Pretransplant Functional Status Predicts Postoperative Morbidity and Mortality after Liver Transplantation in Patients with Cirrhosis

Background/Aims@#This study aimed to investigate whether pretransplant frailty can predict postoperative morbidity and mortality after liver transplantation (LT) in patients with cirrhosis. @*Methods@#We retrospectively reviewed 242 patients who underwent LT between 2018 and 2020 at a tertiary hospital in Korea. @*Results@#Among them, 189 patients (78.1%) received LT from a living donor. Physical frailty at baseline was assessed by the Short Physical Performance Battery (SPPB), by which patientswere categorized into two groups: frail (SPPB <10) and non-frail (SPPB ≥10). Among the whole cohort (age, 55.0±9.2 years; male, 165 [68.2%]), 182 patients were classified as non-frail and 60 patients were classified as frail. Posttransplant survival was shorter in the frail group than the non-frail group (9.3 months vs 11.6 months). Postoperative intensive care unit stay was longer in the frail group than in the non-frail group (median, 6 days vs 4 days), and the 30-day complication rate was higher in the frail group than in the non-frail group (78.3% vs 59.3%). Frailty was an independent risk factor for posttransplant mortality (adjusted hazard ratio, 2.38; 95% confidence interval, 1.02 to 5.57). In subgroup analysis, frail patients showed lower posttransplant survival regardless of history of hepatocellular carcinoma and donor type. @*Conclusions@#Assessment of pretransplant frailty, as measured by SPPB, provides important prognostic information for clinical outcomes in cirrhotic patients undergoing LT.

Associated Factors on Quality of Life in Patients with Parkinson's Disease

The objective of this study is to investigate the clinical and demographic factors that influence the quality of life in patients with Parkinson's disease (PD). This is a crosssectional observational study of 47 patients in 2 hospitals with PD. All participants were asked to complete a disease-specific quality of life (QoL) questionnaire (PDQ-39). We gave a structured questionnaire interview and did a complete neurological examination on the same day. Additionally, we measured depression and dependency with the Geriatric Depression Scale-Short Form (GDS-SF) and the Korean version of the Modified Barthel Index (K-MBI).The PDQ-39 had a significant relationship with each motor part of the Unified Parkinson's Disease Rating Scale, the Korean Mini-Mental State Examination (K-MMSE), the GDS-SF, and the K-MBI (p < 0.05). The factors that independently contributed to the PDQ-39 scores were K-MMSE, GDS-SF, and K-MBI (p < 0.05). Factors having the greatest influence on the PDQ-39 were K-MBI, K-MMSE, and GDS-SF in that order. In addition, the mobility item in the K-MBI was independently a significant relating factor in the PDQ-39 (p < 0.05). These results demonstrated that dependency, especially with the mobility issue, was the greatest influence on the QoL in patients with PD.

Changes in Epidemiological Trends and Rehabilitation Usage in Neurological Diseases in Korea: Stroke

Stroke survivors with disabilities have increased in Korea as the population has aged. Early stroke rehabilitation is known to be an essential therapy in gaining functional independence and preventing complications. Recent research on the rehabilitation usage of stroke patients was reviewed in this manuscript. For the past 15 years, it was found that comprehensive rehabilitation assessments have been performed faster in more stroke patients, and intensive inpatient stroke rehabilitation has been applied to more stroke patients at an earlier stroke phase in Korea. In addition, the effect of rehabilitation was maintained. However, few reports have assessed the status of stroke rehabilitation in Korea. Therefore, basic statistical research based on accurate national statistics is needed in the future.

Post-stroke Hyperglycemia in Non-diabetic Ischemic Stroke is Related With Worse Functional Outcome: A Cohort Study

Objective@#To investigate long-term and serial functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia. @*Methods@#The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) is a large, multi-center, prospective cohort study of stroke patients admitted to participating hospitals in nine areas of Korea. From KOSCO, ischemic stroke patients without diabetes were recruited and divided into two groups: patients without diabetes without (n=779) and with post-stroke hyperglycemia (n=223). Post-stroke hyperglycemia was defined as a glucose level >8 mmol/L. Functional assessments were performed 7 days and 3, 6, and 12 months after stroke onset. @*Results@#There were no significant differences in baseline characteristics between the groups, except in the age of onset and smoking. Analysis of the linear correlation between the initial National Institutes of Health Stroke Scale (NIHSS) score and glucose level showed no significant difference. Among our functional assessments, NIHSS, Fugl-Meyer Assessment (affected side), Functional Ambulatory Category, modified Rankin Scale, and Korean Mini-Mental State Examination (K-MMSE) showed statistically significant improvements in each group. All functional improvements except K-MMSE were significantly higher in patients without post-stroke hyperglycemia at 7 days and 3, 6, and 12 months. @*Conclusion@#The glucose level of ischemic stroke patients without diabetes had no significant correlation with the initial NIHSS score. The long-term effects of stress hyperglycemia showed worse functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia.

