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The most powerful Tohoku–Oki (TO) earthquake that occurred in Japan on 11 March 2011 affected Japan as well as South Korea. In the current study, we investigated contemporary geodetic deformation inside South Korea before and after the TO earthquake using Global Navigation Satellite System (GNSS) measurements from 01 January 2008 to 31 December 2017. Measured velocities of GNSS sites are modeled by Auto‐regressive moving average (ARMA) method to analyze the long‐term GNSS time‐series variation and to investigate the secular tectonic crustal deformation. We found that the maximum co‐seismic displacements during the TO earthquake reached up to 36.82 ± 0.21 mm in the east and 5.90 ± 0.08 mm in the north directions. The geometric model of the co‐seismic thrust surface was characterized by a rectangular plane with a dip of 12.0° and strike 200°. The thrust is situated at 25 km hypocenter depth, with an area roughly ∼470 km long and ∼120 km wide. The seismicity pattern after the earthquake indicated that the compressional strain started to be replaced by the extensional strain during the post TO earthquake period from 2011 to 2014. Further, the strain became predominantly extensional during the period 2015 to 2017, revealing an effective rotational change that occurred inside the Korean Peninsula. [ABSTRACT FROM AUTHOR]

Borderline ovarian tumors (BOTs) represent noninvasive tumors with uncertain malignant potential. They have a favorable prognosis although they can also recur or be fatal. There are limited population-based data on BOTs, its incidence and surgical treatment approach. We sought to analyze these trends in South Korea between 2014 and 2018. Data from patients diagnosed with BOT between 2014 and 2018 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample in South Korea. Treatment was analyzed by using codes including adnexal surgery with or without hysterectomy. Data from 4,636,542 women were entered into the database between 2014 and 2018. Data from 5,109 women with BOT, and 537 women with surgery were extracted for analysis. The highest prevalence of BOT occurred in women 40–44 years old. In logistic regression analysis, age was significantly correlated with the prevalence of BOT (p < 0.05). The prevalence of BOT was lower in individuals over 50 than it was in those under 50 years (odds ratio (OR), 0.400 in 2014; OR, 0.457 in 2015; OR, 0.419 in 2016; OR, 0.355 in 2017; OR, 0.347 in 2018). The prevalence of BOT varies significantly with age, and is most common in women in their 40 s. [ABSTRACT FROM AUTHOR]

Corona virus disease 2019 (COVID-19) has been declared a global pandemic and is a major public health concern worldwide. In this study, we aimed to determine the role of environmental factors, such as climate and air pollutants, in the transmission of COVID-19 in the Republic of Korea. We collected epidemiological and environmental data from two regions of the Republic of Korea, namely Seoul metropolitan region (SMR) and Daegu-Gyeongbuk region (DGR) from February 2020 to July 2020. The data was then analyzed to identify correlations between each environmental factor with confirmed daily COVID-19 cases. Among the various environmental parameters, the duration of sunshine and ozone level were found to positively correlate with COVID-19 cases in both regions. However, the association of temperature variables with COVID-19 transmission revealed contradictory results when comparing the data from SMR and DGR. Moreover, statistical bias may have arisen due to an extensive epidemiological investigation and altered socio-behaviors that occurred in response to a COVID-19 outbreak. Nevertheless, our results suggest that various environmental factors may play a role in COVID-19 transmission. [ABSTRACT FROM AUTHOR]

The Republic of Korea and the United States have agreed to the terms of the Wartime OPCON Transfer contingent upon meeting specific conditions. The OPCON Transfer should lead to improved security of the Korean Peninsula while improving the ROK-U.S. combined defense capability. Hence, the Korea Armed Forces must exert efforts to acquire the capabilities and conditions required for the transfer. Further, "the United States' supplementation and continuation capabilities" and "the provision and employment of extended deterrence methods and strategic assets" must be continued. The way to firmly maintain security over the Korean Peninsula is for the ROK military to possess capabilities required for the OPCON Transfer. Of these capabilities, ROKAF's capability is crucial and the ISR+PGMs capabilities must be obtained without fail. Accurate information on military threats and the ability to strike those targets are prerequisites to winning wars. In pursuing the national security strategy task of "strengthening national defense capabilities based on the ROK-U.S. alliance," with support from the general public, rational decisions on airpower requirements and the measurement of enemies' airpower must be made at the national strategic level, to determine what it would take for the ROKAF to lead ROK-U.S. combined air operations. Concurrently, we need to be ready and be prepared to respond to the expansion of neighboring nations' airpower capability. [ABSTRACT FROM AUTHOR]

Background: Physician recommendations for colorectal cancer (CRC) screening have consistently been shown to be a strong predictor of screening. The aim of this study was to investigate perceptions of CRC screening modalities and recommendation behaviors among physicians in Korea.Methods: A cross-sectional, nationally representative survey conducted between November 2013 and February 2014. In total, 379 physicians (241 primary care physicians and 138 physicians affiliated with the Korean Association for the Study of Intestinal Diseases responded to this survey (overall response rate of 31.4%).Results: About 29% of all respondents "always" recommended and about 67% "sometimes" recommended CRC screening. Colonoscopy was perceived as an effective primary screening tool for CRC, and 80% of the physicians recommended colonoscopy for CRC screening. Only 7% recommended FOBT. In multivariate analysis, recommending FOBT was associated with stronger belief in the screening efficacy of FOBT (aOR 3.70, 95% CI 2.09, 6.57), weaker belief in the screening efficacy of colonoscopy (aOR 0.29, 95% CI 0.12, 0.69), and negative decisional balance for colonoscopy screening (aOR 0.82, 95% CI 0.71, 0.95).Conclusions: Although FOBT is provided free-of-charge through a nationwide CRC screening program, colonoscopy was more commonly recommended and preferred by physicians. [ABSTRACT FROM AUTHOR]

Abstract: Aims/Introduction: We investigated the failure of monotherapy in patients with type 2 diabetes mellitus in real practice settings. Materials and Methods: The Korean National Diabetes Program was a prospective, multicenter observational cohort study of type 2 diabetes mellitus patients in Korea. Of the 3,950 patients enrolled in the study, we studied 998 who were continuously maintained on monotherapy for at least 90 days at six participating centers. To balance the baseline characteristics of patients in each group, we used propensity matching at a 1:1 ratio (metformin vs sulfonylureas) and 4:1 ratio (metformin vs meglitinides and metformin vs alpha‐glucosidase inhibitors [aGIs]). The hazard ratios (HRs) of treatments (compared with metformin) were determined by Cox's proportional hazards regression modeling. Results: The median follow‐up time was 56 months, and monotherapy failed in 45% of all patients. The annual incidences of failure were 15.6%, 21.3%, 27% and 9.6% in the metformin, sulfonylurea, meglitinide and aGI groups. Compared with metformin, sulfonylureas and meglitinides were associated with higher risks of monotherapy failure (HR 1.39, 95% confidence interval [CI] 1.08–1.80; HR 1.92, 95% CI 1.13–3.27), and aGIs with risks similar to that of metformin (HR 0.80, 95% CI 0.44–1.45). When analyzed by failure type, sulfonylureas, meglitinides and aGIs were associated with a higher risk of a switch to other agents (HR 4.43, 95% CI 2.14–9.17; HR 18.80, 95% CI 6.21–56.93; HR 4.25, 95% CI 1.49–12.13), and aGIs with a lower risk of prescription of add‐on second agents (HR 0.16, 95% CI 0.04–0.64). Conclusions: Metformin was associated with a lower failure risk than were sulfonylureas and meglitinides, but a comparable aGI failure rate. [ABSTRACT FROM AUTHOR]

