High-dose (60 Gy) intensity-modulated radiotherapy with concurrent weekly cisplatin followed by intracavitary radiation in locally advanced cervical cancer: A phase II prospective clinical trial.

OBJECTIVE: Radiotherapy dose-escalation using intensity-modulated radiotherapy (IMRT) has been necessary to improve treatment results in cervical cancer. METHODS: This was a phase II prospective clinical trial. 88 patients with FIGO II-IVa cervical cancer were enrolled in a single center. They received high-dose (60 Gy) IMRT with weekly cisplatin to the primary tumor and clinically positive nodes followed by intracavitary radiation. The primary endpoint was 30-month PFS rate (Target; 82%, an increase of 20% compared to GOG 120 trial using standard-dose radiotherapy). Secondary endpoints were tumor response, toxicity, recurrence, distant metastasis, and overall survival. RESULTS: Progression-free survival rate at 30 months was 82.8%. Overall survival, locoregional recurrence, distant metastasis, and para-aortic recurrence rates at 30 months were 93.6%, 8.2%, 9.2%, and 2.4%, respectively. Forty-five (51.1%) of 88 patients achieved downstaging on MRI during radiotherapy and 80 (90.9%) patients had clinically complete response at three months after high-dose IMRT and intracavitary radiotherapy. The 30-month recurrence-free survival (92.9% vs. 73.1%, P = 0.009) and overall survival (100% vs. 87.0%, P = 0.006) were significantly higher in the downstaged group than in the non-downstaged group during radiotherapy. Grade 3 or higher hematologic toxicity was found in 11 (12.5%) patients and grade 3 or higher non-hematologic toxicity was found in 3 (3.4%) patients. Fourteen had chronic urinary (8.0%), intestinal (5.7%) toxicity, pelvic insufficiency fracture (2.3%) or vesicovaginal fistula (2.3%). CONCLUSION: High-dose (60 Gy) IMRT with concurrent weekly cisplatin in locally advanced cervical cancer yielded favorable progression-free survival outcome. Tumor response during radiotherapy can be a significant prognostic factor for PFS. CLINICAL TRIAL INFORMATION: This prospective trial is registered at ClinicalTrials.gov Identifier: NCT02993653.

Heterogeneity of Adult Rhinitis for Multimorbidity and Age at Onset among Non-Sensitized Rhinitis and Mono-/Poly-Sensitized Rhinitis: A Retrospective Cross-Sectional Study.

BACKGROUND: Recent studies have proposed that clinical and immunological differences exist between mono- and poly-sensitized subjects with allergic diseases, and poly-sensitization was related to multimorbidity of allergic diseases among children and adolescents. OBJECTIVE: We compared the clinical characteristics and multimorbidity of allergic diseases between adult rhinitis patients mono- and poly-sensitized to common aeroallergens using a retrospective cross-sectional study for tertiary care subjects. METHODS: The medical records of 1,615 patients who were clinically diagnosed with rhinitis by an otolaryngologist and evaluated with skin prick tests were reviewed. The severity of the rhinitis symptoms, comorbidities (asthma, conjunctivitis, and eczema), family history of allergic diseases, and the results of skin prick tests were evaluated. RESULTS: There were 392 patients with mono-sensitized rhinitis (mono-sR), 325 with poly-sensitized rhinitis (poly-sR), and 898 with non-sensitized rhinitis (non-sR). Comorbid conjunctivitis and eczema were most common in poly-sR, followed by mono-sR, and least common in non-sR patients. The age at onset of rhinitis was clearly different between adult patients with non-sR and mono-/poly-sR, but not between patients with mono-sR and poly-sR. However, the age at onset of rhinitis was much younger in non-sR and mono-sR patients with conjunctivitis or eczema than those without such comorbidities. CONCLUSION: Thefrequency of comorbid conjunctivitis and eczema in adult rhinitis patients differed by a quantitative trait of immunoglobulin E sensitization. Depending on the multimorbidity of allergic diseases, onset age of rhinitis seems to be different in adult rhinitis patients.

Asthma in Asia: Physician perspectives on control, inhaler use and patient communications.

