Objective: Primary frozen shoulder causes significant pain and progressively restricts shoulder movements. Diagnosis is made clinically based on patient history and physical examination. Management is mainly non-invasive owing to its self-limiting clinical course. However, clinical practice guidelines for frozen shoulder have not yet been developed in Korea. The developed guidelines aim to provide evidence-based recommendations for the diagnosis and treatment of frozen shoulder. Methods: A guideline development committee reviewed the literature from four databases (PubMed, Embase, Cochrane Library, and KMbase). Using the Population, Intervention, Comparator, and Outcome (PICO) framework, the committee formulated two backgrounds and 16 key questions to address common clinical concerns. Recommendations were made using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Results: Diabetes, thyroid disease, and dyslipidemia significantly increase the risk of developing a frozen shoulder. Although frozen shoulder is often self-limiting, some patients may experience long-term functional disabilities. Ultrasound and magnetic resonance imaging should be used as adjunctive tools alongside clinical diagnosis, and rather than as independent diagnostic methods. Noninvasive approaches, such as medications, physical modalities, exercises, electrical stimulation, and manual therapy, may reduce pain and improve shoulder function. Other noninvasive interventions have limited evidence, and their application should be based on clinical judgment. Intra-articular steroid injections are recommended for treatment, and physiotherapy or hydrodilation with steroid injections can also be beneficial. Conclusion These guidelines provide evidence-based recommendations for diagnosing and treating primary frozen shoulder.

Objective: The study aimed to investigate whether mindfulness could mitigate the impact of job and interpersonal demands arising from stressful organizational cultures in predicting depression during the COVID-19 pandemic. Methods: A total of 280 Korean physical therapists participated in this study. To verify the mediated moderation model, this study implemented an SPSS 26.0 PROCESS Macro (v.3.5) that was based on the verification of Hayes' conditional indirect effect. Results: The study confirmed the moderated mediation effect of mindfulness on the mediating relationship between stressful organizational culture, job demands/interpersonal demands, and depression. Moreover, the conditional indirect effect of mindfulness was found to be statistically significant. However, the impact on interpersonal stress differed from anticipated outcomes. Conclusions Mindfulness, applicable within the framework of the Job Demands-Resources model theory, served as a resource variable and moderated the impact of organizational culture on members' depression. Amidst ongoing debates on mindfulness effectiveness, this study partially confirmed its potential within the Job Demands-Resources model, suggesting a role in mitigating the influence of organizational culture on members' depression as a resource variable.

Objective: The study aimed to investigate whether mindfulness could mitigate the impact of job and interpersonal demands arising from stressful organizational cultures in predicting depression during the COVID-19 pandemic. Methods: A total of 280 Korean physical therapists participated in this study. To verify the mediated moderation model, this study implemented an SPSS 26.0 PROCESS Macro (v.3.5) that was based on the verification of Hayes' conditional indirect effect. Results: The study confirmed the moderated mediation effect of mindfulness on the mediating relationship between stressful organizational culture, job demands/interpersonal demands, and depression. Moreover, the conditional indirect effect of mindfulness was found to be statistically significant. However, the impact on interpersonal stress differed from anticipated outcomes. Conclusions Mindfulness, applicable within the framework of the Job Demands-Resources model theory, served as a resource variable and moderated the impact of organizational culture on members' depression. Amidst ongoing debates on mindfulness effectiveness, this study partially confirmed its potential within the Job Demands-Resources model, suggesting a role in mitigating the influence of organizational culture on members' depression as a resource variable.

Objective: The study aimed to investigate whether mindfulness could mitigate the impact of job and interpersonal demands arising from stressful organizational cultures in predicting depression during the COVID-19 pandemic. Methods: A total of 280 Korean physical therapists participated in this study. To verify the mediated moderation model, this study implemented an SPSS 26.0 PROCESS Macro (v.3.5) that was based on the verification of Hayes' conditional indirect effect. Results: The study confirmed the moderated mediation effect of mindfulness on the mediating relationship between stressful organizational culture, job demands/interpersonal demands, and depression. Moreover, the conditional indirect effect of mindfulness was found to be statistically significant. However, the impact on interpersonal stress differed from anticipated outcomes. Conclusions Mindfulness, applicable within the framework of the Job Demands-Resources model theory, served as a resource variable and moderated the impact of organizational culture on members' depression. Amidst ongoing debates on mindfulness effectiveness, this study partially confirmed its potential within the Job Demands-Resources model, suggesting a role in mitigating the influence of organizational culture on members' depression as a resource variable.

