Is Age-Predicted Maximal Heart Rate Applicable in Patients With Heart or Lung Disease?

Objective@#To compare the predicted and actual maximal heart rate (HRmax) values in the cardiopulmonary exercise test (CPET). @*Methods@#We retrospectively investigated 1,060 patients who underwent a CPET between January 2016 and April 2020 at our institution’s cardiopulmonary rehabilitation center. The following patients were included: those aged >20 years, those tested with a treadmill, and those who underwent symptom-limited maximum exercise testing— reaching ≥85% of the predicted HRmax (62% if taking beta-blockers) and highest respiratory exchange ratio ≥1.1. Ultimately, 827 patients were included in this study. Data on diagnosis, history of taking beta-blockers, age, body mass index (BMI), and CPET parameters were collected. Subgroup analysis was performed according to age, betablockers, BMI (low <18.5 kg/m2, normal, and high ≥25 kg/m2), and risk classification. @*Results@#There was a significant difference between the actual HRmax and the predicted value (p<0.001). Betablocker administration resulted in a significant difference in the actual HRmax (p<0.001). There were significant differences in the moderate-to-high-risk and low-risk groups and the normal BMI and high BMI groups (p<0.001). There was no significant difference between the elderly and younger groups. We suggest new formulae for HRmax of cardiopulmonary patients: estimated HRmax=183-0.76×age (the beta-blocker group) and etimated HRmax=210-0.91×age (the non-beta-blocker group). @*Conclusion@#Age-predicted HRmax was significantly different from the actual HRmax of patients with cardiopulmonary disease, especially in the beta-blocker group. For participants with high BMI and moderate-tosevere risk, the actual HRmax was significantly lower than the predicted HRmax.

Successful Management of Secondary Achalasia in a Patient with Myotonic Dystrophy / 대한연하장애학회지

Myotonic dystrophy (MD) is a systemic disease that affects any level of the gastrointestinal tract. Due to its rare occurrence, achalasia could be misdiagnosed due to symptoms being similar to gastroesophageal reflux (GERD). Moreover, there is no known appropriate treatment for achalasia in patients with MD. A 58-year-old man was diagnosed with type 1 MD. He complained of dyspepsia and chest pain, which showed no improvement even after administering GERD medication. Secondary achalasia was subsequently diagnosed after examining the lower esophageal sphincter by performing a video fluoroscopic-swallowing study (VFSS) and high-resolution manometry. Thereafter, the patient was successfully treated with balloon dilatation, and showed significant improvements in the symptoms. The patient remained well for 1 year. We report a rare case of secondary achalasia in an MD patient. Our study validates that VFSS might be useful for the early diagnosis of achalasia, and esophageal intervention (such as balloon dilatation) should be considered on confirmation of the affliction.

Fungal Load of Groundwater Systems in Geographically Segregated Islands: A Step Forward in Fungal Control

The fungal distribution, diversity, and load were analyzed in the geographically segregated island groundwater systems in Korea. A total of 79 fungal isolates were secured from seven islands and identified based on the internal transcribed spacer (ITS) sequences. They belonged to three phyla (Ascomycota, Basidiomycota, and Chlorophyta), five classes, sixteen orders, twenty-two families, and thirty-one genera. The dominant phylum was Ascomycota (91.1%), with most fungi belonging to the Cladosporium (21.5%), Aspergillus (15.2%), and Stachybotrys (8.9%) genera. Cladosporium showed higher dominance and diversity, being widely distributed throughout the geographically segregated groundwater systems. Based on the diversity indices, the genera richness (4.821) and diversity (2.550) were the highest in the groundwater system of the largest scale. As turbidity (0.064–0.462) increased, the overall fungal count increased and the residual chlorine (0.089–0.308) had low relevance compared with the total count and fungal diversity. Cladosporium showed normal mycelial growth in de-chlorinated sterilized samples. Overall, if turbidity increases under higher fungal diversity, bio-deterioration in groundwater-supplying facilities and public health problems could be intensified, regardless of chlorine treatment. In addition to fungal indicators and analyzing methods, physical hydrostatic treatment is necessary for monitoring and controlling fungal contamination.