OBJECTIVE: We examined the physician perspectives on asthma management in Asia. METHODS: An online/face-to-face, questionnaire-based survey of respiratory specialists and primary care physicians from eight Asian countries/region was carried out. The survey explored asthma control, inhaler selection, technique and use; physician-patient communications and asthma education. Inclusion criteria were >50% of practice time spent on direct patient care; and treated >30 patients with asthma per month, of which >60% were aged >12 years. RESULTS: REALISE Asia (Phase 2) involved 375 physicians with average 15.9(±6.8) years of clinical experience. 89.1% of physicians reporting use of guidelines estimated that 53.2% of their patients have well-controlled (GINA-defined) asthma. Top consideration for inhaler choice was asthma severity (82.4%) and lowest, socio-economic status (32.5%). Then 54.7% of physicians checked their patients' inhaler techniques during consultations but 28.2(±19.1)% of patients were using their inhalers incorrectly; 21.1-57.9% of physicians could spot improper inhaler techniques in video demonstrations. And 79.6% of physicians believed combination inhalers could increase adherence because of convenience (53.7%), efficacy (52.7%) and usability (18.9%). Initial and follow-up consultations took 16.8(±8.4) and 9.2(±5.3) minutes, respectively. Most (85.1%) physicians used verbal conversations and least (24.5%), video demonstrations of inhaler use; 56.8% agreed that patient attitudes influenced their treatment approach. CONCLUSION: Physicians and patients have different views of 'well-controlled' asthma. Although physicians informed patients about asthma and inhaler usage, they overestimated actual usage and patients' knowledge was sub-optimal. Physician-patient interactions can be augmented with understanding of patient attitudes, visual aids and ancillary support to perform physical demonstrations to improve treatment outcomes.

The significant impact of MPs in the industrial/municipal effluents on the MPs abundance in the Nakdong River, South Korea.

Owing to extensive plastic consumption, wastewater from households, business establishments, and industrial activities have been recognised as a significant contributor to microplastics (MPs) in aquatic environments. This case study represents the first investigation of MPs in the Nakdong River, Republic of Korea, that traverses through the largest industrial complex midstream and densely populated cities of Daegu and Busan downstream before flowing into the sea. Monitoring of MP abundance in effluents discharged from three municipal, two industrial, and one livestock wastewater treatment plant (WWTP) into the Nakdong River was conducted over four seasons from August 2022 to April 2023. Identification and quantification of MPs were performed using micro-Fourier transform infrared spectrometry. Seasonal variation in MPs in the Nakdong River was found to be strongly influenced by the nearest upstream WWTPs and rivers, exhibiting a linear relationship that decreased gradually with increasing distance from the WWTPs. The average concentrations of MPs in the six effluent sources ranged from 101 ± 13 to 490 ± 240 particles/L during the yearly monitoring period, while MP concentrations in the river ranged between 79 ± 25 and 120 ± 43 particles/L. Industrial effluents contained higher amounts of discharged MPs (314 ± 78 particles/L) than municipal sources (201 ± 61 particles/L). Notably, two municipal WWTPs, located in the highly densely populated city, discharged the highest total MP amounts per day and released the greatest volumes of effluents. This study provides valuable insights into the monitoring and impact of effluents on MPs in rivers, which could inform MP treatment and management strategies for in river and marine environments.

Analytical Methods and Effects of Bioactive Peptides Derived from Animal Products: A Mini-Review.

Peptides with bioactive effects are being researched for various purposes. However, there is a lack of overall research on pork-derived peptides. In this study, we reviewed the process of obtaining bioactive peptides, available analytical methods, and the study of bioactive peptides derived from pork. Pepsin and trypsin, two representative protein digestive enzymes in the body, are hydrolyzed by other cofactors to produce peptides. Bicinchoninic acid assay, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, chromatography, and in vitro digestion simulation systems are utilized to analyze bioactive peptides for protein digestibility and molecular weight distribution. Pork-derived peptides mainly exhibit antioxidant and antihypertensive activities. The antioxidant activity of bioactive peptides increases the accessibility of amino acid residues by disrupting the three-dimensional structure of proteins, affecting free radical scavenging, reactive oxygen species inactivation, and metal ion chelating. In addition, the antihypertensive activity decreases angiotensin II production by inhibiting angiotensin converting enzyme and suppresses blood pressure by blocking the AT1 receptor. Pork-derived bioactive peptides, primarily obtained using papain and pepsin, exhibit significant antioxidant and antihypertensive activities, with most having low molecular weights below 1 kDa. This study may aid in the future development of bioactive peptides and serve as a valuable reference for pork-derived peptides.

