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Purpose@#The aim of this study was to identify the factors affecting the post-traumatic stress disorder (PTSD) symptoms of intensive care unit (ICU) nurses. The variables include event experiences, cognitive flexibility, and co-worker support. @*Methods@#A survey was conducted among 153 ICU nurses working in a general hospital or an advanced general hospital. The questionnaire was completed between October and December 2018, and 153 copies were used for the final analysis. Data were analyzed using multiple linear regression to determine the factors associated with PTSD symptoms among ICU nurses. @*Results@#The level of PTSD symptoms of ICU nurses was 1.20 ± 0.82 out of 4. Full PTSD, signified by a total score of 25 or more, was reported by 45.1% of the study's 153 participants. The significant influencing factors of PTSD symptoms among ICU nurses were the “experience of traumatic events,” “trusted alliance,” which is a subarea of “coworker support,” and both “control” and “alternative,” which are subareas of “cognitive flexibility.” The explanatory power (49.8%) was statistically significant. @*Conclusions@#These results suggest that a program to enhance the cognitive flexibility and coworker support of ICU nurses needs to be developed to reduce the PTSD symptoms of ICU nurses.
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Interstitial lung disease (ILD) involves persistent inflammation and fibrosis, leading to respiratory failure and even death. Adult tissue-derived mesenchymal stem cells (MSCs) show potential in ILD therapeutics but obtaining an adequate quantity of cells for drug application is difficult. Daewoong Pharmaceutical’s MSCs (DW-MSCs) derived from embryonic stem cells sustain a high proliferative capacity following long-term culture and expansion. The aim of this study was to investigate the therapeutic potential of DW-MSCs in experimental mouse models of ILD. DW-MSCs were expanded up to 12 passages for in vivo application in bleomycin-induced pulmonary fibrosis and collagen-induced connective tissue diseaseILD mouse models. We assessed lung inflammation and fibrosis, lung tissue immune cells, fibrosis-related gene/protein expression, apoptosis and mitochondrial function of alveolar epithelial cells, and mitochondrial transfer ability. Intravenous administration of DWMSCs consistently improved lung fibrosis and reduced inflammatory and fibrotic markers expression in both models across various disease stages. The therapeutic effect of DW-MSCs was comparable to that following daily oral administration of nintedanib or pirfenidone.Mechanistically, DW-MSCs exhibited immunomodulatory effects by reducing the number of B cells during the early phase and increasing the ratio of Tregs to Th17 cells during the late phase of bleomycin-induced pulmonary fibrosis. Furthermore, DW-MSCs exhibited antiapoptotic effects, increased cell viability, and improved mitochondrial respiration in alveolar epithelial cells by transferring their mitochondria to alveolar epithelial cells. Our findings indicate the strong potential of DW-MSCs in the treatment of ILD owing to their high efficacy and immunomodulatory and anti-apoptotic effects.
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Purpose@#Demand for genetic counseling on cancer predisposition syndrome is increasing. We evaluated the psychological effect on counselees after genetic counseling at a clinic in a single center. @*Materials and Methods@#We surveyed a total of 72 enrolled participants who visited a genetic counseling clinic at the Samsung Medical Center (SMC). The initial survey was conducted before the first genetic counseling session, and the second survey was conducted after the second genetic counseling session. A total of 43 participants completed both the initial and second surveys. @*Results@#The initial survey of 72 participants indicated higher feelings of guilt in the group with religion, higher depression and anxiety in the group with a diagnosis of self, and higher anxiety in the group on self-referral to the genetic counseling clinic.In the completed survey of 43 participants, overall decreased depression was observed after the second genetic counseling session (P=0.013). Risk perception and anxiety decreased in the group diagnosed with benign variant/variant of uncertain significance (BV/VUS, 25/3) and increased in the group diagnosed with pathogenic variant (PV, 15). Risk perception and anxiety differed between the BV/VUS and PV groups (P<0.001 and P=0.03, respectively). @*Conclusion@#The genetic counseling clinic at the SMC was effective in ameliorating the depression score. Assessment of survey results revealed different depression scores, feelings of guilt and anxiety, and different effects of the genetic counseling clinic, depending on the subgroups. Understanding the needs and psychological characteristics of different groups is necessary for improving genetic counseling services.
