Soybean meal (SBM) is extensively used as a predominant protein source in animal feed. However, raw soybean cannot be directly utilized in animal feed, due to the presence of the Kunitz trypsin inhibitor (KTi) and the Bowman-Birk protease inhibitor (BBi). These antinutritional factors inhibit the digestive enzymes in animals, trypsin and chymotrypsin, resulting in poor animal performance. To inactivate the activity of protease inhibitors, SBM is subjected to heat processing, a procedure that can negatively impact the soybean protein quality. Thus, it would be beneficial to develop soybean varieties with little or no trypsin inhibitors. In this study, we report on the creation of experimental soybean lines with significantly reduced levels of Bowman-Birk protease inhibitors. RNA interference (RNAi) technology was employed to generate several transgenic soybean lines. Some of these BBi knockdown soybean lines showed significantly lower amounts of both trypsin and chymotrypsin inhibitor activities. Western blot analysis revealed the complete absence of BBi in selected RNAi-derived lines. RNA sequencing (RNAseq) analysis demonstrated a drastic reduction in the seed-specific expression of BBi genes in the transgenic soybean lines during seed development. Confocal fluorescence immunolabeling studies showed that the accumulation of BBi was drastically diminished in BBi knockdown lines compared to wild-type soybeans. The absence of BBi in the transgenic soybean did not alter the overall protein, oil, and sulfur amino acid content of the seeds compared to wild-type soybeans. The seed protein from the BBi knockdown lines were more rapidly hydrolyzed by trypsin and chymotrypsin compared to the wild type, indicating that the absence of BBi enhances protein digestibility. Our study suggests that these BBi knockdown lines could be a valuable resource in order for plant breeders to incorporate this trait into commercial soybean cultivars, potentially enabling the use of raw soybeans in animal feed.

Urine-based liquid biopsy and exosomes constitute exceptional noninvasive techniques for detecting valuable biomarkers associated with diverse diseases. However, current exosome isolation methods struggle to recover sufficient intact exosomes from a large volume of diluted urine, limiting high detection sensitivity. Here, we present a highly sensitive method for detecting exosome markers using microfluidics-based biologically intact exosome separation technology (BEST), which isolates and enriches exosomes from human urine. Numerical simulations demonstrate that hydrodynamic wall repulsion and suction-driven drag forces segregate 100 nm particles representing exosomes from 8 μm particles, indicating apoptotic bodies or larger particles with complete purity, consistent with experiments. We also show a separation purity of 72.4% for urinary exosomes at a suction flow rate of 95 μL/min. Using concentrated exosomes, PCR and Western blotting sensitivities increase by 4.7 and 4.0-fold, respectively, compared with unprocessed pooled urine. Our methodology possesses considerable potential for future molecular diagnostics, necessitating heightened sensitivity.

Research ObjectivesTo investigate the prevalence of wrist proprioception deficits early after stroke and examine differences across three methods of assessing proprioception.DesignObservational survey comparing criterion standard with two alternative variations.SettingThe California Rehabilitation Institute is an inpatient rehabilitation facility (IRF).ParticipantsConvenience sample of 26 patients who were tested 14±7 days post-stroke.InterventionsNone.Main Outcome Measures[1] Wrist Position Sense Test (WPST), a validated, quantitative measure of wrist proprioception that passively moves the tested wrist to a target position and asks the subject to indicate this position by manipulating a pointer with the untested hand. WPST is the criterion standard for identifying abnormal wrist proprioception. [2] An Active (A-WPST) variant requiring active flexion/extension of the tested wrist to match a target position. [3] A Passive (P-WPST) variant requiring the subject to verbally indicate when a target position has been matched during continuous passive movement. A-WPST and P-WPST increase demands on working memory but do not require vision or use of the untested upper extremity.ResultsWPST error was 18+/-9deg in the more-affected wrist, abnormal in 88% of patients; and 11+/-6deg in the less-affected wrist, abnormal in 73% of patients. Error in the more-affected wrist was higher than the less-affected wrist (p< 0.001). A-WPST and P-WPST scores were approximately one-third lower than standard WPST scores (p< 0.01) but were not significantly different from each other. Standard WPST error correlated with A-WPST error (r=0.627, p< 0.01) and P-WPST error (r=0.543, p< 0.01). A-WPST and P-WPST error correlated with each other (r=0.814, p< 0.001).ConclusionsDeficits in wrist proprioception are common after stroke and may be present bilaterally. WPST variants assess proprioception using different cognitive circuits; error is larger when proprioceptive information must be transferred between hemispheres. Assessment method influences the degree of proprioceptive error appreciated in the early days post-stroke.Author(s) DisclosuresDr. Cramer serves as a consultant for Abbvie, Constant Therapeutics, MicroTransponder, Neurolutions, Panaxium, Elevian, Medtronic, Helius, Omniscient, Brainsgate, and TRCare.

