Objectives: This study aimed to develop a NOVA-based scoring approach for evaluating ultra- processed food (UPF) intake among Korean adults and to examine its performance. Previous studies have reported that young adults have the highest levels of UPF consumption. Accordingly, this study focused on adults aged 19–40 years and developed scoring components reflecting dietary patterns specific to Korean eating habits. Methods: Using 24-hour dietary recall data from adults aged 19–40 years in the Korea National Health and Nutrition Examination Survey (2021–2023), foods were classified according to the Korean-adapted NOVA system. The top 10 food groups accounting for ≥ 80% of cumulative UPF-derived energy were selected to construct the scoring components. The tool was operationalized using food frequency questionnaire (FFQ) data from the Gangwon cohort study (2022–2024). Intake frequencies were converted into scores ranging from 0 (“rarely or never”) to 5 (“≥ 1 time/day”), and summed to generate the NOVA–UPF score (range: 0–50). Results: Among 237 young adults (aged 20–49 years), the mean NOVA–UPF score was 22.9 ± 8.3. A positive association was observed between the NOVA–UPF score and FFQbased UPF energy intake (Spearman’s ρ = 0.629, P < 0.001). Cross-classification showed that 51.9% were classified into the same tertile and 94.9% into the same or adjacent tertiles, with a weighted kappa coefficient of 0.279. Conclusion This NOVA-based scoring approach may serve as a preliminary tool for assessing UPF intake in Korean young adults. Further refinement and rigorous validation using quantitative dietary assessment methods and more diverse populations are required before broader application.

Objectives: This study examined the factors associated with stages of change (SOC) in reducing sugar intake among adults, applying the theory of planned behavior. Methods: An online survey was conducted among adults aged 19–49 years residing in Seoul, Korea. Based on their SOC in reducing sugar intake, participants (n = 380) were categorized into a pre-action group (45.3%) and an action group (54.7%). Statistical analysis was performed using χ2-test, analysis of covariance, and one-way analysis of variance with linear contrast. Results: The consumption frequency of sugary foods was significantly higher in the pre-action group than in the action group (P < 0.001). Compared with the action group, participants in the pre-action group perceived the advantages of sugar intake more favorably (P < 0.001), perceived the disadvantages less strongly (P = 0.002), and reported greater influence from significant others (P = 0.004). In contrast, participants in the action group agreed less with insufficient knowledge/skills (P < 0.001), had greater control over the facilitating factors of sugar intake (P < 0.001), and had stronger control beliefs in situations promoting sugar intake (P < 0.001). Behavioral beliefs (P < 0.001) and control beliefs (P < 0.001) showed a significant linear trend across the five SOC, whereas subjective norms did not (P = 0.275). Conclusion Psychosocial factors related to sugar intake reduction clearly differed between the SOC groups. In the pre-action group, nutrition education should emphasize lowering the perceived benefits of sugar intake while increasing awareness of its adverse consequences. Strengthening the perception of control over sugar intake is important, despite the factors or situations promoting sugar intake. This can be achieved by providing practical tips and developing skills to reduce sugar intake. For the action group, it is necessary to maintain the reduced sugar intake through continual support and encouragement.

Objectives: Consumer demand is growing for more rigorous hygiene management within foodservice establishments. The aim of this study was to provide customized data specific to each foodservice establishment, thereby informing policy formulation to improve hygiene management levels. Methods: We surveyed 310 managers of directly managed foodservice establishments (excluding franchises) that were subject to hygiene inspections by the Chungbuk Provincial Office in Korea between September 1 and 27, 2023. Additionally, 30 investigators trained in methods for evaluating the hygiene management levels of foodservice establishments objectively assessed 310 establishments using evaluation sheets. All 310 managers provided consent and personally completed the questionnaires. Data from 277 managers were included in the analysis. General characteristics were analyzed with descriptive statistics in IBM SPSS Statistics 28 (IBM Corp.). Univariate normality verification, measurement model verification, structural model verification, and mediation effect significance analysis were conducted using R’s lavaan package (version 4.3.2.). Results: Managers’ willingness to perform duties had a positive influence on hygiene management level (0.224), enthusiasm for hygiene (0.661), awareness of hygiene compliance (0.616), mandatory perception of the system (0.568), trust in local governments (0.406), and attention to consumers (0.558). In the relationship between managers’ willingness to perform duties and hygiene management level, mandatory perception of the system had a negative mediating effect (–0.223), while trust in local governments had a positive mediating effect (0.264). Conclusion Structural equation modeling was used to identify the complex pathways by which foodservice establishment managers’ willingness to perform duties, mediated by their human factors, influences their hygiene management level. Accordingly, policy implications were presented, suggesting that the hygiene management level of foodservice establishments could be enhanced by increasing managers’ willingness to perform their duties, and that a shift from mandatory regulations by local governments to support-oriented systems that foster trust in local governments is necessary.

