Background/Aims: Advance directives (ADs) in Korean patients with heart failure (HF) and the associations of attitude towards ADs and HF prognosis with ADs were initially assessed using the model of the Korean-Advance Directive (K-AD). Methods: Twenty-four patients with HF (age, 67.1 years; men, 58.3%; ejection fraction, 35.9%) participated. A pilot test to evaluate the feasibility of ADs and the possible associations of attitudes towards ADs and prognosis with end-of-life treatment preferences among patients with HF was conducted. Results: Fifteen patients (62.5%) completed the K-ADs. The major reason for incomplete K-AD was knowledge deficit. Patients valued “comfortable death” the most (45.4%), followed by “giving no burden to the family” (13.6%). Among treatment preferences, hospice care was preferred by the majority (66.7%), while cardiopulmonary resuscitation (CPR) was preferred by the minority (31.8%). Children (50.0%) were mostly appointed as a proxy, followed by the spouse (33.3%). More patients with moderately positive attitudes completed the K-ADs than their counterparts (70.0% vs. 57.1%). The 5-year survival rate was 69.2%; the patients who preferred CPR had a higher survival rate (70.6% vs. 68.5%) whereas those who preferred hospice care had a lower survival rate than their counterparts (70.7% vs. 75.2%). Conclusions The findings support the feasibility of the K-AD model, with a high acceptance rate in two-thirds of the sample. Further studies are warranted to investigate whether treatment preferences are associated with attitude towards ADs and/or HF prognosis using larger sample size.

Purpose: This study investigated intentions and attitudes towards future parenthood and awareness of fertility among university students in South Korea. Methods: The participants comprised 166 female and male undergraduate students enrolled at five universities. A cross-sectional survey was conducted from May to July 2019 using the Korean version of the Fertility Awareness Questionnaire and Attitudes of Parenthood. The data were analyzed using descriptive statistics based on participants' general characteristics, the x2 test to identify differences in intentions, and the t-test to evaluate attitudes towards parenthood and awareness of fertility in female and male students. Results: Both female and male students desired to have two children, but they lacked awareness about fertility. The possibility of combining work and having children, along with the availability of childcare resources, impacted the desire for parenthood. Male students tended to consider parenthood as less impactful on their lives and careers than female students. Social structures might also impact the decision to have children. Conclusion It is important to provide health education emphasizing fertility awareness and parenthood in young adulthood so participants can consider these facts in advance. In addition, the government should provide resources for couples making parenthood decisions.

Purpose: This study presents a translation, cultural adaptation, and psychometric evaluation of two instruments of the Fertility Awareness and Attitudes Towards Parenthood (FAAP) questionnaire (Conditions and Life changes) for use in South Korea. Methods: This methodological study included 166 university students for psychometric evaluation in the sixth step. The first five steps included forward translation, backward translation, committee review, assessment of content validity, and a pre-test. In the sixth step, psychometric properties, including internal consistency, construct validity, and criterion validity, were evaluated. Exploratory factor analysis and confirmatory factor analysis were conducted to identify the structure of the tool and to assess its validity. Results: The Korean version showed acceptable internal consistency. Cronbach's ⍺ was .73 for FAAPC-conditions and .83 for FAAP-Life changes. FAAP-Conditions showed a four-factor structure (social conditions, relationship with partner, external environment, and child-rearing support) and FAAP-Life changes had a two-factor structure (reward and burden). In the confirmatory analysis, CMIN/DF, TLI, IFI, SRMR, CFI, and RMSEA were satisfactory. Conclusion This study provided preliminary evidence of the acceptability, reliability, and validity of the Korean version of the FAAP questionnaire in university students in South Korea. Nonetheless, further evaluation among Korean young adults is warranted to validate this instrument.

This study was conducted in order to investigate body awareness and dietary life according to gender. Subjects of the study were 120 men and 127 women aged 20 to 30 years, who exercise regularly at a fitness center in Seoul. The subjects were asked to fill out a questionnaire on body awareness, reason for regular exercise, dietary behaviors, and nutrition knowledge. The percentage of overweight and obesity was 69.2% in men, and 25.2% in women. The percentage of subjects who considered themselves as overweight was 38.3% in men and 59.8% in women. Intake of protein in men was higher than the recommended nutrient intake (RNI). Intake of energy in women was lower than the estimated energy requirement (EER). Men who considered themselves as overweight showed lower energy intake than men who considered their body weight as under and normal, whereas no difference in energy intake was observed between women who considered themselves as overweight and women who considered their body weight as under and normal.
Adult* ; Body Weight ; Energy Intake ; Female ; Fitness Centers ; Humans ; Male ; Obesity ; Overweight ; Surveys and Questionnaires