Various species of rhizobium establish compatible symbiotic relationships with soybean (Glycine max) leading to the formation of nitrogen-fixing nodules in roots. The formation of functional nodules is mediated through complex developmental and transcriptional reprogramming that involves the activity of thousands of plant genes. However, host transcriptome that differentiate between functional or non-functional nodules remain largely unexplored. In this study, we investigated differential compatibilities between rhizobium strains (Bradyrhizobium diazoefficiens USDA110 Bradyrhizobium sp. strain LVM105) and cultivated and wild soybeans. The nodulation assays revealed that both USDA110 and LVM105 strains effectively nodulate G. soja but only USDA110 can form symbiotic relationships with Williams 82. LVM105 formed pseudonodules on Williams 82 that consist of a central nodule-like mass that are devoid of any rhizobia. RNA-seq data revealed that USDA110 and LVM105 induce distinct transcriptome programing in functional mature nodules formed on G. soja roots, where genes involved in nucleosome assembly, DNA replication, regulation of cell cycle, and defense responses play key roles. Transcriptome comparison also suggested that activation of genes associated with cell wall biogenesis and organization and defense responses together with downregulation of genes involved in the biosynthesis of isoprenoids and antioxidant stress are associated with the formation of non-functional nodules on Williams 82 roots. Moreover, our analysis implies that increased activity of genes involved in oxygen binding, amino acid transport, and nitrate transport differentiates between fully-developed nodules in cultivated versus wild soybeans.

The type III secretion system (T3SS) is a key factor for the symbiosis between rhizobia and legumes. In this study, we investigated the effect of calcium on the expression and secretion of T3SS effectors (T3Es) in Sinorhizobium fredii NGR234, a broad host range rhizobial strain. We performed RNA-Seq analysis of NGR234 grown in the presence of apigenin, calcium, and apigenin plus calcium and compared it with NGR234 grown in the absence of calcium and apigenin. Calcium treatment resulted in a differential expression of 65 genes, most of which are involved in the transport or metabolism of amino acids and carbohydrates. Calcium had a pronounced effect on the transcription of a gene (NGR_b22780) that encodes a putative transmembrane protein, exhibiting a 17-fold change when compared to NGR234 cells grown in the absence of calcium. Calcium upregulated the expression of several sugar transporters, permeases, aminotransferases, and oxidoreductases. Interestingly, calcium downregulated the expression of nodABC, genes that are required for the synthesis of nod factors. A gene encoding a putative outer membrane protein (OmpW) implicated in antibiotic resistance and membrane integrity was also repressed by calcium. We also observed that calcium reduced the production of nodulation outer proteins (T3Es), especially NopA, the main subunit of the T3SS pilus. Additionally, calcium mediated the cleavage of NopA into two smaller isoforms, which might affect the secretion of other T3Es and the symbiotic establishment. Our findings suggest that calcium regulates the T3SS at a post-transcriptional level and provides new insights into the role of calcium in rhizobia-legume interactions.

