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Introduction In this study we evaluated the effect of electromyostimulation (EMS) on myosin heavy chain (MHC) isoform expression in denervated rat muscles to determine the optimal timing for EMS application. Methods EMS was initiated on post-injury day 1 for the group with denervation receiving immediate EMS (DIEMS) and on post-injury day 15 for the group with denervation receiving delayed EMS (DDEMS) in rat denervated muscles. Muscle wet weight and muscle fiber cross-sectional area (FCSA) were measured. MHC isoforms were analyzed in both protein homogenates and single muscle fibers. Results The expression levels of IIx and IIb isoforms of MHC were significantly lower and higher, respectively, in the gastrocnemius muscles of the DIEMS group, but not the DDEMS group. The DIEMS group also showed larger FCSA and a lower proportion of hybrid single fibers compared with the DDEMS group. Discussion These results indicate that immediate EMS is more effective than delayed EMS for aiding recovery of denervation-induced MHC changes. Muscle Nerve 56: E154-E161, 2017.

Cobalt is an essential metal that is required for the generation of vitamin B12. However, exposure to excess cobalt for a prolonged period may adversely affect the human body, causing hepatotoxicity, pulmonary fibrosis, and neurotoxicity. 3-Aminotriazole (3-AT) is a catalase inhibitor that is often used to examine the cellular role of catalase. In the present study, we showed that 3-AT treatment significantly reduced cobalt (II) chloride (CoCl2)-induced cytotoxicity in HepG2 cells by suppressing the expression and activation of apoptotic markers, caspase-3 and poly adenosine diphosphate ribose polymerase (PARP). Mechanistically, 3-AT treatment attenuated CoCl2-induced accumulation of reactive oxygen species (ROS) and expression of RO S-responsive genes. Furthermore, the CoCl2-induced mitochondrial membrane potential (Δψm) shift and mitochondrial damage were attenuated by 3-AT. Taken together, these findings suggest that 3-AT alleviates CoCl2-induced cytotoxicity by reducing ROS generation and protecting against mitochondrial damage.

Herein, we report an elderly man with lower limb weakness due to multiple peripheral neuropathies associated with rhabdomyolysis that was identified by electro-diagnosis and hip magnetic resonance imaging (MRI). He was diagnosed with acute kidney injury due to rhabdomyolysis following prolonged immobilization after alcoholic intoxication. He complained of thigh pain, hypoesthesia, and weakness in both lower extremities. The electro-diagnostic study showed near complete axonal loss of the sciatic nerve and partial axonal loss of the femoral and obturator nerve, between the gluteal region and the proximal thigh level, which was more severe on the right side than on the left. Hip MRI revealed extensive necrotizing myositis on the gluteal, psoas, and adductor muscles, and an inflammatory lesion around multiple peripheral nerves at the pelvic and proximal thigh level. The clinical course and prognosis were discussed as an example of a neurological complication arising from an inflammatory condition related to rhabdomyolysis.

Rotavirus nonstructural protein 4 (NSP4) has been suggested as a pathogen of rotavirus-associated seizures. We investigated pre-existing serum antibodies against NSP4 and VP6 (the most highly immunogenic rotavirus protein) in patients with rotavirus gastroenteritis and its correlation with the occurrence of seizures.With an enzyme-linked immunosorbent assay, IgG and IgA titers against NSP4 (genotype [A] and [B]) and VP6 were measured in acute-phase sera of 202 children aged 0.5-6.0 years with rotavirus gastroenteritis. The clinical characteristics and antibody levels were compared between patients with (seizure group) and without seizures (non-seizure group).The non-seizure and seizure groups comprised 173 and 29 patients, respectively. Age, sex, hospital stay, presence of fever, white blood cell counts, C-reactive protein, vaccine status, IgG/IgA titers for VP6, and IgA titers for both NSP4s did not differ between the groups. The seizure group showed a lower level of IgG against NSP4 [A] (184.5 vs. 163.0 U/mL; P = 0.03) and NSP4 [B] (269.0 vs. 196.0 U/mL; P = 0.02). Delayed sampling time from the onset of gastroenteritis symptoms (3 vs. 2 days; P = 0.02) and lower serum sodium level (133.4 vs. 136.3 mEq/L; P 0.01) were observed in the seizure group. Even after adjusting these factors, anti-NSP4 [A] IgG (OR 2.56 per 100 U/mL increment; 95% CI, 1.20-5.26, P = 0.01) and anti-NSP4 [B] IgG (OR 1.51 per 100 U/mL-increment; 95% CI, 1.04-2.22, P = 0.03) were independently associated with protection against seizures.Serum anti-NSP4 IgG might protect rotavirus-associated seizures.

Falls and fall-related injuries are common in older populations and have negative effects on quality of life and independence. Falling is also associated with increased morbidity, mortality, nursing home admission, and medical costs. Korea has experienced an extreme demographic shift with its population aging at the fastest pace among developed countries, so it is important to assess fall risks and develop interventions for high-risk populations. Guidelines for the prevention of falls were first developed by the Korean Association of Internal Medicine and the Korean Geriatrics Society. These guidelines were developed through an adaptation process as an evidence-based method; four guidelines were retrieved via systematic review and the Appraisal of Guidelines for Research and Evaluation II process, and seven recommendations were developed based on the Grades of Recommendation, Assessment, Development, and Evaluation framework. Because falls are the result of various factors, the guidelines include a multidimensional assessment and multimodal strategy. The guidelines were developed for primary physicians as well as patients and the general population. They provide detailed recommendations and concrete measures to assess risk and prevent falls among older people.

