PURPOSE : To determine the patterns of electromyographic (EMG) responses and torques of upper extremity muscles in overhead throwers during maximal, eccentric muscle action for shoulder flexion (Flex_Ecc), abduction (Abd_Ecc) and diagonal activities (Dia_Ecc) with full glenohumeral internal rotation, at 60, 120, and 180°/s on the dynamometer.METHODS : Seven asymptomatic subjects (7 men, 4 women) who participate in overhead sports at least three days a week volunteered to participate in this study. Subjects were randomly performed with the test procedure which consisted of at least 5 grade maximal-effort repetitions on the three different testing conditions, at 60, 120, and 180°/s on the dynamometer, while we assessed muscle activation of the anterior deltoid (AD), middle deltoid (MD), posterior deltoid (PD), upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and biceps brachii (BB) muscles by surface electromyography. EMG data was expressed as a percentage of maximum voluntary isometric contraction (%MVIC) that was obtained from the highest root mean square (RMS, 50 ms) of each muscle and was normalized and averaged.RESULT : AD muscle elicited lower muscle activity during Dia_Ecc than Flex_Ecc and Abd_Ecc (P＜0.05) while the MD, PD, UT, MT, and LT muscles elicited overall greater muscle activities during Dia_Ecc. MD and MT muscle activities were significantly greater for the faster speed than for the slower speed as 60°/s during Abd_Ecc (P＜0.05). Peak torque generated greater muscle strength for Dia_Ecc than Flex_Ecc and Abd_Ecc, and it was significantly greater for the faster speed than slower speed during Dia_Ecc (P＜0.05).CONCLUSION : Posterior upper extremity muscle activities and peak torque values were found to be dependent on eccentric muscle action for diagonal shoulder activity at the faster speed. This study provided evidence that isokinetic eccentric muscle strength testing of the posterior upper extremity muscle was effective to develop of a proper program for overhead sports athletes require forceful stability during deceleration phase.

BACKGROUND: Korea has high prescribing rate and rising antibiotic resistance. This study was conducted to understand why primary physicians prescribe antibiotics for acute respiratory infections and to explore the factors that influence antibiotic resistance, and so to suggest strategy to reduce antibiotic resistance. METHODS: A qualitative exploratory approach was used using 4 focus groups composed of physicians from different area. A semi-structured guide was applied in obtaining the physicians' opinions. Common themes were extracted by authors, which were used to gather results and draw conclusion. RESULTS: Participants acknowledged multiple factors such as clinical factor and competitive environment are involved in physicians' decision of antibiotic prescribing. They identified that causes of rising antibiotic resistance were shortage of information, discontinuation of taking antibiotics, and other system factors. CONCLUSION: Participants were certain that less prescribing antibiotics and selecting appropriate antibiotics might be method to reduce antibiotic resistance. To change the prescribing behavior, it should be provided periodically for community physicians with prescribing information and specific guidelines for antibiotics resistance. Patients should be also noticed about antibiotic medication information more accurately. Including prescription incentive policy, improvement of healthcare system will be carried out at the same time.
Anti-Bacterial Agents* ; Delivery of Health Care ; Drug Resistance, Microbial ; Focus Groups ; Humans ; Information Dissemination ; Korea ; Methods ; Motivation ; Prescriptions* ; Respiratory Tract Infections

Purpose: This study evaluated aggressive hyperbaric oxygen therapy (HBOT) by understanding various exposure routes of acute carbon monoxide (CO) poisoning, the risk factors causing acute cardiovascular, and neurological toxicity caused by poisoning. Methods: A retrospective study was conducted based on the medical records of 417 acute CO poisoning patients who visited the emergency care unit from March 2017 to August 2019. The exposure routes, HBOT performance, age, sex, medical history (hypertension, diabetes mellitus, ischemic heart disease, heart failure), intentionality, loss of consciousness (LOC), intake with alcohol or sedatives, and initial test results (carboxyhemoglobin (COHb), troponin- I, electrocardiography, echocardiography, brain MRI) were examined. Comparative analysis of the clinical information was conducted between the groups that showed acute cardiovascular toxicity and neurological toxicity, and groups that did not. Results: Among 417 patients diagnosed with acute CO poisoning, 201 cases (48.2%) were intentional, and charcoal briquette was the most common route (169 patients (40.5%)). Two hundred sixteen cases (51.8%) were accidental, and fire was the most common route (135 patients (32.4%)). The exposure route was more diverse with accidental poisoning. Three hundred ninety-nine patients were studied for acute cardiovascular toxicity, and 62 patients (15.5%) were confirmed to be positive. The result was statistically significant in intentionality, LOC, combined sedatives, initial COHb, HTN, and IHD. One hundred two patients were studied for acute neurological toxicity, which was observed in 26 patients (25.5%). The result was statistically significant in age and LOC. Conclusion Active HBOT should be performed to minimize damage to the major organs by identifying the various exposure routes of CO poisoning, risk factors for acute cardiovascular toxicity (intentionality, LOC, combined sedatives, initial COHb, HTN, IHD), and the risk factors for acute neurological toxicity (age, LOC).

