Long-Term Prognosis of Asthma-Bronchiectasis Overlapped Patients: A Nationwide Population-Based Cohort Study

Purpose: Asthma and bronchiectasis are common chronic respiratory diseases, and their coexistence is frequently observed but not well investigated. Our aim was to study the effect of comorbid bronchiectasis on asthma. Methods: A propensity score-matched cohort study was conducted using the National Health Insurance Service-Health Screening Cohort database. From 2005 to 2008, 8,034 participants with asthma were weighted based on propensity scores in a 1:3 ratio with 24,099 participants without asthma. From the asthma group, 141 participants with overlapped bronchiectasis were identified, and 7,892 participants had only asthma. Clinical outcomes of acute asthma exacerbation(s) and mortality rates were compared among the study groups. Results: The prevalence of bronchiectasis (1.7%) was 3 times higher in asthmatics than in the general population of Korea. Patients who had asthma comorbid with bronchiectasis experienced acute exacerbation(s) more frequently than non-comorbid patients (11.3% vs. 5.8%, P = 0.007). Time to the first acute exacerbation was also shorter in the asthmatics with bronchiectasis group (1,970.9 days vs. 2,479.7 days, P = 0.005). Although bronchiectasis was identified as a risk factor for acute exacerbation (adjusted odds ratio, 1.73; 95% confidence interval [CI], 1.05-2.86), there was no significant relationship between bronchiectasis and all-cause or respiratory mortality (adjusted hazard ratio [aHR], 1.17; 95% CI, 0.67-2.04 and aHR, 0.81; 95% CI, 0.11-6.08). Conclusions: Comorbid bronchiectasis increases asthma-related acute exacerbation, but it does not-raise the risk of all-cause or respiratory mortality. Close monitoring and accurate diagnosis of bronchiectasis are required for patients with frequent exacerbations of asthma.ope

Usefulness of Ultrasound for Carpal Tunnel Syndrome Proven in Meta-Analysis Studies

Carpal tunnel syndrome is a very common and important disease caused by entrapment of the median nerve in the carpal tunnel. With the widespread use of high-resolution ultrasound, ultrasound is being used usefully in the diagnosis of carpal tunnel syndrome. Compared to electrodiagnostic study, ultrasound examinations are easier and, above all, non-invasive. In addition, ultrasound-guided injection can be performed alone or in combination with ultrasound examination. In the case of nerve hydrodissection, which has recently been spotlighted as a treatment for carpal tunnel syndrome, it is the procedure that could not be attempted before without ultrasound equipment. In this paper, through a comprehensive review of meta-analysis literatures, we look back at the value of ultrasound as a diagnostic tool for carpal tunnel syndrome and the effect of ultrasound- guided injection to get an objective perspective and gain new insights. The usefulness of ultrasound will be largely divided into applications of ultrasound-guided injection, diagnosis, and sonoelastography. (Clinical Pain 2023;22:9-13)ope

Application of Ultrasound-Guided Trigger Point Injection for Myofascial Trigger Points in the Subscapularis and Pectoralis Muscles to Post-Mastectomy Patients: A Pilot Study

PURPOSE: To investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients. MATERIALS AND METHODS: This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularis and/or pectoralis muscles were included. We performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis muscle for diagnostic and therapeutic purpose by the newly developed US-guided method. RESULTS: Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline (p<0.05 for both). Duration from onset to surgery and duration of myofascial pain syndrome in the good responder group were significantly shorter than in the bad responder group (p<0.05). Patients did not report any complications related to the procedure or serious adverse events attributable to the treatment. CONCLUSION: In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.ope

Treatment of Full-Thickness Rotator Cuff Tendon Tear Using Umbilical Cord Blood-Derived Mesenchymal Stem Cells and Polydeoxyribonucleotides in a Rabbit Model

