BACKGROUND/OBJECTIVES: Onion, particularly onion peel, is a quercetin-rich food with, anti-inflammatory and immunomodulatory effects. However, the effect of onion peel extract (OPE) in humans is unclear. Thus, the present study aimed to investigate whether OPE improves natural killer (NK) cell activity and cytokine concentration in a randomized doubleblind placebo-controlled trial. SUBJECTS/METHODS: Eighty participants aged 19–64 yrs old with a white blood cell count of 4,000–10,000 cells/µL, symptoms of upper respiratory infection at least once within the previous 12 mon, and perceived stress scale (PSS) over 14 were included. Participants were randomly assigned to take either 1,000 mg/day OPE or a placebo for 8 weeks. RESULTS: Compliance were 87.4 ± 8.6% and 86.9 ± 79.0% in OPE and placebo groups.Compared to the placebo, OPE supplementation improved “Hoarseness” (P = 0.038) of the Wisconsin Upper Respiratory Symptom Survey (WURSS)-21 symptom, and stress scores (P = 0.001; 0.021) of PSS. Supplementation of OPE had no significant effect on NK cell activity and concentrations of cytokines such as interleukin (IL)-2, IL-6, IL-12, IL-1β, interferon-γ, and tumor necrosis factor-α. At baseline, the WURSS-21 symptom and PSS score (P = 0.024;0.026) were higher in the OPE group than the placebo group. Among participants with higher than median WURSS-21 symptom score, OPE supplementation increased NK cell activity (P = 0.038). Supplementation of OPE had no significant effects on safety measurements and adverse events. CONCLUSIONS The present study suggested that OPE supplementation improves NK cell activity in participants with moderate upper respiratory symptoms without any significant adverse effects.

Restoring composite resins with the optimal shades for all primary teeth is a great challenge for pediatric dentists. A newly developed single-shade composite resin can exhibit a color similar to that of the surrounding tooth structure based on the structural color phenomenon. This study aims to evaluate the color adjustment potential (CAP) of a single-shade composite resin compared to conventional multi-shade composite resins in primary teeth. A single-shade composite resin and two conventional multi-shade composite resins were included in this study. Two types of specimens, a single specimen and a dual specimen, were evaluated. For single specimens, duplications of the primary second molar denture teeth were made using experimental composite resins. For dual specimens, cavities were prepared on the buccal surfaces of extracted primary second molars and restored with experimental composite resins. The L*, a*, and b* values were measured using a colorimeter for the extracted teeth and specimens. The mean ΔEab* values for single and dual specimens and CAP were calculated. Bonferroni post-hoc analysis was performed to confirm the statistical significance between the ΔEab* and CAP values of the experimental resins. Among the single specimens, the single-shade composite resin showed significantly higher ΔESingle compared to other composite resins (p < 0.0167). There was no significant difference between ΔEDual for all experimental resins. The single-shade composite resin showed highest CAP compared to other multi-shade composite resins. A single-shade composite resin exhibited the most prominent color adaptability compared to other conventional multi-shade composite resins for primary second molars. A single-shade composite resin can simplify shade matching and provide esthetic outcomes for the restoration of primary second molars.

Osteoporosis and osteoporotic fractures cause socioeconomic concerns, and medical system and policies appear insufficient to prepare for these issues in Korea, where the older adult population is rapidly increasing. Many countries around the world are already responding to osteoporosis and osteoporotic fractures by adopting fracture liaison service (FLS), and such an attempt has only begun in Korea. In this article, we introduce the operation methods for institutions implementing FLS and characteristics of services, and activities of the FLS Committee for FLS implementation in the Korean Society for Bone and Mineral Research. In addition, we hope that the current position statement will contribute to the implementation of FLS in Korea and impel policy changes to enable a multidisciplinary and integrated FLS operated under the medical system.

Background: Exposure to cadmium and mercury is associated with renal dysfunction. This study aimed to investigate the possible ability of dietary education to decrease blood cadmium and mercury levels in patients with chronic kidney disease (CKD). Methods: Twenty-seven patients with CKD were enrolled in this prospective, single-arm pilot study. Patients with blood cadmium levels ≥1.4 μg/L were instructed to reduce their intake of shellfish, while those with blood mercury levels ≥5.0 μg/L were asked to reduce their intake of externally blue-colored fish. Results: Seven dialysis patients and 15 pre-dialysis patients completed the study. Compared with baseline, the blood cadmium (2.0±0.7 μg/L vs. 1.8±0.7 μg/L, p=0.031) and mercury levels (4.4±2.6 μg/L vs. 3.5±1.9 μg/L, p=0.005) after 1 year significantly decreased, although the dietary intake was not significantly different in patients with blood cadmium levels ≥1.4 μg/L and blood mercury levels ≥5.0 μg/L. In pre-dialysis patients, kidney function worsened after 1 year compared with that at baseline despite the reduction in blood cadmium and mercury levels. Conclusions Reduction of food intake containing cadmium and mercury may lower the blood cadmium and mercury levels in CKD patients with higher cadmium and mercury levels. Higher blood cadmium levels may cause renal disease progression in pre-dialysis patients, and further studies are necessary to determine the underlying mechanisms.

