High incidence of major bleeding with off-label use of edoxaban

In clinical practice, edoxaban is sometimes prescribed for off-label use based on the hypothesis that it is as safe and effective as warfarin. However, there is limited safety information on off-label use due to lack of clinical trial. We aimed to analyze the tolerability of off-label use of edoxaban and to identify patient characteristics associated with major bleeding as adverse effects. Patients under edoxaban treatment between January 2017 and December 2017 were enrolled in this retrospective cohort study. The incidence of major bleeding with off-label use compared with on-label use was analyzed using by log-rank test. Univariate and multivariate regression analysis were undertaken to detect independent variables with significant odds ratio that associated with major bleeding. After the exclusion criteria were applied, the patients were divided into two groups: off-label group (n = 30) and on-label group (n = 161). Incidence of major bleeding was found to be higher in the off-label group (13.3%) than in the on-label group (3.7%) (p<0.05). Multivariate adjustment showed that the off-label use or portal vein thrombosis and patients with history of major bleeding has significantly higher incidence of major bleeding. We demonstrated that off-label use of edoxaban may be a significant risk factor for major bleeding.     

Gender difference in the relationship between anemia and vitamin D in Korean adults: the fifth Korea National Health and Nutrition Examination Survey

This study was conducted to assess the relationship between vitamin D deficiency and anemia, by gender, in Korean adults. The data of 16,060 adults were analyzed (men, 6,840; premenopausal women, 4,916; postmenopausal women, 4,340) from the fifth Korean National Health and Nutrition Examination Survey (KNHANES V) (2010–2012). There were several key findings. First, after adjusting for related variables, the odds ratio (OR) of anemia [hemoglobin (Hb) <13 g/dl in men or Hb <12 g/dl in women] using the vitamin D normal group {25-hydroxyvitamin [25(OH)D] ≥15.0 ng/ml} as reference, was significant for the vitamin D deficient group [25(OH)D <15.0 ng/ml] in the overall population [OR, 1.310; 95% confidence interval (CI), 1.168–1.470]. Second, the OR of anemia, using the vitamin D normal group as reference, was significant for the vitamin D deficient group in premenopausal women (OR, 1.293; 95% CI, 1.105–1.513). However, vitamin D deficiency in the vitamin D normal group in men (OR, 1.093; 95% CI, 0.806–1.484) and postmenopausal women (OR, 1.130; 95% CI, 0.906–1.409) was not significant. In conclusion, Vitamin D deficiency is positively associated with anemia in premenopausal women, but not in men and postmenopausal women.     

Different associations of specific non-alcoholic beverages with elevated high-sensitivity C-reactive protein in Korean adults: results from the Korea National Health and Nutrition Examination Survey (2015–2016)

This study examined the associations between specific non-alcoholic beverages and high-sensitivity C-reactive protein (hs-CRP) and their interactions with obesity. The study participants were 4,999 adults aged 19–64 years from the 2015–2016 Korean National Health and Nutrition Examination Survey. The odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using multivariable logistic regression analyses. In women, there was an inverse linear trend between coffee and hs-CRP status (p_trend = 0.0137), and a positive linear trend for soda was also found (≥1/week vs never or almost never, OR = 1.79, 95% CI 1.23–2.61, p_trend = 0.0127). In the stratification analyses, the associa­tions were only observed in obese women. The associations were inverse for coffee and tea but linearly positive for soda in obese women (p_trend<0.05). In men, an inverted J-shaped association between commercial fruit juice/drink and hs-CRP status was found; but after stratification by obesity, the association was linear only in obese men (p_trend<0.05, OR = 2.44, 95% CI 1.44–4.16 in ≥1/week vs never or almost never). Coffee and tea in women may be beneficially associated with hs-CRP status, but soda in women and commercial fruit juice/drink in men may be adversely, particularly for obese adults.     

