Exploring Attitudes Toward "Sugar Relationships" Across 87 Countries: A Global Perspective on Exchanges of Resources for Sex and Companionship.

The current study investigates attitudes toward one form of sex for resources: the so-called sugar relationships, which often involve exchanges of resources for sex and/or companionship. The present study examined associations among attitudes toward sugar relationships and relevant variables (e.g., sex, sociosexuality, gender inequality, parasitic exposure) in 69,924 participants across 87 countries. Two self-report measures of Acceptance of Sugar Relationships (ASR) developed for younger companion providers (ASR-YWMS) and older resource providers (ASR-OMWS) were translated into 37 languages. We tested cross-sex and cross-linguistic construct equivalence, cross-cultural invariance in sex differences, and the importance of the hypothetical predictors of ASR. Both measures showed adequate psychometric properties in all languages (except the Persian version of ASR-YWMS). Results partially supported our hypotheses and were consistent with previous theoretical considerations and empirical evidence on human mating. For example, at the individual level, sociosexual orientation, traditional gender roles, and pathogen prevalence were significant predictors of both ASR-YWMS and ASR-OMWS. At the country level, gender inequality and parasite stress positively predicted the ASR-YWMS. However, being a woman negatively predicted the ASR-OMWS, but positively predicted the ASR-YWMS. At country-level, ingroup favoritism and parasite stress positively predicted the ASR-OMWS. Furthermore, significant cross-subregional differences were found in the openness to sugar relationships (both ASR-YWMS and ASR-OMWS scores) across subregions. Finally, significant differences were found between ASR-YWMS and ASR-OMWS when compared in each subregion. The ASR-YWMS was significantly higher than the ASR-OMWS in all subregions, except for Northern Africa and Western Asia.

Metallothionein Family Proteins as Regulators of Zinc Ions Synergistically Enhance the Anticancer Effect of Cannabidiol in Human Colorectal Cancer Cells.

Cannabidiol (CBD) is a chemical obtained from Cannabis sativa; it has therapeutic effects on anxiety and cognition and anti-inflammatory properties. Although pharmacological applications of CBD in many types of tumors have recently been reported, the mechanism of action of CBD is not yet fully understood. In this study, we perform an mRNA-seq analysis to identify the target genes of CBD after determining the cytotoxic concentrations of CBD using an MTT assay. CBD treatment regulated the expression of genes related to DNA repair and cell division, with metallothionein (MT) family genes being identified as having highly increased expression levels induced by CBD. It was also found that the expression levels of MT family genes were decreased in colorectal cancer tissues compared to those in normal tissues, indicating that the downregulation of MT family genes might be highly associated with colorectal tumor progression. A qPCR experiment revealed that the expression levels of MT family genes were increased by CBD. Moreover, MT family genes were regulated by CBD or crude extract but not by other cannabinoids, suggesting that the expression of MT family genes was specifically induced by CBD. A synergistic effect between CBD and MT gene transfection or zinc ion treatment was found. In conclusion, MT family genes as novel target genes could synergistically increase the anticancer activity of CBD by regulating the zinc ions in human colorectal cancer cells.

Factors Associated With Quality of Death in Korean ICUs As Perceived by Medical Staff: A Multicenter Cross-Sectional Survey.

OBJECTIVES: Facilitating a high quality of death is an important aspect of comfort care for patients in ICUs. The quality of death in ICUs has been rarely reported in Asian countries. Although Korea is currently in the early stage after the implementation of the "well-dying" law, this seems to have a considerable effect on practice. In this study, we aimed to understand the status of quality of death in Korean ICUs as perceived by medical staff, and to elucidate factors affecting patient quality of death. DESIGN: A multicenter cross-sectional survey study. SETTING: Medical ICUs of two tertiary-care teaching hospitals and two secondary-care hospitals. PATIENTS: Deceased patients from June 2016 to May 2017. INTERVENTIONS: Relevant medical staff were asked to complete a translated Quality of Dying and Death questionnaire within 48 hours after a patient's death. A higher Quality of Dying and Death score (ranged from 0 to 100) corresponded to a better quality of death. MEASUREMENTS AND MAIN RESULTS: A total of 416 completed questionnaires were obtained from 177 medical staff (66 doctors and 111 nurses) of 255 patients. All 20 items of the Quality of Dying and Death received low scores. Quality of death perceived by nurses was better than that perceived by doctors (33.1 ± 18.4 vs 29.7 ± 15.3; p = 0.042). Performing cardiopulmonary resuscitation and using inotropes within 24 hours before death were associated with poorer quality of death, whereas using analgesics was associated with better quality of death. CONCLUSIONS: The quality of death of patients in Korean ICUs was considerably poorer than reported in other countries. Provision of appropriate comfort care, avoidance of unnecessary life-sustaining care, and permission for more frequent visits from patients' families may correspond to better quality of death in Korean medical ICUs. It is also expected that the new legislation would positively affect the quality of death in Korean ICUs.

