The International Classification of High-resolution Computed Tomography (HRCT) for Occupational and Environmental Respiratory Diseases (ICOERD) has been developed for the screening, diagnosis, and epidemiological reporting of respiratory diseases caused by occupational hazards. This study aimed to establish a correlation between readings of HRCT (according to the ICOERD) and those of chest radiography (CXR) pneumoconiotic parenchymal opacities (according to the International Labor Organization Classification/International Classification of Radiographs of Pneumoconioses [ILO/ICRP]). Forty-six patients with and 28 controls without mineral dust exposure underwent posterior-anterior CXR and HRCT. We recorded all subjects’ exposure and smoking history. Experts independently read CXRs (using ILO/ICRP). Experts independently assessed HRCT using the ICOERD parenchymal abnormalities grades for well-defined rounded opacities (RO), linear and/or irregular opacities (IR), and emphysema (EM). The correlation between the ICOERD summed grades and ILO/ICRP profusions was evaluated using Spearman’s rank-order correlation. Twenty-three patients had small opacities on CXR. HRCT showed that 21 patients had RO; 20 patients, IR opacities; and 23 patients, EM. The correlation between ILO/ICRP profusions and the ICOERD grades was 0.844 for rounded opacities (p<0.01). ICOERD readings from HRCT scans correlated well with previously validated ILO/ICRP criteria. The ICOERD adequately detects pneumoconiotic micronodules and can be used for the interpretation of pneumoconiosis.

abstract:The 60-film set was developed by experts (expert group) for examining 8 indices: sensitivity (X 1 ) and specificity (X 2 ) for pneumoconiosis, sensitivity(X 3 ) and specificity for (X 4 ) large opacities, sensitivity (X 5 ) and specificity (X 6 ) for pleural plaque, profusion increment consistency for small opacities (X 7 ), and shape differentiation for small opacities (X 8 ) of physicians' reading skills on pneumoconiosis X-ray according to ilO 2000 classification. The aim of this study was to assess the appropriateness of the exam film set for evaluating physicians' reading skills. 29 physicians (a1-group) and 24 physicians (a2-group) attended the 1st and 2nd "asian intensive Reader of Pneumoconioses" (aiR Pneumo) training course, respectively, and 22 physicians (b-group) attended brazilian training course. after training, they took examination of reading 60-film exam set. The examinees' reading results in terms of 8 indices were compared between the examinee groups and the Expert group by parametric unpaired t-test. The Examinee group consisting of a1-group, a2-group and b-group was inferior to the Expert group in all indices. There was no significant difference for X 7 of a1-group, X 7 and X 8 of a2-group (p>0.05) compared with the expert group. There was a significant difference in X 8 at p<0.05 between a1-group and a2-group, in X 3 at p<0.05 between a1-group and b-group, in both X 1 and in X 3 at p<0.05 between a2-group and b-group. accordingly, the 60-film set providing 8 indices designed might be a good method for evaluation of the physicians' reading proficiency at different training settings.

Multifocal small low-signal lesions on T2*-weighted gradient-echo (GE) MRI are reported to be common in the brain of hypertensive patients. We examined factors associated with these lesions. For one year, we routinely obtained T2*-weighted GE images (TR 1000 TE 30 ms, flip angle = 20 degrees) in all adult patients (314) who underwent brain MRI in our hospital, using a 1.5 T superconducting magnet. Patients with multifocal small low-signal lesions with a known or presumed pathogenesis or any condition which may cause intracerebral haemorrhage, such as brain tumours, were excluded from further analysis. Thus, 191 cases remained (104 men and 87 women; age, 62.8+/-11.0 years, range, 30-89 years). The overall prevalence of multifocal small low-signal lesions on the GE images was 15.2% (29/191); they were commonly in the cerebral white matter and basal ganglia. They were detected in 12 (52.2%) of the 23 patients with prior symptomatic brain hemorrhage, 12 (20.7%) of the 58 with prior symptomatic infarcts, and only five (4.5%) of 110 without a prior stroke. Logistic regression analysis indicated that multifocal small low-signal lesions were significantly correlated with a symptomatic acute brain haemorrhage (odds ratio, 13.17), chronic hypertension (4.00) and a symptomatic acute infarct (3.71). The association with symptomatic acute brain haemorrhage suggests that this finding may represent subclinical microhaemorrhage. The diagnostic potential of this finding to identify individuals at risk of symptomatic intracerebral haemorrhage may require further investigation.

