Low Muscle and High Fat Percentages Are Associated with Low Natural Killer Cell Activity: A Cross-Sectional Study.

This study aimed to investigate whether body fat and muscle percentages are associated with natural killer cell activity (NKA). This was a cross-sectional study, conducted on 8058 subjects in a medical center in Korea. The association between the muscle and fat percentage tertiles and a low NKA, defined as an interferon-gamma level lower than 500 pg/mL, was assessed. In both men and women, the muscle mass and muscle percentage were significantly low in participants with a low NKA, whereas the fat percentage, white blood cell count, and C-reactive protein (CRP) level were significantly high in those with a low NKA. Compared with the lowest muscle percentage tertile as a reference, the fully adjusted odd ratios (ORs) (95% confidence intervals (CIs)) for a low NKA were significantly lower in T2 (OR: 0.69; 95% CI: 0.55-0.86) and T3 (OR: 0.74; 95% CI: 0.57-0.95) of men, and T3 (OR: 0.76; 95% CI: 0.59-0.99) of women. Compared with the lowest fat percentage tertile as a reference, the fully adjusted OR was significantly higher in T3 of men (OR: 1.31; 95% CI: 1.01-1.69). A high muscle percentage was significantly inversely associated with a low NKA in men and women, whereas a high fat percentage was significantly associated with a low NKA in men.

Relationship between Serum Cortisol, Dehydroepiandrosterone Sulfate (DHEAS) Levels, and Natural Killer Cell Activity: A Cross-Sectional Study.

The adrenal steroid hormones, cortisol and dehydroepiandrosterone sulfate (DHEAS), are associated with the immune system in opposite actions. This study aimed to investigate the relationship between cortisol and DHEAS serum concentrations, their ratio (CDR), and natural killer cell activity (NKA). This cross-sectional study included 2275 subjects without current infection or inflammation in the final analyses. NKA was estimated by measuring the amount of interferon-gamma (IFN-γ) released by activated natural killer cells; low NKA was defined as IFN-γ level < 500 pg/mL. Cortisol, DHEAS levels, and CDRs were categorized by quartiles in men, premenopausal women, and postmenopausal women. Compared with the lowest quartile as reference, the adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for low NKA of the highest cortisol and CDR group were 1.66 (1.09-2.51) and 1.68 (1.11-2.55) in men, 1.58 (1.07-2.33) and 2.33 (1.58-3.46) in premenopausal women, and 2.23 (1.28-3.87) and 1.85 (1.07-3.21) in postmenopausal women. Only in premenopausal women, the highest DHEAS group showed significantly lower risk of low NKA (OR: 0.51, 95% CI: 0.35-0.76). HPA axis activation indicated as high cortisol level, CDR was significantly associated with low NKA, while high DHEAS levels were inversely associated with low NKA in premenopausal women.

Oxidative balance score is inversely associated with the incidence of non-alcoholic fatty liver disease.

BACKGROUND & AIMS: The contribution of the balance between overall oxidative stress and antioxidant status in non-alcoholic fatty liver disease (NAFLD) is unclear. The oxidative balance score (OBS) comprises dietary and lifestyle pro- and antioxidant components that indicate the overall oxidative stress burden. We investigated the association between OBS and the incidence of NAFLD in middle-aged and older Korean adults. METHODS: Among the 10,030 participants of the Korean Genome and Epidemiology Study_Ansan and Ansung cohort, 5065 without NAFLD at baseline were selected for secondary analysis. OBS was categorized into quartiles. Multiple Cox proportional hazard regression analyses were performed to estimate the hazard ratio (HR) and 95% confidence interval (CI) for NAFLD incidence by sex-specific OBS quartile groups after adjusting for confounders. RESULTS: During the follow-up period (median 13.4 years), 913 (43.2%) men and 1288 (43.9%) women were newly diagnosed with NAFLD. Compared with that of the lowest quartile (Q1) group, the adjusted HR (95% CI) for NAFLD incidence in Q2, Q3, and Q4 groups was 0.85 (0.71-1.00), 0.65 (0.54-0.78), and 0.50 (0.40-0.62) in men, and 0.85 (0.73-0.99), 0.66 (0.56-0.77), and 0.48 (0.40-0.59) in women, respectively, and for NAFLD incidence, per incremental change in OBS, was 0.90 (0.87-0.92) in men and 0.88 (0.86-0.90) in women. CONCLUSIONS: A higher OBS was significantly associated with a lower risk for NAFLD incidence. Maintaining a healthy lifestyle and an antioxidant-rich diet is a potentially viable strategy for preventing NAFLD.