Aim: To determine the effects of early intensive glycaemic control with intensive insulin treatment (IIT) or initial combined oral antidiabetic drug (COAD) therapy on long‐term glycaemic control and the preservation of β‐cell function in people with type 2 diabetes mellitus (T2DM). Methods: Newly diagnosed drug‐naïve patients with T2DM from 8 outpatient diabetes centres were randomized to receive either IIT (n = 50; glargine/glulisine) or COAD (n = 47; glimepiride/metformin) as intensive treatment until the termination criteria to ensure euglycaemia were met. After intensive treatment, the patients completed a follow‐up period with either lifestyle modification (LSM) alone or rescue therapy to maintain target glycated haemoglobin levels of <7% (53 mmol/mol) up to week 104. The primary outcomes were analysed after excluding participants who were anti‐glutamic acid decarboxylase autoantibody‐positive. Results: Both intensive treatment methods were effective for short‐term glycaemic control, but improvements in the disposition index (DI) were significantly greater in the IIT group than in the COAD group (P = .021). During the follow‐up period after intensive treatment, the two groups significantly differed in rescue method regarding the maintenance of comparable levels of glycaemic control (P = .010) and more participants who received IIT exhibited well‐controlled glycaemia with LSM alone. Additionally, the IIT group maintained a higher DI than the COAD group during the follow‐up period. Cox regression analysis showed that the IIT method was associated with a 52.5% lower risk of failing to maintain drug‐free glycaemic remission compared with the COAD method (P = .015). Conclusions: The findings indicate that outpatient clinic‐based IIT to ensure euglycaemia in newly diagnosed patients with T2DM might be an effective initial therapeutic option for improvements in β‐cell function and glycaemic control over the long term, without serious adverse events. [ABSTRACT FROM AUTHOR]

Objective: To investigate the predominant Lactobacillus species types (LSTs) of vaginal microbiota in pregnant Korean women by quantifying five Lactobacillus species and two anaerobes.Methods: In all, 168 pregnant Korean women under antenatal care at Eulji University Hospital and local clinics were enrolled in the prospective cohort study during pregnancy (10-14 weeks). Vaginal samples were collected with Eswab for Quantitative polymerase chain reaction (qPCR) and stored in a -80 °C freezer. qPCR was performed for five Lactobacillus species and two anaerobes. To identify the predominant LSTs, quantifications were analyzed by the Cluster and Tree View programs of Eisen Lab. Also the quantifications were compared among classified groups.Results: L. crispatus and L. iners were most commonly found in pregnant Korean women, followed by L. gasseri and L. jensenii; L. vaginalis was nearly absent. Five types (four predominant LSTs and one predominant anaerobe type without predominant Lactobacillus species) were classified.Conclusions: Five predominant LSTs were identified in vaginal microbiota of pregnant Korean women. L. crispatus and L. iners predominant types comprised a large proportion. [ABSTRACT FROM AUTHOR]

Purpose This study was conducted to describe the trends and age-period-cohort effects on the incidence and mortality rate of cervical cancer in Korea. Materials and Methods The incidence and mortality rate of cervical cancer among ≥ 20-year-old women from 1993 to 2012 were obtained from the Korea Central Cancer Registry and the Korean Statistical Information Service. Age-standardized rates were calculated and Joinpoint regression was used to evaluate the trends in the incidence and mortality rate. Age-period-cohort analysis was performed to investigate the independent effects of age, period and cohort. Results The incidence of cervical cancer decreased from 32.8 per 100,000 in 1993 to 15.9 per 100,000 in 2012 (annual percent change [APC], -3.9%; 95% confidence interval [CI], -4.2% to -3.6%). The mortality rate decreased from 5.2 per 100,000 in 1993 to 2.1 per 100,000 in 2012 (APC, -4.8%; 95% CI, -5.1% to -4.4%); however, the incidence and mortality rates among young women (< 30 years old) increased. An age-period-cohort model of the incidence and mortality rate showed decreasing period effects between 1993 and 2008 and decreasing cohort effects between 1928 and 1973, while birth cohorts after 1973 exhibited slight increases in the incidence and mortality rate of cervical cancer. Conclusion Recent decreases in the incidence and mortality rate of cervical cancer were due to decreases in the period and cohort effects, which reflect the implementation of a cancer screening program and changes in lifestyle. However, our findings also highlighted an increase in cohort effects on the incidence and mortality rate among young women born after 1973. [ABSTRACT FROM AUTHOR]

Kim, H.; Lee, S.B., and Min, K.S., 2017. Shoreline change analysis using airborne LiDAR bathymetry for coastal monitoring. In: Lee, J.L.; Griffiths, T.; Lotan, A.; Suh, K.-S., and Lee, J. (eds.), The 2nd International Water Safety Symposium. Journal of Coastal Research, Special Issue No. 79, pp. 269-273. Coconut Creek (Florida), ISSN 0749-0208. Shoreline is commonly defined as the boundary between land and sea. As a consequence of global climate changes and human interventions, shoreline is constantly changing by erosion and accretion. Korea is also faced with the coastal erosion problem. Therefore, the coastal monitoring method needs to quantitatively analyze the shoreline locations and differences in past and present. For this, our research for coastal monitoring is to adopt the quantitative analysis of shoreline change using airborne bathymetry LiDAR. Bathymetry data is useful for coastal monitoring, since the water depth provide geospatial information of 3D point cloud data, including the shallow water as well as the near-shore. In this study case, bathymetry data was collected by CZMIL in 2013 at Gyeongpo and Wonpyeong beach. Topography data collected by ALTM in 2010 was used to check trend of shoreline change at the same sites. In order to extract shoreline position from the LiDAR data, the shoreline definition is referenced as AHHW (Approximate Highest High Water). As a result, East coast has eroded about 347 m2 of Gyeongpo beach and about 23819.5 m2 of Wonpyeong beach. From this analysis, the average annual rate of erosion is 1.6 m per year. Shoreline change at East coast resulted in a landward retreat by 5 m at the last four years. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to identify the endodontic microbiome in primary teeth with dental caries using high-throughput pyrosequencing and to establish data on the oral microbiome of primary teeth with endodontic infection. Methods Ten primary teeth with dental caries and endodontic infection were included. Samples were collected from root canals using sterilized paper points and analyzed by pyrosequencing, based on the V1-V3 hypervariable region of the 16S rRNA gene. The data were analyzed using the CLcommunity software. Results Analysis of the 10 samples yielded a total of 64,291 16S rRNA gene sequences. In total, 1586 OTUs (range, 91-235), six bacterial phyla, including unclassified, and 187 genera were assigned. At the genus level, Neisseria (group A), Acinetobacter (group B), and Fusobacterium (group C) were prominent. These predominant microorganisms were associated with the clinical condition and reflected the progression of endodontic infection in primary teeth. Conclusions This study revealed a relationship between the oral microbiome and endodontic infection in primary teeth. Additionally, anaerobic bacteria such as Fusobacterium species were dominant in the teeth with apical abscesses. [ABSTRACT FROM AUTHOR]

Objectives: To identify obstetric and maternal factors related to Group B Streptococcus (GBS) colonization in pregnant women in Korea.Methods: The study was conducted between the years 2006-2008 in four hospitals, Cheil and Eulji hospital in Seoul, and Motae and Eulji hospital in Daejeon. We recruited 2,644 pregnant women between 35 to 37 weeks of gestation who had visited for antenatal care. Participants completed a questionnaire, and urine, vaginal and rectal specimens were obtained and cultured using selective broth media. After delivery, medical records were reviewed.Results: GBS colonization was significantly associated with hospital, age group, education, frequency of pregnancy, and premature rupture of membranes (PROM, more than 18 hours). After adjustment for other variables, Cheil hospital (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.20-3.52), and the first pregnancy (OR, 2.32; 95% CI, 1.12-4.81) remained significant. History of vaginitis showed marginal significance (OR, 1.50; 95% CI, 0.98-2.29).Conclusion: To prevent GBS infection of neonates, clinicians should be alert to the potentially higher risk of GBS colonization in pregnant women in their first pregnancy, and women with premature rupture of membranes (PROM) (18 hours+) or who have a history of vaginitis. [ABSTRACT FROM AUTHOR]

This study explores the definition of the industrial use of genetically modified organisms (GMOs), factors that affect it, and how it influences a firm’s economic performance to understand who drives market access for GMOs and GM products, considering the two premises related to sustainable development: 1) the continuing use of GMOs is one of the most prominent driving forces behind a bio-based economy’s growth, and 2) social system members seek protection from the potential risks of GMOs. The results show compelling evidence of a structural relationship between sociopolitical/economic pressures and economic performance. Additionally, these pressures vary by industry, and activities to secure both social and economic legitimacy due to these pressures have a positive impact on overall firm performance. [ABSTRACT FROM AUTHOR]

