This study aimed to investigate the anti-angiogenic effects of the water extract of Pulsatilla koreana (Yabe ex Nakai) Nakai ex T. Mori., Panax ginseng C.A. Meyer and Glycyrrhiza uralensis Fisch (WEPPG).

PURPOSE: This study was done to identify whether pre-conditioning exercise has neuroprotective effects against cerebral ischemia, through enhance brain microvascular integrity. METHODS: Adult male Sprague-Dawley rats were randomly divided into four groups: 1) Normal (n=10); 2) Exercise (n=10); 3) Middle cerebral artery occlusion (MCAo), n=10); 4) Exercise+MCAo (n=10). Both exercise groups ran on a treadmill at a speed of 15 m/min, 30 min/day for 4 weeks, then, MCAo was performed for 90 min. Brain infarction was measured by Nissl staining. Examination of the remaining neuronal cell after MCAo, and microvascular protein expression on the motor cortex, showed the expression of Neuronal Nuclei (NeuN), Vascular endothelial growth factor (VEGF) & laminin. RESULTS: After 48 hr of MCAo, the infarct volume was significantly reduced in the Ex+MCAo group (15.6+/-2.7%) compared to the MCAo group (44.9+/-3.8%) (p<.05), and many neuronal cells were detected in the Ex+MCAo group (70.8+/-3.9%) compared to the MCAo group (43.4+/-5.1%) (p<.05). The immunoreactivity of laminin, as a marker of microvessels and Vascular endothelial growth factor (VEGF) were intensively increased in the Ex+MCAo group compared to the MCAo group. CONCLUSION: These findings suggest that the neuroprotective effects of exercise pre-conditioning reduce ischemic brain injury through strengthening the microvascular integrity after cerebral ischemia.
Animals ; Brain Infarction/pathology ; Disease Models, Animal ; Infarction, Middle Cerebral Artery/metabolism/pathology/*prevention & control ; Laminin/metabolism ; Male ; Microvessels/metabolism ; Neurons/metabolism ; *Physical Conditioning, Animal ; Rats ; Rats, Sprague-Dawley ; Stroke/prevention & control ; Vascular Endothelial Growth Factor A/metabolism

To apply rehabilitation program for stroke patients' functional improvement, various factors such as timing for initiation of rehabilitation, intensity of therapy, and individual compliances should be considered. Both animal and neuroimaging studies suggested that greater intensity of therapy is associated with increased cortical reorganization and subsequent functional recovery, and repetition also may play a major role in inducing and maintaining brain plasticity. However, the proper intensity of rehabilitation therapy has not been well established yet. In this review, we examined the previous studies assessing the effect of intensity and repetition of therapy on functional recovery. From the randomized controlled trials and meta-analysis, increased intensities of treatment and repetitions are shown to be effective in improving activities of daily living and gait function, but limited evidences in functional outcomes of upper extremities. It is difficult to provide standardized optimal intensities and repetitions in clinical practice because of the variability in components of rehabilitation therapies, patients' motivation and participation, the degree of therapists' involvement, and reimbursement and healthcare system. Clinical practice guidelines of US, Europe and Korea recommended that intensive rehabilitation and repetitive task training should be provided to post stroke patients in rehabilitation unit. Further studies are needed to investigate the effective delivery system of rehabilitation program in terms of repetition and intensity.
Activities of Daily Living ; Animals ; Brain ; Delivery of Health Care ; Europe ; Gait ; Humans ; Korea ; Motivation ; Neuroimaging ; Plastics ; Stroke ; Upper Extremity

Pain is often associated with a more rapid progression of cognitive and functional decline, and behavioral disturbance in dementia. Therefore, it is essential to accurately assesses pain for proper intervention in patients with dementia. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale is an excellent behaviour scale which includes most of the domains that are recommended by the American Geriatrics Society to evaluate when assessing pain in patients with dementia. The purpose of this study was to develop the Korean version of the FLACC (K-FLACC) and to verify its reliability and validity in assessing pain of elderly patients with dementia. We developed the K-FLACC to consist of the five domains (face, legs, activity, cry, and consolability) with scores of 0, 1, and 2 for each domain and a total score ranging from 0 to 10 as in the original FLACC. Eighty-eight patients with dementia who visited Konkuk University Medical Center were evaluated. The K-FLACC revealed good validity as compared to the Numeric Rating Scale (NRS; r = 0.617, P < 0.001) and the Face Pain Scale (FPS; r = 0.350, P = 0.001). All of the five domains of the K-FLACC were related to the NRS and FPS, in which the activity domain showed the highest correlation. Test-retest reliability was excellent, as the intra-class correlation coefficient comparing the retest to test was 0.73 (95% confidence interval, 0.59–0.82). Our results show that the K-FLACC is a suitable and valuable scale to assess pain in patients with dementia in Korea.
Academic Medical Centers ; Aged ; Dementia* ; Facial Pain ; Geriatrics ; Humans ; Korea ; Leg* ; Mass Screening ; Reproducibility of Results