Objective: The aim of this study was to investigate regenerative effects of ultrasound- (US-) guided injection with human umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs) and/or polydeoxyribonucleotide (PDRN) injection in a chronic traumatic full-thickness rotator cuff tendon tear (FTRCTT) in a rabbit model. Methods: Rabbits (n = 32) were allocated into 4 groups. After a 5 mm sized FTRCTT just proximal to the insertion site on the subscapularis tendon was created by excision, the wound was immediately covered by a silicone tube to prevent natural healing. After 6 weeks, 4 injectants (0.2 mL normal saline, G1-SAL; 0.2 mL PDRN, G2-PDRN; 0.2 mL UCB-MSCs, G3-MSC; and 0.2 mL UCB-MSCs with 0.2 ml PDRN, G4-MSC + PDRN) were injected into the FTRCTT under US guidance. We evaluated gross morphologic changes on all rabbits after sacrifice. Masson's trichrome, anti-type 1 collagen antibody, bromodeoxyuridine, proliferating cell nuclear antigen, vascular endothelial growth factor, and platelet endothelial cell adhesion molecule stain were performed to evaluate histological changes. Motion analysis was also performed. Results: The gross morphologic mean tendon tear size in G3-MSC and G4-MSC + PDRN was significantly smaller than that in G1-SAL and G2-PDRN (p < 0.05). However, there were no significant differences in the tendon tear size between G3-MSC and G4-MSC + PDRN. In G4-MSC + PDRN, newly regenerated collagen type 1 fibers, proliferating cell activity, angiogenesis, walking distance, fast walking time, and mean walking speed were greater than those in the other three groups on histological examination and motion analysis. Conclusions: Coinjection of UCB-MSCs and PDRN was more effective than UCB-MSC injection alone in histological and motion analysis in a rabbit model of chronic traumatic FTRCTT. However, there was no significant difference in gross morphologic change of tendon tear between UCB-MSCs with/without PDRN injection. The results of this study regarding the combination of UCB-MSCs and PDRN are worth additional investigations.ope

Development of platform 6-DOF motion-mooring system coupled solver using open source libraries

해양플랜트의 작업 성능 및 안정성을 보장하기 위해서는 플랫폼의 거동과 계류계에 작용하는 인장 하중을 정확하게 예측하는 것이 매우 중요하다. 하지만 대부분의 상용 계류계 해석 소프트웨어들은 플랫폼의 거동을 해석하는데 있어 포텐셜 이론을 기반으로 하고 있기 때문에 플랫폼 주위의 점성효과를 고려할 수 없다. 또한 해양플랜트가 설치되는 수심이 깊어질수록, 계류라인의 동역학적 특성이 더욱 요구되어지고 있다. 그리고 극심한 환경 조건하에서도 플랫폼의 거동을 정확하게 예측하기 위해서는 플랫폼 거동과 계류계간의 양방향 연성해석이 필수적이다. 이런 이유로, 본 논문에서는 OpenFOAM 및 MoorDyn과 같은 오픈 소스 라이브러리들을 이용하여 양방향 연성해석 솔버를 개발하였다. OpenFOAM은 플랫폼의 6자유도운동을 점성 유동 이론에 근거하여 해석할 수 있는 오픈 소스 전산유체역학 라이브러리이고, MoorDyn은 집중질량모델을 기반으로 계류계에 작용하는 인장 하중 및 복원력을 정확하게 계산할 수 있는 오픈 소스 계류계해석 라이브러리이다. 양방향 연성해석이 진행되는 매 시간간격마다 OpenFOAM에서 계산된 플랫폼의 거동은 MoorDyn으로 전달되어 경계조건으로 사용되고, MoorDyn에서 계산된 복원력은 OpenFOAM으로 전달되어 외력으로서 작용하게 된다. 끝으로, 개발된 연성해석 솔버에 대해서 계류계의 정적 하중과 형상 해석, 계류계의 동적 하중 해석, 정수 중에서의 자유 감쇠 운동 및 계류계와 연동된 감쇠 운동 해석, 스톡스 5차 파랑 중에서의 플랫폼 계류 운동과 계류계에 작용하는 인장 하중해석에대한 검증을 수행하였다. 모든 계산 결과는 엄밀해, 수치해 및 실험결과와의 비교를 통하여 검증하였다.|It is very important to accurately predict the behavior of the platform and the tensile load of the mooring system to ensure the global performance and stability of the offshore plant. However, most of commercial softwares for mooring system analysis are based on the potential flow theory for the platform behaviour, so they can not consider the viscous effects around it. Also, as the depth of the offshore plant is increased, the dynamic characteristics of the mooring line are becoming more demanding. To estimate the platform responses more accurately even under the severe environments, the two-way (bidirectionally) coupled solver between the platform motion and mooring system is essential. For this reason, in this thesis, the two-way coupled solver was developed using open source libraries such as OpenFOAM and MoorDyn. OpenFOAM is the open source computational fluid dynamics (CFD) library which can simulate the platform 6-DOF motion based on the viscous flow theory. MoorDyn is the open source mooring system analysis library which can simulate the tensile loads and restoring forces accurately based on the lumped mass model. In the two-way coupling procedure, the platform motion of OpenFOAM is transferred to MoorDyn as boundary condition and the restoring force and moment of MoorDyn is transferred to OpenFOAM as external forces in each time step. Finally, the validations of developed coupled solver were conducted for the static mooring tension and line profile, dynamic mooring tension, free and moored decay test in the still water, and the moored platform response and mooring tension in the Stokes 5th order wave. All results were confirmed by the comparison with the analytical solution, numerical solution and experimental results.1. 서 론 1 1.1 연구 배경 및 목적 1 1.2 선행 연구 3 1.3 연구 내용 및 논문의 구성 4 2. MoorDyn 7 2.1 개 요 7 2.2 집중 질량 모델 7 2.2.1 내력(internal forces) 9 2.2.2 외력(external forces) 11 2.2.3 절점의 운동방정식 13 2.3 코드 구조 15 2.3.1 LinesInit( ) 함수 15 2.3.2 LinesCalc( ) 함수 18 2.3.3 LinesClose( ) 함수 20 2.4 수치 안정성 20 3. OpenFOAM 22 3.1 개 요 22 3.2 지배방정식 22 3.3 체적비 이송방정식 24 3.4 난류 모델 25 3.5 수치해석 기법 26 3.6 6자유도운동 26 3.6.1 격자 변형 기법 27 3.6.2 6자유도운동 해석 기법 28 3.7 6자유도강체운동 라이브러리 31 3.7.1 라이브러리 구조 33 3.7.2 구속 모델(restraint model) 38 3.8 수치 파랑 수조 구현 40 3.8.1 완화구역(relaxation zone) 기법 40 3.8.2 파 이론(wave theory) 42 4. 양방향 연성해석 인터페이스 46 4.1 개 요 46 4.2 함수의 동적 로딩(dynamic loading) 47 4.3 새로운 구속 모델 49 4.4 연성 기법 51 4.4.1 느슨한 연성(loose coupling) 51 4.4.2 지연 연성(delayed coupling) 53 4.5 양방향 연성해석 인터페이스 구조 54 4.6 양방향 연성해석 인터페이스 검증 56 4.6.1 시간 동기화 56 4.6.2 변위와 속도 전달 58 4.6.3 계류계의 구속력 전달 60 4.7 디렉토리 구조 62 5. 검증 및 고찰 64 5.1 계류계의 정적하중 및 형상 64 5.2 계류계의 동적하중 71 5.3 정수 중 자유 감쇠 운동 74 5.4 정수 중 계류 감쇠 운동 82 5.5 파랑 중 계류 운동 88 5.5.1 파랑 생성 88 5.5.2 부유체 계류 운동 및 인장 하중 90 6. 결 론 97 참고문헌 100Docto

