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This review aims to summarize the health benefits of exposure to hypoxic conditions during exercise in patients with type 2 diabetes mellitus (T2DM). Exposure to hypoxic conditions during exercise training positively changes the physiological response in healthy subjects. Exposure to hypoxic conditions during exercise could markedly increase skeletal muscle glucose uptake compared to that in normoxic conditions. Furthermore, post-exercise insulin sensitivity of T2DM patients increases more when exercising under hypoxic than under normoxic conditions. Regular exercise under short-term hypoxic conditions can improve blood glucose control at lower workloads than in normoxic conditions. Additionally, exercise training under short-term hypoxic conditions can maximize weight loss in overweight and obese patients. Previous studies on healthy subjects have reported that regular exercise under hypoxic conditions had a more positive effect on vascular health than exercising under normoxic conditions. However, currently, evidence indicating that exposure to hypoxic conditions could positively affect T2DM patients in the long-term is lacking. Therefore, further evaluations of the beneficial effects of exercise under hypoxic conditions on the human body, considering different cycle lengths, duration of exposures, sessions per day, and the number of days, are necessary. In this review, we conclude that there is evidence that exercise under hypoxic conditions can yield health benefits, which is potentially valuable in terms of clinical care as a new intervention for T2DM patients.

Purpose This study aimed to investigate the effects of acute cold stress (10℃, 0℃) compared with ordinary temperature (20℃) on exercise performance and physiological response at rest and during exercise. Methods A total of 10 healthy men (21.55 ± 2.16) were selected. In each environmental condition (20℃, 10℃, 0℃), the three testing order was randomly selected at crossover, and there was a week interval between the graded exercise test (GXT). On the testing day, they remained resting for 30 min in each environmental condition. Dependent variables (body temperature, energy metabolism parameters, skeletal muscle oxygenation profiles, and exercise performance parameters) were measured at rest and during GXT. Results In body temperature, at each environmental condition, there was a significant decrease (p

The purpose of the study was to examine the development of a multiple linear regression model to estimate heart rate variability (HRV) parameters using easy-to-measure independent variables in preliminary experiments. HRV parameters (time domain: SDNN, RMSSD, NN50, pNN50; frequency domain: TP, VLF, LF, HF) and the independent variables (e.g., sex, age, body height, body weight, BMI, HR, HRmax, HRR) were measured in 75 healthy adults (male n = 27, female n = 48) for estimating HRV. The HRV estimation multiple linear regression model was developed using the backward elimination technique. The regression model’s coefficient of determination for the time domain variables was significantly high (SDNN = R2: 72.2%, adjusted R2: 69.8%, P < .001; RMSSD = R2: 93.1%, adjusted R2: 92.1%, P < .001; NN50 = R2: 78.0%, adjusted R2: 74.9%, P < .001; pNN50 = R2: 89.1%, adjusted R2: 87.4%, P < .001). The coefficient of determination of the regression model for the frequency domain variable was moderate (TP = R2: 75.6%, adjusted R2: 72.6%, P < .001; VLF = R2: 41.6%, adjusted R2: 40.3%, P < .001; LF = R2: 54.6%, adjusted R2: 49.2%, P < .001; HF = R2: 67.5%, adjusted R2: 63.4%, P < .001). The coefficient of determination of time domain variables in the developed multiple regression models was shown to be very high (adjusted R2: 69.8%–92.1%, P < .001), but the coefficient of determination of frequency domain variables was moderate (adjusted R2: 40.3%–72.6%, P < .001). In addition to the equipment used for measuring HRV in clinical trials, this study confirmed that simple physiological variables could predict HRV.

Sarcopenic obesity is a physiological issue caused by ageing that worsens the elderly's quality of life by reducing bodily function, increasing body fat, and decreasing muscle mass. Furthermore, it leads to a variety of social and economic issues, including the progression and contraction of a chronic condition, increased health-care expenses, and a rise in the prevalence or mortality rate. It has an adverse influence on metabolic illness symptoms such as decreased body function and physical strength, blood lipids, and body inflammation and hormones. Exercise therapy is currently recommended as a treatment for elderly health concerns. Regular aerobic exercise is effective in increasing body function and muscle mass, and regular resistance exercise is effective in improving body function and muscle mass. Resistance exercise has recently been highlighted in obese elderly persons in order to improve muscular function and prevent falls. Resistance exercise, on the other hand, has several drawbacks, such as the risk of injury, the inability to exercise in a specific location, and the inability to reduce obesity, so a new exercise approach for the sarcopenic obese elderly should be offered. The circuit exercise with weight bearing offers a lower risk of injury, and it can be done in a group setting without regard to cost or location, and it can be done continuously with interest. Circuit training is also advised for the elderly because it improves body composition and a variety of physical characteristics in a very short period of time. Despite these positive effects, the studies reported so far are limited. Future research is needed to confirm the effects of different intensities, frequency, time, and duration of circuit exercise in sarcopenic obesity elderly. Therefore, this review summarizes recent research evidences suggesting that the improvement of muscle mass and body fat mass via circuit exercise program might be a valuable and viable “sarcopenic obesity therapeutic modality.

