OBJECTIVES: This study evaluated and validated the reliability of smartphones as measuring equipment for the dorsi-plantar flexion of ankle joint position sense (JPS) ability. METHODS: The subjects were 20 healthy young students in their 20s. We confirmed the concurrent validity by comparison with existing electrogoniometer data. The reliability of the smartphone was confirmed using the test-retest method. RESULTS: In the case of dorsiflexion, there was no significant difference between the smartphone and electrogoniometer groups (p > 0.05). Regarding the correlation, it was significantly high (r = 0.65, p < 0.05), and ICC(3,1) was good (ICC(3,1) = 0.79). For the case of plantar flexion, there was no significant difference between the smartphone and electrogoniometer groups (p > 0.05), the correlation was significantly high (r = 0.69, p < 0.05), and the ICC(3,1) was very good (ICC(3,1) = 0.82). In the case of dorsiflexion, there was no significant difference between test and retest (p > 0.05), the correlation was intermediate (r = 0.59, p < 0.05), and the ICC(3,1) value was good (ICC(3,1) = 0.74). For plantar flexion, there was no significant difference between test and retest (p > 0.05), the correlation was significantly high (r = 0.63, p < 0.05), and the ICC(3,1) was good (ICC(3,1) = 0.76). CONCLUSIONS: The results showed that smartphones provide high validity and reliability as measurement equipment for JPS of dorsi-plantar flexion of the ankle. Finally, the study also considers that smartphone-based JPS measuring methods may replace the traditional and expensive methods that are currently being used for the same purpose.
Ankle Joint ; Ankle* ; Humans ; Joints* ; Methods ; Proprioception* ; Reproducibility of Results ; Smartphone*

Objectives: Aquatic therapy is a significant intervention method for both patients and healthy individuals. However, in clinical practice, quantitative measurements are rarely applied in aquatic therapy due to the disadvantages of submerging expensive instruments in water. In this study, we used readily available smartphones and armbands to measure leg segments and joint angles during aquatic gait and evaluated the reliability of these measurements. Methods: Waterproof smartphones were strapped to the trunk, thighs, and shanks of 19 healthy young adults using armbands. The angles of the trunk, thigh, and shank segments were measured during aquatic gait. The measurements were repeated 1 day later. The data were analyzed to obtain the angles of the hip and knee joints. Results: Measurement repeatability, calculated using the intraclass correlation coefficient (ICC), was the highest for the shank segment range of motion (ROM) (first 46.79° ± 5.50°, second 50.12° ± 9.98°, ICC = 0.78). There was high agreement in trunk segment ROM (first 6.36° ± 1.42°, second 4.29° ± 1.83°, ICC = 0.73), thigh segment ROM (first 33.49° ± 5.18°, second 37.31° ± 8.70°, ICC = 0.62), and knee joint ROM (first 52.43° ± 11.26°, second 62.19° ± 16.65°, ICC = 0.68) and fair agreement in hip joint ROM (first 34.60°±4.71°, second 37.80° ± 7.84°, ICC = 0.59). Conclusions Smartphones can be used to reliably measure leg segments and joint angles during aquatic gait, providing a simpler method for obtaining these measurements and enabling the wider use of aquatic motion analysis in clinical practice and research.

The global burden of disease study (GBD) provides valuable information for evaluating population health in terms of disease burden. This study collected and reviewed GBD data in Korea for the year 1990 and 2013. The burdens of cancer, cardiovascular disease, communicable disease, and injuries have decreased remarkably, thereby greatly diminishing the overall disease burden on Korea. Meanwhile, the burdens due to non-fatal chronic diseases such as neuropsychiatric and musculoskeletal disease became major burden contributors. Responding to this circumstance presents a complex challenge to the Korean health system and Korean health policy.
Cardiovascular Diseases ; Chronic Disease ; Communicable Diseases ; Health Policy ; Korea* ; Musculoskeletal Diseases

Objective: Delivery of prehospital defibrillation for shockable rhythms by emergency medical service providers is crucial for successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. The optimal range of prehospital defibrillation attempts for refractory shockable rhythms is unknown. This study evaluated the association between the number of prehospital defibrillation attempts and neurologic outcomes in OHCA patients. Methods: A retrospective observational study was conducted using the nationwide OHCA registry. Adult OHCA patients who were treated by emergency medical service providers due to presumed cardiac origin with initial shockable rhythm were enrolled from 2013 to 2016. The final analysis was performed on patients without on-scene return of spontaneous circulation. The number of prehospital defibrillation attempts was categorized as follows: 2–3, 4–5, and ≥6 attempts. The primary outcome was a good neurologic recovery at hospital discharge. Multivariate logistic regression analysis was performed to evaluate the association between neurologic outcomes and the number of prehospital defibrillation attempts. Results: A total of 4,513 patients were included in the final analysis. The numbers of patients for whom 2–3, 4–5, and ≥6 defibrillation attempts were made were 2,720 (60.3%), 1,090 (24.2%), and 703 (15.5%), respectively. Poorer outcomes were associated with ≥6 defibrillation attempts: survival to hospital discharge (adjusted odds ratio, 0.38; 95% confidence interval, 0.21–0.65) and good neurologic recovery (adjusted odds ratio, 0.42; 95% confidence interval, 0.21–0.84). Conclusion Six or more prehospital defibrillation attempts were associated with poorer neurologic outcomes in OHCA patients with an initial shockable rhythm who were unresponsive to on-scene defibrillation and resuscitation.

