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There are no surrogate markers for the development of postherpetic neuralgia (PHN) in patients with herpes zoster (HZ). All patients with HZ were prospectively enrolled to evaluate the associations of saliva varicella zoster virus (VZV) DNA persistence and VZV-specific cell-mediated immunity (CMI) with the development of PHN. Slow clearers were defined if salivary VZV DNA persisted after day 15. Salivary VZV was detected in 60 (85.7%) of a total of 70 patients with HZ on initial presentation. Of 38 patients for whom follow-up saliva samples were available, 26 (68.4%) were classified as rapid clearers and 12 (31.6%) as slow cleares. Initial VZV-specific CMI was lower in slow clearers than rapid clearers (median 45 vs 158 spot forming cells/10 6 cells, P = .02). Of the 70 patients with HZ, 22 (31.4%) eventually developed PHN. Multivariate analysis showed that slow clearers (OR, 15.7, P = .01) and lower initial VZV-specific CMI (OR, 13.8, P = .04) were independent predictors of the development of PHN, after adjustment for age and immunocompromised status. Initial low VZV CMI response and persistence of VZV DNA in saliva may be associated with the development of PHN.

Backgrounds: Drug-induced liver injury (DILI) is a major causal factor for failure in clinical trials and withdrawal of drugs from pharmaceutical markets. Therefore, a human cell-based in vitro system has been established to overcome the limitations of preclinical trials. However, previous studies focused on the drug metabolism in each cell line or described to be superior in one single cell line for assessing DILI. In this study, we used Huh7, HepaRG, and Hepatosight-S cells to evaluate the liver toxicity and dysfunction driven by DILI-inducing drugs. Methods: Cytotoxicity of 17 DILI-inducing drugs was assessed by LDH release assay and the drug-induced liver dysfunction was confirmed by albumin secretion. Furthermore, we analyzed the expression levels of phase I and phase II enzymes and nuclear receptors in each cell lines. Results: DILI-inducing drugs were differently detected in each cell line because each cell line differs on the expression of drug metabolic enzymes which associated with reactivity on DILI inducing drugs. Conclusion: To predict the responses of DILI-inducing drugs in human liver cells, using diverse cell lines having different drug metabolic capabilities is more suitable for predicting DILI.

Aims and objectives To identify whether meaning in life has moderating and mediating effects on the relationship between depression and quality of life in patients with dysphagia. Background Dysphagic patients typically have multidimensional problems, such as depression, which can negatively influence their quality of life. Meaning in life, therefore, can be used as a psychological resource that may enhance quality of life for these patients. Design A descriptive cross-sectional research design was used. Methods Ninety patients with dysphagia were recruited for a survey from eight general and rehabilitation hospitals in Korea. The questionnaires, which included the Korean version of the Swallowing Quality of Life scale developed by Cha, the Center for Epidemiological Studies-Depression Scale developed by Radloff, and the Purpose in Life test developed by Crumbaugh and Maholick, were used for data collection. Descriptive statistics, Hayes' PROCESS macro and Cronbach's alpha were used for data analyses. Results Meaning in life was found to mediate the relationship between depression and quality of life in patients with dysphagia. However, the index of moderation was not statistically significant, which mean that meaning in life did not moderate the relationship between the patients' depression and quality of life. Conclusions Meaning in life had a mediating effect on the relationship between depression and quality of life in patients with dysphagia. Thus, to improve the quality of life of patients with dysphagia, nurses should apply interventions to help them find meaning in life. Relevance to clinical practice Meaning in life can be used as a nursing intervention strategy to improve the quality of life for patients living with dysphagia and depression.

The Conditional Tail Expectation (CTE), also known as the Expected Shortfall and Tail-VaR, has received much attention as a preferred risk measure in finance and insurance applications. A related risk management exercise is to allocate the amount of the CTE computed for the aggregate or portfolio risk into individual risk units, a procedure known as the CTE allocation. In this paper we derive analytic formulas of the CTE and its allocation for the class of multivariate normal mean–variance mixture (NMVM) distributions, which is known to be extremely flexible and contains many well-known special cases as its members. We also develop the closed-form expression of the conditional tail variance (CTV) for the NMVM class, an alternative risk measure proposed in the literature to supplement the CTE by capturing the tail variability of the underlying distribution. To illustrate our findings, we focus on the multivariate Generalized Hyperbolic Distribution (GHD) family which is a popular subclass of the NMVM in connection with Levy processes and contains some common distributions for financial modelling. In addition, we also consider the multivariate slash distribution which is not a member of GHD family but still belongs to the NMVM class. Our result is an extension of the recent contribution of Ignatieva and Landsman (2015).

Background/aims Despite increased demand for cancer patient's to make their own decisions based on an adequate understanding of what is involved in chemotherapy, the primary signing agent and the reasons for surrogate signing have not been appropriately evaluated. Methods The ethics committee of the palliative medicine subgroup of the Korean Cancer Study Group designed this study and solid cancer patients to whom chemotherapy was offered, from seven institutions, were evaluated. The details relating to surrogate's signing of chemotherapy consent were evaluated. Then, we analyzed the factors associated with surrogate's signing according to patient's demographics and characteristics related to chemotherapy consent. Results Surrogate's signing was noted for 20.7% (84/405) of patient and over half of surrogate signings were performed by the patients' son or daughter (60.7%). Two main reasons for surrogate signing were patient's incapacity (34.5%) and taking over authorization from patients (33.3%). The factors associated with more frequent surrogate's signing were absence of spouse, lower education level, outpatient, and when residents played a role as a principle provider of chemotherapy consent. Conclusion This study suggests the lack of patients' own decision making for chemotherapy in some situations. This ethical dilemma must be considered for adequately informed decision making for chemotherapy while ensuring the patients' autonomy is maintained.

