Occurrence of mycotoxins in swine feed from South Korea.

Objectives: To update recent information on contamination levels of mycotoxins in South Korea. Materials and methods: A total of 208 samples sourced from the feeds of swine farms were collected. The contamination levels of mycotoxins, which are aflatoxin (Afla), ochratoxin A (OTA), deoxynivalenol (DON), zearalenone (ZEN), fumonisin (FUM), and T-2 toxin, were investigated by enzyme-linked immunosorbent assays (ELISAs). Results: The detection levels of the total samples were 78.91% for DON, 75.24% for Afla, 47.02% for ZEN, 68.31% for FUM, and 5.94% for OTA and T-2, which were not detected at all. Most of the analyzed mycotoxins showed significant high occurrences in 47.02%-78.91% of the swine feed samples. 11 of the 152 alfa-positive samples exceeded the maximum residue limit (MRL) of Afla proposed by the Korean regulation. In the analysis of mycotoxin detection levels by growth stage, ZEN was found in the nursery stage at a remarkably high concentration level (126.46 ± 63.76 ppb), exceeding the MRL of ZEN for piglets proposed by the European Commission. This mycotoxin was also found in the samples from the gestation barn (89.04 ± 46.05 ppb) and the farrowing house (105.58 ± 94.12) at a high concentration level. Afla was found in the nursery stage at a high concentration (8.00 ± 2.22 ppb), approaching the MRL (10 ppb) of Afla proposed by the Korean regulation. Conclusion: These results indicate that many swine farms in South Korea are still exposed to mycotoxin risk, and special attention and surveillance are necessary for these mycotoxin risks in swine farms.

Deep learning models to predict the editing efficiencies and outcomes of diverse base editors.

Applications of base editing are frequently restricted by the requirement for a protospacer adjacent motif (PAM), and selecting the optimal base editor (BE) and single-guide RNA pair (sgRNA) for a given target can be difficult. To select for BEs and sgRNAs without extensive experimental work, we systematically compared the editing windows, outcomes and preferred motifs for seven BEs, including two cytosine BEs, two adenine BEs and three C•G to G•C BEs at thousands of target sequences. We also evaluated nine Cas9 variants that recognize different PAM sequences and developed a deep learning model, DeepCas9variants, for predicting which variants function most efficiently at sites with a given target sequence. We then develop a computational model, DeepBE, that predicts editing efficiencies and outcomes of 63 BEs that were generated by incorporating nine Cas9 variants as nickase domains into the seven BE variants. The predicted median efficiencies of BEs with DeepBE-based design were 2.9- to 20-fold higher than those of rationally designed SpCas9-containing BEs.

Preoperative patient's expectations and clinical outcomes after rheumatoid forefoot deformity reconstruction by joint sacrificing surgery.

Objective: To study the clinical and radiologic factors related with overall patient satisfaction of joint scarifying reconstruction on severe rheumatoid forefoot deformity (RFD). Methods: Forty cases of RFD were retrospectively enrolled. A questionnaire on the factors for patient's expectations and satisfactions of the greater and lesser toes was administered, including repression of relapse in deformity (D), pain reduction (P), improvement in shoe wearing (S), barefoot activity (B), and appearance (A). Overall satisfaction were assessed using the 5-digit-scale. Hallux valgus angle, 1, 2 intermetatarsal angle, and other radiologic parameters were measured. Pearson's correlation and multiple linear regression analyses were used to evaluate the relationships between these factors and overall satisfaction. Results: Overall satisfaction was 4.0±0.82. Postoperative radiologic parameters were corrected in adequate range. Visual analog scale (VAS) was reduced from 7.2±2.1 to 2.2±1.8. For the greater toe, patient's expectations (D, P, S, B, and A) were 4.2, 4.1, 3.0, 2.5, 2.7 and satisfactions were 4.2, 4.0, 3.4, 3.5, 3.3, respectively. For the lesser toes, patient's expectations (D, P, S, B, and A) were 3.9, 4.1, 3.4, 3.0, 2.8, and satisfactions were 3.4, 4.0, 3.4, 3.6, 2.9, respectively. Satisfactions with P and B, and reduction amounts of VAS were significantly correlated with overall satisfaction. Conclusion: Although forefoot reconstruction with a joint sacrificing procedure is non-physiological, it could be a good surgical option for severe RFD. Each patient's expectations and satisfactions with this procedure could vary. Thus, it seems important to inform patients preoperatively that expectation could be fulfilled well or less.

