PURPOSE: This study examined the effects of squatting with different foot positions on the muscle activation of the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles in subjects with genu varum. METHODS: Thirty four subjects participated in this study. Surface electromyography was used to measure the muscle activation of the VMO and VL muscles at the knee angles (15°, 60°) at three foot positions (internal rotation, neutral position, external rotation) during squatting. RESULTS: Muscle activation differences at different knee angles and foot positions differed significantly between the VMO and VL muscles in both the varus and normal groups. In addition, there was a significant difference according to the knee angles with the foot in external rotation in the VMO and VL ratio. In the varus group, however, the VMO and VL ratio were significantly different only with the feet in internal rotation. In the muscle activation changes of the knee angle differences in the foot position, there was no significant difference in the varus group, but both the VMO and VL muscles were significant different in the normal group. CONCLUSION: In both groups, regardless of the foot position, muscle activation of the VMO and VL muscles increased with increasing knee flexion angle. In the normal group, when squatting with the feet in external rotation, the VMO and VL muscles activations increased with increasing knee angle. In the varus group, however, the foot position did not affect the VMO or VL muscle activation. This study shows that subjects with genu varum and normal subjects have different VMO and VL muscle activation patterns during squat exercises.
Electromyography ; Exercise ; Foot ; Genu Varum ; Knee ; Muscles ; Quadriceps Muscle

OBJECTIVE: There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. MATERIALS AND METHODS: A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. RESULTS: CEA or CAS is indicated when the patient has a symptomatic stenosis > or = 50%, or when the patient has an asymptomatic stenosis > or = 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. CONCLUSION: We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis.
Carotid Arteries ; Carotid Stenosis* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Humans ; Stents

Moyamoya disease (MMD) is a rare progressive steno-occlusive cerebrovascular disorder. Currently, revascularization surgery is used as optimal treatment to overcome MMD. However, revascularization for MMD has reported several complications. Also, iatrogenic complications such as pseudoaneurysms formation or dural arteriovenous fistulas (dAVFs) formation—has been identified in rare cases after the surgical intervention for revascularizations.
We describe two cases. In first case, the patency of the anastomosis site was good and saccular type pseudoaneurysm formation was found at parietal branch of posterior middle meningeal artery (MMA) in transfemoral cerebral angiography (TFCA) performed on the twelfth day after surgery. We decided to treat pseudoaneurysm by endovascular embolization the next day, but the patient was shown unconsciousness and anisocoria during sleep at that day. Computed tomography showed massive subdural hemorrhage at the ipsilateral side, thus we performed decompressive craniectomy and hematoma evacuation.
In second case, the patency of the anastomosis site was good and dAVF formation at right MMA was found in TFCA performed on the sixth day after surgery. We performed endovascular obliteration of the arteriovenous fistula under local anesthesia.
Pseudoaneurysm formation or dAVF formation after revascularization surgery is an exceptional case. If patients have such complications, practioner should carefully screen the patients by implementing digital subtraction angiogram to identify anatomic features; as well as consider immediate treatment in any way, including embolization or other surgery

Objective: This study aimed to elicit expert consensus on the necessary components of a seclusion room module required to accommodate and manage psychiatric emergency patients requiring both medical and surgical interventions in infectious disease situations. Methods: A two-round Delphi survey was conducted among 38 medical professionals, architects, and spatial design experts. The survey assessed the effectiveness, feasibility, and urgency of spatial scales, spatial organization, and movement system domains related to the necessary elements of a seclusion room. Results: In the spatial scale domain, items such as “sufficient width to comply with disability standards (wheelchair accessible)” and “larger space should be provided for patients with a large range of motion or requiring special medical procedures” emerged as priorities. In the movement system domain, priorities included “anticipating situations where stable patients need to be pushed on a stretcher cart from both sides, necessitating a wider passage.” In the spatial organization domain, priorities included “installing interior elements (wall images, media panels, etc.) that aid patient stability, although a separate area for patients’ activities reflecting psychiatric characteristics is not necessary.” Conclusion Expert consensus was achieved regarding the spatial scales, spatial organization, and movement system domains related to the necessary elements of a seclusion room for psychiatric emergency patients.

