Purpose: The American Diabetes Association recommends that patients with diabetes engage in at least 150 minutes of physical activity (PA) per week and perform resistance exercise (RE) at least twice weekly. However, their benefits in controlling glucose levels among women with diabetes are not completely understood. Therefore, we investigated whether meeting PA or RE guidelines is associated with lower odds of uncontrolled glycated hemoglobin (HbA1c) among women. Materials and Methods: We analyzed 1213 women with diabetes from the Korea National Health and Nutrition Examination Survey 2014–2018. Using PA questionnaires, participants were categorized according to whether they met aerobic PA guidelines (≥150 minutes of moderate-to-vigorous PA), RE guidelines (≥twice weekly), or both. Further, HbA1c levels >7.5% were classified as uncontrolled glycemic levels. Multivariate logistic regression models were employed to investigate whether meeting PA or RE guidelines is associated with uncontrolled HbA1c. Results: There was no association between meeting aerobic PA guidelines of >150 minutes per week and uncontrolled HbA1c.However, participating in RE > twice weekly was associated with a 49% lower odds of HbA1c >7.5% in fully adjusted models (odds ratio: 0.51; 95% confidence interval: 0.30–0.87; p<0.05). Moreover, the association between RE participation and lower odds of HbA1c >7.5% was observed regardless of age, body mass index, and prevalence of hypertension. Conclusion Participation in RE may be important for women with diabetes for glycemic control. Further research is needed to better understand the associations between HbA1c and different exercise modalities (i.e., resistance vs. aerobic exercise) in women with diabetes.

Purpose: The purpose of this study is to explore defecation functions related quality of life (QoL) according to the location of cancer in colorectal cancer survivors. Methods: A total of 120 colorectal cancer survivors (67 colon vs. 53 rectum, mean age: 55.3±10.3 years, 46.7% male) who completed treatment were recruited from a tertiary hospital. QoL and defecation function related QoL were surveyed using the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) and EORTC QLQ- colorectal cancer specific core (CR29) questionnaire. Physical activity (PA) levels of participants were surveyed using a global PA questionnaire. Results: There was no statistical difference in general QoL according to the location of cancer, but significant differences were observed in defecation function related QoL. When cancer location is closer to the anus, survivors experience more defecation dysfunction, negatively associated with QoL (Hemicolectomy: 67.71±14.07, anterior resection: 92.22±15.18, lower anterior resection: 151.85±17.20, and ultra-low anterior resection: 263.73±42.69). Conclusion When location of cancer is closer to the anus, colorectal survivors experience significantly more defecation dysfunction and poorer QoL. Strategies to reduce defecation dysfunction according to the location of cancer among colorectal cancer patients should be developed.

Purpose: The purpose of this study was to understand the experience of exercise participation among patients following transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction surgery. Methods: A phenomenological method was used in this study. Exercise experiences for twelve patients, who had undergone TRAM flap breast reconstruction, were collected through focus group interviews. Results: The factors that contributed to exercise barriers in the experience of TRAM flap breast reconstruction patient exercise participation were categorized into 3 groups: ‘fear of exercise after surgery’, ‘weakened emotional condition’, and ‘lack of exercise information’. Exercise facilitators after TRAM flap breast reconstruction were also categorized into 3 groups: ‘desire to improve appearance’, ‘feasiable exercise program’, and ‘exercise experience’. Conclusion The results of this study reveal the exercise barriers and facilitators for patients following TRAM flap breast reconstruction, which should be considered to develop effective exercise programs.

BACKGROUND/OBJECTIVES: Consumption of cholesterol-rich foods, such as eggs, has a minimal effect on circulating cholesterol levels in healthy humans. To gain insight, we investigated whether phospholipids rich in eggs (EPL) interfere with intestinal cholesterol absorption in vivo. MATERIALS/METHODS: To investigate the acute effect of EPL on intestinal cholesterol absorption, male C57BL/6J mice were orally administered with 6, 11, or 19 mg of EPL for three days. We also tested the effect of chronic EPL consumption on cholesterol metabolism in the small intestine and the liver in mice with diet-induced hypercholesterolemia. Male C57BL/6J mice were fed a high fat/high cholesterol (HF/HC; 35% fat, 0.25% cholesterol, w/w) diet for 4 weeks to induce hypercholesterolemia, and subsequently the mice were either fed 0, 0.4 or 0.8% (w/w) of EPL for 6 weeks. RESULTS: Intestinal cholesterol absorption was significantly decreased by the highest dose of acute EPL administration compared to control. Chronic EPL supplementation did not significantly alter intestinal cholesterol absorption nor plasma levels of total cholesterol and low-density lipoprotein cholesterol. In the small intestine and the liver, EPL supplementation minimally altered the expression of genes which regulate cellular cholesterol levels. CONCLUSION: Although chronic EPL consumption was not able to counteract hypercholesterolemia in HF/HC-fed mice, acute EPL administration decreased intestinal cholesterol absorption. This study provides in vivo evidence that acute administration of PLs in eggs prevent cholesterol absorption in the intestine, suggesting a mechanism for a minimal effect of egg consumption on circulating cholesterol levels.
Absorption ; Animals ; Cholesterol ; Diet ; Eggs ; Humans ; Hypercholesterolemia ; Intestinal Absorption ; Intestine, Small ; Intestines ; Lipoproteins ; Liver ; Male ; Metabolism ; Mice ; Ovum ; Phosphatidylcholines ; Phospholipids ; Plasma

