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Min Cheol Chang,1 Seoyon Yang2 1Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea; 2Department of Rehabilitation Medicine, School of Medicine, Ewha Woman’s University Seoul Hospital, Seoul, Republic of KoreaCorrespondence: Seoyon Yang, Department of Rehabilitation Medicine, School of Medicine, Ewha Woman’s University Seoul Hospital, 260 Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea, Tel +82-10-2787-2052, Fax +82-50-4225-2052, Email seoyonyang@gmail.comObjective: Bone single-photon emission computed tomography (SPECT) preferentially localizes areas exhibiting greater bone remodeling and enhanced perfusion, which helps identify areas of pain and inflammation in the lumbar facet joints (LFJs). Herein, we investigated the treatment outcome of intraarticular (IA) corticosteroid injection in patients with LFJ-origin lower back pain (LBP) depending on the presence of increased LFJ uptake on bone SPECT.Methods: We retrospectively recruited 38 patients with LFJ-origin LBP. Of the 38 patients, 22 patients showed increased uptake on bone SPECT (SPECT+ group), and 16 patients did not show increased uptake on bone SPECT (SPECT- group). A numeric rating scale (NRS) was used to assess pain reduction 1 month after treatment with a corticosteroid injection. Treatment was considered successful when the posttreatment NRS score was ≥ 50% lower than the pretreatment NRS score.Results: The NRS scores of the SPECT+ group at the 1-month follow-up were significantly lower than those of the SPECT- group. Additionally, the degree of change in the NRS scores was larger in the SPECT+ group than that in the SPECT- group. In addition, 18 of the 22 patients (81.8%) in the SPECT+ group underwent successful treatment. Eight of the 16 patients (50%) in the SPECT- group underwent successful treatment. The ratio of successful treatment was significantly higher in the SPECT+ group than in the SPECT- group.Discussion: Bone SPECT could help predict the therapeutic outcome after IA LFJ corticosteroid injection and determine the treatment plan for patients with LFJ-origin LBP.Keywords: facet joint, lumbar spine, corticosteroid, injection, single-photon emission computed tomography, pain

Jean Paul Brutus,1 Thiên-Trang Vo,1 Min Cheol Chang2 1Exception MD, Montreal, Canada; 2Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of KoreaCorrespondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1 Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4862, Email wheel633@gmail.comPurpose: Carpal tunnel syndrome (CTS) is commonly encountered in clinical practice. Diagnostic tools that currently exist include painful provocative maneuvers, invasive nerve conduction studies and the use of tests that require physician’s direct participation in an era of sanitary crisis and virtual consultations. Therefore, having an easily accessible, reliable and practical tool for diagnosing CTS would be highly beneficial. Herein, we investigated the diagnostic value of the “pronation compensation sign” that we described for diagnosing CTS.Patients and Methods: We included 18 hands with and 18 hands without CTS (age: CTS hands = 52.5 ± 13.8 years, non-CTS hands = 43.2 ± 12.3 years; sex ratio: CTS hands = 12:8, non-CTS hands = 9:9). The presence of the “pronation compensation sign” was evaluated in each included hand. The presence of the “pronation compensation sign” were compared between CTS and non-CTS hands using the chi-squared test. Statistical significance was set at p < 0.05. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated of the “pronation compensation sign” for CTS.Results: All 18 hands with CTS showed a positive “pronation compensation sign”, while those without CTS were negative. All 18 hands that were positive for the “pronation compensation sign” were hands with CTS, while those that were negative were hands without CTS. The sensitivity and specificity of the “pronation compensation sign” for diagnosing CTS were both 100%. The PPV and NPV of the “pronation compensation sign” for CTS were both 1.000. The rates of the presence of the “pronation compensation sign” were significantly different between hands with and without CTS (p < 0.001).Conclusion: The “pronation compensation sign” seems a useful tool for diagnosing CTS. We believe that the “pronation compensation sign” will help clinicians diagnose CTS with high diagnostic accuracy.Keywords: carpal tunnel syndrome, pronation compensation sign, diagnosis, accuracy, hand

