Another major finding was that the patients showed nonlinguistic errors even in the early stages of the disease, and this is the inconsistent results found in AD patientswith Alphabetical writing. 38 Croisile 38 suggested that visuospatially disorganized handwriting appears later than linguistic abnormalities in the progression of the disease. Specifically, other previous studies 3,25,38 reported that deficits of central writing extend to graphic difficulties and alterations in handwriting spatial organization withdisease progression. In severe stages, patients experienced more problems with letter formation and stroke placement. 3,45,46,49 The contrasting finding might be explained by the characteristics of constructing Hangul syllable which requires more spatial and constructional skills for arranging graphemes. In addition, these findings may be explained by the differences in patient. The previous studies 3,45,46,49 have shown that late onset (above 65 year olds) AD patients exhibit hypometabolism in the medial temporal lobe and lateral temporal region in the early stages; while patientsin early stages of early onset (below 65 year olds) AD, exhibit hypometabolism in the frontal and parietal regions that is responsible for visuoconstructional dysfunction. 71 Moreover, McNeil and Tseng 21 reported that the parietal lobe processes visuospatial and constructional functions in writing. In the patient group, 20 early onset AD patients were included.
however the actual incidence and predictorsof morphometric VFs are unknown. The present study examined the incidence and predictorsof new VFs in a large AS cohort.
Methods: In total, 298 AS patients who fulfilled the modified New York criteria were enrolled and spinal radiographs were evaluated biennially. Clinical and laboratory data and radiographic progression were assessed according to the Bath AS Disease Activity Index, erythrocyte sedimentation rate, C-reactive protein (CRP), and the Stoke AS spine score (SASSS). VF was defined according to the Genant criteria. The incidence of VFs at 2 and 4 years was evaluated using the Kaplan-Meier method. The age-specific standardized prevalence ratio (SPR) for AS patientsin comparison with the general population was calculated.
The main limitation of this study is the relatively small. Further studies with higher number of participants are needed to covariate additional factors which potentially confound the relationship between the brain function and HTN, such as other vascular risk factors. Future studies should also investigate the cognitive phenotypes and other biomarkers (i.e. CSF biomarkers) that are associated with resting-state fMRI alterations in AD patients. Another limitation of this study pertains to the discordant exposure to hypertensive medications in AD patientswith HTN. We cannot completely eliminate the potential confounding factors of medication exposure and differential effects across classes of the drugs. However, it might be a relative strength of our study that all of subjects were anti-dementia medication-naive. There were also limitations in methods. When we extracted frequency fluctuations with a band of 0.01–0.08 Hz, the cardiac and respiratory fluctuation effects were not completely eliminated from the low frequency fluctuations. 18,51-52 These aliasing effects might have reduced the specificity of the connectivity effects. However, it must be noted that previous results from Cordes et al. 53 indicated that physiological noise sources, such as respiratory or cardiac pulsations, had little effect on the cross-correlation coefficients in defining functional connectivity maps.
Thus, the specificity of presently available genetic screen- ing technique in assessing EOAD patients is diminished.
Hence, genetic screening techniques including more delicate
guidelines are needed. Although we could not compute the statistical significance because of the small number of muta- tion cases, a positive family history seems not to be critical in predicting the presence of AD causative mutation in the Korean EOAD patients. We found 2 patients without an overt family history of a first-degree relative having had a genetic mutation, PSEN1 L226F and PSEN2 V214L, while only 1 patient in a familial case did note a recent Korean history, which impairs the precise tracking of family his- tory of dementia. Instead, earlier AO was thought to be a more consistent factor in determining the necessity of checking genetic AD mutations in Korean EOAD patients.
Autonomic dysfunction is accompanied inpatientswith AD or dementia , implying the possibility of excessive hemodynamic change due to drug response.
