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Background: We aimed to verify the validity of the proportional recovery model for the lower extremity. Methods: We reviewed clinical data of patients enrolled in the Korean Stroke Cohort for Functioning and Rehabilitation between August 2012 and May 2015. Recovery proportion was calculated as the amount of motor recovery over initial motor impairment, measured as the Fugl-Meyer Assessment of Lower Extremity score. We used the logistic regression method to model the probability of achieving the full Fugl-Meyer Assessment of Lower Extremity score, whereby we considered the ceiling effect of the score. To show the difference in the prevalence of achieving the full Fugl-Meyer Assessment of Lower Extremity score between 3 and 6 months poststroke, we constructed a marginal model through the generalized estimating equation method. We also performed the propensity score matching analysis to show the dependency of recovery proportion on the initial motor deficit at 3 and 6 months poststroke. Results: We evaluated 1085 patients. The recovery proportions at 3 and 6 months poststroke were 0.67±0.42 and 0.75±0.39, respectively. A 1-unit decrease in the initial neurological impairment and the age at stroke onset increased the probability of achieving the full Fugl-Meyer Assessment of Lower Extremity score, which occurred at both 3 and 6 months poststroke. The prevalence of those who reach full lower limb motor recovery differs significantly between 3 and 6 months poststroke. We also found out that the recovery proportion at both 3 and 6 months poststroke is determined by the initial motor deficits of the lower limb. These results are not consistent with the proportional recovery model. Conclusions: Our results demonstrated that the proportional recovery model for the lower limb is invalid.

Background: Photobiomodulation (PBM) affects local blood flow regulation through nitric oxide generation, and various studies have reported on its effect on improving cognitive function in neurodegenerative diseases. However, the effect of PBM in the areas of the vertebral arteries (VA) and internal carotid arteries (ICA), which are the major blood-supplying arteries to the brain, has not been previously investigated. Objective: We aimed to determine whether irradiating PBM in the areas of the VA and ICA, which are the major blood-supplying arteries to the brain, improved regional cerebral blood flow (rCBF) and cognitive function. Methods: Fourteen patients with mild cognitive impairments were treated with PBM. Cognitive assessment and single-photon emission computed tomography were implemented at the baseline and at the end of PBM. Results: Regarding rCBF, statistically significant trends were found in the medial prefrontal cortex, lateral prefrontal cortex, anterior cingulate cortex, and occipital lateral cortex. Based on the cognitive assessments, statistically significant trends were found in overall cognitive function, memory, and frontal/executive function. Conclusion: We confirmed the possibility that PBM treatment in the VA and ICA areas could positively affect cognitive function by increasing rCBF. A study with a larger sample size is needed to validate the potential of PBM.

ImportanceBecause stroke causes diverse functional deficits, understanding the long-term recovery pattern of each functional domain may inform prognosis and therapeutic strategies.ObjectiveTo observe long-term changes in functional status and residual disability in survivors of first-time stroke.Design, Setting, and ParticipantsThis cohort study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. Between August 2012 and May 2015, 7858 of 10 636 screened patients with first-time strokes from 9 district hospitals in Korea provided informed consent to participate. Data were analyzed from September 2021 through February 2022.ExposureFirst-time stroke.Main Outcomes and MeasuresStudy data include multifaceted face-to-face functional assessments obtained at 8 to 9 points until 60 months after stroke onset. The Korean Mini-Mental State Examination (K-MMSE), Fugl-Meyer Assessment, Functional Ambulatory Category, American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, and Short Korean version of the Frenchay Aphasia Screening Test were performed from 7 days to 60 months after stroke. The Korean Modified Barthel Index was measured from 3 months to 60 months after stroke.ResultsA total of 4443 patients (2649 men [59.62%]; mean [SD] age 62.13 [12.43] years) who underwent repeated functional assessments for 60 months after stroke (3508 patients with ischemic and 935 patients with hemorrhagic stroke) were included. Overall, functions plateaued between 12 and 18 months after stroke and declined after 30 months; for example, mean (SD) K-MMSE improved from 7 days (22.89 [7.89]) to 12 months (26.03 [5.48]) (P P P for interaction P for interaction P for interaction P P = .004), and hemorrhagic stroke type (β vs ischemic stroke = 2.35; SE, 0.81; P = .004).Conclusions and RelevanceThis study found that long-term recovery patterns in multifaceted functional domains differed from one another and varied by patient age, stroke severity, and stroke type. Understanding the diversity of long-term functional recovery patterns and factors associated with these outcomes in survivors of stroke may help clinicians develop strategies for effective stroke care and rehabilitation.

This randomized controlled trial aimed to investigate the effects of dance therapy using telerehabilitation on trunk control and balance training in patients with stroke and compare them with the effects of conventional treatment.We enrolled 17 patients with subacute or chronic stroke who were randomly assigned to either an experimental or a control group. In addition to conventional physical therapy, the experimental group (n = 9) participated in 40-minute, non-face-to-face, dance-therapy sessions and the control group (n = 8) received conventional physical therapy. The primary outcome measures were the Trunk Impairment Scale (TIS) scores to assess trunk control and balance function between the 2 groups as a measure of change from baseline to after the intervention.We found that the TIS scores of the patients in the experimental group significantly improved (P = .017). The TIS results indicated non-inferiority within a predefined margin for dance therapy using telerehabilitation (difference = -0.86, 95% confidence interval [CI] = -2.21 to 0.50).Dance therapy using telerehabilitation significantly improved the TIS scores in the experimental group and was not inferior to conventional rehabilitation treatment when compared in a non-inferiority test. The remote dance program may therefore have similar effects to those of conventional treatment regarding trunk-control improvement in patients with stroke.

Menopause syndrome causes a decline in the quality of life of postmenopausal women. Hormone therapy is recommended for the treatment of menopausal syndromes. However, it has several side effects. Soybean has been safely used to relieve the symptoms of menopause. Lettuce has antidiabetic and anti-inflammatory effects and improves sleep quality. Natural nitric oxide metabolites are produced through fermentation, which increases the effectiveness of the functional substances. This study assessed the alleviation of menopausal syndrome symptoms by natural nitric oxide-containing soybean lettuce extract using the Kupperman index. This study included adult women with menopausal syndrome and a Kupperman index of ≥15. After a four-week study with 40 participants, the final analysis included 39 participants in the experimental group (n = 19) and the placebo group (n = 20). Body mass index, waist circumference, and the total cholesterol, low-density and high-density lipoprotein cholesterol, and triglyceride levels were not altered before and after treatment in both groups. There was a significant decrease in the Kupperman index after treatment in the experimental group, but no significant change was observed in the placebo group. Soybean lettuce extract alleviates menopause syndrome without any special side effects.

Background: Early diagnosis of Alzheimer’s disease (AD) is essential in preventing its progression to dementia. Mild cognitive impairment (MCI) can be indicative of early-stage AD. In this study, we propose a channel-wise feature extraction method of functional near-infrared spectroscopy (fNIRS) data to diagnose MCI when performing cognitive tasks, including two-back, Stroop, and semantic verbal fluency tasks (SVFT). Methods: A new channel-wise feature extraction method is proposed as follows: A region-of-interest (ROI) channel is defined as such channel having a statistical difference (p Results: In the two-back and Stroop tasks, HCs showed activation in the ventrolateral prefrontal cortex (VLPFC). However, in the case of MCI, the VLPFC was not activated. Instead, Ch. 30 was activated. In the SVFT task, the PFC was activated in both groups, but the t-values of HCs were higher than those of MCI. For the SVFT, the classification accuracies using the proposed feature extraction method were 80.77% (LDA) and 83.33% (SVM), showing the highest among the three tasks; for the Stroop task, 79.49% (LDA) and 73.08% (SVM); and for the two-back task, 73.08% (LDA) and 69.23% (SVM). Conclusion: The cognitive disparities between the MCI and HC groups were detected in the ventrolateral prefrontal cortex using fNIRS. The proposed feature extraction method has shown an improvement in the classification accuracies, see Subsection 3.3. Most of all, the suggested method contains a groupdistinction information per cognitive task. The obtained results successfully discriminated MCI patients from HCs, which reflects that the proposed method is an efficient tool to extract features in fNIRS signals.