Yen-Jen Chen,1,2,&ast; Ming-Che Chang,3,&ast; Kai-Ming Jhang,4,&ast; Wen-Fu Wang,4,&ast; Yi-Cheng Liao1 1Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan; 2Department of Psychiatry, Yuanlin Christian Hospital, Changhua, Taiwan; 3Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan; 4Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan&ast;These authors contributed equally to this workCorrespondence: Yi-Cheng Liao, Department of Psychiatry, Changhua Christian Hospital, 135, Nan-Xiao St, Changhua, 500, Taiwan, Tel +886 4 7238595 ext. 7160, Fax +886 4-7251004, Email 40202@cch.org.twBackground: To compare short-term cognitive outcomes among groups with and without neuropsychiatric symptoms (NPSs) or antipsychotic prescription and to determine which disease status or treatment modality is associated with relatively faster cognitive decline.Methods: We retrospectively analyzed a prospective cohort of patients diagnosed with dementia and mild cognitive impairment. All participants were evaluated using the Cognitive Abilities Screening Instrument (CASI) during their initial clinical assessments and at the annual follow-up. The dependent variable was annual delta CASI. Multivariate linear regression analysis was used to assess the degree of association between NPS, antipsychotic use, and cognitive decline after adjusting for confounding factors. Neuropsychiatric symptoms were examined individually to determine their predictive value for cognitive decline.Results: A total of 407 (N = 407) patients were included in the study. NPSs, rather than antipsychotic use, led to faster cognitive decline. A higher baseline NPI total score predicted a significantly faster decline in CASI scores (1-year delta CASI = − 0.22, 95% CI = − 0.38~ − 0.05, p = 0.010). Specific items (delusions, agitation, depression, anxiety, euphoria, and apathy) in the NPS significantly increased cognitive decline.Conclusion: Certain neuropsychiatric symptoms, rather than antipsychotic use, lead to faster cognitive decline in a dementia collaborative care model. Checking for and providing appropriate interventions for NPS in people with dementia and their caregivers are highlighted.Keywords: neuropsychiatric symptoms, antipsychotics, cognitive decline, cognitive abilities screening instrument, dementia collaborative care

Gyu-Sik Choi,1 Mathieu Boudier-Revéret,2 Min Cheol Chang3 1Cheokbareun Rehabilitation Clinic, Pohang-si, Gyeonsangbuk-do, South Korea; 2Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada; 3Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of KoreaCorrespondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4862, Email wheel633@gmail.comPurpose: In this study, we evaluated the therapeutic outcomes of transforaminal epidural steroid injection (TFESI) in managing chronic radicular pain due to foraminal stenosis. Furthermore, we evaluated its effectiveness according to isthmic spondylolisthesis (IS) severity.Patients and Methods: We included 40 patients with radicular pain due to IS-derived foraminal stenosis in our study and treated them with TFESI. Two patients were lost during follow-up. Based on the lateral lumbar radiograph findings, we allocated the recruited patients with < 25% slippage by IS to Group 1 (n = 23) and those having 25– 50% slippage to Group 2 (n = 15). The degree of pain was measured using a numeric rating scale (NRS) at pre-treatment and 1 and 2 months after TFESI.Results: In 38 patients who completed the study, the NRS at pre-treatment was significantly reduced at the 1- and 2-month follow-ups. In the Group analysis, the NRS scores were significantly reduced after TFESI in both Groups 1 and 2, regardless of IS severity. However, the reduction in NRS scores 1 month after TFESI was significantly greater in Group 1 than in Group 2. Moreover, the rate of successful treatment outcomes was significantly higher (65.2%) in Group 1 than in Group 2 (26.7%).Conclusion: After TFESI, chronic radicular pain was significantly reduced regardless of IS severity, and its effect persisted for at least 2 months. However, its effect was superior when the vertebra slippage by IS was less than 25% compared to patients with 25%– 50%.Keywords: isthmic spondylolisthesis, foraminal spinal stenosis, lumbar spinal transforaminal epidural steroid injection, magnetic resonance imaging, corticosteroids

Ming Xing Wang,1,&ast; Jeoung Kun Kim,1,&ast; Min Cheol Chang2 1Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea&ast;These authors contributed equally to this workCorrespondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4682, Email wheel633@ynu.ac.krPurpose: A convolutional neural network (CNN) is one of the representative deep learning (DL) model that is especially useful for image recognition and classification. In the current study, using cervical axial magnetic resonance imaging (MRI) data obtained prior to transforaminal epidural steroid injection (TFESI), we developed a CNN model to predict the therapeutic outcome of cervical TFESI in patients with cervical foraminal stenosis.Patients and Methods: We retrospectively recruited 288 patients with cervical foraminal stenosis who received cervical TFESI due to cervical radicular pain. We collected single T2-axial spine MR image obtained from each patient. The image showing narrowest width of the neural foramen in the level at which TFESI was performed was used for input data. A “favor outcome” was defined as a ≥ 50% reduction in the NRS score at 2 months post-TFESI vs the pretreatment NRS score. A “poor outcome” was defined as a < 50% reduction in the NRS score at 2 months post-TFESI vs the pretreatment score.Results: The area under the curve of our developed model for predicting therapeutic outcome of cervical TFESI in patients with cervical spinal stenosis was 0.801.Conclusion: We showed that a CNN model trained using cervical axial MRI could be helpful for predicting therapeutic outcome after cervical TFESI in patients with cervical foraminal stenosis.Keywords: convolutional neural network, artificial intelligence, deep learning, spinal stenosis, cervical spine, transforaminal epidural steroid injection

