Objective: To investigate the clinical demographics and rehabilitative assessments of encephalitis survivors admitted to a rehabilitation center, and to confirm the effects of inpatient rehabilitation manifested by changes in muscle strength and function after hospitalization. Methods: Data of encephalitis survivors who received rehabilitation at our institution from August 2009 to August 2019 were reviewed. Medical charts were retrospectively reviewed, and motor, functional, and cognitive assessments were collected. Manual muscle testing (MMT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), Korean version of Modified Barthel Index (K-MBI), grip strength, Box and Block Test (BBT), and Korean version of Mini-Mental State Examination (K-MMSE) were performed, and the results upon admission and discharge were compared and analyzed. Results: Most of the patients with encephalitis admitted to our institution had viral or autoimmune etiologies. The assessment results of 18 encephalitis patients upon admission and discharge were compared. The total K-MBI score, FAC, grip strength, and BBT significantly improved, but not the MMT and FMA. Subgroup analysis was performed for viral and autoimmune encephalitis, which are the main causes of the disease, but there was no difference in items with significant changes before and after hospitalization. Conclusion Encephalitis survivors showed a significant improvement in functional assessment scale during their hospital stay through rehabilitation, without significant changes in motor strength. Hence, we can conclude that encephalitis survivors benefit from inpatient rehabilitation, targeting functional gains in activities of daily living training more than motor strength.

OBJECTIVE: To find the optimal needle insertion site for needle electromyography of the pronator teres (PT) muscle among commonly used sites. METHODS: Fifty forearms of 25 healthy subjects were evaluated. Four expected needle insertion points were designated as follows. Point 0 was positioned at the midpoint between the medial epicondyle and medial border of biceps tendon in the elbow crease. Points 1, 2, and 3 were located 2 cm, 3.5 cm and 5 cm distal to point 0, respectively. We assumed that the thickness of PT and the distances between a vertical line from each point to the medial margin of the PT were significant parameters for finding the optimal site. Thus, we measured these parameters through ultrasonographic examination. RESULTS: In men, the PT was thickest at point 2, and in women, at point 1. The distance between the expected needle insertion line and medial margin of PT was longest at point 1 in both men and women, and was statistically significant compared to points 2 and 3. Both men and women had neurovascular bundles located lateral to the expected needle insertion line. CONCLUSION: The most appropriate and safe needle electromyographic insertional site for the PT is 2-3.5 cm distal to the mid-point between the biceps tendon and medial epicondyle in the elbow crease and the needle should be inserted upward and medial.
Elbow ; Electromyography* ; Female ; Forearm ; Humans ; Male ; Needles* ; Tendons ; Ultrasonography*

OBJECTIVE: To demonstrate the prevalence and characteristics of subclinical ulnar neuropathy at the elbow in diabetic patients. METHODS: One hundred and five patients with diabetes mellitus were recruited for the study of ulnar nerve conduction analysis. Clinical and demographic characteristics were assessed. Electrodiagnosis of ulnar neuropathy at the elbow was based on the criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM1 and AANEM2). The inching test of the ulnar motor nerve was additionally performed to localize the lesion. RESULTS: The duration of diabetes, the existence of diabetic polyneuropathy (DPN) symptoms, the duration of symptoms, and HbA1C showed significantly larger values in the DPN group (p<0.05). Ulnar neuropathy at the elbow was more common in the DPN group. There was a statistically significant difference in the number of cases that met the three diagnostic criteria between the no DPN group and the DPN group. The most common location for ulnar mononeuropathy at the elbow was the retrocondylar groove. CONCLUSION: Ulnar neuropathy at the elbow is more common in patients with DPN. If the conduction velocities of both the elbow and forearm segments are decreased to less than 50 m/s, it may be useful to apply the AANEM2 criteria and inching test to diagnose ulnar neuropathy.
Diabetes Mellitus ; Diabetic Neuropathies ; Elbow* ; Electrodiagnosis ; Forearm ; Humans ; Mononeuropathies ; Prevalence ; Ulnar Nerve ; Ulnar Neuropathies*

