Se Hee Jung

Granulocyte-colony stimulating factor attenuates striatal degeneration with activating survival pathways in 3-nitropropionic acid model of Huntington's disease.

Huntingtons disease (HD) has a mitochondrial dysfunction causing the vulnerability to the excitotoxicity and activations of multiple cell death pathways. Recent evidences suggest that the hematopoietic cytokine, granulocyte-colony stimulating factor (G-CSF), exerts pleiotropic neuroprotection in acute neural injury with activating various survival pathways. Thus, we investigated whether G-CSF can modulate neurodegeneration in an HD animal model induced by 3-nitropropionic acid (3NP), which inhibits mitochondrial succinate dehydrogenase complex II. Either G-CSF (50 microg/kg/day) or saline (as vehicle) was administered intraperitoneally for 5 days with 3NP (63 mg/kg/day) continuous osmotic pump infusion into male Lewis rats. We measured motor scales (0-8) daily and sacrificed rats at 5 days. We observed that G-CSF receptors were expressed in 3NP-induced degenerating striatum. Rats treated with G-CSF showed less degree of neurologic deficits. In the G-CSF-treated rats, the striatal lesion volume measured by Nissl staining, TUNEL+ apoptotic cells, Fluorojade C+ degenerating neurons, and c-Jun+ cells were all decreased. In western blotting, G-CSF activated survival pathways including p-ERK, p-eNOS, p-STAT3, and p-Akt. In summary, G-CSF was found to have neuroprotective effects and save striatal cells through activations of survival pathways in the 3NP-induced striatal degeneration model for HD.

Effects of botulinum toxin A therapy with electrical stimulation on spastic calf muscles in children with cerebral palsy.

Kang B-S, Bang MS, Jung SH: Effects of botulinum toxin A therapy with electrical stimulation on spastic calf muscles in children with cerebral palsy. Am J Phys Med Rehabil 2007;86:901–906. Objective:To assess the additive effect of adjuvant electrical stimulation on botulinum toxin A injection in children with spastic diplegic cerebral palsy. Design:Eighteen children with dynamic foot equinus deformity were treated with botulinum toxin A injection into the calf muscles. Seven children were assigned to a treatment group who received botulinum toxin A and adjuvant electrical stimulation, and 11 children were assigned to a control group with botulinum toxin injection only. Before botulinum injection, and at 2 wks and 3 mos after injection, the Physician Rating Scale, passive ranges of ankle and knee motion, and the modified Ashworth scale were measured. Results:A significant increase in passive range of ankle motion was observed at 2 wks after injection in the treatment group and at 3 mos after injection in both groups. Both groups showed significant improvements by the modified Ashworth scale at 2 wks after injection. Subscales of the Physician Rating Scale (equinus foot, crouched gait) and total Physician Rating Scale scores were significantly improved in the treatment group at 3 mos after injection, but this was not observed in the control group. Conclusions:Adjuvant electrical stimulation for a short period after botulinum toxin A injection was found to benefit early improvement of range of motion and maintenance of gait improvement in children with spastic diplegia cerebral palsy showing dynamic equinus.

Prevalence of the Rotator Cuff Tear Increases With Weakness in Hemiplegic Shoulder

Objective To investigate the relationship between the rotator cuff tear (RCT) and the muscle strength in hemiplegic side, and the effects of paralysis on the affected shoulders in hemiplegic patients. Methods A cross-sectional observational study performed in a university hospital was presented. The study enrolled 55 participants with hemiplegia of diverse degree of motor paresis, excluding those with bilateral lesions, history of major trauma or other co-existing musculoskeletal disorders of the shoulder. The main outcome measurements were muscle strength of the affected upper extremity (based on Medical Research Council scale), RCTs of the bilateral shoulders (by ultrasonography), and presence of shoulder pain, subluxation of the glenohumeral joint, passive range of motions, and subacromial spurs. Results Comparing each side of the shoulders, the prevalence of shoulder pain and supraspinatus muscle tear was higher (p<0.0001, p=0.007), and the range of motion was restricted (p<0.0001, p<0.0001, p<0.0001, p<0.0001) in the affected side. There was a significant trend toward higher prevalence of RCT and shoulder subluxation in the weaker shoulder (p=0.019, p<0.0001). In a multivariate analysis, Manual Muscle Test grade of less than three was an independent risk factor for RCT (p=0.025). Conclusion RCT in hemiplegia had a linear trend with muscle weakness in the affected side and the degree of weakness was an independent risk factor for the occurrence of RCT. In addition, shoulder pain, limitation of range of motions, and RCT were more frequent on the hemiplegic side of the shoulders. It is the first study to reveal a linear trend between RCT and upper extremity weakness and will provide physicians an insight to the management of RCTs in hemiplegic patients.

