Background: Verbal learning test is useful and significant test to evaluating memory function. There were many memory tests but few for elderly and dementia patients. Although there have been a variety of Korean memory tests developed, these tests were difficult to administer to dementia patients and elderly individuals with low educational levels. Therefore, we developed the Korean Memory Test (KMT). Methods: The KMT task consists of three trials of free recall of 10 simplified line drawing figures of familiar materials. Three immediate recall trials and one 20 minutes delayed recall and one recognition trial were administered. Sixty-five of probable Alzheimer's patients received the Korean version of Mini-Mental State Examination (K-MMSE), Korean version of expanded Clinical Dementia Rating Scale (CDR) and KMT. Also sixty-seven of normal controls were enrolled. We tested reliability and validity of the KMT and also evaluated scores of the KMT with progression of dementia. Results: The parameters of the KMT correlated with CDR -0.74~-0.77 (p<0.01), K-MMSE 0.66~0.68 (p<0.01). The internal consis- tency was 0.78 (Cronbach's alpha). Most of the KMT's parameters decreased with CDR significantly (p<0.01). Conclusions: The KMT is a good test for evaluating memory function of elderly with low educational level. Also it is a sensitive and specific test to detection of dementia in early stage and has excellent reliability and validity.
Aged* ; Alzheimer Disease ; Dementia ; Humans ; Memory* ; Memory, Short-Term ; Neuropsychology ; Reproducibility of Results* ; Verbal Learning

High mobility group box 1 (HMGB1) is a pivotal mediator of sepsis progression. Remifentanil, an opioid agonist, has demonstrated anti-inflammatory effects in septic mice. However, it is not yet known whether remifentanil affects the expression of HMGB1. We investigated the effects of remifentanil on HMGB1 expression and the underlying mechanism in septic rats. Forty-eight male Sprague-Dawley rats were randomly divided into 3 groups; a sham group, a cecal ligation and puncture (CLP) group, and a CLP with remifentanil treatment (Remi) group. The rat model of CLP was used to examine plasma concentrations of proinflammatory cytokines, tissue HMGB1 mRNA and the activity of nuclear factor (NF)-κB in the liver, lungs, kidneys, and ileum. Pathologic changes and immunohistochemical staining of NF-κB in the liver, lungs, and kidneys tissue were observed. We found that remifentanil treatment suppressed the level of serum interleukin (IL)-6 and tumor necrosis factor (TNF)-α 6 hours after CLP, and serum HMGB1 24 hours after CLP. HMGB1 mRNA levels and the activity of NF-κB in multiple organs decreased by remifentanil treatment 24 hours after CLP. Remifentanil treatment also attenuated nuclear expression of NF-κB in immunohistochemical staining and mitigated pathologic changes in multiple organs. Altogether, these results suggested that remifentanil inhibited expression of HMGB1 in vital organs and release of HMGB1 into plasma. The mechanism was related to the inhibitory effect of remifentanil on the release of proinflammatory cytokines and activation of NF-κB.
Animals ; Cytokines ; HMGB1 Protein ; Humans ; Ileum ; Inflammation ; Interleukins ; Kidney ; Ligation ; Liver ; Lung ; Male ; Mice ; Models, Animal ; Plasma ; Punctures ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; Sepsis ; Tumor Necrosis Factor-alpha

PURPOSE: A multidisciplinary program for early recovery after colorectal surgery has been developed continuously since 2000. The purpose of this study was to evaluate the effects of the standardized postoperative enhanced recovery program (SPERP) after a colorectal resection. METHODS: The patients undergoing laparoscopic colorectal resection for colorectal cancer were cared for by using the SPERP after surgery. The comparison group consisted of patients who had undergone similar surgery before establishment of the SPERP. The two groups were compared with respect to the patients' characteristics, operation methods, operation time, blood loss, amounts of intravenous fluid and intravenous antibiotics, complications, postoperative hospital stay, readmission rate, and reoperation rate. RESULTS: The number of patients being treated with the standardized postoperative recovery program, the standardized group (SG), was 63, and that of the traditional group (TG) was 61. Even though the day of oral feeding (1.02 vs. 2.67 days) was faster in the SG, the day of flatus and defecation was not different between two groups. The postoperative hospital stay in the SG (6.76 days) was significantly shorter than that in the TG (10.43 days). The total amount of intravenous fluid after surgery in the SG was 8,574.75 mL, compared with 19,568.22 mL in the TG. The duration of intravenous antibiotics was 2.69 days in the SG and 7.38 days in the TG (P=0.0001). The rates of complication (27.0% in SG vs. 39.3% in TG), reoperation (3.17% vs. 9.84%), and readmission (7.94% vs. 6.56%) did not increase after implementation of this program. CONCLUSION: The standardized postoperative recovery program reduced the amounts of postoperative intravenous fluid and antibiotics and the postoperative hospital stay without increasing either complications or the readmission rate. A prospective multi-center study of this program is needed.
Anti-Bacterial Agents ; Colorectal Neoplasms ; Colorectal Surgery ; Defecation ; Flatulence ; Humans ; Length of Stay ; Postoperative Complications ; Reoperation

