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The COVID-19 pandemic has a substantial impact on the physical and mental health status of patients with COVID-19. This study's objective was to evaluate the factors associated with mental health in patients isolated with COVID-19.It is a retrospective, cross-sectional study. One hundred and two patients discharged from COVID-19 hospitalization in Korea were analyzed. The primary outcome was the correlation between psychological problems such as anxiety, depression, and fear of stigma and physical symptoms such as respiratory symptoms, gastrointestinal symptoms, headache, and fever. Mental and physical symptoms were ascertained using closed and multiple-choice questions. The secondary outcome was the correlation between mental issues, demographic factors, and disease severity. Hypoxia and the need for oxygen therapy, a need for remdesivir antiviral treatment, and indications of pneumonia progression on chest x-ray were confirmed through a review of medical records and used to measure disease severity.Patients with COVID-19 indicated feelings of depression (48.1%), anxiety (49.1%), and fear of stigma (60.45%), and some continued to experience physical symptoms even after discharge. Logistic regression revealed that gastrointestinal symptoms positively correlated with depression (p lt; .05) and headache positively correlated with fear of stigma (p lt; .05), while the other factors were not statistically significant (p gt; .05).This study showed that psychological symptoms persisted even after discharge. Gastrointestinal symptoms and headache were influential factors in predicting depression and fear of stigma. Based on this, dedicated COVID-19 hospitals should provide mental health support and preventive management.

Background: To improve the rehabilitation team’s awareness of patient mobility and participation by enhancing communication between therapists and nurses and conducting patient education.Methods: This study used a non-equivalent control group with a non-synchronized design. To facilitate communication between therapists and nurses, we used a manual for mobility management to improve the sharing of information on the functional status of patients. We also implemented patient education to improve their awareness of mobility and participation. Finally, we conducted newly devised surveys related to patient functional status and awareness that were applied by therapists and nurses.Results: The nurses reported significantly lower functional levels of patients compared to those assessed by therapists. After the intervention, the kappa values representing the concordance between therapists and nurses improved to almost perfect agreement for transfer ability (κ=0.836), mobility (κ=0.664), and toileting (κ=1.000). We also observed a statistically significant increase in questionnaire scores with respect to nurses’ awareness (p

Background Korea, as one of the fastest-aging countries worldwide, requires an improved healthcare service model for older adults. We evaluated the current healthcare system and developed a service model based on information and communication technologies (ICT) for use in older patients in long-term care facilities (LTCF). Methods We conducted a qualitative literature review, focus group interviews (FGIs), and structured survey to identify the current technology use and status of healthcare systems. We then developed a web-based platform with necessary, high-priority, and usable content for the care of older patients in LTCF. Results We reviewed 60 (23 hypertension, 18 diabetes, and 19 heart failure) articles on information and communication technologies (ICT)-based disease management for clinical effectiveness and improved patient satisfaction. FGIs and structured surveys were used to evaluate the inconvenience in patient and medical information transfer between hospitals and cost and time required for its process. Accordingly, we confirmed the unmet need for an ICT-based service model for management, monitoring, and consultation among older patients and developed the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT), a service platform for older patients residing in LTCF. The medical information exchange system was used to transfer medical information. Health-RESPECT includes an established algorithm for evidence-based comprehensive geriatric assessment and customized management; chronic disease management; management of potentially inappropriate medications; rehabilitation; and consultation and videoconferencing. Conclusion This study identified the current status and unmet needs of healthcare systems for older adults. We developed an ICT-based system to manage older institutionalized patients. However, the Health-RESPECT service model requires further validation.

