Effects of physical activity participation on cognitive impairment in older adults population with disabilities

Background

Existing research on the association between cognitive function and physical activity in the older adults population with disabilities is limited. Additionally, there is a need to explore avenues for enhancing the longevity and quality of life among these individuals.

Objective

This study aimed to investigate the independent and joint associations between cognitive function and levels of physical activity in the older adults population with disabilities.

Methods

A total of 315 older adults adults (men = 182, women = 133), identified with disabilities based on medical evaluation, were recruited from the first survey of the Korean Longitudinal Study of Aging (KLoSA). Participants underwent assessments for cognitive function, physical activity (PA), activities of daily living (ADLs), instrumental activities of daily living (IADLs), and grip strength.

Results

ADLs (p < 0.001) and IADLs (p < 0.001) scores were significantly higher in the male normal cognitive group compared to both the male and female cognitive impairment groups. In an unadjusted model, disabled older adults individuals who did not meet the recommended PA guidelines showed an increased odds ratio for cognitive dysfunction (OR = 2.29, 95% CI = 1.32-3.97). Those participating in PA at least 1 day per week also demonstrated an elevated odds ratio (OR = 1.22, 95% CI = 1.08-1.38) for cognitive dysfunction compared to those who engaged in regular PA. A negative correlation was observed between K-MMSE scores and grip strength (r = 0.448, p < 0.001).

Conclusion

This study provides robust evidence that disabled older adults individuals who do not meet the recommended guidelines for PA or who do not participate in PA at least once a week have an increased likelihood of cognitive impairment compared to those who are regularly active.

Effects of Black Maca supplement on isokinetics muscular performance of elite women's handball players: placebo-controlled, crossover study

Background

The aim of this study was to investigate the changes in isokinetic muscular performance among female adolescent elite handball athletes with the supplementation of Black Maca (BM).

Methods

Eight elite handball athletes were recruited for the present study. The intake capsules contained 2,500 mg of 100% concentrated BM extract and a placebo each, for 4 weeks. Isokinetic muscular performance and physical fitness were measured three times at 4-week intervals after the intake of BM and placebo, including baseline.

Results

The one-way Analysis of Variance (ANOVA) analysis showed a significant improvement in 20 m-shuttle run (P < 0.001), 30°/s flexor (P < 0.01), and 120°/s flexor (P < 0.01) in isokinetic muscle function of the trunk, and 180°/s right extensor (P < 0.05), 180°/s left extensor (P < 0.05), and 180°/s left flexor (P < 0.01) in isokinetic muscle function of the knee, after BM supplementation. Post-hoc analysis indicated that the BM group had significantly higher results compared to the baseline and placebo groups in terms of 20 m-shuttle run, 30°/s flexor and 120°/s flexor of the trunk, 180°/s right extensor, 180°/s left extensor, and 180°/s left flexor of the knee.

Conclusion

BM supplementation can have a positive effect on improving the performance of elite handball players who engage in high-intensity movements by enhancing their isokinetic muscle function and endurance.

Exercise therapy for sarcopenia and diabetes

Aging is characterized by the gradual deterioration of function at the molecular, cellular, tissue, and organism levels in humans. The typical diseases caused by changes in body composition, as well as functional decline in the human body’s organs due to aging include sarcopenia and metabolic disorders. The accumulation of dysfunctional aging β cells with age can cause decreased glucose tolerance and diabetes. Muscle decline has a multifactorial origin, involving lifestyle habits, disease triggers, and age-dependent biological changes. The reduced function of β cells in elderly people lowers insulin sensitivity, which affects protein synthesis and interferes with muscle synthesis. The functional decrease and aggravation of disease in elderly people with less regular exercise or physical activity causes imbalances in food intake and a continuous, vicious cycle. In contrast, resistance exercise increases the function of β cells and protein synthesis in elderly people. In this review, we discuss regular physical activities or exercises to prevent and improve health, which is sarcopenia as decreased muscle mass and metabolic disorders as diabetes in the elderly.

Safety and efficacy of cerebral embolic protection devices in transcatheter aortic valve implantation: a meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Background

Stroke during Transcatheter Aortic Valve implantation (TAVI) is not an uncommon complication with potential devastating consequences. With the extension of TAVI to the low-risk patient, stroke prevention takes on increasing importance. The use of cerebral embolic protection device (EPD) reveals conflicting data. This meta-analysis aims to evaluate the clinical efficacy and safety of EPDs.

Methods

A comprehensive literature search for all studies till May 2022 reporting clinical safety and efficacy outcomes of the only EPD approved for use by the Food and Drug Administration (FDA) was performed. Study outcomes were divided based on time period - overall (up to 30 days and in-hospital) and short (≤7 days). Primary outcome was stroke - major and minor. Secondary outcomes included transient ischaemic attack (TIA), mortality, acute kidney injury (AKI), major vascular and bleeding complications.

Results

A total of 12 studies involving 288531 patients were analysed, which included 3 randomised controlled trials (RCTs), 7 propensity-matched and 2 cohort studies. Regarding overall outcomes, significant differences were noted for mortality (OR 0.59 [0.42-0.84], p=0.0036) and major stroke (OR 0.40 [0.18-0.91], p=0.028) (Fig 1). No significant differences were noted for all stroke (p=0.058), minor stroke (p=0.32), TIA (p=0.49), AKI (p=0.17), major vascular complications (p=0.40) and major bleeding complications (p=0.11). There was significant heterogeneity across the studies for mortality (p=0.032) and all stroke (p=0.009). In the subgroup analysis of studies reporting ≤7 days outcomes (n=5), EPDs showed significantly lower rates of all stroke (0.33 [95% CI 0.19-0.56], p=&lt;0.0001), major stroke (0.19 [0.08-0.48], p=0.0004) and major bleeding complications (OR 0.29 [0.10-0.79], p=0.016), but no significant differences for mortality (p=0.67) and minor stroke (p=0.070). There was no significant heterogeneity across the studies (all p&gt;0.05)

Conclusions

In this meta-analysis including non-randomised studies, the use of EPDs was associated with lower mortality and major stroke rates, although significant heterogeneity was noted for the studies reporting mortality. Further ongoing larger scale RCTs will further clarify these results.

Real-world outcomes of Selexipag for treatment of pulmonary hypertension in an Asian population

Funding Acknowledgements

Type of funding sources: None.

Introduction

Selexipag is an oral selective prostacyclin IP receptor agonist indicated for treatment of pulmonary arterial hypertension (PAH). Data on its real-world safety and efficacy in Asians is lacking.

Purpose

We sought to evaluate the clinical characteristics, treatment regimens and outcomes of patients initiated on selexipag in a tertiary cardiac centre in Asia.

Methods

This was a retrospective study on all patients initiated on selexipag from January 2017 to December 2020. Baseline and follow up characteristics including demographics, functional status and clinical data were collected. Clinical outcomes evaluated included hospitalisation for PH related complications and all-cause mortality. Patients were risk stratified using the COMPERA 2.0 risk scores.

Results

A total of 36 PAH patients were treated with selexipag. At baseline, most patients were WHO functional class II or III (36.4% and 51.5% respectively), with a NT-proBNP of 1335 pg/ml (557 – 2918) and 6 minute walk test (6MWT) duration of 327.5 ±126.4 meters. Selexipag was initiated at 200mcg twice daily dosage for all except one patient (started at 200mcg once daily) and the maximum tolerated dose ranged from 200mcg twice daily to 1400mcg twice daily, with majority tolerating up to a dose of 600mcg twice daily (58.3%). Side effects were reported in 23 patients (63.9%), of which headache (27.8%), diarrhea (30.6%) or musculoskeletal symptoms (27.8%) were predominant. After a median follow up duration of 25.9 ± 23.1 months, selexipag was stopped in 20 patients (55.6%), of which eight patients were due to PAH progression requiring alternative therapy, and 12 patients due to side effects from selexipag. At baseline, patients were classified into low (8.3%), intermediate-low (30.6%), intermediate-high (33.3%) and high risk (27.8%) respectively. Patients who continued on selexipag at follow up showed no change (46.2%), improvement (15.4%) and deterioration (38.5%) in risk score. In the overall cohort of 36 patients, majority (75%) had at least one hospitalisation for PAH related complications and 15 patients (41.7%) demised.

