Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

PURPOSE: The optimal cytotoxic regimens have not been established for patients with non-small cell lung cancer (NSCLC) who develop disease progression on first-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). MATERIALS AND METHODS: We conducted a multi-center randomized phase II trial to compare the clinical outcomes between pemetrexed plus cisplatin combination therapy followed by maintenance pemetrexed (PC) and pemetrexed monotherapy (P) after failure of first-line EGFR-TKI. The primary objective was progression-free survival (PFS), and secondary objectives included overall response rate (ORR), overall survival (OS), health-related quality of life (HRQOL), and safety and toxicity profiles. RESULTS: A total of 96 patientswere randomized, and 91 patientswere treated at 14 centers in Korea. The ORR was 34.8% (16/46) for the PC arm and 17.8% (8/45) for the P arm (p=0.066). With 23.4 months of follow-up, the median PFS was 5.4 months in the PC arm and 6.4 months in the P arm (p=0.114). The median OS was 17.9 months and 15.7 months in PC and P arms, respectively (p=0.787). Adverse events ≥ grade 3 were reported in 12 patients (26.1%) in the PC arm and nine patients (20.0%) in the P arm (p=0.491). The overall time trends of HRQOL were not significantly different between the two arms. CONCLUSION: The outcomes of pemetrexed therapy in NSCLC patients with disease progression after firstline EGFR-TKI might not be improved by adding cisplatin.
Arm ; Carcinoma, Non-Small-Cell Lung ; Cisplatin ; Disease Progression ; Disease-Free Survival ; Epidermal Growth Factor ; Follow-Up Studies ; Humans ; Korea ; Lung Neoplasms ; Lung ; Pemetrexed ; Protein-Tyrosine Kinases ; Quality of Life ; Receptor, Epidermal Growth Factor ; Tyrosine

This study evaluated the quality characteristics of jelly prepared with different levels (0%, 5%, 10%, 15%, 20%, and 25%) of wild carrot (WC, Daucus carota L.) juice as a care food for the elderly. The lightness, redness, yellowness, and delta (Δ) values of the jelly (Control, WCJ5, WCJ10, WCJ15, WCJ20, and WCJ25) decreased with increasing amounts of wild carrot juice added. The mechanical properties, such as hardness, springiness, chewiness, and gumminess, of the jelly were decreased with increasing amounts of wild carrot juice added. The total polyphenol and total flavonoid contents of the jelly increased with increasing amounts of wild carrot juice added. The DPPH radical scavenging activity (IC50) also increased with increasing amounts of wild carrot juice added. The α-glucosidase inhibitory effects of wild carrot (WC) and WCJ25 were 71% and 54.4%, respectively, compared to the positive control (acarbose). The lipase inhibitory effects of WC and WCJ25 were 44.2% and 14.4%, respectively, compared to the positive control group (orlistat). On the other hand, the sensory evaluation score was the best at WCJ20, which contained 20% wild carrot juice. In conclusion, WCJ20 or WCJ25 is expected to be a care food for the elderly with respect to texture as well as the antioxidant and enzymatic activity (α-glucosidase inhibitory and lipase inhibitory activities).
Aged ; Daucus carota* ; Hand ; Hardness ; Humans ; Lipase

Our study focused on the antioxidant activities of Mosidae leaf ethanol extract (MLE) and included measurements of reducing power, total phenolic compounds, DPPH radical scavenging activity, and hydroxyl radical scavenging activity. In order to determine whether or not MLE evidences any chemopreventive activities, experimental lung metastasis was induced via the i.v. inoculation of colon26-M3.1 carcinoma cells into BALB/c mice. Additionally, we attempted to characterize any possible cytotoxic effects in murine normal splenocytes and tumor cells (B16-BL6 and colon26-M3.1). The total phenolic content and reducing capacity were measured at 39 mg/100 mL and 1.24, respectively, whereas the DPPH and hydroxyl radical scavenging activities of MLE were measured to be 88.89% and 22.10%, respectively. Prophylactic i.v. treatment with MLE resulted in a dose-dependent and significant inhibition of lung metastasis. Specifically, a MLE dose of 200 ug per mouse resulted in an 88.90% inhibition of lung metastasis. For the cytotoxicity assay, MLE doses up to 100 ug/mL were not shown to affect the growth of normal murine splenocytes. Additionally, the survival of normal cells was not affected at MLE doses below 500 ug/mL. However, MLE doses up to 500 ug/mL reduced the percentage of tumor cell growth for B16BL6 (67% alive) and colon26-M3.1 (62% alive) cells.
Animals ; Ethanol ; Hydroxyl Radical ; Lung ; Mice ; Neoplasm Metastasis ; Phenol