Background/Aims: Coronavirus 2019 (COVID-19) accelerated the importance of online learning in the field of medical education.This study compared the impact of online lectures on abdominal ultrasonography (USG) with that of offline lectures and assessed the efficacy of abdominal USG lectures for internal medicine (IM) residents and gastroenterology (GI) fellows. Methods: A 30-minute lecture on upper abdominal USG was delivered online or offline, and a test with 39 short-answer questions was conducted before and after the lecture. Results: The study population included 25 physicians (13 IM residents and 12 GI fellows) in the online group and 23 (20 IM residents, three GI fellows) in the offline group. The rates of USG education experience for online and offline groups were 64.0% and 69.6%, respectively (p=0.919). A significant increase in the test scores was observed after a one-time USG lecture in IM residents in both the online and offline, as well as GI fellows in the online (p<0.0001, <0.0001, and p=0.004, respectively). In addition, the delta scores were similar in the online and offline after a one-time lecture (8.8±4.3 vs. 7.8±3.7, respectively; p=0.406). A comparison of the delta-scores of the IM resident and GI fellow showed no significant difference within either the online or offline (9.0±4.5 vs. 8.4±3.6, p=0.927; 7.3±3.8 vs. 7.3±3.0, p=0.985). Conclusions The effectiveness of online USG lectures was comparable to that of offline lectures. In addition, a 30-minute, one-time abdominal USG lecture provided value to IM residents and GI fellows.

Objective: This study aimed to elicit expert consensus on the necessary components of a seclusion room module required to accommodate and manage psychiatric emergency patients requiring both medical and surgical interventions in infectious disease situations. Methods: A two-round Delphi survey was conducted among 38 medical professionals, architects, and spatial design experts. The survey assessed the effectiveness, feasibility, and urgency of spatial scales, spatial organization, and movement system domains related to the necessary elements of a seclusion room. Results: In the spatial scale domain, items such as “sufficient width to comply with disability standards (wheelchair accessible)” and “larger space should be provided for patients with a large range of motion or requiring special medical procedures” emerged as priorities. In the movement system domain, priorities included “anticipating situations where stable patients need to be pushed on a stretcher cart from both sides, necessitating a wider passage.” In the spatial organization domain, priorities included “installing interior elements (wall images, media panels, etc.) that aid patient stability, although a separate area for patients’ activities reflecting psychiatric characteristics is not necessary.” Conclusion Expert consensus was achieved regarding the spatial scales, spatial organization, and movement system domains related to the necessary elements of a seclusion room for psychiatric emergency patients.

Background/Aims: Coronavirus 2019 (COVID-19) accelerated the importance of online learning in the field of medical education.This study compared the impact of online lectures on abdominal ultrasonography (USG) with that of offline lectures and assessed the efficacy of abdominal USG lectures for internal medicine (IM) residents and gastroenterology (GI) fellows. Methods: A 30-minute lecture on upper abdominal USG was delivered online or offline, and a test with 39 short-answer questions was conducted before and after the lecture. Results: The study population included 25 physicians (13 IM residents and 12 GI fellows) in the online group and 23 (20 IM residents, three GI fellows) in the offline group. The rates of USG education experience for online and offline groups were 64.0% and 69.6%, respectively (p=0.919). A significant increase in the test scores was observed after a one-time USG lecture in IM residents in both the online and offline, as well as GI fellows in the online (p<0.0001, <0.0001, and p=0.004, respectively). In addition, the delta scores were similar in the online and offline after a one-time lecture (8.8±4.3 vs. 7.8±3.7, respectively; p=0.406). A comparison of the delta-scores of the IM resident and GI fellow showed no significant difference within either the online or offline (9.0±4.5 vs. 8.4±3.6, p=0.927; 7.3±3.8 vs. 7.3±3.0, p=0.985). Conclusions The effectiveness of online USG lectures was comparable to that of offline lectures. In addition, a 30-minute, one-time abdominal USG lecture provided value to IM residents and GI fellows.

