Publications by authors named "Jae-Young Lim"

250 Publications

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures.

Ann Rehabil Med 2021 Jun 30;45(3):225-259. Epub 2021 Jun 30.

Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

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.
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http://dx.doi.org/10.5535/arm.21110DOI Listing
June 2021

Challenges and Opportunities toward the Decade of Healthy Ageing in the Post-pandemic Era.

Authors:
Jae-Young Lim

Ann Geriatr Med Res 2021 Jun 28;25(2):63-64. Epub 2021 Jun 28.

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

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http://dx.doi.org/10.4235/agmr.21.0064DOI Listing
June 2021

Combined exercise and nutrition intervention for spinal sarcopenia: A pilot study protocol.

Medicine (Baltimore) 2021 Jun;100(24):e26421

Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.

Introduction: Spinal sarcopenia is a multifactorial disorder associated with the atrophy of and fatty changes to the paraspinal muscles. We previously developed the concept of spinal sarcopenia in community-dwelling older adults and investigated the association between conventional sarcopenic indices and spinal sarcopenia. However, interventional studies of spinal sarcopenia are lacking. This pilot study will aim to evaluate the effectiveness of a combined exercise and nutrition intervention for treating spinal sarcopenia.

Methods And Analysis: This open-label single-arm prospective study will include 35 community-dwelling older women who were diagnosed with spinal sarcopenia in our previous cohort study. The 12-week combined intervention will consist of back extensor strengthening exercise and nutritional supplementation. The primary outcome of this study will be isometric back extensor strength after the 12-week intervention. All functional and radiographic outcomes will be measured at 0, 12, and 24 weeks post-intervention. The data will be analyzed using the intention-to-treat principle.
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http://dx.doi.org/10.1097/MD.0000000000026421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213246PMC
June 2021

Diagnosing sarcopenia: Functional perspectives and a new algorithm from the ISarcoPRM.

J Rehabil Med 2021 Jun 21;53(6):jrm00209. Epub 2021 Jun 21.

Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey. E-mail:

Sarcopenia is an important public health problem, characterized by age-related loss of muscle mass and muscle function. It is a precursor of physical frailty, mobility limitation, and premature death. Muscle loss is mainly due to the loss of type II muscle fibres, and progressive loss of motor neurones is thought to be the primary underlying factor. Anterior thigh muscles undergo atrophy earlier, and the loss of anterior thigh muscle function may therefore be an antecedent finding. The aim of this review is to provide an in-depth (and holistic) neuromusculoskeletal approach to sarcopenia. In addition, under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM), a novel diagnostic algorithm is proposed, developed with the consensus of experts in the special interest group on sarcopenia (ISarcoPRM). The advantages of this algorithm over the others are: special caution concerning disorders related to the renin-angiotensin system at the case finding stage; emphasis on anterior thigh muscle mass and function loss; incorporation of ultrasound for the first time to measure the anterior thigh muscle; and addition of a chair stand test as a power/performance test to assess anterior thigh muscle function. Refining and testing the algorithm remains a priority for future research.
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http://dx.doi.org/10.2340/16501977-2851DOI Listing
June 2021

Novel lateral whole-body dual-energy X-ray absorptiometry of lumbar paraspinal muscle mass: results from the SarcoSpine study.

J Cachexia Sarcopenia Muscle 2021 May 28. Epub 2021 May 28.

DInstitute of Aging, Seoul National University, Seoul, South Korea.

Background: Here, we aimed to propose novel lateral whole-body dual-energy X-ray absorptiometry (lateral DXA) as a simple tool for measuring spinal muscle mass and investigate the feasibility of lateral DXA to measure lumbar paraspinal muscle (LPM) mass compared with lumbosacral spine three-dimensional magnetic resonance imaging (3D MRI).

Methods: Twenty consecutive participants were enrolled from a prospective observational cohort (SarcoSpine study). Lateral DXA was scanned with each participant in the lateral decubitus position. The region of interest was defined to analyse the LPM mass. LPM total volume, LPM cross-sectional area at the L3 mid-vertebra and L4/5 mid-disc levels and each signal intensity were measured by 3D MRI. Isokinetic and isometric back extensor muscle strengths as well as back extensor endurance were examined. The correlation between lateral DXA-based mass (weight) and 3D MRI-based LPM volume was analysed.

Results: The mean age of the 20 participants (15 women, 5 men) was 72.2 ± 4.9 years. LPM mass by lateral DXA was positively correlated with LPM volume by 3D MRI (β = 0.333, r = 0.692, p < 0.001) and negatively correlated with signal intensity of the total LPM (β = -0.263, r = -0.530, p = 0.016). LPM mass was also correlated with appendicular limb muscle mass, handgrip strength and gait speed as well as back extensor endurance (r = 0.620, p = 0.004).

Conclusions: Our data suggest that LPM mass assessed by lateral DXA was positively correlated with LPM volume by 3D MRI in older adults. Lateral DXA may be a potential substitute for the cross-sectional area measurement of LPM mass. Further studies are required to validate this lateral DXA technique.
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http://dx.doi.org/10.1002/jcsm.12721DOI Listing
May 2021

Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: a retrospective cohort study.