PURPOSE: The long-term results of a laparoscopic resection for colorectal cancer have been reported in several studies, but reports on the results of laparoscopic surgery for rectal cancer are limited. We investigated the long-term outcomes, including the five-year overall survival, disease-free survival and recurrence rate, after a laparoscopic resection for colorectal cancer. METHODS: Using prospectively collected data on 303 patients with colorectal cancer who underwent a laparoscopic resection between January 2001, and December 2003, we analyzed sex, age, stage, complications, hospital stay, mean operation time and blood loss. The overall survival rate, disease-free survival rate and recurrence rate were investigated for 271 patients who could be followed for more than three years. RESULTS: Tumor-node-metastasis (TNM) stage I cancer was present in 55 patients (18.1%), stage II in 116 patients (38.3%), stage III in 110 patients (36.3%), and stage IV in 22 patients (7.3%). The mean operative time was 200 minutes (range, 100 to 535 minutes), and the mean blood loss was 97 mL (range, 20 to 1,200 mL). The mean hospital stay was 11 days and the mean follow-up period was 54 months. The mean numbers of resected lymph nodes were 26 and 21 in the colon and the rectum, respectively, and the mean distal margins were 10 and 3 cm. The overall morbidity rate was 26.1%. The local recurrence rates were 2.2% and 4.4% in the colon and the rectum, respectively, and the distant recurrence rates were 7.8% and 22.5%. The five-year overall survival rates were 86.1% in the colon (stage I, 100%; stage II, 97.6%; stage III, 77.5%; stage IV, 16.7%) and 68.8% in the rectum (stage I, 90.2%; stage II, 84.0%; stage III, 57.6; stage IV, 13.3%). The five-year disease-free survival rates were 89.8% in the colon (stage I, 100%; stage II, 97.7%; stage III, 74.2%) and 74.5% in the rectum (stage I, 90.0%; stage II, 83.9%; stage III, 59.2%). CONCLUSION: Laparoscopic surgery for colorectal cancer is a good alternative method to open surgery with tolerable oncologic long-term results.
Colon ; Colorectal Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Prospective Studies ; Rectal Neoplasms ; Rectum ; Recurrence ; Survival Rate

BACKGROUND: The impact of institutional case volume to graft failure rate after adult kidney transplantation is relatively unclear compared to other solid organ transplantations. METHODS: A retrospective cohort study of 13,872 adult kidney transplantations in Korea was performed. Institutions were divided into low- (< 24 cases/year), medium- (24–60 cases/year), and high- (> 60 cases/year) volume centers depending on the annual case volume. One-year graft failure rate was defined as the proportion of patients who required dialysis or re-transplantation at one year after transplantation. Postoperative in-hospital mortality and long-term graft survival were also measured. RESULTS: After adjustment, one year graft failure was higher in low-volume centers significantly (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.26–1.78; P < 0.001) and medium-volume centers (aOR, 1.87; 95% CI, 1.57–2.23; P < 0.001) compared to high-volume centers. Low-volume centers had significantly higher mortality (aOR, 1.75; 95% CI, 1.15–2.66; P = 0.01) than that of high-volume centers after adjustment. Long-term graft survival of up to 9 years was superior in high-volume centers compared to low- and medium-volume centers (P < 0.001). CONCLUSION: Higher-case volume centers were associated with lower one-year graft failure rate, lower in-hospital mortality, and higher long-term graft survival after kidney transplantation.
Adult ; Cohort Studies ; Dialysis ; Graft Survival ; Hospital Mortality ; Humans ; Kidney Transplantation ; Kidney ; Korea ; Mortality ; Odds Ratio ; Organ Transplantation ; Retrospective Studies ; Transplants

BACKGROUND: The differences in clinical features are important when differentiating between Alzheimer's disease (AD) and vascular dementia (VD). There have been many studies comparing the severity of progression in both diseases. They have assessed individual symptoms but have not explained the differences and global change of progression comprehensively. We have evaluated the cognitive and non-cognitive functions at the same time and evaluated the differences between AD and VD. METHODS: One hundred and thirty-eight dementia patients from Busan?Gyeongnam Dementia Association outpatient clinics were analyzed. All of the patients underwent the Korean version of the Mini-Mental State Examination (K-MMSE), the expanded version of the Korean Clinical Dementia Rating Scale (CDR), the Korean version of the Neuropsychiatric Inventory (K-NPI), the scales for activity of daily living, and the Short form of the Samsung Dementia Questionnaire (S-SDQ). RESULTS: There were 93 patients with AD and 45 with VD. VD patients revealed more severe Barthel Index of Activity of Daily Living (B-ADL) deficits. AD patients had more severe memory and orientation deficiency in CDR 1 and CDR 2. VD patients revealed much faster decline of K-MMSE score between CDR 2 and CDR 3. CONCLUSIONS: These results suggest that VD patients display more severe B-ADL difficulty, while AD patients display more severe memory difficulty and disorientation. B-ADL progresses in the earlier stages in VD and in the later stages in AD. Global cognitive dysfunction progression is the opposite: in the earlier stages in AD and in the later stages in VD.
Alzheimer Disease* ; Ambulatory Care Facilities ; Dementia ; Dementia, Vascular* ; Humans ; Memory ; Surveys and Questionnaires ; Weights and Measures