PURPOSE: The aim of this study was to determine whether biphasic calcium phosphate (BCP) bone substitute with two different concentrations of Escherichia coli-expressed recombinant human bone morphogenetic protein 2 (ErhBMP-2) enhances new bone formation in a standardized rabbit sinus model and to evaluate the concentration-dependent effect of ErhBMP-2. METHODS: Standardized, 6-mm diameter defects were made bilaterally on the maxillary sinus of 20 male New Zealand white rabbits. Following removal of the circular bony windows and reflection of the sinus membrane, BCP bone substitute without coating (control group) was applied into one defect and BCP bone substitute coated with ErhBMP-2 (experimental group) was applied into the other defect for each rabbit. The experimental group was divided into 2 subgroups according to the concentration of ErhBMP-2 (0.05 and 0.5 mg/mL). The animals were allowed to heal for either 4 or 8 weeks and sections of the augmented sinus and surrounding bone were analyzed by microcomputed tomography and histologically. RESULTS: Histologic analysis revealed signs of new bone formation in both the control and experimental groups with a statistically significant increase in bone formation in experimental group 1 (0.05 mg/mL ErhBMP-2 coating) after a 4-week healing period. However, no statistically significant difference was found between experimental group 1 and experimental group 2 (0.5 mg/mL ErhBMP-2 coating) in osteoinductive potential (P<0.05). CONCLUSIONS: ErhBMP-2 administered using a BCP matrix significantly enhanced osteoinductive potential in a standardized rabbit sinus model. A concentration-dependent response was not found in the present study.
Animals ; Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; Bone Regeneration ; Bone Substitutes ; Calcium ; Durapatite ; Escherichia coli ; Humans ; Hydroxyapatites ; Male ; Maxillary Sinus ; Membranes ; Osteogenesis ; Rabbits ; X-Ray Microtomography

PURPOSE: The aim of this study was to evaluate the improvement of osteogenic potential of biphasic calcium phosphate (BCP) bone substitute coated with synthetic cell-binding peptide sequences in a standardized rabbit sinus model. METHODS: Standardized 6-mm diameter defects were created bilaterally on the maxillary sinus of ten male New Zealand white rabbits, receiving BCP bone substitute coated with synthetic cell binding peptide sequences on one side (experimental group) and BCP bone substitute without coating (control group) on the other side. Histologic and histomorphometric analysis of bone formation was carried out after a healing period of 4 or 8 weeks. RESULTS: Histological analysis revealed signs of new bone formation in both experimental groups (4- and 8-week healing groups) with a statistically significant increase in bone formation in the 4-week healing group compared to the control group. However, no statistically significant difference in bone formation was found between the 8-week healing group and the control group. CONCLUSIONS: This study found that BCP bone substitute coated with synthetic cell-binding peptide sequences enhanced osteoinductive potential in a standardized rabbit sinus model and its effectiveness was greater in the 4-week healing group than in the 8-week healing group.
Artificial Cells ; Bone Regeneration ; Bone Substitutes ; Calcium ; Durapatite ; Humans ; Hydroxyapatites ; Male ; Maxillary Sinus ; Oligopeptides ; Osteogenesis ; Rabbits

Abdominal aortic occlusion (AAO) caused by detachment of cardiac myxoma (CM) is a very rare complication in patients with CM. Although the nature of CMs has been well established, detachment of CM may cause unexpected serious complications such as vicious embolic events. Actually, in several cases of AAO caused by detachment of CM, it has been reported that CM fragments easily migrated to the brain, heart, and lungs, and caused lifelong neurological complications despite appropriate surgical therapy. Herein, we report a case of a patient with AAO caused by detachment of CM who underwent CM excision and abdominal aortic thromboembolectomy. Additionally, we have presented the preoperative and postoperative images using 64-multidetector computed tomography.
Aorta, Abdominal ; Brain ; Heart ; Humans ; Lung ; Myxoma

Hematopoietic stem cell transplantation remains the only curative option for myelodysplastic syndrome (MDS), but the prevalence of the disease in elderly people limits broad application of the procedure, particularly in lower risk group. Azacitidine has been recently approved by the U.S. Food and Drug Administration for MDS regardless of subtype on French-American-British classification. Adverse effects of azacitidine include gastrointestinal, hematological and infusion-related reactions. Azacitidine induced hepatotoxicity has been reported mainly in patients with previous hepatobiliary disease, e.g., extensive tumor infiltration in liver, liver cirrhosis and cholelithiasis. We report here a case of azacitidine-induced hepatitis under no predisposition to hepatobiliary disease.
Aged ; Azacitidine ; Cholelithiasis ; Classification ; Hematopoietic Stem Cell Transplantation ; Hepatitis ; Humans ; Liver ; Liver Cirrhosis ; Myelodysplastic Syndromes* ; Prevalence ; United States Food and Drug Administration