PURPOSE: To prevent surgical site complications, many plastic surgeons use the so-called “conventional protocol,” which immobilizes the shoulder and upper arm for 1 month after reconstruction. In an effort to improve the shoulder mobility of patients who received immediate breast reconstruction with tissue expander insertion (TEI), we introduced an early rehabilitation protocol with a short-term immobilization period of 2 weeks. This study aims to compare this early rehabilitation exercise program with the conventional protocol and to determine factors affecting shoulder mobility and quality of life of patients after immediate breast reconstruction. METHODS: A total of 115 patients with breast cancer who underwent reconstructive surgery were retrospectively reviewed. For patients who underwent reconstruction before January 2017, the conventional protocol was followed with immobilization of their shoulder for over 4 weeks. Patients who underwent reconstruction after January 2017 were educated to undergo a self-exercise program after a short-term immobilization period of 2 weeks. We compared shoulder mobility, pain, quality of life, and complications at postoperative 1 and 2 months between the groups. RESULTS: Patients who received early rehabilitation showed greater shoulder flexion and abduction range at postoperative 1 month than those who received the conventional protocol. This increased shoulder abduction range continued until postoperative 2 months. There were no significant surgical site problems in both groups during the 2 months of follow-up. CONCLUSION: To enhance the recovery of shoulder mobility, early rehabilitation with a shorter immobilization period should be recommended to patients with breast cancer undergoing reconstruction surgery with TEI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03541161
Arm ; Breast Neoplasms ; Breast ; Case-Control Studies ; Female ; Follow-Up Studies ; Humans ; Immobilization ; Mammaplasty ; Mastectomy, Simple ; Plastics ; Quality of Life ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; Rehabilitation ; Retrospective Studies ; Shoulder ; Surgeons ; Tissue Expansion Devices

OBJECTIVE: To determine the midpoint (MD) of extensor hallucis longus muscle (EHL) and compare the accuracy of different needle electromyography (EMG) insertion techniques through cadaver dissection. METHODS: Thirty-eight limbs of 19 cadavers were dissected. The MD of EHL was marked at the middle of the musculotendinous junction and proximal origin of EHL. Three different needle insertion points of EHL were marked following three different textbooks: M1, 3 fingerbreadths above bimalleolar line (BML); M2, junction between the middle and lower third of tibia; M3, 15 cm proximal to the lower border of both malleoli. The distance from BML to MD (BML_MD), and the difference between 3 different points (M1-3) and MD were measured (designated D1, D2, and D3, respectively). The lower leg length (LL) was measured from BML to top of medial condyle of tibia. RESULTS: The median value of LL was 34.5 cm and BML_MD was 12.0 cm. The percentage of BML_MD to LL was 35.1%. D1, D2, and D3 were 7.0, 0.9, and 3.0 cm, respectively. D2 was the shortest, meaning needle placement following technique by Lee and DeLisa was closest to the actual midpoint of EHL. CONCLUSION: The MD of EHL is approximately 12 cm above BML, and about distal 35% of lower leg length. Technique that recommends placing the needle at distal two-thirds of the lower leg (M2) is the most accurate method since the point was closest to muscle belly of EHL.
Cadaver* ; Electromyography ; Extremities ; Leg ; Methods ; Needles* ; Tibia

Background: The aim of this study was to capture multifaceted clinical characteristics of congenital cytomegalovirus (CMV) infection from diagnosis to treatment using a multidisciplinary approach including obstetrics, pediatrics, pathology, and otorhinolaryngology-head and neck surgery. Methods: This is a retrospective study including 30 consecutive cases of congenital CMV infection that were diagnosed at a single tertiary hospital located in Seoul, Korea from January 2009 to December 2020. Congenital CMV infection was defined as a positive result by polymerase chain reaction from urine, saliva or cerebrospinal fluid or positive CMV IgM from neonatal blood sampled within 3 weeks after birth. All cases were analyzed with respect to whole clinical characteristics from diagnosis to treatment of congenital CMV by a multidisciplinary approach including prenatal sonographic findings, maternal immune status regarding CMV infection, detailed placental pathology, neonatal clinical manifestation, auditory brainstem response test, and antiviral treatment (ganciclovir or valganciclovir). Long-term outcomes including developmental delay and hearing loss were also investigated. Results: The total number of births during the study period in our institution was 19,385, with the prevalence of congenital infection estimated to be 0.15%. Among 30 cases of congenital CMV, the median gestational age at delivery was 32.2 weeks [range, 22.6–40.0] and 66.7% of these infants were delivered preterm at less than 37 weeks. Suspected fetal growth restriction was the most common prenatal ultrasound finding (50%) followed by ventriculomegaly (17.9%) and abnormal placenta (17.9%), defined as thick placenta with calcification. No abnormal findings on ultrasound examination were observed in one-third of births. Maternal CMV serology tests were conducted in only 8 cases, and one case each of positive and equivocal IgM were found. The most common placental pathologic findings were chronic villitis (66.7%) and calcification (63.0%), whereas viral inclusions were identified in only 22.2%. The most common neonatal manifestations were jaundice (58.6%) followed by elevation of aspartate aminotransferase (55.2%) and thrombocytopenia (51.7%). After excluding cases for which long-term outcomes were unavailable due to death (n = 4) or subsequent follow up loss (n = 3), developmental delay was confirmed in 43.5% of infants (10/23), and hearing loss was confirmed in 42.9% (9/21) during the follow-up period. In our cohort, 56.7% (17/30) of neonates were treated for congenital CMV with ganciclovir or valganciclovir. Conclusion Our data show that prenatal findings including maternal serologic tests and ultrasound have limited ability to detect congenital CMV in Korea. Given that CMV is associated with high rates of developmental delay and hearing loss in infants, there is an urgent need to develop specific strategies for the definite diagnosis of congenital CMV infection during the perinatal period by a multidisciplinary approach to decrease the risks of neurologic impairment and hearing loss through early antiviral treatment.