In this study, we have examined the feasibility of using elemental sulfur content of soybean seeds as a proxy for the overall sulfur amino acid content of soybean seeds. Earlier, we have identified by high throughput ionomic phenotyping several high and low sulfur containing soybean lines from the USDA Soybean Germplasm Collection. Here, we measured the cysteine and methionine content of select soybean lines by high-performance liquid chromatography. Our results demonstrate that those soybean lines which had high elemental sulfur content also had a higher cysteine and methionine content when compared to soybean lines with low elemental sulfur. SDS-PAGE and immunoblot analysis revealed that the accumulation of Bowman Birk protease inhibitor and lunasin in soybean seeds may only be marginally correlated with the elemental sulfur levels. However, we found a positive correlation between the levels of trypsin and chymotrypsin inhibitor activities and elemental sulfur and sulfur amino acid content of the seeds. Thus, elemental sulfur content and/or protease inhibitor activity measurement can be utilized as a rapid and cost-effective method to predict the overall sulfur amino acid content of soybean seeds. Our findings will benefit breeders in their endeavors to develop soybean cultivars with enhanced sulfur amino acid content.

Background Although transcranial magnetic stimulation (TMS) is the optimal tool for identifying individual motor hotspots for transcranial electrical stimulation (tES), it requires a cumbersome procedure in which patients must visit the hospital each time and rely on expert judgment to determine the motor hotspot. Therefore, in previous study, we proposed electroencephalography (EEG)-based machine learning approach to automatically identify individual motor hotspots. In this study, we proposed an advanced EEG-based motor hotspot identification algorithm using a deep learning model and assessed its clinical feasibility and benefits by applying it to stroke patient EEGs. Methods EEG data were measured from thirty subjects as they performed a simple hand movement task. We utilized the five types of input data depending on the processing levels to assess the signal processing capability of our proposed deep learning model. The motor hotspot locations were estimated using a two-dimensional convolutional neural network (CNN) model. The error distance between the 3D coordinate information of the individual motor hotspots identified by the TMS (ground truth) and EEGs was calculated using the Euclidean distance. Additionally, we confirmed the clinical benefits of our proposed deep-learning algorithm by applying the EEG of stroke patients. Results A mean error distance between the motor hotspot locations identified by TMS and our approach was 2.34 ± 0.19 mm when using raw data from only 9 channels around the motor area. When it was tested on stroke patients, the mean error distance was 1.77 ± 0.15 mm using only 5 channels around the motor area. Conclusion We have demonstrated that an EEG-based deep learning approach can effectively identify the individual motor hotspots. Moreover, we validated the clinical benefits of our algorithm by successfully implementing it in stroke patients. Our algorithm can be used as an alternative to TMS for identifying motor hotspots and maximizing rehabilitation effectiveness. ### Competing Interest Statement GYC, NJP, WSK, and HJH have a patent-pending entitled 'Apparatus and method for detecting individual motor hotspot position based on brainwave using convolutional neural network, and transcranial electrical stimulation apparatus using the same', number 10-2020-0133831, number PCT/KR/2021/002118, and number J10178.0001.

