The added value of SPECT/CT lymphoscintigraphy in the initial assessment of secondary extremity lymphedema patients.

An added value of SPECT/CT over planar lymphoscintigraphy for initial staging in patients with secondary extremity lymphedema was investigated. Furthermore, we developed a hybrid SPECT/CT classification combining dermal backflow (DBF) of SPECT and honeycomb pattern (HP) of CT, correlated it with lymphoscintigraphic staging and clinical severity. Forty-one patients with secondary extremity lymphedema who underwent lymphoscintigraphy with SPECT/CT were included retrospectively. The severity of extremity lymphedema was assessed using CT volumetry. Lymphoscintigraphic findings were evaluated using the Taiwan Lymphoscintigraphy Staging (TLS), and CT-based and SPECT-based quantitative analysis were performed. TLS was performed by planar scintigraphy only and with SPECT/CT, respectively. The SPECT/CT findings were classified into DBF-/HP-, DBF+/HP-, DBF+/HP+, and DBF-/HP+. Based on these findings, patients were categorized into five classes: Class 1 = DBF-HP- entire limb, Class 2 = DBF+/HP- proximal/distal limb without DBF+/HP+ or DBF-/HP+, Class 3 = DBF+/HP+ proximal/distal limb without DBF-/HP+, Class 4 = Mixed DBF+/HP+ and DBF-/HP+ in proximal/distal limb, Class 5 = DBF-/HP+ entire limb. Adding SPECT/CT to planar scintigraphy showed a 15.4% modification rate in lymphoscintigraphic staging. HP volume ratio significantly increased as clinical severity and lymphoscintigraphic staging increased, while DBF volume ratio increased with severity and followed expected patterns according to lymphoscintigraphic staging. Hybrid SPECT/CT lymphoscintigraphic classification showed strong positive correlation with clinical severity and TLS. Our results demonstrated substantial modification of lymphoscintigraphic staging by adding SPECT/CT to a conventional planar scintigraphy. In addition, a hybrid SPECT/CT is expected to provide new indicators reflecting lymphoscintigraphic staging and clinical severity by providing both of functional DBF and anatomical HP information.

Factors affecting unmet medical needs of patients with diabetes: A population-based study.

AIMS: The purpose of this study was to identify unmet medical needs and related factors in patients with diabetes. DESIGN: A cross-sectional study. METHODS: Participants included 2269 diabetes patients aged >19 years by using data from the National Health and Nutrition Examination Surveys. A complex sample design multiple logistic regression analysis was performed. RESULTS: The study found that 8.7% of diabetes patients experienced unmet medical needs, and it was found to be higher for those who thought their self-assessed health status was unhealthy and often felt stressed in their daily life. Gender and education level had a moderating effect on income level on unmet medical needs experience. CONCLUSION: These findings have important implications for nursing practice in the management of diabetes. Nurses can develop targeted interventions that address the specific needs of patients who are at risk for unmet medical needs, particularly those from low-income backgrounds. By considering the factors that contribute to unmet medical needs and the moderating effect of income level, nurses can improve patient outcomes and reduce the burden of diabetes.

Assessment and diagnosis of right ventricular failure-retrospection and future directions.

The right ventricle (RV) has a critical role in hemodynamics and right ventricular failure (RVF) often leads to poor clinical outcome. Despite the clinical importance of RVF, its definition and recognition currently rely on patients' symptoms and signs, rather than on objective parameters from quantifying RV dimensions and function. A key challenge is the geometrical complexity of the RV, which often makes it difficult to assess RV function accurately. There are several assessment modalities currently utilized in the clinical settings. Each diagnostic investigation has both advantages and limitations according to its characteristics. The purpose of this review is to reflect on the current diagnostic tools, consider the potential technological advancements and propose how to improve the assessment of right ventricular failure. Advanced technique such as automatic evaluation with artificial intelligence and 3-dimensional assessment for the complex RV structure has a potential to improve RV assessment by increasing accuracy and reproducibility of the measurements. Further, noninvasive assessments for RV-pulmonary artery coupling and right and left ventricular interaction are also warranted to overcome the load-related limitations for the accurate evaluation of RV contractile function. Future studies to cross-validate the advanced technologies in various populations are required.

Assessment of indoor radon exposure in South Korea.

