Association Between Individual Air Pollution (PM 10 , PM2.5) Exposure and Adverse Pregnancy Outcomes in Korea: A Multicenter Prospective Cohort, Air Pollution on Pregnancy Outcome (APPO) Study

Background@#Prenatal exposure to ambient air pollution is linked to a higher risk of unfavorable pregnancy outcomes. However, the association between pregnancy complications and exposure to indoor air pollution remains unclear. The Air Pollution on Pregnancy Outcomes research is a hospital-based prospective cohort research created to look into the effects of aerodynamically exposed particulate matter (PM) 10 and PM 2.5 on pregnancy outcomes. @*Methods@#This prospective multicenter observational cohort study was conducted from January 2021 to June 2023. A total of 662 women with singleton pregnancies enrolled in this study. An AirguardK ® air sensor was installed inside the homes of the participants to measure the individual PM 10 and PM 2.5 levels in the living environment. The time–activity patterns and PM 100 and PM 2.5 , determined as concentrations from the time-weighted average model, were applied to determine the anticipated exposure levels to air pollution of each pregnant woman. The relationship between air pollution exposure and pregnancy outcomes was assessed using logistic and linear regression analyses. @*Results@#Exposure to elevated levels of PM 10 throughout the first, second, and third trimesters as well as throughout pregnancy was strongly correlated with the risk of pregnancy problems according to multiple logistic regression models adjusted for variables. Except for in the third trimester of pregnancy, women exposed to high levels of PM 2.5 had a high risk of pregnancy complications. During the second trimester and entire pregnancy, the risk of preterm birth (PTB) increased by 24% and 27%, respectively, for each 10 μg/m 3 increase in PM 10. Exposure to high PM 10 levels during the second trimester increased the risk of gestational diabetes mellitus (GDM) by 30%. The risk of GDM increased by 15% for each 5 μg/m 3 increase in PM2.5 during the second trimester and overall pregnancy, respectively. Exposure to high PM 10 and PM 2.5 during the first trimester of pregnancy increased the risk of delivering small for gestational age (SGA) infants by 96% and 26%, respectively. @*Conclusion@#Exposure to high concentrations of PM 10 and PM 2.5 is strongly correlated with the risk of adverse pregnancy outcomes. Exposure to high levels of PM10 and PM2.5 during the second trimester and entire pregnancy, respectively, significantly increased the risk of PTB and GDM. Exposure to high levels of PM 10 and PM2.5 during the first trimester of pregnancy considerably increased the risk of having SGA infants. Our findings highlight the need to measure individual particulate levels during pregnancy and the importance of managing air quality in residential environment.

Interprofessional Education Collaboration between Chung Ang Medical School and Sungshin Nursing School / 의학교육논단

Interprofessional collaboration is crucial for patient-centered care and safety. Since healthcare students will be part of interprofessional teams in the future, they need to understand the unique contributions of various healthcare professions to patient care and develop skills in collaboration, communication, leadership, and mutual respect. In response to this need, healthcare faculties have adopted interprofessional education as an innovative teaching method. However, traditional health education has typically taken place within individual schools, resulting in a limited understanding of other professional roles and identities. In our study, we introduced an interprofessional education model involving two different colleges. A total of 152 undergraduate students, comprising 101 medical students from Chung Ang University and 51 nursing students from Sungshin Women’s University, participated in the program. A one-day interprofessional education program was conducted to promote collaboration between medical and nursing students. The program included team building and communication games, scenario-based simulations, such as a “room of errors,” and tabletop exercises. Key factors for successful interprofessional education include carefully planned scheduling, leadership, and commitment from participating colleges, faculty support and training, the use of diverse teaching methods and technology, and alignment regarding educational directions among the faculty. We believe that this model may provide valuable insights for healthcare institutions aiming to develop and implement interprofessional curricula.

