Lateral facial thread lifting procedure with temporal anchoring in deep temporal fascia: Anatomical perspectives of superficial temporal artery.

INTRODUCTION: Thread lifting is a non-surgical cosmetic procedure that utilizes threads to lift and tighten sagging skin on the face. In Lateral face lifting with anchoring technique, the threads are inserted into the skin and anchored in place to provide support to the skin at artery free zone. This technique utilizes a long cog thread, allowing for stronger fixation points. The optimal location for thread anchoring is in the fascia of the treatment area. METHOD AND MATERIALS: The study was performed with twelve cadavers with twenty-four specimens of head from cadavers and was processed using phosphotungstic acid-based contrast enhancement micro-computed tomography and conventional computed tomography. The superficial temporal artery with branches of parietal and temporal were then observed with image Slicer program to analyze the safe anchoring place for the deep temporal fascia. The main branch was selected with diameter over 0.3 mm and less than 0.3 mm was regarded as arteriole. Additionally, a case of deep temporal tagging with the Secret Miracle (Hyundae Meditech Co., Ltd., South Korea) has been used for lifting procedures. RESULT: The main branch of the parietal branch located posteriorly was located mean of -13 mm (range of +5.5 mm to -23 mm). And the temporal artery ran most anteriorly had mean of 44 mm anteriorly (range of 32 to 59 mm). The safe area for the tagging is at the deep temporal fascia between the superior temporal line and inferior temporal line. The safe range of deep temporal fascia is a vertical line crossing tragus from 1 to 3 cm anteriorly. CONCLUSION: By analyzing the result of the superficial temporal artery of parietal and temporal branches the ideal tagging place for the thread anchoring area has been suggested.

Aesthetic doctors' perception and attitudes toward tolerance in botulinum toxin.

BACKGROUND: Botulinum toxin is a crucial therapeutic tool with broad indications in both cosmetic and medical fields. However, the expanding cosmetic use and increased dosages of botulinum toxin have raised concerns about resistance, making it essential to study the awareness and management practices among healthcare professionals. METHODS: A survey was conducted among clinical physicians using botulinum toxin. The study investigated their experiences, awareness, and management practices related to toxin resistance. Real-time mobile app-based surveys were administered to clinicians attending the 45th International Academic Conference of the Korean Academy of Laser and Dermatology (KALDAT) on December 3, 2023. RESULTS: Among 3140 participants, 673 clinical physicians completed the survey. Of these, 363 clinicians (53.9%) reported experiencing botulinum toxin resistance. Regarding the resistance rate, 59.4% indicated less than 1%, 36% reported approximately 1%-25%, and 95.4% reported less than 25%. Efforts to prevent resistance included maintaining intervals of over 3 months (54.8%), using products with lower resistance potential (47.0%), employing minimal effective doses (28.2%), and minimizing re-administration (14.9%). CONCLUSION: In the South Korean aesthetic medicine community, a majority of clinical physician's report encountering botulinum toxin resistance. Given the potential loss of various benefits associated with resistance, there is a need to establish appropriate guidelines based on mechanistic studies and current status assessments. Educating clinicians on applicable guidelines is crucial.

High-Intensity Focused Ultrasound Increases Facial Adipogenesis in a Swine Model via Modulation of Adipose-Derived Stem Cell Cilia.

Decreased medial cheek fat volume during aging leads to loss of a youthful facial shape. Increasing facial volume by methods such as adipose-derived stem cell (ASC) injection can produce facial rejuvenation. High-intensity focused ultrasound (HIFU) can increase adipogenesis in subcutaneous fat by modulating cilia on ASCs, which is accompanied by increased HSP70 and decreased NF-κB expression. Thus, we evaluated the effect of HIFU on increasing facial adipogenesis in swine (n = 2) via modulation of ASC cilia. Expression of CD166, an ASC marker, differed by subcutaneous adipose tissue location. CD166 expression in the zygomatic arch (ZA) was significantly higher than that in the subcutaneous adipose tissue in the mandible or lateral temporal areas. HIFU was applied only on the right side of the face, which was compared with the left side, where HIFU was not applied, as a control. HIFU produced a significant increase in HSP70 expression, decreased expression of NF-κB and a cilia disassembly factor (AURKA), and increased expression of a cilia increasing factor (ARL13B) and PPARG and CEBPA, which are the main regulators of adipogenesis. All of these changes were most prominent at the ZA. Facial adipose tissue thickness was also increased by HIFU. Adipose tissue volume, evaluated by magnetic resonance imaging, was increased by HIFU, most prominently in the ZA. In conclusion, HIFU increased ASC marker expression, accompanied by increased HSP70 and decreased NF-κB expression. Additionally, changes in cilia disassembly and length and expression of adipogenesis were observed. These results suggest that HIFU could be used to increase facial volume by modulating adipogenesis.