Effects of emotion coaching group programme for mothers of preschool children with smart device overdependence: a mixed methods study.

BACKGROUND: Smart device overdependence adversely affects the overall development of preschool children. This study aimed to provide an emotion coaching group programme to mothers raising preschool children who are overly dependent on smart devices and to confirm the programme's effectiveness. METHODS: This concurrent embedded mixed methods study used a non-equivalent control group pre-post design to verify the quantitative effect of the programme, and a descriptive research design to verify the qualitative effect. The study collected data from June 2019 to March 2021 from 51 (25 experimental, 26 control) mothers raising children aged 3-6 years in South Korea. The quantitative study examined the effects of an eight-session programme, conducted once a week for two hours, on mothers' emotional intelligence, parenting behaviour, and their children's attachment stability and smart device overdependence using a non-equivalent control group pre-post design. The analysis used a generalized estimate equation. For qualitative research, focus group interviews were used as a descriptive research design method, and content analysis was used for analysis. RESULTS: Quantitatively, the results showed significant differences between the experimental and control groups in terms of changes in maternal emotional intelligence (χ2 = 14.99, p = .001), maternal positive parenting behaviour (χ2 = 9.32, p = .009), children's unstable attachment to their mothers (χ2 = 9.49, p = .009), and children's overdependence on smart devices (χ2 = 14.48, p = .001). Qualitatively, the study derived five themes for the experiences of mothers who participated in the programme: "hope for desirable parenting without emotional difficulties," "feelings touched by reflection," "warm but authoritative parenting," "children who became responsible by gaining psychological stability," and "changed view of my home." CONCLUSIONS: The emotion coaching group programme was effective in improving the emotional intelligence and parenting behaviour of mothers raising preschool children. The programme also improved preschool children's attachment stability to their mothers and overdependence on smart devices. The programme can be useful in community practice, and the present study can be used as evidence for education and research related to device overdependence.

Parents' lived experiences of losing adolescent children in the Korean Ferry Sewol disaster: Lessons through a qualitative meta-synthesis.

This study meta-synthesized qualitative studies on the parents' experiences of losing their adolescent children due to the human-made disaster, Ferry Sewol disaster in Korea, 2014. Five Korean and five international electronic databases were searched. Twenty-one studies were selected and critically appraised. Thematic analysis was employed. Four themes (with 10 subthemes) were derived: screaming in excruciating pain at the unbelievable deaths of children, family love evolving amidst pain and deepening into higher value, relationships collapsed and reformed while experiencing various social perspectives, and transitioning from a life of holding on to a life of progress. Bereaved parents experience psychological, physical, social pain for a long time, but gradually tried not to waste their children's death, forming new values and life goals. There is pressing need to devise sustained recovery strategies that account for distinct characteristics and needs of affected population groups.

Influence of knee flexion angle on graft bending angle during anterior cruciate ligament reconstruction using the transportal technique.

This study aimed to examine change in the graft bending angle (GBA) according to various knee flexion angles in creating femoral tunnel by the transportal technique in ACL reconstruction, and to reveal knee flexion angle minimizing GBA while maintaining stable femoral tunnel characteristics. Patients who underwent ACL reconstruction using the transportal technique between January 2017 and December 2018 were retrospectively reviewed. Patients were classified into three groups according to knee flexion angle when creating femoral tunnel (group 1: < 120° (n = 19); group 2: 120-129° (n = 32); group 3: ≥ 130° (n = 33). GBA was measured on three-dimensional knee model reconstructed from postoperative computed tomography images. The length of the femoral tunnel and posterior wall blow-out were also checked. There was significant difference of GBA between the groups (group 1 = 112.1°; group 2 = 106.4°; group 3 = 101.4°, p < 0.001). The knee flexion angle in creating femoral tunnel was negatively correlated with GBA (r = - 0.733, p < 0.001). Five patients in group 1 had short femoral tunnel. GBA was influenced by knee flexion angle in creating femoral tunnel and got more acute as the knee flexion angle increased. Considering length and risk of wall blow-out in femoral tunnel, and GBA, knee flexion angle between 120 and 130° could be recommended as appropriate angle to create optimal femoral tunnel in ACL reconstruction using the transportal technique.

A whole-genome reference panel of 14,393 individuals for East Asian populations accelerates discovery of rare functional variants.