BMC Geriatr 2021 04 28;21(1):283. Epub 2021 Apr 28.

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea.

Background: The incidence and number of fragility hip fractures are gradually increasing, resulting in a wide consumption of medical resources. Various factors affecting functional recovery in patients with fragility hip fractures are known, and comorbid diseases are one of them. The purpose of this study is to determine the effect of comorbidities on functional outcomes in patients surgically treated for fragility hip fractures, thereby contributing to the efficient distribution of medical resources.

Methods: This was a retrospective cohort study performed in the three tertiary rehabilitation facilities. A total of 211 patients (50 men and 161 women; average age 81.6 ± 6.7 years) who had undergone surgery for fragility hip fractures were followed up from immediately after transfer to the Department of Rehabilitation Medicine to 6 months postoperatively. Comorbidities referred to a summary of the following conditions: hypertension, diabetes mellitus, chronic liver disease, dementia, cerebrovascular accident, and osteoporosis. Functional outcomes included Koval's grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM)-locomotion, Modified Rivermead Mobility Index, Berg Balance Scale (BBS), 4-Meter Walking speed Test (4MWT), the Korean version of the Mini-Mental State Examination(K-MMSE), Geriatric Depression Scale (GDS), EuroQol Five-Dimension (EQ-5D) questionnaire, the Korean version of the Modified Barthel Index (K-MBI), the Korean version of the Instrumental Activities of Daily Living (K-IADL), and Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale (K-FRAIL). For all tests, each patient was assessed immediately after transfer and 6 months post-surgery.

Results: Multivariate linear regression analyses adjusted for age, sex, the initial variable of the functional outcomes, and comorbidities revealed that dementia had a significant negative impact on Koval's grade and K-FRAIL 6 months postoperatively. Diabetes mellitus had a significant negative impact on the FAC, GDS, EQ-5D, K-IADL, and K-FRAIL 6 months postoperatively. Patients with osteoporosis showed a significant negative outcome of FIM-locomotion 6 months postoperatively. A cerebrovascular accident revealed a significant negative impact on the BBS 6 months postoperatively. In addition, hypertension led to significantly less favorable outcomes of the K-FRAIL 6 months postoperatively.

Conclusions: This study confirmed that comorbidities, particularly dementia and diabetes mellitus, significantly influence functional outcomes 6 months after fragility hip fracture surgeries.
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http://dx.doi.org/10.1186/s12877-021-02227-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082882PMC
April 2021

Effectiveness of interactive augmented reality-based telerehabilitation in patients with adhesive capsulitis: protocol for a multi-center randomized controlled trial.

BMC Musculoskelet Disord 2021 Apr 26;22(1):386. Epub 2021 Apr 26.

Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: As the primary treatment for adhesive capsulitis, intensive and accurate home exercise is as important as physical therapy in hospitals. Augmented reality (AR)-based telerehabilitation has been implemented recently in various musculoskeletal conditions to increase patient compliance and enable patients to exercise with the correct posture. The objective of this study is to present a protocol for investigating the additive effect of interactive AR-based telerehabilitation in comparison with the usual care for patients with adhesive capsulitis.

Methods: This study presents the protocol of a prospective, multi-center, single-blinded, two-armed randomized controlled trial (RCT). One hundred patients with stage I or II adhesive capsulitis will be recruited at the physical medicine and rehabilitation clinic. Patients will be randomly divided into two groups with 1:1 allocation. The intervention group will receive 3 months of hospital-based physical therapy in conjunction with home-based telerehabilitation. The control group will receive 3 months of hospital-based physical therapy in conjunction with a home-based exercise described in a brochure provided by the hospital. The primary outcome will be the change in passive range of motion (ROM) of the affected shoulder joint from baseline to 12 weeks after baseline assessment. The secondary outcomes will be active ROM, pain measured with the numeric rating scale, shoulder pain and disability index, 36-Item Short Form Survey, EuroQoL-5D-5L, and Canadian Occupational Performance Measure.

Discussion: This will be the first RCT study protocol to investigate the effect of telerehabilitation in patients with adhesive capsulitis. The result of this RCT will determine whether AR-based telerehabilitation is more effective than a brochure-based home exercise program and will provide evidence of the usefulness of "telerehabilitation" using hardware (IoT) and software (monitoring platform) technologies to develop "digital therapeutics" for the future.

Trial Registration: This trial was retrospectively registered at the Clinicaltrials.gov website on 20 March 2020, with the identifier NCT04316130 .
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http://dx.doi.org/10.1186/s12891-021-04261-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074703PMC
April 2021

Clinical Characteristics and Treatment Outcomes of Childhood Acute Promyelocytic Leukemia in Korea: a Nationwide Multicenter Retrospective Study by Korean Pediatric Oncology Study Group.

Cancer Res Treat 2021 Apr 20. Epub 2021 Apr 20.

Department of Pediatrics, Kosin University of Medicine, Busan, Korea.

Purpose: Acute promyelocytic leukemia (APL) is a rare disease in children and there are some different characteristics between children and adult. We aimed to evaluate incidence, clinical characteristics and treatment outcomes of pediatric APL in Korea.