With regard to the correlation between the chosen drug and SBP in TIVA, there is a possibility that the drop in SBP may be inversely proportional to the concentration of remifentanil. Remifentanil is quickly degraded by esterase in blood and tissues; however, the level of esterase declines with aging, with a decrease of about 30% at the age of 80. The volume of distribution also decreases by about 20%, which leads to a higher peak concentration compared to that in younger adults. Further, extra precaution is demanded when bolus-injecting remifentanil, as it may induce severe hypotension and bradycardia . During TIVA, a high-dose drug is injected at the early stage to achieve the initial effect-site concentration, after which the dose is reduced, and this may cause side effects. In fact, when remifentanil is used, reduced blood pressure is maintained for a while even after adjusting the dose after the stimulus is lost. This may explain why inotropics were usually used during TIVA. Atropine, a medication for bradycardia, was also used only in TIVA cases, and patientsin these cases are speculated to have developed opioid-induced bradycardia caused by remifentanil.
factors such as age and race, histopathological factors such as stage, mitotic index, and lymphovascular invasion [3,4].
Advances in imaging techniques in the last few decades have enabled timely detection of recurrent and metastatic diseasein oncology practice. Data pertaining to the metastatic pat- tern of ULMS has not been adequately captured in any of the prior studies including the largest study of 1,396 patientswith ULMS obtained from the Surveillance, Epidemiology, and End Results (SEER) data base . Most of the existing studies have focused mainly on the management and prognostic factors of ULMS [3,5-7]. The predictorsof metastases, however have not been analyzed in any of these studies. With respect to the metastatic pattern, the literature is replete with several individual case reports of atypical metastatic sites [8-17]. In the large series, the emphasis has always been on lymph nodal involvement and the need for lymphadenectomy . The pur- pose of our study was therefore to review a large database ofpatientswith ULMS at our tertiary cancer institute to describe the pattern of metastasis in ULMS and provide a correlation with various clinical and histopathologic parameters.
Therefore, patientswith incident CKD might have characteris- tics other than a lower initial eGFR.
There were some limitations to the present study. Only one assessment of 24-hr ABPM was performed in all patients at base- line. Despite the difference in baseline renal function of the par- ticipants, the consistency in circadian BP variation was reported to be poor in CKD stages 3-5 and single measurements of 24-hr ABPM were probably inadequate for the evaluation of dipping status (29). In addition, because it was a retrospective study, anti- hypertensive medications during the follow-up period were not equally controlled. Furthermore, uniform intervention of use in antihypertensive medications was not performed; therefore we could not evaluate the effect of different usage of various anti- hypertensives. Finally, we could not compare other outcomes according to dipper status, such as cardiovascular morbidity and mortality, with the exception of renal outcomes, due to the rela- tively small size and short follow-up periods.
Our study has some limitations. First, there is no glo- bal consensus regarding the definition of NTM-LD pro- gression. One study defined the progression of NTM-LD as initiation of treatment , while another defined it as radiologic deterioration . We defined the progres- sion of NTM-LD as treatment required for NTM-LD by duty physicians. This could be a potential confounder because physicians might be more likely to initiate treat- ment for patients who are younger or patientswith MAC rather than MABC lung disease. Second, we did not perform subgroup analysis according to each of the NTM species because of the small number of pa- tients in each group. Differences in terms ofpredictors Table 2 Body morphotype and composition of 150 participants with nontuberculous mycobacterial lung disease at study entry
eventually resulting in CSVD 2 . On the other hand, sporadic SVCI results from vascular risk factors. Specifically, hypertension and diabetes can cause arteriosclerosis in small vessels, which then leads to CSVD, including white matter hyperintensities (WMH) and lacunes on magnetic resonance imaging (MRI) 3 .
Previous studies have shown that genetic forms of dementia have distinct features compared to sporadic forms. Specifically, autosomal dominant Alzheimer’sdisease (AD) starts earlier and deteriorates faster than spo- radic AD, although autosomal dominant AD and sporadic AD share a common pathophysiological cascade 4,5 . Previous studies have also shown that autosomal dominant AD results in cortical thinning in the parietal region, in contrast to sporadic AD 6 . Autosomal dominant AD also results in increased amyloid uptake, predominantly in the striatum 7–9 . Likewise, CADASIL and SVCI may show distinct distributions of WMH, although CADASIL and SVCI share the same CSVD MRI markers, including WMH and lacunes 10 .
This study investigated predictors according to the clin- ical profiles obtained during initial visits to our facility.
