Earticle

Current approaches to regulating osteoarthritis primarily focus on symptom management; however, these methods often have significant side effects and may not be suitable for long-term care. As an alternative to conventional treatments, injecting stem cells into knee joint cartilage is a promising option for repairing damaged cartilage. In this review, we outline the general procedure for stem cell treatment of knee joint cartilage regeneration, emphasizing the potential of intra-articular stem cell injections as a therapeutic option for osteoarthritis. We examined and summarized patient evaluation and preparation for knee joint stem cell therapy, stem cell harvesting, stem cell preparation, injection procedures for stem cell therapy, post-injection care and monitoring, potential outcomes of stem cell therapy, and considerations and risks associated with stem cell therapy. Overall, stem cell injections for knee joint cartilage damage represent a promising frontier in orthopedic care. They offer potential benefits such as pain and inflammation reduction, promotion of cartilage repair and regeneration, and the possibility of avoiding more invasive treatments such as knee surgery. Ongoing collaboration among researchers, clinicians, and regulatory organizations is crucial for advancing this field and translating scientific discoveries into effective clinical applications.

PURPOSE: This study aimed to evaluate the intra- and inter-rater reliability of visual and photographic assessments of forward head posture (FHP) and to estimate measurement error from biological and technical sources. METHODS: Ten experienced physical therapists independently rated the FHP severity of 100 asymptomatic adults using both real-time visual observation and standardized photographic images. Reliability was analyzed using Cohen's kappa coefficients and frequency distributions of absolute point differences. Biological and technical error components were estimated under the assumption of independent variance sources. RESULTS: Both methods demonstrated substantial intrarater reliability (κ = .68 for visual, κ = .71 for photographic), with exact agreement exceeding 70%. Inter-rater reliability was lower, particularly for visual observation (κ = .39), whereas photographic assessments showed moderate agreement (κ = .51). Technical factors accounted for approximately 90% of intra-rater variability, whereas biological error contributed only 3%, indicating minimal short-term postural fluctuation in asymptomatic adults. CONCLUSION: Indirect assessments of FHP were consistent within raters but more variable across raters, especially in live visual settings. Variability was largely attributable to technical factors. These findings underscore the need for standardized scoring rubrics, rater calibration, and complementary objective tools (e.g., CVA measurement) to enhance reliability, particularly in multi-rater clinical contexts.

Purpose: The purpose of the current study was to determine the intra- and inter-rater reliability of muscle thickness measurement of the TA using ultrasonography (US) conducted at different inward pressures of approximately 0.5 kg, 1.0 kg, and no pressure control. Methods: Twenty healthy subjects were recruited for this study. Two different examiners measured the thicknesses of the dominant TA of each subject randomly to assess the intra- and inter-rater reliability. The measurement values were analyzed using the intra-class correlation coefficient (ICC) with a 95% confidence interval, standard error of measurement, minimal detectable change, and coefficient of variance. Results: All intra-rater reliability ICC values showed high reliability above 0.9. Inter-rater reliability ICC values showed high reliability above 0.9 with 0.5 and 1.0 kg of inward pressure. In contrast, Inter-rater reliability ICC values showed poor reliability (0.23) with no pressure control of inward pressure. Conclusion: The findings showed that maintaining consistent inward pressure is essential for reliable results when the muscle thickness of the TA is measured by different examiners in a clinical setting.

Objective: This reliability study examined the effects of applying varying induced inward pressures using a transducer placed at 0° neutral ankle position (NEU) and 15° ankle dorsiflexion (DF) on tibialis anterior (TA) muscle thickness using a custom-made device with a force indicator during rehabilitative ultrasound imaging. Design: Cross-sectional study. Methods: Twenty-four healthy subjects were recruited in this study. Two examiners measured the muscle thickness of the TA at 0° NEU and 15° DF in 3 conditions of inward pressures (1.0 N, 2.0 N, and 4.0 N) using a custom-made holder. The muscle thickness was measured three times for each of the conditions arranged in random order. For intra- and inter-rater reliability, the intraclass correlation coefficients (ICCs) with 95% confidence intervals, standard error of measurement, minimal detectable change, and coefficient of variation were analyzed. One-way repeated measures analysis of variance was conducted for investigating changes of TA muscle thickness according to the inward pressures of the transducers. Results: The intra-rater reliability of TA muscle thickness measurement was excellent (ICC_3,1: 0.92-0.96) for all conditions (at both ankle joint angles per varying inward pressure). Likewise, the inter-rater reliability of TA muscle thickness measurement was excellent (ICC_2,1: 0.89-0.97) under same conditions. The mean of TA thickness showed the trend of decreasing significantly with increased inward pressures at all ankle joint angles (p<0.05). Conclusions: Use of this custom-made device with a force indicator is useful to accomplish the high intra- and inter-rater reliability of TA muscle thickness measurement at both ankle joint angles in reducing the measurement error.

