Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

During a disease survey in October 2019, leaf spot symptoms with a yellow halo were observed on Korean angelica (Anglica gigas) plants grown in fields in Pyeongchang, Gangwon Province, Korea. Incidence of diseased leaves of the plants in the investigated fields ranged from 10% to 60%. Morphological and cultural characteristics of two single-spore isolates from the leaf lesions indicated that they belonged to the genus Didymella. Molecular phylogenetic analyses using combined sequences of LSU, ITS, TUB2, and RPB2 regions showed distinct clustering of the isolates from other Didymella species. In addition, the morphological and cultural characteristics of the isolates were somewhat different from those of closely related Didymella spp. Therefore, the novelty of the isolates was proved based on the investigations. Pathogenicity of the novel Didymella species isolates was confirmed on leaves of Korean angelica plants via artificial inoculation. This study reveals that Didymella gigantis sp. nov.causes leaf spot in Korean angelica.

During disease surveys of Angelica acutiloba plants in Korea, leaf spot symptoms were observed in a field in Andong in July 2019, and stem rot symptoms in vinyl greenhouses in Yangpyeong in April 2020. Incidence of leaf spot and stem rot of the plants ranged from 10 to 20% and 5 to 30%, respectively. Morphological and cultural characteristics of fungal iso lates from the leaf spot and stem rot symptoms fitted into those of the genus Phoma.Molecular phylogenetic analyses of two single-spore isolates from the symptoms using con catenated sequences of LSU, ITS, TUB2, and RPB2 genes authenticated an independent clus ter from other Didymella (anamorph: Phoma) species. Moreover, the isolates showed different morphological and cultural characteristics in comparison to closely related Didymella species. These discoveries confirmed the novelty of the isolates. Pathogenicity of the novel Didymella species isolates was substantiated on leaves and stems of A. acutiloba through artificial inocu lation. Thus, this study reveals that Didymella acutilobae sp. nov. causes leaf spot and stem rot in Angelica acutiloba.

Purpose: This study was conducted to analyze the social factors influencing the ‘authenticity of suicidal ideation’ based post-suicidal care programs in emergency departments (EDs). Methods: This retrospective study was an analysis using the data of patients who had attempted suicide and visited the ED in tertiary urban hospitals from January 1, 2016, to December 31, 2018. The variables examined included gender, age, history of previous psychiatric disease, suicide method, and the number of previous attempts. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the registration rate for the community-based post-suicide care program. Results: Overall,1,460 suicides were analyzed, 177 (1.16%) showed a high authenticity of suicide. The social factors influencing the authenticity of suicide intent were the unmarried status of men and women, joblessness, history of mental illnesses, more than two previous suicide attempts, the influence of alcohol, and an attempt to commit suicide after midnight more specifically between 24:00 to 6:00 hours in the morning (p<.05). The factors influencing the severity of the condition of high authenticity suicide patients were low Glasgow coma scores (12 points or less), lactate levels, and oxygen saturation observed in the patients who were admitted to the intensive care unit for treatment and died (p<.05). Conclusion The need for evidence-based preventive measures and early assessment tools at the emergency medicine level is emphasized to reduce the rate of suicide attempts. If the results of this study are used in the management of suicide prevention, the evaluation of the authenticity of suicide intent will be more likely to be made at the emergency medicine level, allowing the severity to be assessed earlier.

PURPOSE: The purpose of this study is to evaluate the clinical effectiveness of a rehabilitation program for the patients with lateral epicondylitis. MATERIALS AND METHODS: Twenty-three patients with lateral epicondylitis were included from April 2009 to October 2009 and all the patients were treated with a rehabilitation program for 6 weeks. The evaluation at baseline and at 12 weeks after rehabilitation included the subjective assessment of symptoms and the objective assessment with measuring the grip strength and muscle power of the wrist extensors and flexors and the forearm supinators and pronators. After 6 months, subjective satisfaction was evaluated via telephone calls. The data was analyzed using the Wilcoxon signed rank test (SPSS ver. 16.0). RESULTS: At 12 weeks, the subjective satisfaction was improved in on the three questionnaires. The grip strength increased from 25.1 kg to 37.8 kg (p<0.05). On the Biodex analysis, there was significant difference at the wrist extensors. At 6 months, 21 cases had excellent or good results according to the score and 2 cases complained of remaining pain. CONCLUSION: Our rehabilitation program is thought to be good treatment for the patients with lateral epicondylitis, and it is a practical and precautionary step for the cases of lateral epicondylitis if the patients themselves are educated to volutarily participate in the program.
Elbow ; Forearm ; Hand Strength ; Humans ; Muscles ; Surveys and Questionnaires ; Telephone ; Wrist

Tumoral calcinosis is a periarticular calcific lesion and rare complication in patients with maintenance hemodialysis. The pathogenesis of tumoral calcinosis is poorly understood but may be due to elevated serum phosphorus, a high calcium phosphorus (Ca x P) product or secondary hyperparathyroidism in hemodialysis patients. A 30-year-old man presented with pain and palpable mass of left shoulder. He had been on maintenance hemodialysis with high flux dialyzer for 10 years. Laboratory finding showed hyperphosphatemia and elevated intact PTH concentration. A shoulder X-ray and CT scan demonstrated a massive calcification. Following partial resection, pain was relieved. Here we report a case of tumoral calcinosis of shoulder in a hemodialysis patient with untreated hyperphosphatemia and secondary hyperparathyroidism.
Adult ; Calcinosis ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Hyperphosphatemia ; Phosphorus ; Renal Dialysis ; Shoulder