The purpose of this study was to assess the clinical outcomes and change of ROM between patients with adhesive capsulitis of the hip (ACH) who underwent arthroscopic treatment and those who underwent conservative treatment at a minimum follow-up of two years. From 2010 to 2017, 35 hips (32 patients, 10 men and 22 women) diagnosed with primary ACH were enrolled and followed up for a minimum of two years. Arthroscopic surgery was performed in 17 patients (20 hips, operation group), and conservative treatment was performed in 15 patients (15 hips, control group). Outcomes were measured with the visual analogue scale (VAS), University of California, Los Angeles (UCLA) activity scale, modified Harris hip score (mHHS), and degree of range of motion (ROM). The patients in the operation group were younger than those in the control group (mean age, 36.6 vs 46.2, p = 0.032). The VAS scores were significantly lower in the operation group than in the control group at two weeks, six weeks, and 24 months of follow-up. Moreover, the operation group showed a trend of better values of UCLA and mHHS, with no statistical differences during the entire follow-up; these patients also achieved greater improvements of external rotation at six weeks’ evaluation. The patients with ACH in the two groups shows improvement of pain, UCLA scale, mHHS, and ROM at a minimum two year follow-up. Based on this study, we do not routinely recommend surgical treatment. However, patients with intractable pain and severe limitation of ROM are possible candidate of arthroscopic capsular release.

Background: In Korea, fast aging country, an optimal healthcare service model for older adults should be developed. The purpose of this study is to identify the current healthcare system and to develop new healthcare service model using information and communication technologies (ICT) for older patients. Methods: Qualitative literature review, focus group interview and structured survey were conducted to identify current healthcare systems for older patients. Afterwards, we developed healthcare service model which include contests of comprehensive geriatric assessment, disease management, drug management, rehabilitation and consultation service using ICT. Result: Sixty (23 hypertension, 18 diabetes and 19 heart failure) articles are reviewed. ICT based chronic disease management models was effective and patients’ satisfaction were improved. In focus group interview and structured survey, current patients and medical information transfer between hospitals was inconvenient, costly and time consuming, especially in long-term care hospital (LTCH) and nursing home (NH) and the necessity of service model to manage older patients using ICT was confirmed. ICT based service model for older patients dwelling LTCH and NH was developed (Health-RESPECT) which include evidence based 1) comprehensive geriatric assessment (CGA) and establishment of customized management strategy 2) chronic disease management service with decision support system 3) potentially inappropriate medication management service 4) rehabilitation service and 5) consultation and videoconference service. Conclusion : This study is meaningful to identify current healthcare systems in older adults and to develop a system to manage older patient living in LTCH and NH using ICT. However, Health-RESPECT service model will need to be validated in further study.

The elderly population growth rate is extremely high in Korean society, and life expectancy is close to 85 years old for women and 80 for men as of people born in 2015. The future hip fracture prediction model of Korea shows that the elderly hip fracture rate will increase by 1.4 times by 2025, which will impose a serious socioeconomic burden on Korean society and become a key issue of public health management. The fracture liaison service (FLS) is defined adequate treatment and services for patients over 50 years old with fragility fractures, enabling systematic identification and decreasing the risk of subsequent osteoporotic fractures. In Korean society, the introduction of FLS, which is verified not only in the socioeconomic aspects but also in the treatment of patients, is thought to be essential. However, the challenges that need to be addressed in order to implement FLS include the lack of awareness regarding the necessity of this system, the lack of healthcare systems, and inadequate policies. In the future, further studies on the FLS and its clinical and socioeconomic effects for the Korean medical system will be necessary.

Osteonecrosis of the femoral head (ONFH) usually affects patients younger than 50 years and frequently leads to collapse of the femoral head and subsequent osteoarthritis of the hip. Joint-preserving procedures are attempted in the early stages without collapse, while total hip arthroplasty (THA) is done during more advanced stages with femoral head collapse or a fracture in the necrotic portion. Thus, accurate staging of the disease is mandatory to decide therapeutic strategy. The purpose of this study is to determine the prevalence of occult fracture in the necrotic portion among osteonecrotic femoral heads, which were classified as Association Research Circulation Osseous (ARCO) stage 1 or 2 on radiographs.A preoperative computer tomography (CT) scan was routinely performed to obtain an adequate cup position in patients undergoing THA at our institution. Radiographs and CT scans of 308 patients, who underwent unilateral THA due to ONFH from January 2011 to December 2014, were assessed by two orthopedic surgeons to compare the stage based on simple radiography and that based on CT scans.Among the 308 hips, which were classified as stage I or II lesions on simple radiography, fracture inside the necrotic portion was seen in 63 hips (20.5%) on CT scans. Fifty-nine of the 63 patients were followed for two to five years. Further collapse of the femoral head occurred in 41 patients, and 36 of them underwent THA during the follow up.In this study, 20.5% of hips classified as ARCO stage I or II on simple radiography were found to be ARCO stage III on CT imaging. When a joint-preserving treatment is considered for early stage ONFH, CT examination is necessary for more precise staging of the disease.

Although a few trials have explored the relationship between postoperative delirium (POD) and incident dementia in patients with hip surgery, the numbers of participants in each study are relatively small. Thus, we performed a meta-analysis to examine whether POD after hip surgery is a risk factor for incident dementia.Six prospective cohort studies investigating the development of incident dementia in patients with POD after hip surgery were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- and random- effect models.POD significantly increased the risk of incident dementia and cognitive decline (overall odds ratio [ORs] = 8.957; 95 % confidence interval [CI], 5.444-14.737; P 0.001 in fixed-effects model; overall ORs = 8.962; 95 % CI, 5.344-15.029; P 0.001 in random-effects model). A publication bias was not evident in this study.Our meta-analysis revealed that POD after hip surgery is a risk factor for incident dementia. Early identification of cognitive function should be needed after surgery and appropriate prevention and treatment for dementia will be required, especially in cases with POD.

