Differences in strategies for prevention of COVID-19 transmission in hospitals: nationwide survey results from the Republic of Korea.

BACKGROUND: Hospital infection control measures against coronavirus disease 2019 (COVID-19) are often based on expert discretion due to the lack of detailed guidelines. AIM: To survey the current strategies for preventing the transmission of COVID-19 in medical institutions. METHODS: Thirteen key issues related to the prevention of COVID-19 transmission within medical institutions were selected via discussion among infectious diseases specialists, and related critical questions were obtained following a review of national-level guidelines in government databases. Six hospitals had an open survey between 11th and 25th August 2020 to provide responses to these topics. An online questionnaire developed from these data was sent to infection control teams at 46 hospitals in South Korea between 31st January 2021 and 20th February 2021. FINDINGS: All 46 hospitals responded to the survey. All operated screening clinics, but 89.1% (41/46) allowed symptomatic patients without COVID-19-associated symptoms to visit general outpatient clinics. Most hospitals (87.2%, 34/39) conducted polymerase chain reaction (PCR) tests for all hospitalized patients. Of 35/46 (76.1%) hospitals with pre-emptive isolation policies for hospitalized patients, 31 (88.6%) released patients from isolation after a single negative PCR test, while most (76.9%, 20/26) allowed shared-room accommodation for patients meeting the national criteria for release from isolation despite positive PCR results with above cycle threshold values (34.6%, 9/26), or after a certain period that satisfied the national criteria (26.9%, 7/26). CONCLUSION: Individual hospitals in South Korea are currently relying on experience to frame relevant guidelines, and responded differently to some infection control issues on hospital settings during the COVID-19 pandemic.

Chlorhexidine sensitivity in staphylococci isolated from patients with central line-associated bloodstream infection.

Since 2011, 2% chlorhexidine in 70% isopropyl alcohol (2% chlorhexidine tincture) has been widely used in Korea. To investigate changes in chlorhexidine sensitivity of staphylococci causing central line-associated bloodstream infections, 264 blood culture isolates from adult patients treated in intensive care units of five university hospitals between 2008 and 2016 were analysed. We observed no significant changes in chlorhexidine minimum inhibitory and bactericidal concentrations, or in the prevalence of resistance-associated genes before and after introduction of 2% chlorhexidine tincture. Thus, there was no evidence of increased resistance to chlorhexidine in staphylococci causing central line-associated bloodstream infections.

Diagnosis of Critical Illness Myopathy After Liver Transplantation and Muscle Condition Monitoring: A Case Report.

BACKGROUND: Intensive care unit-acquired weakness (ICUAW) can occur after liver transplantation. Early diagnosis of ICUAW and monitoring of muscle condition during rehabilitation are helpful in improving functional recovery. METHODS AND MATERIALS: A 47-year-old man with liver cirrhosis developed limb weakness after liver transplantation. The patient had a Medical Research Council sum score of 2 weeks post-liver transplantation with marked proximal limb weakness. Direct muscle stimulation was performed on the right tibialis anterior muscle; the nerve-to-muscle ratio of compound muscle action potentials was 0.96, which indicated critical illness myopathy. Fatigue analysis using surface electromyography was performed 4 times after liver transplantation. RESULTS AND CONCLUSIONS: The maximal voluntary contraction tended to increase during rehabilitation, whereas the percentage of maximal voluntary contraction tended to decrease, indicating that muscle strength was increased. The fatigue index gradually decreased, showing that muscle endurance had improved along with strength. Muscle fatigue can be evaluated during rehabilitation using surface electromyography to prevent damage of the impaired muscle and to control exercise intensity. Early diagnosis of ICUAW and evaluation of muscle fatigue during rehabilitation will ensure a better prognosis for patients with ICUAW.

Trends in device utilization ratios in intensive care units over 10-year period in South Korea: device utilization ratio as a new aspect of surveillance.

