Sam-Gyu Lee

Patterns of using complementary and alternative medicine by stroke patients at two university hospitals in Korea.

This study measured the prevalence of complementary and alternative medicine (CAM) use among Korean stroke patients. Questionnaire-based 20-min interviews were conducted at the hospitals by a trained nurse after an outpatient visit. It included questions on demographic information, clinical information and the utilization of CAM. Of 304 stroke-patient respondents, 164 (54%) had used CAM, of which 66% had started taking CAM products following suggestions from family members and other relatives. Of the 57% of users who felt that CAM was effective, 84% considered that it improved the symptoms of stroke and 16% felt it was effective in achieving psychological relaxation. Of the eight CAM categories used by respondents, 92% used traditional Oriental medical treatments, 36% used plant- and animal-derived over-the-counter health care products, 24% used minerals and vitamins, and 11% used manual therapies. The majority of stroke patients (68%) were trying a new type of CAM, and half of the respondents (45%) relied on the knowledge of their general practitioner about CAMs when deciding whether to use them. Most of the stroke patients in this study used CAM, and a half of them reported beneficial effects. Despite the presence of adverse side effects, they tended to be used without discussion with chief physicians, and hence physicians should be actively involved in the usage of CAM.

Serum albumin at admission for prediction of functional outcome in ischaemic stroke patients

This study aimed to investigate the effect of serum albumin at admission, measured within 24 h after stroke onset, on the functional outcome in ischaemic stroke patients. The medical records of 76 first-ever hemiplegic ischaemic stroke patients were reviewed. Collected data included age, sex, initial stroke severity, cerebrovascular risk factors, lesion-related variables, aetiologic subtype of stroke and serum albumin at admission. The functional outcome was measured by functional independence measure (FIM) and modified Barthel index (MBI). Serum albumin at admission and initial National Institutes of Health Stroke Scale (NIHSS) score were correlated with the functional outcome, respectively. Serum albumin at admission was an independent predictor of MBI gain on multiple regression analysis. Serum albumin at admission would be a useful predictor of the functional outcome and trials for the correction of hypoalbuminaemia from the acute stage would be helpful to decrease the risk of poor outcome in ischaemic stroke patients.

Enzyme-responsive doxorubicin release from dendrimer nanoparticles for anticancer drug delivery

Background Since cancer cells are normally over-expressed cathepsin B, we synthesized dendrimer-methoxy poly(ethylene glycol) (MPEG)-doxorubicin (DOX) conjugates using a cathepsin B-cleavable peptide for anticancer drug targeting. Methods Gly-Phe-Leu-Gly peptide was conjugated with the carboxylic acid end groups of a dendrimer, which was then conjugated with MPEG amine and doxorubicin by aid of carbodiimide chemistry (abbreviated as DendGDP). Dendrimer-MPEG-DOX conjugates without Gly-Phe-Leu-Gly peptide linkage was also synthesized for comparison (DendDP). Nanoparticles were then prepared using a dialysis procedure. Results The synthesized DendGDP was confirmed with 1H nuclear magnetic resonance spectroscopy. The DendDP and DendGDP nanoparticles had a small particle size of less than 200 nm and had a spherical morphology. DendGDP had cathepsin B-sensitive drug release properties while DendDP did not show cathepsin B sensitivity. Further, DendGDP had improved anticancer activity when compared with doxorubicin or DendDP in an in vivo CT26 tumor xenograft model, ie, the volume of the CT26 tumor xenograft was significantly inhibited when compared with xenografts treated with doxorubicin or DendDP nanoparticles. The DendGDP nanoparticles were found to be relatively concentrated in the tumor tissue and revealed stronger fluorescence intensity than at other body sites while doxorubicin and DendDP nanoparticles showed strong fluorescence intensity in the various organs, indicating that DendGDP has cathepsin B sensitivity. Conclusion DendGDP is sensitive to cathepsin B in tumor cells and can be used as a cathepsin B-responsive drug targeting strategy. We suggest that DendGDP is a promising vehicle for cancer cell targeting.

