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Objective To evaluate the effect of combined hyperbaric oxygen therapy (HBOT) and steroid therapy in severe idiopathic sudden sensorineural hearing loss (ISSNHL). Methods Between January 2010 and July 2017, we evaluated 218 patients with ISSNHL and divided them into 2 groups: those with hearing loss greater than 80 dB and those with hearing loss of 60-79 dB. Each group was further divided into 3 groups according to the treatment method: oral steroids alone (PO), PO+intratympanic injection (IT), and PO+IT+HBOT. The treatment effect was evaluated for improvement in hearing thresholds at mid-term (3 weeks later) and final term (2 months later). Results When comparing the 3 treatment groups within the group that had a hearing loss greater than 80 dB, no differences were observed in the gaps in hearing thresholds and in the duration of improvement (P = .0764 and .2938, respectively). However, in the group with 60-79 dB hearing loss, the gaps in hearing thresholds at mid-term were 27.50 dB in the PO group, 38.13 dB in the PO+IT group, and 51.25 dB in the PO+IT+HBOT group. The treatment was more effective and faster in the initial period in the PO+IT+HBOT group than in the other groups. In addition, the results of frequency analysis showed greatest treatment efficacy at low frequencies of hearing. Conclusion Patients with ISSNHL above 80 dB are less likely to recover hearing even after PO+IT+HBOT. However, this treatment initially accelerates recovery in patients with a hearing loss below 80 dB. Therefore, the appropriate indication for HBOT benefits in patients with severe or profound ISSNHL should be reviewed.

Hernandez, DJ, Healy, S, Giacomini, ML, and Kwon, YS. Effect of rest interval duration on the volume completed during a high-intensity bench press exercise. J Strength Cond Res XX(X): 000-000, 2020-Between-set rest intervals (RIs) are one of the most important variables in resistance training; however, no known research has investigated the effects of RIs greater than 5 minutes during high-intensity strength training. The purpose of this research was to examine the effects of 3 different RIs on repetition sustainability and training volume (sets × reps × resistance) during a high-intensity bench press exercise. Fifteen resistance-trained male subjects (mean ± SD, age = 25.5 ± 4.5 years, and bench press 1 repetition maximum [1RM] ratio [1RM/body mass] = 1.39 ± 0.1) completed 3 experimental sessions, during which 4 sets of the bench press were performed with 85% of 1RM load. Subjects performed the bench press using 3 different RIs in a random counterbalanced design. Data were analyzed using both a one- and two-way analysis of variance with repeated measures. As sets progressed, repetitions were significantly different (p < 0.05) between all RIs, and only the 8-minute RI (p < 0.05) allowed for the complete sustainability of repetitions over 4 consecutive sets. Subjects attained the greatest training volume (p < 0.05) using an 8-minute RI between sets compared with a 2- or 5-minute RI. Similarly, a significantly greater training volume was achieved using the 5-minute RI compared with the 2-minute RI. Resistance-trained men, with the goal of greater volume during strength training, would benefit from longer RIs, specifically using an 8-minute RI between 4 consecutive sets of a bench press exercise.

Jeong Bae Ko,1,&ast; Kwang Bok Kim,1,&ast; Young Sub Shin,1 Hun Han,1 Sang Kuy Han,2 Duk Young Jung,3 Jae Soo Hong1 1Digital Health Care R&D Department, Korea Institute of Industrial Technology, Cheonan, Chuncheongnam-do, South Korea; 2Robotics R&D Department, Korea Institute of Industrial Technology, Ansan, Gyeonggi-do, South Korea; 3Seongnam Senior Experience Complex, Eulji University, Seongnam, Gyeonggi-do, South Korea&ast;These authors contributed equally to this workCorrespondence: Jae Soo HongDigital Health Care R&D Department, Korea Institute of Industrial Technology, Cheonan, Chuncheongnam-do, South KoreaTel +82 41-589-8412Fax +82 41-589-8413Email jshong94@kitech.re.krDuk Young JungSeongnam Senior Experience Complex, Eulji University, Seongnam, Gyeonggi-do, South KoreaTel +82 41-589-8412Email dyjung@eulji.ac.krPurpose: Sarcopenia is a symptom in which muscle mass decreases due to decreasing in the number of muscle fibers and muscle cross-sectional area as aging. This study aimed to develop a machine learning classification model for predicting sarcopenia through a inertial measurement unit (IMU)-based physical performance measurement data of female elderly.Patients and Methods: Seventy-eight female subjects from an elderly population (aged: 78.8± 5.7 years) volunteered to participate in this study. To evaluate the physical performance of the elderly, the experiment conducted timed-up-and-go test (TUG) and 6-minute walk test (6mWT) with worn a single IMU. Based on literature review, 132 features were extracted from collected data. Feature selection was performed through the Kruskal–Wallis test, and features datasets were constructed according to feature selection. Three major machine learning-based classification algorithms classified the sarcopenia group in each dataset, and the performance of classification models was compared.Results: As a result of comparing the classification model performance for sarcopenia prediction, the k-nearest neighborhood algorithm (kNN) classification model using 40 major features of TUG and 6mWT showed the best performance at 88%.Conclusion: This study can be used as a basic research for the development of self-monitoring technology for sarcopenia.Keywords: sarcopenia, physical activity, machine learning, inertial measurement unit

