Patients with whiplash injuries usually complain of neck, shoulder, or back pain; dizziness; headache; vertigo; paresthesias; and cognitive or psychological symptoms. However, to date, whiplash ...injury also remains one of the most poorly understood motor vehicle injuries. The source of initial symptoms among patients with whiplash injuries is often unclear. It is generally assumed that the symptoms of patients with whiplash injuries have an organic basis. This review briefly summarized the pathophysiology and mechanisms being investigated by many researchers to potentially explain whiplash injury. Each anatomical area described is injured during a whiplash exposure if the impact during whiplash injuries exceeds that tissue’s tolerance. For each anatomical area affected during whiplash injuries, continued research is necessary to better understand the pathophysiology and mechanisms of whiplash injuries. A better understanding of each potentially injured anatomical area during whiplash injuries will help improve the management of whiplash injuries. KCI Citation Count: 0
Abstract Background To date, there have been conflicting suggestions regarding the initial pathogenesis of carpal tunnel syndrome (CTS). It has been characterized as either inflammation of the median ...nerve caused by compression or noninflammatory fibrosis of the subsynovial connective tissue (SSCT). Objective To investigate the initial pathogenesis of CTS, we compared the deformation and displacement of the median nerve in accordance with the electrophysiological severity between patients with CTS (via the Bland scale) and healthy controls. Design Cross-sectional, case-control study. Setting General teaching hospital, rehabilitation unit. Patients Thirteen hands of 10 healthy participants and 39 hands of 27 patients with CTS were recruited and classified into 4 groups (stage 0−3) according to the severity of the electrodiagnostic test results. Methods Ultrasound images of the median nerve in response to the wrist and finger motions were analyzed. Main Outcome Measure We measured the deformation of the median nerve (the maximal change values of the median nerve area, and aspect ratio of the minimum-enclosing rectangle MER) and movement of the median nerve (the maximal change value of the median nerve displacement) in response to the motions of wrists and finger. The maximal change value of the median nerve displacement was normalized with respect to the width of the wrist. Moreover, the maximal change values of the median nerve area, and the aspect ratio of the MER, were also normalized to the median nerve area and the aspect ratio of the MER in wrist-neutral position with finger extension. Result CTS patients in stage 3 showed a significantly lower normalized maximal change of the median nerve movement compared with CTS patients in stages 0, 1, and 2 ( P <.001). Regarding the deformation of the median nerve, however, there were statistically significant differences among all groups (area, P < .001; MER, P <.001). According to multivariate logistic regression analysis, the normalized maximal change of the aspect ratio of the MER is a meaningful parameter in diagnosing the initial stage of CTS ( P < .01). Conclusion These results showed that the deformation of the median nerve may be associated with the initial pathogenesis; however, further studies are necessary to validate the findings of this study. Level of Evidence To be determined.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
To evaluate clinical features and determine rehabilitation strategies of dysphagia, it is crucial to measure the exact response time of the pharyngeal swallowing reflex in a videofluoroscopic ...swallowing study (VFSS). However, measuring the response time of the pharyngeal swallowing reflex is labor-intensive and particularly for inexperienced clinicians, it can be difficult to measure the brief instance of the pharyngeal swallowing reflex by VFSS. To accurately measure the response time of the swallowing reflex, we present a novel framework, able to detect quick events. In this study, we evaluated the usefulness of machine learning analysis of a VFSS video for automatic measurement of the response time of a swallowing reflex in a pharyngeal phase. In total, 207 pharyngeal swallowing event clips, extracted from raw VFSS videos, were annotated at the starting point and end point of the pharyngeal swallowing reflex by expert clinicians as ground-truth. To evaluate the performance and generalization ability of our model, fivefold cross-validation was performed. The average success rates of detection of the class "during the swallowing reflex" for the training and validation datasets were 98.2% and 97.5%, respectively. The average difference between the predicted detection and the ground-truth at the starting point and end point of the swallowing reflex was 0.210 and 0.056 s, respectively. Therefore, the response times during pharyngeal swallowing reflex are automatically detected by our novel framework. This framework can be a clinically useful tool for estimating the absence or delayed response time of the swallowing reflex in patients with dysphagia and improving poor inter-rater reliability of evaluation of response time of pharyngeal swallowing reflex between expert and unskilled clinicians.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Coronavirus disease (COVID-19) is rapidly spreading worldwide. Although 10-20% of patients with COVID-19 have severe symptoms, little is known about the risk factors related to the aggravation of ...COVID-19 symptoms from asymptomatic or mild to severe disease states.
