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Du-Ri Kim1,2 *, Seunghwan Song1,3 *, Gwon-Min Kim,1 Jae Hyeok Chang,1,4 Young Jin Tak,5 Up Huh,1,3 Jeong Su Cho,3 Yung Liao,6 Kap-Soo Han,7 Myoung-Hwan Ko,7,8 Jong-Hwan Park1 1Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea; 2Department of Occupational Therapy, Graduate School of Inje University, Gimhae, Korea; 3Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea; 4Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea; 5Department of Family Medicine, Pusan National University Hospital, Busan, Korea; 6Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan; 7Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea; 8Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea*These authors contributed equally to this workCorrespondence: Myoung-Hwan KoDepartment of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, KoreaTel +82-63-250-1785Email mhko@jbnu.ac.krJong-Hwan ParkHealth Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49241, KoreaTel +82-51-240-7071Email parkj@pusan.ac.krPurpose: Information and communication technology (ICT)-based training devices for older adults’ care related to dementia are being developed to enhance older adults’ cognitive functions. Older adults who require bicycle training devices can improve muscle strength and balance of lower limbs by continuously contracting and relaxing lower-limb muscles and improving cognitive function to prevent dementia. This study was conducted to investigate the effects of an ICT-based multicomponent program on body composition and cognitive function in older adults.Patients and Methods: In a randomized controlled intervention test on 20 people over the age of 60 (exercise group: n = 10; control: n = 10), the multicomponent program was applied to the exercise group twice per week, once per day for 12 weeks, at 30 min per session, whereas the control group was advised to maintain their usual daily activities.Results: Comparing body composition changes and cognitive function changes before and after intervention exhibited statistically significant differences in skeletal muscle mass (P=0.01) and modified Alzheimer’s disease assessment scale–cognitive score (P=0.01) between the two groups.Conclusion: It can be difficult to be engaged in a simple repetitive exercise program. Therefore, to meet older adults’ interests and expectations, a customized ICT-based multicomponent program, which can improve body composition and cognitive function in older adults and is believed to help prevent dementia, is recommended.Trial Registration: UMIN000042129 (https://www.umin.ac.jp/english/).Keywords: ICT-based multicomponent program, body composition, cognitive function, dementia, older adults

Su Hwan Lee, Soo Jung Kim, Yeji Han, Yon Ju Ryu, Jin Hwa Lee, Jung Hyun Chang Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea Background: Muscle mass is known to be associated with mortality in elderly adults. Because hand grip strength (HGS) is known as a simple assessment tool for muscular strength, many researchers have studied the association between HGS and disease. However, empirical evidence for the relationship between chronic obstructive pulmonary disease (COPD) and HGS is still controversial. The aim of this study was to evaluate the association between COPD and HGS, using Korean population data. Methods: This was a population-based cross-sectional study. Data were obtained from the sixth Korean National Health and Nutrition Examination Survey, which was conducted from 2013 to 2015. To reduce the effects of HGS-related factors and potential confounding factors, propensity score matching was used to match subjects with and without COPD. Results: Among 14,930 subjects, 832 were enrolled in each group (non-COPD and COPD) after propensity score matching. COPD subjects did not have lower HGS than non-COPD subjects (non-COPD vs COPD, male, 38.0±7.0 vs 38.9±7.0 kg, P=0.044, female, 23.8±4.6 vs 24.2±4.9 kg, P=0.342). Lung function was classified by Global Initiative for Chronic Obstructive Lung Disease stages and was not significantly associated with HGS. For male COPD subjects, there was a significant correlation between HGS and the EuroQol Five-Dimension Questionnaire (EQ5D) utility score index, which is an indicator of quality of life that adjusts for age and body mass index (r=0.201, P

