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Introduction: Amid the growing global concern about obesity, young adults in South Korea are particularly affected, with 30.8% of people aged 19-34 classified as obese. Given the urban-centric lifestyle of Korean youth, understanding the relationship between daily life activities and the urban environment holds great promise for effective interventions. This study aims to explore the daily life activities of young adults with obesity in Seoul, a city known for its highly accessible and compact environment. The research questions explore the interaction between daily life activities and the neighbourhood environment and consider weight management in an urban context., Methods and Analysis: This study uses an extended qualitative geographic information system approach to explore a district in Seoul with a highly accessible and compact urban environment. The sample comprises young adults with obesity (aged 19-34) residing in the study area, with recruitment targeting up to 51 participants for data saturation. A qualitative, multimethod approach combines descriptive and spatiotemporal data collection. Descriptive data are being collected, including in-depth interviews and photographs of daily food consumption. Spatial data collection involves field observations, cognitive mapping and mobile Global Positioning System tracking. Temporal data is gathered through participants drawing round timetables, detailing their daily schedules. Data analysis will entail thematic analysis of the interview data and content analysis of the spatiotemporal data. For the integrated analysis, pattern finding will be used to synthesise the data., Ethics and Dissemination: This study was approved by the institutional review board of Seoul National University on 11 July 2022. Data collection and curation are currently underway, and the results of the analysis will be shared with the scientific community at international conferences and peer-reviewed journals. We are planning an open seminar to share our research findings with relevant policy-makers, community organisations and health professionals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The number of single-person households is increasing globally-including in South Korea, where they account for over 30% of all households. Young single-person households in South Korea face health problems and housing challenges. Both the perceived and objective aspects of the neighbourhood environment, as a community asset, play a significant role in sustaining a healthy lifestyle. This study aims to explore and describe the meaning, roles and spatiotemporal characteristics of neighbourhood environments for a healthy lifestyle in young single-person households experiencing housing poverty in Seoul, South Korea., Methods and Analysis: This ongoing study uses an extended qualitative geographic information systems approach to explore a district in the city of Seoul that has the highest population density of young single-person households experiencing housing poverty. The study sample comprises young single-person households aged 19-39 years who are experiencing housing poverty in the study area, with an expected saturation point of approximately 55 participants. We employ online and offline recruitment strategies to ensure the inclusion of diverse perspectives and a multimethod approach that combines descriptive and spatiotemporal data collection techniques (eg, individual in-depth interviews, field observations and mobile global positioning system tracking). The data analysis encompasses thematic and content analyses to understand the neighbourhood environment's perceived attributes and the spatiotemporal characteristics of healthy lifestyles. In the integrated analysis, we plan to combine the qualitative findings with living space and daily-life patterns using qualitative software and a hybrid relational database., Ethics and Dissemination: The Institutional Review Board of Seoul National University approved the research protocol on 18 May 2021. The findings will be shared at international conferences and published in academic journals. Additionally, an online seminar will be conducted to share the results with policy-makers, researchers, community organisations and health workers working with young single-person households experiencing housing poverty., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

