Dietary Sources, Stabilization, Health Benefits, and Industrial Application of Anthocyanins-A Review.

Natural phytochemicals are well known to protect against numerous metabolic disorders. Anthocyanins are vacuolar pigments belonging to the parent class of flavonoids. They are well known for their potent antioxidant and gut microbiome-modulating properties, primarily responsible for minimizing the risk of cardiovascular diseases, diabetes, obesity, neurodegenerative diseases, cancer, and several other diseases associated with metabolic syndromes. Berries are the primary source of anthocyanin in the diet. The color and stability of anthocyanins are substantially influenced by external environmental conditions, constraining their applications in foods. Furthermore, the significantly low bioavailability of anthocyanins greatly diminishes the extent of the actual health benefits linked to these bioactive compounds. Multiple strategies have been successfully developed and utilized to enhance the stability and bioavailability of anthocyanins. This review provides a comprehensive view of the recent advancements in chemistry, biosynthesis, dietary sources, stabilization, bioavailability, industrial applications, and health benefits of anthocyanins. Finally, we summarize the prospects and challenges of applications of anthocyanin in foods.

TB-free Ebeye: Results from integrated TB and noncommunicable disease case finding in Ebeye, Marshall Islands.

Background: Tuberculosis (TB) incidence rates in the Republic of the Marshall Islands are among the highest in the world, 480/100,000 in 2017. In response, the Health Ministry completed islandwide screening in Ebeye Island in 2017. Methods: Participants were interviewed to obtain TB history, exposures, and symptoms. TB assessment included chest radiography with sputum collection for GeneXpert® MTB-RIF if indicated. TB diagnosis was made by consensus of visiting TB experts. Participants were also screened for Hansen's disease (HD) and diabetes mellitus (DM). For persons aged ≥21 years, blood pressure, cholesterol, and blood glucose were assessed. Results: A total of 5,166 persons (90.0 % of target population) completed screening leading to the identification of 39 new cases of TB (755/100,000) and 14 persons with HD (270/100,000). DM was detected in 1,096 persons (27 %), including in 351 persons not previously diagnosed. The rate of hypertension was 61 % and of hypercholesterolemia was 15 %. New or prevalent TB diagnosis was associated with newly diagnosed or history of DM (aOR 4.68, 2.15-10.20). Conclusions: In Ebeye, an integrated TB screening campaign found TB, HD, DM, and hypertension. TB and DM were strongly associated.

A deep learning-based framework for predicting pork preference.

Meat consumption per capita in South Korea has steadily increased over the last several years and is predicted to continue increasing. Up to 69.5% of Koreans eat pork at least once a week. Considering pork-related products produced and imported in Korea, Korean consumers have a high preference for high-fat parts, such as pork belly. Managing the high-fat portions of domestically produced and imported meat according to consumer needs has become a competitive factor. Therefore, this study presents a deep learning-based framework for predicting the flavor and appearance preference scores of the customers based on the characteristic information of pork using ultrasound equipment. The characteristic information is collected using ultrasound equipment (AutoFom III). Subsequently, according to the measured information, consumers' preferences for flavor and appearance were directly investigated for a long period and predicted using a deep learning methodology. For the first time, we have applied a deep neural network-based ensemble technique to predict consumer preference scores according to the measured pork carcasses. To demonstrate the efficiency of the proposed framework, an empirical evaluation was conducted using a survey and data on pork belly preference. Experimental results indicate a strong relationship between the predicted preference scores and characteristics of pork belly.

Comparison of pork belly characteristics and weights of primal cuts between gilt and barrow of Landrace × Yorkshire × Duroc pigs measured by AutoFomIII.