Study on the Digestion-Induced Changes in the Characteristics and Bioactivity of Korean Native and Overseas Cattle-Derived Peptides.

This study was conducted to compare and analyze the changes in the biochemical characteristics and biological activity of peptide extracts derived from Chickso, Hanwoo, and Wagyu beef during digestion. The results of the in vitro digestion analysis revealed that the digestion rate, total free amino acid content, and antioxidant and antihypertensive activities of Chickso loin and shank myofibrillar proteins were significantly higher (p<0.05) than those of Hanwoo and Wagyu loin and shank myofibrillar proteins. Particularly, the peptide extracts of Chickso loin and shank had a high angiotensin-converting enzyme inhibitory activity. In mice in vivo digestion experiment, the blood serum of mice fed with Chickso loin peptide extract (<10 kDa) showed the highest antioxidant enzyme activity. Thus, Chickso peptide extracts were deemed to be similar or more bioactive than Hanwoo and Wagyu peptide extracts, and can be used as bioactive materials.

Self-assembly-induced formation of high-density silicon oxide memristor nanostructures on graphene and metal electrodes.

We report the direct formation of ordered memristor nanostructures on metal and graphene electrodes by a block copolymer self-assembly process. Optimized surface functionalization provides stacking structures of Si-containing block copolymer thin films to generate uniform memristor device structures. Both the silicon oxide film and nanodot memristors, which were formed by the plasma oxidation of the self-assembled block copolymer thin films, presented unipolar switching behaviors with appropriate set and reset voltages for resistive memory applications. This approach offers a very convenient pathway to fabricate ultrahigh-density resistive memory devices without relying on high-cost lithography and pattern-transfer processes.

Methods for improving meat protein digestibility in older adults.

This review explores the factors that improve meat protein digestibility and applies the findings to the development of home meal replacements with improved protein digestion rates in older adults. Various methods improve the digestion rate of proteins, such as heat, ultrasound, high pressure, or pulse electric field. In addition, probiotics aid in protein digestion by improving the function of digestive organs and secreting enzymes. Plant-derived proteases, such as papain, bromelain, ficin, actinidin, or zingibain, can also improve the protein digestion rate; however, the digestion rate is dependent on the plant enzyme used and protein characteristics. Sous vide processing improves the rate and extent of protein digestibility, but the protein digestion rate decreases with increasing temperature and heating time. Ultrasound, high pressure, or pulsed electric field treatments degrade the protein structure and increase the proteolytic enzyme contact area to improve the protein digestion rate.

Current technologies, regulation, and future perspective of animal product analogs - A review.

The purpose of this study was to investigate the recent development of meat analog, industrialization, and the related legal changes worldwide. Summarizing the current status of the industrialization of meat analog, studies on plant-based meat, mycoprotein, and edible insects were mainly conducted to investigate their sensory properties (texture, taste, flavor, and color resembling meat), nutritional and safety evaluations, acquisition method of meat alternatives, and commercialization. Cultured meat is mainly studied for developing muscle satellite cell acquisition and support techniques or materials for the formation of structures. However, these technologies have not reached the level for active industrialization. Even though there are differences in the food categories and labeling between countries, it is common to cause confusion or to relay false information to consumers; therefore, it is important to provide accurate information. In this study, there were some differences in the food classification and food definition (labeling) contents for each country and state depending on the product shape or form, raw materials, and ingredients. Therefore, this study can provide information about the current research available on meat alternatives, improve regulation, and clarify laws related to the meat analog industry, which can potentially grow alongside the livestock industry.

Highly tunable self-assembled nanostructures from a poly(2-vinylpyridine-b-dimethylsiloxane) block copolymer.

An extraordinarily large degree of tunability in geometry and dimension is demonstrated in films of a self-assembled block copolymer. A poly(2-vinylpyridine-b-dimethylsiloxane) block copolymer with highly incompatible blocks was spun-cast on patterned substrates and treated with various solvent vapors. The degree of selective swelling in the poly(2-vinylpyridine) matrix block could be controlled over an extensive range, leading to the formation of various microdomain morphologies such as spheres, cylinders, hexagonally perforated lamellae, and lamellae from the same block copolymer. The systematic control of swelling ratio and the choice of solvent vapors offer the unusual ability to control the width of very well-ordered linear features within a range between 6 and 31 nm. This methodology is particularly useful for nanolithography based on directed self-assembly in that a single block copolymer film can form microdomains with a broad range of geometries and sizes without the need to change molecular weight or volume fraction.

