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Study design A single-blind crossover study. Objectives This study aimed to evaluate neuropathic pain in persons with spinal cord injury (SCI) after the application of transcutaneous spinal direct current stimulation (tsDCS). Setting Outpatient Clinic of the Rehabilitation Department, Seoul National University Hospital. Methods The effect of single sessions of both anodal and sham tsDCS (2 mA, 20 min) on chronic neuropathic pain in ten volunteers with complete motor cervical SCI was assessed. The active electrode was placed over the spinal process of the tenth thoracic vertebra and the reference electrode, at the top of the head. Pre-to post-tsDCS intervention changes in pain intensity (numeric rating scale, NRS), patient global assessment, and present pain intensity (PPI) were assessed before and after the tsDCS session (immediately post stimulation, and at 1 and 2 h post stimulation). Results All participants underwent the stimulation procedure without dropout. Our results showed no significant pre-to post-treatment difference in pain intensity between the active and sham tsDCS groups. Only in the sham tsDCS stimulation, NRS and PPI scores were reduced after the stimulation session. Furthermore, in the mixed effect model analysis, the response in the second period appeared to be more favorable. Conclusion The results suggest that a single session of anodal tsDCS with the montage used in this study is feasible but does not have a significant analgesic effect in individuals with chronic cervical SCI. Sponsorship The study was funded by Seoul National University Hospital (No. 0420160470) and Korea Workers' Compensation & Welfare Service.

ObjectiveTo investigate the length of hospital stay (LOS) after stroke using the database of the Korean Health Insurance Review & Assessment Service.MethodsWe matched the data of patients admitted for ischemic stroke onset within 7 days in the Departments of Neurology of 12 hospitals to the data from the database of the Korean Health Insurance Review & Assessment Service. We recruited 3,839 patients who were hospitalized between January 2011 and December 2011, had a previous modified Rankin Scale of 0, and no acute hospital readmission after discharge. The patients were divided according to the initial National Institute of Health Stroke Scale score (mild, ≤5; moderate, >5 and ≤13; severe, >13); we compared the number of hospitals that admitted patients and LOS after stroke according to severity, age, and sex.ResultsThe mean LOS was 115.6±219.0 days (median, 19.4 days) and the mean number of hospitals was 3.3±2.1 (median, 2.0). LOS was longer in patients with severe stroke (mild, 65.1±146.7 days; moderate, 223.1±286.0 days; and severe, 313.2±336.8 days). The number of admitting hospitals was greater for severe stroke (mild, 2.9±1.7; moderate, 4.3±2.6; and severe, 4.5±2.4). LOS was longer in women and shorter in patients less than 65 years of age.ConclusionLOS after stroke differed according to the stroke severity, sex, and age. These results will be useful in determining the appropriate LOS after stroke in the Korean medical system.

BackgroundLower extremity joint contractures have negative effects on gait in children with Duchenne muscular dystrophy (DMD). Thus, contracture prevention is essential for maintaining a patient’s functional ability and an acceptable quality of life. This study investigated hip flexion (HF), knee flexion (KF), and ankle joint plantar flexion (APF) contractures among male patients with DMD, based on the patients’ ambulatory status. Differences in major joint contractures, based on passive stretching exercise participation, were also investigated.MethodsA total of 128 boys with DMD, followed at the DMD clinic of a tertiary care hospital, were included in this cross-sectional study. The passive ranges-of-motion of the hip, knee, and ankle joints were measured, in the sagittal plane, using a goniometer. The Vignos Scale was used to grade ambulatory function. Boys with DMD who performed stretching exercises for more than 5 min/session, > 3 sessions/week, were classified into the stretching group.ResultsThe HF (23.5o), KF (43.5o), and APF (34.5o) contracture angles in the non-ambulatory group were more severe than those in the ambulatory group. APF contractures (41 patients, 52.6%) were more frequently observed early, even within the ambulatory period, than were hip (8 patients, 10.3%), and knee joint (17 patients, 21.8%) contractures. Passive stretching exercises > 3 sessions/week were not associated with the degree of lower extremity joint contractures in the ambulatory or non-ambulatory group.ConclusionHF, KF, and APF contractures are more common and severe when there is deterioration of ambulatory function. Stretching exercises alone are unlikely to prevent lower extremity joint contractures.

III.

Oxidative stress has been associated with many diseases as well as aging. Electrolyzed-reduced water (ERW) has been suggested to reduce oxidative stress and improve antioxidant potential. This study investigated the effects of drinking ERW on biomarkers of oxidative stress and health-related indices in healthy adults. We conducted a randomized, double-blind, placebo-controlled clinical trial on 65 participants, who were allocated into two groups. Of these, 61 received intervention (32 with ERW and 29 MW [mineral water]). All participants were instructed to drink 1.5 L/day of ERW or MW for eight weeks. Biomarkers of oxidative stress and health-related indices were assessed at baseline as well as after 4 weeks and 8 weeks of intervention. Of the primary outcome variables assessed, diacron-reactive oxygen metabolites (d-ROMs) and biological antioxidant potential showed a significant interaction between the groups and time, with d-ROMs levels significantly decreased at 8 weeks in ERW compared to those in MW. Among the secondary outcome variables, total, visceral, and subcutaneous fat mass significantly changed over time, with a significant association observed between the group and time. Thus, daily ERW consumption may be a potential consideration for a sustainable and innovatively simple lifestyle modification at the workplace to reduce oxidative stress, increase antioxidant potential, and decrease fat mass.

Avulsion fracture of the acromion is rare. It is difficult to diagnosis because there is little displacement and it occurs even without direct trauma. We experienced a case without direct trauma that was diagnosed with ultrasonography. A 55-year-old male patient visited our outpatient clinic with shoulder pain resulting from a significant stress at the trapezius muscle during lifting of a steel reinforcement. Simple radiography revealed a calcific deposit over the acromion rather than a fracture. Avulsion fracture was identified with ultrasonography. This is the first report demonstrating that ultrasonography has an advantage over radiographs in the diagnosis of an avulsion fracture of the acromion of the scapula.

Objectives This study attempted to identify the factors that contribute to successful telemedicine service. This was done by analyzing the operational state of successful telemedicine services offered in Gangwon Province of Korea and their outcome for the last fifteen years. Methods A comparative analysis was made based on reports and a thesis on the satisfaction rate of patients and providers, patient compliance to treatment, and economic assessment of Gangwon telemedicine service, which were carried out in three periods: the years 2006, 2010, and 2012. Results The satisfaction surveys in all three periods showed similar results for patients (4.46±0.70 point) and healthcare practitioners, including nurses (3.82±0.62 point) and physicians (3.60±0.56 point), in decreasing order from the year 2012. Through the survey of patients' compliance with treatment, it was confirmed that telemedicine services increased patients' compliance with drug administration, facilitated improvement of lifestyle habits, improved glycated hemoglobin for patients with diabetes mellitus, and enhanced the rate of blood pressure control. In the survey conducted on patients' willingness to pay for telemedicine services in 2007, it was found that those patients were willing to pay about $3.5 for services. Conclusions The telemedicine services of Gangwon Province increased patients' compliance with drug administration, improved blood glucose control, enhanced blood pressure control for patients with hypertension, and provided economic advantage.