Materials And Methods: Seventy-nine pediatric APL patients diagnosed from January 2009 to December 2016 in 16 tertiary medical centers in Korea were reviewed retrospectively.

Results: Of 801 acute myeloid leukemia(AML) children, 79 (9.9%) were diagnosed with APL. The median age at diagnosis was 10.6 years (range, 1.3-18.0). Male and female ratio was 1:0.93. Thirty patients (38.0%) had WBC count greater than 10x109/L at diagnosis. All patients received induction therapy consisting of all-trans retinoic acid (ATRA) and chemotherapy. Five patients (6.6%) died during induction chemotherapy and 66 (86.8%) patients achieved complete remission (CR) after induction chemotherapy. The causes of death were 3 intracranial hemorrhage (ICH), 1 cerebral infarction, and 1 sepsis. Five patients (7.1%) suffered a relapse during or after maintenance chemotherapy. The estimated 4-year event-free survival rate (EFS) and overall survival rates (OS) were 82.1 ± 4.4%, 89.7 ± 5.1% respectively. The 4-yr OS was significantly higher in patients with initial WBC <10x109/L than in those with initial WBC ≥10x109/L (p=0.02).

Conclusion: This study showed that the CR rates and survival outcomes in Korean pediatric APL patients were relatively good. The initial WBC count was the most important prognostic factor and most causes of death were related to serious bleeding in the early stage of treatment.
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http://dx.doi.org/10.4143/crt.2021.313DOI Listing
April 2021

Handgrip strength: Should repeated measurements be performed in both hands?

Geriatr Gerontol Int 2021 May 11;21(5):426-432. Epub 2021 Mar 11.

Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.

Aim: We aimed to determine whether both hands should be tested for handgrip strength and whether it is necessary to perform repeated measurements in each hand.

Methods: The data were obtained from the Korea National Health and Nutrition Examination Survey conducted from 2014 to 2018. The participants performed three trials of handgrip strength measurement for each hand alternately, with 60-s rest between the trials. From this pool of data, we included 23 901 participants aged ≥19 years who had completed surveys on the handgrip strength test, and obtained their medical history.

Results: The dominant hand had a significantly stronger handgrip strength than the non-dominant hand (32.75 ± 0.10 vs. 30.95 ± 0.09 kg, P < 0.001); however, 26.4% of the subjects had stronger handgrip strength in the non-dominant hand. During the three repeated measurements, the handgrip strength gradually increased; however, the mean difference between the trials (0.579 and 0.104 kg) was below the noninferiority threshold. In older adults, however, the mean difference in the handgrip strength between the first and the second trial was higher than the noninferiority threshold.

Conclusions: While the handgrip strength gradually increased during three repeated measurements, the difference was clinically important only in older adults. Hence, we suggest that the handgrip strength should be measured in both hands and at least twice in older adults, whereas a single attempt provides a maximal value in younger adults. Geriatr Gerontol Int 2021; 21: 426-432.
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http://dx.doi.org/10.1111/ggi.14146DOI Listing
May 2021

Prevalence and Effect of Obesity on Mobility According to Different Criteria in Polio Survivors.

Am J Phys Med Rehabil 2021 03;100(3):250-258

From the Department of Rehabilitation Medicine, Seongnam Citizens Medical Center, Seongnam-si (K-HS); Department of Rehabilitation Medicine, Dongmasan General Hospital, Masan-Si (JHL); Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Bucheon-si (S-YL); and Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea (JYL, J-YL).

Objective: Obesity is a major and functionally important problem in polio survivors. The aim of this study was to investigate the prevalence of obesity using body mass index and percentage body fat in polio survivors and to analyze the relationship between obesity and mobility.

Design: Eighty-four polio survivors were included. Anthropometric parameters, knee extensor strength, and the Short Physical Performance Battery were evaluated. A questionnaire was used to explore the late effects of poliomyelitis. Obesity was determined using both body mass index and percentage body fat.

Results: The prevalence of obesity in polio survivors was 39.3% and 81.5% using the body mass index and percentage body fat criteria, respectively. The Short Physical Performance Battery scores were significantly different between the obese and nonobese groups as determined by percentage body fat (P < 0.05). Only percentage body fat was significantly associated with mobility after controlling for the confounding variables in obese polio survivors (P < 0.05).

Conclusions: Obesity in polio survivors was underestimated when the body mass index criteria were used. Percentage body fat was a significantly associated factor for mobility in obese polio survivors. Obesity determined by percentage body fat criteria is useful to address obesity-related problems in polio survivors.
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http://dx.doi.org/10.1097/PHM.0000000000001556DOI Listing
March 2021

Treatment Outcomes of Pediatric Acute Myeloid Leukemia in the Yeungnam Region: A Multicenter Retrospective Study of the Study Alliance of Yeungnam Pediatric Hematology-Oncology (SAYPH).

Children (Basel) 2021 Feb 5;8(2). Epub 2021 Feb 5.

Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University, School of Medicine, Yangsan 50612, Korea.