There have been many studies on adolescent idiopathic scoliosis related abnormal muscle contractions of the spine. However, previous studies using surface electromyography to investigate paraspinal muscle asymmetry are controversial, lacking in clarity of results, and hindered by methodological limitations. The purpose of this study was to investigate the relationship between imbalance factors including surface electromyography activity according to the scoliosis curve type and leg length discrepancy and adolescent idiopathic scoliosis curve types. Seventy-nine patients with scoliosis were prospectively enrolled and were divided into five types: single thoracic, thoracolumbar, lumbar, double thoracic, and double major. Cobb angle and structural variables were measured. Surface electromyography examinations were conducted at the 7th, 12th thoracic erector spinae, 3rd lumbar erector spinae, and multifidus muscles during the superman position keeping prone spinal extension to lift the arms and legs off the floor. Whole spine radiographs were obtained to measure the Cobb angle, coronal imbalance, pelvic height and angle, and femoral head height. In the double major, thoracolumbar, and lumbar types, the mean root mean squared (RMS) EMG amplitudes were significantly higher on the convex side than the concave side (P T7 and ESL3 where the apex was located were significantly higher at the convex side than those of the concave side (P T7/ESL3: 0.517/0.573). The TL and L types showed a similar pattern. The mean RMS EMG amplitudes of the EST12 concave side and MuL3 and ESL3 concave sides were significantly lower than those of the convex side in the TL and L types, respectively (P T12/MuL3/ESL3: 0.960/0.264/0.448). Conversely, there were no significant differences in the single thoracic and double thoracic types. All structural variables (coronal imbalance, pelvic height and angle, and femur head height) were higher in the lumbar type, but only coronal imbalance was significantly different (P

Objective: To investigate the neurological and functional recovery patterns of ischemic spinal cord injury (ISCI) compared with traumatic spinal cord injury (TSCI) in the acute to chronic phase. Design: Retrospective cohort study. Settings: Department of Neurology, Neurosurgery, Rehabilitation Medicine at a tertiary hospital. Participants: Fifty-four patients with ISCI and 86 patients with TSCI. Interventions: Not applicable. Outcome measures: MRI findings, American Spinal Injury Association Impairment Scale (AIS), modified Rankin Scale (mRS), Korean Spinal Cord Independence Measure (KSCIM), ambulatory status, and bladder status were reviewed. The functional outcomes were measured at admission, discharge, and >6 months after discharge. Results: AIS classification did not significantly change after 6 months in both ISCI and TSCI groups. Between admission and discharge, the proportion of patients needing a wheelchair or assistive device to ambulate decreased more in the ISCI group compared with the TSCI group [odds ratio (OR) 0.40, P = 0.04]. In addition, the proportion of catheterized voiding in the ISCI group was significantly higher than in the TSCI group at all time points (OR 5.12, P 6 months post discharge. Conclusion: The ISCI group showed better recovery of mobility during inpatient rehabilitation period and worse recovery of bladder function as demonstrated by higher number of patients requiring bladder catheterization at all time points when compared with the TSCI group.

The aims of the study were to identify the differences of forces in the hip adductors between with or without the abduction bar and to evaluate the effect of hip compression bandage on the spasticity of the adductor muscles.Thirty-three patients with cerebral palsy (Gross Motor Functional Classification System IV and V) were prospectively included. Surface electromyography was taken by attaching electromyography on the adductor and abductor muscles. Theraband was used as hip compression bandage. Surface electromyography were taken when spasticity provoked with and without abduction bar, as well as with both abduction bar and hip compression bandage. Root mean square values were measured.Root mean square values were significantly increased with abduction bar in the adductor longus, adductor magnus, and tensor fascia lata muscles. Adductor Sum and Net Adduction Index showed significant increases after the use of abduction bar. After applying hip compression bandage, the Net Adduction Index was significantly decreased.Our results showed significant changes in the adductor muscles' amplitude, Adduction Sum, and Net Adduction Index. These results indicate that forces that worsen hip dislocation may develop, and therefore, abduction bar should either not be used for spastic cerebral palsy patients or should only be used with hip compression wrapping in place as well.