Hyung Cheol Kim,1,&ast; Min Cheol Chang,2,&ast; Sung Han Oh,1 Su Bin Lee,3 Soo Young Yang,3 Dong Ah Shin3 1Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea; 3Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea&ast;These authors contributed equally to this workCorrespondence: Dong Ah Shin, Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Republic of Korea, Tel +82 02-2-2228-1004, Email cistern@yuhs.acPurpose: This study aimed to use thermal grill illusion (TGI), an experimental model of pain processing and central mechanisms, to evaluate the perception of TGI-related sensations or pain in patients with chronic lower back pain (CLBP).Patients and Methods: The perception of TGI (warmth/heat, cold, unpleasantness, pain, burning, stinging, and prickling) was examined in 66 patients with CLBP and compared with that in 22 healthy participants. The visual analog scale (VAS) scores for CLBP, Oswestry Disability Index (ODI), and 12-Item Short Form Survey (SF-12) scores were obtained from the included patients with CLBP.Results: The CLBP group showed a less intense perception of TGI for sensations of warmth/heat, unpleasantness, and pain than the control group. The CLBP group felt burning sensations lesser than the control (2.77 vs 4.55, P=0.016). In the CLBP group, there were significant correlations between the ODI and the degree of unpleasantness (r=0.381, P=0.002) and prickling sensation (r=0.263, P=0.033). There were also significant correlations between the mental component score of the SF-12 and the degree of warmth/heat (r=− 0.246, P=0.046), unpleasantness (r=− 0.292, P=0.017), pain (r=− 0.292, P=0.017), and burning sensations (r=− 0.280, P=0.023).Conclusion: Our results may be useful for clinicians to evaluate the effectiveness of drugs or interventions to manage centralized LBP.Keywords: thermal grill illusion, chronic pain, back pain

Jung Hwan Lee,1 Jun Ho Lee,2 Min Cheol Chang3 1Namdarun Rehabilitation Clinic, Yongin-City, Gyeonggi-Do, South Korea; 2Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, 02447, South Korea; 3Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, 705-717, Republic of KoreaCorrespondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4862, Email wheel633@gmail.comPurpose: This study aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) in patients with lumbosacral disc herniation by comparing its effect between those diagnosed by clinical evaluation and plain radiography only (X-ray group) and those by additional magnetic resonance imaging (MRI) (MRI group). Additionally, we investigated the accuracy of the preliminary clinical assumption in the X-ray group using confirmative post-injection MRI.Patients and Methods: We retrospectively recruited 367 patients with back and radicular pain due to lumbosacral disc herniation from a single pain clinic. Among them, 201 and 166 patients were categorized into the X-ray and MRI groups, respectively. In the X-ray group, the pathological level assumed initially by clinical evaluation and plain radiography concurred with that confirmed later on post-injection MRI in 139 patients (corresponding group); the remaining 62 patients lacked this concurrence (non-corresponding group). The NRS scores and Macnab criteria results were compared between the X-ray and MRI groups as well as the corresponding and non-corresponding groups.Results: Both the X-ray and MRI groups showed significant reductions in the NRS scores at 2 and 10 weeks post-injection when compared with the pretreatment scores. However, no significant difference was noted between the groups in terms of the magnitude of clinical improvement assessed by successful reduction in the NRS or Macnab scores. Furthermore, similar results were obtained in the comparison between the corresponding and non-corresponding groups of the X-ray group.Conclusion: TFESI guarantees favorable clinical outcomes even in the absence of confirmative MRI in patients with back and radicular pain. The preemptive application of this procedure could be prioritized and justified in patients suspected of lumbosacral disc herniation based on clinical evaluation and plain radiography only without the preceding MRI verification.Keywords: lumbosacral disc herniation, epidural injection, transforaminal, numeric rating scale, plain radiography

Dong Ah Shin,1 Min Cheol Chang2 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of KoreaCorrespondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4862, Email wheel633@gmail.comAbstract: Herniated intervertebral discs (HIVDs) can cause lower back pain and leg pain, but not all cases are painful. We suggest five potential reasons for painless HIVDs. First, when inflammation resolves or is insufficient, pain may not occur. Second, rare cases exhibit motor or sensory deficits without pain, suggesting a mechanical rather than inflammatory component. Third, changes in gene expression within the dorsal root ganglia may prevent persistent inflammation and pain. Fourth, reorganization of neural circuits in the spinal dorsal horn can reduce nociceptive signals and lead to painlessness. Fifth, effective pain coping strategies and higher pain tolerance may mask any discomfort. Understanding these factors can improve clinicians’ knowledge and aid in pain management.Keywords: herniated intervertebral disc, painless, inflammation, reorganization