Study on the reduction of heterocyclic amines by marinated natural materials in pork belly.

This study was conducted to determine the effect of natural ingredient seasoning on the reduction of heterocyclic amine (HCA) production that may occur when pork belly is cooked at a very high temperature for a long time. Pork belly seasoned with natural ingredients, such as natural spices, blackcurrant, and gochujang, was cooked using the most common cooking methods, such as boiling, pan fry, and barbecue. HCAs in pork belly were extracted through solid-phase extraction and analyzed via high-performance liquid chromatography. For short-term toxicity, a mouse model was used to analyze weight, feed intake, organ weight, and length; hematology and serology analysis were also performed. Results revealed that HCAs formed only when heating was performed at a very high temperature for a long time, not under general cooking conditions. Although the toxicity levels were not dangerous, the method showing the relatively highest toxicity among various cooking methods was barbecue, and the natural material with the highest toxicity reduction effect was blackcurrant. Furthermore, seasoning pork belly with natural materials containing a large amount of antioxidants, such as vitamin C, can reduce the production of toxic substances, such as HCAs, even if pork belly is heated to high temperatures.

Review of the Current Research on Fetal Bovine Serum and the Development of Cultured Meat.

The purpose of this review is to summarize studies that investigate blood and the main components of fetal bovine serum (FBS) in vertebrates, including major livestock, and review the current research on commercializing cultured meat. Detailed research on FBS is still lacking; however, some studies have shown that FBS consists of proteins, carbohydrates, growth factors, cytokines, fats, vitamins, minerals, hormones, non-protein nitrogen, and inorganic compounds. However, there are few studies on how the composition of FBS differs from blood or serum composition in adult animals, which is probably one of the main reasons for not successfully replacing FBS. Moreover, recent studies on the development of FBS replacers and serum-free media have shown that it is difficult to conclude whether FBS has been completely replaced or serum-free media have been developed successfully. Our review of the industrialization of cultured meat reveals that many basic studies on the development of cultured meat have been conducted, but it is assumed that the study to reduce or replace ingredients derived from fetuses such as FBS has not yet been actively developed. Therefore, developing inexpensive and edible media is necessary for the successful industrialization of cultured meat.

Electromagnetic Wave Absorbing, Thermal-Conductive Flexible Membrane with Shape-Modulated FeCo Nanobelts.

Electromagnetic wave (EMW)-absorbing materials, manufactured with composites of magnetic particles, are essential for maintaining a high complex permeability and modulated permittivity for impedance matching. However, commonly available EMW-absorbing materials are unsatisfactory owing to their low complex permeability in the high-frequency band. Herein, we report a thin, flexible EMW-absorbing membrane comprising shape-modulated FeCo nanobelts/boron nitride nanoparticles, which enables enhanced complex permeability in the S, C, and X bands (2-12 GHz). The boron nitride nanoparticles that are introduced to the FeCo nanobelts demonstrate control of the complex permittivity, leading to an effective impedance matching close to 1, consequently resulting in a high reflection loss value of -42.2 dB at 12.0 GHz with only 1.6 mm thickness. In addition, the incorporation of boron nitride nanoparticles improves the thermal conductivity for the heat dissipation of the absorbed electromagnetic wave energy. Overall, the comprehensive study of nanomaterial preparation and shape modulation technologies can lead to the fabrication of an excellent EMW-absorbing flexible composite membrane.

Relationship between gut microbiota and colorectal cancer: Probiotics as a potential strategy for prevention.

