The intra- and inter-rater reliability of measuring trunk coronal asymmetry by adjusting positioning variability: A prospective study.

BACKGROUND: Chronic low back pain (LBP) can lead to muscle spasms, limited range of motion, and abnormal posture, resulting in trunk muscle asymmetry. OBJECTIVE: This study aimed to assess the intra- and inter-rater reliability of a quantitative measurement of trunk coronal asymmetry in patients with chronic LBP, minimizing unnecessary gravity and friction force using a manual table in the prone position. METHODS: This prospective study was conducted at a single center, targeting patients with chronic LBP to measure trunk coronal asymmetry on a manual table in the prone position. The intra-class correlation coefficient (ICC) was calculated using one-way random-effects and two-way mixed-effects models. RESULTS: Fifty-eight patients who had LBP for more than three months were enrolled from May 1, 2021, to December 31, 2021. The intra- and inter-rater reliabilities of the two examiners' measurements were 0.872 and 0.899, and 0.852, respectively. Based on pain severity, the participants were classified into mild and severe groups, with ICCs of 0.823 and 0.889, and 0.936 and 0.918, respectively. CONCLUSION: Measurement of trunk coronal asymmetry in the prone position using a manual table demonstrates high intra- and inter-rater reliability. In addition, the reliability increases with greater pain severity.

Case reports of primary lymphedema tarda in South Korea: Two case reports of unilateral primary lymphedema tarda in lower extremities.

RATIONALE: Primary lymphedema is a form of lymphedema marked by a dysfunction of the lymphatic system without preceding medical conditions. One rare subtype of primary lymphedema, lymphedema tarda, occurs in those older than 35 years and is difficult to diagnose. This paper reports 2 cases of unilateral lymphedema tarda in the lower extremities in South Korea. PATIENT CONCERNS: The 2 patients complained of worsening swelling in the lower extremity for several months without any direct surgical or traumatic history related to the inguinal or lower extremity lymphatic system. DIAGNOSIS: Primary lymphedema tarda may be determined by ultrasonography. Other vascular or infection-origin causes were excluded from further evaluations. INTERVENTIONS: To confirm primary lymphedema tarda, lymphangiography was performed. In each case, lower extremity lymphangiography indicated dermal backflow and no lymph node uptake at the inguinal node of the affected side, which was compatible with lymphedema. OUTCOMES: The patients reported slight improvement in the symptoms after several weeks of rehabilitation. LESSONS: This paper is the first report of the unilateral primary lymphedema tarda in South Korea. Further investigations are warranted to find the related etiology of this rare disease and a multimodality regimen is needed for improvement of symptoms.

The Clinical Usefulness of Ultrasonographic Measurement Technique in Patients with Lower Extremity Lymphedema.

Background: A previous study reported a new ultrasonography (US) measurement technique to evaluate the cross-sectional area (ΔCSA) of lymphedema in the upper extremity. This ΔCSA correlated well with parameters, such as the circumference, volumetry, and bioimpedance analysis (BIA) in healthy people and upper extremity lymphedema patients. This study examined whether a US measurement technique is clinically useful in patients with lymphedema in the lower extremity. Methods and Results: Forty patients diagnosed with unilateral lower extremity lymphedema were enrolled in this study. The subjects' leg circumference, BIA, isokinetic strength, and ΔCSA were examined on the same day. The leg circumference was measured at 15 cm above the knee (AK) and below the knee (BK) crease using a tape measure. BIA was performed by a trained physical therapist, and the data of impedance (Z) at 1 and 5 kHz of each side of the lower limbs and extracellular water (ECW) were used. A fully experienced physician measured soft tissue thickness, the distance between the skin and the fascia of the muscle, three times each at the anterior, medial, posterior, and lateral aspects of the bilateral legs by US at 15 cm AK and BK. The amount of soft tissue in the ΔCSA was calculated using the designed formula from the mean values of the thicknesses. Each parameter was calculated as the ratio of the sound side to the lesion side. The Pearson and Spearman correlation coefficients were used to assess the significance of these parameters. The ratio of ΔCSA measured at 15 cm AK and BK showed strong positive correlations with the circumference difference at the same level (rho = 0.790, p = 0.000, and rho = 0.882, p = 0.000, respectively). In addition, it showed moderate or strong correlations with the ratio of Z at 5 and 1 kHz in the BIA of the lower limbs (AK15, r = -0.511, p = 0.001 and r = -0.497, p = 0.001; BK15, r = -0.780, p = 0.000 and r = -0.756, p = 0.000, respectively). Although ECW and body mass index showed weak positive correlations with the ratio of ΔCSA measured at 15 cm BK, there was no significant correlation between the ratio of ΔCSA and the isokinetic muscle strength. Conclusion: The ΔCSA results showed moderate-to-strong correlations with other conveniently used methods except for the isokinetic muscle strength. As the US ΔCSA technique could measure lymphedema status with a structural consideration, it could also be recommended as a conventional measurement method in patients with upper and lower extremity lymphedema.