Conclusion

In this real-world study, while selexipag was associated with a stable or improved PAH risk scores in majority of patients, there was a subset of patients with disease progression or intolerance to the medication. Further studies are warranted to identify patients who will benefit most from this therapy.

COVID-19 Prevention Guidance and the Incidence of Febrile Neutropenia in Patients with Breast Cancer Receiving TAC Chemotherapy with Prophylactic Pegfilgrastim

Chemotherapy-induced febrile neutropenia (FN) is a medical emergency that causes severe adverse effects and death. Respiratory infections are one of the main causes of fever in patients with FN. We studied whether infection prevention and control (IPC) guidance for coronavirus 2019 disease reduced the incidence of FN. We reviewed female patients with breast cancer treated with adjuvant docetaxel, doxorubicin, and cyclophosphamide with prophylactic pegfilgrastim between 2019 and 2021. IPC guidance was implemented in April 2020. There was no difference in the incidence of chemotherapy-induced neutropenia between patients with and without IPC. In patients with IPC, the incidence of FN (9.5%) was lower than that of patients without IPC (27.9%). The hospitalization duration (0.7 ± 1.5 days) and total hospital cost (279.6 ± 42.6 USD) of the IPC group were significantly lower than that of the non-IPC group (2.0 ± 3.8 days and 364.7 ± 271.6 USD, respectively). IPC guidance should be implemented to prevent FN in high-risk patients with breast cancer.

Correcting Postural Deviations: An Evidence- Supported Shift in Paradigm

Somatic syndromes of the spinal region may develop secondary to postural dysfunction. Traditionally, emphasis has been placed on correcting postural asymmetries by attempting to change muscle-tendon unit length. The effectiveness of this approach in providing prolonged muscle-tendon unit length changes and optimal postural outcomes has met with controversy. The time has come for a redirection of goals in conservative care for postural dysfunction of the spinal regions. An emphasis needs to be placed on continuous, self-awareness training of postural correction that will facilitate lasting neuromuscular adaptations. The purpose of this review is to rationalize the need to veer from exercises attempting to adjust the muscle-tendon unit length and recognize the evidence-supported impact of simple self-correction strategies meant to facilitate neuromuscular adjustments and correct postural asymmetries.

Importance of Injury Prevention and Management for Youth Handball Athletes

The Article Abstract is not available.  

600 Acute Appendicitis as an Early Manifestation of Colorectal Cancer for Patients Aged 40 Years and Above

Aim

Presence of underlying colorectal cancer with acute appendicitis is not unfamiliar in medical literature. However, there remains no clear guidance in the follow-up care post-appendicectomy. This study aims to investigate whether acute appendicitis can be an early manifestation of colorectal cancer in older adults and determine the need of routine pre-operative CT imaging and post-operative colonoscopy as a follow-up screen for early detection of colorectal cancer.

Method

This is a retrospective study comprising 1236 patients, aged 40 years and above, who underwent appendicectomy between January 2006 to September 2021. Results of radiological investigation pre-appendicectomy and colonoscopy post-appendicectomy were reviewed. Patients who were diagnosed immediately and subsequently following appendicectomy were recorded and analysed.

Results

Of the 1236 patients underwent appendicectomy, 636 (51.5%) were male and 600 (48.5%) were female (Median age 53 years; range 40–96 years). Out of 412 (33.3%) patients who had CT imaging, only one revealed sigmoid tumour which was later confirmed as moderately differentiated adenocarcinoma. 71 (5.7%) patients had colonoscopy post-appendicectomy. Among these, two were diagnosed with caecal cancer. A total of 22 (1.8%) patients were diagnosed with colorectal cancer: 13 adenocarcinoma, 5 carcinoid tumours, 3 low-grade mucinous carcinoma peritonei and 1 lymphoma. 15 (1.2%) were diagnosed at the time of appendicectomy, whereas the remaining 7 (0.6%) were diagnosed between 6 months to 11 years post-appendicectomy.

Conclusion

Preliminary finding suggests this is an area that warrant further study. Patients aged 40 years and above may benefit from colonoscopy following appendicectomy to exclude the possibility of underlying colorectal cancer.

Usefulness of Hounsfield Units and the Serum Neutrophil-to-Lymphocyte Ratio as Prognostic Factors in Patients with Breast Cancer

Breast cancer is a leading cause of death worldwide. Tumor vascularity and immune disturbances are hallmarks of cancer. This study aimed to investigate the reciprocal effect of tumor vascularity, assessed by the tumor-to-aorta ratio (TAR) of Hounsfield units (HU) on computed tomography (CT), and host immunity, represented by the serum neutrophil-to-lymphocyte ratio (NLR) from peripheral, complete blood cell counts and its impact on patient survival. Female patients with breast cancer who received primary treatment between 2003 and 2018 at Wonju Severance Hospital, Korea, were included. The final cohort included 740 patients with a mean age of 54.3 ± 11.3 (22−89) years. The TAR was 0.347 ± 0.108 (range, 0.062−1.114) and the NLR was 2.29 ± 1.53 (0.61−10.47). The cut-off value for the TAR and NLR were 0.27 and 1.61, respectively. The patients with a TAR > 0.27 showed a poor recurrence free-interval (RFI) only when their NLR was larger than 1.61, and vice versa. The patients showed worse RFI when they had both high TAR and NLR. Our results suggest a dynamic reciprocal communication between tumor vascularity and systemic immunity.

Intravenous epoprostenol therapy in the treatment of pulmonary arterial hypertension: the Singapore experience

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary arterial hypertension (PAH) is a progressive disease with significant morbidity and mortality. While intravenous (IV) Epoprostenol, a prostacyclin analogue, has been shown to improve exercise tolerance, symptoms, hemodynamics and survival, there are challenges with initiation and maintenance of this IV therapy.

Purpose

We aim to describe our local experience of the use of IV Epoprostenol in the treatment of PAH patients in Singapore, highlighting various issues and challenges.

Methods

From 2016, patients at a tertiary cardiac institution diagnosed with Group 1 PAH and remaining in intermediate to high risk class with progressive symptoms (despite being on maximum tolerable doses of PhosphoDiEsterase-5 inhibitors and Endothelin-1 receptor antagonists) were assessed and counselled for initiation of Epoprostenol therapy. With a fixed set of local protocols, comprehensive assessment and support of a multi-disciplinary team including physicians, specialist nurses and pharmacists, suitable patients were started on this treatment.

Results

A total of 12 patients (11 female, mean age 42.8 +/- 11.0 years) were included. The average New York Heart Association class of the patients initiated on Epoprostenol was II-III. The pulmonary artery pressures and pulmonary vascular resistance on right heart catheterization prior to initiation was 52.5 (IQR 47.0-54.0) mmHg and 12.6 (IQR 10.0-14.2) Woods respectively. The duration from diagnosis to time of initiating Epoprostenol was 89 (IQR 62-140) months. Epoprostenol was generally well tolerated. The most common side effect experienced was diarrhea (5/12 patients) followed by headache and musculoskeletal complains (3/12 patients each). Of the 12 patients, 6 passed away after 12 (IQR 10-16) months of Epoprostenol therapy. Of the remaining 6, PAH was diagnosed 110 (IQR 104-136) months ago and Epoprostenol therapy has been continued for 17 (IQR 14-27) months. Of those who survived, right ventricle size and PA pressures on echocardiography remained relatively stable as compared to those who passed on. 2 patients had line related infections requiring a line change 1 and 2 times respectively.

Conclusion

While not without its challenges, the establishment of concrete protocols with the support of a multidisciplinary team allows for the introduction of IV Epoprostenol as an additional potential line of effective therapy for PAH patients in Singapore.

