Changes in Grip Strength and Associations with Grip Strength in Breast Cancer Survivors Treated with Adjuvant Chemotherapy

Purpose@#The aim of this study was to identify the change in hand grip strength (HGS) for consecutive 6 months in breast cancer survivors (BCS) undergoing postoperative adjuvant chemotherapy (adjCTX) and to determine the factors relevant to HGS after chemotherapy completion @*Methods@#This study was a retrospective observational cohort study. BCS (N=38) who underwent breast cancer surgery and subsequent adjCTX were enrolled. The HGS of both sides was measured before adjCTX and 3 weeks, 2 months and 6 months after adjCTX. And we also collected body composition, anthropometric measurements, social demographics and clinical data. Then we analyzed the changes in HGS over time, and correlation of collected data with HGS at 6 months. @*Results@#A significant increase in HGS of the unaffected side was observed within the first 3 weeks of adjCTX and maintained up to 6 months. In correlation analysis, HGS of both sides was positively correlated with the ipsilateral HGS at 3 weeks, and contralateral HGS at 6 months. And skeletal muscle mass was also positively correlated with the HGS of the unaffected side. In addition, subjects treated with targeted therapy had lower HGS of the unaffected side. However, HGS of the affected side was significantly lower in subjects with breast reconstruction and treated without radiotherapy. @*Conclusions@#To maintain the early recovery of HGS, active and continuous exercise intervention for strengthening might be necessary.

Changes in Grip Strength and Associations with Grip Strength in Breast Cancer Survivors Treated with Adjuvant Chemotherapy

Purpose@#The aim of this study was to identify the change in hand grip strength (HGS) for consecutive 6 months in breast cancer survivors (BCS) undergoing postoperative adjuvant chemotherapy (adjCTX) and to determine the factors relevant to HGS after chemotherapy completion @*Methods@#This study was a retrospective observational cohort study. BCS (N=38) who underwent breast cancer surgery and subsequent adjCTX were enrolled. The HGS of both sides was measured before adjCTX and 3 weeks, 2 months and 6 months after adjCTX. And we also collected body composition, anthropometric measurements, social demographics and clinical data. Then we analyzed the changes in HGS over time, and correlation of collected data with HGS at 6 months. @*Results@#A significant increase in HGS of the unaffected side was observed within the first 3 weeks of adjCTX and maintained up to 6 months. In correlation analysis, HGS of both sides was positively correlated with the ipsilateral HGS at 3 weeks, and contralateral HGS at 6 months. And skeletal muscle mass was also positively correlated with the HGS of the unaffected side. In addition, subjects treated with targeted therapy had lower HGS of the unaffected side. However, HGS of the affected side was significantly lower in subjects with breast reconstruction and treated without radiotherapy. @*Conclusions@#To maintain the early recovery of HGS, active and continuous exercise intervention for strengthening might be necessary.

A prospective clinical of lithium disilicate pressed zirconia and monolithic zirconia in posterior implant-supported prostheses: A 24-month follow-up / 대한치과보철학회지

PURPOSE: The purpose of this study was to compare the clinical outcomes of lithium disilicate ceramic pressed zirconia prostheses and monolithic zirconia prostheses and to investigate the complications after two years of follow-up in posterior edentulous site. MATERIALS AND METHODS: A total 17 patients (male: 12, female: 5) were treated with 60 posterior fixed implant-supported prostheses (LP. lithium disilicate ceramic pressed zirconia prostheses: n = 30, MZ. monolithic zirconia prostheses: n = 30). After 24-month, clinical examination of Implant survival rate, marginal bone resorption, probing depth, plaque index, bleeding index, calculus and complications were evaluated. RESULTS: There were no failed implants and all implants were normal in function without mobility. Marginal bone resorption was lower in LP group than MZ group at 12-month (P < .05), and 12-month probing depth and calculus deposit in LP group were significantly higher than MZ group (P < .05). Most common complications in MZ were marginal bone resorptions more than 1.5.mm and 2 chipping occurred in LP group. CONCLUSION: Within the limitations of the present study, lithium disilicate ceramic pressed zirconia is considered as a predictable treatment option as much as monolithic zirconia in posterior fixed implant-supported prostheses.

