“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. Good Practice Point was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.
Canada ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

"Clinical Practice Guideline for Stroke Rehabilitation in Korea 2012" is a 2nd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 1st edition published in 2009. After 1st stroke rehabilitation CPG, many studies concerning stroke rehabilitation have been published and the necessity for update has been raised. The Korea Centers for Disease Control and Prevention supported the project "Development of Clinical Practice Guideline for Stroke Rehabilitation" in 2012. Thirty-two specialists in stroke rehabilitation from 18 universities and 3 rehabilitation hospitals and 10 consultants participated in this project. The scope of this CPG included both ischemic and hemorrhagic stroke from the acute to chronic stages. The purpose of this CPG is to provide guidelines for doctors and therapists to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. "Clinical Practice Guideline for Stroke Rehabilitation in Korea 2012" consists of 'Chapter 1; Introduction of Stroke Rehabilitation', 'Chapter 2; Rehabilitation for Stroke Syndrome, 'Chapter 3; Rehabilitation for Return to the Society', and 'Chapter 4; Advanced Technique for Stroke Rehabilitation'. Both the adaptation and de novo development methods were used to develop this 2nd edition of CPG. The appraisal of foreign CPGs was performed using 'Korean appraisal of guidelines for research and evaluation II' (K-AGREE II); moreover, four CPGs from Scotland (2010), Austrailia (2010), USA (2010), Canada (2010) were chosen for adaptation. For de novo development, articles that were published following the latest foreign CPGs were searched from the database system, PubMed, Embase, and Cochrane library. Literatures were assessed in the aspect of subjects, study design, study results' consistency, language and application possibility in the Korean society. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. GPP (Good Practice Point) was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised.
Canada ; Centers for Disease Control and Prevention (U.S.) ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

BACKGROUND: CD4(+)CD25(high+)regulatory T cells (Tregs) are considered to be of vital importance for maintaining immunologic self-tolerance and preventing autoimmune diseases. These cells have been found to be deficient in skin lesions and in the peripheral blood of patients with psoriasis. OBJECTIVE: To investigate the role of Tregs in the pathogenesis of psoriasis and to evaluate the changes in Tregs in relation to the severity and the clinical course of psoriasis. METHODS: Immunohistochemistry (CD3, 4, 8, 79 and FOXP3) was performed in 22 psoriatic patients compared to 5 normal controls. Flow cytometry (CD3, 4, 8, 25 and FOXP3) was performed in 18 psoriatic patients and 8 normal volunteers and reverse transcriptase polymerase chain reaction (foxp3 mRNA) was performed in 8 psoriasis patients. RESULTS: An increase in the FOXP3(+) cell fraction was detected in the lesional psoriatic skin irrespective of the severity of psoriasis as compared with the normal skin. However, a decrease in FOXP3(+) cells was observed in the samples obtained from psoriasis of 'acute course'. FOXP3(+) Treg populations in the blood of the 'acute course' psoriasis was not different compared to that of 'chronic course' psoriasis and normal controls. CONCLUSION: The deficiency of FOXP3(+) Tregs in the lesional psoriatic skin might be responsible for the exacerbation of psoriasis.
Autoimmune Diseases ; Flow Cytometry ; Humans ; Immunohistochemistry ; Psoriasis ; Reverse Transcriptase Polymerase Chain Reaction ; Skin ; T-Lymphocytes ; T-Lymphocytes, Regulatory