Objective To evaluate whether medial knee support (MKS) in seating systems aggravates hip displacement in children with cerebral palsy (CP). Design Retrospective chart review. Setting Rehabilitation department of tertiary university hospital. Participants Children with CP (N=76) using seating systems (intervention group, n=42; mean age 6.86y) and using regular wheelchairs (control group, n=34; mean age 8.15y). Interventions The intervention group was provided with a seating system with MKS. We enrolled children who did not use a seating system in the control group, retrospectively. Main Outcome Measures By radiographic images, Reimer’s migration index (MI), lateral center edge angle (CEA), and femur neck shaft angle (NSA) were measured. We compared the demographic data, clinical variables, and radiographs between the 2 groups. Results In the intervention group, there was a significant deterioration in the MI, from 26.89% to 44.18% after using the system (P Conclusion We should consider the possibility that seating systems with MKS may exacerbate hip displacement in children with CP.

Background: In Korea, fast aging country, an optimal healthcare service model for older adults should be developed. The purpose of this study is to identify the current healthcare system and to develop new healthcare service model using information and communication technologies (ICT) for older patients. Methods: Qualitative literature review, focus group interview and structured survey were conducted to identify current healthcare systems for older patients. Afterwards, we developed healthcare service model which include contests of comprehensive geriatric assessment, disease management, drug management, rehabilitation and consultation service using ICT. Result: Sixty (23 hypertension, 18 diabetes and 19 heart failure) articles are reviewed. ICT based chronic disease management models was effective and patients’ satisfaction were improved. In focus group interview and structured survey, current patients and medical information transfer between hospitals was inconvenient, costly and time consuming, especially in long-term care hospital (LTCH) and nursing home (NH) and the necessity of service model to manage older patients using ICT was confirmed. ICT based service model for older patients dwelling LTCH and NH was developed (Health-RESPECT) which include evidence based 1) comprehensive geriatric assessment (CGA) and establishment of customized management strategy 2) chronic disease management service with decision support system 3) potentially inappropriate medication management service 4) rehabilitation service and 5) consultation and videoconference service. Conclusion : This study is meaningful to identify current healthcare systems in older adults and to develop a system to manage older patient living in LTCH and NH using ICT. However, Health-RESPECT service model will need to be validated in further study.

Main purpose was to evaluate the applicability of a 3D-printer equipped with a hot-melt pneumatic dispenser as a single-step process to prepare tablet dosage forms. Dutasteride, a poorly water-soluble drug, was selected as a model drug. Soluplus®, Kollidon® VA 64, Eudragit® E PO, and hydroxypropyl cellulose (HPC) were premixed as bulking agents prior to printing. Differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), and thermogravimetric analysis (TGA) were utilized to evaluate the physicochemical properties of the 3D-printed tablets. Moreover, different geometries were designed to correlate the surface area/volume (SA/V) of the tablets with respect to their release profiles. As a result, printed dutasteride was confirmed to be in an amorphous state and not recrystallized even after the accelerated storage stability. Out of the four bulking agents, Kollidon® VA 64, enhanced the dissolution of the printed dutasteride, reaching above 80% within 15 min. These results suggest that the hot-melt pneumatic dispenser was efficient in converting the solid state into an amorphous state, which significantly enhanced the dissolution. On the other hand, the tube-shaped 3D-printed tablet exhibited the fastest drug dissolution profile, which had the highest SA/V ratio in comparison to the cube, hemisphere, and pyramid shapes. These results confirm the dependency of the drug dissolution rate not only on its crystallinity but also on the surface area of the 3D-printed tablet. Therefore, a 3D-printer equipped with a hot-melt pneumatic dispenser possesses useful applicability in enhancing drug dissolution, especially for poorly water-soluble drugs, in a single-step process.

