Outcomes of Endoscopic Resection for Early Gastric Cancer in Very Elderly Patients: A Nationwide Population-Based Study

Background/Aims@#Few studies have investigated the long-term outcomes of endoscopic resection for early gastric cancer (EGC) in very elderly patients. The aim of this study was to determine the appropriate treatment strategy and identify the risk factors for mortality in these patients. @*Methods@#Patients with EGC who underwent endoscopic resection from 2006 to 2017 were iden-tified using National Health Insurance Data and divided into three age groups: very elderly (≥85 years), elderly (65 to 84 years), and non-elderly (≤64 years). Their long- and short-term outcomes were compared in the three age groups, and the survival in the groups was compared with that in the control group, matched by age and sex. We also evaluated the risk factors for long- and short-term outcomes. @*Results@#A total of 8,426 patients were included in our study: 118 very elderly, 4,583 elderly, and 3,725 non-elderly. The overall survival and cancer-specific survival rates were significantly lower in the very elderly group than in the elderly and the non-elderly groups. Congestive heart failure was negatively associated with cancer-specific survival. A significantly decreased risk for mortality was observed in all groups (p<0.001). The very elderly group had significantly higher readmission and mortality rates within 3 months of endoscopic resection than the non-elderly and elderly groups. Furthermore, the cerebrovascular disease was associated with mortality within 3 months after endoscopic resection. @*Conclusions@#Endoscopic resection for EGC can be helpful for very elderly patients, and it may play a role in achieving overall survival comparable to that of the control group.

Optimization of Multi-Atlas Segmentation with Joint Label Fusion Algorithm for Automatic Segmentation in Prostate MR Imaging

Purpose@#Joint label fusion (JLF) is a popular multi-atlas-based segmentation algorithm, which compensates for dependent errors that may exist between atlases.However, in order to get good segmentation results, it is very important to set the several free parameters of the algorithm to optimal values. In this study, we first investigate the feasibility of a JLF algorithm for prostate segmentation in MR images, and then suggest the optimal set of parameters for the automatic prostate segmentation by validating the results of each parameter combination. @*Materials and Methods@#We acquired T2-weighted prostate MR images from 20 normal heathy volunteers and did a series of cross validations for every set of parameters of JLF. In each case, the atlases were rigidly registered for the target image. Then, we calculated their voting weights for label fusion from each combination of JLF’s parameters (rpxy , rpz , rsxy , rsz , β). We evaluated the segmentation performances by five validation metrics of the Prostate MR Image Segmentation challenge. @*Results@#As the number of voxels participating in the voting weight calculation and the number of referenced atlases is increased, the overall segmentation performance is gradually improved. The JLF algorithm showed the best results for dice similarity coefficient, 0.8495 ± 0.0392; relative volume difference, 15.2353 ± 17.2350; absolute relative volume difference, 18.8710 ± 13.1546; 95% Hausdorff distance, 7.2366 ± 1.8502; and average boundary distance, 2.2107 ± 0.4972; in parameters of rpxy = 10, rpz = 1, rsxy = 3, rsz = 1, and β = 3. @*Conclusion@#The evaluated results showed the feasibility of the JLF algorithm for automatic segmentation of prostate MRI. This empirical analysis of segmentation results by label fusion allows for the appropriate setting of parameters.

Perception about Age at the Start and End of Periodic Health Examinations: a Survey-based Study on University Hospital in Korea

