Results of this study suggest that it is important to preserve the endplate as much as possible to prevent graft subsidence into the vertebral body, particularly in patients with poor bone quality. It is preferable to make one central hole rather than multiple smaller holes in the endplate for vascularity of the bone graft because it reduces the surface area exposed to fracture stresses.

BackgroundChronic obstructive pulmonary disease (COPD) is one of the major morbidities in public health, and the use of mHealth technology for rehabilitation of patients with COPD can help increase physical activity and ameliorate respiratory symptoms.ObjectiveThis study aimed to develop a comprehensive rehabilitation management platform to improve physical activity and quality of life in patients with COPD.MethodsThe study comprised the following 2 stages: (1) a pilot stage in which a prototype app was developed; and (2) a fully-fledged platform development stage in which 2 apps and 1 COPD patient monitoring website were developed. We conducted a randomized clinical trial to investigate the efficacy of the apps developed in the second stage of the study. In addition, two 12-week exercise regimens (fixed and fixed-interactive) were tested for the trial. The clinical parameters of the respiratory function and patient global assessment (PGA) of the app were obtained and analyzed. Notably, Android was the chosen operating system for apps.ResultsWe developed 2 COPD rehabilitation apps and 1 patient monitoring website. For the clinical trial, 85 patients were randomized into the following 3 groups: 57 were allocated to the 2 intervention groups and 28 to the control group. After 6 weeks, the COPD assessment test scores were significantly reduced in the fixed group (P=.01), and signs of improvement were witnessed in the fixed-interactive group. In addition, the PGA score was moderate or high in all aspects of the user experience of the apps in both intervention groups.ConclusionsA well-designed mobile rehabilitation app for monitoring and managing patients with COPD can supplement or replace traditional center-based rehabilitation programs and achieve improved patient health outcomes.Trial RegistrationClinicalTrials.gov NCT03432117; https://clinicaltrials.gov/ct2/show/NCT03432117 (Archived by WebCite at http://www.webcitation.org/71Yp0P64a)

Background Advanced lung cancer patients often have chronic lung disease with reduced exercise capacities and various symptoms leading to altered quality of life (QoL). No studies have assessed pulmonary rehabilitation (PR) employing a mobile app and an Internet of Things device in advanced lung cancer patients undergoing chemotherapy. Objective This study aimed to determine the feasibility and efficacy of smartphone app–based PR on exercise capacity, symptom management, and QoL in patients with advanced lung cancer undergoing chemotherapy. Methods A total of 100 patients were recruited in a prospective, single-arm intervention study using a smartphone app–based PR program for 12 weeks. Exercise capacity (6-min walking distance, 6MWD), QoL, symptom scale scores, and distress indexes were investigated. Results A total of 90 patients completed the PR program. The most common cause of drop out was hospitalization because of cancer progression. After PR, there was significant improvement in the 6MWD; 380.1 m (SD 74.1) at baseline, 429.1 m (SD 58.6) at 6 weeks ( P <.001), and 448.1 m (SD 50.0) at 12 weeks ( P <.001). However, the dyspnea scale score showed no significant improvement in the patients overall, but there was a trend for improvement in those with a stable tumor response ( P =.07). Role ( P =.02), emotional ( P <.001), and social functioning ( P =.002) scale scores showed significant improvement after PR. Symptom scale scores for fatigue ( P <.001), anorexia ( P =.047), and diarrhea ( P =.01) also showed significant improvement. There was significant improvement in depression ( P =.048) and anxiety ( P =.01), whereas there was no significant change in QoL ( P =.06) and severity of pain ( P =.24). Conclusions Smartphone app–based PR represents an effective and feasible program to improve exercise capacity and to manage symptoms and distress in patients with advanced lung cancer who are undergoing chemotherapy.

ObjectiveTo investigate the correlation of the ultrasonographic wrist-to-forearm median nerve area ratio (WFR) and cross sectional area of median nerve at the wrist (CSA-W) to the electrophysiologic severity in patients with carpal tunnel syndrome (CTS).MethodOne hundred and ten wrists electrophysiologically graded as mild, moderate, and severe CTS and 38 healthy controls underwent ultrasonography of median nerve at the distal wrist crease and mid-forearm. WFR and CSA-W were analyzed according to the severity of CTS.ResultsWFR was 1.12±0.14, 1.91±0.33, 2.27±0.47 and 3.02±0.97 and the CSAs-W was 7.23±1.67 mm2, 13.51±3.72 mm2, 14.67±2.93 mm2, and 18.74±6.01 mm2 in controls, mild (n=28), moderate (n=46), and severe (n=36) CTS, respectively. CSA-W displayed significant differences between the control and the mild CTS, moderate CTS and severe CTS groups. However, there was no significant difference between mild CTS and moderate CTS groups. WFR revealed significant difference between all groups. The sensitivity and specificity of the WFR in grading the severity of CTS were higher than those of the CSA-W.ConclusionUltrasonography is a useful complementary tool for the evaluation of CTS. Both WFR and CSA-W are highly correlated with severity grade of CTS. However, WFR is superior to CSA-W for diagnosis and grading of the severity of CTS.

Background Lung cancer patients experience various symptoms during treatment. Although pulmonary rehabilitation is an effective way to improve these symptoms, a medical environment of limited availability makes it difficult to provide seamless and adequate rehabilitation for lung cancer patients. Objective This study aimed to investigate the effects of a personalized pulmonary rehabilitation program using real-time mobile patient health data for patients with non–small cell lung cancer. Methods We conducted a prospective clinical trial in 64 patients with non–small cell lung cancer aged between 20 and 80 years at a large tertiary hospital in Seoul, South Korea. A 12-week personalized pulmonary rehabilitation program, called efil breath, was administered to determine the effectiveness of the newly developed rehabilitation app. Participants were randomly allocated to the fixed exercise or fixed-interactive exercise group (which received the personalized program). We measured changes in 6-minute walk distance (6MWD) and dyspnea (modified Medical Research Council [mMRC] score) at 6 weeks; and quality of life and service satisfaction at 12 weeks. We used the paired t test to analyze the variables. Results Patients used the newly developed mobile health pulmonary rehabilitation app and a real-time patient monitoring website. In all participants, significant changes were observed in 6MWD at 12 weeks from a mean of 433.43m (SD 65.60) to 471.25m (SD 75.69; P =.001), and mMRC from a mean score of 0.94 (0.66) to 0.61 (SD 0.82; P =.02). The intervention significantly improved their quality of life (EuroQol-visual analog scale [EQ-VAS]) compared with baseline (mean score 76.05, SD 12.37 vs 82.09, SD 13.67, respectively; P =.002). Conclusions A personalized mobile health–based pulmonary rehabilitation app for recording and monitoring real-time health data of patients with non–small cell lung cancer can supplement traditional health care center–based rehabilitation programs. This technology can encourage improvement of physical activity, dyspnea, and quality of life.