The objectives of this study was to determine whether a new physically modified cornstarch by ultra-fine- or nanoscale pulverizer to reduce particle size offers better bioactive function than native cornstarch in weanling Sprague-Dawley rats. Male weaning Sprague-Dawley rats were fed diets containing native cornstarch (NAC), ultra fine pulverized cornstarch (UFC) or nano-scale pulverized cornstarch (NSC) for 4 weeks. In vitro rate of starch hydrolysis, growth performance, organ weight, intestine length intestinal proliferation and the fermentation by Bifidobacterium of rat cecum were evaluated. The diet with reduced particle size (UFC or NSC) significantly increased body weight gain and organ weight. Feed efficiency was increased in NSC fed rats and was not affected in UFC fed rats. Intestinal proliferation was decreased in NSC group. Reduction of particle size also increased cecal short chain fatty acid concentration and the growth and acidifying activity of Bifidobacterium. It is concluded that a reduction of particle size of starch granules by physically modification may increase growing performance and gut function.
Animals ; Bifidobacterium ; Body Weight ; Cecum ; Diet ; Fermentation ; Humans ; Hydrolysis ; Intestines ; Male ; Organ Size ; Particle Size ; Rats ; Rats, Sprague-Dawley ; Starch ; Weaning

This study was designed to investigate the effects of mulberry leaf powder supplementation on lead (Pb) status and mineral (Ca, Fe, Cu and Zn) content in Pb-administered rats for 4 weeks. Thirty two male rats were divided into 4 groups: a control, Pb, Pb5M (500 ppm Pb + 5% mulberry leaf powder), and Pb10M (500 ppm Pb + 10% mulberry leaf powder). There were no significant differences in food intake and initial body weight among groups. Mulberry leaf powder treatments showed significant decreases in food efficiency ratio and body weight gain. But FER of Pb5M% and Pb10M were significantly increases than that of Pb group. The levels of serum aspartate transaminase (AST) and creatinine were decreased by mulberry leaf powder treatment. Minerals content of liver and kidney were significantly decreased in the Pb groups than that of control group. Whereas, fecal minerals content were significantly increased in the Pb5M and Pb10M than those of control group. Pb content of serum, liver and kidney was significantly increased in the Pb group than those of control group. However, by mulberry leaf powder administration (Pb5M and Pb10M), Pb level of serum, liver and kidney were lowered than that of Pb group. And fecal Pb excretion was significantly increased in the Pb5M and Pb10M than that of Pb group. These results showed mulberry leaves were effective for lowing Pb accumulation in serum, organs, which may have potential to prevent Pb toxicity.
Animals ; Aspartate Aminotransferases ; Body Weight ; Creatinine ; Eating ; Humans ; Kidney ; Liver ; Male ; Minerals* ; Morus* ; Rats*