We developed a formate-removing methanogenic inoculum (FRI) to facilitate succinate production from crude glycerol by Escherichia coli. FRI converted formate to methane, thereby enabling glycerol fermentation without additional electron acceptors under neutral pH. FRI was selectively enriched from sludge from the anaerobic digester of the Seonam sewage treatment plant (Seoul); this process was assessed via Illumina sequencing and scanning electron microscopy imaging. Methanobacterium congolense species occupied only 0.3% of the archaea community in the sludge and was enriched to 99.5% in complete FRI, wherein succinate-degrading bacteria were successfully eliminated. Co-culture with FRI improved glycerol fermentation and yielded 7.3 mM succinate from 28.7 mM crude glycerol, whereby FRI completely converted formate into methane. This study is the first to demonstrate methane production by M. congolense species, using formate. M. congolense-dominated FRI can serve as a renewable facilitator of waste feedstock fermentation and enable the production of commercially important compounds.

Purpose This paper aims to examine the effect of music tempo on impatience in intertemporal tradeoff decisions. It finds that fast (vs slow) tempo music increases impatience. This occurs because fast (vs slow) tempo music makes temporal distance, and hence the waiting time until the receipt of delayed benefits, feel subjectively longer. Design/methodology/approach The study tests the hypotheses through four laboratory experiments. Findings In Studies 1a (N = 88) and 1b (N = 98), the results demonstrate that when participants listen to fast (vs slow) tempo music, they judge temporal distance to be longer. In Study 2 (N = 94), the results demonstrate that when participants listen to fast (vs slow) tempo music, they become more impatient when considering a smartphone purchase. In Study 3 (N = 218), the results demonstrate that when participants listen to fast (vs slow) tempo music, they become more impatient when considering a gift certificate, and that this delay discounting effect is attributable to the change in their temporal distance judgment. Research limitations/implications The current research reports a novel factor that influences impatience in intertemporal decisions and temporal distance judgment. Practical implications This research provides useful guidelines for retail managers and marketers regarding the effect of background music in stores. Originality/value This is the first study demonstrating a music tempo effect on temporal distance judgment and impatience in intertemporal tradeoff decisions.

The instability of iridium oxide at high temperature has long been a bottleneck for in growing pyrochlore iridate thin films in a vacuum chamber. To overcome this problem, we investigated the chemical instability of IrO2 thin films, which are the simplest form of iridate, via in-operando spectroscopic ellipsometry (SE). We observed that IrO2 thin films undergo IrO2 dissociation and IrO3 gas formation depending on the thermodynamic conditions. The chemical kinetics observations of IrO2 were confirmed by ex-situ X-ray diffraction and atomic force microscopy. SE experimental data were compared with models used to describe the evolution of the two chemical reactions. Real-time in-operando SE analysis based on the Maxwell Garnett theory yielded a precise IrO2 dissociation speed for the given thermodynamic conditions. Moreover, the real-time in-operando SE technique allowed us to observe the phase transition from solid IrO2 to gaseous IrO3. This study on the chemical instability of IrO2 at high temperature affords insights into a new method for in-situ pyrochlore iridate and other iridates thin-film growth.

Despite the urgent need to control dementia, an effective treatment has yet to be developed. Along with the Korean government's policy of cooperation between conventional medicine (CM) and Korean medicine (KM), integrative medical services for dementia patients are being provided. This study aimed to compare the integrative medical clinic (IMC) for dementia used by Dongguk University Hospitals (DUH) with other service models and to review the characteristics and treatment outcomes of patients who had visited DUH over the past 5 years. Patients' electronic medical records from May 2015 to June 2020 were searched and their data were analyzed to evaluate the IMC's service model. Patient demographic and clinical characteristics, diagnostic tests, and treatment patterns for CM and KM were collected. The proportion of patients who did not show worsening cognitive function was described in detail. A strength of the DUH integrative medicine clinic is its ability to manage both KM and CM patients in the same space at the same time. Among the 82 patients who visited the clinic during our study period, 56 remained for data analysis after we excluded patients who met the exclusion criteria; nineteen patients had diagnoses of mild cognitive impairment. Among collaboration patterns, the first visit to the IMC had the highest proportion (55.4%). Among diagnosed tests in CM, laboratory tests and neuropsychological tests were used the most. In KM, a heart rate variability test was frequently used. The most common CM treatment prescribed was anticonvulsants, with 22 patients (39.2%) receiving donepezil, whereas the most frequent KM treatments were acupuncture (82.1%) and herbal medicine (78.6%). Twelve patients were followed up with the Mini-Mental State Examination, and 8 demonstrated either no worsening or improved cognition (baseline Mini-Mental State Examination range: 21-26). All 8 patients had mild cognitive impairment including 6 with amnestic, multidomain impairment. This study searched for a way to improve cognitive dysfunction and dementia using an integrative approach, and it shows promising results for mild cognitive impairment. However, more precisely designed follow-up studies are needed to address the present work's limitations of a retrospective study design and a small sample size.

There are limited data directly comparing humoral and T cell responses to the ChAdOx1 nCoV-19 and BNT162b2 vaccines. We compared Ab and T cell responses after first doses of ChAdOx1 nCoV-19 vs. BNT162b2 vaccines. We enrolled healthcare workers who received ChAdOx1 nCoV-19 or BNT162b2 vaccine in Seoul, Korea. Anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) S1 protein-specific IgG Abs (S1-IgG), neutralizing Abs (NT Abs), and SARS-CoV-2-specific T cell response were evaluated before vaccination and at 1-wk intervals for 3 wks after vaccination. A total of 76 persons, comprising 40 injected with the ChAdOx1 vaccine and 36 injected with the BNT162b2 vaccine, participated in this study. At 3 wks after vaccination, the mean levels (±SD) of S1-IgG and NT Abs in the BNT162b2 participants were significantly higher than in the ChAdOx1 participants (S1-IgG, 14.03±7.20 vs. 6.28±8.87, p