Risk stratification and prognosis in pulmonary arterial hypertension: the Singapore experience

Funding Acknowledgements

Type of funding sources: None.

Aims & Background: Guidelines recommend the risk stratification of patients with pulmonary arterial hypertension (PAH) at baseline and on follow-up, so as to guide the management and titration of therapy in these patients.  This approach has been validated in various pulmonary hypertension registries in the West.  We aim to study the value of risk stratification on the prognosis of PAH patients in Asia.

Methods

A retrospective review of all PAH patients from 2002 to 2018 from a single tertiary cardiac centre was performed. Inclusion criteria was the availability of both initial visit and follow-up data. Patients were classified into low-, medium-, and high-risk groups in both initial and follow-up visits based on the variables in the 2015 ESC/ERS PH risk stratification table  according to the "score and average" method used by SPAHR and COMPERA registries (total score divided by number of variables assessed and rounded to nearest integer). An average score of 1, 2 and 3 was defined as low, medium and high risk respectively. The primary outcomes was all-cause mortality.

Results

 A total of 102 patients (mean age 57 ± 18 years old, 82 females) were included. Survival was significantly affected by PAH subtype and risk profile. On multivariate analysis, baseline risk did not impact on mortality. Follow-up risk stage impacted on prognosis, with significantly poorer prognosis noted in both intermediate- (adj HR 3.12, 95% CI 1.03 – 9.48, p = 0.045) and high-risk (adj HR = 7.84, 95% CI 2.22 – 27.64, p = 0.001) groups. Patients who improved their risk groups to low risk on follow-up had  similar survival to stable low-risk patients, but those patients whose risk group worsened on follow-up had significantly worse prognosis (adj HR = 5.44, 95% CI 1.26 – 13.75, p = 0.02).

Conclusion

Risk stratification is useful in prognosticating Asian PAH patients. There is potential survival benefit in optimising treatment to achieve a low-risk profile.

Relationship between metabolic syndrome and moderate-to-vigorous physical activity among adults 18 years old and over

The prevalence of metabolic syndrome (MetS) risk factors among the Korean population requires effective health surveillance and examination of the effects of preventative behaviors. Thus, the objective of this study is to evaluate the relationships between the clustering of MetS and MVPA in a large sample of 36,987 Koreans ranging from 20 to 80 years of age. This study recruited a total of 36,987 adults (23,813 males and 13,174 females). All participants were assessed for moderate-to-vigorous physical activity (MVPA) using the Korean version short form of the International Physical Activity Questionnaire (IPAQ). The International Diabetes Federation and the Adult Treatment Panel III criteria for blood pressure, hyperglycemia, low high-density lipoprotein cholesterol (HDL-C), and high triglycerides (TG) defined MetS. Waist circumference (WC) was determined by Asian-Pacific region populations. According to the 150-minute MVPA, there were differences in MetS risk factors in young adult males, and only three factors (WC, HDL-C, and TG) were different males in ≥ 70 years old. In females, there was a difference in MetS risk factors in the elderly, and only three factors (WC, blood pressure, and TG) were different females in ≤ 29 years old. The males who did not met the recommended MVPA had a 1.16 to 3.14 -times increase in the MetS risk factors. The females who did not met the recommended MVPA had a 1.18 to 2.57 -times increase in the MetS risk factors. Our study provides evidence that Korean adults who do not engage in recommended MVPA levels increase the odds ratio for each of the MetS risk factors when compared to those who meet the recommendations.

The effect of whole body vibration on the sprint ability of Korean national bobsled and skeleton athletes

This study aims to find out whether whole body vibration has an effect on the sprint ability to shorten the time of bobsled-skeleton athletes. Seventeen bobsled-skeleton athletes (male = 11, female = 6) were recruited from Korea Winter Olympics National Team. Participants were randomly assigned to either a sprint immediately after whole body vibration or a sprint without whole body vibration protocol during two separate visits by a period of 3 months. To evaluate the effects of the sprint ability, measurements were performed 60-m sprint recorded test. In males, at the 45m (p<0.05) significant faster sprint section record after WBV more than Non-WBV. In females, at the 15m (p<0.05), 30m (p<0.01), 45m (p<0.05), and 60m (p<0.05) significant faster sprint section record after WBV more than Non-WBV. In males, at the 30m (p<0.05), 45m (p<0.05), and 50m (p<0.05) significant faster sprint cumulative record after WBV more than Non-WBV. In females, at the 15m (p<0.05), 30m (p<0.05), 45m (p<0.01), 50m (p<0.01), and 60m (p<0.01) significant faster sprint cumulative record after WBV more than Non-WBV. This study indicated that significant faster after WBV more than Non-WBV in males and females bobsled-skeleton athletes.

Variation in myokine and adipokine levels according to menstrual cycle following regular resistance exercise

BACKGROUND

The purpose of this study was to analyze the differences between myokine and adipokine factors under stable conditions according to the menstrual cycle (luteal and follicular phases), and investigate the effect of regular resistance exercise on the changes in myokine and adipokine factors according to menstrual cycle in obese female college students.

METHODS

The study participants were female college students with a body fat percentage of 30% or more (n = 20), divided into two groups: luteal phase (n = 12) and follicular phase (n = 8). They performed regular resistance exercise three times a week, 60 minutes daily, for 16 weeks. Parameters measured include body composition via impedance, visceral fat area using computed tomography and myokine and adipokine factors in blood.

RESULTS

Levels of BDNF (p < .05), NGF (p < .01), and adiponectin (p < .01) were significantly increased in the luteal phase group after 16 weeks relative to the baseline values. Leptin (p < .01) was significantly decreased in the luteal phase group after 16 weeks. Weight, body mass index, % fat, and visceral fat area were significantly decreased in both groups after 16 weeks. Muscle mass was significantly increased in both groups after 16 weeks.

CONCLUSIONS

Regular resistance exercise affected the reduction in visceral fat area and had a positive effect on body composition, which might be altered favorably by myokines and adipokines. Thus, the timing of blood collection is very important in obese female college students.

A Factual Survey on the Injury of Youth Athletes for Prevention and Management

The article's abstract is not available.  

Differences in body composition and physical fitness of Korean national bobsleigh and skeleton athletes

BACKGROUND

This study aimed to classify Olympic medalists and non-medalists among national bobsled and skeleton athletes and determine the physical fitness differences between the two groups.

METHODS

Five bobsleigh and skeleton athletes who won gold and silver medals in the 2018 Pyeongchang Winter Olympics and 11 national bobsled and skeleton team athletes were recruited. The participants were assessed for physiological parameters such as body composition, anthropometry, physical fitness, isokinetic strength, and maximum strength.

RESULTS

Physical fitness factors back strength (t=2.571, p<0.05), squat ability (t=3.061, p<0.01), and left and right leg curls (t=4.578, p<0.001; t=4.719, p<0.001, respectively) were significantly different between the groups. The original value of the primary discriminant analysis was 1.868 and the canonical correlation was 0.807. The average value of the discriminant function of the medalists was 1.896, while the of the non-medalists was -0.862, indicating that the two groups were completely different.

CONCLUSIONS

Medalists have higher squat abilities, abdominal strength, and leg curl strength than nonmedalists, particular with regard to hamstring strength. Currently, in most sports events, athletes undergo physical training to improve performance; however, training programs that reflect the characteristics of the sport and the physical characteristics of excellent athletes are still insufficient.

