PURPOSE: The purpose of this study was to identify factors influencing psychosocial well-being in family caregivers of patients with amyotrophic lateral sclerosis (ALS). METHODS: A descriptive correlational design was used. The transactional model of stress and coping was used to investigate the psychosocial well-being of 137 family caregivers of patients with ALS. Data were collected through self-reported questionnaires from January to November 2016. Data were analyzed using an independent t-test, one-way ANOVA, Pearson's correlation, and hierarchical multiple regression analysis with the SPSS WIN 21.0 program. RESULTS: The regression model had an adjusted R2 of .49, which indicated that meaning-focused coping, social support, ALS patient-family caregiver relationship (especially a spousal relationship), and tracheostomy were significant predictors of caregivers' psychosocial well-being. CONCLUSION: Meaning-focused coping and social support significantly influenced caregivers' psychosocial well-being. Therefore, interventions to improve caregivers' psychosocial well-being must focus on increasing meaning-focused coping and social support resources.
Adaptation, Psychological ; Amyotrophic Lateral Sclerosis* ; Caregivers* ; Humans ; Social Adjustment ; Tracheostomy

PURPOSE: The aim of this study is to examine a path model on the relationship among social capital, physical activity and subjective health status in the community indwelling elderly. METHODS: The study was conducted utilizing the 2014 Seoul Survey, in the method of analyzing cross-sectional design and secondary data. Among 45,497 participants in total, the data of 4578 adults aged 65 or above was analyzed. Social capital was measured by social trust and social participation. Physical activity was measured by regular exercise. Additionally, a numerical rating scale was used to assess subjective health status. The data were analyzed using descriptive statistics, Pearson's correlation coefficients and path analysis. RESULTS: Social participation and physical activity showed a direct effect on subjective health status in community indwelling elderly while social trust and physical activity showed an indirect effect on their subjective health status. The hypothetical path model of community indwelling elderly's subjective health status was proved correct. CONCLUSION: Findings from this study indicate that health-promoting intervention for community indwelling elderly should consider social trust and participation.
Adult ; Aged ; Diagnostic Self Evaluation ; Humans ; Methods ; Motor Activity ; Seoul ; Social Capital ; Social Participation

A proportion of patients experience acute or even prolonged cognitive impairment after surgery, a condition known as postoperative cognitive dysfunction (POCD). It is characterized by impairment in different cognitive domains and neuroinflammation has been implicated as one of the inciting factors as strategies targeting inflammation tend to improve cognitive performance. Siegesbeckia Orientails L. (S. Orientails) is a common Chinese medicinal herb used for managing chronic inflammatory diseases. We investigated if pretreatment with S. Orientails before surgery confers any neuroprotective effects in postoperative animals in terms of reducing inflammation and mitigating cognitive impairment. Three-month-old male C57BL/6N mice were fed different doses of S. Orientails extract for 14 days before they underwent a laparotomy. After cognitive testing they were sacrificed on postoperative day (POD) 3. Our results showed that animals with extract pretreatment demonstrated memory improvement in a dose-dependent manner compared with control. Further, evidence for the attenuation of systemic and neuroinflammation was found in the pretreated animals, along with the inhibition of inflammatory pathways and significantly reduced tau phosphorylation in the hippocampus. Taken together, these results demonstrated a neuroprotective effect of S. Orientails in postoperative animals, indicating a therapeutic potential of S. Orientails in minimizing POCD and the possibility of utilizing this traditional Chinese medicine perioperatively.
Animals ; Asian Continental Ancestry Group ; Cognition Disorders ; Hippocampus ; Humans ; Inflammation* ; Laparotomy ; Male ; Medicine, Chinese Traditional ; Memory ; Mice ; Neuroprotective Agents ; Phosphorylation ; Plants, Medicinal

BACKGROUND/AIMS: Because there is a lack of effective biomarkers, we aimed to discover proteomic candidate markers for hepatocellular carcinoma (HCC) in cirrhotic patients at the highest-risk of HCC, and to validate the markers. METHODS: We collected tumor tissue from 5 cirrhotics with HCC, and from 5 cirrhotics without HCC, who underwent liver resection or transplantation. These tissue samples were analyzed by 2-dimensional difference gel electrophoresis coupled with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and potential markers were validated at the transcriptional and translational levels. We also performed western blot assays using other blood samples from 10 cirrhotics with HCC and 10 without HCC. RESULTS: Among the 66 distinguishable spots on 2-D gel images, we identified 15 proteins overexpressed more than 1.5 fold in terms of volume ratio in the tumors. Ten of the over-expressed proteins were identified by MALDI-TOF MS; of those, only methionine adenosyltransferase 1 (MAT1), a protein specific for liver, and acyl-CoA dehydrogenase were significantly up-regulated in tumors in further immunoblotting analyses (Ps<0.05). There was no between-pair difference in MAT1 mRNA measured by real-time polymerase chain reaction (P=0.96). However, in western blots of serum samples, distinct MAT1 bands were observed in all 10 HCC patients, but in only 2 of the non-HCC patients. CONCLUSIONS: MAT1 is a potential marker for surveillance in cirrhotic patients with and without prior HCC.
Acyl-CoA Dehydrogenase ; Biomarkers ; Blotting, Western ; Carcinoma, Hepatocellular ; Humans ; Immunoblotting ; Liver ; Liver Cirrhosis ; Mass Spectrometry ; Methionine Adenosyltransferase ; Methionine ; Proteomics ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Two-Dimensional Difference Gel Electrophoresis