BACKGROUND: Angioimmunoblastic T-cell lymphoma (AITL) is a complex lymphoproliferative disorder and often mimics a viral infection with frequent skin involvement. Epstein-Barr virus (EBV) and human herpes virus (HHV)-6 are reported to be associated with AITL, but there are conflicting results. OBJECTIVE: We evaluated the association of EBV and HHV-6 with AITL. METHODS: We reviewed the clinical, histological and immunophenotypical features of 19 cases of AITL. Among them, 11 lymph node biopsies of AITL were examined for HHV-6, -7, and -8 by polymerase chain reaction (PCR) using virus-specific primers. In situ hybridization of EBV early region RNA (EBER) was performed and T cell receptor (TCR) gene rearrangement was also investigated in some cases. RESULTS: Among these 19 cases, maculopapular, plaque or nodular skin lesions accompanied AITL in 12 cases. Clonal TCR gene rearrangement was seen in 8/9 cases tested. EBER in situ hybridization was positive in 8 cases (57.1%). Among 7 cases with skin biopsies, five cases were consistent with cutaneous involvement of AITL, 1 case was a drug eruption, and the other case was Kaposi's sarcoma. Except a HHV-8 (+) case who also had Kaposi's sarcoma, all of these cases were negative for HHV-6, -7 and -8. CONCLUSION: Skin manifestation seems to be a cardinal component of AITL, be it in the context of presentation, progression or recurrent disease. Recognition of clinicopathological features of skin lesions in AITL as diagnostic clues should be stressed among dermatologists. The lack of HHV-6, -7 and -8 in lymph node biopsy of AITL argues against a pathogenic role for HHVs in AITL.
Biopsy ; Drug Eruptions ; Gene Rearrangement ; Genes, T-Cell Receptor ; Herpesvirus 4, Human ; Herpesvirus 6, Human ; Herpesvirus 8, Human ; Humans ; In Situ Hybridization ; Lymph Nodes ; Lymphoma, T-Cell ; Lymphoproliferative Disorders ; Polymerase Chain Reaction ; Receptors, Antigen, T-Cell ; RNA ; Sarcoma, Kaposi ; Skin ; Skin Manifestations ; Viruses

Discovery of Helicobacter (H.) pylori has led to a fundamental change in our understanding of gastric diseases in humans. Previous studies have found various Helicobacter spp. in dogs and cats, and pets have been questioned as a zoonotic carrier. The present study surveyed the Helicobacter infections and investigated the presence of H. felis and H. pylori infections in domestic and feral cats in Korea. Sixty-four domestic cats and 101 feral cats were selected from an animal shelter. Saliva and feces were evaluated by Helicobacter genus-specific polymerase chain reaction (PCR). Genus-specific PCR positive samples were further evaluated for H. felis and H. pylori using specific primer pairs. Thirty-six of 64 (56.3%) samples from domestic cats and 92 of 101 (91.1%) samples from feral cats were PCR positive; the positive rate of feces samples was higher than that of saliva samples in both groups. H. felis and H. pylori species-specific PCR was uniformly negative. The prevalence of Helicobacter spp. in feral cats was approximately two-fold higher than that of domestic cats. The fecal-oral route may be more a common transmission route not only between cats but also in humans.
Animals ; Cat Diseases/*epidemiology ; Cats ; DNA, Bacterial/genetics ; Feces/microbiology ; Helicobacter Infections/epidemiology/microbiology/*veterinary ; Helicobacter felis/genetics/isolation & purification ; Helicobacter pylori/genetics/isolation & purification ; Korea/epidemiology ; Polymerase Chain Reaction/veterinary ; Saliva/microbiology ; Species Specificity

Skeletal muscle contains several precursor cells that generate muscle, bone, cartilage and blood cells. Although there are reports that skeletal muscle-derived cells can trans-differentiate into neural-lineage cells, methods for isolating precursor cells, and procedures for successful neural induction have not been fully established. Here, we show that the preplate cell isolation method, which separates cells based on their adhesion characteristics, permits separation of cells possessing neural precursor characteristics from other cells of skeletal muscle tissues. We term these isolated cells skeletal muscle-derived neural precursor cells (SMNPs). The isolated SMNPs constitutively expressed neural stem cell markers. In addition, we describe effective neural induction materials permitting the neuron-like cell differentiation of SMNPs. Treatment with retinoic acid or forskolin facilitated morphological changes in SMNPs; they differentiated into neuron-like cells that possessed specific neuronal markers. These results suggest that the preplate isolation method, and treatment with retinoic acid or forskolin, may provide vital assistance in the use of SMNPs in cell-based therapy of neuronal disease.
Animals ; Antigens, Differentiation/metabolism ; Cell Adhesion ; *Cell Differentiation ; Cell Lineage ; Cell Separation ; Cells, Cultured ; Forskolin/pharmacology ; Mice ; Mice, Inbred ICR ; Muscle, Skeletal/*cytology/metabolism ; Neurons/*cytology/metabolism ; Stem Cells/*cytology/metabolism ; Tretinoin/pharmacology

