Differences in sarcopenia status and mortality according to physical activity: results from the Korean Longitudinal Study on Health and Aging (KLoSHA).

PURPOSE: There is increasing evidence that promoting physical activity can prevent sarcopenia. However, physical activity (PA) decreases with age, and the impact of PA intensity on health is unclear. This study investigated the relationship between the level of PA and sarcopenia, and the association between PA levels and mortality in patients with and without sarcopenia. METHODS: Data were derived from the Korean Longitudinal Study on Health and Aging. PA was classified as sedentary behavior, light PA, or moderate-to-vigorous PA. Each PA level was subdivided based on the median time spent engaged in that activity, yielding eight PA profiles. Logistic regression and Cox proportional hazard models were used to investigate the association between PA level and sarcopenia, and between PA profiles and mortality. RESULTS: This study included 620 participants (50.2% women; mean age 75.7 ± 7.5 years), of whom 130 (21.0%) participants were identified sarcopenia. During follow-up (mean 10.9 ± 4.1 years), 264 (42.6%) participants died. Overall, sarcopenic participants were less physically active than non-sarcopenic participants. After multivariate adjustment, more sedentary behavior and less moderate-to-vigorous PA were associated with sarcopenia and all related variables, except muscle mass. Compared with the reference, non-sarcopenic participants with lower sedentary behavior and concomitantly higher moderate-to-vigorous PA had significantly lower hazard ratios for mortality, while higher light PA reduced mortality in sarcopenic participants regardless of time spent engaged in sedentary behavior or moderate-to-vigorous PA. CONCLUSIONS: PA, especially sedentary behavior and moderate-to-vigorous PA, was associated with sarcopenia and related variables, but the level of PA that prevented death differed according to sarcopenia status. Our findings may help determine the optimal intensity and amount of PA.

Obesity, Physical Performance, Balance Confidence, and Falls in Community-Dwelling Older Adults: Results from the Korean Frailty and Aging Cohort Study.

Obesity affects physical functions in numerous ways. We aimed to evaluate the association between obesity and falls, physical performance, and balance confidence in community-dwelling older adults. Using first-year baseline data from the Korean Frailty and Aging Cohort Study, 979 older adults were included. General obesity was defined based on the body mass index and body fat percentage, whereas central obesity was classified based on the waist circumference and waist-to-height ratio. Data regarding fall history and balance confidence were acquired using self-questionnaires, and a timed up-and-go test was performed to measure balance-related physical performance. Overall, 17.3% of participants experienced falls in the previous year. Central obesity, as determined by waist circumference (odds ratio, 1.461; 95% confidence interval, 1.024-2.086; p-value, 0.037) and by waist-to-height ratio (odds ratio, 1.808; 95% confidence interval, 1.015-3.221; p-value, 0.044) was significantly associated with falls. Interestingly, general obesity, measured by body fat percentage, was protective against fall-related fractures (odds ratio, 0.211; 95% confidence interval, 0.072-0.615; p-value, 0.004). Participants with central obesity had poorer physical performances in the timed up-and-go test (odds ratio, 2.162; 95% confidence interval, 1.203-3.889; p-value, 0.010) and lower balance confidence according to the Activities-specific Balance Confidence scale (odds ratio, 1.681; 95% confidence interval, 1.153-2.341; p-value 0.007). In conclusion, assessment of central obesity, particularly waist circumference, should be considered as a screening strategy for falls, and older adults with a high waist circumference should receive advice on fall prevention.

A 42-year-old patient with renal cell carcinoma presenting as low back pain: A case report.

