Cognitive improvement effect of gintonin might be associated with blood-brain barrier permeability enhancement: dynamic contrastenhanced MRI pilot study

Along with the multiple neuroprotective effect, recent studies suggest that gintonin might increase the blood brain barrier permeability. We evaluated the effect of gintonin on the vascular permeability changes in different brain segments, using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). In this 8-week, randomized, open label pilot study, ten participants with subjective memory impairment but preserved cognitive function assigned to gintonin-enriched fraction (GEF) 300 mg/day or placebo groups. Korean versions of the Alzheimer's disease assessment scale (ADAS-K) and DCE-MRI parameters including Ktrans and Vp in different brain segments were evaluated at baseline and at 8 weeks after treatment. Nine participants completed the study protocol. No adverse events occurred during the observation period for 8 weeks in both groups. Following gintonin administration, increment trends of the brain permeability that did not reach a statistical significance were observed in the left hippocampus (Ktrans and Vp , both, p = 0.062), left thalamus and in left putamen (Ktrans , p = 0.062), and left insula and right amygdala (Vp , p = 0.062), but not in the control placebo group. The increment of the Ktrans value in the left thalamus from the baseline was highly correlated with the change of the ADAS scores (r = −0.900, p = 0.037). Gintonin might enhance the blood-brain barrier (BBB) permeability in the brain structures involved in cognitive functions. Further efficacy exploration for the synergistic effect of gintonin's BBB permeability enhancement to its other cognitive enhancing mechanisms are warranted.

Efficacy of Oxcarbazepine for Sleep-Related Leg Cramps: A Retrospective Study

Objectives@#Sleep-related leg cramps (SRLC) are common among older people. Severe clinical symptoms of SRLC usually cause great discomfort to patients. To date, many treatment drugs have been tried; however, there are currently no drugs approved for treating this condition. We aimed to assess the efficacy of a new drug, oxcarbazepine (OXC), in the treatment of SRLC. @*Methods@#We retrospectively analyzed clinical outcomes following OXC administration. A daily dose of 150 mg OXC was prescribed to control nocturnal leg cramps. Clinical outcomes were measured using the Clinical Global Impression Scale to confirm the effectiveness of OXC. @*Results@#A total of 88.9% (16/18) of patients clinically improved four weeks after OXC prescription, and 94% (15/16) of patients continued to improve at the last follow-up (3–6 months). None of the patients complained of side effects related to 150 mg OXC. @*Conclusions@#OXC may be a new medical option for treatment of SRLC.

Clinical Reasoning: A 23-Year-Old Man with Intermittent Impaired Awareness

No abstract available.

Symptom Aggravation in Restless Legs Syndrome during Menstrual Cycle

OBJECTIVES@#The purpose of this study is to confirm restless legs syndrome (RLS) symptom aggravation during menstrual period and verify factors related to symptom aggravation.@*METHODS@#A total of 20 premenopausalfemale RLS patients were classified into two groups according to symptom aggravation during menstrual period (menstrual RLS group and non-menstrual RLS group). They answered a questionnaire including duration and quantity of menstruation, other medical conditions, and premenstrual syndrome symptoms. Laboratory tests including iron panel and hemoglobin levels were done.@*RESULTS@#Six out of 20 patients (30%) complained of symptom aggravation during menstrual period. RLS symptoms were aggravated by 40±33.47% compared to non-menstrual period in menstrual RLS group. One patient was taking additional medication for aggravated symptoms. Menstrual duration, quantity of menstrual bleeding showed no difference between menstrual RLS and non-menstrual RLS groups. On laboratory tests, two patients from non-menstrual RLS group were diagnosed with iron deficiency anemia. Serum iron levels, total iron binding capacity, serum iron saturation, and serum ferritin levels did not show difference between the two groups, while hemoglobin levels were significantly lower (13.8 vs. 12.4 g/dL) in non-menstrual RLS group (p=0.044).@*CONCLUSIONS@#RLS symptoms aggravate during menstrual period in 30% of premenopausal RLS patients. Low ferritin levels were not related to menstrual RLS symptom aggravation. Further study is required to verify other factors such as hormonal fluctuations.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Korea: Clinical Features, Treatment, and Outcome