The duration of previous treatment at other institutions, previous drug-naïve status, and baseline Y-BOS scores were found to be important clinical predictorsof medi- cation response. Given that more responders than non-res- ponders had been drug-naïve or had received medication only briefly in the past, we can hypothesize that in- appropriate anti-obsessional pharmacotherapy may de- crease the effect of treatment. That fewer responders ini- tially reported severe symptoms and that the number of responders increased as the duration of pharmacological treatment increased indicated that longer periods of medi- cation are required for patientswith more severe ob- sessive-compulsive symptoms. This finding is consistent with the study conducted by de Haan et al., 26) which showed that OCD patient with severe symptoms needed more medication than did OCD patientswith mild symptoms.
J KPT The Journal of Korean Physical Therapy
들을 해결하기 위하여 약물요법과 병행하여 다양한 중재방법들이 시행되고 있다. 이 중 본 연구에서는 파킨슨병 환자의 보행능력 향상 에 효과적이라고 보고된 트레드밀 보행훈련을 시행하였다. 8 하지만 파킨스병은 단순한 신체활동의 반복적인 연습으로 전반적인 보행능 력을 증진시키는데 한계가 있다. 최근 유산소 운동이 파킨슨병 환자 의 운동신경 퇴행을 지연시킴으로써 기능 변화를 완화시킨다고 하 였다. 2 또한, 잠재적으로 신경세포의 생존을 향상시켜 신경발생을 자 극하고 세포의 단백질 함량수준을 향상시킨다고 보고되고 있다. 10 이 에 본 연구는 파킨슨병 환자들에게 트레드밀 보행 훈련과 유산소운 동을 통하여 파킨슨병의 질병 정도와 보행능력에 어떠한 영향을 미 치는지 알아보고자 본 연구를 시행하였다. 본 연구 결과 보행훈련과 유산소운동을 병행한 실험군에서 질병 정도의 감소와 보행 능력 중 보행 지구력의 향상에 도움이 되는 것으로 나타났다.
2. 연구 대상 및 절차
2.1. 연구 대상
본 연구는 2007년 8월부터 2009년 1월까지 병원에 내원하여 신경과 전문의로부터 파킨슨병으로 진단 받은 환자를 대상으 로 이루어졌으며, 사전에 연구에 대하여 충분히 설명 하였고, 담당의와 환자에게 개별적으로 동의를 구하였다. 참가한 대상 자는 항파킨슨 약물을 복용하기 전 상태인 특발성 파킨슨병 환자(Idiopathic Parkinson’s Disease, IPD) 20명과 통제군으로 신체 활동에 불편이 없는 정상 노인 22명이다. 자세한 대상자 정보는 <표 1>에 제시하였다. 환자군과 통제군에서 고혈압과 당뇨 관련 약물을 복용하는 경우가 많아 다른 약물복용 유무 를 대상자 선정기준에 고려하지 않았다. 대상자와 보호자의 보고에 의하여 피험자 모두 일상생활에 어려움을 초래하는 인 지와 청력문제는 없음을 확인하였다.
그렇기 때문에 음성강도가 증가하지 않아도 클리어 스피치를 통해 부정확한 조음과 운율 문제를 즉각적으로 해결할 수 있는 보상전략으로 제공될 수 있다.
호기류율(airflow rate)은 음성을 산출할 경우, 일정 시간 동안 성대를 지나가는 공기의 양을 말한다. 이를 시간으로 나눈 수치 를 평균 호기류율(mean airflow rate; MFR)이라고 하며 단위시간 내에 성문을 지나는 평균 공기량을 말한다. 본 연구에서 평균 호 기류율 역시 강도와 마찬가지로 유의미한 차이가 나타나지 않 았지만, 산책 문단에서 평균 호기류율은 클리어 스피치를 사용 할 경우 약 28.28mL/s 증가하였고, 문장인지검사의 경우 약 50.01mL/s 감소하였다. 평균 호기류율은 성문폐쇄부전이 있는 경우 값이 증가하며, 성문폐쇄근의 긴장이 심한 경우에는 값이 감소한다. Hanson et al.(1984)의 연구에서는 파킨슨 환자 대부분 에게서 성대의 휨과 같은 병리적 문제가 나타난다고 보고하였 다. 성대의 휨은 파킨슨병뿐만 아니라 정상 노인에게서도 흔히 나타나는 문제이기 때문에, 산책 문단같이 짧은 문장을 클리어 스피치로 읽기 위해서 파킨슨환자들이 발성을 위한 많은 노력 이 필요하지 않을 뿐만 아니라, 증가된 호흡 수로 인해 성대를 지나는 평균 호기류율이 더 많아지는 것으로 예상된다. 반면, 문 장인지검사같이 더 길어진 말 과제에서는 호흡 수가 증가하지 만, 그에 따른 생리적인 강직과 발성을 위한 노력이 증가하면서 평균 호기류율이 감소하는 것으로 보여진다.