Alicea, SK, Parrott, AD, Manos, TM, and Kwon, YS. Comparison of the affective responses to continuous training and high-intensity interval training protocols: application of the dual-mode model. J Strength Cond Res XX(X): 000-000, 2020-High-intensity interval training (HIIT) is time-efficient and has physiological benefits similar to or greater than that of continuous training (CT); however, there are mixed results regarding how HIIT protocols influence affect. The purpose of this study was to compare acute affective responses between HIIT and CT protocols over time using the Dual-Mode Model (DMM) as a theoretical framework. Subjects included 12 healthy women (aged 19-28 years) who completed a HIIT protocol consisting of a 2-minute work interval (100% V[Combining Dot Above]O2max) followed by a 2-minute rest interval (∼55% V[Combining Dot Above]O2max), and a CT protocol set at the workrate corresponding to their respiratory compensation point (RCP; ∼80% V[Combining Dot Above]O2max). Protocols were matched for average intensity, total duration, and energy expenditure. After blood pressure, anthropometrics, body composition, and V[Combining Dot Above]O2max measurements were taken, responses were recorded for affect (Feeling Scale [FS]), arousal (Felt Arousal Scale [FAS]), and rate of perceived exertion (RPE) before each protocol, during the last 10 seconds of every 2 minutes during the protocol, and at time points 2, 5, and 10 minutes after the protocol. Heart rate was also monitored continuously, and exercise enjoyment was measured before and after exercise. A repeated-measures analysis of variance revealed no significant differences in affect between CT (M = 2.5, SD = 2.1) and HIIT (M = 2.6, SD = 2.1) protocols over the duration of the exercise. There were no significant differences in mean RPE between CT (M = 12.9, SD = 2.7) and HIIT (M = 13.0, SD = 1.9) protocols (t = 0.333, p = 0.745) or in enjoyment between CT (M = 2.3, SD = 1.1) and HIIT (M = 2.0, SD = 0.9) protocols (t = -0.288, p = 0.492). In addition, based on visual inspection, the general patterning of the mean FS and FAS values between HIIT and CT was similar within the circumplex model, supporting the DMM. In conclusion, a HIIT protocol at V[Combining Dot Above]O2max and 1:1 exercise:rest interval did not result in a different affect response, perceived exertion, or enjoyment level when compared with a CT protocol at RCP.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic disrupted the emergency medical care system worldwide. We analyzed the changes in the management of intracerebral hemorrhage (ICH) and compared the pre-COVID-19 and COVID-19 eras. MATERIALS AND METHODS: From March to October of the COVID-19 era (2020), 83 consecutive patients with ICH were admitted to four comprehensive stroke centers. We retrospectively reviewed the data of patients and compared the treatment workflow metrics, treatment modalities, and clinical outcomes with the patients admitted during the same period of pre-COVID-19 era (2017-2019). RESULTS: Three hundred thirty-eight patients (83 in COVID-19 era and 255 in pre-COVID-19 era) were included in this study. Symptom onset/detection-to-door time [COVID-19; 56.0 min (34.0-106.0), pre-COVID-19; 40.0 min (27.0-98.0), p=0.016] and median door to-intensive treatment time differed between the two groups [COVID-19; 349.0 min (177.0-560.0), pre-COVID-19; 184.0 min (134.0-271.0), p

Objective: To evaluate the clinicopathological characteristics of grade group 1 (GG1) prostate cancer in Korean populations.Methods: We retrospectively analyzed 492 consecutive radical prostatectomy specimens from our institution, which included those from 322 men with clinical GG1 and 170 with clinical GG2 tumors between years 2009 and 2018. The incidence of Gleason score (GS) upgrading, extraprostatic extension (EPE), and seminal vesicle invasion (SVI) were evaluated in patients with clinical GG1. In pathological GG1 cases, the distribution of adverse pathological features including EPE, lymphovascular invasion (LVI), perineural invasion (PNI), and biochemical recurrence (BCR) was analyzed.Results: Altogether, 78 (24.2%) out of 322 men in the clinical GG1 group demonstrated upgrading of GS, including 19 men with pathological Gleason score 4 + 3 = 7 and 6 with ≥ pathological Gleason score 4 + 4 = 8 cases. EPE was found in 37 (11.5%) and 22 (8.9%) men in clinical GG1 and pathological GG1 group, respectively. The incidence of LVI and PNI in the pathological GG1 cases was 2.8% (n = 7) and 28.6% (n = 71), respectively. BCR was observed in 4 men in pathological GG1 T2 (n = 226) and 2 men in GG1 T3 (n = 22) group. When we compared the pathological features between pathological GG1 T3 vs. GG2 T2, there was no statistical differences in the incidence of LVI and PNI between the two groups.Conclusions: Contrary to the current concept that GG1 is almost always clinically insignificant, it seems that GG1 still possess its respectable position as a group of cancer with aggressiveness. These findings should be kept in mind when deciding on treatment options for prostate cancer patients in the Asian populations.