Effectiveness of Kinesio Taping for Dynamic Postural Stability in Adolescent Athletes with Chronic Ankle Instability: A Pilot Study

OBJECTIVES To determine the effectiveness of K-tape on dynamic postural stability of the injured limb in adolescent athletes with chronic ankle instability (CAI) by measuring reach distance with the modified Star Excursion Balance Test (mSEBT).METHODS Twenty volunteers (20 females [17.78 ± 1.22 yrs], height [163.89 ± 7.69 cm], mass [62.51 ± 9.81 kg]) with CAI. Four strips of K-tape were applied to the injured limb. Participants completed 4 trials of testing (2 with tape, 2 without tape) using the mSEBT as the assessment tool. We applied 4 strips of K-tape to the injured limb and then tested postural stability using the mSEBT to see if there was an increase of reach distance in the mSEBT. Measuring reach distance in Anterior (AN), Posteromedial (PM), Posterolateral (PL) on the injured limb with K-tape and without K-tape condition. We measured the reach distances and then normalized the distance to account for height differences. A repeated measures t-test was used for this study.RESULTS There is no statistically significant different between the condition with K-tape and without K-tape in the reach distances on the mSEBT in adolescent athletes with CAI.CONCLUSIONS Based on the results, there appears to be no improvement of reach distance using the mSEBT in adolescent athletes with CAI. Therefore, clinicians need their thoughtful consideration for applying K-tape to improve dynamic postural stability in adolescent athletes with CAI.

Sleep quality and athletic performance according to chronotype

BACKGROUND

When studying the quality of sleep in relation to athletic performance, the athlete's chronotype and habitual time consider important factors. We aim to investigate the sleep quality and athletes' performance according to chronotype in elite athletes.

METHODS

Three hundred forty elite athletes (males = 261, females = 79) were recruited for the present study. All participants were screening for chronotype by the Korean versions of the Morningness - Eveningness Questionnaire (MEQ-K). The Pittsburgh Sleep Quality Index (PSQI) and Wingate Anaerobic Test (WAnT) were measurement after screening.

RESULTS

PSQI global score, PSQI sleep quality, PSQI sleep onset latency, PSQI sleep disturbance, and PSQI daytime dysfunction were significant differences among the groups. WAnT mean power (W), mean power (W/kg), peak power (W), and peak power (W/kg) were significant differences among the groups. A negative correlation coefficient was found between PSQI score and WAnT mean power (W) (r = - 0.256, p < 0.01), mean power (W/kg) (r = - 0.270, p < 0.01), peak power (W) (r = - 0.220, p < 0.01), and peak power (W/kg) (r = - 0.248, p < 0.01).

CONCLUSIONS

This study indicates that related poor sleep quality and late-type chronotype may reduce the athletes' performance in elite athletes. In addition, the sleep quality is much higher in the early-type chronotype than in the late-type chronotype. Moreover, it also the athletic performance was better in the early-type chronotype than in the late-type chronotype.

Profile of reticulated platelets in the early, subacute and late phases after transient ischemic attack or ischemic stroke

Information regarding the profile of reticulated platelets (RP) in ischemic cerebrovascular disease (CVD) patients is limited. Data from two prospective, observational, case-control studies were combined to compare the %RP using whole blood flow cytometry in patients ≤ 4 weeks of TIA/stroke onset (baseline, N = 210), and 14 ±7 days (14d, N = 182) and ≥ 90 days (90d, N = 145) after starting or changing antiplatelet therapy with healthy controls (N = 34). There were no differences in median %RP between the overall CVD patient population at baseline or 14d vs. controls (P ≥ 0.2). However, the median %RP was significantly higher in CVD patients overall at 90d (P = .036), and in the subgroup of patients with "lacunar" TIA/ischemic stroke at baseline (P = .04) and at 90d (P = .01), but not at 14d (P = .06) vs. controls. There were no significant differences in the median %RP between other TIA/stroke subgroups and controls (P ≥ 0.05). Elevated circulating reticulated platelets, as a marker of increased platelet production/turnover, may occur following an ischemic event in a well-phenotyped TIA/ischemic stroke population overall, but may precede symptom onset at least in the subgroup with small vessel occlusion. These data improve our understanding of the profile of reticulated platelets in CVD patients.

Aged Lumbar Extension Strength of Chronic Low Back Pain in Korean Population of 10-80 Years

Background:

The purpose of this study was to find the basic data of medical and exercise therapy by indexing lumbar extension muscle strength of low back pain (LBP) patients.

Methods:

In this cross-sectional study, 3078 chronic LBP participants from The J hospital, Seoul, Republic of Korea, from 2003 to 2010 were enrolled. Maximum muscle strength was measured at maximum flexion angle and maximum extension angle according to range of motion (ROM) results. For each isometric test, participants were seated and secured in the MEDX (medx lumbar extension machine, Ocala, FL, USA) machine.

Results:

The relative ROM (P=0.012) differed significantly among the aged groups in all participants. In addition, mean of strength (P<0.001), maximal of strength (P<0.001), mean of strength %BW (P<0.001) and maximal of strength %BW (P<0.001) are significant differences in all participants. The results of multiple regression analysis was the ‘model A’, maximal of strength for 32.1% of the variance in weigh, body mass index and range of motion. In addition, ‘model B’ was 30.4%, ‘model C’ was 28.8%, ‘model D’ was 28.5%, ‘model E’ was 21.7%, and ‘model F’ was 23.5% of the variance in weigh, body mass index and range of motion.

Conclusion:

We found the three predictor (weight, BMI, and ROM) variables accounted for 32.1% of the variance in maximal of strength %BW, the highest in < 29 yr groups. Our data indicate the basic data of medical and exercise therapy by indexing lumbar extension muscle strength of LBP patients.

The Effects of Self-Talk on Shooting Athletes' Motivation

Self-talk is helpful in motivating shooting athletes and promoting effortful behavior. This study aimed to examine how the degree and intensity of self-talk of shooting athletes during matches affects their actual internal motivation and careers. In particular, the primary objective was to determine the effects of the level and intensity of self-talk on the effort value, fun and interest, tension and anxiety, and competence of intrinsic motivation for different levels of achievement and athletic performance. One hundred seventy participants who were shooting athletes registered with the Korea Shooting Federation (national team, n = 55; high performance team, n = 62; general team, n = 53). The self-talk questionnaire was developed to measure the Test of Performance Strategies (TOPS). The intrinsic motivation scale developed and applicable to sports situations was used to measure the motivation of the shooting athletes. Significant differences were observed using MANOVA as well as the basic statistics of intrinsic motivation by self-talk. The intrinsic motivation self-talk was correlated to effort value, fun and interest, and competence. There was a significant relationship between shooting athletes' self-talk and intrinsic motivation. This study indicated that athletes using self-talk experienced more fun and interest, and they perceived higher effort value and competence. Further, the multiple regression analysis revealed that self-talk affected the intrinsic motivational factors of effort value and fun and interest.

Comparison of Muscle Cross-sectional Area and Lumbar Muscle Strength According to Degenerative Spinal Diseases

OBJECTIVES The purpose of this study was to investigate the difference in the cross - sectional area (CSA) of multifidus and Iliopsoas muscles and the lumbar extension muscle strength according to degenerative spinal diseases (LHI; lumbar herniation of intervertebral disc group, SS; spinal stenosis group, S; spondylolisthesis group).METHODS The CSA of multifidus and Iliopsoas muscles size were measured by PACS(Picture Achiving and Communication System) using MRI at the L4/5 level and lumbar extension muscle strength (72˚, 60˚, 48˚, 36˚, 24˚, 12˚, 0˚) was measured using lumbar extension machine(MedX) in 97 patients of degenerative spinal diseases(male: 57, female: 40). The collected data were analyzed by one-way ANOVA using the SPSS program.RESULTS The results of this study showed that the CSA of total and right multifidus muscle in the LHI was significantly higher than that of the S (p <.05; p <.05) in the male group. The difference between the left and right CSA of multifidus in the LHI group was significantly higher than that of the SS (p <.05) in the male group (p <.05) and total group (p <.05). The CSA of iliopsoas muscle in the S was significantly higher than that of the LHI in the male and total group (p <.05; p <.05). In case of lumbar extension muscle strength, the S showed significantly higher muscle strength at 36 and 48 degrees than that of the SS in the male group. In the total group, LHI showed significantly higher muscle strength at 60 degrees of lumbar extension muscle strength than that of the S.CONCLUSION Multifidus muscle appears to be a key factor in prevention and treatment intervention in low back pain patients. In particular, in the case of S group, exercise therapy for strengthening the multifidus muscle is need for the rehabilitation.