To examine the effects of a rural community-based program integrating health education and self-directed home-based resistance training on the mobility function of older women with knee osteoarthritis (OA).Participants were assigned to the control (CON) or intervention (INT) group. Participants completed a mobility function assessment and questionnaire evaluation. The CON group received only the health education program and the INT group also participated in resistance training for 5 months. Primary outcomes were mobility function measured using a timed chair stand (TCS), timed upgo (TUG), gait speed (GS), and knee extensor strength (KES). We evaluated body composition and questionnaire results (WOMAC score, SARC-F scale, and SOF index) as secondary outcomes.There were significant differences in the interactions of group-by-time effects for TCS (p 0.001), TUG (p = 0.006), GS (p = 0.020), and knee strength (p = 0.010). In the CON group, TCS (p = 0.003) and TUG (p = 0.005) increased compared with baseline, while in the INT group, TCS decreased significantly (p 0.001) and TUG tended to decrease after the intervention. The INT group showed improvement in GS (p 0.001) and KES (p = 0.003) after the intervention. By contrast, the CON group showed decreasing GS (p = 0.021) and KES (p = 0.011) compared with baseline. The SARC-F scale differed significantly in the interaction of group-by-time effects (p = 0.030), while the body composition, SOF index, and WOMAC score did not differ.These results suggest that an integrated intervention program combining self-directed home-based resistance training with health education effectively improves the mobility function of older adults with knee OA dwelling in rural areas.

Background The microRNAs (miRNAs) down‐regulated in aged mouse skeletal muscle were mainly clustered within the delta‐like homologue 1 and the type III iodothyronine deiodinase (Dlk1‐Dio3) genomic region. Although clustered miRNAs are coexpressed and regulate multiple targets in a specific signalling pathway, the function of miRNAs in the Dlk1‐Dio3 cluster in muscle aging is largely unknown. We aimed to ascertain whether these miRNAs play a common role to regulate age‐related muscle atrophy. Methods To examine anti‐atrophic effect of miRNAs, we individually transfected 42 miRNA mimics in fully differentiated myotubes and analysed their diameters. The luciferase reporter assay using target 3′ untranslated region (UTR) and RNA pull‐down assay were employed to ascertain the target predicted by the TargetScan algorithm. To investigate the therapeutic potential of the miRNAs in vivo, we generated adeno‐associated virus (AAV) serotype 9 expressing green fluorescent protein (GFP) (AAV9‐GFP) bearing miR‐376c‐3p and infected it into the tibialis anterior muscle of old mice. We performed morphometric analysis and measured ex vivo isometric force using a force transducer. Human gluteus maximus muscle tissues (ages ranging from 25 to 80 years) were used to investigate expression levels of the conserved miRNAs in the Dlk1‐Dio3 cluster. Results We found that the majority of miRNAs (33 out of 42 tested) in the cluster induced anti‐atrophic phenotypes in fully differentiated myotubes with increasing their diameters. Eighteen of these miRNAs, eight of which are conserved in humans, harboured predicted binding sites in the 3′ UTR of muscle atrophy gene‐1 (Atrogin‐1) encoding a muscle‐specific E3 ligase. Direct interactions were identified between these miRNAs and the 3′ UTR of Atrogin‐1, leading to repression of Atrogin‐1 and thereby induction of eIF3f protein content, in both human and mouse skeletal muscle cells. Intramuscular delivery of AAV9 expressing miR‐376c‐3p, one of the most effective miRNAs in myotube thickening, dramatically ameliorated skeletal muscle atrophy and improved muscle function, including isometric force, twitch force, and fatigue resistance in old mice. Consistent with our findings in mice, the expression of miRNAs in the cluster was significantly down‐regulated in human muscle from individuals > 50 years old. Conclusions Our study suggests that genetic intervention using a muscle‐directed miRNA delivery system has therapeutic efficacy in preventing Atrogin‐1‐mediated muscle atrophy in sarcopenia.

OBJECTIVES We aimed to validate a multi-sensor-based kiosk (automatically measured Short Physical Performance Battery [eSPPB] kiosk) that can perform automated measurement of the SPPB. DESIGN Prospective, cross-sectional study. SETTING Rehabilitation clinic of a tertiary-care hospital. PARTICIPANTS Ambulatory outpatients, aged 65 years or older (N = 40). MEASUREMENTS The eSPPB kiosk was developed to measure the three components of the SPPB: standing balance, gait speed, and chair stand test with embedded sensors and algorithms. Correlations between the total and component-specific scores of the eSPPB and manually measured SPPB (mSPPB), assessed by a physical therapist, were assessed. Further, correlations between SPPB parameters and geriatric functional measures were also evaluated. RESULTS This study included 40 participants with a mean age of 74.4 ± 6.5 years, a mean total eSPPB score of 10.1 ± 2.1, and a mean total mSPPB score of 10.2 ± 2.1. The intraclass correlation coefficient between the eSPPB and mSPPB total score was 0.97 (P

This study compared manual stopwatch-based and automatic instrument-based measurements for gait speed (GS) obtained from the individual's usual walking pace using a 4-m walking test with different starting protocols in healthy older adults.One hundred fifty-three healthy older adults aged ≥ 65 years (57 men, 96 women) participated. GS was measured using both a stopwatch and automatic timer with or without 2-m acceleration and deceleration phases. In the GS measurement using the stopwatch, the first tester stood in the middle of the timing zone (MS1) while the second walked beside the participants from the beginning line to the ending line (MS2).In the manual method, MS1 and MS2 showed similar GS for both standing and moving starts. There was no significant difference in GS measured between with the manual stopwatch and with the automatic timer in standing start. However, in the moving start protocol, GS measured with the manual stopwatch was significantly faster, by 0.05 m/s in MS1 (p 0.001) and 0.04 m/s in MS2 (p 0.001) compared to the timed GS with the automatic timer. GS measured manually using a moving start was significantly faster than that measured manually using a standing start (MS1, 0.06 m/s, 5.0%, p 0.001; MS2, 0.08 m/s, 6.8%, p 0.001); however, there was no difference between the start protocols when automatic measurements were performed (p = 0.135).The starting protocol (starting and moving start) affected the usual 4-m GS when measured using a manual stopwatch. Therefore, we suggest that careful evaluation to measure GS for functional assessment of older adults using the moving start with a manual stopwatch.