Purpose: The purpose of this study was to propose a new reference point for measurement of the infrasternal angle and to investigate the intra- and inter-rater reliabilities of infrasternal angle measurement using photographs. Methods: Twenty-four healthy male college students participated as subjects in this study. Photographs were taken of subjects in two postures, one standing with the shoulders relaxed and one standing with the shoulders at $150^{\circ}$ abduction. All photographs were analyzed using Image J software. Raters used the photographs to measure the infrasternal angle between the xiphoid process, the medial margin of rib and navel on the right and left sides. The reliability of the infrasternal angle measurement was assessed by means of intraclass correlation coefficients [ICC (3,1)]. The level of statistical significance was set at p<0.05. Results: The intra- and inter-rater reliabilities of the infrasternal angle measurement for the right side at rest were excellent (ICC=0.866 and 0.813, respectively), as were those for the left side at rest (ICC=0.919 and 0.846, respectively). At $150^{\circ}$ shoulder abduction, the intra- and inter-rater reliabilities for measurement of the infrasternal angle on the right side were excellent (ICC=0.972 and 0.778, respectively), as were those for the left side (ICC=0.914 and 0.826, respectively). Conclusion: These findings suggest that this technique can be successfully used to measure the infrasternal angle, thus suggesting a new reference point for determining the length of the internal oblique and external oblique muscles in clinical situations.

The purpose of the current study was to determine the intra- and inter-rater reliability of muscle thickness (MT) measurement of the psoas major (PM) using ultrasonography (US) conducted at different inward pressures of approximately .5 kg, 1.0 kg, 1.5 kg, and 2.0 kg. Twelve healthy male subjects were recruited for the study. The thicknesses of both PMs of each subject were measured by two different examiners in a random manner to assess the intra- and inter-rater reliability. The measurement values were analyzed using the intra-class correlation coefficient (ICC) with a 95% confidence interval (CI). ICC (2,1) was used to determine the inter-rater reliability and ICC (3,1) was used to assess the intra-rater reliability of the MT measurement of the PM. The results indicated higher ICC values for intra-rater reliability compared to inter-rater reliability. In addition, the value for intra-rater reliability with .5 kg inward pressure [ICC=.99 (95%CI=.98~.99)] was higher compared to 1.0 kg, 1.5 kg, and 2.0 kg. Other inward pressures for intra- and inter-rater reliability in current study were also demonstrated to have excellent values (ICC=.94~.99). These findings showed that maintaining consistent inward pressure is essential for maintaining reliability of the results when the MT of the PM is measured by different examiners in a clinical setting.

Ely's test is commonly used to assess rectus femoris muscle flexibility. however, a reliability limit of this test was demonstrated by a previous study. In this study, we present an alternative method using an application for a digital horizontal level in a smartphone (DHLS) to complement the reliability limit of Ely's test. The aim of this study was to examine the reliability of Ely's test using DHLS on the pelvis, compared to using visual observation (VO) of pelvic and hip motions. Nineteen patients with lumbar extension-rotation syndrome were recruited for this study. An examiner examined the rectus femoris flexibility (both pass/fail and goniometer scoring) through Ely's test using both DHLS and VO. A retest session was completed two hours later for within-day reliability and seven days later for between-day intra-rater test-retest reliability. Results showed higher Kappa values for pass/fail scoring and higher intraclass correlation coefficient values for goniometer scoring in Ely's test using DHLS, compared to using VO. Measurement error and Bland and Altman plots further demonstrated the degree of intra-rater variance during Ely's test using DHLS in a clinical setting, compared to using VO. These results demonstrated that Ely's test using DHLS showed acceptable reliability compared to using VO. Ely's test using DHLS could be widely used for measuring the rectus femoris muscle flexibility in patients with lumbar extension-rotation syndrome, although the inter-rater reliability needs to be established first.