Objective To determine whether modified constraint-induced movement therapy (mCIMT) with continuous restraint is feasible and effective in improving the use of the paretic arm in the real world among infants and toddlers with unilateral cerebral palsy (CP). Design Single-blind randomized controlled trial. Setting Tertiary hospital. Participants Children aged 7 to 36 months with unilateral CP (N = 24; 16 boys, 8 girls). Intervention The experimental group received 2-hour clinic-based mCIMT sessions (5 days per week for 3 weeks), and a continuous restraint was applied. Main Outcome Measures Standardized assessments were conducted. Peabody Developmental Motor Scales-2 (PDMS-2), Gross Motor Function Measure-66, Pediatric Motor Activity Log (PMAL), and Pediatric Evaluation of Disability Inventory were measured pre- and postintervention. Children who agreed to participate in the accelerometer study additionally wore accelerometers on both their wrists for 3 days before and after the intervention. Results The mCIMT group exhibited greater improvement in PMAL-how often (p = 0.048; ηp2 = 0.173), PMAL-how well (p = 0.008; ηp2 = 0.289), and PDMS-2 visual motor integration (p = 0.014; ηp2 = 0.256) posttreatment than the control group. The percentage of time in moderate-to-vigorous physical activity (z = –2.24; p = 0.03) and vector magnitude average counts (z = –2.52; p = 0.01) significantly increased in children in who wore accelerometers (N = 8) after the 3-week mCIMT protocol. Conclusion mCIMT with continuous restraint applied to infants and toddlers with unilateral CP appeared to have a positive effect on paretic hand use in the real world. Clinical Trial Registration Number NCT03418519

Background Standing biomass, litter production, rate of litter decomposition, amount of litter on forest floor, and amount of soil organic carbon distribution were investigated from March 2016 to November 2018 in order to evaluate the ecosystem value through organic carbon distribution in the Pinus densiflora forest at Namsan, Seoul Metropolitan City. Results The amount of organic carbon in the Pinus densiflora forest was 261.09 ton C ha−1 during the research period, and fixed organic carbon in plant through net photosynthesis was 3.2 ton C ha−1 year−1. The organic carbon in plant was 62.77 ton C ha−1 (24.04%), in litter on the forest floor was 3.65 ton C ha−1 (1.40%), and in soil was 194.67 ton C ha−1 (74.56%). The value of plant, litter on forest floor, and soil organic carbon distribution were each 6,277,000 won ha−1, 365,000 won ha−1, and 19,467,000 won ha−1. The value per ton of fixed organic carbon in plant through net photosynthesis was 320,000 won ha−1 year−1 and the value of ecosystem services stored in carbon in the Namsan forest ecosystem was about 26.1 million won ha−1 for 3 years. Conclusions The results of this study suggest that the pine forests of Namsan rapidly decompose leaves due to the high atmospheric temperature and accumulate a large amount of organic carbon in the soil to provide climate control regulatory service function.

This research aims to study the effect of climate change on the phenology, growth, and physiological traits of Silene capitata Kom., a Korean endangered species II. This study increased CO2 concentration in a closed glass greenhouse, with the daily mean temperature and CO2 concentration respectively being 4.61 °C and 93.63 ppm higher than the outside temperature (ambient conditions, control). The seeds of S. capitata were sown in control and treatment environments in March 2013 while seedlings were transplanted into individual pots in May 2013. To research phenological changes, the first day of the flowering and ripening of the plants transplanted in 2013 and first day of leafing in 2014 were observed. The growth and physiological responses of mature leaves were also studied in 2013. There was no difference in the first day of flowering, but the first day of ripening was earlier in the treatment group than the control group. There was no difference in the number of rosette leaves between the two groups, but leaf area was wider in the treatment group than the control group. Transpiration rate and stomatal conductance were higher in the treatment group than the control group, chlorophyll content decreased, and photosynthetic rate and water use efficiency were the same for both groups. As a result of simple regression analysis among the transpiration rate, stomatal conductance, photosynthetic rate, and water use efficiency, stomatal conductance increased when transpiration rate increased. Stomatal conductance increased with photosynthetic rate in the control unlike in the treatment group. The photosynthetic rate and water use efficiency increased with transpiration rate in the control group unlike in the treatment group. Furthermore, water use efficiency increased as photosynthetic rate increased in both groups. Due to high CO2 concentration, the photosynthetic rate was no longer controlled by the stomata, which appeared to suppress the excessive production of photosynthetic products by reducing chlorophyll content. It is believed that the phenological responses of S. capitata under climate change conditions will advance and that stable growth will be difficult in regions lacking moisture due to the high transpiration rate.

