Association Between Vitamin E and Handgrip Strength in the Korean General Population in KNHANES VII (2018)

Objective@#To investigate the association between vitamin E and handgrip strength (HGS) with multiple factors. @*Methods@#A total of 1,814 participants were included (822 men and 981 women) from the Korean subjects of the 7th Korea National Health and Nutrition Examination Survey in 2018. Data were analyzed using multiple logistic regression to determine the correlation between vitamin E and HGS with potential confounding factors. @*Results@#In the multiple logistic regression model, only the young age group (19–40 years) of men showed a positive relationship between vitamin E and HGS. However, in older age groups (41–80 years) of men and all age groups of women, there was no statistically significant result. After adjusting for confounding factors, young men showed higher vitamin E levels and higher HGS. Conversely, women and older age groups did not show significant results after adjusting for confounding factors. @*Conclusion@#In this study, the serum vitamin E level had a positive effect on HGS in young men (<40 years). Further research is needed on this topic regarding vitamin E intake and other objective measures.

Association Between Vitamin E and Handgrip Strength in the Korean General Population in KNHANES VII (2018)

Objective@#To investigate the association between vitamin E and handgrip strength (HGS) with multiple factors. @*Methods@#A total of 1,814 participants were included (822 men and 981 women) from the Korean subjects of the 7th Korea National Health and Nutrition Examination Survey in 2018. Data were analyzed using multiple logistic regression to determine the correlation between vitamin E and HGS with potential confounding factors. @*Results@#In the multiple logistic regression model, only the young age group (19–40 years) of men showed a positive relationship between vitamin E and HGS. However, in older age groups (41–80 years) of men and all age groups of women, there was no statistically significant result. After adjusting for confounding factors, young men showed higher vitamin E levels and higher HGS. Conversely, women and older age groups did not show significant results after adjusting for confounding factors. @*Conclusion@#In this study, the serum vitamin E level had a positive effect on HGS in young men (<40 years). Further research is needed on this topic regarding vitamin E intake and other objective measures.

Congenital Torticollis with Bilateral Sternocleidomastoid Muscle Contracture

Congenital muscular torticollis is a common musculoskeletal disorder characterized by the shortening of the sternocleidomastoid muscle, thus leading to an ipsilateral tilt of the head and contralateral rotation of the face. Most of the congenital muscular torticollis is ipsilateral. Bilateral congenital muscular torticollis is extremely rare. Congenital muscular torticollis is known to be associated with several musculoskeletal and neurologic disorders including brachial plexus injury. Therefore, early diagnosis and intervention are crucial for the treatment and prevention of associated complications. Here, we report a case of a 1-month-old infant with bilateral congenital muscular torticollis suspicious of Erb-Duchenne palsy.

Congenital Torticollis with Bilateral Sternocleidomastoid Muscle Contracture

Congenital muscular torticollis is a common musculoskeletal disorder characterized by the shortening of the sternocleidomastoid muscle, thus leading to an ipsilateral tilt of the head and contralateral rotation of the face. Most of the congenital muscular torticollis is ipsilateral. Bilateral congenital muscular torticollis is extremely rare. Congenital muscular torticollis is known to be associated with several musculoskeletal and neurologic disorders including brachial plexus injury. Therefore, early diagnosis and intervention are crucial for the treatment and prevention of associated complications. Here, we report a case of a 1-month-old infant with bilateral congenital muscular torticollis suspicious of Erb-Duchenne palsy.