Proposal of facial pigmentary unit and facial hyperpigmentation type for Fitzpatrick skin types II-IV.

BACKGROUND: Studies on facial hyperpigmentation across different facial units are limiting. We aimed to analyze melanin pigmentation images to observe facial pigmentary demarcation lines (FPDLs) and suggest facial hyperpigmentation types for normal individuals. MATERIALS AND METHODS: 3D facial melanin pigmentation images of 173 volunteers were obtained and analyzed for the presence of FPDLs. Pigmentation severity was assessed for each of the thirteen facial pigment units. The images were then grouped according to a pattern of hyperpigmentation to suggest three facial hyperpigmentation types-dark spot, photoaging and post-inflammatory hyperpigmentation. RESULTS: Four groups of FPDLs including a novel group I were observed. Nasal, frontal, auricular were the darkest pigmented facial pigment unit, and the anterior neck was the least pigmented. The dark spot type was the most common facial hyperpigmentation type. The photoaging type and the PIH type showed age-dependent distribution, as the photoaging type was more common among the subjects over 40s, and the PIH type was more common in younger subjects. CONCLUSION: Facial hyperpigmentation among healthy individuals with Fitzpatrick skin types II-IV is often accompanied by FPDLs and categorized into three types. Each type is modeled after the pattern of pigmentation associated with certain dermatological disorders. The practical implications of facial hyperpigmentation types can be resourceful in various fields including prevention and treatment of pigmentary disorders.

Current practices and perceived effectiveness of polynucleotides for treatment of facial erythema by cosmetic physicians.

BACKGROUND: Polynucleotides (PN) are increasingly used for the treatment of facial erythema in the Republic of Korea. However, there are limited pre-clinical and clinical data on the efficacy of polynucleotides for facial erythema. In this study, we investigated the current practice and perceived effectiveness of polynucleotide treatment for facial erythema among cosmetic physicians. METHODS: By conducting a survey among clinicians who use PN in clinical practice, we explored the current practices and assessed the perceived effectiveness of polynucleotides in treating facial erythema. RESULTS: A total of 557 physicians who used polynucleotides for facial erythema participated in the survey. Polynucleotides were used by 84.4%, 66.4%, and 47.4% of physicians for facial erythema caused by inflammatory facial dermatosis, repeated laser/microneedle radiofrequency, and steroid overuse, respectively. Among those users, 88.1%, 90%, and 83.7% respectively in those same categories answered that polynucleotides were "highly effective" or "effective." Furthermore, they agreed that polynucleotides have the following properties: wound healing/regeneration (95.8%), protection of skin barrier (92.2%), hydration (90.5%), vascular stabilization (81.0%), and anti-inflammation (79.5%). CONCLUSION: Our findings showed that cosmetic physicians in the Republic of Korea have used PN as a part of combination treatment for facial erythema resulting from inflammatory facial dermatosis and repeated laser/ microneedle radiofrequency, rather than from steroid overuse. Also, most clinicians agreed that PN was effective for treatment of facial erythema. Given the lack of pre-clinical and clinical trial evidence, the empirical responses of practicing physicians provide useful information to guide clinical practice and further research.

Development and Usability of a Virtual Reality-Based Filler Injection Training System.

PURPOSE: As filler procedures have increased in popularity, serious injection-related complications (e.g., blindness and stroke) have also increased in number. Proper and effective training is important for filler procedure safety; however, limitations exist in traditional training methods (i.e. anatomical illustrations and cadaver studies). We aimed to describe the development process and evaluate the usability of a virtual reality (VR)-based aesthetic filler injection training system. MATERIALS AND METHODS: We developed the virtual reality hardware for the training system and a short guide, with a lecture regarding safe filler injection techniques. One hundred clinicians who attended a conference tested the training system. Participants completed system usability scale (SUS) and satisfaction questionnaires. RESULTS: Nearly half of the participants were aged 35-50 years, and 38% had more than 5 years of aesthetic experience. The mean SUS score was 59.8 (standard deviation, 12.23), with no significant differences among the evaluated subgroups. Approximately 76% of participants provided SUS scores of more than 51, indicating acceptable usability. Participants aged 35-50 years were more likely to rate the system as having poor usability than were those aged < 35 years (odds ratio = 5.20, 95% confidence interval: 1.35-20.08). CONCLUSIONS: This study was the first to develop and explore the usability of a VR-based filler training system. Nearly three-fourths of participants indicated that the training system has an acceptable level of usability. However, assessments in precise target audiences and more detailed usability information are necessary to further refine the training system. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Hot melt extruded-based nano zinc as an alternative to the pharmacological dose of ZnO in weanling piglets.