Secondary rhabdoid tumors (RTs) with atypical teratoid/rhabdoid tumor-like features rarely arise from, or coexist with, pleomorphic xanthoastrocytomas (PXAs), and their clinicopathological and molecular characteristics remain poorly understood. We report a 17-year-old girl with a temporal lobe mass that, upon gross total resection, pathologically contained both RT and PXA components. Immunohistochemistry revealed loss of INI1 expression restricted to the RT component, while the PXA area retained INI1. Next-generation sequencing identified a shared BRAF::TRIM24 fusion and homozygous deletion of CDKN2A/2B in both components, indicating a shared clonal origin. Additionally, a germline ATM frameshift mutation (c.5288_5289insGA) was identified in both tumor components, making the first such report in central nervous system tumors. SMARCB1 loss was confined to the RT component, further supporting the hypotheses of clonal evolution and secondary transformation. Despite gross total resection, craniospinal irradiation, and chemotherapy, the patient developed rapid leptomeningeal dissemination and died 5 months after surgery. This case provides clinicopathological and molecular evidence for clonal evolution and secondary transformation of PXA into an RT. The presence of germline ATM mutation may have therapeutic and biological relevance. Further studies are required to clarify the pathogenesis and optimal management of these rare and aggressive tumors.

Background: Although several reports have addressed tendinous mallet finger (TMF), they have not identified which method best informs surgeons about the extent of residual extension lag in these patients. We aimed to assess the association between sonographic classification of acute TMF and the degree of extension lag remaining at the final follow-up. Methods: The inclusion criterion was acute TMF with symptom onset within 2 weeks. Thirty-eight patients (23 male and 15 female) participated, with a mean follow-up of 17.1 months (range, 12.3–23.5 months). Range of motion, including extension lag, was measured at both the initial presentation and the final follow-up. All patients were managed conservatively using a finger splint for a period exceeding 6 weeks. Ultrasonography was performed for all participants to assess the severity of terminal extensor tendon injury. Statistical analyses examined the relationship between sonographic type and extension lag at final follow-up. Results: At initial presentation, the mean extension lag was 46.0°, which improved to 17.5° at the last follow-up. TMF cases were categorized into 3 sonographic types (hypo-echoic, thinned, and wavy) based on ultrasound characteristics. A significant difference in extension lag at final follow-up was observed among the TMF groups (p = 0.005). Patients with the wavy type had the greatest mean extension lag, whereas those with the hypo-echoic type had the least mean extension lag, with statistical significance. Conclusions Sonographic assessment of TMF can aid in predicting residual extension lag in patients with TMF undergoing conservative treatment with a finger splint.

Background: The etiology of adolescent idiopathic scoliosis is multifactorial, and the influence of lifestyle factors such as sleep is not clearly understood. Differences in scoliosis incidence between urban and rural areas have been reported, but the contributing factors remain unclear. Therefore, this study investigated the association between sleep patterns and the incidence of idiopathic scoliosis and explored whether these patterns contribute to the observed urban-rural disparity. Methods: This retrospective study utilized data from the Korea Children and Youth Panel Survey (2010–2016) and the Health Insurance Review and Assessment Service for 4,693 students (age, 7–18 years). Various lifestyle factors including sleep patterns, learning time, and activity times, were compared between urban and rural areas, and a correlation analysis was performed between these factors and the age-specific incidence of idiopathic scoliosis. Results: Urban students, who exhibited higher idiopathic scoliosis incidence rates, tended to have later bedtimes and shorter total sleep durations than rural students. Longer learning hours were also observed in urban areas. Significant correlations were found between idiopathic scoliosis incidence and bedtime (p = 0.031), total sleep time (p = 0.026), and changes in total sleep time (p = 0.011). Conclusions Our findings indicate that later bedtimes and shorter sleep durations may contribute to idiopathic scoliosis development in children and adolescents. The higher idiopathic scoliosis incidence in urban students than in rural students could be partially explained by these sleep pattern differences, highlighting the need for further research into the role of sleep in scoliosis onset and prevention.

Background: and Purpose: Given the irreversible nature of dementia, this study examined the effects of a 20-week exercise-based dementia prevention program in community-dwelling older adults, focusing on prior exercise experience and program adherence. Methods: In this exploratory, non-randomized trial, 55 older adults (65–79 years) were allocated to an intervention (n=26) or control (n=29) group, and blinding was not feasible.The intervention comprised supervised rhythmic aerobic exercise with cognitive-motor components performed three times per week. Cognition was the primary outcome, and secondary outcomes included physical fitness, blood pressure, and blood biomarkers.Subgroup analyses classified participants by prior exercise experience and intervention exposure: G1 and G2 comprised control subgroups with no intervention exposure, whereas G3 and G4 comprised intervention-exposed subgroups stratified by adherence. Results: No significant group-by-time interactions were observed for cognitive outcomes.Participants with prior exercise experience and low adherence (G2) showed significant improvement on the Korean Mini-Mental State Examination (β=1.66, p=0.024) despite declines in physical fitness, whereas higher adherence in G3–G4 was associated with stable or favorable physical performance, with G4 showing a positive trend in the 30-second sit-tostand test. Systolic blood pressure decreased significantly in G2–G4. Conclusions Although overall cognitive gains were modest and not group specific, prior exercise experience and sustained adherence were associated with favorable changes in physical fitness and vascular outcomes, suggesting that tailored multicomponent exercise programs and long-term engagement may help promote cognitive health in older adults.