BACKGROUND: Device-associated infection (DAI) is an important issue related to patient safety. It is important to reduce unnecessary device utilization in order to decrease DAI rates. AIM: To investigate the time trend of device utilization ratios (DURs) of voluntarily participating hospitals, collected over a 10-year period through the Korean National Healthcare-associated Infections Surveillance System (KONIS). METHODS: DURs from 2006 to 2015 in 190 intensive care units (ICUs) participating in KONIS were included in this study. DURs were calculated as the ratio of device-days to patient-days. The pooled incidences of DAIs and DURs were calculated for each year of participation, and the year-wise trends were analysed. FINDINGS: Year-wise ventilator utilization ratio (V-DUR) increased significantly from 0.40 to 0.41 (F = 6.27, P < 0.01), urinary catheter utilization ratio (U-DUR) increased non-significantly from 0.83 to 0.84 (F = 1.66, P = 0.10), and C-line utilization ratio (CL-DUR) decreased non-significantly from 0.55 to 0.51 (F = 1.62, P = 0.11). In the subgroup analysis, 'medical ICU' (F = 2.79, P < 0.01) and 'hospital with >900 beds' (F = 3.07, P < 0.01) were associated with the significant increase in V-DUR. CONCLUSION: In Korea, V-DUR showed a significant, year-wise increasing trend. The trends for U-DUR and CL-DUR showed no significant decrease. Efforts are required to ensure the reduction of DURs.

Three-dimensional isotropic fast spin-echo MR lymphangiography of T1-weighted and intermediate-weighted pulse sequences in patients with lymphoedema.

AIM: To evaluate the feasibility of magnetic resonance (MR) lymphangiography acquired using three-dimensional (3D) isotropic T1-weighted fast spin-echo (FSE) and 3D isotropic intermediate-weighted FSE sequences, as the new method of MR lymphangiography, and to compare the results of these two methods in patients with lymphoedema. MATERIALS AND METHODS: Thirty-three extremities of 27 patients with primary or secondary lymphoedema and who had undergone radionuclide lymphoscintigraphy and MR lymphangiography with 3D isotropic T1-weighted FSE and 3D isotropic intermediate-weighted FSE were included in the study. The results of both imaging techniques were independently reviewed by two readers in consensus who rated the lymphatic drainage pattern, the quality of the depiction of lymphatic vessels and lymph nodes, and the level of lymph vessel enhancement. The assessment scores of each imaging sequence were compared using the Wilcoxon signed-rank test. The results were expressed as means with standard deviations. RESULTS: More lymphatic vessels were visualised on T1-weighted FSE than on intermediate-weighted FSE (p<0.001). As more lymphatic vessels were detected on T1-weighted FSE, the per-extremity grade of the lymphatic drainage pattern was higher (p=0.046) and the visible levels of lymph-vessel enhancement were also significantly higher (p=0.004) on the T1-weighted FSE sequence, whereas the conspicuity of lymph nodes was superior on intermediate-weighted FSE (p=0.004). CONCLUSION: MR lymphangiography using the 3D FSE pulse sequence is a feasible and noticeable new technique of MR lymphangiography. Between the two applicable protocols used, T1-weighted FSE provided better information regarding lymphatic vessels and their drainage, whereas intermediate-weighted FSE has the advantage of depicting lymph nodes in lymphoedematous extremities.

Low pulmonary function is related with a high risk of sarcopenia in community-dwelling older adults: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011.