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Purpose@#Demand for genetic counseling on cancer predisposition syndrome is increasing. We evaluated the psychological effect on counselees after genetic counseling at a clinic in a single center. @*Materials and Methods@#We surveyed a total of 72 enrolled participants who visited a genetic counseling clinic at the Samsung Medical Center (SMC). The initial survey was conducted before the first genetic counseling session, and the second survey was conducted after the second genetic counseling session. A total of 43 participants completed both the initial and second surveys. @*Results@#The initial survey of 72 participants indicated higher feelings of guilt in the group with religion, higher depression and anxiety in the group with a diagnosis of self, and higher anxiety in the group on self-referral to the genetic counseling clinic.In the completed survey of 43 participants, overall decreased depression was observed after the second genetic counseling session (P=0.013). Risk perception and anxiety decreased in the group diagnosed with benign variant/variant of uncertain significance (BV/VUS, 25/3) and increased in the group diagnosed with pathogenic variant (PV, 15). Risk perception and anxiety differed between the BV/VUS and PV groups (P<0.001 and P=0.03, respectively). @*Conclusion@#The genetic counseling clinic at the SMC was effective in ameliorating the depression score. Assessment of survey results revealed different depression scores, feelings of guilt and anxiety, and different effects of the genetic counseling clinic, depending on the subgroups. Understanding the needs and psychological characteristics of different groups is necessary for improving genetic counseling services.
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Since the American College of Medical Genetics and Genomics and Association of Molecular Pathology published their guidelines in 2015, most interpretations of genetic tests have followed them. However, all variants have only limited evidence along 28 interpretation standards, especially de novo variants. When de novo variants, which are classified as variants of uncertain significance (VUS) due to lack of evidence, are detected, segregation in the affected family could provide an important key to clarifying the variants. Autosomal dominant polycystic kidney disease is the most common inherited kidney disorder with pathogenic variants in the PKD1 or PKD2 genes. We detected a novel in-frame deletion variant in the PKD1 gene, c.7575_7577del (p.(Cys2526del)), which was interpreted as a VUS. We analyzed this variant in a Korean family to decide for segregation. Here, we report the variant as a likely pathogenic variant based on the evidence of segregation in three affected relatives and two unaffected members.
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Background@#The poultry red mite, Dermanyssus gallinae, is a serious problem in the laying hen industry worldwide. Currently, the foremost control method for D. gallinae is the implementation of integrated pest management, the effective application of which necessitates a precise monitoring method. @*Objectives@#The aim of the study was to propose an accurate monitoring method with a reliable protocol for caged-layer poultry farms, and to suggest an objective classification for assessing D. gallinae infestation on caged-layer poultry farms according to the number of mites collected using the developed monitoring method. @*Methods@#We compared the numbers of mites collected from corrugated cardboard traps, regarding with length of sampling periods, sampling sites on cage, and sampling positions in farm buildings. The study also compared the mean numbers of mites collected by the developed method with the infestation levels using by the conventional monitoring methods in 37 caged-layer farm buildings. @*Results@#The statistical validation provided the suitable monitoring method that the traps were installed for 2 days on feed boxes at 27 sampling points which included three vertical levels across nine equally divided zones of farms. Using this monitoring method, the D. gallinae infestation level can be assessed objectively on caged-layer poultry farms. Moreover, the method is more sensitive than the conventional method in detecting very small populations of mites. @*Conclusions@#This method can be used to identify the initial stages of D. gallinae infestation in the caged-layer poultry farms, and therefore, will contribute to establishment of effective control strategies for this mite.
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Purpose@#Scoliosis is a common musculoskeletal problem in adolescents. This study aimed to identify the prevalence of adolescent idiopathic scoliosis (AIS) and its associated factors among Korean adolescents. The prevalence of thin individuals among students with AIS was compared based on body mass index (BMI) classifications. @*Methods@#This study was a secondary data analysis and used the 2016 Korean National Health Examination for School Students data. Data from 16,412 students were analyzed using descriptive statistics, Chi-square tests, and logistic regression analysis. @*Results@#The prevalence of AIS was higher in women (3.8%) than in men (1.6%), and a higher school year was a risk factor for AIS in both sexes. In woman adolescents, scoliosis was associated with thinness; however, the risk of AIS was inversely associated with overweight/obesity in both sexes. The prevalence of thin woman students with scoliosis differed based on the criteria used: 3.3% by the World Health Organization criteria and 14.3% by the International Obesity Task Force criteria. @*Conclusion@#The prevalence of thin students with scoliosis could increase by up to four times depending on the BMI criteria. For early screening of thin people at risk of AIS among female students, the criterion of International Obesity Task Force should be used as it is more permissive of thinness. This is also because of the underestimation of AIS prevalence when using the BMI Z score of the World Health Organization cutoff.