Comparison of normal and abnormal fertilization of in vitro-matured human oocyte according to insemination method.

AIM: Our purpose was to compare the normal fertilization rate, multi-pronuclei (PN) formation rate, and embryonic development of in vitro-matured oocytes between conventional insemination and intracytoplasmic sperm injection (ICSI). METHODS: A total of 213 stimulated in vitro fertilization (IVF) cycles were selected, in which at least one immature oocyte was obtained (from 2010 to 2014). Immature oocytes were assigned to germinal vesicle (GV)-stage or metaphase I (MI)-stage oocyte groups. Cycles with obligatory ICSI due to male-factor infertility were excluded. Cycles were divided into two groups according to fertilization method: there were 97 cycles with conventional insemination and 116 cycles with ICSI. After in vitro maturation of 324 GV-stage oocytes and 341 MI-stage oocytes, the fertilization rate, multi-PN formation rate, and embryonic development were compared according to the fertilization method. RESULTS: The normal fertilization rate was similar in the conventional insemination and the ICSI both in GV-derived and MI-derived oocytes. Both fertilization methods resulted in a similar multi-PN formation rate in GV-derived oocytes; however, in MI-derived oocytes, the multi-PN formation rate was zero with ICSI and this was significantly lower than that with conventional insemination (9.6%, P = 0.001). CONCLUSION: In non-male-factor infertility, ICSI should be considered when MI oocytes are matured.

Cytochalasin derivatives from a jellyfish-derived fungus Phoma sp.

Four new cytochalasin derivatives (1-4), together with proxiphomin (5), were isolated from a jellyfish-derived fungus Phoma sp. The planar structures and relative stereochemistry were established by analysis of 1D and 2D NMR data. The absolute configuration was defined by the modified Mosher's method. The compounds showed moderate cytotoxicity against a small panel of human solid tumor cell lines (A549, KB, and HCT116).

Prognostic value of central venous oxygen saturation and blood lactate levels measured simultaneously in the same patients with severe systemic inflammatory response syndrome and severe sepsis.

BACKGROUND: Blood lactate levels and central venous oxygen saturation (ScvO(2)) are known to be useful indicators of global tissue hypoxia. However, it is unclear whether ScvO(2) correlates with lactate levels when measured simultaneously and whether changes in ScvO(2) or lactate levels in serial measurements have prognostic value. We investigated the correlation between ScvO(2) and lactate levels measured simultaneously and their association with clinical outcomes. METHODS: We performed a prospective observational study of patients with severe systemic inflammatory response syndrome (SIRS) and severe sepsis who were admitted to the medical intensive care unit. ScvO(2) and lactate levels were measured simultaneously at the time of study enrollment, every 6 h for 24 h, and then every 24 h until the goal was reached. RESULTS: Twenty-five patients were enrolled in the study; 13 have died and 12 have survived. There was no correlation between lactate levels and ScvO(2). Neither lactate levels nor ScvO(2) at the time of admission differed between nonsurvivors and survivors. Normalization of lactate levels within 48 h was significantly associated with survival. CONCLUSIONS: In patients with severe SIRS and severe sepsis, simultaneously measured ScvO(2) and lactate levels showed no correlation, and normalization of lactate levels within 48 h was a predictive factor for survival.

A Deep Learning-Based Approach for Prediction of Vancomycin Treatment Monitoring: Retrospective Study Among Patients With Critical Illness.

