Effect of Integrated Cognitive Intervention Therapy in Patients with Mild to Moderate Alzheimer's Disease

Background@#and Purpose: The effect of the integrated program comprising cognitive training, art therapy, and music therapy has not been extensively studied in patients with Alzheimer's disease (AD). The present study investigated the effect of integrated cognitive intervention therapy on cognition, and activity of daily life (ADL), and mood in patients with mild to moderate AD. @*Methods@#In this study, the data of 59 patients who met the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer disease and Related Disorders Association (NINCDS-ADRDS) criteria of probable AD among those who registered at the Centenarian's Good Memory Program in Goyang from September 2014 to August 2019 were collected. We statistically analyzed the scores of Korean version of a Mini-Mental Status Examination (K-MMSE), Korean Dementia Screening Questionnaire-Cognition (KDSQ-C), Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), and Seoul-Instrumental Activities of Daily Living (S-IADL) of the same patients before and after the use of integrated cognitive intervention therapy. @*Results@#K-MMSE slightly increased from 18.7±4.5 to 19.7±5.0 (p<0.001) and KDSQ-C improved from 14.5±7.6 before therapy to 12.6±7.2 after therapy (p=0.001). Mean S-IADL score improved from 17.6±7.6 before therapy to 15.7±9.5 after therapy (p<0.001). Additionally, mean GDS score before the therapy was 5.6±3.5 that improved to 4.2±3.0 after the therapy (p<0.001).Mean BAI score decreased from 8.4±10.3 before therapy to 5.9±8.4 after therapy (p=0.001). @*Conclusions@#In conclusion, this study demonstrated the possibility that the use of an integrated cognitive therapy improved cognition, ADL, and mood (depression and anxiety) in patients with mild to moderate ADs.

The change of stroke volume variation during thoracotomy or one lung ventilation

BACKGROUND: Stroke volume variation (SVV) is based on cyclic changes of intrathoracic pressure during respiratory cycle. Thoracotomy and one-lung ventilation (OLV) can lead to changes in airway and intrathoracic pressure. The aim of this study was to determine whether thoracotomy and converting from two lung ventilation to OLV could affect SVV values. METHODS: Thirty patients who were scheduled for pulmonary lobectomy or pneumonectomy requiring OLV were enrolled. Induction and maintenance of anesthesia were performed with propofol and remifentanil via total intravenous anesthesia. Hemodynamic variables including mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), and SVV were measured at intervals of 1 min for 10 min after thoracotomy and OLV, respectively. RESULTS: MAP and HR increased from baseline at intervals between 3 and 10 min and between 4 and 10 min after thoracotomy, respectively (P < 0.001). CI increased between 4 and 10 min (P < 0.001). SVV did not change for 10 min after thoracotomy. After OLV, MAP decreased between 4 and 10 min (P = 0.112). SVV was the highest at 1 min after OLV. It returned to the baseline value at 7 min (P < 0.001). CI decreased between 8 and 10 min after OLV (P < 0.001). CONCLUSIONS: SVV can increase after OLV temporarily. Transient increase of SVV may be considered when fluid responsiveness is predicted by SVV during early period after OLV.

The comparison of two different intraarticular injections using a sonographic anterolateral approach in patients with osteoarthritic knee

BACKGROUND: The intraarticular (IA) injection has become popular for the management of the osteoarthritic knee without an effusion. The success rate of IA injection would be better if it was able to be visually confirmed. We hypothesized that an anterolateral approach, which targets the synovial membrane of the lateral condyle using ultrasound, would provide an equivalent alternative to the anterolateral approach, targeting the synovial membrane of the medial condyle for IA injection of the knee. METHODS: A total of 96 knees with osteoarthritis were randomized placed into the two groups, which were group I (anterolateral approach to the medial condyle) and group II (anterolateral approach to the lateral condyle). The primary outcome was to compare the success rate of the two methods of IA injection. The required length of the needle for injection was also measured and compared. Pain intensity was assessed using the Numeric Rating Scale in order to evaluate the success of injection. RESULTS: There were no significant differences in the success rate between both groups. The success rate of group I and group II were 87.8% (95%, CI 78.7–97.0) and 91.5% (95%, CI 83.6–99.5), respectively (P = 0.549). The needle depth was 5.0 ± 0.8 (3.0 to 6.1 cm) in group I, and 3.0 ± 0.8 (1.5 to 5 cm) in group II (P < 0.001). CONCLUSIONS: The anterolateral approach to the lateral femoral condyle, using ultrasound, is an alternative method to the approach targeting the medial femoral condyle, using shorter needle.