Background: Postpartum hemorrhage is the leading cause of maternal mortality. Oxytocin being the most popular uterotonic agent, has been routinely administered after both vaginal delivery and cesarean section. Carbetocin is a newer uterotonic agent and provides the benefit of a longer duration of action without additional administration post-delivery. Methods: We recruited 34 women undergoing elective cesarean section under spinal anesthesia. All patient was received spinal anesthesia using 0.5% hyperbaric Marcaine 8–10 mg in conjugation with fentanyl 20 μg in the left lateral decubitus position. Hartmann’s solution 10–15 ml/kg was administered before carbetocin. The operation started as soon as sensory block at level T4–T6 was confirmed. A non-invasive hemodynamic monitoring cuff (Finometer®) was attached to the patient’s finger soon after the induction of spinal anesthesia. Using the Finometer, we recorded the heart rate and mean arterial pressure at every 15 s, starting from 15 s before the administration of carbetocin to 5 min after. After the removal of the placenta, the bolus group was administered intravenous bolus injection of carbetocin 100 μg and the infusion group was administered carbetocin 100 μg diluted in 50 ml normal saline, over 5 min using an infusion pump. Results: The demographic data showed no significant difference between the two groups. Furthermore, there were no significant hemodynamic differences between the two groups. Conclusions The method of administration of carbetocin does not influence its hemodynamic effects.

BACKGROUND: AND PURPOSE: To compare the characteristics of neuropathic pain in neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). METHODS: From 2016 to 2018, 500 patients with NMOSD and MS from 6 referral hospitals in Korea underwent pain investigation. After the patients with current pain were matched for sex ratio and disease duration as confounding factors, PainDETECT questionnaires were assessed in 99 NMOSD and 58 MS patients to investigate neuropathic pain. The short form of the Brief Pain Inventory from 74 patients with neuropathic pain component was also analysed. RESULTS: According to the PainDETECT questionnaire, mechanical allodynia (p=0.014) and thermal hyperalgesia (p=0.011) were more severe in NMOSD patients than in MS patients. Strong involvements (score >3) of the pain in domains of tingling/prickling sensation (p=0.024), mechanical allodynia (p=0.027), sudden pain attacks (p=0.018), and thermal hyperalgesia (p=0.002) were significantly more frequent in NMOSD compared to MS patients. Among the patients experiencing pain with a neuropathic component, total pain-related interference (p=0.045) scores were significantly higher in NMOSD patients than in MS patients. In daily life, pain interfered with normal work (p=0.045) and relationships with other people (p=0.039) more often in NMOSD patients than in MS patients. Although pain medication was prescribed more frequently in NMOSD patients, the percentage of patients experiencing medication-related pain relief was lower in those patients. CONCLUSIONS The severity of neuropathic pain and the pain-related interference in daily life were greater in NMOSD patients than in MS patients. Individualized analgesic management should be considered based on a comprehensive understanding of neuropathic pain in these patients.

PURPOSE: The purpose of this study was to evaluate the effect of alendronates on bone remodeling around titanium implant in the maxilla of rats. MATERIALS AND METHODS: The maxillary first molars were extracted and customized-titanium implants were placed immediately in thirty male Sprague-Dawley rats. The rats were divided into experimental (bisphosphonate) group and control group. At 4 weeks after implantation, the rats in the bisphosphonate group were subcutaneously injected with alendronate three times a week for 6 weeks where as the rats in control group were injected with saline. The rats were sacrificed at 1, 2, 3, 4, or 6 weeks after starting of injection and maxillary bones were collected subsequently. Alveolar bone remodeling around the implants were evaluated by radiographic and histologic analysis. Microarray analysis and immunohistomorphologic analysis were also performed on one rat, sacrificed at 6 weeks after starting of injection, from each group. Statistical analysis was performed using repeated measures analysis of variance and independent t test at a significance level of 5%. RESULTS: There was no statistically significant difference in the bone area (%) around implant between the bisphosphonate group and the control group. However, the amount of empty lacuna was significantly increased in the bisphosphonate group, especially in the rats sacrificed at 4 weeks after starting of injection compared to that of the corresponding control group. The bisphosphonate group showed the same level of TRAP positive cell count, osteocalcin and angiopoietin 1 as the control group. CONCLUSION: Alendronate may not decrease the amount of osteoclast. However, the significantly increased amount of empty lacuna in the bisphosphonate group may explain the suppression of bone remodeling in the bisphosphonate group.
Alendronate* ; Angiopoietin-1 ; Animals ; Bisphosphonate-Associated Osteonecrosis of the Jaw ; Bone Remodeling* ; Cell Count ; Humans ; Jaw ; Male ; Maxilla ; Microarray Analysis ; Molar ; Osteocalcin ; Osteoclasts ; Rats* ; Rats, Sprague-Dawley ; Titanium