Correlation Between Neuromelanin-Sensitive MRI and 18F-FP-CIT PET in Early-Stage Parkinson’s Disease:Utility of a Voxel-Wise Analysis by Using High-Spatial-Resolution MRI

Background@#and PurposeThe correlation between dopamine transporter (DAT) imaging and neuromelanin-sensitive magnetic resonance imaging (NM-MRI) in early-stage Parkinson’s disease (PD) has not yet been established. This study aimed to determine the correlation between NM-MRI and DAT positron-emission tomography (PET) in patients with early-stage PD. @*Methods@#Fifty drug-naïve patients with early-stage PD who underwent both 0.8-mm isovoxel NM-MRI and DAT PET were enrolled retrospectively. Using four regions of interest (nigrosome 1 and nigrosome 2 [N1 and N2] regions) from a previous study, the contrast ratios (CRs) of 12 regions were measured: N1, N2, flipped N1, flipped N2, combined N1 and N2, and whole substantia nigra pars compacta [SNpc] (all on both sides). The clinically more affected side was separately assessed. The standardized uptake value ratios (SUVRs) were measured in the striatum using DAT PET. A partial correlation analysis was performed between the SUVR and CR measurements. @*Results@#CR of the flipped left N1 region was significantly correlated with SUVR of the right posterior putamen (p=0.047), and CR values of the left N1 region, left N2 region, flipped right N1 region, and combined left N1 and N2 regions were significantly correlated with SUVR of the left posterior putamen (p=0.011, 0.038, 0.020, and 0.010, respectively). SUVR of the left anterior putamen was significantly correlated with CR of the left N2 region (p=0.027). On the clinically more affected side, the CR values of the N1 region, combined N1 and N2 regions, and the whole SNpc were significantly correlated with SUVR of the posterior putamen (p=0.001, 0.024, and 0.021, respectively). There were significant correlations between the SUVR of the anterior putamen and the CR values of the N1 region, combined N1 and N2 regions, and whole SNpc (p=0.027, 0.001, and 0.036, respectively). @*Conclusions@#This study found that there were significant correlations between CR values in the SNpc on NM-MRI and striatal SUVR values on DAT PET on both sides in early-stage PD.

Validation of the Korean Version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale

Background@#and PurposeImpulse-control disorder is an important nonmotor symptom of Parkinson's disease (PD) that can lead to financial and social problems, and be related to a poor quality of life. A nationwide multicenter prospective study was performed with the aim of validating the Korean Version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (K-QUIP-RS). @*Methods@#The K-QUIP-RS was constructed using forward and backward translation, and pretesting of the prefinal version. PD patients on stable medical condition were recruited from 27 movement-disorder clinics. Participants were assessed using the K-QUIP-RS and evaluated for parkinsonian motor and nonmotor statuses and for PD-related quality of life using a predefined evaluation battery. The test–retest reliability of the K-QUIP-RS was assessed over an interval of 10–14 days, and correlations between the KQUIP-RS and other clinical scales were analyzed. @*Results@#This study enrolled 136 patients. The internal consistency of the K-QUIP-RS was indicated by a Cronbach's α coefficient of 0.846, as was the test–retest reliability by a Guttman split-half coefficient of 0.808. The total K-QUIP-RS score was positively correlated with the scores for depression and motivation items on the Unified PD Rating Scale (UPDRS), Montgomery-Asberg Depression Scale, and Rapid-Eye-Movement Sleep-Behavior-Disorders Questionnaire. The total K-QUIP-RS score was also correlated with the scores on part II of the UPDRS and the PD Quality of Life-39 questionnaire, and the dopaminergic medication dose. @*Conclusions@#The K-QUIP-RS appears to be a reliable assessment tool for impulse-control and related behavioral disturbances in the Korean PD population.