OBJECTIVE: The aim of this study was to investigate relationships between cognitive impairment and functional outcomes in stroke patients with spatial neglect. METHOD: Twenty seven right hemisphere ischemic stroke patients who admitted to an inpatient rehabilitation unit were included. Patients were divided into two group based on KF-NAP scores: Neglect group (n=18) and non-neglect group (n=9). Neglect group (n=18) were subdivided into two groups by discharge FIM scores as poor outcome group (n=8, <70) and good outcome group (n=10, ≥70). Cognitive function assessments including attention (Attention & Calculation, Digit span test-Forward), memory (Digit span test-Backward, SVLT-Immediate recalls/Delayed recalls) and visual perception (LOTCA-Visual perception/Visuomotor organization), and stroke severity assessment including NIHSS, FMA, K-MMSE, and FIM were performed. Cognitive impairments and functional outcomes were compared between two groups. RESULTS: There were significant differences in NIHSS, FMA (affected U/E, affected L/E), discharge FIM, FIM gain and LOTCA-visuomotor organization between Neglect group and non- neglect group (p<0.05). Among the patients with spatial neglect, there were significant differences in KF-NAP, K-MMSE and assessment scores of memory and visual perception between poor outcome group and good outcome group. Attention, memory and visual perception were significantly correlated with KF-NAP scores (p<0.05). CONCLUSION: Stroke patients with spatial neglect showed more severe impairment in cognitive, motor and general functional status, which resulted in delayed functional recovery. Spatial neglect patients with combined memory and visual perception impairment may show poor functional outcome.
Humans ; Inpatients ; Memory ; Rehabilitation ; Stroke* ; Visual Perception

Extracellular vesicles (EVs) are sub-micrometer lipid vesicles secreted from parental cells with their information such as DNA, RNA, and proteins. EVs can deliver their cargo to recipient cells and regulate the signaling pathway of the recipient cells to determine their destiny. Depending on the cargo of EVs, the recipient cells can be changed into abnormal state or be relieved from diseases. Therefore, EVs has been spotlighted as emerging therapeutics in biomedical research. However, slow EV secretion rate is the major limitation for the clinical applications of EVs. EV secretion is highly environmental dependent and can be regulated by various stimulants such as chemicals, oxygen levels, pH, radiation, starvation, and culture methods. To overcome the limitation of low productivity of EVs, EV stimulation methods have been widely studied and applied to massive EV productions. Another strategy is the synthesis of artificial EVs from cells by physical methods such as nitrogen cavitation, extrusion via porous membrane, and sonication. These physical methods disrupt cellular membrane and reassemble the membrane to lipid vesicles containing proteins or drugs. In this review, we will focus on how EV generation can be enhanced and recent advances in large scale EV generation strategies.

Extracellular vesicles (EVs) are sub-micrometer lipid vesicles secreted from parental cells with their information such as DNA, RNA, and proteins. EVs can deliver their cargo to recipient cells and regulate the signaling pathway of the recipient cells to determine their destiny. Depending on the cargo of EVs, the recipient cells can be changed into abnormal state or be relieved from diseases. Therefore, EVs has been spotlighted as emerging therapeutics in biomedical research. However, slow EV secretion rate is the major limitation for the clinical applications of EVs. EV secretion is highly environmental dependent and can be regulated by various stimulants such as chemicals, oxygen levels, pH, radiation, starvation, and culture methods. To overcome the limitation of low productivity of EVs, EV stimulation methods have been widely studied and applied to massive EV productions. Another strategy is the synthesis of artificial EVs from cells by physical methods such as nitrogen cavitation, extrusion via porous membrane, and sonication. These physical methods disrupt cellular membrane and reassemble the membrane to lipid vesicles containing proteins or drugs. In this review, we will focus on how EV generation can be enhanced and recent advances in large scale EV generation strategies.

Femoral neck stress fractures are rare and when treating are difficult to achieve favorable outcomes. This study characterizes outcomes associated with the use of cephalomedullary nails for fixation of Pauwels type-3 vertical femoral neck undisplaced-incomplete insufficiency fractures. Four consecutive patients with a Pauwels type-3 vertical femoral neck tensile insufficiency fracture from 2016 to 2018 were reviewed. Magnetic resonance imaging data revealed tensile visible fracture lines and hip-joint effusions with a high shear angle. For all patients, bone mineral density and vitamin D levels were low; vitamin D therapy was initiated immediately. Surgical procedures were conducted with cephalomedullary nails (Gamma 3 locking nail system; Stryker) under general anesthesia. A cephalomedullary nail appears to be a safe and effective alternative to the use of multiple parallel screws or a sliding hip screw for fixation of vertical femoral neck stress fractures (level of evidence: Level V).