PURPOSE: The aims of this study were to investigate the prevalence of upper tract involvement in ketamine-associated uropathy, and to determine the predictors of hydronephrosis in patients with a history of ketamine abuse. METHODS: This was a cross-sectional study of a prospective cohort of patients with ketamine-associated uropathy. Data including demographics, pattern of ketamine abuse, pelvic pain and urgency or frequency (PUF) symptom score, uroflowmetry (UFM) parameters, serum renal function, and liver function tests were collected. Upon consultation, ultrasonography was performed to assess the function of the urinary system. RESULTS: From December 2011 to October 2015, we treated 572 patients with ketamine-associated uropathy. Of these patients, 207 (36.2%) had managed to achieve abstinence at the time of their first consultation. Ninety-six patients (16.8%) in the cohort were found to have hydronephrosis on ultrasonography. Univariate analysis identified age, duration of ketamine abuse, PUF symptom score, voided volume on UFM, serum creatinine levels >100 μmol/L, and an abnormal serum liver enzyme profile as factors associated with hydronephrosis. Logistic regression revealed the following parameters to be statistically related to hydronephrosis: age (adjusted odds ratio [OR], 1.090; 95% confidence interval [CI], 1.020–1.166; P=0.012), functional bladder capacity (adjusted OR, 0.997; 95% CI, 0.995–0.999; P=0.029), serum creatinine >100 μmol/L (adjusted OR, 3.107; 95% CI, 1.238–7.794; P=0.016, and an abnormal serum liver enzyme profile (adjusted OR, 1.967; 95% CI, 1.213–3.187; P=0.006). CONCLUSIONS: Ketamine-associated uropathy can involve the upper urinary tract. Patient demographics as well as investigations of UFM, renal function tests, and liver function tests may allow us to identify at-risk patients.
Cohort Studies ; Creatinine ; Cross-Sectional Studies ; Cystitis ; Demography ; Humans ; Hydronephrosis ; Ketamine ; Liver ; Liver Function Tests ; Logistic Models ; Lower Urinary Tract Symptoms ; Odds Ratio ; Pelvic Pain ; Prevalence ; Prospective Studies ; Ultrasonography ; Urinary Bladder ; Urinary Tract* ; Urination Disorders

OBJECTIVE: Sleep disturbance is common in the elderly, which is result from multi-factorial causes encompassing socio-demographic, behavioral, and clinical factors. We aimed to identify factors associated with insomnia among the elderly in a rural community in South Korea, a country with a rapidly growing aged population. METHODS: This cross-sectional study used the data from the second wave of the Korean Social life, Health and Ageing Project, which is a cohort study of individuals living in a typical rural community in South Korea. Socio-demographic, behavioral, and clinical characteristics were obtained through face-to-face interviews. Various factors suspected to be associated with insomnia were compared between elderly participants with and without insomnia, and multiple logistic regression analyses were conducted to identify independent risk factors for insomnia. RESULTS: We found that 32.4% of 509 participants (72.8±7.7 years old) had insomnia. Female sex [odds ratio (OR)=2.19], low education level (OR=2.44), current smoking (OR=2.26), number of chronic diseases (OR=2.21 for 2–3 chronic diseases; OR=2.06 for 4 or more chronic diseases), and depression (OR=2.53) were independently associated with insomnia. CONCLUSION: We found that sex, education, chronic disease, and depression independently increase the risk of insomnia of the elderly in a Korean rural community. To overcome the elderly's insomnia, interventions should target modifiable factors such as depression. To promote active aging, longitudinal studies of factors associated with insomnia among the elderly should be performed in different regions and communities.
Aged* ; Aging ; Chronic Disease ; Cohort Studies ; Cross-Sectional Studies ; Depression ; Education ; Female ; Humans ; Korea ; Logistic Models ; Longitudinal Studies ; Republic of Korea ; Risk Factors ; Rural Population* ; Sleep Initiation and Maintenance Disorders* ; Smoke ; Smoking