This study aimed to analyze the status of sarcopenia, obesity, osteoporosis, and cardiometabolic disease according to the level of physical activity (PA) among elderly people in Korea. Among the data obtained from the National Health and Nutrition Survey (2008–2011), we analyzed the data of a total of 3,573 Korean elderly people over 65 years of age who were surveyed for dual X-ray absorptiometry (DXA) and PA. Higher levels of PA were associated with a lower prevalence of cardiometabolic disease (χ2 = 33.865, p < 0.001), osteoporosis (χ2 = 94.198, p < 0.001), sarcopenia, obesity, and sarcopenic obesity (χ2 = 71.828, p < 0.001). Above moderate-active PA was associated with lower body weight (p < 0.001), body fat mass (p < 0.001), and percent body fat (p < 0.001), and higher free-fat mass (p < 0.001) and appendicular skeletal muscle mass (ASM) (p < 0.001) than in low-active PA. In addition, when high-active is the risk factors of cardiometabolic were lower in waist circumference (p = 0.001), total cholesterol (TC) (p = 0.015), and triglyceride (TG) (p < 0.001) than low- and moderate-active PA, and higher in high-density lipoprotein cholesterol (HDL-C) (p < 0.001). The prevalence of cardiometabolic diseases was significantly decreased in high-active PA (odds ratio (OR) 0.60, 95% confidence interval (CI) 0.50–0.71); waist circumference (OR 0.85, 95% CI, 0.73–0.99; OR 0.59, 95% CI, 0.50–0.70) and HDL-C (OR 0.76, 95% CI, 0.65–0.88; OR 0.56, 95% CI, 0.47–0.67) significantly improved in moderate- and high-active PA, respectively, and TG (0.67 95% CI, 0.55–0.80) significantly improved in high-active PA. Osteoporosis (OR 0.62, 95% CI, 0.53–0.74; OR 0.46, 95% CI, 0.38–0.55) and sarcopenia (OR 0.77, 95% CI, 0.60–0.98; OR 0.73, 95% CI, 0.57–0.93) were significantly improved in moderate- and high-active PA, respectively. The incidence of obesity (OR 0.47, 95% CI, 0.39–0.57) and sarcopenic obesity (OR 0.47, 95% CI, 0.30–0.75) were significantly decreased in high-active PA. Therefore, we verified a lower prevalence of sarcopenia, osteoporosis, obesity, and cardiac metabolic disease in Korean elderly with more active PA. This suggests that more active PA maybe reduce the prevalence of sarcopenia, osteoporosis, obesity, and cardiometabolic diseases in older adults.

We investigated the effects of acute thermal stress (30 °C and 40 °C) and ordinary temperature (20 °C) on cardiorespiratory function, skeletal muscle oxygenation, and exercise performance in healthy men. Eleven healthy males (21.5 ± 2.3 years) performed a graded exercise test (GXT) using a cycle ergometer in each environmental condition (20 °C, 30 °C, and 40 °C) in a random order with an interval of 1 week between each test. Before the test, they were allowed to rest for 30 min in a given environmental condition. All dependent variables (body temperature, cardiorespiratory function parameters, skeletal muscle oxygenation profiles, and exercise performance) were measured at rest and during GXT. GXT was started at 50 W and increased by 25 W every 2 min until subjects were exhausted. Body temperature increased proportionally at rest and at the end of exercise as thermal stress increased. There were no differences in the rating of perceived exertion, oxygen uptake, respiratory exchange ratio, and carbon dioxide excretion between environmental conditions. Heart rate (HR), minute ventilation (VE), and blood lactate levels were significantly higher at 30 °C and 40 °C than at 20 °C, and oxygen pulse was significantly lower at 40 °C than at 20 °C at various exercise loads. None of the skeletal muscle oxygenation profiles showed significant changes at rest or during exercise. Maximal oxygen uptake, peak power, and exercise time significantly decreased proportionally as thermal stress increased, and this decrease was most pronounced at 40 °C. Acute thermal stress induces a decrease in exercise performance via increased body temperature, HR, VE, and blood lactate levels and decreased oxygen pulse during load-homogenized exercise. This phenomenon was more prominent at 40 °C than at 30 °C and 20 °C.

A 41-year-old male was diagnosed with tongue cancer. Preoperative imaging revealed no metastatic lymph nodes. Intraoperative sonography detected a minute hypoechoic lesion in the sublingual space. A pea-sized mass was found during dissection of that space and histopathology revealed a metastatic lymph node. The lingual lymph node should routinely be evaluated sonographically prior to surgical resection of tongue cancer.

Purpose The purpose of this study was to examine the effects of 16 weeks’ combined exercise training on insulin resistance, inflammatory markers, oxidative stress, leukocyte telomere length, body composition, and daily living fitness in elderly women with type 2 diabetes mellitus (DM). Methods Twenty-eight participants were randomly assigned into one of two groups, i.e., exercise training group (EX: n=14) and control group (CON: n=14). Subjects in EX participated in 3 sessions of 60 min-combined exercise for 16 weeks, whereas subjects in CON were asked to maintain their normal life pattern during the same period. The variables regarding insulin resistance, inflammatory markers, oxidative stress, leukocyte telomere length, body composition, and daily living fitness were measured and compared between two groups as well as between pre-post test utilizing a repeated two-way ANOVA. Results Main results were as follows: 1) Fasting plasma insulin and HOMA-IR tended to decrease in EX, whereas increased significantly in CON. 2) IL-6, TNF-α, hs-CRP decreased in EX, but the changes were not statistically significant. 3) MDA increased significantly and GPx decreased significantly in both EX and CON. 4) Leukocyte telomere length increased significantly in EX. 5) Fat-free mass increased in EX, whereas fat mass and percent body fat decreased significantly in EX. 6) Arm curl, chair stand, sit & reach, tandem test, 10m walking speed, and up & go improved significantly in EX. Conclusion It was concluded that the combined exercise for 16 weeks had a positive effect on improving insulin resistance, increasing leukocyte telomere length, as well as enhancing body composition and daily living fitness in elderly women with type 2 diabetes.

Sarcopenia is defined as an age-related decrease in muscle mass, strength, and function. We investigated the effect of circuit training on body composition, balance, muscle mass and strength, and pulmonary function in Korean women with sarcopenia. We randomly assigned 26 Korean women with sarcopenia ( Mage = 74.9, SD = 4.5 years) to either an exercise group (EG) ( n = 13) or a control group (CG) ( n = 13). The EG performed 25-75 minutes of circuit exercise training (gradually increasing time periods) three times per week over 12 weeks, while the CG maintained their usual daily lifestyle during the intervention period. We measured body weight, body mass index, percent body fat, free fat mass, balance ability, peak torque in shoulder, knee, and lumbar joints normalized for bodyweight (BW), forced vital capacity, percentage of forced expiratory volume in one second, and forced expiratory flow 25–75% before and after the intervention. The EG showed improved body composition (i.e., body mass index, fat-free body mass, fat mass; all p 2 > 0.180), balance (i.e., right and left of static and dynamic balance and fast 10-m walk; all p 2 > 0.151), muscular function (i.e., 90°/s and 180°/s peak power per kilogram BW, 90°/s average power per kilogram BW, 180°/s total work, and 180°/s endurance ratio; all p 2 > 0.157), and pulmonary function (all p 2 > 0.292). On the other hand, the CG showed no significant changes. Circuit exercise training improves muscle mass and strength, body composition, balance, and pulmonary function in women with sarcopenia.