Background Terminal ileal (TI) ulcers are occasionally detected in asymptomatic individuals and mostly resolve without any treatment. In patients with ulcerative colitis (UC), TI ulcers are infrequently observed without evidence of backwash ileitis. However, the clinical significance and natural course of the lesions are unclear. The aim of our study was to evaluate the frequency and clinical implications of TI ulcers in patients with UC. Methods We retrospectively reviewed 397 patients with UC via successful TI intubation during colonoscopy. We compared the clinical characteristics of patients manifesting TI ulcers with those who did not. The natural course of TI lesions was also investigated during the follow-up periods. Results Forty-one patients (10.3%) showed TI ulcers without evidence of inflammation in the right colon. The patients with and without TI ulcers were not different in terms of baseline characteristics, disease activity and extent at the time of the UC diagnosis, proximal extension, Mayo endoscopic score at the last endoscopic examination, medication history, UC-related hospitalization, and relapse during follow-up periods. Of the 30 patients who underwent follow-up colonoscopy in patients with TI ulcers, 23 (76.7%) showed resolution of TI ulcer. In addition, patients with remaining TI ulcers did not differ in disease activity and biopsy results compared with those with resolving TI ulcers. Conclusions Discrete TI ulcers are more common in patients with UC, compared with the healthy cohort. No significant clinical impact on disease extension and severity is found.

Background As the role of immunotherapies and personalized medicine grow, cancer patients have faced many choices in treatments and have suffered financial toxicity. These challenges brought the need for the value framework (VF) to guide treatment decision making. Methods A survey was taken to 102 oncologists about perception for VF. They were asked about priorities among several considerations when they prescribe cancer drugs. Their views on the need for development and potential implications of VF in Korea were assessed, also. Results The survey shows that 90% of the respondents choose clinical efficacy as the most important value in cancer drugs selection, and the cost of drug was more weighted value in immune checkpoint inhibitors (13.7%). Approximately half (53.9%) answered that they were aware of the existing VFs. Over 90% of respondents agreed with the need for development of a VF for cancer drugs based on Korean healthcare system and further usefulness for decisions about reimbursement issues. Seventy-one percent answered that two representative VFs (American Society Clinical Oncology-VF and European Society for Medical Oncology-Magnitude of Clinical Benefit Scale) should be reflected in value measurement of cancer drugs in Korea. Conclusion The Korean oncologists recognized the necessity for the clinical application of VF. Further discussion between the stakeholders should be followed to alleviate the financial burden through the value-based decision making of cancer drugs., Graphical Abstract

The purpose of this study was to evaluate the bone-generating ability of a new bovine-derived xenograft (S1-XB) containing hydrogel. For control purposes, we used Bio-Oss and Bone-XB bovine-derived xenografts. S1-XB was produced by mixing Bone-XB and hydrogel. Cell proliferation and differentiation studies were performed to assess cytotoxicities and cell responses. For in vivo study, 8 mm-sized cranial defects were formed in 16 rats, and then the bone substitutes were transplanted into defect sites in the four study groups, that is, a Bio-Oss group, a Bone-XB group, an S1-XB group, and a control (all n = 4), in the control group defects were left empty. Eight weeks after surgery, new bone formation areas were measured histomorphometrically. In the cell study, extracts of Bio-Oss, Bone-XB, and S1-XB showed good results in terms of the osteogenic differentiation of human mesenchymal stem cells (hMSCs) and no cytotoxic reaction was evident. No significant difference was observed between mean new bone areas in the Bio-Oss (36.93 ± 4.27%), Bone-XB (35.07 ± 3.23%), and S1-XB (30.80 ± 6.41%) groups, but new bone area was significantly smaller in the control group (18.73 ± 5.59%) (p &lt, 0.05). Bovine-derived bone graft material containing hydrogel (S1-XB) had a better cellular response and an osteogenic effect similar to Bio-Oss.

Niobium pentoxide (Nb

The purpose of this study was twofold: (a) to examine and compare levels of parental self-efficacy (PSE) and parenting practices (PP) between parents of young children with and without disabilities regarding physical activity (PA) participation of their children and (b) to analyze and compare the relationship between PSE and PP. A total of 235 participants completed a survey measuring levels of PSE and PP related to the promotion of PA for their children. The results showed no differences in levels of PSE and PP between parents of children with and without disabilities (p > 0.05). A positive moderate relationship was found between PSE and PP from total participants (r = 0.497, p

Varicella-zoster virus (VZV) infects and establishes latency in neurons in the ganglia of the cranial nerve, dorsal root and enteric ganglia. VZV reactivation in enteric neurons (enteric zoster) can cause non-specific abdominal pain and/or serious gastrointestinal dysfunction without cutaneous manifestations. Detection of VZV DNA in saliva may be useful for identifying enteric zoster. We evaluated the frequency of putative enteric zoster based on the presence of salivary VZV DNA in patients with acute abdominal pain.Adult patients who visited the emergency room due to moderate to severe acute abdominal pain were prospectively enrolled at a tertiary hospital between May 2019 and November 2019. Abdominopelvic computed tomography (APCT) was performed in all patients. We also evaluated the presence of salivary VZV DNA in patients with confirmed coronavirus disease-19 (COVID-19) who were under stressful conditions. Saliva samples were collected from all studied patients. Enteric zoster was suspected based on the presence of salivary VZV DNA, detected using real-time polymerase chain reaction (PCR).Fifty patients with moderate to severe abdominal pain were enrolled. Five of 50 patients exhibited positive VZV-DNA PCR results. APCT revealed that among these five patients, two had pancreatic head cancer, two had small bowel obstruction after intra-abdominal surgery, and one had no remarkable findings. However, all 14 patients with COVID-19 showed negative salivary VZV-DNA PCR results.Approximately 10% of patients with moderate to severe acute abdominal pain showed positivity for salivary VZV DNA. Further studies are warranted on whether antiviral therapy based on salivary VZV-DNA PCR results may relieve abdominal pain in the studied patient population.clinicaltrial.gov, number NCT03862092.

