OBJECTIVES: This study investigated whether the lower extremity muscle mass index (LMI) mediates the relationship between general obesity, central obesity, and knee osteoarthritis in middle-aged and elderly women in Korea. METHODS: Data of 2,843 women aged ≥50 years were collected from the Korean National Health and Nutrition Examination Survey conducted between 2009 and 2011. General obesity and central obesity were evaluated based on body mass index (BMI) and waist circumference (WC), calculated through anthropometric measurements and body composition assessments. LMI was calculated by dividing the muscle mass in both legs—measured using the dual-energy X-ray absorptiometry—by body weight. Knee osteoarthritis was defined as a Kellgren-Lawrence scale (KL) grade of ≥2 as assessed through radiographic images. RESULTS: Knee osteoarthritis prevalence, indicated by KL grades, was significantly higher in the general obesity and central obesity groups compared to the normal group, and conversely, lower with varying LMI levels. Using mediation analysis with bootstrapping and adjusting for covariates, we found that LMI mediated the relationship between BMI and KL (β, 0.005; 95% confidence interval [CI], 0.000 to 0.010) and WC and KL grade (β, 0.002; 95% CI, 0.001 to 0.003), explaining 4.8% and 6.7% of the total effects of BMI and WC on KL grade, respectively. CONCLUSIONS The study suggested that LMI partially mediates the link between general obesity and/or central obesity and knee osteoarthritis, proposing that a higher proportion of lower limb muscle mass relative to body weight can alleviate the increased risk of knee osteoarthritis caused by obesity.

Purpose: This study aimed to investigate the role of muscle strength exercise in the association between obesity status and knee osteoarthritis (KOA). Methods: The study subjects were 1,266 elderly women aged 65 years and older who participated in the Korea National Health and Nutrition Examination Survey from 2009 to 2011. Participants were categorized into three groups (normal, single obesity, multi-obesity) based on the presence or absence of obesity and abdominal obesity determined by body mass index and waist circumference. Additionally, they were categorized into two groups based on the presence or absence of muscle strength exercise. Logistic regression used to examine the odds ratios (OR) and 95% confidence intervals (CI) for KOA according to the independent and combined levels of obesity status and participation in strength training. Results: The multi-obesity group had a significantly higher probability of being exposed to KOA compared to the normal group (OR, 2.489; 95% CI, 1.837−3.372). However, there was no significant difference between the groups with and without participation in muscle strength exercise. We also calculated ORs for KOA exposure according to muscle strength exercise participation by obesity status. The results showed that in the multi-obesity group, the probability of KOA exposure was significantly higher in the group not participating in muscle strength exercise compared to the group participating in muscle strength exercise (OR, 2.998; 95% CI, 1.312−6.853). Conclusion This study suggests that regularly participating in muscle strength exercise may play a protective role against the risk of KOA associated with obesity and abdominal obesity.

Purpose: This study compared isokinetic knee strength profiles by knee surgery history in basketball players. Methods: A total of 17 professional female basketball players (age, 23.7±3.8 years) participated in this study. All the participants performed maximal isokinetic knee strength test concentrically at a velocity of 60°• sec −1 and 180°• sec −1 . Strength variables included peak torque (PT), body mass normalized PT (NPT), bilateral strength difference (BD), hamstrings to quadriceps strength (H/Q) ratio. Independent t-test and one-way analysis of variance were used to compare mean differences in the measured parameters by knee surgery history and limb-based sugroups, respectively. Results: Nine subjects had a history of knee surgery. At all velocities, there were no significant group differences in PTs, NPTs, BDs, and H/Q ratios of the knee extensor and flexor muscles by knee surgery history. Overall, NPTs of knee extensor and flexor muscles were 2.91−3.01 N• m• kg −1 and 1.55−1.59 N• m• kg−1 , respectively, and H/Q ratios ranged from 52% to 55%. At 180°• sec −1 . NPTs of knee extensor and flexor muscles were 1.90−1.92 N• m• kg −1 and 1.08−1.10 N• m• kg −1 , respectively, and H/Q ratios ranged from 57% to 58%. Conclusion The current findings suggested that isokinetic knee strength profiles measured at 60°• sec −1 and 180°• sec −1 velocities were similar regardless of a history of knee surgery in the professional female basketball players.