Currently, pigs breed in Korea are LYD (Landrace × Yorkshire × Duroc) crossbred pigs. Pigs used as fresh meat are gilts and barrows. However, the current supply of pork is not satisfying Korean consumers. In addition, the comparison of carcasses between gilts and barrows only studies carcass weight, backfat thickness, or meat quality, and there are very few studies comparing carcass characteristics. The purpose of this study was to compare characteristics of 7 primal cuts of gilts and barrows as measured by AutoFom III. A total of 350,179 pigs were used, including 176,461 gilts and 173,718 barrows. Characteristics of seven primal cuts were measured using AutoFom III. In the case of carcass weight, there was no significant difference in grade 1+. For all other survey items except for grade 2, gilts showed significantly (p < 0.05) higher values. For all grades except for pork belly, amounts of the remaining six primal cuts were higher in gilts (all p < 0.05,). In addition, the ratio of intermuscular fat in the pork belly of barrows showed a higher value than that in the pork belly of gilts (p < 0.05). The amount of pork belly, which is the most popular among consumers in Korea, not only produced more production than gilts in barrows, but also showed a higher value than gilts in barrows for the ratio of intermuscular fat affecting taste. In summary, gilts produced higher yields than barrows in all parts except pork belly. For the production of only pork belly, barrows showed higher production than gilts.

Carotenoid and Tocopherol Profiling in 18 Korean Traditional Green Leafy Vegetables by LC-SIM-MS.

Fruits and vegetables are a vital source of redox-active phytochemicals in the diet. Traditional green leafy vegetables (GLVs) are a rich source of carotenoids, dietary fiber, minerals, phenols, vitamins, and tocopherols and are commonly consumed in rural areas worldwide. In traditional Korean medicine, many GLVs are used to treat various ailments. However, data on the carotenoid and tocopherol content of many traditional GLVs consumed in the Republic of Korea are insufficient. The current work aims to compare the carotenoid and tocopherol profiles of 18 traditional GLVs by utilizing a single ion monitoring LC-MS approach to identify the potential GLVs for commercial cultivation and healthy diet formulations. Among the traditional GLVs investigated, (all-E)-lutein was the most abundant carotenoid, ranging from 44.4% in Glehnia littoralis to 52.1% in Heracleum moellendorffii. It was followed by (all-E)-violaxanthin and (all-E)-ß-carotene. The highest contents of (all-E)-violaxanthin (75.6 µg/g FW), 9-Z-neoxanthin (48.4 µg/g FW), (all-E)-luteoxanthin (10.8 µg/g FW), (all-E)-lutein (174.1 µg/g FW), total xanthophylls (310.5 µg/g FW), (all-E)-ß-carotene (69.6 µg/g FW), and total carotenoids (380.1 µg/g FW) were recorded in Pimpinella brachycarpa. Surprisingly, Taraxacum mongolicum also showed the highest contents of (all-E)-violaxanthin, (all-E)-lutein, and total carotenoids, which were statistically non-significant (p > 0.05, Tukey HSD) with P. brachycarpa. The highest concentration of (all-E)-zeaxanthin (14.4 µg/g FW) was recorded in Solidago virga-aurea. Among the studied herbs, 13.9 (H. moellendorffii)-133.6 µg/g FW (Toona sinensis) of α-tocopherol was recorded. Overall, the results suggest that P. brachycarpa and T. mongolicum are rich sources of carotenoids. On the other hand, T. sinensis is a rich source of α-tocopherol. These GLVs can be utilized in the diet to enhance the intake of health-beneficial carotenoids and α-tocopherol.

Physico-Chemical Properties and Storage Stability of an Emulsion as a Fat Replacer in Meat Analogs during the Freezing Storage.

This study determined the effects of physicochemical and microbial properties of emulsion as a fat replacer in meat analogs during freezing storage. Meat analogs were prepared with different fat replacers: vegetable oil (O) for control, oil in water emulsion (E), and non-emulsified oil in water emulsion (EC) for emulsion control. After that, meat analogs were stored for 0.5, one, three, and six months at −18 °C and −60 °C. The results showed that the drip loss of all samples was not significantly different (p > 0.05). However, the liquid holding capacity of EC and E was significantly higher than that of O (p < 0.05). Additionally, the microstructures of meat analogs of E and EC were smaller with denser pore sizes than O. This explains the significantly lower hardness of E and EC compared to O (p < 0.05). Overall, E showed superior physiochemical and sensory quality. During the storage, the stability of chemical properties, such as volatile basic nitrogen and thiobarbituric acid reactive substances, showed no significant changes (p > 0.05). Moreover, the microbial studies (total viable counts and Escherichia coli count) suggested that meat analogs did not deteriorate during the preparation and storage. Thus, this study suggests that emulsion-type fat replacers influence meat analogs' physicochemical and sensorial properties. However, these properties are not influenced by the storage temperature and duration.