Subtypes of Sleep Disturbance in Parkinson's Disease Based on the Cross-Culturally Validated Korean Version of Parkinson's Disease Sleep Scale-2

Hand Tremor Questionnaire: A Useful Screening Tool for Differentiating Patients with Hand Tremor between Parkinson's Disease and Essential Tremor

BACKGROUND AND PURPOSE: Hand tremor is one of the most frequent symptoms in movement disorders, and differential diagnoses for hand tremor include Parkinson's disease (PD) and essential tremor (ET). However, accurately differentiating between PD and ET in clinical practice remains challenging in patients presenting with hand tremor. We investigated whether a questionnaire-based survey could be useful as a screening tool in patients with hand tremor. METHODS: A questionnaire related to hand tremor consisting of 12 items was prospectively applied to patients with PD or ET in three movement-disorder clinics. Each question was analyzed, and a query-based scoring system was evaluated for differentiating hand tremors between PD and ET. RESULTS: This study enrolled 24 patients with PD and 25 patients with ET. Nine of the 12 questions differed significantly between PD and ET: 1 about resting tremor, 4 questions about action tremor, and 4 about asymmetry. A receiver operating characteristics curve analysis revealed that the 9-item questionnaire showed a good discrimination ability, with a sensitivity of 88% and a specificity of 84%. CONCLUSIONS: The developed Hand Tremor Questionnaire might be a good screening tool for hand tremors in patients with PD and ET.

Validation of the Korean Version of the Scales for Outcomes in Parkinson's Disease-Sleep

BACKGROUND: Sleep problems commonly occur in patients with Parkinson's disease (PD), and are associated with a lower quality of life. The aim of the current study was to translate the English version of the Scales for Outcomes in Parkinson's Disease-Sleep (SCOPA-S) into the Korean version of SCOPA-S (K-SCOPA-S), and to evaluate its reliability and validity for use by Korean-speaking patients with PD. METHODS: In total, 136 patients with PD from 27 movement disorder centres of university-affiliated hospitals in Korea were enrolled in this study. They were assessed using SCOPA, Hoehn and Yahr Scale (HYS), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Sleep Scale 2nd version (PDSS-2), Non-motor Symptoms Scale (NMSS), Montgomery Asberg Depression Scale (MADS), 39-item Parkinson's Disease Questionnaire (PDQ39), Neurogenic Orthostatic Hypotension Questionnaire (NOHQ), and Rapid Eye Movement Sleep Behaviour Disorder Questionnaire (RBDQ). The test-retest reliability was assessed over a time interval of 10–14 days. RESULTS: The internal consistency (Cronbach's α-coefficients) of K-SCOPA-S was 0.88 for nighttime sleep (NS) and 0.75 for daytime sleepiness (DS). Test-retest reliability was 0.88 and 0.85 for the NS and DS, respectively. There was a moderate correlation between the NS sub-score and PDSS-2 total score. The NS and DS sub-scores of K-SCOPA-S were correlated with motor scale such as HYS, and non-motor scales such as UPDRS I, UPDRS II, MADS, NMSS, PDQ39, and NOHQ while the DS sub-score was with RBDQ. CONCLUSION: The K-SCOPA-S exhibited good reliability and validity for the assessment of sleep problems in the Korean patients with PD.

Pontine Infarct Presenting as Peripheral Type Unilateral Facial Palsy

Acute peripheral facial palsy usually manifests Bell's palsy of unknown cause, and rarely lacunar infarct which located in facial nucleus can mimic peripheral facial palsy. A 73 year-old man with isolated facial asymmetry diagnosed with lacunar infarction which selectively involve the facial fascicles which lie in inferolateral aspect of pons. Clinicians should take into account the possibility of central lesion and brain stem infarction, even when patients present with isolated peripheral type facial palsy.

Validation of the Korean Version of the Scale for Outcomes in Parkinson's Disease-Autonomic

