Changes in Shoulder Trauma during the COVID-19 Pandemic: A South Korean Survey.

Background: This study aimed to investigate the changes in the incidence of shoulder trauma and surgery 1 year after the outbreak of coronavirus disease 2019 (COVID-19) with social restriction compared with 1 year before the pandemic. Methods: Patients managed in our orthopedic trauma center between February 18, 2020, and February 17, 2021 (COVID-19 period) for shoulder trauma were compared with patients managed for the same duration a year ago (non-COVID-19 period; February 18, 2019, to February 17, 2020). The incidence of shoulder trauma, surgery, and mechanism of injury were compared between these periods. Results: The total number of shoulder trauma cases was lower in the COVID-19 period than in the non-COVID-19 period, although the difference was not significant (160 vs. 180 cases, p = 0.278). In addition, traumatic shoulder surgeries decreased during the COVID-19 period (57 vs. 69 cases, p = 0.285). The incidence of shoulder trauma according to four diagnostic classifications (contusion, sprain/subluxation, fracture, and dislocation) and fracture/dislocation types did not differ between the periods. During the COVID-19 period, accidental falls outdoors (45 vs. 67, p = 0.038) and sports-related injuries (15 vs. 29, p = 0.035) significantly decreased, but accidental falls at home (52 vs. 37, p = 0.112) increased compared with those during the non-COVID-19 period, although the difference was not significant. The monthly incidence of shoulder trauma decreased 2 months after the first outbreak (significant in March, p = 0.019), then steadily increased and significantly decreased during the second outbreak (August, p = 0.012). However, the third outbreak (December, p = 0.077) had little effect on the incidence of shoulder trauma. The number of monthly traumatic shoulder surgeries showed a similar pattern to the monthly incidence of shoulder trauma. Conclusions: During the COVID-19 pandemic, annual shoulder trauma cases and surgeries decreased compared to those in the non-COVID-19 period, even though the difference was insignificant. The incidence of shoulder trauma and surgery was significantly reduced in the early COVID-19 period; however, the effect of the pandemic on orthopedic trauma practice was minimal after approximately half a year. Decreases in falls outdoors and sports-related injuries, but an increase in falls at home, were observed during the COVID-19 pandemic.

An Analysis of Health Perceptions and Performance in Elementary Students in Korea during the ongoing COVID-19 Pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, social distancing guidelines changed lifestyles, including increased sedentary time, physical inactivity, and disrupted sleep patterns among children. The purpose of the present study is to analyze the health awareness (mental health, disease, physical activity, sleep, eating habit, and hygiene health management) of elementary school students during the COVID-19 pandemic, and use the importance-performance analysis (IPA) technique to identify gender differences in health perceptions. We collected data on 1006 students, which was analyzed using frequency analysis, reliability testing, independent sample t-tests, and importance-performance analysis (IPA). A median importance value of 0.163 and a median performance value of 4.048 were selected as cross points to distribute the IPA matrix into four quadrants. The highest performance was given for wearing a mask and sanitary practice; the IPA matrix indicated that the sense of belonging, happiness, trust, and movement activity were located in quadrant I. Children's regular physical activity and level of physical activity were low, especially that of girls. Children's sleep management was poor. Their physical activity and sleep-related factors must be improved under the facilitation of the national government, public education institutions, and families.

Who has experienced better or worse health conditions since the outbreak of COVID-19?: results from a representative cross-sectional survey in Seoul.

BACKGROUND/OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has affected the entire world population in many ways. This study aimed to analyze the patterns of changes in eating, food purchasing and preparation, physical activity, and subjective health after COVID-19 outbreak by various sociodemographic factors and to understand the factors associated with changes in subjective health. SUBJECTS/METHODS: A cross-sectional survey using a representative sample from Seoul was used for the analysis. The data collection was conducted from September to October 2020. A total of 3,833 citizens aged more than 18 years old participated in the Seoul Food Survey. Descriptive statistics and generalized ordinal logistic regression models were used to understand the changes in health behaviors, health indicators, and subjective general health by various socioeconomic status. RESULTS: It was shown that the changes in household income, food expenditure, food consumption and physical activities differed significantly by age, education, occupation, income, weight, and food security status. Low-income and food-insecure households were affected more severely by the pandemic. Older age, household food insecurity, income reduction, increased home cooking and frequency of having instant foods, decreased physical activity and weight gain were significant factors explaining worse perceived health during the COVID-19 pandemic. CONCLUSIONS: The results suggest that focusing on older populations and low-income families with food insecurity should be prioritized during infectious disease outbreaks. In addition, the role of physical activities and instant food consumption in explaining perceived health should be investigated further in this prolonged battle with the pandemic situation.

