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Background The Korean Pregnancy Outcome Study (KPOS) was established to investigate the determinants of adverse pregnancy outcomes among Korean women. Methods We recruited 4,537 pregnant women between 2013 and 2017 from two tertiary centers located in Seoul, Korea, and a total of 4,195 Korean women met inclusion criteria in the baseline analysis. A range of data on socio-demographics, past medical histories, reproductive information, health-related behaviors, psychological health and clinical information were obtained using interviewer-based questionnaires and clinical assessment at 12, 24, and 36 gestational weeks (GW), delivery and 6-8 weeks postpartum. Blood samplings were performed at 12, 24 and 36 GW, and placental tissues were obtained after delivery. The main outcome of this study was pregnancy-related complications including gestational diabetes mellitus (GDM), gestational hypertension, and screening positive for peripartum depression. Depression was assessed using the Korean version of the Edinburgh Postnatal Depression Scale, and a score of ≥10 indicated a positive screen for depression. Results Among 4,195 eligible pregnant women with a median age of 33.0 years, 3,565 (85.0%) pregnancy outcomes were available in this study, including 30 miscarriages, 16 stillbirths, and 3,519 deliveries. Mean gestational age was 38.8 GW, and mean birth weight was 3,236 gram. The prevalence of pregnancy complications of GDM, hypertensive disorders, and screening positive of depression during pregnancy and postpartum was 7.0%, 1.4%, 27.8%, and 16.6%, respectively. Conclusions We designed KPOS to identify the determinants of pregnancy-related outcomes, and it may provide effective strategies for the prevention of pregnancy complications in Korean pregnant women.

Aims and objectives This study aimed to compare anxiety, resilience, and depression between COVID‐19 unit (confirmed patients and suspected patients) and non‐COVID‐19 unit nurses and assess their effects on depression. Background Nurses working during the global pandemic are known to be physically and psychologically exhausted, and experience severe anxiety and depression. However, there is a lack of studies comparing anxiety and depression between COVID‐19 and non‐COVID‐19 unit nurses. Design Descriptive research study. Methods This study was conducted on 64 nurses who directly worked for more than a month in a COVID‐19 unit of a general hospital with nationally designated negative‐pressure isolation beds and 64 nurses working in a non‐COVID‐19 unit. Data were collected through questionnaires and were analysed using SPSS 25.0. Reporting of this research adheres to the STROBE guidelines. Results Anxiety and depression were significantly higher in nurses working with patients suspected to have COVID‐19 rather than nurses working with confirmed COVID‐19 patients and non‐COVID‐19 patients. Resilience was significantly lower in suspected patient unit nurses than in COVID‐19 unit nurses. Anxiety was the major factor predicting depression in both COVID‐19 unit (confirmed patients and suspected patients) and non‐COVID‐19 unit nurses with 76.6%, 80.7%, and 63.6% explanatory power, respectively. Conclusions Among nurses working in COVID‐19 units, suspected patients unit nurses had higher depression than confirmed patients unit nurses due to an unsafe facility environment, insufficient personal protective equipment, and unknown conditions of the patients. Thus, interventions which have a high impact on depression need to be provided to relieve anxiety. Relevance to clinical practice The nursing organisation must provide comprehensive support including coordinated shifts, internal motivation, incentives, up‐to‐date information, and clear infection prevention guidelines to relieve anxiety caused by exhaustive workload, uncertainty of infectious diseases, and lack of human and material resources.

OBJECTIVE To determine the association between insufficient sleep in the prenatal period and postpartum depression (PPD), and whether changes in sleep patterns during pregnancy increase the risk of PPD. METHODS A prospective cohort study was conducted between March 2013 and November 2017. Participants completed a sleep questionnaire pre-pregnancy and at 12, 24 and 36 gestational weeks (GW). Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS) at 4 weeks postpartum, and the cut-off score for PPD was 10 or more. RESULTS Of 2512 participants, 410 (16.3%) were identified as having PPD. Only insufficient sleep at 36 GW was significantly associated with PPD after adjusting for confounding factors (odds ratio 1.79, 95% confidence interval 1.40-2.27, P

Objective:This study aims to explore factors associated with the work intention of hospital workers in the early stages of the coronavirus disease (COVID-19) outbreak in South Korea.Methods:An online self-reported survey was conducted in a tertiary hospital. Respondents were asked to report their perceived threat and perceived risk of infection, evaluation of hospital response, demographics, and job-related factors. Descriptive statistics and multivariate regression analyses were performed.Results:A total of 441 employees participated in this study. Of respondents, 60% were willing to accept their work during an infectious disease outbreak and 12.5% were unwilling to accept the work. In addition, 8% of respondents reported that they had considered quitting their job, 54.4% reported that their job was dangerous, and 50.1% of respondents perceived the severity of COVID-19 as high. Perceived threat and effectiveness of hospital response were associated with hospital employees’ intention to work.Conclusions:Hospital workers are at the front line of the COVID-19 outbreak. This study highlighted hospital workers’ perceived effectiveness of organizational response to the outbreak, and perceived threats were found to be important factors for whether they continued to work or not in the fight against the outbreak.

This study aimed to investigate the effects of the luting methods on the amount of cement remnants in implant restorations and to determine the restoration surface with the maximum amount of residual cement. Forty abutments and crowns were divided into 4 groups as follows: TB group, luting with zinc oxide-eugenol cement; TBV group, luting with zinc oxide-eugenol cement after application of a separating agent over the transmucosal area of the abutment; PI group, luting with methacrylate cement; and PIV group, luting with methacrylate cement after application of a separating agent. After cementation, all the quadrants of the specimens were photographed, and the amount and location of the cement remnants were statistically analyzed (P ≤ .05). The amount of cement remnants was significantly smaller in the groups with a separating agent. The type of luting material did not significantly affect the results. Cement remnants were more abundant on the mesial and distal sides than on the buccal and lingual sides of the restoration.

