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The study aimed to review the current postpartum care service system and suggest measures of improvement for the public reinforcement of the private-postpartum care center (PCC). We conducted a review of literature, including an internet search, and we analyzed the in-depth interviews using questionnaires answered by workers from the 6 private-PCCs operated in Goyang city. Using these data, we derived possible measures which could improve the publicity of private-PCCs. It was found that the 11 nationwide public-PCCs had serious operating deficits, and its utilization by the vulnerable was insufficient. In areas where private-PCCs are concentrated, we can propose the following policies to strengthen publicity, rather than establishing another public-PCC. First, it is important to provide support for private-PCCs to apply cost reductions for vulnerable groups, similar to the maternal and newborn medical care of public-PCCs. Second, publicity would be strengthened by reorganizing the pregnancy and childbirth education program, while also offering additional services for mothers with stillbirths and abortions. For the integrated management of postpartum care services, this should be shifted towards reinforcing the publicity of private-PCCs, rather than operating a public-PCC in relatively concentrated private-PCC areas. Through these policies, it is expected that financial and administrative waste will be reduced, and an integrated management system for postpartum care services will be established.

This study aimed to review the definitions of reproductive health rights, investigate reproductive health status, and suggest policy strategies to promote reproductive health in Korea. Current laws, the Constitution of the World Health Organization, works from Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights, the Program of Action of the International Conference on Population Development, the Nairobi Statement on ICPD25, and the Convention on the Elimination of all Forms of Discrimination Against Women were reviewed to define reproductive health rights. The reproductive health status focusing on high-risk pregnancy was analyzed. Definitions of reproductive health rights include the right of every person to have lifetime access to the information, resources, services, and support needed to achieve bodily integrity, privacy and personal autonomy regarding their reproductive health. Most indices of reproductive health in Korea analyzed here are and would remain negative. Reproductive health should be approached from the perspectives of rights. We should continuously monitor the indicators of reproductive health and policies corresponding to low fertility rates in Korea should focus on improving women’s reproductive health. This suggests support for obstetrics and gynecology check-ups and treatments before pregnancy and postpartum care, the provision of education on the importance of prepregnancy health care for men and women and comprehensive information and counseling services. It is also necessary to establish a delivery infrastructure for safe pregnancy and childbirth and unify governmental ministries related to pregnancy and childbirth.

Objective The aim of this survey was to investigate the recommendations and clinical practice patterns of the Korean Society of Maternal and Fetal Medicine (KSMFM) members, regarding management of isolated oligohydramnios (IO). Methods From December 2018 to February 2019, questionnaires were e-mailed to the KSMFM members at 257 institutes that are listed by the Korean Statistical Information Services (KOSIS) as suitable labor premises. Responses to the seven questions on the management of IO, from diagnosis to treatment, were evaluated. Results A total of 72 KSMFM members responded to this survey. Nearly all participants (90.1%) used the amniotic fluid index (AFI) as the primary method for estimating amniotic fluid volume. The majority of the participants (73.6%) believed that IO was a risk factor for adverse pregnancy outcomes, including abnormal fetal heart rate (73.6%), need for cesarean delivery (58.3%), intrauterine fetal demise (52.8%), and meconium aspiration syndrome (50%). Almost 70% of the participants believed that induction of labor might decrease perinatal morbidities, and that late-preterm to early-term period (36-38 gestational weeks) was a suitable timeframe for delivery, if the fetus was sufficiently grown and antenatal testing revealed reassuring results. Less than half of the participants (47.2%) believed that maternal oral or intravenous hydration was a useful intervention for IO management. Conclusions KSMFM members preferred labor induction at late-preterm to early-term, to decrease perinatal morbidity in cases of IO, although it was still uncertain whether labor induction improved the outcomes. Further prospective studies are needed regarding IO management.