OBJECTIVE: This study was conducted to investigate the effects of hot-melt extruded ZnO nano-particles (HME-ZnO) as an alternative for P-ZnO on growth performance, nutrient digestibility, Zn bioavailability, intestinal microbiota, and intestinal morphology of weanling pigs. METHODS: A total of 450 piglets (Landrace×Yorkshire×Duroc) were randomly allotted to five treatments based on initial body weight and sex. The experimental diets were fed in a meal form as phase 1 from d 0 to 14 and phase 2 from d 15 to 28. Treatments were the control diet without ZnO supplementation, the diet containing 2,500 ppm Zn as ZnO, and three diets containing 500, 1,000, or 2,500 ppm Zn as HME-ZnO. RESULTS: The overall result showed a higher (p<0.01) average daily gain in weanling pigs fed ZnO-supplemented diets in comparison to the control diet. There was a decrease (p<0.01) in fecal score in the ZnO-supplemented diets. Dietary supplementation of ZnO improved (p<0.05) crude protein digestibility. The weanling pigs fed the P-ZnO diet had a lower (p<0.01) Zn digestibility in the feces than HME-ZnO supplemented treatments. Weanling pigs fed diets supplemented with ZnO had greater (p<0.05) Lactobacillus spp. populations and lower Clostridium spp. (p<0.05) and Coliforms (p<0.01) populations in the ileum. Weanling pigs fed diets supplemented with increasing concentrations of HME-ZnO linearly decreased Clostridium spp. (p<0.05) and Coliforms (p<0.01) in the ileum. Lower (p<0.05) Clostridium spp. and Coliforms counts in the colon were observed in pigs fed with ZnO-supplemented diets. Weanling pigs fed diets supplemented with ZnO showed a greater (p<0.01) villus height in the duodenum. CONCLUSION: Dietary supplementation of HME-ZnO and P-ZnO showed a potential to improve the digestibility of protein, intestinal Coliform and Clostridium, villus height in duodenum and ileum. Moreover, HME-ZnO showed a higher Zn digestibility compared with P-ZnO.

Changes in the Layers of the Temple During Pinch Manipulation: Implications for Thread Lifting.

BACKGROUND: During minimally invasive aesthetic procedures, the skin is often pinched to facilitate filler injection or thread insertion into the desired layer. However, little is known about changes in the facial layers during pinch manipulation. OBJECTIVE: To determine which layer of the temple is lifted during pinching and whether the artery and the nerve are affected by pinching. MATERIALS AND METHODS: At 11 sites on 3 fresh Korean cadavers, the skin of the temple was pinched gently or deeply, and the skin pulled up was cut at the bottom. The exposed areas were grossly and histologically examined. RESULTS: With gentle pinching, the subcutaneous fat and superficial temporal fascia (STF) layer were separated, and the fat was removed with the skin. The superficial temporal artery and temporal branches of the facial nerve were intact. With deep pinching, the STF was separated from the deep temporal fascia and lifted with the skin. CONCLUSION: When thread lifting is performed, deep pinching is helpful for anchoring thread to the temporal fascia, whereas gentle pinching helps to insert thread into the safe subcutaneous fat layer, where no significant blood vessels or nerves are present.

Acute and genetic toxicity of GS-E3D, a new pectin lyase-modified red ginseng extract.