A Rare Case of Methotrexate Induced Pancreatitis in Ectopic Pregnancy / 이화의대지

Ectopic pregnancy (EP) refers to blastocyst implantation outside the uterine endometrium. EP is major cause of maternal morbidity and mortality. Treatment options include surgery, medical therapy with methotrexate, or expectant management. Methotrexate is the primary regimen used in cases of early, unruptured ectopic pregnancies. Most side effects of methotrexate are minor, including nausea, vomiting, abdominal discomfort, and photosensitive skin reaction. Serious side effects, including bone marrow suppression, and pulmonary fibrosis, are invariably observed when methotrexate is administered in high doses with frequent dosing intervals, in chemotherapeutic protocols for malignancy. These side effects are uncommon with the doses used to treat ectopic pregnancies. Since cases of methotrexate-induced pancreatitis are rare, we report a case of pancreatitis in a patient with EP treated with methotrexate and expect to consider pancreatitis as a side effect of methotrexate in a patient with upper abdominal pain undergoing methotrexate chemotherapy.

Influence of Fall-related Perception on Behavioral Intention of Fall Prevention among Hospitalized Older Patients / 기본간호학회지

Purpose@#This study aimed 1) to identify hospitalized older patients' fall-related perceptions (including subjective fall risk assessment, confidence in performing fall risk behavior, fear of falling, and recognition of fall consequences) and behavioral intention for fall prevention, and 2) to investigate the influence of fall-related perceptions on the behavioral intention for fall prevention. @*Methods@#A cross-sectional survey was conducted among 150 hospitalized older patients admitted to a large general hospital. A structured questionnaire was administered from October 1, 2020 to January 31, 2021. Cohen's kappa and multiple linear regression analysis were utilized to analyze the data. @*Results@#The average scores were 1.43±0.65 for the subjective fall risk assessment, 4.08±0.44 for confidence in performing fall risk behavior, and 2.04±0.61 for the behavioral intention for fall prevention, on a 1~5 scale, with higher scores indicating higher levels of the attributes. They had an average of 1.48±0.56 for fear of falling and 2.43±0.35 for the recognition of fall consequences, on a 1~4 scale. Low agreement was found between the subjective fall risk assessment by hospitalized elderly patients and the objective fall risk assessment by nurses using the Morse Fall Scale. The hospitalized elderly patients' subjective fall risk assessment, confidence in performing fall risk behavior, and fear of falling were significant factors influencing behavioral intention for fall prevention. @*Conclusion@#The approach to preventing falls among hospitalized older patients should include assessing fall-related perceptions and providing education to correct inappropriate perceptions about falls.

Comparisons of System Thinking and Innovative Behavior Among Students, Managers, and Educators in Nursing through Game-based Table-top Simulation / 의료커뮤니케이션

Purpose@# : This study investigated the differences in system thinking and innovative behavior among nursing students, nursing managers, and nursing educators by implementing a table-top simulation. @*Methods@# : This study used a non-equivalent pretest-posttest design. The game-based table-top simulation, Friday night at the ER® was separately implemented to three groups including 14 nursing students (on April 13, 2021), 15 nursing managers (on April 29, 2021), and 14 nursing educators (on January 25, 2022). The system thinking scale and innovative behavior scale were used to measure the effect of table-top simulation. Wilcoxon signed rank and Kruskal-Wallis test were utilized using the SPSS program for data analysis. @*Results@# : There was no statistically significant increase in the pre- and post-scores of system thinking in each group. However, the innovative behavior scores significantly increased in all groups after simulation. There were no significant differences in systems thinking and innovative behavior among the three groups. @*Conclusion@# : The game-based table-top simulation provides motivation for innovative behavior through communication and teamwork among team members.