Changes in neutrophil to lymphocyte ratio (NLR) during neoadjuvant treatment correlated with patients' survival

INTRODUCTION

Neoadjuvant treatment has been widely used for patients with advanced breast cancer, and pathological complete response (pCR) has been proposed as a surrogate marker. However, more than 50% of patients will not achieve pCR and an appropriate, practical prognostic marker is required for these patients.

MATERIALS AND METHODS

A retrospective analysis of patients treated with neoadjuvant treatment for stage I-III disease was performed. Clinicopathological data including the neutrophil-to-lymphocyte ratio (NLR) were collected. NLRs were collected serially according to the treatment schedule. Changes in NLRs were calculated, of which the performance capacity as a prognostic factor was evaluated, and a Kaplan-Meier plot was developed and compared with the log rank test RESULTS: Changes in NLRs of each time points of 148 patients were used to assess performance capacity as a prognostic factor for invasive disease-free survival (IDFS), overall survival (OS) and distant disease-free survival (DDFS), and that of shortly prior to the third cycle treatment showed statistical significance. With a cut off value of 0.1258, patients could be divided into high- and low-risk of invasive disease recurrence. Kaplan-Meier curves were developed and the log rank test showed that patients in high-risk group after 2 cycles of neoadjuvant treatment were significantly correlated with worse survival outcomes than those in low-risk group.

CONCLUSION

Changes in NLRs after neoadjuvant treatment showed statistically significant correlation with patient survival and could categorize patients into high- and low-risk groups. Larger, prospectively designed clinical trials are required to substantiate findings of this study.

Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience

Background

Several studies have reported the use of acellular dermal matrix in breast reconstruction. However, the primary role of acellular dermal matrix in these studies was to support the implant; there are no reports on the use of acellular dermal matrix exclusively as volume replacement. Thus, we aimed to evaluate the safety and effectiveness of filling of the defect with acellular dermal matrix in oncoplastic breast-conserving surgery.

Methods

We prospectively recruited 120 adult breast cancer patients who were scheduled to undergo oncoplastic breast-conserving surgery with acellular dermal matrix filling from 2017 to 2018. Intraoperatively, diced human acellular dermal matrix measuring 3–5 mm was used on each side to fill in the excisional defect immediately. After 6 months, satisfaction of the patients and surgeons with overall and cosmetic outcomes was evaluated with a survey using a 10-point scale. Postoperative complications were assessed at 2 weeks and 6 months postoperatively.

Results

Of the 117 patients who were evaluated for their satisfaction, 94.0% were strongly satisfied with the cosmetic outcomes and 90.4% were strongly satisfied overall. Patient overall satisfaction scores were higher than surgeon satisfaction scores (p < 0.001). Of the 117 patients who underwent evaluation of complications 6 months postoperatively, six (5.1%) had hematoma and seven (6.0%) had seroma. The overall reoperation rate due to complications was 8.5%. Only two patients needed acellular dermal matrix removal due to hematoma and inflammation.

Conclusion

Oncoplastic breast-conserving surgery with acellular dermal matrix filling of defects can be performed safely with high cosmetic satisfaction.

Trial registration

ICTRP, KCT0003886; retrospectively registered May 3, 2019, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=KCT0003886

Relationship between 'on-treatment platelet reactivity', shear stress, and micro-embolic signals in asymptomatic and symptomatic carotid stenosis

BACKGROUND

Assessment of 'high on-treatment platelet reactivity (HTPR)' could enhance understanding of the pathophysiology of first or recurrent vascular events in carotid stenosis patients on antiplatelet therapy.

METHODS

This prospective, multi-centre study assessed antiplatelet-HTPR status and its relationship with micro-emboli signals (MES) in asymptomatic vs. symptomatic ≥ 50-99% carotid stenosis. Platelet function/reactivity was assessed under 'moderately high shear stress' with the PFA-100^® and 'low shear stress' with VerifyNow^® and Multiplate^® analysers. Bilateral 1-h transcranial Doppler ultrasound of the middle cerebral arteries classified patients as MES + ve or MES - ve.

RESULTS

Data from 34 asymptomatic patients were compared with 43 symptomatic patients in the 'early phase' (≤ 4 weeks) and 37 patients in the 'late phase' (≥ 3 months) after TIA/ischaemic stroke. Median daily aspirin doses were higher in early symptomatic (225 mg; P < 0.001), but not late symptomatic (75 mg; P = 0.62) vs. asymptomatic patients (75 mg). There was a lower prevalence of aspirin-HTPR in early (28.6%; P = 0.028), but not late symptomatic (38.9%; P = 0.22) compared with asymptomatic patients (56.7%) on the PFA-100^®, but not on the VerifyNow^® or Multiplate^® (P ≤ 0.53). Early symptomatic patients had a higher prevalence of aspirin-HTPR on the PFA-100^® (28.6%) vs. VerifyNow^® (9.5%; P = 0.049), but not Multiplate^® assays (11.9%, P = 0.10). There was no difference in aspirin-HTPR prevalence between any symptomatic vs. asymptomatic MES + ve or MES - ve subgroup.

DISCUSSION

Recently symptomatic moderate-severe carotid stenosis patients had a lower prevalence of aspirin-HTPR than their asymptomatic counterparts on the PFA-100^®, likely related to higher aspirin doses. The prevalence of antiplatelet-HTPR was positively influenced by higher shear stress levels, but not MES status.

Paediatric cataract surgery in Hospital Kuala Lumpur - A 5-year review of visual outcomes

INTRODUCTION

Paediatric cataract surgery is challenging with reported post-operative visual acuity (VA) of 0.3LogMar or better varying between 33% to 68% of patients.

OBJECTIVE

The aim is to document the post-operative refraction, VA and complications of non-traumatic pediatric cataract surgery performed in a tertiary referral center in Malaysia.

METHODOLOGY

This retrospective study reviewed case notes of all consecutive patients aged 12 years and below who underwent cataract surgery from January 2010 to December 2015. Patients were recruited if they had a minimum of six months post-operative follow-up. Exclusion criteria included traumatic cataract, central nervous system abnormalities, incomplete medical records or pre-existing ocular pathology. Subjects were divided into two groups based on refraction at one month. Subjects with refraction within 1- dioptre of the targeted spherical equivalent were in the success group and the rest were in the failure group.

RESULTS

A total of 111 subjects were recruited (65 subjects in success group and 46 subjects in the failure group). Mean age at surgery was 33.14 (SD: 33.47) months. The success group had significantly longer axial length (p:0.0045, CI: 0.566-0.994, OR: 0.750). At final review, 44.1%(49/111) subjects had visual acuity of 0.3LogMar or better. The success group had better final mean VA in comparison to the failure group (p:0.034, CI:1.079-7.224, OR: 2.791).

CONCLUSION

The outcome of non-traumatic paediatric cataract surgery was acceptable with 58.6% achieved targeted refractive correction at 1-month post-operative period. Longer axial length was associated with better refractive outcome. Capsule related complications was the most common intra-operative complication.

The effects of the elastin polymorphisms on carotid intima-media thickness in women aged 30 - 70

[Purpose]

Elastin is one of the major determinants of arterial distensibility of large blood vessels that forms the principal component of elastic fibers from the media of arteries. However, the association between elastin(ELN) genotype and vascular function is still unclear.

[Methods]

120women were recruited from the Saha-gu (Busan, Korea) Community Center. Measurements of body composition and vascular function included carotid intima-media thickness (CIMT), carotid artery luminal diameter (CLD), minimum (diastolic) artery luminal diameter (CLD_min) and maximum (systolic) artery luminal diameter (CLD_max). Genotyping for the ELN (rs 2071307) polymorphism was performed using the TaqMan approach. ELN gene distribution of subjects were in the Hardy-Weinberg equilibrium (p=0.402).