Purpose: Communicating the harms and benefits of thyroid screening is necessary to help individuals decide on whether or not to undergo thyroid cancer screening. This study was conducted to assess changes in thyroid cancer screening intention in response to receiving information about overdiagnosis and to determine factors with the greatest influence thereon. Materials and Methods: Data were acquired from subjects included in the 2013 Korean National Cancer Screening Survey (KNCSS), a nationwide, population-based, cross-sectional survey. Of the 4,100 respondents in the 2013 KNCSS, women were randomly subsampled and an additional face-to-face interview was conducted. Finally, a total of 586 female subjects were included in this study. Intention to undergo thyroid cancer screening was assessed before and after receiving information on overdiagnosis. Results: Prior awareness of overdiagnosis in thyroid cancer screening was 27.8%. The majority of subjects intended to undergo thyroid cancer screening before and after receiving information on overdiagnosis (87% and 74%, respectively). Only a small number of subjects changed their intention to undergo thyroid cancer screening from positive to negative after receiving information on overdiagnosis. Women of higher education level and Medical Aid Program recipients reported being significantly more likely to change their intention to undergo thyroid cancer screening after receiving information on overdiagnosis, while women with stronger beliefs on the efficacy of cancer screening were less likely to change their intention. Conclusion: Women in Korea appeared to be less concerned about overdiagnosis when deciding whether or not to undergo thyroid cancer screening. [ABSTRACT FROM AUTHOR]

This article seeks to offer a broad examination of the historical trajectory of Neo- Confucian thought in the Chosŏn Dynasty of the nineteenth century. In so doing, the article aspires to go beyond the pre-established view of equating Neo-Confucianism with the conservative wijŏng ch'ŏksa ("upholding orthodoxy, rejecting heterodoxy") movement. First, attention will be paid to the fact that sequels to some of the most authoritative Neo-Confucian texts, such as the Reflections on Things at Hand (Jinsi lu) and Elementary Learning (Sohak), continued to appear in the Chosŏn period. The publication of sequels to Reflections was part of a trend to establish a canon by systematizing the Korean Neo-Confucian tradition within the format of the Reflections, and thereby situate Korean Neo-Confucianism as the succeessor of the Neo-Confucian canons of the Six Classics, Four Books, and Reflections. The publication of the sequels to Elementary Learning was part of a trend to popularize Korean Neo-Confucianism by organizing it within the format of the Elementary Learning and thus propagate Neo- Confucian ethics throughout the various strata of society. If these sequels were efforts to systematize the tradition of Korean Neo-Confucianism in a scholarly format, the encounter of Korean Neo-Confucianism with modernity led to undertakings that sought to engage with this new reality through the production of the Kugyŏng yŏnŭi (Extensive exposition of the Nine Canons). In this work, we can identify attempts by Korean Neo- Confucianists to communicate with the contemporary currents of modernity. This article reflects on the historical significance of the academic trends of nineteenth-century Korean Neo-Confucianism, which can be characterized as canonization, popularization, and contemporization. It thus seeks to overcome the wijŏng ch'ŏksa framework and give justice to the changes that Korean Neo-Confucianism underwent during this period. [ABSTRACT FROM AUTHOR]

The objective of the research was to determine the chemical composition as well as the physicochemical properties of the longissimus muscle from Korean entire and castrate elk. Twelve elk stags were raised and fed on concentrate with ad libitum hay. All animals were equally divided into castrated and non-castrated (entire) males, and slaughtered at 5 year of age. It was found that entire elk, in comparison with castrate elk, had higher content of moisture and lower content of fat (p<0.05). Compared with entire males, the castrates had lower pH and shear force values (p<0.05). However, castrates had higher L*, a*, and b* values compared with entires (p<0.05). An analysis of the fatty acid profile revealed that the muscles of entire and castrate elk had the most abundant concentrations of the following fatty acids: palmitic acid (C16:0) of the saturated fatty acid, and oleic acid (C18:1n-9) of the unsaturated fatty acid. The entire elk contains higher proportions of linoleic acid (C18:3n6), eicosenoic acid (C20:1n9), and arachidonic acid (C20:4n6) (p<0.05). Cholesterol content in elk was not affected by castration. The predominant free amino acid was glutamic acid related to umami taste. It is apparent that the castrate animals carried higher content of histidine, isoleucine, and leucine than those of the entire group (p<0.05). In this study, it was concluded that venison quality of elk is affected by castration and these results can provide fundamental information for venison production. [ABSTRACT FROM AUTHOR]

Background and Aims: Hypoglycemia is one of the most important adverse events in individuals with type 2 diabetes mellitus (T2DM). However, hypoglycemia-related events are usually overlooked and have been documented less in clinical practice. Materials and Methods: We evaluated the incidence, clinical characteristics, and medical expenses of hypoglycemia related events in T2DM patients based on the Korea National Diabetes Program (KNDP), which is the largest multi-center, prospective cohort in Korea (n = 4,350). For accurate outcomes, the KNDP data were merged with claims data from the Health Insurance Review and Assessment Service (HIRA) of Korea. Results: During a median follow-up period of 3.23 years (95% CI: 3.14, 3.19), 88 subjects (2.02%) were newly diagnosed with hypoglycemia, and the incidence of hypoglycemia was 6.44 cases per 1,000 person-years (PY). Individuals with hypoglycemia were significantly older (59.7±10.7 vs. 53.3±10.4 years, p < 0.001), had more hospital visits (121.94±126.88 days/PY, p < 0.001), had a longer hospital stays (16.13±29.21 days/PY, p < 0.001), and incurred greater medical costs ($2,447.56±4,056.38 vs. $1,336.37±3,403.39 /PY, p < 0.001) than subjects without hypoglycemia. Conclusion: Hypoglycemia-related events were infrequently identified among the medical records of T2DM subjects. However, they were associated significantly with poor clinical outcomes, and thus, hypoglycemia could have a substantial burden on the Korean national healthcare system. [ABSTRACT FROM AUTHOR]

The kinetic energy and momentum of rainfall are widely used as erosivity indicators for estimating soil detachment (erosion) induced by the impact of raindrops. Because direct measurements of the force or kinetic energy of rainfall on ground surfaces are not widely available, many empirical relationships have been derived to link the kinetic energy and intensity (I) of rainfall, the factor that has the most control over soil erosion and is readily accessible. This study considered three rainfall erosivity indices: kinetic energy expenditure ( KE time , J m −2 h −1 ), kinetic energy content ( KE mm , J m −2 mm −1 ), and momentum ( M , kg m s −1 m −2 s −1 or N m −2 ). The relationships between these rainfall erosivity indices ( KE time , KE mm , and M ) and rainfall intensity were established by fitting to an existing functional model based on measurements of the number of drops by size and terminal velocity made from January 2010 to July 2011 using a laser optical disdrometer in Daejeon City, Korea. The best fit for the relationship between the three kinetic energy indices and rainfall intensity was obtained with a power law ( KE time -I , and M−I ) and an exponential model ( KE mm - I ). Validation results for two different events indicated good performance for the KE time -I and M−I equations, with a similar distribution of observed data and power-law curve fitting. However, the rainfall momentum index produced much lower uncertainty as determined from the measured terminal velocity when the equipment was exposed to in situ changeable conditions. Therefore, we suggest that the power-law relationship between momentum and rainfall intensity is the most suitable equation for the prediction of rainfall erosivity. [ABSTRACT FROM AUTHOR]