BACKGROUND: Vancomycin pharmacokinetics are highly variable in patients with critical illnesses, and clinicians commonly use population pharmacokinetic (PPK) models based on a Bayesian approach to dose. However, these models are population-dependent, may only sometimes meet the needs of individual patients, and are only used by experienced clinicians as a reference for making treatment decisions. To assist real-world clinicians, we developed a deep learning-based decision-making system that predicts vancomycin therapeutic drug monitoring (TDM) levels in patients in intensive care unit. OBJECTIVE: This study aimed to establish joint multilayer perceptron (JointMLP), a new deep-learning model for predicting vancomycin TDM levels, and compare its performance with the PPK models, extreme gradient boosting (XGBoost), and TabNet. METHODS: We used a 977-case data set split into training and testing groups in a 9:1 ratio. We performed external validation of the model using 1429 cases from Kangwon National University Hospital and 2394 cases from the Medical Information Mart for Intensive Care-IV (MIMIC-IV). In addition, we performed 10-fold cross-validation on the internal training data set and calculated the 95% CIs using the metric. Finally, we evaluated the generalization ability of the JointMLP model using the MIMIC-IV data set. RESULTS: Our JointMLP model outperformed other models in predicting vancomycin TDM levels in internal and external data sets. Compared to PPK, the JointMLP model improved predictive power by up to 31% (mean absolute error [MAE] 6.68 vs 5.11) on the internal data set and 81% (MAE 11.87 vs 6.56) on the external data set. In addition, the JointMLP model significantly outperforms XGBoost and TabNet, with a 13% (MAE 5.75 vs 5.11) and 14% (MAE 5.85 vs 5.11) improvement in predictive accuracy on the inner data set, respectively. On both the internal and external data sets, our JointMLP model performed well compared to XGBoost and TabNet, achieving prediction accuracy improvements of 34% and 14%, respectively. Additionally, our JointMLP model showed higher robustness to outlier data than the other models, as evidenced by its higher root mean squared error performance across all data sets. The mean errors and variances of the JointMLP model were close to zero and smaller than those of the PPK model in internal and external data sets. CONCLUSIONS: Our JointMLP approach can help optimize treatment outcomes in patients with critical illnesses in an intensive care unit setting, reducing side effects associated with suboptimal vancomycin administration. These include increased risk of bacterial resistance, extended hospital stays, and increased health care costs. In addition, the superior performance of our model compared to existing models highlights its potential to help real-world clinicians.

Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation.

BACKGROUND: Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. METHODS: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. RESULTS: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029-1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). CONCLUSIONS: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

Pesticides in multigrains and risk assessment for Koreans by age group.

Using GC-MS/MS, 365 pesticides were analysed simultaneously in multigrains collected in the metropolitan area in 2018 and 2019. A risk assessment was performed for the detected pesticides. The limit of quantification, recovery and relative standard deviation for the pesticides ranged from 0.9-10.5 µg/kg, 70.3-89.3% and 3.0-10.3%, respectively. Among the 240 samples of multigrains, a total of 104 pesticides were detected, resulting in a detection rate of 32.9%. Out of these, 79 samples contained more than one pesticide. Risk assessment was conducted across all age groups, ranging from children to the elderly. The hazard quotient of phenothrin in glutinous rice was found to be 0.977, which was the highest in this study. However, the hazard index did not exceed 1 in any age group. These results indicated that the detected pesticides do not pose a serious public health concern. Nonetheless, regular monitoring is necessary to ascertain food safety.

Maternal Attribution, Perceptions of Parenting, and Behavior Management Strategies as Predictors of Mother-Teacher Discrepancies in Rating Behavior Problems of Korean Preschoolers.

The present study aimed to investigate mother-teacher discrepancies in reports of preschoolers' behavior problems and to examine whether maternal attribution to behavior problems, perception of parenting, and behavior management strategies predicted the discrepancies. The mothers and teachers of 384 preschoolers aged 3-6 years from 16 preschools of Seoul, South Korea, completed the Child Behavior Checklist and the Caregiver-Teacher Report Form. Based on their ratings, they were classified into three groups: (a) mother-teacher Agreement Group, (b) Disagreement Group with Mother only reporting at Risk (Disagreement Group-MR), and (c) Disagreement Group with Mother only reporting No Risk (Disagreement Group-MNR). The results showed marginal similarities between mothers' and teachers' reports of behavior problems, indicating both low correlations and differences in percentages of at-risk children. Multinomial logistic regressions revealed that maternal attribution and maternal perception of parenting difficulties predicted group membership regarding mother-teacher discrepancies. For both internalizing and externalizing problems, mothers who attributed environmental factors as primary causes of children's behavior problems were more likely to be in the Agreement Group than the Disagreement Group-MNR. With regard to externalizing problems, the more the mothers perceived parenting difficulties, the more likely they were to belong to either of the Disagreement Groups. The outcomes suggest the importance of considering that mothers' reports of children's behavior and mother-teacher discrepancies partly mirror mothers' beliefs and perceptions regarding children's behavior and parenting. Professionals need to be aware that information from mother-teacher discrepancies can be of help in understanding mothers as well as children in practice.