CD5 Expression Dynamically ChangesDuring the Differentiation of Human CD8+ T Cells Predicting Clinical Response to Immunotherapy

Defining the molecular dynamics associated with T cell differentiation enhances our understanding of T cell biology and opens up new possibilities for clinical implications. In this study, we investigated the dynamics of CD5 expression in CD8+ T cell differentiation and explored its potential clinical uses. Using PBMCs from 29 healthy donors, we observed a stepwise decrease in CD5 expression as CD8+ T cells progressed through the differentiation stages. Interestingly, we found that CD5 expression was initially upregulated in response to T cell receptor stimulation, but diminished as the cells underwent proliferation, potentially explaining the differentiation-associated CD5 downregulation. Based on the proliferationdependent downregulation of CD5, we hypothesized that relative CD5 expression could serve as a marker to distinguish the heterogeneous CD8+ T cell population based on their proliferation history. In support of this, we demonstrated that effector memory CD8+ T cells with higher CD5 expression exhibited phenotypic and functional characteristics resembling less differentiated cells compared to those with lower CD5 expression. Furthermore, in the retrospective analysis of PBMCs from 30 non-small cell lung cancer patients, we found that patients with higher CD5 expression in effector memory T cells displayed CD8+ T cells with a phenotype closer to the less differentiated cells, leading to favorable clinical outcomes in response to immune checkpoint inhibitor (ICI) therapy. These findings highlight the dynamics of CD5 expression as an indicator of CD8+ T cell differentiation status, and have implications for the development of predictive biomarker for ICI therapy.

Effects of Group Reminiscence Therapy Based on Korean Traditional Play for Mild Cognitive Impairment and Dementia Patients

Objective@#This study explored the efficacy of group reminiscence therapy, incorporating traditional plays, for individuals with mild cognitive impairment (MCI) and dementia patients. @*Methods@#We provided 10 sessions of group reminiscence therapy to 25 MCI and dementia patients. We conducted assess-ments, both before and after the program, encompassing a range of tests, namely the Mini-Mental Status Examination (MMSE), Dysexecutive Questionnaire, Zarit Burden Interview (ZBI-K), Dementia Care Assessment Packet-Instrumental Activities of Daily Living, Geriatric Depression Scale (GDS-K), and Neuropsychiatric Inventory (NPI-K). @*Results@#Following the program, there was a significant improvement in MMSE scores for MCI patients (19.17 to 22.33, p=0.027). There was a significant improvement in NPI-K scores for dementia patients (8.05 to 3.74, p=0.006). There was a sig-nificant improvement in GDS-K scores for MCI patients (17.00 to 14.00, p=0.043). There was a significant improvement in ZBIK scores for dementia (28.53 to 17.68, p=0.001) and MCI patients (29.17 to 16.33, p=0.046). @*Conclusion@#Our study suggested that group reminiscence therapy based on traditional play might be effective in global cog-nition of MCI patients, neuropsychological symptoms of dementia patients, depression of MCI patients, and caregiver burden of all subjects.

Non-epitheliotropic Cutaneous T-cell lymphoma in a cat: a case report

Cutaneous lymphoma is rare in cats. An 11-year-old spayed female Persian cat presented with crust, ulceration, and multiple nodules on the shoulder and forelimb for 2 months. Computed tomography revealed a diffuse, irregularly margined lesion in the dorsal cutis extending from cervical to thoracic vertebrae. Cytological evaluation predominantly revealed large round cells with multilobulated nuclei and basophilic cytoplasm. Histopathological examination confirmed round CD3+/PAX5- cells packed in the dermis. Thus, the diagnosis of non-epitheliotropic cutaneous lymphoma with a diffuse large T-cell type was made. The disease progressed rapidly for the next 2 weeks, and the owner elected humane euthanasia.