Influence of Thoracic Flexion Syndrome on Proprioception in the Thoracic Spine

[Purpose] This study was performed to determine the difference in thoracic repositioning sense in young people with and without thoracic flexion syndrome (TFS) in target positions of half extension. [Subjects] People with TFS (n = 15; 7 men and 8 women) and people without TFS (n = 15; 7 men and 8 women) were recruited from three universities. Subjects were guided into a sitting extension target posture and were asked to move from a neutral position (2 s) to an extension target position (2 s); 10 trials were performed. [Results] People with TFS showed a significantly higher thoracic repositioning error in the extension target position than people without TFS. [Conclusion] People with TFS show a higher thoracic spine repositioning error in extension than people without TFS. A rehabilitation program to treat TFS should be implemented for individuals with decreased position sense of the thoracic spine.Key words: Proprioception, Repositioning error, Thoracic flexion syndrome     

Retrogression of Nervous Fibers According to the Age of Patients with Diabetes Mellitus (DM)

[Purpose] This study was performed to discover the possible onset time of diabetic neuropathy by age of diabetic patients, and to provide the knowledge necessary for preventing or managing diabetic neuropathy. [Subjects] The subjects of this study were outpatients who visited D Hospital Department of Neurology with complaints of significant neuropathic symptoms including dullness, numbness and paraesthesia. [Methods] Stimulations of 5 Hz, 250 Hz and 2,000 Hz were generated with a Neurometer CPT (Neurotron Inc., Baltimore, MD, USA) and delivered selectively to C fibers, A-delta fibers and A-beta fibers. The intensity of the stimulations of 5 Hz, 250 Hz and 2,000 Hz was incrementally increased as much as 0.01 mA. [Result] The results of this experiment show that the period of retrogression of nervous fibers was different significantly according to the age of patients with diabetes mellitus. Especially, in the case of individuals in their 50''s, Aβ, Aδ, and C fibers in both the right and left lower limbs significantly changed within a period of 2 months. In the case of individuals in their 60''s, Aβ and C fibers of the right lower limb meaningfully changed 2 months after the onset of the disease, and Aβ, Aδ, and C fibers of the left lower limb also significantly changed within a period of 2 months. [Conclusion] We discovered that patients suffering from DM especially in their 50''s or 60''s should be thoroughly followed for their condition, right from the onset of DM, in order to prevent the retrogression of nervous fibers.Key words: Diabetes mellitus, Nervous fiber, Neuropathy     

Recommendations for health-enhancing physical activities in type 2 diabetes patients

[Purpose] Type 2 diabetes mellitus is a disease of civilization with epidemiological coverage. An integral component of a comprehensive process of type 2 diabetes mellitus prevention and treatment is reasonably proportioned exercise. The aim of the study was to evaluate the weekly physical activity of patients with type 2 diabetes mellitus and healthy subjects with respect to recommendations of the American College of Sports Medicine and American Diabetes Association. [Subjects] The study involved 31 patients with type 2 diabetes mellitus (treatment duration 9 ± 0.8) and 31 healthy people. [Methods] Physical activity levels were determined by the International Physical Activity Questionnaire. A χ² test was applied to determine the percentage of people who met recommendations. [Results] Analysis of the obtained results demonstrated that the intensity of physical activity in patients with diabetes was moderate or low. The men in the control group met the recommendations for standard health-related activities significantly more often than the patients with diabetes. In women, there was no such relationship, since most of the women were insufficiently physically active. [Conclusion] The conclusion to be drawn is that there is an urgent need to develop and implement effective programs to enhance physical activity among people at risk of diseases of civilization, including type 2 diabetes.Key words: Health recommendations, Physical activity, Type 2 diabetes     

The Effects of Vibration Stimuli Applied to the Shoulder Joint on the Activity of the Muscles Around the Shoulder Joint

[Purpose] The present study compared the muscle activity of the upper trapezius with those of the serratus anterior and the lower trapezius when slings, unstable surfaces, were laterally vibrated, to examine the effects of vibration during sling exercises on shoulder stabilization muscles. [Methods] The subjects performed push-up exercises on a sling and maintained isometric contraction in the final stage, while vibration was manually administered to the rope of the sling during the isometric-contraction stage. Vibration within a range of 10 cm was delivered for five seconds at a frequency of 1 Hz in time with a metronome. Vibrations were applied for five seconds at 3 Hz and 3.5 Hz, respectively. [Results] The serratus anterior showed a significant differences between isometric contraction with vibration of 3 Hz and isometric contraction with vibration of 3.5 Hz. [Conclusion] The upper trapezius and the lower trapezius showed prominent changes in muscle activity at 3.5 Hz, and the serratus anterior showed prominent changes in muscle activity at 3 Hz and 3.5 Hz. Therefore, as vibration frequency increased, making the load-bearing surface more unstable, the recruitment of the upper trapezius, the lower trapezius, and the serratus anterior increased. To perform exercises that selectively strengthen the serratus anterior, the exercises should be performed at a vibration frequency of 3 Hz.Key words: Vibration, Shoulder joint, Muscle activity     