BACKGROUND CONTEXT Lumbosacral disc herniation (LDH) is one of the most frequent musculoskeletal diseases causative of sick leave in the workplace and morbidity in daily activities. Nonsurgical managements are considered as first line treatment before surgical treatment. PURPOSE This clinical practice guideline (CPG) is intended to provide physicians who treat patients diagnosed with LDH with a guideline supported by scientific evidence to assist in decision-making for appropriate and reasonable treatments. STUDY DESIGN/SETTING A systematic review. PATIENT SAMPLE Studies of human subjects written in Korean or English that met the following criteria were selected: patients aged ≥18 years, clinical presentation of low back and radicular leg pain, diagnosis of LDH on radiological evaluation including computed tomography or magnetic resonance imaging. OUTCOMES MEASURES Pain and functional evaluation scales such as visual analogue scale, numeric rating scale, and Oswestry disability index METHODS The MEDLINE (PubMed), EMBASE, Cochrane Review, and KoreaMed databases were searched for articles regarding non-surgical treatments for LDH published up to July 2017. Of the studies fulfilling these criteria, those investigating clinical results after non-surgical treatment including physical and behavioral therapy, medication, and interventional treatment in terms of pain control and functional improvements were chosen for this study. RESULTS Nonsurgical treatments were determined to be clinically effective with regards to pain reduction and functional improvement in patients with LDH. Nevertheless, the evidence level was generally not evaluated as high degree, which might be attributed to the paucity of well-designed randomized controlled trials. Exercise and traction were strongly recommended despite moderate level of evidence. Epidural injection was strongly recommended with high degree of evidence and transforaminal approach was more strongly recommended than caudal approach. CONCLUSIONS This CPG provides new and updated evidence-based recommendations for treatment of the patients with LDH, which suggested that, despite an absence of high degrees of evidence level, non-surgical treatments were clinically effective.

We aimed to evaluate treatment outcomes of pediatric acute lymphoblastic leukemia (ALL) subgroups by risk-stratification, in the Yeungnam region of Korea.We reviewed the courses of 409 newly diagnosed ALL patients from January 2004 to December 2013 in the Yeungnam region.All patients were classified into three risk groups: standard risk (SR, n=212), high risk (HR, n=153) and very high risk (VHR, n=44). The mean follow-up time was 73.6 ± 39.4 months. The 7-year event-free survival (EFS) and overall survival (OS) rates were 78.7 ± 2.1% and 86.8 ± 1.8%, respectively. Significant 7-year EFS and OS rates for SR (84.0 ± 2.7%, 93.7 ± 1.8%), HR (76.5 ± 3.5%, 82.1 ± 3.3%), and VHR (60.6 ± 7.5%, 69.9 ± 7.5%) were observed (P0.001), respectively. Relapse occurred in 52 patients, and the cumulative 7-year incidence of relapse differed according to risk groups (SR vs. HR vs. VHR=12.6% vs. 14.0% vs. 29.6%, P=0.003).For the 46 relapsed patients who were treated, the 3-year EFS and OS were 42.3 ± 8.3%and 46.4± 8.4%. Among the 44 VHR patients, EFS was not significantly different between the chemotherapy-treated patients and those received hematopoietic stem cell transplantation (P=0.533). The 7-year EFS of the hyperleukocytosis subgroup (24 cases, 14 under 10 years of age)showed a tendency for better prognosis than that of the other VHR subgroups (P=0.178).Our results revealed improved outcomes in pediatric ALL patients with risk-stratified therapy. The hyperleukocytosis subgroup without any combined chromosomal abnormalities may respond favorably to chemotherapy alone after first complete remission.

Slc25a17 is known as a peroxisomal solute carrier, but the in vivo role of the protein has not been demonstrated. We found that the zebrafish genome contains two slc25a17 genes that function redundantly, but additively. Notably, peroxisome function in slc25a17 knockdown embryos is severely compromised, resulting in an altered lipid composition. Along the defects found in peroxisome-associated phenotypic presentations, we highlighted that development of the swim bladder is also highly dependent on Slc25a17 function. As Slc25a17 showed substrate specificity towards coenzyme A (CoA), injecting CoA, but not NAD+ , rescued the defective swim bladder induced by slc25a17 knockdown. These results indicated that Slc25a17 acts as a CoA transporter, involved in the maintenance of functional peroxisomes that are essential for the development of multiple organs during zebrafish embryogenesis. Given high homology in protein sequences, the role of zebrafish Slc25a17 may also be applicable to the mammalian system.

INTRODUCTION We investigated the apoptotic response to different degrees of denervation in young and older rats randomized into control (C), partial (PD), and complete denervation (CD) of muscles innervated by the sciatic nerve. METHODS Muscle wet weight to body weight (MWW/BW), myosin heavy chain (MHC) isoforms, and fiber cross-sectional area were determined in gastrocnemius and soleus muscles. Apoptotic responses were determined by changes in myonuclei and expression of Bcl-2 and BAX. RESULTS PD and CD resulted in significant reductions in MWW/BW and FCSA in both young and older rats. Older controls had greater apoptotic responses than young controls. Apoptotic responses were greater in PD and CD than in C in both age groups. No statistical interaction between denervation and age group was seen. CONCLUSIONS Older age was associated with increased level of apoptosis, but older muscle was not more vulnerable to the effect of denervation. Muscle Nerve 55: 262-269, 2017.

Skeletal muscle mass and power decrease with age, leading to impairment of mobility and metabolism in the elderly. Ca2+ signaling is crucial for myoblast differentiation as well as muscle contraction through activation of transcription factors and Ca2+-dependent kinases and phosphatases. Ca2+ channels, such as dihydropyridine receptor (DHPR), two-pore channel (TPC) and inositol 1,4,5-triphosphate receptor (ITPR), function to maintain Ca2+ homeostasis in myoblasts. Here, we observed a significant decrease in expression of type 1 IP3 receptor (ITPR1), but not types 2 and 3, in aged mice skeletal muscle and isolated myoblasts, compared with those of young mice. ITPR1 knockdown using shRNA-expressing viruses in C2C12 myoblasts and tibialis anterior muscle of mice inhibited myotube formation and muscle regeneration after injury, respectively, a typical phenotype of aged muscle. This aging phenotype was associated with repression of muscle-specific genes and activation of the epidermal growth factor receptor (EGFR)-Ras-extracellular signal-regulated kinase (ERK) pathway. ERK inhibition by U0126 not only induced recovery of myotube formation in old myoblasts but also facilitated muscle regeneration after injury in aged muscle. The conserved decline in ITPR1 expression in aged human skeletal muscle suggests utility as a potential therapeutic target for sarcopenia, which can be treated using ERK inhibition strategies.