The Lagrangian FLEXible PARTicle (FLEXPART) dispersion model and National Centers for Environmental Prediction/Global Forecast System (NCEP/GFS) meteorological data were used to simulate the long range transport pathways of three artificial radionuclides: 131 I, 137 Cs, and 133 Xe, coming into Korean Peninsula during the Fukushima Dai-ichi nuclear accident. Using emission rates of these radionuclides estimated from previous studies, three distinctive transport routes of these radionuclides toward the Korean Peninsula for a period from 10 March to 20 April 2011 were exploited by three spatial scales: 1) intercontinental scale – plume released since mid-March 2011 and transported to the North to arrive Korea on 23 March 2011, 2) global (hemispherical) scale – plume traveling over the whole northern hemisphere passing through the Pacific Ocean/Europe to reach the Korean Peninsula with relatively low concentrations in late March 2011 and, 3) regional scale – plume released on early April 2011 arrived at the Korean Peninsula via southwest sea of Japan influenced directly by veering mesoscale wind circulations. Our identification of these transport routes at three different scales of meteorological circulations suggests the feasibility of a multi-scale approach for more accurate prediction of radionuclide transport in the study area. In light of the fact that the observed arrival/duration time of peaks were explained well by the FLEXPART model coupled with NCEP/GFS input data, our approach can be used meaningfully as a decision support model for radiation emergency situations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Measurement of the cardiac chamber is essential, and current guidelines recommend measuring and reporting values for both sides of the cardiac chamber during echocardiographic evaluation. Normal echocardiographic reference values have been suggested previously, but detailed information about right-sided chambers and values according to gender was not included. METHODS: This is a prospective multicenter (23 centers) study evaluating normal Korean adult subjects using comprehensive echocardiography. We included normal adult subjects (age; 20-79 years old) who had no significant cardiac disorders or illnesses, such as hypertension or diabetes, which could affect cardiac structure and function. We measured the cardiac chamber including both right and left ventricles as well as atria according to current echocardiography guidelines and compared values according to gender and age groups. RESULTS: A total of 1003 subjects were evaluated and the mean age was 48 ± 16 years. Left ventricular (LV) dimensions increased, but LV volume decreased in older subjects. Right ventricular (RV) area decreased in women and older subjects, and the RV long-axis dimension showed a similar trend. Left atrial (LA) volume increased in men but there were no differences in LA volume index between men and women. The dimension of great arteries increased in men and older subjects. CONCLUSION: Since there were considerable differences between men and women and in the different age groups, and the trends differed significantly between different echo variables, normal echocardiographic cutoff values should be differentially applied based on age and gender. [ABSTRACT FROM AUTHOR]

Background: The possibility of developing breast cancer is a concern for all women; however, few studies have examined the relationship between cancer worry and the stages of adoption for breast cancer screening in Korea. Here, we investigated the associations between cancer worry, the stages of adopting breast cancer screening, and socio-demographic factors known to influence screening behaviors. Methods: This study was based on the 2013 Korean National Cancer Screening Survey, an annual cross-sectional survey that utilized nationally representative random sampling to investigate cancer screening rates. Data were analyzed from 1,773 randomly selected women aged 40–74 years. Chi-squared tests and multinomial logistic analyses were conducted to determine the associations between cancer worry and the stages of adoption for breast cancer screening and to outline the factors associated with each stage. Results: Korean women were classified into the following stages of adoption for breast cancer screening: pre-contemplation (24.7%), contemplation (13.0%), action/maintenance (50.8%), relapse risk (8.9%), and relapse (2.6%). Women in the action/maintenance stages reported more moderate to higher levels of worry about getting cancer than those in the pre-contemplation stage. Further, age of 40–49 years and having private cancer insurance were associated with women in the action/maintenance stages. Conclusion: Interventions to address breast cancer worry may play an important role in increasing participation and equity in breast cancer screening. [ABSTRACT FROM AUTHOR]

The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D). [ABSTRACT FROM AUTHOR]

Objectives: To identify any association between implementing smoking regulation policies and workers' urine cotinine concentration levels in Korea. Methods: From the first stage of the Korean National Environmental Health Survey conducted by the National Institute of Environmental Research from 2009 to 2011, 2,475 non-smoking workers selected. We analyzed the trend in the changes of cotinine concentration in urine using the general linear model and linear regression, in various jobs as categorized by the National Center for Health Statistics (NCHS) and Korea Standard Classification of Occupations (KSCO). Results: The urine cotinine concentration tended to decrease every year (2.91 ng/ml in 2009, 2.12 ng/ml in 2010, and 1.31 ng/ml in 2011), showing a decreasing trend (P < 0.001). The total subjects' decreased cotinine concentration in urine between 2009 and 2011 was 2.72 ng/ml (54.1 % relative decrease). The changes in each subgroup's urine cotinine concentration ranged from 1.59 to 6.03 ng/ml (33.2 to 77.5 %). All groups except for the managerial group (n = 49), which had a small sample size, had statistically significant negative regression coefficients (p < 0.05). The ranges of the decrease in urine cotinine were 2.75 ng/ml (53.6 %) for males and 2.72 ng/ml (54.9 %) for females. The negative slope in urine cotinine level was statistically significantly greater in men than women. The changes in urine cotinine by occupation as classified by the NCHS occupational categories ranged from 2.43 to 3.36 ng/ml (46.6 to 61.5 % relative decrease). The negative slopes in urine cotinine levels of the white-collar and farm workers were statistically significantly greater than those of the service workers and blue-collar workers. The change by occupation as classified by the KSCO ranged from 1.59 to 6.03 ng/ml (a 33.2 to 77.5 % relative decrease). The negative slopes in urine cotinine levels of the professionals and related workers and clerks were statistically significantly greater than those of the service workers and plant and machine operators and assemblers. Conclusions: The cotinine concentration in urine among non-smoking worker groups tended to decline from 2009 to 2011. Such a result may be an indirect indicator of the effectiveness of smoking regulation policies including the revision of the National Health Promotion Act. [ABSTRACT FROM AUTHOR]

Normal rice starches were isolated from six different rice varieties grown in Korea and their molecular structure, crystalline structure, and in vitro digestibility were investigated. Apparent amylose content was the highest in starch from Junam cultivar (25.5%) and lowest in Hopum (22.4%). Starch from Hiami cultivar had the lowest molecular weights of amylose and amylopectin, average amylopectin chain length, proportion of short chains (DP 6–12), and proportion of long chains (DP ≥ 37) among the tested rice starches. The relative crystallinity and ratio of 1047/1022 ranged from 30.2 to 36.7% and from 0.638 to 0.652, respectively. Hiami had the lowest gelatinization temperatures and the highest gelatinization enthalpy. Hiami had the highest pasting temperature (92.1 °C), the lowest setback (515 cP) and final viscosity (876 cP), whereas Hanareum had the lowest pasting temperature (82.7 °C), the highest setback (1002 cP), and final viscosity (1580 cP). The rapidly digestible starch (RDS), slowly digestible starch (SDS), and resistant starch (RS) content ranged from 43.9–53.5%, 35.5–52.6%, and 0.5–15.6%, respectively. The Junam cultivar had the lowest RDS content, whereas Hiami had the highest RDS content. The RS content of Hanareum (16.2%) and Boramchan (14.5%) was significantly higher than that of other normal rice cultivars (3.0–6.5%). [ABSTRACT FROM AUTHOR]

This paper presents the contribution of the international meeting industry to the Korean national economy. To obtain more accurate results, the study adopted three improvements over previous research: consideration of both supply and demand; direct expenditure surveys of participants and hosts; and re-categorization of related business sectors. The results of the input-output analysis showed that per capita expenditure for international and domestic participants was US$2,432.4 and US$459.3, respectively, and the per capita average budget was US$562.1. Based on these findings, the total contribution of the international meeting industry to the Korean economy exceeds US$1,343.2 million in output, US$236.6 million in personal income, US$589.3 million in value added, US$61.5 million in tax revenue and 16,336 full-time-equivalent jobs. These results provide two key implications, providing evidence of the importance of both the supply and demand sides and the relative importance of each sub-industry for increasing economic benefit. [ABSTRACT FROM AUTHOR]

