Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is made clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder. Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the Population, Intervention, Comparator, and Outcome (PICO) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term functional disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and rather than as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilation with steroid injections can also be beneficial. Conclusion These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Background: This study aimed to evaluate the relationship between clinical experience and death certificate (DC) errors by analyzing DCs written by experienced emergency physicians (EPs). Methods: DCs issued by four experienced EPs over a 10-year period were retrospectively reviewed. DC errors were divided into major and minor errors based on whether they affected the cause of death (COD) determination. The errors were judged through first and second evaluations. Basic information regarding DCs and 10-year changes in DC errors were analyzed. Results: A total of 505 DCs were analyzed, with an average of 34 to 70 for each study year.The number of CODs written in the DCs tended to decrease over time. The presentation of major DC errors did not show a tendency to change over time. However, the sum of the major and minor errors tended to increase over time. Secondary conditions as the underlying COD tended to increase, and the incompatible causal relationships between CODs tended to decrease over time in the detailed analysis of major errors. The increasing tendency for incorrect other significant conditions, incorrect type of accident, incorrect intention of the external cause, no record of the trauma mechanism, and record of the trauma mechanism without another COD were found in the detailed analysis of minor errors. Conclusion DC errors did not decrease as clinical experience increased. Education to reduce DC errors and a feedback process for written DCs are necessary, regardless of clinical experience.

Objective: To compare the predicted and actual maximal heart rate (HRmax) values in the cardiopulmonary exercise test (CPET). Methods: We retrospectively investigated 1,060 patients who underwent a CPET between January 2016 and April 2020 at our institution’s cardiopulmonary rehabilitation center. The following patients were included: those aged >20 years, those tested with a treadmill, and those who underwent symptom-limited maximum exercise testing— reaching ≥85% of the predicted HRmax (62% if taking beta-blockers) and highest respiratory exchange ratio ≥1.1. Ultimately, 827 patients were included in this study. Data on diagnosis, history of taking beta-blockers, age, body mass index (BMI), and CPET parameters were collected. Subgroup analysis was performed according to age, betablockers, BMI (low <18.5 kg/m2, normal, and high ≥25 kg/m2), and risk classification. Results: There was a significant difference between the actual HRmax and the predicted value (p<0.001). Betablocker administration resulted in a significant difference in the actual HRmax (p<0.001). There were significant differences in the moderate-to-high-risk and low-risk groups and the normal BMI and high BMI groups (p<0.001). There was no significant difference between the elderly and younger groups. We suggest new formulae for HRmax of cardiopulmonary patients: estimated HRmax=183-0.76×age (the beta-blocker group) and etimated HRmax=210-0.91×age (the non-beta-blocker group). Conclusion Age-predicted HRmax was significantly different from the actual HRmax of patients with cardiopulmonary disease, especially in the beta-blocker group. For participants with high BMI and moderate-tosevere risk, the actual HRmax was significantly lower than the predicted HRmax.

Purpose: Errors in pediatric death certificates (DCs) have been rarely reported. We analyzed the errors in writing the DCs issued in an emergency department (ED). Methods: The DCs issued at the ED to patients aged 18 years or younger were retrospectively analyzed. Their medical records were reviewed by 4 emergency physicians. Major and minor errors in the DCs were defined based on the International Statistical Classification of Diseases and Related Health Problems 10th revision guidelines. The DCs were classified into the disease group and the external group by the manner of death, and the errors were compared. Results: Among a total of 87 DCs issued in the ED, 97.5% and 100% were confirmed to contain at least 1 error in the disease (n = 40) and external (n = 47) groups, respectively. The median numbers of errors in the analyzed DCs were 2.0 and 3.0 in the disease and external groups, respectively (P = 0.004). In the disease group, the most frequent major error was reporting only a secondary condition as the underlying cause of death without antecedent causes (6 cases [15.0%]). In the external group, the most frequent major error was writing 2 or more causes in a single line for the cause of death (17 cases [36.2%]). In both groups, the most common minor error was omission of a time interval record for the cause of death (disease, 37 cases [92.5%]; external, 42 cases [89.4%]). Conclusion Any errors were identified in 98.9% of pediatric DCs issued in the ED, and the total number of errors was larger in the external group.

