Comparison of Each Eye According to the Order of Noninvasive Keratographic Tear Film Evaluation.

PURPOSE: To investigate the effect of order of examination on the results of noninvasive keratograph tear film evaluation using Keratograph5M in dry eye patients. METHODS: One hundred and four patients with dry eye symptoms were analyzed retrospectively. All patients underwent bilateral noninvasive tear film evaluation using measurements of tear meniscus height (TMH) and noninvasive keratograph break-up time (NIKBUT) obtained using Keratograph5M. Measurements were performed sequentially in the order of right TMH, left TMH, right NIKBUT, and left NIKBUT. RESULTS: There was no statistically significant difference in TMH values between the right and left eyes (0.24 ± 0.08 and 0.23 ± 0.08 mm, respectively). Mean NIKBUT-first (time at first tear film break-up) and mean NIKBUT-average (the mean of all tear film break-up time over the entire cornea) were 6.17 ± 3.28 and 10.00 ± 3.97 seconds, respectively, for right, and 7.43 ± 3.86 and 11.57 ± 4.34 seconds, respectively, for left eyes. In addition, mean NIKBUT-first between right and left eyes, and mean NIKBUT-average between them were statistically significant (p = 0.013 and p = 0.007, respectively). Mean NIKBUT and mean TMH differences were not significantly influenced by right or left eyes, age, or sex (all p > 0.050). Spearman correlation analyses of TMH, NIKBUT-first, and NIKBUT-average results showed moderate positive correlations between right and left eyes (r = 0.470, r = 0.322, and r = 0.576, respectively; p < 0.001). CONCLUSIONS: TMH evaluation was not affected by test order; however, NIKBUT measurement was affected by test order, because of reflex tearing due to forced eye opening during the examination. Therefore, TMH should be evaluated before NIKBUT, and sufficient time interval and caution should be needed between NIKBUT measurements on both eyes.

Effects of Y-27632, a Rho-associated Kinase Inhibitor, on Human Corneal Endothelial Cells Cultured by Isolating Human Corneal Endothelial Progenitor Cells.

CONCLUSIONS: Y-27632 enabled the isolation and expansion of HCEPs. It also enhanced the proliferation, viability, and migration of differentiated HCEPs. METHODS: HCEPs were isolated and expanded in a medium with and without 10µM Y-27632, and then differentiated into HCECs in a medium with fetal bovine serum. The characteristics of HCEPs and differentiated HCEPs were confirmed by immunofluorescence staining. The proliferation, viability, morphology, and wound-healing ability of differentiated HCEPs were assessed in the presence of different concentrations of Y-27632. PURPOSE: Human corneal endothelial progenitor cells (HCEPs), which has been selectively isolated and differentiated into human corneal endothelial cells (HCECs), are crucial for repairing corneal endothelial damage. In this study, we evaluated the roles of a Rho-assisted kinase (ROCK) inhibitor, Y-27632, on the isolation and expansion of HCEPs, and assessed the in vitro effects of different concentrations of Y-27632 on the differentiated HCEPs. RESULTS: Y-27632 enabled the isolation and expansion of HCEPs from the corneal endothelium. The differentiated HCEPs showed an optimal increase in proliferation and survival in the presence of 10µM Y-27632. As the concentration of Y-27632 increased, differentiated HCEPs became elongated, and actin filaments were redistributed to the periphery of cells. Y-27632 also caused a concentration-dependent enhancement in the wound-healing ability of differentiated HCEPs.

Mesenchymal Stem Cell-Derived Exosomes and Intervertebral Disc Regeneration: Review.

Intervertebral disc degeneration (IVDD) is a common cause of lower back pain (LBP), which burdens individuals and society as a whole. IVDD occurs as a result of aging, mechanical trauma, lifestyle factors, and certain genetic abnormalities, leads to loss of nucleus pulposus, alteration in the composition of the extracellular matrix, excessive oxidative stress, and inflammation in the intervertebral disc. Pharmacological and surgical interventions are considered a boon for the treatment of IVDD, but the effectiveness of those strategies is limited. Mesenchymal stem cells (MSCs) have recently emerged as a possible promising regenerative therapy for IVDD due to their paracrine effect, restoration of the degenerated cells, and capacity for differentiation into disc cells. Recent investigations have shown that the pleiotropic effect of MSCs is not related to differentiation capacity but is mediated by the secretion of soluble paracrine factors. Early studies have demonstrated that MSC-derived exosomes have therapeutic potential for treating IVDD by promoting cell proliferation, tissue regeneration, modulation of the inflammatory response, and reduced apoptosis. This paper highlights the current state of MSC-derived exosomes in the field of treatment of IVDD with further possible future developments, applications, and challenges.

