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One form of abnormal scapular alignment is scapular downward rotation (SDR). Changes in muscle function in SDR have not been clearly identified, and SDR exercises also require investigation. Although a diagonal pattern of exercise is commonly used as part of the exercise protocol, a direct comparison of shoulder and scapular diagonal exercises has not yet been conducted. The objectives of this study were to determine the altered activation of the scapular musculature in the SDR group and to investigate which diagonal pattern of exercise effectively activates the scapular musculature.Thirty-two participants (18 in the control group and 14 in the SDR group) volunteered to participate in this study. Electromyographic signals were collected from four muscles, the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and anterior deltoid (AD), during standing performance of diagonal shoulder and scapular exercises.The control group showed significantly lower UT activity, UT/LT ratio, and UT/SA values than the SDR group (p .05). Activation of the AD was significantly higher in the SDR than in the control group (p .05). SA and AD activation were significantly higher in shoulder diagonal pattern exercises than in scapular diagonal pattern exercises (p .05). The scapular posterior elevation pattern exercise showed significantly higher UT and LT activities than anterior elevation and shoulder diagonal pattern exercises (p .05).Our findings suggest that reduced activation of the UT could lead to greater activation in the AD in SDR. Scapular posterior elevation exercise is advantageous as selectively activates the trapezius musculature, and shoulder diagonal pattern exercise is advantageous in activating the SA and AD.

The present study aimed to investigate lumbar multifidus (LM) thickness and perceived exertion during graded superman exercises (GSE) or GSE with an abdominal drawing-in maneuver (GSE-AD) in young adults. Twelve young adult males and females, who were informed of the purpose and procedures of this study and then gave their voluntary consent to participate, were included in this study. All subjects randomly performed three GSE and GSE-AD over 3 days. Ultrasonography was used to measure the LM thickness to the left and right of the L5 region. Additionally, the issue of whole-body fatigue felt by the subject while performing the GSE or GSE-AD was measured using the Borg scale. The intrarater reliability of the LM measurement was found to be intraclass correlation coefficient (ICC[3,1])=0.97 (0.87–0.99) at resting and ICC(3,1)=0.94 (0.78–0.99) at contraction. Both the left and right LM showed significantly higher contraction during the grade 3 GSE (P< 0.05). The whole-body fatigue was significantly greater following GSE 2 and 3 than following GSE-AD 2 and 3 (P0.05). It is recommended that the abdominal drawing-in maneuver be applied with grade 3 GSE to enhance stability and reduce spinal fatigue.

BACKGROUND: Problems related to ankle instability, decreased proprioceptive sensation, altered static and dynamic balance abilities are suggested as major representative factors that contribute to the recurrence of ankle sprains. OBJECTIVE: To assess the effect of a three-week intervention (intervention emphasizing diagonal eccentric contraction (IEDEC) and intervention of general exercise (IGE)) on static and dynamic balance abilities, ankle strength and joint position sense at pre- and post-intervention, and at two- and three-week post-intervention. METHODS: Twenty-five participants with ankle instability, including a history of ankle sprain and recurrent episodes of giving way, were enrolled in the study. They were randomly classified into the IEDEC group (n= 12) and the IGE group (n= 13). Dynamic balance was examined using the Y Balance Test, four-way ankle strength was measured, and the static balance was evaluated using the total displacement of the center of pressure (COP). To identify the joint position error, eversion and inversion of the ankle angle were measured. RESULTS: The results revealed significant increases in ankle dynamic stability and strength at two and three weeks post-intervention (p< 0.05). Similarly, the total displacement of the COP differed significantly over time, with a higher COP during the initial measurement than at two and three weeks intervention (p< 0.05) General balance training with IEDEC can improve position sense during ankle inversion (p< 0.05). CONCLUSION: General balance training with IEDEC improved the position sense of the inversion. Combined therapeutic intervention, such as with the manual technique, could be a beneficial approach to maximize the treatment effects.