Benefits and harms of normal saline instillation before endotracheal suctioning in mechanically ventilated adult patients in intensive care units: A systematic literature review and meta-analysis.

OBJECTIVES: This systematic review aimed to identify the effects of normal saline instillation before endotracheal suctioning on clinical outcomes in critically ill patients on a mechanical ventilator. RESEARCH METHODOLOGY: This review was based on the guidelines of the National Evidence-based Healthcare Collaborating Agency in Korea and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Six electronic databases were searched for relevant literature. Other sources were also searched, including the reference lists of identified reports and previous systematic reviews. After the initial literature search, a two-step retrieval process was performed to select eligible studies. Then, data were collected using a newly developed form, and the risk of bias was assessed using the checklists of the Joanna Briggs Institute. Data were analyzed using both narrative syntheses and meta-analyses. RESULTS: In total, 16 studies: 13 randomized controlled trials and three quasi-experimental studies, were included. From the narrative syntheses, instilling normal saline before endotracheal suctioning was associated with a decrease in oxygen saturation, prolonged time for oxygen saturation to recover to baseline, decreased arterial pH, increased secretion amount, reduced incidence of ventilator-associated pneumonia, increased heart rate, and increased systolic blood pressure. Meta-analyses showed a significant difference in heart rate at five minutes after suctioning but no significant differences in oxygen saturation at two and five minutes after suctioning and heart rate at two minutes after suctioning. CONCLUSION: This systematic review indicated that instilling normal saline before performing endotracheal suctioning has more harmful effects than benefits. IMPLICATIONS FOR CLINICAL PRACTICE: As recommended in the current guidelines, it is necessary to refrain from routine normal saline instillation before endotracheal suctioning.

Cell death induction and intracellular vesicle formation in human colorectal cancer cells treated with Δ9-Tetrahydrocannabinol.

BACKGROUND: Δ9-Tetrahydrocannabinol (Δ9-THC) is a principal psychoactive extract of Cannabis sativa and has been traditionally used as palliative medicine for neuropathic pain. Cannabidiol (CBD), an extract of hemp species, has recently attracted increased attention as a cancer treatment, but Δ9-THC is also requiring explored pharmacological application. OBJECTIVE: This study evaluated the pharmacological effects of Δ9-THC in two human colorectal cancer cell lines. We investigated whether Δ9-THC treatment induces cell death in human colorectal cancer cells. METHODS: We performed an MTT assay to determine the pharmacological concentration of Δ9-THC. Annxein V and Western blot analysis confirmed that Δ9-THC induced apoptosis in colorectal cancer cells. Metabolic activity was evaluated using MitoTracker staining and ATP determination. We investigated vesicle formation by Δ9-THC treatment using GW9662, known as a PPARγ inhibitor. RESULTS: The MTT assay showed that treatment with 40 µM Δ9-THC and above inhibited the proliferation of colorectal cancer cells. Multiple intracytoplasmic vesicles were detected upon microscopic observation, and fluorescence-activated cell sorting analysis showed cell death via G1 arrest. Δ9-THC treatment increased the expression of cell death marker proteins, including p53, cleaved PARP-1, RIP1, and RIP3, suggesting that Δ9-THC induced the death of colorectal cancer cells. Δ9-THC treatment also reduced ATP production via changes in Bax and Bcl-2. Δ9-THC regulated intracytoplasmic vesicle formation by modulating the expression of PPARγ and clathrin, adding that antiproliferative activity of Δ9-THC was also affected. CONCLUSION: In conclusion, Δ9-THC regulated two functional mechanisms, intracellular vesicle formation and cell death. These findings can help to determine how cannabinoids can be used most effectively to improve the efficacy of cancer treatment.

