High grade anorectal stricture complicating Crohn's disease: endoscopic treatment using insulated-tip knife

Endoscopic treatments have emerged as an alternative to surgery, in the treatment of benign colorectal stricture. Unlike endoscopic balloon dilatation, there is limited data on endoscopic electrocautery incision therapy for benign colorectal stricture, especially with regards to safety and long-term patency. We present a case of a 29-year-old female with Crohn's disease who had difficulty in defecation and passing thin stools. A pelvic magnetic resonance imaging scan, gastrograffin enema, and sigmoidoscopy showed a high-grade anorectal stricture. An endoscopic insulated-tip knife incision was successfully performed to resolve the problem. From our experience, we suggest that endoscopic insulated-tip knife treatment may be a feasible and effective modality for patients with short-segment, very rigid, fibrotic anorectal stricture

Status of Rehabilitation After Ischemic Stroke: A Korean Nationwide Study

Objective To investigate the post-stroke rehabilitation status according to stroke severity using the database of the Korean Health Insurance Review and Assessment Service. Methods The data of patients admitted to the neurology departments of 12 hospitals within 7 days of onset of ischemic stroke were collected. A total of 2,895 patients hospitalized between November 2010 and December 2011 were included. The patients were classified into three groups according to their initial National Institutes of Health Stroke Scale (NIHSS) scores (mild, ≤5; moderate, >5 and ≤13; and severe, >13). Length of hospital stay (LoS) with rehabilitation, NIHSS score after acute care, and scores on modified Rankin Scale (mRS) were examined at 1 year post-stroke according to stroke severity and ongoing rehabilitation. Results The total LoS for ongoing rehabilitation significantly increased with stroke severity (mild, 91.66±149.70; moderate, 197.26±241.93; severe, 263.50±275.75 days; p<0.01). However, the proportion of LoS with ongoing rehabilitation to the total LoS tended to decline with increasing stroke severity (mild, 77.93±29.50, p<0.01; moderate, 71.83±32.13; severe, 62.29±37.19). The home discharge rate of the group that underwent continuous inpatient rehabilitation was significantly higher in patients with moderate and severe stroke, respectively (14.2% vs. 0.0%, p<0.001; 7.4% vs. 0.0%, p=0.032). Conclusion This study showed that intermittent rehabilitation was often provided after acute care, whereas ongoing rehabilitation positively affected rate of home discharge in patients with moderate and severe stroke in Korea. These results represent evidence for improving the healthcare system to promote adequate rehabilitation in the future

Synthesis of Porous Silica with Hierarchical Structure Directed by a Silica Precursor Carrying a Pore-Generating Cage

We have obtained a new class of porous silica with good structural order and additional corrugated nanopores clustered around the primary mesopores from the co-condensation of TEOS and adamantylphenol-grafted trimethoxysilane (adam-graft SQ) using a triblock Pluronic P123 (EO20PO70EO20,Mw = 5800) copolymer as a structure-directing agent. Thermally activated removal of pore-generating moieties (i.e., adamantylphenol groups) in adam-graft SQ involves the generation of secondary micro-to-small mesopores, while the block copolymer template generates 2D-hexagonal mesopores. We found that the mesostructural characteristics and the generation of secondary indented pores right next to the mesopores can be tailored by the addition order of the two silica precursors (TEOS and adam-graft SQ), varying the molar ratio between TEOS and adam-graft SQ in the starting sol mixture, and the degree of silica polymerization. The increase in the hexagonal unit cell parameters is attributed to the increment of pore size originating from the removal of adamantylphenol moieties. It is believed that the hydrophobicity of adamantylphenol groups plays a key role in its selective incorporation into the region near the PPO core blocks and the subsequent generation of corrugated pores along the silica channels resulting in the increase of pore diameter.This work was financially supported by the Korea Science and Engineering Foundation (KOSEF) grant through the Acceleration Research Program (R17-2007-059-01000-0) and the NANO Systems Institute – National Core Research Center (R15-2003-032-02002-0) funded by the Ministry of Education, Science and Technology (MEST) and the Brain Korea 21 Program endorsed by the MEST. Financial support from the Korean Collaborative Project for Excellence in Basic System IC Technology (System IC 2010) is also greatly acknowledged