BACKGROUND: Cyclosporine effectively suppresses immune responses and inhibits skin homing T cell responses in psoriasis. E-selectin is known to be up-regulated on vascular endothelium of inflammatory skin lesions such as psoriasis. PURPOSE: Based on our previous study that cyclosporine decreased lesional cutaneous lymphocyte antigen (CLA)+ T cells in psoriatic patients, we tried to find any change of CLA+ T cells in peripheral blood in psoriatic patients, since psoriasis is a disease of systemic T cell activation. Subjects and Methods: Peripheral blood of 8 patients with chronic plaque type psoriasis at 0, 3, 6, 12, 18 weeks after cyclosporine was examined by flow cytometry using anti-CLA antibody. Five skin biopsy samples at 0, 3, 6, 12, 18 weeks were immunohistochemically stained with anti E-selectin antibody. RESULTS: Our results demonstrate that the number of CD3+ CLA+ and CD4+CLA+ T cells was significantly reduced in the peripheral blood at week 3, but gradually increased to the level of baseline at 18 weeks. In psoriatic skin lesions, with decrease of PASI score and CLA+ T cells number, the expression of E-selectin on the endothelial cells was gradually decreased throughout 18 weeks of therapy. CONCLUSION: These results suggest that cyclosporine suppresses the migration of skin homing T cells to psoriatic skin lesions, in part, through the inhibition of E-selectin on the endothelial cells.
Biopsy ; Cyclosporine* ; E-Selectin ; Endothelial Cells ; Endothelium, Vascular ; Flow Cytometry ; Humans ; Lymphocytes ; Psoriasis ; Skin* ; T-Lymphocytes

PURPOSE: To investigate the feasibility of using a poly (epsilon-caprolactone) (PCL) sheet seeded with autologous muscle-derived stem cells as a bladder substitute. MATERIALS AND METHODS: Muscle-derived stem cells were isolated from the gastrocnemius muscle of 9 female Sprague-Dawley rats using a preplate technique, and cultured on a 5x5mm PCL sheet. The sheets were implanted into the mesentery of the rats in an autologous manner. Three rats were sacrificed 2, 4 and 8 weeks after implantation, and the morphological changes were assessed by H&E and immunofluorescence staining including DAPI, myosin heavy chain (MHC) and choline acetyl transferase (CAT). RESULTS: All the rats survived for the scheduled time. A mild inflammatory reaction was observed around the PCL sheet in the postoperative 2-week specimen but this receded with time. Muscle cells on the sheet were observed over the experimental period. The 8-week specimen showed a moderate amount of muscle cells on the sheet, and MHC and CAT immunofluorescence staining showed a positive reaction. The muscle layer was not well organized. Angiogenesis was quite noticable between the sheet and the muscle cells on the 8-week specimen. CONCLUSIONS: A PCL sheet seeded with autologous muscle-derived stem cells showed skeletal muscle differentiation on the sheets 8 weeks after mesenteric implantation in an autologous manner. This suggests the feasibility of using a PCL sheet seeded with autologous muscle-derived stem cell as a bladder substitute.
Animals ; Atrophy ; Cats ; Choline ; Female ; Fluorescent Antibody Technique ; Humans ; Mesentery ; Muscle Cells ; Muscle, Skeletal ; Myosin Heavy Chains ; Rats ; Rats, Sprague-Dawley ; Regeneration* ; Stem Cells* ; Transferases ; Urinary Bladder*

