BACKGROUNDS: Though K-ADL was developed and validated, weighting each item of K-ADL is needed to evaluate the severity of functional disability as a whole. METHODS: Nominal group technique was used to weight individual items of K-ADL. Relevant experts were recruited; one specialist in geriatrics, one expert in elderly health service, one doctor expert in questionnarie, one nurse and two social welfare workers and one caregiver who work in nursing home for elderly, one nurse working at dementia care center. At the first round, each expert assigned the weights of each item. At the second round, those experts met, discussed, and re-evaluated each weighting. Using the newly developed weighted score, we measured its validity compared to brain-disability grade and three experts' decision of severe dysfunction. RESULTS: For inability to perform task, 7 points were given to 'dressing'and 'washing face', 6 points to 'bathing', 9 points to 'feeding', 8 points to 'transfer and toileting'. If any assistance is needed, 7 points were scored to 'dressing', 4 points were scored to 'washing face', 'feeding', 'transfer' and 'toileting', 2 points were scored to 'dressing'. Correlation coefficient between weighted K-ADL sum and brain-disability grade was -0.665(p=0.000). CONCLUSIONS: We assigned differential weighting to each of K-ADL and found that summing weighted K-ADL was excellent in some validity test.
Aged ; Caregivers ; Dementia ; Geriatrics ; Health Services ; Humans ; Nursing Homes ; Social Welfare ; Specialization ; Weights and Measures

Osteomesopyknosis is a rare sclerosing bone disorder of autosomal dominant inheritance. We report a first case of osteomesopyknosis in Korea. A 16-year old girl complained of diffuse back pain for 1 year. We performed physical examination, biochemical investigations and imaging studies. A radiograph of spine revealed rugger-jersey vertebra and sandwich vertebra. Bone specific alkaline phosphatase, osteocalcin and C-terminal telopeptides of type I collagen were normal. Only an axial skeleton involvement was shown on the whole body bone scan. This patient was diagnosed to have osteomesopyknosis. Osteomesopyknosis is characterized by normal level of bone turnover marker and an axial bone involvement. Osteomesopyknosis can be occurred in Korea and needs to be considered when patients, especially young patients, suffer from back pain and have only axial osteosclerosis.
Alkaline Phosphatase ; Back Pain ; Bone Diseases ; Collagen Type I ; Female ; Humans ; Korea ; Osteocalcin ; Osteosclerosis ; Physical Examination ; Skeleton ; Spine ; Wills

PURPOSE: Rheumatoid arthritis (RA) is a common, chronic inflammatory arthritis that develops most often in women. Gonadal hormones may account for the sexual dimorphism in the immune response and for the greater incidence of autoimmune disease in females. Gonadotrophin-releasing hormone (GnRH), one of the gonadal hormones, plays an important role in immune system modulation. This study examined the effects of single nucleotide polymorphisms (SNP) in GnRH on gender differences in the pathophysiology of RA. MATERIALS AND METHODS: The presence of SNPs rs2659590, rs2321248, rs6186, rs6185, and rs2321049 in the human GnRH1 gene was confirmed in Korean RA patients by Taqman(R) SNP genotyping assays. A total of 153 unrelated female, Korean RA patients and 96 female Korean controls participated. RESULTS: There were no significant associations between GnRH1 polymorphisms and RA. However, we found that the rs2659590, rs6185 and rs2321248 polymorphism might be associated with a susceptibility to aberrantly high erythrocyte sedimentation rates in female RA patients. CONCLUSION: Additional studies, with a larger number of patients and in different populations will be required to assess whether GnRH1 polymorphisms and these haplotypes could be used as susceptibility or resistance markers in RA. To our knowledge, this study is the first to analyze associations between SNPs of GnRH1 and RA.
Arthritis ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Blood Sedimentation ; Female ; Gonadal Hormones ; Gonadotropin-Releasing Hormone ; Haplotypes ; Humans ; Immune System ; Incidence ; Polymorphism, Single Nucleotide

BACKGROUND: Both human leukocyte antigen (HLA) class I and programmed death-ligand 1 (PD-L1) molecules are known to play important roles in cancer immunity. In this study, we evaluated HLA class I expression in resected adenocarcinoma of the lung, and investigated its prognostic impact in correlation with PD-L1 expression. METHODS: HLA class I and PD-L1 expression was evaluated by immunohistochemistry in a total of 403 resected lung adenocarcinomas using tissue microarray. Correlations between the expression of HLA class I/PD-L1 and clinicopathologic features and prognostic significance were analyzed. RESULTS: HLA class I expression was reduced in 91.6% of adenocarcinoma, and more frequently reduced in patients with younger age, absence of vascular invasion, and low pathologic stage (p = .033, p = .007, and p = .012, respectively). Positive PD-L1 expression in tumor cells was 16.1% (1% cut-off), and associated with poor differentiation, presence of vascular invasion and nodal metastasis (p < .001, p = .002, and p = .032, respectively). On survival analysis, HLA class I or PD-L1 expression alone did not show any statistical significance. On the integrated analysis, HLA class I (+)/PD-L1 (+) subgroup showed a significantly shorter overall survival than other groups (p = .001). Multivariate analysis revealed that coexpression of HLA class I and PD-L1 was an independent poor prognostic factor of lung adenocarcinoma. (p < .001; hazard ratio, 6.106; 95% confidence interval, 2.260 to 16.501). CONCLUSIONS: Lung adenocarcinoma with coexpression of HLA class I and PD-L1 was associated with poor prognosis. This subgroup may evade immune attack by expressing PD-L1 protein despite HLA expression.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Humans ; Immunohistochemistry ; Leukocytes ; Lung ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis

PURPOSE: Erectile dysfunction (ED) remains a major complication from cavernous nerve injury during radical prostatectomy. Recently, stem cell treatment for ED has been widely reported. This study was conducted to investigate the availability, differentiation into functional cells, and potential of human muscle-derived stem cells (hMDSCs) and human adipose-derived stem cells (hADSCs) for ED treatment. MATERIALS AND METHODS: We compared the neural differentiation of hMDSCs and hADSCs. Human muscle and adipose tissues were digested with collagenase, followed by filtering and centrifugation. For neural induction, isolated hMDSCs and hADSCs were incubated in neurobasal media containing forskolin, laminin, basic-fibroblast growth factor, and epidermal growth factor for 5 days. Following neural induction, hMDSCs and hADSCs were differentiated into neural cells, including neurons and glia, in vitro. RESULTS: In neural differentiated hMDSCs (d-hMDSCs) and differentiated hADSCs (d-hADSCs), neural stem cell marker (nestin) showed a significant decrease by immunocytochemistry, and neuronal marker (beta-tubulin III) and glial marker (GFAP) showed a significant increase, compared with primary hMDSCs and hADSCs. Real-time chain reaction analysis and Western blotting demonstrated significantly elevated levels of mRNA and protein of beta-tubulin III and GFAP in d-hADSCs compared with d-hMDSCs. CONCLUSIONS: We demonstrated that hMDSCs and hADSCs can be induced to undergo phenotypic and molecular changes consistent with neurons. The neural differentiation capacity of hADSCs was better than that of hMDSCs.
Adipose Tissue ; Blotting, Western ; Caves ; Cell Differentiation ; Centrifugation ; Collagenases ; Epidermal Growth Factor ; Erectile Dysfunction ; Forskolin ; Humans ; Immunohistochemistry ; Laminin ; Male ; Muscles ; Neural Stem Cells ; Neuroglia ; Neurons ; Prostatectomy ; RNA, Messenger ; Stem Cells ; Tubulin

PURPOSE: The present study was conducted to develop a mild vascular cognitive impairment (MVCI) assessment tool for patients with stroke and to examine its validity, reliability, and clinical adequacy. METHODS: Items of this tool were developed based on previously verified cognitive assessment tools. Face, content, and criterion (concurrent) validities, optimal cut-off score for differentiation of MVCI and normal cognitive function, clinical adequacy, internal consistency, and inter-rater reliability of the assessment tool were determined in 60 stroke patients at a university hospital located in Incheon, South Korea. RESULTS: The devised MVCI assessment tool contains 20 items which were designed to assess seven cognitive domains: orientation, memory, language, attention, reasoning/abstraction, visuospatial perception, and executive function/problem solving. Content, face, and construct validities were well supported. Clinical adequacy testing revealed that the overall probability of correctly discriminating MVCI using the MVCI assessment tool for stroke was 90.0%, which was statistically significant. Furthermore, a score of 23 was found to be the optimal cut-off score for MVCI. Internal consistency and inter-rater reliability were also well supported. CONCLUSIONS: The findings of this study indicate that the developed MVCI assessment tool for stroke could serve as a clinically useful tool for detecting MVCI and for properly assessing degree of cognitive impairment in stroke patients.
Aged ; Female ; Humans ; Male ; Middle Aged ; *Mild Cognitive Impairment/complications/diagnosis ; Neuropsychological Tests/*standards ; Psychometrics/*methods ; Reproducibility of Results ; Republic of Korea ; Sensitivity and Specificity ; Stroke/*complications

To investigate effect of fatigue and anticipation on lower extremity joint load during a side-cutting maneuver in female collegiate soccer players, thirteen female collegiate soccer players whose right leg dominant participated in this study. Three dimensional motion analysis system and a force plate were used to record the 45degrees side cutting maneuver. In the first, anticipated and unanticipated cutting were measured in the pre-fatigue condition. Second, participations performed the fatigue protocol by the squat exercise with weight lifting. And then, two different type of cutting task were measured again after fatigue condition. The cutting direction let known before start their running in case of the anticipated cutting, the random signal of cutting direction were presented in the unanticipated condition. In the results, the most influential variable was anticipation factor. Lower limb angles represented significantly flexed posture during unanticipated cutting than anticipated condition. Maximum knee flexion moment represented significantly higher in unanticipated cutting than anticipated cutting. Adduction and internal rotation moment of lower limb joint decreased in unanticipated cutting. Fatigue factor was influenced by the initial contact angles of the ankle joint. Lower limb angles at the initial ground contact indicated more erect posture in post-fatigue condition. The unanticipation factor had more effect on locomotors ability of lower limb in this study. Therefore, the sensory-motor training to adapt to unanticipated situation should be considered for the injury prevention training program.
Ankle Joint ; Anterior Cruciate Ligament ; Fatigue ; Female ; Humans ; Joints ; Knee ; Leg ; Linear Energy Transfer ; Lower Extremity ; Posture ; Running ; Soccer ; Weight Lifting