Purpose Breast cancer patients undergoing axillary lymph node dissection (ALND) are at risk of lymphedema (LE). Successful management of LE relies on early diagnosis using sensitive modalities. In the current study, we explored the effectiveness of a surveillance program for lymphedema management (SLYM) compared to standard care. Methods Breast cancer patients who underwent ALND in Seoul National University Bundang Hospital from January 2008 to December 2015 were included in this prospective study. The SLYM commenced in May 2011. The LE outcomes of patients treated prior to initiation of the SLYM were compared with those of patients after SLYM implementation. Results A total of 707 patients were included, 390 in the SLYM group and 317 in the historical control (HC) group. A total of 203 patients (28.7 %) had episodes of all-stage LE during follow-up. Of these, 126 (19.7 %) were in the surveillance group and 77 (24.3 %) in the HC group. The overall 5-year cumulative incidence of LE (greater than stage 3) was 25 (95 % CI 15.4–34.6) (6.4 %) in the SLYM group and 48 (95 % CI, 15.4–34.6) (15.1 %) in the HC group. In the SLYM group, poor compliance had a significant impact on LE incidence (OR = 2.98, P = 0.002). Low level of self-monitoring and insight scores were significantly related to LE incidence (OR = 1.31, P = 0.025) after adjusting for age, body mass index, the type of surgery chosen, radiation therapy, and chemotherapy. With a cut-off of 29.5 days from operation to the first visit to the LE clinic, the sensitivity was 60 % and the specificity 61 % in terms of predicting a LE event. Conclusions Surveillance improves LE prevention compared to clinical evaluation. The first visit to the LE clinic should be made within 1 month after surgery. In the first year, visits should be made at intervals of less than 3 months. Electronic supplementary material The online version of this article (doi:10.1007/s10549-016-3993-7) contains supplementary material, which is available to authorized users.

Recent studies have focused on evidence-based interventions to prevent mobility decline and enhance physical performance in older adults. Several modalities, in addition to traditional strengthening programs, have been designed to manage age-related functional decline more effectively. In this study, we reviewed the current relevant literatures to assess the therapeutic potential of eccentric exercises for age-related muscle atrophy (sarcopenia). Age-related changes in human skeletal muscle, and their relationship with physical performance, are discussed with reference to in vitro physiologic and human biomechanics studies. An overview of issues relevant to sarcopenia is provided in the context of the recent consensus on the diagnosis and management of the condition. A decline in mobility among the aging population is closely linked with changes in the muscle force–velocity relationship. Interventions based specifically on increasing velocity and eccentric strength can improve function more effectively compared with traditional strengthening programs. Eccentric strengthening programs are introduced as a specific method for improving both muscle force and velocity. To be more effective, exercise interventions for older adults should focus on enhancing the muscle force–velocity relationship. Exercises that can be performed easily, and that utilize eccentric strength (which is relatively spared during the aging process), are needed to improve both muscle force and velocity.

Aim In the present study, we determined the effect of an integrated health education and elastic band resistance training program on body composition, physical function, muscle strength and quality in community-dwelling elderly women. Methods We recruited participants with eligibility inclusion criteria, and randomly assigned them to either the control group (n = 19) or the intervention group (n = 19). The integrated intervention program comprised of health education and individual counseling, and elastic band training for 18 weeks (8 weeks of supervised training and 10 weeks of self-directed training). We assessed body composition, muscle strength and quality, and physical function at pre-, after 8 weeks (mid-) and 18 weeks (post-training). Results After the intervention, there were no significant changes in skeletal muscle index, fat free mass, total lean mass and total fat mass for both the control group and intervention group. However, the interaction effect was significantly different in SPPB score (P Conclusions These results show the effectiveness of following self-directed resistance training with health education after supervised training cessation in improvement of short physical performance battery and leg muscle strength. This intervention program might be an effective method to promote muscle strength and quality, and to prevent frailty in elderly women. Geriatr Gerontol Int 2017; 17: 825-833.

Secondary lymphedema is a common irreversible side effect of breast cancer surgery. We investigated if risk of secondary lymphedema in breast cancer survivors was related to changes in serum phospholipid fatty acid composition. Study subjects were voluntarily recruited into the following three groups: breast cancer survivors who had sentinel lymph node biopsy without lymphedema (SLNB), those who had auxillary lymph node dissection without lymphedema (ALND), and those who had ALND with lymphedema (ALND + LE). Body mass index (BMI), serum lipid profiles, bioimpedance data with single-frequency bioimpedance analysis (SFBIA), and serum phospholipid compositions were analyzed and compared among the groups. BMI, serum total cholesterol (total-C), and low-density lipoprotein cholesterol (LDL-C) and SFBIA ratios increased only in the ALND + LE. High polyunsaturated fatty acids (PUFAs) and high C20:4 to C18:2 n-6 PUFAs (arachidonic acid [AA]/linoleic acid [LA]) was detected in the ALND and ALND + LE groups compared to SLNB. The ALND + LE group showed increased activity indices for delta 6 desaturase (D6D) and D5D and increased ratio of AA to eicosapentaenoic acid (AA/EPA) compared to the ALND and SLNB groups. Correlation and regression analysis indicated that D6D, D5D, and AA/EPA were associated with SFBIA ratios. We demonstrated that breast cancer survivors with lymphedema had elevated total PUFAs, fatty acid desaturase activity indices, and AA/EPA in serum phospholipids. Our findings suggested that desaturation extent of fatty acid composition might be related to the risk of secondary lymphedema in breast cancer survivors.

