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Electrostrictive materials based on (Na0.5Bi0.5)TiO3 are promising lead-free candidates for high-precision actuation applications, yet their properties require further improvement. This study aims to enhance the electromechanical properties of a predominantly electrostrictive composition, 0.685(Na0.5Bi0.5)TiO3-0.065BaTiO3-0.25SrTiO3, by using templated grain growth. Textured ceramics were prepared with 1~9 wt% NaNbO3 templates. A high Lotgering factor of 95% was achieved with 3 wt% templates and sintering at 1200 °C for 12 h. Polarization and strain hysteresis loops confirmed the ergodic nature of the system at room temperature, with unipolar strain significantly improving from 0.09% for untextured ceramics to 0.23% post-texturing. A maximum normalized strain, Smax/Emax (d33*), of 581 pm/V was achieved at an electric field of 4 kV/mm for textured ceramics. Textured ceramics also showed enhanced performance over untextured ceramics at lower electric fields. The electrostrictive coefficient Q33 increased from 0.017 m4C−2 for untextured ceramics to 0.043 m4C−2 for textured ceramics, accompanied by reduced strain hysteresis, making the textured 0.685(Na0.5Bi0.5)TiO3-0.065BaTiO3-0.25SrTiO3 composition suitable for high-precision actuation applications. Dielectric properties measured between −193 °C and 550 °C distinguished the depolarization, Curie–Weiss and Burns temperatures, and activation energies for polar nanoregion transitions and dc conduction. Dispersive dielectric constants were found to observe the “two” law exhibiting a temperature dependence double the value of the Curie–Weiss constant, with shifts of about 10 °C per frequency decade where the non-dispersive THz limit was identified.

Abstract Background Lumbar lordosis (LL) can be restored, and screw-related complications may be avoided with the stand-alone expandable cage method. However, the long-term spinopelvic changes and safety remain unknown. We aimed to elucidate the long-term radiologic outcomes and safety of this technique. Methods Data from patients who underwent multi-level stand-alone expandable cage fusion and 80 patients who underwent screw-assisted fusion between February 2007 and December 2012, with at least 5 years of follow-up, were retrospectively analyzed. Segmental angle and translation, short and whole LL, pelvic incidence, pelvic tilt, sacral slope (SS), sagittal vertical axis, thoracic kyphosis, and presence of subsidence, pseudoarthrosis, retropulsion, cage breakage, proximal junctional kyphosis (PJK), and screw malposition were assessed. The relationship between local, lumbar, and spinopelvic effects was investigated. The implant failure rate was considered a measure of procedure effectiveness and safety. Results In total, 69 cases were included in the stand-alone expandable cage group and 150 cases in the control group. The stand-alone group showed shorter operative time (58.48 ± 11.10 vs 81.43 ± 13.75, P = .00028), lower rate of PJK (10.1% vs 22.5%, P = .03), and restoration of local angle (4.66 ± 3.76 vs 2.03 ± 1.16, P = .000079) than the control group. However, sagittal balance (0.01 ± 2.57 vs 0.50 ± 2.10, P = .07) was not restored, and weakness showed higher rate of subsidence (16.31% vs 4.85%, P = .0018), pseudoarthrosis (9.92% vs 2.42%, P = .02), cage, and retropulsion (3.55% vs 0, P = .01) than the control group. Conclusions Stand-alone expandable cage fusion can restore local lordosis; however, global sagittal balance was not restored. Furthermore, implant safety has not yet been proven.

Differential microhabitat use may be beneficial to achieving fitness in seasonally variable environmental conditions. To explore whether the microhabitat use of the nocturnal Schlegel’s Japanese gecko, Gekko japonicus, varies seasonally and depends on juvenile, male, and female reproductive groups, we investigated five categorical and five quantitative measure variables of microhabitat use in a wild population both in spring and summer. Most geckos were found on white, vertical planes of concrete and plastered brick walls. None of the categorical variables (type of location, substrate, substrate color, light source, and refuge) significantly differed according to season or group, while substrate temperature and irradiance at the location where geckos were observed and the distance from the nearest potential refuge were significantly greater in summer than in spring. The quantitative measure variables did not differ among the reproductive groups. These results suggest that G. japonicus seasonally adjusts its microhabitat use mainly in terms of quantitative measure variables rather than categorical variables.

