OBJECTIVE: To compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery. METHODS: We recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength (tip, palmar and lateral pinch), and forearm circumference of the subjects were assessed before and after the hand-squeezing exercise. The cephalic vein size, blood flow velocity and volume were also measured by ultrasonography in the operated limb. RESULTS: All of the 3 types of pinch strengths, grip strength, and forearm circumference were significantly increased in the group using GD Grip. Cephalic vein size and blood flow volume were also significantly increased. However, blood flow velocity showed no difference after the exercise. The group using Soft Ball showed a significant increase in the tip and lateral pinch strength and forearm circumference. The cephalic vein size and blood flow volume were also significantly increased. On comparing the effect of the two different hand exercises, hand-squeezing exercise with GD Grip had a significantly better effect on the tip and palmar pinch strength than hand-squeezing exercise with Soft Ball. The effect on cephalic vein size was not significantly different between the two groups. CONCLUSION: The results showed that hand squeezing exercise with GD Grip was more effective in increasing the tip and palmar pinch strength compared to hand squeezing exercise with soft ball.
Arteriovenous Fistula* ; Blood Flow Velocity ; Exercise* ; Extremities ; Forearm* ; Hand Strength* ; Hand* ; Humans ; Pinch Strength ; Renal Dialysis ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Resistance Training ; Ultrasonography ; Veins

BACKGROUND: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. MATERIAL AND METHOD: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: 47.4+/-15.1): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (MVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. RESULT: The follow-up period was 835.3 patient-years (mean: 5.9+/-3.5) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs (2.16+/-0.23) of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those (2.03+/-0.27) measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). CONCLUSION: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients' compliance should be done for achieving more effective anticoagulation therapy.
Ambulatory Care Facilities ; Aortic Valve ; Atrial Fibrillation ; Compliance ; Follow-Up Studies ; Heart ; Heart Valve Prosthesis ; Heart Valves ; Hemorrhage ; Humans ; Incidence ; International Normalized Ratio ; Mitral Valve ; Prothrombin Time ; Thromboembolism

OBJECTIVE: Workload is known to affect the hypothalamus-pituitary-adrenal axis. Although many studies had revealed that job stress related factors could affect the neuroendocrine system among blue-collar workers, these studies had limitations as they had not evaluated the workload by objective methods which took into consideration individual physiological differences. This study was conducted to evaluate the effects of physical workload adjusted job stress on cortisol regulation by using objective tools for workers having various job tasks. METHODS: Among 110 foundry workers, shipyard workers, and fine machine assemblers for whom saliva samples were obtained, 102 without any past history of conditions that could affect hormonal regulation such as diabetes, and hypertension were included in this study. Among the 102 study participants, 15 workers whose saliva for morning or afternoon or heart rate monitoring data was not attained were excluded from the final analysis. Workload was evaluated by RHR (relative heart rate) using a heart rate monitor, and job stress was evaluated by Karasek's Job Content Questionnaire. Saliva samples were gathered during 8 - 9 am and 5 - 6 pm, and salivary cortisol levels were analysed by radioimmunoassay. RESULTS: After adjusting several variables which could effect cortisol secretion including job stress, among the higher RHR group morning salivary cortisol level was increased (beta=60.32, S.E.=26.35, p=0.0266), afternoon salivary cortisol level was decreased (beta=-7.43, S.E.=29.73, p=0.8044), and salivary cortisol level difference between morning and afternoon was increased (beta=72.10, SE=35.50, p=0.0509). CONCLUSIONS: As physical workload increases morning cortisol level, which is caused by the effect of arousal, and decreases afternoon cortisol level, which is caused by exhaustion, physical workload enlarges the width of diurnal cortisol variance. Therefore, physical exhaustion due to excessive workload could have adverse effects on the neuroendocrine system.
Arousal ; Axis ; Heart ; Heart Rate ; Hydrocortisone* ; Hypertension ; Neurosecretory Systems ; Questionnaires ; Radioimmunoassay ; Saliva