OBJECTIVE: Autonomic symptoms are commonly observed in patients with Parkinson's disease (PD) and often limit the activities of daily living. The Scale for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) was developed to evaluate and quantify autonomic symptoms in PD. The goal of this study was to translate the original SCOPA-AUT, which was written in English, into Korean and to evaluate its reliability and validity for Korean PD patients. METHODS: For the translation, the following processes were performed: forward translation, backward translation, expert review, pretest of the pre-final version and development of the final Korean version of SCOPA-AUT (K-SCOPA-AUT). In total, 127 patients with PD from 31 movement disorder clinics of university-affiliated hospitals in Korea were enrolled in this study. All patients were assessed using the K-SCOPA-AUT and other motor, non-motor, and quality of life scores. Test-retest reliability for the K-SCOPA-AUT was assessed over a time interval of 10−14 days. RESULTS: The internal consistency and reliability of the K-SCOPA-AUT was 0.727 as measured by the mean Cronbach's α-coefficient. The test-retest correlation reliability was 0.859 by the Guttman split-half coefficient. The total K-SCOPA-AUT score showed a positive correlation with other non-motor symptoms [the Korean version of non-motor symptom scale (K-NMSS)], activities of daily living (Unified Parkinson's Disease Rating Scale part II) and quality of life [the Korean version of Parkinson's Disease Quality of Life 39 (K-PDQ39)]. CONCLUSION: The K-SCOPA-AUT had good reliability and validity for the assessment of autonomic dysfunction in Korean PD patients. Autonomic symptom severities were associated with many other motor and non-motor impairments and influenced quality of life.

Relationship among Types of Nursing Organizational Culture, Self-leadership and Burnout as Perceived by Perioperative Nurses / 간호행정학회지

PURPOSE: This study was designed to assess the types of nursing organizational culture, and degree of self-leadership and burnout as perceived by perioperative nurses, and to identify correlations between these variables. METHODS: Participants were 155 nurses from 3 tertiary hospitals in Seoul and data were analyzed using descriptive statistics, ANOVA, Scheffé, and Pearson correlation coefficient. RESULTS: In the types of nursing organizational culture, the mean score for hierarchy-oriented culture was 3.57, and for self-leadership, 3.61 and for burnout, 2.87. In the relationship between the types of nursing organizational culture, self-leadership and burnout, relation-oriented culture (r=.24, p<.01), innovation-oriented culture (r=.23, p<.01) and task-oriented culture (r=.22, p<.01) had a slight positive correlation with self-leadership in that order. The innovation-oriented culture (r=-.29, p<.01) and relation-oriented culture (r=-.42, p<.01) among the types of nursing organizational culture showed a negative correlation with burnout while the hierarchy-oriented culture (r=.28, p<.01) showed a positive correlation with burnout. Self-leadership showed a negative correlation with burnout (r=-.42, p<.01). CONCLUSION: The results show that nurses in operating rooms have a high awareness of hierarchy-oriented culture that affects burnout in a negative way while having a low awareness of relation-oriented culture that has a positive influence on burnout.

Validity Test of K-SKAGOAO for Korean Nursing Groups and the Relationship of Nursing Group Power and Job Satisfaction, Organizational Commitment, Organizational Performance / 임상간호연구

PURPOSE: The purpose of this study was to test validity and reliability of the Korean-Sieloff King Assessment of Group Outcome Attainment within organization in Korea (K-SKAGOAO), and also to explore the relationship of Korean nursing group power and job satisfaction, organizational commitment, organizational performance. METHODS: Participants were 481 nurse managers, nurse unit managers or staff nurses with over 7 years experience. Data were collected by post mail and analyzed using descriptive statistics, ANOVA, Kruskal-Wallis test, Tukey test, and Spearman's correlation. RESULTS: Content Validity Index was over .82 and Cronbach's α coefficient for the K-SKAGOAO was .97. The mean score for Korean nursing group power was 136.77 among the total participants, 139.89 among nurse managers, 136.74 among nurse unit managers and 132.47 among staff nurses. These results showed high nursing group power in Korea nursing organization in hospitals. There was also a significant difference according to nurse position (p=.003). Korean nursing group power was positively related to job satisfaction, organizational commitment, and organizational performance. CONCLUSION: Findings show that the K-SKAGOAO has validity and reliability. Nursing groups can use the K-SKAGOAO to evaluate the nursing group power of each nursing organization and to develop strategies to improve nursing power and nursing outcomes.