Community-based preconception care for men and women of childbearing age has been introduced in Seoul. The program aims to focus on problem areas such as low birth rate, fertility issues potentially due to late marriages, preterm or premature births, and low-birthweight in newborn babies. The district administration officials of Seoul, as well as, academics from the Korean Society of Maternal and Child Health, developed a protocol by using a questionnaire and laboratory test for screening risk factors in pregnancy. The protocol was tested on a trial basis in four local districts in Seoul from July 2017 to 2018, extended to 12 local districts in 2019, and all 25 districts in Seoul in 2020. The protocol includes Anti-Mullerian Hormone tests to assess women’s ovarian reserve and male health checkups that include semen analysis and physical examinations of genitalia. These tests are conducted for early detection and treatment of infertility, especially in cases of late marriages. In order to prevent women being abandoned during pregnancy (leading them to single-parenting), the protocol also emphasizes building a gender-sensitive environment by encouraging more male participation. A monitoring group comprised of Seoul city district officials and academics from the Korean Society of Maternal and Child Health, regularly visited the local districts to observe improvements and keep the program officials up to date. In addition, the group also conducted a mobile phone survey for feedback on the program. The interest and support of the residents in Seoul city, and positive results and development in pregnancy care and childbirth, are needed to stabilize and extend this protocol.

Objectives The current study aimed to investigate whether pregnancy outcomes are affected by maternal rhesus (Rh) status by comparing the primigravida pregnancy outcomes of Rh-negative women with those of Rh-positive women. Methods The study data were collected from the Korea National Health Insurance Claims Database and the National Health Screening Program for Infants and Children. In total, 1,664,882 primigravida women who gave birth between January 1, 2007 and December 31, 2014, were enrolled in this study. As the risk and severity of sensitization response increases with each subsequent pregnancy, only primigravida women were enrolled. The patients were divided into 2 groups according to Rh status, and the pregnancy outcomes were compared. Results In total, 1,661,320 women in the Rh-positive group and 3,290 in the Rh-negative group were assessed. With regard to adverse pregnancy outcomes, there was no statistically significant difference between the 2 groups in terms of the prevalence of preeclampsia, postpartum hemorrhage, abruptio placenta, placenta previa, and uterine artery embolization. A univariate analysis revealed that none of the adverse pregnancy outcomes were significantly correlated to Rh status (preeclampsia: odds ratio [OR], 1.00, 95% confidence interval [CI], 0.81-1.23; postpartum hemorrhage: OR, 1.10, 95% CI, 0.98-1.24; abruptio placenta: OR, 0.80, 95% CI, 0.46-1.37; and placenta previa: OR, 1.08, 95% CI, 0.78-1.42). The adjusted ORs of postpartum hemorrhage and preterm birth did not significantly differ. Conclusion Maternal Rh status is not associated with adverse outcomes in primigravida women.

Objective To increase the rate of successful external cephalic version (ECV) and to minimize the complications, it is important to identify the predictors of success. Therefore, the purpose of this study was to investigate whether the height of the elevated fetal buttock (HOB) is a valuable predictor of successful ECV or not. Methods This prospective study was conducted from August 2016 to June 2018. A total of 139 pregnant women with breech presentation were enrolled in the study. HOB from the maternal pubic symphysis was measured on ultrasonography. The predictability and cut-off value of HOB for successful ECV were evaluated. Results Among the 139 patients, 114 (82%) had successful ECV. The adjusted odds ratio for multiparity, amniotic fluid index (AFI) >14 cm, and HOB >7.8 cm were 10.80 (95% confidence interval [CI], 1.57-74.94), 5.26 (95% CI, 1.06-26.19), and 10.50 (95% CI, 1.03-107.12), respectively. Areas under the curve (AUCs) for AFI, HOB, and parity were 0.66 (95% CI, 0.54-0.78), 0.74 (95% CI, 0.64-0.85), and 0.69 (95% CI, 0.62-0.76), respectively. HOB had the largest AUC, but there were no significant differences among the AUCs of other factors. The cut-off value of HOB was 6 cm. Conclusion This study showed that the AUC of HOB was greater than that of parity and AFI, although it was not statistically significant. As HOB is a noninvasive and comprehensive marker to predict successful ECV, consideration of HOB would be helpful before conducting ECV. Further studies are needed.