OBJECTIVES: The aims of the study were to make a questionnaire for assessing physical workloads and to evaluate its reliability and validity. METHODS: A total of 220 workers (foundry workers 30, large vehicle assemblers 30, shipyard workers 75, and automobile manufacturers 80) completed a self-administered questionnaire and took examinations for physical work capacity and working heart rate. We excluded data with insufficient responses or incorrect physical work capacity and working heart rate. Finally, the data of 154 workers (70.0%) were used for our study. In order to evaluate the reliability and validity of the questionnaire, we used statistical analyses including the scaling assumption test and a comparison with the objective tool for physical workload which was evaluated by working energy expenditure. RESULTS: The items of the questionnaire in the same categories had close distribution in the evaluation of the scaling assumption. The item internal consistency was 0.41-0.73 for posture factor, and 0.62-0.79 for non-posture factor. The item discriminate validity was 100%. Cronbach's alphacoefficient of the total items was 0.73 (0.58 for posture factor and 0.74 for nonposture factor). In the correlation between working energy expenditure and questions, general physical activity (p=0.008), proportion of the workday with hands above shoulder (p=0.002), proportion of the workday with trunk bent (p=0.028), proportion of the workday with awkward posture (p=0.048), sweating after work (p=0.006), total scales (p=0.003) and Borg scale (p=0.011) all had statistical significance. CONCLUSIONS: Our questionnaire for assessing physical workloads demonstrated statistically significant reliability and validity. But the questions for the proportions of the workday with sitting work posture and with static posture should be modified via a larger study.
Automobiles ; Energy Metabolism ; Hand ; Heart Rate ; Motor Activity ; Posture ; Questionnaires* ; Reproducibility of Results* ; Shoulder ; Sweat ; Sweating ; Weights and Measures

PURPOSE: This study was conducted in order to describe how intern physicians in the emergency department (ED) spent their time, and the frequency of tasks performed by them. METHODS: This was an observational, time-motion study for 15 intern physicians in 15 emergency centers. Observers in each hospital shadowed interns for a 60-minute period, two times, both day and night shift. They recorded time spent on various activities, type and number of activities. The proportion of activity that can be replaced by other staff members was calculated. RESULTS: Average number of duty hours of interns was 80.9 hours (63~87.8) per week. A total of 662 activities were observed during 30 hours. Interns' activities were classified as direct patient care 28.2%, personal time 24.2%, documentation 17.0%, procedures 16.7%, communication 8.1%, transportation 2.6%, indirect patient care 2.0%, learning activity 0.8%, and administrative work 0.4%. The proportion of procedural task showed negative correlation with the number of emergency medical technicians (r=-0.710, p=0.003). The proportion of activity that can be replaced by staff members other than doctors was 24.3% (0~47%) of time, except personal or learning activity. CONCLUSION: Results of this study showed that only 24.3% of interns' activity in the emergency department could be replaced by staff members other than doctors. Because the proportion of activities that could be replaced was variable among hospitals, each hospital should perform task analysis of interns' activity in order to forecast alternative manpower.
Cross-Sectional Studies* ; Emergencies ; Emergency Medical Technicians ; Emergency Service, Hospital* ; Humans ; Internship and Residency ; Learning ; Patient Care ; Time and Motion Studies ; Transportation

PURPOSE: The Tox-Info system is a poisonous substance information database developed by the Korean National Institute of Food and Drug Safety Evaluation. The aim of this study was to estimate the coverage effectiveness of the Tox-Info system by comparing the toxic substances included in the database with the distribution of the toxic substances implicated in the cases of intoxicated patients presenting to emergency departments. The secondary aim of the study was to propose any additional substances that should be added to the database. METHODS: We retrospectively reviewed the medical records of patients suffering with toxic exposure who had visited any of 12 selected emergency departments in Korea from January 2010 to December 2011. The identified toxic substances were classified into groups including prescription drugs, agricultural chemicals, household products, animals or plants, herbal drugs, and others. We calculated the coverage rate of the Tox-Info database relative to the number of intoxication cases and the type of toxic substances involved. RESULTS: A total of 5,840 intoxicated patient records were collected. Their mean age was 46.6+/-20.5 years and 56.2% were female. Of the total intoxication cases, 87.8% of the identified toxic substances were included in the Tox-Info database, while only 41.6% of all of the types of identified toxic substances were included. Broken down by category, 122 prescription drugs, 15 agricultural chemicals, 12 household products, 14 animals or plants and 2 herbal drugs involved in poisoning cases were not included in the Tox-info database. CONCLUSION: This study demonstrated the clinical usefulness of the Tox-Info system. While 87.8% of the substances involved in the cases were included in the Tox-Info database, the database should be continuously updated in order to include even the most uncommon toxic substances.
Agrochemicals ; Animals ; Emergencies ; Female ; Household Products ; Humans ; Korea ; Medical Records ; Prescription Drugs ; Retrospective Studies ; Stress, Psychological