Purpose: This study aimed to investigate the effect of cardiovascular disease (CVD) risk and physical fitness on cognitive impairment in Korean elderly women. Methods: In a cross-sectional design, a total of 308 Korean elderly women, aged 60 years or older, participated in this study. Measured parameters included the 10-year Framingham risk score (FRS), physical fitness (i.e., upper and lower body strength and flexibility and endurance), and cognitive performance based on Mini-Mental State Examination for dementia screening. The participants were classified as low (＜ 10%) or intermediate and high (≥ 10%) risk groups based on the 10-year FRS and as unfit (lower 50%) or fit (higher 50%) on a composite z-score of physical fitness. Logistic regression was used to estimate the odd ratios (ORs) and confidence intervals (CIs) of cognitive impairment according to the 10-year FRS and physical fitness-based classification. Results: The low FRS/unfit and intermediate or high FRS/unfit groups had significantly higher risks of cognitive impairment (OR, 3.714; 95% CI, 1.324– 10.418; p=0.013 and OR, 11.345; 95% CI, 4.810– 26.762; p＜ 0.001, respectively) compared with the low FRS/fit group (OR, 1). In particular, the elevated risk of cognitive impairment remained significant (OR, 3.876; 95% CI, 1.400– 10.726; p=0.009) even after adjustments for covariates such as age, body mass index, education, and physical inactivity. Conclusion The current findings suggest that an intervention targeting at both CVD risk reduction and physical fitness promotion is urgent as a preventive and/or therapeutic measure against declines in cognitive function in Korean elderly women.

Purpose: This study aimed to investigate the effect of cardiovascular disease (CVD) risk and physical fitness on cognitive impairment in Korean elderly women. Methods: In a cross-sectional design, a total of 308 Korean elderly women, aged 60 years or older, participated in this study. Measured parameters included the 10-year Framingham risk score (FRS), physical fitness (i.e., upper and lower body strength and flexibility and endurance), and cognitive performance based on Mini-Mental State Examination for dementia screening. The participants were classified as low (＜ 10%) or intermediate and high (≥ 10%) risk groups based on the 10-year FRS and as unfit (lower 50%) or fit (higher 50%) on a composite z-score of physical fitness. Logistic regression was used to estimate the odd ratios (ORs) and confidence intervals (CIs) of cognitive impairment according to the 10-year FRS and physical fitness-based classification. Results: The low FRS/unfit and intermediate or high FRS/unfit groups had significantly higher risks of cognitive impairment (OR, 3.714; 95% CI, 1.324– 10.418; p=0.013 and OR, 11.345; 95% CI, 4.810– 26.762; p＜ 0.001, respectively) compared with the low FRS/fit group (OR, 1). In particular, the elevated risk of cognitive impairment remained significant (OR, 3.876; 95% CI, 1.400– 10.726; p=0.009) even after adjustments for covariates such as age, body mass index, education, and physical inactivity. Conclusion The current findings suggest that an intervention targeting at both CVD risk reduction and physical fitness promotion is urgent as a preventive and/or therapeutic measure against declines in cognitive function in Korean elderly women.

Through this meta-analysis, we sought to examine the prevalence of, risks for, and factors associated with bullying involvement (victimization, perpetration, perpetration-victimization) among students with autism spectrum disorder (ASD). Additionally, we attempted to examine sources of variance in the prevalence and effect sizes of bullying in students with ASD across studies. Systematic database and literature review identified 34 relevant studies (31 for Western countries, three for Eastern countries). Pooled prevalence estimates for victimization, perpetration, and perpetration-victimization in general were 67%, 29%, and 14%, respectively.The risk of victimization in students with ASD was significantly higher than that in typically developing students and students with other disabilities. Further, deficits in social interaction and communication, externalizing symptoms, internalizing symptoms, and integrated inclusive school settings were related to higher victimization, and externalizing symptoms were related to higher perpetration. Finally, moderation analyses revealed significant variations in the pooled prevalences thereof depending on culture, age, school settings, and methodological quality and in the pooled effect sizes according to publication year and methodological quality. Our results highlight needs for bullying intervention for students with ASD, especially those who are younger, are in an inclusive school setting, and have higher social difficulties and externalizing/internalizing symptoms; for intensive research of bullying experiences among students with ASD in Eastern countries; and for efforts to improve the methodological quality of such research.