The aim of this study was to characterize the physicochemical properties and microbial communities of particulate matter (PM) in Seoul, Korea. We collected long-term (2017-2019) precipitation samples and PM 10 and PM 2.5 monitoring data to determine the impact of soluble and insoluble chemical species on the soil surface. Ambient PM 10 concentrations were higher than PM 2.5 concentrations during the monitoring period, but both decreased during rainfall due to the washing effect of precipitation. PM 2.5 particles had a "fluffy" shape and contained sulfur (0.2%), but suspended particles (SPs) contained many carbon particles (approximately 60%). Spherical particles containing metal oxides, Fe and Al, might be originated from coal combustion, wild fires, and metal-refining processes under high-temperature conditions. Dissolved ions in precipitation included those eluted from salts and coal combustion based on the correlation coefficients of Na and Cl (R = 0.953) and F and NO 3 (R = 0.706). The δ 15 N-NO 3 and δ 34 S-SO 4 of precipitation were enriched as the atmospheric temperature decreased from 9.8 to -1.6°C, implying the influence of domestic coal combustion. Backward trajectories showed that, in winter, air parcels passed through industrialized cities from China to South Korea. The microbial communities associated with PM were strongly influenced by atmospheric conditions. Proteobacteria (range from 4.6 to 76.7%) and Firmicutes (range from 6.0 to 91.4%) were the most dominant phyla and were significantly affected by changes in the PM 2.5 environment. The results indicate that the acidity of precipitation and the composition of aerosols were affected by fossil fuel combustion and mineral dust, and that atmospheric conditions may change as PM 2.5 concentrations increase., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: After the third wave of coronavirus disease 2019 (COVID-19), by mid-February 2021, approximately 0.16% of the Korean population was confirmed positive, which appeared to be among the lowest rates worldwide at that time. However, asymptomatic transmission is challenging for COVID-19 surveillance. Therefore, a community-based serosurvey of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted to understand the effectiveness of Korea's strong containment strategy., Methods: We collected 5,002 residual sera samples from January 30 to March 3, 2021, from 265 medical facilities in Seoul, 346 in Gyeonggi Province, and 57 in Incheon. Sixty samples from tertiary institutions were excluded. We defined the sub-regions according to the addresses of the medical facilities where the specimens were collected. Elecsys Anti-SARS-CoV-2 was used for screening, and positivity was confirmed using the SARS-CoV-2 sVNT Kit. Prevalence was estimated using sampling weights and the Wilson score interval for a binomial proportion with a 95% confidence interval., Results: Among the 4,942 specimens, 32 and 25 tested positive for COVID-19 in the screening and confirmatory tests, respectively. The overall crude prevalence of SARS-CoV-2 antibodies was 0.51%. The population-adjusted overall prevalence was 0.55% in women and 0.38% in men. The region-specific estimation was 0.67% and 0.30% in Gyeonggi Province and Seoul, respectively. No positive cases were detected in Incheon., Conclusions: The proportion of undetected cases in Korea remained low as of early 2021. Therefore, an infection control strategy with exhaustive tracing and widespread pre-emptive testing appears to be effective in containing community spread of COVID-19.

We compared the effects of ezetimibe/rosuvastatin 10/5 mg versus rosuvastatin 20 mg on carotid atherosclerotic plaque inflammation measured by 18 FDG PET/CT. Fifty patients with acute coronary syndrome (ACS) were randomly assigned to the ezetimibe/rosuvastatin 10/5 mg and rosuvastatin 20 mg groups. The primary outcome was the percent change in the target-to-background ratio (TBR) of the index vessel in the most diseased segment (MDS), as assessed by 18 FDG PET/CT at baseline and at 6 months. Forty-eight patients completed follow-up PET/CT. MDS TBR was - 6.2 ± 13.9% for patients in the ezetimibe/rosuvastatin group and - 10.8 ± 17.7% for those in the rosuvastatin group (difference, 4.6 percentage points; upper limitation of one-sided confidence interval = 13.8; p = 0.60 for noninferiority). In conclusion, combination therapy with ezetimibe 10 mg and rosuvastatin 5 mg compared with rosuvastatin 20 mg did not meet the criterion for non-inferiority for primary outcome, and the present study was not conclusive on whether the former was non-inferior to the latter. Graphical Abstract.

Since mitral valve (MV) complex (MVC) longitudinally bridges left ventricular (LV) base end and its middle, insufficient MVC longitudinal tissue length (TL) elongation relative to whole LV myocardial longitudinal TL elongation could limit LV-base-longitudinal-TL elongation, leading to predominant LV-base-transverse-TL elongation, constituting LV spherical remodeling. In 30 patients with dilated cardiomyopathy (DCM), 30 with aortic regurgitation (AR), and 30 controls, LV sphericity, LV-apex- or base-transverse- and longitudinal-TL, MVC-longitudinal-TL, and whole-LV-longitudinal-TL were measured by three-dimensional (3D) echocardiography. Ratio of each measure versus mean normal value (i.e., LV-apex-transverse-TL ratio) was considered to express the directional and regional tissue elongation. [LV-base-longitudinal-TL ratio/global-LV-TL ratio] and [MVC-longitudinal-TL ratio/whole-LV-longitudinal-TL ratio] were obtained as the degree of LV-base-longitudinal-TL or MVC-longitudinal-TL elongation relative to the whole LV elongation. LV-apex-transverse-, LV-apex-longitudinal-, and LV-base-transverse-TL ratios were significantly increased (1.27 to 1.42, P < 0.01) in both DCM and AR, while the LV-base-longitudinal-TL ratio was not increased in DCM [1.04 ± 0.19, not significant (ns)] and only modestly increased in AR (1.12 ± 0.21, P < 0.01). Whole-LV-longitudinal-TL ratio was significantly increased in both DCM and AR (1.22 ± 0.18 and 1.20 ± 0.16, P < 0.01), while MVC-longitudinal-TL ratio was not or only modestly increased in both groups (1.07 ± 0.15, ns, and 1.12 ± 0.17, P = 0.02, respectively). Multivariable analysis revealed that LV sphericity was independently related to a reduced [LV-base-longitudinal-TL ratio/global-LV-TL ratio] (standard β = -0.42, P < 0.01), which was further related to a reduced [MVC-longitudinal-TL ratio/whole-LV-longitudinal-TL ratio] (standard β = 0.72, P < 0.01). These are consistent with the hypothesis that relatively less MVC-longitudinal-TL elongation in the process of primary LV myocardial tissue elongation may limit LV-base-longitudinal-TL elongation, contributing to LV spherical remodeling. NEW & NOTEWORTHY Left ventricular (LV) spherical remodeling is associated with poor prognosis and less-effective cardiac performance, which commonly develops in dilated cardiomyopathy. However, its mechanism remains unclear. We hypothesized and subsequently clarified that less mitral valve complex (MVC) tissue longitudinal elongation relative to whole LV myocardial tissue longitudinal elongation is related to disproportionately less LV base longitudinal versus transverse myocardial tissue elongation, constituting spherical remodeling. This study suggests modification of MVC tissue elongation could be potential therapeutic targets.

