Development of visual-motor integration scale for the Korean old people.

Effective methods to detect old people cognitive decline in early stages are needed in Korea, which is the fastest aging country in the world. This study aimed to develop a brief cognitive function measurement, Visual-Motor Integration Scale for the Korean elderly (VMIS-KE). In this methodological research, 16 preliminary items on visual-motor integration for the old people were chosen after literature review and expert validation. One hundred eighty participants aged 20-79 years were recruited to verify the validity and reliability of this measurement from community sources in Daegu city. The collected data were analyzed by exploratory factor analysis and confirmative factor analysis using SPSS and AMOS 18.0 program. The three factors (figure cognition, memory, and spatial cognition) with 12 items were finally extracted. Goodness of the fit was confirmed through confirmatory factor analysis. The Cronbach α was 0.867. The scores of overall VMIS-KE and every subcategory significantly decreased with age, especially in the 70s. VMIS-KE is the first valid and reliable measurement to assess cognitive decline of the Korean old people through visual motor integration, and can easily and quickly detect high-risk groups of dementia regardless of their educational level.

Predicting Individuals' Experienced Fear From Multimodal Physiological Responses to a Fear-Inducing Stimulus.

Emotions are experienced differently by individuals, and thus, it is important to account for individuals' experienced emotions to understand their physiological responses to emotional stimuli. The present study investigated the physiological responses to a fear-inducing stimulus and examined whether these responses can predict experienced fear. A total of 230 participants were presented with neutral and fear-inducing film clips, after which they self-rated their experienced emotions. Physiological measures (skin conductance level and response: SCL, SCR, heart rate: HR, pulse transit time: PTT, fingertip temperature: FT, and respiratory rate: RR) were recorded during the stimuli presentation. We examined the correlations between the physiological measures and the participants' experienced emotional intensity, and performed a multiple linear regression to predict fear intensity based on the physiological responses. Of the participants, 92.5% experienced the fear emotion, and the average intensity was 5.95 on a 7-point Likert scale. Compared to the neutral condition, the SCL, SCR, HR, and RR increased significantly during the fear-inducing stimulus presentation whereas FT and PTT decreased significantly. Fear intensity correlated positively with SCR and HR and negatively with SCL, FT, PTT, and RR. The multiple linear regression demonstrated that fear intensity was predicted by a combination of SCL, SCR, HR, FT, and RR. Our findings indicate that the physiological responses to experiencing fear are associated with cholinergic, sympathetic, and α-adrenergic vascular activation as well as myocardial ß-sympathetic excitation, and support the use of multimodal physiological signals for quantifying emotions.

Reliability of Physiological Responses Induced by Basic Emotions: A Pilot Study.

BACKGROUND: Although emotion-specific autonomic responses based on the discrete theory of emotion have been widely studied, studies on the reliability of physiological responses to emotional stimuli are limited. In this study, we aimed to assess the reliability of physiological changes induced by the six basic emotions (happiness, sadness, anger, fear, disgust, and surprise) that were measured during 10 weekly repeated experiments. METHODS: Twelve college students participated, and in each experiment, physiological signals were collected before and while participants were watching emotion-provoking film clips. Additionally, the participants self-evaluated the emotions that they experienced during the film presentation at the end of each emotional stimulus. To avoid adaptation of participants to identical stimuli during repeated measurements, we used 10 different film clips for each emotion, and thus a total of 60 film clips over 10 weeks were used. Physiological features, such as skin conductance level (SCL), fingertip temperature (FT), heart rate (HR), and blood volume pulse (BVP), were extracted from the physiological signals. Two reliability indices, Cronbach's alpha and intraclass correlation coefficient, were calculated from the physiological features to assess internal consistency and interrater reliability, respectively. RESULTS: We found that SCL, HR, and BVP measured during the emotion-provoking phase over the 10 weekly sessions were more reliable than those assessed at baseline. Furthermore, SCL, HR, and BVP from the emotion-provoking phase exhibited excellent internal consistency and interrater reliability. CONCLUSIONS: Our findings suggest that these features can be used as reliable physiological indices in emotion studies. The results also support the significance of physiological signals as meaningful indicators for emotion recognition in HCI (human computer interface) area.