Effects of Air Purifiers on Patients with Allergic Rhinitis: a Multicenter, Randomized, Double-Blind, and Placebo-Controlled Study

Purpose: Exposure to particulate matter (PM) is a well-known risk factor in the triggering and exacerbation of allergic airway disease. Indoor environments, where people spend most of their time, are of utmost importance. To assess the effects of air purifiers [equipped with high-efficiency particulate air (HEPA) filters] on allergic rhinitis (AR) in adult patients, we performed a multicenter, randomized, double-blind, and placebo-controlled study. Materials and methods: Patients with house dust mite (HDM)-induced AR were randomly assigned to either active or mockup (placebo) air-purification groups. Two air purifiers (placed in living room and bedroom) were operated for 6 weeks in each home environment. The primary study endpoint was to achieve improvement in AR symptoms and medication scores. Secondary endpoints were to achieve improvement in the quality of life (QoL) and visual analog scale (VAS) scores, as well as in the indoor (bedroom and living room) concentrations of PM2.5 and PM10. Results: After 6 weeks of air purifier use, medication scores improved significantly in the active (vs. placebo) group, although subjective measures (symptoms, VAS, and QoL scores) did not differ. Bedroom PM2.5 concentrations initially exceeded living room or outdoor levels, but declined (by up to 51.8%) following active purifier operation. Concentrations of PM2.5 in living room and PM10 in bedroom and living room were also significantly reduced through active purification. Conclusion: The use of air purifiers with HEPA filters significantly reduced medication requirements for patients with HDM-induced AR and significantly lowered indoor PM2.5 concentrations, regardless of room placement. Active intervention to reduce household air pollutants may help improve allergic airway disease (clinicaltrials.gov NCT03313453).ope

Ultrasound Guidance for Intra-Articular Shoulder Injections for Frozen Shoulder

Frozen shoulder is a common shoulder disease that causes shoulder pain and limitation of shoulder motion. Intra-articular corticosteroid injection is one of the first-line treatment methods for frozen shoulder. Ultrasound guidance allows visualization of the glenohumeral joint and can improve the accuracy of the injection. Ultrasound-guided intra-articular injection can be performed via an anterior, posterior, or rotator cuff interval approach. This review article aims to summarize and discuss the most effective approach with ultrasound guided intra-articular injection for frozen shoulder. Also this review to introduce hydraulic distension with ‘pumping technique’ to obtain the maximal stretching effect on the capsule.ope

