Adequate nutritional support and high body mass index (BMI) are good prognostic factors for disease progression and survival in amyotrophic lateral sclerosis (ALS). However, whether the composition ...of body weight, such as body fat percentage, has an independent effect on ALS prognosis remains unclear. The clinical data of 53 ALS patients were collected by medical record review. The data included: disease onset, sex, age, time of diagnosis, survival duration, presence of percutaneous endoscopic gastrostomy (PEG), nasogastric tube, tracheostomy, and availability of oral intake throughout the course of the disease, and interval measurement values of body mass by bioelectrical impedance analysis (BIA). The interval change (∆) of the BIA parameters was calculated by subtracting the follow-up values from the baseline values. Change in body fat percentage/interval between BIA measurements (months) (hazard ratio HR = 0.374, p = 0.0247), and availability of oral food intake (HR = 0.167, p = 0.02), were statistically significant for survival duration in multivariate hazard proportional regression analysis. Survival analysis and Kaplan–Meier curves showed similar results. Higher average monthly change in body fat percentage and availability of oral food intake are prognostic factors in ALS survival.
Abstract
Background
Handgrip strength (HGS), an indicator of overall muscle strength, is a key component in sarcopenia diagnosis. Although exercise is an effective strategy to prevent sarcopenia, the ...most appropriate exercise type targeting sarcopenia needs to be established. This study aimed to investigate the relationship between the physical activity (PA) patterns and HGS.
Methods
This was a cross-sectional study using the data from the 7th Korea National Health and Nutrition Examination Survey (2016–2018). The study population included 12,814 adults aged ≥ 40 years. According to the World Health Organization PA guidelines for public health, both aerobic (moderate to vigorous PA ≥ 150 min/week) and resistance exercises (≥ 2 sessions/week) are recommended. Study participants were categorized into one of the four groups depending on their adherence to each of two exercise guidelines (“neither,” “aerobic only,” “resistance only,” and “combined”). By defining normal HGS cutoff values as the lowest quartile of HGS from the population aged 20 years and above, we classified participants as “preserved” HGS group if their HGS was equal to or above the cutoff values. A Poisson regression model was used to calculate adjusted prevalence ratios (APRs) for preserved HGS across the four PA guideline adherences stratified by age and sex groups.
Results
In middle-aged adults, the “combined” exercise group was independently associated with the preserved HGS (male, age 50–59 years, APR = 1.072; male, age 60–69 years, APR = 1.180; female, age 50–59 years, APR = 1.112; female, age 60–69 years, APR = 1.188). For adults aged ≥ 70 years, meeting only aerobic or resistance exercise guidelines showed a positive association with HGS before adjusting for other health-related variables. In males of ≥ 70 years, the APR of preserved HGS was highest in the “combined” exercise group (“resistance only,” APR = 1.459, “combined,” APR = 1.664), while in women aged ≥ 70 years, the significance was lost after adjusting for covariates.
Conclusions
Adults meeting both aerobic and resistance exercise guidelines were associated with the highest prevalence of preserved HGS. Performing both types of exercise might be the most effective way to prevent sarcopenia that should be investigated in future clinical trials.
The aim of this study was to show the safety and feasibility of single-port laparoscopic surgery (SPLS) by comparing its short-term outcomes with those following conventional laparoscopic surgery.
...Single-port laparoscopic surgery maximizes the advantages of laparoscopic surgery, and therefore it can be an ultimate attainment of laparoscopic surgery. However, no comparative study has addressed its role in colorectal cancer.
Prospectively collected data of patients who had undergone either conventional laparoscopic surgery (n = 106) or SPLS (n = 73) for colorectal cancer between March 2006 and May 2010 were analyzed retrospectively. The short-term outcomes of these 2 operative modalities were compared.