BACKGROUND: Based on scientific evidence, the Korean National Health Examination recommends age 40 as an appropriate time for screening. However, awareness of the health examination itself or of the appropriate age for screening has not been discussed extensively with examinees. This study aims to evaluate the perception about age at the start and end of periodic health examinations (PHE). METHODS: A self-administered survey was completed by 887 subjects who visited either the health promotion center or the outpatient clinic at a university hospital in Korea between February 15 and May 18, 2016. Participants were divided into two groups: 587 were periodic health examinees, and 300 were visitors to the family medicine clinic. Their awareness of PHE was compared using the Chi-square test and multiple logistic regression. RESULTS: Both groups had similar (P>0.05) perceptions regarding the awareness, knowledge and usefulness of the PHE. Both groups preferred to continue taking a PHE with no upper limit on the age when it could be taken. This tendency was more prominent among subjects with higher levels of education and household income. In both groups with individuals under age 50 said that the appropriate age to begin screening is 40 or younger. CONCLUSIONS: The perception regarding the ages at which to start and end the PHE was confirmed according to the subject of visit; a wider range of appropriate ages was preferred than is included in the current recommendations.

Diffuse Thyroid Uptake Incidentally Found on 18F-Fluorodeoxyglucose Positron Emission Tomography in Subjects without Cancer History

OBJECTIVE: We investigated the clinical significance of incidental diffuse thyroid uptake (DTU) on 18F-FDG PET in subjects without a history of cancer. MATERIALS AND METHODS: This study included 2062 studies from adults who underwent 18F-FDG PET as a cancer screening program. Subjects were divided into the following two groups: with (group I) or without (group II) DTU. The presence of DTU and the thyroid visual grading score were compared with thyroid function tests, serum anti-microsomal antibody (AMA) levels, and the presence of diffuse parenchymal change (DPC) on ultrasonography (USG). RESULTS: DTU was found in 6.6% of the scans (137/2062). Serum thyroid stimulating hormone (TSH) and AMA levels were significantly higher in group I than in group II. Increased AMA level (55.1%) and DPC (48.7%) were more frequently found in group I (p < 0.001). The proportion of subjects with any abnormal results in serum free thyroxine, triiodothyronine, TSH, or AMA levels or DPC on USG was significantly higher in group I than in group II (71.5% vs. 10.6%, p < 0.001), and was significantly and gradually increased according to the visual grading score group (0 vs. 1-2 vs. 3-4 = 10.6% vs. 58.5% vs. 90.9%, p < 0.001). TSH and is AMA levels were significantly increased according to the visual grading score. CONCLUSION: The presence or degree of incidental DTU on 18F-FDG PET is closely correlated with increased serum AMA and TSH levels, and the presence of DPC on USG. Therefore, the most plausible pathological cause of DTU may be cell damage by an autoimmune mechanism.

Transmission of Toxocara canis via Ingestion of Raw Cow Liver: A Cross-Sectional Study in Healthy Adults

The aim of this study is to ascertain the relationship between ingestion of raw cow liver and Toxocara canis infection. A total of 150 apparently healthy adults were divided into 2 groups; 1 group consisted of 86 adults with positive results of Toxocara ELISA, and the other group of 64 adults with negative results. One researcher collected the history of ingestion of raw cow liver within 1 year and recent history of keeping dogs. Among 86 seropositive adults for T. canis, 68 (79.1%) had a recent history of ingestion of raw cow liver. Multivariate statistical analysis showed that a recent ingestion of raw cow liver and keeping dogs were related to an increased risk of toxocariasis (odds ratios, 4.4 and 3.7; and 95% confidence intervals, 1.9-10.2 and 1.2-11.6, respectively). A recent history of ingestion of raw cow liver and keeping dogs was significantly associated with toxocariasis.

Adherence to Varenicline and Abstinence Rates for Quitting Smoking in a Private Health Promotion Center-Based Smoking Cessation Clinic / 결핵및호흡기질환