Negative symptoms are recognized as a fundamental feature of schizophrenia throughout the disease course. Epigenetic alterations in the oxytocin receptor gene (OXTR) may be a key mechanism involved in social-emotional disturbances of schizophrenia. Here, we investigated OXTR methylation and its association with clinical and brain network connectivity phenotypes of negative symptoms, particularly anhedonia-asociality, in individuals with recent-onset schizophrenia (ROS) and at ultrahigh risk (UHR) for psychosis. Sixty-four ROS (39 women), 46 UHR (19 women), and 98 healthy individuals (52 women) participated in this study. OXTR methylation was quantified using the pyrosequencing method. A subset of participants (16 ROS, 23 UHR, and 33 healthy controls [HCs]) underwent a 5.5-minute resting-state functional magnetic resonance imaging to determine the relationship between OXTR methylation and the striatal-amygdala network functional connectivity (FC) underlying anhedonia-asociality. Both men and women with ROS and UHR showed significantly decreased OXTR methylation compared to HCs. In women with ROS and UHR, decreased OXTR methylation showed a significant correlation with increased anhedonia-asociality. FC of the striatal-amygdala network, positively associated with the severity of anhedonia-asociality, showed an inverse correlation with OXTR methylation. This study suggests that epigenetic alterations of OXTR, which can be detected before the development of full-blown psychosis, confer susceptibility to schizophrenia and play a crucial role in the manifestation of anhedonia-asociality, particularly in women.

The perovskite solar cell (PSC) is a rapidly advancing solar technology with high efficiencies and low production costs. However, as the PSC contains methylammonium lead iodide (CH3NH3PbI3, MAPbI3) in the light-harvesting active layer, addressing the safety issue of PSCs is an important prerequisite for its commercialization. In this study, the potential hazards of the PSC were investigated with consideration of Pb species released from PSC using an ecotoxicity, cytotoxicity, chronic toxicity, and genotoxicity battery assay. PSC and its degradation products can cause significant toxicity, with PSC being more toxic than the individual degradation products. The order of ecotoxicity and cytotoxicity was found to be Pb2+ > PSC > PbI2 = PbO. Aquatic toxicity of PSC and its degradation products was suggested by Daphnia magna acute, chronic, and genotoxicity results. The current study highlights the non-negligible hazard potentialities of the PSC and its degradation products, as evidenced by our ecotoxicity and cytotoxicity battery assay. Our study indicates that great caution should be taken in the mass production of PSCs and could facilitate proper risk assessment. Based on our study, some considerations on the implementation of the “safe-by-design (SbD)” approach for the sustainable development of PSC technology can be formulated.

PURPOSE To evaluate the association between low handgrip strength and type of dental prosthesis used in Korean adults in a cross-sectional study of nationally representative big data. MATERIALS AND METHODS This study included 7,681 participants aged ≥ 19 years who were classified into the following four groups: NP (not using a dental prosthesis); FDP (using tooth-supported or implant-supported fixed dental prostheses); RPD (using removable partial dentures); and CD (using removable complete dentures). Low handgrip strength was defined as the lowest quartile of handgrip strength in each sex. The relationship between handgrip strength and dental prosthesis use was analyzed with adjustment for potential confounders. Multivariate logistic regression analyses were performed to examine the association between the use of dental prostheses and low handgrip strength (α = .05). RESULTS The handgrip strength level of RPD users was significantly lower than those not using removable dentures (P < .0001). The respective adjusted odds ratios (with 95% CI) for low handgrip strength in the NP, FDP, RPD, and CD groups were 1 (reference), 0.90 (0.77, 1.05), 1.44 (1.13, 1.83), and 1.70 (1.29, 2.23) after adjustment for confounding factors. Using removable partial and/or complete dentures was associated with a 1.64-fold higher risk of low handgrip strength compared to not using removable dental prostheses. CONCLUSIONS The use of removable dentures was associated with low handgrip strength and may be considered a potential risk indicator for functional decline in Korean adults.

The present study was designed to compare the stress distributions in two restoration types of implants and the surrounding bone. The first restoration type was a conventional cement-retained zirconia crown, and the second was a novel cementless screw-retained zirconia crown with a base abutment. A three-dimensional finite element method was used to model the implants, restorations, and supporting bone. A comparative study of the two implants was performed under two masticatory loads: a vertical load of 100 N and a 30-degree oblique load of 100 N. Under both loading conditions, the maximum von Mises stress and strain values in the implant and supporting bone were higher in the conventional cement-retained restoration model than in the cementless screw-retained model. In terms of stress distribution, the cementless screw-retained zirconia crown with base abutment may be considered a superior restoration option compared to the conventional cement-retained zirconia crown.

The immune system plays an important role in maintaining body homeostasis. Recent studies on the immune-enhancing effects of ginseng saponins have revealed more diverse mechanisms of action. Maillard reaction that occurs during the manufacturing processes of red ginseng produces a large amount of Amadori rearrangement compounds (ARCs), such as arginyl-fructose (AF). The antioxidant and anti-hyperglycemic effects of AF have been reported. However, the possible immune enhancing effects of non-saponin ginseng compounds, such as AF, have not been investigated. In this study the effects of AF and AF-enriched natural product (Ginofos, GF) on proliferation of normal mouse splenocytes were evaluated in vitro and male BALB/c mice models. The proliferation of splenocytes treated with mitogens (concanavalin A, lipopolysaccharide) were further increased by addition of AF (p &lt, 0.01) or GF (p &lt, 0.01), in a dose dependent manner. After the 10 days of oral administration of compounds, changes in weights of spleen and thymus, serum immunoglobulin, and expression of cytokines were measured as biomarkers of immune-enhancing potential in male BALB/c mice model. The AF or GF treated groups had higher weights of the thymus (0.94 ± 0.25 and 0.86 ± 0.18, p &lt, 0.05, respectively) than that of cyclophosphamide treated group (0.59 ± 0.18). This result indicates that AF or AF-enriched extract (GF) increased humoral immunity against CY-induced immunosuppression. In addition, immunoglobulin contents and expression of cytokines including IgM (p &lt, 0.01), IgG (p &lt, 0.05), IL-2 (p &lt, 0.01), IL-4 (p &lt, 0.01), IL-6 (p &lt, 0.01), and IFN-γ (p &lt, 0.05) were also significantly increased by supplementation of AF or GF. These results indicate that AF has immune enhancing effects by activation of adaptive immunity via increase of expression of immunoglobulins and cytokines such as IgM, IgG, IL-2, IL-4, IL-6 and thereby proliferating the weight of thymus. Our findings provide a pharmacological rationale for AF-enriched natural products such as ginseng and red ginseng that can possibly have immune-enhancement potential and should be further evaluated.

