Association Between Vitamin E and Handgrip Strength in the Korean General Population in KNHANES VII (2018).

OBJECTIVE: To investigate the association between vitamin E and handgrip strength (HGS) with multiple factors. METHODS: A total of 1,814 participants were included (822 men and 981 women) from the Korean subjects of the 7th Korea National Health and Nutrition Examination Survey in 2018. Data were analyzed using multiple logistic regression to determine the correlation between vitamin E and HGS with potential confounding factors. RESULTS: In the multiple logistic regression model, only the young age group (19-40 years) of men showed a positive relationship between vitamin E and HGS. However, in older age groups (41-80 years) of men and all age groups of women, there was no statistically significant result. After adjusting for confounding factors, young men showed higher vitamin E levels and higher HGS. Conversely, women and older age groups did not show significant results after adjusting for confounding factors. CONCLUSION: In this study, the serum vitamin E level had a positive effect on HGS in young men (<40 years). Further research is needed on this topic regarding vitamin E intake and other objective measures.

The Predictive Value of Language Scales: Bayley Scales of Infant and Toddler Development Third Edition in Correlation With Korean Sequenced Language Scale for Infant.

OBJECTIVE: To compare the relationship of the Bayley Scales of Infant and Toddler Development 3rd Edition (K-BSID-III) language score and the Sequenced Language Scale for Infant (SELSI) score and evaluate the sensitivity and specificity of K-BSID-III language score and optimal cutoff value with receiver operator characteristic (ROC) curve analysis in infants and toddlers with delayed language development. METHODS: A total of 104 children with suspected language developmental delay were included in this retrospective study. Subjects were tested using the K-BSID-III and SELSI and subdivided into several groups according to the severity of language scores. ROC curve analysis was performed to assess K-BSID-III for delayed language development. RESULTS: Receptive and expressive language subscales of the K-BSID-III showed markedly significant correlation with the SELSI scores (p<0.001). ROC analysis showed an area under the curve of 0.877 (p<0.001) in SELSI receptive score and 0.935 (p<0.001) in SELSI expressive score. The optimal cutoff value where sensitivity of 85% and specificity of 81% were achieved with the K-BSID-III receptive score was 1.50 (between average and low average) in the SELSI receptive score. The optimal cutoff value where sensitivity of 96% and specificity of 82% were achieved with the K-BSID-III expressive score was also 1.50 in the SELSI expressive score. CONCLUSION: In this study, the correlations between K-BSID-III and SELSI language scores were statistically significant. However, the interpretation should be considered carefully in low average group due to tendency of underestimation of delayed language development.

Subacute combined degeneration associated with vitamin E deficiency due to small bowel obstruction: A case report.

RATIONALE: There have been a few reported cases of subacute combined degeneration (SCD) associated with vitamin E deficiency, but the period of intestinal malabsorption was more than several years. We present a rare case of acute onset SCD that occurred in a relatively short period of several weeks with vitamin E deficiency related to small bowel obstruction. PATIENT CONCERNS: A 50-year-old woman had abdominal pain. A small bowel obstruction was suspected and conservative treatment was performed. She underwent bowel surgery after 2 weeks without any improvement. Following the operation, she was in a state of reduced consciousness. She was treated in an intensive care unit. Her consciousness level gradually recovered to alert in a week, but other symptoms such as ataxia, weakness on limbs, severe dysarthria, and dysphagia occurred. Since then, she had spent nearly 6 weeks in a bed-ridden state without improving. DIAGNOSIS: SCD associated with vitamin E deficiency was confirmed by laboratory investigations, electrophysiologic test, and whole spine magnetic resonance imaging scans. INTERVENTIONS: For vitamin E supplementation, she was administered a dose of 1200 mg/d. Physical therapy was focused on strengthening exercise, balance, and walker gait training. Occupational therapy was focused on activities of daily living training and dysphagia rehabilitation. OUTCOMES: After 6 weeks, her muscle strengths and functional level were substantially improved. The vitamin E level was recovered to normal range. LESSONS: This case suggests that if neurological symptoms occur in patients with intestinal obstruction, clinicians need to consider a deficiency of micronutrients such as vitamin E and vitamin B12. Patients with short clinical courses suffer less neurological damage and achieve faster recovery.