Clinical Usefulness of Ultraperformance Liquid Chromatography-Tandem Mass Spectrometry Method for Low Serum Testosterone Measurement.

Background: Mass spectrometry methods exhibit higher accuracy and lower variability than immunoassays at low testosterone concentrations. We developed and validated an ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) assay for quantifying serum total testosterone. Methods: We used an ExionLC UPLC (Sciex, Framingham, MA, USA) system and a Sciex Triple Quad 6500+ (Sciex) MS/MS system in electrospray ionization and positive ion modes with multiple reaction monitoring transitions to evaluate precision, accuracy, linearity, lower limit of quantitation (LLOQ), carryover, ion suppression, stability, and reference intervals. For method comparison, we measured serum testosterone concentrations using this method in 40 subjects whose testosterone concentrations ranged from 0.14 to 55.48 nmol/L as determined using the Architect i2000 immunoassay (Abbott Diagnostics, Abbott Park, IL, USA) and in an additional 160 sera with testosterone concentrations <1.67 nmol/L. Results: The intra- and inter-run precision CVs were <2.81%, and the accuracy bias values were <3.85%, which were all acceptable. The verified linear interval was 0.03-180.84 nmol/L; the LLOQ was 0.03 nmol/L. No significant carryover and ion suppression were observed. The testosterone in serum was stable at 4°C, at -20°C, and after three freeze-thaw cycles. The reference intervals were successfully verified. The correlation was good at testosterone concentrations of 0.14-55.48 nmol/L; however, the Architect assay showed positive percent bias at concentrations <1.67 nmol/L. Conclusions: The UPLC-MS/MS assay shows acceptable performance, with a lower LLOQ than the immunoassay. This method will enable the quantitation of low testosterone concentrations.

Gastroesophageal reflux disease with laryngopharyngeal manifestation in Korea.

BACKGROUND/AIMS: Globus pharyngeus and hoarseness are common extraesophageal manifestations inpatients with gastroesophageal reflux disease. The aim of this study was to evaluate the clinical characteristics, laryngoscopic findings, endoscopic findings, and response to proton pump inhibitors in patients presenting laryngeal symptoms suspected to be caused by GERD. METHODOLOGY: We retrospectively reviewed the medical records of 160 patients that presented with globus and/or hoarseness and underwent acid suppression therapy under the impression of GERDfrom May 2003 to April 2009. RESULTS: Sixty patients(37.5%) reported classical GERD symptoms such as heartburn and/or acid regurgitation. Sixty nine percent(69%) of patients (95/138) showed abnormal laryngoscopic findings such as laryngeal edema/hyperemia, vocal cord swelling/hyperemia, arytenoids swelling/hyperemia, vocal cord nodule, vocal cord polyp, post-glottic swelling/hyperemia, etc. Endoscopically, 41.9%(39/93) showed normal endoscopic findings and 49.5% (46/93) showed minimal changes. 8.6% (8/93)of patients showed erosive reflux disease. Therapeutic response was not significantly different among patients treated with standard dose PPIs (44/58, 75.9%),half dose PPIs (17/22, 77.3%), or revaprazan (18/21,85.7%). CONCLUSIONS: Among patients with globus pharyngeus and/or hoarseness and suspected GERD, only 37.5% reported classical symptoms of GERD such as heartburn and/or acid regurgitation, 69% showed ab-normal laryngoscopic findings, 58.1% showed abnormal endoscopic findings, and 80% showed therapeutic response to acid suppression therapy.

Change in management and outcome of mechanical ventilation in Korea: a prospective observational study.