Rapid Eye Movement Sleep Behavior Disorder in Parkinson's Disease: A Preliminary Study

OBJECTIVE: Rapid eye movement sleep behavior disorder (RBD) is associated with α-synucleinopathies, such as Parkinson's disease (PD). We aimed to assess the differences in the clinical characteristics of PD with and without RBD. METHODS: Forty-two patients previously diagnosed with PD were evaluated for clinical history, motor and cognitive functioning using the Unified Parkinson's Disease Rating Scale (UPDRS) and Mini-Mental State Examination (MMSE), autonomic symptoms, sleep characteristics using the Pittsburg Sleep Quality Index (PSQI), and the presence of RBD using the Korean version of the RBD screening questionnaire (RBDSQ). The prevalence of RBD and the patients' demographic features were evaluated. The patients were classified into two groups, PD with RBD and PD without RBD, based on the RBDSQ scores. The motor and cognitive functions, as well as other clinical features of the two groups were compared. RESULTS: A total of 42 PD patients were enrolled. Eighteen patients were classified as PD with RBD. Compared to PD without RBD, PD with RBD showed higher scores of rigidity in the UPDRS subscale. Regarding sleep problems, PD with RBD revealed higher sleep disturbance, lower sleep efficiency, and lower overall sleep quality in the PSQI. There was no difference in cognitive dysfunction between the two groups according to the Korean version of the MMSE. CONCLUSIONS: PD with RBD was associated with poorer sleep and motor symptoms. Therefore, RBD symptoms in PD are possibly poor prognostic markers.

Clinical Heterogeneity of Atypical Pantothenate Kinase-Associated Neurodegeneration in Koreans

OBJECTIVE: Neurodegeneration with brain iron accumulation (NBIA) represents a group of inherited movement disorders characterized by iron accumulation in the basal ganglia. Recent advances have included the identification of new causative genes and highlighted the wide phenotypic variation between and within the specific NBIA subtypes. This study aimed to investigate the current status of NBIA in Korea. METHODS: We collected genetically confirmed NBIA patients from twelve nationwide referral hospitals and from a review of the literature. We conducted a study to describe the phenotypic and genotypic characteristics of Korean adults with atypical pantothenate kinase-associated neurodegeneration (PKAN). RESULTS: Four subtypes of NBIA including PKAN (n = 30), PLA2G6-related neurodegeneration (n = 2), beta-propeller protein-associated neurodegeneration (n = 1), and aceruloplasminemia (n = 1) have been identified in the Korean population. The clinical features of fifteen adults with atypical PKAN included early focal limb dystonia, parkinsonism-predominant feature, oromandibular dystonia, and isolated freezing of gait (FOG). Patients with a higher age of onset tended to present with parkinsonism and FOG. The p.R440P and p.D378G mutations are two major mutations that represent approximately 50% of the mutated alleles. Although there were no specific genotype-phenotype correlations, most patients carrying the p.D378G mutation had a late-onset, atypical form of PKAN. CONCLUSIONS: We found considerable phenotypic heterogeneity in Korean adults with atypical PKAN. The age of onset may influence the presentation of extrapyramidal symptoms.

Diffuse Calcification Restricted on Periventricular White Matter by Primary Hypoparathyroidism

No abstract available.

Subarachnoid Hemorrhage Showed Only on T2-Weighted Magnetic Resonance Imaging

We present the case of a 28-year-old pregnant woman with subarachnoid hemorrhage who was initially unable to undergo a CT scan and exhibited interestingly high signal intensities only on T2-weighted MRI without any signal change on fluid attenuated inversion recovery and gradient-echo imaging. These findings could be explained by a combination of factors that increase the signal intensity with elevations in the concentrations of protein and oxyhemoglobin due to massive bleeding and with the decreased fluid void signal inferred by the presence of hydrocephalus.