Stenotrophomonas maltophilia (previously named Xanthomonas maltophilia) is an aerobic, non-fermentive, Gram-negative bacillus that is wide spread in the environment. It was considered to be an organism with limited pathogenic potential, which was rarely capable of causing diseases in human other than those who were in debilitated or immunocompromised state. More recent studies have established that Stenotrophomonas maltophilia can behave as a true pathogen. Endocarditis due to this organism is rare, and only 24 cases of Stenotrophomonas maltophilia endocarditis have been reported in the medical literature. Most cases were associated with risk factors, including intravenous drug abuse, dental treatment, infected intravenous devices, and previous cardiac surgery. We present a case with two episodes of Stenotrophomonas maltophilia endocarditis after mitral valve prosthesis implantation, which was treated with antibiotics initially, and a combination of antibiotics and surgery later. To our knowledge, this is the first case of repetitive endocarditis due to Stenotrophomonas maltophilia.
Adult ; Anti-Bacterial Agents/*therapeutic use ; Bioprosthesis/adverse effects/*microbiology ; Endocarditis, Bacterial/*drug therapy/physiopathology ; Gentamicins/therapeutic use ; Gram-Negative Bacterial Infections/*drug therapy/physiopathology ; Heart Valve Prosthesis/adverse effects/*microbiology ; Humans ; Male ; Mitral Valve ; Recurrence ; Stenotrophomonas maltophilia/*drug effects ; Treatment Outcome ; Trimethoprim-Sulfamethoxazole Combination/*therapeutic use ; Vancomycin/therapeutic use

A rare manifestation of systemic lupus erythematosus (SLE) is cerebral venous sinus thrombosis (CVST), in which early diagnosis and aggressive therapy are of prime importance for favorable outcome. The pathogenesis of CVST is largely unknown, but it is thought to be caused by cerebral vasculitis, antiphospholipid antibodies or other conditions associated with enhanced coagulability. We describe two cases of SLE with CVST which were not associated with antiphospholipid antibodies. Both cases were treated with immunosuppressants (intravenous methylprednisolone and cyclophosphamide pulse therapy) and anticoagulant drugs (heparin and subsequent maintenance therapy with warfarin). There was a marked improvement of neurologic symptoms with the disappearance of thrombus in a follow-up MRI. The possibility of CVST should be considered in any patients with SLE who show neuropsychiatric manifestations.
Adult ; Anti-Inflammatory Agents, Steroidal/therapeutic use ; Anticoagulants/therapeutic use ; Brain/radiography ; Cyclophosphamide/therapeutic use ; Female ; Glucocorticoids, Synthetic/therapeutic use ; Heparin/therapeutic use ; Human ; Immunosuppressive Agents/therapeutic use ; Lupus Erythematosus, Systemic/*complications ; Magnetic Resonance Imaging ; Methylprednisolone/therapeutic use ; Middle Age ; Sinus Thrombosis, Intracranial/*complications/drug therapy/physiopathology/radiography ; Treatment Outcome ; Warfarin/therapeutic use

BACKGROUND: To the best of our knowledge, the report on Amanita subjunquillea poisoning has not been found in the medical literature. We investigated the clinical aspects of Amanita subjunquillea poisoning. METHODS: Sixteen subjects who had ingested the mushroom (A. subjunquillea) were examined for clinical features, laboratory and radiologic findings prospectively. RESULTS: The mean incubation period was 11.5 hours(range: 3 to 17 hours). The initial presentations were gastrointestinal symptoms which persisted for 2 to 4 days. The transaminase levels were elevated in all subjects and peaked on day 3 after ingestion of the mushrooms (mean AST/ALT levels : 3241 IU/L and 3741 IU/L, respectively). Biochemical evidence of pancreatitis and disseminated intravascular coagulation were frequent (83.3% and 62.5%, respectively). Liver ultrasonography and scintigraphy revealed abnormalities in most cases. Massive hepatic necrosis was confirmed by liver biopsy in one subject. The overall mortality was 12.5%. CONCLUSION: Clinical manifestations of A. subjunquillea poisoning were similar to those of other poisonous Amanitaceae intoxication. However, the mortality rate was lower in A. subjunquillea poisoning. Our data showed strong evidence that A. subjunquillea should be classified in the group of poisonous mushrooms.
Agaricales ; Amanita* ; Biopsy ; Disseminated Intravascular Coagulation ; Eating ; Liver ; Massive Hepatic Necrosis ; Mortality ; Pancreatitis ; Poisoning* ; Prospective Studies ; Radionuclide Imaging ; Ultrasonography