Impaired Opening of the Upper Esophageal Sphincter in Patients with Medullary Infarctions

The aim of this study was to report on nine dysphagic patients with medullary infarction and to evaluate swallowing characteristics based on the location of the lesions.We retrospectively reviewed the medical records of these nine patients. The medullary lesions were midlateral (three patients), dorsolateral (one patient), inferodorsolateral (four patients), and paramedian (one patient). The levels of the lesions were upper (four patients), middle (two patients), upper and middle (two patients), and middle and lower medulla (one patient). Dysphagia after medullary infarction was more common in patients with upper or middle medullary level and dorsolateral medullary level lesions. The common findings on videofluoroscopic swallowing studies in patients with lateral medullary infarctions were impaired upper esophageal sphincter opening, aspiration from pyriform sinuses’ residue caused by pharyngeal weakness, and multiple swallowing to clear boluses from the pharynx to the esophagus. In patients with medullary infarctions, the lesion levels and loci and their related clinical findings can be useful in predicting dysphagia and aspiration. Because severe dysphagia with serious complication is very common in patients with medullary infarctions, active diagnostic and therapeutic approaches are needed.

Korean Stroke Cohort for functioning and rehabilitation (KOSCO): study rationale and protocol of a multi-centre prospective cohort study

BackgroundDevelopment of a long-term stroke care plan requires serial assessment of long-term patient function and consideration of caregiver mood. However, to date, few comprehensive cohort studies have included both stroke patients and caregivers.Methods/DesignKOSCO is a large, multi-centre prospective cohort study for all acute first-ever stroke patients admitted to participating hospitals in nine distinct areas of Korea. This study is designed as a 10-year, longitudinal follow-up investigating the residual disabilities, activity limitations, and quality of life issues arising in patients suffering from first-ever stroke. The main objectives of this study are to identify the factors that influence residual disability and long-term quality of life. The secondary objectives of this study are to determine the risk of mortality and recurrent vascular events in patients with acute first-ever stroke. We will investigate longitudinal health behaviors and patterns of healthcare utilization, including stroke rehabilitation care. We will also investigate the long-term health status, mood, and quality of life in stroke patient caregivers. In addition, we will identify baseline and ongoing characteristics that are associated with our secondary outcomes.DiscussionKOSCO is a prospective, multi-centre, 10-year longitudinal follow-up study investigating the residual disabilities, activity limitations, and quality of life issues arising in patients suffering from first-ever stroke.

The Effect of C-Reactive Protein on Functional Outcome in Ischemic Stroke patients

This study was performed to evaluate the effect of C-reactive protein (CRP) measured within 24 hr after stroke onset on functional outcome in ischemic stroke patients. The medical records of 28 first-ever hemiplegic ischemic stroke patients with the lesions on the middle cerebral arterial territory were reviewed. Subjects were classified into experimental group (serum CRP ≥ 0.5 mg/dL) and control group (serum CRP < 0.5 mg/dL) based on the level of serum CRP measured within 24 hr after stroke onset. Serum CRP measured within 24 hr after stroke onset was significantly correlated with functional scales in ischemic stroke patients.

Effects of (-)-epigallocatechin-3-gallate on the activity of substantia nigra dopaminergic neurons.

Despite many studies on the biological and pharmacological properties of (-)-epigallocatechin-3-gallate (EGCG), an active component of green tea, information on neuronal modulation by EGCG is limited. This study was designed to investigate the effects of EGCG on the electrical activity of rat substantia nigra dopaminergic neurons using whole-cell patch clamp recordings. The spike frequency was increased to 6.33+/-0.23 (p<0.05) and 7.15+/-0.29 (p<0.05) by 5 and 10 microM EGCG, respectively, from the control level of 5.49+/-0.19 spikes/second, respectively (n=18). The resting membrane potential of the cells was decreased to -45.66+/-0.45 and -43.99+/-0.87 (p<0.05), by 5 and 10 microM EGCG, respectively, from -47.82+/-0.57 mV. The amplitude of afterhyperpolarization was decreased to 12.73+/-0.45 (p<0.05) and 11.60+/-0.57 (p<0.05) by 5 and 10 microM EGCG, respectively, from 13.80+/-0.31 mV. The neuronal activity of dopaminergic neurons is closely linked to dopamine release. When neurons switch from a single-spike firing to bursts of action potentials, the release of dopamine increases. The above experimental results suggest that EGCG increases the neuronal activity via inhibition of calcium-dependent potassium currents underlying the afterhyperpolarization, and it could act as a facilitating factor that elicits NMDA-dependent bursts of action potentials like apamin or bicuculline methiodide.

