【 Objective 】 Preventing exacerbations is an important disease management goal for patients with chronic obstructive pulmonary disease (COPD). Although pulmonary rehabilitation is recommended for preventing COPD exacerbations, frequent outpatient pulmonary rehabilitation is difficult due to social backgrounds. Therefore, in this study, we aimed to evaluate the efficacy of infrequent outpatient pulmonary rehabilitation in preventing COPD exacerbations. 【 Methods 】 This 12 ‐ month retrospective study included patients with COPD who participated in outpatient pulmonary rehabilitation (the pulmonary rehabilitation group) and those who received only outpatient visits (the no ‐ pulmonary rehabilitation group ) . The primary outcomes were the presence of COPD exacerbations, the number of COPD exacerbations, and the number of days to the first exacerbation. Data were collected from medical records. Then, statistical analysis was performed by comparing each item between the two groups. The Kaplan ‐ Meier method and log ‐ rank test were used to compare COPD exacerbations and the number of days to the first COPD exacerbation. 【 Results 】 There were no differences in the number of patients with COPD exacerbations and the primary outcome measures between the groups. However, the number of days to the first COPD exacerbation was significantly longer in the pulmonary rehabilitation group. 【 Discussion 】 Exacerbations were considered to be influenced by the frequency, intensity of exercise, and rehabilitation program. There was no effect on reducing the number of COPD exacerbations or the number of COPD exacerbations. However, it could be that the program promoted active lifestyles and behavioral changes and effectively extended the time to COPD exacerbation.

In the current study, we examined the synergistic effect of IL-17A and TNF-α to contraction of airway smooth muscle cells and its mechanism. In smooth muscles contraction assay, 12hrs incubation both with 10 ng/ml of IL-17A and 10 ng/ml of TNF-α increased ASM contractility synergistically. In western blot, the expressions of RhoA and Rock2 which are key proteins to ASM contraction were increased when ASM cells were treated with IL-17A and TNF-α. Then, we performed qRT-PCR for mRNA of RhoA and Rock2. The mRNA levels of both RhoA and Rock2 were increased when treated with 10 ng/ml of IL-17A and 10 ng/ml of TNF-α for 12 hrs. We speculated IL-17A and TNF-a synergistically stabilized mRNA and confirmed that T-half of mRNA of RhoA and Rock2 were extended when treated with the two cytokines for 1hr. This study indicates that IL-17A and TNF-α enhance ASM contraction synergistically, and suggests that the mechanism is regulation of RhoA and Rock2 mRNA stabilities.

In the current study, we examined the synergistic effect of IL-17A and TNF-α to contraction of airway smooth muscle cells and its mechanism. In smooth muscles contraction assay, 12hrs incubation both with 10 ng/ml of IL-17A and 10 ng/ml of TNF-α increased ASM contractility synergistically. In western blot, the expressions of RhoA and Rock2 which are key proteins to ASM contraction were increased when ASM cells were treated with IL-17A and TNF-α. Then, we performed qRT-PCR for mRNA of RhoA and Rock2. The mRNA levels of both RhoA and Rock2 were increased when treated with 10 ng/ml of IL-17A and 10 ng/ml of TNF-α for 12 hrs. We speculated IL-17A and TNF-a synergistically stabilized mRNA and confirmed that T-half of mRNA of RhoA and Rock2 were extended when treated with the two cytokines for 1hr. This study indicates that IL-17A and TNF-α enhance ASM contraction synergistically, and suggests that the mechanism is regulation of RhoA and Rock2 mRNA stabilities.

[Purpose] Our study aimed to verify the reliability and validity of the translated Mongolian version of the Zarit Caregiver Burden Interview (ZBI). [Participants and Methods] We obtained the basic information of patients and their caregivers when they were hospitalized (Study 1). Subsequently, after the hospital discharged the patients, the caregivers answered the ZBI by telephone during the 4th and 5th weeks (Studies 2 and 3, respectively). To evaluate reliability, we calculated the correlation coefficient, compared the total scores of the ZBI obtained in Studies 2 and 3, and calculated Cronbach's alpha coefficient. To evaluate validity, we calculated the correlation coefficient of the score of item 22 and the sum of the scores of items 1-21. [Results] The correlation coefficient for reliability was high, and the difference between the two studies was insignificant. Cronbach's alpha coefficient was 0.92. The correlation coefficient was high for validity as well. [Conclusion] The Mongolian version of the ZBI has high reliability and validity.

[Purpose] The purpose of this study was to examine the effect of 12-month rehabilitation with low loading program on chronic respiratory disease. [Subjects and Methods] Twelve patients with chronic respiratory disease participated in this study, in which the effect of long-term rehabilitation for 12 months was assessed. Nine patients had chronic obstructive pulmonary disease, two had asthma, and one had interstitial pneumonia. In all patients, symptoms, lower-extremity strength, walking distance, activities of daily living, and quality of life were investigated to examine the effect of respiratory rehabilitation. [Results] After 12 months, the isometric knee extension strength and weight-bearing index both showed a significant increase. [Conclusion] The findings of this study suggested that improvement in lower-limb muscle strength can be achieved through long-term intervention, and indicated the validity of repetitive standing and walking exercises.