An Objective Assessment Scale for "Come-to-Sit" Using a Specifically Designed Jacket in Stroke Patients

OBJECTIVE: To compare an objective assessment scale for "come-to-sit" in stroke patients with the previously established subjective assessment scales of "performance-based assessment" and the "ability for basic movement scale". METHOD: A specifically designed jacket was used to determine the objective degree of assistance needed for patients to perform the task. While patients were sitting up, the investigator evaluated the amount of assistance needed in a fully dependent state (A) and with maximal effort (B). Using this measure, we obtained an objective scale, {(A-B)/A} x100. In addition, patients were tested in two starting positions: hemiplegic-side lying and sound-side lying. We then compared the objective scale with subjective scales and other parameters related to functional outcomes. RESULTS: For both starting positions, the objective assessment scale showed high correlation with the previously established subjective scales (p<0.01). Only the hemiplegic-side lying-to-sit objective scale showed a significant correlation with the parameters used to assess functional outcomes (p<0.05). In terms of Brunnstrom stages, only the leg stage showed a significant correlation with the objective "come-to-sit" scale (p<0.01). CONCLUSION: The objective scale was comparable to established subjective assessment scales when used by an expert. The hemiplegic-side lying-to-sit maneuver had a high correlation with patient's functional recovery. Specifically, balance and lower extremity function appear to be important factors in the "come-to-sit" activity.

The Relationship between Korean Version of Berg Balance Scale with Ambulation Activities in Subjects with Stroke in Brain Stem and Cerebellum

OBJECTIVE: To evaluate the correlation between Korean version of Berg balance scale (K-BBS) with activities related to ambulation in subjects with stroke in brain stem and cerebellum by obtaining the cutoff value for each step of K-BBS. METHOD: We divided the step of activities related to ambulation into 4 stages; independent sitting, independent sit to stand, independent ambulation with Q (quadripod) cane and independent ambulation without any assistance. Accordingly, we measured the K-BBS and checked the activity step in 31 subjects with stroke every other week. Data were analyzed by ROC (receiver operating characteristic) curve technique to obtain each cutoff value of the K-BBS representing individual step of activities. RESULTS: The ROC analysis showed that each step of activity matched the following cutoff values: independent sitting, 5; independent sit to stand, 16; independent gait with Q cane, 25; and independent gait without any assistance, 35. CONCLUSION: K-BBS is a useful instrument in representing each step of activities related to ambulation and the cutoff values. Also, it is helpful for judging the assistance level for ambulation in subjects with stroke in brain stem and cerebellum.

The Korean Version of Berg Balance Scale as an Index of Activity Related to Ambulation in Subjects with Stroke

OBJECTIVE: To investigate the clinical usefulness of the Korean version of Berg balance scale (K-BBS) by obtaining the cutoff value for the activities related to ambulation in subjects with stroke. METHOD: We measured the K-BBS and checked the activities related to ambulation in 52 subjects with stroke every other week. The activities related to ambulation were composed of 4 stages, including independent sitting, independent sit to stand, independent gait with Q (quad) cane and independent gait without any assistance. Data were analyzed by ROC (Receiver operating characteristic) curve technique to obtain each cutoff value of the K-BBS representing for the individual activities. RESULTS: The ROC analysis showed that each activity matched the following cutoff values: independent sitting, 5; independent sit to stand, 18; independent gait with Q cane, 25; and independent gait without any assistance, 34. CONCLUSION: The K-BBS would be a useful instrument to tell the degrees of the activities related to ambulation and the cutoff values could be helpful for judging the assistance level for ambulation in patients with stroke.