[Results]

The relative CIMT differed significantly among the ELN genotypes. And not significant differences in CLD and CIMT/CLD ratio, but AA genotype was tended higher than other genotypes (AG and GG). The relative CIMT and CLD min differed significantly between the ELN alleles. And not significant differences in CLD max and CIMT/CLD ratio, but A allele was tended higher than G allele.

[Conclusion]

These results suggest that ELN gene polymorphism might be used a one of the genetic determinants of vascular disease in both pre- and postmenopausal women.

Beyond first-line non-anthracycline-based chemotherapy for extranodal NK/T-cell lymphoma: clinical outcome and current perspectives on salvage therapy for patients after first relapse and progression of disease

Background

Current standard treatment, including non-anthracycline-based chemotherapy and optimal combining of radiotherapy, has dramatically improved outcomes of patients with extranodal natural killer/T-cell lymphoma (ENKTL) during the last decade. This study was conducted to investigate the clinical outcome of ENKTL patients with relapsed or progressive disease after initial current standard therapy.

Patients and methods

We retrospectively reviewed patients diagnosed with ENKTL at six centers in four countries (China, France, Singapore, and South Korea) from 1997 to 2015 and analyzed 179 patients who had relapsed or progressed after initial current standard therapy.

Results

After a median follow-up of 58.6 months (range 27.9-89.2), the median second progression-free survival (PFS) was 4.1 months [95% confidence interval (CI) 3.04-5.16] and overall survival (OS) was 6.4 months (95% CI 4.36-8.51). Multivariate Cox-regression analysis revealed that elevated lactate dehydrogenase, multiple extranodal sites (≥2), and presence of B symptoms were associated with inferior OS (P < 0.05). OS and PFS were significantly different according to both prognostic index of natural killer lymphoma (PINK) and PINK-E (Epstein-Barr virus) models. Salvage chemotherapy with l-asparaginase (l-Asp)-based regimens showed a significantly better clinical benefit to response rate and PFS, although it did not lead to OS improvement. First use of l-Asp in the salvage setting and l-Asp rechallenge at least 6 months after initial treatment were the best candidates for salvage l-Asp containing chemotherapy.

Conclusions

Most patients with relapsed or refractory ENKTL had poor prognosis with short survival. Further studies are warranted to determine the optimal treatment of patients with relapsed or refractory ENKTL.

Oncogenic activation of JAK3-STAT signaling confers clinical sensitivity to PRN371, a novel selective and potent JAK3 inhibitor, in natural killer/T-cell lymphoma

Aberrant activation of the JAK3-STAT signaling pathway is a characteristic feature of many hematological malignancies. In particular, hyperactivity of this cascade has been observed in natural killer/T-cell lymphoma (NKTL) cases. Although the first-in-class JAK3 inhibitor tofacitinib blocks JAK3 activity in NKTL both in vitro and in vivo, its clinical utilization in cancer therapy has been limited by the pan-JAK inhibition activity. To improve the therapeutic efficacy of JAK3 inhibition in NKTL, we have developed a highly selective and durable JAK3 inhibitor PRN371 that potently inhibits JAK3 activity over the other JAK family members JAK1, JAK2, and TYK2. PRN371 effectively suppresses NKTL cell proliferation and induces apoptosis through abrogation of the JAK3-STAT signaling. Moreover, the activity of PRN371 has a more durable inhibition on JAK3 compared to tofacitinib in vitro, leading to significant tumor growth inhibition in a NKTL xenograft model harboring JAK3 activating mutation. These findings provide a novel therapeutic approach for the treatment of NKTL.

Stenosis detection and quantification on cardiac CTCA using panoramic MIP of coronary arteries

In this work, we proposed to demonstrate the entire 3D coronary tree using panoramic maximum intensity projection (MIP) of coronary arteries, and to detect and quantify coronary stenosis from computed tomography coronary angiography (CTCA). The performance of the proposed method was assessed in comparison with invasive coronary angiography (ICA) as reference standard. Six anonymized CTCA datasets were tested. MIP method achieved a sensitivity of 82% and a specificity of 95% for the stenosis detection with a good reproducibility (i.e. Cohen's kappa coefficient of 0.74 for the intra-rater agreement, and 0.45 for the inter-raters agreement). In stenosis quantification, three image options are provided. The original density images resulted in an accuracy of 0.85. The edge map images resulted in an accuracy of 0.79. The image combination had a better accuracy of 0.89 than any single image option. In conclusion, the panoramic MIP provided fast and accurate way for the stenosis detection and quantification. It may be helpful to assist the radiologist in identifying the location of the greatest narrowing in clinical practice.

Association of ACTN3 polymorphisms with BMD, and physical fitness of elderly women

[Purpose] Association of ACTN3 polymorphism with bone mineral density and the physical fitness of elderly women is still unclear. Therefore, this study investigated the association between ACTN3 genotype and bone mineral density, and the physical fitness of elderly women. [Subjects and Methods] Sixty-eight elderly women (67.38 ± 3.68 years) were recruited at a Seongbuk-Gu (Seoul, Korea) Medical Service Public Health Center. Measurements of physical fitness included muscle strength, muscle endurance, flexibility, agility, balance and VO₂max. Bone mineral density (BMD), upper limb muscle mass, lower limb muscle mass, percent body fat and body fat mass for the entire body were measured by dual-energy X-ray absorptiometry and an analyzer. Genotyping for the ACTN3 R577X (rs1815739) polymorphism was performed using the TaqMan approach. [Results] ACTN3 gene distribution of subjects were in the Hardy-Weinberg equilibrium (p=0.694). The relative bone mineral density trunk, pelvis and spine differed significantly among the ACTN3 genotypes. There were no significant differences among bone mineral densities of the head, arms, legs, ribs and total, but the RR genotype tended to be higher than other genotypes. Physical fitness was not significantly different among the ACTN3 genotypes. [Conclusion] These results suggest that ACTN3 gene polymorphisms could be used as one of the genetic determinants of bone mass in elderly women, and in particular, they indicate that individuals with the RR genotype have higher BMD and bone mineral composition.

JAK-STAT and G-protein-coupled receptor signaling pathways are frequently altered in epitheliotropic intestinal T-cell lymphoma

Epitheliotropic intestinal T-cell lymphoma (EITL, also known as type II enteropathy-associated T-cell lymphoma) is an aggressive intestinal disease with poor prognosis and its molecular alterations have not been comprehensively characterized. We aimed to identify actionable easy-to-screen alterations that would allow better diagnostics and/or treatment of this deadly disease. By performing whole-exome sequencing of four EITL tumor-normal pairs, followed by amplicon deep sequencing of 42 tumor samples, frequent alterations of the JAK-STAT and G-protein-coupled receptor (GPCR) signaling pathways were discovered in a large portion of samples. Specifically, STAT5B was mutated in a remarkable 63% of cases, JAK3 in 35% and GNAI2 in 24%, with the majority occurring at known activating hotspots in key functional domains. Moreover, STAT5B locus carried copy-neutral loss of heterozygosity resulting in the duplication of the mutant copy, suggesting the importance of mutant STAT5B dosage for the development of EITL. Dysregulation of the JAK-STAT and GPCR pathways was also supported by gene expression profiling and further verified in patient tumor samples. In vitro overexpression of GNAI2 mutants led to the upregulation of pERK1/2, a member of MEK-ERK pathway. Notably, inhibitors of both JAK-STAT and MEK-ERK pathways effectively reduced viability of patient-derived primary EITL cells, indicating potential therapeutic strategies for this neoplasm with no effective treatment currently available.

Prognostic Role of Adjuvant Chemotherapy in Node-Negative (N0), Triple-Negative (TN), Medullary Breast Cancer (MBC) in the Korean Population

BACKGROUND

Despite the favorable prognosis for medullary breast cancer (MBC), the guidelines for the use of adjuvant chemotherapy for MBC have not been clearly established. This study investigated the prognostic role of adjuvant chemotherapy in Korean patients with node-negative (N0), triple-negative (TN) MBC patients.