This study aimed to analyze feature importance by applying explainable artificial intelligence (XAI) to postural deformity parameters extracted from a computer vision-based posture analysis system (CVPAS). Overall, 140 participants were screened for CVPAS and enrolled. The main data analyzed were shoulder height difference (SHD), wrist height difference (WHD), and pelvic height difference (PHD) extracted using a CVPAS. Standing X-ray imaging and radiographic assessments were performed. Predictive modeling was implemented with XGBoost, random forest regressor, and logistic regression using XAI techniques for global and local feature analyses. Correlation analysis was performed between radiographic assessment and AI evaluation for PHD, SHD, and Cobb angle. Main global features affecting scoliosis were analyzed in the order of importance for PHD (0.18) and ankle height difference (0.06) in predictive modeling. Outstanding local features were PHD, WHD, and KHD that predominantly contributed to the increase in the probability of scoliosis, and the prediction probability of scoliosis was 94%. When the PHD was >3 mm, the probability of scoliosis increased sharply to 85.3%. The paired t-test result for AI and radiographic assessments showed that the SHD, Cobb angle, and scoliosis probability were significant (p < 0.05). Feature importance analysis using XAI to postural deformity parameters extracted from a CVPAS is a useful clinical decision support system for the early detection of posture deformities. PHD was a major parameter for both global and local analyses, and 3 mm was a threshold for significantly increasing the probability of local interpretation of each participant and the prediction of postural deformation, which leads to the prediction of participant-specific scoliosis.

Background and Objectives: Symptomatic adjacent segment degeneration (ASD) with lumbar spinal canal stenosis (LSCS) is a common complication after spinal intervention, particularly interbody fusion. Stand-alone posterior expandable cages enable interbody fusion with preservation of the previous operation site, and screw-related complications are avoided. Thus, the aim of this study was to investigate the clinicoradiologic outcomes of stand-alone posterior expandable cages for ASD with LSCS. Materials and Methods: Patients with persistent neurologic symptoms and radiologically confirmed ASD with LSCS were evaluated between January 2011 and December 2016. The five-year follow-up data were used to evaluate the long-term outcomes. The radiologic parameters for sagittal balance, pain control (visual analogue scale), disability (Oswestry Disability Index), and early (peri-operative) and late (implant) complications were evaluated. Results: The data of 19 patients with stand-alone posterior expandable cages were evaluated. Local factors, such as intervertebral and foraminal heights, were significantly corrected (p < 0.01 and p < 0.01, respectively), and revision was not reported. The pain level (p < 0.01) and disability rate (p < 0.01) significantly improved, and the early complication rate was low (n = 2, 10.52%). However, lumbar lordosis (p = 0.62) and sagittal balance (p = 0.80) did not significantly improve. Furthermore, the rates of subsidence (n = 4, 21.05%) and retropulsion (n = 3, 15.79%) were high. Conclusions: A stand-alone expandable cage technique should only be considered for older adults and patients with previous extensive fusion. Although this technique is less invasive, improves the local radiologic factors, and yields favorable clinical outcomes with low revision rates, it does not improve the sagittal balance. For more widespread application, the strength of the cage material and high subsidence rates should be improved.