Multiple strictures of small bowel induced by nonsteroidal anti-inflammatory drugs (NSAIDs), were known as diaphragm disease. The purpose of these case reports is to present 3 cases of diaphragm disease of small bowel and summarize the clinical features of this disease entity. A 34-year-old man, a 63-year-old man, and a 66-year-old woman were admitted to Daegu Catholic University Medical Center because of recurrent intestinal obstructions. Two of these patients had taken heavy NSAIDs use. Capsule endoscopy was performed in all cases and the all capsules were retained by circumferential strictures of the ileum. Segmental resection of the strictures was performed in 2 patients and 1 underwent just enterotomy and capsule removal. In conclusion, clinicians should be aware that diaphragm disease might be a cause of small bowel obstruction especially in patients receiving long term NSAIDs therapy.
Academic Medical Centers ; Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Capsule Endoscopy ; Capsules ; Constriction, Pathologic ; Daegu ; Diaphragm* ; Enteritis ; Female ; Humans ; Ileum ; Intestinal Obstruction ; Middle Aged ; Mucositis

BACKGROUND AND OBJECTIVES: Supervised lifestyle interventions, including dietary and exercise programs, may be infeasible to implement in real-world settings. Therefore, this study aimed to evaluate the effectiveness of a home-based lifestyle modification intervention on blood pressure (BP) management. METHODS: Eighty-five patients aged over 20 years and diagnosed with prehypertension or mild hypertension were randomly assigned to an advice-only comparison group (C group, n=28), a Dietary Approaches to Stop Hypertension (DASH) diet education group (D group, n=30), or a DASH and home-based exercise group (D+Ex group, n=27). The intervention lasted for 8 weeks. The primary outcome was the difference in office systolic blood pressure (SBP) before and after the study period (Trial registry at ClinicalTrials.gov, NCT01637909). RESULTS: Seventy-two participants (87.8%) completed the trial. The degree of change in office SBP did not significantly differ among the intervention groups; however, the D+Ex group demonstrated a tendency toward decreased SBP. Upon analysis of 24-hour ambulatory BP measurements, daytime ambulatory SBP was significantly lower in the D+Ex group (134 mmHg; 95% confidence interval [CI], 131 to 137; p=0.011) than in the C group (139.5 mmHg; 95% CI, 130.9 to 137), and daytime ambulatory SBP was significantly decreased in the D+Ex group (−5.2 mmHg; 95% CI, −8.3 to −2.1; p=0.011) compared to the C group (0.4 mmHg, 95% CI, −2.5 to 3.3). CONCLUSIONS: In conclusion, lifestyle modification emphasizing both diet and exercise was effective for lowering BP and should be favored over diet-only modifications.
Blood Pressure ; Diet ; Education ; Humans ; Hypertension ; Life Style ; Prehypertension

BACKGROUND AND OBJECTIVES: Supervised lifestyle interventions, including dietary and exercise programs, may be infeasible to implement in real-world settings. Therefore, this study aimed to evaluate the effectiveness of a home-based lifestyle modification intervention on blood pressure (BP) management. METHODS: Eighty-five patients aged over 20 years and diagnosed with prehypertension or mild hypertension were randomly assigned to an advice-only comparison group (C group, n=28), a Dietary Approaches to Stop Hypertension (DASH) diet education group (D group, n=30), or a DASH and home-based exercise group (D+Ex group, n=27). The intervention lasted for 8 weeks. The primary outcome was the difference in office systolic blood pressure (SBP) before and after the study period (Trial registry at ClinicalTrials.gov, NCT01637909). RESULTS: Seventy-two participants (87.8%) completed the trial. The degree of change in office SBP did not significantly differ among the intervention groups; however, the D+Ex group demonstrated a tendency toward decreased SBP. Upon analysis of 24-hour ambulatory BP measurements, daytime ambulatory SBP was significantly lower in the D+Ex group (134 mmHg; 95% confidence interval [CI], 131 to 137; p=0.011) than in the C group (139.5 mmHg; 95% CI, 130.9 to 137), and daytime ambulatory SBP was significantly decreased in the D+Ex group (−5.2 mmHg; 95% CI, −8.3 to −2.1; p=0.011) compared to the C group (0.4 mmHg, 95% CI, −2.5 to 3.3). CONCLUSIONS In conclusion, lifestyle modification emphasizing both diet and exercise was effective for lowering BP and should be favored over diet-only modifications.