Min Cheol Chang,1,&ast; Donghwi Park,2,&ast; Yoo Jin Choo3 1Department of Rehabilitation Medicine, Yeungnam University Hospital, Daegu, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; 3Medical Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, 41061, Republic of Korea&ast;These authors contributed equally to this workCorrespondence: Yoo Jin Choo, Medical Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, 80, Cheombok-ro, Dong-gu, Daegu, 41061, Republic of Korea, Tel +82 10 7344 7841, Email cyj361@hanmail.netPurpose: In the current study, we investigated the usefulness of the quick response (QR) code linked to the source of a video of home-based therapeutic exercise to promote home-based therapeutic exercise in patients with LDH and LSS.Patients and Methods: Forty patients with LDH and LSS were included in this study. The patients were randomly assigned to one of two groups: QR codes or control groups (20 patients per group). The QR code group received QR code stickers linked with a video that includes a demonstration on how to exercise for the back muscles. We instructed the patients to perform home-based therapeutic exercises three or more days a week. Patients in the control group were asked to perform the therapeutic exercise without providing a QR code to them. The primary outcome was the number of exercises per week. The scores of the numeric rating scale (NRS) and Oswestry disability index (ODI) were investigated as secondary outcomes.Results: The patients in the QR code group exercised for the lower back muscles on average about two times a week, and 40% of the patients in the QR code group performed the exercise three or more days a week. However, almost no patients in the control group performed therapeutic exercises. Patients in the QR code group showed significantly lower ODI scores at the 1-month and 2-month follow-ups compared with the control group. In addition, the patients who exercised ≥ 3 times per week showed more improvement in the disability than those who exercised < 3 times per week. The NRS scores for lower back pain and radicular leg pain were not significantly different between the QR code and control groups.Conclusion: We found that QR codes can be useful for encouraging patients with LDH or LSS to perform home-based therapeutic exercises.Keywords: lumbar disc herniation, lumbar spinal stenosis, quick response code, exercise, pain, disability

Seoyon Yang,1 Mathieu Boudier-Revéret,2 Ming-Yen Hsiao,3,4 Soyoung Kwak,5 Min Cheol Chang5 1Department of Rehabilitation Medicine, Ewha Woman’s University Seoul Hospital, Ewha Woman’s University School of Medicine, Seoul, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal, Montreal, Canada; 3Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan; 4Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; 5Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of KoreaCorrespondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4682, Email wheel633@gmail.comObjective: To investigate whether the response to intra-articular facet joint corticosteroid injection can determine the long-term prognosis (at least 5 years after injury) of whiplash injury-related neck pain sustained 3– 12 months after injury.Methods: Of 65 patients who visited a university hospital for persistent whiplash injury-induced axial neck pain sustained 3– 12 months after injury (numeric rating scale score ≥ 3) and had received intra-articular facet joint corticosteroid injection, 40 completed the telephone interview. We divided the patients into “good response group” (≥ 50% pain reduction at 1 month after the injection) and “poor response group” (< 50% pain reduction at 1 month after the injection). We asked participants regarding the presence and degree of neck pain, its impact on work, and the use of oral pain medication or injection treatment.Results: A follow-up at least 5 years after the injury found that the number of patients with persistent whiplash injury-related neck pain was significantly lower in the good response group than in the poor response group. The number of patients taking oral pain medications prescribed by a medical doctor or receiving injection treatments in a pain clinic or hospital for neck pain was lower in the good response group than in the poor response group. The number of patients who answered that their work was affected by neck pain was lower in the good response group than in the poor response group.Conclusion: The response to intra-articular corticosteroid injection might be helpful in determining at least 5-year outcomes of chronic whiplash injury-induced pain.Keywords: whiplash injury, facet joint, corticosteroid, injection, neck pain, chronic pain, outcome, prognosis