Background Bisphosphonates are widely used as bone stabilizers, which can cause major side effects including bisphosphonate-related osteonecrosis of the jaw (BRONJ) that occurs more frequently in the mandible. Consequently, there is a need for a detailed investigation of BRONJ of the maxilla and, in particular, of involvement of the maxillary sinus. Objective Our aim was to evaluate the characteristic radiologic and clinical manifestations in patients with maxillary sinusitis and a history of long-term bisphosphonate use. Methods Between January 2015 and July 2018, 55 patients with symptoms consistent with chronic rhinosinusitis who underwent a paranasal sinus computed tomography (CT) and had a history of >12 months of bisphosphonate therapy were included in the analysis. Results Radiologically and clinically evident chronic rhinosinusitis was noted in 24 of the 55 patients, of whom more than half (14/24, 58.3%) had BRONJ. The CT studies demonstrated that the maxillary sinus was involved in all 24 patients, characterized by unilateral involvement (70.8%) and bony remodeling in the posterior maxillary region (90.5%). The evidence of osteitis on CT and/or single-photon emission CT was observed in the majority of cases (19/21, 90.5%) and 12 patients (50.0%) had oroantral fistula. However, there were no differences in the clinical appearance of the diseases with respect to the radiologic aspects. Conclusions Besides its well-known effects on the mandible, long-term bisphosphonate use can also affect the maxillary sinus, with typical clinical and radiological manifestations.

In this study, we observed their growth and physiological responses using a variety of duty ratio under the mixed light using red, blue, and white lights. The red+blue mixed light was treated with 95%, 90%, 85%, 80%, and 75% duty ratios and red+blue+white mixed light with 85% and 70% duty ratios. We examined the width and length of leaves, total number of leaves, and number of shoots to examine their growth responses. The physiological responses were studied by measuring their photosynthetic rate, transpiration rate, stomatal conductance, water use efficiency, chlorophyll content, and fluorescence (Fo, Fm, and Fv/Fm). We found that lower duty ratio caused the length and width of the leaves to grow longer under red+blue mixed light but that it did not cause any difference in the red+blue+white mixed light condition. In addition, there was no difference in the number of leaves and shoots among all treatments. In the red+blue mixed light condition, the photosynthetic rate was no difference, but both transpiration rate and stomatal conductance were the highest at 95% duty ratio than in other ratios. Water use efficiency pattern was similar to that of photosynthetic rate; water use efficiency was no difference. Chlorophyll content was the highest at 95% duty ratios, and it was the least at 90%, 85%, and 75% duty ratio. Fo and Fm values were relatively high at 85% and 80% duty ratio and low at 90% duty ratio while Fv/Fm showed no difference. Under the red+blue+white mixed light, all physiological items showed no difference between 70 and 85% treatments. But, photosynthetic rate, water use efficiency, chlorophyll content, and Fv/Fm were relatively greater in the red+blue+white mixed light than in the red+blue mixed light. Therefore, red+blue+white mixed light treated with 70% duty ratio could lessen the environmental stress and save more power when cultivating Silene capitata in a plant factory.

This study was conducted from March 2011 to February 2013 in order to evaluate the ecosystem value by examining the organic carbon distribution and cycling in the Quercus glauca forest, evergreen oak community at Seonheul-Gotjawal, Jeju Island. The amount of organic carbon distribution was 124.5 ton C ha− 1 in 2011 and 132.63 ton C ha− 1 in 2012 for aboveground biomass. And it was 31.13 ton C ha− 1 in 2011 and 33.16 ton C ha− 1 in 2012 for belowground biomass. In total, the amount of organic carbon distribution in plants was 155.63 and 165.79 ton C ha− 1 in 2011 and 2012, respectively. In 2011 and 2012 respectively, the amount of organic carbon distribution was 3.61 and 6.39 ton C ha− 1 in the forest floor and it was 78.89 and 100.71 ton C ha− 1 in the soil. As shown, most carbon was distributed in plants. Overall, the amount of organic carbon distribution of the Q. glauca forest was 238.13 ton C ha− 1 in 2011 and 272.89 ton C ha− 1 in 2012. In 2011, the amount of organic carbon fixed in plants through photosynthesis (NPP) was 14.22 ton C ha− 1 year− 1 and the amount of carbon emission of soil respiration was 16.77 ton C ha− 1 year− 1. The net ecosystem production (NEP) absorbed by the Q. glauca forest from the atmosphere was 5 ton C ha− 1 year− 1. The carbon storage value based on such organic carbon distribution was estimated about 23.81 mil won ha− 1 in 2011 and 27.29 mil won ha− 1 in 2012, showing an annual increment of carbon storage value by 3.48 mil won ha− 1. The carbon absorption value based on such NEP was estimated about 500,000 won ha− 1 year− 1.

We previously reported that cold application to the palms between sets of high-intensity bench press exercise produces an ergogenic effect in men. In this study, we hypothesized that palm cooling (PC) or heating during rest intervals between high-intensity weight training sets will increase total repetitions and exercise volume load (kilograms) in resistance trained female subjects in a thermoneutral (TN) environment. Eight female subjects (mean ± SD, age = 25 ± 6 years, height = 160 ± 6 cm, body mass = 56 ± 7 kg, 1-repetition maximum [1RM] = 52 ± 6 kg, weight training experience = 6 ± 2 years) completed 4 sets of 85% 1RM bench press exercise to failure, with 3-minute rest intervals. Exercise trials were performed in a counterbalanced order on 3 days, separated by at least 3 days in TN, Palm heating (PH), and PC conditions. Heating and cooling were applied by placing both hands in a hand cooling device with the hand plate set to 45° C for heating and 10° C for cooling. Data were analyzed using a 2-factor repeated-measures analysis of variance and Tukey's post hoc tests. Palm cooling repetitions were significantly higher than TN repetitions during the second set, and PH repetitions were significantly higher than those of TN during the fourth set. Total exercise volume load (kilograms) for both PC (1,387 ± 358) and PH (1,349 ± 267) were significantly higher than TN (1,187 ± 262). In women, both heating and cooling of the palms between sets of resistance exercise increased the total exercise volume load performed. This ergogenic response to a peripheral sensory input is consistent with the central governor theory of muscular fatigue.