BACKGROUND: Varenicline is an effective smoking cessation aid. However, smokers prescribed with varenicline do not always receive varenicline for 12 weeks, as recommended. This study analyzed the subjects who received varenicline and investigated the effect of varenicline treatment duration on the success rate of 6-month smoking cessation. METHODS: This study retrospectively analyzed 78 subjects, who received varenicline, out of the 105 smokers that had visited the smoking cessation clinic after medical examination from September 2007 to December 2009. RESULTS: The subjects were all males. Twenty-two subjects (28.2%) had varenicline treatment for 12 weeks or longer; 18 subjects (23.1%) for 8~12 weeks; 22 subjects (28.2%) for 4~8 weeks; and 16 subjects (20.5%) for less than 4 weeks. The total success rate of the 6-month smoking cessation was 47.4%. The success rate of the 6-month smoking cessation was 63.6% in the group that received varenicline for 12 weeks or longer, which was higher than 41.1% of the group that early terminated the varenicline treatment (p=0.074). The period of varenicline treatment was extended for one more week, the odds ratio of the 6-month smoking cessation success increased to 1.172-folds (p=0.004; 95% confidence interval, 1.052~1.305). Adverse events occurred in 30.8% of the subjects who received varenicline, but no serious adverse events were found. CONCLUSION: If varenicline treatment period is extended, the odds ratio of the success rate for the 6-month smoking cessation increases. Therefore, an effort to improve drug compliance for varenicline in clinical practices could be helpful for the long-term success of smoking cessation.

Continuous renal replacement therapy in neonates weighing less than 3 kg / 소아과

PURPOSE: Continuous renal replacement therapy (CRRT) is becoming the treatment of choice for supporting critically ill pediatric patients. However, a few studies present have reported CRRT use and outcome in neonates weighing less than 3 kg. The aim of this study is to describe the clinical application, outcome, and complications of CRRT in small neonates. METHODS: A retrospective review was performed in 8 neonatal patients who underwent at least 24 hours of pumped venovenous CRRT at the Samsung Medical Center in Seoul, Korea, between March 2007 and July 2010. Data, including demographic characteristics, diagnosis, vital signs, medications, laboratory, and CRRT parameters were recorded. RESULTS: The data of 8 patients were analyzed. At the initiation of CRRT, the median age was 5 days (corrected age, 38(+2) weeks to 23 days), and the median body weight was 2.73 kg (range, 2.60 to 2.98 kg). Sixty-two patient-days of therapy were reviewed; the median time for CRRT in each patient was 7.8 days (range, 1 to 37 days). Adverse events included electrolyte disturbances, catheter-related complications, and CRRT-related hypotension. The mean circuit functional survival was 13.9+/-8.6 hours. Overall, 4 patients (50%) survived; the other 4 patients, who developed multiorgan dysfunction syndrome, died. CONCLUSION: The complications of CRRT in newborns are relatively high. However, the results of this study suggest that venovenous CRRT is feasible and effective in neonates weighing less than 3 kg under elaborate supportive care. Furthermore, for using potential benefit of CRRT in neonates, efforts are required for prolonging filter survival.

Operative Treatment with Gamma 3 Nail in Femur Intertrochanteric Fracture

PURPOSE: To evaluate clinical and radiological results of surgical treatment of femur intertrochantenric fracture using Gamma 3 nail. MATERIALS AND METHODS: With clinical study, 22 patients who were treated surgically by Gamma 3 nail were retrospectively evaluated. By postoperative radiograph and last follow up radiograph we measured Tip-apex distance, Cleveland index, Neck-shaft angle change Lag screw slippage and Union time. And By medical record review, the clinical results were evaluated with the operation time, intraperative estimated blood loss, amount of transfusion, change of mobility and complication. RESULTS: The mean change of femur neck shaft angle was 5.18 degrees. The mean lag screw sliding was 5.43 mm. The mean bone union time was 11.8 weeks. From all of these examples shows bone union. The mean operative time was 41 min, blood loss was 161 ml and the transfusion amount was 0.3 pint. In Ceder et al mobility score, it showed 0.2 point decreased and in Jensen social function score, it showed 0.6 point increased. Comparing the results before and after operation, the results were satisfactory. CONCLUSION: Using the Gamma 3 nail, the treatment of fermur intertrochanteric fractures showed good results both radiologically and clinically.