Objectives: The present study evaluated the effects of sa-am acupuncture (SAA) simpo-jeongkyeok (SPJK) treatment on the blood pressure (BP), pulse rate (PR), and body temperature (BT) of patients with hwa byung (HB). Methods: This patient assessor blind, randomized, placebo controlled trial included 50 volunteers, divided randomly into two groups. The treatment group underwent SPJK (PC9, LR1, PC3, KI10) while the control (sham) group received minimal needle insertion at non acupoints. The BP in both arms, PR, and BT at several acupoints were measured before and after treatment at the 1st, 2nd, 3rd, and 4th visits and before treatment at the follow-up visit. We analyzed data by using the repeated measured analysis of variance (RM ANOVA), Mann-Whitney U, and wilcoxon signed rank tests; differences at P < 0.05 were considered significant. Results: No significant differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP) and PR between the treatment and control group were observed at each visit. However, the decrease in the SBP for the treatment group before and after each visit was significantly higher than it was in the control group. The SBP in both arms in the treatment group was decreased between visits 1 and 2, 1 and 3, 1 and 4, and 1 and follow-up. The DBP in both arms and in the right arm between visits 1 and 3 in the treatment group showed decreases. A minimal BT increase for treatment at CV06 and CV12 and a minimal BT decrease for treatment at CV17 and (Ex) Yintang were found. Patients in the treatment group who visited more frequently experienced a greater decrease in the PR, but that effect was not maintained. Conclusion: The results suggest that SAA SPJK treatment has instant positive effects on the BP, PR, and BT in patients with HB, but the effects on the BP and PR are not maintained.

The Korean crevice salamander, Karsenia koreana, is the only known plethodontid salamander in Asia. In this study, we provide the first report of this salamander’s complete mitochondrial genome. The mitogenome had a length of 16,780 bp and consisted of 13 protein-coding genes, 2 rRNA genes, 22 tRNA genes, and 2 noncoding regions. The presented sequence may be highly useful for future phylogenetic and evolutionary studies of Plethodontidae.

Copper sulfide (CuS) thin films were deposited on a glass substrate at room temperature using the radio-frequency (RF) magnetron-sputtering method at RF powers in the range of 40−100 W, and the structural and optical properties of the CuS thin film were investigated. The CuS thin films fabricated at varying deposition powers all exhibited hexagonal crystalline structures and preferred growth orientation of the (110) plane. Raman spectra revealed a primary sharp and intense peak at the 474 cm−1 frequency, and a relatively wide peak was found at 265 cm−1 frequency. In the CuS thin film deposited at an RF power of 40 W, relatively small dense particles with small void spacing formed a smooth thin-film surface. As the power increased, it was observed that grain size and grain-boundary spacing increased in order. The binding energy peaks of Cu 2p3/2 and Cu 2p1/2 were observed at 932.1 and 952.0 eV, respectively. Regardless of deposition power, the difference in the Cu2+ state binding energies for all the CuS thin films was equivalent at 19.9 eV. We observed the binding energy peaks of S 2p3/2 and S 2p1/2 corresponding to the S2− state at 162.2 and 163.2 eV, respectively. The transmittance and band-gap energy in the visible spectral range showed decreasing trends as deposition power increased. For the CuS/tin sulfide (SnS) absorber-layer-based solar cell (glass/Mo/absorber(CuS/SnS)/cadmium sulfide (CdS)/intrinsic zinc oxide (i-ZnO)/indium tin oxide (ITO)/aluminum (Al)) with a stacked structure of SnS thin films on top of the CuS layer deposited at 100 W RF power, an open-circuit voltage (Voc) of 115 mA, short circuit current density (Jsc) of 9.81 mA/cm2, fill factor (FF) of 35%, and highest power conversion efficiency (PCE) of 0.39% were recorded.

In this paper, we report the development of Cd-free buffers using atomic layer deposition (ALD) for Cu(In,Ga)(S,Se)2-based solar cells. The ALD process gives good control of thickness and the S/S +O ratio content of the films. The influence of the growth per cycle (GPC) and the S/(S+O) ratio, and the glass temperature of the atomic layer deposited Zn(O,S) buffer layers on the efficiency of the Cu(In,Ga)(S,Se)2 solar cells were investigated. We present the first results from our work on cadmium-free CIGS solar cells on substrates with an aperture area of 0.4 cm2. These Zn(O,S) layers were deposited by atomic layer deposition at 120 °C with S/Zn ratios of 0.7, and layers of around 30 nm. The Zn(O,S) 20% (Pulse Ratio: H2S/H2O+H2S) process results in a S/Zn ratio of 0.7. We achieved independently certified aperture area efficiencies of 17.1% for 0.4 cm2 cells.