Background: Protein intake is a modifiable factor associated with sarcopenia prevention; however, no appropriate methods exist to assess dietary protein intake in Koreans. This study developed and validated a simple and convenient food frequency questionnaire (FFQ) to determine protein intake in Koreans. Methods: A total of 120 participants aged >19 years were asked to complete both the FFQ used by the Korean National Health and Nutrition Examination Survey (KNHANES) and the newly developed Korean Protein Assessment Tool (KPAT). Protein intakes measured using the FFQ and the KPAT were compared using Pearson correlation coefficients, Bland-Altman plots, and intraclass correlation coefficients. Results: Protein intakes from the FFQ (62.06±25.56 g/day) and KPAT (61.12±24.26 g/day) did not differ significantly (P=0.144). Pearson’s correlation coefficient values ranging from 0.92 to 0.96 indicated a positive correlation, while the intraclass correlation coefficient of 0.979 indicated excellent reliability in protein intake of the FFQ and the KPAT. The Bland-Altman plot also showed high agreement in the mean differences in protein intakes estimated by the FFQ and the KPAT. Conclusions KPAT, a newly developed and simplified method, showed an acceptable correlation compared to previous FFQ tools. Thus, the KPAT may be useful to assess dietary protein intake in the Korean population.

Background: The purpose of the present study was to assess the daily protein uptake and its relationship with sarcopenia, as defined by the Asian Working Group for Sarcopenia (AWGS), among elderly patients with hip fractures. Methods: Forty-seven elderly patients with hip fractures were enrolled in this retrospective observational study. The main outcome measures included protein uptake, muscle mass, and grip strength for sarcopenia in elderly patients. Sarcopenia was diagnosed according to AWGS. Wholebody densitometry was used to measure skeletal muscle mass, and muscle strength was evaluated using handgrip testing. Results: Of 47 patients with hip fractures (12 men and 35 women), 37 (79%) patients exhibited insufficient protein intake (range, 0.01-0.588 g/kg/day), and 10 (21%) patients exhibited excessive protein intake (range, 1.215-2.121 g/kg/day). The mean daily protein intake was 56.5 g (range, 7.2–136.0 g). Prevalence of low muscle strength (handgrip strength <18 kg in women and <26 kg in men) was detected in 13 (37%) women and 8 (67%) men (P=0.076). Sarcopenia (lower muscle mass and lower muscle strength) was detected in 9 (26%) women and 6 (50%) men (P=0.119). Although lower protein intake was marginally associated with sarcopenia (P=0.189), it was significantly associated with lower grip strength (P=0.042). Conclusions The present study demonstrated that insufficient protein intake in elderly patients with hip fractures was common, and lower protein intake was significantly associated with lower muscle strength.

The aim of this in-vitro study is to evaluate the effect of potassium iodide (KI) on erythrosine-mediated photodynamic therapy (PDT) against Streptococcus mutans biofilms. S. mutans ATCC 25175 was cultured to form a biofilm on a hydroxyapatite disk. After diluting erythrosine to 20 μM and KI to 10, 50, and 100 mM, respectively, PDT was performed. The number of surviving bacteria was calculated as colony forming units (CFU)/mL and the statistical significance of the difference between groups was confirmed by Bonferroni post-hoc analysis. Cell viability was visually evaluated using confocal laser scanning microscopy (CLSM). As a result of the experiment, a significant decrease (p < 0.05) in CFU was observed in the experimental groups in which PDT was performed after applying KI regardless of the concentration of KI. In addition, a significant reduction (p < 0.05) in CFU was observed in the experimental group to which 100 mM KI was applied compared to 10 mM KI. The same results were confirmed when observing CLSM. KI significantly improved the efficacy of erythrosine-mediated PDT on S. mutans biofilms at all concentrations. This may compensate for the low sensitivity of PDT to biofilm-state bacteria strains, but it is necessary to establish an optimal clinical protocol through further research.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Background: Statin treatment has decreased the risk of cardiovascular events in patients with chronic kidney disease (CKD). Erythrocyte membrane oleic acid level is higher in patients with acute coronary syndrome. This study aimed to evaluate the effect of pravastatin on the erythrocyte membrane fatty acid (FA) contents in patients with CKD. Methods: Sixty-two patients were enrolled from January 2017 to March 2019 (NCT02992548). Pravastatin was initially administered at a dose of 20 mg for 24 weeks. The pravastatin dose was increased to 40 mg after 12 weeks if it was necessary to control dyslipidemia. The primary outcome was change in erythrocyte membrane FA, including oleic acid, after pravastatin treatment for 24 weeks. Results: Forty-five patients finished this study, and there was no adverse effect related to pravastatin. Compared with baseline, total cholesterol and low-density lipoprotein cholesterol levels were significantly decreased after pravastatin treatment. Compared with baseline, saturated FA, oleic acid, and arachidonic acid levels were significantly increased and polyunsaturated FA and linoleic acid (LA) levels were significantly decreased after pravastatin treatment. There was also a decrease in eicosapentaenoic acid after pravastatin treatment in CKD patients with estimated glomerular filtration rate <60 mL/min/1.73 m2. Conclusion Administration of pravastatin in patients with CKD leads to a decrease in FA known to be protective against the risk of CVD. Omega-3 FA or LA supplementation might be necessary to recover changes in erythrocyte membrane FA contents when pravastatin is used for treating dyslipidemia in patients with CKD.