Considerable attention has been directed to understanding the influence of heterointerfaces between Ruddlesden–Popper (RP) phases and ABO3 perovskites on the kinetics of oxygen electrocatalysis at elevated temperatures. Here, we report the effect of heterointerfaces on the oxygen surface exchange kinetics by employing heteroepitaxial oxide thin films formed by decorating LaNiO3 (LNO) on La1.85Sr0.15CuO4 (LSCO) thin films. Regardless of LNO decoration, tensile in-plane strain on LSCO films does not change. The oxygen surface exchange coefficients (kchem) of LSCO films extracted from electrical conductivity relaxation curves significantly increase with partial decorations of LNO, whereas full LNO coverage leads to the reduction in the kchem of LSCO films. The activation energy for oxygen exchange in LSCO films significantly decreases with partial LNO decorations in contrast with the full coverage of LNO. Optical spectroscopy reveals the increased oxygen vacancies in the partially covered LSCO films relative to the undecorated LSCO film. We attribute the enhanced oxygen surface exchange kinetics of LSCO to the increased oxygen vacancies by creating the heterointerface between LSCO and LNO.

Objectives The development of a rapid diagnostic test for viable SARS-CoV-2 is important for infection control. Real-time RT-PCR assays detect non-viable virus and cell culture differentiates viable virus but it takes several weeks and is labor-intensive. Subgenomic RNAs may reflect replication-competent virus. We therefore evaluated the usefulness of subgenomic RNAs for diagnosing viable SARS-CoV-2 in patients with COVID-19. Methods Patients with various severities of confirmed COVID-19 were enrolled at a tertiary hospital between February and December 2020. RT-PCR assay results for genomic and subgenomic RNA of SARS-CoV-2 from nasopharyngeal swab, sputum, and saliva specimens were compared with cell culture results. Results A total 189 specimens from 20 COVID-19 patients were tested in genomic and subgenomic PCR assays, and cultured on Vero cells. Of these 189 samples, 62 (33%) gave positive culture results, 93 (49%) negative results, and the remaining 34 (18%) indeterminate results. Compared with cell culture results, the sensitivities of genomic RNA and subgenomic RNA of the N and S genes were comparable as 100%, but the specificity of subgenomic RNA (N, 65% and S, 68%) was higher than that of genomic RNA (N, 23% and S, 17%, p value < 0.001). The mean durations of positive culture and subgenomic RNA were 11.39 ± 10.34 and 13.75 ± 11.22 days after symptom onset (p value = 0.437), respectively, while that of genomic RNA was 22.85 ± 11.83 days after symptom onset (p value < 0.001). Conclusion Our comparison of subgenomic RNA detection with symptom duration and SARS-CoV-2 culture positivity provides a significant advancement on the transmissibility-based approach beyond the detection of SARS-CoV-2 genomic RNA, and warrants further studies on the development of better diagnostic strategy.

Purpose The main purpose of the Life-Sustaining Treatment Decisions Act recently enacted in Korea is to respect the patient’s self-determination. We aimed to investigate the current status and features of patient self-determination after implementation of the law.Materials and Methods Between February 2018 and January 2019, 54,635 cancer deaths were identified from the National Health Insurance Service (NHIS) database. We analyzed the characteristics of decedents who complied with the law process by self-determination compared with decedents with family determination and with decedents who did not comply with the law process.Results In multivariable analysis, patients with self-determination were younger, were less likely to live in rural areas, were less likely to belong to the highest income quintile, were less likely to be treated in general hospitals, and were more likely to show a longer time from cancer diagnosis compared with patients with family determination. Compared with patients who did not comply with the law process, patients with self-determination were younger, lived in Seoul or capital area, were less likely to belong to the highest income quintile, were treated in general hospitals, were less likely to have genitourinary or hematologic malignancies, scored higher on the Charlson comorbidity index, and showed a longer time from cancer diagnosis. Patients with self-determination were more likely to use hospice and less likely to use intensive care units (ICUs) at the end-of-life (EOL).Conclusion Decedents with self-determination were more likely to be younger, reside in the Seoul or capital area, show a longer time from cancer diagnosis, and were less likely to belong to the highest income quintile. They utilized hospice more frequently, and received less ICU care at the EOL.

The aim of this study is to evaluate the wear volume of interim crowns fabricated using digital light processing 3D printing according to the printing angle. A total of five patients undergoing the placement of a single crown on the mandibular molar were included. Interim crowns were fabricated directly in the oral cavity using the conventional method. A digital light processing 3D printer was then used to fabricate crowns with build angles of 0, 45, and 90 degrees. Therefore, four fabricated interim crowns were randomly delivered to the patients, and each was used for one week. Before and after use, the intaglio surfaces of the interim crowns were scanned using a 3D scanner. The volume changes before and after use were measured, and changes in the height of the occlusal surface were evaluated using the root mean square value. Data normality was verified by statistical analysis, and the wear volume in each group was evaluated using a one-way analysis of variance and Tukey’s honestly significant difference test (α = 0.05). Compared with the RMS values of the conventional method (11.88 ± 2.69 µm) and the 3D-printing method at 0 degrees (12.14 ± 2.38 µm), the RMS values were significantly high at 90 degrees (16.46 ± 2.39 µm) (p < 0.05). Likewise, there was a significant difference in the change in volume between the groups (p = 0.002), with a significantly higher volume change value at 90 degrees (1.74 ± 0.41 mm3) than in the conventional method (0.70 ± 0.15 mm3) (p < 0.05). A printing angle of 90 degrees is not recommended when interim crowns are fabricated using digital light processing 3D printing.