BACKGROUND/AIMS: There are few studies describing contemporary status of mechanical ventilation in Korea. We investigated changes in management and outcome of mechanical ventilation in Korea. METHODS: International, prospective observational cohort studies have been conducted every 6 years since 1998. Korean intensive care units (ICUs) participated in 2010 and 2016 cohorts. We compared 2016 and 2010 Korean data. RESULTS: Two hundred and twenty-six patients from 18 ICUs and 275 patients from 12 ICUs enrolled in 2016 and 2010, respectively. In 2016 compared to 2010, use of non-invasive ventilation outside ICU increased (10.2% vs. 2.5%, p = 0.001). Pressure-control ventilation was the most common mode in both groups. Initial tidal volume (7.1 mL/kg vs. 7.4 mL/kg, p = 0.372) and positive end-expiratory pressure (6 cmH2O vs. 6 cmH2O, p = 0.141) were similar, but peak pressure (22 cmH2O vs. 24 cmH2O, p = 0.011) was lower in 2016. More patients received sedatives (70.7% vs. 57.0%, p = 0.002) and analgesics (86.5% vs. 51.1%, p < 0.001) in 2016. The awakening (48.4% vs. 31.0%, p = 0.002) was more frequently attempted in 2016. The accidental extubation rate decreased to one tenth of what it was in 2010 (1.1% vs. 10.2%, p < 0.001). The ICU mortality did not change (31.4% 35.6%, p = 0.343) but ICU length of stay showed a decreasing trend (9 days vs. 10 days, p = 0.054) in 2016. CONCLUSION: There were temporal changes in care of patients on mechanical ventilation including better control of pain and agitation, and active attempt of awakening.

Effects of multistrain probiotic-containing yogurt on second-line triple therapy for Helicobacter pylori infection.

BACKGROUND AND AIMS: The adjuvant effects of probiotic-containing yogurt on second-line triple therapy for Helicobacter pylori (H. pylori) infection have not been evaluated. METHODS: A total of 337 patients with persistent H. pylori infection, after first-line triple therapy, were randomly assigned to receive either triple therapy with (yogurt group, n=151) or without (control group, n=186) Will yogurt. Triple therapy consisted of 400 mg moxifloxacin q.d., 1000 mg amoxicillin b.i.d., and 20 mg esomeprazole b.i.d. for 14 days. Will yogurt contains Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium longum, and Streptococcus thermophilus. H. pylori eradication was evaluated by the (13)C-urea breath test, histology, or the rapid urease test. RESULTS: The eradication rates by intention-to-treat analysis were 66.7% and 68.9% in the control and yogurt groups, respectively (P=0.667). The eradication rates by per-protocol analysis were 78.5% and 86% in the control and the yogurt groups, respectively (P=0.110). The adverse event rates were 25.3% and 28.5% in the control group and yogurt group, respectively (P=0.508). CONCLUSIONS: The addition of yogurt containing probiotics to moxifloxacin-containing second-line treatment neither improved H. pylori eradication rates nor reduced the adverse events of treatment.

Reliability of the Korean version of the Richards-Campbell Sleep Questionnaire.

BACKGROUND: Sleep disorders are common in critically ill patients. Unfortunately, sleep assessment is challenging in many intensive care units (ICUs). The Richards-Campbell Sleep Questionnaire (RCSQ) is a simple subjective tool that has been validated and used in many countries. This study aimed to evaluate the reliability of the Korean version of the RCSQ (K-RCSQ). METHODS: This prospective, cross-sectional, observational study was conducted in the ICUs of two hospitals. In total, 52 consenting patients answered questionnaires regarding their previous night's sleep (K-RCSQ) and the noise they experienced (range, 0-100). RESULTS: The K-RCSQ showed excellent internal consistency of 0.960 by Cronbach's alpha. The mean total score of the K-RCSQ was 41.9±28.9 (range, 0-100). The mean perceived ICU noise score was 40.7±28.1 (range, 0-90). There was a significant linear correlation between noise score and average K-RCSQ score (r=-0.37, P<0.001). CONCLUSIONS: The K-RCSQ demonstrated excellent reliability (internal consistency). This simple tool may help assess sleep quality in critically ill patients and improve the quality of ICU care.

Differences in the Severity and Variability of Restricted and Repetitive Behaviors in ASD Children With and Without Service Experiences.