RATIONALE: Renal cell carcinoma (RCC) is the most common renal neoplasm, accounting for 2.4% of all cancers in Korea. Although the usual clinical manifestations of RCC include flank pain, hematuria, and palpable mass, RCC is generally characterized by a lack of early warning signs and is mostly discovered incidentally in advanced stage. This case report describes a 42-year-old Korean man diagnosed with giant RCC who presented with simple back pain. PATIENT CONCERNS: The clinical manifestation of a 42-year-old Korean man was chronic back pain. DIAGNOSES: Contrast-enhanced computed tomography showed a 19.1-cm sized heterogeneous enhancing mass on the right kidney and tumor thrombosis extending into inferior vena cava. INTERVENTION: Due to the large size of the tumor and extensive tumor thrombosis, the multidisciplinary team decided to administer neoadjuvant chemotherapy and an anticoagulant. Following 12 cycles of treatment with nivolumab and cabozantinib, he underwent a right radical nephrectomy with an adrenalectomy and tumor thrombectomy. OUTCOMES: Treatment was successful and posttreatment he started a cancer rehabilitation program. He was followed-up as an outpatient and no longer complains of back pain. LESSONS: RCC can manifest clinically as back pain, with diagnosis being difficult without appropriate imaging modalities. RCC should be included in the differential diagnosis of patients with low back pain, even at a young age.

The Impact of the Physical Activity Level on Sarcopenic Obesity in Community-Dwelling Older Adults.

Previous studies have reported that low levels of physical activity result in sarcopenic obesity (SO). However, the effects of specific intensities of physical activity on SO and the optimal amount of physical activity for lowering the prevalence of SO have not been well studied. This study aimed to identify the effects of physical activity levels and intensity on SO and the optimal amount of physical activity related to a lower prevalence of SO. This cross-sectional study used data from the nationwide Korean Frailty and Aging Cohort Study (KFACS), which included 2071 older adults (1030 men, 1041 women). SO was defined according to the criteria of the European Society for Clinical Nutrition Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Multivariate logistic regression analysis was performed to investigate the association between the physical activity level and SO. The high activity group had a significantly lower prevalence of SO than the non-high activity (low and moderate activity) group. On the other hand, moderate-intensity physical activity was associated with a lower prevalence of SO. A total physical activity energy expenditure of > 3032 kcal/week (433 kcal/day) for men and 2730 kcal/week (390 kcal/day) for women was associated with a reduced prevalence of SO. The high physical activity and total physical energy expenditure described above may be beneficial for reducing the prevalence of SO.

Cross-sectional and longitudinal association between atrial fibrillation and sarcopenia: Findings from the Korean frailty and aging cohort study.

BACKGROUND: Sarcopenia is commonly observed in patients with cardiovascular diseases. However, studies on the association between sarcopenia and atrial fibrillation and their causal relationships are limited. We performed cross-sectional and longitudinal analyses to investigate the association between sarcopenia and atrial fibrillation among community-dwelling older adults. METHODS: A total of 2225 participants from the Korean Frailty and Aging Cohort Study (KFACS) from 2016 to 2017 were included in this cross-sectional analysis. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 consensus. Atrial fibrillation was diagnosed on the basis of electrocardiographic findings. We investigated whether atrial fibrillation increased the risk of incident sarcopenia 2 years later and whether sarcopenia, in turn, increased the 2-year risk of developing atrial fibrillation using KFACS data from 2018 to 2019. RESULTS: Of the 2225 participants (54.2% women; mean age 76.0 ± 3.9 years), 509 (22.9%) had sarcopenia at baseline. In the cross-sectional analysis, sarcopenia was associated with atrial fibrillation after multivariate adjustment [odd ratio (OR), 2.127; 95% confidence interval (CI), 1.240-3.648; P = 0.006]. Among the sarcopenia components, low physical performance was associated with atrial fibrillation (OR, 1.872; 95% CI, 1.123-3.120; P = 0.016). During the 2-year follow-up period, atrial fibrillation was not associated with new-onset of sarcopenia (OR, 1.483; 95% CI, 0.597-3.685; P = 0.396), and sarcopenia also did not significantly increase the risk of incident atrial fibrillation (OR, 1.120; 95% CI, 0.384-3.264; P = 0.836). CONCLUSIONS: Although we found a significant association between sarcopenia and atrial fibrillation in a cross-sectional analysis, we could not establish a causal relationship between the two based on 2 years of follow-up. Further research with long-term follow-up is required to identify causal relationship between atrial fibrillation and sarcopenia.

Global, Regional, and National Burden of Spine Pain, 1990-2019: A Systematic Analysis of the Global Burden of Disease Study 2019.