Decrease in Talocrural Joint Mobility is Related to Alteration of the Arterial Blood Flow Velocity in the Lower Limb in Diabetic Women

[Purpose] The purpose of this study was to correlate the talocrural range of motion (ROM) and blood flow velocity in the lower limb arteries of diabetic women. [Subjects and Methods] Thirty women were divided into a control group (G1), consisting of 15 sedentary right-handed subjects (41.27 ± 7.24 years old) who had no history of blood system disorder, and a diabetes group (G2), consisting of 15 sedentary right-handed subjects (57.87 ± 6.20 years old) who had type 2 diabetes mellitus. Talocrural ROM was measured by using goniometry for dorsiflexion and plantar flexion movements. In addition, blood flow velocity of the dorsalis pedis, posterior tibial, and popliteal arteries was also assessed. [Results] No significant differences were found between the groups by comparing talocrural ROM and arterial blood velocity. However, a significant association was found in G2 only between the following variables: plantar flexion and blood flow velocity of the dorsalis pedis artery (rs = 0.57), plantar flexion and blood flow velocity of the popliteal artery (rs = 0.50), and dorsiflexion and blood flow velocity of the posterior tibial artery (rs = 0.57). [Conclusion] The decrease in talocrural ROM is related to a decrease in the arterial blood flow velocity in diabetic women.Key words: Diabetes mellitus, Arthrometry, Physical therapy     

Effects of exercise on glycemic control in type 2 diabetes mellitus in Koreans: the fifth Korea National Health and Nutrition Examination Survey (KNHANES V)

[Purpose] The aim of this study was to investigate the effect of exercise on glycemic control using data from fifth Korea National Health and Nutrition Examination Survey and to provide appropriate exercise guidelines for patients with type 2 diabetes mellitus in Korea. [Subjects and Methods] We selected 1,328 patients from the fifth Korea National Health and Nutrition Examination Survey database who had type 2 diabetes and ranged in age from 30 to 90 years. Statistical analyses included χ² tests, multiple linear regression, and logistic regression. [Results] Factors found to be significantly related to glycemic control included income level, physical activity based on intensity of aerobic exercise, use of diabetes medicine, presence of hypertension, duration of diabetes, and waist circumference. In addition, engaging in combined low- and moderate-intensity aerobic exercise when adjusted for resistance exercise was found to lower the risk of glycemic control failure. [Conclusion] Patients with type 2 diabetes mellitus in Korea should engage in combined low- and moderate-intensity aerobic exercise such as walking for 30 minutes or more five times a week. Physical activity is likely to improve glycemic control and thus prevent the acute and chronic complications of diabetes mellitus.Key words: Exercise, Glycemic control, Type 2 diabetes mellitus     

Evaluation of oxygen uptake adjusted by skeletal muscle mass in cardiovascular disease patients with type 2 diabetes

[Purpose] We aimed to evaluate oxygen uptake adjusted by total skeletal muscle mass in patients with cardiovascular disease with or without type 2 diabetes mellitus. [Participants and Methods] The participants included 54 males ≥50 years of age without heart failure who underwent cardiopulmonary exercise testing during cardiac rehabilitation. We divided the participants into two groups: patients with type 2 diabetes mellitus (DM group) and patients without type 2 diabetes mellitus (NDM group). [Results] We found no significant differences in age, weight, fat mass, or skeletal muscle mass between the groups. There were also no differences in cardiac function, body composition, and heart rate response. The DM group showed significantly lower peak oxygen uptake values adjusted by skeletal muscle mass, despite the absence of significant differences in skeletal muscle mass. A significant positive correlation was found between peak oxygen uptake and age, weight, and skeletal muscle mass. Stepwise regression analysis revealed that age, skeletal muscle mass, and medical history of diabetes were independent predictors of absolute peak oxygen uptake. [Conclusion] Peak oxygen uptake adjusted by skeletal muscle mass in patients with cardiovascular disease and type 2 diabetes mellitus is lower than that in those without type 2 diabetes mellitus.Key words: Cardiopulmonary exercise testing, Peak oxygen uptake, Skeletal muscle mass     