Myung-Sun Kim,1 Bit-Na Kang,1 Jae Young Lim2 1Department of Psychology, Sungshin Women’s University, Seoul, Republic of Korea; 2Department of Psychiatry, Keyo Medical Foundation, Keyo Hospital, Uiwang, Republic of Korea Purpose: Decision-making is the process of forming preferences for possible options, selecting and executing actions, and evaluating the outcome. This study used the Iowa Gambling Task (IGT) and the Prospect Valence Learning (PVL) model to investigate deficits in risk-reward related decision-making in patients with chronic schizophrenia, and to identify decision-making processes that contribute to poor IGT performance in these patients. Materials and methods: Thirty-nine patients with schizophrenia and 31 healthy controls participated. Decision-making was measured by total net score, block net scores, and the total number of cards selected from each deck of the IGT. PVL parameters were estimated with the Markov chain Monte Carlo sampling scheme in OpenBugs and BRugs, its interface to R, and the estimated parameters were analyzed with the Mann–Whitney U-test.Results: The schizophrenia group received significantly lower total net scores compared to the control group. In terms of block net scores, an interaction effect of group × block was observed. The block net scores of the schizophrenia group did not differ across the five blocks, whereas those of the control group increased as the blocks progressed. The schizophrenia group obtained significantly lower block net scores in the fourth and fifth blocks of the IGT and selected cards from deck D (advantageous) less frequently than the control group. Additionally, the schizophrenia group had significantly lower values on the utility-shape, loss-aversion, recency, and consistency parameters of the PVL model. Conclusion: These results indicate that patients with schizophrenia experience deficits in decision-making, possibly due to failure in learning the expected value of each deck, and incorporating outcome experiences of previous trials into expectancies about options in the present trial. Keywords: IGT, PVL model, risk-reward related decision-making&nbsp

Objective To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear. Methods In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments. Results A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear.

Falls and fall-related injuries are common amongst the elderly population and have deleterious effects on the quality of life or independence in daily living in the elderly. Falling is also associated with substantial morbidity, mortality, nursing home admission, and an increase in medical costs. Given that Korea has shown an extreme demographic shift with its population aging at the fastest pace among developed countries, assessment of fall risks and implementing intervention strategies to the high-risk population are getting more important. The guidelines for the prevention of falls were developed first by The Korean Association of Internal Medicine and The Korean Geriatric Society. These guidelines were developed by an adaptation process and the use of an evidence-based method; 4 guidelines were retrieved by systematic review and by the AGREE (appraisal of guidelines for research and evaluation) II process and 7 statements were made based on the grading of evidence, and these recommendations followed the GRADE (grades of recommendation, assessment, development, and evaluation) framework. Given that falls result from a various combination of many factors, the guidelines contain multidimensional assessment measures and multimodal strategies to prevent falls. These guidelines were developed not only for use by primary physicians but also for patients and the general population. Therefore, these guidelines provide detailed recommendations and concrete measures for the assessment of the risk of a fall and to prevent falls amongst the elderly population. Keywords: Accidental falls; Guidelines; Aged; Prevention Language: ko

Purpose: Mumps meningitis is a common complication of mumps infection; however, information on mumps meningitis in the postvaccine era is limited. The purpose of the present study was to determine factors associated with mumps meningitis and to discuss the effect of vaccination on this disease. Methods: We retrospectively reviewed patients younger than 19 years with mumps, diagnosed at a university hospital in Korea between 2003 and 2013. Patients were divided into groups with and without meningitis, and the clinical features of the 2 groups were compared. Results: The study enrolled 119 patients: 19 patients with meningitis and 100 patients without. Univariate analysis showed that older age (median: 15 years vs. 9.5 years, respectively), a longer interval from last vaccination (median: 10.2 years vs. 4.8 years, respectively), and febrile presentation (94.7% vs. 31.0%, respectively) were significantly associated with mumps meningitis. Sex, number of vaccination doses, bilateral parotitis, and the presence of complications other than meningitis did not differ between the 2 groups. In multivariate logistic regression analysis, age (odds ratio, 1.38; 95% confidence interval, 1.01–1.89; P=0.04) and fever (odds ratio, 30.46; 95% confidence interval, 3.27–283.61; P

Objectives To explore upper-limb disability with respect to health outcomes, operationalized by Disabilities of the Arm, Shoulder, and Hand, and to identify factors associated with each element of upper-limb disability over a 2-year period in breast cancer survivors. Design Prospective cohort study. Setting University hospital cancer center. Participants Individuals (N=191) recruited from all the patients with newly diagnosed breast cancer before cancer surgery at a university hospital between April 2006 and March 2007. Interventions Not applicable. Main Outcome Measures We evaluated demographics, social variables, and upper-limb disability in a baseline assessment preoperatively. Follow-up evaluations were conducted in outpatient clinics 3 months after surgery and at 12 and 24 months after surgery. Linear regression models with the generalized estimating equations of the compound symmetry covariance structure were used. Results Time since surgery was inversely associated with the impairment items score (β=−.20; 95% confidence interval [CI], −.49 to −.08) and positively associated with the activity limitation items score (β=.59; 95% CI, .29–.88). The impact of upper-limb disability preoperatively on the items involving both the activity limitation and participation restrictions scores was positive (β=2.89; 95% CI, .76–5.02) after adjusting for demographic, treatment type, and socioeconomic factors. Conclusions Our study revealed that upper-limb impairment recovered with time after breast cancer surgery; however, upper-limb function-related activity and participation were reduced through 2 years after surgery.

To evaluate the association between the phase angle and functional outcomes in patients after in-hospital postoperative rehabilitation for fragility hip fracture.A prospective observational study was conducted in 68 patients over 65 years of age who had undergone a two-week postoperative rehabilitation for hip fracture. Phase angle of the non-fractured limb was used to reduce the error caused by postoperative edema. Participants were divided into groups according to phase angle terciles. Multivariable linear regression models adjusted for relevant factors known to affect functional outcomes after hip fracture were performed to identify the association between phase angle of the non-fractured limb and functional outcomes at discharge as evaluated the Functional Ambulation Category and Berg Balance Scale.The mean age of this study population was 81.9 ± 6.2 years and the average phase angle of the non-fractured limb was 3.6 ± 1.3°. The lowest tercile of phase angle (3.0°) was independently associated with worse functional outcomes as measured by the Functional Ambulation Category and Berg Balance Scale at discharge (adjusted coefficient [β] = -0.287, P = 0.004; β = -0.172, P = 0.049, respectively) after adjusting for relevant covariates.Low phase angle of the non-fractured limb was independently associated with worse functional outcomes at rehabilitation discharge in patients who undergoing hip fracture surgery. Phase angle may reflect both the pre-fracture body composition and functional status. It is a useful indicator for functional outcomes after postoperative rehabilitation for fragility hip fracture.

