Functional Evaluation of Autonomic Nervous System in Patients with Chronic Renal Failure

OBJECTIVE: To evaluate the autonomic nervous system function in chronic renal failure patients compared to normal control and to assess the effect of dialysis method and underlying diseases such as diabetes mellitus and hypertension, on autonomic nervous system function in chronic renal failure patients. METHOD: We checked palm and sole skin temperature with digital thermometer, sympathetic skin responses and heart rate variability in chronic renal failure patients (77 persons) and normal control group (77 persons). RESULTS: The amplitude of sympathetic skin response (SSR) and heart rate variability (RRIV) of patients group showed statistically significant difference compared to control group (p0.05). CRF without diabetes mellitus and hypertension showed significant difference on amplitude of SSR and RRIV (p0.05) between hemodialysis and peritoneal dialysis groups. CONCLUSION: SSR test and RRIV could be valuable measure to evaluate autonomic nervous system functions in the patients with chronic renal failure.

The Development of PC-based Mini-Mental Status Examination

OBJECTIVE: The aim of this study is to develop the PC-based Mini-mental Status Examination (PC-MMSE) including its protocol to improve the reliability of MMSE, to have convenience for administration, and to evaluate the test-retest reliability. METHOD: The factors of decreasing the reliability on MMSE are analyzed such as following. 1) The way of question, pronunciation, and loudness of speech can be different between the test-retest or tester-tester, 2) the learning effect can occur when the test is repeatedly administrated, and 3) the test protocol is not determined in detail. The PC-MMSE and its protocol are designed to solve this problem. PC-MMSE has been developed to have functions such as following. 1) It was made constant verbal stimulation, 2) the question contents of the same level of difficulty in changeable items were developed and some of those can be randomly selected, and 3) it was made the adminstration of test and the management on the test results, conveniently. Protocol on PC-MMSE was also developed for standardization in the administration of test. These two tests of PC-MMSE on 26 stroke patients are administrated for the evaluation of test-retest reliability. RESULTS: The test-retest Spearman's correlation coefficient of PC-MMSE is 0.967 (p<0.01). The Spearman's correlation coefficient of PC-MMSE which is related with sex, education, lesion site, and hemiplegic side is more than 0.89. CONCLUSION: The PC-MMSE and its protocol are thought to be useful for the repeated evaluation of cognitive function.

The Effects of Long Bed Immobilization on the Heart Rate Variability

OBJECTIVE: The aims of this study were to know the effects of long time bed immobilization on the heart rate variability and to know the correlation between the heart rate variability and other anthropometric parameters. METHOD: The subjects of this study were 60 normal sedentary persons as control group and 22 patients who had been immobilized for a long time because of musculoskeletal problems without any systemic diseases. The heart rate variabilities were measured through the R-R interval variation at rest, deep breathing and valsalva maneuver. These values were compared between control and patient group and were analysed for correlation with age, weight, height, body mass index (BMI), amounts of smoking (pack years), spans of immobilization and physical activity scale (PAS). RESULTS: The mean heart rate variability of patients were 0.132+/-0.072, 0.216+/-0.109, and 0.289+/-0.171 in rest, deep breathing and valsalva maneuver respectively which were lower than the corresponding 0.176+/-0.085, 0.314+/-0.146, and 0.322 +/-0.174 of normal control group. The heart rate variabilities were negatively correlated with age, BMI and amounts of smoking but positively correlated with the height. The physical activity scale of preimmobilization state was negatively correlated with resting heart rate variability but was positively correlated with heart rate variability during deep breathing and valsalva maneuvering state. CONCLUSION: The long bed immobilization significantly decreased the heart rate variability and the heart rate variability could be used as a useful tool to measure the effects of immobilization on the heart.