UNLABELLED: Sarcopenia is the age-related reduction of skeletal muscle mass in older individuals. Respiratory muscle strength may be related to skeletal muscle mass and, thus, the present study attempted to estimate the risk of sarcopenia relative to decreased pulmonary function. The present findings demonstrated that low pulmonary function was associated with low muscle mass in community-dwelling older adults. INTRODUCTION: Lean body mass is related to pulmonary function in patients with chronic obstructive pulmonary disease (COPD). However, the relationship between muscle mass and pulmonary function in healthy older adults has yet to be clarified. Thus, the present study investigated the association of pulmonary function with muscle mass in an older community-dwelling Korean population. METHODS: This study included 463 disease-free subjects over 65 years of age who underwent anthropometric measurements, laboratory tests, spirometry, and the estimation of appendicular skeletal muscle (ASM) mass in the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES). Low muscle mass was defined as the value of ASM divided by height squared (ASM/height(2)) that was less than two standard deviations (SD) below the sex-specific mean of the young reference group. RESULTS: Forced expiratory volume in 1 s (FEV1[L]) and forced vital capacity (FVC[L]) were positively correlated with ASM/height(2) in males (p < 0.001 and p = 0.001, respectively) but not in females (p = 0.360 and p = 0.779, respectively). A univariate logistic regression analysis revealed that males with low FEV1 or FVC were more likely to have low muscle mass (odds ratio [OR] = 3.11, 95% confidence interval [CI] 1.62-5.99 for FEV1; OR = 1.99, 95% CI 1.13-3.53 for FVC); similar results were found for females, but the significance was lower (OR = 11.37, 95% CI 0.97-132.91 for FEV1; OR = 7.31, 95% CI 1.25-42.74 for FVC). After adjusting for age, smoking, and moderate physical activity, a low FEV1 value was associated with low muscle mass in both males (OR = 2.90, 95% CI 1.50-5.63) and females (OR = 9.15, 95% CI 1.53-54.77). CONCLUSIONS: Using nationally representative data from the 2008-2011 KNHANES, low pulmonary function was found to be associated with low muscle mass in community-dwelling older Korean adults.

Correlation of diffusion tensor imaging and phase-contrast MR with clinical parameters of cervical spinal cord injuries.

STUDY DESIGN: This is a cross-sectional study. OBJECTIVES: The goal of this study was to characterize the diffusion properties across segments of the spinal cord and peak cerebrospinal fluid (CSF) velocities in the stenotic spinal canal, and to determine the correlation between these properties and clinical and electrophysiological parameters in patients with cervical spinal cord injury (SCI). SETTING: This study was conducted in the University teaching hospital. METHODS: The study involved 17 patients with cervical SCI. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of the spinal cord and peak systolic and diastolic velocities of CSF were measured at the level of maximum compression (region 1) and at the levels above (region 2) and below (region 3) the level of injury with no signal change in conventional magnetic resonance imaging. Neurological and electrophysiological parameters were measured, including American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA motor score, ASIA sensory score, Modified Barthel Index, Spinal Cord Independence Measure III (SCIM III), somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP). RESULTS: The ADC was significantly higher and the FA was significantly lower in regions 1, 2 and 3 of the SCI patients than in the normal controls (P<0.05 each). FA of the level below correlated with AIS, ASIA sensory score and SCIM III score, and FA of the level above correlated with SSEP latencies and MEP amplitudes (P<0.05 each). The reductions in FA correlated with CSF flow, functional measurements and evoked potentials. CONCLUSIONS: Diffusion tensor imaging can be used to quantify the proximal and distal extents of spinal cord damage. Reductions in FA were correlated with CSF flow, functional measurements and evoked potentials.

Dexmedetomidine does not reduce emergence agitation in adults following orthognathic surgery.