Geographical Isolation and Root-Associated Fungi in the Marine Terrains:A Step Toward Establishing a Strategy for Acquiring Unique Microbial Resources

This study aimed to understand whether the geo-ecological segregation of native plant species affects the root-associated fungal community. Rhizoplane (RP) and rhizosphere (RS) fungal microbiota of Sedum takesimense native to three geographically segregated coastal regions (volcanic ocean islands) were analyzed using culture-independent methods: 568,507 quality sequences, 1399 operational taxonomic units, five phyla, and 181 genera were obtained. Across all regions, significant differences in the phyla distribution and ratio were confirmed. The Chao’s richness value was greater for RS than for RP, and this variance coincided with the number of genera. In contrast, the dominance of specific genera in the RS (Simpson value) was lower than the RP at all sites. The taxonomic identity of most fungal species (95%) closely interacting with the common host plant was different. Meanwhile, a considerable number of RP only residing fungal genera were thought to have close interdependency on their host halophyte. Among these, Metarhizium was the sole genus common to all sites. These suggest that the relationship between potential symbiotic fungi and their host halophyte species evolved with a regional dependency, in the same halophyte species, and of the same natural habitat (volcanic islands); further, the fungal community differenced in distinct geographical regions. Importantly, geographical segregation should be accounted for in national culture collections, based on taxonomical uniqueness.

Geographical Isolation and Root-Associated Fungi in the Marine Terrains:A Step Toward Establishing a Strategy for Acquiring Unique Microbial Resources

This study aimed to understand whether the geo-ecological segregation of native plant species affects the root-associated fungal community. Rhizoplane (RP) and rhizosphere (RS) fungal microbiota of Sedum takesimense native to three geographically segregated coastal regions (volcanic ocean islands) were analyzed using culture-independent methods: 568,507 quality sequences, 1399 operational taxonomic units, five phyla, and 181 genera were obtained. Across all regions, significant differences in the phyla distribution and ratio were confirmed. The Chao’s richness value was greater for RS than for RP, and this variance coincided with the number of genera. In contrast, the dominance of specific genera in the RS (Simpson value) was lower than the RP at all sites. The taxonomic identity of most fungal species (95%) closely interacting with the common host plant was different. Meanwhile, a considerable number of RP only residing fungal genera were thought to have close interdependency on their host halophyte. Among these, Metarhizium was the sole genus common to all sites. These suggest that the relationship between potential symbiotic fungi and their host halophyte species evolved with a regional dependency, in the same halophyte species, and of the same natural habitat (volcanic islands); further, the fungal community differenced in distinct geographical regions. Importantly, geographical segregation should be accounted for in national culture collections, based on taxonomical uniqueness.

Fungal Clusters and Their Uniqueness in Geographically Segregated Wetlands: A Step Forward to Marsh Conservation for a Wealth of Future Fungal Resources