Underrepresentation of non-European (EUR) populations hinders growth of global precision medicine. Resources such as imputation reference panels that match the study population are necessary to find low-frequency variants with substantial effects. We created a reference panel consisting of 14,393 whole-genome sequences including more than 11,000 Asian individuals. Genome-wide association studies were conducted using the reference panel and a population-specific genotype array of 72,298 subjects for eight phenotypes. This panel yields improved imputation accuracy of rare and low-frequency variants within East Asian populations compared with the largest reference panel. Thirty-nine previously unidentified associations were found, and more than half of the variants were East Asian specific. We discovered genes with rare protein-altering variants, including LTBP1 for height and GPR75 for body mass index, as well as putative regulatory mechanisms for rare noncoding variants with cell type-specific effects. We suggest that this dataset will add to the potential value of Asian precision medicine.

Comparison of the Goutallier Classification of Fatty Infiltration for the Subscapularis With a Novel Modified Classification.

Background: Fatty infiltration in the subscapularis muscle extends to the upper portion of the muscle first and then to the lower portion only after some degree of fatty change has taken place in the upper region. Although the Goutallier classification is the most widely used method to categorize fatty infiltration, how to accurately and reliably determine the extent of infiltration is controversial. Purpose: To examine a modified classification that is more reliable in (1) assessing fatty infiltration of the subscapularis muscle and (2) predicting the structural integrity of the repaired tendon by identifying cutoff points for retear. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: This study retrospectively examined the records of 545 patients who underwent arthroscopic repair for a subscapularis tear. Two shoulder surgeons reviewed the preoperative magnetic resonance imaging scans of all enrolled patients and evaluated the fatty infiltration of the subscapularis muscle based on the original Goutallier classification, as well as a novel modified Goutallier classification designed to measure the proportion of fat and muscle in the upper and lower portions of the muscle separately. Intra- and interobserver agreement of the reviewers was calculated using κ statistics. Using receiver operating characteristic curve analysis, we determined the cutoff point for the particular fatty infiltration grade related to the occurrence of retear for each classification scheme. Results: The κ values for interobserver reliability were 0.743 and 0.856 for the original and modified Goutallier classifications, respectively, with the modified classification having significantly higher reliability (Z = 4.064; P < .001). Cutoff points for the fatty infiltration grade associated with retear were 2.5 for the original Goutallier classification (sensitivity, 65.3%; specificity, 95.6%; accuracy, 87.8%) and 3.5 for the modified classification (sensitivity, 52.5%; specificity, 97.8%; accuracy, 89.7%). Conclusion: In assessing fatty infiltration of the subscapularis muscle, the modified Goutallier classification showed higher reliability than the original Goutallier classification. The cutoff point for potential retear (grade 3.5) was at a point where the fatty infiltration extended to the lower portion of the subscapularis muscle.

Clinical validity of oncogenic driver genes detected from circulating tumor DNA in the blood of lung cancer patients.

Background: This study aimed to evaluate the concordance of oncogenic driver mutations between tumor tissues and circulating tumor DNA (ctDNA) in patients with lung cancer. In addition, this study attempted to reveal the clinical utility of ctDNA in lung cancer treatment. Methods: Recurrent or metastatic non-small cell lung cancer (NSCLC) patients were prospectively enrolled in this study. Tumor tissue and serial blood samples were obtained from newly diagnosed patients (Cohort A) or patients treated with targeted therapy (Cohort B) and targeted gene panel sequencing was conducted to identify tumor mutational profiles. Results: At the time of diagnosis, patients in Cohort A with a high cell-free DNA (cfDNA) concentration had poorer overall survival than those with a low cfDNA concentration. The sensitivity and precision of ctDNA analysis in pre-treatment patients compared with those of tissue sequencing were 58.4% and 61.5%, respectively. Known lung cancer-associated variants of oncogenic driver genes, including EGFR and KRAS, and tumor suppressor genes, including TP53 and APC, were frequently detected in the ctDNA of the patients (76.9%). An association between smoking and TP53 mutation status was observed in both tissues and ctDNA (P=0.005 and 0.037, respectively). In addition, the EGFR T790M resistance mutation was detected solely from the ctDNA of two patients after treatment with an EGFR tyrosine kinase inhibitor. Conclusions: ctDNA may be a reliable prognostic biomarker with an additional role in treating patients with lung cancer. Further analyses are necessary to understand the properties of ctDNA and widen its clinical use.