This study examined the prevalence of self-perceived chewing discomfort depending on the type of dental prosthesis used in South Korean adults. The subjects were 12,802 people over 20 years of age who participated in a health interview and dental examination. Chewing discomfort was examined using a self-assessed report with a structured questionnaire. Using multivariable logistic regression analysis, adjusted odds ratios were evaluated along with their 95% confidence intervals (&alpha, = 0.05). After adjusting for covariates, including age, gender, smoking, drinking, hypertension, diabetes, body mass index, education, income, and toothbrushing frequency, the odds ratios (95% confidence intervals) for chewing discomfort in groups without a dental prosthesis, with fixed dental prostheses, with removable partial dentures, and with removable complete dentures were 1 (reference), 1.363 (1.213&ndash, 1.532), 2.275 (1.879&ndash, 2.753), and 2.483 (1.929&ndash, 3.197), respectively. The association between the prevalence of chewing discomfort and the type of dental prosthesis used was statistically significant even after adjusting for various confounders (p &lt, 0.0001). The type of dental prosthesis was related to chewing discomfort among South Korean adults.

Aim We aimed to identify a key molecule that maintains periodontal tissue homeostasis during biophysical force-induced tooth movement (BTM) by orchestrating alveolar bone (AB) remodelling. Materials and methods Differential display-PCR was performed to identify key molecules for BTM in rats. To investigate the localization and expression of the identified molecules, immunofluorescence, real-time RT-PCR and Western blotting were performed in rats and human periodontal ligament (PDL) cells. Functional test and micro-CT analysis were performed to examine the in vivo effects of the identified molecules on BTM. Results Secretory leucocyte peptidase inhibitor (SLPI) in the PDL was revealed as a key molecule for BTM-induced AB remodelling. SLPI was enhanced in the PDL under both compression and tension, and downregulated by an adenyl cyclases inhibitor. SLPI induced osteoblastogenic genes including runt-related transcription factor 2 (Runx2) and synergistically augmented tension-induced Runx2 expression. SLPI augmented mineralization in PDL cells. SLPI induced osteoclastogenic genes including receptor activator of nuclear factor kappa-Β ligand (RANKL) and synergistically augmented the compression-induced RANKL and macrophage colony-stimulating factor (MCSF) expression. Finally, the in vivo SLPI application into the AB significantly augmented BTM. Conclusions SLPI or its inhibitors might serve as a biological target molecule for therapeutic interventions to modulate BTM.

Background Patients with schizophrenia and individuals at ultra-high risk for psychosis (UHR) have been reported to exhibit impaired recognition of facial emotion expressions. This impairment has involved both inaccuracy and negative bias of facial emotion recognition. The present study aimed to investigate whether UHR individuals display both types of impaired facial emotion recognition and to explore correlations between these impairments and schizotypy, as well as paranoia levels, in these individuals. Methods A total of 43 UHR individuals and 57 healthy controls (HC) completed a facial emotion recognition task consisting of 60 standardized facial photographs. To explore correlations, we assessed schizotypy using the Revised Physical Anhedonia Scale and Magical Ideation Scale and paranoia level using the Paranoia Scale and persecution/suspicious item of the Positive and Negative Syndrome Scale in UHR individuals. Results Compared with HC, UHR individuals exhibited less accuracy for facial emotion recognition (70.6% vs. 75.6%, p=0.010) and a higher rate of "fear" responses for neutral faces (14.5% vs. 6.0%, p=0.003). In UHR individuals, inaccuracy was significantly correlated with schizotypy scores, but not with paranoia level. Conversely, "disgust" response for neutral faces was the only fear response correlated with paranoia level, and no threat-related emotion response correlated with schizotypy scores. Discussion UHR individuals exhibited inaccuracy and negative bias of facial emotion recognition. Furthermore, schizotypy scores were associated with inaccuracy but not with negative bias of facial emotion recognition. Paranoia level was correlated with "disgust" responses for neutral faces but not with inaccuracy. These findings suggest that inaccuracy and negative bias of facial emotion recognition reflect different underlying processes, and that inaccuracy may be a vulnerability marker for schizophrenia.

Objective: This cross-sectional study investigated the relationship between handgrip strength and oral health behaviours among Koreans.Methods: The data of 7589 individuals (3384 men and 4205 women...

Maladaptive coping may play an important role in the manifestation of symptoms, functioning, and overt psychosis onset in individuals at ultra-high risk (UHR) for psychosis. To determine the factors associated with coping strategies, the relationships between cognitive appraisals and coping styles were investigated in UHR individuals. Sixty-five UHR individuals and 83 healthy controls were assessed for coping styles and cognitive appraisals of attribution bias as a primary appraisal and self-efficacy and perceived social support as a secondary appraisal. UHR participants relied more on a passive, tension-reduction coping style and less on an active, problem-focused coping style. These maladaptive coping styles in UHR individuals were significantly associated with their cognitive appraisals of stress. Aberrant attribution style of hostility perception and composite blaming bias were associated with problem-focused coping and tension-reduction, respectively. Perceived social support was related to problem-focused coping, seeking social support, and wishful thinking. General self-efficacy was associated with problem-focused coping. Our findings suggest that cognitive appraisals themselves may be the major determinants of coping styles in UHR individuals. The identified attribution styles, perceived social support, and self-efficacy may provide some clues regarding specialized interventions for the buildup of adaptive coping strategies in UHR individuals.

Aim To improve strategies for the early identification of individuals at a heightened risk for the development of psychosis, we investigated the relationships and interactions between 3 psychosis-proneness dimensions for the development of schizophrenia spectrum psychosis: schizotypy, basic symptoms and the ultra-high risk (UHR) criteria. Methods Seventy-seven UHR individuals and 79 healthy controls were assessed for schizotypy and basic symptoms using self-report questionnaires at baseline. UHR participants were monthly assessed for conversion to psychosis over a mean period of 25.8 months. Results Sixteen UHR participants (20.8%) converted to schizophrenia spectrum psychosis. In stepwise Cox regression, the interaction between basic symptoms and physical anhedonia was selected as a sole predictor of conversion in UHR participants, whereby the self-reported number of the 8 basic symptoms significantly increased the risk for conversion in those with pronounced physical anhedonia. Conclusion Our findings suggest that questionnaire-assessed basic symptoms, irrespective of their predictive validity, may predict a psychotic breakdown in pre-identified UHR individuals who are with genetic vulnerability to schizophrenia. Including all 3 psychosis-proneness dimensions into prediction models might help establish a more valid pathogenetic model of schizophrenia, and moreover, may provide some clues about course alteration strategies in hopes of preventing UHR individuals from converting to psychosis.