OBJECTIVE: To describe the global, regional, national, and temporal trends in neck pain (NP) and low back pain (LBP) from 1990 to 2019 and analyze associations with age, sex, and sociodemographic index (SDI). DESIGN: Temporal trends analyses of the Global Burden of Disease 2019 data for global, regional, and national prevalence, incidence, and years lived with disabilities (YLDs) of NP and LBP from 1990 to 2019. SETTING: Not applicable. PARTICIPANTS: Not applicable. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): The temporal trends in prevalence, incidence, and YLDs of NP and LBP, and associations with age, sex, and SDI. RESULTS: Globally, the prevalence, incidence, and YLDs of NP and LBP significantly increased; however, the age-standardized rates of NP showed a stable trend, and those of LBP slightly decreased from 1990 to 2019. The burden of NP and LBP was higher in women than in men. Both NP and LBP exhibited similar age-related trends, with the total numbers and rates increasing with age and reaching their highest points in the middle- and old-aged groups, respectively, in 2019. Overall, the prevalence, incidence, and YLDs of NP and LBP were higher in regions with higher SDI over the 3 decades. CONCLUSIONS: NP and LBP impose significant major public health burden globally. Although both conditions are more frequent in women and middle-aged groups and tend to be prevalent in countries with high SDI, they have distinct temporal and regional patterns. By comprehending temporospatial trends in the disease burden of NP and LBP, policymakers and health care professionals can make future interventions and policies to effectively manage these conditions worldwide as well as to achieve equity in prevention, diagnosis, and treatment.

Acute cricopharyngeal achalasia after general anesthesia in myotonic dystrophy: A case report.

RATIONALE: Myotonic dystrophy type 1 (DM-1) is a progressive multisystem genetic disorder that causes myotonia and both distal limb and facial/neck muscle weakness by expanding the CTG repeats of the DMPK gene in chromosome 19q13.3. General anesthesia is indicated in DM-1 patients owing to their sensitivity to anesthetic drugs such as opioids, hypnotics, and neuromuscular blocking agents. PATIENT CONCERNS: A 48-year-old male patient underwent a laparoscopic cholecystectomy for gallstones under general anesthesia. He experienced sudden cardiac arrest and respiratory failure the day after surgery. After a thorough review of past medical history, we recognized that 15 years prior, he had been diagnosed with classic type DM-1, but the diagnosis was not self-reported before general anesthesia. Symptoms of severe dysphagia developed subsequently. In a videofluoroscopic swallowing study (VFSS), we observed abrupt aggravation of myotonic dysphagia after general anesthesia. VFSS revealed cricopharyngeal opening dysfunction, with a remaining large residue in the pyriform sinus, resulting in a severe cricopharyngeal achalasia pattern. DIAGNOSIS: Acute cricopharyngeal achalasia after general anesthesia. INTERVENTION AND OUTCOME: The patient underwent a dysphagia rehabilitation program that included cricopharyngeal opening exercises and functional electrical stimulation. However, no significant improvement was observed in the cricopharyngeal achalasia in a 3-month follow-up VFSS. LESSONS: Low body temperature and anesthetic medications such as opioids and hypnotic agents can induce myotonia in the cricopharyngeal muscle.

Effectiveness and clinical application of multidisciplinary combined exercise and nutrition intervention for sarcopenic older adults with metabolic syndrome: study protocol for a multicentre randomised controlled trial.

INTRODUCTION: Among chronic diseases affecting older adults, metabolic syndrome (MetS) is known to be closely related to sarcopenia. Insulin resistance may play a key role in the increased frequency of sarcopenia associated with metabolic disorders. To date, an exercise-nutrition combined intervention has been the treatment of choice for sarcopenia. However, trials of combined interventions for individuals with sarcopenia and MetS are still lacking. This study aims to develop and conduct a standardised intervention, named the Multidisciplinary combined Exercise and Nutrition inTervention fOR Sarcopenia (MENTORS), for sarcopenic older patients with MetS. METHODS AND ANALYSIS: This multicentre, randomised controlled trial includes 168 community-dwelling older adults with sarcopenia and MetS. The 12-week MENTORS comprises an exercise intervention consisting of an introductory phase (3 weeks; twice-weekly visits), an expanded phase (3 weeks; twice-weekly visits) and a maintenance phase (6 weeks; once-weekly visits); and a nutrition intervention tailored to the nutritional status of individual subjects. Outcomes will be measured at 0-week, 12-week and 24-week postintervention. The data will be analysed using the intention-to-treat and per-protocol principle. ETHICS AND DISSEMINATION: Before screening, all participants will be provided with oral and written information. Ethical approval has already been obtained from all participating hospitals. The study results will be disseminated in peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT04948736.