[Purpose] The purpose of this study was to confirm that the difference in excess post-exercise oxygen consumption (EPOC) during exercise of the spending the same calories between the continuous and interval exercise. [Methods] Thirty-four healthy college students who did not regularly exercise volunteered to participate in our study. Continuous exercise was performed on an ergometer for 30 min at 60% of maximal oxygen consumption (VO2 max). Interval exercise was performed on a cycle ergometer at 80% VO2 max for 2 min initially, followed by 40% VO2 max for 1 min, and 80% VO2 max for 3 min. This was repeated six times for a total of 26 min. [Results] The major findings were as follows: (1) energy consumption during exercise was not significantly different between continuous exercise and interval exercise groups; (2) EPOC was higher in interval exercise than in continuous exercise for all dependent variables (i.e., total oxygen consumption, total calories, summation of heart rate); and (3) there were no significant differences in the lipid profile between continuous and interval groups. [Conclusions] Our study confirmed that after equalizing energy expenditure for continuous and interval exercise on a cycle ergometer in subjects in their twenties, interval exercise results in higher EPOC than continuous exercise. These data suggest that interval exercise may be more effective than continuous exercise in reducing body fat, for a given amount of energy expenditure.

[Purpose] The purpose of this study was to comparatively investigate the correlation among body composition, resting metabolic rate (RMR), and physical activity (PA) between young and middle-aged Korean adults. [Methods] A total of 53 [male n=23, female n=30] subjects were included in this study, among whom 34 subjects were healthy young adults [male n=18, female n=16] and 19 were middle-aged adults [male n=5, female n=14]. The body composition and RMR of all the participants were measured after overnight fasting (≥8 h). The Korean version of the WHO Global Physical Activity Questionnaire (GPAQ) was used to assess physical activity. [Results] Body composition was not significantly different between young adults and middle-aged adults. Whole-body bone mineral density and bone mineral contents (BMC) were significantly lower in middle-aged adults than in young adults. Total blood cholesterol (TC) and blood glucose levels were significantly higher in middle-aged adults (TC; 195.21 ± 43.34, glucose; 103.57 ± 12.61 mg/dL) than in young adults. RMR was significantly lower in middle-aged adults (1619.57 ± 290.28 kcal/day) than in young adults (1894.37 ± 405.00 kcal/day). In middle-aged adults physical activity (PA). PA (METs, min, EE) was inversely correlated with fat mass (FM, kg, and %) and blood triglyceride (TG) level in young adults. In middle-aged adults, PA showed a significant positive correlation with lean body mass (LBM), FM (%), and RMR. Furthermore, PA EE showed significant interrelatedness with BMC among middle-aged adults. [Conclusion] These results demonstrated that high PA levels enable LBM and RMR maintenance in middle- aged adults. Furthermore, in young adults, more PA is required to induce change in body composition.

Purpose To review our experiences of descending necrotizing mediastinitis (DNM) secondary to deep neck infection (DNI) and determine appropriate airway management for decreasing mortality and morbidity of patients with DNM. Methods Medical records of 20 patients (8 women and 12 men) who had been managed for DNM secondary to DNI between March 2006 and December 2019 were analyzed. Diagnosis and extent of infection were confirmed by computed tomography of the neck and chest. The upper airway was closely monitored with a fiberoptic laryngoscope. Complications were evaluated according to various types of airway management in our serial cases. Results Five (25%) out of 20 patients died as a result of septic shock and multiorgan failure. None of these patients died of accidental airway obstruction or airway management mishaps. Keeping short-term orotracheal intubation was safe and adequate after the initial surgery. Early tracheotomy was performed for 4 patients and it was significantly associated with mortality (P = .032). Three patients who underwent late tracheotomy had no mortality. Patients with tracheotomy had longer duration of overall hospital stay than those without tracheotomy. Conclusions Well-controlled airway management might decrease mortality, hospitalization, and airway complications in patients with DNM secondary to DNI. Keeping orotracheal intubation rather than upfront tracheotomy should be first considered when managing airway along with examination of the upper airway with a fiberoptic laryngoscope.

Hypoxic training is often performed by competitive swimmers to enhance their performance in normoxia. However, the beneficial effects of aerobic continuous and interval training under hypoxia on hemodynamic function, autonomic nervous system (ANS) function, and endurance exercise performance remain controversial. Here we investigated whether six weeks of aerobic continuous and interval training under hypoxia can improve hematological parameters, hemodynamic function, ANS function, and endurance exercise performance versus normoxia in amateur male swimmers. Twenty amateur male swimmers were equally assigned to the hypoxic training group or normoxic training group and evaluated before and after six weeks of training. Aerobic continuous and interval training in the hypoxia showed a more significantly improved hemodynamic function (heart rate, −653.4 vs. −353.7 beats/30 min, oxygen uptake, −62.45 vs. −16.22 mL/kg/30 min, stroke volume index, 197.66 vs. 52.32 mL/30 min) during submaximal exercise, ANS function (root mean square of successive differences, 10.15 vs. 3.32 ms, total power, 0.72 vs. 0.20 ms2, low-frequency/high-frequency ratio, −0.173 vs. 0.054), and endurance exercise performance (maximal oxygen uptake, 5.57 vs. 2.26 mL/kg/min, 400-m time trial record, −20.41 vs. −7.91 s) than in the normoxia. These indicate that hypoxic training composed of aerobic continuous and interval exercise improves the endurance exercise performance of amateur male swimmers with better hemodynamic function and ANS function.