Functional Improvement Following Revision Surgery in a Patient with the Dual Disability of a Complicated Residual Limb and Contralateral Hemiplegia: A Case Report

The number of reported cases with dual disability is increasing for the past few decades. Currently, dual disability of lower limb amputation and motor weakness after stroke became a strong issue in public concern. The functional levels of patients have shown in the wide range from independent community ambulation to non-ambulation. Thus, it indicates that favorable outcomes for dual disability may depend upon adopted rehabilitative strategies. We present the case of a man with left below-knee amputation and severe right-sided weakness following a huge putaminal hemorrhage. He had suffered from extreme pain and misfit of the prosthetic socket and the complicated residual limb for three years prior to the stroke. Forty days post-stroke, we performed a revision surgery to resolve the complications of bony overgrowth, verrucous hyperplasia, and neuroma and applied an ankle foot orthosis (AFO). Two years post-stroke, he was able to ambulate outside his home and negotiate stairs using a cane. This is the first case with the dual disability of lower limb amputation and contralateral hemiplegia to undergo revision surgery. The results suggest that an early revision surgery and use of an AFO are crucial for achieving a higher level of mobility in such cases.

Rasch Analysis of the Clinimetric Properties of the Korean Dizziness Handicap Inventory in Patients with Parkinson Disease / 대한평형의학회지

OBJECTIVES: The Korean Dizziness Handicap Inventory (KDHI), which includes 25 patient-reported items, has been used to assess self-reported dizziness in Korean patients with Parkinson disease (PD). Nevertheless, few studies have examined the KDHI based on item-response theory within this population. The aim of our study was to address the feasibility and clinimetric properties of the KDHI instrument using polytomous Rasch measurement analysis. METHODS: The unidimensionality, scale targeting, separation reliability, item difficulty (severity), and response category utility of the KDHI were statistically assessed based on the Andrich rating scale model. The utilities of the orderedresponse categories of the 3-point Likert scale were analyzed with reference to the probability curves of the response categories. The separation reliability of the KDHI was assessed based on person separation reliability (PSR), which is used to measure the capacity to discriminate among groups of patients with different levels of balance deficits. RESULTS: Principal component analyses of residuals revealed that the KDHI had unidimensionality. The KHDI had satisfactory PSR and there were no disordered thresholds in the 3-point rating scale. However, the KDHI showed several issues for inappropriate scale targeting and misfit items (items 1 and 2) for Rasch model. CONCLUSIONS: The KDHI provide unidimensional measures of imbalance symptoms in patients with PD with adequate separation reliability. There was no statistical evidence of disorder in polytomous rating scales. The Rasch analysis results suggest that the KDHI is a reliable scale for measuring the imbalance symptoms in PD patients, and identified parts for possible amendments in order to further improve the linear metric scale.

Influence of abutment materials on the implant-abutment joint stability in internal conical connection type implant systems

PURPOSE: This study evaluated the influence of abutment materials on the stability of the implant-abutment joint in internal conical connection type implant systems. MATERIALS AND METHODS: Internal conical connection type implants, cement-retained abutments, and tungsten carbide-coated abutment screws were used. The abutments were fabricated with commercially pure grade 3 titanium (group T3), commercially pure grade 4 titanium (group T4), or Ti-6Al-4V (group TA) (n=5, each). In order to assess the amount of settlement after abutment fixation, a 30-Ncm tightening torque was applied, then the change in length before and after tightening the abutment screw was measured, and the preload exerted was recorded. The compressive bending strength was measured under the ISO14801 conditions. In order to determine whether there were significant changes in settlement, preload, and compressive bending strength before and after abutment fixation depending on abutment materials, one-way ANOVA and Tukey's HSD post-hoc test was performed. RESULTS: Group TA exhibited the smallest mean change in the combined length of the implant and abutment before and after fixation, and no difference was observed between groups T3 and T4 (P>.05). Group TA exhibited the highest preload and compressive bending strength values, followed by T4, then T3 (P<.001). CONCLUSION: The abutment material can influence the stability of the interface in internal conical connection type implant systems. The strength of the abutment material was inversely correlated with settlement, and positively correlated with compressive bending strength. Preload was inversely proportional to the frictional coefficient of the abutment material.

