BACKGROUND/OBJECTIVES: Lutein, a dietary carotenoid, plays a crucial role in protecting eye health as an anti-inflammatory agent and antioxidant. Green leafy vegetables constitute a major source of lutein; however, comparative studies on different consumption methods are limited. Therefore, this study aimed to evaluate the bioavailability of lutein from lutein-rich foods, namely, raw vegetables and raw vegetable juice. SUBJECTS/METHODS: In this study, 18 adults were recruited. They were randomly divided into three groups: commercial lutein supplement (LUT, 20 mg), raw vegetable (RV), and raw vegetable juice (RVJ) groups. Blood was collected at 0-, 4-, 6-, 8-, 12-, 24-, and 30-h intervals after the consumption of each test meal. Participants’ serum lutein levels were analyzed using high-performance liquid chromatography (HPLC). Considering lutein’s wellestablished anti-inflammatory properties, changes in inflammatory status were assessed by measuring serum high-sensitivity C-reactive protein (hs-CRP) levels. Furthermore, urinary metabolomic profiling was conducted using 1 H nuclear magnetic resonance spectroscopy to evaluate metabolic alterations. RESULTS: After consuming each lutein-rich food, participants’ blood lutein levels were analyzed, and the serum concentration peaked at 12 h (0.37 ± 0.13 μg/mL), 24 h (0.61 ± 0.18 μg/mL), and 30 h (0.42 ± 0.16 μg/mL) after RV, LUT, and RVJ consumption, respectively.Additionally, hs-CRP levels decreased following lutein-rich food consumption. Twelve hours after consumption, hs-CRP levels decreased to 0.81 and 0.83 mg/L in the RV and RVJ groups, respectively. Twenty-four hours after consumption, they further decreased to 0.68 and 0.74 mg/L in the LUT and RVJ groups, respectively. Thirty hours after consumption, a reduction to 0.61 mg/L was observed in the RVJ group. Furthermore, after consuming each luteinrich food, N-acetyl glycoprotein levels decreased at 24 h, reflecting metabolic alterations potentially associated with lutein metabolism. CONCLUSION These findings suggest that the short-term consumption of lutein-rich foods, regardless of their type or source, potentially yields health benefits.

Purpose: This study was performed to predict individualized treatment strategies in ruptured abdominal aortic aneurysm (rAAA) by estimating the survival benefit of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) based on anatomical and physiological features using a causal inference model. Methods: This retrospective study included 45 patients with de novo rAAA who underwent EVAR or OSR between 2012 and 2024. Thirty-three variables were analyzed. The model estimated individualized treatment effects (ITE) for 30-day survival.Model interpretability was assessed using Shapley Additive Explanations (SHAP) analysis. Five-fold cross-validation, receiver operating characteristic (ROC) analysis, and calibration plots were used for model evaluation. A clinical decision tree was developed to derive simplified decision rules. Results: The mean ITE was 0.22 ± 0.42, with 33% of patients classified as OSR-benefit candidates. SHAP analysis revealed that suprarenal angle, infrarenal angle, iliac anatomy, and proximal neck characteristics strongly influenced treatment effects. However, some predictors, such as low hemoglobin and systolic blood pressure favoring OSR, conflicted with clinical intuition. ROC analysis showed an area under the curve of 1.00, but calibration suggested overfitting due to a small sample size. Treatment-matched patients had a higher 30-day mortality rate than mismatched patients, suggesting potential bias or unmeasured confounding. The decision tree identified clinically relevant features but displayed structural inconsistencies and impractical cutoff values due to the limited sample size. Conclusion The X-learner model demonstrated the feasibility of individualized treatment prediction in rAAA but suffered from overfitting and limited generalizability. Validation with larger multicenter cohorts is necessary to confirm clinical applicability.

BACKGROUND/OBJECTIVES: Owing to coronavirus disease 2019 (COVID-19), the shift from offline to online classes has caused significant changes in high school students' daily habits, including sleep patterns and dietary intake. This study explored the association between sleep schedule fluctuations and dietary quality among high school girls during the COVID-19 pandemic. This study examined the association between bedtime, wake-up time, and adolescent dietary quality during the weekly online/offline school period among 517 high school girls in Incheon, South Korea. SUBJECTS/METHODS: The participants were divided into 2 groups: normal sleepers (n = 244), who maintained normal sleep schedules defined as a midpoint between bedtime and wake-up time before 5:30 a.m., during in-person and online classes; and late sleepers (n = 273), who maintained a normal sleep schedule during in-person classes but exhibited late sleep patterns defined as a midpoint after 5:30 a.m., during online classes. RESULTS: Shorter sleep duration was characteristic of late sleepers with circadian rhythm disruption, who also displayed poorer dietary quality, including higher consumption of caffeinated beverages and street food and never consuming breakfast. Among the 5 constituent factors, disrupted sleep timing was associated with lower Nutrition Quotient for Adolescents scores in total, moderation, and environment. This association persisted independent of the grade level, even after adjusting for school grade. These findings highlight the significant effect of sleep patterns on dietary habits. CONCLUSION This study highlights the significant relationship between disrupted circadian rhythms and poor dietary quality among high-school girls. These findings reveal the need for interventions to promote healthy sleep patterns as a strategy to improve the dietary quality and overall health of adolescents.