Objective: The purpose of this study was to investigate the effect of visual block with ankle joint fatigue on gait and dynamic balance ability. Design: Cross-sectional study. Methods: Thirty healthy young adults (men=15, women=15) between 22 to 25 years of age voluntarily participated in this study. All subjects performed the gait and dynamic balance test successively in two conditions: the visual block and the open eyes condition. Before the gait and dynamic balance test, muscle fatigue on the ankle joint was induced to all subjects by doing ankle dorsiflexion and plantarflexion alternately, and then gait parameters (step length, stride length, cadence, velocity, single limb support, and double limb support) were assessed by walking on the GAITRite system (CIR Systems Inc., USA). Subjects also performed the functional reach test (FRT) for assessment of dynamic balance. This study examined gait parameters and FRT scores in each visual block and open eyes condition. Results: The results showed that FRT scores with the visual block condition significantly decreased compared to without visual blocking (p

Recent studies have indicated a potential correlation between rheumatoid arthritis (RA) and periodontal inflammation. We undertook this study to verify whether RA mediates periodontitis-like phenotypes in experimental mouse models of RA and to explore the role of nicotinamide phosphoribosyltransferase (NAMPT) in periodontal inflammation during RA pathogenesis. Periodontal inflammation and alveolar bone loss have been reported in mice with collagen-induced arthritis (CIA) and in genetically modified tumor necrosis factor–α (TNF-α) transgenic (TG) mouse models. Among the adipokines examined in our study, NAMPT expression was markedly upregulated in the periodontal ligament (PDL) tissues in RA mouse models and in human PDL cells stimulated by the proinflammatory cytokines, interleukin (IL) 1β and TNF-α. When NAMPT was overexpressed with the Nampt-synthesizing adenovirus vector (Ad- Nampt), the PDL cells exhibited an increased expression of cytokines (IL6), chemokines (IL8 and chemokine [C-C motif] ligand 5 [CCL5]), inflammatory mediators (cyclooxygenase 2 [COX-2]), and matrix-degrading enzymes (matrix metalloproteinase [MMP] 1 and MMP3). Inhibition of NAMPT by the intracellular NAMPT (iNAMPT) inhibitor, FK866, or by the sirtuin inhibitor, nicotinamide, in PDL cells led to inhibition of the IL1β or Ad- Nampt–induced upregulation of catabolic factors, whereas treatment with recombinant NAMPT protein or blockade of extracellular NAMPT (eNAMPT) with blocking antibody did not. Moreover, NAMPT inhibition by the intraperitoneal or intragingival injection of FK866 in CIA mice inhibited periodontal tissue damage, under conditions of RA. Thus, our results verified the co-occurrence of RA and periodontal inflammation using experimental mouse models of RA, suggesting that iNAMPT in PDL cells plays a pivotal role in the pathogenesis of RA-mediated periodontal inflammation by regulating the expression levels of catabolic genes, such as IL6, IL8, CCL5, COX-2, MMP1, and MMP3.

Supraclavicular (SC) and infraclavicular (IC) brachial plexus block (BPB) are commonly used for upper extremity surgery. Recent clinical studies have compared the effect of SC- and IC-BPB, but there have been controversies over spread of sensory blockade in each of the 4 peripheral nerve branches of brachial plexus.This study included a systemic review, using the Medline and EMBASE database from their inceptions through March 2016. Randomized controlled trials (RCTs) comparing SC- and IC-BPB were included. The prespecified primary outcome was the incidences of incomplete sensory blockade in each of the 4 terminal nerve branches of brachial plexus. Secondary outcome included the incidence of successful blockade, performance time, onset of sensory block, duration of analgesia, and complication rates.Ten RCTs involving 676 patients were included. Pooled analyses showed the incidence of incomplete block at 30 minutes in radial nerve territory was significantly higher in IC-BPB, favoring SC-BPB (risk ratio 0.39; 95% confidence interval [0.17-0.88], P = .02, I = 0%). However, subgroup analysis according to the number of injections of IC-BPB showed that double or triple injections IC-BPB yielded no difference in the incomplete radial block. Furthermore, the incidence of incomplete ulnar block at 30 minutes was significantly lower in IC-BPB when using double or triple injection IC-BPB. There was no difference in the secondary outcomes between SC- and IC-BPB groups, with the exception of complication rates. The incidence of paresthesia/pain on local anesthetic injection, phrenic nerve palsy, and Horner syndrome was significantly higher in the SC group, favoring IC-BPB.This meta-analysis demonstrated that IC-BPB showed a significantly high incidence of incomplete radial nerve sensory block at 30 minutes, which may be avoided by double or triple injection. Furthermore, IC-BPB with multiple injection technique showed significantly lower incidence of incomplete ulnar block than SC-BPB. There were no differences in the incidence of successful blockade, block onset, and duration of analgesia between SC- and IC-BPB. Procedure-related paresthesia/pain and adjacent nerve-related complications were more frequent in SC-BPB. However, because of the small sample size, publication bias remains a concern when interpreting our results. Further studies with sufficient sample size and reporting large number of outcomes are required.

Cymbidium is one of the most important genera of flowering plants in the Orchidaceae family, and comprises a wide variety of beautiful and colorful species. Among these, only a few species possess floral scents and flavors. In order to increase the availability of a new Cymbidum hybrid, &ldquo, Sunny Bell&rdquo, this study investigated the volatile floral scents. Volatiles of the floral organs of the new Cymbidium hybrid, &ldquo, at the full-flowering stage were characterized with headspace solid-phase microextraction gas chromatography-mass spectrometry (HS-SPME-GC-MS) analysis. A divinylbenzene-carboxen-polydimethylsiloxane (DVB-CAR-PDMS) fiber gave the best extraction for volatile components. Twenty-three components were identified as the main volatiles for the floral organs of the new Cymbidium hybrid, &ldquo, at the full-flowering stage, twelve compounds in the column, sixteen compounds in the labellum, eleven compounds in the sepals, and nine compounds in the petals were identified. Terpenes are the major source of floral scents in this plant. As a result of GC-MS analysis, the most abundant compound was linalool (69&ndash, 80%) followed by &alpha, pinene (3&ndash, 27%), 4,8-dimethyl-1,3,7-nonatriene (5&ndash, 18%), eucalyptol (6&ndash, 16%), and 2,6-dimethylnonane (2&ndash, 16%). The main components were identified as monoterpenes in the petals and sepals, and as monoterpenes and aliphatics in the column and labellum. The results of this study provide a basis for breeding Cymbidium cultivars which exhibit desirable floral scents.