We demonstrated the hypothesis that combined exercise improves body composition, cardiometabolic risk factors, blood pressure (BP), arterial stiffness, and physical functions, in obese older men. Older men (n = 20) were randomly assigned to combined exercise training (EXP, n = 10) or control groups (CON, n = 10). The combined exercise was comprised of elastic-band resistance training and walking/running on a treadmill and bicycle at 60&ndash, 70% of maximal heart rate for 3 days/weeks. EXP showed significant decreases in body weight, body mass index, and %body fat (p &lt, 0.05). The exercise program significantly reduced BP, mean arterial pressure, pulse pressure, and brachial-ankle pulse wave velocity. Furthermore, while the plasma levels of low-density lipoprotein cholesterol and epinephrine were significantly reduced in EXP, VO2 peak and grip strength were significantly enhanced (p &lt, 0.05). In conclusion, it is indicated that 12-week regular combined exercise improves body composition, cardiometabolic risk factors, hemodynamics, and physical performance in obese older men.

This study evaluated the effects of intermittent interval training in hypoxic conditions for six weeks compared with normoxic conditions, on hemodynamic function, autonomic nervous system (ANS) function, immune function, and athletic performance in middle- and long-distance runners. Twenty athletes were divided into normoxic training (normoxic training group (NTG), n = 10, residing and training at sea level) and hypoxic training (hypoxic training group (HTG), residing at sea level but training in 526-mmHg hypobaric hypoxia) groups. All dependent variables were measured before, and after, training. The training frequency was 90 min, 3 d per week for six weeks. Body composition showed no significant difference between the two groups. However, the HTG showed more significantly improved athletic performance (e.g., maximal oxygen uptake). The hemodynamic function (e.g., oxygen uptake, oxygen pulse, and cardiac output) during submaximal exercise and ANS function (e.g., standard deviation and root mean square of successive differences, high frequency, and low/high frequency) improved more in the HTG. Immune function parameters were stable within the normal range before and after training in both groups. Therefore, hypoxic training was more effective in enhancing athletic performance, and improving hemodynamic and ANS function, further, it did not adversely affect immune function in competitive runners.

This study aimed to compare the effects of an acute Pilates program under hypoxic vs. normoxic conditions on the metabolic, cardiac, and vascular functions of the participants. Ten healthy female Pilates experts completed a 50-min tubing Pilates program under normoxic conditions (N trial) and under 3000 m (inspired oxygen fraction = 14.5%) hypobaric hypoxia conditions (H trial) after a 30-min exposure in the respective environments on different days. Blood pressure, branchial ankle pulse wave velocity, and flow-mediated dilation (FMD) in the branchial artery were measured before and after the exercise. Metabolic parameters and cardiac function were assessed every minute during the exercise. Both trials showed a significant increase in FMD, however, the increase in FMD was significantly higher after the H trial than that after the N trial. Furthermore, FMD before exercise was significantly higher in the H trial than in the N trial. In terms of metabolic parameters, minute ventilation, carbon dioxide excretion, respiratory exchange ratio, and carbohydrate oxidation were significantly higher but fat oxidation was lower during the H trial than during the N trial. In terms of cardiac function, heart rate was significantly increased during the H trial than during the N trial. Our results suggested that, compared to that under normoxic conditions, Pilates exercise under hypoxic conditions led to greater metabolic and cardiac responses and also elicited an additive effect on vascular endothelial function.

[Purpose] Hemodynamic function is a parameter indicating oxygen delivery and utilization capacity and is an important determinant of exercise performance. The present study aimed to determine whether intermittent hypoxic training (IHT) ameliorates hemodynamic function and exercise performance in competitive swimmers. [Methods] Twenty competitive swimmers (10 men, 10 women) volunteered to participate in the study. Participants were divided into the normoxic training (NT) group and the hypoxic training (HT) group and were subjected to training in a simulated altitude of 3000 m. We evaluated hemodynamic function profiles over 30 min of submaximal exercise on a bicycle and exercise performance before and after 6 weeks of training, which involved continuous exercise at 80% maximal heart rate (HRmax) for 30 min and interval exercise at 90% of HRmax measured before training for 30 min (ten rounds comprising 2 min of exercise followed by 1 min of rest each round). [Results] Significant changes in oxygen consumption (decrease) and end-diastolic volume (increase) were observed only in the HT group. Heart rate (HR), cardiac output (CO), and ejection fraction (EF) were significantly reduced in both groups, but the reduction rates of HR and CO were greater in the HT group than in the NT group. Exercise performance measures, including maximal oxygen consumption and 400-m time trial, were significantly increased only in the HT group. [Conclusion] Our findings suggested that 6 weeks of IHT, which involved high-intensity continuous and interval exercise, can effectively improve exercise performance by enhancing hemodynamic function in competitive swimmers.

Background: Obesity is recognized as an important global health problem that increases the risk of all-cause death. It is a major risk factor for various cardiovascular and metabolic diseases. Methods: We conducted this review through searching the related literature plus internet links. Results: Recently, many researchers have been applying various efficient alternative exercise paradigms for treating obesity, such as high-intensity interval training, whole-body vibration training, and hypoxic therapy. Compared with moderate-intensity continuous training, high-intensity interval training involves a shorter exercise time but higher energy expenditure and excess post-exercise oxygen consumption via a higher exercise intensity and is effective for treating obesity. Whole-body vibration training effectively reduces the rate of fat production and accumulation through passive vibration of the whole body and improving the body composition, muscle function, and cardiovascular function of the obese population. Hypoxic therapy has been reported to improve obesity and obesity-related diseases through appetite loss, reduced dietary intake, increased energy consumption, improved glycogen storage and fatty acid oxidation, angiogenesis and left ventricle remodeling, decreased mechanical load, and reduced sarcopenia progression due to aging. Conclusion: The new therapeutic exercise modalities, namely, high-intensity interval training, whole-body vibration training, and hypoxic therapy, are practical, useful, and effective for improving obesity and various metabolic and cardiovascular diseases induced by obesity.