Objective: To assess the role of arterial spin-labeling (ASL) perfusion MRI in identifying cerebral perfusion changes after indirect revascularization in children with moyamoya disease. Materials and Methods: We included pre- and postoperative perfusion MRI data of 30 children with moyamoya disease (13 boys and 17 girls; mean age ± standard deviation, 6.3 ± 3.0 years) who underwent indirect revascularization between June 2016 and August 2017. Relative cerebral blood flow (rCBF) and qualitative perfusion scores for arterial transit time (ATT) effects were evaluated in the middle cerebral artery (MCA) territory on ASL perfusion MRI. The rCBF and relative time-topeak (rTTP) values were also measured using dynamic susceptibility contrast (DSC) perfusion MRI. Each perfusion change on ASL and DSC perfusion MRI was analyzed using the paired t test. We analyzed the correlation between perfusion changes on ASL and DSC images using Spearman’s correlation coefficient. Results: The ASL rCBF values improved at both the ganglionic and supraganglionic levels of the MCA territory after surgery (p = 0.040 and p = 0.003, respectively). The ATT perfusion scores also improved at both levels (p < 0.001 and p < 0.001, respectively). The rCBF and rTTP values on DSC MRI showed significant improvement at both levels of the MCA territory of the operated side (all p < 0.05). There was no significant correlation between the improvements in rCBF values on the two perfusion images (r = 0.195, p = 0.303); however, there was a correlation between the change in perfusion scores on ASL and rTTP on DSC MRI (r = 0.701, p < 0.001). Conclusion Recognizing the effects of ATT on ASL perfusion MRI may help monitor cerebral perfusion changes and complement quantitative rCBF assessment using ASL perfusion MRI in patients with moyamoya disease after indirect revascularization.

Objective: To assess the role of arterial spin-labeling (ASL) perfusion MRI in identifying cerebral perfusion changes after indirect revascularization in children with moyamoya disease. Materials and Methods: We included pre- and postoperative perfusion MRI data of 30 children with moyamoya disease (13 boys and 17 girls; mean age ± standard deviation, 6.3 ± 3.0 years) who underwent indirect revascularization between June 2016 and August 2017. Relative cerebral blood flow (rCBF) and qualitative perfusion scores for arterial transit time (ATT) effects were evaluated in the middle cerebral artery (MCA) territory on ASL perfusion MRI. The rCBF and relative time-topeak (rTTP) values were also measured using dynamic susceptibility contrast (DSC) perfusion MRI. Each perfusion change on ASL and DSC perfusion MRI was analyzed using the paired t test. We analyzed the correlation between perfusion changes on ASL and DSC images using Spearman’s correlation coefficient. Results: The ASL rCBF values improved at both the ganglionic and supraganglionic levels of the MCA territory after surgery (p = 0.040 and p = 0.003, respectively). The ATT perfusion scores also improved at both levels (p < 0.001 and p < 0.001, respectively). The rCBF and rTTP values on DSC MRI showed significant improvement at both levels of the MCA territory of the operated side (all p < 0.05). There was no significant correlation between the improvements in rCBF values on the two perfusion images (r = 0.195, p = 0.303); however, there was a correlation between the change in perfusion scores on ASL and rTTP on DSC MRI (r = 0.701, p < 0.001). Conclusion Recognizing the effects of ATT on ASL perfusion MRI may help monitor cerebral perfusion changes and complement quantitative rCBF assessment using ASL perfusion MRI in patients with moyamoya disease after indirect revascularization.

Background: Hysteroscopic surgery has been used in various gynecological fields. However, massive fluid overload can occur as a complication due to persistent infusion of media for uterine cavity distension. We present the case of a woman who developed cardiomyopathy with pulmonary edema and epistaxis during hysteroscopic surgery.Case: A 76-year-old female underwent hysteroscopic septectomy. She manifested abrupt, active nasal bleeding and regurgitation in the intravenous line. Heart rate, SpO2, and PETCO2 decreased from 55 beats/min to 29 beats/min, from 100% to 56%, and from 31 mmHg to 9 mmHg, respectively. After the operation, brain CT showed bilateral prominent superior ophthalmic vein dilation. Echocardiography showed left ventricle apical ballooning and global hypokinesia. The patient recovered after two days of conservative management, with no sequelae. Conclusions Although hysteroscopic surgery is a simple procedure, careful monitoring is necessary to prevent complications from absorption of fluid distending media during the procedure.