The objective of this study is to update the national and regional indoor radon concentrations in South Korea and assess indoor radon exposure. Based on the previously published survey results and the collected measurement data of surveys conducted since 2011, a total of 9271 indoor radon measurement data covering 17 administrative divisions are finally used for analysis. The annual effective dose from the indoor radon exposure is calculated using dose coefficients recommended by the International Commission on Radiological Protection. The population-weighted average indoor radon concentration was estimated to be a geometric mean of 46 Bq m-3(GSD = 1.2) with 3.9% of all samples showing values exceeding 300 Bq m-3. The regional average indoor radon concentration ranged from 34 to 73 Bq m-3. The radon concentrations in detached houses were relatively higher than those in public buildings and multi-family houses. The annual effective doses to the Korean population due to indoor radon exposure were estimated to be 2.18 mSv. The updated values in this study might better represent the national indoor radon exposure level in South Korea because they contain more samples and cover a wider range of geographical areas than previous studies.

A Rapid Assessment of Sensitivity to Reward Delays and Classwide Token Economy Savings for School-Aged Children.

Delay discounting tasks measure the relation between reinforcer delay and efficacy. The present study established the association between delay discounting and classroom behavior and introduced a brief measure quantifying sensitivity to reward delays for school-aged children. Study 1 reanalyzed data collected by Reed and Martens (J Appl Behav Anal 44(1):1-18, https://doi.org/10.1901/jaba.2011.44-1, 2011) and found that 1-month delay choices predicted student classroom behavior. Study 2 examined the utility of the 1-month delay indifference point in predicting saving and spending behavior of second-grade students using token economies with two different token production schedules. Collectively, results showed (a) the 1-month delay indifference point predicted classroom behavior, (b) children who discounted less and had greater self-regulation, accrued and saved more tokens, and (c) a variable token production schedule better correlated with discounting than a fixed schedule. Implications are discussed regarding utility of a rapid discounting assessment for applied use.

PET Imaging of System xC - in Immune Cells for Assessment of Disease Activity in Mice and Patients with Inflammatory Bowel Disease.

We aimed to explore whether the imaging of antiporter system xC - of immune cells with (4S)-4-(3-18F-fluoropropyl)-l-glutamate (18F-FSPG) PET can assess inflammatory bowel disease (IBD) activity in murine models and patients (NCT03546868). Methods: 18F-FSPG PET imaging was performed to assess IBD activity in mice with dextran sulfate sodium-induced and adoptive T-cell transfer-induced IBD and a cohort of 20 patients at a tertiary care center in South Korea. Immunohistochemical analysis of system xC - and cell surface markers was also studied. Results: Mice with experimental IBD showed increased intestinal 18F-FSPG uptake and xCT expression in cells positive (+) for CD11c, F4/80, and CD3 in the lamina propria, increases positively associated with clinical and pathologic disease activity. 18F-FSPG PET studies in patients, most of whom were clinically in remission or had mildly active IBD, showed that PET imaging was sufficiently accurate in diagnosing endoscopically active IBD and remission in patients and bowel segments. 18F-FSPG PET correctly identified all 9 patients with superficial or deep ulcers. Quantitative intestinal 18F-FSPG uptake was strongly associated with endoscopic indices of IBD activity. The number of CD68+xCT+ and CD3+xCT+ cells in 22 bowel segments from patients with ulcerative colitis and the number of CD68+xCT+ cells in 7 bowel segments from patients with Crohn disease showed a significant positive association with endoscopic indices of IBD activity. Conclusion: The assessment of system xC - in immune cells may provide diagnostic information on the immune responses responsible for chronic active inflammation in IBD. 18F-FSPG PET imaging of system xC - activity may noninvasively assess the IBD activity.

Systematic Review and Meta-Analysis of Token Economy Practices in K-5 Educational Settings, 2000 to 2019.

Token economy systems have been widely used as an evidence-based classroom management strategy to reinforce and improve prosocial responses. While token economies have been widely applied to educational settings, there have been mixed results regarding the effectiveness depending on the classroom type. To better understand the components contributing to the effectiveness, the researchers analyzed 24 token economy studies conducted in general and special education classrooms from kindergarten to fifth grade between 2000 and 2019. Eight token economy components and effect sizes were identified for each study and compared across different classroom types. The results showed that the token economy intervention yielded large effect sizes for both general and special education classroom types. There were differences in the usage of token components including backup reinforcer types, token production rate, and exchange production rate based on classroom types. Implications for future research and practice for educators and clinicians are discussed.

Body mass index and relative handgrip strength are associated with the prevalence of hypertension in Korean elderly: Korean national fitness assessment in 2019.