[Purpose] The purpose of this study was to compare the excess post-exercise oxygen consumption (EPOC) between different types of exercises in women with normal weight obesity (NWO). [Methods] Nine university students with NWO having body mass index 30% participated in the study. First, continuous exercise (CEx) on an ergometer for 30 minutes at 60% of maximal oxygen consumption (VO2max) and interval exercise (IEx) at 80% VO2max for 2 minutes were performed. This was followed by exercise performed at 40% VO2max for 1 minute and at 80% VO2max for 3 minutes, performed 6 times repeatedly for a total of 26 minutes. The accumulation of short duration exercise (AEx) was performed for 3-bouts of 10 minutes each at 60% VO2max. [Results] The major findings were as follows: energy consumption during the exercises showed no significant difference between CEx, IEx, and AEx; EPOC was higher in IEx and AEx as compared to CEx for all dependent variables (e.g. total oxygen consumption, total calorie, summation of heart rate, and EPOC duration); and the lipid profile showed no significant difference. [Conclusion] Our study confirmed that when homogenizing the energy expenditure for various exercises in NWO individuals, EPOC was higher in IEx and AEx than in CEx. Therefore, IEx and AEx can be considered as effective exercise methods for increasing energy expenditure in NWO females.

Ji Han Lee,1 Won Sang Jung,2 Woo Hee Choi,3 Hyun Kook Lim4 1Washington University in St Louis, St Louis, MO, USA; 2Department of Radiology, 3Department of Nuclear Medicine, 4Department of Psychiatry, Saint Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea Objective: Among patients with Alzheimer’s disease (AD), sleep disturbances are common and serious noncognitive symptoms. Previous studies of AD patients have identified deformations in the brain stem, which may play an important role in the regulation of sleep. The aim of thisstudy was to further investigate the relationship between sleep disturbances and alterations in brain stem morphology in AD.Materials and methods: In 44 patients with AD and 40 healthy elderly controls, sleep disturbances were measured using the Neuropsychiatry Inventory sleep subscale. We employed magnetic resonance imaging-based automated segmentation tools to examine the relationship between sleep disturbances and changes in brain stem morphology.Results: Analyses of the data from AD subjects revealed significant correlations between the Neuropsychiatry Inventory sleep-subscale scores and structural alterations in the left posterior lateral region of the brain stem, as well as normalized brain stem volumes. In addition, significant group differences in posterior brain stem morphology were observed between the AD group and the control group.Conclusion: This study is the first to analyze an association between sleep disturbances and brain stem morphology in AD. In line with previous findings, this study lends support to the possibility that brain stem structural abnormalities might be important neurobiological mechanisms underlying sleep disturbances associated with AD. Further longitudinal research is needed to confirm these findings. Keywords: Alzheimer’s disease, sleep, brain stem, MRI, shape analysis

Purpose The purpose of this study was to evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) elasticity imaging. Materials and Methods One hundred and twenty-seven thyroid nodules were examined by both ARFI elastography and B-mode sonography. Virtual Touch tissue quantification (VTQ) values of the thyroid nodules were measured. Scoring of B-mode sonographic findings of each thyroid nodules was performed. The sums of these VTQ and the B-mode scores were determined. The comparative diagnostic performances of the VTQ value, the B-mode score, and the combined score were analyzed. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each scoring mode were: B-mode score, 84%, 85%, 66%, 94%, and 85%; VTQ, 75%, 91%, 73%, 92%, and 86%; and combined score, 88%, 87%, 70%, 95%, and 88%. The areas under the curves for B-mode, VTQ, and combined score were 0.895, 0.837, and 0.912, respectively. Pairwise comparisons of receiver-operating characteristic curves showed no statistical differences between B-mode and VTQ, and B-mode and combined score. Combined score showed better diagnostic performance than VTQ value (p = 0.0023). Conclusion ARFI VTQ value is a good diagnostic modality for differentiating malignant thyroid nodules from benign nodules. However, ARFI evaluation is not superior to B-mode sonographic evaluation, but only has a better diagnostic performance when combined with B-mode sonographic findings.

We aimed to evaluate the effects of a 2-week exercise training program in hypobaric hypoxic conditions on exercise performance and immune function in Korean national cycling athletes with disabilities. Six Korean national cycling athletes with disabilities participated in exercise training consisting of continuous aerobic exercise and anaerobic interval exercise in hypobaric hypoxic conditions. The exercise training frequency was 60 min (5 days per week for 2 weeks). Before and after the exercise training, exercise performance and immune function were measured in all athletes. Regarding the exercise performance parameters, the 3-km time trial significantly decreased and blood lactate levels after the 3-km time trial test significantly increased by exercise training in hypobaric hypoxic conditions. Regarding the oxygen-transporting capacity, significant differences were not observed. Regarding immune function, the number of leukocytes and natural killer cells significantly decreased and that of eosinophils, B cells, and T cells significantly increased. These results indicated that our 2-week hypoxic training showed the potential to improve exercise performance in Korean national disabled athletes. However, the effects of our hypoxic training method on immune function remained unclear.

ObjectiveThis study aimed to evaluate the effect of various levels of hypoxia versus normoxia on exercise perfor-mance, measured by metabolic parameters and skeletal muscle oxygenation profiles during graded exercise test (GXT) in healthy men.MethodsIn this randomized crossover trial, 11 healthy male participants (age 21.5 ± 2.3 years) performed the GXT using a cycle ergometer at sea-level (760 torr) and at various hypobaric hypoxia: 633, 526, and 433 torr, corresponding to simulated altitudes of 1500, 3000, and 4500 m, respectively. The GXT was started at 50 W and increased by 25 W every 2 min until the participants were exhausted. The pedal frequency was set to 60 rpm. Metabolic parameters (heart rate, HR; minute ventilation, VE; carbon dioxide excretion, VCO2; respiratory exchange ratio, RER; peripheral capillary saturation, SpO2; oxygen consumption, VO2; and blood lactate, O2 pulse) and skeletal muscle oxygen profiles (oxygenated hemoglobin and myoglobin, OxyHb; deoxygenated hemoglobin and myoglobin, DeoxyHb; and tissue oxygen saturation, StO2) were measured for every 2 min during the GXT. Exercise performance was evaluated by maximal oxygen con-sumption, peak power, and duration of exercise time obtained through GXT.ResultsRegarding metabolic parameters, HR (P 0.05) did not show significant difference under different environmental conditions. In skeletal muscle oxygen profiles, none of the param-eters showed noticeable changes. Regarding exercise performance, VO2max (P < 0.05) and exercise time (P < 0.05) decreased significantly as hypoxia became more severe, and peak power (P < 0.05) decreased significantly at simulated altitudes of 3000 and 4500 m compared to normoxia.ConclusionA decrease in exercise performance is due to a decrease in metabolic function under various hypoxia compared to normoxia and the decrease was more pronounced as hypoxia became more severe.