The Predictive Value of Language Scales: Bayley Scales of Infant and Toddler Development Third Edition in Correlation With Korean Sequenced Language Scale for Infant

Objective@#To compare the relationship of the Bayley Scales of Infant and Toddler Development 3rd Edition (K-BSID-III) language score and the Sequenced Language Scale for Infant (SELSI) score and evaluate the sensitivity and specificity of K-BSID-III language score and optimal cutoff value with receiver operator characteristic (ROC) curve analysis in infants and toddlers with delayed language development. @*Methods@#A total of 104 children with suspected language developmental delay were included in this retrospective study. Subjects were tested using the K-BSID-III and SELSI and subdivided into several groups according to the severity of language scores. ROC curve analysis was performed to assess K-BSID-III for delayed language development. @*Results@#Receptive and expressive language subscales of the K-BSID-III showed markedly significant correlation with the SELSI scores (p<0.001). ROC analysis showed an area under the curve of 0.877 (p<0.001) in SELSI receptive score and 0.935 (p<0.001) in SELSI expressive score. The optimal cutoff value where sensitivity of 85% and specificity of 81% were achieved with the K-BSID-III receptive score was 1.50 (between average and low average) in the SELSI receptive score. The optimal cutoff value where sensitivity of 96% and specificity of 82% were achieved with the K-BSID-III expressive score was also 1.50 in the SELSI expressive score. @*Conclusion@#In this study, the correlations between K-BSID-III and SELSI language scores were statistically significant. However, the interpretation should be considered carefully in low average group due to tendency of underestimation of delayed language development.

Nocturnal Restless Arms and Face Improved by Dopamine Agonist: Is It a Variant of Restless Legs Syndrome?

The symptoms of restless legs syndrome (RLS) usually involve legs and can extend to other body parts. However, isolated body parts other than leg have rarely been involved. A 32-year-old woman had abnormal sensations of both forearms and face during night, which caused a difficulty falling in sleep. The symptoms were relieved by shaking and rubbing. She experienced a clear benefit from pramipexole, but a recurrence of restlessness was followed in both arms subsequent to pramipexole withdrawal. Finally, she had been prescribed a dose of 0.375 mg, which was well tolerated for 6 years. We report a case of nocturnal restless arms and face without leg involvement, which was like RLS in terms of clinical criteria except lesion site.

Assessment of Preterm Infants Using the Bayley-III Scales in Korea

OBJECTIVE: To assess the well-being of preterm newborns using the Bayley-III scales in a Korean-based population, and to evaluate the perinatal risk factors influencing developmental outcome. METHODS: Using the Bayley-III scales, we assessed 120 preterm infants who were referred for evaluation of neurodevelopmental performance. We subdivided them into an extremely preterm group (n=18) and a very/moderate to late preterm group (n=102). Bayley-III mean scores and the rate of infants showing a delay were compared for both groups. The relationship between perinatal risk factors and Bayley-III scores was analyzed. The risk factors were considered as very low birth weight, history of neonatal medical problems, and abnormal radiologic findings in brain magnetic resonance images (MRIs). RESULTS: Although no significant differences in mean scores were observed between the extremely preterm group and the very/moderate to late preterm group, the rate of babies showing developmental delay in motor composite scores was significantly higher in the extremely preterm group. The proportions of preterm infants with cognitive, language, and motor delays were 38.3%, 26.7%, and 35.0%, respectively. Very low birth weight was a significant risk factor for low cognitive, language, and motor composite scores. Also, abnormal radiologic findings on brain MRI were significant indicators of lower motor composite scores. CONCLUSION: Cognitive development was the most frequently delayed domain in preterm infants and motor development was more frequently delayed in the extremely preterm group. The very low birth weight and abnormal radiologic findings in brain MRI were predictive factors for neurodevelopmental outcome.

Parasellar Meningioma Mimicking Cluster Headache Treated with Novalis Stereotactic Radiosurgery

Cluster headache is a unique primary headache disorder characterized by unilateral severe orbital pain with ipsilateral autonomic symptoms. Symptomatic cluster headache can be caused by variable diseases, such as cerebral aneurysm, arteriovenous malformation, cerebral venous thrombosis, carotid dissection, pituitary tumor, and meningioma. We report a 33-year-old woman with parasellar meningioma mimicking cluster headache. After Novalis stereotactic radiosurgery, pain attacks disappeared.