BACKGROUND: Despite the importance of restricted and repetitive behaviors (RRBs) in diagnosing autism spectrum disorder (ASD), specific RRBs that distinguish children with ASD who are receiving services from those who have ASD but are unidentified and untreated until school age remain unclear. This study examined the differences in the severity and variability of RRBs among three groups (ASD with service experiences [ASDws], ASD without service experiences [ASDwos], and No ASD) and investigated specific RRBs predicting group membership. METHOD: A total of 296 children who screened positive for ASD completed confirmative diagnostic assessments. The severity and variability scores of RRBs were obtained using 16 items of the Autism Diagnostic Interview-Revised. RESULTS: Both ASD groups had higher proportions of children with severe RRBs for the majority of RRBs and exhibited a greater number of RRBs than the No ASD group. However, discrepancies between the ASDwos and the No ASD groups were not as apparent as those between the ASDws and the No ASD groups. RRBs characterized by a repetitive motor/physical component and unusual sensory responses differentiated the ASDws group from the ASDwos group. Conversely, RRBs characterized by rigid adherence to routine, and ritualistic behavior increased the odds of membership in the ASDwos group over the No ASD group. CONCLUSIONS: Our results may improve the ability of clinicians and parents to detect ASD in the community by observing specific RRBs, especially in cognitively intact school-aged children who show significant compulsive/ritualistic behaviors and rigidity to routines/sameness RRBs, even in the absence of multiple RRBs or severe repetitive sensorimotor behaviors.

Efficacy of dual progesterone administration (intramuscular and vaginal) for luteal support in fresh day 3 or day 4 embryo transfer cycles.

OBJECTIVE: The aim of this study was to compare in vitro fertilization outcomes between fresh day 3 or day 4 embryo transfer cycles with dual progesterone (P) administration (intramuscular and vaginal) and cycles with single intramuscular P administration for luteal support. METHODS: We selected 124 cycles from 100 women (under age 40 years) who underwent oocyte pick-up (number of trials ≤ 3, 4-14 oocytes obtained) and transfer of two or three day 3 or day 4 embryos at two infertility centers from January 2014 to June 2019. Dual P (intramuscular P [50 mg] daily+vaginal P) was used in 52 cycles and a single intramuscular administration of P (50 mg daily) was used in 72 cycles. RESULTS: Women's age, infertility factors, number of oocytes retrieved, number of transferred embryos, and mean embryo score were similar between the dual P group and the single P group. Although the number of trial cycles was significantly higher (1.9 vs. 1.5), and the mean endometrial thickness on the trigger day (10.0 mm vs. 11.0 mm) was significantly lower in the dual P group, the implantation rate, clinical pregnancy rate, ongoing pregnancy rate, and miscarriage rate for both day 3 and day 4 transfers were similar between the two groups. CONCLUSION: In fresh day 3 or day 4 embryo transfer cycles, dual P administration did not demonstrate any clinical advantages. Intramuscular P alone appears to be sufficient for luteal support.

Risk factors for recurrence of vaginal intraepithelial neoplasia in the vaginal vault after laser vaporization.

BACKGROUND: We sought to investigate risk factors for recurrence of vaginal intraepithelial neoplasia (VAIN) in the vaginal vault after laser vaporization. MATERIALS AND METHODS: Among 162 patients treated with laser vaporization in the vaginal vault after hysterectomy between March 1998 and August 2007, the clinical data of 68 patients were reviewed retrospectively. They underwent hysterectomy before laser vaporization due to the International Federation of Gynecology and Obstetrics (FIGO) stage Ia1-Ib1 cervical cancer (n = 17), cervical carcinoma in situ (CIS, n = 18), cervical intraepithelial neoplasia (CIN) (CIN I, n = 4; CIN II, n = 9; CIN III, n = 12), leiomyoma (n = 5) and endometrial polyp (n = 3). All patients were diagnosed as VAIN I (n = 24), VAIN II (n = 18) and VAIN III (n = 26) in the vaginal vault before laser vaporization. Risk factors for recurrence of VAIN in the vaginal vault after laser vaporization were investigated by multivariate logistic regression analysis. RESULTS: The median age was 48 years (range, 32-74 years), and the median duration of follow-up was 33 months (range, 10-115 months). Among all patients, 18 (26.5%) showed disease recurrence. Age (< or =48 years) and VAIN III in the vaginal vault before laser vaporization were risk factors for recurrence after laser vaporization (age < or =48 years, adjusted OR, 2.07, 95% CI, 1.18-7.01; VAIN III in the vaginal vault before laser vaporization, adjusted OR, 8.42, 95% CI, 1.63-18.56). CONCLUSION: Laser vaporization may be a feasible method for the treatment of VAIN in the vaginal vault after hysterectomy. However, age (< or =48 years) and VAIN III in the vaginal vault before laser vaporization should be considered as risk factors for recurrence after laser vaporization.