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This study reviewed the literature on religiousness and spirituality (RS) published in three major journals in counseling psychology. We aimed to evaluate (a) the content and methods of RS research and (b) operational definitions of RS constructs and suggestions for research and practice. At Level 1, we reviewed 901 articles that included an RS related word(s) anywhere in the article. At Level 2, we further analyzed 108 empirical studies and 31 conceptual articles that included RS as a study variable or a primary topic. Both quantitative and qualitative (i.e., thematic analysis) methods were used for data analysis. To summarize the key findings, major topics related to RS included mental health, wellbeing, LGBTQ experiences, help-seeking, counseling process, eudaimonic wellbeing, identity, discrimination, and minority stress. Religiousness and spirituality tended to be defined in a dichotomous way. We suggest future directions for research, practice, advocacy, education, and training, building on the holistic, multicultural, and positive premises of counseling psychology.

Mobile live commerce is emerging as a new distribution channel as connectivity and information sharing become easier due to the increase in the use of SNS and mobile phones. Nevertheless, there is a lack of research in this field, and it is meaningful to look at how this new technology-based commerce leads to purchase intention in terms of the value of shopping perceived by consumers. This study aims to (1) analyze the characteristic factors of mobile live commerce, which is rapidly emerging due to brisk changes in the distribution industry in the non-contact era; and (2) verify the relationship between shopping value and purchase intention. We analyzed 283 surveys using partial least squares structural equation modeling (PLS-SM) with statistical product and service solutions (SPSS) and R-programming. We inferred that convenience, ubiquity, social presence, attractiveness, and vividness were the characteristics of mobile live commerce that had a positive effect on the pleasure value, and that social presence, attractiveness, vividness, professionalism, information quality, and compatibility had positive effects on the perceived value. The hedonic value also had a positive effect on the perceived value, and both pleasure and perceived values had strong positive effects on the purchase intention. However, the professionalism of the sources did not affect the hedonic value, and the convenience and ubiquity did not affect the perceived value.

The levels of burning susceptibility to ultraviolet (UV) radiations are affected by various factors, including Fitzpatrick skin types, skin color, sex, and ethnicity. However, studies on the relationship between skin biophysical properties and erythemal responses to UV radiations are rare.This study aimed to investigate biophysical properties of the skin that determined individual skin sensitivity to UV radiation.As an indicator of skin sensitivity to UV radiation, Korean women were subjected to minimal erythema dose (MED) testing. The skin biophysical properties, such as skin hydration, transepidermal water loss (TEWL), were measured. MED were also evaluated in further variations in the skin, including barrier disruption.A significant negative correlation was observed between TEWL and MED. With an increase in TEWL, that represents reduced skin barrier function, skin UV sensitivity also increased. Artificial alteration of skin conditions also changed erythemal response to UV radiation. When the skin barrier was disrupted, MED significantly decreased, indicating increased skin UV sensitivity. It is hypothesized that the altered penetration of UV radiation into the stratum corneum under the respective skin conditions caused different erythema reactions.For the first time in a clinical study, the skin biophysical properties, including skin barrier function, were found to have significant effects on skin sensitivity to UV radiation. This finding could help predict individual susceptibility to UV damage. Therefore, skincare products that improve skin conditions associated with UV sensitivity, as well as sunscreen are important for protection against the hazards of UV radiation.