PURPOSE: This study aimed to evaluate whether prophylactic extended-field pelvic radiotherapy (EF-PRT) yields better results than standard whole pelvic radiotherapy (WPRT) in patients with pelvic lymph node-positive cervical cancer treated with concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS: A total of 126 cases of stage IB-IVA cervical cancer that had pelvic lymph node involvement in magnetic resonance imaging and were treated with CCRT between 2000 and 2016 were reviewed. None of the patients had paraaortic lymph node (PALN) metastases. The patients were classified to two groups, namely, those treated with EF-PRT, including prophylactic para-aortic radiotherapy, and those treated only with WPRT. The median dose to the PALN area in patients treated with EF-PRT was 45 Gy. All patients received concurrent cisplatin-based chemotherapy. RESULTS: Overall, 52 and 74 patients underwent EF-PRT and WPRT, respectively. Patient characteristics and irradiated dose were not significantly different, except the dose to the para-aortic area, between the two groups. The median follow-up period was 75.5 months (range, 5 to 195 months). The 10-year cumulative recurrence rate of PALN for EF-PRT vs. WPRT was 6.9% and 10.1% (p = 0.421), respectively. The 10-year disease-free survival and overall survival for EF-PRT vs. WPRT were 69.7% vs. 66.1% (p = 0.748) and 71.7% vs. 72.3% (p = 0.845), respectively. Acute gastrointestinal complications were significantly higher in EF-PRT (n = 21; 40.4%) than WPRT (n = 26; 35.1%) (p = 0.046). Late toxicities were not significantly different in both groups. CONCLUSION: In this study, prophylactic radiotherapy for PALN does not have an additional benefit in patients with pelvic lymph node-positive cervical cancer treated with CCRT.
Chemoradiotherapy ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Survival Rate ; Uterine Cervical Neoplasms*

PURPOSE: The purpose of this study was to examine the effect of post-operative exercise on body composition, psychological factors, time to flatus and length of hospital stay in stage 1~3 colorectal cancer patients. METHODS: A total of 35 post surgery patients were recruited and randomly assigned to the exercise or controlled group. Participants in the exercise group exercised twice a day while participants in the control group followed the clinical pathways (CP). RESULTS: A total of 25 participants completed the trial. Post-operative exercise resulted in a clinically meaningful, but statistically insignificant reduction in body weight (Exercise: -1.10±1.63 kg vs. CP: -0.63±1.16 kg; p=.111), fat mass (Exercise: -1.43±0.95 kg vs. CP: 0.64±4.29 kg; p=.100). When participants' body composition were compared to their baseline values at the baseline, only the exercise group experienced a significant reduction in body weight, body mass index (BMI) and fat mass. In addition, post-operative exercise significantly improved health related quality of life (Exercise: 2.27±2.08 vs CP: -12.82±22.47; p=.008). However, there was no difference in time to flatus and the length of hospital stay between groups. CONCLUSION: The current pilot study suggests that the post-operative exercise program was safe and produced for health related quality of life improvements in colorectal cancer patients.
Body Composition ; Body Mass Index ; Body Weight ; Colorectal Neoplasms* ; Critical Pathways ; Flatulence ; Humans ; Length of Stay ; Pilot Projects ; Psychology ; Quality of Life

With recent advances in molecular diagnostic methods and targeted cancer therapies, several molecular tests have been recommended for gastric cancer (GC) and colorectal cancer (CRC). Microsatellite instability analysis of gastrointestinal cancers is performed to screen for Lynch syndrome, predict favorable prognosis, and screen patients for immunotherapy. The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor has been approved in metastatic CRCs with wildtype RAS (KRAS and NRAS exon 2–4). A BRAF mutation is required for predicting poor prognosis. Additionally, amplification of human epidermal growth factor receptor 2 (HER2) and MET is also associated with resistance to EGFR inhibitor in metastatic CRC patients. The BRAF V600E mutation is found in sporadic microsatellite unstable CRCs, and thus is helpful for ruling out Lynch syndrome. In addition, the KRAS mutation is a prognostic biomarker and the PIK3CA mutation is a molecular biomarker predicting response to phosphoinositide 3-kinase/AKT/mammalian target of rapamycin inhibitors and response to aspirin therapy in CRC patients. Additionally, HER2 testing should be performed in all recurrent or metastatic GCs. If the results of HER2 immunohistochemistry are equivocal, HER2 silver or fluorescence in situ hybridization testing are essential for confirmative determination of HER2 status. Epstein-Barr virus–positive GCs have distinct characteristics, including heavy lymphoid stroma, hypermethylation phenotype, and high expression of immune modulators. Recent advances in next-generation sequencing technologies enable us to examine various genetic alterations using a single test. Pathologists play a crucial role in ensuring reliable molecular testing and they should also take an integral role between molecular laboratories and clinicians.