Background Unmet long-term needs and rehabilitation needs are prevalent among stroke survivors and affect their quality of life. We aimed to identify the long-term unmet needs and unmet rehabilitation needs among stroke survivors in South Korea and evaluate their intercorrelations with health-related quality of life. Methods Stroke survivors who were admitted to four Regional Cardiocerebrovascular Disease Centers between January 1, 2015 and December 31, 2019 were telephonically surveyed using a computer-assisted telephone interview method. With the aim of surveying approximately 1,000 patients, 9,204 people were recruited through random sampling. Unmet needs were evaluated on the basis of Longer-term Unmet Needs after Stroke questionnaire items. Quality of life was evaluated using the EuroQoL 5-dimension, 3-level (EQ-5D-3L) questionnaire and the EQ-5D index. Results Among the participants, 93.6% experienced at least one unmet need and 311 (32.6%) reported unmet rehabilitation needs. The number of unmet needs, age, modified Rankin Scale (mRS) score, and previous stroke showed significant negative correlations with the EQ-5D index (p-value < 0.05). The age-adjusted odds ratio (OR) for reporting unmet rehabilitation needs significantly increased with problems in mobility (OR, 4.96; 95% confidence interval [CI], 3.64-6.76), self-care (OR, 4.46; 95% CI, 3.32-5.98), usual activities (OR, 5.78; 95% CI, 4.21-7.93), pain/discomfort (OR, 3.76; 95% CI, 2.76-5.06), anxiety/depression (OR, 3.67; 95% CI, 2.74-4.91), higher mRS score (OR, 3.13; 95% CI, 2.29-4.28), prior hyperlipidemia (OR, 1.35; 95% CI, 1.00-1.81), and number of unmet needs (OR, 1.30; 95% CI, 1.25-1.36). Conclusions Unmet needs were prevalent among stroke survivors and were associated with a lower quality of life and increased odds of reporting unmet rehabilitation needs. Further research is needed to investigate strategies for addressing these subjective unmet needs with the aim of improving the long-term quality of life of stroke survivors. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research was supported by the ?Korea National Institute of Health? Research. (Project No. 2020ER630602) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB No. B-2009-639-302) and Chungbuk National University Hospital (IRB No. 2020-12-014). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The pseudonymized data that support the findings of this study are available from the corresponding author, Pf. Nam-Jong Paik, or the IRB of Seoul National University Bundang Hospital (snubhirb@gmail.com), upon reasonable request, subsequent approval from the local IRB, and completion of a legal data sharing agreement. * CI : Confidence interval EQ-5D-3L : EuroQoL 5-dimension, 3-level LTC : Long-term care LUNS : Longer-term Unmet Needs after Stroke mRS : modified Rankin Scale NDRS : National Disability Registration System NIHSS : National Institutes of Health Stroke Scale OR : Odds ratio QoL : Quality of life RCCVC : Regional Cardiocerebrovascular Disease Center SD : Standard deviation TIA : Transient ischemic attack

Proprioception is critical to motor control and functional status but has received limited study early after stroke. Patients admitted to an inpatient rehabilitation facility for stroke (n = 18, mean(±SD) 12.5 ± 6.6 days from stroke) and older healthy controls (n = 19) completed the Wrist Position Sense Test (WPST), a validated, quantitative measure of wrist proprioception, as well as motor and cognitive testing. Patients were serially tested when available (n = 12, mean 11 days between assessments). In controls, mean(±SD) WPST error was 9.7 ± 3.5° in the dominant wrist and 8.8 ± 3.8° in the nondominant wrist (p = 0.31). In patients with stroke, WPST error was 18.6 ± 9° in the more-affected wrist, with abnormal values present in 88.2%; and 11.5 ± 5.6° in the less-affected wrist, with abnormal values present in 72.2%. Error in the more-affected wrist was higher than in the less-affected wrist (p = 0.003) or in the dominant (p = 0.001) and nondominant (p < 0.001) wrist of controls. Age and BBT performance correlated with dominant hand WPST error in controls. WPST error in either wrist after stroke was not related to age, BBT, MoCA, or Fugl-Meyer scores. WPST error did not significantly change in retested patients. Wrist proprioception deficits are common, bilateral, and persistent in subacute stroke and not explained by cognitive or motor deficits.

Alteration of electroencephalography (EEG) signals during task-specific movement of the impaired limb has been reported as a potential biomarker for the severity of motor impairment and for the prediction of motor recovery in individuals with stroke. When implementing EEG experiments, detailed paradigms and well-organized experiment protocols are required to obtain robust and interpretable results. In this protocol, we illustrate a task-specific paradigm with upper limb movement and methods and techniques needed for the acquisition and analysis of EEG data. The paradigm consists of 1 min of rest followed by 10 trials comprising alternating 5 s and 3 s of resting and task (hand extension)-states, respectively, over 4 sessions. EEG signals were acquired using 32 Ag/AgCl scalp electrodes at a sampling rate of 1,000 Hz. Event-related spectral perturbation analysis associated with limb movement and functional network analyses at the global level in the low-beta (12-20 Hz) frequency band were performed. Representative results showed an alteration of the functional network of low-beta EEG frequency bands during movement of the impaired upper limb, and the altered functional network was associated with the degree of motor impairment in chronic stroke patients. The results demonstrate the feasibility of the experimental paradigm in EEG measurements during upper limb movement in individuals with stroke. Further research using this paradigm is needed to determine the potential value of EEG signals as biomarkers of motor impairment and recovery.

