The brain-derived neurotrophic factor (BDNF) plays a crucial role in neuroprotection, and we have previously demonstrated BDNF-mediated neuroprotective effects in mesenchymal stromal cells (MSCs). The present study aimed to investigate whether BDNF-overexpressing MSCs enhance the therapeutic efficacy of naïve MSCs in a preclinical model of severe neonatal intraventricular hemorrhage (IVH). We exposed primary rat neuronal cells to 40 U of thrombin overnight in vitro. Subsequently, the neuronal cells were co-cultured with either naïve MSCs or BDNF-overexpressing MSCs (1×105 cells in 1 mL media) for 24 hours. Next, 300 μL of maternal blood was injected into bilateral ventricles on postnatal day (P)4 to induce severe IVH in newborn Sprague-Dawley male rats. At P6, either naïve MSCs or BDNF-overexpressing MSCs (1×105 cells in 10 μL saline) were transplanted intraventricularly. Behavioral function tests, including passive avoidance, followed by endpoint analyses of brain tissue and cerebrospinal fluid were performed at P35. BDNF-overexpressing MSCs enhanced the effects of naïve MSCs against cell death, cytotoxicity, and oxidative stress in vitro. Notably, naïve and BDNF-overexpressing MSCs did not attenuate post-hemorrhagic ventricular dilatation, neuronal cell death, or gliosis. However, BDNF-overexpressing MSCs attenuated microglial activation.Furthermore, inflammatory cytokine (interleukin [IL]-1α, IL-1β, IL-6, and tumor necrosis factor-α) levels and memory function assessed using a passive avoidance test significantly improved in the BDNF-overexpressing MSC transplanted group compared with the naïve MSC transplanted group. Our data suggest that BDNF-overexpressing MSCs may offer superior protective effects to naïve MSCs in a neonatal IVH model.

Objectives: Food neophobia in children is often associated with limited exposure and familiarity to some foods. Cooking-based nutrition education (CBNE), which promotes acceptance through direct experience, may support the development of healthy eating habits. This study aimed to develop and implement a standardized CBNE program for school-aged children in Seoul, South Korea, and to evaluate its effectiveness by assessing changes in raw vegetable intake. Raw vegetable intake is an early indicator of the effectiveness of nutrition education on diverse topics in promoting healthy eating habits. Methods: A single-group pre–post study was conducted with 37 children aged 6–11 years who participated in a 2-day CBNE program in October 2023. The participants completed pre- and post-education questionnaires and raw vegetable intake assessments. Four low-preference vegetables (bell pepper, carrot, cucumber, and tomato) were selected and served raw (25 g each) before and after the program. Intake changes were analyzed using paired t-tests, and Pearson’s correlation and hierarchical regression analyses were performed to identify predictors. Results: Total raw vegetable intake significantly increased post-education (P = 0.008), particularly for carrots (P = 0.023). By subgroup, raw vegetable intake significantly increased in girls, upper-grade students, and those who consumed four or more vegetable side dishes per meal. Hierarchical regression analysis revealed that while vegetable preference was initially significant, vegetable-related experiences (β = 0.395, P = 0.026) and diversity of vegetable side dishes per meal (β = 0.403, P = 0.032) were stronger predictors in the final model (adj R2 = 0.333). Conclusion The CBNE program may enhance vegetable intake in children. Although preference remained the strongest individual factor, vegetable experience and the diversity of vegetable side dishes per meal had a greater combined effect. These findings underscore the importance of repeated and diverse exposure, not only by supporting previous studies that link such exposure to increased intake but also by suggesting that environmental support may be essential for sustaining healthy eating habits.