Usefulness of the Combined Motor Evoked and Somatosensory Evoked Potentials for the Predictive Index of Functional Recovery After Primary Pontine Hemorrhage

OBJECTIVE: To investigate the predictive index of functional recovery after primary pontine hemorrhage (PPH) using the combined motor evoked potential (MEP) and somatosensory evoked potential (SEP) in comparison to the hematoma volume and transverse diameter measured with computerized tomography. METHODS: Patients (n=14) with PPH were divided into good- and poor-outcome groups according to the modified Rankin Score (mRS). We evaluated clinical manifestations, radiological characteristics, and the combined MEP and SEP responses. The summed MEP and SEP (EP sum) was compared to the hematoma volume and transverse diameter predictive index of global disability, gait ability, and trunk stability in sitting posture. RESULTS: All measures of functional status and radiological parameters of the good-outcome group were significantly better than those of the poor-outcome group. The EP sum showed the highest value for the mRS and functional ambulatory category, and transverse diameter showed the highest value for "sitting-unsupported" of Berg Balance Scale. CONCLUSION: The combined MEP and SEP is a reliable and useful tool for functional recovery after PPH.

Evaluation of clinical status of removable partial dentures / 대한치과보철학회지

STATEMENT OF PROBLEM: Although many efforts have been continually made to estimate long term prognosis of removable partial dentures, the complication of removable partial dentures was still found because of inaccurate fabrication procedure and improper maintenance care. PURPOSE: The purpose of this study was to evaluate the clinical status of removable partial dentures. MATERIAL AND METHODS: A total of 112 individuals with 153 removable partial dentures (35 - 87 years, 64 women and 48 men) were examined by intra-oral examination, diagnostic cast and radiographic examination. Results and CONCLUSION: The results of this study were as follows: 1. Length of service of removable partial dentures was 5.3 +/- 4.3 years (mean), 4.0 years (median). 2. A total of 45 removable partial dentures were considered failures. The loss of 18 abutments of 369 was founded. 3. Type of arch, Kennedy classification and type of opposite dentition were found to have no influence on longevity and success rate of removable partial dentures (P > .05). 4. Most common major connector was the palatal plate in maxilla and the number of lingual bar and linguoplate designed in mandible were similar. 5. The circumferential type retainer was the most commonly used retainer. 6. Sixty-three percent of the class I and II removable partial dentures incorporated indirect retention into the design. 7. Approximately 81% of the removable partial dentures had at least one defect. Excessive wear of posterior teeth (27.9%), lack of integrity (23.2%), lack of stability (22.6%) were frequent defects of removable partial dentures.

Influence of the Cytochrome P450 Polymorphism on Clinical Response to Aripiprazole in Patients with Schizophrenia / 대한정신약물학회지

OBJECTIVE: Aripiprazole is an atypical antipsychotic drug metabolized partly by the hepatic cytochrome P450 enzyme, CYP2D6. The aim of this study was to investigate the influence of the CYP2D6 polymorphism on the pharmacokinetics of and clinical response to aripiprazole. METHODS: The study followed a prospective, multicenter, single-medication group design and involved a 26-week study of aripiprazole treatment in Korean patients with schizophrenia. Eighty-nine patients with schizophrenia were recruited and divided into 4 groups according to CYP2D6 genotype: homozygous extensive metabolizer (EM), heterozygous EM, intermediate metabolizer (IM), and poor metabolizer (PM). During the 26 weeks of the study, the pharmacokinetics of the blood samples was analyzed at week 3 and week 8 of drug administration. We used the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Barnes Akathisia Scale (BAS) for akathisia, the Simpson Angus Scale (SAS) for Par-kinsonism, the Abnormal Involuntary Movement Scale (AIMS) for tardive dyskinesia, and metabolic profiles as clinical measures. RESULTS: The sample was divided into 4 schizophrenia subgroups (homozygous EM, n=15; heterozygous EM, n=47; IM, n=22; PM, n=5). Pharmacokinetics analyses showed that patients with poorer functional alleles (PM) had smaller clearance and more than twice as long half-lives compared to those with homozygous EMs characterized by two functional alleles. PMs tended to show higher AUCs than EMs. Over the 26-week treatment period, however, no significant differences in the clinical responses (changes in the PANSS scores) were observed. The prevalence of extra-pyramidal symptoms (Parkinsonism, tardive dyskinesia, akathisia) did not differ among these groups despite the pharmacokinetic differences. CONCLUSION: Despite its relatively small sample size, this study suggested that the CYP2D6 polymorphism might not constitute the major factor contributing to the clinical response to and adverse effects of aripiprazole.