Dabie bandavirus (severe fever with thrombocytopenia syndrome virus [SFTSV]) induces an immunopathogenic disease with a high fatality rate; however, the mechanisms underlying its clinical manifestations are largely unknown. In this study, we applied targeted proteomics and single-cell transcriptomics to examine the differential immune landscape in SFTS patient blood. Serum immunoprofiling identified low-risk and high-risk clusters of SFTS patients based on inflammatory cytokine levels, which corresponded to disease severity. Single-cell transcriptomic analysis of SFTS patient peripheral blood mononuclear cells (PBMCs) at different infection stages showed pronounced expansion of B cells with alterations in B-cell subsets in fatal cases. Furthermore, plasma cells in which the interferon (IFN) pathway is downregulated were identified as the primary reservoir of SFTSV replication. This study identified not only the molecular signatures of serum inflammatory cytokines and B-cell lineage populations in SFTSV-induced fatalities but also plasma cells as the viral reservoir. Thus, this suggests that altered B-cell function is linked to lethality in SFTSV infections.IMPORTANCE SFTSV is an emerging virus discovered in China in 2009; it has since spread to other countries in East Asia. Although the fatality rates of SFTSV infection range from 5.3% to as high as 27%, the mechanisms underlying clinical manifestations are largely unknown. In this study, we demonstrated that SFTSV infection in fatal cases caused an excessive inflammatory response through high induction of proinflammatory cytokines and chemokines and the aberrant inactivation of adaptive immune responses. Furthermore, single-cell transcriptome sequencing (RNA-seq) analysis of SFTS patient PBMCs revealed that SFTSV targets the B-cell lineage population, especially plasma cells, as the potential viral reservoir in patients for whom the infection is fatal. Thus, SFTSV infection may inhibit high-affinity antibody maturation and secretion of plasma B cells, suppressing neutralizing antibody production and thereby allowing significant virus replication and subsequent fatality.

This study sought to adapt the existing value framework (VF) to produce a reliable and valid Korean oncology VF. Two VFs developed by The American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) were selected for examination in the present study. Forward and backward translations were conducted for six high-priced drugs indicated for non-small-cell lung cancer and multiple myeloma. Inter-rater reliability was measured based on the intraclass correlation coefficient (ICC) and variation was described using the coefficient of variation. The relative weights of factors critically considered by Korean oncologists were derived following the analytic hierarchy process (AHP), and focus group interviews (FGIs) were used to obtain qualitative data regarding the applications of these two VFs in the Korean setting. The ICCs of the Korean VFs were 0.895 (0.654–0.983) for ASCO and 0.726 (0–0.982) for ESMO translations, suggesting excellent reliability for ASCO and good reliability for ESMO. AHP demonstrated that clinical benefit has the highest priority, which is consistent with the ASCO VF. The FGIs suggested that the result for AHP is acceptable and that both ESMO and ASCO VFs should be used complementarily. Although further evaluation with a larger sample size is needed, the Korean versions of ESMO/ASCO VFs are valid and reliable tools and are acceptable to Korean stakeholders, yet they should be applied with caution.

A technology must be developed to automatically identify extreme stress states of children who cannot properly express their emotions when recognizing dangerous situations, which threaten the safety of children, in real time. This study presents a stress-state identification model for children based on machine learning, biometric data, a smart band for collecting biometric data, and a mobile application for monitoring the stress state of the child classified. In addition, through an experiment comparing a dataset using only voice data and a dataset using both voice and heart rate data, we aimed to verify the effectiveness of the combination of the two biosignal datasets. As a result of the experiment, the SVM model showed the highest performance with an accuracy of 88.53% for the dataset using both voice data and heart rate data. The results of this study presented strong implications for the possibility of automating the stress-state identification of a child, and it is expected that the developed method can be used to take preventive measures for dangerous situations to children.

The most important characteristics of coronavirus disease 2019 (COVID-19) transmission that makes it difficult to control are 1) asymptomatic and presymptomatic transmission, 2) low incidence or lack of dominant systemic symptoms such as fever, 3) airborne transmission that may need a high infectious dose, and 4) super-spread events (SSEs). Patients with COVID-19 have high viral loads at symptom onset or even a few days prior to symptom onset, and most patients with COVID-19 have only mild respiratory symptoms or merely pauci-/null-symptoms. These characteristics of the virus enable it to easily spread to the community because most patients are unaware of their potential infectivity, and symptom-based control measures cannot prevent this type of transmission. Furthermore, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is also capable of airborne transmission in conditions such as aerosol-generating procedures, under-ventilated indoor spaces, and over-crowded areas. In this context, universal mask-wearing is important to prevent both outward and inward transmission until an adequate degree of herd immunity is achieved through vaccination. Lastly, the SSEs of SARS-CoV-2 transmission emphasize the importance of reducing contacts by limiting social gatherings. The above-mentioned transmission characteristics of SARS-CoV-2 have culminated in the failure of long-lasting quarantine measures, and indicate that only highly effective vaccines can keep the communities safe from this deadly, multifaceted virus.

