Purpose: The purpose of this study is to confirm the effect of resilience, family support, and spiritual well-being on posttraumatic growth(PTG) in lung cancer patients undergoing chemotherapy. Methods: The study collected data from January 20 to July 6, 2023 on 124 lung cancer patients who were admitted to hospital of C university in Seoul and received chemotherapy treatment. Patients were asked to complete a questionnaire consisting of general characteristics, disease characteristics, resilience, family support, spiritual well-being and PTG. Data were analyzed using t-tests, One-way ANOVA, Pearson's correlation and multiple regression analysis. Results: The mean score for PTG in lung cancer patients was 55.17, resilience was 72.46, family support was 49.00, and spiritual well-being was 53.50. Significant positive correlations were found for PTG with resilience (r=.62, p<.001), family support (r=.40, p<.001) and spiritual well-being (r=.47, p<.001). Factors contributing to PTG of lung cancer patients were resilience (β=.50, p<.001), spiritual well-being (β=.20, p=.008), and gender (β =.14, p=.043). Conclusion This study aims to provide basic data for the PTG intervention program by identifying factors affecting the PTG of lung cancer patients. It is necessary to develop new nursing intervention programs to improve PTG for patients with lung cancer based on strategies to enhance resilience and spiritual well-being.

Purpose: This study evaluated whether combination therapy is more effective than monotherapy in elderly patients with metastatic or recurrent gastric cancer (MRGC) as first-line chemotherapy. Materials and Methods: Elderly (≥ 70 years) chemo-naïve patients with MRGC were allocated to receive either combination therapy (group A: 5-fluorouracil [5-FU]/oxaliplatin, capecitabine/oxaliplatin, capecitabine/cisplatin, or S-1/cisplatin) or monotherapy (group B: 5-FU, capecitabine, or S-1). In group A, starting doses were 80% of standard doses, and they could be escalated to 100% at the discretion of the investigator. Primary endpoint was to confirm superior overall survival (OS) of combination therapy vs. monotherapy. Results: After 111 of the planned 238 patients were randomized, enrollment was terminated due to poor accrual. In the full-analysis population (group A [n=53] and group B [n=51]), median OS of combination therapy vs. monotherapy was 11.5 vs. 7.5 months (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.56 to 1.30; p=0.231). Median progression-free survival (PFS) was 5.6 vs. 3.7 months (HR, 0.53; 95% CI, 0.34 to 0.83; p=0.005). In subgroup analyses, patients aged 70-74 years tended to have superior OS with combination therapy (15.9 vs. 7.2 months, p=0.056). Treatment-related adverse events (TRAEs) occurred more frequently in group A vs. group B. However, among severe TRAEs (≥ grade 3), there were no TRAEs with a frequency difference of > 5%. Conclusion Combination therapy was associated with numerically improved OS, although statistically insignificant, and a significant PFS benefit compared with monotherapy. Although combination therapy showed more frequent TRAEs, there was no difference in the frequency of severe TRAEs.

Background/Aims: This study aimed to develop a rehabilitation program for musculoskeletal pain experienced by gastrointestinal endoscopists and to investigate its usefulness. Methods: This was a multicenter cohort study. During the first 2 weeks, a questionnaire regarding daily workload and musculoskeletal symptoms was administered. Then, a rehabilitation program including equipment/posture correction and stretching was conducted during the remaining 6 weeks. Follow-up daily workload and musculoskeletal symptom surveys were distributed during the last 2 weeks. The program satisfaction survey was performed at the 6th and 8th weeks. Results: Among 118 participants (69 men), 94% (n=111) complained of musculoskeletal pain at baseline. Various hospital activities at baseline were associated with multisite musculoskeletal pain, whereas only a few workloads were correlated with musculoskeletal pain after the rehabilitation program. Follow-up musculoskeletal pain was negatively correlated with equipment/ posture program performance; arm/elbow pain was negatively correlated with elbow (R=–0.307) and wrist (R=–0.205) posture; leg/foot pain was negatively correlated with monitor position, shoulder, elbow, wrist, leg, and foot posture. Higher performance in the scope position (86.8% in the improvement vs 71.3% in the aggravation group, p=0.054) and table height (94.1% vs 79.1%, p=0.054) were associated with pain improvement. An increased number of colonoscopy procedures (6.27 in the aggravation vs 0.02 in the improvement group, p=0.017) was associated with pain aggravation. Most participants reported being average (32%) or satisfied (67%) with the program at the end of the study. Conclusions Our rehabilitation program is easily applicable, satisfactory, and helpful for improving the musculoskeletal pain experienced by gastrointestinal endoscopists.