Etiologic Factors of Rotator Cuff Disease in Elderly: Modifiable Factors in Addition to Known Demographic Factors.

With the aging society, musculoskeletal degenerative diseases are becoming a burden on society, and rotator cuff disease is one of these degenerative diseases. The purpose of this study was to examine the incidence of shoulder osteoarthritis and the etiologic factors of rotator cuff disease in the Korean elderly population. A total of 102 patients performing ultrasonography were recruited, and their demographic factors were analyzed. As functional factors, visual analog scale and the peak torque of external and internal rotators of the shoulder using an isokinetic dynamometer were measured. As an anatomical factor, the acromiohumeral distance in the plain radiograph of the glenohumeral anterior-posterior view was used. There were more female patients (65.7%) than male patients (34.3%). The age range with the highest number of respondents was 50-59 years old. The mean visual analogue score was 4.09 (Min 1 to Max 9). Age and dominant hand side factors appear to be the crucial etiologic factors of the presence and severity of rotator cuff disease. The lower net value of the external rotator strength is weakly related to the presence of rotator cuff disease after adjusting for age, and this is the only modifiable factor in the study.

Effects of trunk stabilization training robot on postural control and gait in patients with chronic stroke: a randomized controlled trial.

Our study aimed to confirm the therapeutic effects of using a trunk stabilization training robot (3DBT-33) in patients with chronic stroke. A total of 38 patients with chronic stroke were randomly assigned to either an experimental or a control group. The robot group (n = 19) received 30 min of trunk stability robot training in addition to conventional physical therapy, while the control group (n = 19) received a similar conventional physical therapy as the robot group. All participants were assessed using the following: the Functional Ambulation Categories (FAC), timed up and go (TUG) test, Berg Balance Scale (BBS), Korean Modified Barthel Index (K-MBI), and Fugl-Meyer Assessment of Lower Extremity (FMA-LE). There were statistically significant improvements in all parameters at follow-up assessment after 4 weeks of intervention (P < 0.05). There were statistically significant differences in the FMA-LE, K-MBI, and BBS between the robot and control groups (P < 0.05). There was no significant difference in FAC (P = 0.935) and TUG (P = 0.442). Minimal detectable change was more significantly observed in the FMA-LE and BBS than in FAC, TUG, and K-MBI. The findings in the present study showed that trunk stabilization rehabilitation training using a rehabilitation robot in patients with chronic stroke was effective in improving the balance and functions in the lower extremities.

Factors influencing return to work after stroke: the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study.