The aim of the study was to evaluate the value of computed tomography (CT) texture analysis (CTTA) in predicting ultrasound (US) classification of incidentally detected thyroid nodule (ITN) on chest CT.A total of 117 ITNs (≥1 cm in the longest diameter) on chest CT scan of 107 patients was divided into 4 categories according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) classification on recent thyroid US within 3 months. Computed tomography texture features were extracted with or without filtration using commercial software. The texture features were compared between the benign (K-TIRADS 2; n = 21) and the suspicious (K-TIRADS 3, 4, 5; n = 96) nodules. Multivariate regression and area under the receiver operating characteristic curve analysis were performed to determine significant prediction factors of the suspicious nodules.The mean value of positive pixels was significantly higher in the suspicious nodules except the unfiltered image (P0.05). Entropy of the suspicious nodules was significantly higher with unfiltered and fine filters (P0.05), and kurtosis of the suspicious nodules was significantly higher with medium and coarse filters (P0.05). A logistic regression model incorporating mean value of positive pixels and kurtosis with a medium filter using volumetric analysis demonstrated the best performance to predict the suspicious nodules with an area under the receiver operating characteristic curve of 0.842 (P0.001, sensitivity 82.3%, and specificity 81.0%).Computed tomography texture analysis for ITN larger than 1 cm showed significant correlation with systematic thyroid US classification and presented excellent performance to predict the suspicious nodules.

Background Facial involvement of vitiligo is an important factor in patient’s life and has often been evaluated separately from body surface area in clinical trials. However, no reliable measurement tools to measure facial vitiligo specifically are available thus far. Objective To develop and validate a practical instrument for assessing facial vitiligo Methods The ratios of a hand to a fingertip unit (FTU) of 98 healthy volunteers (age range: 2-69 years) were calculated to define the FTU. Facial Vitiligo Area Scoring Index (F–VASI) was measured as the sum of all FTUs of each vitiligo lesion on the face (range: 0-112 FTU). In the validation study, 6 raters evaluated 11 patients with facial vitiligo twice at an interval of 2 weeks. Results One hand was measured at 32.1±1.3 FTU, and it was highly consistent among subjects across different age groups, genders, and races. F−VASI showed remarkably high accuracy (concordance correlation coefficient: 0.946, smallest detectable change: 2.2 FTU) as well as high intra-rater reliability (intraclass correlation coefficient: 0.903) and inter-rater reliability (0.903). Limitations Lack of dynamic validation of responsiveness Conclusion F−VASI using the FTU is an intuitive, precise, and reliable instrument for assessing the extent of facial involvement in vitiligo patients.

Kidney organoids derived from the human pluripotent stem cells (hPSCs) recapitulating human kidney are the attractive tool for kidney regeneration, disease modeling, and drug screening. However, the kidney organoids cultured by static conditions have the limited vascular networks and immature nephron-like structures unlike human kidney. Here, we developed a kidney organoid-on-a-chip system providing fluidic flow mimicking shear stress with optimized extracellular matrix (ECM) conditions. We demonstrated that the kidney organoids cultured in our microfluidic system showed more matured podocytes and vascular structures as compared to the static culture condition. Additionally, the kidney organoids cultured in microfluidic systems showed higher sensitivity to nephrotoxic drugs as compared with those cultured in static conditions. We also demonstrated that the physiological flow played an important role in maintaining a number of physiological functions of kidney organoids. Therefore, our kidney organoid-on-a-chip system could provide an organoid culture platform for in vitro vascularization in formation of functional three-dimensional (3D) tissues.

Background/Aims: To investigate the short- and long-term efficacy of intra-articular glucocorticoid injections (IAGI) in patients with rheumatoid arthritis (RA).Methods: This was a retrospective study of RA patients who had active arthritis in the hand or wrist joints and who received IAGI (or not) as an adjunct to disease- modifying antirheumatic drugs (DMARDs). Short-term efficacy was assessed based on changes in the disease activity score in 28 joints (DAS28) after 3 months and long-term efficacy was assessed based on changes in the van der Heijde Sharp score (HSS) of hand radiographs over 2 years. Radiographic progression was defined as ΔHSS/year ≥ 2. Logistic regression analysis identified predictors of early achievement of low disease activity (LDA) and radiographic progression.Results: Overall, 126 RA patients received IAGI into the hand or wrist joints and 107 were IAGI-naive. After 3 months, 67% of IAGI-treated patients and 48% of IAGI-naive patients achieved LDA (p = 0.002). Over the next 2 years, 35% of patients treated with IAGI showed radiographic progression compared with 27% of IAGI-naive patients (p = 0.2). IAGI plus biologic DMARDs was associated with achievement of LDA in 3 months. Achieving LDA in 3 months (odds ratio [OR], 0.403; 95% confidence interval [CI], 0.192 to 0.847), wrist arthritis (OR, 2.408; 95% CI, 1.184 to 4.897), and baseline HSS (OR, 1.021; 95% CI, 1.003 to 1.039) were associated with radiographic progression.Conclusions: IAGI was associated with early achievement of LDA. LDA was associated with slower radiographic progression. The wrist is more vulnerable to joint damage and requires more aggressive treatment.