Climate change and environmental pollution are increasingly ravaging countries around the world. This study examines the direct effects of perceived environmental threats and political participation, as well as their joint effects, on individuals&rsquo, support for a lower standard of living and the increased government spending necessary for environmental protection. Using the 2014 South Korean General Social Survey and an ordered probit, the study finds that individuals&rsquo, perceptions of environmental threats are associated positively with their support for government spending and a lower standard of living. Political participation is statistically significant and positive only in its relationship with support for a lower standard of living. Nevertheless, political participation is a powerful moderator and amplifies positive relationships between individuals&rsquo, perceptions of environmental threats and their support for a lower standard of living and government spending on environmental protection. In estimating predicted probabilities of strong support, perceived environmental threats and political participation jointly increased support for lower living standards by 35.67% and for government spending by 69.58%.

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as “age-related loss of muscle mass, plus low muscle strength, and/or low physical performance” and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength

Background Alarm services in the Order Communication System improve awareness for related physicians including orthopaedic surgeons, internal medicine doctors, and other relevent doctors. This prospective observational multicenter study was to compare the diagnostic and treatment rates of osteoporosis between an alarm service group and a no alarm service group. Methods From January 2017 to december 2017, The subjects included patients aged 50 years or older with hip fractures from 16 hospital-based multicenter cohorts. Among the 16 hospitals, 5 university hospitals established an alarm service for osteoporosis management (i.e., Alarm group) and 11 university hospitals did not set-up alarm services (i.e., Control group). The rate of dual energy X-ray absorptiometry (DXA) test and the initiation rate of antiosteoporosis medications between the 2 groups were compared at enrollment and at 6 months follow-up. Results During the study period, 1,405 patients were enrolled. The DXA examination rate and initiation rate of osteoporosis treatment between the Alarm group and the Control group were 484 patients (89.8%) vs. 642 patients (74.1%) (P

Osteoporosis and osteoporosis related fractures contribute a large part of the medical cost in developed countries. Considering the preventive effect of osteoporotic medications, high rate of mortality and complications, poor quality of life after osteoporosis related fractures, the growing trend of older populations in the future, osteoporosis and osteoporosis related fractures are important targets of preventive treatment and also targets of socioeconomic cost reduction. Treating osteoporosis and preventing osteoporosis related fractures have become an essential element in Korean medical system. Despite the various differences in the health care system, hospitals in many other countries are operating fracture liaison service and they have confirmed its cost-effectiveness. In Korea's health care system, further research on cost-effectiveness as well as its clinical effects is needed.

Purpose Sodium is an essential nutritional electrolyte that affects growth. A low serum sodium concentration in healthy premature infants beyond 2 weeks of life is called late-onset hyponatremia (LOH). Here, we investigated the association between LOH severity and growth outcomes in premature infants. Methods Medical records of premature infants born at ≤32 weeks of gestation were reviewed. LOH was defined as a serum sodium level

Skeleton plays diverse roles via crosstalk between others, thus it is conceivable that lower BMD per se may reflect negative influences on health status and threats to life independent of fracture events. We investigated investigate the association between BMD and mortality, and to examine whether the rate of bone loss can predict future mortality in an elderly population. This study was conducted as a part of the Korean Longitudinal Study on Health and Aging, a community-based prospective study of Korean people aged 65 years and older that began in 2005. A total of 648 people (318 men and 330 women) were included. Dual energy X-ray absorptiometry were conducted at baseline and at 5 years. Mortality data were collected until the date of death or the last follow-up in December 2014. Osteoporosis in all skeletal sites significantly related to increased risk of mortality in men and women, but the associations were stronger for BMD in the femur neck and total hip than in the lumbar spine. A multivariable Cox proportional-hazards model showed that baseline BMD level was a significant independent predictor of increased all-cause mortality for all three skeletal sites in men, and for lumbar spine and total hip in women. Furthermore, faster bone loss of BMDs, as shown by the decline in BMD in the lumbar spine, femur neck, and total hip, was significantly related to increased risk of mortality after adjusting for all covariates in men. Faster BMD loss at femur neck was also related to the increased risks of mortality in women. Conclusively, both a lower baseline values and greater decline in BMD were associated with excess morality in community-dwelling elderly population; there associations were stronger in men than in women. This study emphasizes the importance of skeletal health for healthy aging, revealing lower bone mass and faster bone loss may be markers of poorer health that are driving excess mortality.

Background Most adults with cerebral palsy encounter newly developing physical health problems and premature functional decline with aging. These physical and functional losses along with the characteristic symptoms of cerebral palsy may heighten the risk of sarcopenia. Objective To determine the prevalence of sarcopenia among a selected group of adults with cerebral palsy and to identify the factors associated with their sarcopenia among them. Design Cross-sectional study. Setting University hospitals and communities for persons with disabilities. Participants A total of 80 adults with cerebral palsy (46 men and 34 women with mean age of 42.8 ± 8.86 years) were included. Method Muscle mass, strength, and physical performance were measured to diagnose sarcopenia. Participants also completed a structured questionnaire for physical, psychological, or socioeconomic attributes and health-related quality of life. Main outcome measures Prevalence of sarcopenia in adults with cerebral palsy. Results The prevalence of sarcopenia was 47.9%. Sarcopenia was significantly associated with sex, the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), body mass index (BMI), and trunk fat. Male, higher GMFCS and lower BMI were significant risk factors of sarcopenia. Sarcopenic adults with cerebral palsy showed significantly lower health-related quality of life. Conclusion The prevalence of sarcopenia in adults with cerebral palsy was higher than that of general population despite the young age of the selected group. Modifiable risk factor was a low BMI. Level of evidence III.