The effect of actively induced vibration using shoulder joint on pain and dysfunction in patients with low back pain.

[Purpose] This study aimed to determine the effect of a Flexi-Bar exercise program with vibration stimulation on pain and dysfunction in patients with low back pain. [Subjects and Methods] This study included 30 patients with low back pain. The participants were divided into a control (n=15) group and an experimental group (n=15). General physical therapy was used in both groups. A Flexi-Bar exercise program with vibration stimulation was used in the experimental group. The Visual Analog Scale was used to measure pain severity. The Oswestry Disability Index was used to measure the extent of dysfunction due to low back pain. [Results] The VAS and ODI of the experimental group showed a significant difference compared to that of the control group. [Conclusion] The results show that a Flexi-Bar exercise program with vibration stimulation is effective in alleviating pain and dysfunction in patients with low back pain.

Neural substrates involved in anger induced by audio-visual film clips among patients with alcohol dependency.

BACKGROUND: Very little is known about the neural circuitry underlying anger processing among alcoholics. The purpose of this study was to examine the altered brain activity of alcoholic individuals during transient anger emotion. METHODS: Using functional magnetic resonance imaging (fMRI), 18 male patients diagnosed with alcohol dependence in an inpatient alcohol treatment facility and 16 social drinkers with similar demographics were scanned during the viewing of anger-provoking film clips. RESULTS: While there was no significant difference in the level of experienced anger between alcohol-dependent patients and non-alcoholic controls, significantly greater activation was observed in the bilateral dorsal anterior cingulate cortex (dACC) and the right precentral gyrus among alcoholic patients compared to the normal controls. CONCLUSIONS: In summary, specific brain regions were identified that are associated with anger among patients with alcohol dependency.

Radiological-pathological correlation study of hepatocellular carcinoma undergoing local chemoradiotherapy and surgery.

BACKGROUND AND AIMS: Optimal response criteria and assessment timing were investigated through radiologic-pathologic correlation in hepatocellular carcinoma (HCC) treated with localized chemoradiotherapy (CRT). METHODS: We reviewed 19 consecutive HCC patients who underwent surgical resection after radiotherapy and concurrent hepatic arterial infusion chemotherapy. Patients who received transarterial chemoembolization before RT or surgery were excluded from evaluation. Tumor diameters and total and enhancing tumor volumes were measured from CT images obtained 1, 3, 6, and 9 months after CRT. Percent changes calculated using size (RECIST and WHO) and enhancement criteria (mRECIST and EASL) were correlated with percent changes in total and enhancing tumor volumes, and with percent viable tumor in surgical specimens. RESULTS: Median time between CRT and resection was 4.1 months (range, 1.5-15.4 months). CR and PR rates were 0 and 68% by RECIST, 0 and 63% by WHO, 53% and 37% by mRECIST, and 53% and 42% by EASL. Pathologic CR (pCR) rate was 52.6%. Radiologic criteria showed strong correlation with tumor volumes at 1 and 3 months after CRT; at 6 months, however, size and enhancement criteria showed strong correlation only with total and enhancing tumor volumes, respectively. Enhancement criteria were better predictors of pathologic response at all times including preoperative evaluation (RECIST: R(2) = 0.303, P = 0.015 and WHO: R(2) = 0.366, P = 0.006 vs. mRECIST: R(2) = 0.760, P < 0.0001 and EASL: R(2) = 0.768, P < 0.0001). Time interval >6 months before resection showed significant correlation with pCR (P = 0.013). CONCLUSIONS: We recommend using enhancement criteria in assessing tumor viability, especially if the tumor was to be resected <6 months after CRT.

Objective Analysis of Poly-L-Lactic Acid Injection Efficacy in Different Settings.

