Explore the vast range of titles available.

The prevalence of metabolic syndrome (MS) is increasing among the elderly, and new lifestyle-based treatment strategies are warranted. We conducted a randomized, double-blind controlled trial of the effects of aquatic exercise (AE) and/or consumption of burdock root extract (BE) on body composition and serum sex hormones, i.e., testosterone, estradiol, sex hormone-binding globulin (SHBG), and dehydroepiandrosterone-sulfate (DHEA-S) in elderly women with MS. The percentage of abdominal fat was decreased in the AE group. Waist circumference was increased in the control (CON) group, but not in the other groups. SHBG and estradiol levels were enhanced by both AE and BE and correlated with changes in fat-related body composition. DHEA-S levels only increased in the BE group, which was consistent with changes in lean body mass. Testosterone levels decreased in the CON group, which correlated with changes in lean body mass, skeletal muscle mass, body fat, and waist circumference. Our findings suggested that the combined AE/BE intervention exerted no synergistic and/or additive effects on any sex-related outcome measures in elderly women with MS.

High-intensity or repetitive exercise induces metabolic stress and neuromuscular fatigue in skeletal muscle. Using a within-subjects repeated-measures crossover design, eight male amateur swimmers completed five experimental sessions at one-week intervals. Following an isokinetic fatigue protocol, five recovery interventions were applied in a randomized order: control (NT), foam roller (FR), vibration foam roller (VFR), and whole-body vibration at 12 Hz (WBV-12) and 20 Hz (WBV-20). The isokinetic fatigue protocol produced a significant reduction in bilateral extensor peak torque (229.2 ± 37.8%BW to 189.8 ± 27.5%BW; t(7) = 4.19, p = 0.004, d = 1.48), confirming successful fatigue induction. Outcome measures included visual analog scale (VAS) scores, blood lactate concentration, and knee extensor/flexor peak torque (%BW) assessed at three time points. A two-way repeated-measures ANOVA (intervention × time) revealed significant main effects of recovery methods at the post-recovery time point for VAS scores (F(4,28) = 5.98, p = 0.001, η[sup.2]g = 0.248), blood lactate (F(4,28) = 5.12, p = 0.003, η[sup.2]g = 0.226), and isokinetic peak torque (F(4,28) = 10.75, p < 0.001, η[sup.2]g = 0.226). Post hoc Bonferroni analysis indicated that VFR and WBV-20 produced significantly higher lactate recovery rates than NT. Active recovery interventions produced lower perceived fatigue scores and greater lactate reductions than passive rest; however, individual Bonferroni pairwise comparisons for VAS and blood lactate did not reach adjusted significance, and these findings should be considered preliminary. WBV-20 demonstrated statistically confirmed superiority in isokinetic muscle function recovery (Bonferroni p < 0.05 vs. NT, FR, and VFR), suggesting its potential as an effective post-exercise recovery strategy for neuromuscular restoration.

Among potent dietary supplements, Momordica charantia, commonly called bitter melon, has various biological effects, such as antioxidant and anti-inflammatory effects, and improves energy metabolism and fatigue recovery. However, it is unknown whether Momordica charantia extract (MCE) induces antifatigue effects during exercise training in high-temperature environments. This study aimed at investigating the efficacy of MCE by examining 10 male tennis players consuming 100 mL MCE/dose (6 times a day over 4 weeks) during the summer training season. Peripheral (ammonia and uric acid) and central (serotonin, dopamine, and prolactin) fatigue parameters were measured before and after MCE consumption; before, during, and after exercise; and the next morning. After consuming MCE supplements, ammonia levels were higher during and after exercise and recovered the next morning, whereas uric acid levels did not change at any time point. Serotonin levels were lower during exercise. Dopamine levels were higher, especially during exercise. Prolactin levels were lower at all time points, especially during and after exercise. Although high-intensity training in a hot environment causes accumulation of fatigue-related metabolites, our results indicate that 4 weeks of MCE intake positively influenced fatigue parameters, suggesting that MCE can efficiently combat fatigue.

Cases of foreign body ingestion are encountered relatively often in clinical settings; however, serious complications are rare. In such cases, mediastinal abscess due to esophageal perforation can become a life-threatening complication. We encountered two cases of severe complications due to an esophageal fish bone foreign body. The first case was a 40-year-old male with an intramural esophageal abscess due to a fish bone after eating fish five days before visiting the hospital. The patient underwent surgical treatment, but the esophageal abscess did not improve; so, the abscess was drained through endoscopic mucosal dissection, and the abscess improved. In the second case, a 64-year-old male, who had eaten fish three days before visiting the hospital, had esophageal perforation by a fish bone, and abscess formation in the mediastinum and the lesser sac in the abdominal cavity were observed. Although surgical treatment was performed, the intra-abdominal abscess formation was not controlled; so, percutaneous drainage (PCD) was inserted, and the abscess improved. Both patients were discharged without any complications. Here, we report two cases that were improved through surgical treatments and additional treatments such as endoscopic dissection and PCD.