Impact of the ambulatory blood pressure monitoring profile on cognitive and imaging findings of cerebral small-vessel disease in older adults with cognitive complaints.

We investigated ambulatory blood pressure (BP) monitoring (ABPM) profiles and magnetic resonance imaging (MRI) findings of cerebral small-vessel disease (cSVD) in older adults with cognitive complaints who were grouped as follows: subjective cognitive decline, mild cognitive impairment, and dementia of Alzheimer's type. Group comparisons and correlation analyses among demographic characteristics, cognitive and MRI findings, and ABPM profiles were performed. Furthermore, multivariate logistic regression analyses for dependent variables of (1) dementia or not and (2) MRI criteria of subcortical vascular dementia (SVaD) or not were conducted with independent variables of dichotomized ABPM profiles. A total of 174 subjects (55 males and 119 females) were included: mean age 75.36 ± 7.13 years; Mini-Mental State Examination (MMSE) score 20.51 ± 6.23. No MRI and ABPM findings except medial temporal atrophy were different between three groups. Twenty-four-hour systolic BP (sBP) was correlated with MMSE score (r = -0.182; p = 0.022) and the severity of white matter hyperintensity (WMH) (r = 0.157; p = 0.048). A higher daytime sBP was associated with dementia (odds ratio (OR): 3.734; 95% confidence interval (CI): 1.041-13.390; p = 0.043) and MRI finding of SVaD (OR: 10.543; 95% CI: 1.161-95.740; p = 0.036). Although there were no differences in ABPM profiles between three groups, a higher BP-especially a higher sBP-correlated with cognitive dysfunction and severity of WMH in older adults. Only higher daytime sBP was an independent predictor for dementia and MRI findings of SVaD. Among various ABPM profiles in this study, a higher BP, especially a higher sBP, may be considered the most important for clinical and MRI findings of cSVD.

Effect of Molar Occlusal Balance on Cognitive Function in the Elderly.

BACKGROUND: Elderly people with dementia, who are increasing at a rate comparable to the rate at which theelderly population is growing, are becoming a serious social problem in Korea. Therefore, the purpose of this study was to investigate the association between molar occlusal balance and cognitive function among Koreans aged 65 years and older. METHODS: A total of 308 participants aged 65 years and older who attended a senior center were recruited for the study with their consent. The Korean version of the Mini-Mental State Examination (MMSE-DS) was used to assess cognitive function, and masticatory ability was measured according to the ability to chew food, the number of remaining teeth, and the self-perceived perceived masticatory function. Relative molar occlusal balance was measured using the T-scan Ⅲ system. All collected data were analysed using SPSS version 23.0. RESULTS: There was a significant association between cognitive function and molar masticatory ability (P < .05). The participants with relative molar occlusal balance had a higher MMSE-DS score when compared to those with relative incision occlusal balance, adjusted for sociodemographic factors and number of remaining teeth, subjective masticatory ability, chewing ability, occlusion time, and denture use. Cognitive function was higher when relative molar occlusion was greater compared to anterior occlusion in anterior-posterior teeth balance. CONCLUSIONS: Cognitive function in elderly people was higher when the relative molar occlusal balance was greater. Mastication with posterior teeth may have a more important effect on stimulation of cognitive function. Therefore, oral health care focusing on maintenance of molar teeth may be crucial for elderly persons.

Analysis of Neuropsychiatric Symptoms in Patients with Alzheimer's Disease Using Quantitative EEG and sLORETA.

OBJECTIVE: The electrocortical activities associated with the neuropsychiatric symptoms (NPSs) of Alzheimer's disease (AD) were investigated using frequency-domain electroencephalography (EEG) spectral source analysis, and the potential electrocortical indices identified. MATERIALS AND METHODS: Scalp EEG data were obtained from 51 patients with AD to investigate the presence of four NPS subdomains, hyperactivity, psychosis, affective symptoms, and apathy. EEG power spectra and the standardized low-resolution brain electromagnetic tomography (sLORETA)-localized EEG cortical sources were compared between the groups with and without the four NPS subdomains in eight frequency bands: 1-4, 4-8, 8-10, 10-12, 12-18, 18-20, 20-30, and 30-45 Hz. RESULTS: The power spectral analysis of EEG data showed that AD patients with psychosis had lower values at the α2-band in most areas. In patients with apathy, the θ-to-ß power ratio showed a greater activity over the frontal and central regions. The cortical source analysis using sLORETA revealed that patients with psychosis showed decreased values in the α2-band and patients with apathy showed higher δ-values, especially in the right frontal and temporal regions. CONCLUSION: The results of the present study showed that both classical EEG spectral and EEG source analysis could differentiate patients with and without NPSs, especially psychosis and apathy subdomains. Spectral and sLORETA analyses provided information helpful for a better characterization in patients with NPSs.