BACKGROUND: Poly-L-lactic acid (PLLA) filler is known to have continuous volume effect. OBJECTIVE: The objective of this study is to analyze objective volume effect of PLLA in different settings of injection schedule on the cheek. METHODS: A split-face, evaluator-blind randomized study in 24 volunteers was conducted. One side was injected 3 times with 4 cc dose and the other side was injected 2 times with 6 cc dose per visit. Facial volume loss scale (FVLS) and Vectra were evaluated. RESULTS: Measured average FVLS showed statistically significant improvement both in 3 and 2 times injection sides and maintained efficacy until 12 months. Vectra showed volume difference (cc) between before and after injection. In 3 times injection side, it was increased 2.12 (after 1 month) to 3.17 (after 12 months). In 2 times injection side, it was increased 2.26 (after 1 month) to 3.19 (after 12 months). Gradual volume improvement over 12 months was statistically significant in both sides. There was no statistically significant difference between 3 and 2 times injection in FVLS and Vectra. There was no severe adverse event. CONCLUSION: Poly-L-lactic acid has continuous volume effect and there was no significant difference by injection times at the same total injection volume.

Analysis of physiological signals for recognition of boredom, pain, and surprise emotions.

BACKGROUND: The aim of the study was to examine the differences of boredom, pain, and surprise. In addition to that, it was conducted to propose approaches for emotion recognition based on physiological signals. METHODS: Three emotions, boredom, pain, and surprise, are induced through the presentation of emotional stimuli and electrocardiography (ECG), electrodermal activity (EDA), skin temperature (SKT), and photoplethysmography (PPG) as physiological signals are measured to collect a dataset from 217 participants when experiencing the emotions. Twenty-seven physiological features are extracted from the signals to classify the three emotions. The discriminant function analysis (DFA) as a statistical method, and five machine learning algorithms (linear discriminant analysis (LDA), classification and regression trees (CART), self-organizing map (SOM), Naïve Bayes algorithm, and support vector machine (SVM)) are used for classifying the emotions. RESULTS: The result shows that the difference of physiological responses among emotions is significant in heart rate (HR), skin conductance level (SCL), skin conductance response (SCR), mean skin temperature (meanSKT), blood volume pulse (BVP), and pulse transit time (PTT), and the highest recognition accuracy of 84.7% is obtained by using DFA. CONCLUSIONS: This study demonstrates the differences of boredom, pain, and surprise and the best emotion recognizer for the classification of the three emotions by using physiological signals.

Brain activation during processing of angry facial expressions in patients with alcohol dependency.

BACKGROUND: Alcoholism is associated with abnormal anger processing. The purpose of this study was to investigate brain regions involved in the evaluation of angry facial expressions in patients with alcohol dependency. METHODS: Brain blood-oxygenation-level-dependent (BOLD) responses to angry faces were measured and compared between patients with alcohol dependency and controls. RESULTS: During intensity ratings of angry faces, significant differences in BOLD were observed between patients with alcohol dependency and controls. That is, patients who were alcohol-dependent showed significantly greater activation in several brain regions, including the dorsal anterior cingulate cortex (dACC) and medial prefrontal cortex (MPFC). CONCLUSIONS: Following exposure to angry faces, abnormalities in dACC and MPFC activation in patients with alcohol dependency indicated possible inefficiencies or hypersensitivities in social cognitive processing.

Influence of aging on visual perception and visual motor integration in Korean adults.

This study investigated age-related changes of cognitive function in Korean adults using the Korean-Developmental Test of Visual Perception-2 (K-DTVP-2) and the Visual Motor Integration-3rd Revision (VMI-3R) test, and determined the main factors influencing VP and VMI in older adults. For this research, 139 adults for the K-DTVP-2 and 192 adults for the VMI-3R, from a total of 283 participants, were randomly and separately recruited in province, Korea. The present study showed that the mean score of the K-DTVP-2 and VMI-3R in 10-yr age increments significantly decreased as age increased (K-DTVP-2, F= 41.120, P< 0.001; VMI-3R, F= 16.583, P< 0.001). The mean score of the VMI-3R and K-DTVP-2 were significantly decreased in participants in their 50s compared to those in their 20s (P< 0.05). Age (t= -9.130, P< 0.001), gender (t= 3.029, P= 0.003), and the presence of diseases (t= -2.504, P= 0.013) were the significant factors affecting K-DTVP-2 score. On the other hand, age (t= -6.300, P< 0.001) was the only significant factor affecting VMI-3R score. K-DTVP-2 score (Standardized ß= -0.611) decreased more sensitively with aging than VMI-3R (Standardized ß= -0.467). The two measurements had a significant positive correlation (r = 0.855, P< 0.001). In conclusion, it can be suggested that VP and VMI should be regularly checked from an individual's 50s, which is a critical period for detecting cognitive decline by aging. Both the K-DTVP-2 and VMI-3R could be used for determining the level of cognitive deficit by aging.