Objectives: The purpose of this study is to report the clinical effect of Korean medicine (KM) treatment for Henoch-Schonlein purpura (HSP). Methods: Five HSP patients who demonstrated a Yin deficiency and who had a history of a previous upper respiratory tract infection were included in this study. Four patients had arthritis and three had severe stomachache. One of them appeared to have proteinuria and hematuria before starting KM treatment. Results: All patients were improved with only herbal medicine, Jarotang (JRT). Purpura in the lower extremities and abdominal pain, which were not treated by using a corticosteroid, disappeared and had not recurred after 6 months. Conclusion: These cases indicate that JRT may be effective in treating HSP in patients who demonstrate Yin deficiency, even though the number of cases was limited to five.

Marine reptiles are declining globally, and recent climate change may be a contributing factor. The study of sea snakes collected beyond their typical distribution range provides valuable insight on how climate change affects marine reptile populations. Recently, we collected 12 Laticauda semifasciata (11 females, 1 male) from the waters around southern South Korea-an area located outside its typical distribution range (Japan, China including Taiwan, Philippines and Indonesia). We investigated the genetic origin of Korean specimens by analyzing mitochondrial cytochrome b gene (Cytb) sequences. Six individuals shared haplotypes with a group found in Taiwan-southern Ryukyu Islands, while the remaining six individuals shared haplotypes with a group encompassing the entire Ryukyu Archipelago. These results suggest L. semifasciata moved into Korean waters from the Taiwan-Ryukyu region via the Taiwan Warm Current and/or the Kuroshio Current, with extended survival facilitated by ocean warming. We highlight several contributing factors that increase the chances that L. semifasciata establishes new northern populations beyond the original distribution range.

Abstract Carbon nanotube/polytetrafluoroethylene composite polymer targets are proposed for use in the fabrication of fluorocarbon thin films using the mid-frequency sputtering process. Fluorocarbon thin films deposited using carbon nanotube/polytetrafluoroethylene composite targets exhibit an amorphous phase with a smooth surface and show a high water contact angle, optical transmittance, and surface hardness. X-ray photoelectron spectroscopy and Fourier transform infrared spectroscopy studies reveal that as the carbon nanotube concentration increased in the composite target, a carbon cross-linked structure was formed, which enhanced the film hardness and the modulus of the fluorocarbon thin film. Large-area fluorocarbon thin films with a substrate width of 700 mm were successfully fabricated by a pilot-scale roll-to-roll sputtering system using a carbon nanotube/polytetrafluoroethylene composite target.

Category: Diabetes Introduction/Purpose: Ulcer healing in the diabetic patients is challenging due to a prolonged inflammatory response, extracellular matrix degradation irregularities, and increased bacteria presence. Collagen components are fundamental to the process of wound healing and skin formation. Recently, collagen-containing wound dressings, which create a biological scaffold matrix, have been used in the treatment of diabetic foot ulcer (DFU). However, there is not enough evidence to support that 100% collagen dressing can replace the diabetic wound management. In this study, we examined the effectiveness and safety of a new collagen dressing material in the treatment of DFU. Methods: This study was a prospective, randomized, placebo-controlled, single-center study conducted between November 2011 and September 2014. The inclusion criteria were type 1 or 2 diabetes, a ulcer size ≥ 1.0 cm2 that did not exhibit signs of healing for 6 weeks, Wagner grade 1 or 2, and palpable pulses at the ankle. The assessments of DFU included size, microbial culture study, detailed description of DFU, and clinical photos. Patients in the study group were treated with a collagen dressing material (100% porcine type I collagen) and foam dressing, while patients in the control group were treated with only foam dressing. Dressing changes had been performed two or three times per week. Complete ulcer healing rate was evaluated as a primary endpoint and ulcer size were compared between the two groups as a secondary endpoint. Results: Thirty patients were included in the final analysis (study group: 17 patients, control group: 13 patients). There were no significant differences between two groups regarding demographic factors and baseline DFU characteristics. The study group presented a higher rate of complete healing as compared to that in the control group [82.4% (14/17), 38.5% (5/13), respectively, P = 0.022]. At the last follow-up, ulcer sizes of the study group were smaller than those of the control group (P = 0.048). The Kaplan-Meier analysis for the complete ulcer healing also showed a significantly higher rate of complete healing in the study group (Hazard ratio = 3.0, log-rank P = 0.025). There were no adverse events related to the dressing materials. Conclusion: This study supports that the wound dressing using 100% collagen materials may offer a safe and effective treatment for DFU.

