Neuromuscular diseases (NMD) vary widely with regard to their onset, progression, and symptoms, which include muscle weakness, sensory loss, pain, fatigue, and joint contractures. Owing to this diversity, creation of a unified exercise therapy approach is challenging.Current Concepts: Exercise recommendations for patients with NMD prioritize maintenance of patients’ current functional status, prevention of further decline, and provision of compensatory training. Conventionally, highintensity exercises are not recommended owing to the risks of overwork weakness and muscle injury. Recent studies indicate that tailored aerobic exercises can improve endurance, cardiovascular function, and overall health without worsening muscle injury. Flexibility exercises are essential to prevent joint contractures. Resistance training should focus on avoidance of high-intensity and eccentric exercises and on maintenance of rather than an increase in muscle strength.Discussion and Conclusion: Evidence regarding the benefits of exercise in patients with NMD is inconsistent. Aerobic exercise is usually safe and may help maintain function and increase maximal oxygen uptake; however, low-intensity exercise is preferred to avoid fatigue and muscle injury. Resistance training may help preserve muscle strength in some patients; however, high-intensity workouts are not should be avoided to mitigate the risk of muscle overload and injury. Tailored exercise programs designed according to disease characteristics are essential.. Further well-designed, large-scale studies are necessary to establish effective and safe exercise guidelines for patients with NMD.

Neuromuscular diseases (NMD) vary widely with regard to their onset, progression, and symptoms, which include muscle weakness, sensory loss, pain, fatigue, and joint contractures. Owing to this diversity, creation of a unified exercise therapy approach is challenging.Current Concepts: Exercise recommendations for patients with NMD prioritize maintenance of patients’ current functional status, prevention of further decline, and provision of compensatory training. Conventionally, highintensity exercises are not recommended owing to the risks of overwork weakness and muscle injury. Recent studies indicate that tailored aerobic exercises can improve endurance, cardiovascular function, and overall health without worsening muscle injury. Flexibility exercises are essential to prevent joint contractures. Resistance training should focus on avoidance of high-intensity and eccentric exercises and on maintenance of rather than an increase in muscle strength.Discussion and Conclusion: Evidence regarding the benefits of exercise in patients with NMD is inconsistent. Aerobic exercise is usually safe and may help maintain function and increase maximal oxygen uptake; however, low-intensity exercise is preferred to avoid fatigue and muscle injury. Resistance training may help preserve muscle strength in some patients; however, high-intensity workouts are not should be avoided to mitigate the risk of muscle overload and injury. Tailored exercise programs designed according to disease characteristics are essential.. Further well-designed, large-scale studies are necessary to establish effective and safe exercise guidelines for patients with NMD.

Neuromuscular diseases (NMD) vary widely with regard to their onset, progression, and symptoms, which include muscle weakness, sensory loss, pain, fatigue, and joint contractures. Owing to this diversity, creation of a unified exercise therapy approach is challenging.Current Concepts: Exercise recommendations for patients with NMD prioritize maintenance of patients’ current functional status, prevention of further decline, and provision of compensatory training. Conventionally, highintensity exercises are not recommended owing to the risks of overwork weakness and muscle injury. Recent studies indicate that tailored aerobic exercises can improve endurance, cardiovascular function, and overall health without worsening muscle injury. Flexibility exercises are essential to prevent joint contractures. Resistance training should focus on avoidance of high-intensity and eccentric exercises and on maintenance of rather than an increase in muscle strength.Discussion and Conclusion: Evidence regarding the benefits of exercise in patients with NMD is inconsistent. Aerobic exercise is usually safe and may help maintain function and increase maximal oxygen uptake; however, low-intensity exercise is preferred to avoid fatigue and muscle injury. Resistance training may help preserve muscle strength in some patients; however, high-intensity workouts are not should be avoided to mitigate the risk of muscle overload and injury. Tailored exercise programs designed according to disease characteristics are essential.. Further well-designed, large-scale studies are necessary to establish effective and safe exercise guidelines for patients with NMD.