Degree of extraversion and physiological responses to physical pain and sadness.

Extraversion is a personality frequently discussed as one of the strongest and most consistent factors that relates to individual subjective wellbeing. The goal of this study was to better understand how people with varying degrees of extraversion psychologically and physiologically respond differently to unpleasant circumstances. Emotional responses (e.g., levels of intensity, valence, and arousal) were assessed in determining the sensitivity level to negative stimuli that were specifically designed to provoke physical pain and sadness emotion. Physiological changes (e.g., heart rate (HR), blood volume pulse (BVP), and respiratory sinus arrhythmia (RSA)) were also measured during pain and sadness to observe sympathetic and parasympathetic activities. Our results showed that the degree of extraversion was associated with less unpleasant responses to sadness, less HR responses to both pain and sadness, and greater RSA responses to sadness. The findings suggest that the lower HR reactivity to painful and sad situations and greater RSA reactivity to sad situations in extraversion could be possibly due to increased parasympathetic activity. Additionally, enhanced parasympathetic activity to negative situations may explain an important mechanism underlying the positive connection between extraversion and subjective wellbeing.

Influence of mild traumatic brain injury during pediatric stage on short-term memory and hippocampal apoptosis in adult rats.

Traumatic brain injury (TBI) is a leading cause of neurological deficit in the brain, which induces short- and long-term brain damage, cognitive impairment with/without structural alteration, motor deficits, emotional problems, and death both in children and adults. In the present study, we evaluated whether mild TBI in childhood causes persisting memory impairment until adulthood. Moreover, we investigated the influence of mild TBI on memory impairment in relation with hippocampal apoptosis. For this, step-down avoidance task, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, and immunohistochemistry for caspase-3 were performed. Male Sprague-Dawley rats were used in the experiments. The animals were randomly divided into two groups: sham-operation group and TBI-induction group. The mild TBI model was created with an electromagnetic contusion device activated at a velocity of 3.0 m/sec. The results showed that mild TBI during the pediatric stage significantly decreased memory retention. The numbers of TUNEL-positive and caspase-3-positive cells were increased in the TBI-induction group compared to those in the sham-operation group. Defective memory retention and apoptosis sustained up to the adult stage. The present results shows that mild TBI induces long-lasting cognitive impairment from pediatric to adult stages in rats through the high level of apoptosis. The finding of this study suggests that children with mild TBI may need intensive treatments for the reduction of long-lasting cognitive impairment by secondary neuronal damage.

Treadmill exercise ameliorates symptoms of attention deficit/hyperactivity disorder through reducing Purkinje cell loss and astrocytic reaction in spontaneous hypertensive rats.

Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder of cognition. We investigated the effects of treadmill exercise on Purkinje cell and astrocytic reaction in the cerebellum of the ADHD rat. Adult male spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKYR) weighing 210± 10 g were used. The animals were randomly divided into four groups (n= 15): control group, ADHD group, ADHD and methylphenidate (MPH)-treated group, ADHD and treadmill exercise group. The rats in the MPH-treated group as a positive control received 1 mg/kg MPH orally once a day for 28 consecutive days. The rats in the treadmill exercise group were made to run on a treadmill for 30 min once a day for 28 days. Motor coordination and balance were determined by vertical pole test. Immunohistochemistry for the expression of calbindinD-28 and glial fibrillary acidic protein (GFAP) in the cerebellar vermis and Western blot for GFAP, Bax, and Bcl-2 were conducted. In the present results, ADHD significantly decreased balance and the number of calbindin-positive cells, while GFAP expression and Bax/Bcl-2 ratio in the cerebellum were significantly increased in the ADHD group compared to the control group (P< 0.05, respectively). In contrast, treadmill exercise and MPH alleviated the ADHD-induced the decrease of balance and the number of calbindine-positive cells, and the increase of GFAP expression and Bax/Bcl-2 ratio in the cerebellum (P< 0.05, respectively). Therefore, the present results suggested that treadmill exercise might exert ameliorating effect on ADHD through reduction of Purkinje cell loss and astrocytic reaction in the cerebellum.