Drug-induced liver injury (DILI) is the serious and fatal drug-associated adverse effect, but its incidence is very low and individual variation in severity is substantial. Acetaminophen (APAP)-induced liver injury accounts for >50% of reported DILI cases but little is known for the cause of individual variations in the severity. Intrinsic genetic variation is considered a key element but the identity of the genes was not well-established. Here, pre-biopsy method and microarray technique was applied to uncover the key genes for APAP-induced liver injury in mice, and a cause and effect experiment employing quantitative real-time PCR was conducted to confirm the correlation between the uncovered genes and APAP-induced hepatotoxicity. We identified the innately and differentially expressed genes of mice susceptible to APAP-induced hepatotoxicity in the pre-biopsied liver tissue before APAP treatment through microarray analysis of the global gene expression profiles (Affymetrix GeneChip® Mouse Gene 1.0 ST for 28,853 genes). Expression of 16 genes including Gdap10, Lpl, Gabra3 and Ccrn4l were significantly different (t-test: FDR <10%) more than 1.5 fold in the susceptible animals than resistant. To confirm the association with the susceptibility to APAP-induced hepatotoxicity, another set of animals were measured for the expression level of selected 4 genes (higher two and lower two genes) in the liver pre-biopsy and their sensitivity to APAP-induced hepatotoxicity was evaluated by post hoc. Notably, the expressions of Gabra3 and Lpl were significantly correlated with the severity of liver injury (p<0.05) demonstrating that these genes may be linked to the susceptibility to APAP-induced hepatotoxicity.
Acetaminophen ; Animals ; Drug-Induced Liver Injury ; Genetic Variation ; Incidence ; Lipoprotein Lipase* ; Lipoproteins* ; Liver ; Methods ; Mice ; Microarray Analysis ; Real-Time Polymerase Chain Reaction ; Receptors, GABA-A* ; Toxicogenetics ; Transcriptome

Background: Several T-cell response assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are available; however, their comparability and correlations with antibody responses remain unclear. We compared four SARS-CoV-2 T-cell response assays and two anti-SARS-CoV-2 spike antibody assays. Methods: We enrolled 89 participants who had received a booster dose of the BNT162b2 vaccine after two doses of the ChAdOx1 or BNT162b2 vaccine. Fifty-six participants without breakthrough infection (BI) (ChAdOx1/BNT162b2 group: N=27; BNT162b2 group: N=29) and 33 with BI were included. We evaluated two whole-blood interferon-gamma release assays (IGRAs) (QuantiFERON and Euroimmun), T-SPOT.COVID, an in-house enzyme-linked immunospot (ELISPOT) assay (targeting the spike and nucleocapsid peptides of wild-type and Omicron SARS-CoV-2), Abbott IgG II Quant, and Elecsys Anti-S, using Mann–Whitney U, Wilcoxon signed-rank, and Spearman’s correlation tests. Results: The correlations between the IGRAs and between the ELISPOT assays (ρ=0.60–0.70) were stronger than those between the IGRAs and ELISPOT assays (ρ=0.33–0.57). T-SPOT.COVID showed a strong correlation with Omicron ELISPOT (ρ=0.70). The anti-spike antibody assays showed moderate correlations with T-SPOT.COVID, Euroimmun IGRA, and ELISPOT (ρ=0.43–0.62). Correlations tended to be higher in the BI than in the noninfected group, indicating that infection induces a stronger immune response. Conclusions T-cell response assays show moderate to strong correlations, particularly when using the same platform. T-SPOT.COVID exhibits potential for estimating immune responses to the Omicron variant. To accurately define SARS-CoV-2 immune status, both T-cell and B-cell response measurements are necessary.

Purpose: This study was conducted to assess the effects of a personalized nutritional intervention program on food security and health and nutritional status of elderly people in the city of Seoul. Methods: A total of 372 elderly adults aged 65 years or above who resided in Seoul were enrolled in this study. Personalized supplementary food supply and nutritional education based on chronic disease status, disability and cooking ability were implemented for 4 months. To evaluate the effectiveness of the program, nutrient intake, food security status, anemia status, chronic disease management, and frailty status, and prevalence of malnutrition (Mini Nutritional Assessment) were examined. Results: After the program, all subjects displayed significantly increased nutrient intake.Before the intervention, all subjects were in a state of food insecurity; however, after the intervention, 37.1% of the subjects were food secure. Moreover, the rates of being at risk of malnutrition and malnutrition in subjects were decreased and instead rate of those who improved to normal increased to 29.8% from 0% of normal rate before the prevention. The rate of subjects without anemia increased from 18.7% to 28.5% after the intervention. In addition, the rate of subjects with intensive or periodic management of chronic diseases decreased, while those with occasional management of chronic diseases increased from 0% to 4.6%. Furthermore, the rates of being at risk of frailty and frailty were decreased and the normal rate increased from 0% to 9.7% instead. Age group-based analysis showed that elderly people over 80 years showed less improvement in the management of the chronic disease status and the frailty status. Conclusion Personalized supplementary food supplies and nutritional education improved not only the nutritional status but also disease status in vulnerable older adults, and the effects were more significant in adults aged less than 80 years.