Cerebral vasculitis is thought to be a possible underlying mechanism of severe neurological complications of Kawasaki's disease (KD), such as cerebral infarct or aneurysm rupture. To evaluate the intracranial inflammatory response in patients with acute-stage KD, we measured the levels of cytokines (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) and pentraxin-3 (PTX3) in the cerebrospinal fluid of patients with KD (n = 7) and compared the levels to those of the age- and sex-matched febrile control patients (bacterial meningitis [n = 5], enteroviral meningitis [n = 10], nonspecific viral illness without central nervous system involvement [n = 10]). PTX3 and TNF-α were rarely detected and only in trace concentration in KD, and the levels of IL-6 were not different from those of nonspecific viral illnesses. These mediators are not established biomarkers for cerebral vasculitis but might reflect vascular inflammation in various diseases including KD. Therefore, intracranial inflammation including vasculitis seems to be insignificant in our patients with KD. However, our results might be attributed to the fact that these patients lacked any clinical signs of cerebral or coronary vessel involvement. None of them underwent brain imaging. To clarify this issue, further studies involving patients with neurologic symptoms and proven involvement of cerebral vessels are needed.

The primary cilia are evolutionarily conserved microtubule-based cellular organelles that perceive metabolic status and thus link the sensory system to cellular signaling pathways. Therefore, ciliogenesis is thought to be tightly linked to autophagy, which is also regulated by nutrient-sensing transcription factors, such as PPARA (peroxisome proliferator activated receptor alpha) and NR1H4/FXR (nuclear receptor subfamily 1, group H, member 4). However, the relationship between these factors and ciliogenesis has not been clearly demonstrated. Here, we present direct evidence for the involvement of macroautophagic/autophagic regulators in controlling ciliogenesis. We showed that activation of PPARA facilitated ciliogenesis independently of cellular nutritional states. Importantly, PPARA-induced ciliogenesis was mediated by controlling autophagy, since either pharmacological or genetic inactivation of autophagy significantly repressed ciliogenesis. Moreover, we showed that pharmacological activator of autophagy, rapamycin, recovered repressed ciliogenesis in ppara(−)(/−) cells. Conversely, activation of NR1H4 repressed cilia formation, while knockdown of NR1H4 enhanced ciliogenesis by inducing autophagy. The reciprocal activities of PPARA and NR1H4 in regulating ciliogenesis were highlighted in a condition where de-repressed ciliogenesis by NR1H4 knockdown was further enhanced by PPARA activation. The in vivo roles of PPARA and NR1H4 in regulating ciliogenesis were examined in greater detail in ppara(−)(/)(−) mice. In response to starvation, ciliogenesis was facilitated in wild-type mice via enhanced autophagy in kidney, while ppara(−)(/)(−) mice displayed impaired autophagy and kidney damage resembling ciliopathy. Furthermore, an NR1H4 agonist exacerbated kidney damage associated with starvation in ppara(−)(/)(−) mice. These findings indicate a previously unknown role for PPARA and NR1H4 in regulating the autophagy-ciliogenesis axis in vivo.

[Purpose] Myogenic progenitors play a critical role in injury-induced myofiber regeneration. The purpose of this study was to characterize the effects of oleate and L-carnitine on the overall behavior of proliferating myogenic progenitors (myoblasts) and its link to the mitochondrial biogenic process. [Methods] C2C12 myoblasts were cultured either with no treatment, oleate, L-carnitine, or their mixture. Proliferating myoblasts were investigated under a phase-contrast microscope. Myonuclei and myosin heavy chain were stained with DAPI and MF20 antibody, respectively, in differentiated myotubes and visualized under florescence microscopy. Mitochondrial biogenic markers and porin were assessed by qRT-PCR or immunoblotting. [Results] Increased proliferation rate was observed in myoblasts conditioned with oleate or a mixture of oleate and L-carnitine in contrast to that in non-treated (NT) and L-carnitine-treated myoblasts. Myoblast viability was not statistically different among all tested groups. Fusion index and myotube width were greater in oleate- or L-carnitine-conditioned myotubes than those in NT myotubes, with the greatest effect seen in myotubes conditioned with the mixture. The gene expressions of Pgc1-α, Nrf1, and Tfam were the greatest in myotubes conditioned with the mixture, whereas the level of Ncor1 expression was lower compared to those of the other groups. Protein level of porin was the greatest in myotubes conditioned with the mixture, followed by that of individually treated myotubes with oleate and L-carnitine. [Conclusion] These results provide a critical piece of cellular evidence that combined treatment of oleate and L-carnitine could serve as a potential therapeutic strategy to facilitate biological activation of myogenic progenitors.

We compared transplant outcomes between donor types and stem cell sources for childhood acute myeloid leukemia (AML). The medical records of children with AML in the Yeungnam region of Korea from January 2000 to June 2017 were reviewed. In all, 76 children with AML (male-to-female ratio = 46:30) received allogenic hematopoietic stem cell transplantation (allo-HSCT). In total, 29 patients received HSCT from either a matched-related donor or a mismatched-related donor, 32 patients received an unrelated donor, and 15 patients received umbilical cord blood. In term of stem cell sources, bone marrow was used in 15 patients and peripheral blood in 46 patients. For all HSCT cases, the 5-year overall survival (OS) was 73.1% (95% CI: 62.7-83.5) and the 5-year event-free survival (EFS) was 66.1% (95% CI: 54.5-77.7). There was no statistical difference in 5-year OS according to the donor types or stem cell sources (P = .869 and P = .911). There was no statistical difference in 5-year EFS between donor types or stem cell sources (P = .526 and P = .478). For all HSCT cases, the 5-year relapse rate was 16.1% (95% CI: 7.3-24.9) and the 5-year non-relapse mortality (NRM) was 13.3% (95% CI: 5.1-21.5). There was no statistical difference in the 5-year relapse rate according to the donor types or stem cell sources (P = .971 and P = .965). There was no statistical difference in the 5-year NRM between donor types or stem cell sources (P = .461 and P = .470).