Purpose: Persimmon (Diospyros kaki Thunb.) is rich in phytochemicals (e.g., tannin and beta-carotene.), vitamins (e.g., vitamins A and C), minerals (e.g., calcium and potassium), and dietary fiber. Persimmon exhibits efficacy against diseases such as cancer, hypertension, and heart disease. This study examined the antioxidant and immune-enhancing activities of Fuyu (a sweet persimmon) and Hachiya (an astringent persimmon) and evaluated their potential as functional food ingredients. Methods: The antioxidant and immune-enhancing activities of Fuyu and Hachiya persimmons were evaluated by extracting them with hot water and ethanol (100%). The antioxidant activity was assessed by measuring the total phenolic content (TPC), total flavonoid content (TFC), 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity (RSA), and oxygen radical absorbance capacity (ORAC). Six-year domestic red ginseng was used as a reference for assessing the immune-enhancing activity. Nitric oxide (NO) production, phagocytosis, cytokine levels interleukin [IL]-2, IL-4, IL-10, and interferon-γ), and inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) gene expression were analyzed. Results: The hot water extracts of Fuyu and Hachiya persimmon exhibited significantly higher TPC, TFC, DPPH RSA, and ORAC levels than the ethanol extract. The Hachiya persimmon extract generally showed comparable or higher immune-enhancing activity than the Fuyu persimmon extract in NO production, cytokine activity, phagocytosis, and expression of iNOS and COX-2 genes. Conclusion Hachiya persimmon possesses superior antioxidant properties to Fuyu persimmon while exhibiting comparable immune-enhancing activity. These characteristics highlight its potential for beneficial applications. Nevertheless, further research is required to elucidate these effects and optimize their use in health-promoting interventions.

BACKGROUND/OBJECTIVES: Owing to coronavirus disease 2019 (COVID-19), the shift from offline to online classes has caused significant changes in high school students' daily habits, including sleep patterns and dietary intake. This study explored the association between sleep schedule fluctuations and dietary quality among high school girls during the COVID-19 pandemic. This study examined the association between bedtime, wake-up time, and adolescent dietary quality during the weekly online/offline school period among 517 high school girls in Incheon, South Korea. SUBJECTS/METHODS: The participants were divided into 2 groups: normal sleepers (n = 244), who maintained normal sleep schedules defined as a midpoint between bedtime and wake-up time before 5:30 a.m., during in-person and online classes; and late sleepers (n = 273), who maintained a normal sleep schedule during in-person classes but exhibited late sleep patterns defined as a midpoint after 5:30 a.m., during online classes. RESULTS: Shorter sleep duration was characteristic of late sleepers with circadian rhythm disruption, who also displayed poorer dietary quality, including higher consumption of caffeinated beverages and street food and never consuming breakfast. Among the 5 constituent factors, disrupted sleep timing was associated with lower Nutrition Quotient for Adolescents scores in total, moderation, and environment. This association persisted independent of the grade level, even after adjusting for school grade. These findings highlight the significant effect of sleep patterns on dietary habits. CONCLUSION This study highlights the significant relationship between disrupted circadian rhythms and poor dietary quality among high-school girls. These findings reveal the need for interventions to promote healthy sleep patterns as a strategy to improve the dietary quality and overall health of adolescents.

Purpose: This study evaluated the educational impact of an artificial intelligence (AI)–based decision support system for breast ultrasonography (US) on medical professionals not specialized in breast imaging. Methods: In this multi-case, multi-reader study, educational materials, including American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) descriptors, were provided alongside corresponding AI results during training. The AI system presented results in the form of AIheatmaps, AI scores, and AI-provided BI-RADS assessment categories. Forty-two readers evaluated the test set in three sessions: the first session (S1) occurred before the educational intervention, the second session (S2) followed education without AI assistance, and the third session (S3) took place after education with AI assistance. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and overall performance, were compared between the sessions. Results: The mean sensitivity increased from 66.5% (95% confidence interval [CI], 59.2% to 73.7%) to 88.7% (95% CI, 84.1% to 93.3%), with a statistically significant difference (P<0.001), and the AUC non-significantly increased from 0.664 (95% CI, 0.606 to 0.723) to 0.684 (95% CI, 0.620 to 0.748) (P=0.300). Both measures were higher in S2 than in S1. The AI-achieved AUC was comparable to that of the expert reader (0.747 [95% CI, 0.640 to 0.855] vs. 0.803 [95% CI, 0.706 to 0.900], P=0.217). Additionally, with AI assistance, the mean AUC for inexperienced readers was not significantly different from that of the expert reader (0.745 [95% CI, 0.660 to 0.830] vs. 0.803 [95% CI, 0.706 to 0.900], P=0.120). Conclusion The mean AUC and sensitivity improved after incorporating AI into breast US education and interpretation. AI systems with high-level performance for breast US can potentially be used as educational tools in the interpretation of breast US images.