Chin Kook Rhee,1 Jung Hyun Chang,2 Eu gene Choi,3 Hyun kuk Kim,4 Yong-Soo Kwon,5 Sun Young Kyung,6 Ji-Hyun Lee,7 Myung Jae Park,8 Kwang Ha Yoo,9 Yeon Mok Oh10 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University Medical Center, Seoul, 3Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Daejeon Hankook Hospital, Daejeon, 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, 6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center of CHA University, Seongnam, 8Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, KyungHee University Hospital, Seoul, 9Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, 10Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Abstract: A new quinolone, zabofloxacin, has now been developed; hence, a non-inferiority trial is needed to compare this new compound with another widely used quinolone to examine its efficacy and safety for the treatment of chronic obstructive pulmonary disease (COPD) exacerbations. This was a prospective, multicenter, double-blind, double-dummy, randomized, controlled, parallel-group, Phase III, non-inferiority clinical trial designed to compare oral zabofloxacin (367 mg once daily for 5 days) with moxifloxacin (400 mg once daily for 7 days) for the treatment of patients with COPD exacerbation. In all, 345 COPD patients with a moderate COPD exacerbation were enrolled in the study via the outpatient clinics at 31 university hospitals. Clinical per protocol analysis revealed that the clinical cure rate for zabofloxacin was 86.7% and that for moxifloxacin was 86.3% (the rate difference, 0.4%; 95% confidence interval, –7.7%–8.6%). Intention-to-treat analysis revealed clinical cure rates of 77.1% and 77.3% (difference, –0.2%; 95% confidence interval, –9.0%–8.8%), respectively. These results confirm that zabofloxacin is not inferior to moxifloxacin. The favorable microbiological response rate for zabofloxacin was 67.4% and that for moxifloxacin was 79.5% (P=0.22). Patients in the zabofloxacin group showed better patient-oriented outcomes, as measured by EXAcerbations of Chronic Pulmonary Disease Tool-Patient-Reported Outcome and the COPD assessment test scores, than patients in the moxifloxacin group. Adverse drug reactions related to zabofloxacin occurred in 9.7% of cases and those related to moxifloxacin occurred in 9.6% of cases (P=0.97). The dropout rate due to adverse events was 0% (0/175) in the zabofloxacin group and 1.8% (3/167) in the moxifloxacin group (P=0.12). Oral zabofloxacin (367 mg once daily for 5 days) was not inferior to oral moxifloxacin (400 mg once daily for 7 days) for the treatment of patients with COPD exacerbation. Keywords: chronic obstructive pulmonary disease, exacerbation, zabofloxacin, quinolone, EXACT-PRO, CAT

Seok Jeong Lee,1 Seo Woo Kim,1 Kyoung Ae Kong,2 Yon Ju Ryu,1 Jin Hwa Lee,1 Jung Hyun Chang1 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, 2Department of Clinical Trial Center, School of Medicine, Ewha Womans University, Seoul, Republic of Korea Background: Chronic obstructive pulmonary disease (COPD) patients include those who have never smoked. However, risk factors other than smoking in never-smokers have not been elucidated sufficiently. This study investigated the risk factors for COPD among never-smokers in Korea using population-based data. Methods: The data were retrieved from the Korean National Health and Nutrition Survey IV conducted from 2007 to 2009. Among subjects aged 40 years or older who underwent appropriate pulmonary function tests, never-smokers not diagnosed with asthma and not showing a restrictive pattern on pulmonary function tests were enrolled. Risk factors of COPD in never-smokers were analyzed using logistic regression models. Results: Among 24,871 participants in the representative Korean cohort, 3,473 never-smokers were enrolled. COPD patients accounted for 7.6% of the never-smokers. In the logistic regression analysis, low education status (odds ratio [OR]: 2.0; 95% confidence interval [CI]: 1.2–3.2), occupational exposure (OR: 2.6; 95% CI: 1.3–5.3), a history of tuberculosis (OR: 4.5; 95% CI: 2.3–8.7), bronchiectasis (OR: 6.0; 95% CI: 1.4–25.4), male sex (OR: 4.2; 95% CI: 2.6–6.7), advanced age (60–69 years vs 40–49 years; OR: 3.8; 95% CI: 2.0–7.0), and being underweight (body mass index