The Relationship between Lung Function and Metabolic Syndrome in Obese and Non-Obese Korean Adult Males / 당뇨병

BACKGROUND: The existence of an association between lung function and metabolic syndrome (MetS) has been debated in cases involving non-obese subjects. To address this debate, we performed a cross-sectional study to investigate the association between lung function and MetS in both obese and non-obese populations. METHODS: The present study consisted of a total of 1,951 Korean male subjects. In this study group, we investigated relationships between lung function and MetS risk factors such as fasting serum glucose, systolic blood pressure (SBP), insulin resistance index, waist circumference (WC), and hemoglobin A(1C) level. RESULTS: Forced vital capacity (FVC) values were significantly lower in the MetS group compared with those of the non-MetS group. In both non-obese (body mass index [BMI] or = 25 kg/m2), fasting serum glucose, hemoglobin A(1C) level, insulin resistance index, SBP, WC, and the prevalences of diabetes and MetS were significantly higher in subjects in the lowest FVC quartile compared with those in the highest FVC quartile. Odds ratios for the presence of MetS risk factors, after adjusting for age and height, ranged from 1.21 to 1.39 (P < 0.01) for a one standard deviation decrease in FVC. CONCLUSION: The results of our study suggest that decreased vital capacity in Korean adult male subjects is associated with MetS, irrespective of obesity.

Relationship between Serum Uric Acid Level and Hypertension: A Retrospective Cohort Study / 가정의학회지

BACKGROUND: Many epidemiological studies suggest the pathogenic role of serum uric acid level in development of hypertension. Several cross-sectional studies have shown the relationship between uric acid and development of hypertension in Korea. We investigated whether uric acid associates with the development of hypertension in a retrospective cohort study. METHODS: We included 2,353 people who did not have hypertension initially and underwent general medical examination between 1997 and 1998 and were re-examined after 10 years later. Study people divided into three groups according to serum uric acid level tertiles. RESULTS: The incidences of hypertension in tertile groups were 14.1% (108/764), 22.0% (175/769), and 24.3% (193/793) and they showed statistically significant difference. We performed multivariable logistic regression with serum uric acid and other risk factors of hypertension. The incidence of hypertension in second and third tertile group were significantly higher than first tertile group (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.11 to 2.10; P = 0.009 in second tertile group and OR, 1.66; 95% CI, 1.17 to 2.37; P = 0.005 in third tertile group). CONCLUSION: Serum uric acid level is associated with the development of hypertension.

Examination for helminth eggs and protozoan cysts in fecal samples from healthy Korean adults, 2000~2006 / 대한내과학회지

BACKGROUND/AIMS: Contemporary clinicians have very little understanding of the importance of preventing parasitic disease. This aim of this study was to estimate trends in intestinal parasitic disease via stool examination in healthy Korean adults. METHODS: We reviewed stool examination results to detect any intestinal parasite infections in newly examined healthy patients at the Health Promotion Center of Samsung Medical Center from 2000 to 2006. RESULTS: The rates of overall intestinal parasite infection showed substantial growth from 2000 to 2006: 2.51%, 2.63%, 3.56%, 4.04%, 4.48%, 3.94%, and 4.45% (p<0.001) for 2000 to 2006, respectively. Rates of infection with helminthic eggs (five species) increased from 0.80% in 2000 to 1.50% in 2006 (p<0.001). This trend corresponds to the positive rate of Clonorchis sinensis helminthes (0.45% to 1.43%; p<0.001). Total protozoan cysts infection (four species) also increased (from 1.96% to 2.99%, p<0.001), especially with infection of Endolimax nana (1.15% to 2.23%; p<0.001). CONCLUSIONS: Rates of intestinal parasite infection have increased over the last seven years, especially with C. sinensis and E. nana. These results demonstrate that Korean doctors should pay more attention to the diagnosis and treatment of parasite infections to further patient education and prevent parasitic infections.