In this study, two workable designs of a heat-pump-driven liquid desiccant (HPLD) air-conditioning system were proposed for residential buildings. The proposed HPLD systems were designed to work as a multi-functional air-conditioning system without additional equipment which would solve the low practicality due to the large scale and complexity of the conventional liquid-desiccant-assisted air-conditioning system. The critical difference between the two systems is the sump design for containing the desiccant solutions: Case A has a single sump instantly mixing weak and strong solutions, whereas Case B has dual sumps containing weak and strong solutions separately. The thermal load of target space was estimated using TRNSYS 18, and energy performances of both HPLD systems for summer and winter operation modes were analyzed using EES by integrating several established models and theoretical analyses. Owing to decrease in solution cooling and heating loads, the results show that Case B, compared with Case A, saved 28% of energy consumption and improved mean energy-efficiency by 37.5% for summer operation mode, and saved 12% of energy consumption and improved mean energy-efficiency by 4.95% for winter operation mode. In conclusion, Case B has a better application potential for residences in terms of energy performance.

The aim of this study was to examine and characterize the reversibility of the cervical somatosensory electrophysiological pathways during neutral and flexed neck positions. The parameters of somatosensory evoked potentials (SEPs) during neutral and flexed neck positions (N9, N13, and N20 SEP latencies; N9–N13 and N13–N20 inter-peak latencies; and the changes in N9–N13 and N13–N20 inter-peak latency during neutral and flexed neck positions) were measured in the patients with Hirayama disease (HD) and also in the healthy controls. In patients with HD, there was a significant difference in the mean value of N13–N20 inter-peak latency during the flexed neck position compared to that of the healthy controls (p

Study design A retrospective observational study. Objective The aim of this study was to investigate the prognostic significance of contrast-enhanced magnetic resonance imaging (MRI) for detecting pedicle enhancement and predicting future collapse in patients with acute benign osteoporotic vertebral compression fracture (OVCF). Summary of background data Traditional morphological classification regarding compression versus burst fractures cannot accurately anticipate the prognosis of further collapse. Identifying subgroups with a higher risk for further collapse may be beneficial in determining the treatment modality, which should be decided immediately after the injury. Methods One hundred fourteen patients with benign OVCFs who, at the onset, underwent contrast-enhanced spine MRI between 2003 and 2016 were retrospectively analyzed. Patients were recruited on the basis of predefined inclusion and exclusion criteria. The primary outcome was the compression progression rate; other potential variables included demographic and clinical characteristics, initial compression rates, and kyphotic angles. In addition, other structural abnormalities on MRI were assessed. The compression progression rates were compared according to pedicle enhancement, and the prognostic significance of pedicle enhancement for further collapse were analyzed. Results Further compression progression rates were significantly higher in the pedicle-enhanced (PE) group than in the nonenhanced (NE) group. Multivariate logistic analysis revealed that pedicle enhancement may be associated with further compression progression ≥10%. The vertebral augmentation (VAG) protective effect against collapse was only significant within the PE group, while bone densitometry and patients' mobility were significant only within the NE group. The log-rank test revealed a statistically significant difference in the rates of further collapse ≥10% during the 1 year between the groups. Conclusion Sign of pedicle enhancement is a potential risk factor for further compression progression. Contrast-enhanced MRI should be performed at the onset to better determine the future risk of collapse and to choose a better treatment modality for benign OVCF patients. Level of evidence 3.

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Introduction Various phenotypes have been identified for MYH7 gene mutation-related myopathy. Here, we describe a patient with severe muscular weakness and skeletal deformity with de novo heterozygous MYH7 gene mutation. Patient concerns A 33-year-old woman presented with early onset of muscular weakness, with delayed motor development during infancy. At age 8 years, she was unable to walk, with signs of skeletal deformity, including the progression of kyphoscoliosis. At age 31 years, she developed dyspnea. Diagnosis She diagnosed with esophageal hiatal hernia with abdominal CT. In electromyography, short duration, small amplitude motor unit action potential (MUAP), and early recruitment patterns were observed in the involved proximal muscles, suggesting myopathy. Muscle histopathology showed fiber-type disproportion. Interventions Next-generation sequencing study revealed a heterozygous in-frame deletion variation in the exon 14 of the MYH7 gene (c.1498_1500del/p.Glu500del), which is a novel variation confirmed by conventional Sanger sequencing. Compared with the parental test, this variant was concluded as de novo. Outcomes She received laparoscopic hiatal hernia repair and Nissen fundoplication for esophageal hiatal hernia. After surgery, her postural dyspnea improved. As there is no fundamental treatment for MYH7-related myopathies, she continued conservative treatment for her symptoms. Conclusion Here, we presented a rare case of de novo mutation of the myosin head domain in the MYH7 gene. This report broadens both the phenotypic and genotypic spectra of MYH7-related myopathies.