Category: Ankle Introduction/Purpose: Chronic lateral ankle instability (CLAI) has shown significant relationship with cavovarus deformity in prior studies. Isolated lateral ankle ligament reconstruction in patients who have CLAI with cavovarus deformity has been shown poor outcome if the deformity had not been corrected. Traditionally, cavovarus foot has been associated with neuromuscular conditions, however, nowadays it occurs in a less severe form even in the normal population. Mild cavovarus deformity is thought to be an anatomical risk factor for CLAI, but there are still debates on the correction of the mild deformity. The purpose of the current study was to evaluate clinical and radiographic outcomes of the modified Broström operation (MBO)s with additional procedures for the CLAI with mild cavovarus deformity. Methods: We reviewed total 12 patients who underwent MBOs with additional procedures for CLAI with mild cavovarus deformity between August 2009 and September 2013. Patients were evaluated by visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Karlsson-Peterson (KP) ankle score. The talar tilt angle and the anterior displacement of the talus on ankle stress radiographs and the first metatarsal- talus angle, the arch height between cuneiform and fifth metatarsal base and the calcaneal pitch angle on foot lateral standing radiographs were examined. Results: The mean follow-up period was 31.5 months. Calcaneal lateral closing wedge osteotomy was performed in 6 patients to correct fixed hindfoot varus, and first metatarsal dorsiflexion osteotomy in 9 patients to correct remnant plantarflexion of the first ray. Three of 12 patients underwent both calcaneal and first metatarsal osteotomies. The mean VAS score decreased from 5.5 to 1.7 at last follow-up (p=0.002). The mean AOFAS score and the mean KP ankle score were significantly improved (61.0 to 85.3 (p< 0.001), 56.8 to 83.1 (p < 0.001)) and there was no recurrence of instability. Radiographically, the mean talar tilt angle and the anterior displacement of the talus were decreased (p=0.001, p=0.007), and the first metatarsal- talus angle and the arch height were decreased at last follow-up (p=0.001, p=0.003). Conclusion: Concomitant correction of mild cavovarus deformity with MBO for CLAI improves clinical outcomes and prevents recurrent instability. A comprehensive evaluation and cautious approach for deformity should be followed when treating patients with chronic ankle instability.