Acute myeloid leukemia (AML) is the second most common pediatric leukemia, with a survival rate of 70%. In this retrospective study, we evaluated the treatment outcomes of pediatric AML among 144 patients diagnosed between 2000 and 2013. After induction, 80.6% of patients achieved complete remission (CR). The 5-year overall survival (OS) and event-free survival (EFS) rates were 58.8 ± 4.2% and 49.8 ± 4.2%, respectively. Based on the response to induction therapy, the 5-year OS was 66.9 ± 5.7% in patients with CR ( < 0.001). Ninety-nine patients with CR after induction therapy were examined, and their 5-year OS and EFS were 66.4 ± 4.9% and 56.3 ± 5.1%, respectively. The 5-year OS rates according to treatment were 59.9 ± 7.4% in the chemotherapy group and 72.3 ± 6.3% in the hematopoietic stem cell transplantation (HSCT) group ( = 0.089). The EFS was 50.1 ± 7.4% in the chemotherapy group and 61.7 ± 6.9% in the HSCT group ( = 0.098). OS and EFS according to cytogenetics were insignificant. Our findings confirmed that the response to induction treatment was important for survival and HSCT had no significant survival benefits compared with those of chemotherapy. Moreover, many early induction deaths under the age of 2 years were observed.
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http://dx.doi.org/10.3390/children8020109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915354PMC
February 2021

Effects of Aging on Angiogenic and Muscle Growth-Related Factors in Naturally Aged Rat Skeletal Muscles.

Ann Geriatr Med Res 2020 Dec 29;24(4):305-312. Epub 2020 Dec 29.

Department of Physical Education, College of Physical Education, Keimyung University, Daegu, Korea.

Background: This study explored the effects of aging on the expression of angiogenic and muscle protein synthesis factors, as well as the number of satellite cells affecting sarcopenia in naturally aged rat skeletal muscles.

Methods: We divided 16 Sprague-Dawley rats into young (12 weeks old, n=8) and old (24 months old, n=8) groups and compared muscle and body weight (BW) between them. We also analyzed the expression levels of angiogenic and muscle growth proteins in soleus (slow-twitch) and extensor digitorum longus (EDL; fast-twitch) muscles by western blotting and assessed the number of skeletal muscle satellite cells and myonuclei and mean fiber cross-sectional area (CSA) using by immunofluorescence staining.

Results: EDL/BW was significantly lower in old rats than in young rats (p=0.002). The vascular endothelial growth factor level in soleus muscles was significantly lower in old rats than in young rats (p=0.001). Hypoxia-inducible factor 1-alpha and fetal liver kinase 1 levels in EDL muscles were lower in old rats than in young rats (p=0.001). The mammalian target of rapamycin (mTOR), p70S6K, and 4E-BP1 levels were significantly lower in the soleus muscles of old rats than in those of young rats (p<0.01). Similarly, insulin growth factor-1, Akt, mTOR, and p70S6K levels were significantly lower in EDL muscles of old rats than in those of young rats (p<0.01). Additionally, myonuclei/fiber, Pax7/fiber, and mean fiber CSAs in both muscle types were significantly lower in old rats than in young rats (p<0.01).

Conclusion: Conclusion These data suggest different regulation of indices of angiogenic and muscle growth with aging in different muscle types.
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http://dx.doi.org/10.4235/agmr.20.0077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781957PMC
December 2020

Mechanical Properties of Single Muscle Fibers: Understanding Poor Muscle Quality in Older Adults with Diabetes.

Ann Geriatr Med Res 2020 Dec 28;24(4):267-273. Epub 2020 Dec 28.

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Background: While aging causes muscle weakness, type 2 diabetes mellitus (T2DM) is also considered a high-risk factor for the induction of skeletal muscle weakness. Previous studies have reported increased collagen content in insulin-resistant skeletal muscles. Here, we studied the mechanical properties of aged skeletal muscle in subjects with T2DM to investigate whether aged skeletal muscles with T2DM induce higher passive tension due to the abundance of extracellular matrix (ECM) inside or outside of the muscle fibers.

Methods: Samples from the gluteus maximus muscles of older adults with diabetes (T2DM) and non-diabetic (non-DM) older adults who underwent elective orthopedic surgery were collected. Permeabilized single muscle fibers from these samples were used to identify their mechanical properties. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was used to quantify titin and fiber type distributions in these samples.

Results: We confirmed a significant predominance of type I fiber ratio in both T2DM and non-DM aged muscles. While the average cross-sectional area and maximal active tension of the single fibers were smaller in the T2DM group than those in the non-DM group, the difference was not statistically significant. T2DM subjects showed significantly greater passive tension and lower titin-/ECM-based passive tension ratios than those in non-DM subjects, which indicated that more ECM but less titin contributed to the total passive tension.

Conclusion: Based on our findings, we concluded that T2DM may cause increased passive stiffness of single skeletal muscle fibers in older adults because of an excessive accumulation of ECM in and around single muscle fibers due to increased insulin resistance.
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http://dx.doi.org/10.4235/agmr.20.0078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781968PMC
December 2020

Effectiveness of a Home-Based Fragility Fracture Integrated Rehabilitation Management (FIRM) Program in Patients Surgically Treated for Hip Fractures.