Background: Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently. Individuals at ultra-high risk (UHR) for psychosis already present poor social functioning; among those individuals, the conversion rate from the putative prodromal phase to overt psychosis is 20%–30% within 1–2 years. Here, we analyzed the factor structure of self-related variables and neuro- and socio-cognitive function, and investigated whether these factors were associated with psychosocial function and prognostic outcome in individuals with recent-onset schizophrenia (ROSPR) or at UHR for psychosis. Methods: We evaluated 60 individuals at UHR for psychosis, 47 individuals with ROSPR, and 71 healthy controls using a comprehensive neurocognitive test battery and self-reported attribution scales, self-esteem, resilience, aberrant subjective experiences of schizotypy (physical anhedonia, social anhedonia, magical ideation, and perceptual aberration), and basic symptoms. We assessed psychosocial function with the Quality of Life Scale (QLS). Results: Factor analysis of all subjects revealed a four-factor structure comprising social-cognitive bias, reflective self, neurocognition, and pre-reflective self factors. Multiple regression analysis at baseline revealed that the factor structure predicted QLS. In the UHR group, social-cognitive bias, reflective self, neurocognition, and negative symptoms were significant determinants, explaining 38.0% of total QLS score variance. In the ROSPR group, reflective self and negative symptoms were significant determinants, explaining 54.4% of total QLS score variance. During follow-up, 13 individuals at UHR for psychosis developed psychosis (cumulative prevalence: 31.2% ± 7.6% at 6 years), with neurocognition score at baseline remaining a significant predictor of conversion [χ2(1) = 4.009, p = 0.045; hazard ratio 0.56, 95% confidence interval 0.31–0.99, p = 0.048]. Five patients with schizophrenia were (re)admitted during follow-up (cumulative prevalence: 16.1% ± 7.1% at 6 years); no factor was found to predict (re)admission. Conclusion: Factor analysis revealed an intrinsic four-factor structure of social-cognitive bias, reflective self, neurocognition, and pre-reflective self. The four factors were associated with social functioning at baseline and prodrome-to-psychosis conversion during follow-up, indicating the clinical significance of the four-factor structure. These findings provide a framework for understanding schizophrenia.

For patients with systemic diseases who face difficulties visiting dental clinics, wearing fixed partial denture in the anterior region on the same day of tooth extraction can reduce the total period of treatment and the number of visits, as well as post-treatment psychological effect on the patient.

Objective: The arm swing is associated with gait ability in healthy young adults. The purpose of this study was to examine the effects of arm swing during gait in healthy young adults. Design: Cross-sectional study. Methods: Forty-five subjects without any orthopedic or neurological injuries participated in this study. All subjects performed all three conditions according to the arm swing type as follows: first procedure (condition 1), walking as usual without arm swing constraint; second procedure (condition 2), constraint of dominant arm swing walking as usual; third procedure (condition 3), constraint of both arm swing walking as usual. Gait parameters such as gait velocity, stride length, cadence, step time, single limb support, and double limb support were measured in all arm swing conditions performed randomly, with the mean value obtained from three measurements. A rest period of 5 minutes was given to prevent repetition of each condition and learning effect. All data was analyzed using repeated measures ANOVA to notice the changes between arm swing conditions. Results: Within walking conditions, significant difference of gait velocity, stride length, cadence, and double limb support was noticed (p

Background: Smoking causes a deterioration of pulmonary function and affects hemoglobin levels. However, no studies have investigated the relationship between pulmonary function and anemia and hemoglobin levels in non-smokers. Therefore, this study aimed to investigate the abovementioned relationship. Methods: This study used data from the 6th Korea National Health and Nutrition Examination Survey conducted from 2013 to 2015. Among the 2,886 people who underwent pulmonary function tests (PFTs), smokers and those who had pulmonary diseases, such as pulmonary tuberculosis, asthma, lung cancer, and chronic obstructive pulmonary disease, were excluded. Finally, 487 participants were included in this analysis. PFT components such as forced vital capacity (FVC), forced expiratory volume 1 second (FEV1), FEV1/FVC, forced expiratory flow between 25% and 75% (FEF 25%75%), and peak expiratory flow rate (PEFR) were dependent variables, while anemia and hemoglobin level were independent variables. Multivariate regression analysis was performed to adjust for age, height, body weight, days of walking per week, and amount of vigorous exercise in male and female participants. Results: Among the PFT components, FVC had a negative effect on anemia in male participants; none of the other components had any association with anemia. None of the components had any significant influence in female participants. Moreover, the PFT components had no significant effect on the hemoglobin levels in both male and female participants. Conclusion: There is no clear association between the pulmonary function of healthy non-smokers and anemia or hemoglobin levels.

Objective: This study was aimed to compare the thickness and pennation angle of gastrocnemius through ultrasonography during the heel-drop exercise on ankle dorsiflexion angle. Design: Cross-sectional study. Methods: Nineteen normal adults in their 20s had voluntarily participated in this study. All subjects performed the ankle heel-drop exercise with ankle dorsiflexed to 0°, 10°, and 20°: heel-drop exercise with ankle dorsiflexed to 0° was executed on floor-level, heel-drop exercise with ankle dorsiflexed to 10° on a wooden-block of 2.3 cm in height, and heel-drop exercise with ankle dorsiflexed to 20° on a wooden-block of 5.5 cm in height. In each regimen, the subjects completed a session of 100 heel-drop exercises (10 repetitions×10 sets; with 30 seconds rest following each set; with 24 hours rest following each exercise). Before and immediately after each heel-drop exercise, the thickness and pennation angle of gastrocnemius were measured using an ultrasonography. Results: After the performance of the heel drop exercises with ankle dorsiflexed to 0°, 10°, and 20°, the thickness of the gastrocnemius was significantly higher than pre-exercise (p

Purpose: The purpose of this prospective study was to assess the change of marginal bone level around three different types of external-hex implants after 5 years using radiography. Materials and Methods: Included in this study were 54 patients randomly put into three different groups; rough-surface implants (Branemark), machined coronal aspect implants (Restore), and microthreaded coronal aspect implants (Hexplant). Clinical and radiographic assessments were performed contemporaneously with implant loading (baseline) and at 1, 3, and 5 years post-functional loading. A mixed-model analysis was employed to examine mean marginal bone change significance in the three treatment groups. Results: In a total of 31 out of 54 patients, 81 of 135 implants remained to the end of the study. At 5 years, the microthreaded coronal aspect implants had 0.61 ± 0.32 mm mean crestal bone loss; the rough-surface implants without microthread, 0.99 ± 0.38 mm; and the machined coronal aspect implants, 1.06 ± 0.39 mm. The rough-surface implants and the machined coronal aspect implants did not exhibit statistically significantly different marginal bone loss, whereas the microthreaded coronal aspect implants exhibited significantly less marginal bone loss (P = .0015). Conclusion: In this research, rough-surface implants with microthreads showed positive long-term effects in preserving peri-implant bone level against functional loads when compared with implants lacking these aspects at the coronal part. Most of the bone loss was shown within 1 year of loading, and all types of implants stabilized after 1 year.

