Earticle

현대는 급격한 경제발전으로 업무 시간이 늘어났으며, 인간의 직립보행은 현대사회에서 가장 대표적인 질환이 되었다. 이러한 만성요통환자들의 요천각도 변화가 있는 환자들의 HVLA와 흉추가동성운동을 통해 요천각도와 통증 및 기능장애에 어떠한 영향을 미치는지 알아보고자 한다. 요통환자에게 흉추가동성운동과 HVLA를 실시한 후, 요천각도, 통증, 기능장애 변화에 영향을 비교하기 위해 6개월 이상 만성요통으로 판정된 요통환자를 대상으로 흉추가동성운동과 HVLA를 실시하였다. 흉추저운동성의 만성요통환자의 요천각도 감소에는 HVLA의 적용이 효과적인 것으로 나타났고, 통증과 기능장애는 흉추가동성운동과 HVLA가 모두 효과적인 것으로 나타났다. 이에 만성요통에서 요천각도, 통증, 기능 장애의 개선에 있어서 흉추가동성운동과 HVLA가 긍정적 영향을 발휘하는 것으로 나타났다.

The rapid economic development of modern times has led to the extension of working hours, and chronic low back pain caused by walking upright has become the most prevalent disease in modern society. The purpose of this study was, therefore, to investigate the effects of HVLA and thoracic mobilization exercise on lumbosacral angle, pain, and dysfunction in patients with chronic low back pain patients whose lumbosacral angle changes are observed. The effects of thoracic mobilization exercise and HVLA on lumbosacral angle, pain, and dysfunction in low back pain patients with chronic low back pain diagnosed more than six months before were investigated. HVLA was found to be effective in reducing lumbosacral angle, alleviating pain, and dysfunction and the thoracic mobilization exercise was found to be effective in alleviating pain and dysfunction. These results showed that thoracic mobilization exercise and HVLA have positive effects on the improvement of lumbosacral angle, pain, and dysfunction in patients with chronic low back pain.

최근 IT 기술이 발달함에 따라 기업에서 생성되는 다양한 종류의 데이터(또는 정보)가 외부의 기관이나 개인 에게 유출되는 상황이 잦아지고 있다. 그러나 기업 차원에서 기업 정보의 역기능을 줄이기 위한 대응방인이 미흡한 상황이다. 본 논문에서는 기업 정보화의 역기능을 최소화하기 위한 역할기반의 기업 정보 처리 모델을 제안한다. 제안 모델은 기업 정보를 관리 및 감독하기 위한 관련 부서를 통해 기업 정보를 보호하고, 신속하고 체계적인 복구 및 운영 전략을 수립할 수 있도록 하여 기업 정보화 서비스의 효율성을 향상시켰다. 제안 모델은 정보에 접근하는 사용자의 권한과 역할을 관리자가 중앙 관리하여 정보에 접근하는 사용자가 이상 징후가 포착되면 정보 접근을 차단 한 후 신속하고 체계적인 복구 및 운영 연속성 전략을 수립하고 있다. 실험 결과, 제안 모델은 기존 모델에 비해 바이 러스 피해가 48.8% 낮았다. 또한, 기업내 발생되는 정보 역기능에 대한 유통 건수는 기존 모델에 비해 17.9% 낮은 결과를 얻었다.

Recently, As the IT skills development, the different kinds of data (or information) generated by the company are becoming more frequent leaked to outside organizations and individuals. However, it is insufficient situation to reduce the dysfunctional corporate information at the enterprise level. In this paper, we propose a role-based enterprise information processing model to minimize the dysfunctions of corporate information. The proposed model is to allow you to set protect corporate information through the relevant departments for the management and supervision of enterprise information, and rapid and systematic recovery and operating strategy was to improve the efficiency of enterprise information services. The proposed model is caught blocking access to information access to information to establish a rapid and systematic recovery and operational continuity strategy after the administrator user permissions and roles that access to information is centrally managed by the user when the abnormality. In experimental results, virus damage was lower 48.8% than the previous model. In addition, information on the number of dysfunction distribution occurring within the company gained 17.9% lower results than the previous model.