Objective: Delivery of prehospital defibrillation for shockable rhythms by emergency medical service providers is crucial for successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. The optimal range of prehospital defibrillation attempts for refractory shockable rhythms is unknown. This study evaluated the association between the number of prehospital defibrillation attempts and neurologic outcomes in OHCA patients. Methods: A retrospective observational study was conducted using the nationwide OHCA registry. Adult OHCA patients who were treated by emergency medical service providers due to presumed cardiac origin with initial shockable rhythm were enrolled from 2013 to 2016. The final analysis was performed on patients without on-scene return of spontaneous circulation. The number of prehospital defibrillation attempts was categorized as follows: 2–3, 4–5, and ≥6 attempts. The primary outcome was a good neurologic recovery at hospital discharge. Multivariate logistic regression analysis was performed to evaluate the association between neurologic outcomes and the number of prehospital defibrillation attempts. Results: A total of 4,513 patients were included in the final analysis. The numbers of patients for whom 2–3, 4–5, and ≥6 defibrillation attempts were made were 2,720 (60.3%), 1,090 (24.2%), and 703 (15.5%), respectively. Poorer outcomes were associated with ≥6 defibrillation attempts: survival to hospital discharge (adjusted odds ratio, 0.38; 95% confidence interval, 0.21–0.65) and good neurologic recovery (adjusted odds ratio, 0.42; 95% confidence interval, 0.21–0.84). Conclusion Six or more prehospital defibrillation attempts were associated with poorer neurologic outcomes in OHCA patients with an initial shockable rhythm who were unresponsive to on-scene defibrillation and resuscitation.

The transformation of papillary thyroid carcinoma (PTC) to anaplastic thyroid carcinoma (ATC) is well documented in the literature but is an exceptionally rare occurrence in metastatic foci outside the primary thyroid lesion. Even rarer is the simultaneous occurrence of PTC and ATC in the cervical lymph nodes. We report the case of an 85–year–old man who presented with a rapidly growing neck mass diagnosed as PTC. Following surgery, multiple ATC foci in the metastatic cervical lymph node were found coexisting with PTC, whereas in the thyroid, only PTC was found. This case is of high clinical significance because transformation of PTC to ATC outside the thyroid gland per se is very rare and because it suggests rapidly growing tumors in an elderly patient. The use of core needle biopsies in cases with suspected rapid tumor growth can aid in proper diagnosis, surgical decision making, and patient counselling.

BACKGROUND AND OBJECTIVES: The clinical significance and need for the treatment of primary snoring and mild obstructive sleep apnea have been recently questioned. In this study, we analyzed therapeutic outcome and the methods of treatment of such diseases.SUBJECTS AND METHOD: A retrospective review was conducted using the medical records of patients diagnosed with primary snoring or mild obstructive sleep apnea at a single institution from 2013 to 2015 through polysomnography or WATCHPAT. RESULTS: Of the 18 patients (37%) with primary snoring, 13 patients (72.2%) underwent surgery, four patients (22.2%) were treated with surgery and mandibular advancement device, and one patient (5.6%) underwent automatic positive airway pressure therapy. Of the 78 patients (61%) with mild obstructive sleep apnea, 35 patients (44.8%) had surgery, 24 patients (30.8%) were treated with mandibular advancement device, 13 patients (16.7%) were treated with surgery and mandibular advancement device and 6 patients (7.7%) received automatic positive airway pressure therapy. For primary snoring, while Epworth Sleepiness Scale and Pittsburg Sleep Quality Index did not improve, the snoring visual analog scale decreased significantly. In patients with mild obstructive sleep apnea, Apnea-Hypopnea Index, snoring decibel, Epworth Sleepiness Scale, and Pittsburg Sleep Quality Index were significantly decreased after treatment and the lowest oxygen saturation was significantly increased after treatment. CONCLUSION For primary snoring, the direction of treatment should be determined in accordance with the presence of associated diseases related to sleep disturbance breathing. For mild obstructive sleep apnea, active treatment may be helpful.