Zirconium-89 (t(1/2)=78.41 hours) is an ideal metallic radioisotope for immuno-positron emission tomography (PET), given that its physical half-life closely matches the biological half-life of monoclonal antibodies. In this study, the authors measured the spatial resolution and image quality of Zr-89 PET and compared the results against those obtained using F-18 PET, which is widely regarded as the gold standard for comparison of imaging characteristics.The spatial resolution and image qualities of Zr-89 were measured on the Siemens Biograph Truepoint TrueV PET/CT scanner, partly according to NEMA NU2-2007 standards. For spatial resolution measurement, the Zr-89 point source was located at the center of the axial field of view (FOV) and offset 1/4 axial FOV from the center. For image quality measurements, an NEMA IEC Phantom was used. The NEMA IEC Phantom consists of six hot spheres that were filled with Zr-89 solution. Spatial resolution and image quality (%contrast, %background variability [BV], and source to background ratio [SBR]) were assessed to compare the imaging characteristics of F-18 with those of Siemens Biograph Truepoint TrueV.The transverse and axial spatial resolutions at 1 cm were 4.5 and 4.7 mm for Zr-89, respectively. The %contrast of Zr-89 was 25.5% for the smallest 10 mm sized sphere and 89.8% for the largest 37 mm sized sphere, and for F-18, it was 32.5% for the smallest 10 mm sized sphere and 103.9% for the largest 37 mm sized sphere using the ordered subset expectation maximization (OSEM) reconstruction method. The %BV of F-18 PET was 6.4% for the smallest 10 mm sized sphere and 3.5% for the largest 37 mm sized sphere using the OSEM reconstruction. The SBR of Zr-89 was 1.8 for the smallest 10 mm sized sphere and 3.7 for the largest 37 mm sized sphere, and for F-18, it was 2.0 for the smallest 10 mm sized sphere and 4.1 for the largest 37 mm sized sphere using the OSEM reconstruction method.This study assessed Zr-89 imaging characteristics using a Siemens Biograph Truepoint TrueV PET/CT scanner and compared the results with those obtained for F-18 PET. Although spatial resolution and image quality of Zr-89 PET were lower compared with F-18 PET, due to longer positron range and low positron branching ratio, Zr-89 is advantageous for immuno-PET due to well-matched half-life with monoclonal antibodies.

In this study, the growth and reproductive response of seedlings, grown in plastic pots with sand, to moisture and nutrients were analyzed in order to study the environmental conditions required to create an alternative habitat for Epilobium hirsutum L., an endangered plant. Vegetative and reproductive growths of Epilobium hirsutum L. are accelerated with increase in moisture and organic matter content in the soil. Among vegetative organs, the number of runners related to asexual reproduction was the highest when the moisture content was over 25% and nutrient content between 7 and 14% in the soil. But the number of flowers related to flowering responses, among reproductive organs, was the highest when the moisture content was maintained at 75% and when nutrient content was 21% in the soil. The number of seeds, related to sexual reproduction, was the highest when the moisture content was over 25% and nutrient content between 14 and 21%. The study results show that a place with high moisture and nutrient content in the soil is advantageous to asexual and sexual reproduction of Epilobium hirsutum L. Therefore, we must serve periodically nutrient and seeds to sustain population in in situ conservation. Furthermore, it is advisable to create in riverside where abundant nutrient content have, making alternative habitat of Epilobium hirsutum L. Also, we must find species that have high contribution degree index through vegetation survey.

Background Lead (Pb), mercury (Hg), and cadmium (Cd) are well-known environmental pollutants. They are unnecessary in the biological processes of humans. This study was performed to estimate the representative background exposure levels to the metals by measuring concentrations in whole blood of the Korean general population. Methods This population-based cross-sectional study included 4,000 subjects (1,886 males and 2,114 females) 0–83 years of age in 2010 and 2011. Adult subjects (≥ 19 years of age) were collected by sex- and age-stratified probability method, and preschool- and school-aged subjects were recruited by a cluster sampling method. Written consent was provided prior to blood sampling. Pb and Cd blood concentrations were determined by a flameless atomic absorption spectrophotometry, and blood Hg was analyzed by a direct Hg analyzer. Results The geometric mean, median and 95th percentile of blood Pb was 1.82 µg/dL, 1.83 µg/dL, and 3.78 µg/dL, respectively. The respective values were 2.92 µg/L, 2.87 µg/L, 9.12 µg/L for Hg, and 0.56 µg/L, 0.59 µg/L, 2.20 µg/L for Cd. Blood Pb and Hg were higher in males than in females, but no sex difference was observed, respectively, in subjects 0–4 years of age for Pb and in subjects less than 20 years for Hg. However, blood Cd was higher in females than in males and no sex difference was observed in subjects < 30 years of age. Conclusion This study provides representative data of human exposure to Pb, Hg, and Cd covering whole age groups of the general population in Korea., Graphical Abstract

