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Neuroinflammation is one of the key mechanisms of neuropathic pain, which is primarily mediated by the Toll-like receptor 4 (TLR4) signaling pathways in microglia. Therefore, TLR4 may be a reasonable target for treatment of neuropathic pain. Here, we examined the analgesic effect of TLR4 antagonistic peptide 2 (TAP2) on neuropathic pain induced by spinal nerve ligation in rats. When lipopolysaccharide (LPS)-stimulated BV2 microglia cells were treated with TAP2 (10 µM), the mRNA levels of proinflammatory mediators, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, cyclooxygenase (COX)-2, and inducible nitric oxide synthase (iNOS), were markedly decreased by 54–83% as determined by quantitative PCR (qPCR) analysis. Furthermore, when TAP2 (25 nmol in 20 µL PBS) was intrathecally administered to the spinal nerve ligation-induced rats on day 3 after surgery, the mechanical allodynia was markedly decreased for approximately 2 weeks in von Frey filament tests, with a reduction in microglial activation. On immunohistochemical and qPCR analyses, both the level of reactive oxygen species and the gene expression of the proinflammatory mediators, such as TNF-α, IL-1β, IL-6, COX-2, and iNOS, were significantly decreased in the ipsilateral spinal dorsal horn. Finally, the analgesic effect of TAP2 was reproduced in rats with monoiodoacetate-induced osteoarthritic pain. The findings of the present study suggest that TAP2 efficiently mitigates neuropathic pain behavior by suppressing microglial activation, followed by downregulation of neuropathic pain-related factors, such as reactive oxygen species and proinflammatory molecules. Therefore, it may be useful as a new analgesic for treatment of neuropathic pain.
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Animales , Ratas , Analgésicos , Regulación hacia Abajo , Expresión Génica , Hiperalgesia , Interleucina-6 , Interleucinas , Ligadura , Microglía , Neuralgia , Óxido Nítrico Sintasa de Tipo II , Reacción en Cadena de la Polimerasa , Prostaglandina-Endoperóxido Sintasas , Especies Reactivas de Oxígeno , ARN Mensajero , Asta Dorsal de la Médula Espinal , Nervios Espinales , Receptor Toll-Like 4 , Receptores Toll-Like , Factor de Necrosis Tumoral alfaRESUMEN
No abstract available.
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Humanos , Infarto Cerebral , Salud Global , Tamizaje Masivo , Estudios Retrospectivos , Organización Mundial de la SaludRESUMEN
BACKGROUND AND OBJECTIVES@#Neurologic intolerance (NI) is defined as the occurrence of neurological symptoms during carotid artery stenting (CAS). Because NI is inevitable problem, it may be helpful to anticipate its occurrence. So, we studied factors associated with NI during proximal protected CAS.@*METHODS@#We retrospectively analyzed all consecutive patients underwent proximal protected CAS from August 2012 to January 2017.@*RESULTS@#We included total 123 patients (109 males, 72±8 years old). The total procedure time was 43±12 minutes, and mean occlusion time was 4.8±1.2 minutes. We divided CAS patients into 2 groups according to presence of NI; neurologic tolerance (NT; n=74, 60%) and NI (n=49, 40%) groups. After the univariate analysis, symptomatic carotid artery stenosis (p = 0.003), absence of anterior communicating artery (p = 0.015) and low common carotid artery occlusion pressure (CCAOP, p < 0.001) were associated with NI. After the multivariate analysis, NI was significantly associated with symptomatic carotid artery stenosis (odds ratio [OR], 5.549; p = 0.014) and systolic CCAOP≤42 mmHg (OR, 6.461; p < 0.001). In NI group, 43 patients (88%) recovered right after the balloon deflation and 2 patients were normalized within 2 hours. However, 1 had major stroke and 3 had minor strokes in 4 patients with persistent NI ≥24 hours.@*CONCLUSIONS@#About 40% showed NI during the CAS. Most of them (88%, 43 of 49 patients) recovered after the balloon deflation, but stroke incidence was significantly higher in NI group. Symptomatic carotid artery stenosis and systolic CCAOP ≤42 mmHg were significantly associated with the development of NI during proximal protected CAS.