BACKGROUND: Patients undergoing orthognathic surgery are at high risk of developing emergence agitation. We hypothesised that a single-dose of dexmedetomidine would reduce emergence agitation in adults with nasotracheal intubation after orthognathic surgery. METHODS: Seventy adults (20-45 years old) undergoing orthognathic surgery were randomly assigned to two groups. Patients received intravenous dexmedetomidine 1 µg/kg (dex group) or normal saline (control group) for 10 min at the end of surgery. Remifentanil was infused at 0.02 µg/kg/min during emergence in both groups. The severity of emergence agitation was assessed with the Richmond agitation-sedation scale. Cough, haemodynamic and respiratory profiles, pain, and time to eye opening were evaluated. RESULTS: The incidence of emergence agitation was not different between dex group and control group (38% vs. 47%, P = 0.45). However, severe cough during emergence was reduced in the dex group (P = 0.04). Tachycardia during emergence and recovery phases was attenuated in the dex group. The verbal numeric rating of pain was lower in the dex group. There were no differences in respiratory rate between the two groups. Time to eye opening was prolonged in the dex group. CONCLUSION: The addition of a single dose of dexmedetomidine (1 µg/kg) to low-dose remifentanil infusion did not attenuate emergence agitation in intubated patients after orthognathic surgery compared with low-dose remifentanil infusion alone. However, single-dose dexmedetomidine suppressed coughing, haemodynamic changes, and pain during emergence and recovery phases, without respiratory depression. Delayed awakening might be associated with this treatment.

The relationship between pulmonary function and bone mineral density in healthy nonsmoking women: the Korean National Health and Nutrition Examination Survey (KNHANES) 2010.

UNLABELLED: The aim of this study was to examine the association between pulmonary function and bone mineral density (BMD) in subjects who had never smoked. Pulmonary function was associated with BMD in premenopausal, but not postmenopausal, women. INTRODUCTION: It has been reported that low bone mass is common in patients with pulmonary disorders such as chronic obstructive pulmonary disease. However, in healthy nonsmoking women, the relationship between bone mass and pulmonary function has yet to be clarified. The object of this study was to determine whether pulmonary function is related to BMD in healthy nonsmoking women based on menopausal status. METHODS: This study was a cross-sectional study based on data obtained from the Korean National Health and Nutrition Examination Survey (KNHANES), a nationwide representative survey conducted by the Korean Ministry of Health and Welfare in 2010. This study included 456 subjects who had never smoked and analyzed data concerning pulmonary function and BMD. RESULTS: Functional vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were correlated with BMD at lumbar spine, femur neck (FN), and total hip in premenopausal women (p = 0.030, p = 0.003, p = 0.019, respectively, for FVC; p = 0.015, p = 0.006, p = 0.059, respectively, for FEV1). However, FVC and FEV1 were only correlated with BMD at FN in postmenopausal women (p = 0.003 for FVC; p = 0.006 for FEV1). Body mass index (BMI), FVC, and FEV1 were significantly related with BMD at FN, even after adjusting for age and other confounding factors (ß = 0.334, p < 0.001; ß = 0.145, p = 0.017; and ß = 0.129, p = 0.037, respectively) in premenopausal women. However, only age and BMI were correlated with BMD at FN (ß = -0.268, p = 0.001 and ß = 0.384, p > 0.001) in postmenopausal women after adjusting for confounding factors. CONCLUSIONS: Pulmonary function, including FVC and FEV1 are associated with BMD at FN in healthy nonsmoking premenopausal women but not in postmenopausal women.

MRI to differentiate benign from malignant soft-tissue tumours of the extremities: a simplified systematic imaging approach using depth, size and heterogeneity of signal intensity.

OBJECTIVE: Differentiating between malignant and benign lesions on the basis of MR images depends on the experience of the radiologist. For non-experts, we aimed to develop a simplified systematic MRI approach that uses depth, size and heterogeneity on T(2) weighted MR images (T(2)WI) to differentiate between malignant and benign lesions, and evaluated its diagnostic accuracy. METHODS: MR images of 266 patients with histologically proven soft-tissue tumours of the extremities (102 malignant, 164 benign) were analysed according to depth (superficial or deep), size (<50, ≥50 mm) and signal intensity (homogeneous or heterogeneous) on T(2)WI, to determine the ability of each to predict benign and malignant tumours. These three parameters were categorised into systematic combinations of different orders of application, and each combination was assessed for its ability to differentiate between benign and malignant lesions. RESULTS: Univariate analysis showed that depth, size and heterogeneity on T(2)WI differed significantly between benign and malignant masses (p<0.0001 each). Multiple logistic regression analysis, however, showed that depth was not helpful in distinguishing benign from malignant lesions. The systematic combination of signal intensity, size and depth, in that order, was superior to other combinations, resulting in higher diagnostic values for malignancy, with a sensitivity of 64%, a specificity of 85%, a positive predictive value of 32%, a negative predictive value of 59% and an accuracy of 77%. CONCLUSION: A simplified systematic imaging approach, in the order signal intensity, size and depth, would be a reference to distinguish between benign and malignant soft-tissue tumours for non-experts.