Cadmium (Cd) is the most potent nephrotoxic heavy metal and may affect bone; it also has a long biological half-life in the human body. This study was designed to assess the effect of environmental low-level Cd exposure on kidney function and bone in the general population. The subjects of this cross-sectional study were 1907 healthy Korean adults who had not been exposed to Cd occupationally. We analyzed the concentrations of Cd in the urine, markers of renal tubule damage, such as β2-microglobulin (β2-MG) and N-acetyl-β-D-glucosaminidase (NAG) activity in the urine, calculated the estimated glomerular filtration rate (eGFR) using serum creatinine, and measured bone mineral density (BMD). Also, we analyzed malondialdehyde (MDA) levels in the urine. The geometric mean concentration of Cd in urine was higher in women (1.36 μg/g creatinine) than in men (0.82 μg/g creatinine). Urinary Cd was significantly positively correlated with urinary β2-MG and NAG activity, whereas it was negatively correlated with eGFR and BMD. The risk of renal tubule damage was significantly associated with urine Cd level, and the association remained significant after controlling for various confounding variables. However, no association was observed between urinary Cd level and glomerular dysfunction or bone damage. The concentration of MDA was increased with urinary Cd level in a dose-dependent manner. These findings suggest that low-level environmental Cd exposure may cause microscopic damage to renal tubules through oxidative stress but might not impair kidney glomeruli or bones.

Rationale Epithelial-myoepithelial carcinoma is an extremely rare, malignant neoplasm that occurs most frequently in the major salivary glands and accounts for approximately 1% of all salivary gland neoplasms. Few reports have described the presence of epithelial-myoepithelial carcinoma in the sinonasal region; hence, the treatment guideline and prognosis remain unclear. Patient concerns We reported a case of a 75-year-old woman with complaint of nasal obstruction and frequent epistaxis for 3 years. During the nasal endoscopic examination, a mass in the left nasal cavity originating from the left nasal septum that caused bleeding on touch was observed. Diagnoses A diagnosis of epithelial-myoepithelial carcinoma was made based on the features of histopathology and immunohistochemistry of the surgical specimens. The patient was treated by surgical removal of the septal mass using the endonasal endoscopic approach. Outcomes In the serial follow-up paranasal sinus imaging and endoscopic inspection, evidence of recurrence was absent for 18 months after surgery. Lessons This report highlights a case of epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum, one of the most unusual locations. Diagnosis of epithelial-myoepithelial carcinoma should be made based on the findings of immunohistochemistry of the operative specimen. Clinicians should consider complete surgical resection as the effective treatment of choice.

AIMS Urinary cystatin C has been suggested as a useful biomarker for diagnosis of acute kidney injury (AKI). Multiple myeloma is often complicated by AKI. Therefore, we investigated whether the urinary cystatin C was available for diagnosis of AKI in multiple myeloma. MATERIALS AND METHODS This study included 39 patients with monoclonal gammopathy of undetermined significance (MGUS) or multiple myeloma. We reviewed the medical records retrospectively and investigated whether urinary γ-globulin and myeloma progression had effects on urinary cystatin C excretion. RESULTS Spearman's correlation analysis showed that serum β2-microglobulin and serum cystatin C had a significant positive correlation with the urinary cystatin C excretion (r = 0.513, p = 0.001, r = 0.659, p < 0.001) and FEcystatinC (r = 0.585, p = 0.002, r = 0.711, p < 0.001). The GFRcr also had a significant negative correlation with the urinary cystatin C excretion (r = -0.582, p < 0.001) and FEcystatinC (r = -0.474, p = 0.002). In addition, the urinary γ-globulin had a significant positive correlation with the urinary cystatin C excretion (r = 0.678, p < 0.001) and FEcystatinC (r = 0.731, p < 0.001). Urinary γ-globulin was the most significant factor to influence urinary cystatin C excretion in multiple regression test. CONCLUSION These results indicate that urinary γ-globulin and myeloma progression can increase the fractional and total excretion of urinary cystatin C. Therefore, it is believed that the urinary cystatin C can be affected by urinary γ-globulin and myeloma progression in the diagnosis of AKI in multiple myeloma. In addition, urinary γ-globulin is believed to be the most significant factor to influence on urinary cystatin C.