AIM The aim of the present study was to examine the effect of exercise intervention in hypoxia as a novel treatment method for obesity in older men. METHODS A total of 24 obese 65-70-year-old Korean men (66.5 ± 0.8 years) were randomly assigned to undergo hypoxic training (n = 12) or normoxic training (n = 12), and all participants carried out an exercise intervention composed of aerobic exercise on a treadmill (30 min) and bicycle (30 min), and resistance exercise (30-40 min) in normoxia, and 3000-m normobaric hypoxia separately for a total of 12 weeks, three times a week. Health-related dependent variables (body composition, physical fitness, pulmonary function and heart rate variability) were evaluated at pre- and post-exercise intervention. RESULTS Hypoxic training showed more improved body composition (bodyweight -5.68 vs -3.16 kg, %body fat -5.50 vs -1.97%, fat-free mass 2.09 vs 1.06 kg), physical fitness (chair sit-to-stand 5.67 vs 4.58, pegboard 3.58 vs 2.17, tandem test -1.74 vs -1.31 s, one leg standing 6.27 vs 3.71 s), pulmonary function (forced vital capacity 0.15 vs 0.02 L, forced expiratory volume in 1 s 0.23 vs 0.01 L, percent of forced expiratory volume in 1 s 0.87 vs 0.08, maximal voluntary ventilation 5.26 vs 2.22 L) and heart rate variability (high frequency 0.94 vs 0.19 ms2 , low frequency/high frequency -0.28 vs -0.08, salivary cortisol -0.13 vs -0.04 μg/dL) than normoxic training. CONCLUSIONS Compared with normoxic training, hypoxic training is a novel and successful health promotion method in obese older populations. Geriatr Gerontol Int 2019; 19: 311-316.

Inflammatory myofibroblastic tumors (IMTs) are rare tumors of intermediate malignant potential that can occur anywhere in the body. We describe an interesting case of a hypervascular IMT in the mediastinum that could be resected completely following em- bolization of the feeding vessels. A 17-month-old girl with complaints of cough and fever for 3 months was referred to our hospital. Computed tomography (CT) scan showed a large mass in the right hemithorax that shifted the mediastinum to the left. Primary excision was considered but not performed because there was very active capsule wall bleeding due to the hypervascular tumor. After embolization of the feeding vessels, suc- cessful complete resection was carried out. Approximately 6 weeks after the operation, follow-up CT scan showed no evidence of recurrent disease. Preoperative embolization is a good option for performing complete resection of hypervascular IMTs that could reduce the recurrence rate.

In the normal aging process, sleep changes accompany with increasing sleep fragmentation, nighttime awakenings and greater tendency for daytime sleep. Dementia provokes further deterioration of sleep patterns.1 The prevalence of Alzheimer’s disease (AD), most common form, is rapidly increasing and will probably accelerate dramatically within the next decades as a numbers of people are getting older. Although AD is usually recognized as progressive debilitation of memory, language, and intellect, sleep disturbance is a prevailing and often highly disruptive behavioral symptom associated with AD.2,3 At an early phase of the AD, these neuro behavioral symptoms may appear but seem to be usually associated with a more severe cognitive decline.3,4 The origin of sleep disturbances in AD is considered to be multifactorial. Sleep alterations occur with degeneration of neural pathways that modulate sleep-wake patterns and sleep architecture as well as other environmental factors.3,5 In return, cognitive symptoms may deteriorate through impairment of amyloid-β (Aβ) diurnal pattern and sleep-dependent memory consolidation processes by sleep disorders.6,7 Additionally, a correlation between sleep characteristics and cognitive decline in the elderly has been shown, focusing the fact that sleep and cognition are closely related.8-10 This article will review sleep changes with normal aging and AD, bidirectional relationship between sleep and AD pathology, and underlying mechanism. The result of sleep disturbances in AD will be discussed thereafter. Finally, recommendations as to areas in which future research is needed will be proposed. Received: October 23, 2014 Revised: April 3, 2015 Accepted: April 22, 2015

Although sub-regional analysis methods of the corpus callosum (CC) have been developed, there has been no in vivo magnetic resonance imaging (MRI) study on a sub-regional volume analysis of the CC of late-onset depression (LOD). The aim of this study was to investigate the CC volume differences between LOD subjects and healthy elderly controls using a sub-regional analysis technique. Forty subjects with LOD and thirty nine group-matched healthy control subjects underwent 3T MRI scanning, and sub-regional volumes of the CC were measured and compared between the groups. The volumes of total (F=5.8, p=0.001), the anterior (F=5.2, p=0.001) and the posterior CC (F=5.1, p=0.001) were significantly reduced in the LOD group as compared to the control group. We measured cognitive functions in several different domains (language functions, verbal learning, visuospatial functions, delayed recall, memory consolidation, recognition memory, and executive functions) through the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease. The anterior CC volume in the LOD group showed significant positive correlation with the Verbal Fluency scores. The posterior CC volume in the LOD group was positively correlated significantly with the Word List Memory, the Word List Recall and the Constructional Praxis scores. This study is the first to elaborate the sub-regional volume differences of the CC between controls and LOD patients. These structural changes in the CC might be at the core of the underlying neurobiological mechanisms in LOD.