Scrambler (Calmare) Therapy for Intractable Chronic Pain

Intractable chronic pain is a debilitative pain conditions for most patients. Unfortunately, the pain control managements currently have shown that it is not appropriate to reduce pain and limited efficacy and sometimes unfavorable in some patients. Scrambler (Calmare) therapy, used as an alternative treatment for chronic neuropathic pain recently, is a noninvasive approach to relieve pain by changing pain perception. The author reports the clinical experiences on effectiveness of Scrambler therapy for three patients with intractable pain refractory to conventional treatment.

The Relationship Between Sleep Disturbance and Functional Status in Mild Stroke Patients

OBJECTIVE: To investigate the sleep state of mild stroke patients and relationship between sleep disturbance and functional status. METHODS: A total of 80 acute stroke patients were enrolled in this study. The criteria for inclusion in the study was as following: 1) first stroke, 2) cognitive function preserved enough to perform the test (Mini Mental State Examination > or =24), 3) good functional levels (Modified Rankin Scale or =3), and 5) less than 2 weeks between the stroke and the assessment. Quality of sleep was assessed by using Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS). Activities of daily living was assessed by using the Modified Barthel Index (MBI) and depressed mood was assessed by using the Beck Depression Inventory (BDI). Gross and fine motor function of the upper extremity was assessed by using hand strength test (Jamar dynamometer), Purdue pegboard test, and the 9-hole peg test. RESULTS: The results of the occupational assessment were fine in the good sleepers. The PSQI, ESS, and ISI were correlated with some of the assessment tools (BDI, MBI, Purdue pegboard, 9-hole peg, and hand strength). CONCLUSION: In conclusion, this study emphasizes that sleep disturbance can affect the functional status in mild acute stroke patients. Therefore, clinicians must consider sleep status in stroke patients and need to work to control it.

Ischemic Compression After Trigger Point Injection Affect the Treatment of Myofascial Trigger Points

OBJECTIVE: To investigate the effects of trigger point injection with or without ischemic compression in treatment of myofascial trigger points in the upper trapezius muscle. METHODS: Sixty patients with active myofascial trigger points in upper trapezius muscle were randomly divided into three groups: group 1 (n=20) received only trigger point injections, group 2 (n=20) received trigger point injections with 30 seconds of ischemic compression, and group 3 (n=20) received trigger point injections with 60 seconds of ischemic compression. The visual analogue scale, pressure pain threshold, and range of motion of the neck were assessed before treatment, immediately after treatment, and 1 week after treatment. Korean Neck Disability Indexes were assessed before treatment and 1 week after treatment. RESULTS: We found a significant improvement in all assessment parameters (p<0.05) in all groups. But, receiving trigger point injections with ischemic compression group showed significant improvement as compared with the receiving only trigger point injections group. And no significant differences between receiving 30 seconds of ischemic compression group and 60 seconds of ischemic compression group. CONCLUSION: This study demonstrated the effectiveness of ischemic compression for myofascial trigger point. Trigger point injections combined with ischemic compression shows better effects on treatment of myofascial trigger points in the upper trapezius muscle than the only trigger point injections therapy. But the duration of ischemic compression did not affect treatment of myofascial trigger point.

Predictive Value of Test of Infant Motor Performance for Infants based on Correlation between TIMP and Bayley Scales of Infant Development