Multi-organ metastases of primary chondrosarcoma of the mammary gland of a spayed Toy Poodle.

We report the clinical and histopathological findings associated with multi-organ metastases of primary mammary chondrosarcoma in a 12-year-old spayed female Toy Poodle. At post-mortem examination, multifocal, sharply demarcated, grey-white to bright brown, round nodules of variable size were randomly distributed in the lungs, myocardium, liver, pancreas, spleen, intestinal tract and kidneys. Histologically, immature cartilage structures and primitive mesenchymal cells were seen in these organs. Neoplastic cells located in the cartilaginous basophilic extracellular matrix had cytoplasmic vacuolation and round vesicular nuclei and were stained with Safranin O and Alcian blue. To the best of our knowledge, this is the first report of a multi-organ metastatic chondrosarcoma that originated in the mammary gland of a dog.

Self-directed learning quotient and common learning types of pre-medical students in Korea by the Multi-Dimensional Learning Strategy Test 2nd edition: a descriptive study.

This study aimed to find the self-directed learning quotient and common learning types of pre-medical students through the confirmation of 4 characteristics of learning strategies, including personality, motivation, emotion, and behavior. The response data were collected from 277 out of 294 target first-year pre-medical students from 2019 to 2021, using the Multi-Dimensional Learning Strategy Test 2nd edition. The most common learning type was a self-directed type (44.0%), stagnant type (33.9%), latent type (14.4%), and conscientiousness type (7.6%). The self-directed learning index was high (29.2%), moderate (24.6%), somewhat high (21.7%), somewhat low (14.4%), and low (10.1%). This study confirmed that many students lacked self-directed learning capabilities for learning strategies. In addition, it was found that the difficulties experienced by each student were different, and the variables resulting in difficulties were also diverse. It may provide insights into how to develop programs that can help students increase their self-directed learning capability.

Effects of Single Nucleotide Polymorphisms and Mediterranean Diet in Overweight or Obese Postmenopausal Women With Breast Cancer Receiving Adjuvant Hormone Therapy: A Pilot Randomized Controlled Trial.

Background and Aims: Weight management is recommended in overweight or obese breast cancer patients, as they have an increased risk of cancer recurrence and poor prognosis. Furthermore, identifying the relationships between genetic factors and nutrition could help suggest possible individualized nutritional solutions in weight management. The objective of this pilot randomized controlled trial was to investigate the influence of two obesity-associated single nucleotide polymorphisms and the Mediterranean diet intervention on weight loss and modification of nutrient intake and metabolic parameters in overweight or obese, postmenopausal, breast cancer patients receiving adjuvant hormone therapy. Methods: Seventy-eight breast cancer patients were randomly assigned to the Mediterranean diet (MeDiet) group or control group, and seventy-one were finally analyzed. Body composition, nutrient intake, and metabolic parameters were assessed at baseline and after the 8-week intervention. Fat mass and obesity-associated (FTO) rs7185735 and melanocortin-4 receptor (MC4R) rs476828 variants were genotyped. Results: We found that both variants did not influence weight loss or improvement of metabolic parameters within the Mediterranean diet intervention. Intake of saturated fatty acid (SFA) and trans fat was significantly increased in C carriers compared with the TT genotype of MC4R rs476828 only in the control group (p = 0.002 for SFA; p = 0.016 for trans fat), whereas no significant difference was observed between genotypes in the MeDiet group. There were statistically significant interactions between MC4R rs476828 and dietary intervention for changes in SFA intake (p = 0.009) and trans fat intake (p = 0.049). Conclusion: Our data suggest that considering the effects of genotype may be more necessary when the Mediterranean diet is not followed and that this diet may have a protective role against the effects of certain genotypes. Further studies are required to determine the potential mechanism of the observed gene-diet interaction. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04045392].