Winged Scapula Caused by Rhomboideus and Trapezius Muscles Rupture Associated with Repetitive Minor Trauma: A Case Report

We experienced a rare case of winged scapula that was caused by the rupture of the rhomboideus major and the lower trapezius muscles without any nerve injury in a 12 yr old female after she had carried a heavy backpack. Electrodiagnostic study revealed that the onset latencies, amplitudes and conduction velocities were normal in the long thoracic nerve, the spinal accessory nerve and the dorsal scapular nerve. The needle EMG findings were normal as well. An explorative operation was performed and the rupture of the rhomboideus major and lower trapezius muscles was detected. Direct surgical repair of the ruptured muscle was carried out and the deformity was corrected. The anatomical and functional restoration was satisfactorily accomplished.

Effect of obesity on functional outcomes at 6 months post-stroke among elderly Koreans: a prospective multicentre study

Objectives We examined whether obesity based on body mass index (BMI) was a predictor of functional independence measure (FIM) at 6 months after ischaemic stroke onset while adjusting for stroke risk factors and covariates and stratifying by age group. Design This is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation that was designed as a nested case study within a nationwide hospital-based cohort. Setting We identified all patients who were admitted to nine representative hospitals in Korea from 2012 until 2014 under a diagnosis of acute first-ever ischaemic stroke. The hospitals were selected from the metropolitan district, mid-sized cities and a small-sized city. Participants The sample included 2057 patients with acute ischaemic stroke who were at least 18 years old. Primary and secondary outcome measures We divided participants into two age levels (<65 and ≥65 years). Participants were classified into five groups according to their baseline BMI at admission: underweight (BMI<18.5), normal (18.5≤BMI<23), overweight (23≤BMI<25), obese (25≤BMI<30) and extremely obese (30≤BMI). Results The proportion of patients who were aged ≥65 years was 55.0%. The proportions of underweight, normal, overweight, obese and extremely obese patients were 2.6%, 24.3%, 29.6%, 37.2% and 6.3%, respectively, in the <65 years group and 5.5%, 34.5%, 27.9%, 28.8% and 3.3%, respectively, in the ≥65 years group. In a multiple linear regression, the 6-month FIM after stroke in the elderly group was significantly associated with being extremely obese (7.95, p<0.05) after adjusting for confounding variables. In the <65 years group, the 6-month FIM was not associated with any weight category. Conclusions This nationwide hospital-based cohort study showed that extreme obesity is a predictor of a good 6-month FIM, especially in patients with ischaemic stroke who are at least 65 years of age.

The Correlation between F-wave Motor Unit Number Estimation (F-MUNE) and Functional Recovery in Stroke Patients

The aim of this study was to follow up the changes in the number of motor units according to the Brünnstrom stage through a motor unit number estimation of the F-wave (F-MUNE) after a stroke, and to identify the functional significance of F-MUNE. Twenty-five patients (15 men, 10 women) with a first unilateral stroke were recruited. The maximal M-potential was evoked by the supramaximal stimulation of the median nerve at the wrist, and the maximal stimulation intensity was determined on both hemiplegic and unaffected hands. The reproducible all-or-none F-wave was evoked in 30% of the maximal stimulation intensity and was constantly stimulated at that level. The prototypes of the F-wave were chosen, and the values of F-MUNE were calculated by dividing the amplitude of the maximal M-potential by the mean amplitude of the F-prototype. The changes in F-MUNE were compared according to the progression of the Brünnstrom stage and correlated with those of the functional scales. The mean motor unit numbers decreased significantly in the hemiplegic side compared with the unaffected side. According to the progression of the Brünnstrom stage, the values of F-MUNE were reduced significantly by increasing the amplitude and recruitment of the F-prototype, and the functional scores also improved. These results show that the F-MUNE equation did not show a functional recovery-related increase in stroke patients.