Korean red ginseng and its extract have been used as traditional medicines and functional foods in countries worldwide. Pectin lyase-modified red ginseng extract (GS-E3D) was newly developed as a dietary supplement for obesity, diabetes-related renal dysfunction, etc. In this study, the safety of GS-E3D on acute toxicity and genotoxicity was evaluated. For acute study, Sprague-Dawley rats were administrated by oral gavage at a dose of 5000 mg/kg GS-E3D. To evaluate genotoxicity of GS-E3D, we conducted three-battery tests, which are Ames test using Escherichia coli (WP2uvrA pKM101) and Salmonella typhimurium strains (TA98, TA100, TA1535 and TA1537), chromosomal aberration test -using Chinese hamster lung cells, and micronucleus test using ICR mice. In acute toxicity studies, there were no dead animals or abnormal necropsy findings in the control group and GS-E3D (5000 mg/kg) treated group. GS-E3D did not induce mutagenicity in the bacterial test, chromosomal aberrations in Chinese hamster lung cells and micronuclei in bone marrow cells of mice. Conclusively, the approximate lethal dose of GS-E3D was greater than 5000 mg/kg bw and GS-E3D has no genotoxic potential in the three-battery tests on genotoxicity.

Radiological grading of osteoarthritis on Rosenberg view has a significant correlation with clinical outcomes after medial open-wedge high-tibial osteotomy.

PURPOSE: To determine the classification scheme for osteoarthritis severity grading that most closely correlates with postoperative clinical outcomes and to identify the positive and negative prognostic factors for medial open-wedge high-tibial osteotomy (OWHTO). METHODS: Seventy-nine consecutive patients with primary varus osteoarthritis were treated using OWHTO. Arthritic grading was determined by arthroscopic assessment according to the modified Outerbridge classification and by radiographic classification according to the Kellgren-Lawrence (KL) grading scale on standing anteroposterior (AP) and 45° posteroanterior (PA) flexion weight-bearing radiography. Clinical outcome was assessed using the Oxford Knee Score (OKS), which was evaluated both preoperatively and at the postoperative 2-year follow-up after OWHTO. Multivariate regression analyses were used to explore and quantify the influence of baseline patient demographics, variables related to arthroscopic and radiological grades of arthritis, as well as postoperative alignment changes on the OKS. RESULTS: At the 2-year follow-up, the mean OKS had improved from 20 ± 4 to 39 ± 5 points (p < 0.001). The average mechanical femorotibial and mechanical medial proximal tibial angle (MPTA) changed from 6.9° ± 3.4° to valgus 2.7° ± 2.8° and from 85.6° ± 2.4° to 92.9° ± 3.7° (all p < 0.001). The osteoarthritis severity grade based on the KL scale was 2.4 ± 0.9 on standing AP radiography, 2.8 ± 0.9 on 45° PA flexion weight-bearing radiography (p = 0.003), and 3.4 ± 0.7 according to the modified Outerbridge classification. In the multivariate analyses, the KL grade on 45° PA flexion weight-bearing radiography (p = 0.01) and postoperative MPTA (p = 0.01) showed significant negative correlations with postoperative OKS at the 2-year follow-up. CONCLUSION: The KL grading system based on 45° PA flexion weight-bearing radiography showed the strongest significant negative correlation with postoperative OKS after the OWHTO procedure using three different common OA classification schemes, which should be considered to determine the surgical indication of HTO. The KL grading system based on 45° PA flexion weight-bearing radiography showed the strongest correlation with high-tibial osteotomy-surgical indications and the counselling of patients with advanced osteoarthritis. LEVEL OF EVIDENCE: IV.

A Retrospective Comparison of Union Rates After Open Wedge High Tibial Osteotomies With and Without Synthetic Bone Grafts (Hydroxyapatite and ß-tricalciumphosphate) at 2 Years.

PURPOSE: To evaluate the clinical and radiological results of no bone graft (NBG) after opening wedge high tibial osteotomy (OWHTO) with a locking plate and to compare the bone union rate between the synthetic bone graft (SBG) group and the NBG group after OWHTO using serial radiographs. METHODS: From 2012 to 2015, OWHTOs were performed with SBG or without bone graft using long locking plates. Inclusion criteria were: (1) OWHTO for disease of the medial compartment with varus deformity, and (2) minimum 2-year follow-up and radiographs taken serially to 2 years. Exclusion criteria were: (1) follow-up period <2 years (n = 8) or (2) absence of at least 1 radiograph taken at each follow-up point (n = 14). We retrospectively reviewed radiographs taken preoperatively and at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Groups comprised those filled with a synthetic bone [hydroxyapatite (HA) and ß-tricalciumphosphate (TCP), n=33, SBG group] or without a bone graft (n = 38, NBG group). We compared bone union rate between the 2 groups by measuring the union zone from zone 1 to zone 5 in serial radiographs using Fisher's exact test. RESULTS: OWHTO was performed in a total of 93 knees and 71 knees were included in this study. Both groups showed good clinical and radiological results without correction loss at 2 years. The entire NBG group and 93.9% of the SBG group showed union over zone 3 at 2 years. However, the NBG group showed significantly more incorporation than the SBG group at 6 months (P = .006), 1 year (P = .0003), and 2 years (P = .0003). CONCLUSIONS: Union without correction loss was obtained after OWHTO without bone graft. The NBG group showed significantly more incorporation than the SBG group (HA and ß-TCP) within 2 years. LEVEL OF EVIDENCE: Level IV, case series.