Serum Low-Density Lipoprotein Cholesterol Levels and Depressive Mood in Korean Adults: A Nationwide Population-Based Study.

BACKGROUND: The association between serum cholesterol levels and depression has been studied extensively; however, results are inconsistent. This study aimed to investigate the association between low-density lipoprotein cholesterol (LDL-C) levels and depressive symptoms among Korean adults. METHODS: This cross-sectional study used data obtained from the 2007-2015 Korea National Health and Nutrition Examination Survey. In total, 40,904 adults were included in the final analysis. Participants were categorized into five groups according to their LDL-C levels, using the Korean guidelines for dyslipidemia. Symptoms of depression were evaluated using a self-reported questionnaire. Weighted logistic regression was used to examine the relationship between LDL-C levels and self-reported depressive symptoms. RESULTS: Compared with the intermediate category, the lowest (<70 mg/dL) and highest (≥160 mg/dL) LDL-C categories were associated with depressive symptoms, after adjusting for potential confounding factors (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.008-1.409; OR, 1.241; 95% CI, 1.073-1.435, respectively). The highest LDL-C category was positively associated with depressive symptoms in those who were middle-aged, female, had a low body mass index, and taking or not taking dyslipidemia medications. CONCLUSION: A U-shaped association was identified between LDL-C categories and self-reported depressive symptoms. Our findings suggest that LDL-C levels that are too low or too high are associated with self-reported depressive symptoms. Further prospective studies are needed to determine the causal relationship of this association.

Association between dairy protein and body composition in middle-aged and older women: A community-based, 12-year, prospective cohort study.

BACKGROUND & AIMS: Changes in body composition during aging include decreased muscle mass and increased fat mass. Women with low muscle mass with abdominal obesity (LMAO), in particular, could be at higher risk of morbidities and mortality than those with either sarcopenia or obesity alone. Dairy products, which contain whey protein and all essential amino acids, could have a beneficial role in preserving muscle mass and reducing obesity. We aimed to analyze the association between dairy protein and the development of LMAO in women using a large-scale, community-based prospective cohort. METHODS: Our analysis included 4251 women from the Korean Genome and Epidemiology Study. Participants were categorized into three groups by the tertile of dairy protein intake, which was assessed using a semi-quantitative 103-food item food frequency questionnaire. Appendicular skeletal muscle mass was estimated using the anthropometric equation. Low muscle mass (LM) was defined as a muscle mass of less than 15 kg in women. Abdominal obesity (AO) was defined as a weight to height ratio of 0.58 or greater. LMAO was defined as LM in combination with AO. Multiple Cox hazard regression analysis was conducted to examine associations between dairy protein intake and incident LMAO. RESULTS: During follow-up (mean, 9.6 years), 280 women newly developed LMAO. According to Cox proportional regression models, the hazard ratios (95% confidence interval) for incident LMAO in the middle and highest tertiles were 0.89 (0.74-1.06) and 0.71 (0.59-0.86), compared with lowest tertile, after adjusting for confounding variables. CONCLUSIONS: These findings indicate that high dairy protein intake is inversely related with LMAO development in Korean women. Dairy protein intake could be effective in preventing incident LMAO.

Differential Biases and Variabilities of Deep Learning-Based Artificial Intelligence and Human Experts in Clinical Diagnosis: Retrospective Cohort and Survey Study.