Two Clinical Cases of Feline Hemoplasmosis in Korea

Feline hemotropic mycoplasmosis (hemoplasmosis) is an infection of the red blood cells caused by the Mycoplasma haemofelis (Mhf), Candidatus Mycoplasma haemominutum (CMhm), and Candidatus Mycoplasma turicensis (CMt). The existence of Mhf, CMhm, and CMt has been demonstrated in feral cats in Korea using molecular methods, but no clinical cases have yet been reported. This study reports 2 clinical cases of hemotropic mycoplasmosis caused by CMhm and CMt in 2 anemic cats. The first case was a client-owned intact female domestic shorthair cat that presented with fever, pale mucous membranes, and normocytic normochromic non-regenerative anemia. Prior to referral, an immunosuppressive prednisolone dose was administered at the local veterinary clinic for 1 month. The cat was diagnosed with high-grade alimentary lymphoma. Organisms were found on the surface of the red blood cells on blood smear examination. The second case was of a rescued cat that presented with dehydration and fever. The cat had normocytic normochromic non-regenerative anemia. Necropsy revealed concurrent feline infectious peritonitis. Polymerase chain reaction assay targeting 16S rRNA revealed CMhm infection in case 1 and dual infection of CMhm and CMt in case 2. Normocytic normochromic non-regenerative anemia was observed in both cats before and during the management of the systemic inflammation. This is the first clinical case report in Korea to demonstrate CMhm and CMt infections in symptomatic cats.

18F-THK5351 PET Positivity and Longitudinal Changes in Cognitive Function in β-Amyloid-Negative Amnestic Mild Cognitive Impairment

Purpose@#Neuroinflammation is considered an important pathway associated with several diseases that result in cognitive decline. 18F-THK5351 positron emission tomography (PET) signals might indicate the presence of neuroinflammation, as well as Alzheimer’s disease-type tau aggregates. β-amyloid (Aβ)-negative (Aβ–) amnestic mild cognitive impairment (aMCI) may be associated with non-Alzheimer’s disease pathophysiology. Accordingly, we investigated associations between 18F-THK5351 PET positivity and cognitive decline among Aβ– aMCI patients. @*Materials and Methods@#The present study included 25 amyloid PET negative aMCI patients who underwent a minimum of two follow-up neuropsychological evaluations, including clinical dementia rating-sum of boxes (CDR-SOB). The patients were classified into two groups: 18F-THK5351-positive and -negative groups. The present study used a linear mixed effects model to estimate the effects of 18F-THK5351 PET positivity on cognitive prognosis among Aβ– aMCI patients. @*Results@#Among the 25 Aβ– aMCI patients, 10 (40.0%) were 18F-THK5351 positive. The patients in the 18F-THK5351-positive group were older than those in the 18F-THK5351-negative group (77.4±2.2 years vs. 70.0±5.5 years; p<0.001). There was no difference between the two groups with regard to the proportion of apolipoprotein E ε4 carriers. Interestingly, however, the CDR-SOB scores of the 18F-THK5351-positive group deteriorated at a faster rate than those of the 18F-THK5351-negative group (B=0.003, p=0.033). @*Conclusion@#The results of the present study suggest that increased 18F-THK5351 uptake might be a useful predictor of poor prognosis among Aβ– aMCI patients, which might be associated with increased neuroinflammation (ClinicalTrials.gov NCT02656498).

Difference of Perceived Readiness for Interprofessional Learning among Medical and Nursing Students after Simulation-based Interprofessional Education / 의료커뮤니케이션

Background@#The purpose of this study was to investigate the differences of readiness for interporfessional learning before and after applying a simulation-based interprofessional education (sim-IPE) program among medical and nursing students. @*Methods@#This study used one-group pretest-posttest design. A sim-IPE program was implemented for 94 medical and 41 nursing students during half a day. The program was consisted of team building games, simulation, board games, and case discussion. The readiness for interprofessional learning scale (RIPLS) which is a 5-point Likert type and has four domains was used to assess students’ perceptions pre- and post-IPE program. Also, students were requested to write three words that immediately came to mind when they saw a word of ‘teamwork’. Data were analyzed by frequency, mean and standard deviation, paired t-test, and Cronbach’s alpha. @*Results@#A total scores of RIPLS significantly increased from 78.3 to 86.7 points after implementing a simulation-based IPE program (t=-14.80, p<.001). Among the most submitted words by students, a ranking of ‘communication’ has risen from fifth pre-IPE to second post-IPE. @*Conclusions@#Based on the results form our study, a simulation-based IPE program provides a very valuable educational opportunity for students to increase positive attitude to interprofessional learning. A variety of IPE programs should be developed and incorporated in all healthcare professional curriculums.