PURPOSE: This study aimed to analyze the prevalence of hypertension according to the body mass index (BMI) and relative handgrip strength (RHGS) among elderly individuals in Korea. METHODS: We analyzed the data of 44,183 Korean elderly individuals over 65 years old (men: n = 15,798, age = 73.31 ± 5.04 years, women: n = 28,385, age = 72.14 ± 5.04 years) obtained from the Korean National Fitness Assessment in 2019. All the participants were categorized into three groups according to the BMI and RHGS; additionally, one-way ANOVA and logistic regression analysis were performed. RESULTS: Overweight (men: 1.16 odds ratio [OR] 1.06-1.26, 95% confidence interval [CI]; women: 1.15 OR, 1.07-1.23 95% CI) and obese (men: 1.54 OR, 1.42-1.66 95% CI; women: 1.44 OR, 1.36-1.53 95% CI) elderly individuals showed a higher prevalence of hypertension than elderly individuals with normal weight, after controlling for age. In men, a lower RHGS was associated with a higher prevalence of hypertension after controlling for age (weak RHGS: 1.09 OR, 1.00-1.17 95% CI; middle RHGS: 1.21 OR, 1.12-1.31 95% CI vs. strong RHGS). CONCLUSION: A higher BMI was associated with the prevalence of hypertension in the elderly Korean population. In addition, a lower RHGS was associated with the prevalence of hypertension in elderly Korean men.

A first nation-wide assessment of soil-transmitted helminthiasis in Fijian primary schools, and factors associated with the infection, using a lymphatic filariasis transmission assessment survey as surveillance platform.

BACKGROUND: Soil-transmitted helminthiasis (STH) is endemic in Fiji but its prevalence is not known and likely to have changed after a decade of mass drug administration (MDA) for lymphatic filariasis (LF). By linking with LF transmission assessment surveys (LF-TAS), we undertook the first nation-wide assessment of STH in Fijian primary schools, as well as an analysis of factors associated with STH infections. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional assessment for STH was conducted in all four Divisions of Fiji from 2014 to 2015. In the Western, Central, and Northern Divisions, schools were sub-sampled after LF-TAS, while, in the Eastern Division, schools were selected via simple random sampling. For the diagnosis of STH, stool samples were examined by coproscopy with a single Kato-Katz thick smear (KK) and the formol-ether-acetate concentration technique, except for the samples from the Eastern Division where only KK was used. Mean prevalence of any STH among class 1-2 students at the national level was 10.5% (95% CI: 6.9-15.5). Across the three Divisions via LF-TAS, the prevalence levels for ascariasis were 8.7% (95% CI: 4.3-16.6), hookworm 3.9% (95% CI: 2.3-6.6) and trichuriasis 0%. In the Eastern Division, ascariasis prevalence was 13.3% (95% CI: 6.4-25.6), and hookworm 0.7% (95% CI: 0.2-2.5), with one case of trichuriasis. Among class 3-8 students, ascariasis prevalence was lower. Lower risk of any STH was associated with wearing shoes (adjusted OR 0.54, 95% CI: 0.32-0.90) and having piped water from the Fiji Water Authority at home (adjusted OR 0.48, 95% CI: 0.25-0.92). CONCLUSIONS: After a decade of community-based LF-MDA, STH in school-age children in Fiji is now close to 10%, but localities of endemicity remain. Preventive chemotherapy should be maintained in areas with elevated STH prevalence alongside targeted delivery of integrated WASH interventions. LF-TAS has provided an opportunity to develop future public health surveillance platforms.

In vitro and in vivo assessment of the genotoxic effects of ceric ammonium nitrate and 1,3-propane sultone.

A variety of methods have been developed for accurate and systematic evaluation of chemical genotoxicity. Ceric ammonium nitrate (CAN) and 1,3-propane sultone (1,3-PS) have been extensively applied in industrial fields. Although 1,3-PS, but not CAN, has been reported as a potent carcinogen, systematic assessment of the genotoxic properties of these chemicals has not been conducted. The purpose of this study was to establish a decision tree for evaluating genotoxicity based on the good laboratory practices (GLP) system using 1,3-PS and CAN as test chemicals. In vitro studies were performed including the bacterial reverse mutation assay, chromosomal aberration assay, and micronucleus assay. We conducted in vivo studies using a combined micronucleus and alkaline comet (MN-CMT) assay and the Pig-a gene mutation assay, which is a promising method for detecting gene mutations in vivo. CAN showed negative responses in all in vitro genotoxicity assays and the in vivo combined MN-CMT assay. Meanwhile, 1,3-PS had positive results in all in vitro and in vivo genotoxicity assays. In this study, we confirmed the genotoxicity of 1,3-PS and CAN using both in vitro and in vivo assays. We propose a decision tree for evaluating chemical-induced genotoxicity.