BACKGROUND/OBJECTIVES: Zinc is an essential trace mineral which is important for the growth and development of the human body and immunological and neurological functions.Inadequate zinc intake may cause zinc deficiency with its adverse consequences. In this study, we aimed to estimate the dietary zinc intake levels and sources among Koreans. SUBJECTS/METHODS: For this secondary analysis, we obtained data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2019. Individuals aged ≥ 1 yr who had completed a 24-h recall were included. The dietary zinc intake of each individual was calculated by applying data from a newly developed zinc content database to the KNHANES raw data. We also compared the extracted data with the sex-, age-specific reference values suggested in the Korean Dietary Reference Intakes 2020. The prevalence of adequate zinc intake was then evaluated by the proportion of the individuals who met the estimated average requirement (EAR). RESULTS: The mean zinc intake of Koreans aged ≥ 1 yr and adults aged ≥ 19 yrs were 10.2 and 10.4 mg/day, equivalent to 147.4% and 140.8% of the EAR, respectively. Approximately 2 in 3 Koreans met the EAR for zinc, but the zinc intake differed slightly among the different age and sex groups. In children aged 1–2 yrs, 2 out of 5 exceeded the upper level of intake, and nearly half of the younger adults (19–29 yrs) and the elders (≥ 75 yrs) did not meet the EAR. The major contributing food groups were grains (38.9%), meats (20.4%), and vegetables (11.1%). The top 5 food contributors to zinc intake were rice, beef, pork, egg, and baechu kimchi, which accounted for half of the dietary intake. CONCLUSION The mean zinc intake among Koreans was above the recommended level, but 1 in 3 Koreans had inadequate zinc intake and some children were at risk of excessive zinc intake. Our study included zinc intake from diet only, thus to better understand zinc status, further research to include intake from dietary supplements is needed.

BACKGROUND/OBJECTIVES: The purpose of this study was to establish a database (DB) of foods containing vitamin D that were investigated in the Korea National Health and Nutrition Examination Survey (KNHANES), to estimate the dietary vitamin D intake, to evaluate the dietary adequacy of this intake, and to identify the major food sources of Koreans that contain vitamin D. SUBJECTS/METHODS: This study used data from the KNHANES 2016–2019. Individuals aged ≥ 1 year who participated in the nutrition survey (n = 28,418) were included. The dietary intake was assessed by the 24-h dietary recall method and individual dietary vitamin D intake was estimated using a newly established vitamin D DB. Dietary adequacy was evaluated by comparing the dietary intake of the participants with adequate intake (AI) as defined by Dietary Reference Intakes for Koreans (KDRIs) 2020. RESULTS: The average dietary vitamin D intake for all the subjects was 3.13 μg/d, which was 33.1% of AI. Dietary vitamin D intake was lower in rural residents, the elderly, and those with low income. The major food groups that contributed to the total dietary vitamin D intake were fish and shellfish (61.59%), eggs (17.75%), meat (8.03%), milk (4.25%), legumes (3.93%), and grains (3.84%). The top 10 individual food items that contributed to the total vitamin D intake were eggs (17.44%), squid (8.5%), eels (7.44%), salmon (5.35%), mackerel (5.27%), anchovies (4.65%), yellow croakers (4.58%), pork meat (4.47%), soymilk (4.46%), and skipjack tuna (3.80%). CONCLUSION These results show that the mean dietary vitamin D intake of Koreans is lower than the reference AI level. Nutritional policies need to be put in place to increase the vitamin D intake of Koreans in the future. In addition, comprehensive research on all the sources of vitamin D, including intake of supplements and biosynthesis in the skin, is required.