Jung Wha Chung,1 Kyoung Ae Kong,2 Jin Hwa Lee,1 Seok Jeong Lee,1 Yon Ju Ryu,1 Jung Hyun Chang11Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University, 2Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Korea Background and objective: Overlap syndrome shares features of both asthma and chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate characteristics of overlap syndrome and their effect on self-rated health (SRH). Methods: We analyzed data from the Fourth Korea National Health and Nutrition Examination Survey of 2007–2009. Subjects with acceptable spirometry and available wheezing history were included. Subjects were classified into four groups based on forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) results and the presence or absence of self-reported wheezing for the previous 12 months: 1) COPD group, defined as having FEV1/FVC

Background and purposeIsocitrate dehydrogenase (IDH) wild-type lower-grade gliomas (histologic grades II and III) with epidermal growth factor receptor (EGFR) amplification or telomerase reverse transcriptase (TERT) promoter mutation are reported to behave similar to glioblastoma. We aimed to evaluate whether MR imaging features could identify a subset of IDH wild-type lower-grade gliomas that carry molecular features of glioblastoma.Materials and methodsIn this multi-institutional retrospective study, pathologically confirmed IDH wild-type lower-grade gliomas from 2 tertiary institutions and The Cancer Genome Atlas constituted the training set (institution 1 and The Cancer Genome Atlas, 64 patients) and the independent test set (institution 2, 57 patients). Preoperative MRIs were analyzed using the Visually AcceSAble Rembrandt Images and radiomics. The molecular glioblastoma status was determined on the basis of the presence of EGFR amplification and TERT promoter mutation. Molecular glioblastoma was present in 73.4% and 56.1% in the training and test sets, respectively. Models using clinical, Visually AcceSAble Rembrandt Images, and radiomic features were built to predict the molecular glioblastoma status in the training set; then they were validated in the test set.ResultsIn the test set, a model using both Visually AcceSAble Rembrandt Images and radiomic features showed superior predictive performance (area under the curve = 0.854) than that with only clinical features or Visually AcceSAble Rembrandt Images (areas under the curve = 0.514 and 0.648, respectively; P

A novel contour integral approach termed Medg is introduced for computation of the surface energy required for the formation of multiple edge cracks. The method is developed by reinterpretation of the conventional M-integral with deliberate delimitation of integration contour and selection of coordinate origin. Due to path independence, this method is efficient, easy to implement by using finite elements, and does not require a complicated mesh around the crack tips for good accuracy. Attention is also addressed to discussion of the size effects on proper interpretation of its physical meaning. The adequacy of the numerical results computed for the finite size corrections has been validated by using some of the available empirical formulations. It is observed that the size effect can be neglected when the crack size remains under one-tenth of the structure size. The results of a specific multi-cracked geotechnical structure suggest that, the damage state such as degradation of the structural stiffness due to the presence of edge cracks can be properly inspected by using Medg. [ABSTRACT FROM AUTHOR]

The axial distraction mobilization techniques are frequently employed for treating patients with joint hypomobility. However, there is a lack of basic biomechanical studies and description of this procedure. The purpose of this study was to analyze humeral head displacement while performing an axial distraction mobilization of the glenohumeral joint. Twelve experienced orthopedic physical therapists participated. Distraction mobilization techniques were performed in three different positions of glenohumeral abduction on a fresh cadaveric specimen. Outcome measures were displacements of the humeral head center during distraction mobilization. Result indicated that displacement of the humeral head was largest in the resting position (27.38 mm) followed by the neutral (22.01 mm) and the end range position (9.34 mm). There were significant differences for both the displacement of the humeral head (p<0.002) and the distraction forces used (p<0.015) among the three joint positions. Greater gain in mobility was obtained in distraction at the end range position. In conclusion, during distraction mobilization, the force applied by the therapist and displacement of the humeral head depends on the joint position tested. Our results also provide rationales for choosing end range distraction mobilization for improving joint mobility. [ABSTRACT FROM AUTHOR]