This retrospective study included 211 patients who were asymptomatic or with mild presentations of COVID-19. We evaluated the differences in demographic and clinical data between the cured (discharged to home) and transferred (aggravated to severe-stage COVID-19) groups.
A multivariate logistic analysis showed that body temperature, chills, initial chest X-ray findings, and the presence of diabetes were significantly associated with predicting the progression to severe stage of COVID-19 (p < 0.05). The odds ratio of transfer in patients with COVID-19 increased by 12.7-fold for abnormal findings such as haziness or consolidation in initial chest X-ray, 6.32-fold for initial symptom of chills, and 64.1-fold for diabetes.
Even if patients are asymptomatic or have mild symptoms, clinicians should closely observe patients with COVID-19 presenting with chills, body temperature > 37.5 °C, findings of pneumonia in chest X-ray, or diabetes.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Giga-casting, a revolutionary approach for manufacturing large, single-piece car body components from aluminium, has emerged as a potential game-changer in the automotive industry. However, these ...large, thin-walled castings are prone to distortions during solidification and heat treatment processes. Straightening these distortions is crucial to ensure structural integrity, facilitate downstream assembly, and maintain aesthetic qualities. This paper proposes a novel method for straightening giga-cast components using a multi-pin straightening machine. The machine's versatility stems from its ability to adapt to various geometries through multiple strategically controlled straightening pins. This paper introduces the concept of a "straightening stroke decision algorithm" to achieve precise straightening and overcome the challenges of complex shapes. This algorithm determines the stroke length for each pin, combining a polynomial model representing the global stiffness of the component with a machine learning model that captures the stiffness changes arising from the current geometry. The effectiveness of the proposed approach is evaluated through comprehensive numerical experiments using finite element analyses. The straightening performance is assessed for the straightening algorithm with different machine learning models (deep neural network and XGBoost) and compared to a traditional optimisation method. The proposed surrogate models decided the straightening strokes so that the maximum remaining distortion became 0.02% of the largest dimension of each target geometry. The results of the numerical experiment showed that the proposed straightening method is suitable for straightening distortion in large thin-walled components.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
We developed a new exercise method called the submandibular push exercise that can strengthen the suprahyoid muscle by inducing only the motion of the hyoid bone without neck flexion. In this study, ...we aimed to investigate and compare the muscle activity of the suprahyoid and infrahyoid muscles in the course of performing three different swallowing exercises. Twenty healthy participants and fifteen patients with dysphagia were recruited. Each participant consecutively performed three exercises: Shaker, CTAR, and submandibular push exercises. To investigate muscle activation, surface electromyography was performed on the suprahyoid, infrahyoid, and SCM muscles, during the exercises. Root mean square (RMS) was measured. In healthy participants, the submandibular push exercise showed a significantly higher RMS value in the suprahyoid and infrahyoid muscles than the Shaker and CTAR exercises using repeated ANOVA with Tukey's post hoc test (p < 0.05). In patients with dysphagia, the submandibular push and Shaker exercises showed significantly higher RMS value in the suprahyoid and infrahyoid muscles than the CTAR exercise. However, no significant difference was found between the submandibular push and Shaker exercises. In both healthy and patients with dysphagia, the mean RMS values of the SCM muscles during the submandibular push exercise were significantly lower than those during the Shaker exercise using repeated ANOVA with Tukey's post hoc test (p < 0.05). In conclusion, considering the relatively superior selectiveness in suprahyoid and infrahyoid muscle contraction, the submandibular push exercise using visual feedback from pressure sensor could be an efficient supplementary exercise to the conventional swallowing muscle exercises. However, further studies may be necessary to confirm the improvement in swallowing difficulty.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