Semiconductor products used in high-performance computing (HPC) and artificial intelligence (AI) applications require higher memory bandwidth, greater input/output (I/O) count, better power delivery network (PDN) performance and improved heat dissipation characteristics. To meet these requirements, a 2.5D package architecture with a Through Silicon Via (TSV)-bearing silicon (Si) interposer is mainly used in volume production. However, a redistribution layer (RDL) interposer is emerging as a cost effective and higher performance alternative. To implement an improved high-performance, multifunctional interposer, S-Connect technology has been developed that uses a multi-chip, fan-out interposer with various functionalities, such as a die-to-die (D2D) connection, where integrated passive devices (IPDs) and active devices can be integrated. If active devices are included in the interposer, S-Connect technology enables a 3D system where multiple active chips are vertically integrated. In this paper, the S-Connect design differences from the existing 2.5D package using Si interposer with TSVs and its fabrication process flow are explained. S-Connect technology provides manufacturing flexibility to apply various types of interconnects. Two different connect features will be discussed. Firstly, a Si connect will be explored having a back end of line (BEOL) and TSV approach that can provide the same die-to-die routing with smaller than $1-\mu \mathrm{m}$ line/space (L/S) and vertical connections as a Si interposer. The second option uses a multilayer RDL, which can be fabricated on Si, glass and even on the epoxy mold compound (EMC). The RDL can also provide vertical interconnects such as TSVs in Si. For demonstration, a test vehicle (TV) with one logic chip and two memory chips mounted on a multi-chip, fan-out interposer with an area approximately 1.5 times larger than the reticle was used. The interposer consists of two connect chips with $2-\mu \mathrm{m}$ L/S RDL and 6 mechanical IPDs located under the logic die. Two types of the connect chips were used - RDL on Si wafer and RDL on EMC having TMVs. The top die to interposer joints were made using $\mu$ -bumps with $25-\mu \mathrm{m}$ size on a $45-\mu \mathrm{m}$ pitch in the logic and $25-\mu \mathrm{m}$ size on a $55-\mu \mathrm{m}$ pitch in the memory die. Both the top and bottom sides of the fan-out interposer have a single layer of RDL. To interconnect the bottom side of the interposer and the package substrate, copper (Cu) pillar C4 bumps at $150-\mu \mathrm{m}$ pitch were formed. Once the top die and interposer assembly is complete, the subsequent processes are standard flip chip ball grid array (FCBGA) process flows. Moisture sensitivity and long-term reliability test results will be presented as well as warpage behavior, which is critical for the large body packages. Lastly, the advantages of the S-Connect package will be compared to other 2.5D and flip chip solutions in terms of manufacturability, ability to integrate multiple functionalities and cost.

This study presents how the author implemented motivation-oriented teaching in college English conversation classes. After years of frustration with encouraging students to get interested in class, she introduces exciting video clips of Korean celebrities speaking English. The decision is made from the observation that students nowadays are strongly and extensively influenced by celebrities on social network service (SNS) or television. The video clips show celebrities speaking English in different occasions. This case study compares the knowledge-based with the motivation-based instruction conducted with performing arts students. In the motivation-based class, the students showed increased attention to class activities. Their active responses to questions also suggest that they seem to closely attach themselves to celebrities more than to the instructor. Celebrities in this class served as a good motivator to students. The results of the course evaluation indicated that students improved their interest and attention in the course.

Amniotic fluid is crucial for the well-being of the fetus. Recent studies suggest that dehydration in a pregnant woman leads to oligohydramnios. We assessed the variation in the amniotic fluid index (AFI) during the summer and non-summer seasons and evaluated neonatal outcomes. We retrospectively reviewed electrical medical records of pregnant women who visited the Konkuk University Medical Center for antenatal care, between July 2005 and July 2019. A total of 19,724 cases from 6438 singleton pregnant women were included after excluding unsuitable cases. All AFI values were classified as 2nd and 3rd trimester values. Additionally, borderline oligohydramnios (AFI, 5–8) and normal AFI (AFI, 8–24) were assessed according to the seasons. The average AFI between the summer and non-summer season was statistically different only in the 3rd trimester, but the results were not clinically significant. In the 3rd trimester, the summer season influenced the increased incidence of borderline oligohydramnios. The borderline oligohydramnios group showed an increased small-for-gestational-age (SGA) rate and NICU admission rate. In the summer season, the incidence of borderline oligohydramnios was seen to increase. This result would be significant for both physicians and pregnant women.