Purpose To compare visual improvements between initial intravitreal t-PA with gas injection before anti-vascular endothelial growth factor (VEGF) and anti-VEGF injection monotherapy for submacular haemorrhage (SMH) associated with age-related macular degeneration (AMD). Methods We retrospectively reviewed medical records of naive patients treated with intravitreal t-PA with gas injection before anti-VEGF (Group 1) or only with intravitreal anti-VEGF injection (Group 2) for SMH [disc area (DA) ≥ 2] associated with AMD from two institutions. Both groups received 3 monthly loads of anti-VEGF injections followed by injections as needed for AMD treatment. Changes in best-corrected visual acuity (BCVA, logMAR) between the initial visit and after 6 months of treatment were compared between two groups. Results A total of 82 patients were enroled. Of these, 32 patients and 50 patients were grouped in Groups 1 and 2, respectively. The mean change in BCVA over 6 months for Group 1 was -0.52 ± 0.88, which was significantly larger (p = 0.044) than the mean change for Group 2 (-0.15 ± 0.58). We compared visual improvements between the two groups based on the following SMH size categories: ≤5, >5, and ≤15, and >15 DA. When the SMH size was ≤5, or >5 and ≤15 DA, the mean change in BCVA was larger for Group 1 than for Group 2, but this difference was not significant. When SMH size was >15 DA, Group 1 patients exhibited a mean visual improvement of -0.79 ± 0.80, which was significantly greater (p = 0.029) than that of Group 2 (-0.06 ± 0.67). Conclusions Patients that were primarily treated for SMH associated with AMD using t-PA and gas injection (followed by anti-VEGF injection) exhibited better visual improvement than those treated with anti-VEGF monotherapy, especially in patients exhibiting larger SMH sizes (>15 DA) at the initial visit.

Understanding cancer heterogeneity is essential to finding diverse genetic mutations in metastatic cancers. Thus, it is critical to isolate all types of CTCs to identify accurate cancer information from patients. Moreover, full automation robustly capturing the full spectrum of CTCs is an urgent need for CTC diagnosis to be routine clinical practice.

Our study aimed to confirm the therapeutic effects of using a trunk stabilization training robot (3DBT-33) in patients with chronic stroke. A total of 38 patients with chronic stroke were randomly assigned to either an experimental or a control group. The robot group (n = 19) received 30 min of trunk stability robot training in addition to conventional physical therapy, while the control group (n = 19) received a similar conventional physical therapy as the robot group. All participants were assessed using the following: the Functional Ambulation Categories (FAC), timed up and go (TUG) test, Berg Balance Scale (BBS), Korean Modified Barthel Index (K-MBI), and Fugl-Meyer Assessment of Lower Extremity (FMA-LE). There were statistically significant improvements in all parameters at follow-up assessment after 4 weeks of intervention (P < 0.05). There were statistically significant differences in the FMA-LE, K-MBI, and BBS between the robot and control groups (P < 0.05). There was no significant difference in FAC (P = 0.935) and TUG (P = 0.442). Minimal detectable change was more significantly observed in the FMA-LE and BBS than in FAC, TUG, and K-MBI. The findings in the present study showed that trunk stabilization rehabilitation training using a rehabilitation robot in patients with chronic stroke was effective in improving the balance and functions in the lower extremities.

To determine longitudinal changes in the ganglion cell-inner plexiform layer (GC-IPL) thickness of the fellow eyes of patients with neovascular age-related macular degeneration (AMD).Prospective cohort study.Patients with unilateral neovascular AMD, unilateral polypoidal choroidal vasculopathy (PCV), and control subjects were included. After the initial visit, GC-IPL thickness was measured twice more with at least a 1-year interval between examinations using spectral domain optical coherence tomography.Twenty-seven fellow eyes of patients with unilateral choroidal neovascularization (CNV), 33 fellow eyes of patients with unilateral PCV, and 35 eyes of control subjects were enrolled. The GC-IPL thickness of the fellow eyes was 78.41 ± 9.23, 81.20 ± 5.52, and 81.60 ± 3.83 μm in the CNV, PCV, and control groups, respectively, and they showed a significant change over time (P .001, P = .001, and P = .003, respectively). The reduction rate of GC-IPL thickness was -0.88, -0.41, and -0.31 μm per year in the fellow eyes of the CNV, PCV, and control groups, respectively (CNVPCV, control, P.001). In a linear mixed model determination of factors associated with GC-IPL reduction in the fellow eyes of the CNV group, the interaction between baseline GC-IPL thickness and duration showed a significant result (P.001).The fellow eyes of patients with neovascular AMD showed a greater reduction rate of GC-IPL thickness compared with fellow eyes of patients with unilateral PCV and control subjects. In patients with unilateral neovascular AMD, fellow eyes with a thicker GC-IPL at baseline showed a greater reduction in GC-IPL thickness over time.

Purpose We report the clinical outcomes of retinal capillary hemangioma (RCH) after the application of various treatments. Methods We performed a retrospective chart analysis of eight eyes treated for RCH between August 2009 and January 2018. During the follow-up period, the status and progression of the RCHs were checked by fundus photography, fluorescein angiography, and optical coherence tomography, and additional treatments were applied when necessary. Results Three of the five patients had bilateral RCH, and two had unilateral RCH. Six eyes received laser photocoagulation; two eyes received cryotherapy, and one eye received intravitreal Avastin injection. Three eyes each had intravitreal triamcinolone injection, subtenon triamcinolone injection, and intravitreal dexamethasone injection to control inflammation. Also, two patients took oral prednisolone, and one patient used prednisolone eye drops to control inflammation. Two eyes underwent vitrectomy and scleral buckling due to deterioration of the epiretinal membrane and vitreal traction, respectively. As a result of those treatments, the tumors were stable in five of the eight eyes. However, one eye is now in a pre-phthisis state, and one patient who refused treatment showed progression of the tumor, epiretinal membrane, and traction. Conclusions Because RCHs vary in size, the degree of inflammation, and symptoms, this disorder should be actively treated on a case-by-case basis. Fluorescein angiography should be used periodically to determine recurrence of the tumor or inflammation, and the appropriate treatment should be repeated as necessary. Moreover, regular systemic screening tests for von Hippel-Lindau disease should be performed in RCH patients to ensure that they have no abnormalities other than in the eye.

Previous studies have investigated the predictors for home discharge without considering stroke severity. To develop a practical assessment tool that predicts home discharge for moderate stroke patients after subacute rehabilitation therapy in the tertiary hospitals. Stroke patients with National Institutes of Health Stroke Scale scores of 6 to 13 were included in this prospective cohort study. Various demographic, clinical, and functional factors were analyzed as potential predictive factors. A weighted scoring model was developed through the following three-step process: 1) selection of the factors by logistic regression analyses, 2) development of a weighted scoring model, and 3) validation of the generalizability of the model. The home discharge rate was 51% (n = 372), and the overall mean length of stay of hospitalization was 32.5 days. 1) The Cognitive Functional Independence Measure, 2) the Functional Ambulation Categories, 3) the modified Charlson Comorbidity Index, and 4) marital status were independent predictors of home discharge. The coefficient value for marital status was adjusted to 1 in the scoring system, and the values of the other parameters were proportionally converted to the nearest integer. Possible total scores ranged from 0 to 13 in the model, with a higher score indicating a higher probability of home discharge. With a cutoff point of 7, this model showed 87.0% sensitivity and 86.2% specificity (area under the curve = 0.90). This novel assessment tool can be useful in predicting home discharge after subacute rehabilitation of moderate stroke patients.