RESUMEN
BACKGROUND AND OBJECTIVES: Neurologic intolerance (NI) is defined as the occurrence of neurological symptoms during carotid artery stenting (CAS). Because NI is inevitable problem, it may be helpful to anticipate its occurrence. So, we studied factors associated with NI during proximal protected CAS. METHODS: We retrospectively analyzed all consecutive patients underwent proximal protected CAS from August 2012 to January 2017. RESULTS: We included total 123 patients (109 males, 72±8 years old). The total procedure time was 43±12 minutes, and mean occlusion time was 4.8±1.2 minutes. We divided CAS patients into 2 groups according to presence of NI; neurologic tolerance (NT; n=74, 60%) and NI (n=49, 40%) groups. After the univariate analysis, symptomatic carotid artery stenosis (p = 0.003), absence of anterior communicating artery (p = 0.015) and low common carotid artery occlusion pressure (CCAOP, p < 0.001) were associated with NI. After the multivariate analysis, NI was significantly associated with symptomatic carotid artery stenosis (odds ratio [OR], 5.549; p = 0.014) and systolic CCAOP≤42 mmHg (OR, 6.461; p < 0.001). In NI group, 43 patients (88%) recovered right after the balloon deflation and 2 patients were normalized within 2 hours. However, 1 had major stroke and 3 had minor strokes in 4 patients with persistent NI ≥24 hours. CONCLUSIONS: About 40% showed NI during the CAS. Most of them (88%, 43 of 49 patients) recovered after the balloon deflation, but stroke incidence was significantly higher in NI group. Symptomatic carotid artery stenosis and systolic CCAOP ≤42 mmHg were significantly associated with the development of NI during proximal protected CAS.
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Humanos , Masculino , Arterias , Arterias Carótidas , Arteria Carótida Común , Estenosis Carotídea , Dispositivos de Protección Embólica , Incidencia , Análisis Multivariante , Manifestaciones Neurológicas , Estudios Retrospectivos , Stents , Accidente CerebrovascularRESUMEN
BACKGROUND: Unfractionated heparin is commonly used for anticoagulation in extracorporeal membrane oxygenation (ECMO). Several studies have shown that nafamostat mesilate (NM) has comparable clinical outcomes to unfractionated heparin. This study compared anticoagulation with NM and heparin in a large-animal model. METHODS: Beagle dogs (n=8; weight, 6.5–9 kg) were placed on venovenous ECMO. Blood samples were taken every hour and the following parameters were compared: hemoglobin level, activated partial thromboplastin time (aPTT), thromboelastography (TEG) data, platelet function, and inflammatory cytokine levels. RESULTS: In both groups, the aPTT was longer than the baseline value. Although the aPTT in the NM group was shorter than in the heparin group, the TEG parameters were similar between the 2 groups. Hemoglobin levels decreased in both groups, but the decrease was less with NM than with heparin (p=0.049). Interleukin (IL)-1β levels significantly decreased in the NM group (p=0.01), but there was no difference in the levels of tumor necrosis factor alpha or IL-10 between the 2 groups. CONCLUSION: NM showed a similar anticoagulant effect to that of unfractionated heparin, with fewer bleeding complications. NM also had anti-inflammatory properties during ECMO. Based on this preclinical study, NM may be a good alternative candidate for anticoagulation in ECMO.
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Animales , Perros , Anticoagulantes , Plaquetas , Oxigenación por Membrana Extracorpórea , Hemorragia , Heparina , Interleucina-10 , Interleucinas , Mesilatos , Tiempo de Tromboplastina Parcial , Tromboelastografía , Factor de Necrosis Tumoral alfaRESUMEN
BACKGROUND: Stroke is the number one cause of adulthood disability in Korea. Rehabilitation after stroke can minimize functional disability, enhance recovery toward independence, and optimize community reintegration. The inter-departmental stroke meeting (IDSM) is a potential method to improve rehabilitation outcomes in patients with stroke. We aimed to analyze the effect of IDSM on rehabilitation after acute ischemic stroke management. METHODS: Medical records of 753 patients with acute ischemic stroke admitted to the neurology department of our medical center between January and December 2014 were reviewed retrospectively. In May 2014, weekly IDSMs were initiated. All physicians responsible for the patient's care reviewed patient treatment, methods of secondary prevention, and future rehabilitation plans. RESULTS: The transfer rate significantly increased after initiation of IDSM (phase 2, 3) and the length of stay (LOS) before transfer to the rehabilitation department decreased significantly from 9.68 ± 8.50 days to 5.75 ± 2.12 days. There was a reduction in the total LOS from 52 ± 28.57 days to 35 ± 27.21 days after IDSMs were introduced. In non-transferred patients also, the total LOS reduced significantly. The transfer rate increased significantly and the LOS before transfer to the rehabilitation department decreased significantly after implementation of IDSM in a subgroup of patients with moderate to severe stroke. CONCLUSION: The introduction of IDSM was significantly correlated with improvements in transfer rates and reduction of LOS in hospital. This finding shows that IDSMs are an important intervention to improve therapeutic progress and outcomes for patients with stroke.
