This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases.This position paper focuses on the clinical management of valvular heart diseases with reference to the guidelines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee tried to reflect the recently published results on the topic of valvular heart diseases and Korean data by a systematic literature search based on validity and relevance. In part I of this article, we will review and discuss the current position of aortic valve disease in Korea.

This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases.This position paper focuses on the diagnosis and management of valvular heart diseases with referring to the guide‑ lines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee sought to reflect national data on the topic of valvular heart diseases published to date through a systematic literature search based on validity and relevance. In the part II of this article, we intend to pre‑ sent recommendations for diagnosis and treatment of mitral valve disease and tricuspid valve disease.

Background: and Purpose In young patients (aged 18–60 years) with patent foramen ovale (PFO)- associated stroke, percutaneous closure has been found to be useful for preventing recurrent ischemic stroke or transient ischemic attack (TIA). However, it remains unknown whether PFO closure is also beneficial in older patients. Methods: Patients aged ≥60 years who had a cryptogenic stroke and PFO from ten hospitals in South Korea were included. The effect of PFO closure plus medical therapy over medical therapy alone was assessed by a propensity-score matching method in the overall cohort and in those with a high-risk PFO, characterized by the presence of an atrial septal aneurysm or a large shunt. Results: Out of the 437 patients (mean age, 68.1), 303 (69%) had a high-risk PFO and 161 (37%) patients underwent PFO closure. Over a median follow-up of 3.9 years, recurrent ischemic stroke or TIA developed in 64 (14.6%) patients. In the propensity score-matched cohort of the overall patients (130 pairs), PFO closure was associated with a significantly lower risk of a composite of ischemic stroke or TIA (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.24–0.84; P=0.012), but not for ischemic stroke. In a subgroup analysis of confined to the high-risk PFO patients (116 pairs), PFO closure was associated with significantly lower risks of both the composite of ischemic stroke or TIA (HR: 0.40; 95% CI: 0.21–0.77; P=0.006) and ischemic stroke (HR: 0.47; 95% CI: 0.23–0.95; P=0.035). Conclusion Elderly patients with cryptogenic stroke and PFO have a high recurrence rate of ischemic stroke or TIA, which may be significantly reduced by device closure.

Purpose: This study investigates the alterations in A549 human non-small-cell lung cancer (NSCLC) cells exposed to Citrus junos extract (CJE). We further examine the antiproliferative and apoptotic effects of CJE on NSCLC cells. Methods: Inhibition of proliferation was examined by applying the 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) colorimetric assay on CJE-treated A549 NSCLC cells. The lactate dehydrogenase (LDH) assay was performed to measure the degree of toxicity of CJE on NSCLC cells. The effect on migratory proliferation was confirmed using the scratch wound healing assay. The antiproliferative effect of the CJE on human lung cancer cells was verified through morphological observation, fluorescence microscopy, and caspase-3 colorimetry. Results: Exposure of NSCLC cells to CJE resulted in a dose- and time-dependent decrease in cell activity and increased toxicity to the cells. In addition, microscopic observation revealed a reduced ability of the cancer cells to migrate and proliferate after exposure to the CJE, with simultaneous morphological apoptotic changes. Fluorescence staining and microscopic examination revealed that this death was a process of self-programmed cell death of NSCLC cells. Compared to unexposed NSCLC cells, the expression of caspase-3 was significantly increased in cells exposed to CJE. Conclusion Exposure of A549 human NSCLC cells to CJE inhibits the proliferation, increases the cytotoxicity, and decreases the ability of cells to migrate and grow. Moreover, the expression of caspase-3 increases after CJE treatment, suggesting that the apoptosis of NSCLC cells is induced by a chain reaction initiated by caspase-3. These results indicate that Citrus junos is a potential therapeutic agent for human non-small-cell lung cancer.