In this paper, we consider the problem of classification of misaligned multivariate functional data. We propose to use a model-based approach for the joint registration and classification of such data. The observed functional inputs are modeled as a functional nonlinear mixed effects model containing a nonlinear functional fixed effect constructed upon warping functions to account for curve alignment, and a nonlinear functional random effects component to address the variability among subjects. The warping functions are also modeled to accommodate common effect within groups and the variability between subjects. Then, a functional logistic regression model defined upon the representation of the aligned curves and scalar inputs is used to account for curve classification. EM-based algorithms are developed to perform maximum likelihood inference of the proposed models. The identifiability of the registration model and the asymptotical properties of the proposed method are established. The performance of the proposed procedure is illustrated via simulation studies and an analysis of a hyoid bone movement data application. The statistical developments proposed in this paper were motivated by the hyoid bone movement study, the methodology is designed and presented generality and can be applied to numerous areas of scientific research.

Background: Proprioception is critical to motor control. The prevalence, severity, and clinical correlates of deficits in wrist proprioception early after stroke have received limited attention and were examined in patients admitted to an inpatient rehabilitation facility (IRF). Methods: Patients admitted for stroke to our IRF (n=18) and older healthy controls (n=12) completed the Wrist Position Sense Test (WPST), a validated, quantitative proprioception measure, as well as motor and cognitive testing. Patients were serially tested when available (n=12). Results: In controls, mean (± SD) WPST error was 9.1 ± 3.6 deg in the dominant wrist and 9.2 ± 4.5 deg in the nondominant wrist. In patients with stroke, WPST error was 18.6 ± 9 deg in the more affected wrist, with abnormal values present in 88.2%; and 11.5 ± 5.6 deg in the less affected wrist, which was abnormal in 55.6% of patients. Error in the more affected wrist was higher than in the less affected wrist (p=0.003), dominant wrist of controls (p=0.001), and nondominant wrist of controls (p=0.003). Retesting in patients a mean of 11 days later found error was not significantly changed (17 ± 7.7 deg in more affected wrist and 15.6 ± 16.3 deg in less affected). Among controls, higher dominant hand WPST error correlated with poorer 9-hole peg (rho=0.75, FDR-corrected p=0.048) and Box & Blocks (r=-0.77, FDR-corrected p=0.048) scores; these relationships were not seen in patients with stroke. WPST error in either hand of patients with stroke was not related to MoCA, NIHSS, or Fugl-Meyer scores. ConclusionS: Deficits in wrist proprioception are common early after stroke, with average error twice that of healthy controls. These differences are not explained by cognitive or motor deficits. Relationships that proprioception has with motor function in healthy subjects are disrupted early after stroke.

Inflammatory demyelinating disease of the CNS (IDD) is a heterogeneous group of autoimmune diseases, and multiple sclerosis is the most common type. Dendritic cells (DCs), major antigen-presenting cells, have been proposed to play a central role in the pathogenesis of IDD. The AXL+SIGLEC6+ DC (ASDC) has been only recently identified in humans and has a high capability of T cell activation. Nevertheless, its contribution to CNS auto-immunity remains still obscure. Here, we aimed to identify the ASDC in diverse sample types from IDD patients and experimental autoimmune encephalomyelitis (EAE). A detailed analysis of DC subpopulations using single-cell transcriptomics for the paired cerebrospinal fluid (CSF) and blood samples of IDD patients (total n = 9) revealed that three subtypes of DCs (ASDCs, ACY3+ DCs, and LAMP3+ DCs) were overrepresented in CSF compared with their paired blood. Among these DCs, ASDCs were also more abundant in CSF of IDD patients than in controls, manifesting poly-adhesional and stimulatory characteristics. In the brain biopsied tissues of IDD patients, obtained at the acute attack of disease, ASDC were also frequently found in close contact with T cells. Lastly, the frequency of ASDC was found to be temporally more abundant in acute attack of disease both in CSF samples of IDD patients and in tissues of EAE, an animal model for CNS autoimmunity. Our analysis suggests that the ASDC might be involved in the pathogenesis of CNS autoimmunity.

