Background: Rifampin exhibits highly variable exposure in tuberculosis patients, leading to adverse effects or treatment failure.This study aimed to develop therapeutic drug monitoring (TDM) strategy for rifampin using a single concentration-time point to estimate the area under the concentration-time curve (AUC), with the potential to reduce the number of blood draws. Methods: Plasma concentration(Cp)-time data were obtained from tuberculosis patients by collecting serial venous blood samples after rifampin administration. The Cp timepoint (Ct ) that predicts AUC best was explored using linear regression (Exploration). The accuracy and precision were evaluated using Bland-Altman plot. Physiologically based pharmacokinetic modeling approach was used to evaluate whether the single C t point identified in Exploration provides the best prediction of the AUC (Complement). Results: Cp-time data obtained from 26 participants were evaluable for the determination of AUC by Ct . In Exploration, C4 best predicted the AUC (r2 =0.91, p<0.0001), followed by C2 (r2 =0.84, p<0.0001). In AUC prediction by C4 , the datapoints for predict-ed and observed AUC pairs were randomly scattered in Bland-Altman plot with the mean bias of −0.029 μg · h/mL, and the 95% limit of agreement of −21.1 to 21.1 μg · h/mL. In Complement, C4,sim best predicted the AUC (r2 =0.86, p<0.0001), which supports that C4 reliably predicted AUC. Conclusions For improving treatment outcomes in the treatment of tuberculosis, a single concentration monitoring is applicable to rifampin TDM instead of AUC, potentially making the process less invasive, painful and cumbersome for patients, clinicians and healthcare providers.

Background: Endocrine-disrupting chemicals (EDCs) are environmental pollutants that may impair maternal and fetal health by disrupting hormonal systems, including the thyroid. Both iodine deficiency and excess are associated with thyroid dysfunction and adverse obstetrical outcomes. However, the combined impacts of EDCs and iodine exposure on maternal-fetal thyroid homeostasis remain undetermined. We established the Investigating Birth and Thyroid Outcomes of Maternal-Fetal Environmental Exposures (IBM-E) cohort to prospectively assess the effects of maternal exposures to dietary iodine and EDCs on thyroid function, pregnancy complications, and offspring growth and development. Methods: In this prospective observational study, we aim to enroll 556 pregnant women between 2024 and 2027 at a tertiary hospital in Korea. Maternal blood and urine samples will be collected at six time points, spanning from early pregnancy through 15 months postpartum, with infant samples collected at three time points. EDCs will be quantified using ultra-high performance liquid chromatography-tandem mass spectrometry. Thyroid function and urinary iodine concentration will be measured in both mothers and infants. Results: As of the current interim analyses of 193 mothers and 229 neonates, 15.0% of mothers had thyroid dysfunction and 11.4% developed preeclampsia. Preterm birth occurred in 23.8% of cases, and 16.6% of neonates were small for gestational age. Conclusion The IBM-E cohort is designed to enable the longitudinal assessment of gestational environmental exposures and their potential impacts on maternal and fetal thyroid function, as well as pregnancy and neonatal outcomes. The findings of this study may inform preventive strategies and guide policy development in perinatal environmental health.

Reactive oxygen species (ROS), particularly hydrogen peroxide (H2O2 ), are critical mediators of oxidative stress, which can lead to cellular damage and contribute to various kidney diseases. Poria cocos, a traditional medicinal fungus, has demonstrated various health benefits, particularly in gastrointestinal and neurological health. This study investigates the potential of P. cocos extract (PCE) to reduce H2O2 -induced oxidative injury and promote cell proliferation in feline kidney epithelial cells. PCE treatment significantly improved cell viability in H2O2 -injured cells in a dose-dependent manner. PCE reduced intracellular ROS levels, including superoxide anions, hydroxyl radicals, and intracellular H2O2 , while enhancing the activities of antioxidant enzymes such as superoxide dismutase and catalase. Furthermore, PCE treatment promoted cell proliferation, as evidenced by increased Ki-67 expression, and enhanced the phosphorylation of ERK1/2 and AKT, which are key mediators of cell survival and proliferation. PCE effectively mitigates oxidative stress and promotes cell proliferation in kidney epithelial cells through the activation of the ERK1/2 and AKT pathways, suggesting its potential as a therapeutic agent for oxidative stress-related kidney diseases.