Diabetes is expected to accelerate age-related ganglion cell–inner plexiform layer (GC-IPL) loss, but there is limited information on the rate of reduction in GC-IPL thicknesses. We aimed to evaluate the reduction rate of GC-IPL thickness in diabetic patients, and to compare the rates between patients without and with diabetic retinopathy (DR). We included 112 eyes of 112 patients with diabetes [49 eyes without DR (no-DR group) and 63 eyes with mild to moderate non-proliferative DR (NPDR group)] and 63 eyes of 63 normal controls (control group) in this study. Macular GC-IPL thickness in all participants was measured for 3 years at 1-year intervals. The reduction rates of GC-IPL thickness were determined by linear mixed models and compared among the three groups. The estimated reduction rates of the average GC-IPL thickness in the no-DR (−0.627 μm/year) and NPDR (−0.987 μm/year) groups were 2.26-fold (p = 0.010) and 3.56-fold (p = 0.001) faster, respectively, than the control group (−0.277 μm/year). Age, duration of diabetes, and baseline average GC-IPL thickness were associated with longitudinal changes in average GC-IPL thickness. The GC-IPL reduction rate was significantly faster in diabetic patients, with and without DR. Physicians should therefore be aware that GC-IPL damage continues even if there is no DR.

To evaluate the long-term results of focal laser photocoagulation and photodynamic therapy (PDT) for treatment of central serous chorioretinopathy (CSC). Retrospective chart review. Sixty-two patients with CSC, thirty-three of whom were treated with focal laser photocoagulation, and 29 with PDT and who were followed up for > 6 months, were enrolled. The focal laser was performed at sites of focal leakage (but not subfoveal leaks) shown in fluorescein angiography. PDT was performed at sites of subfoveal or juxtafoveal focal leakage or not definite focal leakages. Best corrected visual acuity (BCVA), central macular thickness (CMT), resolution of subretinal fluid (SRF) and recurrence were analyzed. The follow-up duration of the focal laser group was 35.2 ± 22.6 and of the PDT group, 46.4 ± 21.5 months. Time to resolution of SRF was 1.8 ± 1.5 months for the focal laser group and 1.2 ± 0.5 months for the PDT group. SRF was rapidly absorbed in the PDT group. In both groups, the CMT was decreased 1 month after treatment. The BCVA improved significantly 1 month after treatment in the focal laser group and 3 months after treatment in the PDT group. However, there was no significant difference in CMT reduction and BCVA improvement between the two groups. It subsequently remained similar for up to 3 years. Ten patients (30.3%) in the focal laser group and three patients (10%) in the PDT group recurred during the follow-up period. PDT showed early resolution of the SRF compared to focal laser. In CSC patients, both the CMT and BCVA remained stable for 3 years after treatment. After 3 or more years of follow-up, PDT showed a lower recurrence rate than focal laser.

Background and Purpose: The aim of this study was to verify the validity of the proportional recovery model in view of the ceiling effect of the Fugl-Meyer Assessment. Methods: We reviewed the medical records of patients enrolled in the Korean Stroke Cohort for Functioning and Rehabilitation between August 2012 and May 2015. Recovery proportion was defined as the actual change in Fugl-Meyer Assessment score of the upper extremity between 7 days and 6 months poststroke, relative to the initial neurological impairment. We then used logistic regression to identify clinical factors attributable to a ceiling effect of the Fugl-Meyer Assessment score of the upper extremity and propensity score matching to verify the validity of the proportional recovery rule. Results: We screened 10 636 patients and analyzed 849 patients (mean age, 65.4±11.9 years; female, 320 [37.7%]) with first-ever ischemic stroke. We found, through logistic regression analysis, that a one-unit increase in the initial neurological impairment and the age at stroke onset affected the odds ratio (1.0386 and 0.9736, respectively) of achieving the full Fugl-Meyer Assessment score of the upper limb at 6 months poststroke. We also demonstrated, through propensity score matching, that the difference in initial neurological impairment of the upper extremity resulted in discrepancy of the recovery proportion (0.92±0.20 [0–1] versus 0.81±0.31 [0–1], P Conclusions: We demonstrated that the ceiling effect of the Fugl-Meyer Assessment score of the upper extremity is pronounced in patients with mild initial motor deficits of the upper extremity and that the recovery proportion varies according to the initial motor deficit of the upper limb using logistic regression analysis and propensity score matching, respectively. These results suggest that the proportional recovery model is not valid.

To evaluate changes in peripapillary microvascular parameters in diabetes mellitus (DM) patients using optical coherence tomography angiography (OCTA). Seventy-one diabetic patients (40 in the no diabetic retinopathy [DR] group and 31 in the non-proliferative DR [NPDR] group) and 50 control subjects. OCTA (Zeiss HD-OCT 5000 with AngioPlex) 6 × 6 mm scans centered on the optic disc were analyzed. Peripapillary vessel density (VD), perfusion density (PD) in superficial capillary plexus (SCP) were automatically calculated. The average macular ganglion cell-inner plexiform layer (mGC-IPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses of the no DR and NPDR groups were significantly thinner than those of the control group. The no DR and NPDR groups showed lower peripapillary VD and PD in SCP compared with the control group. Using univariate regression analyses, the average mGC-IPL thickness, the pRNFL thickness, the no DR group and NPDR group were significant factors that affected the peripapillary VD and PD in SCP. Multivariate regression analyses showed that the grade of DR was a significant factor affecting the peripapillary VD and PD in SCP. OCTA revealed that peripapillary microvascular parameters in the no DR and NPDR groups were lower than those of normal controls. The peripapillary VD and PD in SCP were correlated with the mGC-IPL thickness, the pRNFL thickness, and the no DR and NPDR groups. Changes in peripapillary OCTA parameters may help with understanding the pathophysiology of DM and evaluating a potentially valuable biomarker for patients with subclinical DR.

Purpose: To evaluate changes in the foveal microvasculature in patients with dry age-related macular degeneration (dry AMD) using optical coherence tomography angiography (OCTA). Methods: Eighty-three eyes with dry AMD and 83 age- and sex-matched normal eyes were enrolled. A 3 × 3 mm2 OCTA (Zeiss HD-OCT 5000 with AngioPlex; Carl Zeiss Meditec, Dublin, CA, USA) scan was used to acquire images. Vessel density (VD), perfusion density (PD), and the foveal avascular zone (FAZ) of the superficial capillary plexus were analyzed. Results: The VD of the full area, central area, and inner ring of the dry AMD patients (18.61, 8.41, and 20.45, respectively) were significantly lower than those of the controls (20.06, 11.09, and 22.51, respectively). The PD of the full area, central area, and inner ring of the dry AMD patients (0.34, 0.15, and 0.37, respectively) were also significantly lower than those of the controls (0.36, 0.19, and 0.40, respectively). The FAZ area and perimeter in the dry AMD patients (0.29 mm2 and 2.47 mm, respectively) were larger than those in the controls (0.23 mm2 and 2.09 mm, respectively). The FAZ circularity index in the dry AMD patients was smaller than that in the controls (0.61 vs. 0.66). Using univariate linear regression, age, best-corrected visual acuity (BCVA), central macular thickness (CMT), and ganglion cell-inner plexiform layer (GC-IPL) thickness were associated with both VD and PD of the full area. Using multivariate analysis, only GC-IPL thickness was significantly associated with the VD and PD of the full area (p = 0.001 and p = 0.004, respectively). Conclusions: OCTA revealed changes in the foveal microcirculation of patients with dry AMD. Age, BCVA, CMT, and GC-IPL thickness should be considered when analyzing the OCTA data of patients with dry AMD. GC-IPL thickness is particularly important during clinical evaluation of VD and PD in patients with dry AMD.