Thoracic radiculopathy as initial symptoms of hepatocellular carcinoma: A case report.

RATIONALE: Among the patients who complain of neuralgia in the upper extremities, it is very rare to be caused by the first thoracic (T1) spinal nerve dermatome. PATIENT CONCERNS: A 65-year-old presented with neuropathic pain of the left medial antebrachial cutaneous nerve and the medial brachial cutaneous nerve for 2 months. DIAGNOSES: Electrodiagnostic study revealed left thoracic radiculopathy mainly involving the T1 nerve root. Cervical spine magnetic resonance imaging revealed a metastatic tumor of T1 vertebral body compressing the left spinal cord and nerve root. After a systemic diagnostic work-up, he was finally diagnosed with primary hepatocellular carcinoma. INTERVENTIONS: He received transarterial chemoembolization in the liver and radiotherapy to the T1 spine. OUTCOMES: After radiotherapy, the neuropathic pain was slightly improved. LESSONS: If the patient is suspected of having thoracic radiculopathy, the physician should consider not only a herniated disc disease but also systemic disease. Because the prevalence of thoracic radiculopathy is very low and there is a high incidence of cancer that can spread to the spine in the elderly.

Optimal Radial Motor Nerve Conduction Study Using Ultrasound in Healthy Adults.

OBJECTIVE: To obtain reference values, to suggest optimal recording and stimulation site for radial motor nerve conduction study (RmNCS), and to analyze the correlation among RmNCS parameters, demographics and ultrasonography (US) findings. METHODS: A total of 55 volunteers participated in this study. We hypothesized that 'lateral edge of spiral groove (A)' was the optimal stimulation site, and the 'largest cross-sectional area (CSA) of extensor indicis proprius (EIP) muscle (B)' was the optimal recording site. The surface distance between 'A' and the lateral epicondyle of the humerus divided by upper arm length, was named the spiral groove ratio. The surface distance between 'B' and the ulnar styloid process divided by forearm length, was named the EIP ratio. Using US, we identified these sites, and further conducted RmNCS. RESULTS: Data was collected from 100 arms of the 55 volunteers. Mean amplitude and latency were 5.7±1.1 mV and 5.7±0.5 ms, respectively, at the spiral groove, and velocity between elbow and spiral groove was 73.7±7.0 m/s. RmNCS parameters correlated significantly with height, weight, arm length, and CSA of the EIP muscle. Spiral groove ratio and EIP ratio were 0.338±0.03 and 0.201±0.03, respectively; both values were almost the same, regardless of age, sex and handedness. CONCLUSION: We established a reference value and standardized method of RmNCS using US. Optimal RmNCS can be conducted by placing the recording electrode 20% (about one-fifth) of forearm length from the ulnar styloid process, and stimulating at 34% (about one-third) of the humeral length from the lateral epicondyle.

Hirayama Disease with Proximal Involvement.

Hirayama disease is a slowly progressing benign motor neuron disease that affects the distal upper limb. A 29-year-old man visited the hospital with a 1-year history of weakened left proximal upper limb. He was diagnosed with Hirayama disease 9 years ago, while there was no further progression of the muscle weakness afterward. Atrophy and weakness was detected in proximal upper limb muscles. Magnetic resonance imaging and somatosensory evoked potentials were normal. Needle electromyography showed abnormal findings in proximal upper limb muscles. Our patient had Hirayama disease involving the proximal portion through secondary progression. Clinical manifestation and accurate electromyography may be useful for diagnosis. Rare cases with progression patterns as described here are helpful and have clinical meaning for clinicians.