We investigated the potential of machine learning techniques, at an early stage after stroke, to predict the need for ankle-foot orthosis (AFO) in stroke patients. We retrospectively recruited 474 ...consecutive stroke patients. The need for AFO during ambulation (output variable) was classified according to the Medical Research Council (MRC) score for the ankle dorsiflexor of the affected limb. Patients with an MRC score of < 3 for the ankle dorsiflexor of the affected side were considered to require AFO, while those with scores ≥ 3 were considered not to require AFO. The following demographic and clinical data collected when patients were transferred to the rehabilitation unit (16.20 ± 6.02 days) and 6 months after stroke onset were used as input data: age, sex, type of stroke (ischemic/hemorrhagic), motor evoked potential data on the tibialis anterior muscle of the affected side, modified Brunnstrom classification, functional ambulation category, MRC score for muscle strength for shoulder abduction, elbow flexion, finger flexion, finger extension, hip flexion, knee extension, and ankle dorsiflexion of the affected side. For the deep neural network model, the area under the curve (AUC) was 0.887. For the random forest and logistic regression models, the AUC was 0.855 and 0.845, respectively. Our findings demonstrate that machine learning algorithms, particularly the deep neural network, are useful for predicting the need for AFO in stroke patients during the recovery phase.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
To test the hypothesis that aspirin, non-aspirin nonsteroidal anti-infammatory drugs (NA-NSAIDs), or acetaminophen can reduce the risk of ALS, we conducted a systematic review and meta-analysis of ...related previous studies. A comprehensive search was conducted on the PubMed, Embase, Cochrane Library and SCOPUS databases. It included studies published up to 29 February 2020 that fulfilled our inclusion criteria. Aspirin, acetaminophen and NA-NSAIDs use information, between the ALS and control groups, was collected for the meta-analysis. Rates of aspirin, NA-NSAID, and acetaminophen use in ALS group, compared with control group were investigated. In the results, only three studies that relate the risk of ALS to aspirin, NA-NSAIDs and acetaminophen use satisfied the inclusion criteria for the meta-analysis. Regarding aspirin, the studies did not show any statistically significant difference in aspirin use between the ALS and control groups (Odds ratio, 1.04 95% confidence interval, 0.90-1.21). NA-NSAIDs and acetaminophen use, however, did show up statistically significant differences in between the ALS and control groups. (Odds ratio, 0.82 95% confidence interval, 0.73-0.91) and (Odds ratio, 0.80 95% confidence interval, 0.69-0.93). However, our study has some limitations. Firstly, we only included a small number of studies. Secondly, the included studies did not control for past medical history, which may have confounded their results, and in turn, could have caused bias in our study. Thirdly, in this meta-analysis, the ALS patients were not subdivided into sporadic or familial type. Lastly, the studies also did not consider the types of NSAIDs and dosages used of each drug. For more convincing evidence regarding the effectiveness of aspirin, NA-NSAIDs and acetaminophen to reduce the risk of ALS occurrence, more qualified prospective studies are required. In conclusion, the use of NA-NSAIDs and acetaminophen is associated with a decreased risk for the development of ALS. In contrast, aspirin did not have any effect on the reduction of the risk of ALS occurrence.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Introduction
In the current study, we evaluated factors that increase the coronavirus disease (COVID-19) patient death rate by analyzing the data from two cohort hospitals. In addition, we studied ...whether underlying neurological diseases are risk factors for death.
Methods
In this retrospective cohort study, we included 103 adult inpatients (aged ≥ 18 years). We evaluated differences in demographic data between surviving and non-surviving COVID-19 patients.
Results
In a multivariate logistic analysis, age and the presence of chronic lung disease and Alzheimer’s dementia (AD) were the only significant parameters for predicting COVID-19 non-survival (
p
< 0.05). However, hypertension, coronary vascular disease, dyslipidemia, chronic kidney disease, diabetes, and history of taking angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme (ACE) inhibitors, as well as nonsteroidal anti-inflammatory drugs (NSAIDs), were not significantly associated with the death of COVID-19 patients. The optimal cutoff value obtained from the maximum Youden index was 70 (sensitivity, 80.77%; specificity, 61.04%), and the odds ratio of non-survival increased 1.055 fold for every year of age.
Conclusions
Clinicians should closely monitor and manage the symptoms of COVID-19 patients who are over the age of 70 years or have chronic lung disease or AD.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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