Cognitive rehabilitation for elderly people with early-stage Alzheimer’s disease

[Purpose] The purpose of this study was to investigate the effect of cognitive rehabilitation including tasks of cognitive training on performance of everyday activities in elderly people with early-stage Alzheimer’s disease. [Subjects and Methods] Forty-three elderly people (15 men, 28 women) with a diagnosis of Alzheimer’s disease who had a Mini-Mental State Examination (MMSE) score of 18 or above were randomly assigned to two groups: the cognitive rehabilitation group (experimental) and control group. This study used a randomized controlled trial design. Cognitive rehabilitation is consisted of 8 sessions, each lasting 60 minutes (individual 30 min, group 30 min). The eight weekly individual sessions of cognitive rehabilitation were performed consisting of an individualized intervention focusing on a personally meaningful goal. The eight weekly group sessions involved practicing time-and-place orientation, matching faces and names, and learning memory and sustaining attention. [Results] Significant improvements were observed in rating of occupation performance and satisfaction, Quality of Life in Alzheimer’s Disease (QOL-AD), and the orientation subscale of the MMSE in the experimental group, whereas participants in the control group did not show any significant difference in any tests between before and after the intervention. [Conclusion] Cognitive rehabilitation including tasks of cognitive training is an effective intervention for improving performance and satisfaction with respect to activities of daily living and specific cognitive functions.Key words: Alzheimer, Cognitive rehabilitation     

A 3-month multicomponent home-based rehabilitation program for older people with restricted life-space mobility: a pilot study

[Purpose] The purpose of this study was to verify the effects of a 3-month multicomponent home-based rehabilitation program developed on the basis of the reevaluation of older people with restricted life-space mobility. [Participants and Methods] The participants were residents in Japan aged ≥65 years who had Life-Space Assessment scores ≤52.3. Multicomponent home-based rehabilitation was conducted by physical and occupational therapists. Each visit included 40–60 min of combined exercise, practicing activities of daily living, improving the home environment, and caregiver support. The programs were developed in accordance with a flow diagram. The primary outcome was life-space mobility evaluated using the Life-Space Assessment score. [Results] Overall, 30 participants completed the intervention. The mean age of the participants was 82.4 ± 7.5 years. Three months after the intervention initiation, the Life-Space Assessment scores significantly improved from 12.0 to 30.5. The proportion of participants at maximal life-space level 5 (unlimited mobility) doubled from 16.7% at baseline to 33.3%. The functional independent measure score, fall efficacy scale score, and lower limb strength associated with standing up also significantly improved. We found no significant changes in the geriatric depression scale 5 and self-rated good health scores. [Conclusion] Multicomponent home-based rehabilitation can improve life-space mobility in older people with restricted life-space mobility.Key words: Home-based rehabilitation, Life-Space mobility, Older people     

Effects of exercise intensity on hypertension prevalence in Korean men with high sodium intake

[Purpose] The purpose of present study was to investigate the effects of exercise intensity on hypertension prevalence in Korean men with high sodium intake. [Subjects and Methods] This study was based on the data collected from 2007 to 2013 in the Korean National Health and Nutritional Examination Survey. A total of 8853 male adults were included in the analysis. The odds ratios for hypertension according to exercise groups were assessed by using logistic regression of each sodium intake group. [Results] Among the 8853 subjects, 6243 had an eating habit of 4000 mg or more sodium consumption per day, and 2619 had less than 4000 mg. Among the 2619 subjects with less than 4000 mg sodium consumption, 16.7% subjects were diagnosed as having hypertension. In the subjects with 4000 mg or more sodium consumption, compared to the no-exercise group, the moderate-exercise group showed a lower likelihood of developing hypertension, with an odds ratio of 0.63 (95% confidence interval, 0.47–0.85) after adjusting for age. In multivariate models 1 and 2, odds ratios for the likelihood of developing hypertension in the moderate-exercise group decreased to 0.63 (0.43–0.91) and 0.66 (0.45–0.96), respectively. [Conclusion] Moderate exercise is significantly associated with a lower likelihood of developing hypertension in cases of high sodium intake.Key words: Exercise intensity, High sodium intake, Hypertension     