The attitude toward telerehabilitation (TR) among therapists (191 physical therapists and 159 occupational therapists) in Korea was surveyed. The survey consisted of 15 questions in the following 8 domains: awareness(AW), attitude (AT), perceived usefulness (PU), perceived behavioral control (PBC), self-efficacy (SE), facilitating conditions (FC), barriers (B), and behavioral intention (BI). Therapists with experience in TR responded with higher scores in all domains except B, regardless of their specialty. The most perceived barriers to TR were unmatched insurance fees and a lack of technical support. Experience with TR was a major factor in attitude and behavior intention toward TR.

Stroke is one of the leading causes of mortality and disability in Korea. Patients who experience stroke require adequate management throughout the acute to subacute and chronic stages. Many patients with long-term functional issues require rehabilitative management even in the chronic stage. A comprehensive rehabilitation and care model for patients who experience stroke is necessary to effectively manage their needs during rehabilitation and allocate medical resources throughout the stages, thus ensuring reduced unmet needs and improved post-stroke quality of life. In Korea, the government and medical specialists are working on re-organizing the rehabilitation care model, including standardized triage and discharge planning after acute stroke treatment, and establishing systematic transitional and long-term rehabilitation care plans. This review briefly introduces the general rehabilitation triage after acute stroke and describes the current transitional and continuous care systems available for these patients in Korea. We also present the issues faced in transitional and long-term care plans of the current system and the efforts invested in resolving them and promoting long-term care in stroke cases.

The salt-soluble globulins, glycinins (11S globulin), and β-conglycinins (7S globulin), are the most abundant seed proteins of soybean seeds. Together, these two groups of proteins account for 60-70% of total soybean seed proteins. Proteomic assessment of the less abundant soybean seed proteins using general isolation protocols is challenging due to the overwhelming abundance of storage proteins. Development of a simple, fast, and inexpensive method to remove most storage proteins from a seed extract will significantly enhance the study of the nonabundant proteins within seeds. We have developed two simple methods for the depletion of abundant seed proteins resulting in the enrichment of low abundance proteins from soybean seeds. Here, we provide a detailed procedure for the isolation, separation, identification, and quantification of low abundance seed proteins of soybean.

Despite the effectiveness of telephone-based interventions for medical adherence and improved blood pressure, studies on the effect of such interventions on physical activity (PA) are needed. Therefore, we investigated the impact of a telephone-based intervention on PA in patients with subacute stroke. This pre-post study included patients who participated in an education program for stroke rehabilitation before being discharged to home, with a modified Rankin scale (mRS) score of ≤ 3. Patients hospitalized in 2020 (intervention group) received a nurse-led telephone-based intervention with a PA measurement once monthly during the 3 months after discharge. Those hospitalized in 2019 (historical controls) only received a PA measurement 3 months after discharge. Physical activity was assessed via a questionnaire by phone. In addition, demographics, medical history, smoking, mRS scores, and Patient Health Questionnaire-9 data were collected. The study included 139 participants (73 in intervention, 66 in control). The intervention group had a higher proportion of patients with mRS of 0-1 and a shorter length of hospital stay than the historical controls. Three months post-discharge, a significantly higher proportion of participants were physically active in the intervention group (48 [71.6%] vs. control group, 25 [34.7%]). In addition, the intervention group had a significantly higher median energy expenditure (924 vs. 297 MET-min/week) than the control group. The OR of the intervention for achieving 'physically active' individuals was 4.749 (95% CI, 2.313-9.752) before and 5.222 (95% CI, 1.892-14.419) after adjusting for possible confounders. A telephone-based intervention improved PA three months after stroke. Further studies with larger sample size and long-term follow-up are needed.