Factors associated with early onset post-traumatic syringomyelia.

STUDY DESIGN: Retrospective study. OBJECTIVES: To identify factors associated with the development of early onset post-traumatic syringomyelia within 5 years of spinal cord injury. SETTING: Department of Rehabilitation Medicine, Pusan National University School of Medicine, Korea. METHODS: We retrospectively examined the records of 502 patients with traumatic cervical or thoracic spinal cord injury who underwent follow-up magnetic resonance imaging (MRI) examinations more than once a year for at least 5 years. Patients were assessed in terms of the neurological level of injury, the severity of initial spinal cord injury, the use of surgery and the extent of spinal canal involvement. The latter was evaluated by calculating the shortest antero-posterior diameter of the injured vertebral canal and the spinal reserve capacity as shown on MRI at the time of trauma onset and at the time of diagnosis of syringomyelia. RESULTS: Syringomyelia developed within 5 years in 37 (7.3%) of the 502 patients. The mean age of these 37 patients was 44.6 years (range, 17-67 years) and the mean interval from spinal cord injury to onset of syringomyelia was 38.8 months (range, 2-54 months). The development of post-traumatic syringomyelia within 5 years was not significantly related to the severity or level of injury, the use of spinal surgery or the extent of spinal canal encroachment (P≥0.05 for each comparison). CONCLUSION: Early onset syringomyelia occurring within 5 years after spinal cord injury was not associated with neurological injury level, severity of injury, the use of spinal surgery or canal encroachment.

Longitudinal split of the posterior cruciate ligament: description of a new MR finding and evaluation of its potential clinical significance.

AIM: To evaluate the clinical significance of the intra-substance longitudinal split of the posterior cruciate ligament (LS-PCL) and to evaluate its potential clinical significance on MRI. MATERIALS AND METHODS: The databases of two centres were searched for LS-PCL, 6917 knee magnetic resonance imaging (MRI) examinations undertaken were retrospectively reviewed. LS-PCL was defined as increased signal intensity in a PCL in the longitudinal direction, but with an intact ligament outer surface on MRI. Twelve patients were enrolled in this study. Available arthroscopic results, degree of posterior knee instability, and changes in MRI findings, or the degree of instability during follow-up (FU), were reviewed from the patients medical records and via their MRI images. MRI images were reviewed by two musculoskeletal radiologists in consensus for presence and location of LS-PCL and any combined injuries: menisci lesions, ligament injuries, and bone marrow changes. RESULTS: Seven of 12 patients (58.3%) had morphological or functional evidence of PCL injury or insufficiency according to the change of posterior instability on FU stress testing (n=3), insufficiency during arthroscopy (n=2), or decreased extent and altered shape of the PCL split on the FU MRI (n=3). One patient revealed both change of posterior instability on FU stress testing and insufficiency during arthroscopy. Combined injuries were revealed in seven patients. Five patients had isolated LS-PCL: two patients underwent arthroscopic PCL reconstructions; and another three patients revealed knee instability on stress testing. CONCLUSION: Although LS-PCL has not been described before, it can be a type of partial tear of the PCL, which causes PCL insufficiency.

Plasma adiponectin is associated with less atherogenic lipoprotein phenotype.