The purpose of this study was to determine the intra-rater and inter-rater reliability of various forward head posture measurements. Ten healthy adults (age, $20.4{\pm}2.2$ yrs; height, $164.0{\pm}5.5$ cm; weight, $58.7{\pm}7.3$ kg) participated in the study. They were free of injury and neurologic deficits in the upper extremities and neck at the time of testing. The subjects were asked to perform head forward posture by under the guidance of physical therapists. Markers were placed on the C7 spinous process, mastoid process, tragus of the ear, outer canthus, and forehead. Measurement 1 for forward head posture assessment was measured as the angle between the horizontal line through C7 and the line connecting the C7 spinous process with the tragus of the ear. Measurement 2 was measured as the angle between the C7 spinous process, the mastoid process and the outer canthus. Measurement 3 was measured as two kinds of angles the HT (head tilt) angle is between the line from the midpoint of forehead to the tragus line and Y-axis at the tragus point. The NF (neck flexion) angle is between the line from the tragus to the C7 line and the Y-axis at the C7. Intra-rater, inter-rater reliability and coefficient of variation was assessed by comparing the measured values from three kinds of measurements of forward head posture. The intra-rater reliability was indicated by intraclass correlation coefficients [ICC(1,1)] and inter-rater reliability was shown by intraclass correlation coefficients [ICC(3,k)]. The results of study were as follows: ICC(1,1) values for intra-rater reliability of three measurements were in the 'excellent' category. ICC(3,k) values for inter-rater reliability of three measurements were also in the 'excellent' category. The coefficient of variation of method 2 had a lower value than method 1 and method 3. This data means that the measured value of method 2 was less scattered. Further research is needed to determine whether the validity of all measurements is revealed in the 'excellent' category.

Background A short extensor digitorum longus (EDL) is associated with limited ankle dorsiflex-ion, toe deformities (such as hammer toe and claw toe), and diabetic plantar ulcers. Therefore, measurement of EDL is important for the evaluation of patients with foot dysfunction. Purpose The aim of this study was to evaluate the intra- and inter-rater reliability of the muscle length test for EDL. Study design Repeated measures for intra- and inter-test reliability. Methods Thirty participants were recruited. Two physical therapists evaluated EDL length based on the difference in passive ankle plantar flexion angle between relaxed and flexed toe positions. Each examiner measured it in each participant three times. The intraclass correlation coefficient was used to assess the intra- and inter-rater reliability of the muscle length test for EDL. Results The intra- and inter-rater reliability values were 0.83 and 0.75, respectively. The standard error of measurement was 1.93° and the minimum detectable change was 5.35°. Conclusions The muscle length test is a reliable method for measuring EDL length in clinical practice.

Objective To evaluate the short-term clinical effects of intra-articular shoulder injection with botulinum toxin type A (BoNT-A) in acute hemiplegic stroke patients with complex regional pain syndrome type I (CRPS I). Method Fifty patients were assigned at random to receive intra-articular shoulder injection. The treatment groups were divided into two groups: BoNT-A group, 200 IU of BoNT-A and 2 ml of normal saline; triamcinolone acetonide (TA) group, 20 mg of triamcinolone and 2 ml of 2% lidocaine. Uptake ratio of quantitative three phase bone scintigraphy (QTPBS) was calculated by dividing the radioactivity count on the affected side by that on the unaffected side. Shoulder pain was assessed by visual analogue scale (VAS) and neuropathic pain scale (NPS). Range of motion (ROM) of shoulder joint and functional independence measurement (FIM) of upper limb were evaluated. All of them were measured before injection, and 4 weeks after injection. Results After 4 weeks, the uptake ratio of blood pool phase was significantly decreased in hands of BoNT-A group than TA group. VAS, ROM and upper extremity FIM was similarly improved in both groups. Pain intensity and cold pain of NPS were similarly decreased in both groups. Hot pain and dull pain of NPS decreased more significantly decreased in BoNT-A group than TA group. Conclusion In the short-term, intra-articular BoNT-A shoulder injection maybe has the therapeutic effect on acute CRPS I related stroke. And the uptake ratio of blood pool phase of the hand of QTPBS may be useful to assess the therapeutic effect of CRPS after acute stroke.