Background Various exercises have been proposed to mitigate chronic low back pain (LBP). However, to date, no one particular exercise has been shown to be superior. Hence, the aim of this study was to compare the efficiency between 2 exercises: the individualized graded lumbar stabilization exercise (IGLSE) and walking exercise (WE). Methods A randomized controlled trial was conducted in 48 participants with chronic LBP. After screening, participants were randomized to 1 of 4 groups: flexibility exercise, WE, stabilization exercise (SE), and stabilization with WE (SWE) groups. Participants underwent each exercise for 6 weeks. The primary outcome was visual analog scale (VAS) of LBP during rest and physical activity. Secondary outcomes were as follows: VAS of radiating pain measured during rest and physical activity; frequency of medication use (number of times/day); Oswestry disability index; Beck depression inventory; endurances of specific posture; and strength of lumbar extensor muscles. Results LBP during physical activity was significantly decreased in all 4 groups. Exercise frequency was significantly increased in the SE and WE groups; exercise time was significantly increased in the SE group. The endurance of supine, side lying, and prone posture were significantly improved in the WE and SWE groups. Conclusions Lumbar SE and WE can be recommended for patients with chronic LBP because they not only relieve back pain but also prevent chronic back pain through improving muscle endurance.

In clinical practice, we found a unilateral instability in patients with right thoracic scoliosis during asymmetric spinal stabilization exercise (ASSE), which can be an important clue to identify the pathophysiology of idiopathic scoliosis (IS).We investigated the relationship between unilateral postural instability and weakness of paraspinal muscles according to curve pattern. And finally, we propose the new exercise method based on the curve pattern.Combined use of prospective and retrospective clinical trials.Fifteen participants without IS and 10 patients with IS in 1 tertiary referral hospital.In 15 participants without IS, surface electromyography (sEMG) was used to evaluate the muscular activation patterns in the bilateral erector spinae (ES), rectus abdominis (RA), and external oblique (EO) muscles during ASSE. In addition, to assess the clinical effect of ASSE, Cobb angle and rotation grade were measured from 10 patients with IS.The most significant findings from the sEMG data were the increased activities of ipsilateral 7th thoracic ES during hand-up motion, ipsilateral 3rd lumbar ES during leg-up motion, and 12th thoracic and 3rd lumbar ES during side-bridging. In a radiographic analysis, specific components of ASSE that activates the concave side muscles were found to be effective for IS.The paraspinal muscle strengthening of the concave side using ASSE can improve the severity of scoliosis. Based on this research, we could propose a new exercise protocol that can be personalized according to the curve pattern.

The main objective of this study was to develop and characterize a pH-responsive and biodegradable polymeric micelle as a tumor-targeting drug delivery system. The pH-responsive block copolymer was synthesized by a Michael-type step polymerization of hydrophilic methyl ether poly(ethylene glycol) (MPEG) and pH-responsive and biodegradable poly(beta-amino ester), resulting in an amphiphilic MPEG-poly(beta-amino ester) block copolymer. This copolymer, which formed nano-sized self-assembled micelles under aqueous conditions, could be efficiently (74.5%) loaded with doxorubicin (DOX) using a solvent evaporation method. In an in vitro drug release study, these DOX-loaded polymeric micelles showed noticeable pH-dependent micellization-demicellization behavior, with rapid release of DOX from the micelles in weakly acidic environments (pH 6.4) but very slow release under physiological conditions (pH 7.4). Moreover, due to demicellization, the tumor cell uptake of DOX released from polymeric micelles was much higher at pH 6.4 than at pH 7.4. When in vivo anti-tumor activity of pH-responsive polymeric micelles was evaluated by injecting the DOX-loaded polymeric micelles into B16F10 tumor-bearing mice, these micelles notably suppressed tumor growth and also prolonged survival of the tumor-bearing mice, compared with mice treated with free DOX.