BACKGROUND AND AIMS: This study examined the relationships between plasma levels of adiponectin and the features of the atherogenic lipoprotein phenotype (ALP), including HDL subclasses. METHODS AND RESULTS: Blood lipids and apolipoproteins were measured in 293 healthy individuals. LDL particle size and HDL subspecies (HDL(2), HDL(3)) were measured using gradient gel electrophoresis. Plasma adiponectin levels were negatively correlated with levels of apoB (r=-0.199, p<0.001), TG (r=-0.262, p<0.001), and HOMA-IR (r=-0.323, p<0.001) and positively correlated with levels of apoAI (r=0.173, p=0.006), HDL-cholesterol (r=0.287, p<0.001), and LDL particle size (r=0.289, p<0.001). Multiple linear regression analysis revealed the relationship between plasma adiponectin and LDL particle size (p<0.05) was no longer significant after adjusting for plasma TG levels. However, adiponectin (p<0.005) together with apoAI and TG were independent factors for HDL-cholesterol. With regard to HDL subclasses, plasma adiponectin levels were positively correlated with HDL(2b) (r=0.204, p<0.001), HDL(2a) (r=0.132, p<0.05) and negatively with HDL(3a) (r=-0.128, p<0.05), HDL(3b) (r=-0.203, p<0.001), and HDL(3c) (r=-0.159, p<0.01). The relationship between circulating adiponectin and HDL(2) (HDL(2b)+HDL(2a)) was independent of apoB and TG levels (p<0.05), but not of apoAI and HOMA-IR. CONCLUSIONS: Our results show that circulating adiponectin is associated with reduced manifestations of ALP.

Effects of gonadotropins on in vitro maturation and of electrical stimulation on parthenogenesis of canine oocytes.

The objective of this study was to determine the effects of gonadotropins on in vitro maturation (IVM) and electrical stimulation on the parthenogenesis of canine oocytes. In experiment I, cumulus oocyte complexes were collected from ovaries at a random phase of the oestrus cycle and cultured on maturation medium treated with hCG or eCG for 48 or 72 h. There were no significant differences in the effects on the metaphase II (MII) rate between the hCG and eCG treatment groups over 48 h (5.4% vs 5.5%). The MII rate in the co-treatment group of hCG and eCG for 48 h was higher than in each hormone treated group (15.5%, p < 0.05). In experiment 2, the parthenogenetic effect on oocyte development, at various electrical field strengths (1.0, 1.5, 2.0 kV/cm DC) for 60 or 80 mus with a single DC pulse after IVM on the co-treatment of hCG and eCG, was examined. The rate of pronuclear formation (37.1%) in electrical activation at 1.5 kV/60 mus without cytochalasin B (CB) was higher than that of oocytes activated in the other groups (p < 0.05). However, we did not observe the cleavage stages. Also, CB did not influence parthenogenesis of canine oocytes. The results showed that the pronucleus formation rate, indicative of the parthenogenesis start point, could be increased by electrical stimulation. Therefore, these results can provide important data for the parthenogenesis of canine oocytes and suggest the probability of parthenogenesis in canines.

In vitro maturation, in vitro fertilization and embryonic development of canine oocytes.

In this study we have investigated the efficiency of in vitro maturation (IVM) as a basic way to study the development of canine oocytes after in vitro fertilization (IVF). We decided, therefore, to perform two-part experiments. Firstly, experiment I compared the effects of TCM199 without fetal bovine serum (FBS) with TCM199 supplemented with 5% FBS on the in vitro nuclear maturation rate of canine oocytes. For the efficiency of meiotic development to the metaphase II (MII) stage, we found that 4.7% (4/64) of all oocytes grown in TCM199 without FBS developed to the MII stage compared with only 1.7% (1/59) of those grown in TCM199 with 5% FBS for 48 h. Therefore, FBS did not increase in vitro nuclear maturation. In experiment II, the cleavage rate of canine oocytes used for IVF was investigated following heparin treatment. Canine oocytes were fertilized in four groups: Fert-TALP medium without heparin (Fert I) or Fert-TALP medium supplemented with 10, 20 or 30 microg/ml heparin (Fert II, Fert III, Fert IV, respectively). Oocytes that were grown for 24 h in Fert I following fertilization showed the highest rate of all of the groups, 6.5% (5/77) and developed to the early morula stage. Markedly, the oocytes cultured in Fert I for 24 h following insemination had a higher rate of embryonic development than other groups. We can assert that, unlike findings in other mammals, heparin treatment in canine IVF does not increase the efficiency of the fertilization rate and is therefore not an important factor.