Purpose: This study analyzed the immediate effects of intra-abdominal pressure with visual feedback on the muscle activation of the upper trapezius and sternomastoid during natural inspiration and forced inspiration in individuals with costal respiration. Methods: The eighteen individuals with upper costal breathing pattern participated in this study. Surface electromyography was used to analyze the muscle activity of the upper trapezius and sternomastoid during natural inspiration and forced inspiration before and after intra-abdominal pressure. Results: A significant difference in muscle activation was observed with the muscle type, inspiration type, and test session (p<0.05). The muscle activities of the sternomastoid and upper trapezius decreased significantly during forced inspiration after intra-abdominal pressure training (p<0.05). On the other hand, there was no significant difference during natural inspiration in both muscles (p>0.05). A comparison of the difference between the pre-test and post-test during forced inspiration revealed the upper trapezius to be significantly larger than the sternomastoid (p<0.05). No significant difference was noted during natural inspiration (p>0.05). Conclusion: The intra-abdominal pressure has positive effects on correcting the breathing patterns in individuals with costal respiration.

Purpose: This study aimed to identify factors influencing intra-operative core body temperature (CBT), and to develop a predictive model for intra-operative CBT in laparoscopic abdominal surgery. Methods: The prospective observational study involved 161 subjects, whose age, weight, and height were collected. The basal pre-operative CBT, pre-operative blood pressure, and heartbeat were measured. CBT was measured 1 hour and 2 hours after pneumoperitoneum. Results: Explanatory factors of intra-operative hypothermia (<36˚C) were weight (β=.361, p<.001) and pre-operative CBT (β=.280, p=.001) 1 hour after pneumoperitoneum (Adjusted R2=.198, F=7.56, p<.001). Weight was (β=.423, p<.001) and pre-operative CBT was (β=.206, p=.011) 2 hours after pneumoperitoneum (Adjusted R2=.177, F=5.93, p<.001). The researchers developed a predictive model for intra-operative CBT (˚C) by observing intra-operative CBT, body weight, and pre-operative CBT. The predictive model revealed that intra-operative CBT was positively correlated with body weight and pre-operative CBT. Conclusion: Influence of weight on intra-operative hypothermia increased over time from 1 hour to 2 hours after pneumoperitoneum, whereas influence of pre-operative CBT on intraoperative hypothermia decreased over time from 1 hour to 2 hours after pneumoperitoneum. The research recommends pre-warming for laparoscopic surgical patients to guard against intra-operative hypothermia.

Objective To evaluate the efficacy of intra-articular hyaluronic acid (IAHA) injection for hemiplegic shoulder pain (HSP) after stroke.Methods Thirty-one patients with HSP and limited range of motion (ROM) without spasticity of upper extremity were recruited. All subjects were randomly allocated to group A (n=15) for three weekly IAHA injection or group B (n=16) for a single intra-articular steroid (IAS) injection. All injections were administered by an expert physician until the 8th week using a posterior ultrasonography-guided approach. Shoulder joint pain was measured using the Wong-Baker Scale (WBS), while passive ROM was measured in the supine position by an expert physician.Results There were no significant intergroup differences in WBS or ROM at the 8th week. Improvements in forward flexion and external rotation were observed from the 4th week in the IAHA group and the 8th week in the IAS group. Subjects experienced a statistically significant improvement in pain from the 1st week in the IAS and from the 8th week in IAHA group, respectively.Conclusion IAHA seems to have a less potent ability to reduce movement pain compared to steroid in the early period. However, there was no statistically significant intergroup difference in WBS and ROM improvements at the 8th week. IAHA might be a good alternative to steroid for managing HSP when the use of steroid is limited.