Objective To demonstrate the prevalence of cerebral hypoperfusion without focal cerebral lesions in patients with Moyamoya disease (MMD), and the relationship between areas of hypoperfusion and cognitive impairment.Methods Twenty-six MMD patients were included. Patients were categorized according to the presence/absence of hypoperfusion in the frontal, parietal, temporal, and occipital lobes on brain single-photon-emission computed tomography (SPECT) after acetazolamide challenge. Computerized neuropsychological test (CNT) results were compared between groups.Results Only 3 patients showed normal cerebral perfusion. Baseline characteristics were similar between groups. Patients with frontal lobe hypoperfusion showed lower scores in visual continuous performance test (CPT), auditory CPT, forward digit span test, backward digit span test, verbal learning test, and trail-making test. Patients with parietal lobe hypoperfusion showed lower backward digit span test, visual learning test, and trail-making test scores. Related to temporal and occipital lobes, there were no significant differences in CNT results between the hypoperfusion and normal groups.Conclusion MMD patients without focal cerebral lesion frequently exhibit cerebral hypoperfusion. MMD patients with frontal and parietal hypoperfusion had abnormal CNT profiles, similar to those with frontal and parietal lesions. It is suggested that the hypoperfusion territory on brain SPECT without focal lesion may affect the characteristics of neurocognitive dysfunction in MMD patients.

Objective To report the defecation patterns of brain-injured patients and evaluate the relationship between functional ability and colon transit time (CTT) in stroke patients. Method A total of 55 brain-injured patients were recruited. Patient interviews and medical records review of pattern of brain injury, anatomical site of lesion, bowel habits, constipation score, and Bristol scale were conducted. We divided the patients into constipation (n=29) and non-constipation (n=26) groups according to Rome II criteria for constipation. The CTTs of total and segmental colon were assessed using radio-opaque markers Kolomark® and functional ability was evaluated using the functional independence measure (FIM). Results Constipation scores in constipation and non-constipation groups were 7.32±3.63 and 5.04±2.46,respectively, and the difference was statistically significant. The CTTs of the total colon in both groups were 46.6±18.7 and 32.3±23.5 h, respectively. Th e CTTs of total, right, and left colon were signifi cantly delayed in the constipation group (p<0.05). No significant correlation was found between anatomical location of brain injury and constipation score or total CTT. Only the CTT of the left colon was delayed in the patient group with pontine lesions (p<0.05). Conclusion The constipation group had significantly elevated constipation scores and lower Bristol stool form scale, with prolonged CTTs of total, right, and left colon. In classifi cation by site of brain injury, we did not fi nd signifi cantly diff erent constipation scores, Bristol stool form scale, or CTTs between the groups with pontine and suprapontine injury.

Adulthood Attention-Deficit Hyperactivity Disorder (ADHD) debilitates high-level executive functioning, attention and im- pulse control. There is a lack of consensus regarding the specific cognitive markers for ADHD compared with other psychiat- ric disorders that show attention-related problems as secondary symptoms. This study aimed to aid clinicians in utilizing ex- isting tools for intelligence and cognitive function by investigating the key variables that differentiate ADHD from other men- tal disorders. As preliminary research, the study compared the performances of 35 patients with ADHD and 26 patients diag- nosed with other neurotic disorders on the Korean Wechsler Adult Intelligence Scale-IV (K-WAIS-IV), Conners Continuous Perceptual Test 3rd Edition (CPT 3) and Conners Continuous Auditory Test of Attention (CATA). The ADHD group per- formed significantly lower on the Verbal Comprehension Index (VCI) and Working Memory Index (WMI) of K-WAIS-IV; the difference was significant in Similarity, Vocabulary and Arithmetic subtests. Perceptual Reasoning Index (PRI) and VCI differed significantly in the ADHD group unlike their neurotic counterpart. Of the variables in CPT 3, only detection differ- entiated ADHD from other neurotic disorders. Our results implicate there are novel standards and key variables that should be considered when differentiating ADHD from other psychiatric disorders.

