Objective: This paper reports the status of the advanced cardiac life support (ACLS) according to the guidelines by residents belonging to other departments other than the department of emergency medicine. The differences in status between the junior group and senior group was also investigated according to grades of residents.
Methods: The ACLS performance for in-hospital cardiac arrest cases of one academic hospital, except for the cases occurring in intensive care unit between November 2015 and October 2017, were analyzed retrospectively. Data included the characteristics of residents, patients' outcomes, ACLS performance, and conventional treatment having discordance with the ACLS guidelines. Leaders during cardiopulmonary resuscitation (CPR) were divided into a junior group and senior group.
Results: A total of 152 cases were enrolled in this study. Of these, 131 cases (86.2%) showed at least one treatment with inconsistency from the guidelines and the incidence of discordant treatment was similar in the two groups (55 [85.9%] vs. 76 [88.4%], P=0.657). Implicit use of sodium bicarbonate was more frequent in the senior residents group (odds ratio [OR], 3.04; 95% confidence interval [CI], 1.36-6.81). On the other hand, no use of a defibrillator was less frequent in the senior residents group (OR, 0.14; 95% CI, 0.03-0.81).
Conclusion: In both groups, the rate of discordance with the ACLS guidelines during CPR were high. The rate of implicit use of sodium bicarbonate and no use of defibrillator were significantly different in the two groups. A customized education strategy for ACLS is needed for each group.
Electromagnetic continuous casting (EMCC) was used to fabricate Ti-6Al-4V alloys with properties suitable for medical applications. Ti-6Al-4V alloy ingots fabricated by EMCC were subjected to heat treatment, such as residual stress removing (RRS), furnace cooling after solution treatment (ST-FC) and water-cooling after solution treatment (ST-WC), in order to obtain characteristics suitable for the standard. After component analysis, the microstructure and mechanical properties (tensile strength and elongation) were evaluated by ICP, gas analysis, OM, SEM, a Rockwell hardness tester and universal testing machine. The Ti-6Al-4V alloy ingot fabricated by EMCC was fabricated without segregation, and the lamellar structure was observed in the RRS and ST-FC specimens. The ST-WC specimen showed only martensite structure. As a result of evaluating the mechanical properties based on the microstructure results, we found that the water-cooled heat treatment condition after the solution treatment was most suitable for the Ti-6Al-4V ELI standard.
In this study, we focused on the correlation between the solidification structure, heat treatment and mechanical properties of the A356 alloy according to the conditions of Sr modification. The microstructural evolution of the eutectic Si and α-Al phase in the A356 alloy castings depending on the amount of Sr were investigated during solid solution heat treatment using an optical microscope, a scanning electron microscope and an image analyzer. In addition, tensile tests on the heat treated materials examined the relationship between the microstructure and the fracture surface. The as-cast A356 alloys under 40 ppm Sr showed an undermodified microstructure, but that of the added 60-80 ppm Sr had well modified structure of fine fibrous silicon. After solid solution treatment, the microstructure of the undermodified A356 alloy exhibited a partially spheroidized morphology, but the remainder showed the fragmentation of fibrous shaped silicon. The spheroidization of the eutectic silicon in the modified A356 alloys was completed during heat treatment, which was very effective in increasing the elongation. This is supported by the fracture surface in the tensile test.
Background: There are insufficient objective or quantitative evidence for the better intervention to improve proprioception particularly for the application of external load. There are conflicting opinions whether the external load is effective for proprioception improvement or not.
Objects: The purpose of this study was to investigate effects of external load on proprioception of shoulder joint quantitatively using 3D motion capture system.
Methods: Nine healthy adults joined for this study. They were asked to perform scapular plane abduction motion with attaching reflective markers on the trunk and upper limb. The 3D positions of finger marker, while they performed the same task with and without external load, were recorded and analyzed.
Results: All participants showed decreased variable errors in the vertical direction when the external load was applied (p<.02). Even though other directions (y, z) and absolute errors increased, they did not have statistical significances.
Conclusion: Based on this study results, the external load application would be effective for shoulder joint position sense improvement.
