OBJECTIVE: To determine the validity and reliability of the Korean version of the Coma Recovery Scale-Revised (K-CRSR) for evaluation of patients with a severe brain lesion. METHODS: With permission from Giacino, the developer of the Coma Recovery Scale Revised (CRSR), the scale was translated into Korean and back-translated into English by a Korean physiatrist highly proficient in English, and then verified by the original developer. Adult patients with a severe brain lesion following traumatic brain injury, stroke, or hypoxic brain injury were examined. To assess the inter-rater reliability, all patients were tested with K-CRSR by two physiatrists individually. To determine intra-rater reliability, the same test was re-administered by the same physiatrists after three days. RESULTS: Inter-rater reliability (k=0.929, p < 0.01) and intra-rater reliability (k=0.938, p < 0.01) were both high for total K-CRSR scores. Inter- and intra-rater agreement rates were very high (94.9% and 97.4%, respectively). The total K-CRSR score was significantly correlated with K-GCS (r=0.894, p < 0.01), demonstrating sufficient concurrent validity. CONCLUSION: K-CRSR is a reliable and valid instrument for the assessment of patients with brain injury by trained physiatrists. This scale is useful in differentiating patients in minimally conscious state from those in vegetative state.
Adult ; Brain ; Brain Injuries ; Coma* ; Consciousness ; Humans ; Persistent Vegetative State ; Reproducibility of Results ; Stroke

OBJECTIVE: To evaluate effects of caregiver's education program on their satisfaction, as well as patient functional recovery, performed in addition to daily conventional rehabilitation treatment. METHODS: Three hundred eleven subjects diagnosed with first-onset stroke and transferred to the Department of Physical Medicine and Rehabilitation of Inha University Hospital were surveyed. In 2015, caregivers attended an education program for acute and subacute stroke patients. Patients who received an additional rehabilitation therapy were assigned to the experimental group (n=81), whereas the control group (n=100) consisted of transfer cases in 2014 with only conventional treatment. The experimental group was classified by severity using the Korean version of the National Institutes of Health Stroke Scale (K-NIHSS), which was administered to all 181 subjects, in addition to, the Korean version of the Mini Mental Status Examination (K-MMSE), a Modified Barthel Index (K-MBI), and the Berg Balance Scale (K-BBS). Caregiver satisfaction and burden before and after education programs were assessed using the Canadian Occupational Performance Measure (COPM), as well as family burden and caregiver burnout scales. RESULTS: No significant intergroup difference was observed between initial K-NIHSS, K-MMSE, K-BBS, K-MBI scores, and times from admission to transfer. Those with moderate or severe strokes under the experimental condition showed a more significant improvement than the control group as determined by the K-NIHSS and K-BBS, as well as tendential K-MMSE and K-MBI score increases. Satisfaction was significantly greater for family members and formal caregivers of patients with strokes of moderate severity in the experimental group. CONCLUSION: The caregiver's education program for stroke subjects had a positive outcome on patients' functional improvement and caregiver satisfaction. The authors believe that the additional rehabilitation therapy with the education program aids patients to achieve functional improvements for an optimal return to social life.
Caregivers ; Education* ; Humans ; Physical and Rehabilitation Medicine ; Rehabilitation* ; Stroke* ; Treatment Outcome ; Weights and Measures

OBJECTIVE: To compare an objective assessment scale for "come-to-sit" in stroke patients with the previously established subjective assessment scales of "performance-based assessment" and the "ability for basic movement scale". METHOD: A specifically designed jacket was used to determine the objective degree of assistance needed for patients to perform the task. While patients were sitting up, the investigator evaluated the amount of assistance needed in a fully dependent state (A) and with maximal effort (B). Using this measure, we obtained an objective scale, {(A-B)/A} x100. In addition, patients were tested in two starting positions: hemiplegic-side lying and sound-side lying. We then compared the objective scale with subjective scales and other parameters related to functional outcomes. RESULTS: For both starting positions, the objective assessment scale showed high correlation with the previously established subjective scales (p<0.01). Only the hemiplegic-side lying-to-sit objective scale showed a significant correlation with the parameters used to assess functional outcomes (p<0.05). In terms of Brunnstrom stages, only the leg stage showed a significant correlation with the objective "come-to-sit" scale (p<0.01). CONCLUSION: The objective scale was comparable to established subjective assessment scales when used by an expert. The hemiplegic-side lying-to-sit maneuver had a high correlation with patient's functional recovery. Specifically, balance and lower extremity function appear to be important factors in the "come-to-sit" activity.
Deception ; Humans ; Leg ; Lower Extremity ; Research Personnel ; Stroke ; Weights and Measures