Background Severe fever with thrombocytopenia syndrome (SFTS) is emerging in Asian 3 countries, China, Japan and Korea, which are scrub typhus endemic areas, and its incidence is increasing. As the two infections overlap epidemiologically and clinically and the accessibility or sensitivity of diagnostic tests is limited, early clinical prediction may be useful for diagnostic and therapeutic purposes. Methods Patients aged ≥16 years who were clinically suspected and laboratory-confirmed to be infected with Orientia tsutsugamushi or the SFTS virus in South Korea were enrolled. Clinical and laboratory parameters were compared. Scrub typhus was further subclassified according to the status of eschar and skin rash. An SFTS prediction scoring tool was generated based on a logistic regression analysis of SFTS compared with scrub typhus. Results The analysis was performed on 255 patients with scrub typhus and 107 patients with SFTS. At initial presentation, subjective symptoms except for gastrointestinal symptoms, were more prominent in scrub typhus patients. In addition to the characteristic eschar and skin rash, headache was significantly more prominent in scrub typhus, while laboratory abnormalities were more prominent in SFTS. Leukopenia (white blood cell count < 4000/mm 3 ; odds ratio [OR] 30.13), thrombocytopenia (platelet count < 80,000 /mm 3 ; OR 19.73) and low C-reactive protein (< 1 mg/dL; OR 67.46) were consistent risk factors for SFTS (all P  < 0.001). A prediction score was generated using these 3 variables, and a score ≥ 2 had a sensitivity of 93.1% (95% confidence interval [CI], 87.9–96.4%) and a specificity of 96.1% (95% CI, 93.8–97.6%) for SFTS. Conclusion This prediction scoring tool may be useful for differentiating SFTS from eschar- or skin rash-negative scrub typhus. It is a simple and readily applicable tool with potential for use in primary care settings.

BackgroundIncreasing hepatitis-related mortality has reignited interest to fulfill the World Health Organization’s goal of viral hepatitis elimination by 2030. However, economic barriers have enabled only 28% of countries to implement countermeasures. Given the high disease burden among Asians, we aimed to present age, sex, disease activity and treatment-specific annual progression rates among Asian chronic hepatitis B (CHB) patients to inform health economic modeling efforts and cost-effective public health interventions.MethodsWe analyzed 18,056 CHB patients from 36 centers across the U.S. and seven countries/regions of Asia Pacific (9530 treated; 8526 untreated). We used Kaplan–Meier methods to estimate annual incidence of cirrhosis and hepatocellular carcinoma (HCC). Active disease was defined by meeting the APASL treatment guideline criteria.ResultsOver a median follow-up of 8.55 years, there were 1178 incidences of cirrhosis and 1212 incidences of HCC (297 without cirrhosis, 915 with cirrhosis). Among the 8526 untreated patients (7977 inactive, 549 active), the annual cirrhosis and HCC incidence ranged from 0.26% to 1.30% and 0.04% to 3.80% in inactive patients, and 0.55 to 4.05% and 0.19 to 6.03% in active patients, respectively. Of the 9530 treated patients, the annual HCC rates ranged 0.03–1.57% among noncirrhotic males and 2.57–6.93% among cirrhotic males, with lower rates for females. Generally, transition rates increased with age, male sex, the presence of fibrosis/cirrhosis, and active disease and/or antiviral treatment.ConclusionUsing data from a large and diverse real-world cohort of Asian CHB patients, the study provided detailed annual transition rates to inform practice, research and public health planning.