Objective: The purpose of this study was to examine the effect on multifidus and external oblique abdominis muscle activation during hip contraction of three types (concentric, isometric, eccentric) in standing position. Design: Cross-sectional study. Methods: Twenty healthy adult men volunteered to participate in this study. Muscle activation was recorded from gluteus maximus, both multifidus, and both external oblique abdominis by surface electromyography (EMG) while holding position in the type of gluteus maximus contraction. EMG values were normalized by maximum muscle contractions (% maximum voluntary isometric contraction). All subjects performed hip extension with three contraction methods. The type of gluteus maximus contraction using Thera-band was composed of concentric contraction (type 1), isometric contraction (type 2), and eccentric contraction (type 3). To measure muscle activation on the gluteus maximus contraction type, each position were maintained for 5 seconds with data collection taken place during middle three seconds. Muscle activation was measured in each position three times. Results: For the results of this study, there was no significant difference within three contraction patterns of the gluteus maximus (concentric, isometric, and eccentric) each both multifidus, both external oblique abdominis, and gluteus maximus. And there was no significant difference among both multifidus, both external oblique abdominis, and gluteus maximus each hip extension contraction type. Conclusions: These findings suggest that specific contraction types of the gluteus maximus does not lead to a more effective activation of the multifidus, external oblique abdominis, and gluteus maximus.

This study evaluated how zirconia thickness affects shear bond strength (SBS) between zirconia and dual-cure resin cement. Eighty specimens (40 blocks of 1 mm thickness zirconia and 20 of each 1.5 and 2 mm) were divided into 8 groups according to zirconia thickness and light-curing time. Group A, B, C, and D were light-polymerized during 20 s and group E, F, G, and H were light-cured during 40 s. Self-adhesive dual-cure resin cement was placed onto the zirconia surfaces and then light-polymerized. The mean SBS of the 40 s curing time group was statistically higher than that of the 20 s curing time group. However, curing time did not affect the SBS significantly in the 2 mm thickness groups. The mean SBS of the 1.5 and 2 mm groups were statistically lower than those 1 mm groups. Therefore, zirconia thickness significantly affected the SBS of self-adhesive dual-cure resin cement.

Objective This study aimed to determine the expression of chemokine (C-X-C motif) ligand 14 (CXCL14) in pulpal and periodontal cells in vivo and in vitro, and investigate function of CXCL14 and its underlying mechanism in the proliferation and osteogenic differentiation of human periodontal ligament (hPDL) cells. Methods To determine the expression level of CXCL14 in adult rat oral tissues and in hPDL cells after application of biophysical forces, RT-PCR, western blot, and histological analyses were performed. The role of CXCL14 in proliferation and osteogenic differentiation of PDL cells was evaluated by measuring dehydrogenase activity and Alizarin red S staining. Results Strong immunoreactivity against CXCL14 was observed in the PDL tissues and pulpal cells of rat molar, and attenuated apparently by orthodontic biophysical forces. As seen in rat molar, highly expressed CXCL14 was observed in human dental pulp and hPDL cells, and attenuated obviously by biophysical tensile force. CXCL14 expression in hPDL cells was increased in incubation time-dependent manner. Proliferation of hPDL cells was inhibited dramatically by small interfering (si) RNA against CXCL14. Furthermore, dexamethasone-induced osteogenic mineralization was inhibited by recombinant human (rh) CXCL14, and augmented by CXCL14 siRNA. rhCXCL14 increased transforming growth factor-beta1 (TGF- β1) in hPDL cells. Inhibition of the cell proliferation and osteogenic differentiation of hPDL cells by CXCL14 siRNA and rhCXCL14 were restored by rhTGF-β1 and SB431542, respectively. Conclusion These results suggest that CXCL14 may play roles as a growth factor and a negative regulator of osteogenic differentiation by increasing TGF-β1 expression in hPDL cells.

Background The association between diabetes mellitus (DM) and bone diseases is acknowledged. However, the mechanistic pathways leading to the alveolar bone (AB) destruction remain unclear. This study aims to elucidate the mechanical forces (MF)-induced AB destruction in DM and its underlying mechanism. Methods In vivo periodontal tissue responses to MF were evaluated in rats with diabetes. In vitro human periodontal ligament (PDL) cells were either treated with advanced glycation end products (AGEs) alone or with AGEs and MF. Results In vivo, the transcription of VEGF-A, colony stimulating factor-1 (CSF-1), and Ager was upregulated in diabetes, whereas changes in DDOST and Glo1 mRNAs were negligible. DM induced VEGF-A protein in the vascular cells of the PDL and subsequent angiogenesis, but DM itself did not induce osteoclastogenesis. MF-induced AB resorption was augmented in DM, and such augmentation was morphologically substantiated by the occasional undermining resorption as well as the frontal resorption of the AB by osteoclasts. The mRNA levels of CSF-1 and vascular endothelial growth factor (VEGF) during MF application were highly elevated in diabetes, compared with those of the normal counterparts. In vitro, AGEs treatment elevated Glut-1 and CSF-1 mRNA levels via the p38 and JNK pathways, whereas OGT and VEGF levels remained unchanged. Compressive MF especially caused upregulation of VEGF, CSF-1, and Glut-1 levels, and such upregulation was further enhanced by AGEs treatment. Conclusions Overloaded MF and AGEs metabolites may synergistically aggravate AB destruction by upregulating CSF-1 and VEGF. Therefore, regulating the compressive overloading of teeth, as well as the levels of diabetic AGEs, may prove to be an effective therapeutic modality for managing DM-induced AB destruction.