Background: In recent years, a three-dimensional ankle exercise has been proposed as a practice for strengthening the intrinsic foot muscles, however this topic still requires further research. This study aimed to compare the activities of the intrinsic muscles in healthy participants during 3D foot&ndash, ankle exercises, namely, short foot (SF), and toe spread out (TSO). Methods: Prior to the experiment, 16 healthy adults were trained on how to perform SF, TSO, and 3D foot&ndash, ankle exercises for an hour. Once all participants passed the foot&ndash, ankle exercise performance test, we randomly measured the activity of the intrinsic foot muscles using electromyography while the patients were performing foot&ndash, ankle exercises. Results: The abductor hallucis (AbH), extensor hallucis longus (EHL), and flexor hallucis brevis (FHB) activities showed significant differences among the exercises for intrinsic foot muscle strengthening (p &lt, 0.01). Additionally, the AbH/AdH (adductor hallucis) ratio showed significant differences among the exercises for strengthening the intrinsic foot muscles (p &lt, 0.01). Conclusions: Our results showed that the 3D extension exercise is as effective as the therapeutic exercise in terms of the AbH and FHB activities, and the AbH/AdH ratio. On the contrary, the 3D flexion exercise showed superiority in terms of the EHL activity.

Background General ankle-foot orthosis (AFO) cannot be flexibly adjusted to volumetric change in the lower leg because the molding is custom-fit. Thus, we developed a flexible assistive device called elastic neutral AFO (EN-AFO) to help stroke patients hold a neutral ankle position. The purpose of this study was to investigate the effects of EN-AFO and improve gait patterns in stroke patients with rearfoot varus deformity. Methods Fifteen stroke patients with a varus deformity of the foot performed a walking test with and without the use of EN-AFO. Kinematic data were measured with a 3D motion analysis system with inertial measurement unit (IMU) sensors. Results In the stance phase, maximal pelvic tilt and maximal ankle dorsiflexion in the affected side changed, and maximal and minimal pelvic tilts and maximal hip abduction in the less-affected limb effectively changed, as well. During the swing phase, minimal pelvic tilt and minimal ankle abduction in the affective limb greatly changed; particularly, the reduction of maximal ankle inversion was significantly cleared. Conclusions The EN-AFO was effective in controlling the tendency of foot inversion in patients with varus deformities. This is suitable for gait training, as it can adjust the orthosis stiffness according to the foot condition.

BACKGROUND Various forms of trunk exercise have been used for increasing abdominal strength. The plank exercise and bilateral leg raise exercise are one of these trunk exercises. However, there are few studies that compared the effects of these exercise variations. OBJECTIVE The present study aimed to investigate how effectively the trunk muscles during plank and bilateral leg raise exercises are activated. METHOD Surface electromyography responses of the rectus abdominis, internal oblique, and erector spinae muscles were investigated during the plank and bilateral leg raise exercise with different hip position. A total of 18 healthy, physically active female volunteers completed the normal plank exercise, plank exercise with placing the lower leg in a horizontal condition, bilateral leg raise exercise, and bilateral leg raise with lower leg as horizontal condition. RESULTS The horizontal condition caused significant increases in activity of the internal oblique muscles compared with the general condition (p< 0.05). The bilateral leg raise exercise showed significantly greater activation in the rectus abdominis compared to the plank exercise (p< 0.05). CONCLUSION The present study showed that the horizontal condition had the advantage of activating the internal oblique muscles, and the leg raise exercise is effective in strengthening global muscle such as the rectus abdominis.

BACKGROUND A high prevalence and incidence of neck and shoulder pain are common problems that require more attention from health service providers and researchers. Recent findings have indicated that the neck stretching is the one of the most effective physical therapy interventions. Although the recovery of the pain through the stretching exercise has been described in a previous study, functional advantages and changes of the neuromuscular control has not been suggested. Additionally, there was a lack of studies that considered methods of stretching. OBJECTIVE The purpose of the present study was to examine the long-term effects of stretching methods for cervical neuromuscular dysfunction, disability and pain in a sample of sedentary workers with neck pain. METHODS Twenty-four sedentary workers with neck pain participated in this study and were assigned to the following two groups: static stretching (SS), and diagonal active stretching (DS). Active cervical range of motion (ROM), pressure pain threshold (PPT), self reported questionnaire (Neck Disability Index, NDI), and the flexion - relaxation ratio (FRR) from the cervical erector spinae muscles were measured at pre-treatment, post-treatment (after 4 weeks) and follow-up (after 6 and 8 weeks). RESULTS In both groups, the values obtained for the cervical ROM as flexion, extension, lateral flexion, were significantly increased in comparison to pre-treatment (p< 0.05). Significant increases of the left and right neck rotation, left and right FRR were only observed in the DS group (p