BACKGROUND AND PURPOSE: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune synaptic encephalitis and it often responds to treatment. We analyzed the clinical characteristics of anti-NMDAR encephalitis in Korea. METHODS: Serum and/or cerebrospinal fluid (CSF) of adult patients (aged > or =18 years) with encephalitis of undetermined cause were screened for anti-NMDAR antibodies using a cell-based indirect immunofluorescence assay. The patients came from 41 university hospitals. RESULTS: Of the 721 patients screened, 40 were identified with anti-NMDAR antibodies and clinical details of 32 patients were obtained (median age, 41.5 years; 15 females). Twenty-two patients (68.8%) presented with psychiatric symptoms, 16 (50%) with seizures, 13 (40.6%) with movement disorders, 15 (46.9%) with dysautonomia, 11 (34.4%) with memory disturbance, and 11 (34.4%) with speech disturbance. Magnetic resonance imaging, electroencephalography, and CSF examinations yielded nonspecific findings. Tumor information was only available for 22 patients: 5 patients had tumors, and 2 of these patients had ovarian teratomas. Twenty-two patients received immunotherapy and/or surgery, and therapeutic responses were analyzed in 21 patients, of which 14 (66.7%) achieved favorable functional outcomes (score on the modified Rankin Scale of 0-2). CONCLUSIONS: This study investigated the clinical characteristics of adult anti-NMDAR encephalitis in Korea. Currently, elderly patients who do not have tumors are commonly diagnosed with this condition. Understanding the detailed clinical characteristics of this disease will improve the early detection of anti-NMDAR encephalitis in patients both young and old.

The Shoulder Gradient in Patients with Unilateral Shoulder Impingement Syndrome

OBJECTIVE: To investigate the relationship between the shoulder gradient and acromiohumeral interval of both shoulders in patients with unilateral shoulder impingement syndrome. METHOD: Using the angulometer, we measured the shoulder gradient in patients with unilateral shoulder impingement syndrome in a standing position. Using the radiography, we measured the acromiohumeral interval and the angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapula. RESULTS: In patients with unilateral shoulder impingement syndrome, the frequency of shoulder impingement syndrome was 76.2% (16 of 21) on the side of the relatively lower shoulder. The mean acromiohumeral interval on the side of the lower shoulder was 10.03+/-1.28 mm, compared with 10.46+/-1.50 mm for the higher shoulder. The angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapular of the side of the lower shoulder was -0.31+/-3.73 degrees, compared with 3.85+/-4.42 degrees for the higher shoulder. CONCLUSION: The frequency of shoulder impingement syndrome was significantly higher on the side of the relatively lower shoulder, and there is no significant difference in the acromiohumeral interval between the side of the lower shoulder and that of the higher shoulder. In patients with unilateral shoulder impingement syndrome, the scapular on the side of lower shoulder was more rotated downward than on the side of the higher shoulder.

The Correlation between the Cutaneous Silent Period and Ultrasonographic Findings of Median Nerve in Patients with Carpal Tunnel Syndrome

OBJECTIVE: To determine the relation between the latency and duration of the cutaneous silent period (CuSP) and ultrasonographic findings of patients with carpal tunnel syndrome (CTS). METHOD: Subjects included 50 hands of 33 patients with CTS with electrophysiologic evidence of CTS and 50 hands of 39 adults with no evidence of CTS. CuSP was measured on abductor pollicis brevis (APB) and adductor digiti minimi (ADM) by stimulation of digit 3. All subjects were examined with ultrasonography (US). Using US, the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve were calculated under carpal tunnel. Analysis of differences between the control group and the CTS group was performed using ANOVA. RESULTS: Differences of CSA, FR, latency, and duration of CuSP in both APB, ADM muscles were observed between the two groups. Correlations were observed in the patient group in latency and duration of the APB muscle and only in duration of the ADM (p=0.048, r=0.159; p=0.035, r=-0.315; p=0.039, r=-0.293) muscle. Correlations were found only in duration of ADM (p=0.011, r=0.358) in the control group with respect to CSA. However, there was no correlation with FR. CONCLUSION: There seems to be a significant correlation between the CSA of the median nerve and the latency and duration of CuSP in patients with CTS. In addition, there seems to be a significant difference of CSA, FR, and latency in both APB and ADM between the two groups. CuSP and CSA might be useful for study that reflects intact small fibers in patients with CTS.

Association of Meniscus Protrusion with Radiographic Findings and Clinical Assessment in Both Knee Osteoarthritis