Purpose: This study was conducted to examine the proportion and potential predictors of cognitive dysfunction in Korean patients with rheumatoid arthritis (RA). Methods: Patients with RA enrolled in this study during follow-up checkups at one general hospital in Korea. A trained research nurse examined participants using a variety of physical,psychosocial, and biological measurements. The Computerized Neuropsychological Function Test, consisting of 16 indicators encompassing a variety of cognitive subdomains, evaluated each participant’s cognitive function. Participants were categorized as “impaired” if they performed one standard deviation (SD) below the age-based population standards on each test. Adding the converted scores (range 0~16) generated the total cognitive function score. Multiple linear regression analyses were conducted to identify the significant factors influencing cognitive dysfunction. Results: Sixty-five participants with a M±SD age of 62.3±10.45 years were included in this study. The total cognitive function score was 9.69±3.50 (range 2~16). The final multivariate regression model was statistically significant; the model explained 32.7% of cognitive dysfunction variance. Even after controlling for disease severity, glucocorticoid use, depression, and functional limitations, education level (β=-.35, p=.005), income (β=-.26, p=.041), and cardiovascular disease risk factors (β=.28, p=.016) significantly influenced cognitive dysfunction. Conclusion: The findings suggest that future studies regarding which etiological variables contribute to cognitive impairment and how to best assess cognitive function in RA patients must occur due to the high risk potential of cognitive dysfunction.

Background Breast cancer treatments, including surgery, chemotherapy, and radiation therapy, frequently lead to shoulder dysfunction manifesting as pain, restricted range-of-motion, and muscle weakness. Exercise therapy has emerged as a potential rehabilitative intervention; however, inconsistent evidence and protocol variability necessitate systematic evaluation. Purpose To evaluate the effectiveness of exercise therapy for managing post-treatment shoulder dysfunction in patients with breast cancer, particularly focusing on pain reduction, functional improvement, and safety outcomes. Study design Systematic literature review Methods We conducted a comprehensive search of PubMed, CINAHL, and Cochrane Library databases for articles published between January 2000 and May 2024. Eight eligible studies (four randomized controlled trials and four systematic reviews) from multiple countries were included. Interventions comprised early mobilization, progressive resistance training, stretching exercises, and combined aerobic and resistance programs, with durations ranging 12 weeks to 12 months. Primary outcomes included shoulder range-of-motion, pain intensity, muscle strength, and adverse events, including lymphedema. Results Eight studies were included in the review. Patients who underwent exercise interventions had significantly improved shoulder range-of-motion, muscular strength, and functional capacity compared to controls. Pain intensity was reduced across multiple studies. Early mobilization within weeks of surgery showed superior outcomes over delayed approaches. Progressive resistance training proved safe and effective without increasing lymphedema risk. Conclusions Exercise therapy is safe and effective for managing post-treatment shoulder dysfunction in breast cancer patients. Early initiation of individualized programs should be incorporated into standard care protocols. Future research should focus on developing standardized guidelines and investigating long-term outcomes.

Objective To investigate the factors affecting the postoperative swallowing dysfunction in patients who underwent oral cancer surgery. Methods Retrospective review of clinical records of 70 patients (50 males and 20 females) who underwent oral cancer surgeries from July 2007 to April 2015 were enrolled. Multiple regression analysis was performed using the Food Intake LEVEL Scale (FILS) at discharge as the objective variable and age, tumor size, resection of the tongue base, suprahyoid muscle resection, segmental mandibulectomy, neck dissection and radiation therapy as the explanatory variables in 70 patients. In addition, multiple regression analysis was performed between objective variables, which include maximum hyoid bone movement, laryngeal elevation delay time, pharyngeal constriction ratio (PCR), residue in the vallecular and pear-shaped depression (pyriform sinuses), and Penetration-Aspiration Scale score and one of the main factors representing the characteristics of each case as the explanatory variables, and age was treated as an adjustment factor in 23 patients. Results The FILS shows significant negative correlation by age and resection of the tongue base. In videofluoroscopic swallowing study, the maximum movement, PCR and residue in the vallecular are significantly correlated with factors demonstrating the characteristic for each case. Conclusion It was suggested that in elderly patients, the presence of more than half of the tongue base resection, suprahyoid muscle resection and neck dissection cause severe dysphagia after surgery.