Effects of Open Kinetic Chain Exercise for the Gastrocnemius and Tibialis Anterior Muscles on Balance

Purpose@#This study investigated the effects of open kinetic chain (OKC) exercise for the gastrocnemius (GCM) and tibialis anterior (TA) muscles on static and dynamic balance and muscle strength. @*Methods@#We recruited 21 healthy participants, dividing them into 3 groups (GCM, TA, and non-exercise). Each group contains 7 participants. Two exercise groups (GCM and TA) performed OKC exercise with elastic bands twice per week for 4 weeks, while non-exercise group did nothing. We obtained the data for static and dynamic balance and muscle strength before and after the intervention. We used the Kruskal–Wallis test to compare and analyze the pre–post-intervention differences among the groups. @*Results@#For static balance, the stability index of the TA group was the lowest for the dynamic platform (p < 0.05). The dynamic balance of the TA group increased for the anterior and posteromedial directions (p < 0.05). The peak torque increased in the TA group for dorsiflexion (D/F) movement and in the GCM group for plantar flexion movement compared with the other groups, except for the left direction during D/F (p < 0.05). @*Conclusion@#OKC exercises with elastic bands were effective for selectively increasing muscle strength. It is clinically thought that strength training for TA muscles will be effective among the muscles of the ankle.

Vaginal health in women and the possibility of predicting preterm birth through microbiome analysis

With the recent development of next-generation sequencing technology, the microbiome in the body is being revealed in detail. It is also possible to describe the normal vaginal microenvironment and, more specifically, any changes in pregnancy. Moreover, we present the hypothesis that the microbiome is a contributing factor to preterm birth (PTB).Current Concepts: High estrogen status stimulates the maturation and proliferation of vaginal epithelial cells and the accumulation of glycogen, which promotes lactic acid production and maintains the vaginal environment at an acidic pH. The vaginas of most premenopausal women are predominantly colonized by Lactobacillus which plays an important role in local defense. Recently, it has also been reported that there are several specific types of Lactobacillus species, while other anaerobes, including Gardnerella and Atopobium also coexist in the vagina. Vaginal dysbiosis is defined as various expressions of microorganisms, secretion of specific metabolites, and changes in pH. During pregnancy, a multitude of microbiome changes occur in the oral cavity, gut, vagina, and placenta. The risk of PTB increases if the microbiome changes to one of dysbiosis. It is possible to analyze the characteristic microbiome composition related to PTB and to develop biomarkers predicting PTB. It is necessary to educate patients based on these findings.Discussion and Conclusion: Microbiome analysis has contributed significantly to understanding the association between women’s vaginal health and PTB. Continued research will also contribute to public health by assisting in the prediction and prevention of PTB.

Prevalence and Incidence of Dementia in South Korea:A Nationwide Analysis of the National Health Insurance Service Senior Cohort