OBJECTIVE: To evaluate the association of ultrasonographic (US) findings of medial meniscus protrusion (MMP) with clinical and plain radiographic assessment in knee osteoarthritis (OA). METHOD: One hundred and twenty six knees of 63 patients were studied. The degree of protrusion for each knee of patients was measured during standing by US. Radiographs were examined in order to determine whether the participants had radiographic osteoarthritis, graded using the Kellgren-Lawrence (K-L) grade. Clinical assessment was performed by recording a visual analogue scale (VAS). Correlation was obtained between the difference of VAS and MMP in the same patient. Assessment of pain, stiffness, and disability were performed by comparison of K-WOMAC index and MMP in a patient. RESULTS: Mean protrusion (mean+/-S.D.) for knees with each K-L I, II, III, and IV grade were 0.27+/-0.52 cm, 0.38+/-0.60 cm, 0.55+/-0.76 cm, and 0.75+/-0.08 cm, respectively. The difference was significant (p<0.05). Significant correlation was observed between MMP and VAS in K-L grades II (p=0.002, r=0.500) and III (p=0.002, r=0.684), also between DeltaMMP and DeltaVAS (p=0.000, r=0.558). With the K-WOMAC index, MMP were correlated with pain and stiffness (p<0.01), but not with disability score. CONCLUSION: The degree of MMP measured by US is associated with K-L grade in knee OA patients. The degree of MMP can be a reliable indicator, like K-L grade, for radiological severity of knee OA. MMP has been correlated with VAS and with subscore of pain and stiffness, but not disability in the K-WOMAC index.

The Efficacy of Core Strengthening on the Trunk Balance in Patients with Subacute Stroke

OBJECTIVE: To investigate the efficacy of core strengthening on trunk balance in patients with subacute stroke. METHOD: Fifty-nine subacute hemiparetic stroke in-patients participated in this study. All patients were randomly assigned to one of two groups: the control group and the experimental group. Both groups received the same conventional physical therapies for 4 weeks. The experimental group received an additional core strengthening program (CSP). Korean mini-mental state examination (K-MMSE) and Korean Modified Barthel Index (K-MBI) were performed on admission. CSP was performed for 30 minutes a day, 3 days per week for 4 weeks. We selected nine exercises available for stroke patients, and divided them as three steps according to the degree of difficulty. Because of the muscle weakness in stroke patients, a physical therapist often helped them during exercise. Outcome measurement included trunk control test (TCT), trunk impairment scale (TIS), and Berg balance scale (BBS) and we compared both groups before and after the period of training. RESULTS: There were no significant differences in baseline general characteristics and initial values between the two groups. After rehabilitation therapy, both groups showed significant improvements in BBS, TIS, and TCT (p<0.05). Following 4 weeks of therapy, changes of BBS, TIS score in the experimental group were significantly higher than those of the control group (p<0.05). However, the change of TCT score was not significantly different. CONCLUSION: Analysis of different clinical parameters showed that better outcomes in BBS, TIS scores were achieved from CSP. This study suggests that CSP conducted for 4 weeks may be beneficial as a therapeutic technique for use in improvement of trunk balance in patients with subacute hemiparetic stroke.

Epicanthoplasty with Simple Excision Technique

Epicanthoplasty with or without double-eyelid operation is one of the most commonly performed aesthetic procedure in Korea. Although many techniques have been described for the elimination of epicanthal folds, scarring and complexity in design are still barriers for surgeons to overcome. Epicanthoplasty using Hiraga's method was used to minimize these problems. From September of 1996 to July of 2002, the authors performed epicanthoplasty using Hiraga's method on the eyelids of 117 Asian patients to correct epicanthal folds. Results were satisfactory in almost all patients, with no significant complications. Scarring was acceptable. Mean reduction of intercanthal distance was 3.7 mm and mean operation time was within 10 minutes. Hiraga's method is most effective in patients with mild to moderate epicanthal fold. The advantages of this procedure are simplicity in design and short operation time. Most of all, it's technically simple and easy to perform.

Implementation of Microbial Active Database Using Web / 대한의료정보학회지

OBJECTIVE: The contents of microbial information are complicated because of being hierarchical, duplicated as well as their changes are continuous and various. Much of time and cost are required for maintaining, expanding the information after representing them into a relational database. The relational database is not adequate to make the information sharable via Internet. In addition, user's meta-knowledge is insufficient to use the information via Internet and users may not be able to cope with the continuous changes of microbial information through the static web interface. Therefor, this study is conducted to develop an active microbial web database for resolving those problems. METHODS: To solve these problems, object-oriented database, which was able to represent the complicated contents and knowledge, was used, and intelligent agents were implemented to cope with the continuous evolution of microbial information. Also, they were incorporated into user interface to assist users in an interactive environment, who want to use information via Internet. RESULTS: The implemented system have shown advantages of solving difficulties arising from hierarchical and duplicated microbial data. It showed the possibility to share and manage the complex microbial data via Internet. It helped the system to be implemented as the active database, information stored in the object-oriented database. CONCLUSION: This study indicates that a similar approach may lead to develop an expert system based on the web and active database, which is able to be evolved, and to develop intelligent interface, using the agent.