Activation of the gluteus medius according to load during horizontal hip abduction in a one-leg stance

[Purpose] This study researched the influences of different loads on muscle activity of the posterior fibers of the gluteus medius in a one-leg standing position. [Subjects] Twenty-four healthy adult men participated in this study. [Methods] All participants performed the one-leg standing position under four conditions: the standard no-load condition, in which the non-weight-bearing leg was lifted and kept parallel to the back and then pelvic or lumbar rotation was performed without thorax rotation, and the 0 kg, 1 kg, and 3 kg load conditions, in which horizontal shoulder abduction was performed with a load of 0 kg, 1 kg, or 3 kg added to the hand. The electromyographic activity of the posterior fibers of the gluteus medius was measured using a wireless surface electromyography under all conditions. The electromyographic activity of each muscle under the four conditions during the one-leg stance was analyzed using one-way analysis of variance. [Results] The electromyographic activity of the posterior fiber of the gluteus medius was significantly increased under the 3 kg load condition compared with the no-load, 0 kg load, and 1 kg load conditions. [Conclusion] These findings indicated that muscle activation is affected by increases in load in the one-leg standing position. The load on the upper extremity influences the muscle activity of the contralateral lower extremity.Key words: Posterior fibers of the gluteus medius, Horizontal hip abduction, Load     

Factors Increasing Physical Activity Levels in Diabetes Mellitus: A Survey of Patients after an Inpatient Diabetes Education Program

[Purpose] The aim of this study was to understand the factors involved in increasing physical activity levels in type 2 diabetes mellitus patients for improved glycemic control. [Subjects] The subjects were 101 type 2 diabetes mellitus patients who had completed an inpatient diabetes education program. [Methods] The survey evaluated physical activity levels on the basis of the International Physical Activity Questionnaire and a questionnaire listing physical and psychosocial factors. [Results] Four variables—participation or non-participation in farm work, presence or absence of a job, stage of change in attitude toward exercise behavior, and social support—accounted for 34% of physical activity levels in these diabetes mellitus patients. The Spearman’s rank correlation coefficient between physical activity level and HbA1c was −0.31. [Conclusion] Intervention in terms of practical use of living environments, promotion of exercise behavior, and social support may be effective in helping to improve glycemic control.Key words: Type 2 diabetes mellitus, Physical activity, Exercise therapy     

Weaning from mechanical ventilation: a cross-sectional study of reference values and the discriminative validity of aging

[Purpose] To evaluate pre-extubation variables and check the discriminative validity of age as well as its correlation with weaning failure in elderly patients. [Subjects and Methods] Two hundred thirty-nine consecutive patients (48% female) who were on mechanical ventilation and had undergone orotracheal intubation were divided into four subgroups according to their age: <59 years, 60–69 years, 70–79 years, and >80 years old. The expiratory volume (V_E), respiratory frequency (f), tidal volume (V_T), and respiratory frequency/tidal volume ratio (f/V_T) were used to examine differences in weaning parameters between the four subgroups, and age was correlated with weaning failure. [Results] The rate of weaning failure was 27.8% in patients aged >80 years and 22.1% in patients aged <60 years old. Elderly patients presented higher f/V_T and f values and lower V_T values. The areas under the receiver operating characteristic curves for f/V_T ratio were smaller than those published previously. [Conclusion] Our results indicate that aging influences weaning criteria without causing an increase in weaning failure.Key words: Weaning, Mechanical ventilation, Aging     

Impact of task-oriented training on hand function and activities of daily living after stroke