Purpose: Classical swine fever (CSF) reemerged on CSF-free Jeju Island where vaccination is not practiced by the unintentional injection of a live attenuated vaccine (modified live attenuated vaccines–low-virulence Miyagi [MLV-LOM]) in 2014. Since the Jeju provincial authority is considering adopting a voluntary immunization policy using a CSF-E2 subunit vaccine to combat LOM-derived CSF endemic, this study aimed to evaluate in Jeju herds. Materials and Methods: Two vaccination trials using the Bayovac CSF-E2 vaccine licensed for use in South Korea assessed the safety and humoral immunity of the CSF-E2 vaccine in breeding (trial 1) and nursery animals (trial 2) under farm application conditions. Results: Neither local nor systemic (including reproductive) adverse effects were objectively observed in pregnant sows and young piglets following a respective vaccination regime at pregnancy or weaning, respectively. Trial 1 showed that sows immunized with the CSF-E2 vaccine possessed high and consistent E2-specific and neutralizing antibody levels. The CSF-E2 vaccine-immunized pregnant sows subsequently conferred appropriate and steady passive immunity to their offspring. In trial 2, a double immunization scheme of the CSF-E2 vaccine in piglets at 40 and 60 days of age could elicit a consistent and long-lasting adequate antibody response. Additionally, the two trials detected no E rns -specific antibody responses, indicating that CSF-E2 vaccine can differentiate infected from vaccinated animals (DIVA). Conclusion Our trial data collectively provide invaluable information on applying the CSFE2 subunit vaccine to circumvent the possible drawbacks associated with the MLV-LOM concerning the safety, efficacy, and DIVA, in the LOM-endemic field farms and contribute to advanced CSF eradication on Jeju Island.

BACKGROUND: The repair of large bone defects remains a significant challenge in clinical practice and requires bone grafts or substitute materials. In this study, we developed a unique hybrid bone scaffold comprising a three dimensional (3D)-printed metal plate for weight bearing and a biodegradable polymer tube serving as bone conduit. We assessed the long-term effect of the hybrid bone scaffold in repairing radial bone defects in a beagle model. METHODS: Bone defects were created surgically on the radial bone of three beagle dogs and individually-tailored scaffolds were used for reconstruction with or without injection of autologous bone and decellularized extracellular matrix (dECM). The repaired tissue was evaluated by X-ray, micro-computed tomography, and histological observation 6 months after surgery. The functional integrity of hybrid bone scaffold-mediated reconstructions was assessed by gait analysis. RESULTS: In vivo analysis showed that the hybrid bone scaffolds maintained the physical space and bone conductivity around the defect. New bone was formed adjacent to the scaffolds. Addition of autologous bone and dECM in the polymer tube improved healing by enhancing bone induction and osteoconduction. Furthermore, the beagles’ gait appeared normal by 4 months. CONCLUSION The future of bone healing and regeneration is closely related to advances in tissue engineering. Bone production using autologous bone and dECM loaded on 3D-printed hybrid bone scaffolds can successfully induce osteogenesis and provide mechanical force for functional bone regeneration, even in large bone defects.