The present study examined the effect of a 12-week combined resistance and aerobic exercise training program on cardiometabolic biomarkers and red blood cell (RBC) hemorheological function in 20 obese older men (mean age: 68.8 &plusmn, 0.9 years). Subjects were randomly divided into two groups (exercise intervention [EXP, n = 10] and control [CON, n = 10]). The EXP subjects performed resistance and aerobic exercise training program three times per week for 12 weeks, and the CON subjects maintained their regular lifestyle during the intervention period. Body composition was estimated using bioelectrical impedance analysis equipment. Cardiometabolic biomarkers (glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), HOMA &beta, cell function, and leptin) and RBC hemorheological parameters (RBC deformability and aggregation) were analyzed. Percent body fat decreased significantly in the EXP group during the intervention period but increased significantly in the CON group. Insulin increased significantly in the CON group over the 12-week period and both insulin and HOMA-IR were significantly higher in the CON group than in the EXP group at post-test. RBC deformability (RBC EI_3Pa) and aggregation (RBC AI_3Pa) improved significantly only in the EXP group. The present study suggests that combined exercise training can be useful for improving cardiometabolic biomarkers and RBC hemorheological parameters in obese older men and may help prevent metabolic syndrome and cardiovascular diseases.

With recent advancement in amyloid imaging, diagnostic application of this new modality has become a great interest among researchers. New ligands, such as 18F- florbetaben, florbetapir and flutemetamol, have been discovered to overcome limitations of preexisting ligand Pittsburgh compound B. We report here a case of a 37-year-old male patient whose initial complaints comprised of gradual cognitive decline, apraxia, disorientation and sleep disturbances. 18F-Florbetaben amyloid imaging of the patient showed diffuse amyloid retention with prominent striatal uptake. This finding supports the clinical utility of amyloid imaging in diagnostic process of early-onset AD. Moreover, striatal dominant uptake pattern demonstrated in this patient include some meaningful clinical implications that warrant special attention among clinicians.

Background Although there is substantial evidence of associations between frontal-striatal circuits and cerebral vascular burden in late-onset depression (LOD), relationships between vascular burden and hippocampal subfields are not clear. The purpose of this study was to investigate relationships between cerebral vascular burden and hippocampal subfield volume in LOD patients. Methods Fifty subjects with LOD and 50 group-matched healthy control subjects underwent magnetic resonance imaging scanning. Hippocampal subfields volumes were measured and compared between the groups. In addition, association patterns between white matter hyperintensity (WMH) volumes, clinical measures and hippocampal subfield volumes were investigated in the LOD group. Results Subjects with LOD exhibited significant hippocampal volume reductions in the total hippocampus, cornu ammonis (CA) 1 and 3 and dentate gyrus (DG) areas compared with healthy subjects. Total WMH volume was negatively correlated with left total hippocampal volume and CA1 in the LOD group. In addition, depression severity was negatively associated with left and right CA3 volumes in the LOD group. Limitation Our findings of distinctive relationships between WMH and hippocampal subfields demonstrate a simple correlation, but do not prove causation Conclusion This study is the first to elaborate distinctive association patterns between hippocampal subfield volumes and cerebral vascular burden in LOD. These structural changes in the hippocampal CA1, CA3 and DG areas might be at the core of the underlying neurobiological mechanisms of hippocampal dysfunction in LOD. However, longitudinal studies will be needed to identify the mechanisms of these structural changes.

Background The deep subcutaneous adipose tissue (dSAT) is closely related to the obesity-associated complications similarly to the characteristics of visceral adipose tissue (VAT). However, the association between dSAT and metabolic syndrome (MS) is unclear. The purpose of our study was to evaluate the association of distinct abdominal adipose tissue with the cardiometabolic risk factors and MS. Methods Abdominal computed tomography (CT) images were obtained in 365 asymptomatic subjects (187 subjects with MS and 178 without MS). The axial images segmented into superficial and deep SAT by manually tracing the fascia superficialis at L4–5 levels. The concentrations of serum inflammatory cytokines and adipokines were also measured. Results The MS group had significantly lower adiponectin levels but significantly higher levels of resistin, leptin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), intercellular adhesion molecule (ICAM), monocyte chemotactic protein-1 (MCP-1), and oxLDL than the control group (p

Purpose: The objective of this study is to define the clinical implications of consolidations in nodular bronchiectatic type Mycobacterium avium complex (NBMAC) infection. Materials and Methods: A total of 69 patients (M : F = 17 : 52; mean age, 64 years; age range, 41-85 years) with MAC isolated in the sputum culture and nodular bronchiectasis on the initial and follow-up CT scans were included. We retrospectively reviewed the incidence of consolidation and analyzed its clinical course by using radiographic changes with or without anti-MAC drug therapy. Results: In 44 of the 69 cases (64%), focal consolidations were seen on the initial and follow-up CT images. In 35 of the 44 (80%) cases, consolidations completely regressed, and in 3 cases (7%), consolidations partially regressed within 2 months with only antibiotics. In 2 cases (5%), the consolidations remained stable for over 2 months without anti-MAC drug therapy. Only in 4 cases (9%) did the consolidations improve after anti-MAC drug therapy. In 11 of the 38 cases (29%) with responsiveness to antibiotics, non-mycobacterial micro-organisms were identified in sputum, including pseudomonas, hemophilus, staphylococcus, and others. Conclusion: In NB-MAC, consolidations are commonly present on CT. In these conditions, most of consolidations result from pneumonia other than MAC.

Parkinson's disease dementia (PDD) is notorious for its debilitating clinical course and high mortality rates. Consequently, various attempts to investigate predictors of cognitive decline in Parkinson's disease (PD) have been made. Here we report a case of a 75-year-old female patient with PD who visited the clinic with complaints of recurrent visual hallucinations and cognitive decline, whose symptoms were ameliorated by the titration of rivastigmine. Imaging results showed pronounced diffuse cortical amyloid deposition evidenced by 18F-florbetaben amyloid positron emission tomography (PET) imaging. This observation suggests that pronounced amyloid deposition and visual hallucinations in PD patients could be clinically significant predictors of cognitive decline in PD patients. Future research should concentrate on accumulating more evidence for possible predictors of cognitive decline and their association with PD pathology that can enable an early intervention and standardized treatment in PDD patients.