Subacute inhalation toxicity study of synthetic amorphous silica nanoparticles in Sprague-Dawley rats.

Synthetic amorphous silica nanoparticles (SiNPs) are one of the most applied nanomaterials and are widely used in a broad variety of industrial and biomedical fields. However, no recent long-term inhalation studies evaluating the toxicity of SiNPs are available and results of acute studies are limited. Thus, we conducted a subacute inhalation toxicity study of SiNPs in Sprague-Dawley rats using a nose-only inhalation system. Rats were separated into four groups and target concentrations selected in this study were as follows: control (fresh air), low- (0.407 ± 0.066 mg/m3), middle- (1.439 ± 0.177 mg/m3) and high-concentration group (5.386 ± 0.729 mg/m3), respectively. The rats were exposed to SiNPs for four consecutive weeks (6 hr/day, 5 days/week) except for control group of rats which received filtered fresh air. After 28-days of inhalation exposure to SiNPs, rats were sacrificed after recovery periods of one, seven and 28 days. Although there were minimal toxic changes such as temporary decrease of body weight after exposure, increased levels of red blood cells (RBCs) and hemoglobin (Hb) concentration, the lung histopathological findings and inflammatory markers in bronchoalveolar lavage (BAL) fluid including polymorphonuclear (PMN) leukocyte, lactate dehydrogenase (LDH), albumin and protein did not show significant changes at any recovery period. The results of this study suggest that the subacute inhalation of SiNPs had no toxic effects on the lung of rats at the concentrations and selected time points used in this study.

Effect of chemical amendments on remediation of potentially toxic trace elements (PTEs) and soil quality improvement in paddy fields.

Remediation of potentially toxic trace elements (PTEs) in paddy fields is fundamental for crop safety. In situ application of chemical amendments has been widely adapted because of its cost-effectiveness and environmental safety. The main purpose of this research was to (1) evaluate the reduction in dissolved concentrations of cadmium (Cd) and arsenic (As) with the application of chemical amendments and (2) monitor microbial activity in the soil to determine the remediation efficiency. Three different chemical amendments, lime stone, steel slag, and acid mine drainage sludge, were applied to paddy fields, and rice (Oryza sativa L. Milyang 23) was cultivated. The application of chemical amendments immobilized both Cd and As in soil. Between the two PTEs, As reduction was significant (p < 0.05) with the addition of chemical amendments, whereas no significant reduction was observed for Cd than that for the control. Among six soil-related variables, PTE concentration showed a negative correlation with soil pH (r = -0.70 for As and r = -0.54 for Cd) and soil respiration (SR) (r = -0.88 for As and r = -0.45 for Cd). This result indicated that immobilization of PTEs in soil is dependent on soil pH and reduces PTE toxicity. Overall, the application of chemical amendments could be utilized for decreasing PTE (As and Cd) bioavailability and increasing microbial activity in the soil.

Highly Cyclable Lithium-Sulfur Batteries with a Dual-Type Sulfur Cathode and a Lithiated Si/SiOx Nanosphere Anode.

Lithium-sulfur batteries could become an excellent alternative to replace the currently used lithium-ion batteries due to their higher energy density and lower production cost; however, commercialization of lithium-sulfur batteries has so far been limited due to the cyclability problems associated with both the sulfur cathode and the lithium-metal anode. Herein, we demonstrate a highly reliable lithium-sulfur battery showing cycle performance comparable to that of lithium-ion batteries; our design uses a highly reversible dual-type sulfur cathode (solid sulfur electrode and polysulfide catholyte) and a lithiated Si/SiOx nanosphere anode. Our lithium-sulfur cell shows superior battery performance in terms of high specific capacity, excellent charge-discharge efficiency, and remarkable cycle life, delivering a specific capacity of ∼750 mAh g(-1) over 500 cycles (85% of the initial capacity). These promising behaviors may arise from a synergistic effect of the enhanced electrochemical performance of the newly designed anode and the optimized layout of the cathode.