Postoperative rehabilitation using a digital healthcare system in patients with total knee arthroplasty: a randomized controlled trial.

INTRODUCTION: Digital healthcare systems based on augmented reality (AR) show promise for postoperative rehabilitation. We compared the effectiveness of AR-based rehabilitation and conventional rehabilitation after total knee arthroplasty (TKA). MATERIALS AND METHODS: We randomly allocated 56 participants to digital healthcare rehabilitation group (DR group) and conventional rehabilitation group (CR group). Participants in the CR group performed brochure-based home exercises for 12 weeks, whereas those in the DR group performed AR-based home exercises that showed each motion on a monitor and provided real-time feedback. The primary outcome was change in 4-m gait speed. The secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, health-related quality of life [assessed by the EuroQoL 5-Dimension 5-Level (EQ5D5L) questionnaire], pain [measured using a numeric rating scale (NRS)], Berg Balance Scale (BBS), range of motion (ROM), and muscle strength. Outcomes were measured at baseline (T0) and 3 (T1), 12 (T2), and 24 (T3) weeks after randomization. RESULTS: There was no significant difference in baseline characteristics of participants between two groups, except age and body mass index. No group difference was observed in 4-m gait speed (0.37 ± 0.19 and 0.42 ± 0.28 for the DR and CR groups, respectively; p = 0.438). The generalized estimating equation model revealed no significant group by time interaction regarding for 4-m gait speed, WOMAC, EQ5D5L, NRS, BBS, ROM, and muscle strength score. All outcomes were significantly improved in both groups (p < 0.001). CONCLUSION: The use of a digital healthcare system based on AR improved the functional outcomes, pain, and quality of life of patients after TKA. AR-based rehabilitation may be useful treatment as an alternative to conventional rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov (identifier: NCT04513353). Registered on August 9, 2020. http://clinicaltrials.gov/ct2/show/NCT04513353 .

A randomized controlled trial of postoperative rehabilitation using digital healthcare system after rotator cuff repair.

A digital healthcare system based on augmented reality (AR) has promising uses for postoperative rehabilitation. We compare effectiveness of AR-based and conventional rehabilitation in patients after rotator cuff repair (RCR). This study randomly allocates 115 participants who underwent RCR to digital healthcare rehabilitation group (DR group) and conventional rehabilitation group (CR group). The DR group performs AR-based home exercises using UINCARE Home+, whereas the CR group performs brochure-based home exercises. The primary outcome is a change in the Simple Shoulder Test (SST) score between baseline and 12 weeks postoperatively. The secondary outcomes are the Disabilities of the Arm, Shoulder and Hand (DASH) score; Shoulder Pain And Disability Index (SPADI) score; EuroQoL 5-Dimension 5-Level (EQ5D5L) questionnaire score; pain; range of motion (ROM); muscle strength; and handgrip strength. The outcomes are measured at baseline, and at 6, 12, and 24 weeks postoperatively. The change in SST score between baseline and 12 weeks postoperatively is significantly greater in the DR group than in the CR group (p = 0.025). The SPADI, DASH, and EQ5D5L scores demonstrate group×time interactions (p = 0.001, = 0.04, and = 0.016, respectively). However, no significant differences over time are observed between the groups in terms of pain, ROM, muscle strength, and handgrip strength. The outcomes show significant improvement in both groups (all p < 0.001). No adverse events are reported during the interventions. AR-based rehabilitation shows better improvement in terms of shoulder function after RCR compared to conventional rehabilitation. Therefore, as an alternative to the conventional rehabilitation, the digital healthcare system is effective for postoperative rehabilitation.