Aim: To develop an ultrasonographic severity scoring of non-immune hydrops in order to predict perinatal outcomes in women with non-immune hydrops. Methods: The study population consisted of pregnant women who were admitted and delivered with the diagnosis of fetal non-immune hydrops and singleton gestation. Cases were divided into 'perinatal survivor' and 'perinatal non-survivor' groups. Perinatal non-survivor cases were defined as those with stillbirth or neonatal death ≤28 completed days after birth. The presence of an abnormal fluid collection in each body compartment, such as subcutaneous edema, pleural effusion, pericardial effusion, or ascites was assigned a score of 1 point per each body compartment, and the absence of abnormal fluid collection was scored as 0 point. The total number of abnormal fluid collections was converted to a numeric score, which was called the ultrasonographic severity scoring of non-immune hydrops (USNIH). Results: Perinatal death occurred in 46.5% (20/43) of the cases of non-immune hydrops. USNIH in patients of the non-survivor group was significantly higher than that in those of the survivor group [non-survivor group 3 (2-4) vs. survivor 2 (2-3); median (range); P<0.05]. Perinatal mortality rates were higher in patients with USNIH ≥3 points than in those with USNIH of 2 points (67% vs. 13%, P<0.005). This difference remained significant after adjustment for confounding variables. When confining analysis to those with idiopathic non-immune hydrops, women in the perinatal non-survivor group had significantly higher USNIH score than those in the perinatal survivor group, and this difference remained significant after adjustment. Conclusions: Our USNIH system may be a reliable predictive marker for perinatal outcomes in cases of non-immune hydrops, especially in idiopathic hydrops during the antenatal period. [ABSTRACT FROM AUTHOR]

Background The Problem Areas in Diabetes (PAID) scale is widely used for measuring diabetes-related emotional distress. There has been debate over the last 2 decades about the underlying factorial-construct validity of the PAID, with one- to four-factor structures being reported. A short form of the PAID, which comprises five items (PAID-5), was recently developed using Western patients with type 2 diabetes. This study measured the psychometric properties of the full and short forms of the PAID in Korean patients with type 2 diabetes, with the aim of determining which form is preferable. Methods The PAID and PAID-5 were translated into Korean (K-PAID and K-PAID-5, respectively) using a forward-and-backward translation technique. The study participants were recruited from university hospitals. The factorial-construct, convergent, and known-groups validity, and internal-consistency and test-retest reliability of both the K-PAID and K-PAID-5 were evaluated. Results For the K-PAID, confirmatory factor analysis revealed a marginal fit to the one-, two-, three-, and four-factor models. The three- and four-factor models of the K-PAID partially satisfied the internal-consistency and test-retest reliability, and convergent and known-groups validity. For the K-PAID-5, confirmatory factor analysis demonstrated an excellent fit to the onefactor model, with a Cronbach's alpha of 0.87 and an intraclass correlation coefficient of 0.89. The K-PAID-5 satisfied the convergent validity, as evaluated using the Center for Epidemiologic Studies Depression Scale and hemoglobin A1c. Known-groups validity by gender was also satisfied. Conclusions The K-PAID-5 demonstrated excellent psychometric properties as a one-factor scale. The brevity of the K-PAID-5 represents a major advantage in a practical context in that it may impose a minimum burden upon patients with diabetes. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine and compare the prevalences of diabetes awareness, treatment, and adequate glycemic control among cancer survivors in a Korean population and two non-cancer control groups, comprising individuals without a history of cancer but with other chronic diseases (non-cancer, chronic disease controls) and individuals without a history of cancer or any other chronic disease (non-cancer, non-chronic disease controls). Methods: We analyzed data from 2,660 subjects with prevalent diabetes (aged ≥30 years), who had participated in the 2007–2011 Korea National Health and Nutrition Examination Survey. Awareness was defined as a subject having been diagnosed with diabetes by a clinician. Treatment was defined as a subject who was taking anti-diabetic medicine. Adequate glycemic control was defined as a hemoglobin A1c level of <7%. Multivariable logistic regression and predictive margins were used to evaluate whether awareness, treatment, or adequate glycemic control differed among cancer survivors and the two non-cancer control groups. Results: Cancer survivors had greater awareness compared with the non-cancer, chronic disease and non-cancer, non-chronic disease control groups (85.1%, 80.4%, and 60.4%, respectively). Although the prevalences of treatment and adequate glycemic control were higher for survivors compared with the non-cancer, non-chronic disease controls, they were lower compared with the non-cancer, chronic disease controls. The prevalence of diabetes treatment was 67.5% for cancer survivors, 69.5% for non-cancer, chronic disease controls, and 46.7% for non-cancer, non-chronic disease controls; the prevalences of adequate glycemic control in these three groups were 31.7%, 34.6%, and 17.8%, respectively. Conclusions: Cancer survivors were less likely than the non-cancer chronic disease subjects to receive diabetes management and to achieve adequate glycemic targets. Special attention and education are required to ensure that this population receives optimal diabetes care, and the systematic roles for primary care and specialist physicians need to be determined. [ABSTRACT FROM AUTHOR]

s Aim The aim of this study was to evaluate the usefulness of abdomen-to-thorax ratio ( ATR) measured by antenatal ultrasonography for predicting neonatal survival of fetuses with congenital diaphragmatic hernia ( CDH). Material and Methods We identified 75 fetuses who were prenatally diagnosed with CDH and delivered in Seoul National University Hospital from 1998 to 2012, retrospectively. Of these, 40 cases who met the following criteria were included: (i) singleton pregnancy; (ii) a case that had available ultrasonographic images; and (iii) a neonate in whom follow-up until discharge from the hospital was available. ATR was measured as follows: each anteroposterior distance ( APD) in the abdominal and thoracic cavity was measured in the same midsagittal plane with the fetal neutral position. A thoracic APD was measured from the back to the distal end of the sternum and an abdominal APD from the back to the most protruding abdominal surface. ATR is the ratio of the abdominal APD versus the thoracic APD. Results Survival rates were 57.5%. There were significant differences in ATR, lung-head ratio ( LHR), observed/expected- LHR, quantitative lung index and intrathoracic liver between survivors and non-survivors. Regression analysis demonstrated that only ATR and intrathoracic position of the liver were independent predictors of survival. ATR by multivariate analysis had the most influence on survival rate ( P = 0.002). The area under the receiver-operator curve for prediction of survival from ATR was 0.770 ( P = 0.004). The diagnostic cut-off value for ATR was 0.96. Conclusions Because ATR is effective to predict neonatal survival in CDH fetuses and is easy to measure, it can be used as another powerful parameter for managing CDH fetuses. [ABSTRACT FROM AUTHOR]

Aim The aim of this prospective study was to investigate the relationship between periodontitis and preeclampsia in never-smokers. Materials and Methods Pregnant women were recruited at 21 to 24 weeks of gestation from March 2009 to June 2013. Information on demographics, health behaviours, obstetric history, and systemic diseases that can influence periodontal status and preeclampsia was collected. Full-mouth periodontal probing was performed by two trained examiners. The inter-examiner Kappa value was 0.822 for clinical attachment loss ( CAL). Periodontitis was defined as clinical periodontal attachment loss ( CAL) of 4.0 mm or greater on 2 or more sites not on the same tooth. Information on the occurrence of preeclampsia was collected by five obstetricians. Results We studied a total of 283 subjects, comprised of 67 subjects with periodontitis and 216 subjects without periodontitis. Of these, 13 (4.6%) women were diagnosed with preeclampsia. After adjusting for all confounders, the adjusted odds ratio of periodontitis for preeclampsia was 5.56 (95% confidence interval of 1.49-20.71). Conclusions There was a significant relationship between periodontitis and the occurrence of preeclampsia among never-smokers. [ABSTRACT FROM AUTHOR]

Korean reunification could be achieved by a confederation agreement between the South Korean government and the North Korean regime that preserves the existing North Korean elite or by a unilateral absorption of the North in which the North's population and territory would be directly incorporated into the South Korean political system. Which of these is a more plausible path to Korean unity? Two regimes confederate when one regime offers a bargain and the other accepts it; the confederation agreement itself then shapes future bargaining between the regimes. Absorption, in contrast, ends one of the regimes and so precludes future negotiations. The confederation path to reunification is more likely when the regimes can confederate in a way that preserves the balance of bargaining leverage between them, which will be when the weaker regime can claim unique competence at governing its territory and when both regimes can maintain their security via a combination of internal resources and external ties. When these factors are not present, absorption is the more likely path to reunification. We illustrate the theory by the reunification of Yemen via a confederation and the reunification of Germany via absorption and apply its logic to the unresolved case of Korea. We conclude that a confederation agreement between North and South Korea is unlikely in the foreseeable future. [ABSTRACT FROM AUTHOR]