Background/Aims: Synchronous multiple gastric cancer (SMGC) accounts for approximately 6% to 14% of gastric cancer (GC) cases. This study aimed to identify risk factors for SMGC. Methods: A total of 14,603 patients diagnosed with GC were prospectively enrolled. Data including age, sex, body mass index, smoking, alcohol consumption, family history, p53 expression, microsatellite instability, cancer classification, lymph node metastasis, and treatment were collected. Risk factors were analyzed using logistic regression analysis between a single GC and SMGC. Results: The incidence of SMGC was 4.04%, and that of early GC (EGC) and advanced GC (AGC) was 5.43% and 3.11%, respectively. Patients with SMGC were older (65.33 years vs 61.75 years, p<0.001) and more likely to be male. Lymph node metastasis was found in 27% of patients with SMGC and 32% of patients with single GC. Multivariate analysis showed that SMGC was associated with sex (male odds ratio [OR], 1.669; 95% confidence interval [CI], 1.223 to 2.278; p=0.001), age (≥65 years OR, 1.532; 95% CI, 1.169 to 2.008; p=0.002), and EGC (OR, 1.929; 95% CI, 1.432 to 2.600; p<0.001). Survival rates were affected by Lauren classification, sex, tumor size, cancer type, distant metastasis, and venous invasion but were not related to the number of GCs. However, the survival rate of AGC with SMGC was very high. Conclusions SMGC had unique characteristics such as male sex, older age, and EGC, and the survival rate of AGC, in which the intestinal type was much more frequent, was very good (Trial registration number: NCT04973631).

PURPOSE: This study aimed to evaluate the effect of pretreatment of three different universal adhesives (Single Bond Universal [SBU], All-Bond Universal [ABU], and Prime&Bond universal [PBU]) on the bonding durability of an adhesive (Panavia F 2.0, PF) and a conventional (Duo-Link, DL) resin cements to air-abraded zirconia. MATERIALS AND METHODS: Rectangular-shaped zirconia specimens were prepared. The chemical composition and surface energy parameters of the materials were studied by Fourier transform infrared spectroscopy and contact angle measurement, respectively. To evaluate resin bonding to the zirconia, all the bonding specimens were immersed in water for 24 h and the specimens to be aged were additionally thermocycled 10000 times before the shear bond strength (SBS) test. RESULTS: The materials showed different surface energy parameters, including the degree of hydrophilicity/hydrophobicity. While the DL/CON (no pretreatment) showed the lowest SBS and a significant decrease in the value after thermocycling (P < .001), the PF/CON obtained a higher SBS value than the DL/CON (P < .001) and no decrease even after thermocycling (P = .839). When the universal adhesives were used with DL, their SBS values were higher than the CON (P < .05), but the trend was adhesive-specific. In conjunction with PF, the PF/SBU produced the highest SBS followed by the PF/ABU (P = .002), showing no significant decrease after thermocycling (P > .05). The initial SBS of the PF/PBU was similar to the PF/CON (P = .999), but the value decreased after thermocycling (P < .001). CONCLUSION The universal adhesive pretreatment did not necessarily show a synergistic effect on the bonding performance of an adhesive resin cement, whereas the pretreatment was beneficial to bond strength and durability of a conventional resin cement.

Objective: The study aimed to investigate whether mindfulness could mitigate the impact of job and interpersonal demands arising from stressful organizational cultures in predicting depression during the COVID-19 pandemic. Methods: A total of 280 Korean physical therapists participated in this study. To verify the mediated moderation model, this study implemented an SPSS 26.0 PROCESS Macro (v.3.5) that was based on the verification of Hayes' conditional indirect effect. Results: The study confirmed the moderated mediation effect of mindfulness on the mediating relationship between stressful organizational culture, job demands/interpersonal demands, and depression. Moreover, the conditional indirect effect of mindfulness was found to be statistically significant. However, the impact on interpersonal stress differed from anticipated outcomes. Conclusions Mindfulness, applicable within the framework of the Job Demands-Resources model theory, served as a resource variable and moderated the impact of organizational culture on members' depression. Amidst ongoing debates on mindfulness effectiveness, this study partially confirmed its potential within the Job Demands-Resources model, suggesting a role in mitigating the influence of organizational culture on members' depression as a resource variable.