Estimating the long-term effects of mass screening for latent and active tuberculosis in the Marshall Islands.

BACKGROUND: Ambitious population-based screening programmes for latent and active tuberculosis (TB) were implemented in the Republic of the Marshall Islands in 2017 and 2018. METHODS: We used a transmission dynamic model of TB informed by local data to capture the Marshall Islands epidemic's historical dynamics. We then used the model to project the future epidemic trajectory following the active screening interventions, as well as considering a counterfactual scenario with no intervention. We also simulated future scenarios including periodic interventions similar to those previously implemented, to assess their ability to reach the End TB Strategy targets and TB pre-elimination in the Marshall Islands. RESULTS: The screening activities conducted in 2017 and 2018 were estimated to have reduced TB incidence and mortality by around one-third in 2020, and are predicted to achieve the End TB Strategy milestone of 50% incidence reduction by 2025 compared with 2015. Screening interventions had a considerably greater impact when latent TB screening and treatment were included, compared with active case finding alone. Such combined programmes implemented at the national level could achieve TB pre-elimination around 2040 if repeated every 2 years. CONCLUSIONS: Our model suggests that it would be possible to achieve TB pre-elimination by 2040 in the Marshall Islands through frequent repetition of the same interventions as those already implemented in the country. It also highlights the importance of including latent infection testing in active screening activities.

Correlation between the Korean pork grade system and the amount of pork primal cut estimated with AutoFom III.

It is impossible to know the amount of pork primal cut by pig carcass grade which is determined only by carcass weight and backfat thickness in the Korean Pig Carcass System. The aim of this study was to investigate the correlation between the pig carcass grade and the amount of pork primal cut estimated with AutoFom III. A total of 419,321 Landrace, Yorkshire, and Duroc (LYD) pigs were graded with the Korean Pig Carcass Grade System. Amounts of belly, neck, loin, tenderloin, spare ribs, shoulder, and ham were estimated with AutoFom III. Regression equations for seven primal cuts according to each grade were derived. There were significant differences among the three carcass grades due to heteroscedasticity variance (p < 0.0001). Three regression equations were derived from AutoFom III estimation of primal cuts according to carcass grades. The coefficient of determination of the regression equation was 0.941 for grade 1+, 0.982 for grade 1, and 0.993 for grade 2. Regression equations obtained from this study are suitable for AutoFom III software, a useful tool for the analysis of each pig carcass grade in the Korean Pig Carcass Grade System. The high reliability of predicting the amount of primal cut with AutoFom III is advantageous for the management of slaughterhouses to optimize their product sorting in Korea.

Anticancer Potential of Lipophilic Constituents of Eleven Shellfish Species Commonly Consumed in Korea.

The present study was aimed to investigate the composition and contents and the major lipophilic compounds, including the sterols, fatty acids, and tocols of shellfish species. Moreover, to explore the antitumor activity of these lipophilic constituents, their cytotoxicity potentials were determined against five different human cancer cells, including colon carcinoma (HCT116), epithelial melanoma (A2058), glioblastoma multiforme (T98G), lung carcinoma (A549), and adenocarcinoma (HeLa). The results show a significant variation in the contents and composition of lipophilic constituents among the studied species. The highest omega-3 (n-3) polyunsaturated fatty acids (PUFAs) were recorded from arrow squid and pacific oysters, accounting for 53.2% and 53.0% of their total fatty acids, respectively. However, the highest cholesterol content was also recorded in arrow squid (154.4 mg/100 g; 92.6% of total sterols). In contrast, in the Japanese littleneck, Yesso scallop, and common orient clam, cholesterol was just 17.1%, 18.3%, and 18.9% of total sterols, respectively, making them the richest source of non-cholesterol sterols (NCS). Lipids extracted from shellfish species showed ABTS+•- and DPPH•-scavenging activities. In the cytotoxicity analysis, lipids extracted from the Argentine red shrimp showed the highest cytotoxicity against glioblastoma multiforme T98G cells, with an IC50 value of 12.3 µg/mL. The composition and cytotoxicity data reported herein may help explore the nutritional and anticancer potentials of shellfish species.