Of the 179 study subjects, 103 (57.5%) had colon cancer and 76 (42.5%) had rectal cancer. Various operative methods, from right hemicolectomy to abdominoperineal resection, were used according to location through either conventional laparoscopic or SPLS approach. In its comparison, mean surgical time was greater in the SPLS group (255 vs 276 minutes, P < 0.008). Acquired length of sufficient surgical margins and the number of harvested lymph nodes were comparable. Postoperative recovery was faster in the SPLS group, in terms of shorter time duration before first flatus (SPLS vs conventional laparoscopic surgery; 2.5 ± 1.2 vs 3.2 ± 1.8 days, P = 0.004), earlier initiation of free oral fluids (1.8 ± 2.2 vs 2.6 ± 1.7 days, P = 0.000) and of a solid diet (4.2 ± 2.9 vs 6.5 ± 2.7 days, P = 0.000), less frequent usage of parenteral narcotics (2.2 ± 3.2 vs 3.5 ± 4.0 times, P = 0.029), and shorter hospital stay (9.6 ± 9.6 vs 15.5 ± 9.8 days, P = 0.000).
This study shows that SPLS is both safe and feasible in colorectal cancer, and that it has equivalent or better short-term outcomes than conventional laparoscopic surgery. Accordingly, the authors conclude that SPLS can be an alternative to conventional laparoscopic surgery for colorectal cancer.
Objectives:
To evaluate the validity of the revised 2017 McDonald criteria for multiple sclerosis (MS) compared with the 2010 McDonald criteria to predict conversion to clinically definite multiple ...sclerosis (CDMS) in patients with clinically isolated syndrome (CIS).
Methods:
A total of 163 patients from seven referral hospitals in Korea, who experienced a first clinical event suggestive of MS between 2006 and 2017, were enrolled. Patients were stratified into two groups according to outcome at the last visit: CDMS converters who experienced a second clinical event and non-converters.
Results:
Of the 163 patients with a mean follow-up of 63 months, 60% converted to CDMS. The sensitivity, specificity, positive and negative predictive values and accuracy were, respectively, 88.8%, 43.1%, 70.2%, 71.8% and 70.6% for the 2017 McDonald criteria and 53.1%, 69.2%, 72.2%, 49.5% and 59.5% for the 2010 McDonald criteria. After exclusion of 82 patients who received disease-modifying agents before the second attack, the specificity of the 2017 and 2010 McDonald criteria increased to 85.0% and 95.0%, but sensitivity decreased to 83.6% and 47.5%, respectively.
Conclusion:
The 2017 McDonald criteria afforded higher sensitivity and accuracy but lower specificity compared with the 2010 McDonald criteria for prediction of conversion to CDMS in Korean CIS patients.
The head-up tilt table test (HUT) is one of the primary clinical examinations for evaluating orthostatic intolerance (OI). HUT can be divided into three phases: dynamic tilt phase (supine to tilt ...up), static tilt phase (remain tilted at 70°), and post tilt phase (tilt down back to supine position). Commonly, blood pressure (BP) and heart rate (HR) are monitored to observe for OI symptoms, but are indirect measurements of cerebral perfusion and can lead to inaccurate HUT evaluation. In this study, we implemented a 108-channel near-infrared spectroscopy (NIRS) probe to characterize HUT performance by monitoring cerebral hemodynamic changes for healthy controls (HCs), OI patients with normal HUT results, and OI patients with positive HUT results: vasovagal syncope (VS), postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), and orthostatic hypertension (OHT). By the end of the static tilt phase, OI patients typically did not show a complete recovery back to baseline cerebral oxygenation and total blood volume compared to HCs. We characterized the return to cerebral homeostasis by polynomial fitting total blood volume changes and determining the inflection point. The OI patients with normal HUT results, VS, OH, or OHT showed a delay in the return to cerebral homeostasis compared to the HC group during HUT.
The interpretation of video head-impulse tests (video-HITs) can often be complicated, limiting their clinical utility in acute vestibular syndrome. We aimed to determine video-HIT findings in ...patients with posterior circulation strokes (PCSs) and vestibular neuritis (VN).