Examination for helminth eggs and protozoan cysts in fecal samples from healthy Korean adults, 2000~2006 / 대한내과학회지

BACKGROUND/AIMS: Contemporary clinicians have very little understanding of the importance of preventing parasitic disease. This aim of this study was to estimate trends in intestinal parasitic disease via stool examination in healthy Korean adults. METHODS: We reviewed stool examination results to detect any intestinal parasite infections in newly examined healthy patients at the Health Promotion Center of Samsung Medical Center from 2000 to 2006. RESULTS: The rates of overall intestinal parasite infection showed substantial growth from 2000 to 2006: 2.51%, 2.63%, 3.56%, 4.04%, 4.48%, 3.94%, and 4.45% (p<0.001) for 2000 to 2006, respectively. Rates of infection with helminthic eggs (five species) increased from 0.80% in 2000 to 1.50% in 2006 (p<0.001). This trend corresponds to the positive rate of Clonorchis sinensis helminthes (0.45% to 1.43%; p<0.001). Total protozoan cysts infection (four species) also increased (from 1.96% to 2.99%, p<0.001), especially with infection of Endolimax nana (1.15% to 2.23%; p<0.001). CONCLUSIONS: Rates of intestinal parasite infection have increased over the last seven years, especially with C. sinensis and E. nana. These results demonstrate that Korean doctors should pay more attention to the diagnosis and treatment of parasite infections to further patient education and prevent parasitic infections.

The Surgical Treatment of Distal Femur Medial Condyle Fracture Using Lateral Anatomical Plate of Opposite Side through Medial Approach

PURPOSE: To evaluate clinical and radiological results of surgical treatment of distal femur medial condyle fracture using lateral anatomical plate of opposite side through medial approach. MATERIALS AND METHODS: This study reviewed the results of 9 cases of distal femur medial condyle fracture treated with lateral anatomical plate of opposite side through medial approach from December 2005 to June 2007, after a follow up of more than 12 months. There were 2 males and 7 females with a mean age of 63.1 (57~72) years. The clinical results were evaluated using the Schatzker's criteria, and the radiographic results were evaluated using the bone union time. RESULTS: Using the Schatzker's criteria, 7 cases of the 9 patients (78%) showed exellent results. The mean time for bone union was 13.4 (11~15) weeks. There were 3 cases of pain on full weight bearing same as previous operative state by degenerative osteoarthritis. There weren't complications as joint stiffness, infection, varus & rotational deformity, malunion, nonunion, and metal failure. CONCLUSION: Plate fixation using medial approach provides the proper anatomical reduction and stronger fixation, and outcome good results.

Candidate gene polymorphisms for diabetes mellitus, cardiovascular disease and cancer are associated with longevity in Koreans

Long-lived people may have a unique genetic makeup that makes them more resistant than the general population to prevalent age-related diseases; however, not much is known about genes involved in the longevity. To identify susceptibility variants controlling longevity, we performed a high-throughput candidate gene study using 137 Koreans over 90 yr old and 213 young healthy Koreans. We evaluated 463 informative markers located in 176 candidate genes mostly for diabetes mellitus, cardiovascular disease and cancer under five genetic models. We estimated the odds ratios for each allele, genotype, haplotype, and gene-gene interaction using logistic regression analysis. Associations between 13 genes and longevity were detected at a P-value less than 0.01. Particularly, the rs671 (A) allele of the aldehyde dehydrogenase 2 family (mitochondrial) (ALDH2) gene was associated with longevity only in men (OR 2.11, P = 0.008). Four genes, proprotein convertase subtilisin/kexin type 1 (PCSK1, P = 0.008), epidermal growth factor receptor (EGFR, P = 0.003), paired box 4 (PAX4, P = 0.008), and V-yes-1 Yamaguchi sarcoma viral related oncogene homolog (LYN, P = 0.002) consistently yielded statistical evidence for association with longevity. The findings of the current study may provide a starting point for future studies to unravel genetic factors controlling longevity in Koreans.