BackgroundHelicobacter pylori (H. pylori) is an important pathogen that causes chronic gastritis and peptic ulcer, and is related to the development of gastric carcinoma. Several chemicals, including antibiotics, have been used to eradicateH.pylori. However, more studies are yet requred to accomplish a sufficient therapy.Pediococcus acidilactici(P. acidilactici) J9 were studied for inhibition of binding ofH.pyloribinding to human gastric cell lines. This study was performed in order to investigate the repeated-dose toxicity ofP. acidilacticiJ9 in male and female mice.ResultsC57BL/6 male and femaleMus musculuswere divided into four groups (n = 10 in each group).P. acidilacticiJ9 was administered daily by oral injection of vehicle control at dosage levels to a low-dose group (500 mg/kg/day), middle-dose group (1000 mg/kg/day), and high-dose group (2000 mg/kg/day) for 2 weeks. After 14 days of exposure, the blood biochemistry and hematology were investigated, along with a histopathology exam. There were no bacterial-related deaths or abnormal clinical signs in either gender of mouse. The data was observed during the period in terms of body weight, food intake, and water consumption. Also, no alterations in organ weights upon administration ofP. acidilacticiJ9 alone were observed. The adhesion and growth ofH. pyloriwere inhibited by a 24 h treatment ofH. pyloriandP. acidilacticiJ9 on adenocarcinoma gastric (AGS) cells, which are gastric cancer cells. Compared to the control group (AGS cell andH. pylori), the number ofH. pylorianalyzed by FACS significantly (p P. acidilacticiJ9 for 24 h.ConclusionsThese results suggest that the oral application ofP. acidilacticiJ9, up to a dosage level of 2000 mg/kg/day, causes no adverse effects in both male and female mice.P. acidilacticiJ9 inhibits the adhesion ofH.pylorito AGS cancer cells. When used as probiotics,P. acidilacticiJ9 may help decrease the occurrence of gastritis and reduce the risk ofH.pyloriinfection with promising safety issues.

Introduction: Neonatal chest compression (CC) should be performed to a 1/3 anterior-posterior (AP) chest diameter depth, however, the optimal AP depth is unknown. Hypothesis: We hypothesized that in asphyxiated neonatal piglets a 40% AP depth compared to 1/3, or 1/4 AP depth will reduce time to achieve return of spontaneously circulation and improve survival. Methods: Newborn piglets (n=8/group) were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by asphyxia and cardiac arrest. Piglets were randomly allocated to four intervention groups (“AP 12.5% depth”, “AP 1/4 depth”, “AP 1/3 depth” or “AP 40% depth“). CCs were performed using an automated CC machine with a rate of 90/min. Hemodynamic and respiratory parameters were continuously measured. Results: Median (IQR) time to return of spontaneously circulation was 70 (60-117), 85 (72-90), 90 (90-130), and 600 (600-600) sec with AP 40% depth, AP 1/3 depth, AP 1/4 depth, AP 12.5% depth, respectively. No piglet in the AP 12.5% depth group achieved ROSC while the short-term survival (1h) in the other groups was 100%. Systolic and diastolic blood pressure, central venous pressure, carotid blood flow, tidal volume, and minute ventilation increased with increasing AP depth. Conclusions: Time to return of spontaneously circulation and survival was similar between 1/4, 1/3, and 40% AP depth, while 12.5% AP depth did not result in return of spontaneously circulation. Hemodynamic and respiratory parameters improved with increasing AP depth suggesting that 40% AP depth might provide improved organ perfusion and oxygen delivery.

Highlights • Our enhanced protocols presented a significant reduction in doffing contaminations. • Long-sleeve apron as the broad outer layer perfectly protected major contaminations. • Tracking contamination showed every touch with outer surfaces brought contamination. • Wipes certainly decreased contamination amounts from contaminated glove surfaces. • But wipes did not fully clean glove contaminations between fingers and fingertips., Background Due to variations and the inadequate use of personal protective equipment (PPE), this study aimed to evaluate our enhanced PPE protocols for minimizing doffing contamination. Methods Among 3 PPE kits (simple, Level D, and Level C), 30 participants conducted the first simulation in their adapted way and the second following enhanced protocols. After donning, participants performed a 1-minute simulation of direct care on a patient simulator covered with fluorescent powder. For tracking contamination routes between doffing processes, fluorescent powder contamination was examined with ultraviolet lamps in the darkened room. Results Participants were mostly registered nurses (N = 27, 90%), female (87%), and on average 31.7 years old with 8.5 years of clinical experience. Among 61 total simulations, 32 had at least 1 contamination (52.5%); “Noticeable” level (40%) at the “hands-fingers” and “shirt” body areas were most frequent. For first and second simulations with identical PPE kits, compared to the first with adapted practice, the second with enhanced protocols showed a significant reduction in doffing contamination rates (72.7% vs 22.7%, P = .0009 for both Level C and D; 77.8% vs 27.8%, P = .0027 for Level D). Conclusions Our enhanced protocols could significantly reduce contaminations. More studies are necessary to provide safer PPE protocol options.

In this study, image search techniques are suggested based on dual rearrangement of object corner. Suggested algorithm is proceeded in the following stages. First, edges and corner points are extracted in the image. Then, the dispersion value and the number of white level are extracted in each of the corner areas. In addition, correlogram feature table is configured by using the dispersion value and the number of white level measuring the similarity of them. Suggested technique turned out to be outstanding in performance from objects with distinct structure in the image and strong against movement or rotation of an object. In addition, it represented an improved recall by about 0.05 compared to searching form in the use of corner patch histogram.

Data on the filtration efficacies of various masks against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are limited. We thus evaluate the effectiveness of the surgical mask, the N95 respirator mask, and its equivalent (KF94 mask) in filtering SARS-CoV-2. Patients hospitalised with SARS-CoV-2 infection were instructed to cough five times each while wearing (1) no mask, (2) surgical mask, (3) KF94 mask, and (4) N95 mask. The coughs were separated by 20-second intervals, and the patients were rested for at least 5 min between each setting. SARS-CoV-2 viral loads in patient samples (i.e. nasopharyngeal swabs and saliva), petri dishes placed in front of the patients during coughing, and swabs from the outer and inner surfaces of the masks were analysed with PCR. A total of 7 patients with SARS-CoV-2 infection participated in the mask test. SARS-CoV-2 was detected on the petri dishes after coughing in 3 out of 7 cases with the surgical mask or no mask. Viral particles were not found in the petri dishes after coughing while wearing the N95 mask or the KF94 mask. While viral particles were detected in both the inner and outer surfaces of the surgical masks, those were detected only in the inner surfaces of the N95 and K94 masks. Surgical masks were less effective in filtering viral particles from coughing patients with SARS-CoV-2 infection. N95 masks and its equivalents efficiently blocked SARS-CoV-2 particles from coughing patients.