Reliability Test of Korean Version of Berg Balance Scale

OBJECTIVE: The purpose of this study is to translate the Berg Balance Scale (BBS) to the Korean version (K-BBS) and to evaluate its reliability. METHOD: With the agreement of Katherine Berg, the original editor of the BBS, two physiatrists and three physical therapists had translated the English version of BBS into Korean (K-BBS). This was back-translated into English by a Korean-American physiatrist fluent in English. After a 2- hour K-BBS education course, the video recorded K-BBS of 18 stroke patients were reviewed by nine examiners (four physiatrists and five physical therapists) to assess the inter- rater and the intra-rater reliability. Kendall's correlation coefficient and Pearson's correlation coefficient were computed to assess the intra-rater and test-retest reliability, respectively. RESULTS: The inter-rater reliability was 0.97 at 2 separate evaluations with an interval of 10 days (p<0.05). The intra- rater reliability was 0.95 (p<0.05) in the physiatrist group and 0.97 (p<0.05) in the physical therapist group. CONCLUSION: We recommend that the Korean version of the Berg balance scale is a reliable instrument to be used in balance assessment of stroke patients.

Desired Location and Shape of Korean Women's Breasts; Anthropometric Analysis of Awarded Portraits and Torsos of 1990~2000 / 체질인류학회지

The aim of this study is to elucidate the desired location and shape of Korean women's breast. Thirty-three awarded portraits and torsos from 1990 to 2000 were analyzed. Eleven anthropometric ratio were calculated. Vertically, nipple was located 1/3 distance from sternal notch to umblicus. Horizontally, nipple was at 1/3 distance lateral from the midclaviclar line to acromion. The distance between lateral borders of breast were same as the width of chest cage. The projection of breast was 2/5 of anteroposterior diameter of chest cage. The result of this study may be of use in breast surgeries including reconstruction, augmentation and reduction.

Inositol 5'-phosphatase, SHIP1 interacts with phospholipase C-gamma1 and modulates EGF-induced PLC activity

Phospholipase C-gamma1, containing two SH2 and one SH3 domains which participate in the interaction between signaling molecules, plays a significant role in the growth factor-induced signal transduction. However, the role of the SH domains in the growth factor-induced PLC-gamma1 regulation is unclear. By peptide-mass fingerprinting analysis, we have identified SHIP1 as the binding protein for the SH3 domain of PLC-gamma1. SHIP1 was co-immunoprecipitated with PLC-gamma1 and potentiated EGF-induced PLC-gamma1 activation. However, inositol 5'-phosphatase activity of SHIP1 was not required for the potentiation of EGF-induced PLC-gamma1 activation. Taken together, these results suggest that SHIP1 may function as an adaptor protein which can potentiate EGF-induced PLC-gamma1 activation without regards to its inositol 5'-phosphatase activity.

Cloning and characterization of 5'-upstream region of human phospholipase C-beta2 gene

5'-upstream region of the phospholipase C-beta2 gene, 810 bp, was cloned and characterized. S1 nuclease mapping and primer extension analyses revealed that a single transcriptional start site locates at 284 nucleotides upstream from the beginning of translation. The 5-upstream region lacks both TATA motif and typical initiator sequence, but retains GC-rich segment. Two putative regulatory regions, a negative region (-636/-588) and a positive region (-98/ -13) were identified in the upstream region of PLC-beta2 gene. We suggest that the transcription of PLC-beta2 may be regulated by binding of regulatory proteins to the negative and/or positive regulatory regions located in the upstream of the gene.

The mechanism of phospholipase C-gamma1 regulation

Phospholipase C (PLC)1 hydrolyzes phosphatidylinositol 4,5-bisphosphate to generate the second messengers, inositol 1,4,5-trisphosphate (IP3) and diacylglycerol (DAG). IP3 induces a transient increase in intracellular free Ca2+, while DAG directly activates protein kinase C. Upon stimulation of cells with growth factors, PLC-gamma1 is activated upon their association with and phosphorylation by receptor and non-receptor tyrosine kinases. In this review, we will focus on the activation mechanism and regulatory function of PLC-gamma1.