The present study examined whether a culture-based virtual reality (VR) training program is feasible and tolerable for patients with amnestic mild cognitive impairment (aMCI), and whether it could improve cognitive function in these patients. Twenty-one outpatients with aMCI were randomized to either the VR-based training group or the control group in a 1:1 ratio. The VR-based training group participated in training for 30 min/day, two days/week, for three months (24 times). The VR-based program was designed based on Korean traditional culture and used attention, processing speed, executive function and memory conditions to stimulate cognitive function. The adherence to the culture-based VR training program was 91.55% ± 6.41% in the VR group. The only adverse events observed in the VR group were dizziness (4.2%) and fatigue (8.3%). Analysis revealed that the VR-based training group exhibited no significant differences following the three-month VR program in Korean Mini-Mental State Examination (K-MMSE) scores, working memory functions such as performance on the digit span test, or in Stroop test performance and word fluency. We conclude that although the 12-week culture-based VR training program did not improve cognitive function, our findings revealed that the culture-based VR training program was feasible and tolerable for participants with aMCI.

Background Little is known of the effect of wearable devices on metabolic impairments in clinical settings. We hypothesized that a wearable device that can monitor and provide feedback on physical activity may help resolve metabolic syndrome. Objective This study aimed to examine the objective effects of the use of these devices on metabolic syndrome resolution. Methods Patients diagnosed with metabolic syndrome were recruited. Participants were prescribed regular walking using a wearable device (Coffee WALKIE +Dv.3, GC Healthcare CI, Korea) on their wrist for 12 weeks. Participants received self-feedback on the amount of their exercise through an app on their mobile phone. The information on physical activities of the participants was uploaded automatically to a website. Thus, a trained nurse could provide individuals with feedback regarding the physical activity via telephone consultation on alternate weeks. Blood pressure (BP), body composition, fasting plasma glucose, and lipid profiles were recorded. The primary outcome was metabolic syndrome resolution. The secondary outcome was an improvement in the components of metabolic impairment. Results Of the 53 participants recruited, 20 participants with a median age of 46 (range 36-50) years completed the trial. There was no significant difference in the amount of calorie expenditure at weeks 4, 8, and 12. After 12 weeks, metabolic syndrome was resolved in 9 of 20 participants (45%), and the mean number of metabolic impairment components per person decreased from 3.4 to 2.9. Particularly, the mean systolic and diastolic BP decreased from mean 136.6 (SD 18.5) mm Hg to mean 127.4 (SD 19.5) mm Hg and from mean 84.0 (SD 8.1) mm Hg to mean 77.4 (SD 14.4) mm Hg (both P =.02), respectively. Conclusions This study found that a 12-week intervention via feedback, based on a wearable physical activity monitor, helped metabolic syndrome patients to be more engaged in regular walking and it improved impaired metabolic components, especially in BP. However, some practical challenges regarding patients’ adherence and sustained engagement were observed.

Intra-coronary nicorandil infusion had no significant effect on PMI and cardiac enzymes after PCI in patients with stable or unstable angina.

PurposeThiazolidinediones are insulin-sensitizing agents that reduce neointimal proliferation and the adverse clinical outcomes associated with percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM). There is little data on whether or not low dose pioglitazone reduces adverse clinical outcomes.Materials and MethodsThe study population included 121 DM patients with coronary artery disease and they were randomly assigned to 60 patients taking 15 mg of pioglitazone daily in addition to their diabetic medications and 61 patients with placebo after the index procedure with drug-eluting stents (DESs). The primary end points were rate of in-stent restenosis (ISR) and change in atheroma volume and in-stent neointimal volume. The secondary end points were all-cause death, myocardial infarction (MI), stent thrombosis and re-PCI.ResultsThere were no statistical differences in the clinical outcomes and the rate of ISR between the two groups [all-cause death; n=0 (0%) in the pioglitazone group vs. n=1 (1.6%) in the control group, p=0.504, MI; n=2 (3.3%) vs. n=1 (1.6%), p=0.465, re-PCI; n=6 (10.0%) vs. n=6 (9.8%), p=0.652, ISR; n=4 (9.3%) vs. n=4 (7.5%), p=1.000, respectively]. There were no differences in changes in neointimal volume, percent neointimal volume, total plaque volume and percent plaque volume between the two groups on intravascular ultrasonography (IVUS) study.ConclusionOur study demonstrated that low dose pioglitazone does not reduce rate of ISR, neointimal volume nor atheroma volume in DM patients who have undergone PCI with DESs, despite the limitations of the study.

Anesthetic management of critical airway stenosis is often very challenging. Extracorporeal membrane oxygenation (ECMO) may provide adequate respiratory support when conventional approaches fail. We report our experience of ECMO support for critical airway surgery. Between April 2012 and March 2015, nine patients underwent ECMO-supported airway operation. The reason for surgery was tracheal stenosis in nine patients, and tracheomalacia, tracheal tumor, and external tracheal compression by mediastinal mass in one patient each. Resection and end-to-end anastomosis was performed in four patients; the remainder underwent diverse procedures, including tracheoplasty, tracheal ballooning, tracheostomy, and debulking of mediastinal mass. Extracorporeal membrane oxygenation support was sufficient for gas exchange during surgery and six patients were successfully weaned off intraoperatively. The median time on ECMO was 2.42 hours (range: 14.43-216 hours). No ECMO-related complications occurred. The median intensive care unit stay, median hospital stay, and mean follow-up period were 2 days (range: 1-61 days), 33 days (range: 9-303 days), and 17.1 ± 10.8 months, respectively. The rate of freedom from reintervention was 71.4%; the mean survival rates over 1 and 2 years were 76.2% and 63.5%, respectively. Our experience indicates that ECMO is a feasible and safe method for critical airway surgery.