Purpose: Since the introduction of nab-paclitaxel plus gemcitabine (nab-P+GEM) as first-line (1L) treatment for metastatic pancreatic adenocarcinoma (mPDAC), optimal second-line (2L) chemotherapy after progression is unclear. We assessed clinical outcomes of 2L chemotherapy for disease that progressed on 1L nab-P+GEM. Materials and Methods: Among the 203 patients previously treated with 1L nab-P+GEM for mPDAC at Asan Medical Center, between February and December 2016, records of 120 patients receiving 2L chemotherapy after progression on nab-P+GEM were retrospectively reviewed. The response rate and survival were evaluated along with analysis of prognostic factors. Results: Fluoropyrimidine-oxaliplatin doublets (FOLFOX or XELOX) were used in 78 patients (65.0%), fluoropyrimidine monotherapy in 37 (30.8%), and liposomal irinotecan plus fluorouracil in two (1.7%). The median progression-free survival (PFS) and overall survival (OS) were 3.29 months and 7.33 months from the start of 2L therapy. Fluoropyrimidine-oxaliplatin regimens and fluoropyrimidine monotherapy did not yield significantly different median PFS (2.89 months vs. 3.81 months, p=0.40) or OS (7.04 months vs. 7.43 months, p=0.86). A high neutrophil-lymphocyte ratio (> 2.2) and a short time to progression with 1L nab-P+GEM (< 6.4 months) were independent prognostic factors of poor OS with 2L therapy. Conclusion 2L fluoropyrimidine-oxaliplatin doublets and fluoropyrimidine monotherapy after failure of 1L nab-P+GEM had modest efficacy, with no differences in treatment outcomes between them. Further investigation is warranted for the optimal 2L chemo-regimens and sequencing of systemic chemotherapy for patients with mPDAC.

BACKGROUND: This study investigated the association between physical activity and body fatness with serum vitamin D level in older adults. METHODS: A total of 233 older adults (39 men and 194 women) aged older than 65 years were voluntarily recruited from a local community. Physical activity was monitored using a uniaxial accelerometer. Body fatness was measured using a standardized protocol. Subjects were classified as sufficient (>30 ng/mL), insufficient (20-29 ng/mL), or deficient (<20 ng/mL) based on serum vitamin D level. Pearson correlation analyses were used to calculate bivariate correlations between variables. Logistic regression was used to determine the odds ratio of serum vitamin D inadequacy. RESULTS: There were linear increases in physical activity parameters including daily steps (P<0.001), low-intensity physical activity (P<0.001), moderate-intensity physical activity (P<0.001), and high-intensity physical activity (P<0.001) and linear decreases in body fatness parameters such as body mass index (P=0.039) and waist circumference (P=0.020) across incremental vitamin D levels. Vitamin D level was positively associated with daily steps (P<0.001), low-intensity physical activity (P<0.001), moderate-intensity physical activity (P<0.001), and high-intensity physical activity (P<0.001) and negatively associated with body mass index (P=0.001), percentage body fat (P=0.005), and waist circumference (P=0.003). Compared to the active group (reference), the inactive group (P=0.001) had a significantly higher odd ratio for serum vitamin D deficiency even after adjusting for age and sex (P=0.002). CONCLUSION: The findings of this study suggest that physical activity and vitamin D supplementation should be promoted for healthy aging.
Adipose Tissue ; Adult ; Aging ; Body Mass Index ; Humans ; Logistic Models ; Male ; Motor Activity ; Odds Ratio ; Vitamin D Deficiency ; Vitamin D ; Vitamins ; Waist Circumference

No abstract available.
Adipose Tissue ; Adult ; Humans ; Motor Activity ; Vitamin D Deficiency ; Vitamin D ; Vitamins

Ischiofemoral impingement syndrome is known as one of the causes of hip pain due to impingement of ischium and femur, and usually correlated with trauma or operation. We report a rare case of ischiofemoral impingement syndrome that has no history of trauma or surgery. A 48-year-old female patient was referred for 2 months history of the left hip pain, radiating to lower extremity with a hip snapping sensation. She had no history of trauma or surgery at or around the hip joint and femur. The magnetic resonance imaging (MRI) of the lumbar spine showed no abnormality, except diffuse bulging disc without cord compression at the lumbosacral area. Electrophysiologic study was normal, and there were no neurologic abnormalities compatible with the lumbosacral radiculopathy or spinal stenosis. Hip MRI revealed quadratus femoris muscle edema with concurrent narrowing of the ischiofemoral space. The distance of ischiofemoral space and quadratus femoris space were narrow. It was compatible with ischiofemoral impingement syndrome. After treatment with nonsteroidal anti-inflammatory drugs, physical therapy, and exercise program, the patient's pain was relieved and the snapping was improved. To our knowledge, this is the first reported case of a nontraumatic, noniatrogenic ischiofemoral impingement syndrome, and also the first case to be treated by a nonsurgical method in the Republic of Korea.
Edema ; Female ; Femur ; Hip ; Hip Joint ; Humans ; Ischium ; Lower Extremity ; Magnetic Resonance Imaging ; Muscles ; Radiculopathy ; Republic of Korea ; Sensation ; Spinal Stenosis ; Spine