Background: This study presents a framework for determining the allocation and distribution of the limited amount of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: After analyzing the pandemic strategies of the major organizations and countries and with a literature review conducted by a core panel, a modified Delphi survey was administered to 13 experts in the fields of vaccination, infectious disease, and public health in the Republic of Korea. The following topics were discussed: 1) identifying the objectives of the vaccination strategy, 2) identifying allocation criteria, and 3) establishing a step-bystep vaccination framework and prioritization strategy based on the allocation criteria. Two rounds of surveys were conducted for each topic, with a structured questionnaire provided via e-mail in the first round. After analyzing the responses, a meeting with the experts was held to obtain consensus on how to prioritize the population groups. Results: The first objective of the vaccination strategy was maintenance of the integrity of the healthcare system and critical infrastructure, followed by reduction of morbidity and mortality and reduction of community transmission. In the initial phase, older adult residents in care homes, high-risk health and social care workers, and personal support workers who work in direct contact with coronavirus disease 2019 (COVID-19) patients would be prioritized. Expansion of vaccine supply would allow immunization of older adults not included in phase 1, followed by healthcare workers not previously included and individuals with comorbidities. Further widespread vaccine supply would ensure availability to the extended adult age groups (50–64 years old), critical workers outside the health sector, residents who cannot socially distance, and, eventually, the remaining populations. Conclusion This survey provides the much needed insight into the decision-making process for vaccine allocation at the national level. However, flexibility in adapting to strategies will be essential, as new information is constantly emerging.

Background: This study presents a framework for determining the allocation and distribution of the limited amount of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: After analyzing the pandemic strategies of the major organizations and countries and with a literature review conducted by a core panel, a modified Delphi survey was administered to 13 experts in the fields of vaccination, infectious disease, and public health in the Republic of Korea. The following topics were discussed: 1) identifying the objectives of the vaccination strategy, 2) identifying allocation criteria, and 3) establishing a step-bystep vaccination framework and prioritization strategy based on the allocation criteria. Two rounds of surveys were conducted for each topic, with a structured questionnaire provided via e-mail in the first round. After analyzing the responses, a meeting with the experts was held to obtain consensus on how to prioritize the population groups. Results: The first objective of the vaccination strategy was maintenance of the integrity of the healthcare system and critical infrastructure, followed by reduction of morbidity and mortality and reduction of community transmission. In the initial phase, older adult residents in care homes, high-risk health and social care workers, and personal support workers who work in direct contact with coronavirus disease 2019 (COVID-19) patients would be prioritized. Expansion of vaccine supply would allow immunization of older adults not included in phase 1, followed by healthcare workers not previously included and individuals with comorbidities. Further widespread vaccine supply would ensure availability to the extended adult age groups (50–64 years old), critical workers outside the health sector, residents who cannot socially distance, and, eventually, the remaining populations. Conclusion This survey provides the much needed insight into the decision-making process for vaccine allocation at the national level. However, flexibility in adapting to strategies will be essential, as new information is constantly emerging.