Shikimate is a key high-demand metabolite for synthesizing valuable antiviral drugs, such as the anti-influenza drug, oseltamivir (Tamiflu®). Microbial-based strategies for shikimate production have been developed to overcome the unstable and expensive supply of shikimate derived from traditional plant extraction processes. In this study, a microbial cell factory using Corynebacterium glutamicum was designed to overproduce shikimate in a fed-batch culture system. First, the shikimate kinase gene (aroK) responsible for converting shikimate to the next step was disrupted to facilitate the accumulation of shikimate. Several genes encoding the shikimate bypass route, such as dehydroshikimate dehydratase (QsuB), pyruvate kinase (Pyk1), and quinate/shikimate dehydrogenase (QsuD), were disrupted sequentially. An artificial operon containing several shikimate pathway genes, including aroE, aroB, aroF, and aroG were overexpressed to maximize the glucose uptake and intermediate flux. The rationally designed shikimate-overproducing C. glutamicum strain grown in an optimized medium produced approximately 37.3 g/L of shikimate in 7-L fed-batch fermentation. Overall, rational cell factory design and culture process optimization for the microbial-based production of shikimate will play a key role in complementing traditional plant-derived shikimate production processes.

Purpose: The purpose of this study was to identify the supportive care needs of parents of preterm children in South Korea using text data from a portal site.Methods: In total, 628 online newspaper articles and 1,966 social network service posts published between January 1 and December 31, 2019 were analyzed. The procedures in this study were conducted in the following order: keyword selection, data collection, morpheme analysis, keyword analysis, and topic modeling. Results: The term "yirundung-yi", which is a native Korean word referring to premature infants, was confirmed to be a useful term for parents. The following four topics were identified as the supportive care needs of parents of preterm children: 1) a vague fear of caring for a baby upon imminent neonatal intensive care unit discharge, 2) real-world difficulties encountered while caring for preterm children, 3) concerns about growth and development problems, and 4) anxiety about possible complications.Conclusion: Supportive care interventions for parents of preterm children should include general parenting methods for babies. A team composed of multidisciplinary experts must support the individual growth and development of preterm children and manage the complications of prematurity using highly accessible media.

Objective. To investigate the impact of the amendment of the Korean National Health Insurance (KNHI) reimbursement criteria for anti-tumor necrosis factor-α (TNF-α) agents based on from conventional clinical and laboratory measurements to disease activity score of 28 joints (DAS28) on treatment pattern, clinical response, and persistence rate in patients with rheumatoid arthritis (RA). Methods. This multicenter retrospective cohort study evaluated 148 RA patients eligible for the initiation of anti- TNF-α agents as the first-line biologics by either the past (n=95) or current (n=53) KNHI reimbursement criteria. Persistence was defined as the duration between the initiation and discontinuation of anti-TNFα agents. Results. In total, 106 (71.6%), 35 (23.6%), and 7 (4.7%) RA patients started treatment with adalimumab, etanercept, and infliximab, respectively. RA patients who received anti-TNF-α agents under the current reimbursement criteria had a significantly lower mean DAS28-erythrocyte sedimentation rate (ESR) (6.02 vs. 6.95, p＜0.001) and daily prednisolone-equivalent glucocorticoid dose (4.51 vs. 6.17 mg, p＜0.001) than those who received anti-TNF-α agents under the past reimbursement criteria. No significant differences in the 1-year remission rate defined by DAS28-ESR＜2.6 (17.9% vs. 30.2%, p=0.085) and the persistence rate (p=0.703) between the past and current reimbursement criteria was observed. Conclusion. Our data suggest that less active RA patients can receive reimbursement for anti-TNF-α agents under the current criteria, and the amendment of the KNHI reimbursement criteria may improve access to anti-TNF-α agents without affecting the treatment response and persistence rate. (J Rheum Dis 2020;27:159-167)