Ming-Chuan Lee,1 Yu-Tsang Wang,2 Yu-Ju Li,1 Ching-Yi Tsai,1 Su-Te Chen,1 Wun-Jyun Jhuang,1,3 Meng-Chi Chang,1 Mei-Yu Chien,1 Hsiang-Chun Lee1,3– 5 1Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; 2Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; 3Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; 4Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; 5Institute/Center of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, 804, TaiwanCorrespondence: Hsiang-Chun Lee, Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan, Tel +886-7-3121101#2293, Fax +886-7-3234845, Email hclee@kmu.edu.twPurpose: Manifestations of metabolic syndrome (MetS) carry risks for atrial fibrillation (AF). The study determined whether any electrocardiographic parameter can reflect increased AF risk in individuals with MetS.Patients and Methods: From our University Hospital database, we examined the presence of AF and its correlation with MetS manifestations, renal function, lipid profiles, and electrocardiographic parameters (P wave duration, PR interval, QRS width, and QTc intervals). Between January 2008 and December 2015, data from 4479 adults (women 41.6% vs men 58.4%) were identified.Results: The overall prevalence of AF was 12.4%, without sex differences (women, 12.8% vs men, 12.1%). Patients with AF were older (age 73.9 ± 11.8 vs non-AF 67 ± 13.5 years), with lower lipid levels (TG, total cholesterol, and LDL-cholesterol, all p < 0.0001), and at lower eGFR level (64.1 ± 30.9 vs non-AF 68.8 ± 41.4 mL/min/1.73m2, p < 0.0001). Besides, sex differences were present in all electrocardiographic parameters (all p < 0.05). Hypertension had the highest odds ratio (1.33; p = 0.026) for AF. Comparing AF to non-AF, the QTc of quartiles was significantly different (p < 0.0089). The shortest and longest QTc quartiles had an increased incidence of AF.Conclusion: AF risk in patients with MetS phenotypes can be reflected by QTc quartiles.Keywords: atrial fibrillation, electrocardiography, metabolic syndrome, lipid, QTc interval

Min Cheol Chang,1 Donghwi Park2 1Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of KoreaCorrespondence: Donghwi ParkDepartment of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunghwando-ro, Dong-gu, Ulsan, 44033, Republic of KoreaTel +82-52-250-7222Fax +82-52-250-7228Email bdome@hanmail.netObjective: With the advance of the internet, social media platforms have become a major source of medical information. We assessed the reliability, quality, and usefulness of the most-viewed YouTube videos of epidural steroid injection (ESI).Methods: A search was conducted on YouTube on February 13, 2020, using the keywords “epidural injection,” “epidural steroid injection,” “epidural transforaminal injection,” and “epidural transforaminal steroid injection.” The top 50 most-viewed videos were assessed with a modified DISCERN scale (mDISCERN) and a Global Quality Scale (GQS). Further, the usefulness of information in each video was evaluated.Results: Only 22% of videos contained information with high reliability, and these were produced by hospitals or physicians. None of the videos provided by media organizations and patients were reliable. As for information quality, only 34% were moderate to excellent quality. Even of the videos produced by hospitals or physicians, approximately half were of generally poor or poor quality. Regarding the usefulness of information, although 76% were assessed to contain useful information, 8% had misleading information. Particularly, four of these videos contained misleading information, and three were provided by patients who experienced ESI.Conclusion: YouTube is a platform where medical information is actively shared and widespread. Here, we found that the reliability and quality of videos were low even when these were produced by hospitals or physicians. Further, the quality tended to be much lower when it was provided by media organizations or patients. Future efforts by physicians and professional societies to improve the reliability and quality of medical content are necessary.Keywords: epidural steroid injection, back pain, sciatica, online media, quality, social media

Kai-Ming Jhang,1,* Wen-Fu Wang,1,2,* Hsin-Fang Chang,3,* Ming-Che Chang,4 Hsin-Hung Wu3,5,6 1Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan; 2Department of Holistic Wellness, Ming Dao University, Changhua, Taiwan; 3Department of Business Administration, National Changhua University of Education, Changhua, Taiwan; 4Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan; 5Department of M-Commerce and Multimedia Applications, Asia University, Taichung City, Taiwan; 6Faculty of Education, State University of Malang, Malang, East Java, Indonesia*These authors contributed equally to this workCorrespondence: Hsin-Hung Wu Email hhwu@cc.ncue.edu.twPurpose: The aim of this study was to elucidate the factors and caring scenarios associated with a moderate to severe care burden in the caregivers of patients with vascular cognitive impairment (VCI).Patients and Methods: This cross-sectional study included 158 patients with VCI and their caregivers who were managed by the dementia collaborative care team at Changhua Christian Hospital, Taiwan. Gender, age, clinical dementia rating, walking ability, behavioral symptoms, and psychological symptoms were the variables from the patients with VCI. Age, marital status, relation to the VCI patient, education, employment status, help of key activities, type of primary care, frequency of care, ZBI (Zarit burden interview) caregiving burden, and caregiver’s mood were the evaluated variables for the caregivers. The Apriori algorithm was used to identify the attributes that resulted in different caregiving burdens from a comprehensive viewpoint of both VCI patients and their caregivers.Results: A total of 1193 rules were identified with 1134 rules belonging to caregivers with a mild to moderate burden and 59 rules belonging to caregivers with a moderate to severe burden. Seven general rules were created based on a summary of these 59 rules. The results showed that an employed female caregiver who was taking care of her husband alone for ≥ 6 days per week, and who was helping with all key activities was likely to experience a moderate to severe burden when the patient had VCI. Moreover, if the caregiver had a relatively low education level and expressed an abnormal mood during the assessment, this increased the likelihood of the caregiver having a moderate to severe burden.Conclusion: The caregiver’s gender, relation to the care recipient, education level, mood status, employment status, and care loading were associated with a higher burden of care for caregivers of patients with VCI. Therefore, a dementia care team should provide personalized training for caregivers about the disease, care skills for specific behaviors and psychological symptoms of dementia (BPSD), and strategies to cope with their own feelings. Caregivers should also be referred to appropriate social resources, such as support groups or respite care.Keywords: vascular cognitive impairment, dementia, caregivers, caregiving burden, Zarit burden interview, caring scenario, Apriori algorithm

