This study aims to explore educational and political efforts for PE teachers to implement ICT-based PE class by analyzing three significant phases (PE teacher, the curriculum, and teaching environment). To reach the goal of this study, we conducted AHP and IPA analysis to find out the priorities in order to implement ICT-based PE class. As a result, a total of 27 detailed contents were created by IPA analysis. Based on the IPA results, we interrogated what detailed contents should be firstly applied into actual PE practices by analyzing four dimensions by utilizing IPA. Based on the results, this study concluded with some significance, which are required to establish a better PE environment in the future society.

Background Emerging evidence suggests that epithelial cell-derived microRNAs (miRNA) are involved in the pathogenesis of inflammatory bowel disease; however, as of now specific implications in the real clinical practice, especially in relation to biologics use are yet far-fetched. Therefore, we tried to investigate specific epithelial cell derived miRNA signatures related to clinical and endoscopic activity in Crohn’s disease (CD) patients. Methods We prospectively collected terminal ileum tissue samples via ileocolonoscopy from healthy control (n=12), CD patients in remission (n=32) and active CD patients (n=36). CD remission was defined as clinical remission of Crohn's disease activity index (CDAI) <150 and achievement of endoscopic mucosal healing. Both inflamed and non-inflamed lesions were sampled in the active CD patients. Clinical information, medication use, chemistry data were measured within a week from the tissue sample date. miRNA levels were measured by small-RNA sequencing and qRT-PCR. Diagnostic ability of specific miRNA found were evaluated by receiver operating characteristic (ROC) curve analysis. Results The study cohort was followed up until January 2022. Mean follow-up period of the prospective CD cohort was 13.06 months. In comparing to the healthy control, CD patients in remission and active state revealed specific miRNA profiles in small-RNA sequencing. Through RT-PCR validation, we found that the expression levels of miR-141-3p, miR-338-3p, miR-378a-3p, and miR-200b-3p were significantly decreased, while miR-125b-5p, miR-29b-3p and miR-155-5p were significantly increased in the inflamed tissue of active CD patients. Moreover, in case of active CD patients, expressions of miR-150-5p, miR-200b-3p and miR-155-5p were significantly down-regulated in those using biologics, compared with biologics naïve patients. This may suggest that these miRNAs were not only as biomarkers of CD patients, but also as biomarkers related to inflammation and biologics response. ROC curve analysis suggested miRNAs with different diagnostic activity related to both clinical disease activity and endoscopic inflammation status. MiR-338-3p, miR-141-3p and miR-378a-3p demonstrated area under curve of greater than 0.9 in predicting active CD patients. Conclusion We report specific miRNA biomarkers identifying CD and its disease inflammation activity with relation to biologics use, suggesting potential treatment target in CD pathogenesis. These miRNA signatures could also be of potential clinical use in positioning biologics, which we intend to explore in the near future.

Background Avascular necrosis (AVN) is bone death due to disruption of blood supply causing disability and significant morbidity. Although considered multi-factorial, corticosteroid use is a well-known risk factor. Not only is AVN more prevalent in Inflammatory bowel disease (IBD), but IBD patients are often exposed to higher corticosteroids usage. Therefore, we aimed to investigate epidemiology and risk factors of avascular necrosis in Asian IBD patients. Methods We conducted a nationwide population-based cohort using Korean National Health Insurance Service (NHIS) database from January 2007 to December 2020. Newly diagnosed IBD patients were defined according to the International Classification of Diseases, 10th revision (ICD-10), and at least one prescription of IBD-specific medications. 1:3 sex-, age- matched subjects from the general population were selected. We investigated newly diagnosed AVN using the ICD-10 code and the incidence rates and risk of AVN were assessed with multivariate cox regression models. Results A total of 62,417 IBD population was identified, where ulcerative colitis (UC) comprised of 44,106. Age at diagnosis was younger in Crohn's disease (CD) than in UC (30±15 years and 43±16.3 years). UC population revealed greater number of comorbidities such as hypertension (16.7% and 7.1% for UC and CD, respectively), diabetes mellitus (12.4% and 9.5%), dyslipidemia (27.6% and 25.2%), and cerebrovascular diseases (4.5% and 2.5%). During the mean follow-up period of 6.75 years, 54,591 (87.5%) of the total IBD patients were exposed to systemic steroids (86.4% and 90.1% for UC and CD, respectively). Approximately 76.8% in the IBD group were prescribed with ≥10 mg/day of corticosteroids with mean duration of 16.3±35.1 days. A total of 100 (0.16%) newly diagnosed AVN cases were observed in the IBD population. Time from the index date to AVN diagnosis was 4.47±3.29 years. Compared to the non-IBD controls, the incidence of AVN was significantly increased in IBD subjects (adjusted hazard ratio [aHR] with 95% confidence interval [CI], 1.28 [1.01-1.63]). UC patients in particular were at an elevated risk for developing AVN (aHR with 95% CI, 1.39 [1.07-1.80]), whereas risk analysis for CD patients demonstrated results that were statistically not significant (aHR with 95% CI, 1.00 [0.63-1.57]). Table 1 Incidence rates and risk ratios of AVN in patients with IBD Conclusion Risk of AVN was elevated in Korean IBD patients compared to non-IBD population, especially for UC. Physicians dealing with IBD patients should be aware of etiological factors of AVN along with corticosteroid use. Future study is needed to investigate on the mechanisms associated with AVN in IBD.

Background The aims of this study are to explore the changes of gut microbiome after anti-TNF-α therapy (adalimumab; ADA) and to identify biomarkers to predict clinical remission to ADA in patients with active ulcerative colitis (UC). Methods Fecal samples were taken before (baseline) and after ADA administration at weeks 8 and 56 in patients with active UC. Fecal bacterial taxonomic composition and diversity were investigated by 16S sequencing and analyzed by divisive amplicon denoising algorithm version 2 (DADA2) at the level of amplicon sequence variant (ASV). The table was imported into R 4.0.2 to analyze for richness, diversity, heatmap and ordination plot . The linear discriminant analysis effect size (LEfSe) was used for statistical analysis. Clinical remission was assessed using the Mayo score. Results 260 fecal samples from 146 patients with UC administering ADA and 40 fecal samples of healthy controls (HC) were analyzed. The mean age of the participants was 44 ±14.8 years, and 60.7% were male (patients 64.9%, healthy control 42.5%). Overall communities (β-diversity) of gut microbiota in HC clearly differed from those before, after 8 weeks, and after 56 weeks of ADA treatment in patients with UC regardless of remission. The compositions of microbiota were affected by the disease severity and extent. ADA treatment significantly reduced the dissimilarity among samples in remitters at both 8 and 56 weeks, which were not observed in non-remitters. In remitters, the abundance of genus Staphylococcus was significantly decreased and genera Bifidobacterium and Dorea were significantly increased during ADA treatment period. The baseline samples of remitter at week 8 showed a higher abundance of 40 ASVs, including Sporosarcina (ASV2803), Bacteroides sp. (ASV1298, ASV1490), and Enterobacter (ASV9330, ASV9332) compared to baseline of non-remitters. Given that the 48 ASVs increased or decreased in baseline samples of remitters at week 8, the best log ratio of average relative abundance of increased ASVs/decreased ASVs to predict remission for ADA treatment was 0.07459, with 72.4% sensitivity and 84.3% specificity on the receiver operating curve (area under the curve, 0.855). Conclusion The composition of gut microbiota varies depending on the status of the disease and the effectiveness of the ADA treatment. Relative abundance of s fecal bacteria before treatment can be a biomarker for predicting efficacy of ADA in patients with UC.

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