Factors Associated to Returning Home in the First Year after Stroke

The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the ‘Return home’ group and 99 subjects in the ‘Rehabilitation hospitalization’ group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.

Dysphagia as the First Symptom of Hyperthyroidism without Goiter: A Case Report / 대한연하장애학회지

Hyperthyroidism is a rare cause of dysphagia. We report a case of dysphagia as the first symptom of hyperthyroidism in a patient who improved with antithyroid agents and swallowing rehabilitation. An 81-year-old man was diagnosed with Graves’ disease after being hospitalized for recurrent aspiration symptoms that included cough and sputum for two months. The patient was given methimazole, propranolol, and Lugol solution as well as conventional swallowing rehabilitation for 60 minutes a day. Two weeks after initiation of treatment, the patient’s thyroid function tests saw improvement. He showed significant improvement in dysphagia after 3 weeks of treatment.Persisting improvement in swallowing was also found at 6 months post-treatment. Dysphagia may be the first symptom of hyperthyroidism in elderly patients, and physicians should consider performing thyroid function tests for evaluating such patients.

Feasibility of Transcranial Direct Current Stimulation in Patients with Deep Brain Stimulation: a Case Report

Although deep brain stimulation (DBS) has been reported to be effective to ameliorate motor and non-motor dysfunctions, freezing of gait (FoG) is often resistant to DBS in patients with Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) has been reported as an alternative therapeutic strategy to ameliorate FoG in PD patients. In this case report, we describe the effects of cumulative tDCS over the primary motor cortex of the lower leg to reduce FoG in 2 cases of PD patients with DBS. Two PD patients who had undergone DBS of the subthalamic nucleus visited the rehabilitation medicine department for refractory FoG. Each patient received cumulative tDCS over the primary motor cortex of the lower leg over to reduce FoG. Neither patient required change in dose of dopaminergic medication during the tDCS period nor a significant side effect during and after tDCS.Although the FoG-questionnaire (FoG-Q) in case 1 showed no change after 10 tDCS treatments, the patient in case 2 reported a significant improvement of FoG-Q from 11 to 3 after 5 days of tDCS. We present the safety and feasibility of tDCS in PD patients with DBS who showed refractory FoG.

Factors Associated with Changes in Functional Independence after Six Months of Ischemic Stroke

The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from −4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.

Factors Associated to Returning Home in the First Year after Stroke

The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the ‘Return home’ group and 99 subjects in the ‘Rehabilitation hospitalization’ group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.

Feasibility of Transcranial Direct Current Stimulation in Patients with Deep Brain Stimulation: a Case Report

Although deep brain stimulation (DBS) has been reported to be effective to ameliorate motor and non-motor dysfunctions, freezing of gait (FoG) is often resistant to DBS in patients with Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) has been reported as an alternative therapeutic strategy to ameliorate FoG in PD patients. In this case report, we describe the effects of cumulative tDCS over the primary motor cortex of the lower leg to reduce FoG in 2 cases of PD patients with DBS. Two PD patients who had undergone DBS of the subthalamic nucleus visited the rehabilitation medicine department for refractory FoG. Each patient received cumulative tDCS over the primary motor cortex of the lower leg over to reduce FoG. Neither patient required change in dose of dopaminergic medication during the tDCS period nor a significant side effect during and after tDCS.Although the FoG-questionnaire (FoG-Q) in case 1 showed no change after 10 tDCS treatments, the patient in case 2 reported a significant improvement of FoG-Q from 11 to 3 after 5 days of tDCS. We present the safety and feasibility of tDCS in PD patients with DBS who showed refractory FoG.

Factors Associated with Changes in Functional Independence after Six Months of Ischemic Stroke

The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from −4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.

Factors Associated to Returning Home in the First Year after Stroke

The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the ‘Return home’ group and 99 subjects in the ‘Rehabilitation hospitalization’ group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.

Erratum to: Impact of Functional Status on Noncardioembolic Ischemic Stroke Recurrence Within 1 Year: The Korean Stroke Cohort for Functioning and Rehabilitation Study

At the request of the author, the author's alphabetical affiliation and address should be as follow.