PURPOSE To evaluate the changes of axial length (AXL) in eyes with unilateral idiopathic central serous chorioretinopathy (CSC) after resolution of serous retinal detachment. METHODS A total of 31 patients diagnosed with idiopathic unilateral CSC were included in this study. The changes of AXL according to serous retinal detachment were examined. The keratometric value and AXL were measured using partial coherence interferometry. Serous retinal detachment and central macular thickness (CMT) were measured by spectral domain optical coherence tomography. RESULTS The mean age of the 31 CSC patients, including 19 males, was 42.7 years. The AXL was significantly increased from 23.41 to 23.58 mm after resolution of serous retinal detachment (p < 0.001). The CMT was significantly decreased from 413.4 to 226.8 μm after resolution of serous retinal detachment (p < 0.001). The differences in AXL correlated with CMT differences and subretinal fluid height (r = -0.616, p < 0.001 and r = -0.637, p < 0.001, respectively), and the best-corrected visual acuity was significantly different after resolution of serous retinal detachment (p < 0.001). CONCLUSIONS In unilateral idiopathic CSC with serous retinal detachment, a shortened AXL in the acute phase was restored after resolution of serous retinal detachment.

Many studies have reported the effect of hypertension on microcirculation of the retina. Advance of optical coherence tomography angiography (OCTA) allows us more detailed observations of microcirculation of the retina. Therefore, we compared OCTA parameters between chronic hypertension (disease duration of at least 10 yrs; Group A, 45 eyes), relieved hypertensive retinopathy (grade IV HTNR vs. C; 19.4 mm−1vs. 20.1 mm−1, Group B vs. D; 19.8 mm−1vs. 21.8 mm−1, all p vs. C; 0.35 mm2vs. 0.30 mm2, Group B vs. D; 0.36 mm2vs. 0.29 mm2, all p

This study investigated the long-term functional changes in patients with moderate-to-severe ischemic stroke. In addition, we investigated whether there was a difference between the modified Barthel Index (MBI) and Functional Independence Measure (FIM) according to severity. To evaluate the changes in the long-term functional independence of the subjects, six evaluations were conducted over 2 years, and the evaluation was performed using MBI and FIM. A total of 798 participants participated in this study, of which 673 were classified as moderate and 125 as severe. During the first 3 months, the moderate group showed greater recovery than the severe group. The period of significant change in the National Institutes of Health Stroke Scale (NIHSS) score was up to 6 months after onset in the moderate group, and up to 3 months after onset in the severe group. In the severe group, MBI evaluation showed significant changes up to 6 months after onset, whereas FIM showed significant changes up to 18–24 months. Our results showed that functional recovery of patients with ischemic stroke in the 3 months after onset was greater in the moderate group than in the severe group. FIM is more appropriate than MBI for evaluating the functional status of patients with severe stroke.

To identify cancer/testis (CT) antigens and immunogenic proteins, immunoscreening of testicular and small-cell lung cancer cell line NCI-H889 cDNA libraries was performed using serum obtained from a small-cell lung cancer (SCLC) patient. We obtained 113 positive cDNA clones comprised of 74 different genes, designated KP-SCLC-1 through KP-SCLC-74. Of these genes, 59 genes were found to be related to cancers by EMBASE analysis. Three of these antigens, including KP-SCLC-29 (NOL4), KP-SCLC-59 (CCDC83), and KP-SCLC-69 (KIF20B), were CT antigens. RT-PCR and western blot analysis showed that NOL4 was frequently present in small-cell lung cancer cell lines (8/9, 8/9). In addition, NOL4 mRNA was weakly, or at a low frequency, or not detected in various cancer cell lines. Our results reveal that NOL4 was expressed at protein levels in small-cell lung cancer tissues (10/10) but not detected in lung adenocarcinoma and squamous cell carcinoma by immunohistochemical analysis. Serological response to NOL4 was also evaluated by western blot assay using NOL4 recombinant protein. A humoral response against NOL4 proteins was detected in 75% (33/44) of small-cell lung cancer patients and in 65% (13/20) of healthy donors by a serological western blot assay. These data suggest that NOL4 is a specific target that may be useful for diagnosis and immunotherapy in SCLC.

PURPOSE It is hypothesized that an unstable tear film would affect the quality and repeatability of optical coherence tomography angiography (OCTA). Therefore, OCTA repeatability according to tear break-up time (TBUT) was compared. METHODS The 3 × 3 OCTA was performed twice and, the eyes were divided into 3 groups according to the TBUT (Group 1: TBUT ≤ 5 seconds, 43 eyes; Group 2: 5 seconds 10 seconds, 34 eyes). The intraclass correlation coefficient, coefficient of variation, and test-retest SD were calculated and compared. RESULTS The signal strengths of OCTA were 9.1 ± 1.2, 9.5 ± 0.8, and 9.5 ± 0.8 in each group from Groups 1, 2, and 3, respectively, which showed significant difference (P = 0.049). The intraclass correlation coefficient of vessel density were 0.733, 0.840, and 0.974 in Groups 1 to 3, respectively, and the values increased in the order of Groups 1, 2, and 3. The coefficient of variation were 6.41 ± 6.09, 3.29 ± 2.22, and 1.30 ± 1.17, and the test-retest SD were 0.83 ± 0.70, 0.47 ± 0.31, and 0.19 ± 0.17 in Groups 1, 2, and 3, respectively. The coefficient of variation and test-retest SD values decreased in the order of Groups 1, 2, and 3, and showed a significant difference (all, P < 0.05). CONCLUSION The repeatability of OCTA tended to decrease with a shorter TBUT. When the TBUT is

Objective To investigate the effects of axial length (AL) on the peripapillary microvascular density acquired from optical coherence tomography angiography (OCTA). Methods Retrospective observational study. A total of 111 eyes from 111 normal healthy subjects were examined. The subjects were divided into three groups according to the AL: Group 1 (AL: < 24.0 mm; 35 eyes), Group 2 (AL: 24.0–25.99 mm; 37 eyes), and Group 3 (AL: ≥ 26 mm; 39 eyes). Peripapillary OCTA images were acquired using 6× 6 mm angiography scans, and vessel density (VD) and perfusion density (PD) of the superficial capillary plexus were calculated automatically. VD and PD were compared among the three groups according to the distance from the optic disc (inner and outer rings). Linear regression analyses were also performed to identify clinical factors associated with average VD. Results The average ALs of Groups 1–3 were 23.33± 0.57, 25.05± 0.60, and 27.42± 0.82, respectively. Average VD (P = 0.009) and PD (P = 0.029) in the inner ring increased with increasing AL. However, average VD (P < 0.001) and PD (P < 0.001) in the outer ring decreased with AL increased; the same trends were found for the full areas (VD, p Conclusions Peripapillary VD and PD were significantly associated with AL. Depending on the distance from the disc, peripapillary VDs and PDs of the inner and outer rings were differentially affected by AL. Physicians should therefore consider the effects of AL in the analyses of peripapillary microvasculature.