BACKGROUND/OBJECTIVES: Accurate estimation of nutrient intake from food consumption requires reliable food composition data. However, since nutrient content changes during cooking, the application of raw ingredient composition may lead to overestimation, particularly for energy and fat in meat dishes. In this study, the suitability of applying cooked food codes for meat dishes to improve the validity of recipe-based nutrient content estimation was evaluated.MATERIALS/METHODS: Pork (thin-sliced and thick-cut belly and shoulder butt) and beef (tenderloin, loin, rib meat, and brisket point) were examined for cooking yield after grilling and their nutrient contents were estimated. Each cut was portioned to 100 g of raw meat and cooked in triplicate. Nutrient content was calculated using both raw and cooked meat codes from the Korean Standard Food Composition Table, and differences in energy, fat, and protein content were compared. RESULTS: When grilled under standardized conditions, the average cooking yield was approximately 65% for pork and 80% for beef (P < 0.0001). Thin slices of pork belly had a lower yield (62.6%) than thicker cuts (68.0%), while beef brisket point had the lowest yield among beef cuts (63.6%). Applying cooked meat codes and measured cooking yields resulted in overall decreases in energy (−10% to −50%) and fat (−20% to −60%) content, with slight increase in protein (up to +34%, P < 0.0001). For beef tenderloin, additional comparisons using matched raw and grilled data from the United States Department of Agriculture SR Legacy Database showed smaller percent differences in energy, fat, and protein than those obtained from the Korean database. CONCLUSION Incorporating measured cooking yields and corresponding cooked meat codes into recipe-based databases can improve the accuracy of nutrient intake estimation. The development of nutrient databases that reflect differences in cooking conditions—including temperature, duration, and doneness—should be prioritized to enhance the validity of national dietary surveys.

Background: Regulatory agencies operate their own advisory committee with external experts to address complex scientific issues in the approval of pharmaceutical products. However, each advisory committee operates very differently. Hence, the authors per-formed a comprehensive gap analysis among the committees operated by Food and Drug Administration (FDA), European Medicines Agency (EMA) and Ministry of Food and Drug Safety (MFDS). Methods: The regulations, guidelines, minutes and reports on advisory committees were retrieved from the websites of FDA, EMA and MFDS. A gap analysis comparing the advisory committeesof each regulatory authority was performed, including the disclosure of information and meeting procedures, and conflict-of-interest policies. Results: Substantial differences were found among the advisory committees in the strictness of conflict-of-interests and the transparency of meeting details. Whereas FDA and EMA disclose the detailed curriculum vitae of each committee member, MFDS does only names and majors. Whereas FDA live-streams each meeting and publishes the transcript of all dialogues by each member, EMA and MFDS release only anonymized summary minutes without live broadcasts. Whereas FDA and EMA require members to disclose their financial interests, MFDS merely requires signing a statement that confirms no conflict-of-interest. Conclusions Compared with Advisory Committee of FDA and Scientific Committee of EMA, the Central Pharmaceutical Affairs Advisory Committee (CPAAC) of MFDS appears to require substantial improvements in the disclosure of conflict-of-interests and the transparency ofmeeting details. This gap analysis will likely serve as a basis for policy discussions to improve the credibility of CPAAC.

Purpose: This study aimed to examine the interrupting effect of social distancing (SD) on emergency department (ED) patients with ischemic heart disease (IHD), stroke, asthma, and suicide attempts by PM 2.5 exposure in eight Korean megacities from 2017 to 2020. Materials and Methods: The study used National Emergency Department Information System and AirKorea data. A total of 469014 patients visited EDs from 2017 to 2020. Interrupted time series analysis was employed to examine changes in the level and slope of the time series, relative risk, and confidence intervals (CIs) by PM 2.5 exposure. The SD level was added to the sensitivity analysis. Results: The interrupted time series analysis demonstrated a significant increase in the ratio of relative risk (RRR) of IHD patients in Seoul (RRR=1.004, 95% CI: 1.001, 1.006) and Busan (RRR=1.007, 95% CI: 1.002, 1.012) post-SD. Regarding stroke, only patients in Seoul exhibited a significant decrease post-SD (RRR=0.995, 95% CI: 0.991, 0.999). No significant changes were observed for asthma in any of the cities. In the case of suicide attempts, Ulsan demonstrated substantial pre-SD (RR=0.827, 95% CI: 0.732, 0.935) and post-SD (RRR=1.200, 95% CI: 1.057, 1.362) differences. Conclusion While the interrupting effect of SD was not as pronounced as anticipated, this study did validate the effectiveness of SD in modifying health behaviors and minimizing avoidable visits to EDs in addition to curtailing the occurrence of infectious diseases.

Background: To analyze the effects of socioeconomic status (type of insurance and income level) and cancer stage on the survival of patients with liver cancer in Korea. Methods: A retrospective cohort study was constructed using data from the Healthcare Big Data Platform project in Korea between January 1, 2007, and December 31, 2017. A total of 143,511 patients in Korea diagnosed with liver cancer (International Classification of Diseases, 10th Revision [ICD-10] codes C22, C220, and C221) were followed for an average of 11 years. Of these, 110,443 died. The patient’s insurance type and income level were used as indicators of socioeconomic status. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a Cox proportional hazards regression model to analyze the relationship between the effects of sex, age, and cancer stage at first diagnosis (Surveillance, Epidemiology, and the End Results; SEER), type of insurance, and income level on the survival of patients with liver cancer. The interactive effects of the type of insurance, income level, and cancer stage on liver cancer death were also analyzed. Results: The lowest income group (medical aid) showed a higher risk for mortality (HR (95% CI); 1.37 (1.27–1.47) for all patients, 1.44 (1.32–1.57) for men, and 1.16 (1.01–1.34) for women) compared to the highest income group (1–6) among liver cancer (ICD-10 code C22) patients. The risk of liver cancer death was also higher in the lowest income group with a distant cancer stage (SEER = 7) diagnosis than for any other group. Conclusion Liver cancer patients with lower socioeconomic status and more severe cancer stages were at greater risk of death. Reducing social inequalities is needed to improve mortality rates among patients in lower social class groups who present with advanced cancer.