Background/Aims: We aimed to compare the effectiveness and safety of Janus kinase inhibitors (JAKi) vs. biologic disease- modifying antirheumatic drugs (bDMARD) in Korean patients with rheumatoid arthritis (RA) who had an inadequate response to conventional synthetic DMARDs. Methods: A quasi-experimental, multi-center, prospective, non-randomized study was conducted to compare response rates between JAKi and bDMARDs in patients with RA naïve to targeted therapy. An interim analysis was performed to estimate the proportion of patients achieving low disease activity (LDA) based on disease activity score (DAS)–28– erythroid sedimentation rate (ESR) (DAS28-ESR) at 24 weeks after treatment initiation and to evaluate the development of adverse events (AEs). Results: Among 506 patients enrolled from 17 institutions between April 2020 and August 2022, 346 (196 JAKi group and 150 bDMARD group) were included in the analysis. After 24 weeks of treatment, 49.0% of JAKi users and 48.7% of bDMARD users achieved LDA (p = 0.954). DAS28-ESR remission rates were also comparable between JAKi and bDMARD users (30.1% and 31.3%, respectively; p = 0.806). The frequency of AEs reported in the JAKi group was numerically higher than that in the bDMARDs group, but the frequencies of serious and severe AEs were comparable between the groups. Conclusions Our interim findings reveal JAKi have comparable effectiveness and safety to bDMARDs at 24 weeks after treatment initiation.

BACKGROUND/OBJECTIVES: Magnesium is an essential nutrient for human health.However, inadequate intake is commonly reported worldwide. Along with reduced consumption of vegetables and fruits and increased consumption of refined or processed foods, inadequate magnesium intake is increasingly reported as a serious problem.This study aimed to assess magnesium intake, its dietary sources, and the adequacy of magnesium intake in Korean populations. SUBJECTS/METHODS: Data was obtained from the Korea National Health and Nutrition Examination Survey 2016–2019 and included individuals aged ≥1 yr who had participated in a nutrition survey (n=28,418). Dietary intake was assessed by 24-h recall, and dietary magnesium intake was estimated using a newly established magnesium database. Diet adequacy was evaluated by comparing dietary intake with the estimated average requirement (EAR) suggested in the Korean Dietary Reference Intakes 2020. RESULTS: The mean dietary magnesium intake of Koreans aged ≥1 yr was 300.4 mg/d, which was equivalent to 119.8% of the EAR. The prevalence of individuals whose magnesium intake met the EAR was 56.8%. Inadequate intake was observed more in females, adolescents and young adults aged 12–29 yrs, elders aged ≥65 yrs, and individuals with low income. About four-fifths of the daily magnesium came from plant-based foods, and the major food groups contributing to magnesium intake were grains (28.3%), vegetables (17.6%), and meats (8.4%). The top 5 individual foods that contributed to magnesium intake were rice, Baechu (Korean cabbage) kimchi, tofu, pork, and milk. However, the contribution of plant foods and individual contributing food items differed slightly by sex and age groups. CONCLUSIONS This study found that the mean dietary magnesium intake among Koreans was above the recommended intake, whereas nearly one in 2 Koreans had inadequate magnesium intake. To better understand the status of magnesium intake, further research is required, which includes the intake of dietary supplements.