Background: In vitro and animal studies have demonstrated that bone morphogenetic protein-7 (BMP-7), renowned for its osteogenic properties, also exerts beneficial effects on muscle metabolism by enhancing myogenesis and reversing muscle atrophy. Despite being proposed as a common regulatory factor for both muscle and bone, the impact of BMP-7 on human muscle health has not been thoroughly investigated. Methods: This cross-sectional study involved 182 community-dwelling older adults who underwent a comprehensive geriatric assessment in South Korea. Sarcopenia was diagnosed using Asian-specific cutoffs, and serum BMP-7 levels were quantified via enzyme immunoassay. Results: The mean age of the participants was 72.2±7.3 years, with 62.6% being female. After adjustments for confounders, serum BMP-7 levels were not significantly different between individuals with and without sarcopenia, nor were there differences based on skeletal muscle mass, strength, or physical performance levels (p=0.423 to 0.681). Likewise, no correlations were detected between circulating BMP-7 levels and any sarcopenia assessment metrics such as skeletal muscle index, grip strength, gait speed, or chair stand completion times (p=0.127 to 0.577). No significant associations were observed between increases in serum BMP-7 concentrations and the risk of sarcopenia or poor muscle phenotypes (p=0.431 to 0.712). Stratifying participants into quartiles based on serum BMP-7 levels also indicated no differences in sarcopenia-related parameters (p=0.663 to 0.996). Conclusion Despite experimental evidence supporting BMP-7’s role in muscle metabolism, this study found no significant association between serum BMP-7 levels and clinical indicators of muscle health in older adults. These findings challenge the utility of serum BMP-7 as a biomarker for sarcopenia in this demographic.

Purpose: This study aimed to evaluate the outcomes and current status of reduced-port laparoscopic distal gastrectomy (RLDG) compared with multiport laparoscopic distal gastrectomy (MLDG) based on a 2019 nationwide survey of surgical gastric cancer treatments by the Korean Gastric Cancer Association (KGCA). Materials and Methods: The study was conducted retrospectively from March to December 2020 using data from the 2019 KGCA nationwide survey database. To compare RLDG and MLDG based on age, sex, body mass index, American Society of Anesthesiologists score, histological type, tumor invasion, and lymph node metastasis, propensity score matching was performed. Results: Of the 14,076 registered patients with gastric cancer, the five-port approach was the most favored for multiport gastrectomy, accounting for 6,396 (70.9%) cases, followed by the four-port approach, with 1,462 (16.2%) cases. The single-port approach was used in 303 (3.4%) cases, the two-port approach in 95 (1.1%) cases, and the three-port approach in 731 (8.1%) cases. RLDG was performed in 805 patients (6.4%), MLDG was conducted in 4,831 patients (34.3%), and 804 patients were 1:1 matched in each group. The average operation time was shorter in the RLDG (168.2±49.1 min vs. 179.5±61.5 min, P<0.001). No significant difference was found in blood loss (84.8±115.9 cc vs. 75.5±119.6 cc, P=0.152), overall complication rates (11.3% vs. 13.1%, P=0.254), or complications ≥ to grade IIIa (3.2% vs. 4.4%, P=0.240). Conclusions This study revealed that RLDG is a safe and effective surgical option for gastric cancer with the potential to offer shorter operation times without increasing the risk of complications.

Purpose: Since 1995, the Korean Gastric Cancer Association (KGCA) has been periodically conducting nationwide surveys on patients with surgically treated gastric cancer. This study details the results of the survey conducted in 2023. Materials and Methods: The survey was conducted from March to December 2024 using a standardized case report form. Data were collected on 86 items, including patient demographics, tumor characteristics, surgical procedures, and surgical outcomes. The results of the 2023 survey were compared with those of previous surveys. Results: Data from 12,751 cases were collected from 66 institutions. The mean patient age was 64.6 years, and the proportion of patients aged ≥71 years increased from 9.1% in 1995 to 31.7% in 2023. The proportion of upper-third tumors slightly decreased to 16.8% compared to 20.9% in 2019. Early gastric cancer accounted for 63.1% of cases in 2023.Regarding operative procedures, a totally laparoscopic approach was most frequently applied (63.2%) in 2023, while robotic gastrectomy steadily increased to 9.5% from 2.1% in 2014.The most common anastomotic method was the Billroth II procedure (48.8%) after distal gastrectomy and double-tract reconstruction (51.9%) after proximal gastrectomy in 2023.However, the proportion of esophago-gastrostomy with anti-reflux procedures increased to 30.9%. The rates of post-operative mortality and overall complications were 1.0% and 15.3%, respectively. Conclusions The results of the 2023 nationwide survey demonstrate the current status of gastric cancer treatment in Korea. This information will provide a basis for future gastric cancer research.