Changes in Language Function and Recovery-Related Prognostic Factors in First-Ever Left Hemispheric Ischemic Stroke

OBJECTIVE: To investigate longitudinal changes in language function in left-hemispheric ischemic stroke patients as well as factors that influence language recovery until 1 year after stroke onset.METHODS: We analyzed data from 235 patients with first-ever left-hemispheric ischemic stroke. All patients completed the Korean version of the Frenchay Aphasia Screening Test (K-FAST) at 7 days (T1), 3 months (T2), 6 months (T3), and 1 year (T4) after stroke onset. Repeated measures analysis of variance (ANOVA) was used to investigate changes in language function between time points. Subgroup analysis was performed according to the K-FAST scores at T1. Stroke lesion volume was assessed using diffusion tensor images, and involvement of language-related brain regions was examined. Multiple regression analysis was used to analyze factors influencing improvement of K-FAST score.RESULTS: The K-FAST scores at T1, T2, T3, and T4 differed significantly (p < 0.05). In the subgroup analysis, only the severe group showed continuous significant improvement by 1 year. Factors that negatively influenced improvement of language function were the age at onset, initial National Institutes of Health Stroke Scale (NIHSS) score, and initial K-FAST score, whereas education level and stroke lesion volume positively affected recovery. Involvement of language-related brain regions did not significantly influence long-term language recovery after ischemic stroke.CONCLUSION: Recovery of language function varied according to the severity of the initial language deficit. The age at stroke onset, education level, initial severity of aphasia, initial NIHSS score, and total stroke lesion volume were found to be important factors for recovery of language function.

Sulfuretin Prevents Obesity and Metabolic Diseases in Diet Induced Obese Mice

The global obesity epidemic and associated metabolic diseases require alternative biological targets for new therapeutic strategies. In this study, we show that a phytochemical sulfuretin suppressed adipocyte differentiation of preadipocytes and administration of sulfuretin to high fat diet-fed obese mice prevented obesity and increased insulin sensitivity. These effects were associated with a suppressed expression of inflammatory markers, induced expression of adiponectin, and increased levels of phosphorylated ERK and AKT. To elucidate the molecular mechanism of sulfuretin in adipocytes, we performed microarray analysis and identified activating transcription factor 3 (Atf3) as a sulfuretin-responsive gene. Sulfuretin elevated Atf3 mRNA and protein levels in white adipose tissue and adipocytes. Consistently, deficiency of Atf3 promoted lipid accumulation and the expression of adipocyte markers. Sulfuretin’s but not resveratrol’s anti-adipogenic effects were diminished in Atf3 deficient cells, indicating that Atf3 is an essential factor in the effects of sulfuretin. These results highlight the usefulness of sulfuretin as a new anti-obesity intervention for the prevention of obesity and its associated metabolic diseases.

Analysis of Errors on Death Certificate for Trauma Related Death

PURPOSE@#This study was to investigate errors of death certificate (DC) issued for patients with trauma.@*METHODS@#A retrospective review for DC issued after death related to trauma at a training hospital trauma center was conducted. Errors on DC were classified into major and minor errors depending on their influence on the process of selecting the cause of death (COD). All errors were compared depending on the place of issue of DC, medical doctors who wrote the DC, and the number of lines filled up for COD of DC.@*RESULTS@#Of a total 140 DCs, average numbers of major and minor errors per DC were 0.8 and 3.7, respectively. There were a total of 2.8 errors for DCs issued at the emergency department (ED) and 5.4 errors for DCs issued beyond ED. The most common major error was more than one COD on a single line for DCs issued at the ED and incompatible casual relation between CODs for DCs issued beyond ED. The number of major errors was 0.5 for emergency physician and 0.8 for trauma surgeon and neurosurgeon. Total errors by the number of lines filled up for COD were the smallest (3.1) for two lines and the largest (6.0) for four lines.@*CONCLUSIONS@#Numbers of total errors and major errors on DCs related to trauma only were 4 and 0.8, respectively. As more CODs were written, more errors were found.

Impact of Functional Status on Noncardioembolic Ischemic Stroke Recurrence Within 1 Year: The Korean Stroke Cohort for Functioning and Rehabilitation Study

