The Korean version of the FRAIL scale: clinical feasibility and validity of assessing the frailty status of Korean elderly

BACKGROUND/AIMS: The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale is a screening tool for frailty status using a simple 5-item questionnaire. The aim of this study was to evaluate the clinical feasibility and validity of the Korean version of the FRAIL (K-FRAIL) scale. METHODS: Questionnaire items were translated and administered to 103 patients aged ≥ 65 years who underwent a comprehensive geriatric assessment at the Seoul National University Bundang Hospital. In this cross-sectional study, the K-FRAIL scale was compared with the domains and the multidimensional frailty index of the comprehensive geriatric assessment. We also assessed the time required to complete the scale. RESULTS: The participants' mean age was 76.8 years (standard deviation [SD], 6.1), and 55 (53.4%) were males. The mean overall frailty index was 0.19 (SD, 0.17). For K-FRAIL-robust, prefrail, and frail patients, the mean frailty indices were 0.09, 0.18, and 0.34, respectively (p for trend < 0.001). A higher degree of impairment in the K-FRAIL scale was associated with worse nutritional status, poor physical performance, functional dependence, and polypharmacy. The number of items with impairment in the K-FRAIL scale was positively associated with the frailty index (B = 3.73, p < 0.001). The K-FRAIL scale could differentiate vulnerability from robustness with a sensitivity of 0.90 and a specificity of 0.33. Of all patients, 75 (72.8%) completed the K-FRAIL scale within < 3 minutes. CONCLUSIONS: The K-FRAIL scale is correlated with the frailty index and is a simple tool to screen for frailty in a clinical setting.

Nutritional Intake of Pregnant Women with Gestational Diabetes or Type 2 Diabetes Mellitus

Adequate intake of nutrients by pregnant women diagnosed with gestational diabetes mellitus (GDM) or type 2 diabetes (T2DM) is very important for appropriate weight gain and maintenance of normoglycemia without ketonuria. The aim of this study was to investigate the nutritional intake of pregnant women with GDM or T2DM who had not been provided with nutritional education regarding blood glucose management. Between June 2008 and May 2010, 125 pregnant women who had been diagnosed with GDM or T2DM and had not received any nutrition education regarding glycemic control and proper diet during pregnancy were interviewed to collect data regarding background characteristics, health-related behaviors, and course of pregnancy and instructed to record their dietary intake using a 24-hour recall method for one day. Using the collected data, the index of nutritional quality, nutrient adequacy ratio, and mean adequacy ratio values of the subjects were calculated. Analysis of the values indicated that the majority of the subjects did not meet recommended intake levels for most micronutrients and consumed an undesirable ratio of macronutrients, specifically a higher percentage of total carbohydrates than the current recommendation level. The GDM and T2DM groups obtained 56.6% and 63.6%, respectively (p = 0.012), of their calories by carbohydrate intake, which exceeded the recommended levels (125.8% in GDM groups, 141.3% in T2DM groups).

Development and validation of the Korean Nursing Delirium Scale

PURPOSE: The aims of this study were to develop and test the validity of the Korean Nursing Delirium Scale (Nu-DESC) for older patients in hospital. METHODS: The Korean Nu-DESC was developed based on the Nu-DESC (Gaudreau, 2005), and revised according to nursing records related to signs and symptoms of older patients with delirium (n=361) and the results of a pilot study (n=42) in one general hospital. To test the validity of the Korean Nu-DESC, 75 older patients whom nurses suspected of delirium from 731 older patients from 12 nursing units were assessed by bedside nurses using the Korean Nu-DESC. A Receiver Operating Characteristic Curve of the Korean Nu-DESC was constructed with an accompanying Area Under the Curve (AUC). RESULTS: Specific examples such as irritable, kidding, sleeping tendency, which were observed by bedside nurses in Korea, were identified in the five features of signs and symptoms of delirium in the instrument. The Korean Nu-DESC was psycho-metrically valid and had a sensitivity and specificity of .81-.76 and .97-.73, respectively. The AUC were .89, .74. CONCLUSION: Results of this study indicate that the Korean Nu-DESC is well-suited for widespread clinical use in busy inpatients settings and shows promise as a research instrument.