Background@#and Purpose Dementia is rapidly becoming more common in the elderly population of South Korea, and there are regional difference in its demographics. This study investigated the trajectories in the prevalence and incidence of dementia based on the Seoul metropolitan area and other areas in South Korea using big data from the National Health Insurance Service (NHIS). @*Methods@#We examined a population-based elderly cohort obtained from the NHIS Senior Cohort (NHIS-SC) data set that comprises approximately half a million recipients of medical insurance in South Korea during 2003–2015. The age-standardized prevalence and incidence of dementia as well as their trajectories from 2003 were estimated. Regional differences in these rates between Seoul metropolitan area and other areas were also analyzed. @*Results@#The standardized prevalence of dementia per 100,000 increased significantly from 178.11 in 2003 to 5,319.01 in 2015 (p<0.001). The standardized prevalence of dementia was higher in other areas than in Seoul metropolitan area. The standardized incidence of dementia per 100,000 person-years also increased significantly, from 126.41 in 2003 to 2,218.25 in 2015 (p<0.001). The standardized incidence of dementia was similarly higher in other areas than in Seoul metropolitan area (p<0.001). @*Conclusions@#This study has shown that the standardized prevalence and incidence of dementia increased steadily from 2003 to 2015 in South Korea based on the NHIS-SC data set, and differed between Seoul metropolitan area and other areas.

Effects of Electrical Automatic Massage on Cognition and Sleep Quality in Alzheimer’s Disease Spectrum Patients: A Randomized Controlled Trial

Purpose@#Muscle relaxation following electrical automatic massage (EAM) has been found to reduce fatigue, depression, stress, anxiety, and pain in individuals with various conditions. However, the effects of EAM have not been extensively explored in patients with Alzheimer’s disease (AD). @*Materials and Methods@#Here, we conducted a randomized controlled study to evaluate the effects of EAM on the cognitive and non-cognitive functions of patients with AD spectrum disorders. @*Results@#We found that EAM attenuated changes in attention-associated cognitive scores and subjective sleep quality relative to those in controls. @*Conclusion@#While further studies in a clinical setting are needed to support our findings, these encouraging results suggest that EAM may be an alternative therapy for the management of associated symptoms in AD (ClinicalTrials.gov ID: NCT03507192, 24/04/2018).

Cohort profile: the Ewha Birth and Growth Study / 한국역학회지

With the introduction of life-course epidemiology, researchers realized the importance of identifying risk factors in early life to prevent chronic diseases. This led to the establishment of the Ewha Birth and Growth Study in 2001; the study is a prospective birth cohort designed to provide evidence of early life risk factors for a child’s growth and health. Participants were recruited from those who visited Ewha Womans University Mokdong Hospital (a tertiary hospital in southwest Seoul, Korea) for prenatal care at 24-28 weeks of gestation. In total, 891 mothers enrolled in this study between 2001 and 2006 and their offspring (n=940) were followed-up. Regular check-up examinations of offspring were conducted at 3 years, 5 years, and 7 years of age and every year thereafter. To consider age-related health issues, extensive data were collected using questionnaires and measurements. In 2021, the study subjects will reach 19 years of age, and we are planning a check-up examination for early adulthood. About 20 years have passed since the cohort data were collected, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. Recently, we started reporting on topics related to adolescent health. The findings will facilitate identification of early life risk factors for chronic diseases and the development of interventions for diseases later in life.

Cohort profile: the Ewha Birth and Growth Study / 한국역학회지

With the introduction of life-course epidemiology, researchers realized the importance of identifying risk factors in early life to prevent chronic diseases. This led to the establishment of the Ewha Birth and Growth Study in 2001; the study is a prospective birth cohort designed to provide evidence of early life risk factors for a child’s growth and health. Participants were recruited from those who visited Ewha Womans University Mokdong Hospital (a tertiary hospital in southwest Seoul, Korea) for prenatal care at 24-28 weeks of gestation. In total, 891 mothers enrolled in this study between 2001 and 2006 and their offspring (n=940) were followed-up. Regular check-up examinations of offspring were conducted at 3 years, 5 years, and 7 years of age and every year thereafter. To consider age-related health issues, extensive data were collected using questionnaires and measurements. In 2021, the study subjects will reach 19 years of age, and we are planning a check-up examination for early adulthood. About 20 years have passed since the cohort data were collected, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. Recently, we started reporting on topics related to adolescent health. The findings will facilitate identification of early life risk factors for chronic diseases and the development of interventions for diseases later in life.