Objectives: To reduce urban carbon emissions, in this study, we aimed to suggest strategies for disseminating the planetary health diet (PHD) guidelines to adult cafeterias in a government worksite in Seoul based on the theory of planned behavior (TPB) and focus group interviews (FGI). Methods: A total of 132 adults who worked at a government worksite in Seoul and used its cafeteria were included for a TPB-based survey. Factor analyses and multiple regression were used to investigate the relationships between attitude (cognitive•affective), subjective norms, and perceived behavioral control (PBC, internal•external) and the behavioral intention to adopt the PHD. To identify the contextual factors related to PHD dissemination, 14 participants underwent in-depth interviews. Results: Affective attitudes and PBC (internal•external) constructs of the TPB were significantly related with the intention to adopt PHD: external PBC (β = 0.324, P < 0.001), internal PBC (β = 0.269, P < 0.01), and affective attitudes (β = 0.226, P < 0.05). The FGI results highlighted the insufficiency of simply providing healthy meals to encourage the adoption of PHDs, but that menu development and natural acceptance strategies are needed to increase palatability. In addition, the need for strategies to promote PHDs at an organizational level was identified, as it is directly influenced by the company of partners with whom one dines. Furthermore, users' perceptions of how “Meals for the Planet” are delivered and suggestions for its improvement were also interpreted. Conclusion Our results suggest that users' beliefs, convictions, and emotions are important while promoting or educating individuals about sustainable PHDs. Our findings are expected to help local governments or private group cafeterias that wish to introduce PHDs in the future, given the growing importance of environmentally conscious eating.

Purpose: This study aimed to explore customer perspectives of nursing services in tertiary hospitals. Methods: The data comprised mobile Voice Of Customer (VOC) data related to “nursing” or “nurses” generated from June 25, 2019, to December 31, 2022, in a tertiary hospital. A total of 44,727 VOC data points were collected, of which 4,040 were selected for the final analysis. Text network analysis and topic modeling were conducted using NetMiner 4.5.1. Results: Topic modeling identified five topics for positive aspects and four topics for areas requiring improvement.The positive aspects were: 1) sincere nursing care; 2) rapid response from professional medical staff; 3) teamwork for delivering customer-centric services; 4) provision and coordination of system-based healthcare services; and 5) customer-focused responsiveness. The areas requiring improvement were: 1) demand for skilled nursing care tailored to customer expectations; 2) demand for enhanced communication and reduced mechanical responses; 3) demand for appropriate handling of diverse situations; and 4) demand for overall improvements to the healthcare system, including reservation systems. Conclusion These results may be used to enhance customer and patient experiences in tertiary hospitals and are necessary for utilization from a hospital management perspective.

Purpose: This study aimed to explore customer perspectives of nursing services in tertiary hospitals. Methods: The data comprised mobile Voice Of Customer (VOC) data related to “nursing” or “nurses” generated from June 25, 2019, to December 31, 2022, in a tertiary hospital. A total of 44,727 VOC data points were collected, of which 4,040 were selected for the final analysis. Text network analysis and topic modeling were conducted using NetMiner 4.5.1. Results: Topic modeling identified five topics for positive aspects and four topics for areas requiring improvement.The positive aspects were: 1) sincere nursing care; 2) rapid response from professional medical staff; 3) teamwork for delivering customer-centric services; 4) provision and coordination of system-based healthcare services; and 5) customer-focused responsiveness. The areas requiring improvement were: 1) demand for skilled nursing care tailored to customer expectations; 2) demand for enhanced communication and reduced mechanical responses; 3) demand for appropriate handling of diverse situations; and 4) demand for overall improvements to the healthcare system, including reservation systems. Conclusion These results may be used to enhance customer and patient experiences in tertiary hospitals and are necessary for utilization from a hospital management perspective.

Objective: To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI). Materials and Methods: A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm 2 was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive.The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC). Results: Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4–79.9), 90.8% (95% CI: 85.6–94.2), and 83.5% (95% CI: 78.6–87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8–97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9–89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1–79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52–0.63) before training and 0.68 (95% CI: 0.62–0.74) after training, with a difference of 0.11 (95% CI: 0.02–0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69–0.74) before training and 0.79 (95% CI: 0.76–0.80) after training (P = 0.002). Conclusion Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.