MRI of paraspinal muscles in lumbar degenerative kyphosis patients and control patients with chronic low back pain.

AIM: To compare lumbar musculature in lumbar degenerative kyphosis (LDK) patients and chronic low-back pain (CLBP) patients. MATERIALS AND METHODS: The study group comprised LDK patients (54 women, aged 44-74 years, mean 60 years) and a control group with CLBP (54 women, aged 45-73 years, mean 60 years). The cross-sectional areas (CSA) of psoas, erector spinae, multifidus, and disc, were measured at the L4-L5 level using magnetic resonance imaging (MRI). Lumbar muscularity was expressed as three ratios: the ratio between CSA of psoas, erector spinae, multifidus and CSA of disc (PS:disc, ES:disc, MF:disc). Multifidus and erector spinae atrophy were evaluated at the L3-L4 level and the degree of fatty atrophy was estimated using three grades: mild, moderate, and severe. The shapes of thoracolumbar fascia were analysed at the L5-S1 level and were classified as flat or convex. RESULTS: Lumbar muscularity was found to be significantly smaller (p<0.001) in LDK patients (PS:disc=0.79, SD 0.22; ES:disc=1.36, SD 0.49; MF:disc=0.55, SD 0.21) than the control group patients (PS:disc=0.98, SD 0.23; ES:disc=1.71, SD 0.46; MF:disc=0.86, SD 0.30). Patients with LDK had a higher proportion of fat deposits in the multifidus and erector spinae muscle (p<0.001), and the thoracolumbar fascia at the L5-S1 level was more commonly flat (p<0.01). CONCLUSION: Evaluation of paraspinal musculature should be considered when assessing MRI images of the lumbar spine. Measurement of the CSA, visual grading of fatty atrophy and the assessment of the fascia may help physician and radiologist reach a more confident diagnosis for the patients with clinically suspicious LDK.

Evaluation of haemodynamic flow to the hip in patients with systemic lupus erythematosus.

OBJECTIVE: One of the groups with high risk for osteonecrosis is patients with systemic lupus erythematosus (SLE). No predictive test, however, is known to detect osteonecrosis. The purpose of this study was to evaluate haemodynamic flow to the proximal femur in SLE patients. METHODS: Twenty-two SLE patients without osteonecrosis were evaluated in comparison with 15 healthy controls. Medial and lateral circumflex arteries of 44 hips in the 22 SLE patients and 30 hips in the healthy controls were examined using ultrasound equipment with colour and power Doppler capability. Arterial pulsatility index (PI) and peak systolic velocity (PSV) were determined with neutral and internal rotation positions (stimulated ischaemia). RESULTS: PSV was significantly increased in SLE patients compared to healthy controls in both the neutral position (70.6+/-40.4 vs. 46.9+/-19.3; p<0.001) and after internal rotation of the femoral head (74.8+/-42.3 vs. 49.9+/-19.9; p<0.001). PI was also higher in SLE patients than in healthy controls in both the neutral position (8.9+/-6.3 vs. 5.5+/-3.4; p<0.001) and after internal rotation (8.1+/-7.1 vs. 3.9+/-2.4; p<0.001). CONCLUSION: PSV and PI of arteries to the femur head in SLE patients were significantly higher than in healthy controls.

The association of SNP276G>T at adiponectin gene with circulating adiponectin and insulin resistance in response to mild weight loss.