OBJECTIVE: To assess the relationship of scores on the test of infant motor performance (TIMP), with those on the Bayley scales of infant development (BSID), and to investigate the sensitivity and specificity of TIMP and the optimal cut-off value of TIMP scores using ROC analysis. METHOD: Seventy-six preterm and term infants were recruited from neonatal intensive care units. Subjects were tested with the TIMP at their initial visit and after 6 months, they were tested by using BSID. RESULTS: In the reliability study, TIMP scores showed highly significant correlation with the Bayley physical developmental index (BPDI) (p=0.001) and Bayley mental developmental index (BMDI) (p=0.017). Receiver operator characteristics (ROC) curve analysis was performed to evaluate the TIMP test for screening infant motor development. ROC analysis showed an area under the curve (AUC) of 0.825 (p=0.005) in BPDI and 0.992 (p=0.014) in BMDI, indicating an excellent classification performance of the model. The optimal cut-off value where a sensitivity of 86%, and specificity of 68% were achieved with the TIMP was 1.50 (between average and below average) in BPDI and where a sensitivity of 100%, and specificity of 66% were achieved with the TIMP was 1.50 in BMDI. CONCLUSION: Our results indicate that the TIMP provides a reliable and valid measurement that can be used for the evaluation of motor function in preterm and term infants. TIMP was highly sensitive and specific with the follow-up examination of BSID. Therefore it can be used as a reliable screening tool for neonates and infants aged <4 months.

Comparison of Manual Balance and Balance Board Tests in Healthy Adults

OBJECTIVE: To investigate the correlations of scores on the Timed Up and Go (TUG) test and the Single Leg Stance (SLS) test with stability scores on the Biodex Balance System (BBS) in healthy adults. METHOD: The postural balance of 73 participants was measured on the TUG and SLS tests and with the Overall Stability Index (OSI) on the BBS. The participants were divided into groups by age and by times on the TUG and SLS. The correlations between TUG or SLS and OSI scores were analyzed by groups. RESULTS: TUG scores were significantly correlated with OSI scores in age under 65 years, TUG over 10 seconds and SLS over 30 seconds groups (level 12). TUG scores were also correlated with OSI in total (level 10) and TUG under 10 seconds groups (level 2). However, there were no significant relationships between SLS and OSI scores. CONCLUSION: OSI scores on the BBS are significantly correlated with TUG scores, especially at the easy levels. According to the findings of present study, relatively easy BBS levels are considered to assess the postural balance in healthy adults.

The Effects of Neuromuscular Electrical Stimulation on Swallowing Function in Healthy Older Adults

OBJECTIVE: To evaluate the effects of neuromuscular electrical stimulation on the swallowing function in healthy older adults without clinical dysphagia. METHOD: The subjects were 18 healthy older adults aged >70 years and 10 young adults aged <30 years without symptoms or a history of dysphagia. Both groups were evaluated by the functional dysphagia scale (FDS) and pharyngeal transit time (PTT), using a videofluoroscopic swallowing study with semisolid material. Only the healthy older adults group received neuromuscular electrical stimulation (NMES) on suprahyoid and infrahyoid muscles, 60 min/day, 5 days/wk, for 2 weeks. The healthy older adults group was then re-evaluated by FDS and PTT. RESULTS: The average PTT in young adults was lower than in healthy older adults. FDS of the oral phase was larger in the older adults than in the young adults. After NMES for 2 weeks in older adults, there was a significant improvement in the averages for PTT and FDS. CONCLUSION: The results of this study showed that healthy older adults without clinical dysphagia had decreased swallowing function when they were compared with young adults. After NMES, the swallowing function, evaluated by FDS and PTT, was improved in healthy older adults.

Iatrogenic Rickets Myopathy: A case report

Gait disturbance in infants and toddlers results from various diseases, such as musculoskeletal, neuropathic, metabolic, and inherited disorders. These disorders lead to myopathies with muscle weakness. Nutritional deficiency can cause myopathy but it is very rare, because of early diagnosis and effective treatment. Vitamin D deficiency also can induce myopathy. Rickets, the clinical term of chronic vitamin D deficiency, results in secondary hyperparathyroidism that can show the characteristics of myopathy, such as muscle weakness, especially on the proximal muscles of lower extremities and the following waddling gait. We report a rare case of iatrogenic rickety myopathy.