The Associations of Total and Differential White Blood Cell Counts with Obesity, Hypertension, Dyslipidemia and Glucose Intolerance in a Korean Population

Although many studies have reported an association between total white blood cell count and metabolic syndrome, relatively few reports are available on the association between differential white blood cell counts and metabolic syndrome. The medical records of 15,654 subjects (age, median 46, range 14-90 yr; 8,380 men and 7,274 women) who visited the Center for Health Promotion were investigated. It was found that as total white blood cell (WBC) and differential WBC counts increased the frequencies of diabetes, hypertension, obesity, dyslipidemia, and metabolic syndrome also increased. Moreover, these significant relationships persisted after adjusting for age, gender, smoking, alcohol intake, educational background, and household income. The odds ratios (95% CI) for metabolic syndrome was 2.64 (2.30- 3.04) in the highest quartile of total WBC count, with corresponding figures of 2.14 (1.88-2.44) for neutrophils, 2.32 (2.03-2.64) for lymphocytes, 1.56 (1.37-1.78) for monocytes, 1.36 (1.20-1.54) for basophils, and 1.82 (1.59-2.08) for eosinophils versus the lowest quartiles of the appropriate total and differential counts, respectively, after adjusting for the variables mentioned above. These independent associations were also observed by subgroup analyses according to the smoking status. Our data suggest that even within normal ranges, total WBC count and the differential WBC counts are associated with the presence of metabolic syndrome.

The Age-specific Seroprevalence of Hepatitis A Virus Antibody in Korea / 대한간학회지

BACKGROUNDS/AIMS: The epidemiology of hepatitis A is associated with socioeconomic and hygiene status. Recently, the prevalence of hepatitis A in young adults has been steadily increasing in Korea. This study is to investigate the age-specific seroprevalence of hepatitis A virus in Korea. METHODS: Stored sera from 250 healthy adult subjects who visited the health promotion center in Samsung Medical Center between July and August 2006 were tested for IgG hepatitis A virus antibody (anti-HAV). RESULTS: The prevalence of anti-HAV was 2%, 72%, 92%, 94%, 100% in 20's, 30's, 40's, 50's, and 60's, respectively. The prevalence of anti-HAV was significantly lower in subjects below age 40 compared to those above 40 (37.0% vs. 95.3%, p<0.001). The seroprevalence was higher in area outside of Seoul compared to those living in Seoul in age group below 40 (25.6% vs. 55.6%, p=0.01). In Seoul area, the prevalence was significantly lower in Kangnam-Gu, Seocho-Gu, and Songpa-Gu district compared to the other areas of Seoul in the age group below 40 (20.0% vs. 42.1%, p<0.05). CONCLUSION: The seroprevalence of hepatitis A virus antibody in Korean population below 40 is quite low and immunity to hepatitis A virus in those subjects can be a public health issue. In view of changing seroepidemiology, a policy for hepatitis A vaccination in population below 40 might be warranted.

A Correlation between Low Back Pain and Associated Factors: A Study Involving 772 Patients who Had Undergone General Physical Examination

Many factors are associated with the development of low back pain. Among them, exercise, obesity, smoking, age, educational level and stress are the most common. This study examined the association of these factors with low back pain. An additional aim was to determine a procedure for preventing low back pain. This study analyzed the responses to a questionnaire sent to 772 individuals who had undergone a medical examination at this hospital in 2003 and excluded the individuals who had shown symptoms or their test results indicated a particular disease. Assuming that there were no variables, individuals who exercised regularly 3-4 times per week would have a lower chance of having low back pain than those who did not exercise regularly. The analysis revealed that individuals with a college degree or higher education have a lower chance of experiencing low back pain than those with only a high school education or even college drop-outs. When the other variables were constant, age, extent of obesity (body mass index), smoking and level of stress were not found to affect the development of low back pain. The level of education was associated with the development of low back pain. However, regular exercise 3-4 times per week or more would be most effective in reducing the incidence and duration of low back pain.