Blue honeysuckle (BH, Lonicera caerulea) is used as a traditional medicine in Russia, Japan and China, but is not commonly considered as an edible berry in Europe, USA or Korea. BH has been revealed to decrease serum cholesterol and triacylglycerol (triglyceride or TG) levels through the activation of AMP-activated protein kinase (AMPK), thus it is expected to be a health functional food and pharmaceutical agent for the prevention of non-alcoholic liver damage, in addition to effects as a suppressor of hyperlipidemia and as an anti-obesity agent. In the present study, the pharmacological activity of BH extract (BHe) was observed in high-fat diet (HFD)-fed mice. Significant increases in fat pad weight, body weight, fat accumulation (body and abdominal fat density, and thickness of the periovarian and abdominal wall) and serum biochemical levels (aspartate transaminase, alanine amino-transferase, alkaline phosphatase, lactate dehydrogenase, γ-glutamyltransferase, total cholesterol, low-density lipoprotein and TG, with the exception of high-density lipoprotein) were observed in HFD-fed mice. In addition, increases in adipocyte hypertrophy, the area of steatohepatitis and hepatocyte hypertrophy were observed, whereas decreased zymogen content was identified upon histopathological observation. Increased deterioration of the endogenous antioxidant defense system (liver catalase, glutathione and superoxide dismutase) and hepatic lipid peroxidation was observed. In addition, there were decreases in hepatic glucokinase activity, AMPKα1 and AMPKα2 mRNA expression, adipose tissue uncoupling protein 2 expression, and adiponectin mRNA expression, increases in phosphoenolpyruvate carboxykinase and glucose-6-phosphatase activity, hepatic acetyl-CoA carboxylase 1 mRNA expression, and the expression of leptin, CCAAT/enhancer-binding protein (C/EBP) α, C/EBPβ and sterol-regulatory-element-binding protein 1c mRNA in the periovarian tissue. Furthermore, non-alcoholic fatty liver disease (NAFLD) and obesity were significantly inhibited by the continuous administration of BHe for 84 days. These results revealed that BHe may be a promising novel drug or functional food candidate for the treatment of obesity and NAFLD.

Background We hypothesised that the balance of spastic chronic stroke patients is related to myofascial problems. We performed myofascial release (MFR) with a tennis ball on the affected limb, as suggested by Myers. Purpose This study investigated the benefits of 8 weeks of MFR using a tennis ball on the balance of spastic patients. Methods Eight stroke patients were enrolled voluntarily after providing informed consent. All subjects received 8-week interventions with MFR using a tennis ball three times per week. The patients were evaluated using the Berg Balance Scale (BBS) and Timed ‘Up & Go' (TUG) test before and after 4 and 8 weeks of the intervention. Results There were significant differences in the BBS scores ( p = 0.001). The TUG time decreased significantly at 4 and 8 weeks ( p = 0.034). Conclusion Myofascial release appears to improve the balance of spastic chronic stroke patients; however, further studies should evaluate the effective of MFR on walking in stroke patients and determine the mechanism of the effect of MFR.

The purpose of this study was to identify the changes in the cervical range of motion (CROM), the cervical flexion-relaxation ratio (CFRR), and neck pain after dynamic neck training (DNT) combined with hold-relax technique (HRT) for young college students with video display terminal (VDT) syndrome. For this study, 15 young college students with VDT syndrome were recruited. DNT combined with HRT was applied to all participants in a sitting position for 15 min. Postintervention, the CROM and the CFRR were significantly higher than preintervention, and neck pain had significantly decreased. DNT combined with HRT showed immediate effects on the CROM, the CFRR, and neck pain in young college students with VDT syndrome.