Who has experienced better or worse health conditions since the outbreak of COVID-19?: results from a representative cross-sectional survey in Seoul

BACKGROUND/OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has affected the entire world population in many ways. This study aimed to analyze the patterns of changes in eating, food purchasing and preparation, physical activity, and subjective health after COVID-19 outbreak by various sociodemographic factors and to understand the factors associated with changes in subjective health. SUBJECTS/METHODS A cross-sectional survey using a representative sample from Seoul was used for the analysis. The data collection was conducted from September to October 2020. A total of 3,833 citizens aged more than 18 years old participated in the Seoul Food Survey. Descriptive statistics and generalized ordinal logistic regression models were used to understand the changes in health behaviors, health indicators, and subjective general health by various socioeconomic status. RESULTS It was shown that the changes in household income, food expenditure, food consumption and physical activities differed significantly by age, education, occupation, income, weight, and food security status. Low-income and food-insecure households were affected more severely by the pandemic. Older age, household food insecurity, income reduction, increased home cooking and frequency of having instant foods, decreased physical activity and weight gain were significant factors explaining worse perceived health during the COVID-19 pandemic. CONCLUSIONS The results suggest that focusing on older populations and low-income families with food insecurity should be prioritized during infectious disease outbreaks. In addition, the role of physical activities and instant food consumption in explaining perceived health should be investigated further in this prolonged battle with the pandemic situation.

Health Perceptions of Korean and Japanese Adolescents During the Prolonged COVID-19 Pandemic: An Importance Performance Analysis

Background: This study compares and analyzes the importance and performance of Korean and Japanese adolescents' health awareness in the long COVID-19 pandemic situation. Methods: A frequency analysis was conducted on data collected from 1341 Korean and Japanese adolescents in September 2021 through online and offline surveys to confirm their characteristics (reliability was verified through Cronbach's alpha). A paired sample test was conducted to analyze health awareness differences and performance of each variable between Korean and Japanese middle-school students and between male and female participants, substantiated by importance-performance analysis (IPA). Results: First, Korean adolescents perceived importance for all factors of health perception greater as compared to their Japanese counterparts. Second, performance differences between Korean and Japanese adolescents were especially significant in hygiene management, disease management and physical activity. Third, in Quadrant 4 of the IPA matrix, there were similarities and differences in a particular factor of health perception between Korean and Japanese adolescents. On this basis, we proposed measures emphasizing the importance of health, to enhance Korean and Japanese adolescents' performance. Conclusions: It is important for national government, public education institutions, and families to couple a therapeutic approach with a preventive and management approach that encourages periodic exercise, desirable diet, and adequate sleep when exploring measures to maintain and promote adolescents' health.

High-Risk Non-Small Cell Lung Cancer Treated With Active Scanning Proton Beam Radiation Therapy and Immunotherapy.