[Purpose] This study aimed to clarify the relationship between scapular dyskinesis and shoulder external rotation strength and muscle activity. [Subjects and Methods] Both shoulders of 20 healthy males were evaluated. They were classified into 19 normal, 8 subtly abnormal, and 13 obviously abnormal shoulders using the scapular dyskinesis test. Subtly abnormal shoulders were subsequently excluded from the analysis. Shoulder external rotation strength and muscle activity (infraspinatus, serratus anterior, upper, middle, and lower trapezius) were measured in 2 positions using a handheld dynamometer and surface electromyography while sitting in a chair with shoulder 0° abduction and flexion (1st position), and while lying prone on the elbows with the shoulders elevated in the zero position (zero position). The strength ratio was calculated to quantify the change in strength between the positions (zero position / 1st position). [Results] In the obviously abnormal shoulder group, the strength in the 1st position was significantly stronger, the strength ratio was significantly smaller, and the serratus anterior in the zero position showed significantly lower activity than the normal shoulder group. [Conclusion] In shoulder external rotation in the zero position, in obviously abnormal shoulders, the serratus anterior is poorly recruited, weakening the shoulder external rotation strength.

[Purpose] This study aimed to clarify activation of the infraspinatus and scapular stabilizing muscles during shoulder external rotation at various shoulder elevation angles. [Subjects] Twenty subjects participated in this study and all measurements were performed on the right shoulder. [Methods] Isometric shoulder external rotation strength and surface electromyographic data were measured with the shoulder at 0°, 45°, 90°, and 135° elevation in the scapular plane. The electromyographic data were collected from the infraspinatus, upper trapezius, middle trapezius, lower trapezius, and serratus anterior muscles. These measurements were compared across the various shoulder elevation angles. [Results] The strength measurements did not differ significantly by angulation. The infraspinatus activity was 92%, 75%, 68%, and 57% of the maximum voluntary contraction, which significantly decreased as shoulder elevation increased. The serratus anterior activity was 24%, 48%, 53%, and 62% of the maximum voluntary contraction, which significantly increased as shoulder elevation increased. [Conclusion] Shoulder external rotation torque was maintained regardless of shoulder elevation angle. The shoulder approximated to the zero position as the shoulder elevation increased so that infraspinatus activity decreased and the scapular posterior tilting by the serratus anterior might generate shoulder external rotation torque.

[Purpose] The purpose of this study was to clarify the effect on the range and strength of shoulder rotation of repeated shadow pitching exercise. [Subjects] The subjects were 9 male high-school baseball club pitchers. [Methods] Before and after consecutive normal pitching and shadow pitching, we compared the shoulder internal and external rotation range of motion (ROM) with or without the scapula fixed, shoulder internal and external rotation strength, and subjective fatigue on the throwing side between the two tasks. [Results] Normal pitching and shadow pitching decreased shoulder internal and external rotation strength. However, decrease of shoulder internal rotation ROM was found only in normal pitching, and shadow pitching increased shoulder external rotation. [Conclusion] The results suggest that the contribution of the scapulothoracic joint to shoulder rotation during the pitching motion of shadow pitching is large, possibly decreasing the risk of throwing injury.

[Purpose] The purpose of this study was to determine the effect of various hand position widths during the push-up plus (PUP) exercise on the activity of the scapular stabilizing muscles and other upper-extremity muscles involved in the exercise. [Subjects and Methods] Nine healthy men participated in our study. The PUP exercise was performed on a stable surface in seven different hand positions, namely shoulder width (SW), and narrower SW (NSW) and wider SW (WSW) at 10%, 20%, and 30%. Surface electromyography was used to measure the muscle activities and muscle ratio of the upper trapezius (UT), middle trapezius, lower trapezius (LT), serratus anterior (SA), pectoralis major, deltoid anterior, latissimus dorsi (LD), and triceps muscles. [Results] The SA and LD muscle activities significantly decreased in the 30% NSW and 20% WSW hand positions, respectively. The UT/LT muscle ratio significantly increased in the 30% WSW hand position. [Conclusion] The results of this study suggest that during the PUP exercise, the SW hand position should be used. In the 30% NSW hand position, the SA muscle activity decreased, and the UT/ LT ratio increased in the 30% WSW hand position.

[Introduction] 6-Minute Walk Test (6MWT) is a valuable tool for measuring exercise tolerance in patients with chronic respiratory diseases (CRD). However, severe CRD patients often show marked depression in SpO2 during or after walking that leads to interruption of 6MWT. Therefore we tried to evaluate their exercise tolerance by 30-second Chair-Stand Test (CS-30). CS-30 used to be performed for evaluating physical fitness in elderly who were instructed to stand up and sit down on the chair as fast as possible during a 30-second period. This study is aimed at confirming usefulness of CS-30 as one of safe assessments for exercise tolerance in CRD. [Methods] 33 patients with CRD (18 COPD / 15 IPF. Age73.7±9.6 yrs) performed 6MWT and CS-30. SpO2 was recorded before and after the tests. In COPD, muscle strength of quadriceps was measured by hand-held dynamometer. [Results] Significant correlation between 6-minute walking distance (383.0±99.6m) and frequency of standing-up (13.9±4.4times) was found (p [Conclusion] CS-30 can evaluate exercise tolerance in patients with CRD like 6MWT. This study suggests that CS-30 is a valuable method to evaluate exercise tolerance in CRD patients who show SpO2 depression with exercise.