Background and objectives: Obese people have many foot-related disorders and plantar fasciitis (PF) is the most common disorder among them. However, research on the role of therapeutic exercises in PF is lacking and there is no evidence to suggest its benefits. As such, a further insight into therapeutic exercises is needed within this group. This case study investigated the effect of three-dimensional (3D) ankle exercises using a combined isotonic (CI) technique on function and balance in an obese subject with PF. Material and methods: The subject in this study was a 28-year-old obese woman who was diagnosed with PF by an orthopedic surgeon. A 3D ankle exercise program was commenced three times a week for 15 min over 4 weeks. The evaluations were conducted at five intervals: pre-test, and at 1, 2, 3 and 4 weeks from the initiation of the intervention. The tests were conducted in the following order: the patient-specific functional scale test (PSFS), an ultrasound of the plantar fascia, the heel pressure and balance test, the pressure pain threshold (PPT), and the 4-way ankle strength test. Results: The mean score of the PSFS test reduced by 70.55% after 4 weeks of the intervention. The thickness of the plantar fascia and heel pressure measured during single-leg standing decreased by 6.67% and 10.37%, respectively, after 4 weeks of the intervention. The anteroposterior and medial-lateral balance ability showed improvements of 8.29% and 8.61%, respectively, after 4 weeks of the intervention. The PPT improved by 38.01% after 4 weeks of the intervention. In the 4-way ankle strength test, dorsiflexion, plantar flexion, inversion, and eversion increased by 14.46%, 9.63%, 4.3% and 13.25%, respectively, after 4 weeks of the intervention. Conclusion: 3D ankle exercises utilizing the CI technique were shown to be effective in improving foot function, pressure pain, and muscle strength in dorsiflexion and inversion in an obese patient with PF.

The purpose of this study was to investigate changes of gait pattern, muscle activity, and perceived comfort in response to variations of height-elevating insoles (HEIs) in young adults. The subjects of this study were 30 young adults who voluntarily consented to participate in this experiment after listening to its purpose and method. They were di-vided into 3 groups who wore HEIs height (0, 3, and 7 cm). Each group consisted of 10 young adults and wore the HEIs for 4 hr a day. Electro-myographic signals were collected from the tibialis anterior, the gas-trocnemius, the hamstring, and the right and the left erector spinae (ES) before and after walking with the HEI. Gait pattern was measured be-fore and after walking with the HEI. Perceived comfort was measured after a subject wore the insoles for 4 hr. The activities of ES showed significant differences among the three groups. The activity of the left ES was significantly different between groups 1 (0 cm) and 2 (3 cm) and groups 1 and 3 (7 cm). The activity of the right ES was significantly dif-ferent between groups 1 and 3. The left stride length and the left step length showed significant differences between groups 1 and 3. Per-ceived comfort was significantly different among the three groups. As the HEIs increased, the activities of ES were gradually increased and the left step length and stride were decreased. Using of higher HEIs over 4 hr may be occurred excessive activities of the ES, abnormal gait patterns, and perceived discomfort.

This study investigated the reliability of ultrasound in combination with surface electromyogram (EMG) for evaluating the activity of the abdominal muscles in individuals with and without low back pain during the abdominal drawing-in maneuver (ADIM). The study recruited ten individuals with or without low back pain, respectively. While the participants were performing the ADIM, the activities of the transversus abdominis (TrA) and the internal oblique (IO) were measured using ultra-sound, while the activities of the external oblique (EO) and the rectus abdominis (RA) were measured using surface EMG. Intra-class correlation coefficients (ICC) were used to verify the inter-rater reliability of ultrasound in combination with surface EMG at rest and during the ADIM, and Bland-Altman plots were used to verify intra-rater reliability. The inter-rater reliability for the two groups at rest and during the ADIM was excellent (ICC2,1 = 0.77–0.95). In the Bland-Altman plots, the mean differences and 95% limits of agreement in the abdominal muscles of the two groups at rest were −0.03∼0.03 mm (−0.66 to 0.60 mm) and −0.12∼ −0.05 (−0.58 to 0.48% MVIC), respectively. The mean differences and 95% limits of agreement in the abdominal muscles of the two groups during the ADIM were −0.04∼0.02 mm (−0.73 to 0.65 mm) and −0.19∼0.05% MVIC (−1.24 to 1.34% MVIC), respectively. The ultrasound in combination with surface EMG showed excellent inter-rater and intra-rater reliability at rest and during the ADIM.

[Purpose] This study investigated the effects of visual stimulus using central and peripheral vision fields on postural control. [Subjects and Methods] The subjects consisted of 40 young adult volunteers (15 males, 25 females) who had been informed of the study purpose and procedure. The subjects were randomly divided into four groups of differing visual stimulus. Each group was given visual intervention in a standing position for 3 minutes. Postural control was evaluated before and after visual intervention. [Results] The results of the functional reach test and body sway test showed significant differences among the four groups. [Conclusion] The two-way peripheral vision-field group showed significantly more body sway after visual intervention than the other three groups. This finding may suggest two-way peripheral vision field is a more effective visual stimulus for training postural control and balance.