Objective: This study compared the effects of preperitoneal pelvic packing (PPP) versus resuscitation alone, angioembolization, PPP with pelvic stabilization, resuscitative endovascular balloon occlusion of the aorta (REBOA) with PPP, pelvic stabilization, and REBOA. Methods: A comprehensive search was performed using multiple databases, trial registries, grey literature, and conference proceedings from inception until March 10, 2022. The risk of bias in non-randomized studies of intervention (ROBINS-I) and ROB 2.0 tools were used to assess the risk of bias for non-randomized studies and randomized controlled trials, respectively. The certainty of evidence was rated using the GRADE approach. Results: Twenty-two studies, including 1,762 participants, were retrieved. Based on randomized controlled trials, there was a high uncertainty regarding the effects of PPP versus angioembolization on improving the mortality rate (risk ratio [RR]=0.74; 95% confidence interval [CI] 0.22-2.49; very low certainty of evidence) and improving the hemorrhagic mortality rate (RR=0.19; 95% CI 0.01-3.72; very low certainty of evidence). Based on non-randomized studies, there was a high uncertainty regarding the effects of PPP versus angioembolization on improving the mortality rate (RR=0.76; 95% CI 0.48-1.21; I2=54%; very low certainty of evidence), improving the hemorrhagic mortality rate (RR=0.66; 95% CI 0.18-2.46; I2=75%; very low certainty of evidence), and reducing the post procedural complications (RR=0.76; 95% CI 0.39-1.48; I2=66%; very low certainty of evidence). Conclusion There is high uncertainty regarding the effects of PPP compared to resuscitation only, angioembolization, PPP with pelvic stabilization, REBOA following PPP, pelvic stabilization, and REBOA. (Registration No. CRD42022311628)

Purpose: Sour cherry (Prunus cerasus L.) contains abounding phytochemicals, such as polyphenols and anthocyanins, and has antioxidative effects. Adenosine monophosphateactivated protein kinase (AMPK) is a crucial regulator in enhancing the lipid metabolism.This study hypothesized that the intake of sour cherry affects AMPK signaling. Therefore, this study examined whether sour cherry regulates AMPK to balance the hepatic lipid metabolism and exert ameliorating effects. Methods: Male C57BL/6J mice had obesity induced with a 45% fat diet. The mice were divided into four groups: control (CON), high-fat diet (HFD), low percentage sour cherry powder (LSC), and high percentage sour cherry powder (HSC). The mice in the sour cherry groups were fed 1% sour cherry or 5% sour cherry in their respective diets for 12 weeks. Results: The body weight, visceral fat weight, and lipid droplet size significantly decreased in the treatment groups. The serum and hepatic triglyceride and total cholesterol levels improved significantly in the HSC group. The low-density lipoprotein cholesterol levels were also reduced significantly, whereas the high-density lipoprotein cholesterol levels were increased significantly in both treatment groups. The sterol regulator binding protein-1c and fatty acid synthase expression levels as fatty acid synthesis-related enzymes were significantly lower in the treatment groups than in the high-fat diet group. Furthermore, the adipose triglyceride lipase and hormone-sensitive lipase expression levels as lipolytic enzyme activity and AMPK/acetyl-CoA carboxylase/carnitine palmitoyltransferase-1 as fatty acid β-oxidationrelated pathway were upregulated significantly in both sour cherry groups. Conclusions These results show that sour cherry intake improves hepatic lipid synthesis and chronic diseases by activating AMPK signaling. Therefore, this study suggests that phytochemical-rich sour cherry can be developed as a healthy functional food.

Background: This study aimed to establish a strategy to improve the poor working environment and working conditions among long-term healthcare workers in Korea. Methods: A total of 600 questionnaires with which long-term health care workers participated in the targeted base areas of each city and province nationwide were distributed directly and 525 responses were collected and 506 responses were analyzed. Surveys, on-site field visits, and in-depth interviews were also conducted to understand the working environment as well as conditions and establish a strategy for improving the working environment among long-term healthcare workers to understand the demands of working conditions and working conditions. Results: Korean long-term care workers firstly and mostly enumerated their risk factors for ill-health when lifting or moving elderly recipients directly by hand (69.9%), followed by increased physical workload with old beds, tools, and facilities (42.3%) in the workplaces, shortage of manpower (32%), and source of infection (30%). To improve the working environment as well as conditions, Korean long-term care workers considered improving low-wage structures, ergonomic improvements to solve excessive physical loads, and increasing various bonus payments as well as implementing the salary system, positive social awareness, and increasing resting time. Of 506 responses, 92.3% replied that the long-term care insurance system for the elderly should be developed to expand publicization at the national level. Conclusion This study proposes to improve the low-wage structure of Korean long-term care workers, automation and improvement of facilities, equipment, and tools to eliminate excessive physical loads (beneficiary elderly lifting), and reduction of night labor.