METHODS

We included data from 252 patients with N0 TN MBC, obtained from the Korean Breast Cancer Registry database. Patients were categorized as those who did not undergo adjuvant chemotherapy (group I) or those who did (group II). Clinicopathological characteristics, breast cancer-specific survival (BCSS), and overall survival (OS) were compared between the groups. In addition, a subgroup analysis for survival based on tumor size was conducted.

RESULTS

A total of 252 N0 TN MBC patients with tumor sizes >1 cm who were diagnosed between April 1997 and March 2011 were enrolled. The median age was 44.95 years (range, 25-72 years), and the median follow-up period was 93.94 months (range, 23-195 months). Overall, the BCSS and OS in group II (97.3% and 97.3%, respectively) were significantly better compared with those in group I (89.2% and 86.2%, respectively). In the subgroup analysis, in patients with tumors >2 cm in size, those in group II had significant better BCSS and OS (97.5% and 97.5%, respectively) compared with those in group I (78.3% and 73.9%, respectively). In contrast in those with tumors 1-2 cm in size, there were no significant differences in BCSS and OS between the groups (both 97.1% for group I, and 95.2% and 92.9%, respectively for group II). Multivariate analysis revealed that adjuvant chemotherapy significantly improved BCSS (P = 0.009) and OS (P = 0.007), but only for patients with larger tumors (>2 cm).

CONCLUSIONS

In patients with N0 TN MBC, adjuvant chemotherapy had a significant clinical survival benefit, but only in those with tumors >2 cm.

The COL5A1 genotype is associated with range of motion

PURPOSE

The aim of our study was to investigate the association between COL5A1 genotype and Range of Motion as measured by the passive straight leg raise (SLR) and whole body join laxity (WBJL) in Asian population.

METHODS

One hundred and seventy seven participants including Korean and Japanese college students (male = 109, female = 68) participated in the study. Each subject performed the passive straight leg raise and whole body join laxity test. Genotyping for the COL5A1 (rs 12722) polymorphism was performed using the TaqMan approach. The COL5A1 genotype exhibited a Hardy-Weinberg equilibrium distribution in our population.

RESULTS

The physical parameters including height, weight, and BMI were higher in < 90° group than > 90° group. The SLR exhibited significant difference among the COL5A1 group. However, the WBJL did not differ significantly among the COL5A1 genotype, but significant difference was seen in CC genotype when compared to CT (2.99 ± 1.72) or TT (2.70 ± 1.52) genotype.

CONCLUSION

We concluded that COL5A1 gene polymorphism is associated with increased SLR ROM in Asian population.

Effects of a healthy life exercise program on arteriosclerosis adhesion molecules in elderly obese women

[Purpose] The aim of this study was to investigate the change in the arteriosclerosis adhesion molecules after a healthy life exercise program that included aerobic training, anaerobic training, and traditional Korean dance. [Subjects] The subjects were 20 elderly women who were over 65 years of age and had 30% body fat. [Methods] The experimental group underwent a 12-week healthy life exercise program. To evaluate the effects of the healthy life exercise program, measurements were performed before and after the healthy life exercise program in all the subjects. [Results] After the healthy life exercise program, MCP-1 and the arteriosclerosis adhesion molecules sE-selectin and sVCAM-1 were statistically significantly decreased. [Conclusion] The 12-week healthy life exercise program reduced the levels of arteriosclerosis adhesion molecules. Therefore, the results of our study suggest that a healthy life exercise program may be useful in preventing arteriosclerosis and improving quality of life in elderly obese women.

Effects of a 12-week healthy-life exercise program on oxidized low-density lipoprotein cholesterol and carotid intima-media thickness in obese elderly women

[Purpose] This study examined the effects of a 12-week exercise program on plasma level of oxidized low-density lipoprotein cholesterol in obese elderly women, who are at increased risk of heart disease morbidity. [Subjects and Methods] Twenty participants were assigned into either a control (n = 10) or a supervised exercise program (n = 10) group. The 12-week exercise intervention was performed 3 days per week and involved combined aerobic exercise, resistance exercise, and traditional Korean dance. [Results] Two-factor analysis of variance revealed significant group × time interactions for body mass, diastolic blood pressure, appendicular muscle mass. For high-density lipoprotein cholesterol, oxidized low-density lipoprotein cholesterol, and the ratio of oxidized low-/high-density lipoprotein cholesterol, two-factor analysis of variance revealed significant interactions (group × time), indicating responses differed significantly between the control and exercise groups after 12 weeks. [Conclusion] A 12-week low- to moderate-intensity exercise program appears to be beneficial for obese elderly women by improving risk factors for cardiovascular disease.

Do We Have the Right Prognostic Index for Diffuse Large B Cell Lymphoma (DLBCL) in the Era of Rituximab?

Introduction:

Whilst the addition of rituximab, a humanized monoclonal antibody to standard CHOP chemotherapy (R-CHOP) has improved the outcomes of DLBCL, the validity of the previously identified prognostic index based on clinical parameters is questioned. It is conceivable that prognostic model may alter with introduction of new therapeutics with differing efficacy and mechanisms of action.

Methods:

We conducted a retrospective analysis comparing the relevance of International Prognostic Index (IPI), Age-adjusted IPI and Revised International Prognostic Index (R-IPI) in 320 consecutive patients with DLBCL from 2003–2008 treated with R-CHOP chemotherapy with curative intent. We evaluated the prognostic factors determinant of survival in our group of patients.

Results:

Patients were followed up for a median of 2.70 years. IPI was only able to stratify patients into 3 main risk groups instead of 4. In addition, among patients <60, aa-IPI no longer seem a robust prognostic model. We showed that R-IPI was able to separate patients into 3 different prognostic groups and perhaps most relevant in the era of chemo-immunotherapy. Significant prognostic factors identified in multivariate analysis were performance status (P=0.004) and bone marrow involvement (P=0.026).

Conclusion:

The most robust prognostic index for patients with DLBCL in the era of rituximab remains uncertain. Incorporation of molecular markers into clinical parameters should be evaluated, a study we are embarking on.

Central nervous system (CNS) relapse in diffuse large B cell lymphoma (DLBCL): pre- and post-rituximab

Central nervous system (CNS)-directed prophylactic intrathecal (IT) therapy is indicated in patients with Burkitt and acute lymphoblastic lymphoma. Its role in diffuse large B cell lymphoma (DLBCL), a heterogeneous subtype, is less well defined. While addition of rituximab to standard cyclophosphamide-hydroxydaunorubicin-oncovin-prednisone (CHOP) chemotherapy (R-CHOP) has improved the outcomes of DLBCL patients, its role in reducing CNS relapse is unclear. We aim to (1) evaluate the clinical risk factors predictive of CNS relapse, (2) the role of rituximab in influencing CNS relapse, and (3) role of intrathecal prophylaxis. Four hundred ninety-nine patients with DLBCL from 2000 to 2008 were included (CHOP 179 vs. R-CHOP 320). IT prophylaxis was administered to 82 patients based on our institution's guidelines. Baseline characteristics between CHOP- and R-CHOP-treated patients were similar. Although R-CHOP significantly increased the complete remission rate from 71% to 81% (P < 0.01), CNS relapse rates remained unchanged (R-CHOP 6% vs. CHOP 5.1%). On multivariate analysis, poor performance status (Eastern Cooperative Oncology Group >1; hazard ratio (HR) = 2.01, 95% confidence interval (CI) 1.29-3.14), failure to attain remission (non-complete response (CR) vs. CR: HR = 2.39, 95% CI = 1.03 to 5.51), testicular (HR = 6.67, 95% CI = 1.62 to 27.53), kidney (HR = 20.14, 95% CI = 5.23 to 77.46), and breast involvement (HR = 6.14, 95% CI = 1.61 to 23.37) were each independently predictive of CNS relapse. Use of IT prophylaxis did not appear to decrease CNS relapse. Median survival after CNS relapse was 3.2 months. CNS relapse, a fatal event, remains a challenge in R-CHOP-treated patients. IT prophylaxis may not be sufficient to reduce CNS relapse, and strategies including systemic agents with high CNS penetration should be evaluated in high-risk patients identified in this study.