PURPOSE: A catheter-associated urinary tract infection, which frequently occurs in patients with an indwelling Foley catheter, can cause serious morbidity or mortality. Recently, antibiotic coated Foley catheters, to prevent catheter-associated urinary tract infections, have become commercially available. This study investigated the long-term effects of the use of antibiotic-coated Foley catheters on biofilm formations. MATERIALS AND METHODS: Silicone Foley or antibiotic-coated Foley catheters were indwelled in 72 patients with a neurogenic bladder. Each catheter was removed 1, 3, 5, 7, 14 and 28 days after insertion. The cell densities of the biofilm bacteria were evaluated by counting the number of colonies on plate cultures. The biofilm formations on the catheters were evaluated by scanning electron microscopy. The inner surface morphology of the catheter was imaged by field emission scanning electron microscopy (Philips-XL20SFEG), at 10kV, following gold sputtering for electrical conductance. Six catheters were studied in each group, and the means calculated for comparisons. RESULTS: Thick bacterial biofilms were observed on both the antibiotic- coated and silicone Foley catheters 7 days after insertion. There were no significant differences in the cell densities of the biofilm bacteria between the two types of catheter during days 7-28 after insertion (p<0.05). Two to three species of bacteria were isolated from the catheters in each patient; the most common species were Pseudomonas, Klebsiella, Serratia, Proteus species and Escherichia coli. CONCLUSIONS: The antibiotic-coated Foley catheters showed no preventive effects on the biofilm formations after 7 days of indwelling compared with the silicone Foley catheters. Our data suggest that the routine use of antibiotic-coated Foley catheters to prevent catheter-associated infection in patients with a neurogenic bladder is not reasonable. The emergence of resistance associated with antibiotic-coated catheters should be evaluated.
Anti-Bacterial Agents ; Bacteria ; Biofilms* ; Catheter-Related Infections ; Catheters* ; Cell Count ; Escherichia coli ; Humans ; Klebsiella ; Microscopy, Electron, Scanning ; Mortality ; Proteus ; Pseudomonas ; Serratia ; Silicones ; Urinary Bladder, Neurogenic ; Urinary Tract Infections

PURPOSE: We tried to find out an adequate sol-gel transition temperature of female urethra for the injection of thermosensitive polymer in incontinent patients. We measured the temperatures of three portions of female urethra and bladder. MATERIALS AND METHODS: Total of 53 female incontinent patients participated, excluding those with any kind of infection which could lead to an elevation of body temperature. The basal body temperatures were checked at the axilla, tympanic membrane and mouth. Temperatures of the proximal(U1), middle(U2), distal(U3) urethra and bladder(B) were measured by a digital thermometer under a lithotomy position. We divided our patients into 3 groups which were patients in follicular phase(F), luteal phase(L) and menopause(M). The temperature difference between the 4 portions of the urethra(D1; between U1 and U2, D2; between U2 and U3, D3: between U3 and B), was also analyzed. Statistics was done by the ANOVA of repeated measures, one-way ANOVA and Pearson correlation coefficient. RESULTS: The mean age of the patients was 48.1+/-10.7 years. The mean temperature of B, U1, U2, and U3 groups were 37.1+/-0.25 degreesC, 37.0+/-0.25 degreesC, 36.9+/-0.24 degreesC, and 36.7+/-0.25 degreesC. The mean temperature difference of D1, D2, and D3 were 0.2471+/-0.089 degreesC, 0.079+/-0.066 degreesC and 0.066+/-0.058 degreesC. The Pearson correlation coefficient of D1, D2 and D3 were 0.938, 0.965 and 0.970. This showed there was a constant temperature increase from distal urethra to bladder step by step. The number of patients in F, L and M groups were 25(47.2%), 10(18.9%) and 18(33.9%). There was no significant urethral temperature difference at each point(U1, U2, U3 and B) among these three groups. CONCLUSION: There was a constant temperature increase from distal urethra to bladder step by step. This is a baseline study for female urethra for future clinical study. We suggest that our data can be used as deciding the sol-gel transition temperature for thermosensitive polymer injection into incontinent female urethra.
Axilla ; Basal Bodies ; Body Temperature ; Female ; Humans ; Mouth ; Polymers ; Thermometers ; Transition Temperature ; Tympanic Membrane ; Urethra ; Urinary Bladder*