White fat cells secrete adipokines that induce inflammation and obesity has been reported to be characterized by high serum levels of inflammatory cytokines such as IL-6 and TNF-alpha. Rheumatoid arthritis (RA) is a prototype of inflammatory arthritis, but the relationship between RA and obesity is controversial. We made an obese inflammatory arthritis model: obese collagen-induced arthritis (CIA). C57BL/6 mice were fed a 60-kcal high fat diet (HFD) from the age of 4 weeks and they were immunized twice with type II collagen (CII). After immunization, the obese CIA mice showed higher arthritis index scores and histology scores and a more increased incidence of developing arthritis than did the lean CIA mice. After treatment with CII, mixed lymphocyte reaction also showed CII-specific response more intensely in the obese CIA mice than lean CIA. The anti-CII IgG and anti-CII IgG2a levels in the sera of the obese CIA mice were higher than those of the lean CIA mice. The number of Th17 cells was higher and the IL-17 mRNA expression of the splenocytes in the obese CIA mice was higher than that of the lean CIA mice. Obese CIA mice also showed high IL-17 expression on synovium in immunohistochemistry. Although obesity may not play a pathogenic role in initiating arthritis, it could play an important role in amplifying the inflammation of arthritis through the Th1/Th17 response. The obese CIA murine model will be an important tool when we investigate the effect of several therapeutic target molecules to treat RA.
Adipokines/immunology/metabolism ; Animals ; *Arthritis, Experimental/genetics/immunology/pathology ; Cell Differentiation/genetics/immunology ; *Collagen Type II/administration & dosage/immunology ; Disease Models, Animal ; Gene Expression ; Humans ; Inflammation/chemically induced/*immunology ; Interleukin-17/metabolism ; Interleukin-6/blood ; Joints/immunology/pathology ; Mice ; Mice, Inbred C57BL ; *Obesity/genetics/immunology/pathology ; *Th17 Cells/immunology/metabolism ; Tumor Necrosis Factor-alpha/blood

OBJECTIVE: To evaluate the effect of multiple sensory stimulation on cortical excitability by using transcranial magnetic stimulation (TMS). METHOD: Thirteen right handed young adults without neurological deficit were enrolled. Cortical excitability was tested by measuring recruitment of motor evoked potentials [recruitment curve (RC)], intracortical inhibition (ICI), and intracortical facilitation (ICF) at the abductor pollicis brevis of the dominant hand in two different conditions: (1) group A: active thumb and index finger pinch movement while observing the congruent finger movement in a screen with 0.2 Hz bell sound for 30 minutes, (2) group B: the same active finger movement in a dark screen with the same bell sound for 30 minutes. All of these procedures were done with a randomized crossover design. RESULTS: The amplitude of MEP and the slope of all RC (140%,160% of the resting motor threshold) of group A showed increment after visually-guided finger movement and the level of ICI showed decrement after visually guided finger movement (p<0.05), but there was no change in the level of ICF (p>0.05) in group A. In group B, the amplitude of MEP and the levels of ICI, ICF showed no significant changes following finger movement with no visual guidance (p>0.05), but the slope of RC with 140% showed increment (p<0.05). CONCLUSION: These findings suggest that cortical excitability can be enhanced by simple repetitive motor practice. The congruent sensori-motor stimulations lead to corresponding additional effect on cortical excitability, presumably by recruitment of remote motor neurons.

OBJECTIVE: To evaluate the correlation between the K-BBS (Korean version of Berg balance scale), a tool for assessing balance, with the WISCI (walking index for spinal cord injury), and SCIM (spinal cord independence measure) in patients with post-acute spinal cord injuries. In addition, the difference in the K-BBS, WISCI, SCIM according to the degree of severity of the SEP (somatosensory evoked potential) findings of the posterior tibial nerve was analyzed in these patients. METHOD: Thirty patients with post-acute spinal cord injuries were assessed with the K-BBS, WISCI, and SCIM every other week until discharge. A posterior tibial SEP study was recorded at the beginning of rehabilitation. Delayed latency or small amplitude in the SEP on one or both sides was regarded as the mild group, and non-evoked SEP on both sides was regarded as the severe group. Improvement in walking was based on the change in the scores from admission to discharge. The statistical analysis included the non-parametric Spearman rank correlation and t-test; p<0.05 RESULTS: The assessment scales showed a high correlation between the K-BBS, WISCI, and SCIM (p<0.05). The relationship between the K-BBS and WISCI was specifically strong (r=0.936). Moreover, there was a significant difference in the scores of the K-BBS, WISCI, and SCIM according to the severity of the SEP (p<0.05). CONCLUSION: The findings of a statistical correlation of the K-BBS and the posterior tibial SEP with the WISCI and SCIM provides strong support for their use as outcome measures.
Evoked Potentials, Somatosensory ; Humans ; Outcome Assessment (Health Care) ; Spinal Cord ; Spinal Cord Injuries ; Tibial Nerve ; Walking ; Weights and Measures