J Clin Med 2020 Dec 23;10(1). Epub 2020 Dec 23.

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si 13620, Korea.

Background: The purpose of this study was to investigate the effectiveness of a home-based fragility fracture integrated rehabilitation management (H-FIRM) program following an inpatient FIRM (I-FIRM) program in patients surgically treated for hip fracture.

Methods: This nonrandomized controlled trial included 32 patients who underwent hip surgery for a fragility hip fracture. The patients were divided into two groups: a prospective intervention group ( = 16) and a historical control group ( = 16). The intervention group performed a nine-week H-FIRM program combined with the I-FIRM program. The historical control group performed the I-FIRM program only. Functional outcomes included Koval's grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM) locomotion, Modified Rivermead Mobility Index (MRMI), 4 m walking speed test (4MWT), and the Korean version of Modified Barthel Index (K-MBI). All functional outcomes were assessed one week (before I-FIRM), three weeks (before I-FIRM), and three months (after H-FIRM) after surgery.

Results: Both groups showed significant and clinically meaningful improvements in functional outcomes over time. Compared with the control group, the intervention group showed clinically meaningful improvements in Koval's grade, FAC, FIM locomotion, MRMI, 4MWT, and K-MBI from baseline to three months.

Conclusion: H-FIRM may be an effective intervention for improving functional outcomes in older people after fragility hip fractures.
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http://dx.doi.org/10.3390/jcm10010018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794998PMC
December 2020

Clinical Characteristics and Treatment Outcomes in Children, Adolescents, and Young-adults with Hodgkin's Lymphoma: a KPHOG Lymphoma Working-party, Multicenter, Retrospective Study.

J Korean Med Sci 2020 Nov 30;35(46):e393. Epub 2020 Nov 30.

Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.

Background: Hodgkin's lymphoma (HL) constitutes 10%-20% of all malignant lymphomas and has a high cure rate (5-year survival, around 90%). Recently, interest has increased concerning preventing secondary complications (secondary cancer, endocrine disorders) in long-term survivors. We aimed to study the epidemiologic features and therapeutic outcomes of HL in children, adolescents, and young adults in Korea.

Methods: We performed a multicenter, retrospective study of 224 patients aged < 25 years diagnosed with HL at 22 participating institutes in Korea from January 2007 to August 2016.

Results: A higher percentage of males was diagnosed at a younger age. Nodular sclerosis histopathological HL subtype was most common, followed by mixed cellularity subtype. Eighty-one (36.2%), 101 (45.1%), and 42 (18.8%) patients were classified into low, intermediate, and high-risk groups, respectively. Doxorubicin, bleomycin, vinblastine, dacarbazine was the most common protocol (n = 102, 45.5%). Event-free survival rate was 86.0% ± 2.4%, while five-year overall survival (OS) rate was 96.1% ± 1.4%: 98.7% ± 1.3%, 97.7% ± 1.6%, and 86.5% ± 5.6% in the low, intermediate, and high-risk groups, respectively ( = 0.021). Five-year OS was worse in patients with B-symptoms, stage IV disease, high-risk, splenic involvement, extra-nodal lymphoma, and elevated lactate dehydrogenase level. In multivariate analysis, B-symptoms and extra-nodal involvement were prognostic factors for poor OS. Late complications of endocrine disorders and secondary malignancy were observed in 17 and 6 patients, respectively.

Conclusion: This is the first study on the epidemiology and treatment outcomes of HL in children, adolescents, and young adults in Korea. Future prospective studies are indicated to develop therapies that minimize treatment toxicity while maximizing cure rates in children, adolescents, and young adults with HL.
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http://dx.doi.org/10.3346/jkms.2020.35.e393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7707923PMC
November 2020

Comparison of Bone Preservation in Elderly Patients with Femoral Neck Fracture After Bipolar Hemiarthroplasty Using Shorter Femoral Stem and Standard Femoral Stem.

Indian J Orthop 2020 Nov 30;54(6):868-878. Epub 2020 Apr 30.

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.

Background: This randomized control study was designed to compare the clinical and radiological outcomes, including periprosthetic bone mineral density (BMD) changes, between the short and standard stems after using cementless hemiarthroplasty in elderly patients with femur neck fractures.

Materials And Methods: From January 2013 to May 2017, 151 patients (aged ≥ 65 years) underwent hemiarthroplasties due to femoral neck fractures. Patients were randomized into two groups; 77 patients in Group A implanting the short femoral stem and 74 patients in Group B implanting the standard femoral stem. Clinical and radiographic evaluations were performed in all patients.

Results: 75 patients (40 patients in Group A and 35 patients in Group B) completed routine follow-up for a minimum of 2 years. The clinical outcomes, including ambulatory functions and thigh pain, were similar in both groups. All the femoral stems acquired radiologic stability. At postoperative one year, BMD values in Gruen zone (G) seven on the standard stem side were significantly lower than those on the short stem side ( = 0.038). At the second year of follow-up, the BMD values of Group A in G1, G3, G4, and G7 were significantly greater than those of Group B ( = 0.007, 0.032, 0.026, and  < 0.000, respectively).