Development of the Korean Global Physical Activity Questionnaire: reliability and validity study.

The goal of this study was to develop a Korean version of the Global Physical Activity Questionnaire (K-GPAQ) and to examine its reliability and validity. The English version of the GPAQ was translated to the Korean language (K-GPAQ) via forward-backward translation. Reliability of the K-GPAQ was evaluated using a one-week interval test-retest method with 115 individuals. Criterion-related validity of the K-GPAQ was examined with 199 participants using accelerometers. Cohen's kappa and Spearman's correlation coefficients were used to measure test-retest reliability and validity, respectively. A Bland-Altman analysis was used to assess agreement between physical activity (PA) levels measured via K-GPAQ and the accelerometer. Coefficients for the reliability of the K-GPAQ showed moderate agreement for recreational PA and slight agreement for work-related PA (Cohen's kappa: 0.60-0.67 for recreational PA and 0.30-0.38 for work-related PA and Spearman's rho: 0.27-0.47 for work-related PA and 0.53-0.70 for recreational PA). Criterion validity of the total amount of PA, as measured by the K-GPAQ and the accelerometer, showed a weak but significant correlation (r = 0.34, p < 0.01). The K-GPAQ is a reliable and valid questionnaire to measure PA although K-GPAQ overestimated PA levels.

Noninvasive Assessment of Exosome Pharmacokinetics In Vivo: A Review.

Exosomes, intraluminal vesicles that contain informative DNA, RNA, proteins, and lipid membranes derived from the original donor cells, have recently been introduced to therapy and diagnosis. With their emergence as an alternative to cell therapy and having undergone clinical trials, proper analytical standards for evaluating their pharmacokinetics must now be established. Molecular imaging techniques such as fluorescence imaging, magnetic resonance imaging, and positron emission tomography (PET) are helpful to visualizing the absorption, distribution, metabolism, and excretion of exosomes. After exosomes labelled with a fluorescer or radioisotope are administered in vivo, they are differentially distributed according to the characteristics of each tissue or lesion, and real-time biodistribution of exosomes can be noninvasively monitored. Quantitative analysis of exosome concentration in biological fluid or tissue samples is also needed for the clinical application and industrialization of exosomes. In this review, we will discuss recent pharmacokinetic applications to exosomes, including labelling methods for in vivo imaging and analytical methods for quantifying exosomes, which will be helpful for evaluating pharmacokinetics of exosomes and improving exosome development and therapy.

ICT-Based Comprehensive Health and Social-Needs Assessment System for Supporting Person-Centered Community Care.

OBJECTIVES: This study developed an information and communication technology (ICT)-based comprehensive health and social-needs assessment (CHSNA) system based on the International Classification of Functioning, Disability, and Health (ICF) with the aim of enhancing person-centered community care for community residents and supporting healthcare professionals and social workers who provide healthcare and social services in the community. METHODS: Items related to a CHSNA tool were developed and mapped with ICF codes. Experts validated the CHSNA system design and process using the Delphi method, and a pilot test of the initial version of the system was conducted. RESULTS: The following three steps of CHSNA were embedded in the system, which had a user-friendly screen and images: basic health assessment, life and activity assessment, and in-depth health assessment. The assessment results for the community residents were presented with visualized health profiles, including images, graphs, and an ICF model. CONCLUSIONS: The developed CHSNA system can be used by healthcare professionals, social workers, and community residents to evaluate the reasoning underlying health and social needs, to facilitate the identification of more appropriate healthcare plans, and to guide community residents to receive the best healthcare services. A CHSNA system can improve the implementation of standardized terminology utilizing the ICF and the accuracy of needs assessments of community residents.

Risk assessment of volatile organic compounds (VOCs) detected in sanitary pads.