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Purpose@#Scoliosis is a common musculoskeletal problem in adolescents. This study aimed to identify the prevalence of adolescent idiopathic scoliosis (AIS) and its associated factors among Korean adolescents. The prevalence of thin individuals among students with AIS was compared based on body mass index (BMI) classifications. @*Methods@#This study was a secondary data analysis and used the 2016 Korean National Health Examination for School Students data. Data from 16,412 students were analyzed using descriptive statistics, Chi-square tests, and logistic regression analysis. @*Results@#The prevalence of AIS was higher in women (3.8%) than in men (1.6%), and a higher school year was a risk factor for AIS in both sexes. In woman adolescents, scoliosis was associated with thinness; however, the risk of AIS was inversely associated with overweight/obesity in both sexes. The prevalence of thin woman students with scoliosis differed based on the criteria used: 3.3% by the World Health Organization criteria and 14.3% by the International Obesity Task Force criteria. @*Conclusion@#The prevalence of thin students with scoliosis could increase by up to four times depending on the BMI criteria. For early screening of thin people at risk of AIS among female students, the criterion of International Obesity Task Force should be used as it is more permissive of thinness. This is also because of the underestimation of AIS prevalence when using the BMI Z score of the World Health Organization cutoff.
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PURPOSE: The aim of the study is to evaluate the current and prospective status of nursing in Korea and develop a strategic framework and plan to accommodate the increased demands on nurses in the changing health-care system. METHODS: This study used a mixed-methods approach including a literature review, an online survey with health-care consumers, expert panel interviews, and an analysis of strengths, weaknesses, opportunities, and threats to develop the strategic plans and framework. RESULTS: The vision of the strategic framework involved improving health and quality of life, and its mission was to elevate the status of Korea's nursing sector as a key health-care profession through high-quality and innovative nursing education, research, and practice. The five values in accordance with the mission and vision were innovation, creation, collaboration, excellence, and authenticity. Three strategic goals, namely, education, research, and practice, were identified, and 31 related strategic tasks were developed. CONCLUSION: In response to the rising social demand for a paradigm shift in nursing care services, there is a need for advancements in nursing education, research, and practice in Korea. This study provide some recommendations to achieve these aims.
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Cooperative Behavior , Education , Education, Nursing , Health Policy , Korea , Nurse's Role , Nursing Care , Nursing , Prospective Studies , Quality of Lifeالملخص
The commensal microbiota contributes to the maintenance of immune homeostasis in the human body. Autoimmunity can be aggravated or alleviated by the microbiota, which affects both innate and adaptive immune cells. Many studies have demonstrated the role of gut dysbiosis, the alteration of the gut microbiome, in the development and progression of numerous autoimmune diseases. Systemic sclerosis (SSc) is an autoimmune disease of the connective tissue and is characterized by skin and lung fibrosis, as well as injuries in small arteries. Recent studies have shown variable degrees of dysbiosis in SSc patients and the effect of probiotics on these patients, providing evidence for the potential link between microbiota and SSc. However, further research is needed to elucidate the key microorganisms and the mechanisms through which they affect the pathoimmunological process of SSc. This review summarizes the current knowledge regarding the association between microbiota and SSc, and discusses the changing perspectives and potential therapy strategies based on the microbiota and its products.