Background and aim A post-stroke checklist was developed to improve the standard of long-term post-stroke care and health-related quality of life. We aimed to investigate the prevalence of worsening problems using a post-stroke checklist at 3, 6, and 12 months post-stroke and their associations with health-related quality of life in patients with stroke. Methods In stroke patients admitted between June 2014 and December 2015, post-stroke checklist and EuroQol-5D three level were assessed at post-stroke 3 (n=181), 6 (n=175), and 12 months (n=89). The prevalence of worsening problems and its association with EQ-5D index at post-stroke 3 and 6 months were analyzed. Results The most frequently and continuously identified worsening problems were mood disturbances (reported by 8.8%, 16.0% and 13.5% of patients at 3, 6, and 12 months post-stroke, respectively). Worsening mobility was significantly associated with worse EQ-5D index at post-stroke 3 months (β= −0.583; 95% confidence interval [CI], −1.045 to −0.120; P=0.014). The worsening of mobility and communication was significantly associated with worse EQ-5D index at post-stroke 6 months (mobility: β= −0.170; 95% confidence interval [CI], −0.305 to −0.034; P=0.014, communication: β=−0.164; 95% confidence interval [CI], −0.309 to −0.020; P=0.026). Conclusions A post-stroke checklist may be useful for detection of various subjective worsening problems during serial clinical follow-up after stroke. Appropriate rehabilitation and management strategy to solve the identified problems could improve the quality of life in stroke survivors.

Despite clinical evidence indicating a close relationship between olfactory dysfunction and Alzheimer’s disease (AD), further investigations are warranted to determine the diagnostic potential of nasal surrogate biomarkers for AD. In this study, we first identified soluble amyloid-β (Aβ), the key biomarker of AD, in patient nasal discharge using proteomic analysis. Then, we profiled the significant differences in Aβ oligomers level between patient groups with mild or moderate cognitive decline (n = 39) and an age-matched normal control group (n = 21) by immunoblot analysis and comparing the levels of Aβ by a self-standard method with interdigitated microelectrode sensor systems. All subjects received the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and the Global Deterioration Scale (GDS) for grouping. We observed higher levels of Aβ oligomers in probable AD subjects with lower MMSE, higher CDR, and higher GDS compared to the normal control group. Moreover, mild and moderate subject groups could be distinguished based on the increased composition of two oligomers, 12-mer Aβ*56 and 15-mer AβO, respectively. The longitudinal cohort study confirmed that the cognitive decline of mild AD patients with high nasal discharge Aβ*56 levels advanced to the moderate stage within three years. Our clinical evidence strongly supports the view that the presence of oligomeric Aβ proteins in nasal discharge is a potential surrogate biomarker of AD and an indicator of cognitive decline progression.

Background: There is worldwide interest in the mental health of firefighters, since they are more prone to exposure to traumatic stress and psychiatric disorders. Aims: This study aimed to assess their mental health and provide individualized support to local firefighters through a mental health promotion program. Method: Eighteen hundred and fifty-nine active Korean firefighters in 2015 and 2017 (502 and 1,357, respectively) participated in the ‘Visiting Counselling Centre for Firefighters’ program commissioned by the National Fire Agency. The program consisted of self-administered questionnaires, a group education session, an individual counseling session for every participant, four counseling sessions for certain participants and additional brief intensive counseling (BIC). We administered the Post-traumatic stress disorder Checklist (PCL), Beck’s Depression Inventory (BDI), Beck’s Anxiety Inventory (BAI), Beck Scale for Suicidal ideation (BSS), Insomnia Severity Index (ISI), Korean version of the Alcohol Use Disorders Identification Test (AUDIT-K) and the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) before and after the program. Additional analysis was performed to determine whether BIC participation further improved the psychopathological outcome. Results: The participants showed meaningful improvement in all psychopathological scales; the PCL, BDI, BAI, BSS, ISI, AUDIT-K and WHOQOL-BREF scores all significantly improved. Meanwhile, BIC participation improved certain psychopathological symptoms at a higher degree; the BDI, BAI, BSS and AUDIT-K scores significantly improved. Conclusion: The mental health promotion program improved the mental health of the participating active firefighters in Korea. Meanwhile, BIC participation improved certain psychopathological symptoms at a higher degree. A comprehensive approach for supporting the mental health of firefighters should be considered.

This study examined differences of physical activity levels and social interactions among preschoolers with/without disabilities and those at risk for a developmental delay (DD). Sixty preschoolers (20 in each group) were film during their designated large gross motor time. Their physical activity levels and social interaction were examined using the physical activity level screening. Regarding physical activity levels, the result of a two-way analysis of variance indicated significant main effects for groups, F(2,54)=4.192, P=0.02; preschoolers at risk for a DD were more active than preschoolers without disabilities, P=0.02. For social interaction, a significant main effect for groups, F(2,54)=8.994, P

Background: Helicobacter pylori (H. pylori) is an important pathogen that causes chronic gastritis and peptic ulcer, and is related to the development of gastric carcinoma. Several chemicals, including antibiotics, have been used to eradicate H.pylori. However, more studies are yet requred to accomplish a sufficient therapy. Pediococcus acidilactici J9 were studied for inhibition of binding of H.pylori binding to human gastric cell lines. This study was performed in order to investigate the repeated-dose toxicity of Pediococcus acidilactici J9 in male and female mice.Results: C57BL/6 male and female Mus musculus were divided into four groups (n = 10 in each group). Pediococcus acidilactici J9 was administered daily by oral injection of vehicle control at dosage levels to a low-dose group (500mg/kg/day), middle-dose group (1000mg/kg/day), and high-dose group (2000mg/kg/day) for two weeks. After 14 days of exposure, the blood biochemistry and hematology were investigated, along with a histopathology exam. There were no bacterial-related deaths or abnormal clinical signs in either gender of mouse. The data was observed during the period in terms of body weight, food, intake, and water consumption. Also, no alterations in organ weights upon administration of Pediococcus acidilactici J9 alone were observed.Conclusions: These results suggest that the oral application of Pediococcus acidilactici J9, up to a dosage level of 2,000 mg/kg/day, causes no adverse effects in both male and female mice. Pediococcus acidilactici J9 inhibits the adhesion of H.pylori to AGS gastric cancer cells. When used as probiotics, Pediococcus acidilactici J9 may help decrease the occurrence of gastritis and reduce the risk of H.pylori infection with promising safety issues.