BACKGROUND: Deep learning (DL)-based artificial intelligence may have different diagnostic characteristics than human experts in medical diagnosis. As a data-driven knowledge system, heterogeneous population incidence in the clinical world is considered to cause more bias to DL than clinicians. Conversely, by experiencing limited numbers of cases, human experts may exhibit large interindividual variability. Thus, understanding how the 2 groups classify given data differently is an essential step for the cooperative usage of DL in clinical application. OBJECTIVE: This study aimed to evaluate and compare the differential effects of clinical experience in otoendoscopic image diagnosis in both computers and physicians exemplified by the class imbalance problem and guide clinicians when utilizing decision support systems. METHODS: We used digital otoendoscopic images of patients who visited the outpatient clinic in the Department of Otorhinolaryngology at Severance Hospital, Seoul, South Korea, from January 2013 to June 2019, for a total of 22,707 otoendoscopic images. We excluded similar images, and 7500 otoendoscopic images were selected for labeling. We built a DL-based image classification model to classify the given image into 6 disease categories. Two test sets of 300 images were populated: balanced and imbalanced test sets. We included 14 clinicians (otolaryngologists and nonotolaryngology specialists including general practitioners) and 13 DL-based models. We used accuracy (overall and per-class) and kappa statistics to compare the results of individual physicians and the ML models. RESULTS: Our ML models had consistently high accuracies (balanced test set: mean 77.14%, SD 1.83%; imbalanced test set: mean 82.03%, SD 3.06%), equivalent to those of otolaryngologists (balanced: mean 71.17%, SD 3.37%; imbalanced: mean 72.84%, SD 6.41%) and far better than those of nonotolaryngologists (balanced: mean 45.63%, SD 7.89%; imbalanced: mean 44.08%, SD 15.83%). However, ML models suffered from class imbalance problems (balanced test set: mean 77.14%, SD 1.83%; imbalanced test set: mean 82.03%, SD 3.06%). This was mitigated by data augmentation, particularly for low incidence classes, but rare disease classes still had low per-class accuracies. Human physicians, despite being less affected by prevalence, showed high interphysician variability (ML models: kappa=0.83, SD 0.02; otolaryngologists: kappa=0.60, SD 0.07). CONCLUSIONS: Even though ML models deliver excellent performance in classifying ear disease, physicians and ML models have their own strengths. ML models have consistent and high accuracy while considering only the given image and show bias toward prevalence, whereas human physicians have varying performance but do not show bias toward prevalence and may also consider extra information that is not images. To deliver the best patient care in the shortage of otolaryngologists, our ML model can serve a cooperative role for clinicians with diverse expertise, as long as it is kept in mind that models consider only images and could be biased toward prevalent diseases even after data augmentation.

Newly appointed medical faculty members' self-evaluation of their educational roles at the Catholic University of Korea College of Medicine in 2020 and 2021: a cross-sectional survey-based study.

This study aimed to investigate the degree to which newly appointed medical faculty members at the Catholic University of Korea are aware of Harden and Crosby's 12 educational roles and to identify their preferred educational roles. A 12-item survey questionnaire was distributed to 110 participants, and 100 responses were included in the analysis. The respondents gave the highest score to "clinical or practical teacher" and the lowest score to "curriculum planner" for their current personal competencies. For their preferred personal future competencies, they assigned the highest score to "on the job role model" and the lowest score to "student assessor." They gave almost equally high values to all 12 roles. However, individual faculty members had different preferences for educational roles. Accordingly, medical schools need to plan and implement customized faculty development programs, and efforts to provide appropriate educational roles according to individual faculty members' preferences are needed.

Fat-to-Muscle Ratios and the Non-Achievement of LDL Cholesterol Targets: Analysis of the Korean Genome and Epidemiology Study.

Maintaining optimal low-density lipoprotein (LDL) cholesterol levels is necessary to prevent cardiovascular disease (CVD). Excessive fat mass and decreased muscle mass are both associated with increased risks of developing dyslipidemia. Thus, we investigated the longitudinal relationship between the fat-to-muscle ratio (FMR) and the non-achievement of LDL cholesterol targets. We analyzed a total of 4386 participants aged 40-69 years from the Korean Genome and Epidemiology Study. FMR was defined as the ratio of total fat mass to total muscle mass, measured by bioelectrical impedance. The non-achievement of an LDL cholesterol target was defined as an LDL cholesterol level higher than the established target level according to individual CVD risk. The adjusted hazard ratios and 95% confidence interval for the incidence of non-achievement of LDL cholesterol targets for the sex-specific middle and highest tertiles vs. the referent lowest tertile of FMR were 1.56 (1.29-1.90) and 1.86 (1.47-2.31) in men and 1.40 (1.18-1.66) and 1.31 (1.06-1.62) in women after adjusting confounders. Our findings suggest that FMR, a novel indicator of the combined effects of fat and muscle mass, is useful for predicting non-achievement of LDL cholesterol targets.