The Impact of Acute Phase Domain-Specific Cognitive Function on Post-stroke Functional Recovery

Objective To assess whether the cognitive function in the acute stage evaluated by domain-specific neuropsychological assessments would be an independent predictor of functional outcome after stroke. Methods Forty patients underwent 4 domain-specific neuropsychological examinations about 3 weeks after the onset of stroke. The tests included the Boston Naming Test (BNT), the construction recall test (CRT), the construction praxis test (CPT), and the verbal fluency test (VFT). The Korean version of Modified Barthel Index (K-MBI) at 3 months and the modified Rankin Scale (mRS) at 6 months were investigated as functional outcome after stroke. Functional improvement was assessed using the change in K-MBI during the first 3 months and subjects were dichotomized into good status and poor status according to mRS at 6 months. The domain-specific cognitive function along with other possible predictors for functional outcome was examined using regression analysis. Results The z-score of CPT (p=0.044) and CRT (p<0.001) were independent predictors for functional improvement measured by the change in K-MBI during the first 3 months after stroke. The z-score of CPT (p=0.049) and CRT (p=0.048) were also independent predictors of functional status at post-stroke 6 months assessed by mRS. Conclusion Impairment in visuospatial construction and memory within one month after stroke can be an independent prognostic factor of functional outcome. Domain-specific neuropsychological assessments could be considered in patients with stroke in the acute phase to predict long-term functional outcome.

Post-polio syndrome and risk factors in korean polio survivors: a baseline survey by telephone interview.

Objective To obtain information on the socioeconomic, medical, and functional status of polio survivors, and to use these results as the preliminary data for establishing the middle-aged cohort of polio survivors. Methods The subjects were recruited based on the medical records of multiple hospitals and centers. They were assessed through a structured questionnaire over the phone. Post-poliomyelitis syndrome (PPS) was identified according to the specified diagnostic criteria. Differences between polio survivors with or without PPS were evaluated, and the risk factors for PPS were analyzed by the odds ratio (OR). Results Majority of polio survivors were middle-aged and mean age was 51.2±8.3 years. A total of 188 out of 313 polio survivors met the adopted criteria for PPS based on the symptoms, yielding a prevalence of 61.6%. Mean interval between acute poliomyelitis and the development of PPS was 38.5±11.6 years. Female gender (OR 1.82; confidence interval [CI] 1.09-3.06), the age at onset of poliomyelitis (OR 1.75; CI 1.05-2.94), the use of orthoses or walking aids (OR 2.46; CI 1.44-4.20), and the history of medical treatment for paralysis, pain or gait disturbance (OR 2.62; CI 1.52-4.51) represented independent risk factors for PPS. Conclusion We found that the majority of Korean polio survivors entered middle age with many medical, functional, and social problems. Female gender, early age of onset of poliomyelitis, the use of orthoses or walking aids, and the history of medical treatment for paralysis, pain or gait disturbance were identified as the significant risk factors for PPS. A comprehensive and multidisciplinary plan should be prepared to manage polio survivors considering their need for health care services and the risk factors for late effects, such as PPS.

Cell proliferation and synaptogenesis in the cerebellum after focal cerebral ischemia.

Cerebral ischemia induces cortical function reorganization and neocortical neurogenesis in the cerebral hemisphere. However, whether the cerebellum undergoes corresponding dynamic change after cerebral injury has not been determined. We investigated the characteristics of cell proliferation and synaptogenesis in the cerebellum after focal cerebral ischemia. After induction of focal cerebral ischemia in rats, bromodeoxyuridine (BrdU, 100 mg/kg, intraperitoneally, daily) was administered for 5 days. Brain sections were analyzed using immunohistochemistry at days 7, 14, and 28. BrdU+ cells and Iba-1+ cells were counted, and cerebellar synaptophysin immunoreactivity was quantitatively analyzed. Rats with cerebral ischemia showed increased numbers of BrdU+ cells in the cerebellum at day 28 compared to sham-operated rats. Neither neuronal markers nor GABAergic markers were co-labeled with BrdU+ cells, suggesting that none of the proliferating cells contributed to neurogenesis. Instead, the number of Iba-1+ cells in the cerebellum was increased, which suggests that microglia are activated in the cerebellum after cerebral ischemia. The optical density of synaptophysin in the cerebellum of rats with cerebral ischemia was significantly increased in the molecular and granular layers at days 7 and 14. Cerebellar synaptophysin expression was significantly correlated with cerebellar cell proliferation. This study shows that the cerebellum undergoes specific and dynamic changes at the cellular level after focal cerebral ischemia, including cell proliferation and synaptogenesis.

Falls in Korean Polio Survivors: Incidence, Consequences, and Risk Factors.

Falls and fall-related injuries are important issue among polio survivors. The purpose of this study was to determine the incidence of, and consequences and factors associated with falls among Korean polio survivors. A total of 317 polio survivors participated in this study. All participants completed a questionnaire including fall history, symptoms related to post-polio syndrome and other information through a telephone interview. Among them, 80 participants visited our clinic for additional physical measurements and tests. Of the 317 respondents, 68.5% reported at least one fall in the past year. Of the fallers, 42.5% experienced at least one fall during one month. Most falls occurred during ambulation (76.6%), outside (75.2%) and by slipping down (29.7%). Of fallers, 45% reported any injuries caused by falls, and 23.3% reported fractures specifically. Female sex, old age, low bone mineral density, the presence of symptoms related to post-polio syndrome (PPS), poor balance confidence, short physical performance battery and weak muscle strength of knee extensor were not significantly associated with falls. Only leg-length discrepancy using spine-malleolar distance (SMD) was a significant factor associated with falls among Korean polio survivors. Our findings suggest that malalignment between the paralytic and non-paralytic limb length should be addressed in polio survivors for preventing falls.