Association between mastication-related factors and the prevalence of dementia in Korean elderly women visiting senior centres.

OBJECTIVE: The purpose of this study was to evaluate the mastication ability of elderly women by assessing the number of their remaining teeth, subjective mastication comfort, subjective chewing ability of five food items, relative occlusion balance and mastication performance involving in chewing gum. BACKGROUND: Korea has already entered an aged society, issues related to the elderly are also growing; for example, dementia is emerging as a social problem. In addition, oral health of the elderly is very important because it is directly related to nutrient intake. A total of 101 subjects aged ≥65 who attended senior citizen centres in Daegu city provided consent and were included in this study. MATERIALS AND METHODS: The Korean version of the Mini-Mental State Examination (MMSE-DS) was used to evaluate cognitive function. To assess the degree of objective mastication, we measured colour changes using a chewing gum and posterior occlusion force using a T-scan Ⅲ® system. RESULTS: There was an association between mastication ability and cognitive function, indicated by the colour changes in the chewing gum (P < .05). The participants with greater relative posterior occlusion forces had higher MMSE-DS scores than those with stronger relative anterior occlusion forces. There was a positive correlation between cognitive function and posterior occlusion force. CONCLUSION: The elderly having more occlusion force of posterior teeth rather than anterior teeth were associated with better cognitive ability. Therefore, it may be important for the elderly to restore the masticatory function for the posterior part to prevent against deterioration of cognitive function.

Observational Study of Clinical and Functional Progression Based on Initial Brain MRI Characteristics in Patients with Alzheimer's Disease.

BACKGROUND: Magnetic resonance imaging (MRI) is a useful tool to predict the diagnosis and progression of Alzheimer's disease (AD), especially for primary physicians. However, the correlation between baseline MRI findings and AD progression has not been fully established. OBJECTIVE: To investigate the correlation between hippocampal atrophy (HA) and white matter hyperintensities (WMH) on initial brain MRI images and the degree of cognitive decline and functional changes over 1 year. METHODS: In this prospective, 12-month observational study, dementia outpatients were recruited from 29 centers across South Korea. Baseline assessments of HA and WMH on baseline brain MRI were derived as well as cognitive function, dementia severity, activities of daily living, and acetylcholinesterase inhibitor (AChEI) use. Follow-up assessments were conducted at 6 and 12 months. RESULTS: Among 899 enrolled dementia patients, 748 were diagnosed with AD of whom 654 (87%) were taking AChEIs. Baseline WMH showed significant correlations with age, current alcohol consumption, and Clinical Dementia Rating score; baseline HA was correlated with age, family history, physical exercise, and the results of cognitive assessments. Among the AChEI group, changes in the Korean version of the Instrumental Activities of Daily Living (K-IADL) were correlated with the severity of HA on baseline brain MRI, but not with the baseline severity of WMH. In the no AChEI group, changes in K-IADL were correlated with the severity of WMH and HA at baseline. CONCLUSION: Baseline MRI findings could be a useful tool for predicting future clinical outcomes by primary physicians, especially in relation to patients' functional status.

Relationship between the activities of daily living, oral health-related quality of life and dementia.

AIM: The aim of the present study was to investigate the association between the activities of daily living and the oral health-related quality of life and dementia in older adults. METHODS: Over a period of 18 months, we visited 12 elderly care facilities and recruited 375 participants, 345 of whom were selected to undergo oral health examinations and oral health-related surveys. Each investigation was carried out face-to-face by a professional worker. RESULTS: Cognitive ability was found to be good when the results of the activities of daily living and the oral health-related quality of life examinations were good. If the results of the activities of daily living examination were bad, the odds ratio of dementia was 2.66, and adjusted odds ratio for age, sex, residence type, education level and denture was 2.99, representing a significant difference (P < 0.05). CONCLUSIONS: Most oral problems are not simply the outcome of aging, with oral hygiene management being the most important determining factor. Oral health problems can be prevented, and in order to improve the quality of life of older adults, attention must be paid to oral healthcare. Geriatr Gerontol Int 2018; 18: 943-949.