Purpose: Medical professionals’ practices and knowledge regarding cancer pain management have often been cited as inadequate. This study aimed to evaluate knowledge, practices and perceived barriers regarding cancer pain management among physicians and nurses in Korea. Methods: A nationwide questionnaire survey was administered to physicians and nurses involved in the care of cancer patients. Questionnaire items covered pain assessment and documentation practices, knowledge regarding cancer pain management, the perceived barriers to cancer pain control, and processes perceived as the major causes of delay in opioid administration. Results: A total of 333 questionnaires (149 physicians and 284 nurses) were analyzed. Nurses performed pain assessment and documentation more regularly than physicians did. Although physicians had better knowledge of pain management than did nurses, both groups lacked knowledge regarding the side effects and pharmacology of opioids. Physicians working in the palliative care ward and nurses who had received pain management education obtained higher scores on knowledge. Physicians perceived patients’ reluctance to take opioids as a barrier to pain control, more so than did nurses, while nurses perceived patients’ tendency to under-report of pain as a barrier, more so than did physicians. Physicians and nurses held different perceptions regarding major cause of delay during opioid administration. Conclusions: There were differences between physicians and nurses in knowledge and practices for cancer pain management. An effective educational strategy for cancer pain management is needed in order to improve medical professionals’ knowledge and clinical practices. [ABSTRACT FROM AUTHOR]

Objective: In East Asia the recently increased number of marriages in response to pregnancy is an important social issue. This study evaluated the association of marriage preceded by pregnancy (bridal pregnancy) with obstetric outcomes among live births in Korea. Methods: In this population-based study, 1,152,593 first singleton births were evaluated from data registered in the national birth registration database from 2004 to 2008 in Korea. In the study population, the pregnancy outcomes among live births from the bridal pregnancy group (N = 62,590) were compared with the outcomes of the post-marital pregnancy group (N = 564,749), composed of women who gave birth after 10 months but before 24 months of marriage. The variables preterm birth (PTB; <37 weeks gestation) and low birth weight (LBW; <2.5 kg) were used to determine the primary outcome. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated after controlling for socio-demographic factors. Results: The socio-demographic factors among the bridal pregnancy group were associated with a social disadvantage and particular risk factors. In the subgroup analyses of maternal age, differences in adverse pregnancy outcomes from bridal pregnancy were identified between women in the following age group: (i) ≤19, (ii) 20–39, and (iii) ≥40 years. After the multivariate analysis, the aORs for each age group were 1.47 (95% CI: 1.15–1.89), 1.76 (1.70–1.83), and 1.13 (0.77–1.66), respectively, for PTB and 0.92 (0.70–1.21), 1.60 (1.53–1.66), and 1.11 (0.71–1.74), respectively, for LBW. In the adjusted logistic regression models, bridal pregnancy was associated with PTB (1.76, 1.69–1.82) and LBW (1.53, 1.48–1.59). Conclusion: Pregnancy outcomes among live births from bridal pregnancies are associated with higher risks for PTB and LBW in Korea. [ABSTRACT FROM AUTHOR]

Background: In April 2011 a tertiary hospital in Seoul, Korea reported several cases of severe respiratory distress of unknown origin in young adults. Methods: To find the route of transmission, causative agent and patient risk factors of the outbreak, an investigation of the epidemic was initiated. Clinicopathological conferences led to the suspicion that the cases related to an inhalation injury. An age- and sex-matched case-control study was therefore performed to examine the inhalation exposure of the patients to various agents. Results: Of the 28 confirmed cases, 18 agreed to participate. A total of 121 age- and sex-matched controls with pulmonary, allergic or obstetric disease were selected. All patients and controls completed questionnaires with questions about exposure to various inhalants. The crude ORs for patient exposure to indoor mould, humidifier use, humidifier detergent use and insecticide use were 4.4 (95% CI 1.5 to 13.1), 13.7 (95% CI 1.8 to 106.3), 47.3 (95% CI 6.1 to 369.7) and 3.9 (95% CI 1.3 to 11.7), respectively. However, when considered concurrently, indoor mould and insecticide use lost statistical significance. Moreover, humidifier use was ruled out as the cause because of a lack of biological plausibility and the weak strength of the association. This suggested that humidifier disinfectant was the cause of the outbreak. This information led the Korean government to order the removal of humidifier detergents from the market. In the years following the ban, no additional cases were detected. Conclusions: Epidemiological evidence strongly suggests that the lung injury outbreak was caused by humidifier detergent use at home. [ABSTRACT FROM AUTHOR]

Background and Aim Sorafenib is recommended as a standard treatment for advanced hepatocellular carcinoma ( HCC). The efficacy and safety of sorafenib as a first-line therapy in Korean patients with advanced HCC were investigated. Methods From 2007 to 2012, 86 patients with advanced HCC ( Barcelona Clinic Liver Cancer stage C) treated with sorafenib as a first-line therapy were enrolled from five tertiary hospitals. Predictors of overall survival ( OS) and progression-free survival ( PFS) were analyzed. Results The median age was 59.5 years, and 71 (82.6%) were males; 57 (66.3%) patients were in Child- Pugh class A. The median OS and PFS were 5.0 (range 4.0-5.9) and 3.2 (range 2.6-3.7) months, respectively. Regarding OS, Child- Pugh class A (6.0 vs 2.8 months), tumor diameter < 5 cm (6.0 vs 4.3 months), baseline α-fetoprotein < 200 ng/m L (5.8 vs 4.1 months), and the advent of hand-foot-skin reaction of ≥ grade 2 (5.9 vs 4.0 months) were independent favorable predictors (all P < 0.05). Similarly, regarding PFS, Child- Pugh class A (4.3 vs 2.1 months), tumor diameter < 5 cm (3.9 vs 2.8 months), baseline α-fetoprotein < 200 ng/ mL (5.6 vs 2.8 months), and the advent of hand-foot-skin reaction of ≥ grade 2 (4.5 vs 2.6 months) were independent favorable predictors (all P < 0.05). All toxicities during sorafenib treatment were manageable. Conclusions Because the efficacy of sorafenib seems marginal in Korean patients with treatment-naïve HCC, how to select candidates with favorable outcomes should be further investigated. [ABSTRACT FROM AUTHOR]

Purpose This study was conducted in order to determine the most cost-effective strategy, in terms of interval and age range, for liver cancer screening in the high-risk population of Korea. Materials and Methods A stochastic model was used to simulate the cost-effectiveness of liver cancer screening by combined ultrasonography and alpha-fetoprotein testing when varying both screening intervals and age ranges. The effectiveness of these screening strategies in the high-risk population was defined as the probability of detecting preclinical liver cancer, and cost was based on the direct cost of the screening and confirmative tests. Optimal cost-effectiveness was determined using the incremental cost-effectiveness ratio. Results Among the 36 alternative strategies, one-year or two-year interval screening for men aged between 50 and 80 years, six-month or one-year interval screening for men aged between 40 and 80 years, and six-month interval screening for men aged between 30 and 80 years were identified as non-dominated strategies. For women, identified non-dominated strategies were: one-year interval screening between age 50 and 65 years, one-year or six-month interval screening between age 50 and 80 years, six-month interval screening between age 40 and 80 years, and six-month interval screening between age 30 and 80 years. Conclusion In Korea, a one-year screening interval for men aged 50 to 80 years would be marginally cost-effective. Further studies should be conducted in order to evaluate effectiveness of liver cancer screening, and compare the cost effectiveness of different liver cancer screening programs with a final outcome indicator such as qualityadjusted life-years or disability-adjusted life-years. [ABSTRACT FROM AUTHOR]