Protein S is a vitamin K-dependent coagulation factor that acts as an anticoagulant. Deficiency of protein S increases the risk of thromboembolic events. We report a case of isolated protein S deficiency in a 39-year-old woman suff ering arterial occlusion in both lower legs. She underwent a surgical procedure using thrombectomy and balloon angioplasty of her left lower extremity. Later, she had right trans-tibial amputation because of the reperfusion injury. Th roughout the evaluation of thromboembolic events, we diagnosed a large thrombus in the right atrium and an asymptomatic pulmonary thromboembolism. Th e patient was successfully treated with right atrial thrombectomy and systemic anticoagulation. Careful evaluation for protein S levels may be necessary in patients with arterial thromboembolic events, especially young adults.

The thalamus, located between the cerebrum and midbrain, is a nuclear complex connected to the cerebral cortex that influences motor skills, cognition, and mood. The thalamus is composed of 50?60 nuclei and can be divided into four areas according to vascular supply. In addition, it can be divided into five areas according to function. Many studies have reported on a thalamic infarction causing motor or sensory changes, but few have reported on behavioral and executive aspects of the ophthalmoplegia of the thalamus. This study reports a rare case of a paramedian thalamus infarction affecting the dorsomedial area of the thalamus, manifesting as oculomotor nerve palsy, an abnormal behavioral change, and executive dysfunction. This special case is presented with a review of the anatomical basis and function of the thalamus.

Objective To determine whether cognitive function is associated with white matter hyperintensities (WMH) in patients with infratentorial stroke.Methods This was a retrospective, cross-sectional study. Twenty-four first-ever infratentorial stroke patients between 18 and 60 years of age were enrolled. WMH was evaluated by the Fazekas scale and the Scheltens scale. Cognitive functions were assessed using the Korean Mini-Mental Status Examination (K-MMSE), Rey-Osterrieth Complex Figure Test, and the Seoul Computerized Neuropsychological Test Battery (SCNT) at one month after stroke. All participants were divided into two groups based on the presence of WMH (no-WMH group and WMH group). General characteristics and cognitive functions were compared between the groups.Results There were no significant differences in general characteristics, such as age, stroke type, hypertension history, and education level between the two groups. However, K-MMSE in the WMH group was significantly lower compared to the no-WMH group (p<0.05). The verbal learning test score in SCNT was significantly higher in the no-WMH group compared to the WMH group (p<0.05). Executive function in the no-WMH group tended to be higher compared to the WMH group.Conclusion Impairment of cognitive function in patients with infratentorial stroke appeared to be associated with WMH. WMH should be carefully evaluated during rehabilitation of infratentorial stroke patients.

Objective To clarify the profile of cognitive dysfunction and the effects of intensive exercise in spinocerebellar degeneration (SCD). Methods We enrolled 60 healthy controls and 16 patients with purely cerebellar type SCD without gait disturbance or organic changes other than cerebellar changes. To assess cognitive function, we evaluated the participants using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Montreal Cognitive Assessment-Japanese (MoCA-J) at admission and after intensive exercise. Results Compared to the controls, SCD patients showed significant cognitive decline. As a result of intensive exercise, significant improvements in motor and cognitive functions were observed: the MMSE score improved from 27.7±1.9 to 29.0±1.3 points (p<0.001); the FAB score improved from 14.8±2.2 to 15.8±2.0 points (p=0.002); and the MoCA-J score improved from 24.6±2.2 to 26.7±1.9 points (p<0.001). For sub-scores, significant improvements were noted in serial 7, lexical fluency, motor series, and delayed recall. Conclusion Our study indicates that intensive exercise can be effective not only for motor dysfunction but also for cognitive dysfunction (Clinical Trial Registration No. UMIN-CTR: UMIN000040079).

