Objective: The purpose of this study was to evaluate the efficacy of intra-articular ketorolac to improve intra-articular hyaluronic acid (HA) therapy in knee osteoarthritis with respect to the initiation of pain relief. Methods: This study was desig
Abstract Background Poststroke rehabilitation reportedly improves functional outcomes and minimizes disability. However, previous studies have demonstrated conflicting results regarding the effects of rehabilitation therapy on post-stroke mortality. Therefore, we aimed to investigate the association between rehabilitation therapy within the first six months after stroke and long-term all-cause mortality in patients with stroke using data from the Korean National Health Insurance System. Methods A total of 10,974 patients newly diagnosed with stroke using ICD-10 codes (I60-I64) between 2013 and 2019 were enrolled and followed-up for all-cause mortality until 2019. Post-stroke patients were categorized into three groups according to the frequency of rehabilitation therapy: no rehabilitation therapy, ≤ 40 sessions, and > 40 sessions. Cox proportional hazard models were used to assess the mortality risk according to rehabilitation therapy stratified by disability severity. Results Higher frequency of rehabilitation therapy was associated with significantly lower post-stroke mortality in comparison to no rehabilitation therapy (HR=0.88, 95% CI 0.79-0.9 9), especially among individuals with severe disability after stroke (HR=0.74, 95% CI 0.62-0.87). An inverse association between number of rehabilitation therapy sessions and mortality was identified in a multivariate Cox regression model with restricted cubic splines. In the context of stroke type, higher frequency of rehabilitation therapy was associated with reduced mortality rates compared to no rehabilitation therapy only in patients with hemorrhagic stroke (HR=0.60, 95% CI 0.49-0.74). While socioeconomic factors were not associated with mortality, older age, male sex, and pneumonia were associated with increased mortality risk, regardless of disability severity. Conclusions Post-stroke rehabilitation therapy within six months of stroke onset seems to play a substantial role in reducing long-term mortality after stroke. A higher frequency of rehabilitation therapy is recommended for post-stroke patients, particularly among those with severe disability.
The aims of this study were; 1) to develop the final version of the Korean Roland-Morris Disability Questionnaire (RDQ), and 2) to compare the responsiveness between the RDQ and the Oswestry Disability Index (ODI) scores in patients having low back pain. The psychometric properties of the final Korean RDQ were evaluated in 221 patients. Among them, 30 patients were reliability tested. Validity was evaluated using an 11-point numerical rating scale (NRS) and the Korean ODI. The receiver operating characteristic (ROC) curve analysis of the RDQ and the ODI was compared in 54 patients with lumbar zygapophyseal (facet) joint pain. There was a moderate relationship between the RDQ and NRS (r = 0.59, P < 0.01) and a strongly positive correlation between the RDQ and the ODI (r = 0.76, P < 0.001). The Korean RDQ with the higher area under the ROC curve showed a better overall responsive performance than did the ODI in patients with lumbar facet joint pain after medial branch radiofrequency neurotomy (P < 0.01). The results of the study present the final version of the Korean RDQ is valid for assessing functional status in a Korean population with chronic low back pain.
Background: Intra-articular corticosteroid or hyaluronic acid (HA) is commonly prescribed for frozen shoulder. However, few studies have investigated histological and molecular changes after injection. Purpose: To compare the effectiveness of intra-articular injections of triamcinolone and HA in a frozen shoulder rat model and verify a greater effect of triamcinolone in passive shoulder abduction compared with HA. Study Design: Controlled laboratory study. Methods: Twenty male Sprague-Dawley rats were randomly allocated into 4 groups (n = 5 in each): control group, which did not receive cast immobilization or injection, and 3 experimental groups, which received 3 weeks of unilateral shoulder immobilization followed by intra-articular injections (normal saline, triamcinolone, or HA) at the immobilized shoulder. Passive shoulder abduction angle, histological and immunohistochemical staining, and Western blotting results were assessed 2 weeks after injection. The intensity and extent of staining were converted to semiquantitative scores for further analysis. Results: Shoulder abduction angles before sacrifice were 153.0°± 2.7° (control group), 107.0°± 5.7° (saline group), 139.0°± 9.6° (triamcinoline group), and 110.0°± 10.6° (HA group), showing significant differences between control and saline groups, control and HA groups, saline and triamcinoline groups, and triamcinoline and HA groups ( P < .001) but not between control and triamcinoline groups ( P = .053). Histologic evaluation revealed an increase in synovial folds and thickening of the capsular membrane in the saline and HA groups; this change was not evident in the triamcinolone group. A comparison of semiquantitative scores revealed greater expression levels of proteins involved in fibrosis and angiogenesis in the saline and HA groups compared with the control and triamcinolone groups. In Western blotting, the expression of inflammatory cytokines and the receptor for advanced glycation end products was significantly lower in the triamcinolone and HA groups than in the saline group. Conclusion: Triamcinolone injection was more effective than normal saline or HA injection in improving range of motion and reversing fibrotic and angiogenic features of frozen shoulder. Both triamcinolone and HA injections elicited anti-inflammatory effects. Clinical Relevance: The antifibrotic and antiangiogenic properties of triamcinolone and the anti-inflammatory properties of both triamcinolone and HA should be considered when performing injections in clinical settings.