THE EFFECTS OF WEARING ROLLER SHOES ON GROUND REACTION FORCE CHARACTERISTICS DURING WALKING

Roller shoes have become increasingly popular among children and it features retractable wheels which allowing the user to walk or roll without changing the footwear. Maintaining balance during forward walking with roller shoes is not an easy task. To prevent falling backward, the user needs to lock the knees and tighten the ankles and thighs while the upper body is slightly leaning forward. Constant walking with roller shoes forces the user to walk in a manner much different from normal gait. Prolonged exposure to un-natural stresses on human body forces our body to evolve by strengthening those incorrect, and temporary functions (Clement et aI., 1981). For children, the chronic stress may lead to serious injuries in the lower extremity later in life. If any potential' of injury exists in a movement it is critical to examine the associated forces that may lead to injury. To the best of our knowledge, the effects of wearing roller shoes on ground reaction forces (GRF) characteristics have rarely been studied, especially in the youth population. Thus, the purpose of this study was to compare GRF characteristics during walking wearing jogging and roller shoes

Low roll-off of efficiency at high current density in phosphorescent organic light emitting diodes

The authors demonstrate that the reduction of quantum efficiency with increasing current density in phosphorescent light emitting diodes (PhOLEDs) is related to the formation of excitons in hole transporting layer based on the analysis of emission spectra and exciton formation zone. Low roll-off of efficiency in a PhOLED was achieved using dual emitting layers (D-EMLs) by confining the exciton formation near the interface between the emitting layers. The external quantum efficiency was maintained almost constant up to 22 mA/cm2 (10 000 cd/m2) by adopting the D-EMLs in Ir(ppy)3 based PhOLEDs, resulting in high external quantum efficiency (ext=13.1%) at high luminance.This work was supported by the Ministry of Commerce, Industry and Energy of Korea through the OLED center, Samsung SDI, Dongwoo Finechem, and CKC Program

Solitary Fibrous Tumor of the Trachea: CT Findings with a Pathological Correlation

We present the multidetector CT findings with a pathologic correlation for the case of a solitary fibrous tumor located in the trachea. The MDCT revealed a well-circumscribed intraluminal mass arising from the trachea, with strong nodular enhancement in the periphery of the mass. The enhancement pattern of the mass corresponded histopathologically to a focal hypocellular area in the center and prominent blood vessels along the periphery of the mass. We also present volume-rendered and virtual bronchoscopic images of this rare submucosal tracheal tumor

A Rare Case of Aortic Valve Myxoma: Easy to Confuse With Papillary Fibroelastoma

Myxoma of the aortic valve is an exceedingly uncommon condition. In this article, we report the case of a 72-year-old man with myxoma arising from the aortic valve. We extirpated the mass and repaired the aortic valve with the patient under cardiopulmonary bypass. The postoperative course was uneventful. Histological examination confirmed that the mass was a myxoma

Histologic discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimens of colorectal polyp in actual clinical practice

Background/AimsWe aimed to assess the rate of histologic discrepancy (HD) between endoscopic forceps biopsy (EFB) and totally resected specimens in colorectal polyp and analyze the risk factors of discordant group, especially under-diagnosis (UD) cases before complete removal of colorectal polyp.MethodsFrom 2010 to 2015, a total of 290 polyps in 210 patients which had baseline pathology report before endoscopic resection (ER) were analyzed. UD cases were defined as those in which the diagnosis changed to a more advanced histologic feature after ER.ResultsA change in the final histology after ER was noted in 137 cases (47.2%), and after excluding 9 insignificant cases, 128 cases were further categorized into over-diagnosed and under-diagnosed group. UD occurred in 86 cases (29.7%) and change from benign to malignancy was noted in 26 cases (8.9%). On univariate analysis, a larger polyp size (>10 mm) was significantly associated with both HD (P10 mm was the single most significant predictor of both HD (P10 mm was the most important predictor of both HD and UD. We should be careful in making treatment strategy of colorectal polyp based on histologic report of EFB especially when the size of polyp is >10 mm