Purpose] We examined the improvement of hand function and activities of daily living in stroke patients after carrying out task-oriented training. [Subjects] Thirty-two patients who had been diagnosed with stroke and underwent rehabilitation therapy participated in the task-oriented training. [Methods] The participants carried out task-oriented training for 30 min per day for 4 weeks. Their hand function and activities of daily living were evaluated before and after the training. [Results] The task-oriented training had a significant impact in terms of improving hand function and activities of daily living. [Conclusion] According to the results of this study, task-oriented training resulted in improved hand function and activities of daily living in stroke patients.Key words: Task-oriented training, Hand function, Activities of daily living     

Whole-body vibration-induced muscular reflex: Is it a stretch-induced reflex?

[Purpose] Whole-body vibration (WBV) can induce reflex responses in muscles. A number of studies have reported that the physiological mechanisms underlying this type of reflex activity can be explained by reference to a stretch-induced reflex. Thus, the primary objective of this study was to test whether the WBV-induced muscular reflex (WBV-IMR) can be explained as a stretch-induced reflex. [Subjects and Methods] The present study assessed 20 healthy males using surface electrodes placed on their right soleus muscle. The latency of the tendon reflex (T-reflex) as a stretch-induced reflex was compared with the reflex latency of the WBV-IMR. In addition, simulations were performed at 25, 30, 35, 40, 45, and 50 Hz to determine the stretch frequency of the muscle during WBV. [Results] WBV-IMR latency (40.5 ± 0.8 ms; 95% confidence interval [CI]: 39.0–41.9 ms) was significantly longer than T-reflex latency (34.6 ± 0.5 ms; 95% CI: 33.6–35.5 ms) and the mean difference was 6.2 ms (95% CI of the difference: 4.7–7.7 ms). The simulations performed in the present study demonstrated that the frequency of the stretch signal would be twice the frequency of the vibration. [Conclusion] These findings do not support the notion that WBV-IMR can be explained by reference to a stretch-induced reflex.Key words: Skeletal muscle function, Gravitational physiology, Tonic vibration reflex     

Sex differences in knee strength deficit 1?year after anterior cruciate ligament reconstruction

[Purpose] Little is known about the outcome differences between men and women after anterior cruciate ligament (ACL) reconstruction. Therefore, the present study aimed to compare knee muscle strength between men and women 1 year after ACL reconstruction. [Subjects and Methods] Retrospective and outcome study. Between 2012 and 2015, 35 males (mean age, 29.7 ± 010.7 years) and 35 females (mean age, 28.2 ± 11.3 years) who had undergone primary ACL reconstruction were recruited from Samsung medical centers. We assessed the strength deficit in the quadriceps (extensor) and hamstrings (flexor) at 60°/sec and 180°/sec with isokinetic testing equipment. Statistical analysis was conducted with a t-test to determine if sex differences existed in knee strength deficit. [Results] Significant differences were noted between men and women with respect to extensor muscle strength deficit. Women reported less extensor muscle strength than men did, at the angular velocities 60°/sec and 180°/sec. However, no significant sex differences were found at either velocity with respect to the strength deficit of the knee flexor muscles. [Conclusion] Compared to male patients, female patients reported significantly less extensor muscle strength and less improvement 1 year after reconstruction.Key words: Anterior cruciate ligament, Sex, Female     

Effect of Vibration Frequency on Serratus Anterior Muscle Activity during Performance of the Push-up Plus with a Redcord Sling

[Purpose] We investigated the effect of vibration at various frequencies on serratus anterior (SA) muscle activity. [Subjects] Ten male subjects were recruited. [Methods] The subjects performed the push-up plus exercise supported by straps above the surface and vertical ropes in the Redcord sling. During the push-up plus, vibrations of 0, 30, 50, or 90 Hz were applied to the Redcord sling using a mechanical vibration apparatus attached to the rope. SA muscle activity was recorded using electromyography. [Results] SA muscle activity at the 50 Hz vibration frequency was significantly higher than that of no vibration. [Conclusion] Performing the push-up plus using a Redcord sling with mechanical vibration of 50 Hz effectively increased SA muscle activity.Key words: Push-up plus, Mechanical vibration, Serratus anterior