The Functional Assessment of Cancer Therapy-Prostate (FACT-P) Scales in Men with Prostate Cancer: Reliability and Validity of the Korean Version

The Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire is a relevant, worldwide tool used for assessing the health-related quality of life in men with prostate cancer. The purpose of this study was to translate the FACT-P into Korean, to assess its reliability and validity, and to test its discriminative ability between the cancer patients and normal controls. The Korean version was developed via the FACT multilingual translation project. The translated questionnaire was self-administered to 70 prostate cancer patients and 70 age-matched controls. In evaluating its psychometric properties for cancer patients, internal consistency and test-retest reliability were used. Validity was estimated by using inter-subscale correlations and discriminant validity between cancer patients and controls. Cronbach's alpha coefficient for the individual subscales were 0.7 or greater (range 0.73 to 0.89), except for emotional well-being (0.61). The test-retest reliability showed high correlations (intraclass coefficients ranged from 0.72 to 0.93). Inter-subscale correlations demonstrated each subscale was unrelated, but moderate correlation was observed between social/family well-being and functional well-being subscales (r=0.56). The FACT-P scale could discriminate reliably between the cancer patients and controls in most subscales. In conclusion, the Korean version of the FACT-P is a reliable and valid questionnaire in patients with prostate cancer.

Reliability and Validity of Korean Brief Comprehensive Geriatric Assessment Questionnaire

Background: The purpose of this study was to evaluate the applicability of the Korean Brief Comprehensive Geriatric Assessment Questionnaire through testing the reliability and validity of it. Methods: Questionnaire consisted of items on medical, functional, mental, socioeconomic status and lifestyle was administered as test-retest on 78 elderly outpatients at 6 university hospitals in Seoul, Korea. Weighted kappa value, kappa value, Pearson correlation coefficients and overall percent agreement were calculated to measure reliability. Validity coefficient was estimated by using reliability coefficient. Results: Reliability coefficients and validity coefficients were higher than 0.50 (fair or good) for 28 items (87.5%) among 32. For test- retest reliability, median was 1.00 (range, 0.87-1.00) for overall percent agreement, 0.66 (range, 0.27~1.00) for kappa value, and 0.83 (range, 0.65~1.00) for Pearson's correlation coefficients. Differences of reliability and validity were identified by gender for 19 items (59.4%), and by age group for 12 items (37.5%). Conclusion: The Korean Brief Comprehensive Geriatric Assessment Questionnaire appears to be a reliable and valid screening tool. After additional study is performed, this instrument can be used as a useful tool for comprehensive outpatient geriatric assessment.

Metabolic Syndrome Is Associated with Delayed Heart Rate Recovery after Exercise

Heart rate (HR) recovery after exercise is a function of vagal reactivation, and its impairment is a predictor of overall mortality and adverse cardiovascular events. While metabolic syndrome is associated with sympathetic overactivity, little is known about the relationship between metabolic syndrome and HR recovery. A symptom-limited exercise stress test in healthy subjects (n=1, 434) was used to evaluate HR recovery. Metabolic syndrome was defined according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) criteria. Seventeen percent of subjects had > or =3 criteria for metabolic syndrome. HR recovery was lower in men than women and in smokers than nonsmokers. The subject with metabolic syndrome (vs. without) showed lower HR recovery (10.3+/-11.6 vs. 13.6+/-9.7 per minute) and higher resting HR (64.3+/-10.3 vs. 61.6+/-9.1 per minute). HR recovery correlated inversely to age (r=-0.25, p<0.0001), but not to resting HR or maximal oxygen uptake. Delayed HR recovery was associated with metabolic syndrome after an adjustment for age, sex, resting HR and smoking (p<0.01). Metabolic syn-drome is associated with impaired vagal reactivation. Adverse cardiovascular out-comes associated with metabolic syndrome may be mediated by the failure of vagal reactivation in addition to sympathetic overactivity.