Differences among Three Skeletal Muscle Mass Indices in Predicting Non-Alcoholic Fatty Liver Disease: Korean Nationwide Population-Based Study.

Recent studies have investigated the relationship between sarcopenia and non-alcoholic fatty liver disease (NAFLD); however, there is no unified definition of sarcopenia. Thus, we aimed to investigate the differences among three skeletal muscle mass indices (SMI) in predicting NAFLD. This study included 8133 adults from the 2008-2010 Korea National Health and Nutrition Survey. SMI was calculated as appendicular skeletal muscle mass divided by height-square (hSMI), weight (wSMI), or body mass index (bSMI). The presence of NAFLD was defined by using the NAFLD-liver fat score. On the receiver operating characteristic curve analysis, the predictive power of wSMI for NAFLD was significantly higher than those of hSMI and bSMI in men (wSMI vs. hSMI, p = 0.003; wSMI vs. bSMI, p < 0.001). In women, the predictive power of hSMI was only significantly higher than that of bSMI (p = 0.023), and other predictive powers were not significantly different. In addition, hSMI was correlated with insulin resistance and NAFLD-liver fat score in the opposite direction to wSMI and bSMI in both men and women. Among the three definitions of SMI, wSMI showed the highest diagnostic performance for predicting NAFLD in men, suggesting the importance of defining sarcopenia for its association with specific diseases.

Pre-Metabolic Syndrome and Incidence of Type 2 Diabetes and Hypertension: From the Korean Genome and Epidemiology Study.

The aim of this study was to investigate the prevalence of premetabolic syndrome (pre-MetSyn) and its components and to longitudinally examine their association with new-onset type 2 diabetes (T2D) or hypertension. A total of 4037 men and 4400 women aged 40 to 69 years were selected from the Korean Genome and Epidemiology Study, observed from 2001 to 2014. Pre-MetSyn was defined as the presence of one or two components of MetSyn (B, elevated blood pressure; G, elevated glucose; H, low HDL-cholesterol; T, elevated triglycerides; W, increased waist circumference). The prevalence of pre-MetSyn was higher than that of non-MetSyn and MetSyn in both men and women. In multivariate Cox regression analyses, G, T, G+T, W+G, B+G, B+T, W+T, B+H, and H+T in men and G, T, G+H, B+T, and H+T in women were significantly associated with new-onset T2D. B, W, B+H, B+T, W+H, and W+T in men and B, B+T, B+H, B+W, and W+H in women were significantly associated with new-onset hypertension. The prevalence of pre-MetSyn components and their associations with new-onset T2D or hypertension differed according to sex and disease. Our results suggest that specific phenotypes of pre-MetSyn may be important factors for predicting and preventing the development of T2D and hypertension.

Relationship between Serum Alkaline Phosphatase and Low Muscle Mass Index Among Korean Adults: A Nationwide Population-Based Study.

Sarcopenia has attracted interest due to its impact on various health problems. Chronic inflammation is an important contributor to sarcopenia. Thus, we aimed to investigate the association between serum alkaline phosphatase (ALP), which is a novel inflammatory marker, and muscle mass. This study included 15,579 adults from the 2008-2011 Korea National Health and Nutrition Survey. Low skeletal muscle mass index (LSMI) was defined as body mass index-adjusted appendicular skeletal muscle mass less than 0.789 for men and 0.512 for women. Multiple logistic regression revealed that the highest ALP tertile was significantly associated with LSMI compared with the lowest ALP tertile in both men [Odds ratio (OR): 1.41; 95% confidence interval (CI): 1.04-1.91] and women (OR: 1.45; 95% CI: 1.00-2.10) after adjusting for other confounders. On the receiver operating characteristic curve analysis, the predictive power was significantly higher for ALP levels than for white blood cell count in women (p < 0.001), whereas the difference was not significant in men (p = 0.515). Our findings suggest the potential use of serum ALP as an inflammatory marker and a predictor of sarcopenia.