Impact of Vitamin B12 Insufficiency on the Incidence of Sarcopenia in Korean Community-Dwelling Older Adults: A Two-Year Longitudinal Study.

The longitudinal effect of B12 insufficiency on sarcopenia has not yet been investigated in older adults. We aimed to study the impact of B12 levels on alterations in muscle mass, function and strength over two years. Non-sarcopenic older adults (n = 926) aged 70-84 were included. Using the Korean Frailty and Aging Cohort Study, this two-year longitudinal study used data across South Korea. The tools used for assessing muscle criteria were based on the Asian Working Group for Sarcopenia guidelines. Participants were divided into the insufficiency (initial serum B12 concentration < 350 pg/mL) and sufficiency groups (≥350 pg/mL). Logistic regression analyses were performed to evaluate the effect of initial B12 concentration on sarcopenia parameters over a two-year period. In women, multivariate analysis showed that the B12 insufficiency group had a significantly higher incidence of low SPPB scores (odds ratio [OR] = 3.28, 95% confidence interval [CI] = 1.59-6.76) and sarcopenia (OR = 3.72, 95% CI = 1.10-12.62). However, the B12 insufficiency group did not have a greater incidence of sarcopenia or other parameters in men. Our findings suggest B12 insufficiency negatively impacts physical performance and increases the incidence of sarcopenia only in women.

Neutrophil-to-Lymphocyte Ratio as a Predictor of Short-Term Functional Outcomes in Acute Ischemic Stroke Patients.

Background: Neutrophil-to-lymphocyte ratio (NLR), a systemic inflammatory biomarker, has been associated with poorer outcomes in acute ischemic stroke patients. The present study was designed to expand these findings by investigating the association between NLR and short-term functional outcomes in acute ischemic stroke patients. Methods: This retrospective study evaluated patients within 7 days after the onset of acute ischemic stroke. Stroke severity on admission was measured using the National Institutes of Health Stroke Scale (NIHSS). The functional outcomes were assessed using the Berg Balance Scale (BBS), Manual Function Test (MFT), the Korean version of the modified Barthel Index (K-MBI), and the Korean Mini-Mental State Examination (K-MMSE) within 2 weeks of stroke onset. The modified Rankin Scale (mRS) was evaluated at discharge. Results: This study included 201 patients, who were grouped into three NLR tertiles (<1.84, 1.84−2.71, and >2.71) on admission. A multivariate analysis showed that the top tertile group (NLR > 2.71) had significantly higher risks of unfavorable outcomes on the K-MBI (p = 0.010) and K-MMSE (p = 0.029) than the bottom tertile group (NLR < 1.84). Based on the optimal cut-off values from a receiver operating characteristic curve analysis, a higher NLR was significantly associated with higher NIHSS scores (p = 0.011) and unfavorable outcomes on the K-MBI (p = 0.002) and K-MMSE (p = 0.001). Conclusions: A higher NLR is associated with poorer short-term functional outcomes in acute ischemic stroke patients.

Pudendal Nerve Terminal Motor Latency Compared by Anorectal Manometry Diagnosing Fecal Incontinence: A Retrospective Study.

OBJECTIVE: The aim of the study was to compare the clinical value of pudendal nerve terminal motor latency in fecal incontinence patients with that of another diagnostic test-anorectal manometry. DESIGN: This study used a cross-sectional design. Medical records of fecal incontinence patients who underwent pudendal nerve terminal motor latency and anorectal manometry testing were reviewed. Greater than 2.4 ms of pudendal nerve terminal motor latency was determined to be abnormal. Anorectal manometry was performed using a station pull-through technique. Mean resting anal pressure, maximal resting anal pressure, mean squeezing anal pressure, and maximal squeezing anal pressure were investigated. For normal and abnormal pudendal nerve terminal motor latency groups, comparative analyses were performed on anorectal manometry results. RESULTS: A total of 31 patients were included. Thirteen patients showed normal pudendal nerve terminal motor latency. For anorectal manometry results, there was no significant difference between normal and abnormal pudendal nerve terminal motor latency groups. Fourteen patients had diabetes mellitus. Subgroup analysis of the 14 diabetic patients showed no significant difference between normal and abnormal pudendal nerve terminal motor latency groups. For 17 nondiabetic patients, there was a significant difference between the groups with positive correlations with mean/maximal resting anal pressures. CONCLUSIONS: Pudendal nerve terminal motor latency significantly correlates with anorectal manometry in fecal incontinence only in nondiabetic patients.