Objective To investigate whether virtual reality (VR) training will help the recovery of cognitive function in brain tumor patients.Methods Thirty-eight brain tumor patients (19 men and 19 women) with cognitive impairment recruited for this study were assigned to either VR group (n=19, IREX system) or control group (n=19). Both VR training (30 minutes a day for 3 times a week) and computer-based cognitive rehabilitation program (30 minutes a day for 2 times) for 4 weeks were given to the VR group. The control group was given only the computer-based cognitive rehabilitation program (30 minutes a day for 5 days a week) for 4 weeks. Computerized neuropsychological tests (CNTs), Korean version of Mini-Mental Status Examination (K-MMSE), and Korean version of Modified Barthel Index (K-MBI) were used to evaluate cognitive function and functional status.Results The VR group showed improvements in the K-MMSE, visual and auditory continuous performance tests (CPTs), forward and backward digit span tests (DSTs), forward and backward visual span test (VSTs), visual and verbal learning tests, Trail Making Test type A (TMT-A), and K-MBI. The VR group showed significantly (p<0.05) better improvements than the control group in visual and auditory CPTs, backward DST and VST, and TMT-A after treatment. Conclusion VR training can have beneficial effects on cognitive improvement when it is combined with computer-assisted cognitive rehabilitation. Further randomized controlled studies with large samples according to brain tumor type and location are needed to investigate how VR training improves cognitive impairment.

Objective: To explore whether ultrasonographic measurements of tongue thickness are associated with swallowing function and related clinical domains in patients with amyotrophic lateral sclerosis (ALS), this feasibility study was conducted. Few studies have examined the usefulness of ultrasonographic tongue thickness measurement in patients with ALS, but its association with physiological measures remains unclear.Methods: Ten patients with ALS underwent tongue thickness measurement using ultrasonography. Clinical assessments including the Korean version of the ALS Functional Rating Scale-Revised (K-ALSFRS-R), Functional Oral Intake Scale (FOIS), Eating Assessment Tool-10 (EAT-10), Dysphagia Handicap Index, Korean version of the Swallowing Quality of Life Questionnaire, Mini Nutritional Assessment?Short Form (MNA-SF), handgrip strength, and bioelectrical impedance analysis for skeletal muscle index (SMI) were performed. Swallowing physiology was evaluated using the Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale. Simple and partial Pearson’s correlation analyses as well as univariate regression were performed with adjustments for age, sex, and body mass index (BMI).Results: Tongue thickness showed significant associations with multiple functional and systemic measures in the unadjusted analyses, including FOIS, EAT-10, MNA-SF, BMI, SMI, K-ALSFRS-R. After adjustment, the most consistent associations were observed with the MBSImP oral, pharyngeal, and combined phase scores.Conclusion: Tongue ultrasonography may serve as a radiation-free method to preliminarily assess bulbar involvement in ALS. Tongue thickness was most specifically associated with dysphagia outcomes, particularly MBSImP. Given the feasibility design and small sample size, larger longitudinal studies are warranted to confirm its clinical utility in monitoring the progression of dysphagia in patients with ALS.

Dysphagia following anterior cervical spine surgery (ACSS) poses a significant clinical challenge, with recurrent laryngeal nerve (RLN) injury emerging as a potential contributor. This case report describes the case of a 55-year-old male who underwent ACSS and subsequently developed dysphagia and hoarseness due to left RLN damage. Employing videofluoroscopic swallowing study (VFSS)-guided balloon dilatation on postoperative day 12, we observed a notable improvement in the opening of the upper esophageal sphincter (UES), as validated by a follow-up VFSS. The patient successfully transitioned from total parenteral nutrition to oral intake, demonstrating the clinical significance of the intervention. Although promising, long-term follow-up studies are warranted to assess the sustained efficacy of VFSS-guided balloon dilatation and the potential recurrence of dysphagia. Safety considerations and protocol variations merit further investigation, emphasizing the need for collaborative multicenter studies. In conclusion, VFSS-guided balloon dilatation is a potentially effective treatment for post-ACSS dysphagia associated with UES dysfunction caused by RLN injury.