PURPOSE To determine longitudinal changes of the ganglion cell-inner plexiform layer (GC-IPL) thickness in patients with non-exudative age-related macular degeneration (AMD) without other ophthalmic disease. METHODS Thirty-three eyes of 33 patients with early and intermediate non-exudative AMD (non-exudative AMD group) and 33 normal control eyes were followed for 2 years, and GC-IPL thickness was measured by spectral domain optical coherence tomography at 1-year intervals. The mean rate of GC-IPL reduction was estimated using a linear mixed model and compared between two groups. RESULTS The mean age of patients in the non-exudative AMD group and control groups were 68.82 ± 6.81 years and 67.73 ± 5.87 years, respectively (p = 0.488). The mean GC-IPL thickness at the first visit was 76.61 ± 16.33 μm in the non-exudative AMD and 81.76 ± 3.69 μm in control group (p = 0.387), and these values significantly decreased over time, with an average reduction rate of average GC-IPL -0.86 μm/year in the non-exudative AMD group and -0.32 μm/year in the control group. The difference between two groups was statistically significant (p

Purpose To investigate the association between myopia and peripapillary retinal nerve fiber layer (pRNFL) thickness in diabetic patients without diabetic retinopathy (DR). Methods A total of 271 eyes of 271 participants were included. They were divided into four groups according to the presence of myopia (≤ -3 diopters [D]) and diabetes without DR: (1) control group (n = 76), (2) myopia group (n = 57), (3) diabetes group (n = 82), and (4) diabetes + myopia group (n = 56). The peripapillary average and sector RNFL thicknesses were measured and compared among the four groups to determine the effects of myopia and diabetes. Covariates were adjusted using analyses of covariance. Linear regression analyses were fitted to evaluate the factors associated with pRNFL. Results Spherical equivalents were 0.12 ± 1.31 D in the control group, -4.00 ± 1.47 D in the myopia group, 0.00 ± 1.05 D in the diabetes group, and -4.33 ± 1.70 D in the diabetes + myopia group (P < 0.001). The respective axial lengths (ALs) were 23.91 ± 0.99 mm, 25.16 ± 0.94 mm, 23.68 ± 0.77 mm, and 25.34 ± 1.33 mm (P < 0.001). The average pRNFL showed a progressive decrease from the control group (97.16 ± 8.73 µm) to the myopia group (94.04 ± 9.13 µm) to the diabetes group (93.33 ± 9.07 µm) to the diabetes + myopia group (91.25 ± 9.72 µm) (P = 0.009). Age, diabetes, hypertension, and AL were significantly correlated with the pRNFL. The rate of reduction of pRNFL with increasing age was higher in the diabetes + myopia group than in the other groups, and pRNFL in the diabetes groups decreased more steeply with increasing AL compared to the non-diabetic groups. Conclusions Myopia and diabetes are important factors affecting pRNFL thickness, and the simultaneous presence of diabetes and myopia results in greater pRNFL damage than observed with either pathology alone.

Many studies have suggested the possibility of using functional near-infrared spectroscopy (fNIRS) devices as neuroimaging tools in various patients. We aimed to evaluate whether fNIRS to measure the prefrontal cortex (PFC fNIRS) is suitable as a screening tool for cognitive impairments. Sixty participants, divided into normal, mild cognitive impairment, and dementia groups, were instructed to wear an fNIRS device during cognitive assessments to assess whether there is a significant difference in the PFC activity between the groups. A significant difference in PFC activity between the groups was observed during the verbal fluency test. Moreover, the PFC activity during the verbal fluency test significantly correlated with the existing cognitive screening tool score. These results suggested that PFC fNIRS can be used as a cognitive impairment screening tool for mild cognitive impairment and dementia. A larger sample size is needed to validate the potential of PFC fNIRS as a cognitive impairment screening tool.

The purpose of this study was to identify the prevalence and severity of dysphagia in patients diagnosed with aspiration pneumonia, with and without neurologic disorders. We retrospectively reviewed the medical records of inpatients with aspiration pneumonia who underwent a videofluoroscopic swallowing study (VFSS) for evaluation of dysphagia. Patients were divided into two groups based on the presence or absence of neurologic disorders. The prevalence and severity of aspiration and pharyngeal residue due to dysphagia were assessed using the penetration–aspiration scale (PAS) and pharyngeal residue grade (PRG). A total of 784 patients were enrolled; of these, 58.7% were males and the mean age was 76.12 ± 6.69. Penetration–aspiration-related dysphagia (PAS scores 3–8) was seen in 56.5% of all subjects, and 32.5% showed silent aspiration (PAS 8). Pharyngeal residue-related dysphagia (PRG scores 2–3) was seen in 65.2% of all patients, and the PAS and PRG were positively correlated. On dividing the subjects into two groups based on the presence of neurologic disorders, there was no significant difference in prevalence of the dysphagia between groups (PAS: p = 0.641; PRG: p = 0.872) with the proportion of silent aspiration (p = 0.720). In patients hospitalized for aspiration pneumonia, there was a high prevalence of dysphagia. There were no differences in the prevalence and severity of dysphagia in patients with aspiration pneumonia based on the presence or absence of a neurologic disorder. Therefore, diagnostic evaluation of dysphagia is necessary regardless of the presence of neurologic disorders.

To analyze longitudinal changes in peripapillary retinal nerve fiber layer (pRNFL) thicknesses over time in the fellow eyes of patients with unilateral retinal vein occlusion (RVO). A total of 47 patients with unilateral RVO and 47 healthy controls were enrolled. The mean and sectoral pRNFL thicknesses were measured using spectral domain-optical coherence tomography at 1 year intervals, and followed for 3 years. Linear mixed models were performed to calculate and compare the reduction rates of pRNFL thicknesses over time. The mean pRNFL thickness decreased significantly during the 3-year follow-up, with a significant decrease over time in both groups. The reduction rate in mean pRNFL thicknesses was −0.41 μm/year in the control group and −0.68 μm/year in the fellow eyes of RVO group, and the decrease was significantly higher in the fellow eyes of RVO group than in the control group (p p = 0.011) and hypertension (HTN) (estimate: −6.51, p = 0.014) were significantly associated with the reduction in mean pRNFL thicknesses in fellow eyes of RVO group. The fellow eyes of RVO patients showed a greater reduction in pRNFL thickness over time than normal controls. Age and HTN should be considered as factors to decrease the pRNFL thickness over time in fellow eyes of RVO group.

The purpose of this study was to investigate changes in peripapillary microvasculature using optical coherence tomography angiography (OCTA) in systemic hypertension (HTN) patients. This was a cross-sectional study. Based on the duration of HTN, seventy-eight HTN patients were divided into two groups. (HTN group 1

Objective The aim of the study was to analyze differences in body composition between affected and unaffected limbs using segmental bioelectrical impedance analysis in hemiparetic stroke patients. Design The segmental bioelectrical impedance analysis results and body composition of 213 hospitalized hemiparetic stroke patients were retrospectively reviewed. Subjects were divided into acute, subacute, and chronic groups according to the period after the onset of stroke. Segmental lean mass and segmental body water values were compared between affected and unaffected upper and lower limbs in all subjects and in subgroups. The mean differences of body compositions between the affected and unaffected limbs between the three groups were also compared. Results No significant differences in segmental lean mass and segmental body water values were observed between the affected and unaffected upper and lower limbs in total and in three subgroups. The mean differences in segmental lean mass and segmental body water values between the affected and unaffected upper limbs in the chronic group were larger than those in the acute and subacute groups. Conclusions There were no significant differences in body composition between affected and unaffected limbs in patients with hemiparetic stroke. The differences in body composition in the affected and unaffected upper limbs in chronic stroke patients were larger than those in acute and subacute stroke patients. Further longitudinal studies are needed.

ObjectiveTo investigate the thicknesses of the ganglion cell-inner plexiform layer (GC-IPL) and retinal nerve fiber layer (RNFL) of the fellow eyes of patients with unilateral exudative age-related macular degeneration (AMD).MethodsA total of 107 patients with unilateral exudative AMD [34 of typical choroidal neovascularization (tCNV), Group A; 73 of polypoidal choroidal vasculopathy (PCV), Group B] and 73 normal control eyes (Group C) were included. Drusen and subretinal drusenoid deposits were assessed in all participants using fundus photography, autofluorescence, and optical coherence tomography (OCT). The GC-IPL and RNFL thicknesses were measured using Cirrus HD-OCT and compared among groups. Linear regression analyses were used to evaluate the factors associated with GC-IPL thicknesses.ResultsThe average GC-IPL thicknesses of Groups A, B, and C were 77.09 ± 3.87, 80.10 ± 6.61, and 80.88 ± 6.50 μm, respectively (p = 0.022). Sectoral GC-IPLs and central macular thicknesses (CMTs) were significantly different among groups (all, p 0.05). Multivariate linear regression analyses revealed that age (p ConclusionsUnilateral tCNV patients exhibited statistically significant reduction of the GC-IPL thickness in the fellow eyes, compared to values of the fellow eyes of unilateral PCV patients or control patients. RNFL values trended to be lower but did not reach statistical significance.