Chronic full-thickness rotator cuff tears (FTRCTs) represent a major clinical concern because they show highly compromised healing capacity.To evaluate the efficacy of using a 3-dimensional (3D) bioprinted scaffold with human umbilical cord blood (hUCB)-mesenchymal stem cells (MSCs) for regeneration of chronic FTRCTs in a rabbit model.Controlled laboratory study.A total of 32 rabbits were randomly assigned to 4 treatment groups (n = 8 per group) at 6 weeks after a 5-mm FTRCT was created on the supraspinatus tendon. Group 1 (G1-SAL) was transplanted with normal saline. Group 2 (G2-MSC) was transplanted with hUCB-MSCs (0.2 mL, 1 × 106) into FTRCTs. Group 3 (G3-3D) was transplanted with a 3D bioprinted construct without MSCs, and group 4 (G4-3D+MSC) was transplanted with a 3D bioprinted construct containing hUCB-MSCs (0.2 mL, 1 × 106 cells) into FTRCTs. All 32 rabbits were euthanized at 4 weeks after treatment. Examination of gross morphologic changes and histologic results was performed on all rabbits after sacrifice. Motion analysis was also performed before and after treatment.In G4-3D+MSC, newly regenerated collagen type 1 fibers, walking distance, fast walking time, and mean walking speed were greater than those in G2-MSC based on histochemical and motion analyses. In addition, when compared with G3-3D, G4-3D+MSC showed more prominent regenerated tendon fibers and better parameters of motion analysis. However, there was no significant difference in gross tear size among G2-MSC, G3-3D, and G4-3D+MSC, although these groups showed significant decreases in tear size as compared with the control group (G1-SAL).Findings of this study show that a tissue engineering strategy based on a 3D bioprinted scaffold filled with hUCB-MSCs can improve the microenvironment for regenerative processes of FTRCT without any surgical repair.In the case of rotator cuff tear, the cell loss of the external MSCs can be increased by exposure to synovial fluid. Therefore, a 3D bioprinted scaffold in combination with MSCs without surgical repair may be effective in increasing cell retention in FTRCT.
Purpose Mesectodermal leiomyoma is a rare tumor that can arise from smooth muscle tissue in the iris or ciliary body or from heterotopic smooth muscle in the choroid. The purpose of this study was to describe the clinical characteristics and surgical outcomes of mesectodermal leiomyoma of the ciliary body and choroid. Methods Retrospective observation case series of 8 patients who were diagnosed with mesectodermal leiomyoma with histopathologic and immunohistochemical confirmation. Results The median age at presentation was 37.5 years. The median follow-up period was 27 months. Ultrasonography showed dome-shaped smooth surface with low to medium internal reflectivity and regular internal structure in all tumors. The tumor had a median largest base diameter of 10.4 mm and a median thickness of 7.7 mm. They revealed pinkish colored surface and vessels that more developed than other intraocular tumors. The tumors located on ciliary body only in 4 eyes, on choroid only in 2 eyes, and on ciliochoroid in 2 eyes. 6 patients who had tumors on ciliary body only or ciliochoroid underwent lamellar sclerouvectomy. 2 patients who had choroidal tumor received enucleation or partial excision for biopsy each. On immunohistochemistry, all the tumors were stained positively for smooth muscle actin and desmin. After lamellar sclerouvectomy, the tumor did not show recurrence in follow up period. But the patient that underwent partial removal of tumor on choroid showed irregularly changing surface with increasing size. Conclusions Mesectodermal leiomyoma did not show the recurrence after lamellar sclerouvectomy and malignant change of tumor. However these tumors are difficult to differentiate from other intraocular tumor and to conclude definitely that they do not develop malignant change because they have heterogeneity from benign leiomyoma of other body organs.
This study focuses on the comparison of measured data from 6-DOF motion sensor and strain gauge installed in the IBRV ARAON during 2015 summer voyage in the Arctic. Procedures to calculate the global ice load from MotionPak II inertial measurement system and the local load from stain gauge system are discussed. The ship's speed and peak load are determined in the concept of an ice collision "event". It is found that the peak values in the global ice calculated form whole ship motion analysis fall in the range of 1.5~3 times of the local ice load based in strain gauge measurement.
Previous studies have demonstrated conflicting results regarding the effects of rehabilitation therapy on poststroke mortality. We aimed to investigate the association between rehabilitation therapy, including both inpatient and outpatient treatment, within the first 6 months after stroke and long-term all-cause mortality in patients with stroke using the Korean National Health Insurance System data.
【Background: Intra-articular injection is a commonly performed procedure in patients with degenerative osteoarthritis of the knee. Several drugs are used for relief of pain in such cases. Local anesthetics, clonidine and steroids have been confirmed to be effective when used in an intra-articular injection. Ketorolac has recently become one of the most commonly used and potent NSAIDs. There have been many studies about the effect of ketorolac. Methods: Sixty-four patients were divided into 2 groups. In Group I (n = 31), 0.5% bupivacaine 3 ml and sodium hyaluronate 20 mg were used and in Group II (n = 33), 0.5% bupivacaine 3 ml, sodium hyaluronate 20 mg and ketorolac 5 mg were used. We observed the pain relief scale (PRS) at 15 minutes, 1 week and 1-3 months after injection. Results: After 15 minutes, PRS scores were $6.6{\pm}2.7$ (Group I) and $5.1{\pm}3.1$ (Group II), so there was a statistical difference between the two groups. After 1 week, the PRS scores were $5.9{\pm}2.0$ (Group I) and $5.8{\pm}2.4$ (Group II). At 1-3 months later, PRS scores were $5.6{\pm}3.0$ (Group I) and $5.1{\pm}2.7$ (Group II). Thus, there were no significant statistical differences between the two groups at 1 week or 1-3 months later, although some patients were more satisfied with pain relief in Group II at 1-3 months. Conclusions: Ketorolac provides more rapid pain relief of degenerative arthritis when used in intra-articular injection. And there was no statistical difference of effect after 1 week or 1-3 months later. Further studies are required on the effect of the intra-articular use of ketorolac.】
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