Objective: To evaluate the feasibility of single-shot whole thoracic time-resolved MR angiography (TR-MRA) to identify the feeding arteries of pulmonary arteriovenous malformations (PAVMs) and reperfusion of the lesion after embolization in patients with multiple PAVMs. Materials and Methods: Nine patients (8 females and 1 male; age range, 23–65 years) with a total of 62 PAVMs who underwent percutaneous embolization for multiple PAVMs and were subsequently followed up using TR-MRA and CT obtained within 6 months from each other were retrospectively reviewed. All imaging analyses were performed by two independent readers blinded to clinical information. The visibility of the feeding arteries on maximum intensity projection (MIP) reconstruction and multiplanar reconstruction (MPR) TR-MRA images was evaluated by comparing them to CT as a reference. The accuracy of TR-MRA for diagnosing reperfusion of the PAVM after embolization was assessed in a subgroup with angiographic confirmation. The reliability between the readers in interpreting the TR-MRA results was analyzed using kappa (κ) statistics. Results: Feeding arteries were visible on the original MIP images of TR-MRA in 82.3% (51/62) and 85.5% (53/62) of readers 1 and 2, respectively. Using the MPR, the rates increased to 93.5% (58/62) and 95.2% (59/62), respectively (κ = 0.760 and 0.792, respectively). Factors for invisibility were the course of feeding arteries in the anteroposterior plane, proximity to large enhancing vessels, adjacency to the chest wall, pulsation of the heart, and small feeding arteries. Thirty-seven PAVMs in five patients had angiographic confirmation of reperfusion status after embolization (32 occlusions and 5 reperfusions).TR-MRA showed 100% (5/5) sensitivity and 100% (32/32, including three cases in which the feeding arteries were not visible on TR-MRA) specificity for both readers. Conclusion Single-shot whole thoracic TR-MRA with MPR showed good visibility of the feeding arteries of PAVMs and high accuracy in diagnosing reperfusion after embolization. Single-shot whole thoracic TR-MRA may be a feasible method for the follow-up of patients with multiple PAVMs.

A cross-sectional study was conducted for detecting the risk factors and to propose an effective control program for occupational low back pain. The subjects were 1,665 male production workers employed at a steel factory and a welding material manufacturing factory. The data were collected by a self-reported questionnaire and a medical examination with a rehabilitation specialist for ten days in September, 1997. The contents of the questionnaire were as follows: general characteristics, physical characteristics, employment status, type of work, working environment and the experience of low back pain. The number of cases with symptoms of occupational low back pain were 321, so the point prevalence was 19.3 persons/100 persons. The number of cases with a history of occupational low back pain for one year were 554, so the one year period prevalence was 33.3 persons/100 persons. The point and one year period prevalences of occupational low back pain showed no significant differences in age, marital status, educational level and body mass index. The point and one year period prevalences of occupational low back pain showed no significant differences in alcohol drinking, smoking, stretching exercise and regular exercise. The point and one year period prevalences of occupational low back pain were significantly higher in the unsatisfied group than the satisfied group(p < 0.01), However, no significant differences were found among tenures and shift work. The point and one year period prevalences of occupational low back pain were significantly higher in the lifting of heavy materials group than the nonlifting group(p < 0.01). However, no significant differences were found among posture of the waist and the working posture. Through the multivariate logistic regression, significantly associated factors with occupational low back pain were found to be dissatisfaction with job(point prevalence: OR=1.78, 95% CI: 1.21-2.61; one year prevalence: OR=1.76, 95% CI: 1.26-2.47), lifting of heavy materials(point prevalence: OR=1.94. 95% CI: 1.44-2.61: one year prevalence: OR=2.17, 95% CI: 1.70-2.77) and tenure(point prevalence: OR=1.03. 95% CI: 1.01-1.06: one year prevalence: OR=1.02, 95% CI: 1.00-1.05).
Alcohol Drinking ; Body Mass Index ; Cross-Sectional Studies ; Employment ; Humans ; Lifting ; Logistic Models ; Low Back Pain* ; Male ; Marital Status ; Posture ; Prevalence* ; Questionnaires ; Rehabilitation ; Risk Factors* ; Smoke ; Smoking ; Specialization ; Steel* ; Welding*