Here, we investigated fungal microbiota in the understory root layer of representative well-conserved geographically segregated natural wetlands in the Korean Peninsula. We obtained 574,143 quality fungal sequences in total from soil samples in three wetlands, which were classified into 563 operational taxonomic units (OTU), 5 phyla, 84 genera. Soil texture, total nitrogen, organic carbon, pH, and electrical conductivity of soil were variable between geographical sites. We found significant differences in fungal phyla distribution and ratio, as well as genera variation and richness between the wetlands. Diversity was greater in the Jangdo islands wetland than in the other sites (Chao richness/Shannon/Simpson’s for wetland of the Jangdo islands: 283/6.45/0.97 > wetland of the Mt. Gariwang primeval forest: 169/1.17/0.22 > wetland of the Hanbando geology: 145/4.85/0.91), and this variance corresponded to the confirmed number of fungal genera or OTUs (wetlands of Jangdo islands: 42/283 > of Mt. Gariwang primeval forest: 32/169 > of the Hanbando geology: 25/145). To assess the uniqueness of the understory root layer fungus taxa, we analyzed fungal genera distribution. We found that the percentage of fungal genera common to two or three wetland sites was relatively low at 32.3%, while fungal genera unique to each wetland site was 67.7% of the total number of identified fungal species. The Jangdo island wetland had higher fungal diversity than did the other sites and showed the highest level of uniqueness among fungal genera (Is. Jangdo wetland: 34.5% > wetland of Mt. Gariwang primeval forest: 28.6% > wetland of the Hanbando geology: 16.7%).

Duodenoduodenal Intussusception due to a Migrated Percutaneous Radiologic Gastrostomy Tube: A Case Report / 대한연하장애학회지

Patients with dysphagia often have difficulty in supplying adequate nutrition orally, and thus they often use gastrostomy for nutrition support. If the nutrition affects the deterioration of the disease, as in amyotrophic lateral sclerosis, the majority of patients will have a gastrostomy tube for proper nutrition. To prevent complications from gastrostomy tubes, it is important to educate the caregiver or patient about how to properly manage it. If these patients opt for home care because of financial or cultural reasons, it will be difficult for their healthcare team to observe them closely, leading to complications due to lax tube management. In this case, appropriate management education becomes more important. This paper reports an extremely rare case of duodenal intussusception caused by a migrated percutaneous radiologic gastrostomy (PRG) tube in a patient with amyotrophic lateral sclerosis (ALS) using simultaneous oral and enteral nutrition. The patient was treated successfully with urgent tube removal using the air reduction maneuver. This case highlights the importance of gastrostomy management.

Correlation of Swallowing Function With Bilateral Diaphragmatic Movement in Hemiplegic Stroke Patients

OBJECTIVE: To investigate difference in bilateral diaphragm movement of patients with tracheal aspiration according to post stroke residue severity and determine correlations of Penetration-Aspiration Scale (PAS), residue scale, and bilateral diaphragm movement. METHODS: A total of 47 patients diagnosed with hemiplegic stroke were enrolled in this study. PAS, severity of valleculae, and pyriform sinus retention during videofluoroscopic swallowing study (VFSS) were assessed. Bilateral fluoroscopic diaphragm movements during spontaneous breathing and forced breathing were measured. RESULTS: Patients with tracheal aspiration (PAS≥6) had significantly (p=0.035) lower ipsilateral diaphragm movement during spontaneous breathing. Post-swallow residue severity showed statistically significant (p=0.028) difference in patients with ipsilateral diaphragm movement during forced breathing. In linear regression analysis, PAS showed weak correlations with ipsilateral spontaneous diaphragm movement (r=0.397, p=0.006), ipsilateral forced diaphragm movement (r=0.384, p=0.008), and contralateral forced diaphragm movement (r=0.323, p=0.027). Weak correlation was also observed between post swallow residue severity and ipsilateral diaphragm movement during spontaneous breathing (r=0.331, p=0.023) and forced breathing (r=0.343, p=0.018). CONCLUSION: We confirmed the relationship between swallowing function and bilateral diaphragm movement in this study. The severity of dysphagia after hemiplegic stroke was correlated with bilateral diaphragm movement. Further longitudinal studies are needed to assess the effect of breathing exercise on post-stroke dysphagia.