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Humanos , Trastornos Cerebrovasculares , Corea (Geográfico) , Tiempo de Internación , Registros Médicos , Métodos , Neurología , Rehabilitación , Estudios Retrospectivos , Prevención Secundaria , Accidente CerebrovascularRESUMEN
In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure.
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arterias Carótidas/diagnóstico por imagen , Circulación Cerebrovascular/fisiología , Mareo/etiología , Hemodinámica/fisiología , Fallo Renal Crónico/fisiopatología , Diálisis Renal , Factores de Riesgo , Ultrasonografía Doppler DúplexRESUMEN
In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure.
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arterias Carótidas/diagnóstico por imagen , Circulación Cerebrovascular/fisiología , Mareo/etiología , Hemodinámica/fisiología , Fallo Renal Crónico/fisiopatología , Diálisis Renal , Factores de Riesgo , Ultrasonografía Doppler DúplexRESUMEN
Nafamostat mesilate (NM), a synthetic serine protease inhibitor, has anticoagulant and anti-inflammatory properties. The intracellular mediator and external anti-inflammatory external signal in the vascular wall have been reported to protect endothelial cells, in part due to nitric oxide (NO) production. This study was designed to examine whether NM exhibit endothelium dependent vascular relaxation through Akt/endothelial nitric oxide synthase (eNOS) activation and generation of NO. NM enhanced Akt/eNOS phosphorylation and NO production in a dose- and time-dependent manner in human umbilical vein endothelial cells (HUVECs) and aorta tissues obtained from rats treated with various concentrations of NM. NM concomitantly decreased arginase activity, which could increase the available arginine substrate for NO production. Moreover, we investigated whether NM increased NO bioavailability and decreased aortic relaxation response to an eNOS inhibitor in the aorta. These results suggest that NM increases NO generation via the Akt/eNOS signaling pathway, leading to endothelium-dependent vascular relaxation. Therefore, the vasorelaxing action of NM may contribute to the regulation of cardiovascular function.
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Animales , Ratas , Aorta , Arginasa , Arginina , Disponibilidad Biológica , Células Endoteliales , Endotelio , Células Endoteliales de la Vena Umbilical Humana , Mesilatos , Óxido Nítrico , Óxido Nítrico Sintasa , Óxido Nítrico Sintasa de Tipo III , Fosforilación , Relajación , Serina Proteasas , VasodilataciónRESUMEN
PURPOSE: The objective of this study was to investigate the influence of hospital nurses' self-leadership, communication skill, and self-esteem on the quality of nursing service. METHODS: The participants, 230 nurses working at a general hospital in Seoul, completed a cross-sectional descriptive questionnaire survey between January 17 and 28, 2014. The collected data were analyzed using the SPSS 19.0 program for descriptive statistics, t-test, one way & two way ANOVA, correlation, and multiple regression analysis. RESULTS: Nurses' self-esteem and communication skill had significant main effects on self-leadership and the quality of nursing service, but the interaction effect of the two independent variables was not significant. Variables that significantly influenced the quality of nursing service were self-leadership, communication skill, self-esteem, and career longevity. The explanatory power of these variables for the quality of nursing service was 54.4%. CONCLUSION: Findings indicate a need for education programs for nurses which are designed to promote communication skill and enhance self-esteem and self-leadership skills which will in turn enhance the quality of nursing service.