BACKGROUND Infective endocarditis (IE) in cancer patients is increasing, but because little is known about it in these patients, we analyzed patient characteristics and outcomes and compared these factors in IE patients with and without cancer. Methods and Results: This retrospective cohort study included 170 patients with IE newly diagnosed between January 2011 and December 2015. Among 170 patients, 30 (17.6%) had active cancer. The median age of IE patients with cancer was higher than that of non-cancer patients. Nosocomial IE was more common in cancer patients. Non-dental procedures, such as intravenous catheter insertion and invasive endoscopic or genitourinary procedures, were more frequently performed before IE developed in cancer patients. Staphylococcus was the most common pathogen in cancer patients, whereas Streptococcus was the most common in non-cancer patients. In-hospital mortality was significantly higher in cancer patients with IE (34.4% vs. 12.4%, P

Scabies is a highly contagious parasitic disease associated with long-term residence in nursing homes, and it is a public health burden worldwide. However, atypical skin manifestations are frequent and the widely used diagnostic test based on microscopic examinations has limited sensitivity. We evaluated the diagnostic value of polymerase chain reaction (PCR) from skin scraping in patients with suspected scabies. Adult patients with suspected scabies, unrelated diseases or healthy volunteers were enrolled at a tertiary hospital, in Seoul, South Korea, from December 2017 through October 2018. We classified participants based on the consensus criteria established by the International Alliance for the Control of Scabies in 2018; confirmed (microscopic mite detection), clinical (scabies burrow or typical lesions with two history features including itch and close contact with scabies patients), suspected scabies (typical lesion with one history feature or atypical lesion with two history features), or no scabies. PCR was performed on the skin scrapings to target the cytochrome c oxidase subunit 1 (cox1) gene of Sarcoptes scabiei. A total of 47 participants, 33 with suspected scabies, 10 with unrelated diseases, and 4 healthy volunteers were enrolled. Of the 33 patients, 22 were classified as confirmed scabies, 2 as clinical scabies, 6 as suspected scabies, and 3 as no scabies. The sensitivities of the microscopic examination were 100%, 92%, and 73% in confirmed scabies; confirmed and clinical scabies; and confirmed, clinical, and suspected scabies, respectively (p = 0.006). The sensitivities of PCR were 86%, 83%, and 80% in confirmed scabies; confirmed and clinical scabies; and confirmed, clinical, and suspected scabies, respectively (p = 0.59). The specificity of the scabies PCR in the no scabies control was 100% (95% CI = 80–100).PCR testing for scabies may be helpful in the improvement of sensitivity for the diagnosis of scabies by clinical criteria., Author summary Scabies occasionally presents in atypical forms causing a delay in diagnosis, which can lead to the outbreaks in residential and nursing care for elderly people. We hypothesized that polymerase chain reaction (PCR) detection of Sarcoptes scabiei DNA directly has higher sensitivity than microscopic examination. Recently, clinical consensus criteria have been proposed by the International Alliance for the Control of Scabies (IACS) to overcome the low sensitivities of conventional diagnostic tests for scabies. We thus evaluated the diagnostic capability of in-house real-time PCR for the diagnosis of scabies from skin scraping in subjects with suspected scabies and with unrelated disease according to the criteria of the IACS. We found that the diagnostic sensitivity of scabies PCR maintained between 86% and 80% as the level of diagnostic certainty by the IACS criteria decreased, while the diagnostic sensitivity of microscopic examinations decreased from 100% to 73% as the level of diagnostic certainty by the IACS criteria decreased. Our data suggested that our in-house scabies PCR test was a useful adjunct in the improvement for the diagnosis of scabies by the consensus criteria.

Purpose This study aimed to validate the Sheffield Profile for Assessment and Referral to Care (SPARC) as an effective tool for screening palliative care needs among Korean cancer patients. Materials and methods The English version of the SPARC was translated by four Korean oncologists and reconciled by a Korean language specialist and a medical oncologist fluent in English. After the first version of the Korean SPARC (K-SPARC) was developed, back-translation into English was performed by a professional translator and bilingual oncologist. The back-translated version was reviewed by the original author (S.H.A.), and modifications were made (ver. 2). The second version of the K-SPARC was tested against other questionnaires, including the Functional Assessment of Cancer Therapy-General (FACT-G) and the Edmonton Symptom Assessment System (ESAS). Results Thirty patients were enrolled in the pilot trial. Fifteen were male, and the median age was 64.5 years. Six patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or more. All patients except one were receiving chemotherapy. Regarding internal consistency, the Cronbach's α scores for physical symptoms, psychological issues, religious and spiritual issues, independency and activity, family and social issues, and treatment issues were 0.812, 0.804, 0.589, 0.843, 0.754, and 0.822, respectively. The correlation coefficients between the SPARC and FACT-G were 0.479 (p=0.007) for the physical domain and -0.130 (p=0.493) for the social domain. Conclusion This pilot study indicates that the K-SPARC could be a reliable tool to screen for palliative care needs among Korean cancer patients. A further study to validate our findings is ongoing.