The Siemens Biograph TruePoint TrueV (B-TPTV) positron emission tomography (PET) scanner performs 3D PET reconstruction using a system matrix with point spread function (PSF) modeling (called the True X reconstruction). PET resolution was dramatically improved with the True X method. In this study, we assessed the spatial resolution and image quality on a B-TPTV PET scanner. In addition, we assessed the feasibility of animal imaging with a B-TPTV PET and compared it with a microPET R4 scanner. Spatial resolution was measured at center and at 8 cm offset from the center in transverse plane with warm background activity. True X, ordered subset expectation maximization (OSEM) without PSF modeling, and filtered back-projection (FBP) reconstruction methods were used. Percent contrast (% contrast) and percent background variability (% BV) were assessed according to NEMA NU2-2007. The recovery coefficient (RC), non-uniformity, spill-over ratio (SOR), and PET imaging of the Micro Deluxe Phantom were assessed to compare image quality of B-TPTV PET with that of the microPET R4. When True X reconstruction was used, spatial resolution was

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Tyrosine kinase inhibitors (TKIs), such as imatinibmesylate, have been used for the adjuvant treatment of KIT-positive GISTs. Several pathologic changes after imatinib treatment of metastatic GIST including tumor necrosis, myxohyaline or sclerohyalinestroma, proliferative index decline, a varying degree of hemorrhage, edema, and cystic change have been reported in previous studies. More specifically, cystic changes after imatinib treatment were mainly induced by necrosis, hemorrhage, and degeneration. Until now, there have been no reports of cystic changes due to a dilated bile duct entrapped by a totally regressed tumor. We report a case of a 61-year-old man who was diagnosed with high-risk GIST of the stomach complicated by hepatic metastasis and who had such a unique pathologic changes with imatinib treatment.

The widespread belief that local cooling impairs short-term, strenuous exercise performance is controversial. Eighteen original investigations involving cooling before and intermittent cooling during short-term, intensive exercise are summarized in this review. Previous literature examining short-term intensive exercise and local cooling primarily has been limited to the effects on muscle performance immediately or within minutes following cold application. Most previous cooling studies used equal and longer than 10 minutes of pre-cooling, and found that cooling reduced strength, performance and endurance. Because short duration, high intensity exercise requires adequate warm-up to prepare for optimal performance, prolonged pre-cooling is not an effective method to prepare for this type of exercise. The literature related to the effect of acute local cooling immediately before short duration, high intensity isotonic exercise such as weight lifting is limited. However, local intermittent cooling during short-term, high intense exercise may provide possible beneficial effects; first, by pain reduction, caused by an "irritation effect" from hand thermal receptors which block pain sensation, or second, by a cooling effect, whereby stimulation of hand thermal receptors or a slight lowering of blood temperature might alter central fatigue.

This study examined whether palm cooling (PC) could reduce heat strain, measured through changes in core, mean skin, mean body temperatures, and thermal sensation in resting hyperthermic subjects wearing chemical protective garments. Ten male subjects performed three exercise bouts (6.1 km h(-1), 2-4% grade) in a hot, dry environment [mean (SD) air temperature 42.2 (0.5 degrees C), relative humidity 36.5 (1%)] until core temperature reached 38.8 degrees C. Subjects then simulated transport in an armoured vehicle by resting in a seated position for 50 min with either no cooling (NC), (PC at 10 degrees C) or palm cooling with vacuum application around the hand (PCVAC, 10 degrees C, 7.47 kPa negative pressure). Core, skin, and mean body temperatures with PC and PCVAC were lower (P0.05) than NC from 15 to 50 min of cooling, and thermal sensation was lower (P0.05) from 30 to 50 min, with no differences in any variables between PC and PCVAC. Maximal heat extraction averaged 42 (12 W), and core temperature was reduced by 0.38 (0.21 degrees C) after 50 min of PC. Heat extraction with PC was modest compared to other cooling approaches in the literature.

Botulinum toxin type A (BTX-A) has been applied successfully to treat masseteric hypertrophy, but it can cause muscle weakness.To measure the change in maximum bite force (MBF) after BTX-A injection into the human masseter muscle and to evaluate the influence of a booster (repeated) injection.Thirty volunteers completed 18-week follow-up, and MBF was measured. At 18 weeks after the first injection, a booster injection was given to 14 patients, and they were followed up until 18 weeks from the booster injection.Mean MBF was approximately 20% lower at 2 weeks than before the injection, and it recovered gradually after 4 weeks to return to the preinjection level at 12 weeks. MBF differed significantly between before the injection and at 2, 4, and 8 weeks after the injection (p.05). In the booster injection group (n=14), MBF was markedly lower at 6 weeks (p.05), and it recovered gradually in 12 weeks.MBF was significantly lower after booster injection of BTX-A into the human masseter muscle, but it gradually recovered in a predictable pattern, and the degree of discomfort experienced by the subjects had little effect on normal mastication.