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Educación , Hospitales Generales , Longevidad , Servicios de Enfermería , SeúlRESUMEN
BACKGROUND AND PURPOSE: Rapid recanalization might improve clinical outcomes after intraarterial thrombolysis (IAT) for acute ischemic stroke patients with collateral circulation. We determined whether rapid recanalization and collateral circulation affect clinical outcomes after IAT. METHODS: We retrospectively evaluated the clinical and radiological data of 134 consecutive patients who underwent IAT for intracranial artery occlusion. The interval from symptom onset to recanalization after IAT (onset-to-recanalization time) as an estimate of the probability of good clinical outcome (modified Rankin scale 0-2) was calculated in patients with collateral circulation in the ischemic hemisphere, which was rated poor (0/1 American Society of Interventional and Therapeutic Neuroradiology criteria) or good (2-4). Changes in National Institute of Health Stroke Scale (NHISS) score before and after IAT and modified Rankins scale scores 3 months after discharge were compared with respect to onset-to-recanalization time. RESULTS: In patients with good collateral circulation, the estimated onset-to-recanalization time for a 0.5 probability of a good clinical outcome was 347 minutes; with poor collateral circulation, it was 172 minutes for a 0.2 probability of good clinical outcome. Outcome analyses according to onset-to-recanalization time showed patients recanalized 6 hours of onset-to-recanalization time, and non-recanalization: 5.1, 6.9, 11.9, and 19.8, respectively) at discharge and higher percentages of good clinical outcome (69%, 66.7%, 21.9%, and 0%, respectively) 3 months after IAT. CONCLUSIONS: The time window to expect a high probability of a good clinical outcome after IAT is highly dependent on the collateral circulation.
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Humanos , Arterias , Circulación Colateral , Estudios Retrospectivos , Accidente CerebrovascularRESUMEN
Nafamostat mesilate (NM) is a serine protease inhibitor with anticoagulant and anti-inflammatory effects. NM has been used in Asia for anticoagulation during extracorporeal circulation in patients undergoing continuous renal replacement therapy and extra corporeal membrane oxygenation. Oxidative stress is an independent risk factor for atherosclerotic vascular disease and is associated with vascular endothelial function. We investigated whether NM could inhibit endothelial dysfunction induced by tumor necrosis factor-alpha (TNF-alpha). Human umbilical vein endothelial cells (HUVECs) were treated with TNF-alpha for 24 h. The effects of NM on monocyte adhesion, vascular cell adhesion molecule-1 (VCAM-1) and intracellular adhesion molecule-1 (ICAM-1) protein expression, p38 mitogen-activated protein kinase (MAPK) activation, and intracellular superoxide production were then examined. NM (0.01~100 microg/mL) did not affect HUVEC viability; however, it inhibited the increases in reactive oxygen species (ROS) production and p66shc expression elicited by TNF-alpha (3 ng/mL), and it dose dependently prevented the TNF-alpha-induced upregulation of endothelial VCAM-1 and ICAM-1. In addition, it mitigated TNF-alpha-induced p38 MAPK phosphorylation and the adhesion of U937 monocytes. These data suggest that NM mitigates TNF-alpha-induced monocyte adhesion and the expression of endothelial cell adhesion molecules, and that the anti-adhesive effect of NM is mediated through the inhibition of p66shc, ROS production, and p38 MAPK activation.
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Humanos , Asia , Células Endoteliales , Circulación Extracorporea , Células Endoteliales de la Vena Umbilical Humana , Molécula 1 de Adhesión Intercelular , Membranas , Mesilatos , Monocitos , Estrés Oxidativo , Oxígeno , Proteínas Quinasas p38 Activadas por Mitógenos , Fosforilación , Proteínas Quinasas , Especies Reactivas de Oxígeno , Terapia de Reemplazo Renal , Factores de Riesgo , Serina Proteasas , Superóxidos , Factor de Necrosis Tumoral alfa , Regulación hacia Arriba , Molécula 1 de Adhesión Celular Vascular , Enfermedades VascularesRESUMEN
BACKGROUND: To investigate the effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on motor symptoms especially freezing of gait (FoG), and nonmotor symptoms in Parkinson disease (PD). METHODS: In this randomized, double-blind, sham-controlled study, fifteen PD patients were enrolled. For 10 days, 5 Hz, both motor cortices and dorsolateral prefrontal cortex (DLPFC) were stimulated. The motor symptoms and FoG were evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS) part III, FoG questionnaire (FoG-Q), variable parameters of FoG, and kinematic gait analysis. Nonmotor symptoms were evaluated by the Korean version of non-Motor Symptoms Scale (K-NMSS), 39-item Parkinson disease questionnaire (K-PDQ39), Mini-Mental Status examination (K-MMSE), Montreal Cognitive Assessment (K-MoCA), and Frontal assessment battery (FAB). RESULTS: Finally, 12 patients (real:8, sham:4) data were analyzed. FoG-Q and UPDRS part III were improved (p=0.002, 0.022) and variable parameters of FoG was improved after 10 days stimulation in real treatment group. In addition, their effects maintained until 6 weeks from the baseline. In nonmotor symptoms, K-NMSS and K-PDQ 39 were improved until 6 weeks in real treatment group (p=0.002, 0.002), however no changes were shown in cognitive function test. CONCLUSIONS: The high frequency rTMS was effective for FoG, in addition to motor and a few nonmotor symptoms in PD.