Min Cheol Chang,1 Donghwi Park2 1Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of KoreaCorrespondence: Donghwi ParkDepartment of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunghwndo-Ro, Dong-Gu, Ulsan, 44033, Republic of KoreaTel +82-52-250-7222Fax +82-52-250-7228Email bdome@hanmail.netObjective: Although several researches of animal and human subjects have yielded promising results regarding intradiscal injection of platelet-rich plasma (PRP) for the management of intervertebral disc (IVD) pathologies, small sample sizes and unstandardized graft preparation procedures hampered these research efforts. Therefore, we conducted a meta-analysis to evaluate the effectiveness of intradiscal PRP injection for the treatment of discogenic lower back pain.Methods: The PubMed, SCOPUS, Embase, and Cochrane Library databases were systematically searched for relevant studies published from January 01, 1980 to December 14, 2020. The keywords used for the search were (platelet-rich plasma) AND (intradiscal OR back pain OR lumbar spine OR discogenic). Filters were used to select studies with human participants; all study designs were included.Results: After the systematic review, three articles, including one randomized control trial and two prospective observational studies, were included in the final analysis. Analysis of changes in visual analogue scale (VAS) scores showed that VAS scores were significantly reduced two and six months after intradiscal PRP injection (two months: standardized mean difference [SMD] = − 0.837, 95% CI = − 1.158 to − 0.516, P < 0.001; six months: SMD = − 1.430, 95% CI = − 2.209 to − 0.652, P < 0.001), but not after one month (SMD = − 0.661, 95% CI = − 1.346 to 0.023, P = 0.058). Regarding changes in Owestry Disability Index (ODI), ODI scores were significantly reduced after six months (SMD = − 0.964, 95% CI = − 1.885 to − 0.043, P = 0.040).Conclusion: Intradiscal PRP injections are effective in relieving pain and improving disabilities caused by discogenic lower back pain. However, the pain-reducing effect significantly manifests two or six months after the injections, but not after one month.Keywords: platelet-rich plasma, discogenic lower back pain, degenerative disc disease, intervertebral disc, review

Dong Ah Shin,1 Tae Uk Kim,2 Min Cheol Chang3 1Department of Neurosurgery, Yonsei University, College of Medicine, Seoul, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, College of Medicine, Dankook University, Cheonan, Republic of Korea; 3Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of KoreaCorrespondence: Min Cheol ChangDepartment of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu 705-717, Republic of KoreaTel +82-53-620-4682Email wheel633@ynu.ac.krObjective: Minocycline is known to reduce microglial activation, suggesting that it may reduce neuropathic pain. We reviewed studies in humans that evaluated the effectiveness of minocycline in alleviating neuropathic pain.Methods: We searched the PubMed, Embase, Cochrane library, and SCOPUS databases for papers published before January 06, 2021, using the search words minocycline and pain. The inclusion criteria for the selection of articles were (1) minocycline administered to humans and (2) minocycline administered to control neuropathic pain.Results: The primary literature search yielded 2299 relevant papers. Based on the assessment of the titles, abstracts, and full-text, nine publications were selected for this review. Only four of the nine studies showed a positive pain-reducing outcome after minocycline administration. Two of the three studies on chemotherapy-induced neuropathic pain showed a positive pain-reducing effect. Minocycline was effective in controlling pain from diabetic and leprotic neuropathies. However, minocycline was not effective in controlling lumbar radicular pain and pain resolution after carpal tunnel release.Conclusion: Our review provides evidence that minocycline may have some potential for reducing neuropathic pain. Further high-quality studies need to be conducted to validate this potential.Keywords: minocycline, microglia, neuropathic pain, pain, review