OBJECTIVE: To investigate the rate of return to work and identify key factors associated with return to work between 3 months and 2 years after stroke. DESIGN: Prospective cohort study. SETTING: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) in Korea. PARTICIPANTS: A total of 193 persons with first-ever stroke who reported working status at 3 months after stroke. OUTCOME MEASURES: Data on baseline characteristics were collected from medical records. Functional assessments were performed using the National Institutes of Health Stroke Scale, the modified Rankin Scale, the Fugl-Meyer Assessment, the Functional Ambulatory Category, the Korean Mini-Mental State Examination, the Korean version of the Frenchay Aphasia Screening Test, the American Speech-Language-Hearing Association National Outcomes Measurement System, the Korean-Modified Barthel Index, the Geriatric Depression Scale-Short Form and the EuroQol-5 dimensions. An enumeration survey included the Reintegration to Normal Living Index, the Psychosocial Well-being Index-Short Form (, the Family Support Index and the Caregivers Burden Index. RESULTS: Overall, 145 (75.1%) patients who had a stroke in the "Continuously-Employed" group and 48 (24.9%) in the "Employed-Unemployed" group returned to work between 3 months and 2 years after stroke. Multivariate logistic analysis demonstrated that in patients who had a stroke, characteristics such as age, PWI-SF Score, and caregiver characteristics, including age, sex (female) and living arrangements, were significantly associated with return to work between 3 months and 2 years after stroke. CONCLUSION: Age and PWI-SF Score of patients who had a stroke, as well as the age, sex and living arrangements of caregivers, are key factors influencing the return to work after stroke. TRIAL REGISTRATION NUMBER: NCT03402451.

Phytosphingosine-1-phosphate represses the hydrogen peroxide-induced activation of c-Jun N-terminal kinase in human dermal fibroblasts through the phosphatidylinositol 3-kinase/Akt pathway.

Dermal fibroblasts are differentiated mesenchymal cells that regulate the extracellular matrix through the production of dermis components. Dermal fibroblasts can be damaged by reactive oxygen species induced by ultraviolet rays and chemicals. In addition to its effects on the dermis, oxidative stress poses a major threat to organisms and is believed to play an essential role in many disease processes. In this study, we show that human dermal fibroblasts (HDFs) express sphingosine-1-phosphate (S1P) receptors S1P(1), S1P(2), and S1P(3). In addition, cell viability of HDFs is increased by phytosphingosine-1-phosphate (PhS1P) via regulation of the Jun N-terminal kinase (JNK)/Akt pathway. Interestingly, regulation of the JNK/Akt pathway by PhS1P attenuated H(2)O(2)-induced cell growth arrest. Together, our data indicate that PhS1P attenuates H(2)O(2)-induced growth arrest through regulation of the signal molecules Akt and JNK, and suggest that PhS1P may have value as an anti-aging material in cosmetics and medicine.

A validated finite element analysis of nerve root stress in degenerative lumbar scoliosis.

Few studies have shown the relationship between the curve pattern and nerve root symptoms in degenerative lumbar scoliosis, and its mechanism remains unclear. We developed a finite element model of two patterns of scoliotic curves (isolated lateral bending curve, lateral bending combined with rotation curve). The stress on the nerve root was calculated on both sides (right and left) of the apex vertebra. In the lateral bending curves without rotation, the compressive nerve root stress on the concave side was greater than the tensile stress on the convex side at the apex vertebra. In contrast, when the segmental rotation of the vertebrae was added to the lateral bending curve, there was significantly higher tensile stress on the convex side, and lower compressive stress on the concave side. To conclude, rotatory listhesis may be an important pathomechanism in the development of neurologic symptoms on the convex side of the curve.

Design of two-dimensional coils for wireless power transmission to in vivo robotic capsule.

This paper presents a design of two dimensional receiving coils to provide hundreds of milli-watt power via inductive link to in vivo robotic capsules, whose orientation are practically undetermined. The wireless power transmission system consists of a transmitter powered by class E power amplifier, and receiver with 2-dimensional antenna, rectifier, and voltage regulator. Two types of 2-dimensional antennas are designed and evaluated by theoretic and experimental analysis. Experimental results show that the proposed 2-D receiving antenna could deliver the power homogeneously against its orientation, with less than 20% of variation of the possible maximum power.