The endocrinologic complications such as adrenal insufficiency and hypopituitarism are common after traumatic brain injury (TBI) portending poor rehabilitation outcome. Anterior pituitary dysfunction presents as hypothyroidism, hypogonadism, growth hormone deficiency, adrenal insufficiency and hyperprolactinemia, whereas posterior pituitary dysfunction includes syndrome of inappropriate antidiuretic hormone and central diabetes insipidus. Careful history taking and physical examination are essential to detect these abnormalities early. Laboratory tests such as serum/urine sodium and osmolality, thyroid hormone, testosterone, estradiol, cortisol, prolactin, growth hormone or IGF-1 are also necessary. Screening of endocrinologic functions is recommended especially in patients with moderate or severe TBI, skull base fracture or diffuse axonal injury 3 to 6 months after injury. Further studies are needed to reveal the effect of early correction of endocrinologic abnormality on long-term functional outcome.
Adrenal Insufficiency ; Brain Injuries ; Diabetes Insipidus, Neurogenic ; Diffuse Axonal Injury ; Endocrine System Diseases ; Estradiol ; Growth Hormone ; Humans ; Hydrocortisone ; Hyperprolactinemia ; Hypogonadism ; Hypopituitarism ; Hypothyroidism ; Insulin-Like Growth Factor I ; Mass Screening ; Osmolar Concentration ; Physical Examination ; Prolactin ; Skull Base ; Sodium ; Testosterone ; Thyroid Gland ; Treatment Outcome

The final degrees of education for the third and fourth authors were mutually misplaced.

The development of medical and device treatment of heart failure (HF) has improved the survival and quality of life in HF patients. However, not all HF patients respond well to these up-to-date HF treatments. We have termed these non-responders as advanced HF patients. The definition, diagnosis, and treatment of advanced HF are discussed in this review article.Current Concepts: After current guideline-directed treatments, advanced HF patients can experience aggravation and decompensation, usually resulting in hospitalization for the symptoms and volume control. Recurrent decompensation or hospitalization can cause a vicious cycle between the heart and other vital organs, such as the kidney and liver. Current and up-to-date guidelines recommend treatments, including heart transplant, left ventricular assist device (LVAD), and hospice care, for advanced HF. Given the limitation of heart transplant donors, LVAD can be used as a bridge to transplant, in addition to destination therapy. Updated LVAD system can reduce pump-related thrombosis, stroke, and bleeding.Discussion and Conclusion: Current guidelines suggest early recognition of advanced HF and referral to advanced HF specialists. Despite advances in the treatments of advanced HF, unmet needs for further improving clinical outcomes and quality of life exist.

BACKGROUND: In 2005, the Korean Red cross introduced mini-pool nucleic acid testing (NAT) for human immunodeficiency virus (HIV) and hepatitis C virus (HCV), which upgraded to individual donation (ID) NAT including HBV in 2012. In this study, we analyzed the trend of HCV infection among blood donors after introduction of NAT by estimating the residual risk (RR) of transfusion transmitted infection (TTI) of HCV. METHODS: Donation data from 2003 to 2014 were analyzed using the Blood Information Management System (BIMS). Each donation was tested for antibodies and viral RNA for HCV. Prevalence and incidence rate (IR) among repeat donors were determined. RR was determined using the incidence rate/window period model. RESULTS: During the 12-year period, a total of 29,058,436 donations were screened with 34 HCV NAT yield donations. Calculated RR per million donations for HCV was significantly reduced from 13.41 in the pre-NAT period (2003~2004) to 0.52 in the post NAT period (2006~2007) (P<0.001). Most recently (2013~2014), RR for HCV with TTI was estimated by 0.16 per million donations (1:6,289,308). CONCLUSION: RR of TTI with HCV was remarkably decreased since introduction of NAT. However, the prevalence and IR of HCV RNA among first time donors was still high and yield cases were more frequent among repeat donors. Therefore, establishment of a sensitive and accurate screening system and measures for maintaining healthy donors should be considered in order to ensure blood safety.
Antibodies ; Blood Donors ; Blood Safety ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; HIV ; Humans ; Incidence ; Information Management ; Korea* ; Mass Screening ; Prevalence ; Red Cross ; RNA ; RNA, Viral ; Tissue Donors