BACKGROUND: The purpose of this study is to examine physical characteristics of and initial biological properties to anodized titanium treated with poly(d,l-lactide-co-glycolide) (PLG) mixed with recombinant human bone morphogenic protein-2 (rhBMP-2). METHODS: Titanium specimens were prepared in groups of four as follows: group NC was anodized under 300 V as control; group PC was anodized then dropped and dried with solution 0.02 ml PLG; group D was anodized then dropped and dried with solution 0.02 ml PLG/rhBMP-2 (3.75 μg per disc); and group E was anodized then coated with 0.02 ml PLG/rhBMP-2 (3.75 μg per disc) by electrospray. Human osteoblastic-like sarcoma cells were cultured. Cell proliferation and alkaline phosphatase (ALP) activity test were carried out. Runx-2 gene was investigated by the reverse transcription-polymerase chain reaction. Immunofluorescence outcome of osteogenic proteins was observed. RESULTS: After 3 days, there were significantly higher proliferations compared rhBMP-2 loaded titanium discs with rhBMP-2 unloaded discs. The ALPase activity on rhBMP-2 loaded titanium discs was significantly higher than in rhBMP-2 unloaded discs. The expression level of Runx2 mRNA presented the highest on the PLG/rhBMP-2-coated surface. CONCLUSION: PLG polymers mixed with rhBMP-2 might improve proliferation, differentiation and osteogenic protein formation of cells on the anodized titanium.

Amelogenin, an enamel matrix protein has been considered to be exclusively expressed by ameloblasts during odontogenesis. However, burgeoning evidence indicates that amelogenin is also expressed in non‐mineralizing tissues. Under the hypothesis that amelogenin may be a functional molecule in developing hair follicles which share developmental features with odontogenesis, this study for the first time elucidated the presence and functional changes of amelogenin and its receptors during rat hair follicle development. Amelogenin was specifically localized in the outer epithelial root sheath of hair follicles. Its expression appeared in the deeper portion of hair follicles, i.e. the bulbar and suprabulbar regions rather than the superficial region. Lamp‐1, an amelogenin receptor, was localized in either follicular cells or outer epithelial sheath cells, reflecting functional changes during development. The expression of amelogenin splicing variants increased in a time‐dependent manner during postnatal development of hair follicles. Amelogenin expression was increased by treatment with cyclosporin A, which is an inducer of anagen in the hair follicle, whereas the level of Lamp‐1 and ‐2 was decreased by cyclosporin A treatment. These results suggest that amelogenin may be a functional molecule involved in the development of the hair follicle rather than an inert hair shaft matrix protein.

Purpose The purpose of this in vitro study was to evaluate the accuracy of a new implant impression technique using bite impression coping and a dual arch tray. Materials and methods Two implant fixtures were placed on maxillary left second premolar and first molar area in dentoform model. The model with two fixtures was used as the reference. The impression was divided into 2 groups, n=10 each. In group 1, heavy/light body silicone impression was made with pick up impression copings and open tray. In group 2, putty/light body silicone impression was made with bite impression copings and dual arch tray. The reference model and the master casts with implant scan bodies were scanned by a laboratory scanner. Surface tessellation language (STL) datasets from test groups was superimposed with STL dataset of reference model using inspection software. The three-dimensional deviation between the reference model and impression models was calculated and illustrated as a color-map. Data was analyzed by independent samples T-test of variance at α=.05. Results The mean 3D implant deviations of pick up impression group (group 1) and dual arch impression group (group 2) were 0.029 mm and 0.034 mm, respectively. The difference in 3D deviations between groups 1 and 2 was not statistically significant (P=.075). Conclusion Within limitations of this study, the accuracy of implant impression using a bite impression coping and dual arch tray is comparable to that of conventional pick-up impression.

Purpose: It was hypothesized that calcium phosphate (CaP) deposition onto Ti surfaces using biomimetic deposition contributed to not only improving osteogenesis but also suppressing osteoclastogenesis in terms of high surface hydrophilicity. Materials and Methods: Ti discs with two different surfaces were prepared: machined and anodic oxidized surfaces. The specimens of two different surfaces were soaked in modified simulated body fluid solution for 14 days at physiologic condition. Murine RAW 264.7 cells were utilized as osteoclast precursor cells. To evaluate osteoclast differentiation activity on Ti surfaces, tartrate-resistant acid phosphatase activity assay was conducted, and cells on Ti discs were investigated with a field emissionscanning electron microscope (FE-SEM). The expression of nuclear factor of activated T cells 1 (NFATc1) and c-Fos, two critical transcriptional factors involved in osteoclastogenesis, were also assessed in terms of mRNA and protein levels by real-time reverse transcriptase-polymerase chain reaction and western blot, respectively. Results: Tartrate-resistant acid phosphatase activities on both machined and anodic oxidized Ti surfaces soaked in modified simulated body fluid were significantly lower compared with nonimmersed ones. FE-SEM observation showed that the number of differentiated osteoclasts was lower on anodic oxidized surfaces immersed in modified simulated body fluid compared with nonimmersed Ti surfaces. Protein and mRNA expression of NFATc1 and c-Fos were significantly decreased on anodic oxidized Ti surfaces immersed in modified simulated body fluid compared with those on nonimmersed ones. The effects of immersion of Ti discs in modified simulated body fluid on osteoclastogenesis were higher on anodic oxidized surfaces than on machined surfaces. Conclusion: It can be concluded that osteoclastogenesis was inhibited by biomimetic deposition using modified simulated body fluid, especially on anodic oxidized Ti surfaces.

AIM Psychotic experiences, including delusions and hallucinations, and their attenuated forms have been recently suggested as a significant but under-recognized marker of suicide risk. However, the relationship between attenuated positive symptoms and suicide has not yet been clearly demonstrated in individuals at ultra-high risk (UHR) for psychosis. Here, we investigated the effect of attenuated positive symptoms on suicidal ideation in UHR individuals. METHODS Fifty-three healthy controls (HCs) and 74 UHR individuals participated in the present study. All participants were assessed for the intensity of suicidal ideation and depressive symptoms at baseline. The effect of attenuated positive symptoms on suicidal ideation in the UHR group was examined using a multiple linear regression analysis after adjustment for concurrent depressive symptoms. RESULTS UHR participants were found to have significantly greater suicidal ideation and more severe depressive symptoms compared to those of HCs. The regression model demonstrated that suspiciousness significantly increased suicidal ideation in UHR participants, independent of the severity of depressive symptoms. CONCLUSION The findings of the present study suggest that suspiciousness may serve as a risk indicator for suicide in clinical practice for UHR individuals. It is crucial to focus on the risk of suicide in the UHR population, as they require sufficient clinical attention and proper management for crises related to their unusual and confusing experiences.