Regeneration of Full-Thickness Rotator Cuff Tendon Tear After Ultrasound-Guided Injection With Umbilical Cord Blood-Derived Mesenchymal Stem Cells in a Rabbit Model

Rotator cuff tendon tear is one of the most common causes of chronic shoulder pain and disability. In this study, we investigated the therapeutic effects of ultrasound-guided human umbilical cord blood (UCB)-derived mesenchymal stem cell (MSC) injection to regenerate a full-thickness subscapularis tendon tear in a rabbit model by evaluating the gross morphology and histology of the injected tendon and motion analysis of the rabbit's activity. At 4 weeks after ultrasound-guided UCB-derived MSC injection, 7 of the 10 full-thickness subscapularis tendon tears were only partial-thickness tears, and 3 remained full-thickness tendon tears. The tendon tear size and walking capacity at 4 weeks after UCB-derived MSC injection under ultrasound guidance were significantly improved compared with the same parameters immediately after tendon tear. UCB-derived MSC injection under ultrasound guidance without surgical repair or bioscaffold resulted in the partial healing of full-thickness rotator cuff tendon tears in a rabbit model. Histology revealed that UCB-derived MSCs induced regeneration of rotator cuff tendon tear and that the regenerated tissue was predominantly composed of type I collagens. In this study, ultrasound-guided injection of human UCB-derived MSCs contributed to regeneration of the full-thickness rotator cuff tendon tear without surgical repair. The results demonstrate the effectiveness of local injection of MSCs into the rotator cuff tendon. SIGNIFICANCE: The results of this study suggest that ultrasound-guided umbilical cord blood-derived mesenchymal stem cell injection may be a useful conservative treatment for full-thickness rotator cuff tendon tear repair.ope

Comprehensive Rehabilitation in Patients with Acute Respiratory Distress Syndrome due to Coronavirus Disease 2019 (COVID-19)

We described a case in which symptoms and function improved through rehabilitation in a patient with coronavirus disease 2019 (COVID-2019) accompanied by acute respiratory distress syndrome (ARDS), limb weakness, and peroneal neuropathy. A 71-year-old man was diagnosed with COVID-19 and ARDS. He needed extracorporeal membrane oxygenation (ECMO) treatment in an incentive care unit (ICU). After ICU treatment, both ankle dorsiflexor weakness and foot drop were present. Common peroneal neuropathy was diagnosed and it was presumed to be due to long-term ECMO application. Comprehensive rehabilitation was performed to improve respiratory function and functional level. In addition, electrical stimulation therapy was applied to strengthen the ankle dorsiflexor. Before rehabilitation, he could not maintain a sitting position independently and required oxygen supply through tracheostomy. After 6 months rehabilitation, he was able to walk independently without oxygen. However, the ankle dorsiflexor did not improve sufficiently, so ankle foot orthosis was applied for outdoor gait.ope

Characteristics of Myofascial Pain Syndrome of the Infraspinatus Muscle

OBJECTIVE: To report the characteristics of myofascial trigger points (MTrPs) in the infraspinatus muscle and evaluate the therapeutic effect of trigger-point injections. METHODS: Medical records of 297 patients (221 women; age, 53.9±11.3 years) with MTrPs in the infraspinatus muscle were reviewed retrospectively. Because there were 83 patients with MTrPs in both infraspinatus muscles, the characteristics of total 380 infraspinatus muscles with MTrPs (214 one side, 83 both sides) were investigated. Specific characteristics collected included chief complaint area, referred pain pattern, the number of local twitch responses, and distribution of MTrPs in the muscle. For statistical analysis, the paired t-test was used to compare a visual analogue scale (VAS) before and 2 weeks after the first injection. RESULTS: The most common chief complaint area of MTrPs in the infraspinatus muscle was the scapular area. The most common pattern of referred pain was the anterolateral aspect of the arm (above the elbow). Active MTrPs were multiple rather than single in the infraspinatus muscle. MTrPs were frequently in the center of the muscle. Trigger-point injection of the infraspinatus muscle significantly decreased the pain intensity. Mean VAS score decreased significantly after the first injection compared to the baseline (7.11 vs. 3.74; p<0.001). CONCLUSION: Characteristics of MTrPs and the therapeutic effects of trigger-point injections of the infraspinatus muscle were assessed. These findings could provide clinicians with useful information in diagnosing and treating myofascial pain syndrome of the infraspinatus muscle.ope