Gut microbiota comprise microorganisms residing in the gastrointestinal tract. Some of these microbiota are implicated in the progression of colorectal cancer (CRC). Here, we highlight studies on the effects of meat intake and fermented foods on characteristics of gut microbiota that can influence colitis-associated factors underlying CRC. Gut microbiota can influence the development and progression of CRC, through influencing factors such as secretion of toxins; enzymes for activating carcinogenesis (including ß-glucuronidase, ß-glucosidase, azoreductase, nitroreductase, and alcohol dehydrogenase); hydrogen sulfide generation; generation of reactive oxygen species and inflammation; secondary bile salt transformation; and products of protein fermentation. Additionally, some studies that the composition of gut microbiota (probiotics) or prebiotics plays an important role in the production of short chain fatty acids, inactivation enzymes for carcinogenesis, antioxidant activities, and inhibition of pathogen colonization. In this review, we discuss various explanatory mechanisms of the relationship between the multifactorial role of the gut microbiota and the development of CRC. Moreover, this review provides fundamental information on dietary fermented food and the gut microbiota, which is helpful for healthy people and those with CRC alike.

Main mechanisms for carcinogenic heterocyclic amine reduction in cooked meat by natural materials.

Carcinogens such as heterocyclic amine (HCA), produced during meat cooking, pose a risk of digestive and reproductive cancers in humans. Nevertheless, the exact mechanisms for HCA formation in meat and the control of HCA formation are not known. In this review, we provide an overview of the main cause of HCA formation in cooked meat, fundamental data on natural materials to inhibit HCA carcinogenicity, and methods to analyze HCA in cooked meat. Related past studies has shown that natural substances contain various components that act as antioxidants, and these antioxidants can prevent HCA and mutagenic factors. Free radicals and DNA adducts produced by HCA metabolism have carcinogenic properties. Antioxidants have been found to inhibit oxidative stress caused by free radicals and DNA adducts. Therefore, we can be hypothesized that various natural materials can inhibit HCA carcinogens and mutagens.

High-throughput thermal plasma synthesis of FexCo1-x nano-chained particles with unusually high permeability and their electromagnetic wave absorption properties at high frequency (1-26 GHz).

Herein, we introduce novel 1-dimensional nano-chained FeCo particles with unusually-high permeability prepared by a highly-productive thermal plasma synthesis and demonstrate an electromagnetic wave absorber with exceptionally low reflection loss in the high-frequency regime (1-26 GHz). During the thermal plasma synthesis, spherical FeCo nanoparticles are first formed through the nucleation and growth processes; then, the high temperature zone of the thermal plasma accelerates the diffusion of constituent elements, leading to surface-consolidation between the particles at the moment of collision, and 1-dimensional nano-chained particles are successfully fabricated without the need for templates or a complex directional growth process. Systematic control over the composition and magnetic properties of FexCo1-x nano-chained particles also has been accomplished by changing the mixing ratio of the Fe-to-Co precursors, i.e. from 7 : 3 to 3 : 7, leading to a remarkably high saturation magnetization of 151-227 emu g-1. In addition, a precisely-controlled and uniform surface SiO2 coating on the FeCo nano-chained particles was found to effectively modulate complex permittivity. Consequently, a composite electromagnetic wave absorber comprising Fe0.6Co0.4 nano-chained particles with 2.00 nm-thick SiO2 surface insulation exhibits dramatically intensified permeability, thereby improving electromagnetic absorption performance with the lowest reflection loss of -43.49 dB and -10 dB (90% absorbance) bandwidth of 9.28 GHz, with a minimum thickness of 0.85 mm.

Specialist Perception of Severe Asthma in Korea: A Questionnaire Survey.

The Working Group on Severe Asthma of the Korean Academy of Allergy and Clinical Immunology recently published an expert opinion paper on the management of severe asthma in Korea. When developing a consensus, the working group encountered several diagnostic and treatment issues and decided to perform a questionnaire survey of Korean specialists with regard to severe asthma. An e-mail with a uniform resource locator link to the questionnaire was sent to 121 asthma specialists, of whom 44.6% responded. The most commonly accepted definitions of severe asthma were a history of fatal exacerbation or an asthma-triggered need for mechanical ventilation, 3-4 oral corticosteroid (OCS) bursts/year, and maintenance of OCS therapy for 3-6 months per year. Before diagnosing severe asthma, most physicians contemplate chest computed tomography, seek to control chronic rhinosinusitis, and consider poor inhaler compliance. For patients with uncontrolled severe asthma accompanied by type 2 (T2)-high inflammation, most biologics available in Korea were considered appropriate, but gaps were apparent in terms of T2-low asthma treatments. These findings about specialist perception of diagnosis and treatment of severe asthma will inform the use of emerging new drugs and facilitate personalized therapy.