Category: Bunion Introduction/Purpose: Over recent years, a proximal opening wedge osteotomy (POWO) using a novel low-profile plate have gained in popularity for the correction of moderate to severe hallux valgus. However, the proximal opening wedge osteotomy was known to increase the length of the first metatarsal, resulting in tightening of the soft tissues around the first metatarsophalangeal (MTP) joint and predisposing to jamming of the joint and subsequent arthritis. The purpose of this study was to evaluate the arthritic change of first MTP joint after POWO using a low-profile plate for correction of moderate to severe hallux valgus. Methods: We retrospectively reviewed 100 consecutive POWOs using a low-profile plate performed in 87 patients with moderate to severe hallux valgus deformity. After excluding 17 cases, 83 cases in 73 patients were included. For clinical assessment, VAS, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and Foot and Ankle Outcome Score (FAOS) were obtained. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), the relative first metatarsal length which is the first metatarsal length divided by the second metatarsal length and the first MTP joint radiographic arthritic grade by Coughlin and Shurnas were assessed on standard weight bearing radiographs of the foot for radiographic evaluation. Results: Mean follow-up period was 16.1 (12-45) months. The mean VAS, AOFAS score and most of FAOS subscales improved significantly. Significant corrections in the HVA and IMA were obtained and the mean increase in the relative first metatarsal length was 3.8% at last follow-up (P < 0.001). There were 15 (18.1%, 15/83) cases of the first MTP joint arthritis at last follow-up (Radiographic grade I: 5, II: 8, III: 2). Of 62 cases using a large wedge plate (≥5.0 mm), 12 (19.4%, 12/62) cases showed poorer outcomes and a significant progression of the arthritic grade at last follow-up (Fisher's exact test, P=0.031) comparing to using a small wedge plate (< 5.0 mm) (Table 1). Conclusion: The POWO using a low-profile wedge plate is effective and reproducible technique for correction of moderate to severe hallux valgus deformity. However, the exacerbation of preexisting first MTP joint arthritis and the subsequent arthritis can occur after POWOs using a large wedge plate (≥5.0 mm) at short to mid-term follow-up. Therefore, POWOs with a low-profile wedge plate should be used judiciously for correction of moderate to severe hallux valgus.

Background & Aims: Biochemical response to ursodeoxycholic acid (UDCA) therapy is associated with good prognosis in people living with primary biliary cholangitis (PBC). Biochemical response is typically assessed early in disease and it is not known what proportion of patients lose previously attained biochemical response, nor whether this impacts long-term liver transplant (LT)-free survival. Methods: We identified all UDCA-treated patients with PBC from the Canadian Network for Autoimmune Liver disease with biochemical measurements at 1 year, and evaluated their liver biochemistry over time. Inadequate biochemical response was defined as serum alkaline phosphatase ≥1.67x the upper limit of normal or abnormal serum total bilirubin at 1 year of UDCA therapy and all time points thereafter. Multistate Markov models were used to estimate transition rates between biochemical response states and from each state to LT or death. Results were validated in an external cohort (GLOBAL PBC registry). Results: A total of 823 patients from eight centers were included. Mean age at diagnosis was 53 years, 91% were female, 33% had inadequate biochemical response to UDCA at 1 year (n = 269). Patients who retained initial adequate response had lower rates of LT or death compared to patients who subsequently lost response (relative rate 0.102, 95% CI 0.047-0.223). Patients who regained adequate response had lower rates than patients who did not (0.016, 95% CI 0.001-0.568), and patients who lost response once more (0.010, 95% CI 0.001-0.340). Patients who regained adequate response for a third time also had lower rates than patients who did not (0.151, 95% CI 0.040-0.566). Analyses in the GLOBAL PBC registry (n = 2,237) validated these results. Conclusion: Loss of biochemical response at any time is associated with heightened risks of LT or death in people living with PBC. Achievement of biochemical response is an important goal throughout follow-up, regardless of biochemical response profile early in therapy. Impact and implications:: Early biochemical response to ursodeoxycholic acid is associated with good prognosis in patients with primary biliary cholangitis (PBC). Our work demonstrates that patients with PBC transition between biochemical response states over time, and that these transitions correspond with changes in risk of liver transplantation or death. Clinicians should re-evaluate risk and optimize treatment decisions for patients with PBC throughout follow-up, regardless of early biochemical response to therapy.

Growth of the Korean economy has been sluggish, and this situation is more pronounced in the service sector. We argue that capital misallocation, especially in the service sector, could contribute to this slowdown. Utilizing firm and sectoral level data, first we assess the rising dispersion of the marginal revenue product of capital (MRPK) driven by the service sector. This could represent a widening misallocation of capital. Furthermore, a panel regression shows that within-sector misallocations at the sectoral level are closely correlated with the lower growth rate of sectoral real value added. Again, this is mainly observed in the service sector, but not in the manufacturing sector. Misallocations of other resources, labor and the intermediate inputs do not stand out.