This study was conducted to examine the influence of the peripheral vision (PV) induced by moving people on postural control in healthy adults. The subjects consisted of 12 healthy adult volunteers (5 males, 7 females) who had been informed of the study purpose and procedure. The visual interventions were composed of three types. PV1 and PV2 were stimulated using a one-way vertical striped pattern and a two-way vertical striped pattern, respectively. To embody the features of moving people reflected in the mirrors, researchers recorded movements of people or objects provided by mirrors on video image. In this study, this was named PV3. The subjects were exposed to each of the visual stimuli for 3 min in a random order, and their postural control was then evaluated. All the subjects were allowed to practice once prior to performing the one leg stand test, functional reaching test and body sway test. All the evaluations were made before and after the visual intervention, and the subjects rested for 30 min between each intervention. PV3 ranked second in before and after differences of trace length and velocity and had no significant difference from PV2, demonstrating that the PV3, as well as PV2, affected the amount and velocity of body sway. In addition, the standard deviation velocity, trace length and velocity values of PV3 were higher than the PV1 values. Therefore, the treatment of those who have difficulty with postural control and balance maintenance should take place in a controlled therapeutic environment.

[Purpose] The purpose of this study was to research the effect of performing the suboccipital muscle inhibition (SMI) and self-myofascial release (SMFR) techniques in the suboccipital area on the flexibility of the hamstring. [Subjects] Fifty persons with short hamstrings participated in this research. According to the results of the finger-floor distance (FFD) test, the subjects were allocated to SMI and SMFR groups of 25 subjects each. [Methods] The SMI and SMFR techniques were applied to the groups. For the analysis, we used the FFD test and the straight leg raise (SLR) test for the flexibility of hamstring. The evaluator was blindfolded. [Results] In the SMI group, FFD, SLR, and PA were significantly changed after the intervention, and in the SMFR group, there was a significant change in SLR after the intervention. In a comparison between the groups, FED was found to be significantly increased in the SMI group. [Conclusion] Application of the SMI and SMFR to persons with short hamstrings resulted in immediate increases in flexibility of the hamstring. However, we could see that the SMI technique was more effective.

[Purpose] The purpose of this study was to examine the effects of the flexion angle of the knee joint and the abduction angle of the hip joint on the activation of the cervical region and abdominal muscles. [Subjects] A total of 42 subjects were enrolled 9 males and 33 females. [Methods] The bridging exercise in this study was one form of exercise with a knee joint flexion angle of 90°. Based on this, a bridging exercise was conducted at the postures of abduction of the lower extremities at 0, 5, 10, and 15°. [Result] The changes in the knee joint angle and the hip abduction angle exhibited statistically significant effects on the cervical erector spinae, adductor magnus, and gluteus medius muscles. The abduction angles did not result in statistically significant effects on the upper trapezium, erector spinae, external oblique, and rectus abdominis muscles. However, in relation to the knee joint angles, during the bridging exercise, statistically significant results were exhibited. [Conclusion] When patients with both cervical and back pain do a bridging exercise, widening the knee joint angle would reduce cervical and shoulder muscle activity through minimal levels of abduction, permitting trunk muscle strengthening with reduced cervical muscle activity. This method would be helpful for strengthening trunk muscles in a selective manner.