Vibrio parahaemolyticus is a marine bacterium that causes foodborne diarrhea. Many seafood restaurants keep live fish and shellfish in fish tanks for use in raw seafood dishes; thus, the present study aimed to investigate the prevalence, antibiotic-resistance, and virulence characteristics exhibited by V. parahaemolyticus detected in restaurant fish-tank water samples collected in Seoul, South Korea. Fish-tank water samples were collected from 69 restaurants in Seoul, and screened for the presence of V. parahaemolyticus via both a commercial detection kit, and a real-time polymerase chain reaction (RT-PCR) to detect the toxR gene. Antibiotic susceptibility and virulence determinants of V. parahaemolyticus isolates were evaluated and identified using standard disk-diffusion and RT-PCR methods, respectively. Thirty-five (50.7%) of the 69 analyzed water samples were found to be contaminated with V. parahaemolyticus . Those isolates were most often resistant to ampicillin (51.4% of isolates), followed by amikacin and tetracycline (11.4%), and ceftazidime (8.6%). Thirty (85.7%) out of the 35 isolates carried all four cytotoxicity-inducing type III secretion system 1 (T3SS1) genes [specifically, 34 (97.1%), 33 (94.3%), 35 (100%), and 32 (91.4%) isolates carried genes encoding the VP1670, VP1686, VP1689, and VP1694 T3SS1 proteins, respectively]. The type VI secretion systems (T6SS1 and T6SS2) genes were also detected in 11 (31.4%) and 27 (77.1%) isolates, respectively. However, virulence determinants such as the hemolysin ( tdh and trh ), urease ( ure C), T3SS2α, or T3SS2β genes that are known to be associated with enterotoxicity were not detected in all isolates. Although some known major virulence genes were not detected in the V. parahaemolyticus isolates, the results of this study indicate that restaurant fish tanks are a potential source of antibiotic-resistant V. parahaemolyticus . The presented data support the need for strict guidelines to regulate the maintenance of restaurant fish tanks to prevent antibiotic-resistant foodborne vibriosis.

Background: Nutritional status, a key marker of patient frailty, is an important prognostic factor after transcatheter aortic valve replacement (TAVR). Few investigations have evaluated the clinical usefulness of nutritional assessment tools for predicting the risk of mortality following TAVR., Methods: A total of 412 patients with symptomatic severe AS who underwent TAVR between March 2010 and August 2017 were stratified into subgroups by their Geriatric Nutritional Risk Index [GNRI, low ≤ 98 vs. high > 98 (better nutritional status)] and Controlling Nutritional Status (CONUT) score [low ≤ 3 vs. high ≥ 4; (poorer nutritional status)]. The primary study outcome was all-cause mortality at 1 year., Results: Patients with low GNRI score showed a significantly higher 1-year mortality rate as compared to those with high GNRI score (13.0% vs. 3.2%, respectively; P = 0.001). Similarly, patients with high CONUT score had a significantly higher rate of 1-year mortality than those with low CONUT score (15.7% vs. 6.2%, respectively; P = 0.005). However, in multivariable Cox proportional-hazards models, low GNRI was the only independent predictor of mortality (adjusted hazard ratio, 3.77; 95% confidence interval 1.54-9.20; P = 0.004). Overall, integration of GNRI into conventional risk models of STS score or logistic EuroSCORE resulted in improved predictive value for mortality measured by the net reclassification improvement and the integrated discrimination improvement., Conclusions: In patients undergoing TAVR, low GNRI (but not high CONUT score) was independently associated with a higher risk of 1-year mortality. Further research is required to determine whether nutritional screening and management can improve clinical outcomes in patients undergoing TAVR.