Secondary Lymphedema After Intestinal Tuberculosis: A Case Report

Lymphedema, a chronic disease that lowers patients' quality of life, is categorized as primary or secondary. Secondary lymphedema can be improved by treating the underlying cause. However, in many cases, efforts are not made to identify the primary cause of lymphedema and treatment is targeted at the edema itself, resulting in misdiagnosis. Here, we describe the case of a 61-year-old man with right leg edema of unknown cause that had persisted for 3 years. Intestinal tuberculosis was confirmed during a re-evaluation of the cause, and his symptoms improved after anti-tuberculous treatment. This improvement was assessed qualitatively by indocyanine green lymphography before and after treatment, as well as by observation of the clinical symptoms. Lower extremity lymphedema caused by intestinal tuberculosis is extremely rare, and this case reveals the importance of continuing to identify the causes of resistant pathologies.

Instruments to Assess Physical Impairments in Post-Intensive Care Syndrome: A Systematic Review / 중환자간호학회지

PURPOSE: The purpose of this study was to systematically review the instruments utilized to assess physical impairment in post-intensive care syndrome (PICS) of intensive care unit (ICU) survivors.METHOD: Online databases searched were MEDLINE, Cochrane, CINAHL, and Embase. Studies that met the following criteria were included: 1) the study population exclusively had experience with ICU admission; 2) the study assessed pulmonary, neuromuscular, and physical functions; and 3) the study was published in English language journals after 2007.RESULTS: A total of 56 instruments (2 pulmonary, 25 neuromuscular, 29 physical function) from 94 studies were reviewed. They were classified into self-report, observation, and measurement according to the type of assessment. No instrument measured all 3 areas of physical impairment. Five instruments were originally developed for the ICU patients. The most frequently applied instruments were the Medical Research Council and the 36-item Short Form Survey (physical component summary), which were used in 23 studies each. Only 13.8% of reviewed studies reported the reliability or validity of the instruments.CONCLUSION: Our results suggest that the appropriateness of instruments assessing physical impairment in PICS cannot be guaranteed. Despite the multidimensional concept of physical disabilities, most studies measured only one area, and studies that reported psychometric properties were limited. Accordingly, we propose to develop a unique and multifaceted instrument for ICU survivors.

Foodborne Infectious Diseases Mediated by Inappropriate Infection Control in Food Service Businesses and Relevant Countermeasures in Korea

OBJECTIVES: The objective of this review is to propose an appropriate course of action for improving the guidelines followed by food handlers for control of infection. For this purpose, previous epidemiological reports related to acute gastroenteritis in food service businesses mediated by food handlers were intensively analyzed. METHODS: Relevant studies were identified in international databases. We selected eligible papers reporting foodborne infectious disease outbreaks. Among primary literature collection, the abstract of each article was investigated to find cases that absolutely identified a causative factor to be food handlers’ inappropriate infection control and the taxon of causative microbial agents by epidemiological methodologies. Information about the sites (type of food business) where the outbreaks occurred was investigated. RESULTS: A wide variety of causative microbial agents has been investigated, using several epidemiological methods. These agents have shown diverse propagation pathways based on their own molecular pathogenesis, physiology, taxonomy, and etiology. CONCLUSION: Depending on etiology, transmission, propagation, and microbiological traits, we can predict the transmission characteristics of pathogens in food preparation areas. The infected food workers have a somewhat different ecological place in infection epidemiology as compared to the general population. However, the current Korean Food Safety Act cannot propose detailed guidelines. Therefore, different methodologies have to be made available to prevent further infections.

Molecular Identification of Mycorrhizae of Cymbidium kanran (Orchidaceae) on Jeju Island, Korea

A fungal internal transcribed spacer region was used to identify the mycorrhizae of Cymbidium kanran. The family Russulaceae was found to be the most frequently occurring group in both root and soil samples. In phylogenetic analyses, the majority of the Russulaceae clones were clustered with Russula brevipes and R. cyanoxantha. Therefore, C. kanran may form symbiotic relationships with the genus Russula.