Prevalence and Incidence of Dementia in South Korea:A Nationwide Analysis of the National Health Insurance Service Senior Cohort

Background@#and Purpose Dementia is rapidly becoming more common in the elderly population of South Korea, and there are regional difference in its demographics. This study investigated the trajectories in the prevalence and incidence of dementia based on the Seoul metropolitan area and other areas in South Korea using big data from the National Health Insurance Service (NHIS). @*Methods@#We examined a population-based elderly cohort obtained from the NHIS Senior Cohort (NHIS-SC) data set that comprises approximately half a million recipients of medical insurance in South Korea during 2003–2015. The age-standardized prevalence and incidence of dementia as well as their trajectories from 2003 were estimated. Regional differences in these rates between Seoul metropolitan area and other areas were also analyzed. @*Results@#The standardized prevalence of dementia per 100,000 increased significantly from 178.11 in 2003 to 5,319.01 in 2015 (p<0.001). The standardized prevalence of dementia was higher in other areas than in Seoul metropolitan area. The standardized incidence of dementia per 100,000 person-years also increased significantly, from 126.41 in 2003 to 2,218.25 in 2015 (p<0.001). The standardized incidence of dementia was similarly higher in other areas than in Seoul metropolitan area (p<0.001). @*Conclusions@#This study has shown that the standardized prevalence and incidence of dementia increased steadily from 2003 to 2015 in South Korea based on the NHIS-SC data set, and differed between Seoul metropolitan area and other areas.

Effects of Electrical Automatic Massage on Cognition and Sleep Quality in Alzheimer’s Disease Spectrum Patients: A Randomized Controlled Trial

Purpose@#Muscle relaxation following electrical automatic massage (EAM) has been found to reduce fatigue, depression, stress, anxiety, and pain in individuals with various conditions. However, the effects of EAM have not been extensively explored in patients with Alzheimer’s disease (AD). @*Materials and Methods@#Here, we conducted a randomized controlled study to evaluate the effects of EAM on the cognitive and non-cognitive functions of patients with AD spectrum disorders. @*Results@#We found that EAM attenuated changes in attention-associated cognitive scores and subjective sleep quality relative to those in controls. @*Conclusion@#While further studies in a clinical setting are needed to support our findings, these encouraging results suggest that EAM may be an alternative therapy for the management of associated symptoms in AD (ClinicalTrials.gov ID: NCT03507192, 24/04/2018).

Comparison of Pregnancy Prognosis for Gestational Diabetes Diagnosed by the 1-Step and 2-Step Methods

Purpose@#To compare pregnancy complications between the 2 groups of patients with gestational diabetes mellitus (GDM): those diagnosed by the 1-step method and those diagnosed by the 2-step method. @*Methods@#In this retrospective cohort study, the data from outpatient and hospitalization medical records of 201 patients diagnosed with GDM between 2013 and 2017 were reviewed. We compared the pregnancy complications of these patients based on whether they were diagnosed by the 1-step or 2-step method. SPSS ver. 20.0 was used to analyze the data from the 2 groups. The odds ratio and 95% confidence interval of the pregnancy outcomes were estimated using binary logistic regression analysis. @*Results@#On comparing pregnancy-related complications between the groups, there was no significant difference in the incidence of preeclampsia or delivery by cesarean section (p>0.99 and p=0.50, respectively). In the 1-step and 2-step groups, the prevalence of premature birth was significantly high at 19.7 % and 40.3% (p=0.01), respectively. There were no significant differences between the 2 groups in terms of macrosomia, large for gestational age (LGA), small for gestational age (SGA), low APGAR score, and neonatal hypoglycemia (p>0.99, p>0.26, p>0.62, p>0.57, and p>0.45, respectively). @*Conclusion@#On comparing the 2 groups, we found that the 1-step and 2-step GDM groups had similar risks of pregnancy complications, namely preeclampsia, delivery by cesarean section, macrosomia, LGA, SGA, low APGAR scores, and neonatal hypoglycemia.