Conclusions: Both the clinical outcomes and radiologic stability in both group demonstrated similar results in elderly patients with femoral neck fracture at the latest follow-up. In addition, the periprosthetic BMD of the short femoral stems demonstrated better periprosthetic bone preservation at a minimum of 2 years of follow-up.

Level Of Evidences: Therapeutic Level II.
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http://dx.doi.org/10.1007/s43465-020-00115-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572964PMC
November 2020

Validation of an integrated service model, Health-RESPECT, for older patients in long-term care institution using information and communication technologies: protocol of a cluster randomised controlled trial.

BMJ Open 2020 10 10;10(10):e038598. Epub 2020 Oct 10.

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of).

Introduction: There is an increased healthcare need to manage institutionalised older patients owing to the ageing population. To overcome substantial future challenges, the Health-RESPECT (caRE Systems for Patients/Elderly with Coordinated care using icT), a new information and communication technologies based integrated management service model, was developed to provide effective management, enable consultation with distant professionals and share medical information between acute care hospitals and long-term care institutions.

Methods And Analysis: A cluster randomised controlled trial will be conducted to examine the effectiveness of the Health-RESPECT in older patients with chronic diseases and their medical staff in charge. Intervention involves registration with simple comprehensive geriatric assessment, establishment of an individualised care plan for three chronic diseases (hypertension, diabetes and heart failure), medication and rehabilitation management, periodic video-conference and in-system assessment after intervention period. Primary outcomes are control levels of the three chronic diseases, adequacy of drug management and overall functional status. Patients will be assessed at before and after study period and 3 months after study ended. Analysis will be carried out with an intention-to-treat principle. In addition to evaluate intervention effects, clinical usability and economic evaluation will be assessed.

Ethics And Dissemination: The study protocol was reviewed and approved by the Seoul National University Bundang Hospital Institutional Review Board. Study findings will be published in peer-reviewed journals.

Trial Registration Number: KCT0004360.
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http://dx.doi.org/10.1136/bmjopen-2020-038598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552832PMC
October 2020

Special Issue on Long-Term Care for Older Adults in East Asian Countries.

Authors:
Jae-Young Lim

Ann Geriatr Med Res 2020 Sep 23;24(3):173. Epub 2020 Sep 23.

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

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http://dx.doi.org/10.4235/agmr.20.0062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533192PMC
September 2020

Annals of Geriatric Medicine and Research Indexed in PubMed Central: An Important Milestone toward the Leading Journal.

Ann Geriatr Med Res 2020 09 22;24(3):155-156. Epub 2020 Sep 22.

Institute of Geriatric Medicine, Incheon Eun-Hye Hospital, Incheon, Korea.

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http://dx.doi.org/10.4235/agmr.20.0061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533187PMC
September 2020

Early rehabilitation in a critically ill inpatient with COVID-19.

Eur J Phys Rehabil Med 2020 Dec 1;56(6):858-861. Epub 2020 Oct 1.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea -

Background: Survivors of critical coronavirus disease 2019 (COVID-19) suffer from severe physical functional disability. Recent reports from several countries suggest that rehabilitative intervention is needed to improve physical functional decline in the challenging situation of COVID-19.

Case Report: A 58-year-old woman, previously without gait difficulty, was diagnosed with COVID-19 requiring endotracheal intubation and mechanical ventilation. She also developed stress-induced cardiomyopathy. After management in intensive care unit for 15 days, she could not sit on a bed without back support. After receiving short-term inpatient rehabilitation therapy, lower limb muscle strength, balance function, and gait speed had rapidly and significantly improved at the time of hospital discharge and at 1-month follow-up.

Clinical Rehabilitation Impact: As COVID-19 tends to progress rapidly in the acute phase, early rehabilitation is necessary, despite challenges to its implementation. Feasible inpatient rehabilitation for patients with critical COVID-19 will pave the way to improve physical functional disability.
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http://dx.doi.org/10.23736/S1973-9087.20.06406-0DOI Listing
December 2020

Recent Epidemiology of Hip Fractures in South Korea.

Hip Pelvis 2020 Sep 2;32(3):119-124. Epub 2020 Sep 2.

Department of Orthopaedic Surgery, Chung-Ang University Hospital, Seoul, Korea.

The aging of the Korean population is expected to result in an increase in the prevalence of hip fractures. The aim of this review is to evaluate potential hip-fracture trends in Korea during the last few decades. Data from a hip fracture-related epidemiology study informed by: (1) a cohort study; (2) hospital-based cohort study; and (3) claims database, were reviewed and summarized. The incidence of hip fractures rose from 159.1/100,000 in 2008 to 181.5/100,000 in 2012, and the total number of hip fractures is estimated to increase by 1.4 times over the next 10 years (35,729 in 2016 to 51,259 in 2025). The use of intramedullary nails has greatly surpassed the use of plates for the treatment of intertrochanteric fractures. The 1-year cumulative mortality rates in patients aged ≥50 years after hip fractures based on National Health Insurance Service data were 17.2% (3,575/20,849) in 2008 and 16.0% (4,547/28,426) in 2012; the decrease was mainly observed among women. In addition, the mean 1-year mortality rates were 21% for men and 15% for women, indicating that mortality was 1.4 times higher in men than in women. The number of hip fractures is rapidly increasing, and the incidence of hip fractures demonstrated a slightly increasing trend until 2012. Trends in the use of varying surgical options for treatments for femoral neck and intertrochanteric fractures follow global trends. Although the high mortality rate after hip fractures in Korea remains concerning, a decrease in these rates over the study period was observed.
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http://dx.doi.org/10.5371/hp.2020.32.3.119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476784PMC
September 2020