Chromatin alternates between A and B compartments at kilobase scale for subgenic organization.

Nuclear compartments are prominent features of 3D chromatin organization, but sequencing depth limitations have impeded investigation at ultra fine-scale. CTCF loops are generally studied at a finer scale, but the impact of looping on proximal interactions remains enigmatic. Here, we critically examine nuclear compartments and CTCF loop-proximal interactions using a combination of in situ Hi-C at unparalleled depth, algorithm development, and biophysical modeling. Producing a large Hi-C map with 33 billion contacts in conjunction with an algorithm for performing principal component analysis on sparse, super massive matrices (POSSUMM), we resolve compartments to 500 bp. Our results demonstrate that essentially all active promoters and distal enhancers localize in the A compartment, even when flanking sequences do not. Furthermore, we find that the TSS and TTS of paused genes are often segregated into separate compartments. We then identify diffuse interactions that radiate from CTCF loop anchors, which correlate with strong enhancer-promoter interactions and proximal transcription. We also find that these diffuse interactions depend on CTCF's RNA binding domains. In this work, we demonstrate features of fine-scale chromatin organization consistent with a revised model in which compartments are more precise than commonly thought while CTCF loops are more protracted.

Effectiveness of a natural wellness group program using interactive real-time video for unmarried mothers: A quasi-experimental study.

BACKGROUND: Unmarried mothers who raise their children alone in South Korea experience various difficulties in maintaining their health. Improving the health of unmarried mothers, who are socioeconomically vulnerable, is important not only for them but also for the healthy growth and development of their children. We aimed to implement a natural wellness group program using an interactive real-time video platform for unmarried mothers and to verify its effects. METHODS: This quasi-experimental study utilized a sequential explanatory mixed-methods design. The participants were unmarried mothers raising children aged 0-6 years. The quantitative data collection occurred from August to November 2021. For the qualitative data collection, semi-structured interviews were conducted with seven participants from the experimental group. The experimental group received eight 90-minute weekly online sessions, whereas the control group received no intervention. The outcome variables were physical and mental health, depression, anxiety, self-esteem, and parenting stress. RESULTS: A total of 42 unmarried mothers (21 experimental, 21 control) participated. The Wilcoxon signed-rank test revealed significant post-intervention differences in mental health, depression, and self-esteem in the experimental group. Moreover, a generalized estimating equation analysis revealed significant differences in self-esteem levels between the experimental and control groups. Four themes identified through qualitative analysis revealed that the natural wellness group program using interactive real-time video not only increased mothers' vitality and relaxation but also improved depression and anxiety, and had a positive effect on parenting stress. CONCLUSIONS: Natural wellness group programs using interactive real-time videos can help improve the psychological health of unmarried mothers with young children, a group that tends to be socially and psychologically marginalized.

Factors Influencing the Initial Constraint Level of the Knee Joint and Its Effect on Clinical Outcomes After ACL Reconstruction With Hamstring Graft.

Background: A force-based tension protocol that uses a certain amount of tension at graft fixation could still give rise to variations in initial constraint levels of the knee joint in terms of side-to-side difference (SSD) in anterior translation. Purpose: To investigate the factors influencing the initial constraint level in anterior cruciate ligament (ACL)-reconstructed knees and compare outcomes according to the level of constraint in terms of anterior translation SSD. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 113 patients who underwent ipsilateral ACL reconstruction using an autologous hamstring graft and had minimum 2-year follow-up outcomes. All grafts were tensioned and fixed at 80 N using a tensioner at the time of graft fixation. The patients were classified into the following 2 groups according to the initial anterior translation SSD, measured using the KT-2000 arthrometer: a physiologic constraint group with restored anterior laxity ≤2 mm (group P; n = 66) and a high-constraint group with restored anterior laxity >2 mm (group H; n = 47). Clinical outcomes were compared between the groups, and preoperative and intraoperative variables were evaluated to identify factors affecting the initial constraint level. Results: Between group P and group H, generalized joint laxity (P = .005), posterior tibial slope (P = .022), and anterior translation measured in the contralateral knee (P < .001) were found to differ significantly. Measured anterior translation in the contralateral knee was the only significant predictor of high initial graft tension (P = .001). No significant differences were found between the groups regarding clinical outcomes and subsequent surgery. Conclusion: Greater anterior translation measured in the contralateral knee was an independent predictor of a more constrained knee after ACL reconstruction. The short-term clinical outcomes after ACL reconstruction were comparable, regardless of the initial constraint level in terms of anterior translation SSD.