Effect of Electrical Stimulation on Botulinum Toxin A Therapy in Patients With Chronic Myofascial Pain Syndrome: A 16-Week Randomized Double-Blinded Study

OBJECTIVEnTo evaluate the effect of different intensities of electrical stimulation on botulinum toxin A (BTX-A) injection at trigger points (TrPs) in patients with chronic myofascial pain syndrome (MPS).nnnDESIGNnDouble-blind randomized trial.nnnSETTINGnOutpatient rehabilitation clinic.nnnPARTICIPANTSnPatients (N=76) with chronic MPS of the neck and shoulder regions.nnnINTERVENTIONSnPatients were randomly assigned to 1 of 2 intervention groups: BTX-A injection followed by (1) electrical stimulation that induces visible muscle contraction (MOTOR group); or (2) electrical stimulation with an intensity just above the sensory threshold (SENSORY group). Electrical stimulation was administered for 30 minutes a day for 3 consecutive days after injection.nnnMAIN OUTCOME MEASURESnThe primary outcome was the visual analog scale (VAS) for pain. Secondary outcomes included the Neck Pain and Disability Scale (NPAD), Global Assessment of Improvement Scale (GAS), and pressure pain threshold (PPT).nnnRESULTSnThe VAS scores decreased significantly at 4, 8, 12, and 16 weeks from the baseline in both groups. Significant changes in the NPAD score over time were noted only in the SENSORY group at 8, 12, and 16 weeks. The SENSORY group showed lower VAS and NPAD scores at 16 weeks (P=.043 and P=.041, respectively), and higher treatment success rates at 12 and 16 weeks (P=.039 and P=.024, respectively) than the MOTOR group. There was no significant result in the GAS and PPT.nnnCONCLUSIONSnShort-term electrical stimulation may affect the reduction in pain after BTX-A injection at TrPs in patients with chronic MPS of the neck and shoulder regions. Based on the results, it seems that sensory electrical stimulation was superior to motor electrical stimulation as an adjuvant therapy to BTX-A injection in patients with chronic MPS. Further studies are warranted to investigate the method facilitating the effect of BTX-A on MPS.

Factors Associated with Reduced Quality of Life in Polio Survivors in Korea

The purpose of this study is to assess health-related quality of life in polio survivors (PS) compared with that in the general population in Korea. Polio survivors (n = 120) from outpatient clinics at two hospitals, healthy controls (HC, n = 121) and members of the general population with activity limitations (AL, n = 121) recruited through a proportional-allocation, systematic sampling strategy from the Fourth Korean National Health and Nutrition Examination Survey were surveyed with self-rated health-related quality of life (Euro QoL five-dimensions). The proportion of participants who reported problems in mobility, usual activity, and symptoms of anxiety/depression were higher in the PS group compared with the HC and AL groups. There was no significant difference in the self-care dimension across the groups. Polio-specific questionnaire, pain, depression, fatigue, Modified Barthel Index (K-MBI) and Short Physical Performance Battery (SPPB) were assessed in the PS group. Those with post-poliomyelitis syndrome had greater problems in mobility, usual activity, and depression/anxiety. Polio survivors, especially those with more pain and fatigue symptoms, and those who did not have access to medical services had poorer health-related quality of life. These findings afford useful information for potential intervention improving quality of life in polio survivors.

Effect of the Order of Test Diets on the Accuracy and Safety of Swallowing Studies

Objective To assess whether the order of test diets influences the results of swallowing studies with regard to their accuracy and safety. Methods Subjects with suspected dysphagia underwent a videofluoroscopic swallowing study (VFSS) and/or a fiberoptic endoscopic evaluation of swallowing (FEES) and repeated the study on the same day or within a week. The order of test diets comprised of two different sets: trial 1 with the fluid first and trial 2 with the semi-solid food first. Main outcome measurements were the modified penetration-aspiration scale (mPAS) and the pharyngeal residue severity scale (PRSS) for the vallecula and the pyriform sinus. Results Sixty-six patients (44 men and 22 women, aged 65.0±15.0 years) were enrolled in this study. Forty-three subjects were evaluated with VFSS only and 23 with both VFSS and FEES. As a result of the swallowing studies, there was no significant difference in each chosen diet sequence regarding mPAS and PRSS. Furthermore, there was no difference regarding the duration of studies, rate of premature study termination, rate of abnormal findings in post-study chest X-ray, and rate of fever or pneumonia post-study. Conclusion The accuracy and safety of the swallowing studies do not rely on the order of test diets.