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Humanos , Congelación , Marcha , Enfermedad de Parkinson , Corteza Prefrontal , Estimulación Magnética Transcraneal , Tiempo (Meteorología)RESUMEN
BACKGROUND: Neuromodulation therapy has been used to an adjunctive treatment promoting motor recovery in stroke patients. The objective of the study was to determine the effect of repetitive transcranial magnetic stimulation (rTMS) on neurobehavioral recovery and evoked potentials in rats with middle cerebral artery occlusion. METHODS: Seventy Sprague-Daley rats were induced permanent middle cerebral artery occlusion (MCAO) stroke model and successful stroke rats (n=56) assigned to the rTMS (n=28) and sham (n=28) group. The 10 Hz, high frequency rTMS gave on ipsilesional forepaw motor cortex during 2 weeks in rTMS group. The somatosensory evoked potential (SSEP) and motor evoked potential (MEP) were used to evaluate the electrophysiological changes. Behavioral function of the stroke rat was evaluated by the Rota rod and Garcia test. RESULTS: Forty rats (N(rTMS)=20; N(sham)=20) completed all experimental course. The rTMS group showed better performance than sham group in Rota rod test and Garcia test at day 11 (p0.05). The amplitude of MEP and SSEP in rTMS group was larger than sham group at day 18 (p<0.05). CONCLUSIONS: These data confirm that the high frequency rTMS on ipsilesional cerebral motor cortex can help the early recovery of motor performance in permanent middle cerebral artery stroke model and it may simultaneously associate with changes in neurophysiological activity in brain.
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Animales , Humanos , Ratas , Encéfalo , Potenciales Evocados , Potenciales Evocados Motores , Potenciales Evocados Somatosensoriales , Infarto de la Arteria Cerebral Media , Modelos Animales , Corteza Motora , Plásticos , Accidente Cerebrovascular , Estimulación Magnética TranscranealRESUMEN
BACKGROUND AND PURPOSE: We evaluated whether stent-assisted thrombectomy (SAT) is safer or more clinically beneficial than aggressive mechanical clot disruption (AMCD) for patients with acute intracranial artery occlusion. METHODS: We retrospectively analyzed the clinical data of 72 patients (33 with SAT and 39 with AMCD) who underwent intra-arterial thrombolysis for acute intracranial artery occlusions. Procedure parameters, clinical outcomes, and incidence of complications were compared between the SAT and AMCD groups. RESULTS: The time interval to recanalization was shorter in SAT patients (69.2+/-39.6 minutes, mean+/-standard deviation) than in AMCD patients (94.4+/-48.0 minutes, p<0.05). Recanalization was achieved in more SAT patients (91%) than AMCD patients (80%), but with no statistically significance. Urokinase was used less frequently in SAT patients (21%) than in AMCD patients (92%, p<0.05), and the incidence of symptomatic hemorrhages was lower in SAT patients (3%) than in AMCD patients (18%, p<0.05). Device-related complications in SAT patients comprised two cases of stent fracture and one case of distal migration of a captured thrombus. The proportion of patients with good outcomes, defined as scores from 0 to 3 on the modified Rankin Scale, was similar in the two groups at discharge (SAT, 46%; AMCD, 39%), but significantly higher in the SAT group than in the AMCD group at 3 months (64% vs. 40%, p<0.05) and 6 months (67% vs. 42%, p<0.05) after discharge. CONCLUSIONS: The outcomes and clinical parameters were better for SAT during thrombolytic procedures for acute intracranial artery occlusions than for AMCD for up to 6 months. However, some device-related complications occurred during stent interventions.