Variable wireless channel is a big challenge for real-time video applications, and the rate adaptation of realtime video streaming becomes a hot topic. Intra-video coding is important for high-quality video communication and industrial video applications. In this paper, we proposed a novel adaptive scheme for real-time video transmission with intra-only coding over a wireless network. The key idea of this scheme is to estimate the instantaneous remaining capacity of the network to adjust the quality of the next several video frames, which not only can keep low queuing delay and ensure video quality, but also can respond to bandwidth changes quickly. We compare our scheme with three different schemes in the video transmission system. The experimental results show that our scheme has higher bandwidth utilization and faster bandwidth change response, while maintaining low queuing delay.

In this paper, we propose a parallel intra-operation unit and a memory architecture for improving the performance of intra-prediction, which utilizes spatial correlation in an image to predict the blocks and contains 17 prediction modes in total. The design is targeted for portable devices applying H.264/AVC decoders. For boosting the performance of the proposed design, we adopt a parallel intra-operation unit that can achieve the prediction of 16 neighboring pixels at the same time. In the best case, it can achieve the computation of one luma $16{\times}16$ block within 16 cycles. For one luma $4{\times}4$ block, a mere one cycle is needed to finish the process of computation. Compared with the previous designs, the average cycle reduction rate is 78.01%, and the gate count is slightly reduced. The design is synthesized with the MagnaChip $0.18{mu}m$ library and can run at 125 MHz.

Objective To investigate whether the cartilage regenerative effects of intra-aricular platelet-rich plasma (PRP) are different, according to the severity of osteoarthritis (OA), in a collagenase-induced knee OA rabbit model.Method New Zealand white rabbits (N=21) were randomly divided into three groups. Three different doses (0.25 mg, group 1; 0.5 mg, group 2; and 1.0 mg, group 3) of collagenase were injected twice into both knees of each group under an ultrasound guidance. The mean platelet concentration of the PRP fraction was 2,664±970×103/μl and was enriched 8.2-times, compared with the whole blood. PRP (0.3 ml) was injected into the left knee and saline (0.3 ml) into the right knee at 4 weeks, and macroscopic and histological scores of both injected knees were evaluated at 9 weeks after the first collagenase injection.Results Macroscopic and histological scores of group 3 were significantly higher than those of group 1 and 2 (p<0.05). Macroscopic and histological scores of the PRP-injected knees were significantly lower than those of the saline-injected knees, in all groups (p<0.05). Differences of gross morphologic and histologic scores between sa-line- and PRP-injected knees in group 3 were significantly higher than those in group 1 and 2 (p<0.05).Conclusion Intra-articular PRP injection influences cartilage regeneration in all severities of rabbit knee OA, and the cartilage regenerative power of PRP injection in moderate knee OA was greater than that in mild or very mild OA. A large preclinical trial is needed to establish the validity of our study.

Objective To assess the clinical efficacy and safety of intra-articular injection of hyaluronic acid (HA) combined with polydeoxyribonucleotide (PDRN) in patients with knee osteoarthritis in comparison with that of HA alone.Methods The current single-center, prospective, randomized, double-blind, controlled study was conducted in 36 patients with knee osteoarthritis at our medical institution. All the eligible patients (n=30) were equally assigned to two treatment arms (trial group ‘HA+PDRN’ and control group ‘HA’). For efficacy assessment, the patients were evaluated for the visual analogue scale (VAS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Scores (KSS), all of which served as efficacy outcome measures. We monitored time-dependent changes in efficacy outcome measures at baseline and 1, 3 and 6 months. Subsequently, we compared differences in changes in efficacy outcome measures at 6 months from baseline between the two groups. Moreover, we assessed the safety based on the treatment-emergent adverse events (TEAEs), adverse drug reactions (ADRs) and any other complications serving as safety outcome measures.Results There were significant differences in changes in the VAS scores, the WOMAC scores in all domains, except ‘Stiffness’, the total WOMAC scores, and the KSS scores in all the domains at 6 months from baseline between the two groups (p<0.05). In our series, there were no TEAEs, ADRs, and any other complications.Conclusion Intra-articular injections of HA combined with PDRN can also be considered in the treatment of knee osteoarthritis. However, further large-scale and multi-center studies are required to demonstrate the potential of the proposed combination.