Disposable sanitary pads are a necessity for women's health, but safety concerns regarding the use of these products have created anxiety. The aim of this study was to conduct a risk assessment of 74 volatile organic compounds (VOCs), which were expected to be contained within sanitary pads. Of the 74 VOCs, 50 were found in sanitary pads retailed in Korea at concentrations ranging from 0.025 to 3548.09 µg/pad. In order to undertake a risk assessment of the VOCs, the toxicological database of these compounds in the United States Environmental Protection Agency (USEPA), Agency for Toxic Substances and Disease Registry (ATSDR), National Toxicology Program (NTP) and World Health Organization (WHO) was searched. Ethanol was found to exhibit the highest reference dose (RfD) while 1,2-dibromo-3-chloro-propane displayed the lowest RfD. Consequently, a worst-case exposure scenario was applied in this study. It was assumed that there was the use of 7.5 sanitary napkins/day for 7 days/month. In the case of panty liners or overnight sanitary napkins, the utilization of 90 panty liners/month or 21 overnight sanitary napkins/month was assumed, respectively. In addition, 43 kg, the body weight of 12 to 13-year-old young women, and 100% VOCs skin absorption were employed for risk assessment. The systemic exposure dose (SED) values were calculated ranging from 1.74 (1,1,2-trichloroethane) ng/kg/day to 144.4 (ethanol, absolute) µg/kg/day. Uncertainty factors (UFs) were applied ranging from 10 to 100,000 in accordance with the robustness of animal or human experiments. The margin of exposure (MOE) of 34 VOCs was more than 1 (acceptable MOE > 1). Applicable carcinogenic references reported that the cancer risk of five VOCs was below 10-6. Based on our findings, evidence indicates that the non-cancer and cancer risks associated with VOCs detected in sanitary pads currently used in South Korea do not pose an adverse health risk in women.

Assessment of Left Ventricular Ejection Fraction by Thallium-201 Myocardial SPECT-CT in Patients with Angina Pectoris: Comparison with 2D Echocardiography.

PURPOSE: Left ventricular (LV) ejection fraction (EF) is an important parameter for assessing cardiac systolic function and predicting prognosis in patients with cardiovascular disease. The aim of this study was to evaluate the feasibility of assessing LVEF by Tl-201 hybrid myocardial single-photon emission computed tomography (SPECT)/CT using two attenuation correction methods in patients with angina pectoris. METHODS: A total of 339 patients with angina pectoris (62.8 ± 12.9 years, male:female = 206:133) were analyzed. All patients underwent Tl-201 myocardial SPECT/CT and transthoracic two-dimensional (2D) echocardiograph. We compared LVEF assessed by SPECT/CT using two attenuation correction methods: CT-based attenuation correction (CTAC) and non-attenuation correction (non-AC) methods and 2D echocardiography. RESULTS: LVEF assessed by either of the two attenuation correction techniques and 2D echocardiography showed moderate correlation in all patients with angina pectoris (r = 0.487 for CTAC and r = 0.473 for non-AC, p < 0.001). Results were similar in the subgroup of patients with perfusion abnormalities on myocardial SPECT/CT images. Overall diagnostic performances were similar for the CTAC and non-AC methods for evaluating normal and decreased LVEF by myocardial SPECT/CT. CONCLUSION: LVEF measured by the CTAC method of Tl-201-gated myocardial SPECT/CT was comparable with the conventional non-AC method in patients with angina pectoris and in the subgroup of patients with perfusion abnormality. Tl-201-gated myocardial hybrid SPECT/CT can be a reliable tool in the assessment of LVEF in clinic.

Intraoperative Specimen Mammography for Margin Assessment in Breast-Conserving Surgery.

The purpose of this study aimed to determine whether intraoperative specimen mammography is an effective margin assessment method in Asian women. Thus, 182 patients who underwent breast-conserving surgery (BCS) were evaluated. After wide excision, intraoperative specimen mammography was used to assess margin adequacy. The control group comprised 84 patients who underwent BCS and were evaluated for margin of frozen section during surgery. 61.6% patients had dense breasts and 85.7% of dense breasts could margin assess by intraoperative specimen mammography. There were no significant differences in the incidence of extremely close margins (p = 0.421) and second operation (p = 0.252) between both groups. Significant correlations were found between radiological and histological margins (R2 = 0.222, p < 0.05). The frozen section analysis group had longer operative time than the specimen mammography group. The study results show that intraoperative specimen mammography of breast lesions in BCS is useful in identifying margin clearance.

In vivo and in vitro assessment of the bleaching effectiveness of a brush-off patch containing 3.0% hydrogen peroxide.