Difference in Volume Perception According to Beverage or Cup Color in Normal Weight and Obese College Students

We examined the perception of volume in college students with a normal weight versus those students with obesity. College students were divided into a normal weight group ( or =23 body mass index, n=110), The perception of volume was measured under different beverage colors (colorless, black, yellow, and blue) and cup colors (colorless, black, yellow, and blue) containing the same amount of liquid (150 ml). We found that the normal weight group perceived significantly more liquid in a cup with a blue beverage versus a colorless one. The obese group perceived significantly more liquid in a cup with a yellow or blue beverage versus a colorless one. In terms of cup color, the normal weight group perceived significantly more liquid in a black color cup compared to a blue color cup. However, there were no differences in perceived volume according to the color of cup among the obese group. There were no significant differences in the perceived volume between the normal and obese group under all conditions tested. In conclusion, beverage and cup color effects volume perception in normal weight students, while only beverage color effects volume perception in obese students. Therefore, controlling, the color of beverages and cups may help to control the consumption of drinks.

Topical ALA-Photodynamic Therapy for Acne Can Induce Apoptosis of Sebocytes and Down-regulate Their TLR-2 and TLR-4 Expression

BACKGROUND: Although photodynamic therapy (PDT) is widely performed for acne, little is known about its exact therapeutic mechanism. OBJECTIVE: We aimed to estimate the efficacy and safety of PDT on acne and to discover its mode of action. METHODS: We performed PDT on 12 patients with mild to moderate acne. The clinical efficacy was assessed by counting the acne lesions and measuring the sebum secretion before and after PDT. In addition, we took biopsy samples from the peri-lesional areas before and after 3-session of PDT. To examine the degree of apoptosis of the sebaceous follicles, TUNEL assay was performed. To investigate the changes of toll-like receptor (TLR)-2 and TLR-4 expression after PDT, immunohistochemical stainings were also carried out. Finally, we performed TUNEL assay using the cultured sebocytes to confirm the apoptosis of sebocytes in vitro after PDT. RESULTS: There was a significant reduction in the number of inflammatory acne lesions after PDT, compared to baseline (p<0.05). Sebum excretion significantly decreased 2 weeks after the first PDT session except for one patient (p<0.05). The TUNEL positive cells in the peri-lesional sebaceous glands after PDT markedly increased, compared with those of before PDT. A decrease in TLR-2 and TLR-4 expression by sebaceous glands and epidermis after PDT was 50% and 30%, respectively. CONCLUSION: Our results demonstrate that apoptosis of the sebaceous glands is associated with improvement of acne by PDT. PDT has shown to down-regulate TLR-2 and TLR-4 expression in the sebaceous glands and epidermis of acne patients.

A Case of Nasopharyngeal Tuberculosis Resulting in Tuberculous Otitis Media / 대한이비인후과학회지

Both nasopharyngeal tuberculosis and tuberculous otitis media are currently considered as rare diseases and patients have no evidence of active pulmonary or systemic tuberculosis. We experienced a case of 49-year-old female with nasopharyngeal tuberculosis which eventually resulted in tuberculous otitis media. The initial diagnosis was very difficult so the appropriate treatment was delayed. Therefore, it is necessary that appropriate evaluations for nasopharyngeal tuberculosis and tuberculous otitis media include a chest X-ray, smear, culture, biopsy, and M. tuberculosis Polymerase chain reaction (TB-PCR). When nasopharyngeal tuberculosis and tuberculous otitis media are diagnosed, a medical therapy with antituberculous drugs is usually effective, and surgery is rarely needed. So we report our findings in this patient with a review of literautre and discuss the relationship between nasopharyngeal tuberculosis and tuberculous otitis media.