Micropigmentation, also termed medical tattooing, can be a useful alternative treatment for patients with vitiligo who are resistant to conventional treatments. To assess the benefits and risks of micropigmentation in the treatment of refractory vitiligo, 25 lesions of 14 patients with vitiligo (Fitzpatrick skin types III and IV) were subjected to micropigmentation using an electric tattooing machine between December 2018 and March 2019. The procedure was repeated until satisfactory results were obtained. Treatment response was assessed by color matching of the treated lesion and surrounding skin using a 4-point scale (poor, fair, good and excellent). Excellent color matching was achieved in 80% (20/25) of cases after a median of three (range, 1-5) treatment sessions. Procedure-associated pain was considerable, but no anesthetic injection was needed. Immediate erythema and swelling were noticed after each procedure, but resolved within a few days. Overall, the treatment was tolerable. This study was limited by a small sample, no control group and a short follow-up period. This study revealed that micropigmentation was beneficial for patients with refractory vitiligo who had light to moderately colored skin. Pigment selection, implantation depth and selection of body parts amenable to treatment were critical.

Rheumatoid arthritis (RA) is a highly inflammatory autoimmune disease. Although proinflammatory cytokines, including tumor necrosis factor (TNF) and interleukin (IL)-6, play a key role in the pathogenesis of RA, the causes of chronic inflammation are not fully understood. Here, we report that protein phosphatase magnesium-dependent 1A (PPM1A) levels were increased in RA synovial fluid compared with osteoarthritis (OA) synovial fluid and positively correlated with TNF levels. In addition, PPM1A expression was increased in synovial tissue from RA patients and joint tissue from a mouse model of arthritis. Finally, extracellular PPM1A induced inflammation by stimulating macrophages to produce TNF through toll-like receptor 4 (TLR4) and myeloid differentiation primary response protein 88 (MyD88) signaling pathway. Our findings suggest that extracellular PPM1A may contribute to the pathogenesis of RA by functioning as a damage-associated molecular pattern (DAMP) to induce inflammation.

Background The concept of developmentally supportive care in preterm infants is of considerable significance in the neonatal intensive care unit (NICU) setting with regard to preventing complications from preterm birth and promoting optimal growth and development. To provide high-quality developmentally supportive care, NICU nurses must possess high levels of knowledge, importance, perception, and competence. Purpose The purpose of this study was to investigate South Korean NICU nursing staff's level of knowledge concerning developmentally supportive care, as well as the perceived importance, perception, and perceived competence regarding this concept. Methods This study employed a cross-sectional descriptive design. Between June 1 and 19, 2020, 160 nurses completed a self-report questionnaire pertaining to developmentally supportive care, which covered the aspects of knowledge, perceived importance, perception (including attitudes, perceived behavioral control, subjective norms, and intentions), and perceived competence. Results The levels of knowledge, attitude, and intention as a subfactor of perception, and perceived competence pertaining to developmentally supportive care were not high. There was no significant difference in the knowledge and perceived competence of skilled nurses compared with novice nurses. However, skilled nurses recognized that they could provide better developmentally supportive care than novice nurses. Perceived competence was positively correlated with perceived importance and perception. Implications for practice and research Systematic educational programs that can enhance developmentally supportive care competence should be provided to NICU staff nurses. These must clarify the importance of developmentally supportive care and improve NICU nurses' knowledge, attitudes, self-efficacy, and intentions.