The purpose of this study was to investigate the expression of IL-16 in the rheumatoid synovium and the role of inflammatory cytokines and Toll-like receptor (TLR) ligands in IL-16 production by fibroblast- like synoviocytes (FLS) of rheumatoid arthritis (RA) patients. Immunohistochemical staining was performed with a monoclonal antibody to IL-16 in synovial tissues from patients with RA and likewise in patients with osteoarthritis (OA). FLS were isolated from RA synovial tissues and stimulated with IL-15, IL-1beta, IFN-gamma, and IL-17. The IL-16 mRNA level was assessed by semiquantitative RT-PCR and real time (RT) PCR and a comparison was made between IL-16 mRNA levels produced by RA-FLS and OA-FLS. Production of IL-16 was identified by a western blot assay, and IL-16 production after stimulation by specific ligands of TLR2 and TLR4 was assessed by RT-PCR. While immunohistochemical staining demonstrated strong expression of IL-16 mRNA in synovial tissues from patients with RA, similar findings were not present in the OA group. Moreover, mRNA expression of IL-16 by RA-FLS increased after treatment with IL-17 but not with IL-15, IL-1beta, and IFN-gamma. Specifically, IL-17 increased IL-16 mRNA level by RA-FLS and peripheral blood mononuclear cells in a dose-dependent manner. However, IL-17 did not stimulate IL-16 production in OA-FLS. Peptidoglycan, a selective TLR2 ligand, also increased production of IL-16 by RA-FLS dose- dependently, whereas LPS, a selective TLR4 ligand, had no such stimulatory effect. The results from our data demonstrate that IL-17 and TLR2 ligands stimulate the production of IL-16 by RA-FLS.
Arthritis, Rheumatoid/*metabolism ; Base Sequence ; Blotting, Western ; DNA Primers ; Humans ; Immunohistochemistry ; Interleukin-16/*biosynthesis/genetics ; Interleukin-17/*physiology ; RNA, Messenger/genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Toll-Like Receptor 2/metabolism

Spinal subdural hematoma (SDH) is a rare cause of acute spinal cord compression. In most cases, these lesions are observed in association with lumbar puncture or spinal anesthesia, coagulation defect, or an underlying vascular malformation. The use of anticoagulant drug is recommended in managing deep vein thrombosis, acute myocardiac infarct, or acute cerebral infarct. But the risk of bleeding in major organs still exists and is increased by the use of multiple anticoagulants and the intensity of anticoagulation. The risk of spinal hematoma is increased in anticoagulated patients who undergo lumbar puncture or spinal anesthesia. But to dates, there are extremely rare cases of spontaneous spinal SDH occurring in patients with anticoagulant therapy when spinal instrumentation is not also being used. With reviewing some of literatures, we present a case of acute spontaneous spinal SDH developed whilereceiving anticoagulant therapy for treating acute cerebral infarct.
Anesthesia, Spinal ; Anticoagulants ; Chronology as Topic ; Hematoma ; Hematoma, Subdural, Spinal ; Hemorrhage ; Humans ; Spinal Cord Compression ; Spinal Puncture ; Vascular Malformations ; Venous Thrombosis

Primary renal lymphoma is a controversial entity and extremely rare disease, possibly due to the fact that the kidney is one of the extranodal organs usually not containing lymphoid tissue. It is unclear if this conditions can be diagnosed preoperatively with imaging studies. In most cases the diagnosis is made after removal or biopsy of a kidney for suspected primary renal tumor or at autopsy. Treatment usually consists of surgery and chemotherapy with or without radiation therapy and the prognosis is poor. We report a case of primary renal lymphoma presenting with fever in a 13-month- old boy who was treated with surgical intervention and combination chemotherapy.
Autopsy ; Biopsy ; Child* ; Diagnosis ; Drug Therapy ; Drug Therapy, Combination ; Fever ; Humans ; Kidney ; Lymphoid Tissue ; Lymphoma* ; Male ; Prognosis ; Rare Diseases