PURPOSE: The purpose of this study was to identify the changes in the characteristics of patients with carbon monoxide (CO) poisoning, as well as the distinctive differences in intentionally exposed patients. METHODS: The medical records of CO poisoning patients, who visited nine emergency departments between January 2010 and December 2011, were reviewed retrospectively. The clinical information including age, gender, hospitalization, type of discharge, cause and location of exposure, site of onset, concentration of initial blood carboxyhemoglobin (COHb), methods of treatment and presence of neurological complications was examined. The subjects were divided into an intentional and non-intentional group and the differences between them was compared. RESULTS: A total 209 subjects were recruited. The median age was 38 years (29~49.5 years). They frequently complained of nausea and vomiting, and the most common exposures occurred in winter, normally in the home. The cause of exposure was usually fire, followed by incomplete combustion of fuels. The median initial blood COHb was 13.15%. The proportion of intentionally exposed patients was 21%. They were significantly younger, more frequently discharged against medical advice, and showed a higher initial blood COHb level (22.85%) than the non-intentional group. CONCLUSION: This study suggests that those with intentional CO poisoning are normally discharged against medical advice even when they have a higher initial COHb level. An adequate explanation of the delayed neurologic sequelae and short term follow-up observation is recommended for those patients with intentional exposure.
Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Carboxyhemoglobin ; Emergencies ; Fires ; Follow-Up Studies ; Hospitalization ; Humans ; Intention ; Medical Records ; Nausea ; Retrospective Studies ; Suicide ; Vomiting

Far-infrared rays (FIR) are known to have various effects on atoms and molecular structures within cells owing to their radiation and vibration frequencies. The present study examined the effects of FIR on gene expression related to glucose transport through microarray analysis in rat skeletal muscle cells, as well as on mitochondrial biogenesis, at high and low glucose conditions. FIR were emitted from a bio-active material coated fabric (BMCF). L6 cells were treated with 30% BMCF for 24 h in medium containing 25 or 5.5 mM glucose, and changes in the expression of glucose transporter genes were determined. The expression of GLUT3 (Slc2a3) increased 2.0-fold (p < 0.05) under 5.5 mM glucose and 30% BMCF. In addition, mitochondrial oxygen consumption and membrane potential (ΔΨm) increased 1.5- and 3.4-fold (p < 0.05 and p < 0.001), respectively, but no significant change in expression of Pgc-1a, a regulator of mitochondrial biogenesis, was observed in 24 h. To analyze the relationship between GLUT3 expression and mitochondrial biogenesis under FIR, GLUT3 was down-modulated by siRNA for 72 h. As a result, the ΔΨm of the GLUT3 siRNA-treated cells increased 3.0-fold (p < 0.001), whereas that of the control group increased 4.6-fold (p < 0.001). Moreover, Pgc-1a expression increased upon 30% BMCF treatment for 72 h; an effect that was more pronounced in the presence of GLUT3. These results suggest that FIR may hold therapeutic potential for improving glucose metabolism and mitochondrial function in metabolic diseases associated with insufficient glucose supply, such as type 2 diabetes.

Far-infrared rays (FIR) are known to have various effects on atoms and molecular structures within cells owing to their radiation and vibration frequencies. The present study examined the effects of FIR on gene expression related to glucose transport through microarray analysis in rat skeletal muscle cells, as well as on mitochondrial biogenesis, at high and low glucose conditions. FIR were emitted from a bio-active material coated fabric (BMCF). L6 cells were treated with 30% BMCF for 24 h in medium containing 25 or 5.5 mM glucose, and changes in the expression of glucose transporter genes were determined. The expression of GLUT3 (Slc2a3) increased 2.0-fold (p < 0.05) under 5.5 mM glucose and 30% BMCF. In addition, mitochondrial oxygen consumption and membrane potential (ΔΨm) increased 1.5- and 3.4-fold (p < 0.05 and p < 0.001), respectively, but no significant change in expression of Pgc-1a, a regulator of mitochondrial biogenesis, was observed in 24 h. To analyze the relationship between GLUT3 expression and mitochondrial biogenesis under FIR, GLUT3 was down-modulated by siRNA for 72 h. As a result, the ΔΨm of the GLUT3 siRNA-treated cells increased 3.0-fold (p < 0.001), whereas that of the control group increased 4.6-fold (p < 0.001). Moreover, Pgc-1a expression increased upon 30% BMCF treatment for 72 h; an effect that was more pronounced in the presence of GLUT3. These results suggest that FIR may hold therapeutic potential for improving glucose metabolism and mitochondrial function in metabolic diseases associated with insufficient glucose supply, such as type 2 diabetes.