Kai-Ming Jhang,1,* Wen-Fu Wang,1,2,* Hao-Fang Chang,3,* Yu-Huei Liu,4– 6,* Ming-Che Chang,7 Hsin-Hung Wu3,8,9 1Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan; 2Department of Holistic Wellness, Ming Dao University, Changhua, Taiwan; 3Department of Business Administration, National Changhua University of Education, Changhua, Taiwan; 4Graduate Institute of Integrated Medicine, China Medical University, Taichung City, Taiwan; 5Drug Development Center, China Medical University, Taichung City, Taiwan; 6Department of Medical Genetics and Medical Research, China Medical University Hospital, Taichung City, Taiwan; 7Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan; 8Department of M-Commerce and Multimedia Applications, Asia University, Taichung City, Taiwan; 9Faculty of Education, State University of Malang, Malang, East Java, Indonesia*These authors contributed equally to this workCorrespondence: Hsin-Hung Wu No. 2 Shida Road, Changhua City 500, TaiwanTel +886 4 7232105 ext. 7412Fax +886 4-7211292Email hhwu@cc.ncue.edu.twPurpose: The aim of this study was to identify the care needs of male patients with vascular cognitive impairment (VCI) and their caregivers.Patients and Methods: This cross-sectional study enrolled 389 male patients with VCI and their caregivers who were cared for by the dementia collaborative care team at Changhua Christian Hospital, Taiwan. Fifteen care needs consisting of most of quality measures for people living with dementia and their caregivers were developed by the care team. Through face-to-face evaluations, individualized care needs were collected. The Apriori algorithm was used to identify care bundles for the patients and their caregivers.Results: Six basic care needs for patients and their caregivers were identified, including appropriate schedule of activities, regular outpatient follow-up treatment, introduction and referral of social resources, referral to family support groups and care skills training, care for the mood of the caregiver, and health education for dementia and behavioral and psychological symptoms of dementia. Compared to subjects with all dementia subtypes from the previous studies, care for the mood of the caregiver was an important and frequent care need for the male patients with VCI and their caregivers. A comparison among the study and similar studies was made to highlight the strength of this study concentrating on the precise selection of care needs.Conclusion: Collaborative dementia care teams should monitor for caregivers’ depression and include this care need into the care bundle when assessing male subjects with VCI.Keywords: male patients with vascular cognitive impairment, people living with dementia, behavioral and psychological symptoms of dementia, dementia collaborative care model, care need, Apriori algorithm

Min Cheol Chang,1 Donghwi Park2 1Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of KoreaCorrespondence: Donghwi ParkDepartment of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunghwndo-ro, Dong-gu, Ulsan 44033, Republic of KoreaTel +82-52-250-7222Fax +82-52-250-7228Email bdome@hanmail.netAbstract: Administrations of intravenous immunoglobulin (IVIG), an immune-modulating blood-derived product, may be beneficial for managing neuropathic pain. Here, we review previous studies to investigate the effectiveness of IVIG in managing neuropathic pain due to various neurological disorders. The electronic databases PubMed, Scopus, Embase, and the Cochrane Library were searched for studies published up to February 2020. Two reviewers independently assessed the studies using strict inclusion criteria. Ten studies were included and qualitatively analyzed. The review included patients with pain due to complex regional pain syndrome (CRPS), diabetic polyneuropathy, and others, such as postherpetic neuralgia and trigeminal neuralgia. We found that IVIG may be one of the beneficial options for managing neuropathic pain from various neurological disorders. In the four articles reviewed, no major adverse effects were reported, and the trend was toward a positive pain-reducing effect in eight articles. However, to confirm the benefits of IVIG on reducing neuropathic pain, more high-quality studies are required.Keywords: neuropathic pain, intravenous immunoglobulin, complex regional pain syndrome, diabetic polyneuropathy

Min Young Lee,1 Mathieu Boudier-Revéret,2 Hee Kyung Cho,3 Min Cheol Chang1 1Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea; 2Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada; 3Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of KoreaCorrespondence: Min Cheol Chang Email wheel633@gmail.comPurpose: In most cases, lumbosacral radicular pain caused by herniated lumbar discs (HLDs) can be controlled with epidural steroid injections (ESIs). However, when the HLDs are large, the pain may not respond to ESIs. A navigable, percutaneous, disc decompression device has recently been developed to manage radicular pain that is secondary to HLD, which allows the wand tip to approach the herniated disc by rotating a control wheel. We performed a percutaneous disc decompression using the navigable percutaneous disc decompression device in two patients with a large HLD that did not respond to repeated ESIs.Patients and Methods: Patients A and B are presented with scores of 7 and 8 on the numeric rating scale (NRS), respectively. Both had lumbosacral radicular pain due to right central HLDs at L4-5 and L5-S1, despite repeated ESIs. Percutaneous disc decompression was performed under C-arm fluoroscopy. The wand was inserted through the introducer needle. Using the control wheel, we placed the needle tip on the posterolateral portion of the herniated disc. The radiofrequency current was applied to the herniated portion of the disc. The procedural time was 20– 30 minutes.Results: Neither of the patients reported adverse post-procedural effects. At their 1-week follow-up, patient A and B’s NRS pain scores had reduced to 2 and 1, respectively. At their 2-year follow-up, patient A had mild pain (NRS 1), and patient B reported no pain.Conclusion: The navigable percutaneous disc decompression device may be effective for pain alleviation in patients with lumbosacral radicular pain that is refractory to repeated ESIs.Keywords: lumbosacral radicular pain, disc decompression, herniated lumbar disc