Neuromuscular diseases (NMD) vary widely with regard to their onset, progression, and symptoms, which include muscle weakness, sensory loss, pain, fatigue, and joint contractures. Owing to this diversity, creation of a unified exercise therapy approach is challenging.Current Concepts: Exercise recommendations for patients with NMD prioritize maintenance of patients’ current functional status, prevention of further decline, and provision of compensatory training. Conventionally, highintensity exercises are not recommended owing to the risks of overwork weakness and muscle injury. Recent studies indicate that tailored aerobic exercises can improve endurance, cardiovascular function, and overall health without worsening muscle injury. Flexibility exercises are essential to prevent joint contractures. Resistance training should focus on avoidance of high-intensity and eccentric exercises and on maintenance of rather than an increase in muscle strength.Discussion and Conclusion: Evidence regarding the benefits of exercise in patients with NMD is inconsistent. Aerobic exercise is usually safe and may help maintain function and increase maximal oxygen uptake; however, low-intensity exercise is preferred to avoid fatigue and muscle injury. Resistance training may help preserve muscle strength in some patients; however, high-intensity workouts are not should be avoided to mitigate the risk of muscle overload and injury. Tailored exercise programs designed according to disease characteristics are essential.. Further well-designed, large-scale studies are necessary to establish effective and safe exercise guidelines for patients with NMD.

PURPOSE: Type II endoleaks (T2ELs) are the most common type of endoleaks observed after endovascular aneurysm repair (EVAR). However, whether T2ELs should be treated remains debatable. In the present study, we aimed to describe the natural course of T2ELs and suggest the direction of their management. MATERIALS AND METHODS: We reviewed the data of 383 patients who underwent EVAR between 2007 and 2016. Data, including demographic and anatomical details, were collected, and patients with T2ELs were compared to those without them. Patients with T2ELs were categorized into subgroups according to changes in sac size and treatment requirement. RESULTS: We found patent lumbar artery count and lesser thickness of mural thrombi to be significant risk factors for T2ELs. Among the 383 patients, 85 (22.2%) patients were diagnosed with pure T2ELs. Among these 85 patients, the sac size increased in 29 (34.1%) patients, showed no significant change in 39 (45.9%) patients, and decreased in 17 (20.0%) patients. Fifteen (17.6%) patients, among 85 with initial pure T2ELs, showed spontaneous resolution. Five (5.9%) patients among 29, in whom the sac size increased, developed combined-type endoleaks. No sac ruptures were noted among the patients with T2ELs. CONCLUSION: T2ELs with sac expansion potentially contribute to other types of endoleaks. Therefore, periodic screening is important for these patients, particularly for those showing an increasing sac size. In addition, intervention should be considered when other types of endoleaks occur.
Aneurysm ; Aortic Aneurysm ; Arteries ; Endoleak ; Endovascular Procedures ; Humans ; Mass Screening ; Mesenteric Artery, Inferior ; Risk Factors ; Rupture

Purpose: To investigate the effect of regular monitoring of pulmonary function and ventilatory status on the initiation of non-invasive ventilation (NIV) between patients who were routinely monitored before receiving NIV and those who were not. Materials and Methods: This retrospective cohort study included subjects with Duchenne muscular dystrophy (DMD) who first received NIV between 2010 and 2019. The subjects were assigned to either the regular-follow-up (REG) group or the non-REG group, according to their follow-up status, before initiating NIV. We compared the number of emergent cases, the results of nocturnal ventilatory monitoring, and the pulmonary function of each group at initial ventilatory support. Results: In total, 73 subjects were enrolled in the REG group and 47 subjects in the non-REG group. There were significantly more emergency cases due to respiratory insufficiency in the non-REG group (12/47, 25.5%) than in the REG group (3/73, 4.1%). At the time of initial ventilatory support, hypoventilatory symptoms were more common and relatively severe in the non-REG group (37/47, 78.7%) than in the REG group (18/73, 24.7%). The average age at initial ventilatory support of the non-REG group was 2.15 years older than that of the subjects in the REG group. Moreover, subjects who were not regularly monitored exhibited greater deterioration in pulmonary function compared to those who were regularly followed up. Conclusion Regular evaluation of pulmonary function and ventilatory status before the onset of ventilatory insufficiency is crucial to reduce the risk of patients with DMD requiring emergency care due to ventilatory insufficiency.