Purpose: Non-small cell lung cancer (NSCLC) is a deadly malignancy that is frequently diagnosed in patients with significant medical comorbidities. When delivering local and regional therapy, an exceedingly narrow therapeutic window is encountered, which often precludes patients from receiving aggressive curative therapy. Radiation therapy advances including particle therapy have been employed in an effort to expand this therapeutic window. Here we report outcomes with the use of proton therapy with curative intent and immunotherapy to treat patients diagnosed with high-risk NSCLC. Methods and Materials: Patients were determined to be high risk if they had severe underlying cardiopulmonary dysfunction, history of prior thoracic radiation therapy, and/or large volume or unfavorable location of disease (eg, bilateral hilar involvement, supraclavicular involvement). As such, patients were determined to be ineligible for conventional x-ray-based radiation therapy and were treated with pencil beam scanning proton beam therapy (PBS-PBT). Patients who demonstrated excess respiratory motion (ie, greater than 1 cm in any dimension noted on the 4-dimensional computed tomography simulation scan) were deemed to be ineligible for PBT. Toxicity was reported using the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Overall survival and progression-free survival were calculated using the Kaplan-Meier method. Results: A total of 29 patients with high-risk NSCLC diagnoses were treated with PBS-PBT. The majority (55%) of patients were defined as high risk due to severe cardiopulmonary dysfunction. Most commonly, patients were treated definitively to a total dose of 6000 cGy (relative biological effectiveness) in 30 fractions with concurrent chemotherapy. Overall, there were a total of 6 acute grade 3 toxicities observed in our cohort. Acute high-grade toxicities included esophagitis (n = 4, 14%), dyspnea (n = 1, 3.5%), and cough (n = 1, 3.5%). No patients developed grade 4 or higher toxicity. The majority of patients went on to receive immunotherapy, and high-grade pneumonitis was rare. Two-year progression-free and overall survival was estimated to be 51% and 67%, respectively. COVID-19 was confirmed or suspected to be responsible for 2 patient deaths during the follow-up period. Conclusions: Radical PBS-PBT treatment delivered in a cohort of patients with high-risk lung cancer with immunotherapy is feasible with careful multidisciplinary evaluation and rigorous follow-up.

Impact of the COVID-19 Pandemic on Mortality Following Hip and Knee Joint Arthroplasty Surgeries: A Systematic Review and Meta-Analysis.

We performed a meta-analysis comparing the mortality rates after hip and knee joint arthroplasty between the coronavirus 2019 (COVID-19) pandemic and pre-pandemic periods. The purpose of present study was to investigate the impact of the COVID-19 pandemic on mortality rates after hip and knee joint arthroplasty. We systematically searched the MEDLINE, Embase, and Cochrane Library databases for studies published up to 28 March 2022. We included studies which directly compared mortality rates after hip and knee joint arthroplasty between the COVID-19 pandemic and pre-pandemic periods. The methodological quality of the included studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). We compared the overall mortality rate as the primary outcome. For the subgroup analysis, the mortality rates included were: within 30 days and unrelated to COVID-19; we excluded studies with only elective arthroplasties. Readmission rates following arthroplasties were also compared. We included five studies with 3044 patients, of which 838 patients underwent surgeries during the pandemic period and 2206 patients underwent surgeries in the pre-pandemic period. The mean MINORS score was 15.4/24 (range: 15-16). The overall mortality rate showed no significant differences between the pandemic and pre-pandemic periods (OR, 2.71; 95% CI, 0.78-9.35; p = 0.12; I2 = 19%). No differences were observed in mortality following arthroplasties within 30 days and unrelated to COVID-19 nor in the readmission rates. Mortality, after excluding studies with only elective arthroplasty, presented significant differences between the COVID-19 pandemic and pre-pandemic periods (OR, 3.80; 95% CI, 1.18-12.28; p = 0.03, I2 = 0%). The limitation of the present study was that elective arthroplasty and urgent arthroplasty were not completely differentiated. The overall mortality rate in the COVID-19 pandemic period following hip and knee arthroplasty did not show a significant increase. This finding could help to maintain the practice of elective arthroplasty during a pandemic situation in the future (PROSPERO-CRD42022335471).

A Comparison of Barrier Factors between Hospitals with and without Cardiac Rehabilitation Programs in Korea: A Nation-Wide Survey Research

The percentage of patients undergoing cardiac rehabilitation programs (CRP) is very low (30–40%), and hospitals providing CRP are either insufficient or lacking, even in countries with advanced medical care;therefore, this study aims to investigate the barriers, as well as compare the differences between hospitals, with or without CRP. We conducted a survey, in which the questionnaire was distributed through post or email to 607 specialists who work at 164 hospitals performing percutaneous coronary interventions (PCI). The results were as follows: (1) of the 164 hospitals, 132 responded (response rate: 80.5%). While all 47 hospitals with CRP responded (100%), from among the 117 hospitals without CRP, 85 responded (72.7%). (2) Of the 607 specialists, 227 responded (response rate: 36.9%). The response rates according to specialties were as follows: cardiologists (28.9%), cardiac surgeons (24.5%), and physiatrists (64.1%). (3) While the specialists at hospitals with CRP identified patient referral, transportation, and cost as the major barriers, for those at hospitals without CRP, all items were considered barriers, especially the items related to equipment, space, workforce, and budget as being more serious barriers. Therefore, in order to actively promote CRP, it is suggested that governments consider the customized support system according to the performance of CRPs.