BACKGROUND: Malnutrition is common in elderly patients with cancer and is associated with many adverse clinical outcomes, including longer length of hospital stay (LOS), muscle loss, and various postsurgical complications. In particular, elderly patients with hepatocellular carcinoma have a high risk for malnutrition, which is associated with mortality and reduced quality of life. Therefore, we evaluated the association between nutritional status and the LOS after hepatectomy for the treatment of hepatocellular carcinoma in elderly patients. METHODS: A retrospective study was conducted on 66 patients aged ≥65 years admitted consecutively from January 2010 to December 2014 for elective surgery to treat hepatocellular carcinoma. The Geriatric Nutritional Risk Index (GNRI) was applied for the assessment of nutritional risk in hospitalized elderly patients before surgery. RESULTS: The association between several factors that have been identified to influence outcomes and the LOS were evaluated by using multiple regression analysis. We found that only the GNRI was associated with the LOS. CONCLUSION: Our study shows that identifying nutritional risk using the GNRI before elective surgery is associated with increased risk of prolonged LOS. Therefore, prospective research based on GNRI can serve as a valuable resource for evaluating nutritional status of elderly patients under various clinical circumstances. Moreover, this particular research allows us to establish new ways of reducing the length of hospital stay for patients who underwent hepatic resection.
Aged* ; Carcinoma, Hepatocellular ; Hepatectomy* ; Humans ; Length of Stay* ; Malnutrition ; Mortality ; Nutrition Assessment ; Nutritional Status ; Prospective Studies ; Quality of Life ; Retrospective Studies

We report a 32 year-old Chinese lady with history of tetralogy of Fallot, presented to us with chest pain due to hypocalcemia secondary to hypoparathyroidism. With her dysmorphic facial features and intellectual disability 22q11.2 deletion was suspected and confirmed by genetic study. Clinicians should consider the diagnosis of DiGeorge syndrome in adult patient with past medical history of congenital heart disease, facial dysmorphism, intellectual disability and primary hypoparathyroidism.
Adult ; Delayed Diagnosis ; DiGeorge Syndrome ; diagnosis ; genetics ; Female ; Humans ; Hypocalcemia ; diagnosis ; genetics

PURPOSE: Pain or discomfort caused by foot diseases may lead to abnormal gait, resulting in decreased bone mineral density (BMD) of the affected lower limb. We analyzed the effect of foot affection to BMD and its clinical significance. MATERIALS AND METHODS: Bilateral hip BMD was evaluated in 93 patients with unilateral chronic foot disease. To minimize statistical errors, we excluded patients with medical histories that had influence on BMD. Analysis was based on the results of BMD tests at the first visit. All patients denied past medical intervention for osteoporosis. The difference in density between bilateral limbs was determined by comparing BMDs of the neck, upper neck, trochanter and total area of hip. RESULTS: Test results revealed the decrease of BMD in the lower limb with the affected foot, compared to the unaffected side. This decrease was significant in the area of the trochanter (p<0.05). There was no marked difference of BMD in relation with duration of affection, underlying disease or age. Pertaining the location of foot affection, the hindfoot group showed significant decrease in BMD compared to the forefoot group. The group with affection in bone and joint also showed a marked decrease in BMD compared to the soft tissue group (p<0.05). CONCLUSION: Pain and discomfort caused by chronic foot diseases can lead to a decrease in the BMD of the affected lower limb. This may increase the risk of complications such as osteoporotic fracture and muscular atrophy.
Bone Density ; Bone Diseases, Metabolic ; Extremities ; Femur ; Foot ; Foot Diseases ; Gait ; Hip ; Humans ; Joints ; Lower Extremity ; Muscular Atrophy ; Neck ; Osteoporosis ; Osteoporotic Fractures

PURPOSE: The aim of this study was to evaluate the result of combined first metatarsal and calcaneal osteotomy for static cavovarus deformity of the foot. MATERIALS AND METHODS: We performed a dorsal closing wedge 1st metatarsal osteotomy and a lateral and upward displacement calcaneal osteotomy for 9 patients, 12 feet (6 male and 3 female). The mean age at the time of operation was 37 years and the mean followup period was 27 months. The causes of deformity were 2 poliomyelitis, 1 cerebral palsy, 1 Charcot-Marie-Tooth disease and 5 idiopathic type. Five lateral ligament reconstructions of the ankle and six percutaneous Achilles tendon lengthenings were added. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of AOFAS ankle-hindfoot score and talo-1st metatarsal, calcaneus-1st metatarsal and calcaneal pitch angles were checked with weight bearing radiographs in lateral projection. RESULTS: Talo-1st metatarsal and calcaneal pitch angles were reduced from the mean preoperative values of 21degrees and 25degrees to 12degrees and 19degrees, respectively, at last followup. Also, calcaneus-1st metatarsal angle was increased from the mean 114degrees to 144degrees. The mean AOFAS score was improved from 44.5 points preoperatively to 89.2 points at followup. There were 1 metatarso-cueiform joint nonunion, 1 sural nerve injury and 3 remaining symptomatic claw toes. CONCLUSION: Combined first metatarsal and calcaneal osteotomy appears to be an effective procedure for the treatment of adult static cavovarus foot.
Achilles Tendon ; Adult ; Animals ; Ankle ; Cerebral Palsy ; Charcot-Marie-Tooth Disease ; Collateral Ligaments ; Congenital Abnormalities ; Displacement (Psychology) ; Follow-Up Studies ; Foot ; Hoof and Claw ; Humans ; Joints ; Male ; Metatarsal Bones ; Organic Chemicals ; Osteotomy ; Poliomyelitis ; Sural Nerve ; Weight-Bearing