There are some cases of myofascial pain syndrome (MPS) with chronic upper back pain that does not respond to dry needling or trigger point injection, well-known treatments for MPS. A 67-year-old female developed a stabbing upper back pain with trigger point at left T7∼8 levels 10 years ago. She complained of the pain with Numeral Rating Scale (NRS) 8 points. Myofascial release technique and trigger point injection had no effect. Under ultrasound guidance 20 ml of 1% lidocaine was injected into thoracic paravertebral space. Immediately, the pain was reduced to NRS 4 points. One week later, the second block was performed in the same way as the first, and the pain was reduced to NRS 2 points. The stabbing pain disappeared, and oral opioids were discontinued. Ultrasound guided thoracic paravertebral space block is an effective and safe treatment for refractory MPS with chronic upper back pain.

Ultrasound (US)-guided hydrodissection (HD) is a widely applied therapeutic method to release the entrapped peripheral nerve. However, this therapy has only been studied for the nerve entrapments such as carpal tunnel syndrome, and there are no reports of its effect on direct nerve injuries with incomplete axonal damage. Here, we report a case of direct traumatic injury of a median nerve with incomplete axonal injury in a 28-year-old man. He presented hypoesthesia and weakness along with the median nerve territory of the left hand after a laceration wound of the wrist. The patient underwent a surgical procedure, but did not experience prominent improvement for the next six months. Symptoms improved after we performed the US-guided HD with dextrose. We propose this procedure as one of the new treatment methods for direct axonal injury of nerves including the median nerve.

Background: In South Korea, women aged 66 years are eligible for complimentary bone mineral density (BMD) screening via the National Screening Program for Transitional Ages. We aimed to evaluate the 10-year fracture risk in women receiving BMD screening between January 2008 and December 2015. Methods: BMD was classified as normal (T-score ≥–1.0 standard deviation [SD]), osteopenia (T-score <–1.0 SD and >–2.5 SD), and osteoporosis (T score ≤–2.5 SD) from dual-energy X-ray absorptiometry. Follow-up continued from the screening date until a diagnosis for clinical fragility fracture (including sites of the vertebrae, hip, pelvis, clavicle, humerus, forearm, wrist, lower leg, and ankle), censored at the earliest date of trauma, death, or December 2017; fracture was ascertained using diagnostic codes from the National Health Insurance Service database. A multivariable Cox proportional hazard model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of fracture in women with osteopenia or osteoporosis relative to women with normal BMD. Results: Among the 271,197 women screened, 44.0% had osteopenia and 35.2% had osteoporosis. The 10 year cumulative incidence of fragility fractures was 31.1%, 37.5%, and 44.3% in women with normal BMD, osteopenia, and osteoporosis, respectively. Fracture risk was higher in women with osteopenia (HR, 1.31; 95% CI, 1.28 to 1.34) and osteoporosis (HR, 1.68; 95% CI, 1.64 to 1.72) than in women with normal BMD. Conclusion Women with osteopenia and women with osteoporosis, identified by the national BMD screening program, demonstrated a substantially elevated risk of fracture.

Multifidus cervicis plane block has been effectively used to provide analgesia during and after cervical spine surgery, but not for any other purpose. Here, we report three cases of chronic axial neck pain unresponsive to medical treatment. We performed multifidus cervicis plane block bilaterally, which lowered numerical rating scale (NRS) score within 2 weeks. Thus, multifidus cervicis plane block is one of the novel options that may be used for chronic axial neck pain.