BACKGROUND/OBJECTIVES Although Korean fermented foods contain large amounts of salt, which is known to exacerbate health problems, these foods still have beneficial effects such as anti-hypertension, anti-cancer, and anti-colitis properties. We hypothesized that ganjang may have different effects on blood pressure compared to same concentrations of salt. MATERIALS/METHODS Sprague-Dawley rats were divided into control (CT), NaCl (NC), and ganjang (GJ) groups and orally administered with 8% NaCl concentration for 9 weeks. The systolic blood pressure (SBP), serum chemistry, Na+ and K+ concentrations and renal gene expressions were measured. RESULTS The SBP was significantly increased in the NC group compared to the GJ and CT groups. In addition, the Na+ concentration in urine was higher in the GJ and NC groups than the CT group, but the urine volume was increased in the GJ group compared to the other groups. The serum renin levels were decreased in the GJ group compared to the CT group, while the serum aldosterone level was decreased in the GJ group relative to the NC group. The mRNA expression of the renin, angiotensin II type I receptor, and mineralocorticoid receptor were significantly lower in the GJ group compared to other groups. Furthermore, GJ group showed the lowest levels of genes for Na+ transporter in kidney cortex such as Na+/K+ ATPaseα1 (NKAα1), Na+/H+ exchanger 3 (NHE3), Na+/HCO3- co-exchanger (NBC), and carbonic anhydrases II (CAII). CONCLUSIONS The decreased SBP in the GJ could be due to decreased renin and aldosterone levels in serum and increased urinary volume and excretion of Na+ with its transporter gene alteration. Therefore, ganjang may have antihypertensive effect despite its high contents of salt.

The inhibition of acetylcholinesterase (AChE), butyrylcholinesterase (BChE), and β-site amyloid precursor protein cleaving enzyme 1 (BACE1) plays important roles in prevention and treatment of Alzheimer's disease (AD). Among the individual parts of Morus alba L. including root bark, branches, leaves, and fruits, the root bark showed the most potent enzyme inhibitory activities. Therefore, the aim of this study was to evaluate the anti-AD activity of the M. alba root bark and its isolate compounds, including mulberrofuran G (1), albanol B (2), and kuwanon G (3) via inhibition of AChE, BChE, and BACE1. Compounds 1 and 2 showed strong AChE- and BChE-inhibitory activities; 1-3 showed significant BACE1 inhibitory activity. Based on the kinetic study with AChE and BChE, 2 and 3 showed noncompetitive-type inhibition; 1 showed mixed-type inhibition. Moreover, 1-3 showed mixed-type inhibition against BACE1. The molecular docking simulations of 1-3 demonstrated negative binding energies, indicating a high affinity to AChE and BACE1. The hydroxyl group of 1-3 formed hydrogen bond with the amino acid residues located at AChE and BACE1. Consequently, these results indicate that the root bark of M. alba and its active compounds might be promising candidates for preventive and therapeutic agents for AD.

Background: Soluble suppression of tumorigenicity 2 (sST2), N-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitive troponin I (hs-TnI), and high sensitive troponin T (hs-TnT) are representative cardiac biomarkers. The reference intervals (RIs) of these biomarkers have been rarely investigated in umbilical cord blood (UCB). We explored the distribution of these cardiac markers and established their RIs in UCB. Methods: In a total of 293 UCB specimens, sST2, NT-proBNP, hs-TnI, and hs-TnT concentrations were analyzed according to the gestational age, presence of premature membrane rupture (PROM), presence of gestational diabetes mellitus (GDM), and Apgar score at 1 min. Their RIs were defined in 133 UCB specimens from healthy, full-term neonates, using non-parametric percentile methods according to the Clinical and Laboratory Standards Institute guideline (EP28-A3C). Results: The concentrations of four cardiac markers in UCB were different between full-term neonates and pre-term neonates. The concentrations of NT-proBNP and hs-TnI differed according to the presence or absence of PROM. Their concentrations did not differ regardless of the presence of GDM. The concentrations of sST2 and NT-proBNP differed according to the Apgar score at 1 min. The 97.5th percentile upper reference limits were: sST2, 59.9 ng/mL; NT pro-BNP, 1415.3 pg/mL; hs-TnI, 27.8 pg/mL; and hs-TnT, 86.5 pg/mL. Conclusions: The distribution of sST2, NT pro-BNP, hs-TnI, and hs-TnT in UCB together with their RIs would provide fundamental data for future researches and clinical practice.