Effect of complex treatment using visual and auditory stimuli on the symptoms of attention deficit/hyperactivity disorder in children.

We investigated the effects of complex treatment using visual and auditory stimuli on the symptoms of attention deficit/hyperactivity disorder (ADHD) in children. Forty-seven male children (7-13 yr old), who were clinically diagnosed with ADHD at the Balance Brain Center in Seoul, Korea, were included in this study. The complex treatment consisted of visual and auditory stimuli, core muscle exercise, targeting ball exercise, ocular motor exercise, and visual motor integration. All subjects completed the complex treatment for 60 min/day, 2-3 times/week for more than 12 weeks. Data regarding visual and auditory reaction time and cognitive function were obtained using the Neurosync program, Stroop Color-Word Test, and test of nonverbal intelligence (TONI) at pre- and post-treatment. The complex treatment significantly decreased the total reaction time, while it increased the number of combo actions on visual and auditory stimuli (P< 0.05). The Stroop color, word, and color-word scores were significantly increased at post-treatment compared to the scores at pretreatment (P< 0.05). There was no significant change in the TONI scores, although a tendency toward an increase in these scores was observed. In conclusion, complex treatment using visual and auditory stimuli alleviated the symptoms of ADHD and improved cognitive function in children. In addition, visual and auditory function might be possible indicators for demonstrating effective ADHD intervention.

Adjuvant hepatic arterial infusional chemotherapy with 5-fluorouracil and cisplatin after curative resection of hepatocellular carcinoma.

OBJECTIVES: We investigated whether adjuvant hepatic arterial infusional chemotherapy (HAIC) with 5-fluorouracil (5-FU) and cisplatin reduces the recurrence of hepatocellular carcinoma (HCC) after curative resection. METHODS: Between January 2006 and December 2008, 31 HCC patients received four cycles of adjuvant HAIC with 5-FU and cisplatin via port system after curative resection. During the same period, 62 patients, who did not take any adjuvant therapy, were selected as controls. RESULTS: Tumor characteristics, such as distribution of TNM stage, pathologic differentiation, portal vein invasion, or microscopic invasion did not differ between control and adjuvant groups. During follow-up, recurrence developed in 11 adjuvant (35.5%) and 24 control patients (38.7%; p = 0.823). Tumor progression after recurrence was the cause of death in 2 adjuvant (28.6%) and 7 control patients (38.8%; p = 0.912). The 2-year recurrence rate was 9.1% in the adjuvant group and 4.2% in the control group, with the median recurrence-free survival time being 10.5 and 7.5 months, respectively (p = 0.324). The 3-year cumulative survival rate was 73.3% in the adjuvant group and 68.3% in the control group (p = 0.355). CONCLUSION: Adjuvant HAIC with 5-FU and cisplatin did not offer any beneficial effect on the recurrence after curative resection of HCC.

Brain functions associated with verbal working memory tasks among young males with alcohol use disorders.

This study aimed to investigate the differences in brain functions during verbal working memory between individuals with alcohol use disorders (AUD) and normal controls. fMRI was used to scan brain activations associated with verbal working memory while participants performed 2-back and 0-back tasks. A total of 21 young male college students participated in the study. Eleven of those who clinically met the criteria for AUD were assigned to the AUD group, whereas ten demographically similar subjects who were social drinkers but not AUD were assigned to the normal control group. The AUD group showed less activation in bilateral frontal and precentral, left superior temporal, left superior parietal, and left cerebellar cortex during the 2-back task relative to 0-back task compared to the normal control group. In contrast, the control group showed less activation only in the right uncus than the AUD group. These results suggest that subjects with AUD present abnormality in brain functioning during verbal working memory.

Comparison of blood glucose measurements using samples obtained from the forearm, finger skin puncture, and venous serum.