Background: and Purpose: Tailored physical exercise interventions have the potential to promote cognitive health in older adults and offer significant advantages for those more vulnerable to decline. The specific relationship between physical fitness and cognition among the elderly has not been clearly established. The purpose of this investigation was to assess the relationship between physical fitness and cognitive function in older Korean adults. Methods: Eighty-four community-dwelling older adults (mean age: 70.7±5.3 years; 81.0% female) completed a standardized physical fitness battery assessing handgrip strength, sit-and-reach, 30-second sit-to-stand, 2-minute stationary march, 3-m sit-walk-and-return, figure-8-walk, and T-wall response time. Cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Descriptive statistics, partial correlation analyses, and stepwise multiple linear regression were conducted. Results: Slower T-wall response time was significantly correlated with lower RBANS total index, immediate memory, and delayed memory scores. In regression models, slower T-wall response time was independently associated with lower RBANS total index (β=−0.234, p=0.026) and delayed memory scores (β=−0.295, p=0.029). The regression model for immediate memory was not statistically significant overall; therefore, no predictive conclusion was drawn for this domain. Higher education showed a significant positive association with cognitive performance. Conclusions Coordination, as measured by T-wall response time, emerged as the only physical fitness component consistently associated with cognitive performance in older adults. Coordination-related fitness may be an important correlate of cognitive function in older adults and a promising target for future exercise interventions.

Background/Aims: Cardiovascular disease remains a major cause of mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). This study evaluated the association between subclinical carotid atherosclerosis (SCA) and MASLD or MASLD and increased alcohol intake (MetALD) in asymptomatic individuals. Methods: This cross-sectional study included 56,889 adults undergoing health check-ups in South Korea. Hepatic steatosis was diagnosed by ultrasound, and SCA was defined by carotid plaques or increased intima-media thickness. Liver fibrosis was evaluated using the fibrosis-4 index and elastography. Results: SCA was identified in 13.5%. MASLD and MetALD were significantly associated with SCA in models adjusted for demographic and lifestyle factors (adjusted odds ratio [aOR], 1.26;95% confidence interval [CI], 1.19 to 1.33; aOR, 1.43; 95% CI, 1.30 to 1.58; respectively, p<0.001for both). However, these associations attenuated and lost statistical significance when metabolic risk factors were further adjusted. The risk of SCA increased with greater hepatic steatosis and liver fibrosis severity. In patients with MASLD, aORs were 1.70 (hepatic steatosis index >36),1.23 (fibrosis-4 index ≥1.3), and 1.78 (liver stiffness measurement ≥5.6 kPa), compared to indi-viduals without MASLD. Similar trends were observed in the MetALD group. Additionally, hyper-tension and clustering of ≥3 cardiometabolic risk factors were significantly associated with SCA inthe MASLD group, supporting the role of metabolic burden in SCA development. Conclusions MASLD and MetALD were associated with increased SCA risk, particularly in individuals with hepatic steatosis and fibrosis. These findings suggest that metabolic burden and liver disease severity jointly contribute to subclinical atherosclerosis risk.

Background/Aims: Recent advances in computer-aided diagnosis (CADx) systems have demonstrated expert-level accuracy in the optical diagnosis of colorectal polyps. High-confidence (HC) diagnoses have been defined as those made within 3 seconds without hesitation, and these systems have been shown to improve diagnostic accuracy. We aimed to evaluate the performance of endoscopists with varying levels of experience in diagnosing colorectal polyps with the assistance of a new CADx system applying the 3-second rule and without artificial intelligence assistance. Methods: In this multicenter ex vivo study, 35 endoscopists assessed 100 polyps (51 adenomas, 39 hyperplastic polyps, 10 sessile serrated lesions) using narrow-band imaging video clips on an online platform. Assessments consisted of individual endoscopist diagnosis and CADx-assisted diagnosis. HC assignments followed the 3-second rule in both phases. Performance metrics included HC accuracy, HC rate, and adherence to the Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) and Simple Optical Diagnosis Accuracy (SODA) thresholds. Results: HC diagnostic accuracy improved from 78.3% (95% confidence interval [CI], 76.6% to 80.0%) to 89.8% (95% CI, 88.6% to 90.9%) with CADx assistance (p<0.001). The proportion of HC predictions increased from 64.2% to 75.4% (p<0.001). Novice endoscopists showed marked improvement with CADx (74.1% vs 88.8%; p<0.001). CADx-assisted diagnoses nearly met SODA and PIVI thresholds under the 3-second rule. Additional analysis demonstrated that CADx assistance significantly improved interobserver agreement and ground truth, particularly for novices (κ=0.37 to κ=0.65; p<0.001). Conclusions Integrating CADx with the 3-second rule significantly enhances the performance of endoscopists in the optical diagnosis of colorectal polyps, with the greatest benefit observed among novice endoscopists.