Objective:. To conduct a systematic review, critical appraisal, and external validation of survival prediction tools for patients undergoing intrahepatic cholangiocarcinoma (iCCA) resection. Summary background data:. Despite the development of several survival prediction tools in recent years for patients undergoing iCCA resections, there is a lack of critical appraisal and external validation of these models. Methods:. We conducted a systematic review and critical appraisal of survival and recurrence prediction models for patients undergoing curative-intent iCCA resections. Studies were evaluated based on their model design, risk of bias, reporting, performance, and validation results. We identified the best model and externally validated it using our institution’s data. Results:. This review included a total of 31 studies, consisting of 26 studies with original prediction tools and 5 studies that only conducted external validations. Among the 26, 54% of the studies conducted internal validations, 46% conducted external validations, and only 1 study scored a low risk of bias. Harrell’s C-statistics ranged from 0.67 to 0.76 for internal validation and from 0.64 to 0.75 for external validation. Only 81% of the studies reported model calibration. Our external validation of the best model (Intrahepatic Cholangiocarcinoma [ICC]-Metroticket) estimated Harrell’s and Uno’s C-statistics of 0.67 (95% CI: 0.56–0.77) and Uno’s time-dependent area under the receiver operating characteristic curve (AUC) of 0.71 (95% CI: 0.53–0.88), with a Brier score of 0.20 (95% CI: 0.15–0.26) and good calibration plots. Conclusions:. Many prediction models have been published in recent years, but their quality remains poor, and minimal methodological quality improvement has been observed. The ICC-Metroticket was selected as the best model (Uno’s time-dependent AUC of 0.71) for 5-year overall survival prediction in patients undergoing curative-intent iCCA resection.

Up to 50% of colorectal cancer (CRC) patients develop colorectal liver metastases (CRLM). The aim of this study was to gauge the awareness and perception of liver transplantation (LT) for non-resectable CRLM, and to describe the current referral patterns and management strategies for CRLM in Canada. Surgeons who provide care for patients with CRC were invited to an online survey through the Canadian Association of General Surgeons, the Canadian Society of Colon and Rectal Surgeons, and the Canadian Society of Surgical Oncology. Thirty-seven surveys were included. The most utilized management strategy for CRLM was to refer to a hepatobiliary surgeon for assessment of metastectomy (78%), and/or refer to medical oncologists for consideration of chemotherapy (73%). Among the respondents, 84% reported that their level of knowledge about LT for CRLM was low, yet the perception of exploring the option of LT for non-resectable CRLM seemed generally favorable (81%). The decision to refer for consideration of LT for CRLM treatment seemed to depend on patient-specific factors and the local hepatobiliary surgeon’s recommendation. Providing CRC care providers with educational materials on up-to-date CRLM management may help raise the awareness of the use of LT for non-resectable CRLM.

Recent advances in interactive communication have allowed companies to introduce new digital technologies to differentiate their online customer chatting services, but little is known about how customers perceive these new services. To answer this call, the current research examines the effects of avatar presentation, company market status, and agent identity on customers’ perception of service quality and satisfaction in the context of minor service failure that customers encounter through online chatting services. The results of two studies show that customers perceive better service quality and demonstrate lower satisfaction if served by an artificial intelligence [AI] agent (vs. a human-agent), represented by a human picture (vs. a human image). However, this pattern was found only for a company with high market-status, not for a company with low market-status. These results will help marketing practitioners strategically design their chatting service environments according to the nature of services they offer.