[Purpose] The aim of this study was to determine the appropriate pressure variation for performing a successful abdominal drawing-in maneuver (ADIM). The abdominal muscle thickness variations and contraction ratios were examined in relation to pressure variations using a Pressure Biofeedback Unit (PBU) during an ADIM in the supine position. [Methods] The PBU was placed identically between the lumbar lordosis of 20 healthy subjects (12 males and 8 females) and the pressure of the PBU was maintained at 40 mmHg. Then, while the subjects performed ADIM at four random pressure variations (0, 2, 4, or 6 mmHg), the thicknesses of the transversus abdominis (TrA), the internal oblique abdominal muscle (IO), and the external oblique abdominal muscle (EO) were measured using ultrasonography. [Results] Pressure increases of 0-2 mmHg resulted in significant decreases in IO and EO thicknesses compared to pressure increases of 6 mmHg. Increases of 0-2 mmHg also resulted in significant decreases in IO+EO and EO contraction ratios compared to pressure increases of 6 mmHg, while the preferential activation ratio of the TrA was significantly increased. [Conclusion] Compared to the other pressure increases, an increase of 0-2 mmHg effectively regulated the thicknesses and contraction ratios of superficial muscles such as IO and EO, rather than the thickness and contraction ratio of the TrA, showing high and indirect preferential activation ratios for TrA. Therefore, for successful ADIM, rather than using large PBU pressure increases, exercises that promote slight increases of around 0-2 mmHg from a baseline of 40 mmHg are desirable.

Background: In May 2012, an outbreak of viral hepatitis A was reported to the Guangxi Center for Disease Control and Prevention from a middle school in Liujiang County. An investigation was conducted to identify the cause and mode of transmission and to recommend control and prevention measures.Methods: A case was defined as any person from the middle school with onset of fatigue, anorexia, abdominal pain, diarrhoea or jaundice from 20 February to 20 May 2012. We compared attack rates (AR) between boys and girls, assuming that only boys used well water and girls used pipeline water. We then selected 133 students from three classes in each of the three grades to compare AR by reported water source and drinking history.Results: There were 22 cases, an AR of 3.8% (21/553) for students and 1.5% for teachers (1/65). Those who used well water were 8.7 (95% confidence interval [CI] = 2.1–37.2) times more likely to be ill than those using pipeline water. The cohort study showed that students who reported using well water daily were 5.2 (95% CI = 0.7–41.8) times more likely to be ill than those that reported using the pipeline water daily. Eighteen cases were confirmed as hepatitis A.Conclusion: This hepatitis A outbreak was potentially caused by a contaminated school well. We recommended that the school discontinue using the well and that the students should drink boiled water. As there is a vaccine for hepatitis A, we recommended that several doses of the vaccine be stored for controlling outbreaks and for immunizing susceptible populations in future outbreaks.

[Purpose] This study examined the effects of a conventional quadriceps setting exercise (CQS) and a modified quadriceps setting exercise (MQS) on the strength of the quadriceps femoris, hamstring and gluteus maximus muscles, and the walking ability of elderly persons with osteoarthritis (OA) during their early rehabilitation after total knee arthroplasty (TKA). [Subjects] The subject of this study were 44 elderly women aged 65 or over who were scheduled to undergo TKA on one knee and who voluntarily consented to participate in this experiment after listening to its purpose and method. We divided the subjects into an experimental group (n=22) who performed MQS and a control group (n=22) who performed CQS. [Methods] We measured subjectsAf muscle strength and conducted the 6-minute walk test (6MWT) before surgery, 2 weeks after surgery, and 4 weeks after surgery. [Results] Changes in the strength of the hamstring and gluteus maximus muscles were significantly different between the two groups. [Conclusion] MQS may enhance the strength of the hamstring as well as gluteus maximus muscles and is considered an appropriate exercise for the elderly in their early rehabilitation after TKA.

Objective: To observe the effect of Xueshuantong injection (XST, with its ingredient as Notoginseng saponin, on acute cerebral infarction (ACI) and on blood coagulation and fibrinolysis, so as to comprehensively analyse the mechanism of XST.Methods: Fifty ACI patients were randomly divided into 2 groups, and XST group (30 patients) was treated with XST, and the control group (20 patients) given low molecular dextrose, as well as low molecular heparin calcium. The course of treatment for both groups was 15 days. The changes of effective rate, score of neurologic impairment, tissuetype plasminogen activator (tPA), inhibitor of plasminogen activator (PAI), D-D dimmer, antithrombinIII (AT-III), and fibrinogen (Fbg) were all observed.Results: The total effective rate of XST group was 73.33%, that of the control group 65. 00%. After the therapy, plasma level of tPA, ratio of tPA/PAI, and AT-III content were increased obviously, while the plasma level of PAI and D-D dimmer were decreased significantly (all P 0.05).Conclusion: XST injection could be effective to ACI, the mechanism of which is probably related to improving the balance between plasminogen activator and its inhibitory factor, increasing the activity of fibrinolysin, inactivating thrombin, inhibiting platelet aggregation induced by thrombin, and decreasing blood coagulation.