Cycling provides opportunities to promote healthy and sustainable cities. However, few studies examine cyclists' perceived attributes of a bicycle-friendly environment in relation to compact urban contexts. This study explored the attributes of perceived bikeability and urban context related to the cycling experience in Seoul, Korea. Purposive sampling with public recruitment and a snowball technique was used to recruit twenty-two cyclists and three bicycle-related community service providers from a bikeable environment. Qualitative multi-methods, including semi-structured interviews and bicycle tours with a GPS device, were adopted. The main themes of perceived bikeability were derived through thematic analysis. Cyclists perceived the attributes of a bicycle-friendly physical environment as essential components of bikeability. In urban environments where cycling is not yet recognized as the main transportation mode, internal conflict among cyclists and external conflicts between cyclists and other transportation users were evident. A supportive community system included developing an appropriate environment, providing information, and expanding riding opportunities. A bicycle-friendly culture accumulated over a long period influenced the initiation and maintenance of cycling and contributed to a more bikeable community environment. Cyclists' attitude, behaviors, and perceived environment differed according to purpose. Policy, system, and environmental changes are required to promote cycling in compact urban contexts.

Background: Using 18 F-fluorodeoxyglucose ( 18 FDG) positron emission tomography-computed tomography (PET/CT) imaging, we examined the effects of ezetimibe/simvastatin 10/10 mg versus rosuvastatin 10 mg on carotid atherosclerotic plaque inflammation. Whether the combination therapy of ezetimibe with low-dose statin is as effective as potent statin monotherapy in attenuating carotid atherosclerotic plaque inflammation remains unclear., Methods: In this 2-by-2 factorial trial, 50 patients with 18 FDG uptake (target-to-background ratio [TBR] ≥1.6) in the carotid artery and acute coronary syndrome were randomized to receive either simvastatin/ezetimibe 10/10 mg or rosuvastatin 10 mg. 18 FDG PET/CT examinations were performed at baseline and at 6 months. The percent change in the TBR of the index vessel at the most diseased segment (MDS) was the primary endpoint., Results: Baseline characteristics of the two groups were largely similar. At 6-month follow-up, the MDS TBR of the index vessel and aorta significantly decreased in ezetimibe/simvastatin group and tended to decrease in rosuvastatin group. However, the percent change in the MDS TBR of the index vessel was similar between the 2 groups (- 10.22 ± 17.49% vs. -5.84 ± 15.78%, respectively, p = 0.357), as was the percent change in the whole vessel TBR of the index vessel. Likewise, the changes in the MDS TBR or whole vessel TBR of the aorta were similar in both groups. Total cholesterol and low-density lipoprotein cholesterol levels improved to a similar degree in both groups., Conclusion: Treatment with ezetimibe/simvastatin versus rosuvastatin resulted in a similar improvement of carotid atherosclerotic plaque inflammation, suggesting their equivalent anti-inflammatory effects., Trial Registration: The trial is registered at ClinicalTrials.gov : NCT02378064, 3-4-2015. /IRB No. 2015-0194.

Background/aims: Endoscopic submucosal dissection (ESD) of a superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ESD to determine its feasibility and effectiveness for the treatment of SEN., Methods: Patients who underwent ESD for SEN between August 2005 and June 2014 were eligible for this study. The clinical features of patients and tumors, histopathologic characteristics, adverse events, results of endoscopic resection, and survival were investigated., Results: ESD was performed in 225 patients with 261 lesions, including 70 cases (26.8%) of dysplasias and 191 cases (73.2%) of squamous cell carcinomas. The median age was 65 years (range, 44 to 86), and the male to female ratio was 21.5:1. Median tumor size was 37 mm (range, 5 to 85) and median procedure time was 45 minutes (range, 9 to 160). En bloc resection was performed in 245 of 261 lesions (93.9%), with complete resection in 234 lesions (89.7%) and curative resection in 201 lesions (77.0%). Adverse events occurred in 33 cases (12.6%), including bleeding (1.5%), perforation (4.6%), and stricture (6.5%). During a median follow-up period of 35.0 months (interquartile range, 18 to 62), none of the patients showed local recurrence. The 5-year overall and disease-specific survival rates were 89.7% and 100%, respectively., Conclusions: ESD is a feasible and effective procedure for the treatment of SEN based on our 10-year experience, which showed favorable outcomes., Competing Interests: No potential conflict of interest relevant to this article was reported.