Donghwi Park,1 Min Cheol Chang2 1Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; 2Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of KoreaCorrespondence: Min Cheol Chang Email wheel633@gmail.comPurpose: Lumbar transforaminal selective nerve root injection (SNRI) is effective for controlling radicular pain. However, when a patient occasionally experiences severe foraminal stenosis, osteophytes cover the outside opening of the neural foramen, preventing clinicians from inserting a needle tip within the neural foramen.Patients and Methods: An 81-year-old man complained of left L5 radicular pain (left thigh and calf) due to severe left L5-S1 foraminal stenosis. After failure of conventional transforaminal SNRI in the left L5 due to severe degenerative change in the lumbar spine, SNRI was performed using a Racz catheter. After inserting a 16-gauge cannula via the sacral hiatus, the Racz catheter was inserted. The tip of the catheter was positioned near the left L5 nerve root. After confirming the location of the needle tip using a contrast dye, 20 mg (40 mg/mL) of triamcinolone with 0.5 mL of 1% lidocaine and 2 mL of normal saline was injected.Results: Immediately after the procedure, the patient’s pain completely disappeared. During the 1- and 2-month follow-ups, the patient reported only slight pain in the thigh and calf.Conclusion: When it is not possible to perform a conventional transforaminal SNRI, SNRI using a Racz catheter can be an effective treatment option for controlling lumbar radicular pain.Keywords: spinal stenosis, Racz catheter, selective nerve root injection

Kai-Ming Jhang,1,* Ming-Che Chang,2,* Tzu-Ying Lo,3 Che-Wei Lin,4 Wen-Fu Wang,1,5,* Hsin-Hung Wu3,6 1Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan; 2Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan; 3Department of Business Administration, National Changhua University of Education, Changhua, Taiwan; 4Medical Divisions of Performance Center, Changhua Christian Hospital, Changhua, Taiwan; 5Department of Holistic Wellness, Ming Dao University, Changhua, Taiwan; 6Department of M-Commerce and Multimedia Applications, Asia University, Taichung City, Taiwan*These authors contributed equally to this workCorrespondence: Hsin-Hung Wu No. 2 Shida Road, Changhua City 500, TaiwanTel +886 4 7232105 ext. 7412Fax +886 4-7211292Email hhwu@cc.ncue.edu.twPurpose: To elucidate specific combinations of care needs for people living with dementia (PLWD) and their caregivers according to specific subtypes of dementia.Patients and methods: A cross-sectional study at memory clinics in Changhua Christian Hospital, Taiwan, was conducted. Five hundred and eight people living with dementia and their caregivers joined the dementia collaborative care model. The care team established 15 care needs containing most of quality measures for PLWD and their caregivers. Individualized care plans including different combinations of care needs were addressed through face-to-face assessments. Apriori algorithm was used to find specific combinations of care needs for particular groups of PLWD and their caregivers.Results: This study identified the basic care needs of PLWD and caregivers including appropriate scheduling of activities, regular outpatient follow-up treatment, introduction and referral of social resources, referral to family support groups and care skills training, and health education for dementia and behavioral and psychological symptoms of dementia. Patients with Alzheimer’s dementia required more care to prevent traffic accidents and getting lost, while patients with vascular dementia required more care to prevent falls. The older (≥75 years old) PLWD were associated with more needs of fall prevention and care for the mood of the caregiver, especially in the female patients with mild Alzheimer’s dementia (CDR = 1).Conclusion: Bundling the needed care needs might be a more effective means to care for a wide variety of patients with dementia.Keywords: people living with dementia, behavioral and psychological symptoms of dementia, dementia collaborative care model, care need, Apriori algorithm

The group refractive index and physical thickness of dry and hydrated type I collagen films are measured using optical low-coherence reflectometry. The average value for the group refractive index of dry and fully hydrated collagen films at λo = 850 nm is, respectively, 1.53 ±0.02, and 1.43 ±0.02. The physical thickness of type I collagen films nearly doubles when going from the dry (56 μm) to hydrated (118 μm) state.