Effects of prior antibiotic use on clarithromycin resistance in Helicobacter pylori.

BACKGROUND: Macrolide antibiotics are widely used to treat various infections such as pneumonia and sinusitis, and previous exposure to macrolides is presumed to be a risk factor for standard triple therapy failure in Helicobacter pylori (H. pylori) eradication. We aimed to determine whether previous use of macrolide antibiotics could affect clarithromycin resistance of H. pylori. MATERIALS AND METHODS: From the Korea National Health Insurance Service (NHIS2021-1-775) database, a total of 46,160 patients who were tested for clarithromycin resistance of H. pylori from 2016 to 2019 in Korea were identified. Their history of antibiotics in the past 10 years and history of respiratory comorbidity in the past 1 year were investigated. RESULTS: Clarithromycin resistance rate of H. pylori in Korea was 16.2%. A multivariate analysis revealed that female sex (OR: 1.472, p < .001), age > 50 years (OR: 1.340, p < .001), previous use of macrolide antibiotics (clarithromycin, OR: 2.902, p < .001; azithromycin, OR: 1.930, p < .001; erythromycin, OR: 2.060, p = .001; roxithromycin, OR: 2.022, p < .001), and history of respiratory comorbidity (sinusitis, OR: 1.271, p < .001; laryngopharyngitis, OR: 1.135, p = .032; bronchitis, OR: 1.245, p = .001; pneumonia, OR: 1.335, p = .026) were independent risk factors of clarithromycin resistance in H. pylori. CONCLUSIONS: The use of macrolide antibiotics and a recent diagnosis of respiratory disease might increase clarithromycin resistance of H. pylori.

Age, Tear Size, Extent of Retraction, and Fatty Infiltration Associated With a High Chance of a Similar Rotator Cuff Tear in the Contralateral Shoulder Regardless of Symptoms in Patients Undergoing Cuff Repair in the Index Shoulder.

PURPOSE: To investigate the prevalence of a contralateral rotator cuff tear (RCT) in patients with a symptomatic RCT requiring repair and to determine whether findings from magnetic resonance imaging (MRI) of the affected shoulder can predict the presence of a contralateral tear. METHODS: Patients with atraumatic RCTs who had undergone arthroscopic repair between March 2019 and February 2021 were reviewed in this study. MRI of both shoulder joints was performed to evaluate the bilaterality of RCT. Demographic factors and MRI findings of index shoulders were assessed using logistic regression analysis to reveal any correlations with the presence of RCT in the contralateral shoulder. RESULTS: A total of 428 patients were enrolled in this study. When the affected shoulders had a posterosuperior rotator cuff (PSRC) or subscapularis tear including either an isolated or combined tear, 63.6% and 67.8% had the same tears on the contralateral side, respectively. A contralateral-side tear was found in 74.6% (185/248) of symptomatic cases and 44.8% (65/145) of asymptomatic cases, which represents a significant difference (P < .001). Logistic regression analysis revealed that age ≥67.5 years, tear size ≥17 mm, Goutallier grade ≥1.5, and Patte grade ≥1.5 were found to be indicative of potential contralateral PSRC tears. By contrast, the presence of a subscapularis tear in the affected shoulder was the only significant risk factor in predicting a potential subscapularis tear in the contralateral shoulder. CONCLUSIONS: Among patients with a symptomatic RCT requiring arthroscopic repair, 63.6% with a PSRC tear and 67.8% with a subscapularis tear in the affected shoulder were found to have a similar tear in the contralateral shoulder regardless of symptoms. Age, tear size, extent of retraction, fatty infiltration of PSRC tears, and the presence of subscapularis tears were identified as factors predictive of tears on the contralateral side. LEVEL OF EVIDENCE: Level IV, case series.

A Comparative Study on Outcomes of Partial Meniscectomy for Horizontal Cleavage Tear of Medial Meniscus: Complete versus Partial Resection of Inferior Leaf.