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Humanos , Arterias , Infarto Cerebral , Hemorragia , Incidencia , Trombolisis Mecánica , Estudios Retrospectivos , Stents , Accidente Cerebrovascular , Trombectomía , Trombosis , Activador de Plasminógeno de Tipo UroquinasaRESUMEN
Corpora amylacea (CA) are glycoproteinaceous inclusions that accumulate in the human brain during normal aging and neurodegenerative diseases. Although it has been suggested that the cellular sources of CA are neuronal or glial, the mechanisms underlying CA formation remain controversial. The aim of this study was to identify the source of CA in the human brain. Sample of the human brain tissues were obtained from the cadavers. H-E stain, periodic acid-Schiff (PAS) stain, and immunohistochemistry were performed in the brain tissues. Experimental induction of CA was also performed in rats. CA have been found in large numbers in the superficial, rather than in the deep, layer of the white matter in the lateral ventricle that is in contact with the cerebrospinal fluid (CSF) and sometimes near the blood vessels. Destroyed choroid plexi with psammoma bodies have been observed in the lateral ventricle of aged brains containing substantial numbers of CA. The cores of CA were mainly composed of amorphous PAS-positive materials, and glial fibrillary acidic protein-positive astrocytic processes were attached to the surface of the CA. Weak MAP2 was detected on a few CA in the gray matter such as dentate gyrus. PAS-positive CA were located on the border of the hippocampus contacting the CSF in the lateral ventricle in the cysteamine-induced CA animal model. Taken together, main cellular source of CA is astrocytes and CA core formation may be associated with CSF in the aged human brain.
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Anciano , Animales , Humanos , Envejecimiento , Astrocitos , Vasos Sanguíneos , Encéfalo , Cadáver , Coroides , Plexo Coroideo , Giro Dentado , Hipocampo , Inmunohistoquímica , Ventrículos Laterales , Enfermedades Neurodegenerativas , NeuronasRESUMEN
BACKGROUND AND PURPOSE: Cardiovascular risk factors are considered to also be risk factors for dementia. Recent studies have shown that the prevalence of cognitive dysfunction is high in patients with cardiac diseases. However, few studies have investigated the influence of cardiac function on cognition and brain structural changes in dementia. The aims of this study were to determine the relationship between cardiac and cognitive function, and to characterize any structural changes in the brain that could be caused by cardiac function in patients with dementia. METHODS: Dementia patients (n=93) were recruited prospectively with checking for the presence of vascular risk factors such as hypertension. Cognitive function was measured by the Mini-Mental State Examination, modified Mini-Mental State test, and Korean version of the Dementia Rating Scale. Brain magnetic resonance imaging was conducted to evaluate the cerebral white-matter changes (WMC), ventricular dilation, and cortical and hippocampal atrophy. Cardiac function was evaluated using two-dimensional echocardiography. We divided the patients into two groups according to the presence (+) or absence (-) of WMC. RESULTS: In the entire cohort, the size of the left atrium (LA) was positively correlated with the degree of WMC, irrespective of age (p<0.05). The LA was larger in the WMC (+) group (n=42) than in the WMC (-) group. General cognitive function was significantly lower in the WMC (+) group than in the WMC (-) group. Subjects with an enlarged LA tended to exhibit lower cognitive function and more-severe cerebral WMC. CONCLUSIONS: Cardiac dysfunction represented by LA enlargement could be related to cognitive decline and WMC of the brain resulting from impairment of the cerebral hemodynamic process in dementia.