The purpose of this study was to investigate the association between daily beverage intake and obesity in young adults. This cross-sectional study was conducted with 256 adults in their 20s and 30s. Obesity was evaluated by anthropometric measurement of body mass index (BMI), waist to hip ratio and waist to height ratio. In addition, the daily intake of milk, caffeinated beverages, sweetened beverages, and alcoholic beverages was investigated using the dietary record and 24-h recall methods. Based on the BMI, men and women were classified into underweight, normal, overweight and obese. Among men, 38.3% were found to be normal, 28.1% were overweight and 31.3% obese. Among women, 11.7% were underweight, 73.4% were normal, and 10.2% were overweight, which was significantly different from men. In women, the BMI of the milk consumers was significantly lower than the non-consumers. Also, the obesity indices of caffeinated beverage consumers were significantly lower than the non-consumers. An analysis of the correlation between beverage intake and the obesity index showed that the intake of caffeinated beverages among women had a significant negative correlation with the obesity index, and intake of alcoholic beverages had a significant positive correlation with waist to height ratio. This study suggests that intake of milk and caffeinated beverage may have a positive effect on obesity, whereas the intake of alcoholic beverages may have a negative effect, especially in young adult women.

Objectives: This study aimed to investigate the current status of nutrition education via a free learning semester program (NE). The understanding of the program, the potential difficulties, and future initiatives for NE improvement were also investigated. Methods: A total number of 161 nutrition teachers from Gwangju and Jeonnam filled in a questionnaire and participated in this survey, which was performed from July to August 2019. Results: Our results showed that 8.1% of the nutrition teachers had taught nutrition education in free learning semester programs. The most frequently implemented model was subject selection, followed by club activities. Most of the nutrition teachers comprehended the purpose of NE. The attitude of nutrition teachers to NE differed by the understanding of its purpose. Positive attitude was evident due to a better understanding of the purpose by nutrition teachers. Nutrition teachers reported the most common difficulties of NE were the lack of preparation due to the heavy workload and the lack of a standard running program.The most effective method of NE was the activity classes. The experience of practicing NE influenced the choice of contents for each operating model. Nutrition teachers that were experienced in NE conducted via free learning semester programs preferred the selected topics model, but those without experience chose the career search model. Conclusions Although some obstacles exist, nutrition teachers had a positive attitude and perceived well the importance of NE. Therefore, the awareness for the significance of NE of nutrition teachers needs to be improved. For better NE practice, it is necessary to reduce/ manage the workload of general food service. Furthermore, the development of standard running and promotion programs, and teacher training programs should be ensured.

Purpose: This study was conducted to investigate the eating behavior (EB) and nutritional status of university students in Gwangju, and to compare their nutrition quotients (NQs) and problems according to their EB types. Methods: The subjects were 219 (127 female and 92 male) undergraduate students from Gwangju. The Student’s t-test was used to compare the EB levels according to gender, and Pearson’s χ2 test was used to compare the distribution of EB types by gender. A gender-adjusted analysis of covariance (ANCOVA) was conducted to examine the difference in NQs by EB types. Results: First, there were significant differences in the EB scores and the distribution of EB types according to gender. Female students showed higher levels of emotional (Emo) and external (Ext) EBs than the male students, and Emo, Ext, and combined (Com) EB types were more evident among female rather than male students. Second, there was a difference in NQs according to the EB types. The Emo EB type subjects had a lower NQ than those of the restrained (Res) EB type and showed significant differences in diversity and dietary behavior. Specifically, the Emo EB type subjects displayed significantly lower efforts to maintain a healthy diet and subjective health status than the Com EB type and their levels of checking nutrition labels, hand washing, and water intake were significantly lower than that of the Res EB type. The Ext EB type showed significantly lower moderation of Ramyeon and sweetened drink intake than the Res and Com EB types. Conclusion The level of EBs and the distribution of EB types varied according to gender, and the NQs were different according to EB types. The results of this study are expected to contribute to the establishment of customized strategies for improvement by identifying major nutritional problems by gender and the EB types of university students.