Association between cerebrospinal fluid S100B protein and neuronal damage in patients with central nervous system infections.

PURPOSE: S100B protein is widely used as a measure of glial activity or damage in several brain conditions. Central nervous system (CNS) infections can cause neurological sequelae because of parenchyma invasion. It is difficult to predict further neuronal damage in the CNS infection. The present study is aimed to evaluate the role of the cerebrospinal fluid (CSF) S100B protein as an indicator of neuronal damage in CNS infection. MATERIALS AND METHODS: We measured the concentration of CSF S100B protein in 62 patients with a CNS infection using an Enzyme-Linked Immunosorbent Assay. The patients with CNS infections were classified as having no neuronal damage (CNS-N) or as having neuronal damage (CNS+N) according to the presence of neurological change or structural lesions on brain MRI. RESULTS: The CSF S100B protein level of the CNS+N group (n=22, 0.235 µg/L, 0.10-2.18) was significantly higher than that of the CNS-N group (n=40, 0.087 µg/L, 0.06-0.12) and control group (n=40, 0.109 µg/L, 0.07-0.14, p<0.01). Using an arbitrary cut off value, S100B-positive CSF was detected in 2.5% of the CNS-N group and in 50% of the CNS+N group (p<0.05). CONCLUSION: These findings suggest that increased S100B protein levels in the CSF may be associated with the neuronal damage following CNS infections.

Polymorphism of the Glutamate Transporter Protein EAAT2 and Migraine Transformation into Chronic Daily Headache.

BACKGROUND AND PURPOSE: The progression of migraine into chronic daily headache involves multiple risk factors, but the main contributor is not known. Glutamate is the major excitatory neurotransmitter in central sensitization, which is an important process in the pathogenesis of migraine transformation. The glutamate transporter protein excitatory amino acid transporter 2 (EAAT2) is the primary modulator of glutamatergic neurotransmission, and genetic polymorphisms of its gene, EEAT2, have been identified. The aim of this study was to determine the effect of EAAT2 polymorphisms on migraine transformation into chronic daily headache. METHODS: We included 74 migraine patients with episodic attack (M-E) and 59 migraine patients with chronic daily headache (M-CDH). After amplifying EAAT2 by polymerase chain reaction, we assessed its genotype frequencies based on restriction fragment length polymorphisms. We reclassified all migraine patients into two groups according to their EAAT2 genotype, either with the A allele (n=62) or without it (n=71), and compared the clinical variables between the two groups. RESULTS: The genotype frequencies of EAAT2 polymorphisms did not differ between the M-E and M-CDH groups. Comparison between EEAT2 genotypes revealed that the frequency of analgesic usage was significantly higher among migraine patients with the A allele (12.9±1.6 days/month) than in those without the A allele (8.1±1.2 days/month; p=0.019). The other clinical variables of migraine did not differ between the two groups. CONCLUSIONS: The results suggest that EEAT2 polymorphism contributes to the tendency toward frequent analgesic usage in migraine patients. This implies a potential genetic influence on the progression of migraine into chronic daily headache through the development of medication-overuse headache.

APOE ε4 allele status in korean dementia patients with severe white matter hyperintensities.

Few studies have investigated the apolipoprotein E (APOE) ε4 allele status of dementia patients with severe white matter hyperintensities (WMH). In this study, we aimed to characterize the APOE epsivlon genotypes and clinical features of dementia patients with severe WMH. Four hundred and thirty nine patients with dementia and 152 subjects with normal cognition (NC) were recruited from multiple centers in Korea, known as the Clinical Research Center for Dementia of South Korea (CREDOS), since November 2005. The WMH were rated using the scale that had been developed by the CREDOS study. Dementia patients with minimal WMH were considered to have Alzheimer's disease (AD) without WMH (AD-WMH: 325), and those with severe WMH were considered to have Subcortical Ischemic Vascular Dementia (SIVD: 50) or AD with severe WMH (AD+WMH: 64). Comparisons of APOE ε4 allelic prevalence were performed using chi-square analysis. The APOE ε4 allele was more prevalent in those with AD than in those with SIVD and NC (p < 0.001). It was not more prevalent in those with SIVD than in those with NC (p = 0.169). APOE ε4 allele status in AD+WMH did not differ from that in AD-WMH (p = 0.625). The APOE ε4 allele was more prevalent in those with AD than in those with SIVD. APOE ε4 may not be associated with SIVD although it is one of the vascular risk factors.