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Humans , Arteries , Autoimmune Diseases , Autoimmunity , Connective Tissue , Dysbiosis , Fibrosis , Gastrointestinal Microbiome , Homeostasis , Human Body , Lung , Microbiota , Probiotics , Scleroderma, Systemic , Skinالملخص
Blood group determination in dogs is an important factor in transfusion medicine to minimize immediate or delayed adverse reactions after red blood cells transfusion in small animal clinics. Dog erythrocyte antigen (DEA) 1 is the most important blood type due to its high degree of antigenicity causing acute transfusion adverse reactions. The aim of this study was to investigate the prevalence of DEA 1 in various dog breeds in Korea. As a result of testing 592 blood samples from more than 35 dog breeds, DEA 1 blood typing for each breed showed that 57.8% of Malteses, 63.3% of Poodles, 76.2% of Mastiff-like dogs, 72.5% of Pomeranians, 47.7% of Shih Tzus, 70.3% of mixed breeds, 60.0% of Yorkshire Terriers, and 71.4% of Beagles were DEA 1-positive. Miniature Schnauzers and Jindo breeds had a significantly high prevalence (100%) of DEA 1-positive dogs compared to that in other small breed dogs. This is the first report of immunochromatography-detected DEA 1 prevalence in various domestic dog breeds. Although additional studies need clarifying the potential blood transfusion risks in domestic breed dogs with DEA 1, the results of this study may be useful when selecting a blood donor.
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Blood group determination in dogs is an important factor in transfusion medicine to minimize immediate or delayed adverse reactions after red blood cells transfusion in small animal clinics. Dog erythrocyte antigen (DEA) 1 is the most important blood type due to its high degree of antigenicity causing acute transfusion adverse reactions. The aim of this study was to investigate the prevalence of DEA 1 in various dog breeds in Korea. As a result of testing 592 blood samples from more than 35 dog breeds, DEA 1 blood typing for each breed showed that 57.8% of Malteses, 63.3% of Poodles, 76.2% of Mastiff-like dogs, 72.5% of Pomeranians, 47.7% of Shih Tzus, 70.3% of mixed breeds, 60.0% of Yorkshire Terriers, and 71.4% of Beagles were DEA 1-positive. Miniature Schnauzers and Jindo breeds had a significantly high prevalence (100%) of DEA 1-positive dogs compared to that in other small breed dogs. This is the first report of immunochromatography-detected DEA 1 prevalence in various domestic dog breeds. Although additional studies need clarifying the potential blood transfusion risks in domestic breed dogs with DEA 1, the results of this study may be useful when selecting a blood donor.
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Animals , Dogs , Humans , Blood Donors , Blood Group Antigens , Blood Grouping and Crossmatching , Blood Transfusion , Erythrocytes , Chromatography, Affinity , Korea , Prevalence , Transfusion Medicine , Transfusion Reactionالملخص
Objective:To investigate the prevalence of bovine coronavirus (BCoV),bovine rotavirus,and bovine viral diarrhea virus in the feces of normal and diarrheic Korean native calves aged 1-81 days between April and October of 2016 in the Republic of Korea.Methods:Samples were obtained from 50 normal and 93 diarrheic (56 semi-formed,28 loose,and 9 watery feces)calves in six different regions of northern and southern Korea.These fecal samples were tested for BCoV,bovine rotavirus,and bovine viral diarrhea virus by RT-PCR.Results:Among the three pathogens examined,infection with BCoV was especially prominent in relation to diarrhea among calves aged 1-21 days [odds ratio (OR)=9.3,95％ confidence interval (CI):1.1-78.9;P=0.02).Infection with BCoV alone (OR=2.9;95％ CI:1.1-7.6;P=0.03) or coinfection of BCoV with bovine viral diarrhea virus (OR=3.6;95％ CI:1.0-12.4;P=0.04) was significantly associated with the development of loose feces.Grazing and colostrum intake strongly reduced the occurrence of diarrhea as compared to housed calves (OR=0.2;95％ CI:0.1-0.4;P=0.00) and calves that had not been fed colostrum (OR=0.2;95％ CI:0.1-0.7;P=0.02),respectively.Conclusions:The present study suggests that BCoV is involved in calf diarrhea in the Republic of Korea.Therefore,grazing and colostrum intake is recommended for preventing and controlling calf diarrhea caused by BCoV.