Quantitative Evaluation of the Corticospinal Tract Segmented by Using Co-registered Functional MRI and Diffusion Tensor Tractography

PURPOSE: The purpose of this study was to investigate the quantitative evaluation of the corticospinal tract (CST) at the multiple levels by using functional MRI (fMRI) co-registered to diffusion tensor tractography (DTT). MATERIALS AND METHODS: Ten normal subjects without any history of neurological disorder participated in this study. fMRI was performed at 1.5 T MR scanner using hand grasp-release movement paradigm. DTT was performed by using DtiStudio on the basis of fiber assignment continuous tracking algorithm (FACT). The seed region of interest (ROI) was drawn in the area of maximum fMRI activation during the motor task of hand grasp-release movement on a 2-D fractional anisotropy (FA) color map, and the target ROI was drawn in the cortiocospinal portion of anterior lower pons. We have drawn five ROIs for the measurement of FA and apparent diffusion coefficient (ADC) along the corona radiata (CR) down to the medulla. RESULTS: The contralateral primary sensorimotor cortex (SM1) was mainly found to be activated in all subjects. DTT showed that tracts originated from SM1 and ran to the medulla along the known pathway of the CST. In all subjects, FA values of the CST were higher at the level of the midbrain and posterior limb of internal capsule (PLIC) than the level of others. CONCLUSION: Our study showed that co-registered fMRI and DTT has elucidated the state of CST on 3-D and analyzed the quantitative values of FA and ADC at the multiple levels. We conclude that co-registered fMRI and DTT may be applied as a useful tool for clarifying and investigating the state of CST in the patients with brain injury.

Clinical Usefulness of Diffusion Tensor Image Tractography in Stroke Patients: Report of two cases

We report the clinical usefulness of elucidating the state of the corticospinal tract (CST) by the use of diffusion tensor image tractography (DTT) in hemiparetic stroke patients. DTT was performed using 1.5 T magnetic resonance imaging. DTT demonstrated that the CST of the affected hemisphere was preserved in the medial portion of the hematoma in patient 1, but was interrupted by a hematoma in patient 2. DTT seems to be useful for elucidating the status of the CST in hemiparetic stroke patients.

Use of Risperdal Consta during Pregnancy: Report of Four Cases with a Literature Review / 대한정신약물학회지

Risperdal Consta is the first long-acting intramuscular formulation of an atypical antipsychotic. It is frequently used to treat schizophrenia, but its safety for use during pregnancy has not been established. We report four cases of patients with schizophrenia or schizoaffective disorder who took Risperdal Consta during pregnancy. None of the babies born from these four patients had any congenital malformation and all exhibited healthy postnatal development. This paper presents the rationale for the use of antipsychotics including Risperdal Consta during pregnancy and the related problems through a literature review. This serial case report contributes to the body of knowledge regarding the use of antipsychotics during pregnancy.

Use of Risperdal Consta during Pregnancy: Report of Four Cases with a Literature Review / 대한정신약물학회지

Risperdal Consta is the first long-acting intramuscular formulation of an atypical antipsychotic. It is frequently used to treat schizophrenia, but its safety for use during pregnancy has not been established. We report four cases of patients with schizophrenia or schizoaffective disorder who took Risperdal Consta during pregnancy. None of the babies born from these four patients had any congenital malformation and all exhibited healthy postnatal development. This paper presents the rationale for the use of antipsychotics including Risperdal Consta during pregnancy and the related problems through a literature review. This serial case report contributes to the body of knowledge regarding the use of antipsychotics during pregnancy.