Gene Expression Profile during Chondrogenesis in Human Bone Marrow derived Mesenchymal Stem Cells using a cDNA Microarray

Mesenchymal stem cells (MSCs) have the capacity to proliferate and differentiate into multiple connective tissue lineages, which include cartilage, bone, and fat. Cartilage differentiation and chondrocyte maturation are required for normal skeletal development, but the intracellular pathways regulating this process remain largely unclear. This study was designed to identify novel genes that might help clarify the molecular mechanisms of chondrogenesis. Chondrogenesis was induced by culturing human bone marrow (BM) derived MSCs in micromass pellets in the presence of defined medium for 3, 7, 14 or 21 days. Several genes regulated during chondrogenesis were then identified by reverse transcriptase-polymerase chain reaction (RT-PCR). Using an ABI microarray system, we determined the differential gene expression profiles of differentiated chondrocytes and BM-MSCs. Normalization of this data resulted in the identification of 1,486 differentially expressed genes. To verify gene expression profiles determined by microarray analysis, the expression levels of 10 genes with high fold changes were confirmed by RT-PCR. Gene expression patterns of 9 genes (Hrad6B, annexinA2, BMP-7, contactin-1, peroxiredoxin-1, heat shock transcription factor-2, synaptotagmin IV, serotonin receptor-7, Axl) in RT-PCR were similar to the microarray gene expression patterns. These findings provide novel information concerning genes involved in the chondrogenesis of human BM-MSCs.

Skeletal Muscle Mass in Elderly Heart Failure Patients; Comparison between Systolic and Diastolic Heart Failure and Corresponding Significance in Exercise Capacity

BACKGROUND: Exercise intolerance is a common symptom of heart failure and has a detrimental impact on the quality of life. Skeletal muscle atrophy has been considered an important contributor to exercise intolerance; however, most studies have been conducted in patients with advanced systolic heart failure. METHODS: We studied 39 ambulatory heart failure patients (age, 77.9+/-6.5; male, 17 [43.6%]) and 39 age and gender-matched, community-dwelling, elderly subjects. Clinical, laboratory, and echocardiographic evaluations were performed. Dual-energy X-ray absorptiometry was performed to assess the body composition. Exercise capacity was measured by a six-minute walk test. Comprehensive geriatric assessments were also performed to evaluate comorbidity, medication, physical function, cognitive function, and nutritional status. RESULTS: Skeletal muscle mass of heart failure patients showed no differences when compared with that of age- and gender-matched control subjects in any part of the body or in the whole body. Although diastolic heart failure patients showed lower levels of skeletal muscle mass than systolic heart failure patients, no significant difference was identified in either systolic or diastolic heart failure patients compared with respective age- and gender-matched control groups. The six-minute walk distances showed no difference between the groups (257.2+/-117.8 m in the diastolic heart failure group versus 302.7+/-109.4 m in the systolic heart failure group, p=0.226). CONCLUSION: Although skeletal muscle mass has been known to be an independent factor associated with exercise capacity in advanced heart failure patients, skeletal muscle mass was not decreased in ambulatory, elderly heart failure patients when comparing age- and gender-matched control subjects.

A study on the Difference of Disease Related Knowledge Level, Compliance of Health Behavior, and Educational Needs according to Time in Percutaneous Coronary Intervention Patients / 성인간호학회지

PURPOSE: The purpose of this study was to determine the differences in the level of disease related knowledge, compliance of health behavior, and educational needs in relation to time (at discharge and 6 months after discharge) among patients underwent percutaneous coronary intervention (PCI). METHODS: Data were collected from January 1, 2006 to September 30, 2006 and a total of 60 patients participated in the study. The survey was conducted in patients underwent PCI at the time of discharge right after discharge education was provided and at a follow up visit which was 6 months after discharge. RESULTS: The level of disease related knowledge (p<.001), the compliance of health behavior (p<.001), educational need (p=.496), the sub-item of sexual life (p<.001), follow up (p<.001), diet (p=.021), stress (p<.001) in compliance of health behavior, and the sub-item of specific character of disease in educational needs (p=.015) were significantly different between discharge and 6 months after discharge. CONCLUSION: The results of this study suggested that further education should be provided to the patients underwent PCI regarding medication, smoking cessation, daily life and exercise at a time of 6 months after discharge in order to increase patient compliance of health behavior.