We retrospectively analyzed the results of video-HITs in 59 patients with PCS. Irrespective of the actual lesion revealed later on MRIs, ipsilateral and contralateral sides were assigned according to the direction of slow phase of spontaneous nystagmus (SN). Then, the patterns of video-HIT findings were classified according to the vestibulo-ocular reflex (VOR) gain for the horizontal canals; (1) ipsilaterally positive, (2) contralaterally positive, (3) bilaterally normal, and (4) bilaterally positive. The abnormal responses were further defined into (5) wrong-way saccades, (6) perverted, and (7) early acceleration followed by premature deceleration. We also analyzed the asymmetry of the corrective saccadic amplitude between the sides, calculated from the sum of cumulative saccadic amplitudes on both sides. The results were compared with video-HIT results from 71 patients with VN.
Video-HITs were normal in 32 (54%), ipsilaterally positive in 11 (19%), bilaterally positive in 10 (17%), and contralaterally positive in 6 (10%) patients with PCS. Wrong-way saccades were more frequently observed in VN than in PCS (31/71 44% vs 5/59 8%,
< 0.001). Saccadic amplitude asymmetry was greater in VN than in PCS (median 100% interquartile range 82-144, 95% CI 109-160 vs 0% -29 to 34, -10 to 22,
< 0.001). When differentiating VN from PCS, the sensitivity was 81.7%, and specificity was 91.5% at the cutoff value of 71% for saccadic amplitude asymmetry with an area under the curve (AUC) of 0.91 (95% CI 0.86-0.97). The AUC for saccadic amplitude asymmetry was larger than that for the ipsilateral VOR gain (
= 0.041) and other parameters.
Patients with PCS may show various head-impulse responses that deviate from the findings expected in VN, which include normal, contralaterally positive, and negative saccadic amplitude asymmetry (i.e., greater cumulative saccadic amplitude contralaterally). A thorough analysis of corrective saccades in video-HITs can improve the differentiation of PCS from VN even before MRIs.
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. However, no reliable biomarkers have been identified to represent the clinical status. This study aimed to investigate whether ...diffusion tensor imaging (DTI) findings are useful imaging biomarkers to indicate the clinical status of ALS patients. Ninety-six probable or definite ALS cases and 47 age- and sex-matched, normal controls were enrolled. Demographic and clinical data were collected at the time of DTI. DTI data were acquired using a 3-Tesla magnetic resonance imaging scanner and analysed by voxel-wise statistical analyses for fractional anisotropy, axial diffusivity, radial diffusivity, mean diffusivity, and mode of anisotropy. Compared with the healthy control group, the ALS group had significant differences in DTI scalars in the diffuse tracts of the brain, which was predominant in the corticospinal tract at the brainstem and cerebellar peduncle area. Furthermore, the DTI values correlated with the ALS functional rating scale-revised (ALSFRS-R) scores and the delta ALSFRS-R score representing the rate of disease progression. The subgroup analysis revealed a more severe and widespread brain degeneration was observed in rapidly progressive ALS. Therefore, our results suggest that DTI findings are useful as imaging biomarkers for evaluating the clinical severity and rate of disease progression in ALS.