Purpose To determine the comparability of choroidal thickness (ChT) measurements using swept source (SS) and spectral domain (SD) optical coherence tomography (OCT) devices in patients with pachychoroid diseases. Methods Patients with pachychoroid diseases were recruited. OCT scans were performed sequentially with a Cirrus HD OCT 5000 and Plex Elite 9000. Images were analyzed by two independent observers. Each image was independently measured twice by each observer to determine the intraobserver repeatability. Results A total of 55 eyes were included. The average ChT of the subfoveal area using SS-OCT and SD-OCT was 430.5 ± 68.1 and 428.5 ± 57.9 μm, respectively, which did not show a significant result as the main effect in the repeated-measure analysis of variance (P = 0.067). Using SS-OCT, the intraobserver intraclass correlation coefficient (ICC) of both observers was > 0.950 at every measured point, and the interobserver coefficient of repeatability (CR) of the subfoveal area was 45.1 μm (95% confidence interval (CI), 40.8–49.4). Using SD-OCT, the intraobserver ICC of both observers was > 0.800, and the interobserver CR of the subfoveal area was 71.2 μm (95% CI, 64.4–78.0). Additionally, the intraobserver and interobserver CRs showed significantly better repeatability in SS-OCT than SD-OCT in F-test. In patients with ChT ≥ 400 μm, the interobserver CRs of SS-OCT and SD-OCT were 48.4 (95% CI, 42.6–54.2) and 95.2 μm (95% CI, 83.9–106.6), respectively. In patients with a subfoveal active lesion, the interobserver CRs were 44.5 (95% CI, 37.6–51.4) and 100.1 μm (95% CI, 84.6–115.5), respectively. Conclusions Although the ChT measurements were comparable between SS-OCT and SD-OCT devices in pachychoroid diseases, SD-OCT showed low reliability in patients with ChT ≥ 400 μm and subfoveal active lesions. SS-OCT would be therefore more suitable for observation and follow-up of choroidal structures in pachychoroid diseases.

The beneficial effects of light-emitting diode (LED) irradiation have been reported in various pathologies, including cancer. However, its effect in pancreatic cancer cells remains unclear. Herein, we demonstrated that blue LED of 460 nm regulated pancreatic cancer cell proliferation and apoptosis by suppressing the expression of apoptosis-related factors, such as mutant p53 and B-cell lymphoma 2 (Bcl-2), and decreasing the expression of RAC-β serine/threonine kinase 2 (AKT2), the phosphorylation of protein kinase B (AKT), and mammalian target of rapamycin (mTOR). Blue LED irradiation also increased the levels of cleaved poly-(ADP-ribose) polymerase (PARP) and caspase-3 in pancreatic cancer cells, while it suppressed AKT2 expression and inhibited tumor growth in xenograft tumor tissues. In conclusion, blue LED irradiation suppressed pancreatic cancer cell and tumor growth by regulating AKT/mTOR signaling. Our findings indicated that blue LEDs could be used as a nonpharmacological treatment for pancreatic cancer.

The aim of the study was to investigate the correlation between spasticity severity and functional outcomes during the first year after stroke.The Korean Stroke Cohort for Functioning and Rehabilitation is a large, multicenter, prospective cohort study of all patients with acute first-ever stroke admitted to participating hospitals in nine Korean areas. To investigate the correlation between spasticity severity and functional status measured by using the Institutes of Health Stroke Scale (NIHSS), Modified Barthel Index (MBI), Functional Independence Measurement (FIM), Fugl-Meyer Assessment (FMA), Functional Ambulatory Category (FAC), modified Rankin scale (mRS), and American Speech-Language Hearing Association National Outcome Measurement System Swallowing Scale (ASHA-NOMS), data were analyzed at 3, 6, and 12 mos after the occurrence of stroke.A total of 7359 stroke patients, 3056 were finally included. Prevalence rates of spasticity in patients after stroke were 6.8% at 3 mos, 6.9% at 6 mos, and 7.6% at 12 mos. The scores of mRS and NIHSS were higher and those of K-MBI, FIM, FMA, and ASHA-NOMS were lower in more severe spastic patients, indicating poorer functional outcomes (P0.05).This study demonstrated the coexistence of spasticity and poor functional outcome during the first year after first-ever stroke patients.

BACKGROUND The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigm to improve functional ambulation and activities of daily living in spinal cord injury and stroke. However, the effects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population. OBJECTIVE The aim of this study was to determine the long-term effects of Walkbot training on clinical for hips and knee stiffness in individuals with paraplegia or quadriplegia. METHODS Nine adults with subacute or chronic paraplegia resulting from spinal cord injury or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modified Rankin Scale (MRS), Korean version of the Modified Barthel Index (K-MBI), Modified Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program. RESULTS Wilcoxon signed-rank tests showed significant positive intervention effects on K-MBI, maximal hip flexion and extension, maximal knee flexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P < 0.05). These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities. CONCLUSIONS These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the first clinical evidence for intensive, long-term effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy.

Objective To identify contributing factors that can be used to predict which patients with first-ever stroke will return to driving during 1 year after stroke. Design Multicentre cohort study. Subjects A total of 620 first-ever stroke patients who drove before stroke. Methods The Stroke Cohort for Functioning and Rehabilitation is a large, multicentre, prospective cohort study of all patients with acute first-ever stroke admitted to participating hospitals in 9 areas of Korea. This study analysed the data from 1,354 patients who completed a face-to-face survey about return to driving at 1 year after stroke. A multiple binary logistic regression analysis model was used to analyse factors that potentially influenced return to driving during 12 months after stroke. Results Of 620 subjects, 410 (66.1%) returned to driving after stroke. They resumed driving at a mean of 2.15 months after stroke (standard deviation 2.32 years). Regression models showed that sex, age, modified Rankin scale (mRS), education about return to driving, and Fugl-Meyer Assessment (FMA) were significantly related to return to driving. Stroke type, ambulatory function, and language function at 7 days were not correlated with return to driving. Conclusion Male patients, education about return to driving, lower mRS, and higher FMA at 7 days after stroke are predictors of return to driving. This model could be used by clinicians to help counsel patients and their families.

Objective To identify the incidence of dysphagia after ischemic stroke and determine factors affecting the presence of dysphagia. Design Retrospective case-control study. This was an interim analysis of a prospective multicenter Korean stroke cohort. Setting Acute care university hospitals. Participants Patients (N=6000) with first-ever acute ischemic stroke. Patients were divided into 2 groups according to the presence or absence of dysphagia confirmed at 7 days after onset using the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, which was determined after conducting screening or standardized tests. Interventions Not applicable. Main Outcome Measures Age at stroke onset, body mass index (BMI), premorbid modified Rankin Scale (mRS), brainstem lesions, National Institutes of Health Stroke Scale (NIHSS), poststroke mRS, and ASHA-NOMS swallowing level at poststroke day 7 were evaluated. Results Among patients with ischemic stroke, 32.3% (n=1940) had dysphagia at 7 days after stroke onset. At discharge, 80.5% (n=1561) still had dysphagia. The prediction model for the presence of dysphagia identified age at onset, underweight (BMI Conclusions The incidence of dysphagia after ischemic stroke was 32.3%. The prediction model for the presence of dysphagia identified age, low BMI, premorbid disabilities, brainstem lesions, and NIHSS as predictive factors.