e18530 Background: CDPD and lung cancer sometimes occurs simultaneously. COPD has been recognized as an inflammatory disease and may potentially affect biology of the accompanying tumor. It is not fully understood whether presence of CDPD influences clinical characteristics, pathological findings and/or clinical outcomes in patients with ESNSCLC. Methods: Retrospective and consecutive data were collected from the medical records of patients who underwent surgical resections at Kinki-chuo Chest Medical Center, Japan, between January 2009 and December 2010. CDPD status was classified as absence of COPD, stage I and II COPD based on the criteria of Global Initiative for Chronic Obstructive Lung Disease (GOLD). Histology, vascular / lymphatic invasion and the status of epidermal growth factor receptor (EGFR) were determined using the surgical materials. Results: A total of 319 cases was included with median age of 67 (range, 36 - 89). There were 81 cases of relapse and 40 cases of death during the median follow up of 28 months (11 days to 49 months). In the subgroup of non-COPD, stage I and II COPD, the median age, the number of case in gender (male/female), performance status (PS, 0/1), histology (squamous cell carcinoma [SQ] /non SQ), smoking status (never/ever), and EGFR status (wild type/mutant) were 67, 72, 72 (p<0.001) and 105/110, 48/12, 38/6 (p<0.001) and 170/40, 53/7, 27/14 (p=0.029) and 31/184, 12/48, 14/28 (p<0.001) and 89/122, 7/53, 2/39 (p=0.002) and 47/37, 21/3, 9/3 (p=0.013), respectively. No significant difference was observed in disease-free survival (DFS, log-rank p=0.411) and overall survival (OS, log-rank p=0.127) between the patients with and without COPD. In multivariate analysis adjusted for age, gender, PS, histology, smoking status, pathological stage, vascular / lymphatic invasion and EGFR status, presence of COPD did not affect DFS (HR=1.457, p = 0.279) nor OS (HR=0.993, p = 0.990).Conclusions: Although COPD was significantly associated with the elderly, male gender, presence of symptoms, SQ histology, ever smoking, and wild type EGFR, it did not add values of prognostic factors in patients with ESNSCLC.

Background: Although fall predictions using motor ability have been well reported in elderly people, there are few reports on physical cognitive ability. Objective: To examine the relationship of the results of motor function tests that include physical cognitive ability on the ability to predict falls and to determine which test is the most appropriate. Methods: We studied 174 community-dwelling elderly adults (mean age 75.7 ± 5.7, 41 males and 133 females), and measured grip strength, one-leg standing time (OLS), timed up and go test (TUG), functional reach test, sit and reach test, and maximal step length (MSL). The estimation error (EE), which was defined as the difference between the predicted and actual values, was calculated in all motor ability tests. Other assessments included the number of falls in the previous year, BMI, frequency of going out, Mini-Mental State Examination score, and Falls Efficacy Scale. In the baseline study, we divided the subjects into a fall group (n = 33) and a nonfall group (n = 141) and compared motor ability and EE for the two groups. During a 1-year follow-up, the nonfall group (baseline study) was assessed for the same measurements by using the same methods. Results: In the baseline study, the fall group had significantly lower values of OLS and MSL. Furthermore, the fall group significantly overestimated their OLS, TUG, and MSL. In logistic regression analysis, EE of TUG (OR = 1.27) and EE of MSL (OR = 1.08) were detected as risk factors for falls. During follow-up, 11 subjects (7.8%) experienced falls. In logistic regression analysis, TUG (OR = 1.89) and EE of MSL (OR = 1.06) were detected as significant risk factors for falls. Since EE of MSL had higher values of both the area under the receiver operating characteristic curve and the sum of sensitivity and specificity than EE of TUG, the nonfall group was divided into two groups with a cutoff value of 2 cm for EE of MSL. A significant distribution disparity in falls between the two groups was found during follow-up and showed a relative risk of 18.78 for EE of MSL. Conclusions: We suggest that EE of MSL is a potent predictor for falls among healthy elderly adults.