Effect of Aggressive Rehabilitative Treatment on Canalicular Sequestered Lumbar Disc Herniations : Long-term Follow-up Study

OBJECTIVE: To assess long term outcomes of aggressive rehabilitative treatment on canalicular sequestered lumbar disc herniations METHOD: Clinical outcomes of twenty four patients with sequestered disc herniation with symptomatic radicular pain were evaluated prospectively and longitudinally for one year. All patients received aggressive rehabilitative treatment including transforaminal epidural steroid injection, pelvic stabilization exercise, physical therapy, and back school. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry Disability Index (ODI) for back pain before treatment, posttreatment one, three, six, and twelve months. After twelve months, we categorized patients' satisfaction. Four patients were dropp RESULTS: The averages of VAS for lower extremity and back pain reduced significantly from 6.6 and 5.8 at pretreatment to 0.7 and 0.9 at 12 months posttreatment, respectively (p<0.001). The averages of ODI reduced significantly from 73.5% at pretreatment to 22.3% at posttreatment 12 months (p<0.001). Sixteen of twenty patients (80.0%) were satisfied with their current status posttreatment 12 months. CONCLUSION: Sequestered disc herniations could be treated successfully by aggressive rehabilitative treatment. Clinical improvement was achieved from posttreatment one month and persisted for twelve months. Operation might be delayed until aggressive rehabilitation treatment fail to treat sequestered disc herniations.

Influence of Lesion Location on Cortical Recovery Pattern in Hemiparetic Stroke Patients

OBJECTIVE: The aim of this study was to elucidate how the location of cerebral infarct influences cortical recovery pattern in hemiparetic stroke patients. METHOD: Forty-three chronic stroke patients and 21 control subjects were recruited for the study. The patients were classified into 4 groups according to infarct locations: cortex (CO), corona radiata (CR), posterior limb of the internal capsule (PL), and brainstem (BS). Functional MRI was performed using the blood oxygen level-dependent technique at 1.5 T with the motor task of hand grasp-release movements. RESULTS: The activation pattern of the primary sensori-motor cortex (SM1) was found to be significantly influenced by the lesion locations, but that of the secondary motor area was not (Pearson's chi-square test, p<0.05). The contralateral' SM1 activation was the major response in the control group (85.7%) and in the BS group (75.0%). On the other hand, the major activation pattern was `peri-lesional' in the CO group (peri-lesional 57.1%, peri-lesional and ipsilateral 42.9%), `bilateral activation' in the CR (85.7%) and the PL group (100.0%). CONCLUSION: Our results suggested that motor recovery mechanisms could be different according to location of cerebral infarct.

The Relations among Sociodemographic, Clinical and Psychological Characteristics and Quality of Life in Patients with Psychotic Disorders and Their Caregivers / 신경정신의학

OBJECTIVES: Quality of life in patients with psychotic disorders and their caregivers has a important role on the treatment and relapse prevention of the patients. This study was intended to investigate the effects of patient's sociodemographic, clinical and psychological(self-esteem, social support and external control) characteristics, and caregivers' sociodemographic and psychological characteristics on quality of life in patients and caregivers. METHODS: The subjects were composed of 48 out-patients (schizophrenic disorder, mood disorders and other psychotic disorders) and 48 caregivers. Patients' clinical characteristics, patients' and their caregivers' sociodemographic, psychological characteristics(self-esteem, social support and external control) and quality of life were investigated. First of all, patients' self-esteem, social support, external control and quality of life were compared with caregivers'. After the correlations among each characteristics in patients and caregivers were calculated, the multiple regression analyses were conducted, where the predictable variables were those that had already shown significant correlations with quality of life. RESULTS: Patients' self-esteem and quality of life were significantly lower than their caregivers'. In patients, high socioeconomic status and self-esteem were correlated with high perception on the social support and quality of life. Also, the satisfaction to the medication was positively correlated with perception on the social support, quality of life and more external control. In addition, high compliance on medication and high perception on the social support were correlated with high quality of life. In caregivers, patients' onset age was positively correlated with caregivers' quality of life. Also, more caregivers' stress was correlated with their lower self-esteem, and higher caregivers' self-esteem was correlated with higher perception on the social support and quality of life. Furthermore, higher caregivers' perception on the social support was correlated with higher quality of life. The characteristics that predicted patients' quality of life significantly were self-esteem and perception on the social support, and the characteristics that predicted caregivers' quality of life significantly were caregivers' perception on the social support and patients' onset age. CONCLUSION: These results suggested that for improving the quality of life of patients and their caregivers, it was important not only to alleviate and treat the patient's symptom, but also to increase self-esteem and provide social support.