Identifying behavior of long-distance virus transmission and mitigation performance from a COVID-19 outbreak of a daycare center.

During the last two years, hundreds of millions of people in the world have been infected with SARS-CoV-2 due to recurrent waves and closed spaces. Daycare centers are critical infrastructures that cannot be replaced, even during the COVID-19 period. However, the existing settings in daycare centers may pose risks of inevitable close contact between teachers and children, as well as fomite and airborne transmission during care hours. Therefore, reinforced mitigation strategies have been applied in daycare centers to reduce potential indoor virus transfer in many countries. However, numerous outbreaks of COVID-19 have been reported in daycare centers. Therefore, in this study, researchers focused on the risk and behavior of long-distance virus transmission based on the detected viruses on air purifier filter sampling in a daycare center outbreak in Korea. Various experiments of possible situations were conducted in nursing rooms based on field interviews. The experiments monitored the long-distance transmission behavior of aerosol-sized particles and visualized particle behavior at the daycare center. The results of this study revealed that long-distance virus transmission is possible under the current settings in the daycare center, and flush-out can be an important countermeasure with reinforced ventilation methods to prevent potential airborne spread in the daycare center. The results of air purifiers represented that air purifiers should be properly installed and operated in the daycare center to prevent airborne virus spread by airflow during occupied hours. The findings of this study will contribute to the understanding of airborne virus risk and the development of customized virus measures for daycare centers.

Antimicrobial effects of microwave plasma-activated water with skin protective effect for novel disinfectants in pandemic era.

Skin antiseptics have important implications for public health and medicine. Although conventional antiseptics have considerable antimicrobial activity, skin toxicity and the development of resistance are common problems. Plasma-treated water has sterilization and tissue-regenerative effects. Therefore, the aim of this study was to identify whether plasma-activated water (PAW) manufactured by our microwave plasma system can be used as a novel antiseptic solution for skin protection. PAW was produced by dissolving reactive nitrogen oxide gas using microwave plasma in deionized water. The antibacterial effects of PAW against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Bacillus cereus, and Salmonella typhimurium and effective concentrations were investigated by a solid agar plate assay. The factors mediating the effects of PAW were evaluated by the addition of reactive species scavengers. Cytotoxicity and cell viability assays were performed to examine the protective effect of PAW on normal skin cells. PAW exhibited excellent sterilization and no toxicity in normal skin cells. Experiments also confirmed the potential of PAW as a sanitizer for SARS-CoV-2. Our findings support the use of PAW as an effective skin disinfectant with good safety in the current situation of a global pandemic.

Current Status of Cardiac Rehabilitation in the Regional Cardiocerebrovascular Centers in Korea.

Regional Cardiocerebrovascular Centers (RCCs)-a Korean government initiative-seek to reduce medical gaps across regions, and their cardiac rehabilitation (CR) programs are expected to model post-acute care for the Korean CR program. Accordingly, this study aimed to evaluate the current status of CR programs in the RCCs. We distributed surveys on the CR condition, activity, and barriers to 12 RCCs in different provinces. The results revealed significant gaps in the annual number of acute myocardial infarction admissions, and CR candidates, capacity, and density across the 12 RCCs. The CR capacity (50-500) and density (0.42-7.36) indicated particularly large gaps. Twelve RCCs had the necessary facilities, equipment and personnel for CR assessments and management, with high CR referral (97%) and patient education (78%) rates. However, the inpatient CR exercise training (56%) participation rate was inadequate, with much lower enrollment (47%) and adherence (17%) rates to the outpatient CR program and large differences across centers. Therefore, this study's results will provide the evidence required to establish special national health strategies to overcome the CR barriers of patient, doctor/hospital, and policy factors for activating Korean CR programs.

Pembrolizumab-induced cytokine release syndrome in a patient with metastatic lung adenocarcinoma: a case report.