C-reactive protein-to-albumin ratio and 8-year incidence of type 2 diabetes: the Korean genome and epidemiology study.

AIMS: The C-reactive protein-to-albumin ratio (CAR) has been reported as a novel prognostic marker in serious illness and various inflammatory diseases. The aim of this study is to investigate the association of CAR with incidence risk of type 2 diabetes in adults without chronic disease. METHODS: A total of 5904 participants aged 40 to 69 years were selected from the Korean Genome and Epidemiology Study who were observed over 12 years. Multivariable logistic regression was analyzed to examine the relationship between CAR tertiles and incident diabetes. The predictive power of new-onset diabetes by CAR and homeostasis model assessment-insulin resistance (HOMA-IR) were also measured using the random forest model. RESULTS: During a mean follow-up period of 7.6 years, 701 subjects (11.9%) developed diabetes. Compared with the lowest CAR group, the highest CAR group was associated with incidence of diabetes (OR 1.60; 95% CI 1.24-1.89) after adjustment for other potential confounding factors. In the random forest model, CAR did not show a significant difference in prediction of new-onset diabetes compared with HOMA-IR (p = 0.561). CONCLUSIONS: CAR, which is a ratio of commonly used biomarkers and reflects both oxidative stress and antioxidants, is suggested as a predictor of incident diabetes.

Enhanced Electrochemical Performance of Micro-Supercapacitors Via Laser-Scribed Cobalt/Reduced Graphene Oxide Hybrids.

The evolution of "smart life," which connects all internet-of-things (IoT) microdevices and microsensors under wireless communication grids, requires microscale energy storage devices with high power and energy density and long-term cyclability to integrate them with sustainable power generators. Instead of Li-ion batteries with a short lifetime, pseudocapacitors with longer or infinite cyclability and high-power density have been considered as efficient energy storage devices for IoT. However, the design and fabrication of microscale pseudocapacitors have difficulties in patterning microscale electrodes when loading active materials at specific points of the electrodes using conventional microfabrication methods. Here, we developed a facile, one-step fabrication method of micro-supercapacitors (MSCs) through the in situ formation of Co metals and the reduced graphene oxides (rGOs) in a one-pot laser scribing process. The prepared Co/rGO MSC thus exhibited four times higher capacitance than the rGO MSC, due to the Faradaic charge capacitance behavior of the Co/rGO composites.

Relationship between muscle mass index and LDL cholesterol target levels: Analysis of two studies of the Korean population.

BACKGROUND AND AIMS: Decreased skeletal muscle mass is an important change in body composition with aging. Maintaining the optimal low-density lipoprotein (LDL) cholesterol level is crucial for the prevention of cardiovascular diseases (CVD). We investigated whether muscle mass was associated with dyslipidemia. METHODS: We analyzed the data of 17,546 adults from the 2008-2011 Korean National Health and Nutrition Examination Survey (KNHANES) and 5126 adults from the Korean Genome and Epidemiology Study (KoGES). Participants were classified into the lower skeletal muscle mass index (LSMI) group and normal group. LSMI was defined as body mass index (BMI)-adjusted appendicular skeletal muscle mass <0.789 (men) and <0.512 (women) in the KNHANES, and as sex-specific lowest quintile of the BMI-adjusted total skeletal muscle mass in the KoGES. Participants were defined as having dyslipidemia when the serum LDL cholesterol levels were higher than their LDL cholesterol management targets based on their CVD risk level. RESULTS: The odds ratio with 95% confidence interval (CI) for dyslipidemia of the LSMI group was 1.230 (1.016-1.488, p = 0.034) after adjusting for confounding variables compared to the normal group in the 2008-2011 KNHANES. In the KoGES, the hazard ratio with 95% CI for incident dyslipidemia of the LSMI group compared to the normal group was 1.225 (1.101-1.364, p < 0.001). Regardless of abdominal obesity, LSMI was significantly associated with a higher risk of incident dyslipidemia. CONCLUSIONS: LSMI was associated with dyslipidemia regardless of abdominal obesity. Prevention of muscle mass loss may be an important strategy for LDL cholesterol management.