The Correlation of High Resolution Ultrasonographic Findings with EMG and Clinical Symptoms

Several imaging methods are helpful in the diagnosis of carpal tunnel syndrome and they are, for example, traditional X-ray, CT and MRI, etc. CT and MRI have their advantage in direct visualization of structural abnormality of the carpal tunnel and median nerve, but these two modalities are expensive and take much time. Recently, high resolution ultrasonography has been reported to be effective in the study of musculoskeletal system. We designed a case control study to assess the diagnostic value of high resolution ultrasonography. Ninety-six hands of 48 patients, who were confirmed of diagnosis by self-administered questionnaires and electrodiagnostic test, underwent high resolution ultrasonographic studies. We compared sonographic findings with EMG data and patients' severity scores of self-questionnaires. Proximal swelling of median nerve at the entrance of the carpal tunnel correlated with the nerve conduction data. And compression of the median nerve under the transverse carpal ligament correlated with the subjective symptoms. Although ultrasonography is not an ideal method in diagnosis of carpal tunnel syndrome, it may be helpful for estimating the symptom severity and nerve conduction deficit.

An Anatomic Study of the External Nasal Nerve

After rhinoplasty, numbness of the nasal tip has been reported by many surgeons. The nasal tip receives its main sensory nerve supply from the external nasal nerve. However, investigations of the external nasal nerve have not been previously studied. Therefore, anatomic study of the external nasal nerve was performed. Twenty external nasal nerves were dissected in 10 fresh cadaver noses. On dissection, the exit of the nerve between nasal bone and upper lateral cartilage was identified, and the distance from the point of exit to the midline of the nose was measured. The course and the running plane of the nerve were investigated. The nerve branching was also classified into type I; having only 1 nerve without any branch, type II; having 1 nerve proximally, then splitting into 2 main branches, and type III; having 2 main branches from the point of exit. The point of exit of external nasal nerve from distal nasal bone was located 6.5 to 8.5 mm lateral to nasal midline. Nineteen nerves(95%) run in the same deep fatty layer all the way down to the alar cartilages, but one nerve coursed medially between both medial crura. Regarding the branching type of the nerves, type I was found to be the most common, in 10 of 20 nerves. Type II was observed in 6 and type III was seen in 4. Based on our results, the followings are suggested during a rhinoplasty. First, it is best to avoid deep inter- or intracartiaginous incisions. Instead, the dissection should be maintained directly on the surface of the cartilage. Second, dissection at the junction of nasal bone and upper lateral cartilage area of one side should be limited within 6.5mm from midline. Lastly, when the nasal dorsum is augmented by onlay graft, implants or grafts less than 13 mm wide at rhinion level should be used.

Comparison of Effect of Polyurethane Foam Dressings on Epithelialization of White Rat

Polyurethane foam dressings are becoming widely used in partial and full thickness skin wounds since they are safe and convenient for both patients and physicians. However, the influence of polyurethane foam dressings on epithelialization has not been fully determined yet. This study was designed to compare 2 internationally available polyurethane foams and 3 locally made polyurethane foams as to their effects on the epithelialization in vivo. Twenty white rats were used. A 5 mm punch was employed to excise skin and subcutaneous tissue in a round fashion at six sites in the back area of 10 rats. After creating 6 open wounds, above mentioned 5 polyurethane foams and gauze dressings were applied. On the 5th day the lengths of the nonepithelialized area were measured under light microscope. In addition, partial thickness wounds were created using carbon dioxide laser at six sites on the back of the another 10 rats. Six dressings were applied on the wounds as same as above. On the 4th day the degree of the epithelialization was measured and compared. In full thickness wound study the best wound closing was also seen in chitin mixed Medifoam-N group. In partial thickness wound study the best epithelialization was seen in chitin mixed Medifoam-N and chitosan mixed Medifoam-N groups. These results demonstrated that polyurethane foam dressings influenced the epithelialization, and chitin mixed Medifoam-N showed the best result.

Web Based Chromosome Karyotyping Instruction System / 대한의료정보학회지

The task for chromosome karyotyping and diagnosis is requiring repetitive, time consuming job and high cost even it is done by well-experienced cytogenetists. Therefore an web based chromosome karyotyping instruction system has been established to be able to analyze chromosomes and obtain necessary advises from the database instead of human experts and the database is including 2 divisions with database and agent.For the first of all, database model was constructed with relational database consisting of Patient_DB, image_DB, Disease_DB and Manage_DB. As the second procedure, knowledge base by IF THEN production rule was implemented to a knowledge domain with normal and abnormal chromosomes. For the last, independent agent with the inference by knowledge base could enter the inference data into the database.Experimental data were composed of normal chromosomes of 2,736 patients' cases and abnormal chromosomes of 259 patients' cases that have been obtained from GTG-banding metaphase peripheral blood and amniotic fluid samples.The completed system provides variously morphological information by analysis of normal or abnormal chromosomes and it also makes users enable to control and search the information in a short period with learning of high amount of knowledge.