Shikimate is a key intermediate in high demand for synthesizing valuable antiviral drugs, such as the anti-influenza drug and oseltamivir (Tamiflu®). Microbial-based shikimate production strategies have been developed to overcome the unstable and expensive supply of shikimate derived from traditional plant extraction processes. Although shikimate biosynthesis has been reported in several engineered bacterial species, the shikimate production yield is still unsatisfactory. This study designed an Escherichia coli cell factory and optimized the fed-batch culture process to achieve a high titer of shikimate production. Using the previously constructed dehydroshikimate (DHS)-overproducing E. coli strain, two genes (aroK and aroL) responsible for converting shikimate to the next step were disrupted to facilitate shikimate accumulation. The genes with negative effects on shikimate biosynthesis, including tyrR, ptsG, and pykA, were disrupted. In contrast, several shikimate biosynthetic pathway genes, including aroB, aroD, aroF, aroG, and aroE, were overexpressed to maximize the glucose uptake and intermediate flux. The shiA involved in shikimate transport was disrupted, and the tktA involved in the accumulation of both PEP and E4P was overexpressed. The rationally designed shikimate-overproducing E. coli strain grown in an optimized medium produced approximately 101 g/l of shikimate in 7-l fed-batch fermentation, which is the highest level of shikimate production reported thus far. Overall, rational cell factory design and culture process optimization for microbial-based shikimate production will play a key role in complementing traditional plant-derived shikimate production processes.

Background: postoperative atelectasis is a significant clinical problem during thoracic surgery with one-lung ventilation. Intraoperative deep neuromuscular blockade can improve surgical conditions, but an increased risk of residual paralysis may aggravate postoperative atelectasis. Every patient was verified to have full reversal before extubation. We compared the effect of deep versus moderate neuromuscular blockade on postoperative atelectasis quantitatively using chest computed tomography. Methods: patients undergoing thoracic surgery were randomly allocated to two groups: moderate neuromuscular blockade during surgery (group M) and deep neuromuscular blockade during surgery (group D). The primary outcome was the proportion and the volume of postoperative atelectasis measured by chest computed tomography on postoperative day 2. The mean values of the repeatedly measured intraoperative dynamic lung compliance during surgery were also compared. Result: the proportion of postoperative atelectasis did not differ between the groups (1.32 [0.47–3.20]% in group M and 1.41 [0.24–3.07]% in group D, p = 0.690). The actual atelectasis volume was 38.2 (12.8–61.4) mL in group M and 31.9 (7.84–75.0) mL in group D (p = 0.954). Some factors described in the lung protective ventilation were not taken into account and might explain the atelectasis in both groups. The mean lung compliance during one-lung ventilation was higher in group D (26.6% in group D vs. 24.1% in group M, p = 0.026). Conclusions: intraoperative deep neuromuscular blockade did not affect postoperative atelectasis when compared with moderate neuromuscular blockade if full reversal was verified.

Shikimate is a key high-demand metabolite for synthesizing valuable antiviral drugs, such as the anti-influenza drug, oseltamivir (Tamiflu). Microbial-based strategies for shikimate production have been developed to overcome the unstable and expensive supply of shikimate derived from traditional plant extraction processes. In this study, a microbial cell factory using