Non-Alcoholic Fatty Liver Disease Is an Independent Risk Factor for LDL Cholesterol Target Level.

Although patients with non-alcoholic fatty liver disease (NAFLD) face a higher risk of cardiovascular disease (CVD), it is not known whether people with NAFLD are less likely to achieve optimal management of low-density lipoprotein (LDL) cholesterol than those without NAFLD. We aimed to investigate the longitudinal effect of NAFLD on the management of LDL cholesterol in 5610 adults from the Korean Genome and Epidemiology Study. Participants were classified into NAFLD and normal groups. Non-achievement of the target LDL cholesterol level was set according to one's cardiovascular disease (CVD) risk level. The estimated proportion of individuals who did not achieve their LDL cholesterol targets was higher in the NAFLD group than in the normal group during the follow-up period of 12 years in a generalized estimation equation model. Multivariable Cox regression analysis revealed a hazard ratio and 95% confidence interval for incident non-achievement of one's LDL cholesterol target of 1.196 (1.057-1.353) in the NAFLD group (p = 0.005). We found that NAFLD was significantly related to non-achievement of LDL cholesterol targets in this prospective cohort study. Prevention and proper management of NAFLD have important health implications for the prevention of CVD.

Leukocyte count, C-reactive protein level and incidence risk of type 2 diabetes among non-smoking adults: A longitudinal finding over 12 years from the Korean Genome and Epidemiology Study.

AIMS: Chronic low-grade inflammation is closely linked to the development and progression of type 2 diabetes mellitus (T2DM). Since inflammatory markers tend to be chronically elevated in current smokers, we examined the association of inflammatory markers, including leukocyte counts and C-reactive protein (CRP) levels, with incidence risk of T2DM in non-smoking adults. METHODS: 5568 non-smoking participants aged 40-69 years without diabetes at baseline were selected from the Korean Genome and Epidemiology Study (KoGES), a large prospective cohort study. The hazard ratios (HRs) with 95% confidence intervals (CIs) for incident T2DM according to leukocyte and CRP quartiles, respectively, were calculated using multivariate Cox proportional hazards regression models. RESULTS: During the 12-year follow-up period, T2DM developed in 1030 subjects (18.5%, 1030/5568), with an incidence rate of 3.1-4.9 per 2 years. The cumulative incidence of T2DM increased proportionally with increasing leukocyte and CRP quartiles. Compared with the reference first quartile, the HRs of incident T2DM in the second, third, and fourth quartiles of leukocyte counts and third and fourth quartiles of CRP levels increased in a dose-dependent manner after adjusting for potentially confounding variables. CONCLUSIONS: Leukocyte counts and CRP levels are predictors of incident T2DM independent of tobacco smoking.

Development and validation of a portfolio assessment system for medical schools in Korea.

PURPOSE: Consistent evaluation procedures based on objective and rational standards are essential for the sustainability of portfolio-based education, which has been widely introduced in medical education. We aimed to develop and implement a portfolio assessment system, and to assess its validity and reliability. METHODS: We developed a portfolio assessment system from March 2019 to August 2019 and confirmed its content validity through expert assessment by an expert group comprising 2 medical education specialists, 2 professors involved in education at medical school, and a professor of basic medical science. Six trained assessors conducted 2 rounds of evaluation of 7 randomly selected portfolios for the "Self-Development and Portfolio II" course from January 2020 to July 2020. These data are used inter-rater reliability was evaluated using intra-class correlation coefficients (ICCs) in September 2020. RESULTS: The portfolio assessment system is based on the following process; assessor selection, training, analytical/comprehensive evaluation, and consensus. Appropriately trained assessors evaluated portfolios based on specific assessment criteria and a rubric for assigning points. In the analysis of inter-rater reliability, the first round of evaluation grades was submitted, and all assessment areas except "goal-setting" showed a high ICC of 0.81 or higher. After the first round of assessment, we attempted to standardize objective assessment procedures. As a result, all components of the assessments showed close correlations, with ICCs of 0.81 or higher. CONCLUSION: We confirmed that when assessors with an appropriate training conduct portfolio assessment based on specified standards through a systematic procedure, the results are reliable.