreement and from -21.45% to 37.07% for inter-rater agreement. @*Conclusion@#The portable dynamometer anchoring system can measure the isometric strength of the knee extensor reliably in the supine position, and could be used for measurements in patients who have difficulty visiting the laboratory and maintaining a seated posture.

Growth Inhibition of Human Uterine Leiomyoma Cells by Selective Estrogen Receptor Modulator / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to evaluate potential efficacy of selective estrogen receptor modulators (raloxifene and tamoxifen) to human uterine leiomyoma cells. METHODS: The samples were collected from ten hysterectomized specimen. we evaluated the estrogen-responsive growth of human uterine leiomyoma and normal myometrial cells. The potential efficacy of Selective Estrogen Receptor Modulators (SERMs: raloxifene and tamoxifen) to human uterine leiomyoma cells were conducted by MTS, cell count assay and Western-blot. RESULTS: Human uterine leiomyoma and normal myometrial cells that expressed estrogen receptor (ER) showed increases the cell number in the presence of estrogen compared with ER negative uterine leiomyoma cells. Raloxifene and tamoxifen inhibited estrogen-stimulated proliferation of ER-containing human uterine leiomyoma and normal myometrial cells. Raloxifene was more effective in inhibiting estrogen-induced increases of cell number compared with tamoxifen. CONCLUSION: The effect of SERMs on leiomyoma was inhibited the cell proliferation without apoptosis or cell cycle arrest. These data suggest that SERM should be examined as candidate of nonsurgical therapeutic agents for uterine leiomyoma.

Combination Chemotherapy for Malignant Ovarian Germ Cell Tumors / 대한부인종양콜포스코피학회잡지

Thirteen patients with malignant germ cell tumars of the ovary have been treated with a combination chemotherapy. The age of the patients ranged from ll to 50 years and there was no history of radiation therapy of chemotherapy except operation, Stage distributions are as follow ; 2 pstients are stage IV, 3 are stage II and remainied 8 are stage I. 4 patients with immature teratama and 2 patients with mixed germ cell tumor received VAC chemotherapy, as primary therapy, and among them 1 lost to follow up but remained 5 cases live without evidence of disease 39 to 83 gnontha. There were 3 patients with endodermal sinus tumor and 1 received VAC and remeined 2 received FVB as primary chemotherapy, Of them 1 died of disease after 9 months of oyeration and the other 2 live now with no evidence of disease. There were 2 patiente with dysgerminoma and 2 with primary ovarian choriocarcinoma. 1 patient with dysagerminoma and 1 wit choriocarcinoma were died because of chemotherapy toxicity, 1 patient with dysgerminoma, who refused further ehemotherapy after l course of chemot.herapy, died of progressive disease. l patient wit choriocarcinoma now live well without evidence of disease at 35 months. The combination chemotherapy using VAC or PVB regimen represents an effective treatment for malignant. germ cell turnars of the ovary and reveals moderate oxicity.

The Direct Medial Canthal Approach in the Repair of Blowout Fracture of the Medial Orbital Wall

Fracture of the medial orbital wall with entrapment of the medial rectus muscle is a rarely reported occurence. Fractures of the medial orbital wall can occur alone. but they are frequently associated with fractures of the orbital floor. As the result of blowout fracture of the medial orbital wall, epistaxis, limitation of abduction, restriction of abduction, globe retraction upon attempted abduction, and enophthalmos are developed. Serious complications of medial orbital wall trauma are rare. Significant enophthalmos, definite limitation to the forced ductions, or marked incarceration of orbital tissue are usually indications for the need for exploration. Surgical approaches to blowout fracture of the medial orbital wall are made through a skin incision in the lower eyelid placed just below the eyelashes, a conjunctival incision, and direct medial canthal incision. Recently, the authors have repaired two blowout fractures of the medial orbital wall by use of Direct Medial Canthal approach, and follow-up for six months has been done.

Hypotensive Effect of Betaxolol Hydrochloride(Betoptic) In Normal Volunteers: Comparative study With Timolol

Betaxolol Hydrochloride was compared with Timolol in view of the hypotensive effect. Thirty five normal volunteers(70 eyes) of the third decade were enrolled in this study. Thirty volunteers of experimental group were devided into three groups, -0.5% Betaxolol group, 0.25% Timolol group and 0.5% Timolol group. The remaining five volunteers(10 eyes) were used as control group. Double masked single dose study was done by instillating each eye solution into the randomly selected one eye. The intraocular pressure(IOP), Pupil size, Visual acuity, blood pressure, and pulse rate were measured before the instillation of eye solution at first and 30 minutes. 1,2,4,6,12, and 24 hours after the and the statistical significance was estimated by using the paired t-test. The following results were obtained: 1. 0.5% Betaxolol showed a significant reduction of IOP from 30 minutes to 12 hours after the instillation and maximum IOP reduction(18.9 +/- 3.4%) was noted at 4 hours after the instillation. 2. Statistically significant IOP reduction was noted in the contralateral eyes of both Betaxolol and Timolol groups. 3. After the treatment with Betaxolol, the pupil size, visual acuity, blood pressure, and pulse rate were not significantly changed. Transient mild stinging sensation was noted as a local side effect after the instillation of the Betaxolol.