PURPOSE: The goal of this study was to evaluate differences in strength deficits between (i) patients with stage 1 or 2 impingement syndrome and (ii) patients with rotator cuff tears. MATERIALS AND METHODS: We enrolled 43 patients with stage 1 or 2 impingement syndrome (group 1) and 21 patients with rotator cuff tears (group 2). The isokinetic strength of both groups was evaluated at 60degrees/sec for external rotation, internal rotation, adduction and abduction. We measured the peak torque, total work, average power of bilateral sides, peak torque relationship to body weight, and the ratio between unilateral agonist and antagonist. RESULTS: The isokinetic strength deficits assessed in ratio of peak torque to body weight for group 1 and group 2 respectively were; 28.48+/-23.76% and 29.12+/-32.81% for abduction (p=0.929), 7.20+/-13.98% and 18.94+/-19.52%; for adduction (p=0.021), 16.88+/-13.76% and 25.80+/-24.07%; for external rotation (p=0.221), and 14.1+/-25.67% and 29.02+/-35.06% for internal rotation (p=0.059). For average power and total work, group 2 showed a significantly greater deficit for adduction and internal rotation than group 1. CONCLUSION: Those with rotator cuff tears have more isokinetic muscle strength deficits than those with stage 1 or 2 impingement syndrome. Progression from stage 1 and 2 impingement syndrome to stage 3 may result in greatest changes in strength deficits for internal rotation and adduction.
Body Weight ; Humans ; Muscle Strength ; Rotator Cuff ; Shoulder ; Torque

PURPOSE: To evaluate the usefulness of internal fixation with plate in treating infected nonunion of long bone. MATERIALS AND METHODS: From March 1993 to February 2004, ten patients who underwent internal fixation with plate and cancellous bone graft on account of infected nonunion of long bone were retrospectively examined. The medical treatment were composed of thorough and adequate debridement of necrotic tissue, irrigation and plate fixation. Two patients were operated on with bridging plate method. Autologous cancellous bone graft was performed in 6 patients. In 2 cases, it was performed 4 weeks after internal fixation. RESULTS: In 9 patients, radiographic union appeared on the average of 6.8months and infections were cured before union occurred. CONCLUSION: Internal fixation with plate is a useful method for the solid fixation in the treatment of infected nonunion. The general concern was that the inserted hardware worsened the infection, which was overcomed with the operative techniques as bridging plate, debridement and cancellous bone graft.
Debridement ; Humans ; Retrospective Studies ; Transplants

PURPOSE: The purpose of this study was to evaluate the correlation between various subjective, objective tests and real functional performances of the patients after ACL reconstruction. METHOD: Twenty-four patients after ACL reconstruction using 12 hamstring autograft and 12 Achilles allograft were evaluated. Lysholm knee score, IKDC subjective score, Knee Outcome Survey score and Tegner activity score were evaluated for the subjective outcome value. Static instability tests, Biodex dynamometer and hop tests were done for the objective outcome value. Three functional performance tests(FPTs) such as carioca test, shuttle run test and co-contraction test were done for deciding the real performance ability of the patients. Each score system was compared with FPT results. RESULTS: The results of Hamstring group were better than those of Achilles group, but there was no statistical significance. IKDC subjective score, single leg hopping test, and quadriceps power in low velocity of biodex dynamometer tests had a positive correlation with the total FPT results. CONCLUSION: IKDC subjective score, one leg hopping test showed significant correlation with functional performance test and they can be used as effective methods to decide whether the subjects after ACL reconstruction can return to sports activity.
Allografts ; Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Autografts ; Humans ; Humulus ; Knee ; Leg ; Sports

OBJECTIVE: bjective: By identifying the unknown substance responsible for binding with nebulin SH3 domain within the sarcomeric Z-line, we tried to find out Z-line structure which plays an important role on muscle contraction and maintenance of muscle funtion. METHOD: First, the bait plasmid was made by binding the DNA binding domain of Gal4 protein of yeast and the SH3 domain. Second, library plasmid was made by binding activation domain and human skeletal cDNA library. Then, the base sequence of the clone, produced by combining the two proteins expressed by transgenically converted plasmid in yeast, was analyzed. RESULT: We screened out six true positive clones and analyzed the base sequence of the two of six clones. We identified them to be alpha-actinin2. CONCLUSION: We can theorize that Neublin SH3 domain and alpha-actinin2 plays a vital role for the integration of Z-line. Thus, this is an important data in further studying muscle functions, mechanisms, and muscular disease as well.
Base Sequence ; Clone Cells ; DNA ; Gene Library ; Humans* ; Muscle Contraction ; Muscular Diseases ; Plasmids ; src Homology Domains* ; Yeasts