As a leading cause of chronic kidney disease, clinical demand for noninvasive biomarkers of diabetic kidney disease (DKD) beyond proteinuria is increasing. Metabolomics is a popular method to identify mechanisms and biomarkers. We investigated urinary targeted metabolomics in DKD patients. Methods: We conducted a targeted metabolomics study of 26 urinary metabolites in consecutive patients with DKD stage 1 to 5 (n = 208) and healthy controls (n = 26). The relationships between estimated glomerular filtration rate (eGFR) or urine protein-creatinine ratio (UPCR) and metabolites were evaluated. Multivariate Cox analysis was used to estimate relationships between urinary metabolites and the target outcome, end-stage renal disease (ESRD). C statistics and time-dependent receiver operating characteristics (ROC) were used to assess diagnostic validity. Results: During a median 4.5 years of follow-up, 103 patients (44.0%) progressed to ESRD and 65 (27.8%) died. The median fold changes of nine metabolites belonged to monosaccharide and tricarboxylic acid (TCA) cycle metabolites tended to increase with DKD stage. Myo-inositol, choline, and citrates were correlated with eGFR and choline, while mannose and myo-inositol were correlated with UPCR. Elevated urinary monosaccharide and TCA cycle metabolites showed associations with increased morality and ESRD progression. The predictive power of ESRD progression was high, in the order of choline, myo-inositol, and citrate. Although urinary metabolites alone were less predictive than serum creatinine or UPCR, myo-inositol had additive effect with serum creatinine and UPCR. In time-dependent ROC, myo-inositol was more predictive than UPCR of 1-year ESRD progression prediction. Conclusion: Myo-inositol can be used as an additive biomarker of ESRD progression in DKD.

BACKGROUND/OBJECTIVES: Vitamin E is essential for health, and although vitamin E deficiency seems rare in humans, studies on estimates of dietary intake are lacking. This study aimed to estimate dietary vitamin E intake, evaluate dietary adequacy of vitamin E, and detail major food sources of vitamin E in the Korean population. SUBJECTS/METHODS: This study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2019. Individuals aged ≥ 1 year that participated in a nutrition survey (n = 28,418) were included. Dietary intake was assessed by 24-h recall and individual dietary vitamin E intake was estimated using a newly established vitamin E database. Dietary adequacy was evaluated by comparing dietary intake with adequate intake (AI) as defined by Korean Dietary Reference Intakes 2020. RESULTS: For all study subjects, mean daily total vitamin E intake was 7.00 mg α-tocopherol equivalents, which was 61.6% of AI. The proportion of individuals that consumed vitamin E at above the AI was 12.9%. Inadequate intake was observed more in females, older individuals, rural residents, and those with a low income. Mean daily intakes of tocopherol (α-, β-, γ-, and δ-forms) and tocotrienol were 6.02, 0.30, 6.19, 1.63, and 1.61 mg, respectively.The major food groups that contributed to total dietary vitamin E intake were grains (22.3%), seasonings (17.0%), vegetables (15.3%), and fish, and shellfish (7.4%). The top 5 individual food items that contributed to total vitamin E intake were baechu kimchi, red pepper powder, eggs, soybean oil, and rice. CONCLUSIONS This study shows that mean dietary vitamin E intake by Koreans did not meet the reference adequate intake value. To better understand the status of vitamin E intake, further research is needed that considers intake from dietary supplements.

Background: Breast reconstruction using an extended latissimus dorsi (eLD) flap can supplement more volume than reconstruction using various local flaps after partial mastectomy, and it is a valuable surgical method since the reconstruction area is not limited. However, when performing reconstruction, the surgeon should consider latissimus dorsi (LD) volume reduction due to postoperative chemotherapy (POCTx) and postoperative radiotherapy (PORTx). To evaluate the effect of POCTx and PORTx on LD volume reduction, the effects of each therapy—both separately and jointly—need to be demonstrated. The present study quantified LD volume reduction in patients who underwent POCTx and PORTx after receiving breast-conserving surgery (BCS) with an eLD flap. Methods: This study included 48 patients who received immediate breast reconstruction using an eLD flap from January 2013 to March 2017, had chest computed tomography (CT) 7–10 days after surgery and 10–14 months after radiotherapy completion, and were observed for more than 3 years postoperatively. One surgeon performed the breast reconstruction procedures, and measurements of breast volume were obtained from axial CT views, using a picture archiving and communication system. A P-value <0.05 was the threshold for statistical significance. Results: The average volume reduction of LD at 10–14 months after completing POCTx and PORTx was 64.5% (range, 42.8%–81.4%) in comparison to the volume measured 7–10 days after surgery. This change was statistically significant (P<0.05). Conclusions Based on the findings of this study, when harvesting an eLD flap, surgeons should anticipate an average LD volume reduction of 64.5% if chemotherapy and radiotherapy are scheduled after BCS with an eLD flap.