Clinical and Electrophysiological Changes after Open Carpal Tunnel Release: Preliminary Study of 25 Hands / 대한임상신경생리학회지

BACKGROUND: Electrophysiological study has been known as a useful method to evaluate the therapeutic effect of operation in idiopathic carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the clinical and electrophysiological changes after carpal tunnel release (CTR) compared to the preoperative results. METHODS: We analyzed the changes of nerve conduction study (NCS) before and after minimal open carpal tunnel release in 18 patients (25 hands) with CTS. Follow-up study was performed over 6 months after operation. RESULTS: Clinical improvement was seen in all cases after CTR. In contrast, electrophysiological improvement was various depending on the parameters; the mean median sensory latency and nerve conduction velocity (NCV) improved significantly (p = 0.001). The mean median motor latency also improved, but NCV and compound muscle action potential (CMAP) amplitude did not change. The extent of improvement was evident in moderate CTS, but not in severe CTS. CONCLUSIONS: In this preliminary study, all subjects who underwent CTR achieved a clinical relief along with a significant improvement of electrophysiological parameters such as median sensory latency, sensory NCV and median distal motor latency. After CTR, a number of cases with mild to moderate CTS showed a prominent improvement of clinical and electrophysiological parameters, while fewer improvements were seen in severe CTS, although it did not reach the statistical significance.

Intracranial Cystic Metastasis Mimicking Neurocysticercosis in a Pregnant Woman

Brain metastasis can form large cystic lesions, and its differentiation on the basis of imaging findings alone is difficult. A 36-year-old woman with headache visited emergency room. Two years ago, she was diagnosed as neurocysticercosis and had taken anti-parasite medications. However, in the current visit, the sizes of intracranial cystic lesions increased. Brain biopsy reported metastatic neuroendocrine tumor, and chest CT showed the primary site of the tumor. Cystic brain metastasis should be considered in cases with cystic brain lesions.

Relation Between Left Atrial Enlargement and Stroke Subtypes in Acute Ischemic Stroke Patients

OBJECTIVE: Increased atrial size is frequently seen in ischemic stroke patients in clinical practice. There is controversy about whether left atrial enlargement (LAE) should be regarded as a risk factor for cerebral infarction. We investigated the association between indexed left atrial volume (LAVI) and conventional stroke risk factors as well as stroke subtypes in acute ischemic stroke patients. METHODS: One hundred eighty two acute cerebral infarction patients were included in this study. Brain magnetic resonance imaging and transthoracic echocardiography were done for all patients within 30 days of diagnosis of acute cerebral infarction. Echocardiographic LAE was identified when LAVI was more than 27 mL/m2. Stroke subtypes were classified by the Trial of Org 10171 in acute stroke treatment classification. RESULTS: There were significant differences between subjects with normal and increased LAVI in prevalence of stroke risk factors including atrial fibrillation (p = 0.001), hypertension (p = 0.000), valvular heart disease (p = 0.011) and previous stroke (p = 0.031). An increased LAVI was associated with cardioembolic subtype with an adjusted odds ratio was 6.749 (p = 0.002) compared with small vessel disease. CONCLUSION: Increased LAVI was more prevalent in those who had cardiovascular risk factors, such as atrial fibrillation, hypertension, valvular heart disease and history of previous stroke. LAE influenced most patients in all subtypes of ischemic stroke but was most prevalent in the cardioembolic stroke subtype. Increased LAVI might be a risk factor of cerebral infarction, especially in patients with cardioembolic stroke subtype.

Relation Between Left Atrial Enlargement and Stroke Subtypes in Acute Ischemic Stroke Patients

OBJECTIVE: Increased atrial size is frequently seen in ischemic stroke patients in clinical practice. There is controversy about whether left atrial enlargement (LAE) should be regarded as a risk factor for cerebral infarction. We investigated the association between indexed left atrial volume (LAVI) and conventional stroke risk factors as well as stroke subtypes in acute ischemic stroke patients. METHODS: One hundred eighty two acute cerebral infarction patients were included in this study. Brain magnetic resonance imaging and transthoracic echocardiography were done for all patients within 30 days of diagnosis of acute cerebral infarction. Echocardiographic LAE was identified when LAVI was more than 27 mL/m2. Stroke subtypes were classified by the Trial of Org 10171 in acute stroke treatment classification. RESULTS: There were significant differences between subjects with normal and increased LAVI in prevalence of stroke risk factors including atrial fibrillation (p = 0.001), hypertension (p = 0.000), valvular heart disease (p = 0.011) and previous stroke (p = 0.031). An increased LAVI was associated with cardioembolic subtype with an adjusted odds ratio was 6.749 (p = 0.002) compared with small vessel disease. CONCLUSION: Increased LAVI was more prevalent in those who had cardiovascular risk factors, such as atrial fibrillation, hypertension, valvular heart disease and history of previous stroke. LAE influenced most patients in all subtypes of ischemic stroke but was most prevalent in the cardioembolic stroke subtype. Increased LAVI might be a risk factor of cerebral infarction, especially in patients with cardioembolic stroke subtype.