Cytokine release syndrome (CRS) is a well-described immune-related adverse event following chimeric antigen receptor T-cell therapy, but has rarely been reported following anti-programmed death ligand-1 therapy. We report the case of a 55-year-old man with metastatic lung adenocarcinoma who presented with fever, chills and hypotension. Initial labs were notable for highly elevated serum ferritin levels and mildly elevated triglyceride levels. He was ultimately diagnosed with pembrolizumab-induced CRS complicated by multiorgan failure. The patient was treated with steroids and tocilizumab with normalization of inflammatory markers and resolution of renal failure. This case not only highlights the importance of considering CRS in patients who have developed multiorgan failure after immune checkpoint inhibitor therapy, but also demonstrates clinical similarities between CRS and other hyperinflammatory states such as hemophagocytic lymphohistiocytosis.

Potential Therapeutic Effect of Micrornas in Extracellular Vesicles from Mesenchymal Stem Cells against SARS-CoV-2.

Extracellular vesicles (EVs) are cell-released, nanometer-scaled, membrane-bound materials and contain diverse contents including proteins, small peptides, and nucleic acids. Once released, EVs can alter the microenvironment and regulate a myriad of cellular physiology components, including cell-cell communication, proliferation, differentiation, and immune responses against viral infection. Among the cargoes in the vesicles, small non-coding micro-RNAs (miRNAs) have received attention in that they can regulate the expression of a variety of human genes as well as external viral genes via binding to the complementary mRNAs. In this study, we tested the potential of EVs as therapeutic agents for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. First, we found that the mesenchymal stem-cell-derived EVs (MSC-EVs) enabled the rescue of the cytopathic effect of SARS-CoV-2 virus and the suppression of proinflammatory responses in the infected cells by inhibiting the viral replication. We found that these anti-viral responses were mediated by 17 miRNAs matching the rarely mutated, conserved 3'-untranslated regions (UTR) of the viral genome. The top five miRNAs highly expressed in the MSC-EVs, miR-92a-3p, miR-26a-5p, miR-23a-3p, miR-103a-3p, and miR-181a-5p, were tested. They were bound to the complemented sequence which led to the recovery of the cytopathic effects. These findings suggest that the MSC-EVs are a potential candidate for multiple variants of anti-SARS-CoV-2.

Neutralizing Antibody Production in Asymptomatic and Mild COVID-19 Patients, in Comparison with Pneumonic COVID-19 Patients.

OBJECTIVES: To investigate antibody production in asymptomatic and mild COVID-19 patients. METHODS: Sera from asymptomatic to severe COVID-19 patients were collected. Microneutralization (MN), fluorescence immunoassay (FIA), and enzyme-linked immunosorbent assay (ELISA) were performed. RESULTS: A total of 70 laboratory-confirmed COVID-19 patients were evaluated, including 15 asymptomatic/anosmia, 49 mild symptomatic, and 6 pneumonia patients. The production of the neutralizing antibody was observed in 100% of pneumonia, 93.9% of mild symptomatic, and 80.0% of asymptomatic/anosmia groups. All the patients in the pneumonia group showed high MN titer (≥1:80), while 36.7% of mild symptomatic and 20.0% of asymptomatic/anosmia groups showed high titer (p < 0.001). Anti-SARS-CoV-2 antibodies could be more sensitively detected by FIA IgG (98.8%) and ELISA (97.6%) in overall. For the FIA IgG test, all patients in the pneumonia group exhibited a high COI value (≥15.0), while 89.8% of mild symptomatic and 73.3% of asymptomatic/anosmia groups showed a high value (p = 0.049). For the ELISA test, all patients in the pneumonia group showed a high optical density (OD) ratio (≥3.0), while 65.3% of mild symptomatic and 53.3% of asymptomatic/anosmia groups showed a high ratio (p = 0.006). CONCLUSIONS: Most asymptomatic and mild COVID-19 patients produced the neutralizing antibody, although the titers were lower than pneumonia patients. ELISA and FIA sensitively detected anti-SARS-CoV-2 antibodies.

Impact on airborne virus behavior by an electric heat pump (EHP) operation in a restaurant during winter season.