Age of Laying Hens Significantly Influences the Content of Nutritionally Vital Lipophilic Compounds in Eggs.

This study aimed to comparatively analyze the carotenoids, tocopherols, fatty acids, and sterols (e.g., cholesterol) in the eggs of laying hens of early (24 weeks), intermediate (42 weeks), and late age (74 weeks), utilizing high-performance liquid chromatography (HPLC), gas chromatography (GC), and GC-mass spectrometry (MS). The results revealed the significantly (p < 0.05) highest content of nutritionally vital compounds (per g of egg yolk, fresh weight), which included (all-E-)-lutein (21.8 µg), (all-E-)-zeaxanthin (13.4 µg), α-tocopherol (76.5 µg), oleic acid (C18:1n9c; 83.3 mg), α-linolenic acid (C18:3n3; 0.68 mg), γ-linolenic acid (C18:3n6; 0.47 mg), arachidonic acid (C20:4n6; 8.11 mg), docosahexaenoic acid (DHA; C22:6n3; 2.06 mg), and total monounsaturated fatty acids (MUFAs; 94.7 mg) and n-3 polyunsaturated fatty acids (PUFAs; 2.74 mg) in the eggs of early-age laying hens compared to intermediate and late-age. Surprisingly, cholesterol was not significantly different in the eggs obtained from the different age groups. In contrast, the fat quality indices, including the lowest atherogenic index (AI) and thrombogenic index (TI) values and high hypocholesterolemic/hypercholesterolemic (h/H) fatty acid ratio, indicated the health-beneficial potential associated with fat intake from the eggs of intermediate and late-age laying hens. Overall, the results of the present investigation suggest that eggs from early-age laying hens can be recommended for a higher intake of antioxidant carotenoids and tocopherols, while the eggs from intermediate and late-age hens can be recommended for the intake of good quality fats.

Korean Maize Hybrids Present Significant Diversity in Fatty Acid Composition: An Investigation to Identify PUFA-Rich Hybrids for a Healthy Diet.

Precise information on the content and composition of nutritionally essential metabolites in food crops is a prerequisite for dietary recommendations and nutrient-dense food formulations. In the present study, the fatty acid profile of 21 Korean maize hybrids was analyzed by gas chromatography (GC)-mass spectrometry (MS). In the studied hybrids, linoleic acid (LA; C18:2n6c) was dominant (38.0-58.9%), followed by oleic (OA; C18:1n9c) (23.5-45.3%), palmitic (C16:0) (10.8-17.3%), and stearic acids (C18:0) (1.84-3.86%). Among all the quantified fatty acids, the highest variation was recorded for LA and OA. The highest amount of LA (58.9%), the lowest amount of OA (23.5%), and the highest polyunsaturated fatty acids (PUFAs)/monounsaturated fatty acids (MUFAs) ratio of 2.47 were recorded in the Shingwang hybrid. The highest PUFAs/saturated fatty acids (SFAs) ratio of 4.04 was recorded in the Ahndaok hybrid due to the high content of LA (57.8%) and low amount of SFA. Similarly, the highest PUFAs + MUFAs/SFAs ratio of 6.38 was recorded in the Pyeonggangok hybrid as a result of the high OA (34.6%) and LA (51.4%) contents, along with the lowest amount of SFAs. Considering the high levels of health-beneficial MUFAs and PUFAs and low levels of undesirable SFAs, the maize hybrids Pyeonggangok, Ahndaok, and Shingwang can be used in the preparation of a healthy PUFA-rich diet.

Red Shrimp Are a Rich Source of Nutritionally Vital Lipophilic Compounds: A Comparative Study among Edible Flesh and Processing Waste.