BACKGROUND: Blood glucose testing (BGT) at the forearm minimizes the pain experienced during sampling of capillary blood. We compared the BGT results for forearm sampling with those for standard finger skin puncture and venous serum to evaluate the clinical validity of forearm BGT. METHODS: BGT was performed on the finger (G(F)) and forearm (G(A)) with a portable glucometer in 555 subjects, including 61 diabetic patients, under fasting conditions. BGT with venous serum (G(V)) was followed within an hour in 514 subjects. Simple linear regression, intraclass correlation, and Passing-Bablok regression analyses were performed using the G(A)-G(F) and G(A)-G(V) data. RESULTS: G(A) showed an excellent linear relationship with both G(F) and G(V) with a Pearson correlation coefficient (r) of 0.97 (P<0.0001) in the patient group, which was similar to the findings in the normal group except for the lower r values. The mean bias between G(A) and G(F) and between G(A) and G(V) were within +/- 10 mg/dL in both groups. The intraclass correlation coefficients were slightly smaller than the corresponding r values, but they showed the same tendency in both groups. In the Passing-Bablok analyses, the 95% confidence intervals of the slope and intercept parameters were <+/-20% of unity and <+/-20 mg/dL, respectively, which were within the acceptable ranges. All 3 statistical analyses supported the satisfactory agreement of G(A) with G(F) or G(V). CONCLUSIONS: BGT at the forearm was highly consistent with the standard BGT, thereby confirming its applicability in clinical practice for self-testing under steady fasting conditions.

Neuroprotective effects of herbal ethanol extracts from Gynostemma pentaphyllum in the 6-hydroxydopamine-lesioned rat model of Parkinson's disease.

6-Hydroxydopamine administration for 28 days (8 microg/2 microL) reduced the number of tyrosine hydroxylase (TH)-immunopositive neurons to 40.2% in the substantia nigra compared to the intact contralateral side. Dopamine, 3,4-dihydroxyphenylacetic acid, homovanillic acid and norepinephrine levels were reduced to 19.1%, 52.3%, 47.1% and 67.4% in the striatum of 6-hydroxydopamine-lesioned rats compared to the control group, respectively. However, an oral administration of herbal ethanol extracts from Gynostemma pentaphyllum (GP-EX) (10 mg/kg and 30 mg/kg) starting on day 3 post-lesion for 28 days markedly ameliorated the reduction of TH-immunopositive neurons induced by 6-hydroxydopamine-lesioned rat brain from 40.2% to 67.4% and 75.8% in the substantia nigra. GP-EX administration (10 and 30 mg/kg) also recovered the levels of dopamine, 3,4-dihydroxyphenylacetic acid, homovanillic acid and norepinephrine in post-lesion striatum to 64.1% and 65.0%, 77.9% and 89.7%, 82.6% and 90.2%, and 88.1% and 89.2% of the control group. GP-EX at the given doses did not produce any sign of toxicity such as weight loss, diarrhea and vomiting in rats during the 28 day treatment period and four gypenoside derivatives, gynosaponin TN-1, gynosaponin TN-2, gypenoside XLV and gypenoside LXXIV were identified from GP-EX. These results suggest that GP-EX might be helpful in the prevention of Parkinson's disease.

Brain substrates of craving to alcohol cues in subjects with alcohol use disorder.

AIMS: This study's purpose was to identify the neural substrates and mechanisms responsible for craving among subjects with alcohol use disorders (AUDs) using functional magnetic resonance imaging (fMRI). METHODS: Alcohol abusers with AUD (n = 9) and demographically similar non-abusers (n = 9) participated in this study. After given 5 cc of alcohol, subjects were exposed to different types of stimuli [i.e. alcohol, non-alcoholic beverage, and visual control pictures and one rest (cross-hair)]. Craving levels were rated through self-report on a Likert scale immediately after the presentation of visual cues. RESULTS: Brain activations in the fusiform gyri, temporal gyri, parahippocampal gyrus, uncus, frontal gyri, and precuneus were correlated with the level of craving among subjects with AUD in response to alcohol cues. CONCLUSIONS: In conclusion, specific brain regions were identified that are associated with craving among subjects with AUD.

Miniatured blood glucose measurement module interfaced with cellular phone.

Chronic diabetes requires systematic disease management that considers the patients' personal characteristics such as age and sex. The bureaucratic complexity of the Korean medical system lowers the efficiency of diabetes management. The present study developed a miniature blood glucose meter interfaced through the serial port of a cellular phone. The measured glucose level is displayed and efficiently managed by the customized GUI program run on the mobile platform. The present results demonstrate a new medical application example of mobile telecommunication technology.