This study discusses the force-generating capacity of thumb muscles during jar-opening tasks using two grip patterns: the power grip and the precision grip. This study develops a three-dimensional biomechanical model of the thumb to predict muscle forces in jar-opening activities based on external forces measured by a custom-designed jar device. Ten healthy subjects participated in the study. Each participant turned a jar lid of 66 mm diameter counterclockwise with maximal effort and preferred speed using both grip patterns. The average normal and tangential forces applied by the thumb to the jar lid show that the normal force is the primary contributive force for opening a jar. This normal force is approximately three times the tangential force. Muscular force-generating capacity measurements show that the major active muscles during a jar-opening activity for both grips include the flexor pollicis longus, flexor pollicis brevis, abductor pollicis brevis, adductor pollicis, and opponens pollicis. The total muscle force ratios for the precision grip and power grip with respect to externally applied forces are 5.6 and 4.7 respectively. These ratios indicate that the power grip pattern produces less muscle force per unit of external applied load. The technique proposed in this study provides a proper apparatus and model for measuring three-dimensional loads and estimating the force-generating capacity of each muscle and tendon of the thumb during jar-opening tasks. [ABSTRACT FROM AUTHOR]

A simulated jar apparatus was developed to record hand kinetics and torque contribution of a digit during jar-opening activities. The design of the apparatus, namely a jar body and a lid, is similar to a commercial jam jar that is regularly seen in daily living. One six-axis force-torque transducer and a torque cell were mounted inside the jar lid to detect the external force exerted from the digit and fixed on to the jar body to record the overall torque generated by the hand and wrist respectively. The applications of the apparatus were used to test the twisting torque of the hand and to measure the applied forces of the digit, which are both important factors in opening a jar. The contribution of each digit relative to the total twisting torque of the hand could be obtained via the apparatus. The intraclass correlation coefficient of the repeated measurements of the obtained forces and moments for different counterweights was approximately 0.96-1.00, which indicates that the reliability of the measured components of the apparatus is high. The high coefficient of determination (r2 > 0.99) indicates high accuracy of prediction of the measured values with respect to the expected loads. The validation outcomes support the design rationale and actual body part of the simulated jar. In addition, understanding the contribution of a single digit in opening a jar was also achieved via the apparatus and model. [ABSTRACT FROM AUTHOR]

AIM: To determine the iatrogenic absorbed dosage of radiation of the patient in milligray (mGy) computerised tomography dose index volume (CTDIvol) when tested with multidetector computerised tomography (MDCT) in the emergency department (ED) setting and calculate the absorbed dosage of radiation per clinically actionable result and emergently treatable finding (ETF). SETTING: The University of Texas Medical Branch (UTMB) ED located in Galveston, Texas, USA, is a level 1 trauma and tertiary referral centre treating 70,000 patients per annum. METHOD: A retrospective cross-sectional data analysis of 770 emergency patients investigated by MDCT in July 2007. The presence of actionable results and ETF were determined by chart review. RESULTS: A total of 5320 emergency patients was treated in the UTMB ED in July 2007. This included 4508 medical and 812 trauma patients. A total of 1094 MDCT studies was performed, of which complete data were available on 1046. A total of 770 patients was investigated by MDCT, representing 14.47% of all emergency patients. This included 33.99% of trauma patients and 10.96% of medical patients. Actionable results were found in 341 studies and ETF in 105 studies. The mean radiation was 163.27 and 530.23 mGy CTDIvol for actionable results and ETF, respectively, for all studies. The mean radiation was 53.27 and 106.36 mGy CTDIvol for medical and trauma patients, respectively. CONCLUSIONS: The absorbed dosage of radiation of patients investigated by MDCT is clinically significant. The actionable results and ETF in our study demonstrate considerable opportunity for improvement in the utilisation of this technology by physicians. [ABSTRACT FROM AUTHOR]

A 25-yr-old female tetraplegic patient experienced autonomic dysreflexia episodes involving hypertension, headache, facial flushing, and tachycardia. The symptoms were not related to the bladder or bowel. The episodes did not seem to be linked to any mechanical cause. The patient was incidentally diagnosed with hyperthyroidism. Treatment with antithyroid medication resulted in resolution of the autonomic dysreflexia. This case suggests that hyperthyroidism may trigger autonomic dysreflexia in tetraplegic patients. [ABSTRACT FROM AUTHOR]