ObjectivesThe WHO recommends that adults engage in regular moderate-to-vigorous physical activities (MVPAs) and muscle-strengthening activities (MSA), and minimise sedentary behaviour. This study ...aimed to determine the association of occupation with MVPA, MSA and sedentary behaviour in middle-aged Korean workers.Design and settingA cross-sectional study using data from the seventh Korea National Health and Nutrition Examination Survey (2016–2018).ParticipantsWorkers aged between 40 and 69 years in Korea (n=6359).Outcome measuresPopulation-weighted proportions not meeting the MVPA (＜150 min/week) and MSA (＜2 days/week) guidelines, and with high sedentary behaviour (＞7 hours/day) were calculated, and their associations with sociodemographic and work-related variables were assessed using multiple logistic regression analyses. Additionally, the estimated time spent on MVPA, MSA and sedentary behaviour according to the occupation categories (white-collar, pink-collar and blue-collar) was calculated using analysis of covariance (ANCOVA).ResultsThe MVPA level did not show a significant difference across the occupation categories. Blue-collar workers showed significantly lower MSA participation than white-collar and pink-collar workers (male, p=0.006; female, p=0.004; by ANCOVA). High sedentary behaviour was significantly associated with white-collar occupations (p<0.001 by ANCOVA). Longer working hours were negatively associated with MVPA (OR=1.01, 95% CI 1.01 to 1.02) and MSA (OR=1.01, 95% CI 1.00 to 1.02). Workers with higher stress were less likely to participate in MSA (male: OR=1.43, 95% CI 1.10 to 1.86; female: OR=1.39, 95% CI 1.08 to 1.80). Self-employed workers showed lower MVPA levels than employees (male: OR=1.26, 95% CI 1.09 to 1.47; female: OR=1.36, 95% CI 1.13 to 1.64). Daily workers compared with full-time workers (OR=0.38, 95% CI 0.24 to 0.59) and temporary workers compared with regular workers (OR=0.75, 95% CI 0.59 to 0.95) were associated with less sedentary behaviour in men.ConclusionA number of work-related factors were associated with PA levels and sedentary behaviour in middle-aged workers. The workplace is one of the critical elements to intervene in health promotion strategies.
Introduction: The aim of this study was to determine normal reference values for cross‐sectional area (CSA) and the correlation between demographic factors and CSA in the cervical roots and brachial ...plexus trunks using ultrasonography. Methods: Ninety‐five age‐matched healthy individuals were studied. Ultrasonographic tests were performed via nerve tracing from the cervical root to the brachial plexus trunk. The CSA of each nerve was measured in the C5–8 ventral roots and brachial plexus (trunk level). Results: Normal values of each cervical root were: C5, 5.66 ± 1.02 mm2; C6, 8.98 ± 1.65 mm2; C7, 10.43 ± 1.86 mm2; and C8, 10.76 ± 2.02 mm2. Values for the brachial plexus were: upper trunk, 16.70 ± 2.88 mm2; middle trunk, 14.01 ± 2.70 mm2; and lower trunk, 13.75 ± 2.57 mm2. The side‐to‐side discrepancy was 11.91 ± 11.11%. Body mass index (BMI) and height correlated frequently with nerve CSA. Conclusions: These reference values may be helpful in investigating pathologies involving the cervical area. Muscle Nerve 46: 711–716, 2012
Background:
Although neuromyelitis optica (NMO) is a central nervous system (CNS) autoimmune disease distinct from multiple sclerosis (MS). NMO and NMO spectrum disorder (NMOSD) sometimes show ...asymptomatic lesions on brain magnetic resonance imaging (MRI) at onset, and even present with symptomatic brain involvement.
Objectives:
We investigated whether brain MRI at onset can be helpful for the differentiation of MS and NMOSD.
Methods:
We retrospectively analyzed initial brain MRIs, performed within three months of onset, in patients with MS (n = 51) and anti-aquaporin4-antibody-positive patients with NMOSD (n = 67).
Results:
NMOSD patients met the Paty (37%) and Barkhof (13%) criteria, and the criteria of the European Magnetic Imaging in MS (MAGNIMS) study group (9%), for MS. Ovoid lesions perpendicular to the lateral ventricle, isolated juxtacortical lesions in U-fibers and isolated ovoid/round cortical lesions were found only in MS patients, whereas longitudinal corticospinal tract lesions, extensive hemispheric lesions, periependymal lesions surrounding the lateral ventricle and cervicomedullary lesions were found only in NMOSD patients.
Conclusions:
Our study suggests that it is difficult to differentiate MS from NMOSD by the fulfillment of the MRI criteria for MS on brain MRI at onset; however, the characteristic morphology of brain lesions is highly useful for the early differentiation of the two disorders.
PDF