BACKGROUND AND PURPOSE: Few studies have investigated the relationship between the specific functional factors potentially associated with functional level and stroke recurrence. We conducted a study of patients with noncardioembolic ischemic stroke (NCIS) to determine the functional factors affecting recurrence within the first year. METHODS: In total, 568 first-ever NCIS patients (age=65.1±17.4 years, mean±SD) were analyzed in a multicenter, prospective cohort study registered from August 2012. Demographic characteristics, past medical history, comorbidities, laboratory data, stroke features in neuroimaging, acute treatments, and medications at discharge were assessed. Functional factors reflecting gross functional impairment, ambulatory function, motor function, activities of daily living, cognition, language ability, swallowing function, mood, and quality of life were comprehensively evaluated in face-to-face assessments using standardized tools at the time of discharge. RESULTS: The cumulative incidence of stroke recurrence in NCIS was 6.0% (n=34) at 1 year. The period from admission to discharge was 34.4±7.0 days. The independent predictors of stroke recurrence within 1 year in multivariate Cox proportional-hazards regression analyses were 1) age [per-year hazard ratio (HR)=1.04, 95% confidence interval (CI)=0.97–1.06, p=0.048], 2) Charlson Comorbidity Index higher than 2 (HR=1.72, 95% CI=1.26–2.22, p=0.016), 3) modified Rankin Scale score of 3 or more at discharge (HR=1.56, 95% CI=1.22–1.94, p=0.032), and 4) Functional Ambulation Category of 3 or less at discharge (HR=2.56, 95% CI=1.84–3.31, p=0.008). CONCLUSIONS: In addition to patient age, moderate-to-severe functional impairment requiring the help of others (especially for ambulation) at the time of discharge and the severity of comorbidity were independent predictors of stroke recurrence within 1 year of the first NCIS.

iPSC Modeling of Presenilin1 Mutation in Alzheimer's Disease with Cerebellar Ataxia

Disease modeling of Alzheimer's disease (AD) has been hampered by the lack of suitable cellular models while animal models are mainly based on the overexpression of AD-related genes which often results in an overemphasis of certain pathways and is also confounded by aging. In this study, we therefore developed and used induced pluripotent stem cell (iPSC) lines from a middle-aged AD patient with a known presenilin 1 (PSEN1) mutation (Glu120Lys; PS1-E120K) and as a control, an elderly normal subject. Using this approach, we demonstrated that the extracellular accumulation of Aβ was dramatically increased in PS1-E120K iPSC-derived neurons compared with the control iPSC line. PS1-E120K iPSC-derived neurons also exhibited high levels of phosphorylated tau, as well as mitochondrial abnormalities and defective autophagy. Given that the effect of aging is lost with iPSC generation, these abnormal cellular features are therefore indicative of PSEN1-associated AD pathogenesis rather than primary changes associated with aging. Taken together, this iPSC-based approach of AD modeling can now be used to better understand AD pathogenesis as well as a tool for drug discovery.

Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage

Despite advancements in treating ruptured cerebral aneurysms, an aneurysmal subarachnoid hemorrhage (aSAH) is still a grave cerebrovascular disease associated with a high rate of morbidity and mortality. Based on the literature published to date, worldwide academic and governmental committees have developed clinical practice guidelines (CPGs) to propose standards for disease management in order to achieve the best treatment outcomes for aSAHs. In 2013, the Korean Society of Cerebrovascular Surgeons issued a Korean version of the CPGs for aSAHs. The group researched all articles and major foreign CPGs published in English until December 2015 using several search engines. Based on these articles, levels of evidence and grades of recommendations were determined by our society as well as by other related Quality Control Committees from neurointervention, neurology and rehabilitation medicine. The Korean version of the CPGs for aSAHs includes risk factors, diagnosis, initial management, medical and surgical management to prevent rebleeding, management of delayed cerebral ischemia and vasospasm, treatment of hydrocephalus, treatment of medical complications and early rehabilitation. The CPGs are not the absolute standard but are the present reference as the evidence is still incomplete, each environment of clinical practice is different, and there is a high probability of variation in the current recommendations. The CPGs will be useful in the fields of clinical practice and research.

Hemiplegic Shoulder Pain in Shoulder Subluxation after Stroke: Associated with Range of Motion Limitation

We grouped hemiplegic patients with shoulder subluxation according to the presence of hemiplegic shoulder pain (HSP) and aimed to compare the difference in clinical and magnetic resonance (MR) arthrography findings between 2 groups in the effort to find factors possibly related to HSP. We performed a retrospective, cross-sectional analysis of all eligible inpatients treated at one university rehabilitation hospital. Clinical findings including passive range of motion (ROM), motor power, and spasticity and MR arthrography findings in the affected shoulder were compared between the 2 groups. Of 59 patients who met the criteria, 21 (35.6%) and 38 (64.4%) were classified as HSP group and no-HSP group, respectively. Limitation of ROM in flexion and rotator cuff atrophy significantly related with HSP (R² = 0.449, p < 0.05). Limitation of ROM in flexion and rotator cuff atrophy in MR arthrography was 1.1 and 6.4 times more likely associated with HSP, respectively. Additionally, spasticity in flexion correlated with limitation of ROM in flexion (p = 0.049), external rotation (p = 0.034), and with total limitation of ROM (p = 0.033). A significant correlation was evident between HSP and ROM of the shoulder. However, HSP did not correlate with MR arthrography findings, except rotator cuff atrophy.