OBJECTIVE: To investigate the effect of repetitive magnetic stimulation (rMS) of the spinal cord on limb angiogenesis in healthy rats and explore its implication for the treatment of lymphedema. METHOD: Twelve adult male Sprague-Dawley rats were divided into four groups as follows: sham rMS followed by tissue harvest 5 minutes later (group 1, n=2), 1 Hz rMS and tissue harvest 5 minutes later (group 2, n=3), 20 Hz rMS and tissue harvest 5 minutes later (group 3, n=3), 20 Hz rMS and tissue harvest 30 minutes later (group 4, n=4). Animals were treated with 20-minute rMS with 120% of the motor threshold on their left side of upper lumbar spinal cord. Expression of angiogenic factors, that is, Akt, phospho-Akt (pAkt), endothelial nitric oxide synthase (eNOS), phospho-eNOS (p-eNOS) were measured by western blot. Bilateral hindlimb muscles (quadriceps and gastrocnemius) were harvested. RESULTS: Expression of Akt in left quadriceps increased in group 4 compared with group 2 and 3 (3.4 and 5.3-fold each, p=0.026). Expression of eNOS in left plus right quadriceps markedly increased in group 3 and 4 compared with group 1 and 2 (p=0.007). Expressions of eNOS, Akt and p-eNOS, pAkt in gastrocnemius were not comparable between four groups (p>0.05). CONCLUSION: Repetitive magnetic stimulation of the spinal cord may exert an angiogenic effect closely linked to lymphangiogenesis. It has clinical implication for the possible therapy of lymphedema caused by breast, cervical or endometrial cancer operation. Future studies with the specific lymphatic endothelial cell markers are required to confirm the effect of rMS on lymphangiogenesis.
Adult ; Angiogenesis Inducing Agents ; Animals ; Blotting, Western ; Breast ; Endometrial Neoplasms ; Endothelial Cells ; Extremities ; Female ; Hindlimb ; Humans ; Lymphangiogenesis ; Lymphedema ; Magnetics ; Magnets ; Male ; Muscles ; Nitric Oxide Synthase Type III ; Pilot Projects ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Spinal Cord

OBJECTIVE: To investigate the effects of short-term robot-assisted upper limb training on hemiplegic patients compared to conventional physical therapy. METHOD: This study was a prospective, single-blinded, randomized controlled trial. Eighteen hemiplegic patients due to brain lesions were randomly assigned to: (1) robot-assisted upper limb training and conventional upper limb physical therapy for 30 min a day, respectively (Robot group); or (2) conventional upper limb physical therapy for 30 min twice a day (Conventional group). All interventions were provided for 2 weeks, 5 times a week. Each patient was evaluated at pre- and post-treatment by the Fugl-Meyer assessment-upper extremity (FMA-UE), Jebsen hand function test (JHFT), grip power, modified Barthel index-upper extremity (MBI-UE), line bisection test, and Albert test. RESULTS: The Robot group showed significant improvement in FMA-UE (pre: 13.22 +/- 14.20, post: 21.67 +/- 15.84; p = 0.018), MBI-UE (pre: 14.33 +/- 7.42, post: 16.56 +/- 6.95; p = 0.041), and line bisection test (pre: 25.15 +/- 34.48, post: 14.93 +/- 28.38; p = 0.043). The Conventional group showed significant improvement only in MBI-UE (pre: 9.22 +/- 6.06, post: 15.56 +/- 6.19; p = 0.008). The improvement in MBI-UE was larger in the Conventional group than Robot group (6.33 +/- 3.28 vs. 2.22 +/- 2.49; p = 0.014). CONCLUSION: This study suggests that short-term robot-assisted upper limb training may improve upper limb function in hemiplegic patients. However, proper physical therapy may be needed to transfer improved upper limb function to activity of daily living. In addition, goal-directed reaching tasks using a robot are expected to be a treatment option for hemineglect.
Brain ; Extremities ; Hand ; Hand Strength ; Hemiplegia ; Humans ; Perceptual Disorders ; Prospective Studies ; Rehabilitation ; Robotics ; Upper Extremity*