Three Cases of Dermoid Cysts of Auriculotemporal Area / 대한이비인후과학회지

Dermoid cysts, also referred as "dysontogenetic cyst", are ectodermal cysts that contain epithelial linings as well as adnexal structures. They are divided into 3 categories : epidermoids, dermoids and teratoids. Although dermoid cysts represent a separate entity, the term "dermoid" is generally used to indicate all 3 categories. Dermoid cysts may occur in numerous areas of the body. However, dermoid cysts on the head and neck region are relatively rare. A few cases of dermoid cysts have been reported especially in the auriculotemporal area but not in the external auditory canal or preauricular area. We experienced 3 unusual cases of dermoid cysts occurring in the auriculotemporal area that includes external auditory canal, preauricular and postauricular area. Because of its location and rarity, we report these cases of dermoid cyst in the auriculotemporal area with a brief review of literatures.

A Case of Neurilemmoma in the Nasal Vestibule

A schwannoma, also known as neurilemmoma, is a relatively rare benign tumor originating from the schwann cells of the nerve sheath. It occurs along any somatic, sympathetic and cranial nerves except the olfactory and optic nerves. It occurred most frequently in the head and neck but rarely in the nasal cavity and paranasal sinuses. Occurrence was especially rare in the nasal vestibule. Recently we experienced an unusual case of the schwannoma involving the left nasal vestibule. The mass was completely removed via a sublabial approach and histopathological examination and immunohistochemical staining study confirmed the schwannoma. We report this case with review of literatures.

A Case of Retrobulbar Hemorrhage after Endoscopic Sinus Surgery with Microdebrider

Retrobulbar hemorrhage is one of the major complications following endoscopic sinus surgery (ESS) with a microdebrider. Symptoms and physical findings include temporary blindness, ophthalmoplegia, mydriasis, ptosis, proptosis and eyelid ecchymosis. Recently, we experienced a case of retrobulbar hemorrhage after an ESS with a microdebrider resulting from anterior ethmoid artery rupture. We hereby present this case with an emphasis on the importance of prevention, identification and management of retrobulbar hematoma.

Ahmed Valve Implantation for Refractory Glaucoma following Pars Plana Vitrectomy

PURPOSE: To evaluate the effectiveness of Ahmed valve implantation for refractory glaucoma following pars plana vitrectomy. METHODS: Seventeen eyes of 15 patients suffering from secondary glaucoma following pars plana vitrectomy underwent Ahmed valve implantation. All the eyes were in critical condition, and intraocular pressure could not be controlled with anti-glaucoma medications. Success was characterized by an intraocular pressure less than 22 mmHg and greater than 6 mmHg, regardless of anti-glaucoma medication usage. RESULTS: The total success rate was 83.4% at 6 months and 76.4% at the final visit. The reduction in intraocular pressure and the number of medications used postoperatively were both statistically and clinically significant (p< 0.005). Postoperative complications included: transiently increased intraocular pressure, transient hyphema, early postoperative hypotony, choroidal detachment, malposition of the valve tip, and phthisis bulbus. CONCLUSIONS: Ahmed valve implantation is a safe and effective method for refractory glaucoma following vitrectomy.

A Case of Tubeculous Neuroretinitis

OBJECTIVE: Tuberculosis is a chronic infection caused by Mycobacterium tuberculosis that can appear throughout the entire body; however, intraocular tuberculosis is rare. We report a case of tuberculous neuroretinitis accompanied by periphlebitis. METHODS: A 17-year-old female was referred with the diagnosis of retinal vasculitis. In the fundus of her right eye, an edematous disc, serous detachment of the macula, multiple hard exudates, and vascular sheathing around the veins were noted. Also, she had no direct light reflex in her right eye. Although her chest X-ray showed no abnormalities, the Tuberculin test was positive; therefore, the condition was diagnosed with a neuroretinitis accompanied by periphlebitis caused by Mycobacterium tuberculosis. RESULTS: High-dose steroid treatment decreased peripapillary edema but did not improved visual acuity. Treatment with antituberculosis medicine resulted in the recovery of her visual acuity and in fundus changes. CONCLUSIONS: Ocular tuberculosis commonly appears as perivasculitis; however, it can cause a visual disturbance by invading the retina and optic nerve simultaneously.