Category: Ankle Introduction/Purpose: The optimal treatment for symptomatic osteochondral lesion of the talus (OLT) after failed arthroscopic microfracture has been a controversial issue. The use of viscosupplementation for treatment of OLT has been gradually increasing. The hyaluronic acid (HA) injection is believed to play an important role in reducing pain and inflammation, and promoting tissue repair. The purpose of this study is to evaluate the clinical outcomes of intra-articular HA injection for the patients with failed arthroscopic microfracture in OLT. Methods: This study included 12 patients who received three weekly injections of intra-articular HA after arthroscopic microfracture for OLT between October 2014 and October 2015. Five men and seven women were included in this study. The average age at the time of injection was 41 years (range, 19-63 years). All patients had recurrent pain for at least 6 months after the index surgery. The patients were followed for 6.1 months (range: 5.0-7.0). At each visit, the efficacy of HA injection was evaluated by a Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Foot and Ankle Outcome Score (FAOS) pain subscale. In addition, subjective satisfactions were assessed by the Alexander scale. Results: The mean period from the arthroscopic microfracture to the intra-articular HA injection was 26.5 months (range: 6.0- 87.0). Mean VAS decreased from 6.7 ± 1.1 at pre-injection to 2.4 ± 1.6 at post-injection six weeks (p < 0.001), 3.1 ± 1.5 at three months (p = 0.002) and 3.8 ± 2.3 at six months (p = 0.02). Mean AOFAS score improved from 61.0 ± 9.1 at pre-injection to 85.3 ± 11.3 at post-injection six weeks (p < 0.001), 82.9 ± 10.4 at three months (p < 0.001) and 80.4 ± 13.8 at six months (p = 0.001). Mean FAOS pain subscale also improved from 53.2 ± 4.2 at pre-injection to 71.1 ± 9.4 at post-injection six weeks (p < 0.001), 66.7 ± 7.2 at three months (p = 0.001) and 64.4 ± 9.5 at six months (p = 0.036). According to the Alexander scale, there were 58.3% (7/12) good, 25.0% (3/12) fair, and 16.7% (2/12) poor results at post-injection six months. There was no adverse effect. Conclusion: In this study, we found that the main improvement in clinical outcomes occurred during the first six weeks and significantly maintained until at least three or six months. We believe that the HA injection could be a useful treatment option after failed arthroscopic microfracture in OLT.

Category: Diabetes Introduction/Purpose: Fast and complete healing of a diabetic foot ulcer (DFU) is challenging due to the hostile wound healing environment of the diabetic patients. As a part of a multimodal treatment approach, advanced dressing material using hyaluronic acid (HA) has been found to be effective. However, previous studies have used HA with additional biologics, which interferes in determining the true clinical effect of HA in DFU. The purpose of this study is to examine the effectiveness and safety of a new HA dressing material in the treatment of DFU. Methods: This study was a prospective, randomized, placebo-controlled, single-center study conducted between September 2012 and January 2014. The inclusion criteria were type 1 or 2 diabetes, a ulcer size ≥ 1.0 cm2 that did not exhibit signs of healing for 6 weeks, Wagner grade 1 or 2, and palpable pulses at the ankle. The assessments of DFU included size, microbial culture study, detailed description of the DFU, and clinical photos. Patients in the study group were treated with an HA dressing material (hyaluronic acid 80 ± 5% and poloxamer 10 ± 5%), while patients in the control group were treated with a conventional moisture- retentive dressing (petrolatum gauze). Weekly follow-up was conducted with the dressing change up to maximum 12 weeks. Complete ulcer healing rate was evaluated as a primary endpoint. Additionally, healing velocity and the mean duration for achieving a 50% ulcer size reduction was compared between the two groups as a secondary endpoint. Results: Twenty-five patients were included in the final analysis (study group: 13, control group: 12). There were no significant differences between two groups regarding demographic factors and baseline DFU characteristics. The study group presented a significantly higher complete healing rate as compared to that in the control group [84.6% (11/13), 41.6% (5/12), respectively, P = 0.041]. Faster ulcer healing velocity and shorter mean duration for achieving a 50% ulcer size reduction were observed in the study group (P = 0.022, P = 0.004, respectively). The Kaplan-Meier analysis for the median time for 50% ulcer healing rate also showed a significantly shorter duration in the study group (21 days vs 39 days, P = 0.012). There were no adverse events related to the dressing materials. Conclusion: This study supports that a HA dressing without additional substances may offer a safe and effective treatment for DFU.