Aims To quantify the risk of cardiovascular disease (CVD) and all‐cause mortality associated with diabetic foot ulcer (DFU)‐related amputation using a large‐scale, nationally representative cohort. Materials and Methods This longitudinal study included individuals with diabetes who underwent standardized national health checkups between 2009 and 2012, with follow‐up data obtained from the Korean National Health Insurance Service claims database. CVD was defined as an incident myocardial infarction or stroke occurring after the index health checkup. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for CVD and mortality in individuals with DFU‐related amputation compared with those with diabetes but without amputation. Results Among 1,229,689 individuals with diabetes, 1,486 (0.12%) had a DFU‐related amputation at baseline. The median follow‐up was 8.2 years in the non‐amputation group and 6.7 years in the DFU‐related amputation group. People with DFU‐related amputation had a significantly higher incidence rate of CVD compared with those without DFU‐related amputation (32.6 vs. 11.0 per 1000 person‐years) with a HR of 1.9 (95% CI 1.6–2.1). The HRs for myocardial infarction and stroke were 2.2 (95% CI 1.9–2.6) and 1.6 (95% CI 1.4–1.8), respectively. All‐cause mortality significantly increased in people with DFU‐related amputation compared with those without, with an HR of 2.1 (95% CI 1.9–2.3). Conclusions In this nationwide population‐based cohort, DFU‐related amputation was associated with nearly a twofold increased risk of cardiovascular events and mortality. These findings underscore the importance of comprehensive cardiovascular risk assessment and management in patients with diabetic foot complications. Data/Design: Nationwide, population‐based longitudinal cohort using the Korean National Health Insurance Service health checkup database (index 2009–2012) with follow‐up through December 31, 2018. Population/Exposure: Adults with diabetes (N = 1,229,689); DFU‐related amputation at baseline (n = 1,486) vs no DFU‐related amputation. Outcomes: Incident cardiovascular disease (myocardial infarction or stroke) and all‐cause mortality. Key findings: Compared with DFU without amputation, DFU‐related amputation was associated with higher risk of CVD (aHR 1.9), MI (aHR 2.2), stroke (aHR 1.6), and all‐cause mortality (aHR 2.1).Conclusion: DFU‐related amputation was associated with substantially higher risks of cardiovascular events and mortality. *DFU, diabetic foot ulcer.

Introduction: Among patients with urinary tract infection (UTI), bacteremic cases show higher mortality rates than do nonbacteremic cases. Early identification of bacteremic cases is crucial for severity assessment of patients with febrile UTI. This study aimed to identify predictors associated with bacteremia in women with community-onset febrile UTI and to develop a prediction model to estimate the probability of bacteremic cases. Methodology: This cross-sectional study included women consecutively hospitalized with community-onset febrile UTI at 10 hospitals in Korea. Multiple logistic regression identified predictors associated with bacteremia among candidate variables chosen from univariate analysis. A prediction model was developed using all predictors weighted by their regression coefficients. Results: From July to September 2014, 383 women with febrile UTI were included: 115 (30.0%) bacteremic and 268 (70.0%) nonbacteremic cases. A prediction model consisted of diabetes mellitus (1 point), urinary tract obstruction by stone (2), costovertebral angle tenderness (2), a fraction of segmented neutrophils of > 90% (2), thrombocytopenia (2), azotemia (2), and the fulfillment of all criteria for systemic inflammatory response syndrome (2). The c statistic for the model was 0.807 (95% confidence interval [CI], 0.757–0.856). At a cutoff value of ≥ 3, the model had a sensitivity of 86.1% (95% CI, 78.1–91.6%) and a specificity of 54.9% (95% CI, 48.7–91.6%). Conclusions: Our model showed a good discriminatory power for early identification of bacteremic cases in women with community-onset febrile UTI. In addition, our model can be used to identify patients at low risk for bacteremia because of its relatively high sensitivity.

Acute pyelonephritis (APN) is one of the most common bacterial infections. Because health care–associated (HCA) infections in the community setting have similar characteristics to hospital-acquired infections, HCA infections should be distinguished from community-acquired (CA) infections. However, the impact of HCA-APN on treatment outcomes has not been clearly defined. This study aimed to analyze the impact of HCA-APN on the appropriateness of empiric antibiotic therapy and outcomes in community-onset APN. We prospectively identified women older than 18years who were hospitalized with APN via the emergency department and whose urine culture grew bacteria at 10 acute care hospitals in South Korea. Of the 388 APN episodes that were included, 99 (25.5%) were HCA-APN and 289 (74.5%) were CA-APN. Compared with patients with CA-APN, patients with HCA-APN had comorbid conditions and septic shock more frequently. Health care–associated APN was caused by resistant uropathogens more often. Patients with HCA-APN had poorer outcomes (ie, early/final clinical and microbiologic failures); however, this was not statistically significant. Patients with HCA-APN had significantly longer hospital stays than did patients with CA-APN. In the multivariable logistic regression analysis for inappropriate empiric therapy, HCA-APN (odds ratio, 1.96; 95% confidence interval, 1.07-3.57; P=.03) and being bed-ridden (odds ratio, 3.04; 95% confidence interval, 1.31-7.07; P=.01) were significant. Health care–associated APN was associated with inappropriate empiric antibiotic therapy, which might lead to worse outcomes. These HCA factors should be considered when prescribing empiric antibiotic therapy in patients with community-onset APN.