The Test of Infant Motor Performance (TIMP) in Preterm and Term Infants

OBJECTIVE: To assess motor development of preterm and term infants using the test of infant motor performance (TIMP) and to compare the reliability of the TIMP measuring by different raters. METHOD: 55 preterm and term infants were tested with the TIMP at ages ranging from 35 weeks postconceptional age to 14 weeks corrected age. A linear correlation analysis was used to assess the contributions of age, risk, and radiologic findings to the variance in TIMP scores. In the reliability study, the TIMP was administered to the infants by an occupational therapist, and infant performances were videotaped. The performance was then rescored by another tester to examine the interrater reliability. RESULTS: No significant correlations between infant variables and TIMP score changes were revealed. In the reliability study, statistically significant correlation between two raters was found (Cohen's kappa: 0.959, p<0.001). CONCLUSION: TIMP has a good interrater test reliability for use in clinical practice to assess infant motor performance. But the TIMP could not discriminate among infants with differing risks for motor developmental delay. Further evaluation and follow up survey is necessary to find correlation between the development process and medical risk factor among the participated subjects in this study.

The efficacy of sonographic morphology indexing and serum CA-125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors / 부인종양

OBJECTIVE: To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors. METHODS: From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined. RESULTS: There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively. CONCLUSION: The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.

The efficacy of sonographic morphology indexing and serum CA-125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors / 부인종양

OBJECTIVE: To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors. METHODS: From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined. RESULTS: There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively. CONCLUSION: The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.

Screening Test for Depression Using the SF-36 Health Survey in Patients with Chronic Musculoskeletal Pain

OBJECTIVE: To evaluate the usefulness of the mental component summary (MCS) from the short form 36-item health survey (SF-36) as a screening test for depression in patients with chronic musculoskeletal pain and identify the optimal cut-off value that predicts a positive depression score measured by the center for epidemiological study depression survey (CES-D). METHOD: This study was designed as a questionnaire survey. 502 patients who visited our outpatient clinics due to chronic musculoskeletal pain were evaluated. They completed the SF-36 and the CES-D. The correlation between the MCS score from the SF-36 and the CES-D was identified, and also the cut-off value of the MCS score was determined with ROC curves used the CES-D as the standard measure for depression. The MCS scores were compared according to age, sex, duration of diseases, diagnosis, and the presence of depression. RESULTS: The mean overall score of CES-D and the MCS score were 17.5+/-10.2, 52.2+/-16.4 respectively. The MCS scores negatively correlated with the CES-D (gamma=-0.879, p0.05). However, patients with depression had significantly lower MCS scores than patients without depression (p<0.05). The cut-off value was 42.4 with 88.1% of sensitivity and 92.6% of specificity. CONCLUSION: The MCS scores would be useful screening test for depression with cut-off value of 42.4 that predicts the closest result of the CES-D.

Inhibition of trichostatin A-induced antiangiogenesis by small-interfering RNA for thrombospondin-1

Expression of thrombospondin-1 (TSP-1), which is a known inhibitor of tumor growth and angiogenesis, is reciprocally regulated by positive regulators, such as VEGF. Additionally, trichostatin A (TSA) suppresses tumor progression by altering VEGF levels and VEGF-mediated signaling. Thus, understanding TSA-regulated TSP-1 expression and the effects of altered TSP-1 levels might provide insights into the mechanism of action of TSA in anti-tumorigenesis, and provide an approach to cancer therapy. Here, we examined the effect of TSA on TSP-1 expression, and the effects of TSA-induced TSP-1 on cell motility and angiogenesis, in HeLa and bovine aortic endothelial cells. TSA remarkably increased TSP-1 expression at the mRNA and protein levels, by controlling the TSP-1 promoter activity. Both TSA and exogenous TSP-1 reduced cell migration and capillary-like tube formation and these activities were confirmed by blocking TSP-1 with its neutralizing antibody and small-interfering RNA. Our results suggest that TSP-1 is a potent mediator of TSA-induced anti- angiogenesis.