Background: The craniocervical flexion (CCF) exercise is one of the effective exercise in correcting forward head posture (FHP). However, some people with FHP achieve CCF with compensatory movements, for example, low cervical flexion using superficial neck flexors such as the sternocleidomastoid (SCM) muscle. No study has yet investigated whether a dualpressure biofeedback unit (D-PBU) method to prevent low cervical flexion would be helpful in performing pure CCF movement.
Objects: The purpose of this study was to compare the effects of the CCF using D-PBU method and the traditional CCF method on the cross-sectional area (CSA) of the longus colli muscle (LCM) and the activity of SCM muscle in subjects with FHP.
Methods: Twentyfour FHP subjects (male: 16, female: 8) were recruited for this study. All subjects performed CCF using two different methods: The traditional CCF method and the CCF using D-PBU method. The CSA of the LCM was measured via ultrasound, and surface electromyography was used to measure SCM muscle activity.
Results: The change in CSA of the LCM was significantly larger during the CCF using D-PBU method (1.28±.09) compared with the traditional CCF method (1.19±.08) (p<.05). The SCM muscle activity using the CCF using D-PBU method (2.01±1.97 %MVIC) was significantly lower than when using the traditional CCF method (2.79±2.32 %MVIC) (p<.05).
Conclusion: The CCF using D-PBU method can be recommended for increasing LCM activation and decreasing SCM muscle activity during CCF movement in subjects with FHP.
Background: Stroke patients show abnormal walking patterns due to brain injury. In order to have the desired walking pattern, appropriate stimulation is required to activate the central pattern generator. For this reason, our study performed treadmill ambulatory training with rhythmic auditory stimulation. However we did not consider the influence of visual feedback.
Objects: The purpose of this study was to compare the gait abilities in chronic stroke patients following either treadmill walking training with rhythmic auditory stimulation and visual feedback (TRASVF) or treadmill walking training with rhythmic auditory stimulation (TRAS) alone.
Methods: Twenty-one stroke patients were divided into two groups: A TRASVF group (10 subjects) and a TRAS group (11 subjects). They received 30 minutes of neuro-developmental therapy (NDT) and walking training for 30 minutes, five times a week for three weeks. Temporal and spatial gait parameters were measured before and after the training period. The Biodex gait trainer treadmill system measured gait parameters.
Results: After the training periods, the TRASVF group showed a significant improvement in walking speed, the step length of the affected limb, and time on each foot of the affected limb when compared to the TRAS group (p<.05).
Conclusion: The results of this study showed that the treadmill walking training with rhythmic auditory stimulation and visual feedback improved individual gait ability more than the treadmill walking training with rhythmic auditory stimulation alone. Therefore, visual feedback should be considered along with rhythmic auditory stimulation training.
In this study, the effects of the pouring temperature, preheating temperature, surface condition and fraction of the wear resistant part on the production of duo-castings were investigated using a high Cr white cast iron with excellent abrasion resistance and a low Cr alloy steel with good toughness. The constituent materials of the duo-castings were designed to have high hardness, fracture toughness and abrasive wear resistance for the replacement of high Mn alloy steels with low abrasive wear resistance. In particular, the amount of abrasive wear of 17% Cr white cast iron was about 1/20 of that of high Mn alloy steel. There was an intermediate area of about 3mm due to local melting at the bonding interface of the duo-castings. These intermediate regions were different from those of the constituent materials in chemical composition and microstructure. This region led to fracture within the wear resistant part rather than at the bonding interface in the bending strength test. The bending fracture strengths were 516-824 MPa, which were equivalent to the bending proof strength of high Mn steel. The effects of various casting conditions on the duo-cast behavior were studied by simple pouring of low Cr alloy steel melt, but the results proved practically impossible to manufacture duo-castings with a sound bonding interface. However, the external heating method was suitable for the production of duo-castings with a sound bonding interface.
Background: The deep cervical flexor (DCF) muscles have a crucial role in the management of neck pain. For preventing neck pain by activation of the DCF, craniocervical flexion (CCF) is an effective exercise. However, sternocleidomastoid (SCM) muscle is considered to affect negatively the activation of the DCF. SCM muscle which is an accessory muscle for respiration is activated differently depending on types of breathing patterns. It's not certain that breathing patterns affect the SCM and DCF muscles thickness during CCF exercise.