Advanced Na[Ni0.25Fe0.5Mn0.25]O2/C-Fe3O4 sodium-ion batteries using EMS electrolyte for energy storage.

While much research effort has been devoted to the development of advanced lithium-ion batteries for renewal energy storage applications, the sodium-ion battery is also of considerable interest because sodium is one of the most abundant elements in the Earth's crust. In this work, we report a sodium-ion battery based on a carbon-coated Fe3O4 anode, Na[Ni0.25Fe0.5Mn0.25]O2 layered cathode, and NaClO4 in fluoroethylene carbonate and ethyl methanesulfonate electrolyte. This unique battery system combines an intercalation cathode and a conversion anode, resulting in high capacity, high rate capability, thermal stability, and much improved cycle life. This performance suggests that our sodium-ion system is potentially promising power sources for promoting the substantial use of low-cost energy storage systems in the near future.

Investigating the Mechanisms of Intradermal Injection for Easier "Skin Booster" Treatment: A Fluid Mechanics Approach to Determine Optimal Delivery Method.

Background: The use of "skin boosters" for rejuvenating aged skin is widely used. However, the accurate injection of the skin booster into the dermal layer remains a challenge due to the density of the dermis. The purpose of this study was to investigate the optimal mechanical variables of delivery that enabled correct targeting of the product to the dermis for optimal results. Methods: We investigated the impact of mechanical variables (syringe diameter, needle diameter and length, and viscosity of the skin booster) on the force required for intradermal injection in porcine skin. The correlation between these variables and the injection force was examined as well. Results: The results show that smaller syringe diameters, larger needle diameters, shorter needle lengths, and lower viscosity of the skin boosters reduce the injection force needed for intradermal injections. Conclusions: During the administration of skin booster injections, clinicians should take into account optimal conditions that facilitate intradermal injections, thus maximizing rejuvenating outcomes. Furthermore, manufacturers of skin boosters should formulate the products with decreased viscosity and provide the product in conjunction with appropriate needles and syringes, designed to optimize ease of injection.

Importance of dietary supplementation of soluble and insoluble fibers to sows subjected to high ambient temperatures during late gestation and effects on lactation performance.

Heat stress adversely affects sows' performance, which can be improved by applying proper nutritional strategies. This study was conducted to investigate the interactive effects of dietary fiber levels and sources on sows' reproductive performance, metabolic response during gestation, and the carry-over influence on litter performance in the lactation period during heat stress (average room temperature of 27.1 °C). Fifty-four multiparous sows (Landrace × Yorkshire; initial body weight of 236.3 ± 16 kg; 2, 3 and 4 parities) at d 90 of gestation were assigned to a 2 × 3 factorial arrangement (9 sows/treatment), involving 2 dietary fiber levels (4.5% and 6% crude fiber) and 3 dietary fiber sources (wheat bran [WB], palm kernel meal [PK], and beet pulp [BP]). Sows fed the BP diet had highest (P < 0.01) feed intake and constipation index and lowest (P < 0.01) farrowing duration. Piglet weight (P = 0.041) and litter weight (P < 0.01) at weaning were higher in sows in the BP treatment compared to PK treatment. Sows in the BP treatment showed the greatest (P < 0.01) digestibility of crude protein and neutral detergent fiber. The fecal concentration of acetate was the lowest (P < 0.01) in the PK treatment. Total short-chain fatty acid production was increased in the WB and BP treatments compared with the PK. Sows in the BP treatment showed the lowest (P = 0.036) hair cortisol. The blood insulin concentration of sows was higher (P = 0.026) in the high fiber (6%) treatment compared with the low fiber (4.5%) treatment at 90 min and 120 min after the meal. The concentration of phthalic acid, succinic acid, phenylethylamine, hydrocinnamic acid, iron, linoleic acid, glycerol, ketone, and formamide were increased (P < 0.05) in the BP treatment compared with the WB. The BP treatment with high soluble fiber content improved the constipation index, farrowing duration, and litter performance, while high insoluble fibers increased sows comfort and reduced stress factors including respiratory rate and rectal temperature. Therefore, both soluble and insoluble sources of fiber are necessary to be added to the diet of gestating sows.