The extent to which resection of unstable leaf should be performed in horizontal cleavage meniscus tear has not yet been elucidated. The purpose of this study was to compare the clinical outcomes of partial meniscectomy for horizontal cleavage tear of medial meniscus between complete resection of inferior leaf including the periphery up to the joint capsule and partial resection leaving stable peripheral torn meniscal tissue. A total of 126 patients who underwent partial meniscectomy for horizontal cleavage tear of medial meniscus were divided into two groups: group C (n = 34), treated with the complete resection of the inferior leaf; and group P (n = 92), treated with partial resection of the inferior leaf. The minimum follow-up duration was 3 years. Functional outcomes were evaluated using the Lysholm knee scoring scale, International Knee Documentation Committee (IKDC) subjective knee evaluation form, and knee injury and osteoarthritis outcome score (KOOS). Radiologic assessments were performed using the IKDC radiographic assessment scale and measurement of the height of the joint space in the medial compartment of the tibiofemoral joint. The functional outcomes including the Lysholm knee, IKDC subjective score, activities of daily living and sport and recreation subscale of KOOS were worse in group C than in group P (p < 0.001). The radiologic outcomes including postoperative IKDC radiographic scale (p = 0.003) and the postoperative joint space on the affected side (p < 0.001) were also worse in group C than in group P. In the horizontal cleavage tear of medial meniscus, complete resection of the inferior leaf including the periphery up to the joint capsule showed inferior clinical outcomes compared with partial resection leaving stable peripheral rim of torn meniscus at minimum 3-year follow-up. If the peripheral part of the inferior leaf is stable in horizontal cleavage tear of medial meniscus, partial resection of the inferior leaf preserving peripheral rim can be recommended.

Comparison of arthroscopic primary and revision Bankart repair for capsulolabral restoration: a matched-pair analysis.

INTRODUCTION: There have been no previous studies comparing serial radiologic results between primary and revision Bankart repair despite the significance of capsulolabral height and slope restoration. The purpose of this study was (1) to compare serially the height and slope of the repaired labrum in the early postoperative period among primary and revision Bankart repair groups, and (2) to compare clinical outcomes between the two groups. MATERIALS AND METHODS: This study included each 24 patients who underwent arthroscopic primary Bankart repair (Group A) and revision Bankart repair (Group B) matched by age, sex, and glenoid defect ratio. Postoperative serial radiologic assessment of the repaired labral height and slope was proceeded using magnetic resonance imaging (MRI) or computed tomographic arthrography (CTA) at 3 weeks and 6 months. RESULTS: There were no significant differences in labral height and slope at 3 weeks and 6 months postoperatively in Group A. However, significant reductions in labral height and slope were evident between 3 weeks and 6 months postoperatively in Group B (P < 0.05). Group A yielded superior results to Group B with respect to labral height and slope at each time point (P < 0.05) in between-group analyses. The clinical outcomes were not significantly different between the two groups except for the patients' return to their premorbid sports activity level (P = 0.024). CONCLUSIONS: The height and slope of the repaired capsulolabral structures in the early postoperative period after arthroscopic revision Bankart repair group were significantly lower than those of the primary Bankart repair group. Also the reduction of labral height and slope was significant in the revision Bankart repair group over time. Nonetheless, clinical outcomes did not differ significantly except return to premorbid sports activity level at final follow-up.

Effects of a nonviolent communication-based anger management program on psychiatric inpatients.

This quasi-experimental study aimed to determine the effects of a nonviolent communication-based anger management program on self-esteem, anger expression, and aggression in 44 psychiatric inpatients (experimental group: n = 21; control group: n = 24). The program consisted of six sessions of 60 min each, using a non-equivalent control group pretest-posttest design, and thereafter analyzing the intervention effects. Results showed statistically significant differences between the experimental and control groups in anger expression and anger suppression. There were positive, though not statistically significant, changes in self-esteem and aggression. The findings indicated a decreasing effect of anger expression and anger suppression.

Effect of the sagittal osteotomy inclination angle on the posterior tibial slope change in high tibial osteotomy: three-dimensional simulation study.