Cellular senescence, a type of cytostasis, is the irreversible inhibition of the natural cell division in proliferating cells, resulting from various cellular stresses, including telomere shortening, DNA damage, mitochondrial dysfunctions, and pro-inflammatory responses. While cellular senescence can facilitate beneficial physiological processes such as tissue repair and wound healing, senescent cells also contribute to pathophysiological processes of agerelated diseases, including fibrotic lung diseases. The cellular senescence model and co-culture system were established to explore the underlying mechanisms associated with cellular senescence and fibrosis. Rutaecarpine is a bioactive alkaloid isolated from Evodia rutaecarpa (Rutaceae), a traditional herbal medicine. Rutaecarpine enhanced the promotor activity of E-cadherin, reduced TGF-β-induced reorganization of the actin cytoskeleton, and finally inhibited epithelialmesenchymal transition. Rutaecarpine also attenuated fibrotic and senescence features in bleomycin-induced lung fibrosis model. Here, we suggest the relevance between senescence and fibrosis, and a potential therapeutic approach of targeting senescence to attenuate lung fibrosis development.

Purpose: Hypothermia upon admission to the neonatal intensive care unit (NICU) contributes significantly to various neonatal complications, particularly in preterm infants. This study aimed to assess the impact of quality improvement (QI) interventions, including using plastic bags and head caps, and adjusting delivery room temperatures, on improving the admission body temperature and reducing hypothermia in infants born at less than 32 weeks or weighing 1,500 g. Methods: This study retrospectively analyzed the medical records of infants born at less than 32 weeks or weighing 1,500 g who admitted to the NICU at Samsung Medical Center from January 2022 to February 2024. The QI program that was initiated in April 2023 focused on managing admission temperatures using plastic bags and head caps, and maintaining delivery room temperatures at ≥25 °C. The admission temperature and short-term outcomes pre- and post-QI were compared. Results: In a study of 270 patients, implementing QI initiatives significantly raised the admission temperature from 36.2±0.5 to 36.4±0.4 °C (p<0.01), particularly impacting infants weighing ≥1,000 g, in whom mild hypothermia occurrences dropped from 76.3% to 43.9% (p<0.01). This improvement in temperature management significantly decreased both mild and severe hypothermia rates post-QI. Additionally, implementing all three initiatives was more effective than when two or fewer initiatives were implemented. Conclusion Simple and cost-effective QI interventions can increase admission temperatures and decrease hypothermia in neonates. Further research is essential to explore the long-term outcomes and develop effective hypothermia management strategies in neonatal care.

Purpose: To investigate the risk factors associated with hypospadias in very low birth weight (VLBW) infants (VLBWIs). Methods: We retrospectively analyzed 729 infants born at ≥24 weeks of gestational age and weighing <1,500 g from January 2012 to December 2022. We assessed the prevalence of hypospadias by birth weight percentiles and also compared the demographics and placental histopathology of the infants with hypospadias (n=52) and those without hypospadias (n=677). Results: Of the 729 patients analysed, hypospadias was recorded in 26 (20.3%), 14 (26.9%), and 12 (2.5%) infants in the <3rd, ≥3rd–<10th, and ≥10th–<90th percentiles, respectively. Of all of the patients with hypospadias, 50% had birth weights <3rd percentile (p<0.001). The hypospadias group demonstrated a longer mean gestational age (30.1 weeks vs. 27.9 weeks, p<0.001), lower incidence of maternal pregnancy-induced hypertension (48.1% vs. 17.3%, p<0.001), lower incidence of premature rupture of membrane (11.5% vs. 27.1%, p=0.013), lower acute chorioamniotic maternal response (9.1% vs. 35.2%, p<0.001), and higher maternal underperfusion (95.5% vs. 71.9%, p<0.001). Conclusion The frequency of hypospadias was found to be the highest among VBLWIs <3rd percentile, who were severely small for their gestational age (SGA). Additionally, the incidence increased with a decreasing birth weight. Physical examination is necessary at birth for VLBWIs classified as SGA. Moreover, the data on the incidence of hypospadias among VLBWIs in neonatal intensive care units can assist in tracking counseling from the prenatal to the postnatal period for patients born <3rd percentile.