This study was aimed at comparatively analyzing the sterols, tocopherols and fatty acids from edible flesh and processing waste obtained from three shrimp species, utilizing rapid liquid chromatography (LC)-atmospheric-pressure chemical ionization (APCI)-tandem mass spectrometry (MS/MS) and gas chromatography-mass spectrometry (GC-MS). Results revealed the presence of significantly (p < 0.05) high proportions of health-beneficial omega-3 (n3) polyunsaturated fatty acids (PUFAs) in Argentine red shrimp (34.3% in waste and 38.2% in the flesh), compared to black tiger shrimp (16.5-24.2%) and whiteleg shrimp (13.2-22.6%). Among sterols, cholesterol was found most dominant, accounting in the range 349.4 (white shrimp flesh) to 559.3 µg/g fresh weight (FW) (black shrimp waste). Surprisingly, waste was found to contain a substantially higher amount of α-tocopherol, for instance, 21.7 µg/g FW in edible flesh and 35.3 µg/g FW in the waste of black tiger shrimp. The correlation analysis indicated that shrimp with low total contents of lipids might have higher proportions of health-beneficial long-chain (LC)-n3-PUFAs eicosapentaenoic (EPA) and docosahexaenoic acid (DHA). The fat quality indices, including the high ratios of hypocholesterolemic (h)/hypercholesterolemic (H) fatty acids, and lowest values of the atherogenic index (AI) and thrombogenic index (TI) indicated the health-beneficial potential associated with fat intake from red shrimp. Overall, a significant amount of health-beneficial compounds in edible flesh of studied shrimp confers its extraordinary nutritional benefits. Moreover, considering the richness of processing waste with these compounds, their valorization can be prompted.

Relationship between Mammographic Density and Age in the United Arab Emirates Population.

OBJECTIVE: Higher breast density is a strong, independent risk factor for breast cancer. Breast density varies by age, ethnicity, and geographic area although dense breast tissue has been associated with younger age and premenopausal status. The relationship between breast density and age in women in the United Arab Emirates (UAE) has not been determined. This study evaluated breast density in the UAE population and its relationship with age. METHODS: Women participating in the national cancer screening program from August 2015 to May 2018 who underwent screening mammography were included. Breast parenchymal density was classified according to the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) from category a (almost entirely fatty) through d (extremely dense). Subjects were divided into six age groups, and the association between age and breast density was evaluated. RESULTS: Of the 4911 women included, 1604 (32.7%), 2149 (43.8%), 1055 (21.5%), and 103 (2.1%) were classified as having categories a-d breast density, respectively. A significant negative correlation was observed between age and breast density category (p < 0.001). Women of mean age 44 ± 7 years had the highest breast density, whereas those of mean age 56 ± 14 years had the lowest breast density. Comparisons of Emirati women with Lebanese and Western women showed that breast density was lower in Emirati women than in the other populations. CONCLUSIONS: To our knowledge, this is the first study to evaluate the relationship between mammographic breast density and age in UAE women. As in other populations, age was inversely related to breast density, but the proportion of Emirati women with dense breasts was lower than in other populations. Because this study lacked demographic, clinical, and histopathological data, further evaluation is required.

Proposing standardised geographical indicators of physical access to emergency obstetric and newborn care in low-income and middle-income countries.

Emergency obstetric and newborn care (EmONC) can be life-saving in managing well-known complications during childbirth. However, suboptimal availability, accessibility, quality and utilisation of EmONC services hampered meeting Millennium Development Goal target 5A. Evaluation and modelling tools of health system performance and future potential can help countries to optimise their strategies towards reaching Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. The standard set of indicators for monitoring EmONC has been found useful for assessing quality and utilisation but does not account for travel time required to physically access health services. The increased use of geographical information systems, availability of free geographical modelling tools such as AccessMod and the quality of geographical data provide opportunities to complement the existing EmONC indicators by adding geographically explicit measurements. This paper proposes three additional EmONC indicators to the standard set for monitoring EmONC; two consider physical accessibility and a third addresses referral time from basic to comprehensive EmONC services. We provide examples to illustrate how the AccessMod tool can be used to measure these indicators, analyse service utilisation and propose options for the scaling-up of EmONC services. The additional indicators and analysis methods can supplement traditional EmONC assessments by informing approaches to improve timely access to achieve Universal Health Coverage and reach SDG 3.

Risk stratification of triple-negative breast cancer with core gene signatures associated with chemoresponse and prognosis.