OBJECTIVE: The purpose of this study was to determine whether common single nucleotide polymorphisms (SNPs) at the adiponectin (ADIPOQ) locus influence changes in circulating adiponectin and the features of insulin resistance in response to a weight loss intervention. SUBJECTS: In total, 294 nondiabetic/overweight-obese Koreans participated in a clinical intervention study lasting 12 weeks involving a caloric reduction of -300kcal/day. METHODS: Plasma adiponectin, blood lipids, glucose and insulin concentrations were measured at baseline and after weight loss. Insulin resistance was estimated by homeostasis model assessment insulin resistance (HOMA-IR) derived from fasting glucose and insulin concentrations. We genotyped for three SNPs, 45T>G, 276G>T and -11377C>G. RESULTS: At baseline, HOMA-IR was significantly higher in GG homozygotes than in carriers of the T allele at SNP276G>T of the adiponectin gene (P<0.05). With regard to SNP45T>G and SNP -11377C>G, we did not find any genotype related differences in baseline levels of HOMA-IR and adiponectin. In the 45/276 haplotype test, homozygous for the TG haplotype had significantly lower concentrations of plasma adiponectin (P<0.05). After the 12-week weight loss intervention, the significant decreases in HOMA-IR (P<0.001) and increases in adiponectin (P<0.01) were observed in GG homozygotes at SNP276, which were not shown in carriers of the T allele. Furthermore, there was a significant difference in the decreases in HOMA-IR between the GG homozygotes and carriers of the T allele at SNP276 (P<0.05). Regarding SNP45T>G and SNP -11377C>G, there was no association between SNP45T>G and SNP -11377C>G and decreases in HOMA-IR. In the 45/276 haplotype test, there was a significant difference in changes of adiponectin levels among those with different haplotype combinations (P<0.05). CONCLUSION: The SNP276G>T of the ADIPOQ gene is associated with different responses of circulating adiponectin and insulin resistance to mild weight loss in overweight-obese subjects.

Weight loss effect on inflammation and LDL oxidation in metabolically healthy but obese (MHO) individuals: low inflammation and LDL oxidation in MHO women.

OBJECTIVE: Recently, a subtype of obesity characterized as a metabolically healthy but obese (MHO) individual has been identified. However, limited data are available on these MHO individuals' metabolic and inflammatory profiles, and the effect of weight loss on these profiles. We investigated metabolic and inflammatory markers in MHO women to determine the effects of a 12-week weight loss on those markers. SUBJECTS: One hundred and twenty-nine overweight-obese Korean women participated for 12 weeks in a clinical intervention study involving a 300 kcal/day intake reduction. The subjects were divided into two groups: MHO and metabolically abnormal obese (MAO) individuals. METHODS: Computed tomography was performed. C-reactive protein (CRP), interkeukin-6 (IL-6) and oxidized low-density lipoprotein (LDL), as well as blood lipids, glucose and insulin concentrations were determined at baseline and after weight loss. RESULTS: At baseline, plasma CRP (P<0.001), IL-6 (P<0.05) and oxidized LDL (P<0.001) levels were significantly lower in the MHO group than in the MAO group. Visceral fat at L1 (P<0.005) and visceral fat at L4 (P<0.001) were significantly lower in the MHO group than in the MAO group. The treatment induced weight loss averaging 3.11% of initial body weight, and the degree of weight loss between the two groups was similar. Visceral fat at L1 and L4 was reduced from its initial values by 3.2 and 5.4%, respectively, after weight loss. The levels of CRP (P<0.05) and oxidized LDL (P<0.01) were significantly reduced in the MAO group after the 12-week weight loss, whereas these effects were not seen in the MHO group. CONCLUSIONS: Our results showed that MHO individuals exhibited lower visceral fat accumulation and more favorable metabolic and inflammatory states than MAO individuals. After a 12-week weight loss program, significant reductions in blood lipids, CRP and oxidized LDL levels were observed in MAO individuals. However, there was no measurable effect of weight loss on lipid profiles and inflammation in MHO individuals, indicating differing effects of weight loss on these markers between MAO and MHO groups.