Background: This study was undertaken to compare the sensitivities of mice strains during tumor induction by transcription activator-like effector nucleases (TALEN)-mediated Trp53 mutant gene. Alterations of their tumorigenic phenotypes including survival rate, tumor formation and tumor spectrum, were assessed in FVB/N-Trp53 em2Hwl /Korl and C57BL/6-Trp53 em1Hwl /Korl knockout (KO) mice over 16 weeks. Results: Most of the physiological phenotypes factors were observed to be higher in FVB/N-Trp53 em2Hwl /Korl KO mice than C57BL/6-Trp53 em1Hwl /Korl KO mice, although there were significant differences in the body weight, immune organ weight, number of red blood cells, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet count (PLT), total bilirubin (Bil-T) and glucose (Glu) levels in the KO mice relative to the wild type (WT) mice. Furthermore, numerous solid tumors were also observed in various regions of the surface skin of FVB/N-Trp53 em2Hwl /Korl KO mice, but were not detected in C57BL/6-Trp53 em1Hwl /Korl KO mice. The most frequently observed tumor in both the Trp53 KO mice was malignant lymphoma, while soft tissue teratomas and hemangiosarcomas were only detected in the FVB/N-Trp53 em2Hwl /Korl KO mice. Conclusions Our results indicate that the spectrum and incidence of tumors induced by the TALEN-mediated Trp53 mutant gene is greater in FVB/N-Trp53 em2Hwl /Korl KO mice than C57BL/6-Trp53 em1Hwl /Korl KO mice over 16 weeks.

Purpose: The purpose of this study was to investigate the mental health of physical therapy students in clinical practice during the COVID-19 pandemic. Methods: A cross-sectional survey was conducted during the pandemic and was completed by 100 physical therapy students in two universities in Gwangju and Jeollanam-do, South Korea. The Generalized Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9) were used to evaluate their anxiety and depression status. A Chi-square test was conducted to evaluate the association of participant characteristics with the risk of having anxiety and depression. Logistic regression models were used to identify the general characteristic factors related to anxiety or depression. Results: Anxiety was found in 28 (28%) of the participants, and depression in 24 (24%). The risk of anxiety and depression in male physical therapy students was 0.189 and 0.211 times lower, respectively, than those female students (p<0.05). The risk of anxiety and depression in physical therapy students with a history of disease was 11.721 and 7.056 times higher, respectively, than those with a history of disease (p<0.05). The risk of anxiety in physical therapy students in clinical practice was 11.721 times higher than that in students who were not in clinical practice (p<0.05). Conclusion The COVID-19 pandemic has led to a high risk of anxiety and depression among many physical therapy students. More attention and improvements are needed so that physical therapy students can study in a safe environment.

Purpose: The purpose of this study was to investigate the mental health of physical therapy students in clinical practice during the COVID-19 pandemic. Methods: A cross-sectional survey was conducted during the pandemic and was completed by 100 physical therapy students in two universities in Gwangju and Jeollanam-do, South Korea. The Generalized Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9) were used to evaluate their anxiety and depression status. A Chi-square test was conducted to evaluate the association of participant characteristics with the risk of having anxiety and depression. Logistic regression models were used to identify the general characteristic factors related to anxiety or depression. Results: Anxiety was found in 28 (28%) of the participants, and depression in 24 (24%). The risk of anxiety and depression in male physical therapy students was 0.189 and 0.211 times lower, respectively, than those female students (p<0.05). The risk of anxiety and depression in physical therapy students with a history of disease was 11.721 and 7.056 times higher, respectively, than those with a history of disease (p<0.05). The risk of anxiety in physical therapy students in clinical practice was 11.721 times higher than that in students who were not in clinical practice (p<0.05). Conclusion The COVID-19 pandemic has led to a high risk of anxiety and depression among many physical therapy students. More attention and improvements are needed so that physical therapy students can study in a safe environment.

Academies and Institutes ; Aged ; Asbestos ; Biopsy ; Compensation and Redress ; Diagnosis ; Drinking ; Drug Therapy ; Endoscopy ; Gastrectomy ; Gastrointestinal Neoplasms ; Humans ; Korea ; Middle Aged ; Occupational Exposure ; Occupational Health ; Oxygen ; Power Plants ; Rectal Neoplasms ; Ships ; Smoke ; Smoking ; Stomach Neoplasms