BACKGROUND: The burden on caregivers of patients with dementia has an impact on medical, economic, and social areas. However, not enough attention is given to this burden in Korea. There are also very few reports comparing the burden experienced by caregivers of patients with Alzheimer's disease (AD) and vascular dementia (VD). METHODS: One hundred and forty four Alzheimer's and vascular dementia patients were recruited by nine medical centers in the metropolitan city of Busan and the Gyeongnam province. We evaluated the global dementia state of patients in terms of cognitive functions, behavioral and psychological symptoms of dementia, and the activity of daily living along with caregiver burden with the length of care time per day. The Burden Interview, Caregiver Burden Inventory (CBI), Life Satisfaction Index-Z, Beck Depression Inventory, and Beck Anxiety Inventory were conducted by face-to-face interviews with the caregivers. We compared the differences of caregiver burden related to the cause of dementia and according to dementia severity. RESULTS: There were 98 AD patients (68.1%) and 46 VD patients (31.9%). There were 89 females (61.8%) and 55 males (38.2%). Most of the global dementia states did not differ between AD and VD except for the Barthel index (p<0.05). Most of the caregiver burden tests were scored worse in VD. The differences of CBI-time dependent burden and CBI-developmental burden were statistically significant in all the patients (p<0.05). CONCLUSIONS: Our study suggests that VD patients have more caregiver burden than AD patients and that the physical activity of daily living influences caregiver burden.
Alzheimer Disease* ; Anxiety ; Busan ; Caregivers* ; Dementia ; Dementia, Vascular* ; Depression ; Female ; Humans ; Korea ; Male ; Motor Activity

BACKGROUND: Behavioral and psychological symptoms (BPSD) are common in dementia. These may be helpful for clinical differentiation between Alzheimer's disease (AD) and vascular dementia (VD). Most previous studies have reported the prevalence and severity of BPSD regardless of severity of progression. However, we evaluated the differences of BPSD by grading dementia progression and including severe cases only. METHODS: 141 dementia outpatients from clinics of Busan-Gyeongnam Dementia Association in Korea were analyzed. All patients were administered the Korean version of the Neuropsychiatric Inventory (K-NPI), the expanded version of Korean Clinical Dementia Rating Scale (CDR), and the Korean version of Mini-Mental State Examination (K-MMSE). RESULTS: There were 95 patients with AD and 46 patients with VD. AD patients revealed higher frequency of manifested BPSD symptoms and most of subscales showed higher composite scores also. But apathy was more severely and frequently manifested in VD. AD patients had more frequent night-time behavior and aberrant motor symptoms above 3 point in CDR 0.5 and VD patients had more frequent apathy symptom above 3 point in CDR 1. CONCLUSIONS: These results suggest that generally AD patients revealed more frequent and severe BPSDs than VD patients. Apathy was a more dominant symptom in VD. It seemed that some of the symptoms were valuable clues for the differential diagnosis even though a better designed study was required.
Alzheimer Disease* ; Apathy ; Behavioral Symptoms ; Dementia ; Dementia, Vascular* ; Diagnosis, Differential ; Humans ; Korea ; Outpatients ; Prevalence

Background and Objectives: Epidemiological investigations have shown positive correlations between increased diesel exhaust particles (DEP) in ambient air and adverse health outcomes. DEP are the major constituent of particulate atmospheric pollution and have been shown to induce proinflammatory responses both in the lung and systemically. Here, we report the effects of DEP exposure on the properties of human Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs), including stemness, regeneration, and immunomodulation. Methods: and Results: Non-apoptotic concentrations of DEP (10 μg/ml) inhibited the migration and osteogenic differentiation capacity of WJ-MSCs. Gene expression profiling showed that DEP increased intracellular reactive oxygen species (ROS) and expression of pro-inflammatory and metabolic-process-related genes including cFos. Furthermore, WJ-MSCs cultured with DEP showed impaired suppression of T cell proliferation that was reversed by inhibition of ROS or knockdown of cFos. ERK inhibition assay revealed that DEP-induced ROS regulated cFos through activation of ERK but not NF-κB signaling. Overall, low concentrations of DEP (10 μg/ml) significantly suppressed the stemness and immunomodulatory properties of WJ-MSCs through ROS/ERK/cFos signaling pathways. Furthermore, WJ-MSCs cultured with DEP impaired the therapeutic effect of WJ-MSCs in experimental colitis mice, but was partly reversed by inhibition of ROS. Conclusions Taken together, these results indicate that exposure to DEP enhances the expression of pro-inflammatory cytokines and immune responses through a mechanism involving the ROS/ERK/cFos pathway in WJ-MSCs, and that DEP-induced ROS damage impairs the therapeutic effect of WJ-MSCs in colitis. Our results suggest that modulation of ROS/ERK/cFos signaling pathways in WJ-MSCs might be a novel therapeutic strategy for DEP-induced diseases.