[Purpose] This study examined the effects of diagonal shoulder training on an individual with secondary impingement due to scapular dyskinesis. [Subject] A 54 year-old female with secondary impingement participated in this study. [Methods] The patient performed diagonal shoulder training in 4-point kneeling, 3 times per day for 20 minutes over a period of 6 weeks. Evaluations of shoulder pain, range of motion, upper trapezius/lower serratus anterior ratio, and impingement were performed before training and at 2, 4, and 6 weeks. [Results] The patient’s parameters improved gradually. All parameters returned to normal ranges at 4 weeks. [Conclusion] Diagonal shoulder training is effective for improving dysfunction in individuals with secondary impingement. In addition, this training should be applied for more than 4 weeks.

Although the adrenal gland is a common site of metastasis from hepatocellular carcinoma (HCC), adrenal metastases are rarely seen in clinical practice because of its lower metastatic potential compared to the other malignancies. Adrenal metastases usually were detected at the time of diagnosis of primary HCC or simultaneously with intrahepatic recurrence after curative management of HCC. It is very rare that only metastatic HCC is detected without evidence of intrahepatic recurrence. Hereby, we report two cases of adrenal metastasis from HCC without intrahepatic recurrence after hepatic resection.

Enteritis cystica profunda is a very rare disease in which a mucin-filled cystic space is surrounded partially with nonneoplastic columnar epithelium in the submucosa of the small intestine. Most of the cases are accompanied by intestinal diseases, and the disease usually occurs in the jejunum and the ileum and there has been no report of a case that occurred in the ampulla of Vater. A 58-year-old healthy female patient without any particular symptom visited the hospital to get additional examination for a mass found on the ampulla of Vater by accident. In esophagogastroduodenoscopy, a cystic mass showing a positive pillow sign was found on the ampulla of Vater. Endoscopic retrogradecholangiopancreatography was conducted as choledochocele was suspected, but no abnormality was found in the biliary system. In endoscopic ultrasonography, multiseptated cystic structures were detected in the submucosal layer of the duodenum. The lesion was resected completely through endoscopic snare polypectomy and the case was histologically diagnosed as enteritis cystica profunda.

Despite the rapid progress in the clinical application of laparoscopic surgery robots, many shortcomings have not yet been fully overcome, one of which is the lack of reliable haptic feedback. This study implemented a force-feedback structure in our compact laparoscopic surgery robot. The surgery robot is a master-slave configuration robot with 5 DOF (degree of freedom corresponding laparoscopic surgical motion. The force-feedback implementation was made in the robot with torque sensors and controllers installed in the pitch joint of the master and slave robots. A simple dynamic model of action-reaction force in the slave robot was used, through which the reflective force was estimated and fed back to the master robot. The results showed the system model could be identified with significant fidelity and the force feedback at the master robot was feasible. However, the qualitative human assessment of the fed-back force showed only limited level of object discrimination ability. Further developments are underway with this result as a framework.

evaluated. 24 displayed high affinity for Aβ aggregates (Ki = 42 nM). The high affinity of [Tc]24 for Aβ was certified by in vitro autoradiography on brain sections of Tg and AD. Interestingly, [Tc]24 could only label Aβ in blood vessels (white triangle) but not Aβ in parenchyma (gray arrow) of the AD brain (Fig. 1). Moreover, [Tc]24 possesses moderate initial brain uptake (1.21% ID/g) and fast blood washout in normal mice, which is important for specific targeting Aβ located on the cerebrovascular vessel walls outside the BBB. The preliminary results suggest [Tc]24 is promising for detection of Aβ in CAA.

Stump appendicitis is an acute inflammation of the residual appendix and is a rare complication after appendectomy. The physician should be aware of the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy so that delayed diagnosis and treatment can be prevented. Stump appendicitis is usually treated by surgical resection, and endoscopic treatment has not been reported previously. A 48-year-old man who had undergone appendectomy 35 years earlier presented to the hospital because of right lower quadrant discomfort. A computed tomography scan showed a large stone in the residual appendix. Colonoscopic findings revealed a large, smooth, protruding lesion at the cecum with a stone inside the appendiceal orifice. Endoscopic removal after incision of the appendiceal orifice was performed successfully.