In performing medial open-wedge high tibial osteotomy, it is recommended not to alter the posterior tibial slope. However, it remains unclear whether the osteotomy inclination angle affects the posterior tibial slope in the sagittal plane. This study aimed to verify how anterior or posterior osteotomy inclination angle affects the tendency of change in the posterior tibial slope and to conduct quantitative analysis of the extent to which the posterior tibial slope changes according to the degree of the osteotomy inclination angle change in MOWHTO. Computed tomography images of 30 patients who underwent MOWHTO were collected. Three-dimensional models of preoperative original tibia were reconstructed, and virtual osteotomies were performed. The sagittal osteotomy inclination angles formed by the osteotomy line and the medial tibial plateau line were classified as positive in case of anteriorly inclined osteotomy and negative in case of posteriorly inclined osteotomy. Thirteen osteotomies were performed for each tibial model at intervals of 5° from - 30° to 30°. The posterior tibial slope was assessed, and the proportional relationship between the sagittal osteotomy inclination angle and the posterior tibial slope change was analyzed. The posterior tibial slope changed significantly after osteotomy (p < 0.001), except for the cases where the sagittal osteotomy inclination angles were 5°, 0°, and - 5°. Anteriorly and posteriorly inclined osteotomy caused increase and decrease in the posterior tibial slope, respectively. As the inclination angle increased by 1°, the posterior tibial slope increased by 0.079° in anterior inclination osteotomy, while in posterior inclination osteotomy, as the inclination angle decreased by 1°, the posterior tibial slope decreased by 0.067°. The osteotomy inclination angle in the sagittal plane significantly affected the posterior tibial slope. When there was an inclination angle occurred between the osteotomy line and the medial tibial plateau line in the sagittal plane, the posterior tibial slope changed after MOWHTO. The posterior tibial slope tended to increase in anteriorly inclined osteotomy and decrease in posteriorly inclined osteotomy. The change in the posterior tibial slope was proportionally related to the absolute value of the osteotomy inclination angle.

The experience of unmarried mothers raising their children in residential facilities: a phenomenological qualitative study.

BACKGROUND: Birth outside of marriage has been gradually increasing in Korea. However, social perception of unmarried mothers is still negative, and a number of them are not accepted by their family. Therefore, the Korean government has implemented a policy to provide financial aid and communal residence to unmarried mothers who cannot raise children with their family, or afford residence. Unmarried young mothers who rely on this government policy have low economic independence and social adaptation skills. Additionally, they have a high chance of encountering numerous challenges in raising children due to their living conditions in residential facilities and social prejudice. This study was conducted to gain an in-depth understanding of the lived experience of unmarried mothers raising children in residential facilities. METHODS: Data were collected through in-depth interviews with nine unmarried mothers living in residential facilities with their children. An interpretative phenomenological analysis was conducted to analyze the data. RESULTS: The findings revealed that unmarried mothers struggled with various difficulties given the limitations of living in the facility, but attempted to navigate their uncertain future with the determination to be good mothers. Three main themes and eight sub-themes emerged: (1) adaptation to the identity of "unmarried mother", (2) willingly undertaking the heavy burden of childrearing, (3) indispensable but insufficient supports from facilities. Participants had childrearing responsibilities, and tried to be good mothers for their children while struggling to adapt to their new identities. However, their self-doubt as a "good mother" and the absence of the child's father made them feel sorry for their child. Their daily experiences raising children and simultaneously preparing for their own independence were exhausting. The supports from the facilities were helpful but unsatisfactory and led to various psychosocial difficulties such as anxiety, depression, fear, guilty, and anger in unmarried mothers. CONCLUSIONS: Besides information and resources for parenting and independence, active approaches are needed to improve the psychological stability of unmarried mothers raising their children in facilities, and sustain a long-term socioeconomic support system. Thoughtful services tailored to mothers and children are also needed, instead of standardized services.

An online communication skills training program for nursing students: A quasi-experimental study.

In South Korea, in 2019, approximately 45.5% of newly-graduated nurses quit their jobs within one year of employment. To better understand the adjustment to nursing practice upon graduation, we developed an online communication skills training program based on nonviolent communication and evaluated its effectiveness. A quasi-experimental design was adopted. The sample included 28 participants in the experimental group and 27 in the control group after one participant in the control group dropped out. The participants were fourth-year nursing students at the K and S University in Gyeonggi Province, South Korea, with some clinical training in a hospital setting. Data were analyzed using the χ2 test, Fisher's exact test, and independent t-test. Participants' empathy, communication skills, anger, and self-efficacy were assessed before and after the training, as well as across the two groups. The experimental group showed significantly higher levels of empathy, communication skills, and self-efficacy compared to the control group after the program completion. However, there were no significant differences in anger. This study suggests the effectiveness of the online version of the nonviolent communication training. Therefore, providing this program to nursing students scheduled for graduation may help retain newly-graduated nurses.