Risk Factors and Effects of Severe Late-Onset Hyponatremia on Long-Term Growth of Prematurely Born Infants.

Pediatr Gastroenterol Hepatol Nutr 2020 Sep 27;23(5):472-483. Epub 2020 Aug 27.

Department of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea.

Purpose: Sodium is an essential nutritional electrolyte that affects growth. A low serum sodium concentration in healthy premature infants beyond 2 weeks of life is called late-onset hyponatremia (LOH). Here, we investigated the association between LOH severity and growth outcomes in premature infants.

Methods: Medical records of premature infants born at ≤32 weeks of gestation were reviewed. LOH was defined as a serum sodium level <135 mEq/L regardless of sodium replacement after 14 days of life. Cases were divided into two groups, <130 mEq/L (severe) and ≥130 mEq/L (mild). Characteristics and growth parameters were compared between the two groups.

Results: A total of 102 premature infants with LOH were included. Gestational age ([GA] 27.7 vs. 29.5 weeks, <0.001) and birth weight (1.04 vs. 1.34 kg, <0.001) were significantly lower in the severe group. GA was a risk factor of severe LOH (odds ratio [OR], 1.328, =0.022), and severe LOH affected the development of bronchopulmonary dysplasia (OR, 2.950, =0.039) and led to a poor developmental outcome (OR, 9.339, =0.049). Growth parameters at birth were lower in the severe group, and a lower GA and sepsis negatively affected changes in growth for 3 years after adjustment for time. However, severe LOH was not related to growth changes in premature infants.

Conclusion: Severe LOH influenced the development of bronchopulmonary dysplasia and developmental outcomes. However, LOH severity did not affect the growth of premature infants beyond the neonatal period.
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http://dx.doi.org/10.5223/pghn.2020.23.5.472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481060PMC
September 2020

Association between sarcopenia and fall characteristics in older adults with fragility hip fracture.

Injury 2020 Nov 1;51(11):2640-2647. Epub 2020 Sep 1.

Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea. Electronic address:

Introduction: Sarcopenia is known as a risk factor for falls and hip fracture, and understanding fall characteristics is important for the fall-prevention programs. The aim of this study is to investigate whether sarcopenia is associated with fall characteristics in older adults with fragility hip fracture.

Methods: A cross-sectional study was conducted in 147 patients over 65 years of age who had undergone a two-week postoperative rehabilitation for hip fracture. Fall characteristics included the fall type, direction and location. Fall types were categorized into two groups: fragile falls, leg weakness during walking, changing positions or standing; non-fragile falls, slipping or tripping while walking. Correlations between sarcopenia and fall characteristics, and of fall type with sarcopenia and fall characteristics were analyzed. Logistic regression analyzes were used to identify independent risk factors for fragile falls.

Results: Sarcopenia was significantly correlated with fragile falls (r = .222, p = .007) and was more prevalent in the fragile fall group than the non-fragile fall group (53.5% vs. 32.9%). Sarcopenia (OR = 2.354, 95% CI 1.177-4.709, p = .016), moderate comorbidities (OR = 3.572, 95% CI 1.109-11.501, p = .033) and severe comorbidities (OR = 5.396, 95% CI 1.476-19.729, p = .011) by the Charlson Comorbidity Index were significant independent risk factors for fragile falls.

Conclusions: Sarcopenia was correlated with fragile falls; moreover, it was a risk factor for all of these fall types in older adults with fragility hip fracture. Based on these associations, targeted fall-prevention programs for older adults with sarcopenia, a high risk factor of falls and fractures, could help reduce the incidence rates of falls and fragility hip fracture.
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http://dx.doi.org/10.1016/j.injury.2020.08.031DOI Listing
November 2020

Changes in Seroprevalence of Infection over 20 Years in Jinju, Korea, from Newborns to the Elderly.

J Korean Med Sci 2020 Aug 17;35(32):e259. Epub 2020 Aug 17.

Department of Pediatrics, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea.

Background: The objective of this study was to examine changes in the prevalence of cytotoxic-associated gene A (CagA) positive infection in Jinju, Korea, over the last 20 years.

Methods: Three cross-sectional analyses were conducted concurrently. A total of 1,305 serum samples were collected from 1994-1995, 2004-2005, and 2014-2015, respectively. The presence of immunoglobulin (Ig) G, IgA, and IgM antibodies against CagA protein was examined by western blotting.