Objective: The study aimed to investigate whether mindfulness could mitigate the impact of job and interpersonal demands arising from stressful organizational cultures in predicting depression during the COVID-19 pandemic. Methods: A total of 280 Korean physical therapists participated in this study. To verify the mediated moderation model, this study implemented an SPSS 26.0 PROCESS Macro (v.3.5) that was based on the verification of Hayes' conditional indirect effect. Results: The study confirmed the moderated mediation effect of mindfulness on the mediating relationship between stressful organizational culture, job demands/interpersonal demands, and depression. Moreover, the conditional indirect effect of mindfulness was found to be statistically significant. However, the impact on interpersonal stress differed from anticipated outcomes. Conclusions Mindfulness, applicable within the framework of the Job Demands-Resources model theory, served as a resource variable and moderated the impact of organizational culture on members' depression. Amidst ongoing debates on mindfulness effectiveness, this study partially confirmed its potential within the Job Demands-Resources model, suggesting a role in mitigating the influence of organizational culture on members' depression as a resource variable.

Background/Aims: There are few reports regarding mixed carcinoma, defined as a mixture of glandular and poorly cohesive components, in patients with gastric cancer (GC). The aim of this study was to evaluate the proportion and characteristics of mixed carcinoma in GC patients. Methods: A total of 7,215 patients diagnosed with GC at Seoul National University Bundang Hospital were enrolled from March 2011 to February 2020. GC was divided into four groups (wellmoderately differentiated GC, poorly differentiated GC, poorly cohesive carcinoma, and mixed carcinoma). The proportion of each GC type and the clinicopathological features were analyzed and divided into early GC and advanced GC. Results: The proportion of mixed carcinoma was 10.9% (n=787). In early GC, submucosal invasion was the most common in poorly differentiated (53.7%), and mixed carcinoma ranked second (41.1%). Mixed carcinoma showed the highest proportion of lymph node metastasis in early GC (23.0%) and advanced GC (78.3%). In advanced GC, the rate of distant metastasis was 3.6% and 3.9% in well-moderately differentiated GC and mixed carcinoma, respectively, lower than that in poorly differentiated GC (6.4%) and poorly cohesive carcinoma (5.7%), without statistical significance. Conclusions Mixed carcinoma was associated with lymph node metastasis compared to other histological GC subtypes. And it showed relatively common submucosal invasion in early GC, but the rates of venous invasion and distant metastasis were lower in advanced GC. Further research is needed to uncover the mechanism underlying these characteristics of mixed carcinoma (Trial registration number: NCT04973631).

Background: Far-infrared (FIR) irradiation has been reported to improve diverse cardiovascular diseases, including heart failure, hypertension, and atherosclerosis. The dysregulated proliferation of vascular smooth muscle cells (VSMCs) is well established to contribute to developing occlusive vascular diseases such as atherosclerosis and in-stent restenosis. However, the effects of FIR irradiation on VSMC proliferation and the underlying mechanism are unclear. This study investigated the molecular mechanism through which FIR irradiation inhibited VSMC proliferation. Methods: We performed cell proliferation and cell death assay, adenosine 5′-triphosphate (ATP) assay, inhibitor studies, transfection of dominant negative (dn)-AMP-activated protein kinase (AMPK) α1 gene, and western blot analyses. We also conducted confocal microscopic image analyses and ex vivo studies using isolated rat aortas. Results: FIR irradiation for 30 minutes decreased VSMC proliferation without altering the cell death. Furthermore, FIR irradiation accompanied decreases in phosphorylation of the mammalian target of rapamycin (mTOR) at Ser2448 (p-mTOR-Ser2448 ) and p70 S6 kinase (p70S6K) at Thr389 (p-p70S6K-Thr389 ). The phosphorylation of AMPK at Thr172 (p-AMPKThr172 ) was increased in FIR-irradiated VSMCs, which was accompanied by a decreased cellular ATP level. Similar to in vitro results, FIR irradiation increased p-AMPK-Thr172 and decreased p-mTOR-Ser 2448 and p-p70S6K-Thr389 in isolated rat aortas. Pre-treatment with compound C, a specific AMPK inhibitor, or ectopic expression of dn-AMPKα1 gene, significantly reversed FIR irradiation-decreased VSMC proliferation, p-mTOR-Ser2448 , and p-p70S6K-Thr389 . On the other hand, hyperthermal stimulus (39°C) did not alter VSMC proliferation, cellular ATP level, and AMPK/mTOR/p70S6K phosphorylation. Finally, FIR irradiation attenuated plateletderived growth factor (PDGF)-stimulated VSMC proliferation by increasing p-AMPK-Thr172 , and decreasing p-mTOR-Ser2448 and p-p70S6K-Thr389 in PDGF-induced in vitro atherosclerosis model. Conclusion These results show that FIR irradiation decreases the basal and PDGF-stimulated VSMC proliferation, at least in part, by the AMPK-mediated inhibition of mTOR/p70S6K signaling axis irrespective of its hyperthermal effect. These observations suggest that FIR therapy can be used to treat arterial narrowing diseases, including atherosclerosis and in-stent restenosis.