BACKGROUND AND OBJECTIVES: The clinical significance and need for the treatment of primary snoring and mild obstructive sleep apnea have been recently questioned. In this study, we analyzed therapeutic outcome and the methods of treatment of such diseases. SUBJECTS AND METHOD: A retrospective review was conducted using the medical records of patients diagnosed with primary snoring or mild obstructive sleep apnea at a single institution from 2013 to 2015 through polysomnography or WATCHPAT. RESULTS: Of the 18 patients (37%) with primary snoring, 13 patients (72.2%) underwent surgery, four patients (22.2%) were treated with surgery and mandibular advancement device, and one patient (5.6%) underwent automatic positive airway pressure therapy. Of the 78 patients (61%) with mild obstructive sleep apnea, 35 patients (44.8%) had surgery, 24 patients (30.8%) were treated with mandibular advancement device, 13 patients (16.7%) were treated with surgery and mandibular advancement device and 6 patients (7.7%) received automatic positive airway pressure therapy. For primary snoring, while Epworth Sleepiness Scale and Pittsburg Sleep Quality Index did not improve, the snoring visual analog scale decreased significantly. In patients with mild obstructive sleep apnea, Apnea-Hypopnea Index, snoring decibel, Epworth Sleepiness Scale, and Pittsburg Sleep Quality Index were significantly decreased after treatment and the lowest oxygen saturation was significantly increased after treatment. CONCLUSION: For primary snoring, the direction of treatment should be determined in accordance with the presence of associated diseases related to sleep disturbance breathing. For mild obstructive sleep apnea, active treatment may be helpful.
Humans ; Mandibular Advancement ; Medical Records ; Methods ; Oxygen ; Polysomnography ; Respiration ; Retrospective Studies ; Sleep Apnea, Obstructive ; Snoring ; Visual Analog Scale

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is highly prevalent in commercial vehicle operators (CMVOs). This study aimed to evaluate the poor sleep quality, daytime sleepiness, and the prevalence of self-reported OSA in CMVOs.SUBJECTS AND METHOD: We performed a retrospective review of the medical records of patients who visited a single institution with sleep problems from 2011 January to 2016 December. Among the patients, a total of 38 CMVOs was analyzed. Clinical information, questionnaires about sleep quality (Pittsburg sleep questionnaire, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and risk factors for OSA (STOP-Bang) were analyzed. The frequency of motor vehicle accidents and near accidents was assessed, and polysomnography (PSG) was used for OSA diagnosis purposes. RESULTS: The mean age of the study population was 45.3±11.8 years. The average score of PSQI, ESS, and STOP-Bang were 6.75±4.22, 10.79±7.12, and 4.62±3.34, respectively. A significant association between near accidents and high-risk group of OSA was observed [odds ratio (OR)=2.73, 95% confidence interval (CI)=1.08–4.48]. Subjects with poor sleep quality showed significantly increased risk of near accidents (OR=2.34, 95% CI=1.01–3.56). Receiver operating characteristic curves of STOP-Bang questionnaire using apnea-hypopnea index (cut-off value=5) indicates that suspected OSA group predicted by STOP-Bang score was significantly correlated with OSA severity (area under curve=0.72, sensitivity 77.1%, specificity 59.4%). CONCLUSION Administration of STOP-Bang questionnaire before a PSG can identify high-risk subjects, supporting its further use in OSA screening of CMVOs.

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is highly prevalent in commercial vehicle operators (CMVOs). This study aimed to evaluate the poor sleep quality, daytime sleepiness, and the prevalence of self-reported OSA in CMVOs. SUBJECTS AND METHOD: We performed a retrospective review of the medical records of patients who visited a single institution with sleep problems from 2011 January to 2016 December. Among the patients, a total of 38 CMVOs was analyzed. Clinical information, questionnaires about sleep quality (Pittsburg sleep questionnaire, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and risk factors for OSA (STOP-Bang) were analyzed. The frequency of motor vehicle accidents and near accidents was assessed, and polysomnography (PSG) was used for OSA diagnosis purposes. RESULTS: The mean age of the study population was 45.3±11.8 years. The average score of PSQI, ESS, and STOP-Bang were 6.75±4.22, 10.79±7.12, and 4.62±3.34, respectively. A significant association between near accidents and high-risk group of OSA was observed [odds ratio (OR)=2.73, 95% confidence interval (CI)=1.08–4.48]. Subjects with poor sleep quality showed significantly increased risk of near accidents (OR=2.34, 95% CI=1.01–3.56). Receiver operating characteristic curves of STOP-Bang questionnaire using apnea-hypopnea index (cut-off value=5) indicates that suspected OSA group predicted by STOP-Bang score was significantly correlated with OSA severity (area under curve=0.72, sensitivity 77.1%, specificity 59.4%). CONCLUSION: Administration of STOP-Bang questionnaire before a PSG can identify high-risk subjects, supporting its further use in OSA screening of CMVOs.
Diagnosis ; Humans ; Korea ; Mass Screening ; Medical Records ; Methods ; Motor Vehicles ; Polysomnography ; Prevalence ; Retrospective Studies ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Sleep Apnea, Obstructive ; Surveys and Questionnaires