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Humanos , Atrofia , Encéfalo , Cognición , Estudios de Cohortes , Demencia , Ecocardiografía , Atrios Cardíacos , Cardiopatías , Hemodinámica , Hipertensión , Imagen por Resonancia Magnética , Prevalencia , Estudios Prospectivos , Factores de RiesgoRESUMEN
PURPOSE: Medication adherence is an essential part of the management and control of high blood pressure (HBP). Although the Hill-Bone Medication Adherence (HBMA) scale is one of the most frequently used instruments for measuring HBP medication adherence, the psychometric properties of the scale have never been tested among Korean Americans, a population that experiences a disproportionately high prevalence of HBP. Therefore, the objective of this study is to validate a Korean version of the HBMA subscale (HBMA-K). METHOD: We used two, independent samples of Korean Americans (KAs) (combined n = 525) who participated in community-based intervention trials for HBP control. To develop the HBMA-K, the original scale was translated into Korean and then back translated into English. Reliability was assessed by calculating the Cronbach's alpha. Exploratory factor analysis (EFA) was done to assess construct validity. We also calculated the Pearson's correlation coefficients between the scale and theoretically driven variables such as blood pressure, knowledge, and HBP belief to test concurrent validity. RESULTS: The EFA revealed a one-factor solution with eight items, explaining 35.4% of the variance. Cronbach's alpha was .80. The 8-item HBMA-K scale was significantly associated with systolic blood pressure (BP) (r = .18, p < .01), diastolic BP (r = .24, p < .01), HBP knowledge (r = -.13, p < .01), and HBP belief score (r = -.18, p < .05). CONCLUSIONS: The 8-item HBMA-K scale is a valid and reliable instrument for measuring medication adherence among KAs with HBP. It can be easily administered at community and clinical settings to screen hypertensive patients with low medication adherence.
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Humanos , Asiático , Presión Sanguínea , Hipertensión , Cumplimiento de la Medicación , Prevalencia , PsicometríaRESUMEN
BACKGROUND: This study evaluated the relationships between endogenous estrogen levels and vascular risk factors in healthy men and women. METHODS: Demographics and laboratory data were collected from normotensive subjects (123 men and 154 women) in their thirties, forties and fifties who had normal laboratory profiles and no cardiovascular risk factors. Initially, estradiol, low-density lipoprotein (LDL)-cholesterol, triglyceride, and high-density lipoprotein (HDL)-cholesterol, systolic and diastolic blood pressure (SBP and DBP), NO2/NO3, homocysteine, and body mass index (BMI) were measured. Then, the relationships between estradiol and the evaluated items were analyzed with comparison of means and correlation, and stepwise multiple regression analysis based on genders and age-groups. RESULTS: Estradiol levels decreased with aging in women. Lower LDL and triglyceride, higher HDL levels, and lower SBP and DBP observed in women were correlated with decreasing age as well as increasing estradiol level. On the multivariate analysis, however, estradiol levels were negatively correlated with the changes in SBP, DBP, and triglyceride among the lipid variables. BMI was positively related with the increase of SBP and DBP and the estradiol levels. Although higher NO2/NO3 and lower homocysteine levels were observed in women than men, the NO2/NO3 and homocysteine levels had no significant correlation with estradiol changes. CONCLUSION: The study observed the beneficial relationships between endogenous estrogen, and blood pressures and lipids in healthy women. The estrogen-related benefits observed in this study were lower TG levels, SBP, and DBP in young women than those in older women or in men.
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Femenino , Humanos , Masculino , Envejecimiento , Presión Sanguínea , Índice de Masa Corporal , Colesterol , Demografía , Estradiol , Estrógenos , Homocisteína , Lipoproteínas , Análisis Multivariante , Óxido Nítrico , Factores de Riesgo , Enfermedades VascularesRESUMEN
BACKGROUND: Cowden's disease is a rare disorder, characterized by a multiple harmatoma-neoplasia syndrome. Germline mutations in the Phosphatase and Tensin homolog (PTEN) gene have been identified in some individuals with Cowden's disease. The present study aimed to evaluate abnormalities of PTEN and p53 genes in a patient with Cowden's disease. METHODS: Eleven family members including the patient with Cowden's disease were examined in this study. Sequencing analyses were performed on these people and on the normal control group to identify mutation in PTEN and p53 genes. RESULTS: DNA sequencing of PTEN gene showed no mutation in the patient and the family members. The G to C germline mutation was identified only in the patient of Cowden disease at 38th base of intron 2 of p53 gene. CONCLUSIONS: Although the exact role of mutation in p53 gene was not identified in the Cowden's disease, the conformational change of the gene would result in the dysfunction of the tumor suppressor effect of p53 gene. Otherwise, an epigenetic silencing can be a mechanism of disease development in a patient without genetic abnormality.