Background Because primary care is the cornerstone of an effective health care system, many developed countries have striven to establish and strengthen their primary care systems. However, the primary care system in South Korea is not well established, and primary care research is still in its infancy. This study aimed to show the benefits of regular doctors as primary care providers in South Korea by analyzing the effect of regular doctor visits on emergency room (ER) visits. Methods We analyzed cross-sectional data on 11,293 adults aged 18 years and over collected from the 2013 Korea Health Panel Survey (beta version 1.0). We classified those participants with and without regular doctors into the treatment and control groups, respectively, and estimated the average treatment effect (ATE) of having a regular doctor on ER visits. We used counterfactual framework and propensity score analysis to adjust for unevenly distributed confounding covariates between treatments and control groups. Results The estimated conditional ATE of a regular doctor on ER visits was statistically insignificant in the general population (-0.4%; 95% confidence interval [CI], -2.0 to 1.2) and in the subgroup of patients with hypertension (-1.8%; 95% CI, -4.5 to 0.9). However, in patients with diabetes mellitus (DM), the estimated ATE was statistically significant (-5.0; 95% CI, -9.2 to -0.7). Conclusion In the total study population, having a regular doctor did not result in a significant difference in ER visits. However, there was a decrease in ER visits in patients with DM in South Korea.

Evidence from literature supports the existence of associations between serotonin-related genetic variants and obsessive-compulsive disorder (OCD), but few studies have explored the involvement of serotonin receptor type 3 genes (HTR3) in OCD. To identify whether HTR3 variability affects an individual’s susceptibility to OCD, we examined 10 HTR3 variants in 596 individuals with OCD and 599 controls. A significant difference existed in the genotypic distribution of the HTR3B variant rs1176744 between individuals with OCD and controls (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.60–0.91, P = 0.0043). A protective haplotype in HTR3B was also associated with OCD (OR = 0.77, CI = 0.63–0.95, permutated P = 0.0179). Analyses of OCD sub-phenotypes demonstrated significant associations between rs3758987 and early onset OCD in male subjects (OR = 0.49, CI = 0.31–0.79, P = 0.0031) and among rs6766410, rs6443930, and the cleaning dimension in female subjects (OR = 0.36, CI = 0.18–0.69, P = 0.0016 and OR = 0.47, CI = 0.29–0.79, P = 0.0030, respectively). Additionally, rs6766410 was related to contamination-based disgust in OCD (P = 0.0044). These results support that common HTR3 variants are involved in OCD and some of its clinical phenotypes.

Objective Psychosocial dysfunction was a nettlesome problem of schizophrenia even in their prodromal phase as well as in their first-episode. In addition, its relations with psychopathology were not determined. The aim of the present study was to examine whether the social and role function impairment was found in ultra-high risk for psychosis (UHR) individuals as well as first-episode schizophrenia patients and to explore its relations with psychopathology. Methods Thirty-seven normal controls, 63 UHR participants and 28 young, first-episode schizophrenia patients were recruited. Psychosocial functioning was examined by using Global function: Social and Role scale. Psychopathologies of positive, negative and depressive symptom were also measured. Results Social and role functioning in UHR were compromised at the equivalent level of those of first-episode schizophrenia patients. Multiple linear regression analysis revealed that social and role dysfunction was associated with negative symptoms in each UHR and first-episode schizophrenia group. Conclusion These findings suggest that the significant impairment of social and role function may be appeared before the active psychosis onset at the level of extent to those of first-episode schizophrenia patients. The psychosocial intervention strategy especially targeting the negative symptoms should be developed and provided to individuals from their prepsychotic stage of schizophrenia.

Objectives.To evaluate the economic and clinical impact of infection with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species (ESBL-EK).Design.A matched-cohort analysis of the cost of illness.Setting.An 810-bed, urban, community hospital in Hartford, Connecticut.Patients.Twenty-one case patients infected with ESBL-EK at a site other than the urinary tract were matched with 21 control subjects infected with a non–ESBL-producing organism on the basis of pathogen species, age, anatomic site of infection, hospitalization in the intensive care unit (ICU) during the time of infection, date of hospitalization, and initial antibiotics received.Results.Mean infection-related costs per patient were significantly greater for case patients than for control patients ($41,353 vs $24,902; P = .034). Infection-related length of stay was the main driver of cost, which was prolonged for case patients, compared with control patients (21 vs 11 days; mean difference, 9.7 days [95% confidence interval {CI}, 3.2-14.6 days] P = .006). The additional cost attributed to the presence of an ESBL-EK infection was $16,450 per patient (95% CI, $965-$31,937). Case patients were more likely than control patients to have clinical failure (P = .027), and the rate of treatment success for case patients whose initial treatment involved antibiotics other than carbapenems was lower than that for their matched control patients (39% vs 83%; P = .013). Treatment was successful in patients for whom initial treatment was with a carbapenem, regardless of the ESBL status of the pathogen.Conclusion.The cost of non–urinary tract infections caused by ESBL-EK was 1.7 times the cost of non–urinary tract infections caused by non-ESBL producers. Prompt recognition and appropriate antimicrobial selection may minimize this ESBL-related impact on hospital costs.

PURPOSE Alexithymia, defined as a deficit in the ability to recognize and describe one's own feelings, may be related to the development and maintenance of obsessive-compulsive symptoms. The aim of this study was to evaluate the association between the catechol-O-methyltransferase (COMT) Val¹⁵⁸Met polymorphism and alexithymia in patients with obsessive-compulsive disorder (OCD). MATERIALS AND METHODS We recruited 244 patients with OCD (169 males, 75 females). Alexithymia was assessed using the 20-item Toronto Alexithymia Scale (TAS-20), and genotyping of the COMT Val¹⁵⁸Met polymorphism was evaluated. RESULTS Patients with the COMT Val/Val genotype had significantly higher total and "difficulty identifying feelings" (DIF) subdimension scores than those with the Val/Met or Met/Met genotypes. Patients with the COMT Val/Val genotype had significantly higher "difficulty describing feelings" (DDF) subdimension scores than those with the COMT Val/Met genotype. However, there were no differences in the scores for the "externally oriented thinking" (EOT) subdimension among the three genotypes. CONCLUSION These results indicate that the high-activity Val allele of the COMT Val¹⁵⁸Met polymorphism is associated with increased alexithymic traits in patients with OCD. The present finding suggests that alexithymia is an endophenotype of OCD that is mediated by the COMT Val¹⁵⁸Met polymorphism.