A Nationwide Study of Severe Cutaneous Adverse Reactions Based on the Multicenter Registry in Korea.

BACKGROUND: Because severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) rarely occur, clinical data based on large-scale studies are still lacking. OBJECTIVE: To provide information on culprit drugs and clinical characteristics, including morbidity and mortality of SCARs based on a nationwide registry. METHODS: SCAR cases that occurred from 2010 to 2015 were recruited to the Korean SCAR registry from 34 tertiary referral hospitals. Demographics, causative drugs, causality, and clinical outcomes were collected by reviewing the medical record. RESULTS: A total of 745 SCAR cases (384 SJS/TEN cases and 361 DRESS cases) due to 149 drugs were registered. The main causative drugs were allopurinol (14.0%), carbamazepine (9.5%), vancomycin (4.7%), and antituberculous agents (6.3%). A strong preference for SJS/TEN was observed in carbonic anhydrase inhibitors (100%), nonsteroidal anti-inflammatory drugs (84%), and acetaminophen (83%), whereas dapsone (100%), antituberculous agents (81%), and glycopeptide antibacterials (78%) were more likely to cause DRESS. The mortality rate was 6.6% (SJS/TEN 8.9% and DRESS 4.2%). The median time to death was 19 days and 29 days in SJS/TEN and DRESS respectively, and 89.8% of deaths occurred within 60 days after the onset of the skin symptoms. CONCLUSION: Allopurinol, carbamazepine, vancomycin, and antituberculous agents were the leading causes of SCARs in Korea. Some drugs preferentially caused a specific phenotype. The mortality rate of SCARs was 6.6%, and most of the deaths occurred within 2 months.

Effectiveness of a computer-assisted asthma management program on physician adherence to guidelines.

BACKGROUND AND OBJECTIVE: Asthma is an example of a chronic disease for which there are evidence-based guidelines for primary care. The authors undertook this study to demonstrate that physicians' use and adherence to asthma management guidelines are improved when the guidelines are furnished in a computer-based format. METHODS: Based on established guidelines, the authors devised a practical and simple computer-assisted program focused on asthma treatment and monitoring. They then undertook a preliminary investigation, "Easy Asthma Management (EAM)" study, using this program. Finally, the authors evaluated the program's effectiveness by measuring clinical outcomes and changes in prescription patterns before and after the study. RESULTS: A total of 4682 asthma patients followed by 377 physicians were recruited, and 2187 completed the study (46.7%). The means of diurnal and nocturnal symptom scores were significantly reduced after a 3-month enrollment in the EAM study. Interestingly, the fraction of prescriptions for oral beta(2)-agonists, oral methylxanthines, and systemic steroids (oral or injection) significantly decreased after the EAM study (p = .02, p <.001, p <.001, respectively), whereas the fraction of prescriptions for inhaled forms of steroids combined with beta(2)-agonists increased significantly (p <.001). CONCLUSIONS: These findings suggest that a computer-assisted asthma management program can be used to improve the clinical outcomes of patients with asthma, and increase physician adherence to established guidelines.

Customized Asthma Control Test with reflection on sociocultural differences.

We evaluated the utility and feasibility of customizing Asthma Control Test (ACT) items to generate a Korean Asthma Control Test (KACT) specific for Korean patients. We surveyed 392 asthma patients with 19 items, selected to reflect the Korean sociocultural context. Guideline ratings were integrated with the evaluations of specialists (i.e., using both guide base rating together with specialist's rating), and items with the greatest discriminating validity were identified. Stepwise regression methods were used to select items. KACT scale scores showed significant differences between the asthma control ratings generated by integrating ratings (r=0.77, P<0.001), by specialist's evaluations (r=0.54, P<0.001), or by FEV(1) percent predicted (r=0.39, P<0.001). Specialist's and guideline ratings detected 56% and 48.6% of patients with well-controlled asthma, respectively. However, the integrated ratings indicated that only 34.3% of the patients in the test sample were well controlled. The overall agreement between KACT and the integrated rating ranged from 45% to 78%, depending on the cut-off points used. It is possible to formulate a valid, useful country-specific diagnostic tool for the assessment of asthma patients based on the original ACT that reflect differences in sociocultural context.