Non-typhoidal salmonellosis remains a pressing public health problem worldwide. Quinolones, particularly fluoroquinolones, are widely used to treat various infections, including non-typhoidal salmonellosis, which can be a serious illness. The emergence of fluoroquinolone-resistant Salmonella has resulted in treatment failure and high mortality rates. In this study, we estimated the presence of plasmid-mediated quinolone resistance (PMQR) genes in Salmonella enterica isolated from human salmonellosis patients in South Korea from 2016 to 2019. We evaluated the association of these genes with fluoroquinolone susceptibility. Antimicrobial susceptibility tests for Salmonella isolates were performed using the Vitek II system, and the minimum inhibitory concentrations (MIC) of ciprofloxacin and levofloxacin were determined using the E-test method. Plasmid-mediated quinolone resistance (PMQR) genes were detected by PCR amplification and quinolone resistance-determining regions (QRDRs) of the gyrA and parC genes were analyzed following Sanger sequencing of the PCR products. Thirty-four Salmonella strains with reduced susceptibility to fluoroquinolones (ciprofloxacin MIC ≥ 0.125 µg/mL and levofloxacin MIC ≥ 0.25 µg/mL) were selected from 208 human clinical Salmonella isolates. Among them, 22 Salmonella strains harbored one PMQR gene (qnrA, qnrB, or qnrS), and three Salmonella strains carried two PMQR genes (qnrS and aac(6′)-Ib-cr or qnrA and qnrB). qnrS was the most common PMQR gene. Serotyping revealed that Salmonella 4,[5]12:i:- (32.4%, 11/34) and Salmonella Typhimurium (29.4%, 10/34) were the two most predominant serovars, and Multi-locus sequence typing (MLST) showed that ST19 and ST34 were the most frequent sequence types. In conclusion, qnr gene-positive Salmonella 4,[5],12:i:- and Salmonella Typhimurium were the main serovars responsible for reduced susceptibility to fluoroquinolones. Therefore, our findings suggest that PMQR-positive Salmonella strains, which can be isolated from various samples including human, food, and the environment, should be carefully monitored.

Lung cancer screening with low-dose computed tomography reduced mortality in selected high risk patients. However, the use of chest radiography for lung cancer screening in Asian populations is still controversial. We investigated the effectiveness of chest radiographic surveillance using a nationwide health service data in South Korea.Data from the Korean National Health Insurance Service examinee cohort of 2004 to 2013 were examined, and 63,228 patients with lung cancer were identified, 38,494 (57%) of whom underwent chest radiography screening. The others did not undergo lung cancer screening and were considered as a control group. Clinical data including age, smoking, screening intervals, lung cancer stages, treatments, and survival were collected. Survival gain from surveillance after adjustment for lead-time bias based on the sojourn time was calculated. Cox-proportional hazard analyses were performed to evaluate the effectiveness of screening and to determine the appropriate screening interval for chest radiography surveillance.Early lung cancer was found in 38% of patients receiving chest radiography versus 26% of those without surveillance. A patient age of more than 65 years (hazard ratio [HR], 1.53; 95% confidence limits [CL], 1.50-1.56), male (HR, 1.66; 95% CL, 1.62-1.70), and high lung cancer stages at the time of diagnosis were independent factors associated with mortality (each, P 0.001). Chest radiography surveillance was a factor for decreasing mortality in female (HR, 0.81; 95% CL, 0.77-0.84, P 0.001), with mortality reduction of 10% at the 3- and 5-year survival time-points. In female patients, chest radiography surveillance at intervals of less than 3 years was an independent predictor of improved survival.Surveillance chest radiography increased survival in a female screened population in South Korea. Chest radiography intervals of less than 3 years may help to detect lung cancer in female patients.

Clinical features of human metapneumovirus (HMPV) infection have not been well documented for adults. We investigated clinical and radiologic features of HMPV infection in 849 adults in a tertiary hospital in South Korea. We classified patients into groups on the basis of underlying diseases: immunocompetent patients, solid tumor patients, solid organ transplantation recipients, hematopoietic stem cell transplant recipients, hematologic malignancy patients, and patients receiving long-term steroid treatment. Of 849 HMPV-infected patients, 756 had community-acquired infections, 579 had pneumonia, and 203 had infections with other pathogens. Mortality rates were highest in hematopoietic stem cell transplantation recipients (22% at 30 days). Older age, current smoking, and underlying disease were associated with HMPV pneumonia. Body mass index and an immunocompromised state were associated with 30-day mortality rates in HMPV-infected patients. Bronchial wall thickening, ground-glass opacity, and ill-defined centrilobular nodules were common computed tomography findings for HMPV pneumonia. Macronodules and consolidation were observed in