Farm tractors account for the majority of fatal injuries to adolescents working in agriculture and therefore remain a leading occupational priority. The question of whether these injuries occur because adolescents are assigned tractor jobs beyond their physical capabilities has not been answered. The purpose of this study was to estimate the activation forces required to operate controls on 40 tractors in common use in the US and compare them with existing estimates of physical strength for children of varying ages and with recommended ergonomic force limits for repeatedly engaging controls. Activation forces for steering, brakes and clutch were measured on each tractor. The main study finding was that the activation forces required to operate tractors typically exceeded the physical abilities of most children aged 13 to 17 years. This raises serious questions about the ability of children to safely operate tractors in common use on US farms. This study provides an ergonomic approach for evaluating the potential mismatch between young people's strength capabilities and forces required in operating farm tractors. This approach could be used in similar situations where adolescents may operate vehicles (e.g. all-terrain vehicles), machinery or other mechanical devices requiring activation of levers and controls. Study findings potentially inform the establishment of occupational policies surrounding tractor operation by young people. [ABSTRACT FROM AUTHOR]

Rationale: Although chronic obstructive pulmonary disease is a leading cause of mortality and morbidity worldwide, there are only limited data on its prevalence, especially in Asia.Objectives: A population-based epidemiologic survey of chronic obstructive pulmonary disease in a representative national sample was conducted using spirometry.Methods: A stratified multistage clustered probability design was used to select a nationally representative sample. The survey was performed in conjunction with the second Korean National Health and Nutrition Examination Survey of 9,243 adults over the age of 18 years. The participation rate was 88.8% for questionnaires and 52.1% for spirometry.Results: The prevalence of chronic obstructive pulmonary disease based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (a ratio of FEV[1] to FVC of less than 0.7) was 17.2% (men, 25.8%; women, 9.6%) among subjects older than 45 years. Among adults of all ages (age > 18 years), the prevalence of airflow obstruction was 7.8% (10.9% in men, 4.9% in women). The majority of these cases were found to be mild in degree, and only a minority of these subjects had received physician diagnosis or treatment. Multivariate analysis revealed that age over 65 years, male sex, smoking more than 20 pack-years, and low income were independent predictors for chronic obstructive pulmonary disease.Conclusions: Seventeen percent of Korean adults over the age of 45 years have mild chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]

Purpose: To demonstrate the technical feasibility of intensity modulated radiation therapy (IMRT) dose painting using (11)C-choline positron emission tomography PET scans in patients with localized prostate cancer. Methods and Materials: This was an RT planning study of 8 patients with prostate cancer who had (11)C-choline PET scans prior to radical prostatectomy. Two contours were semiautomatically generated on the basis of the PET scans for each patient: 60% and 70% of the maximum standardized uptake values (SUV(60%) and SUV(70%)). Three IMRT plans were generated for each patient: PLAN(78), which consisted of whole-prostate radiation therapy to 78 Gy; PLAN(78-90), which consisted of whole-prostate RT to 78 Gy, a boost to the SUV(60%) to 84 Gy, and a further boost to the SUV(70%) to 90 Gy; and PLAN(72-90), which consisted of whole-prostate RT to 72 Gy, a boost to the SUV(60%) to 84 Gy, and a further boost to the SUV(70%) to 90 Gy. The feasibility of these plans was judged by their ability to reach prescription doses while adhering to published dose constraints. Tumor control probabilities based on PET scan-defined volumes (TCP(PET)) and on prostatectomy-defined volumes (TCP(path)), and rectal normal tissue complication probabilities (NTCP) were compared between the plans. Results: All plans for all patients reached prescription doses while adhering to dose constraints. TCP(PET) values for PLAN(78), PLAN(78-90), and PLAN(72-90) were 65%, 97%, and 96%, respectively. TCP(path) values were 71%, 97%, and 89%, respectively. Both PLAN(78-90) and PLAN(72-90) had significantly higher TCP(PET) (P=.002 and .001) and TCP(path) (P<.001 and .014) values than PLAN(78). PLAN(78-90) and PLAN(72-90) were not significantly different in terms of TCP(PET) or TCP(path). There were no significant differences in rectal NTCPs between the 3 plans. Conclusions: IMRT dose painting for localized prostate cancer using (11)C-choline PET scans is technically feasible. Dose painting results in higher TCPs without higher NTCPs. [ABSTRACT FROM AUTHOR]