Correlation of Videofluoroscopic Swallowing Study Findings With Radionuclide Salivagram in Chronic Brain-Injured Patients.

OBJECTIVE: To investigate the correlation between videofluoroscopic swallowing study (VFSS) and radionuclide salivagram findings in chronic brain-injured patients with dysphagia. METHODS: Medical records of chronic brain-injured patients who underwent radionuclide salivagram and VFSS were retrospectively analyzed. Patients were divided into two groups according to salivagram findings. Differences in patient characteristics and clinical factors, including Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), Functional Ambulatory Category (FAC), feeding method, tracheostomy state, and VFSS findings between the two groups were investigated. RESULTS: A total of 124 patients were included in this study. There were no significant differences in MMSE, MBI, FAC, feeding method, and presence of tracheostomy between the two groups. However, the incidence of aspiration pneumonia history was significantly higher in the positive salivagram group. The Functional Dysphagia Scale (FDS) was significantly associated with positive salivagram findings, especially in the pharyngeal phase. A multivariate logistic regression analysis showed that laryngeal elevation and epiglottic closure was statistically significant FDS parameter in predicting salivary aspiration on a salivagram (odds ratio=1.100; 95% confidence interval, 1.017-1.190; p=0.018). The receiver operating characteristic (ROC) curve of FDS in the pharyngeal phase showed that an optimum sensitivity and specificity of 55.1% and 65.4%, respectively, when the cut-off value was 39. CONCLUSION: In chronic brain-injured patients, inappropriate laryngeal elevation and epiglottic closure is predictive variable for salivary aspiration. Therefore, performing a radionuclide salivagram in patients with FDS of 39 or less in the pharyngeal phase for prevents aspiration pneumonia from salivary aspiration.

Duration of Treatment Effect of Extracorporeal Shock Wave on Spasticity and Subgroup-Analysis According to Number of Shocks and Application Site: A Meta-Analysis.

OBJECTIVE: To investigate duration of the treatment effect of extracorporeal shockwave therapy (ESWT) on spasticity levels measured with Modified Ashworth Scale (MAS) regardless of the patient group (stroke, multiple sclerosis, and cerebral palsy) and evaluate its spasticity-reducing effect depending on the number of shocks and site of application. METHODS: PubMed, EMBASE, the Cochrane Library, and Scopus were searched from database inception to February 2018. Randomized controlled trials and cross-over trials were included. All participants had spasticity regardless of cause. ESWT was the main intervention and MAS score was the primary outcome. Among 122 screened articles, 9 trials met the inclusion criteria. RESULTS: The estimate of effect size showed statistically significant MAS grade reduction immediately after treatment (standardized mean difference [SMD]=-0.57; 95% confidence interval [CI], -1.00 to -0.13; p=0.012), 1 week after (SMD=-1.81; 95% CI, -3.07 to -0.55; p=0.005), 4 weeks after (SMD=-2.35; 95% CI, -3.66 to -1.05; p<0.001), and 12 weeks after (SMD=-1.07; 95% CI, -2.04 to -0.10; p=0.03). Meta-regression and subgroup analysis were performed for the 'immediately after ESWT application' group. The prediction equation obtained from metaregression was -1.0824+0.0002* (number of shocks), which was not statistically significant. Difference in MAS grade reduction depending on site of application was not statistically significant either in subgroup analysis (knee and ankle joints vs. elbow, wrist, and finger joints). CONCLUSION: ESWT effectively reduced spasticity levels measured with MAS regardless of patient group. Its effect maintained for 12 weeks. The number of shocks or site of application had no significant influence on the therapeutic effect of ESWT in reducing spasticity. Ongoing trials with ESWT are needed to address optimal parameters of shock wave to reduce spasticity regarding intensity, frequency, and numbers.