Objective To quantify autonomic dysfunction in fibromyalgia patients compared to healthy controls using heart rate variability (HRV).Methods Sixteen patients with fibromyalgia and 16 healthy controls were recruited in this case control study. HRV was measured using the time-domain method incorporating the following parameters: total heartbeats, the mean of intervals between consecutive heartbeats (R-R intervals), the standard deviation of normal to normal R-R intervals (SDNN), the square root of the mean squared differences of successive R-R intervals (RMSSD), ratio of SDNN to RMSSD (SDNN/RMSSD), and difference between the longest and shortest R-R interval under different three conditions including normal quiet breathing, rate controlled breathing, and Valsalva maneuver. The severity of autonomic symptoms in the group of patients with fibromyalgia was measured by Composite Autonomic Symptom Scale 31 (COMPASS 31). Then we analyzed the difference between the fibromyalgia and control groups and the correlation between the COMPASS 31 and aforementioned HRV parameters in the study groups.Results Patients with fibromyalgia had significantly higher SDNN/RMSSD values under both normal quiet breathing and rate controlled breathing compared to controls. Differences between the longest and shortest R-R interval under Valsalva maneuver were also significantly lower in patients with fibromyalgia than in controls. COMPASS 31 score was negatively correlated with SDNN/RMSSD values under rate controlled breathing.Conclusion SDNN/RMSSD is a valuable parameter for autonomic nervous system function and can be used to quantify subjective autonomic symptoms in patients with fibromyalgia.

Dysphagia secondary to peripheral cranial nerve injury originates from weak and uncoordinated contraction-relaxation of cricopharyngeal muscle. We report on two patients who suffered vagus nerve injury during surgery and showed sudden dysphagia by opening dysfunction of upper esophageal sphincter (UES). Videofluoroscopy-guided balloon dilatation of UES was performed. We confirmed an early improvement of the opening dysfunctions of UES, although other neurologic symptoms persisted. While we did not have a proper comparison of cases, the videofluoroscopy-guided balloon dilatation of UES is thought to be helpful for the early recovery of dysphagia caused by postoperative vagus nerve injury.

Objective To determine whether patients with lumbosacral (LS) radiculopathy and peripheral polyneuropathy (PPNP) exhibit sudomotor abnormalities and whether SUDOSCAN (Impeto Medical, Paris, France) can complement nerve conduction study (NCS) and electromyography (EMG).Methods Outpatients with lower extremity dysesthesia underwent electrophysiologic studies and SUDOSCAN. They were classified as normal (group A), LS radiculopathy (group B), or PPNP (group C). Pain severity was measured by the Michigan Neuropathy Screening Instrument (MNSI) and visual analogue scale (VAS). Demographic features, electrochemical skin conductance (ESC) values on hands and feet, and SUDOSCAN-risk scores were analyzed.Results There were no statistical differences in MNSI and VAS among the three groups. Feet-ESC and hands-ESC values in group C were lower than group A and B. SUDOSCAN-risk score in group B and C was higher than group A. With a cut-off at 48 microSiemens of feet-ESC, PPNP was detected with 57.1% sensitivity and 94.2% specificity (area under the curve [AUC]=0.780; 95% confidence interval [CI], 0646?0.915). With a SUDOSCAN-risk score cut-off at 29%, NCS and EMG abnormalities related to LS radiculopathy and PPNP were detected with 64.1% sensitivity and 84.2% specificity (AUC=0.750; 95% CI, 0.674?0.886). Conclusion SUDOSCAN can discriminate outpatients with abnormal electrophysiological findings and sudomotor dysfunction. This technology may be a complementary tool to NCS and EMG in outpatients with lower extremity dysesthesia.

To find a multiple amputee more severe than a triple amputee is not easy. This is a report of a 36-year-old patient with right knee disarticulation, left trans-femoral amputation and right elbow disarticulation due to peripheral ischemic necrosis, when he was applied vasopressor in septic shock condition. His left hand was also 2nd, 3rd, 4th, and 5th distal interphalangeal joint disarticulation status, and it was more difficult for him to do rehabilitation program, such as donning and doffing the prostheses. For more efficient rehabilitation training program, we first focused on upper extremities function, since we believed that he might need a walking aid for gait training later. After 13 weeks of rehabilitation program, he has become sit to stand and walk short distance independently with an anterior walker. Although he still needs some assistance with activities of daily living, his Functional Independence Measure score improved from 48 to 90 during the course of 13 weeks.