Objective: This study aimed to elicit expert consensus on the necessary components of a seclusion room module required to accommodate and manage psychiatric emergency patients requiring both medical and surgical interventions in infectious disease situations. Methods: A two-round Delphi survey was conducted among 38 medical professionals, architects, and spatial design experts. The survey assessed the effectiveness, feasibility, and urgency of spatial scales, spatial organization, and movement system domains related to the necessary elements of a seclusion room. Results: In the spatial scale domain, items such as “sufficient width to comply with disability standards (wheelchair accessible)” and “larger space should be provided for patients with a large range of motion or requiring special medical procedures” emerged as priorities. In the movement system domain, priorities included “anticipating situations where stable patients need to be pushed on a stretcher cart from both sides, necessitating a wider passage.” In the spatial organization domain, priorities included “installing interior elements (wall images, media panels, etc.) that aid patient stability, although a separate area for patients’ activities reflecting psychiatric characteristics is not necessary.” Conclusion Expert consensus was achieved regarding the spatial scales, spatial organization, and movement system domains related to the necessary elements of a seclusion room for psychiatric emergency patients.

Background/Aims: Coronavirus 2019 (COVID-19) accelerated the importance of online learning in the field of medical education.This study compared the impact of online lectures on abdominal ultrasonography (USG) with that of offline lectures and assessed the efficacy of abdominal USG lectures for internal medicine (IM) residents and gastroenterology (GI) fellows. Methods: A 30-minute lecture on upper abdominal USG was delivered online or offline, and a test with 39 short-answer questions was conducted before and after the lecture. Results: The study population included 25 physicians (13 IM residents and 12 GI fellows) in the online group and 23 (20 IM residents, three GI fellows) in the offline group. The rates of USG education experience for online and offline groups were 64.0% and 69.6%, respectively (p=0.919). A significant increase in the test scores was observed after a one-time USG lecture in IM residents in both the online and offline, as well as GI fellows in the online (p<0.0001, <0.0001, and p=0.004, respectively). In addition, the delta scores were similar in the online and offline after a one-time lecture (8.8±4.3 vs. 7.8±3.7, respectively; p=0.406). A comparison of the delta-scores of the IM resident and GI fellow showed no significant difference within either the online or offline (9.0±4.5 vs. 8.4±3.6, p=0.927; 7.3±3.8 vs. 7.3±3.0, p=0.985). Conclusions The effectiveness of online USG lectures was comparable to that of offline lectures. In addition, a 30-minute, one-time abdominal USG lecture provided value to IM residents and GI fellows.

Objective: This study aimed to elicit expert consensus on the necessary components of a seclusion room module required to accommodate and manage psychiatric emergency patients requiring both medical and surgical interventions in infectious disease situations. Methods: A two-round Delphi survey was conducted among 38 medical professionals, architects, and spatial design experts. The survey assessed the effectiveness, feasibility, and urgency of spatial scales, spatial organization, and movement system domains related to the necessary elements of a seclusion room. Results: In the spatial scale domain, items such as “sufficient width to comply with disability standards (wheelchair accessible)” and “larger space should be provided for patients with a large range of motion or requiring special medical procedures” emerged as priorities. In the movement system domain, priorities included “anticipating situations where stable patients need to be pushed on a stretcher cart from both sides, necessitating a wider passage.” In the spatial organization domain, priorities included “installing interior elements (wall images, media panels, etc.) that aid patient stability, although a separate area for patients’ activities reflecting psychiatric characteristics is not necessary.” Conclusion Expert consensus was achieved regarding the spatial scales, spatial organization, and movement system domains related to the necessary elements of a seclusion room for psychiatric emergency patients.