Psychological Well-being, Perceived Health Status, and Health Promoting Behavior of Clinical Nurses / 간호행정학회지

PURPOSE: This study was designed to assess the degree of psychological well-being, perceived health status, and health promoting behavior of clinical nurses, and to identify correlations between variables. METHODS: Participants were 194 nurses working at S hospital, Seoul and data were analyzed using descriptive statistics, ANOVA, Duncan's test, Pearson correlation coefficient, and multiple regressions. RESULTS: Mean scores were 3.45 (5 point scale) for psychological well-being, 2.82(4 point scale) for perceived health status, and 2.30(4 point scale) for health promoting behavior. Psychological well-being correlated positively with perceived health status (r=.34, p<.001). Perceived health status showed a positive correlation with health promoting behavior (r=.30, p<.001). There was a positive correlation between psychological well-being and health promoting behavior (r=.52, p<.001). Personal growth(t=2.85, p=.005), purpose in life (t=2.30, p=.023) among subscales of psychological well-being, and perceived health status (t=2.13, p=.034) had a significant influence on health promoting behavior. These combinations explained 32.1% of health promoting behavior (F=12.58, p<.001). CONCLUSION: The results of this study suggest strategies to improve health promoting behavior by enhancing psychological well-being of nurses. Furthermore, a study to identify the effects of developed and applied psychological well-being promotion program should be conducted.

A Case of Cluster Headache Accompanied by Myoclonus and Hemiparesis

BACKGROUND: Cluster headache is a primary headache disorder characterized by periodic episodes of intense headache accompanied by autonomic symptoms. We report an unusual clinical presentation of cluster headache that was preceded by myoclonus and accompanied by hemiparesis. CASE REPORT: A 26-year-old man visited hospital due to recurrent jerky movements on the left side of his face and neck area lasting 3 days. These jerky movements had disappeared spontaneously without specific treatment. On the 10th day after onset of the jerky movements, the patient developed a series of unilateral severe headaches that were accompanied by autonomic symptoms lasting 1-2 hours. According to the second edition of The International Classification of Headache Disorders, he was diagnosed as having cluster headache. Two of the 16 severe headache attacks this patient suffered were accompanied by dysarthria and hemiparesis. Electroencephalography performed during hemiparesis revealed diffuse lateralized slow activity on the ipsilateral hemisphere of the headache side. The headache and accompanying hemiparesis disappeared after medical treatment for cluster headache. CONCLUSIONS: We describe a case of cluster headache accompanied by hemiparesis, which was preceded by myoclonus. We also outline the possible mechanisms underlying this case.

Oncology Advanced Nurses' Use of Outcome Indicators and Perception of Outcome Evaluation / 간호행정학회지

PURPOSE: The purpose of this study was to explore the use of outcome indicators and perception of outcome evaluation of oncology advanced practice nurses (APNs). METHOD: A total of 111 oncology APNs from hospitals which have over 400 beds were surveyed. The participants' use of outcome indicators and perception of outcome evaluation were collected using a questionnaire including 84 outcome indicators for APNs developed by Sung et al. and 13 items on APNs' contribution to the hospitals developed by Kleinpell (2005). Data were analyzed using descriptive statistics, t-test, and chi2 test. RESULT: Twelve items out of 84 outcome indicators were used over 50% of the time and 57 items could be used in the future by the participants. Seven of the 10 top-ranking outcome indicators in use were education related and were also expected to be used frequently in the future. The score for participants' perception of outcome evaluation was average-high, 3.82 out of 5. CONCLUSIONS: The results of the study show that the main outcome indicator for oncology APNs is education related, and thus the use of education related outcome indicators is recommended to make oncology APNs' activities be more visible.