To better understand the correlation between Helicobacter pylori (H. pylori) seropositivity and spontaneous preterm birth.A total of 320 pregnant women were classified into two groups: normal control singleton pregnant group (n = 264) and singleton spontaneous preterm birth group (n = 56). Blood samples were collected at the time of delivery, and the H. pylori IgG, various virulence factors and systemic inflammation status were compared between the two groups.Between the two groups, the serum H. pylori IgG, Cytotoxin-associated agntigen A (Cag A), Vacuolating cytotoxin A (Vac A) significantly increased in spontaneous preterm birth group than in the control group. Also, in preterm group, highly sensitive C-reactive protein (hsCRP) as a systemic inflammatory marker is statistically elevated at inflammatory status range. Whereas in the term pregnant group, hsCRP was normal range even though high incidence of H. pylori IgG seropositivity. Also, in the seropositive group, hsCRP is statistically correlated with H. pylori IgG, Cag A and Vac A.There is an association between the presence of antibodies against H. pylori in maternal serum and the development of preterm birth. Furthermore, serology type of H. pylori with Vac A, Cag A relates to preterm birth even though high H. pylori prevalence rate.

Onion peel (OP) extract is known as a rich source of flavonoids, mainly quercetin. We hypothesized that OP has hypocholesterolemic effects. To investigate the effect of OP, C57BL/6J mice were divided into 4 dietary groups (n=10); normal diet (ND); high cholesterol diet (HC); and high cholesterol diet with 100 or 200 mg OP extract (OP-100 or OP-200, respectively) per kg of body weight. After 12 weeks, lower values of liver weight, serum total cholesterol levels, LDL cholesterol, atherogenic index, cardiac risk factor, hepatic triacylglycerol, and total cholesterol, and higher fecal cholesterol levels were observed in the OP-200 than in the HC group. The hepatic mRNA expression levels of low-density lipoprotein receptors (LDL-R) and cholesterol 7-alpha-monooxygenase (CYP7A1) were high in the OP-200 compared to the HC group. These observations suggest that OP promoted lowering of serum and hepatic cholesterol in mice primarily via fecal excretion.

Background/Aims The prevalence of hepatitis C virus (HCV) infection in Busan, Gyeongnam, and Jeonnam Provinces in Korea is more than twice the national average. This study aimed to examine whether demographic and lifestyle characteristics are associated with HCV infection in these areas. Methods A case control study was performed at three study hospitals. HCV cases were matched with two controls for sex and age. Patient controls were selected from non-HCV patients at the same hospital. Healthy controls were subjects participating in medical checkups. Conditional logistic regression models were used. Results A total of 234 matched-case and patient- and healthy-control pairs were analyzed. The significant risk factors for both controls were sharing razors (adjusted odds ratio [aOR], 2.39 and 3.29, respectively) and having more than four lifetime sexual partners (aOR, 2.15 and 6.89, respectively). Contact dockworkers (aOR, 1.91) and tattoos (aOR, 2.20) were significant risk factors for the patient controls. Transfusion (aOR, 5.38), a bloody operation (aOR, 5.02), acupuncture (aOR, 2.08), and piercing (aOR, 5.95) were significant risk factors for the healthy controls. Needle stick injuries and intravenous drug abuse were significant in the univariate analysis. Conclusions More education concerning the dangers of sharing razors, tattoos and piercings is required to prevent HCV infection. More attention should be paid to needle stick injuries in hospitals and the community.