Objective: To evaluate the high resolution computed tomography (HRCT) findings of bronchiolitis obliterans (BO) after bone marrow transplantation (BMT). Materials and Methods: During the past three years, 11 patients were diagnosed as having BO after BMT when they developed irreversible air flow obstruction, with an FEV 1 value of less than 80% of the baseline value, without any clinical evidence of infection. All 11 patients underwent HRCT, of whom eight also underwent follow-up HRCT. The HRCT images were assessed retrospectively for the presence of decreased lung attenuation, segmental or subsegmental bronchial dilatation, diminution of peripheral vascularity, centrilobular nodules, and branching linear structure on the inspiratory images. The lobar distribution of the decreased lung attenuation and bronchial dilatation was also examined. The presence of air trapping was investigated on the expiratory images. The interval changes of the HRCT findings were evaluated in those patients who had followup images. Results: Abnormal HRCT findings were present in all cases; the most common abnormalities were decreased lung attenuation (n=11), subsegmental bronchial dilatation (n=6), diminution of peripheral vascularity (n=6), centrilobular nodules or branching linear structure (n=3), and segmental bronchial dilatation (n=3). Expiratory air trapping was noted in all patients. The decreased lung attenuation and bronchial dilatations were more frequent or extensive in the lower lobes. Interval changes were found in all patients with follow-up HRCT: increased extent of decreased lung attenuation (n=7); newly developed or progressed bronchial dilatation (n=4); and increased lung volume (n=3). Conclusion: HRCT scans are abnormal in patients with BO, with the most commonly observed finding being areas of decreased lung attenuation. While the HRCT findings are not specific, it is believed that their common features can assist in the diagnosis of BO in BMT recipients.

BACKGROUND Lingual thyroglossal duct cysts (LTGDCs) are very rare and liable to be misdiagnosed as simple vallecular or mucus retention cysts. We recognized the importance of complete resection by means of the Sistrunk operation and applied the revised surgical technique to the treatment of LTGDCs. The aim of this study was to evaluate the results of surgical management of LTGDCs from the author's series and analyze its utility. PATIENTS AND METHODS Twelve patients, 10 male and 2 female, who were diagnosed with LTGDCs between January 2007 and December 2012, underwent endoscopic radical resection with microdissection electrodes. All cases were evaluated by enhanced CT and flexible laryngoscope before surgery. We reviewed the collected data including presentation, CT findings, surgical techniques, postoperative complication, and recurrence. RESULTS Most adult LTGDCs presented with foreign body sensation, while one infant presented acute upper airway obstruction. All cysts abutted on the hyoid bone and were located at the midline of the posterior tongue. Endoscopic radical resection with microdissection electrodes was possible by dissecting hyoid periosteum without significant morbidity. All patients excluding 1 infant were not intubated electively overnight and went home the following morning. All patients showed no evidence of recurrence during follow-up. CONCLUSIONS We found that the diagnosis of LTGDCs must be based on the anatomic relationship with the hyoid bone by enhanced sagittal neck CT. Endoscopic radical resection with microdissection electrodes can be recommended for reducing recurrence and morbidity by dissecting the hyoid perichondrium in the treatment of LTGDCs.

The gastrointestinal stromal tumor is the most common mesenchymal neoplasm of the gastrointestinal tract. The gastrointestinal stromal tumor universally expresses KIT and DOG-1 and frequently harbors oncogenic mutations in the KIT gene. While the gastrointestinal stromal tumor usually arises in the alimentary tract, it is rarely found in the extragastrointestinal area. When it is, it is called an extragastrointestinal stromal tumor. Although the pathogenesis, prognostic factors and outcomes of gastrointestinal stromal tumors are well known, those of extragastrointestinal stromal tumors have not been fully studied. We report, herein, a unique primary extragastrointestinal stromal tumor from the pleura in a 73-year-old woman who presented with pleural mass. The extragastrointestinal stromal tumor was surgically resected and confirmed by means of an immunohistochemical study and a molecular analysis.

The aim of this study was to investigate the microstructural alterations of white matter (WM) in Alzheimer's disease (AD) patients with apathy and to observe the relationships with the severity of apathy. Sixty drug-naïve subjects took part in this study (30 apathetic and 30 nonapathetic subjects with AD). The loss of integrity in WM was compared in AD patients with and without apathy through measurement of fractional anisotropy (FA) using by tract-based spatial statistics (TBSS). In addition, we explored the correlation pattern between FA values and the severity of apathy in AD patients with apathy. The apathy group had significantly reduced FA values (p(corrected)

Objectives The purpose of this study is to compare the various magnetic resonance imaging (MRI) sequences when they are used to visualize and evaluate cerebral venous thrombosis. Methods Eleven patients with cerebral venous thrombosis were retrospectively analyzed using computed tomography, MRI, magnetic resonance angiography (MRA), and conventional angiography. The MR sequence included T1-weighted spin echo (SE) imaging, obtained before and after administration of contrast medium, T2-weighted turbo spin echo (TSE), fluid-attenuated inversion recovery (FLAIR), T2*-weighted conventional gradient-echo (GRE), as well as three-dimensional (3D) venous time-of-flight MRA and conventional angiography. Results In all of our patients, the venous sinus thromboses were most successfully detected during the T2*-weighted GRE sequence. The thrombosis was well visualized with the T1-weighted SE sequence in three of four patients in whom it was in the subacute stage. The T2*-weighted GRE sequence was superior to the T2-weighted TSE, T1-weighted SE, and FLAIR sequences in all patients. Enhanced 3D MR venography showed the thrombosed segment of the venous sinus and well correlated with the conventional angiographic findings. Conclusions The T2*-weighted conventional GRE sequences may be the best method for detecting of cerebral venous thrombosis. Therefore, it would seem to be beneficial to integrate a T2*-weighted conventional GRE sequence into the MR protocol to diagnose cerebral venous thrombosis.