Reference Data of the Main Physiological Parameters in Control Sprague-Dawley Rats from Pre-clinical Toxicity Studies / 한국실험동물학회지

The purpose of this paper is to provide reference data related to the body weight, food & water consumptions, urinalysis, hematology and serum biochemistry parameters and absolute & relative organ weights obtained from control Sprague-Dawley rats, used in the 4-week and 13-week repeated-dose toxicity studies conducted in our laboratory between 2005 and 2008. The mean, standard deviation, minimum and maximum range values for hematology and serum biochemistry parameters, data of absolute & relative organ weights, and the difference between sexes and study duration of week 4 versus 13 week are presented. The studies were conducted according to "the standards of Toxicity Study for Medicinal Products" (2005) and The KFDA Notification No. 2000-63 'Good Laboratory Practice (GLP)' (2000) issued by KFDA. These data could be used as reference material of Sprague-Dawley rats by conducting the studies to evaluate the toxicological profile of pre-clinical toxicity studies.

Role of Comprehensive Geriatric Assessment in Evaluating the Efficacy of Treatment in Elderly Patients with Coronary Artery Disease

BACKGROUND: Although the elderly patients who need coronary revascularization are increasing, the effecti- veness and benefit of percutaneous coronary intervention(PCI) or coronary artery bypass surgery(CABG) in the elderly patients have not been evaluated by using comprehensive geriatric assessment. METHODS: From January 2007 to May 2007, 47 patients aged 65 years or older, who had stable angina with more than one coronary artery stenosis, were included in the current study. Comprehensive geriatric assess- ment, including medical, psychosocial, and functional evaluation, was performed by geriatric team. Patients were managed by medical treatment, PCI or CABG according to the decision of attending physician. One year clinical and laboratory evaluations were performed in all the study patients. RESULTS: Baseline characteristics were not significantly different among the medical treatment, PCI, or CABG group, except the extent of coronary artery disease(p=0.007). In addition, comprehensive geriatric assess- ment showed no difference in the three groups. During the follow-up period, major adverse cardiac events (MACE) were observed in 9 patients including 2 cases of cardiac death. Compared with medical treatment and PCI group, CABG group showed impaired ADL status. ADL independency was significantly impaired in CABG group; medical treatment group(84.6%-->91.7%), PCI group(85.2%-->76.9%), and CABG group(71.4%-->33.3%)(p=0.025). However, there was no other difference in cognition, depression, and nutritional status among the groups. CONCLUSION: Compared with medical treatment and PCI group, patients treated by CABG appeared functional dependency in the elderly patients. Effort to identify the risk factor and vulnerable patients should be emphasized especially in the elderly patients who need CABG.

Immunohistochemical Study of Immune Cells, with a Special Emphasis on Macrophage Subpopulations in the Rat Thymus after Cyclophosphamide Treatment / 대한해부학회지

This study was undertaken to investigate the in vivo effects of cyclophosphamide (CY) on immune cells, with a special emphasis on macrophage subpopulations in the thymus of rats. After a single dose of CY (150 mg/kg) was administered to Sprague-Dawley rats by intraperitoneal injection, the rats were sacrificed at days 1, 3, 7, 14 and 28. The immunohistochemical characterization of the tissues were carried out using various monoclonal antibodies in cryostat-cut sections. CD4(+/-) and CD8(+/-) T cells were greatly decreased in number after CY treatment. However, macrophages, including the ED1(+/-) ED2(+/-) and ED3(+/-) macrophages exhibited signs of cellular activation such as an increase in number and size of cell, and an upregulation of the ED1, ED2 and ED3 reactive surface molecule expression. Contrarily, CY elicited a decrease in number of thymic dendritic cells (DCs). CY induced a conspicuous upregulation of ICAM-1 expression in the thymic cortex. Most of these features began to detectable from the first day and reached the maximun on the third and seventh days, but two weeks after CY administration, these phenomena began to disap. In conclusion, the results of the present study shed more light on the effects of CY on various subpopulations of macrophages and other types of immune cells and on ICAM-1 expression in the rat thymus.