The world is having an unprecedented time due to the pandemic. Currently, more than 93 million people have been infected, and over 2 million people have passed away since 2020. SARS-CoV-2 has forced people to change their lifestyles and patterns. Under the pandemic, buildings are no longer safe shelters. The infected transmit infectious viruses to other occupants by direct contact or indirect contact (i.e., indoor airflow). In addition, the airflow from electric heat pump systems can propel indirect contact in indoor spaces. However, the impact of airflow is still not sufficiently identified to develop virus control strategies in buildings. Therefore, this study selected a restaurant in Seoul, Korea, to experiment with airborne virus transmission of direct airflow in winter using virus-similar particles. The results of this study verified the potential exposure of droplets or aerosols to occupants that can be delivered by air current from heating systems in winter. The effect of kitchen hoods was also confirmed as additional ventilation equipment without additional budget investment in restaurants. The recommendations of this study are expected to improve the guidelines for restaurants to ensure occupant's safety during the COVID-19 period.

Cardiorespiratory Fitness, Inflammation, and the Incident Risk of Pneumonia.

INTRODUCTION: Both inflammation and cardiorespiratory fitness (CRF) are associated with the risk of respiratory infections. To clarify the hypothesis that CRF attenuates the incident risk of pneumonia due to inflammation, we conducted a prospective study examining the independent and joint associations of inflammation and CRF on the risk of pneumonia in a population sample of 2041 middle-aged men. METHODS: Cardiorespiratory fitness was directly measured as peak oxygen uptake (V˙o2peak) during progressive exercise testing to volitional fatigue, and categorized into tertiles. Inflammation was defined by high-sensitivity C-reactive protein (hsCRP). Pneumonia cases were identified by internal medicine physicians using the International Classification of Diseases codes in clinical practice. RESULTS: During a median follow-up of 27 yr, 432 pneumonia cases were recorded. High hsCRP and CRF were associated with a higher risk (HR = 1.38; 95% CI, 1.02-1.88) and a lower risk of pneumonia (HR = 0.55; CI, 0.39-0.76) after adjusting for potential confounders, respectively. Compared with normal hsCRP-Fit, moderate to high hsCRP-Unfit had an increased risk of pneumonia (HR = 1.63; CI, 1.21-2.20), but moderate to high hsCRP-Fit was not associated with an increased risk of pneumonia (HR = 1.25; CI, 0.93-1.68). CONCLUSIONS: High CRF attenuates the increased risk of pneumonia due to inflammation. These findings have potential implications for the prevention of respiratory infection characterized by systemic inflammation, such as coronavirus disease-2019 (COVID-19).

A Systematic Review and Meta-Analysis of Clinical Characteristics and Outcomes in Patients With Lung Cancer with Coronavirus Disease 2019.

Cancer is considered to be an independent risk factor for severe illness and higher mortality in patients with coronavirus disease 2019 (COVID-19). These adverse outcomes have been suspected to be more severe in patients with lung cancer. The objective of this systematic review and meta-analysis is to outline patient characteristics, challenges in diagnosis and treatment, and outcomes of patients with lung cancer with COVID-19. A comprehensive search was conducted using EMBASE and PubMed databases using the terms "COVID" and "cancer." Studies that reported clinical characteristics or outcomes of patients with lung cancer with COVID-19 were then systematically identified. Meta-analysis for COVID-19 related mortality associated with lung cancer compared with other cancer types was conducted. The results were reported as OR and confidence intervals using the mixed-effects logistic regression model. The most frequently reported clinical findings in patients with lung cancer with COVID-19 were fever and cough, with 68% and 61%, respectively. Laboratory and radiographic findings were consistent with broadly reported data. The meta-analysis noted a statistically significant increase in mortality rate in patients with lung cancer compared with other patients with cancer, with an OR of 1.62 (95% confidence interval: 1.06-2.48). Patients with lung cancer with COVID-19 also reflected greater severity of illness and higher rates of intensive care unit admissions and mechanical ventilation. COVID-19 in patients with lung cancer is associated with severe disease and increased mortality relative to patients with other malignancies and the general population. There is conflicting evidence on the effect of specific lung cancer treatments on outcomes. Until more definitive data is available, lung cancer-directed treatment should be continued or restarted as early as possible in mild to moderate cases to prevent worsening and cancer-related mortality.