The incidence of complications associated with cerebrovascular diseases in patients who receive hemodialysis for a long-term period is higher than that of other complications. It is known that mortality due to cerebral hemorrhage is two times higher compared to non-dialysis patients. Anti-coagulants used for hemodialysis are essential. Accordingly, in cases in which the cerebral hemorrhage occurred, the selection of anti-coagulants for the prevention of further bleeding poses a great challenge to physicians. The change of hematoma and patient prognosis has a direct relationship. Many ongoing studies are conducted to examine the causative factors causing the increased hematoma and their related prognostic factors. In the current study, we examined the effect of nafamostat mesylate (a serine protease inhibitor) on the change of hematoma compared to heparin in hemodialysis patients.The current study was conducted in 17 hemodialysis patients who developed a cerebral hemorrhage. These patients were assigned to two groups based on the type of anti-coagulants that they used (i.e., nafamostat mesylate and heparin). Then, the factors affecting the change of hematoma following the onset of cerebral hemorrhage were examined. The prognosis of hematoma was assessed based on brain CT scans, which were performed two weeks after the onset of cerebral hemorrhage in four groups. Following this, groups 1 (the decreased hematoma) and 2 (the decreased delay) were merged to group A (resolving group), and groups 3 (the increased hematoma) and 4 (the death following the aggravation) were merged to group B (the expansion group) for further analysis.There were no significant differences in baseline characteristics between the nafamostat group and the heparin group. A comparison between the resolving group and the expansion group also showed that there were no significant differences in baseline characteristics. In the anti-coagulants and the change of hematoma, however, there were significant differences between the two groups (p = 0.024). A comparison of the change of hematoma between the four groups was also made. This showed that platelet counts and BUN level were significant factors (Platelet; p = 0.042, BUN; p = 0.043 ANOVA with resolving group).Nafamostat mesylate has a similar profile of anti-coagulative activity to heparin. It is assumed, however, that nafamostat has an affirmative effect on the recovery of damaged sites following the onset of cerebral hemorrhage. It is an anti-coagulant that can be safely used for hemodialysis following the onset of cerebral hemorrhage.

We observed the acute effects of Qigong training on the levels of human endogenous opioid peptides, such as beta-endorphin, and other stress hormones [adrenocorticotrophic hormone (ACTH), cortisol, and dehydroepiandrosterone-sulfate (DHEA-S)] in a group of ChunDoSunBup Qigong trainees. At pre (-10 min), mid (40 min) and post (70 min) time of training, blood was taken for the determination of plasma level of hormones. The level of beta-endorphin was significantly increased during the mid-time of training while the level of ACTH declined at the mid- and post- time of training. Cortisol and DHEA-S were not significantly changed during training. This result suggests that Qigong training, as a stress coping method, affects and plays a role in hormonal regulation related to the maintenance of homeostasis in man.

To the Editor: We made a mistake in our recently published article: Cho U, Oh WJ, Bae JS, Lee S, Lee YS, Park GS, Lee YS, Jung CK. Clinicopathological Features of Rare BRAF Mutations in Korean Thyroid Cancer Patients. J Korean Med Sci 2014;29:1054-60. All occurrences of "c.1801A>C" must be replaced by "c.1801A>G" in the abstract, graphical abstract, introduction, results, Table 1 and Table 2.

The most common BRAF mutation in thyroid cancer is c.1799T>A (p.Val600Glu), and other BRAF mutations are rarely reported. We investigated the clinicopathological features of thyroid cancer with rare BRAF mutations. A total of 2,763 patients with thyroid cancer underwent molecular testing by direct DNA sequencing for mutations in BRAF exon 15. Among them, 2,110 (76.4%) had BRAF mutations. The c.1799T>A mutation was found in 2,093 (76.9%) of 2,722 papillary carcinomas and in one of 7 medullary carcinomas. Sixteen cases (0.76%) harbored rare mutation types. Five cases had single-nucleotide substitutions, 5 cases had small in-frame deletion or insertion, and one harbored a two-nucleotide substitution. Of these mutations, 2 were novel (c.1797_1798insGAGACTACA, c.[1799T>A; 1801_1812del]). The c.1801A>C mutation was identified in 4 follicular variant papillary carcinomas and one follicular carcinoma. None of the patients with the c.1801A>C mutation showed extrathyroidal extension or lymph node metastasis. The prevalence of rare BRAF mutations was 0.76% of all BRAF-positive thyroid cancers, and the rare mutations were associated with less aggressive pathologic features. Although BRAF mutations are detected exclusively in papillary carcinoma, they are also found in medullary carcinoma and follicular carcinoma. Graphical Abstract

Kyungdon Ryu, Young-Sub Byun, Byoung Kwon Lee, Choong-Won Goh, Kun-Joo Rhee. Inje University Sanggye Paik Hospital, Yonsei University Gangnam Severance Hospital Background: Individuals with a systolic BP of 120 to 139 mmHg or a diastolic BP of 80 to 89 mmHg should be considered as pre-hypertensive. however limited evidence exists on whether the early drug intervention is needed according to identification of other cardiovascular risk factors except diabetes. Aortic pulse wave velocity (PWV) as an index of aortic stiffening is known recently as a new predictor for future cardiovascular events. We examined the relation between PWV and blood pressure response during exercise in the patients with pre-hypertension, because exaggerated blood pressure response during exercise even in asymptomatic normotensive individuals is associated with other established cardiovascular risk factors. Methods: 96 consecutive patients with pre-hypertension were monitored during symptom-limited incremental exercise testing with treadmill. Cuff blood pressure was measured every minute during exercise testing with automatic indirect manometer. Results: Although there were no significant differences in diastolic blood pressure at rest and at the peak exercise between the patients with high PWV ( 15% higher than age-matched average value, nZ39) and those with low PWV(