Results: Overall, seropositivity for anti-CagA IgG antibody was significantly decreased from 63.2% to 42.5% over the last 20 years ( < 0.001). Anti-CagA IgG seropositivities in children and young adults aged 10-29 years decreased from 1994 (60.0%-85.0%) to 2015 (12.5%-28.9%). The age when plateau of increasing IgG seropositivity was reached in each study period shifted from the 15-19 year-old group in 1994-1995 (85.0%) to the 40-49 year-old group in 2014-2015 (82.5%). Overall seropositive rates of anti-CagA IgA and IgM antibodies did not change significantly either over the last 20 years.

Conclusion: infection rate in children and young adults declined over 20 years in Jinju, probably due to improved sanitation, housing, or economy.
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http://dx.doi.org/10.3346/jkms.2020.35.e259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431285PMC
August 2020

Development of Health-RESPECT: An Integrated Service Model for Older Long-Term Care Hospital/Nursing Home Patients Using Information and Communication Technology.

Ann Geriatr Med Res 2020 Mar 30;24(1):27-34. Epub 2020 Mar 30.

Department of Preventive Medicine, Kyung Hee University School of Medicine, Seoul, Korea.

Background: Korea, as one of the fastest-aging countries worldwide, requires an improved healthcare service model for older adults. We evaluated the current healthcare system and developed a service model based on information and communication technologies (ICT) for use in older patients in long-term care facilities (LTCF).

Methods: We conducted a qualitative literature review, focus group interviews (FGIs), and structured survey to identify the current technology use and status of healthcare systems. We then developed a web-based platform with necessary, high-priority, and usable content for the care of older patients in LTCF.

Results: We reviewed 60 (23 hypertension, 18 diabetes, and 19 heart failure) articles on information and communication technologies (ICT)-based disease management for clinical effectiveness and improved patient satisfaction. FGIs and structured surveys were used to evaluate the inconvenience in patient and medical information transfer between hospitals and cost and time required for its process. Accordingly, we confirmed the unmet need for an ICT-based service model for management, monitoring, and consultation among older patients and developed the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT), a service platform for older patients residing in LTCF. The medical information exchange system was used to transfer medical information. Health-RESPECT includes an established algorithm for evidence-based comprehensive geriatric assessment and customized management; chronic disease management; management of potentially inappropriate medications; rehabilitation; and consultation and videoconferencing.

Conclusion: This study identified the current status and unmet needs of healthcare systems for older adults. We developed an ICT-based system to manage older institutionalized patients. However, the Health-RESPECT service model requires further validation.
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http://dx.doi.org/10.4235/agmr.20.0006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370783PMC
March 2020

Appreciation to Our Peer Reviewers in 2019.

Authors:
Jae-Young Lim

Ann Geriatr Med Res 2020 Mar 30;24(1):1-2. Epub 2020 Mar 30.

Editor-in-Chief of Annals of Geriatric Medicine and Research, Seoul National University Bundang Hospital, Seongnam, Korea.

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http://dx.doi.org/10.4235/agmr.20.0014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370778PMC
March 2020

as a Space of for Developing Research Ideas into Better Clinical Practices for Older Adults in Emerging Countries.

Ann Geriatr Med Res 2019 Dec 23;23(4):157-159. Epub 2019 Dec 23.

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.4235/agmr.19.0044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370759PMC
December 2019

Moving Forward as a Growing Platform of Geriatric Medicine and Gerontologic Research.

Authors:
Jae-Young Lim

Ann Geriatr Med Res 2019 Sep 30;23(3):93-94. Epub 2019 Sep 30.

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.4235/agmr.19.0034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370764PMC
September 2019

Dynamic Changes of Fecal Calprotectin and Related Clinical Factors in Neonates.

Front Pediatr 2020 8;8:326. Epub 2020 Jul 8.

Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, South Korea.

Fecal calprotectin (FC) has been widely used for a clinical marker of intestinal inflammation in children and adults. However, the clinical usefulness has not been determined in neonates. The purpose of this study was to investigate the change of FC and associated clinical factors in neonates. In total, 146 neonates among 472 admissions to our NICU between 2018 and 2019 were included, and 242 stool samples were collected. FC was measured in the first, second, and third-fourth week after birth, respectively, using commercial ELISA. The clinical characteristics were reviewed from medical records. Statistical analyses were performed to analyze associated factors regarding on changes of fecal calprotectin. A wide range from 5.5 to 6,000 mg/kg of FC was observed in neonates. FCs during neonatal period were not correlated with the gestational age at birth or birth weight. The meconial calprotectin was higher than FCs after 2 weeks of age ( = 134, 418.06 vs. 243.12 in the second week and 259.58 in the third week after birth). Meconial calprotectin was associated with birth weight and meconium stained amniotic fluid. FC during the neonatal period decreased with postnatal week (-464.93 ± 158.02 at third-fourth week after birth compared with the 1st week, = 0.004) and breast milk (-337.27 ± 150.51 compared with formula milk, = 0.026). Fecal calprotectin tended to decrease with postnatal week during the neonatal period, and breast milk could affect more decrease of FC.
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http://dx.doi.org/10.3389/fped.2020.00326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360719PMC
July 2020