Although hypoalbuminemiais well known marker of malnutrition or a risk factor of postoperative complica- tions, the benefit of albumin replacement to correct pre- operative hypoalbuminemia inpatientswith CD are unclear. Several studies have shown that albumin replace- ment therapy did not decrease the rates of death or major complications [20,21]. However, others found that treat- ment of hypoalbuminemic patientswith exogenous hu- man albumin solution resulted in a greater than twofold decrease in major complications [22,23]. A recent meta- analysis of 71 randomized trials showed that albumin ad- ministration significantly reduced overall morbidity among acutely ill hospitalized patients . Few studies, however, have assessed the clinical relevance of these properties, especially in CD patients who underwent surgery. Nevertheless, characteristics of albumin con- tributing normal oncotic pressure, innate immune re- sponse may help to explain the possible benefits observed after correction of hypoalbuminemia
For example, patientswith intestinal involvement may have a greater risk of CRC and patientswith neurological involvement may have a greater risk of brain/CNS cancer. How- ever, we could not evaluate the cancer risk according to the involved organs. Third, the dura- tion of follow-up was too short to assess completely the development of BD-associated cancers. We could evaluate cancer risk in the early stages of the disease, but not the long- term cancer risk. Nevertheless, our study showed that patientswith BD had an increased risk of overall cancer, solid cancers, and MDS in the early stages of the disease. Many patientswith BD may have symptoms of BD, such as recurrent oral ulcers, before an objective diag- nosis is made. Additionally, patientswith a predisposition toward developing BD may have dysregulated immune responses even before the diagnosis of BD is made. These may result in a high risk of cancer even in the early stage of the disease. Finally, there might have been a detection bias. Patients with BD are more likely to seek health care and to need multiple hos- pital visits, as compared to the general population, and thus they may have a greater rate of cancer detection than the general population does.
Earnshaw 등(2013) 개발 당시 도구의 신뢰도는 Cronbach’s
=.95 였고 본 연구의 신뢰도는 Cronbach’s = .95였다.
3. 자료수집 방법
자료 수집 방법은 부산 D대학병원 파킨슨병 센터의 외래 등록 환자 280명 대상의 편위 표집이었다. Faul, Erdfelder, Lang과 Buchner (2009)에 의해 개발된 G*Power 3.1 프로그 램을 이용한 결과 multiple regression에서 유의수준 .05, 검 정력 95.0%, 효과 크기 .15, 예측인자 4개로 할 경우 필요한 편의 표본크기는 146명이었다. 이에 근거하여 총 260부를 설문조사를 하였으나 특발성 파킨슨병 대상자가 아니거나 부분적으로 답변이 빠진 항목이 있는 설문지를 제외한 결 과 환자와 부양자 각각 250부를 최종 분석하였다. 설문조 사는 면접법과 설문지에 대해 교육한 간호사 3명이 설문문 항을 응답자에게 구두로 질문하고 이에 대한 응답을 기록 하는 면접타계식 방법으로 실시하였다.
II. 재료 재료 재료 및 재료 및 및 및 방법 방법 방법 방법
아주대학교 병원 신경과에서 진단 받은 11명의 파킨슨병 치매환자를 대상으로 하였다. 파킨슨병의 진단은 UK Parkinson’s Disease Society Brain Bank 진단기준을 만족할 경우로 했다(Hughes등, 1992). 파킨슨병 치매는 파킨슨병의 진단 기준을 만족하는 환자가운데 DSM-IV에 의한 치매의 정의에 부합하는 인지기능의 저하를 보이는 자로서, 파킨슨 증상이 발현된 후 적어도 1년 이상이 경과한 뒤 처음으로 인지기능의 저하 증상이 나타난 경우로 정의한다.