BACKGROUND Noninvasive brain stimulation (NBS) using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) has recently been adopted for modulating motor function in stroke patients. OBJECTIVE We investigated the effect of simultaneous dual-mode stimulation using rTMS and tDCS over the bilateral primary motor cortices (M1) to assess its efficacy as compared to single stimulation using rTMS for the recovery of motor function in subacute stroke patients. METHODS Thirty subacute stroke patients were recruited in this study. In the dual-mode stimulation group, 10 Hz rTMS (90% of resting motor threshold, 1,000 pulses) was applied over the ipsilesional M1 for 20 minutes with the simultaneous application of cathodal tDCS (2 mA) on the contralesional M1. The single stimulation group underwent 10 Hz rTMS without tDCS. Ten daily sessions were conducted for two consecutive weeks. The total Fugl-Meyer (FMA-T), upper limb (FMA-UL), and lower limb (FMA-LL) scores were measured before, after, and two months later. RESULTS The FMA-T and FMA- UL were significantly improved over time in both the dual and single stimulation group (p

Objective To investigate whether bihemispheric anodal transcranial direct current stimulation (tDCS) with conventional dysphagia therapy could improve swallowing function in chronic stroke patients with dysphagia. Design Randomized controlled trial. Subjects Twenty-six patients with dysphagia for at least 6 months post-stroke were randomly assigned into: (i) bihemispheric anodal tDCS group; or (ii) sham group. Methods All patients underwent 10 tDCS sessions with simultaneous conventional swallowing therapy for 2 weeks. Both anodal electrodes were attached bilaterally to the pharyngeal motor cortices, and cathodal electrodes were attached to both supraorbital regions. Swallowing function was evaluated with the Dysphagia Outcome and Severity Scale (DOSS) before and immediately after the last intervention session. Results The bihemispheric anodal tDCS group showed a mean significant improvement 0.62 points; standard deviation (SD) 0.77, in the DOSS immediately after all sessions (p = 0.02). However, there was no mean significant improvement in the sham group (0.38 points; SD 0.65(p = 0.06)). There was no significant difference between the 2 groups (p = 0.48). Conclusion The bihemispheric anodal tDCS with conventional dysphagia therapy had additional helpful effects on the improvement in swallowing function in chronic stroke patients.

Purpose To determine the long-term repeatability of optical coherence tomography angiography (OCTA) parameters in normal eyes. Methods We prospectively enrolled 104 normal eyes. Participants were divided into three groups based on differences in the signal strength (SS) of OCTA scans obtained at two visits at least 6 months apart: group 1, SS difference = 2; group 2, 1; group 3, 0. We measured a foveal centred scan area of 3 × 3 mm pattern. All measurements were performed twice at 5-min intervals at the initial visit. The second measurements were performed at least 6 months later. Results In short-term vessel density (VD) repeatability, the coefficient of variation (CV) ranged from 3.89% to 8.10% and the intraclass correlation coefficient (ICC) ranged from 0.785 to 0.941. In terms of long-term repeatability, the CV was 5.39-12.62% and the ICC was 0.598-0.867. In group 1, the ICCs of the inner and full VDs were 0.194 and 0.221, respectively. In groups 2 and 3, the ICCs of the inner and full VDs were 0.611 and 0.603, and 0.763 and 0.765, respectively. The central VDs of all groups had high CV besides high ICC. Conclusions Optical coherence tomography angiography parameters showed good short-term and reasonable long-term repeatability in normal individuals. The differences in SSs between measurements affected such repeatability, so physicians should query the reliability of OCTA parameters when the differences in SS are 2 or more even when the SS is high.

PURPOSE Hypertension (HTN) is expected to accelerate age-related ganglion cell-inner plexiform layer thickness (GC-IPLs) reduction, but there is limited information on the reduction rate of GC-IPLs in HTN patients. We investigate longitudinal changes in the thickness of GC-IPL in patients with HTN. METHODS We performed a prospective, longitudinal and observational study design. Participants were divided into two groups: HTN group (49 eyes) and control group (56 eyes). After the initial visit, GC-IPLs were measured four times at 1-year intervals using spectral-domain optical coherence tomography. The GC-IPL reduction rate was estimated using a linear mixed model and compared between the two groups. Univariate and multivariate generalized linear mixed models were used to identify factors associated with reductions in GC-IPLs over time. RESULTS In a linear mixed model, the GC-IPL reduction rates for the HTN and control groups were -0.64 (p

Purpose To evaluate changes in peripapillary microvascular parameters in the fellow eyes of patients with unilateral retinal vein occlusion (RVO) using optical coherence tomography angiography (OCTA) and to determine the relationships between peripapillary microvasculature and retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) thickness. Methods Eighty-three patients with unilateral RVO (50 patients with branch RVO and 33 with central RVO) and 83 normal controls were enrolled. OCTA (Cirrus HD-OCT 5000 with AngioPlex) 6 × 6-mm scans centered on the optic disc were acquired. Peripapillary vessel density (VD) and perfusion density (PD) were automatically calculated. Results The average RNFL and GC-IPL thicknesses in the fellow eyes of RVO patients were significantly thinner than in normal controls (93.5 vs. 96.6 μm, P = 0.013 and 81.3 vs. 84.1 μm, P = 0.003, respectively). In the fellow eyes of patients with unilateral RVO, the peripapillary VD of the inner ring, outer ring, and full area (17.47, 18.50, and 17.89, respectively) were significantly lower than those of controls (17.87, 18.87, and 18.27, respectively). The peripapillary PD of the inner ring, outer ring, and full area (0.456, 0.467, and 0.456, respectively) were also significantly lower than those of controls (0.468, 0.476, and 0.466, respectively). RNFL and GC-IPL thicknesses were correlated with both peripapillary VD and PD. Conclusions OCTA revealed that peripapillary microvascular parameters in the fellow eyes of patients with unilateral RVO were decreased, and GC-IPL and RNFL thinning were also observed. The RNFL and GC-IPL thicknesses were positively correlated with both peripapillary VD and PD.

PURPOSE To determine the changes in peripapillary retinal nerve fiber layer (pRNFL), macular and ganglion cell-inner plexiform layer (GC-IPL) thicknesses in patients with acute anterior uveitis (AAU). METHODS Patients diagnosed with unilateral non-infectious AAU and normal control were enrolled retrospectively. Optical coherence tomography scans were performed during the initial active phase and inactive phase of AAU. Patients were followed for at least 3 months after resolution of inflammatory activity. RESULTS Thirty-seven AAU patients and 40 controls were included. The average RNFL and central macular thickness (CMT) showed significant differences between patients and control groups during active phase (p

The present pilot study was aimed at conducting a comparative analysis of the level of activation in the prefrontal cortex among a normal elderly group and amnestic and nonamnestic mild cognitive impairment (MCI) groups and investigating the presence of neural compensatory mechanisms according to types of MCI and different cognitive tasks. We performed functional near-infrared spectroscopy (fNIRS) along with cognitive tasks, including two-back test, Korean color word Stroop test, and semantic verbal fluency task (SVFT), to investigate hemodynamic response and the presence of neural compensation and neuroplasticity in the prefrontal cortex of patients with amnestic and nonamnestic MCI compared with a healthy elderly group. During the two-back test, there was no significant difference in the bilateral region-of-interest (ROI) analysis in the three groups. During the Stroop test, right-sided hyperactivation compared to the left side during the task was shown in the nonamnestic MCI and normal groups with statistical significance. Mean acc∆HbO2 on the right side was highest in the nonamnestic MCI group (0.30 μM) followed by the normal group (0.07 μM) and the amnestic MCI group (-0.10 μM). Otherwise, intergroup ROI analysis of acc∆HbO2 in these activated right sides showed no significant difference. During the VFT test, there was no significant difference in the bilateral region-of-interest analysis in the three groups. The highest mean acc∆HbO2 was shown in the normal group (0.79 μM) followed by the nonamnestic MCI group (0.52 μM) and the amnestic MCI group (0.21 μM). Otherwise, there was no significant difference between groups. The hemodynamic response during fNIRS showed different findings according to MCI types and cognitive tasks. Among the three tasks, the Stroop test showed results that were suggestive of neural compensatory mechanisms in the prefrontal cortex in nonamnestic MCI.