The shear bond strength of the composite resin to a CAD/CAM hybrid composite resin block (CRB) can be affected by the composition and microstructure of the hybrid CRB, surface treatment and the properties of the applied adhesive. In this study, the shear bond strengths between composite resin and the hybrid CRBs were measured to evaluate the effect of microstructure differences in hybrid CRBs on the bond strength. Ten conventional and reinforced hybrid CRBs developed by five domestic and international manufacturersand five universal adhesives currently used in dentistry were selected. After polishing the hybrid CRB surface, the specimens were divided into two groups. The first group was HF-treated to observe the microstructure by FE-SEM, and the second group was sandblasted with alumina, measured the surface roughness by CLSM, bonded with composite resin (diameter = 2.0mm) using universal adhesive, and stored in a 37 ℃ water bath for 24 hours, and measured the shear bond strength using a universal testing machine. The measured values were statistically analyzed using the Tukey-multiple comparison test (α= 0.05). It was observed that the size, type, and fraction of the filler particles contained in the regular and reinforced hybrid CRBs affected the microstructure, but the differences did not affect the shear bond strength. All five universal adhesives containing 10-MDP as the main functional monomer met the minimum bond strength (>20 MPa) required for clinical applications.

The bond strength to the silicate-based CAD/CAM blocks may be affected by the composition and microstructure of the silicatebased blocks, surface treatment, and the properties of the applied adhesive. In this study, the shear bond strength to the silicate blocks with various universal adhesives after sandblasting or HF-treatment was measured, and the effects of the additional silane application after surface treatments are evaluated. Six silica-containing blocks and five universal adhesives currently used in dental clinics were selected. After polishing the silicate block surface, the specimens were divided into two groups. The first groups were HF-treated and the second groups were sandblasted with alumina, and the surface roughness, contact angle, and microstructure were analyzed by CLSM (Confocal Laser Scanning Microscope), contact angle analyzer, and FE-SEM (Field Emission Scanning Electron Microscope).Composite resin (2 mm diameter) was bonded with universal adhesive to silicate blocks and stored in a 37 ℃ water bath for 24 hours, and the shear bond strength was measured using a universal testing machine. The measured values were statistically analyzed using the Tukey-multiple comparison test (α=0.05). For hybrid composite ceramics, there was no significant difference in bond strength between sandblasting or HF-treatment, and additional silane application may not be necessary when bonding with a universal adhesive, whereas for leucite-reinforced and lithium disilicate glass-ceramics, HF-treatment may be more favorable for adhesion than sandblasting, and additional silane application appears to be necessary even when applying a universal adhesive.

Malignant ovarian tumors in children are very rare, and consist of about 1% of all childhood malignant tumors. The purpose of this study is to examine the clinical characteristics, treatment, and prognosis for children with malignant ovarian tumors. We retrospectively reviewed the medical records of children under 15 years of age with malignant ovarian tumors who had been treated surgically at Asan Medical Center between 1989 and March 2009. There were 32 patients, ranged in age at surgery from 2 to 15 years (mean; 10.4 years). The median follow-up period was 64.7 months (from 1 month to 188 months). Pathologic diagnosis were; immature teratoma (n=10), mixed germ cell tumor (n=10), and dysgerminoma (n=6). Tumor stage was classified by the staging system of the International Federation of Gynecology and Obstetrics (FIGO). The number of patients in stage I, II, III, and IV were 24 (75%), 2 (6.2%), 4 (12.5%), and 2 (6.1%), respectively. The tumor recurred in 4 patients. Seven patients of group 1 did not receive postoperative adjuvant chemotherapy, and in three of them, the tumor recurred. Twenty-five patients (group 2) underwent postoperative adjuvant chemotherapy, and there was only one recurrence. One patient who did not receive postoperative adjuvant chemotherapy and expired 10 months after operation because of tumor recurrence and distant metastasis. The overall 5-year event free survival (EFS) was 84.2%: group 1 in 44.4%, and group 2 in 95.7%. Tumor recurrence was related to the postoperative adjuvant chemotherapy (p=0.004). In conclusion, proper surgical procedures with relevant postoperative adjuvant chemotherapy might improve clinical results in children with malignant ovarian tumors.
Chemotherapy, Adjuvant ; Child ; Disease-Free Survival ; Dysgerminoma ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Medical Records ; Neoplasm Metastasis ; Neoplasms, Germ Cell and Embryonal ; Obstetrics ; Ovary ; Prognosis ; Recurrence ; Retrospective Studies ; Teratoma