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Bovine coccidiosis is one of the most important parasitic diseases affecting calf productivity. Here, we investigated the prevalence of Eimeria spp. in pre-weaned native Korean calves and determined the correlation between diarrhea and Eimeria spp. Fecal samples were collected from individual calves (288 normal and 191 diarrheic) in 6 different farms. Of the 479 samples, Eimeria oocysts were detected in 124 calves (25.9%). Five Eimeria spp. were identified; E. zuernii (18.8%) was the most prevalent, followed by E. auburnensis (12.5%), E. bovis (7.5%), E. subspherica (5.8%), and E. bukidnonensis (1.0%). A significant correlation was observed between diarrhea and mixed infection with more than 2 Eimeria spp. (odds ratio [OR]=2.21; 95% confidence interval [CI]: 1.09–4.49; P=0.03) compared to single infection (OR=1.29; 95% CI: 0.77–2.15; P=0.33). Of the 5 Eimeria spp. identified, E. subspherica (95% CI: 1.24–5.61; P=0.01) and E. bukidnonensis (95% CI: 825.08–1,134.25; P=0.00) strongly increased the risk of diarrhea by 2.64-fold and 967.39–fold, respectively, compared to other species. Moreover, mixed infection with E. auburnensis and E. bukidnonensis was significantly associated with diarrhea (OR=2,388.48; 95% CI: 1,009.71–5,650.00; P < 0.00) in pre-weaned native Korean calves. This is the first report to demonstrate the importance of E. bukidnonensis associated with diarrhea in pre-weaned native Korean calves. Further epidemiological studies should investigate the prevalence of E. bukidnonensis and the association between E. bukidnonensis and diarrhea.
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Agriculture , Coccidiosis , Coinfection , Diarrhea , Efficiency , Eimeria , Epidemiologic Studies , Oocysts , Parasitic Diseases , Prevalenceالملخص
Objective: To investigate the prevalence of bovine coronavirus (BCoV), bovine rotavirus, and bovine viral diarrhea virus in the feces of normal and diarrheic Korean native calves aged 1-81 days between April and October of 2016 in the Republic of Korea. Methods: Samples were obtained from 50 normal and 93 diarrheic (56 semi-formed, 28 loose, and 9 watery feces) calves in six different regions of northern and southern Korea. These fecal samples were tested for BCoV, bovine rotavirus, and bovine viral diarrhea virus by RT-PCR. Results: Among the three pathogens examined, infection with BCoV was especially prominent in relation to diarrhea among calves aged 1-21 days [odds ratio (OR)=9.3, 95% confidence interval (CI): 1.1-78.9; P=0.02). Infection with BCoV alone (OR=2.9; 95% CI: 1.1-7.6; P=0.03) or co-infection of BCoV with bovine viral diarrhea virus (OR=3.6; 95% CI: 1.0-12.4; P=0.04) was significantly associated with the development of loose feces. Grazing and colostrum intake strongly reduced the occurrence of diarrhea as compared to housed calves (OR=0.2; 95% CI: 0.1-0.4; P=0.00) and calves that had not been fed colostrum (OR=0.2; 95% CI: 0.1-0.7; P=0.02), respectively. Conclusions: The present study suggests that BCoV is involved in calf diarrhea in the Republic of Korea. Therefore, grazing and colostrum intake is recommended for preventing and controlling calf diarrhea caused by BCoV.
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PURPOSE: The purpose of this study was to investigate the individual and working environment-related factors affecting hypertension among middle-aged and elderly self-employed workers in South Korea. METHODS: This was a secondary data analysis of data from the Korean Longitudinal Study of Aging (KLoSA). The study sample included 1,319 middle-aged and elderly self-employed workers who were diagnosed without hypertension and older than 45 years at Wave 1 of the KLoSA. Data were analyzed using descriptive statistics and Cox proportional hazards regression analysis using SPSS 20.0. RESULTS: About 20% of the middle-aged and elderly self-employed workers were diagnosed with hypertension within about 8 years from the baseline. the significant predictors of hypertension among the participants were age, diabetes mellitus, body mass index, frequency of health examinations, working hours per week, the presence of regular day off, and the type of job. CONCLUSION: Middle-aged and elderly self-employed workers are vulnerable to work-related health problems. In order to prevent hypertension among self-employed workers, it is necessary to improve the work environment-related factors as well as individual life styles.
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Aged , Humans , Middle Aged , Aging , Body Mass Index , Diabetes Mellitus , Hypertension , Korea , Life Style , Longitudinal Studies , Statistics as Topic , Surveys and Questionnairesالملخص
PURPOSE: The purpose of this study is to examine factors affecting quality of life among grandparents raising their grandchildren. METHODS: This study carried out a secondary analysis of data from the 2014 Korean Longitudinal Study of Aging (KLoSA) and Statistics Korea. Data collected from 224 grandparents who reported raising their grandchildren were analyzed using descriptive statistics, independent t-test, ANOVA, pearson correlation coefficient, and multilevel regression analysis. RESULTS: The mean score of the participants' quality of life was 62.63. Significant predictors of quality of life of the grandparents included subjective health status, last year's total house income, number of last year's travels, frequency of last year's movie seeing, and number of children's parks per 100,000 population. CONCLUSION: These results suggest that public health nurses in improving quality of life of grandparents focus on children's parks and formal social supports as community factors as well as regular exercise as an individual factor in order to be more effective.