An injectable liquid crystal-forming system (LCFS) was prepared by using sorbitan monooleate (SMO) as a new liquid crystal-forming material for injections, and its potential use of clinically available sustained-release formulation was evaluated. LCFS was prepared using SMO mixed with phosphatidyl choline and tocopherol acetate, and contained 3.75 mg of leuprolide acetate as a monthly dose in 90 μl in liquid form. The semi-solid mesophase was formed from the liquid LCFS when it contacted water. The mesophase showed typical characteristics of the liquid crystalline phase, which was classified as the hexagonal phase. The safety of the LCFS was studied by an in vitro extraction colony assay and by examining the injection site in rats and white rabbits after an autopsy. Both in vitro release test and in vivo pharmacokinetic and pharmacodynamic studies showed a sustained release of leuprolide. When compared with a commercial depot formulation of leuprolide, the LCFS showed a similar AUClast value and significantly reduced initial burst with sufficient suppression of testosterone after subcutaneous injections in rats and dogs. The LCFS can serve as a new type of sustained-release injection formulation for its safety, ease of preparation, and sustained release properties.

Recent researches to develop nano-carrier systems in anti-cancer drug delivery have focused on more complicated design to improve therapeutic efficacy and to reduce side effects. Although such efforts have great impact to biomedical science and engineering, the complexity has been a huddle because of clinical and economic problems. In order to overcome the problems, a simplest strategy to fabricate nano-carriers to deliver doxorubicin (DOX) was proposed in the present study. Two significant subjects (i) formation of nanoparticles loading and releasing DOX and (ii) binding specificity of them to cells, were examined. Folic acid (FA) was directly coupled with pullulan (Pul) backbone by ester linkage (FA/Pul conjugate) and the degree of substitution (DS) was varied, which were confirmed by 1 H NMR and UV spectrophotometry. Light scattering results revealed that the nanogels possessed two major size distributions around 70 and 270 nm in an aqueous solution. Their critical aggregation concentrations (CACs) were less than 10 μg/mL, which are lower than general critical micelle concentrations (CMCs) of low-molecular-weight surfactants. Transmission electron microscopy (TEM) images showed well-dispersed nanogel morphology in a dried state. Depending on the DS, the nanogels showed different DOX-loading and releasing profiles. The DOX release rate from FA8/Pul (with the highest DS) for 24 h was slower than that from FA4/or FA6/Pul, indicating that the FA worked as a hydrophobic moiety for drug holding. Cellular uptake of the nanogels (KB cells) was also monitored by confocal microscopy. All nanogels were internalized regardless of the DS of FA. Based on the results, the objectives of this study, to suggest a new method overcoming the complications in the drug carrier design, were successfully verified.

Madelung’s disease, or benign symmetric lipomatosis, is an uncommon disorder that is defined by the presence of multiple symmetrical fatty accumulations, which usually involve the upper trunk, neck and head (1). This disease predominantly affects men of Mediterranean origin, between the ages of 30 and 60 years, with a history of alcohol abuse. Patients usually complain of cosmetic issues, although they may also suffer from difficulties in swallowing and turning the head, and complain of neck pain or symptoms associated with the organs in the mediastinum (2). Hepatic diseases, such as cirrhosis, or fatty degenerative changes, appear in most patients (3); however, the CT and MRI findings related to Madelung’s disease have not been well described. Here, we reported on an unusual case regarding a patient who presented with symmetrically located bilateral masses in the anterior neck, which had grown progressively over a period of seven years. This case was confirmed both surgically and clinically, although surgical excision was insufficient and not curative.