Purpose - This research aims to examine collaboration from a disciplinary perspective in Korea. There are needs to explore to what extent researchers collaborate by discipline and across discipline along with the impact of collaboration. Design/methodology/approach - In order to investigate collaboration with respect to entire discipline areas and author-declared discipline information we analyzed a national researcher information database (Korean Researcher Information) with a citation index database (Korean Citation Index) covering the entire range of discipline. This study analyzed the data sets for 10 years (2004-2013) including a total of 8 categories and 119 sub-categories of disciplines, 109,551 researchers, 650,263 articles, and 1,170,039 citations in Korea. Findings - The results demonstrate that there are different intensities of collaboration from heavy to minimal across disciplines. In examining collaboration in terms of author and discipline levels, the results show that collaboration in author level rises, then inter-disciplinary collaboration increases accordingly, in most of the 119 discipline sub-categories. A number of disciplines, however, tended to collaborate more intensely within their own rather than with other disciplines. Moreover, the impact of collaboration tended to change over time depending on the types of collaboration. Specifically, inter-disciplinary collaboration was likely to have more immediate impact as pioneer research, especially among more than three disciplines, whereas the impact of intra-disciplinary collaboration is higher as time passes. Originality/value - In this research, a disciplinary investigation on collaboration is conducted for the entire range of disciplines in Korea. Through analyzing distinctive author-declared discipline information from the KRI, this research examines the intensities of collaboration across disciplines, collaboration in author level, and the impact of collaboration.

Objective To evaluate and compare the effects and outcomes of extracorporeal shock wave therapy (ESWT) and intra-articular injections of hyaluronic acid (HA) in patients with knee osteoarthritis (OA).Methods Of the 78 patients recruited for the study, 61 patients met the inclusion criteria. The enrolled patients were randomly divided into two groups: the ESWT group and the HA group. The ESWT group underwent 3 sessions of 1,000 shockwave pulses performed on the affected knee with the dosage adjusted to 0.05 mJ/mm2 energy. The HA group was administered intra-articular HA once a week for 3 weeks with a 1-week interval between each treatment. The results were measured with the visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, 40-m fast-paced walk test, and stair-climb test (SCT). A baseline for each test was measured before treatment and then the effects of the treatments were measured by each test at 1 and 3 months after treatment.Results In both groups, the scores of the VAS, WOMAC, Lequesne index, 40-m fast-paced walk test, and SCT were significantly improved in a time-dependent manner (p<0.01). There were no statistically significant differences measured at 1 and 3 months after treatment between the two groups (p>0.05).Conclusion The ESWT can be an alternative treatment to reduce pain and improve physical functions in patients with knee OA.

Purpose: Influence of benzodiazepine (midazolam)or cholinergic inhibitor (atropine or glycopyrrlate) on intra-operative body temperature remains unclear and controversial. This study compares intra-operative body temperature in 50 abdominal surgical patients under general anesthesia between the administration of midazolam and glycopyrrolate in combination, or glycopyrrolate alone. Methods: Patients who underwent abdominal surgery were recruited from September 2008 through October 2009 at Gachon University Gil hospital in Incheon. Core body temperature was measured in the right ear using a tympanic membrane thermometer at induction of general anesthesia and at 1 hr, 2 hr, and 3 hr after induction. Results: There were no differences in core body temperature at any measurement point between either patient group (F=1.08, p=.377). Core body temperature decreased throughout the 3 hr after induction in both groups (F=9.22, p<.001). Specially, core temperatures at induction of general anesthesia (p<.001), 1 hr (p<.001), 2 hr (p<.001), and 3 hr (p<.001) after induction were lower than before administration of midazolam and glycopyrrolate, or glycopyrrolate alone. Conclusion: We conclude that a cholinergic inhibitor (glycopyrrolate, 0.1 mg) therefore seems not to affect intra-operative body temperature of patients given a benzodiazepine (midazolam, 0.04 mg kg-1), and not to increase body temperature in patients not given a benzodiazepine during the 3 hr after the induction of general anesthesia. Intra-operative warming therefore is needed to prevent hypothermia in surgical patients who receive pre-operative administration of midazolam and/or glycopyrrolate.