PURPOSE: Neoadjuvant chemotherapy studies have consistently reported a strong correlation between pathologic response and long-term outcome in triple-negative breast cancer (TNBC). We aimed to define minimal gene signatures for predicting chemoresponse by a three-step approach and to further develop a risk-stratification method of TNBC. METHODS: The first step involved the detection of genes associated with resistance to docetaxel in eight TNBC cell lines, leading to identification of thousands of candidate genes. Through subsequent second and third step analyses with gene set enrichment analysis and survival analysis using public expression profiles, the candidate gene list was reduced to prognostic core gene signatures comprising ten or four genes. RESULTS: The prognostic core gene signatures include three up-regulated (CEBPD, MMP20, and WLS) and seven down-regulated genes (ASF1A, ASPSCR1, CHAF1B, DNMT1, GINS2, GOLGA2P5, and SKA1). We further develop a simple risk-stratification method based on expression profiles of the core genes. Relative expression values of the up-regulated and down-regulated core genes were averaged into two scores, Up and Down scores, respectively; then samples were stratified by a diagonal line in a xy plot of the Up and Down scores. Based on this method, the patients were successfully divided into subgroups with distinct chemoresponse and prognosis. The prognostic power of the method was validated in three independent public datasets containing 230, 141, and 117 TNBC patients with chemotherapy. In multivariable Cox regression analysis, the core gene signatures were significantly associated with prognosis independent of tumor stage and age at diagnosis. In meta-analysis, we found that five core genes (CEBPD, WLS, CHAF1B, GINS2, and SKA1) play opposing roles, either tumor promoter or suppressor, in TNBC and non-TNBC tumors respectively, depending on estrogen receptor status. CONCLUSIONS: The results may provide a promising prognostic tool for predicting chemotherapy responders among TNBC patients prior to initiation of chemotherapeutic treatment.

Characteristics of Pig Carcass and Primal Cuts Measured by the Autofom â ¢ Depend on Seasonal Classification.

The objective of this study was to investigate slaughtering performance, carcass grade, and quantitative traits of cuts according to seasonal influence by each month in pigs slaughtered in livestock processing complex (LPC) slaughterhouse in Korea, 2017. A total of 267,990 LYD (Landrace×Yorkshire×Duroc) pig data were used in this study. Results of slaughter heads, sex distribution, carcass weight, backfat thickness, grading class, total weight, and fat and lean meat percentages of each cut predicted by Autofom Ⅲ were obtained each month. The number of slaughtered pigs was the highest in early and late fall but the lowest in midsummer. Only in midsummer that the number of females was higher than that of castrates. During 2017, carcass weight was the lowest in late summer. Backfat thickness was in the range of 21-22 mm. In mid and late spring, pigs showed high 1+ grade ratio (37.05% and 36.15%, respectively). For traits of 11 cuts predicted by Autofom Ⅲ, porkbelly showed lower total weight, lean weight, and fat weight in midsummer to early fall but higher lean meat percentage compared to other seasons. Weights of deboned neck, loin, and lean meat were the highest in midfall compared to other seasons (p<0.05). In conclusion, characteristics of slaughtering, grading, and economic traits of pigs seemed to be highly seasonal. They were influenced by seasons. Results of this study could be used as basic data to develop seasonal specified management ways to improve pork production.

Effects of Bromelain and Double Emulsion on the Physicochemical Properties of Pork Loin.

Our aim was to investigate the effects of bromelain embedded in double emulsion (DE) on physicochemical properties of pork loin. We evaluated DE characteristics such as size, zeta potential, and microscopy after fabrication. We marinated meat with distilled water (DW), 1% (w/v) bromelain solution, blank DE, and 1% (w/v) bromelain loaded in double emulsion (DE E) for 0, 24, 48, and 72 h at 4°C, and prepared raw meat for control. The marinated samples were assessed for color, water holding capacity, cooking loss, moisture content, pH, protein solubility, Warner-Bratzler shear force (WBSF) and gel electrophoresis. The droplet size of 1% (w/v) bromelain embedded in DE was increased compared with blank DE (p<0.05) and values of zeta potential decreased. The increase in lightness and color difference range of the DE-treated group was lower than that of the DW-treated group (p<0.05). Moreover, treatment by immersion in 1% (w/v) DE E resulted in the highest water holding capacity values (p<0.05) and lower cooking loss values than water base treatment (p<0.05). Results for myofibrillar protein solubility and WBSF showed a similar trend. 1% (w/v) DE E showed degradation of myosin heavy chain after 48 h in sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Thus, bromelain-loaded DE is useful for controlling and handling enzyme activity in food industry.

Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: Scoring system for predicting malignancy.

BACKGROUND: The management of benign intraductal papilloma diagnosed on core needle biopsy (CNB) remains unclear. This study was designed to evaluate factors predicting malignancy in patients diagnosed with benign papilloma without atypia at ultrasound-guided CNB and to develop a scoring system predicting malignancy based on clinical, radiological and pathological factors on further excisional biopsy. METHODS: The study enrolled patients diagnosed with benign papillomas (including benign and atypical papillary lesions) at CNB. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. RESULTS: A total of 520 CNBs were diagnosed with benign or atypical papilloma. Of these, 452 were benign papilloma without atypia. Of the 250 lesions subsequently excised surgically from 234 women, 17 (6.8%) were diagnosed with malignancy. Multivariate analysis revealed that bloody nipple discharge, size on imaging ≥15 mm, BI-RADS≥4b, peripheral location and palpability were independent predictors of malignancy. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.947 (95% CI: 0.913-0.981, p < 0.001) and a negative predictive value was 100%. In a validation set of 62 patients, an area under the ROC curve was 0.926 (95% CI: 0.857-0.995, p < 0.001). CONCLUSIONS: A scoring system predicting malignancy in patients diagnosed by CNB with benign papilloma without atypia was developed. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate.

Early outcome of the Korean Diagnosis-Related Groups payment system for appendectomy.

PURPOSE: The implementation of the Korean diagnosis-related groups (DRG) payment system has been recently introduced in selected several diseases including appendectomy in Korea. Here, we report the early outcomes with regard to clinical aspects and medical costs of the Korean DRG system for appendectomies in Seoul Metropolitan Government - Seoul National University Boramae Medical Center throughout comparing before and after introduction of DRG system. METHODS: The DRG system was applied since January 2013 at our institute. After the DRG system, we strategically designed and applied our algorithm for the treatment of probable appendicitis. We reviewed the patients who were treated with a procedure of appendectomy for probable appendicitis between July 2012 and June 2013, divided two groups based on before and after the application of DRG system, and compared clinical outcomes and medical costs. RESULTS: Total 416 patients were included (204 patients vs. 212 patients in the group before vs. after DRG). Shorter hospital stays (2.98 ± 1.77 days vs. 3.82 ± 1.84 days, P < 0.001) were found in the group after DRG. Otherwise, there were no significant differences in the perioperative outcomes and medical costs including costs for first hospitalization and operation, costs for follow-up after discharge, frequency of visits of out-patient's clinic or Emergency Department or rehospitalization. CONCLUSION: In the Korean DRG system for appendectomy, there were no significant differences in perioperative outcomes and medical costs, except shorter hospital stay. Further studies should be continued to evaluate the current Korean DRG system for appendectomy and further modifications and supplementations are needed in the future.

The effect of the action observation physical training on the upper extremity function in children with cerebral palsy.

The purpose this study was to investigate the effect of action observation physical training (AOPT) on the functioning of the upper extremities in children with cerebral palsy (CP), using an evaluation framework based on that of the International Classification of Functioning, Disability and Health (ICF). The subjects were divided into an AOPT group and a physical training (PT) group. AOPT group practiced repeatedly the actions they observed on video clips, in which normal child performed an action with their upper extremities. PT group performed the same actions as the AOPT group did after observing landscape photographs. The subjects participated in twelve 30-min sessions, 3 days a week, for 4 weeks. Evaluation of upper extremity function using the following: the power of grasp and Modified Ashworth Scale for body functions and structures, a Box and Block test, an ABILHAND-Kids questionnaire, and the WeeFIM scale for activity and participation. Measurements were performed before and after the training, and 2 weeks after the end of training. The results of this study showed that, in comparison with the PT group, the functioning of the upper extremities in the AOPT group was significantly improved in body functions and activity and participation according to the ICF framework. This study demonstrates that AOPT has a positive influence on the functioning of the upper extremities in children with CP. It is suggested that this alternative approach for functioning of the upper extremities could be an effective method for rehabilitation in children with CP.