Background: Recent interventional studies have indicated that some exercise programs have beneficial physical and immunological effects for older people. Some evidence suggests that exercise programs involving music and/or a rhythmic movement component may be particularly beneficial. Objective: To assess the effects of a new type of movement music therapy (MMT) on physical, immunological, hormonal and psychosocial health parameters among older adults. Methods: 112 elderly female subjects (average age 73.62 ± 5.50 years) who performed little habitual exercise participated in this randomized, controlled, single-blinded intervention trial. The subjects were divided into two groups which participated in different exercise programs (experimental group: MMT; control group: simple exercise program). We assessed a comprehensive range of indices before and after the interventions, which lasted a total of 8 weeks. These indices included (1) the Philadelphia Geriatric Center morale scale, (2) self-rated health status, (3) physical function tests (e.g. blood pressure, pulmonary function, body balance, gait ability, muscle endurance, muscle-strength, and functional mobility), and (4) saliva analysis for physiological function indices (e.g. secretory immunoglobulin A (SIgA), chromogranin A, cortisol, and total protein). Results: In comparisons between the MMT and control interventions in younger elderly subjects (≤74 years old), systolic blood pressure decreased (p = 0.02), pulmonary function improved (p = 0.05) and body balance improved (p = 0.04) in the MMT group, but not in the control group. The SIgA secretion rate of the experimental group remained significantly elevated (p = 0.02) 15 min after exercise compared with before exercise. There were no significant differences between interventions in psychosocial indices. In contrast, no significant differences were detected between interventions in any measures in the older elderly group(≥75 years old). Conclusion: These results indicate that the MMT, even with a short (8-week) intervention period, improves physical and physiological functions to a significantly greater extent in younger elderly individuals compared with a control intervention without music.

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BackgroundHealth care is generally considered to be more highly valued in urban areas than in rural areas. However, studies have reported that there is no difference in the health care values of urban and rural areas in the Kingdom of Thailand, with some studies even indicating that these values are stronger in rural areas. We, therefore, conducted interviews and implemented a qualitative investigation and analysis aimed at elucidating ideals relating to the medical environment among the Kingdom’s urban and rural citizens.MethodsThe study targeted Thai citizens residing in urban and rural areas. The city of Khon Kaen, located in Khon Kaen Province in northeastern Thailand, was selected as the urban area for the study. We selected Donyang village, located in the same province, as the rural study area. In July 2014, we conducted semi-structured group interviews, applying the Constructivist Grounded Theory (CGT) analytical approach.ResultsWe interviewed ten people in Khon Kaen (the urban area) and seven people from Donyang village (the rural area). Five major and distinctive themes emerged from the interviews. These were: locally appropriate standards of medical care, support for local lifestyles, satisfaction with local medical personnel, healthy lifestyles that do not rely on medical services, and desire for regional autonomy/desire to serve the region in terms of medical care. All of these themes were evident in both study areas. Thus, rather than relying on advanced medical services, both urban and rural Thai citizens expressed the desire to continue living within communities (considered as “families”), contributing to them, and tending to all of their health care needs within their communities.ConclusionsThis study revealed five common themes relating to forms of medical care regarded as ideal among urban and rural citizens of Thailand. Its findings could potentially have important implications for areas characterized by urban–rural inequities relating to the accessibility and utilization of medical services.