Objects: The purpose of this study was to investigate the influence of breathing patterns on the SCM and DCF muscles thickness during CCF exercise.
Methods: Forty-five subjects participated in this study, and they were classified according to their breathing pattern, as follows: Costodiaphragmatic breathing (CDB) and upper costal breathing (UCB) groups. Ultrasonographic imaging of the SCM and DCF muscles was performed during five incremental levels of CCF during tidal breathing and expiration.
Results: There was a significant interaction between the breathing pattern and the phase of CCF for percentage of SCM muscle thickness changes (p<.05). In phase 1 CCF, a percentage of SCM muscle thickness changes was increased in the UCB group than in the CDB group (p<.05). There was an increase in DCF muscles thickness with each additional CCF phase (p<.05).
Conclusion: Recruitment of SCM muscle was increased in the UCB group while performing CCF with a low intensity. There were no significant differences on DCF recruitment between the breathing pattern groups. Higher CCF exercise intensities elicited a higher DCF recruitment.
Background: Deficits of both ankle dorsiflexion range of motion (DFROM) and dynamic balance are shown in persons with chronic ankle instability and the elderly, with the risk of falls.
Objects: This study aims to investigate the relationship between DFROM and dynamic balance in elderly subjects and young adults.
Methods: Fifty-nine subjects were divided into three groups: ankle stability young group (SY), ankle instability young group (IY) and ankle stability older group (SO). We recruited three old subjects with ankle instability, but excluded them during a pilot testing due to the safety issue. DFROM was measured by weight bearing lunge test (WBLT) and dynamic balance was measured via star excursion balance test (SEBT) in anteromedial, medial, and posteromedial directions. The group differences in WBLT and SEBT and each group's correlation between WBLT and SEBT were detected using the R statistical software package.
Results: The dorsiflexion range of motion was significantly different between the SY, IY, and SO groups. The SO group showed the highest DFROM and IY group showed the lowest DFROM (SY: 45.88±.66˚, IY: 39.53±1.63˚, SO: 47.94±.50˚; p<.001). However, the SO group showed the lowest dynamic balance score for all SEBT directions (SY: 87.24±2.05 ㎝, IY: 83.20±1.30 ㎝, SO: 77.23±2.07 ㎝; p<.05) and there was no relationship between the dorsiflexion range of motion and dynamic balance in any group.
Conclusion: Our findings suggest that ankle DFROM is not a crucial factor for dynamic stability regardless of aging and ankle instability. Other factors such as muscle strength or movement coordination should be considered for training dynamic balance. Therefore, we need to establish the rehabilitation process by measuring and treating ROM, balance, and muscle strength when treating young adults with and without ankle instability as well as elderly people.
Background: After a stroke, the patient may have abnormal muscle tone due to abnormal alignment. Physical therapists have used stretching, neural mobilization other methods to treat patients after stroke. In addition, joint mobilization is also used to stimulation in pathway of cervical segmental region and to normal cervical spine alignment.
Objects: The purpose of this study was to determine whether Maitland cervical spine mobilization has an immediate effect on muscle tone and stiffness of upper extremity.
Methods: Thirty subjects were divided into a experimental group (n1=10), a placebo group (n2=10), and a control group (n3=10). The Maitland cervical spine mobilization was applied in the supine position. Immediately after the intervention, muscle tone and stiffness of biceps brachii, brachioradialis, deltoid, and pectoralis major were measured using Myoton®PRO. In the placebo group, sham mobilization was applied to the fifth and sixth cervical vertebra, and the control group was instructed to control breathing.
Results: In the experimental group, significant differences were found in muscle tone and stiffness of biceps brachii and brachioradialis in comparison with the affected side and the non-affected side before the intervention (p< .05), whereas there was no significant difference after the intervention (p >.05). Muscle tone of biceps brachii on the non-affected side and pectoralis major on the affected side was significantly decreased before and after the intervention (p<.05). The placebo and control group showed no changes on the non-affected and affected side, and no significant differences were detected before and after the intervention. All the groups revealed no significant differences in muscle tone and stiffness of upper extremity before and after the intervention.
Conclusion: This study suggests that the application of Maitland cervical spine mobilization enhanced muscle tone of upper extremity on the involved side symmetrically, and influenced a decrease in muscle tone.