Purpose: Increasing numbers of atypical femoral fractures have been reported among long-term bisphosphonate users. We evaluated clinical characteristics of atypical femoral fractures throughout Korean multicenter studies. Methods: We retrospectively analysed the bone mineral density, prodromal symptoms before femoral fracture, and medication history of osteoporosis in 76 cases of atypical femoral fracture. Results: The mean age of cases was 71.4 ± 8.8 (range, 43-89) years old. The mean follow-up period after the fracture operation was 24.5 ± 12.9 (range, 12-79) months. BMI was 23.2 ± 3.0 on average. The mean BMD of femur was −1.9 ± 1.4 (range, −4.8 to 1.3). Prodromal symptoms including thigh pain before femoral fracture appeared in 22 (28.9 %) of 76 patients. All patients included in the study used bisphosphonate. The duration of taking bisphosphonate before fracture was 36.8 ± 50.8 (one-204 months) months. Fifty-seven (75 %) of 76 patients were taking the medication for more than three years. Delayed union occurred in 43 (56.5 %) of 76 patients. Delayed union was defined as a fractured bone that did not completely heal within six months of injury. The group of having taken anti-osteoporotic medication for more than three years showed relatively longer union period compared to that for a shorter period medication group (4.8 ± 2.5 months vs 9.3 ± 3.7 months, p = 0.017). The delayed union developed in 43 (56.5 %) of 76 patients and showed a significantly higher incidence in the group with long-term therapy (five/43 vs 38/43, p = 0.021). The bilateral femoral fractures developed in 23 (30.2 %) of 76 patients and showed a high incidence in the group medicated more than three years (two/23 vs 21/23, p = 0.039). Conclusions: The longer bisphosphonates are used, the more the cases of delayed union and the more frequent the development of bilateral fractures following unilateral fractures. With regard to the delayed union, the methods of the acceleration of fracture healing may be beneficial in atypical femoral fracture patients who had been receiving long-term bisphosphonates therapy. Careful observation is required for contra-lateral femurs due to a high incidence of bilateral atypical femoral fractures. [ABSTRACT FROM AUTHOR]

Aim We evaluated the impact of cognitive impairment and depression on functional impairment in people aged in their early 60s. Methods This cross-sectional study included 3034 inhabitants of a rural area of Korea aged 60-64 years. The Korean version of the Mini- Mental State Examination ( MMSE-K), the Geriatric Depression Scale ( GDS-15), and Lawton's Instrumental Activities of Daily Living ( IADL) Scale were used to assess cognitive impairment, depression and functional impairment. Results A total of 30.8% of participants reported that they were dependent for at least one of the items on the IADL scale, and the overall prevalence of cognitive impairment and depression was 17.3% and 25.9%, respectively. The results showed that cognitive impairment had a stronger relationship with IADL impairment than did depression (odds ratio [ OR] = 4.91, 95% confidence interval [ CI] 3.91-6.17; c-statistics = 0.647 and OR = 2.05, 95% CI 1.67-2.50; c-statistics = 0.622, respectively). In particular, subclinical levels of the MMSE- K and GDS-15 score were associated with IADL impairment in participants without cognitive impairment or depression ( OR = 0.73, 95% CI 0.67-0.80, OR = 1.09, 95% CI 1.03-1.16, per 1 point score increase, respectively). Only the MMSE- K score showed a significant association in participants with either cognitive impairment or depression, or both. Our findings also showed the independent association of IADL impairment with age, employment status, education and type of insurance. Conclusions Compared with depression, cognitive impairment was more strongly associated with IADL impairment. Subclinical level of cognitive impairment and depression were also associated with IADL impairment in mentally healthy participants. Therefore, early intervention is required to prevent further decline. Geriatr Gerontol Int 2014; 14: 62-70. [ABSTRACT FROM AUTHOR]

Purpose: In order to provide a systematic and standardized treatment course for MVD patients, a critical pathway (CP) program was developed and the results of its long term application were analyzed. Methods: This was a methodological study. The CP was established and applied to 75 (step I) and 1,216 (step II). Another group of 56 with similar features was used as a control group. Results: The application of CP turned out to be useful in many regards: the rate of hearing loss was reduced from 1.8% to 0% (step I) and 0.5% (step II), and low cranial nerve palsy was reduced from 1.8% to 1.3% and 0.7%, respectively. The length of hospitalization decreased by 2.56 days (25.2%) for step I and 3.05 days (30.0%) for step II. Days of ICU stay were reduced by 7.9% and 1.8%. The total cost per patient was reduced by 14.8% (step I). The cost per day was increased by 13.7% and 52.4%. An increase in the patient satisfaction index was noted, as shown in the ICU information guide (p=.002). Conclusion: The development and application of CP was found to improve the quality of medical treatment and the efficacy of hospital management in MVD patients. Well organized and efficient system and multidisciplinary teamwork are the key component of the successful application of CP. [ABSTRACT FROM AUTHOR]

Objective Interleukin-10 (IL-10) is a pleiotropic immunoregulatory cytokine with a chondroprotective effect that is elevated in cartilage and synovium in patients with osteoarthritis. However, the role of IL-10 during endochondral bone formation and its mechanism of action have not been elucidated. Methods IL-10-/- mice and IL-10-treated tibial organ cultures were used to study loss and gain of IL-10 functions, respectively, during endochondral bone formation. Primary chondrocytes from the long bones of mouse embryos were cultured with and without IL-10. To assess the role of IL-10 in chondrogenic differentiation, we conducted mesenchymal cell micromass cultures. Results The lengths of whole skeletons from IL-10-/- mice were similar to those of their wild-type littermates, although their skull diameters were smaller. The tibial growth plates of IL-10-/- mice showed shortening of the proliferating zone. Treatment with IL-10 significantly increased tibial lengths in organ culture. IL-10 also induced chondrocyte proliferation and hypertrophic differentiation in primary chondrocytes in vitro. Mechanistically, IL-10 activated STAT-3 and the Smad1/5/8 and ERK-1/2 MAP kinase pathways and induced the expression of bone morphogenetic protein 2 (BMP-2) and BMP-6 in primary chondrocytes. Furthermore, the blocking of BMP signaling attenuated the IL-10-mediated induction of cyclin D1 and RUNX-2 in primary chondrocytes and suppressed Alcian blue and alkaline phosphatase staining in mesenchymal cell micromass cultures. Conclusion These results indicate that IL-10 acts as a stimulator of chondrocyte proliferation and chondrogenic or hypertrophic differentiation via activation of the BMP signaling pathway. [ABSTRACT FROM AUTHOR]

Objective This study investigates whether fetal pulmonary artery Doppler waveforms can predict the subsequent development of respiratory distress syndrome (RDS). Study Design A prospective cohort study was performed in women with impending preterm birth. Pulsatility index, resistance index, systolic-to-diastolic ratio, peak systolic velocity, and acceleration time-to-ejection time (At/Et) ratio were measured in the main pulmonary artery of fetus just before delivery. Results Neonates who developed RDS (n = 11) had significantly lower gestational age at birth than those without RDS (n = 31;median: 28.7 [range: 24.7 to 34.9] versus 32.9 [range: 25.7 to 36.0] weeks; p = 0.003); there was no difference in antenatal corticosteroid administration. Pulmonary artery At/Et ratio was significantly higher in fetuses that developed RDS compared with those that did not (median: 0.37 [range: 0.26 to 0.41] versus median: 0.30 [range: 0.21 to 0.44]; p = 0.008). RDS prediction score (=a hundredfold At/Et ratio) is significantly associated with the subsequent development of RDS after controlling for gestational age by logistic regression analysis (odds ratio = 1.31, 95% confidence interval 1.05 to 1.63, p = 0.017). Conclusion An elevated At/Et ratio in the fetal pulmonary artery is independently associated with the development of RDS in preterm infants. These data suggest that fetal pulmonary artery Doppler velocimetry may provide a reliable noninvasive technique to evaluate fetal lung maturity, similar to the way in which middle cerebral artery Doppler has replaced amniocentesis for the assessment of fetal anemia. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the prevalence of cognitive impairment, depression, and comorbidity of the two conditions and related factors in subjects aged in early 60s. This cross-sectional study included 3,174 inhabitants aged 60–64 years old in a rural area of Korea. Cognitive function was evaluated by the Korean version of the Mini-Mental State Examination (MMSE-K), and depression was measured using the short form of the Geriatric Depression Scale (GDS-15). The overall prevalence of cognitive impairment (MMSE-K≤24) was 17.4%, that of depression was 26.0% (GDS-15≥8), and the co-morbidity was 7.1%. Female gender, living with one housemate, and high GDS-15 score were significantly associated with increased cognitive impairment. Employment status and more years of schooling were associated with a decreased probability of cognitive impairment. Increased depression was significantly associated with bereavement and receiving benefits from the Medical Aid Program. Employed status, more years of schooling, and higher MMSE-K scores were significantly associated with decreased depression. The risk of comorbidity was associated with bereavement and receipt of Medical Aid benefits (odds ratio[OR], 1.85; 95% confidence interval[CI], 1.26–2.71; OR, 5.02; 95% CI, 2.37–10.63; respectively). Employment and more years of schooling were associated with a lower risk of comorbidity (OR, 0.46; 95% CI, 0.34–0.62, P-trend <0.01). The correlated factors for cognitive impairment, depression, and comorbidity of the two conditions were similar, and employment status and years of schooling were associated with all three conditions. [ABSTRACT FROM AUTHOR]