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Aging , Diagnostic Self Evaluation , Grandparents , Korea , Longitudinal Studies , Multilevel Analysis , Nurses, Public Health , Quality of Lifeالملخص
Tick-borne pathogens can cause serious problems in grazing cattle. However, little information is available on tick-mediated diseases in cattle grazing on mountains. Thus, this study aimed to understand the potential problems related to tick-borne diseases in grazing cattle through the investigation of prevalent tick-transmitted infections, and their associated hematological changes, in terms of season and grazing type in Korean indigenous cattle (=Hanwoo). Hanwoo cattle from 3 regions of the Republic of Korea (=Korea) were either maintained indoors or placed on grassy mountains from spring to fall of 2014 and 2015. Cattle that grazed in mountainous areas showed a greater prevalence of tick-borne infections with an increased Theileria orientalis infection rate (54.7%) compared to that in non-grazing cattle (16.3%) (P < 0.001). Accordingly, the red blood cell (RBC) count and hematocrit (HCT) values of grazing cattle were significantly lower than those of non-grazing cattle throughout the season (P < 0.05). Moreover, RBC, hemoglobin (Hb), and HCT of T. orientalis-positive group were significantly lower than those of T. orientalis-negative group (P < 0.05). T. orientalis is a widespread tick-borne pathogen in Korea. Grazing of cattle in mountainous areas is closely associated with an increase in T. orientalis infection (RR=3.4, P < 0.001), and with consequent decreases in RBC count and HCT. Thus, these findings suggest that the Hanwoo cattle in mountainous areas of Korea are at a high risk of infection by T. orientalis, which can lead to hematological alterations. This study highlights the necessity of preventive strategies that target T. orientalis infection.
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Animals , Cattle , Erythrocytes , Hematocrit , Korea , Prevalence , Republic of Korea , Seasons , Theileria , Tick-Borne Diseasesالملخص
Acute lymphocytic leukemia (ALL) is uncommon lymphoid malignancy in dogs, and its diagnosis is challenging. A 14-year-old spayed female mixed breed dog was transferred to a veterinary medical teaching hospital for an immediate blood transfusion. The dog showed lethargy, pale mucous membranes, and a weak femoral pulse. Complete blood count revealed non-regenerative anemia and severe leukopenia with thrombocytopenia. ALL was tentatively diagnosed based on the predominance of immature lymphoblasts on blood film examination. For confirmation of lymphoid malignancy, PCR for antigen receptor rearrangement (PARR) on a peripheral blood sample and flow cytometry analysis were performed after blood transfusion. Flow cytometry analysis revealed that lymphocyte subsets were of normal composition, but PARR detected a T-cell malignancy. The dog was diagnosed with ALL and survived 1 wk after diagnosis. In conclusion, after blood transfusion, flow cytometry was not a reliable diagnostic method for an ALL dog, whereas PARR could detect lymphoid malignancy. Our results suggest that PARR should be the first-line diagnostic tool to detect canine lymphoid malignancy after a blood transfusion.
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Adolescent , Animals , Dogs , Female , Humans , Anemia , Blood Cell Count , Blood Transfusion , Diagnosis , Flow Cytometry , Hospitals, Teaching , Lethargy , Leukopenia , Lymphocyte Subsets , Methods , Mucous Membrane , Polymerase Chain Reaction , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Receptors, Antigen , T-Lymphocytes , Thrombocytopeniaالملخص
Enteral feeding therapy has existed since ancient Egypt, but most of the major advances in enteral nutrient techniques and formulas have taken place during the 20th century through the development of sources and ingredients This review provides a historical account of enteral nutrition (EN), including the sources and formulation of macro-and micro-nutrients in the formula and how to manufacture them. The formulas were improved by the development of raw materials that are easier to digest and the next formula is expected to develop functionality using more raw materials, such as ω-3, amino acid, and more functional ingredients to heal the disease.