PURPOSE:Depressive symptoms after acute myocardial infarction (AMI) are related with adverse health outcomes. However, the risk factors and course of depressive symptoms after AMI have not been widely investigated, especially in Asian populations. We aimed to evaluate changes in the prevalence of depressive symptoms and the associated risk factors at 3 mo after AMI. We also investigated the associations among functional capacity, physical activity (PA), and depressive symptoms.METHODS:This cross-sectional study was conducted for 1545 patients who were admitted for AMI and referred to cardiac rehabilitation (CR) between August 2015 and March 2019. Of these patients, 626 patients completed the Patient Health Questionnaire-9 (PHQ-9), the Korean Activity Scale Index (KASI), and the International Physical Activity Questionnaire (IPAQ) 3 mo following AMI. A PHQ-9 score of ≥5 was considered to indicate depressive symptoms.RESULTS:The prevalence of depressive symptoms was 30% at baseline and decreased to 12% at 3 mo after AMI. Depressive symptoms were significantly associated with low functional capacity (OR = 2.20, P = .004) and unemployment status (OR = 1.82, P = .023). After adjusting for variables including functional capacity, depressive symptoms exhibited a significant relationship with low PA after AMI (OR = 1.80, P = .023).CONCLUSION:Systematic screening and treatment for depressive symptoms and efforts to promote CR may help to improve PA and functional capacity in Korean patients with AMI. Such efforts may aid in reducing the depressive symptoms and related adverse outcomes.

OBJECTIVE:To investigate the effects of physical activity (PA) and tobacco use on adverse clinical outcomes after revascularisation for peripheral arterial disease (PAD) in the Western Pacific region, where PAD cases and tobacco use are among the highest in the world.METHODS:This was a retrospective cohort study using the Korean National Health Insurance Service (NHIS) database and included patients who had received revascularisation for PAD between 2010 and 2015. They were categorised as active or inactive based on the number of days per week they engaged in PA and as current or non-tobacco users (self report). The primary outcome was all cause mortality. Secondary outcomes included major adverse outcome (a composite of all cause mortality, myocardial infarction, and stroke) and major adverse limb event (MALE, a composite of amputation and recurrent revascularisation).RESULTS:The relatively healthy cohort comprised 8 324 patients (mean age 64.7 years; 76.9% male) following revascularisation for PAD. Among them, 32.7% were inactive and 26.4% were tobacco users. Active patients had better outcomes than inactive patients (all cause mortality adjusted hazard ratio [adjHR] 0.766; 95% CI 0.685 - 0.855, major adverse outcome adjHR 0.795; 95% CI 0.719 - 0.878, MALE adjHR 0.858; 95% CI 0.773 - 0.953). Tobacco users had poorer outcomes than non-users (all cause mortality adjHR 1.279; 95% CI 1.124 - 1.456, major adverse outcome adjHR 1.263; 95% CI 1.124 - 1.418, MALE adjHR 1.291; 95% CI 1.143 - 1.458).CONCLUSION:Even after receiving revascularisation for PAD, a sizable proportion of patients were physically inactive and used tobacco, leading to adverse clinical outcomes such as death, cardiovascular morbidity, and amputation in Korea. These modifiable risk factors should be addressed systematically, and a comprehensive approach including supervised exercise programmes and tobacco cessation is needed in patients with PAD.

Stroke is one of the leading causes of mortality and disability in Korea. Patients who experience stroke require adequate management throughout the acute to subacute and chronic stages. Many patients with long-term functional issues require rehabilitative management even in the chronic stage. A comprehensive rehabilitation and care model for patients who experience stroke is necessary to effectively manage their needs during rehabilitation and allocate medical resources throughout the stages, thus ensuring reduced unmet needs and improved post-stroke quality of life. In Korea, the government and medical specialists are working on re-organizing the rehabilitation care model, including standardized triage and discharge planning after acute stroke treatment, and establishing systematic transitional and long-term rehabilitation care plans. This review briefly introduces the general rehabilitation triage after acute stroke and describes the current transitional and continuous care systems available for these patients in Korea. We also present the issues faced in transitional and long-term care plans of the current system and the efforts invested in resolving them and promoting long-term care in stroke cases.