OBJECTIVES: To evaluate the efficacy of a brush-off patch containing 3.0% hydrogen peroxide, which is a new over-the-counter (OTC) product for tooth whitening, and determine the optimal protocol for use. MATERIALS AND METHODS: We performed an in vitro study using hydroxyapatite specimens and a clinical trial involving 140 volunteers. The brush-off patch was applied to the specimens (in vitro) or the maxillary anterior teeth (in vivo; 14 days) for 10 min twice daily (case 10 group) or 30 min once daily (case 30 group). We also included control groups in both experiments. Lightness (L*), redness (a*), and yellowness (b*) values were measured using a colorimeter. In the in vivo study, color changes were measured at baseline and 7 and 14 days after the start of patch application. The overall color change (ΔE) was statistically analyzed. RESULTS: In the in vitro study, the color change (ΔE*) after the experiment was significantly different between the two case groups and the control group (p < 0.001). In the in vivo study, the case groups showed color changes at both 7 and 14 days after patch application. In particular, the change in the case 30 group was significantly more prominent on day 14 than on day 7 (p < 0.05). CONCLUSION: Our findings suggest that brush-off patches containing 3.0% hydrogen peroxide are effective OTC products for tooth whitening. CLINICAL RELEVANCE: For best results, brush-off patches containing 3.0% hydrogen peroxide can be applied once daily for 30 min.

Changes in prescription pattern, pharmaceutical expenditure and quality of care after introduction of reimbursement restriction in diabetes in Korea.

Background: To ensure effective prescription practices and reduce diabetes-related pharmaceutical expenditures, Korea adopted a clinical practice guideline for the reimbursement system. Health care providers cannot receive reimbursement from National Health Insurance(NHI) unless it is for an appropriate prescription under the predefined clinical condition. The aim of this study was to evaluate prescription patterns in oral hypoglycemic agents, costs and effects on patient care since the introduction of the diabetes reimbursement restriction. Methods: We used claim data from 2008 to 2013, which included 26 315 diabetes patients and 9907 hospitals. An interrupted time series study design using generalized estimating equations was used to evaluate changes in patterns of single and combination therapy, brand name drug prescriptions, cost and hospital admission following the reimbursement restriction. Results: Following reimbursement restriction initiation, we found a statistically significant decrease in the average prescription rate of brand name drugs (-6.2%), whereas single therapy prescription increased (9.9%). There was also a reduction in trend change in the monthly prescription rate for combination therapy (-1.7%) and brand name drugs (-0.8%). For single therapy, the trend change in prescription rate increased after the intervention (0.8%). A reduction of trend change in pharmaceutical costs (-0.3%) was observed. However, we did not find a significant change in hospital admission for diabetes. Conclusions: Reimbursement restriction affects both pharmaceutical costs and physicians' decisions to prescribe oral hypoglycemic agents. We did not observe a significant reduction in quality of care following the intervention. Collectively, these findings indicate that reimbursement restriction has improved effective drug utilization and decreased health expenditures.

Erratum to: The KMDS-NATION Study: Korean Movement Disorders Society Multicenter Assessment of Non-Motor Symptoms and Quality of Life in Parkinson's Disease NATION Study Group.

This corrects the article on p. 393 in vol. 12, PMID: 27819413.

The KMDS-NATION Study: Korean Movement Disorders Society Multicenter Assessment of Non-Motor Symptoms and Quality of Life in Parkinson's Disease NATION Study Group.

BACKGROUND AND PURPOSE: Nonmotor symptoms (NMS) in Parkinson's disease (PD) have multisystem origins with heterogeneous manifestations that develop throughout the course of PD. NMS are increasingly recognized as having a significant impact on the health-related quality of life (HrQoL). We aimed to determine the NMS presentation according to PD status, and the associations of NMS with other clinical variables and the HrQoL of Korean PD patients. METHODS: We surveyed patients in 37 movement-disorders clinics throughout Korea. In total, 323 PD patients were recruited for assessment of disease severity and duration, NMS, HrQoL, and other clinical variables including demographics, cognition, sleep scale, fatigability, and symptoms. RESULTS: In total, 98.1% of enrolled PD subjects suffered from various kinds of NMS. The prevalence of NMS and scores in each NMS domain were significantly higher in the PD group, and the NMS worsened as the disease progressed. Among clinical variables, disease duration and depressive mood showed significant correlations with all NMS domains (p<0.001). NMS status impacted HrQoL in PD (rS=0.329, p<0.01), and the association patterns differed with the disease stage. CONCLUSIONS: The results of our survey suggest that NMS in PD are not simply isolated symptoms of degenerative disease, but rather exert significant influences throughout the disease course. A novel clinical approach focused on NMS to develop tailored management strategies is warranted to improve the HrQoL in PD patients.