Central nervous system (CNS) relapse in diffuse large B cell lymphoma (DLBCL): pre- and post-rituximab

Central nervous system (CNS)-directed prophylactic intrathecal (IT) therapy is indicated in patients with Burkitt and acute lymphoblastic lymphoma. Its role in diffuse large B cell lymphoma (DLBCL), a heterogeneous subtype, is less well defined. While addition of rituximab to standard cyclophosphamide-hydroxydaunorubicin-oncovin-prednisone (CHOP) chemotherapy (R-CHOP) has improved the outcomes of DLBCL patients, its role in reducing CNS relapse is unclear. We aim to (1) evaluate the clinical risk factors predictive of CNS relapse, (2) the role of rituximab in influencing CNS relapse, and (3) role of intrathecal prophylaxis. Four hundred ninety-nine patients with DLBCL from 2000 to 2008 were included (CHOP 179 vs. R-CHOP 320). IT prophylaxis was administered to 82 patients based on our institution's guidelines. Baseline characteristics between CHOP- and R-CHOP-treated patients were similar. Although R-CHOP significantly increased the complete remission rate from 71% to 81% (P < 0.01), CNS relapse rates remained unchanged (R-CHOP 6% vs. CHOP 5.1%). On multivariate analysis, poor performance status (Eastern Cooperative Oncology Group >1; hazard ratio (HR) = 2.01, 95% confidence interval (CI) 1.29-3.14), failure to attain remission (non-complete response (CR) vs. CR: HR = 2.39, 95% CI = 1.03 to 5.51), testicular (HR = 6.67, 95% CI = 1.62 to 27.53), kidney (HR = 20.14, 95% CI = 5.23 to 77.46), and breast involvement (HR = 6.14, 95% CI = 1.61 to 23.37) were each independently predictive of CNS relapse. Use of IT prophylaxis did not appear to decrease CNS relapse. Median survival after CNS relapse was 3.2 months. CNS relapse, a fatal event, remains a challenge in R-CHOP-treated patients. IT prophylaxis may not be sufficient to reduce CNS relapse, and strategies including systemic agents with high CNS penetration should be evaluated in high-risk patients identified in this study.

Matrix metalloproteinase-dependent shedding of intercellular adhesion molecule-5 occurs with long-term potentiation

Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases that can be released or activated in a neuronal activity dependent manner. Although pathologically elevated levels of MMPs may be synaptotoxic, physiologically appropriate levels of MMPs may instead enhance synaptic transmission. MMP inhibitors can block long term potentiation (LTP), and at least one family member can affect an increase in the volume of dendritic spines. While the mechanism by which MMPs affect these changes is not completely understood, one possibility is that the cleavage of specific synaptic cell adhesion molecules plays a role. In the present study, we have examined the ability of neuronal activity to stimulate rapid MMP dependent shedding of the intercellular adhesion molecule-5 (ICAM-5), a synaptic adhesion molecule that is thought to inhibit the maturation and enlargement of dendritic spines. Since such cleavage would likely occur within minutes if it were relevant to a process such as LTP, we focused on post stimulus time points of 30 min or less. We show that NMDA can stimulate rapid shedding of ICAM-5 from cortical neurons in dissociated cell cultures and that such shedding is diminished by pretreatment of cultures with inhibitors that target MMP-3 and -9, proteases thought to influence synaptic plasticity. Additional studies suggest that MMP mediated cleavage of ICAM-5 occurs at amino acid 780, so that the major portion of the ectodomain is released. Since reductions in ICAM-5 have been linked to changes in dendritic spine morphology that are associated with LTP, we also examined the possibility that MMP dependent ICAM-5 shedding occurs following high frequency tetanic stimulation of murine hippocampal slices. Results show that the shedding of ICAM-5 occurs in association with LTP, and that both LTP and the associated ICAM-5 shedding are reduced when slices are pretreated with an MMP inhibitor. Together, these findings suggest that neuronal activity is linked to the shedding of a molecule that may inhibit dendritic spine enlargement and that MMPs can affect this change. While further studies will be necessary to determine the extent to which cleavage of ICAM-5 in particular contributes to MMP dependent LTP, our data support an emerging body of literature suggesting that MMPs are critical mediators of synaptic plasticity.

Percutaneous transcatheter aortic valve replacement: first transapical implant in Asia

Percutaneous transcatheter implantation of the aortic valve has been demonstrated as an alternative to open heart surgery in high-risk patients with symptomatic severe aortic stenosis (AS) who are not suitable for open surgery. The majority of these new devices are delivered via the transfemoral approach. However, due to the current size of delivery sheaths, the small and tortuous iliofemoral anatomy makes this approach challenging. The transapical approach provides a viable option for this patient subgroup. The first-in-Asia transcatheter aortic valve implantation via the transapical route is described. A 79-year-old Chinese woman with symptomatic severe AS and peripheral arterial disease, who was at high surgical risk, was successfully treated, and had good functional and haemodynamic results at the three-month follow-up.

High SUV uptake on FDG-PET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG-PET/CT staging in lymphoma

BACKGROUND

Data assessing the role of positron emission tomography (PET)/computed tomography (CT) imaging in lymphoma staging is still being accumulated and current staging is based primarily on CT. This study aims to compare the value of PET/CT over conventional CT and bone marrow biopsy (BMB) in the initial evaluation of patients with lymphoma.

METHODS

Data on 122 patients with PET/CT scans as part of their initial staging were prospectively collected and reviewed. All patients had complete staging, including BMB.

RESULTS

Among the 122 patients, 101 had non-Hodgkin's lymphoma (NHL) and 21 had Hodgkin's lymphoma (HL). Compared with conventional CT, PET/CT upstaged 21 (17%) cases [B-cell non-Hodgkin's lymphoma (B-NHL), 12; T-cell non-Hodgkin's lymphoma (T-NHL), 3; HL, 6]. Of significance, in 13 patients with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG)-avid splenic lesions, four had normal CT findings. A maximum FDG uptake of >10 standardized uptake value (SUV) seems to significantly correlate with an aggressive B-cell lineage (odds ratio 2.47, 95% confidence interval 2.23-2.70). Overall, PET scan was concordant with BMB results in 108 (89%) and discordant in 14 (11%) cases. In HL, our data show that PET scan and marrow results agreed in 19 of the cases (90%), being concordantly negative in 18 cases and concordantly positive in one, giving a negative predictive value (NPV) of 100%, sensitivity of 100% and specificity of 90%. Of note, all 13 with early-stage HL had negative PET/CT scan and BMB. In NHL, all 17 cases of T-NHL had concordant PET and BMB results. In patients with aggressive B-NHL, BMB and PET/CT agreed in 58 patients (92%) and disagreed in five (8%), while the corresponding rates in indolent B-cell lymphoma were 14 (67%) and seven patients (33%), respectively. All seven were falsely negative.

CONCLUSIONS

PET/CT upstages 17% of cases and detects occult splenic involvement. This may have potential therapeutic and prognostic implications. SUV >10 may predict for an aggressive histology. Except for indolent B-NHL, our data show that PET scans have a good overall NPV in excluding lymphomatous bone marrow involvement. This is particularly true of early-stage HL, suggesting that BMB may be safely omitted in this group.

Percutaneous transcatheter aortic valve replacement: first transfemoral implant in Asia

Surgical aortic valve replacement (AVR) is the standard of care for patients with symptomatic severe aortic stenosis (AS), providing relief of symptoms and prolonging survival. However, many patients are either denied or not offered surgery due to high surgical risk or non-operability for open AVR. The technology of percutaneous aortic valve implantation emerged in 2002, and has since evolved rapidly with satisfactory results. Currently, almost all the procedures are performed predominantly in Europe and North America. The first-in-Asia percutaneous transcatheter aortic valve implantation via the transfemoral route is described. A 77-year-old man with symptomatic severe AS and at high surgical risk was successfully treated, with sustained clinical improvement and satisfactory haemodynamic results at 30-day follow-up.