BACKGROUND AND PURPOSE High-frequency repetitive transcranial magnetic stimulation (rTMS) aids motor recovery in patients with subacute stroke. However, the response to high-frequency rTMS is highly variable between patients. The aim of this study was to identify the factors associated with improved motor function in response to high-frequency rTMS in subacute stroke patients with moderate to severe upper extremity motor involvement. METHODS Sixty-two patients with subacute stroke were enrolled. rTMS was applied over the primary motor cortex of the affected hemisphere at 10 Hz with 1,000 pulses/day for 10 days. Upper limb motor function was scored with the upper limb of Fugl-Meyer Assessment (FMA-UL) score before intervention and immediately after intervention. All FMA-UL changes greater than or equal to 5 points were considered clinically significant. Potential influencing factors considered included patient characteristics, motor function, corticospinal tract (CST) integrity assessments, and genetics. Multivariate logistic regression analysis was used to identify the significance of each of these factors. RESULTS We found that the two factors with the greatest impact on the improvement in FMA-UL score were: 1) the functional integrity of the CST, and 2) the brain-derived neurotrophic factor (BDNF) genotype (p

Background There are a few reports on the impact of central facial palsy and dysarthria on quality of life (QOL) in stroke patients. Objective To investigate the impact of central facial palsy on QOL compared with dysarthria during the chronic phase in patients with first-ever strokes. Methods This study represents an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation study. We selected data from patients with functional independence of 0 or 1 by the modified Rankin Scale at 6 months after stroke onset, who showed an impairment only in National Institute of Health Stroke Scale items 4 (facial palsy) or 10 (dysarthria). Assessments included the European Quality of Life-5 Dimensions (EQ-5D) and the Geriatric depression scale-short form (GDS-SF). Results Data from 149 patients were selected for this analysis from 3,929 patients who were followed up at 6 months. Thirty-nine and 110 patients were classified into the facial palsy and dysarthria groups, respectively. The groups did not differ significantly in baseline characteristics or functional assessments. EQ-5D was significantly lower in the facial palsy group than in the dysarthria group at 6 months after stroke (p = 0.036). GDS-SF was significantly higher in the facial palsy group than in the dysarthria group (p = 0.005). Conclusions The results of this study revealed that central facial palsy clearly has a more negative impact on QOL than dysarthria in chronic stroke patients with functional independence.

Predicting functional outcome and quality of life (QOL) is critical to the treatment of patients with stroke. The purpose of this study was to analyze the factors influencing functional status and QOL of stroke patients 6 months after a first-ever stroke. This study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation Study, designed to include 10 years of follow-up for first-ever stroke patients. This study analyzed data from 2857 patients who completed face-to-face assessments with the functional independence measurement (FIM) and Euro Quality of Life-5D (EQ-5D) at 6 months after stroke onset. A multivariate regression analysis was used to analyze factors that potentially influenced FIM and EQ-5D results at 6 months after stroke. Of the patients in this study, 80.1 % suffered from ischemic stroke and 19.9 % experienced hemorrhagic stroke. The independent predictors of functional independency measured by FIM at 6 months after stroke were age, initial stroke severity, duration of hospitalization, and functional level at discharge in terms of motor, ambulation, and language. For QOL measured by EQ-5D at 6 months after stroke, age, duration of hospitalization, and motor function at discharge were significant predictors. In conclusion, proper treatment to achieve maximal functional gain at discharge may be an important factor in improving functional independency and QOL in chronic stage stroke survivors. These results provide useful information for establishing comprehensive and systematic care for stroke patients.

Objective To investigate the return to work status of patients with first-ever stroke with functional independence 6 months post-stroke. Design Prospective cohort study. Participants Nine hundred and thirty-three patients with functional independence at 6 months after stroke onset. Methods A complete post-enumeration survey was performed through a review of the medical records for first admission. In addition, structured self-administered questionnaires and a face-to-face interview were performed assessing occupational status, quality of life, and emotional status at 6 months after stroke. Results Of the patients in this study, 60.0% returned to work at 6 months after stroke. Sex, age, educational level, and comorbidity level were independent factors related to return to work. The rate of return to work in female patients under 65 years of age was similar to that of male patients 65 years of age or older. Stroke patients who returned to work showed better emotional statuses than those who did not return to work. Conclusion Many stroke patients did not return to work despite functional independence at 6 months after stroke. Based on the results of this study, we suggest providing appropriate vocational rehabilitation for stroke patients and proper education for employers to increase the rate of early return to work in stroke patients.

PurposeTo determine the repeatability of superficial vessel density measurements using Spectral domain Ocular coherence tomography angiography(SD-OCTA) in patients diagnosed with retinal vein occlusion(RVO).DesignProspective observational study.SubjectsPatients who visited our retinal clinic from August 2017 to August 2018, diagnosed with RVO were recruited for the study.MethodsTwo consecutive 3×3 mm pattern scans were performed using the Cirrus HD-OCT 5000 along with AngioPlex software (Carl Zeiss Meditec) in each eye by single skilled examiner. All scans were analyzed using en face OCTA images to measure vessel density (VD) automatically. For further analysis of the effect of central macular thickness(CMT), eyes were divided into two groups according to CMT of 400μm (Group 1: CMT > 400μm, Group 2: CMT < 400μm). To identify factors affecting the repeatability of VD measurements, linear regression analyses were conducted for the coefficient of variation (CV) of VD by investigating demographics and ocular variables.Main outcome measuresThe intraclass correlation coefficient (ICC), coefficient of variation (CV) of VD measurements.ResultsA total of 57 eyes from 57 patients were examined: 35 eyes with BRVO and 22 eyes with CRVO. In all 57 eyes with RVO, the ICC and CV of the full VD(VD of 3mm diameter circle) were 0.800 and 10.61%, respectively. Univariate analyses showed that the mean CMT (B, 0.001; p 400μm) were 0.348 and 22.55% respectively. In group 2 (CMT < 400μm), the ICC and CV of the full VD were 0.910 and 7.76%, respectively.ConclusionsThe repeatability of VD measurement in eyes with RVO was reasonably comparable to previous studies. Repeatability of VD measurement was significantly affected by central macular thickness.

Robotic mirror therapy (MT), which allows movement of the affected limb, is proposed as a more effective method than conventional MT (CMT). To improve the rehabilitation effectiveness of post-stroke patients, we developed a sensory stimulation-based continuous passive motion (CPM)-MT system with two different operating protocols, that is, asynchronous and synchronous modes. To evaluate their effectiveness, we measured brain activation through relative and absolute power spectral density (PSD) changes of electroencephalogram (EEG) mu rhythm in three cases with CMT and CPM-MT with asynchronous and synchronous modes. We also monitored changes in muscle fatigue, which is one of the negative effects of the CPM device, based on median power frequency (MPF) and root mean square (RMS). Relative PSD was most suppressed when subjects used the CPM-MT system under synchronous control: 22.11%, 15.31%, and 16.48% on Cz, C3, and C4, respectively. The absolute average changes in MPF and RMS were 1.59% and 9.78%, respectively, with CPM-MT. Synchronous mode CPM-MT is the most effective method for brain activation, and muscle fatigue caused by the CPM-MT system was negligible. This study suggests the more effective combination rehabilitation system for MT by utilizing CPM and magnetic-based MT task to add action execution and sensory stimulation compared with CMT.