Aim: The aims of the current study were to assess the validity of the fecal occult blood test (FOBT) in an organized screening setting in Korea and to determine factors associated with FOBT validity, such as screening round, age group, and anatomical location of the cancer. Methods: Study participants were those who were 50 years and older who received an FOBT through the National Cancer Screening Program between 2004 and 2007. Colorectal cancer diagnoses were ascertained through linkage with the Korean National Cancer Incidence Database. The positivity rate, colorectal cancer detection rate, interval cancer rate, sensitivity, specificity, and positive predictive value of the FOBT were calculated. Results: A total of 2,193,093 tests were included in the analysis. Overall, the sensitivity of the FOBT for colorectal cancer was 59.7% for the first round and 56.1% for the subsequent round. Sensitivity was highest for distal colon cancer (65.9%) in the first round, and for rectal cancer (58.4%) for the subsequent round. The sensitivity and positive predictive value of the FOBT generally improved between 2004 and 2008. Conclusions: The FOBT showed reasonable validity in an organized screening setting, and the validity of the FOBT varied by screening round, anatomical location, and screening year. [ABSTRACT FROM AUTHOR]

Background: With the increased incidence of diabetes mellitus, the importance of early intervention in prediabetes has been emphasized. We previously reported that fermented kimchi, a traditional Korean food, reduced body weight and improved metabolic factors in overweight participants. We hypothesized that kimchi and its fermented form would have beneficial effects on glucose metabolism in patients with prediabetes. Methods: A total of 21 participants with prediabetes were enrolled. During the first 8 weeks, they consumed either fresh (1-day-old) or fermented (10-day-old) kimchi. After a 4-week washout period, they switched to the other type of kimchi for the next 8 weeks. Results: Consumption of both types of kimchi significantly decreased body weight, body mass index, and waist circumference. Fermented kimchi decreased insulin resistance, and increased insulin sensitivity, QUICKI and disposition index values (p = 0.004 and 0.028, respectively). Systolic and diastolic blood pressure (BP) decreased significantly in the fermented kimchi group. The percentages of participants who showed improved glucose tolerance were 9.5 and 33.3% in the fresh and fermented kimchi groups, respectively. Conclusions: Consumption of kimchi had beneficial effects on glucose metabolism-related and anthropometric factors in participants with prediabetes. Fermented kimchi had additional effects on BP and insulin resistance/sensitivity. The percentage of participants who showed improvement in glucose tolerance was high in the fermented kimchi group. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Our study aims to describe changes in carcinoma in situ (CIS) and invasive cervical carcinoma (ICC) in Korean women diagnosed between 1993 and 2009. Methods: All cases of CIS and invasive cervical carcinoma diagnosed from 1993 to 2009 in the Korean National Cancer Incidence database were analyzed. Age-standardized rates (ASRs) and annual percent changes (APCs) in incidence rates were compared according to age and histological type. Additionally, we used Korea National Health and Nutrition Examination Survey (KNHANES) to know the association between screening rate for cervical cancer and incidence rate of cervical cancer. Results: Between 1993 and 2009, 72,240 cases of ICC were reported in Korea. Total incidence rate of ICC was 14.7 per 100,000 females. ASRs of ICC declined 3.8% per year, from 19.3 per 100,000 in 1993 to 10.5 per 100,000 in 2009. Although the overall incidence rate of adenocarcinoma remained stable, invasive squamous cell carcinoma showed a decreasing trend (APC −4.2%). For women aged 60–79 years, ASRs for squamous cell carcinoma increased from 1993 to 2001, and decreased from 2001 to 2009 (APC: −4.6%). Total 62,300 cases of CIS were diagnosed from 1993 to 2009. Total incidence rate of CIS was 12.2 per 100,000 females. ASRs of CIS increased 5.7% per year, from 7.5 per 100,000 in 1993 to 19.0 per 100,000 in 2009. Adenocarcinoma in situ increased 13.2% per year. There was a strong positive correlation between screening rate for cervical cancer and incidence rate for CIS (p-value = 0.03) whereas screening rate showed a strong negative correlation with incidence rate for squamous ICC (p-value = 0.04). Conclusions: The increasing trend in CIS, coupled with a decreasing trend in ICC, suggests the important role of cervix cancer screening. The incidence of adenocarcinoma showed a plateau, but the incidence of adenocarcinoma in situ showed an increasing trend. [ABSTRACT FROM AUTHOR]

Abstract: Metal contamination from mining activity is of great concern because of potential health risks to the local inhabitants. In the present study, we investigated the levels of Cd, Cu, As, Pb, and Zn in environmental samples and foodstuffs grown in the vicinity of the mines in Goseong, Korea, and evaluated potential health risks among local residents. Soils near the mines exceeded the soil quality standard values of Cu, As, and Zn contamination. The concentrations of Cd, Cu, Pb, and Zn in crop samples collected from the study area were significantly higher than those of the reference area. Some rice samples collected from the study area exceeded the maximum permissible level of 0.2 mg Cd/kg. The intake of rice was identified as a major contributor (≥75%) to the estimated daily intake among the residents. The average estimated daily intakes of metals were, however, below the provisional tolerable daily intake. [Copyright &y& Elsevier]

Background: Liver cancer is the second most-frequent cause of cancer death in Korea. Hepatitis B virus (HBV) infection is a major cause of liver cancer, and this disease is effectively prevented by HBV vaccination. This study was conducted to investigate factors associated with the lack of HBV vaccine uptake in the general adult male population in Korea. Methods: Data of men who participated in a nationwide cross-sectional interview survey were analyzed. A total of 2,174 men 40 years of age and older were interviewed between 2006 and 2008. None of the participants was infected with HBV or was experiencing sequelae of an HBV infection. Results: Only half (50.4%) of the men received one or more dose of the three-dose series of HBV vaccinations, and 32.5% received all three doses. Compared with men who had completed the vaccination regimen, non-vaccinated men were more likely to lack supplemental medical insurance for cancer (odds ratio = 0.66, 95% confidence interval: 0.52-0.84), have lower incomes (p-trend = 0.010), and be less educated (p-trend = 0.021). Lower education was also more prevalent in the non-vaccinated group compared with the incompletely vaccinated group. Those who had completed the vaccination regimen were likely to be more educated than those in the incompletely vaccinated group (p-trend = 0.044). The most commonly cited reason for not obtaining the HBV vaccine was lack of knowledge regarding the need for the vaccination. The number of men who cited this reason decreased as a function of education. Conclusions: It is important to develop strategic interventions targeted at less-educated men to increase uptake of a complete three-dose series of HBV vaccinations as a primary approach to preventing liver cancer. [ABSTRACT FROM AUTHOR]