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Purpose: The aim of this descriptive study was to identify the factors influencing depression risk among South Korean nursing students. Methods: The data were collected from nursing students attending two universities through web-based questionnaires that surveyed them about depression, academic stress, social network service (SNS) addiction tendency, and upward social comparison from August 22 to September 4, 2021. The collected data from 196 nursing students were analyzed by t-test, one-way ANOVA, Pearson’s correlation coefficients, and multiple linear regression.Results: The mean score of depression (using CES-D Korean version) among nursing students was 13.91, which denotes probable depression. Concerning the variance with regard to depression among nursing students, 20.2% was explained by clinical practice period, academic stress, and upward social comparison. Conclusion: Programs to relieve academic stress and depression should be developed in a simple way and systematically provided at the organizational level so that nursing students secure sufficient support during the initial and continuing period of clinical practicums. Concomitantly, an attempt to reduce the upward social comparison should be highly considered.

Purpose: As coronavirus disease 2019 (COVID-19) and other emerging infectious diseases continue to threaten health security, a strategy is required to increase nursing students’ care intention for patients with such diseases. This study aimed to identify factors influencing Korean nursing students’ care intentions in regard to patients with emerging infectious diseases.Methods: The care intention, COVID-19 knowledge level, ethical sensitivity, beliefs, attitudes toward the care intention, subjective norms, and perceived behavioral control were investigated using the theory of planned behavior. An online survey was completed from December 2020 to January 2021 by 227 nursing students who had complete a clinical practicum. Descriptive statistics, correlation, and hierarchical regression analyses were conducted on the data.Results: The care intention was higher in men than in women nursing students and in junior than in senior students. Behavioral and normative beliefs, attitude toward the behavior, and perceived behavioral control significantly predicted care intention. Ethical sensitivity increased the predictability of nursing students’ care intentions for emerging infectious disease patients.Conclusion: The theory of planned behavior predicted nursing students’ care intentions for emerging infectious diseases. Therefore, an experience-based response program on emerging infectious diseases is required for nursing students.

Esculetin is an antioxidant and anti-inflammatory compound derived from coumarin. Oxidative stress can cause overproduction of reactive oxygen species (ROS), which can lead to the development of chronic kidney failure. In this study, human embryonic kidney 293 (HEK293) cells were treated with tert-butyl hydroperoxide (t-BHP) to determine the antioxidant effects of esculetin. HEK293 cells were treated with t-BHP to validate changes in cell viability, ROS production, and apoptosis, and then treated with esculetin to evaluate the changes. Changes in mRNA and protein levels were analyzed using a proteome kit, PCR, and Western blotting. Esculetin improved HEK293 cell viability and reduced apoptosis caused by t-BHP-induced oxidative stress. At the mRNA and protein levels, esculetin decreased pro-apoptotic factor expression as well as increased anti-apoptotic factor expression. The antioxidant efficacy of esculetin was validated when it inhibited the apoptosis caused by t-BHP-induced oxidative stress in HEK293 cells.

Purpose: To evaluate the difference in each retinal layer thickness in central retinal vein occlusion (CRVO) with resolved macular edema after intravitreal antivascular endothelial growth factor injection and normal contralateral eyes..Methods: Patients with ischemic and nonischemic CRVO whose macular edema resolved after intravitreal antivascular endothelial growth factor injections and did not recur for at least 6 months, and a normal contralateral eye were enrolled. Each retinal layer thickness between CRVO and normal contralateral eyes was compared according to Early Treatment Diabetic Retinopathy Study subfields using spectral domain optical coherence tomography.Results: The thicknesses of outer nuclear layer, photoreceptor layer, and retinal pigment epithelium in central ring, ganglion cell layer, inner plexiform layer, outer nuclear layer, and photoreceptor layer in the inner ring, and ganglion cell layer in the outer ring of CRVO eyes were significantly thinner than those of normal contralateral eyes (all p < 0.05). Whereas, inner nuclear layer and outer plexiform layer thicknesses in central ring of CRVO eyes were 23.86 ± 8.8 and 25.76 ± 7.6 μm, respectively, which was significantly thicker than those of normal contralateral eyes (19.52 ± 7.7 and 22.76 ± 6.5 μm; p = 0.019 and p = 0.043, respectively). Additionally, the mean best-corrected visual acuity of CRVO eyes were significantly correlated with photoreceptor layer thickness in central ring (p = 0.005).Conclusions: In CRVO eyes with resolved macular edema, the outer retinal layers were thinner as well as inner retinal layers, whereas inner plexiform layer and outer nuclear layer were thicker than normal fellow eyes. Additionally, photoreceptor layer thickness in foveal area had a significant impact on visual acuity in CRVO.

Background Worldwide, prostate cancer (PC) is the second most diagnosed cancer and the fifth leading cause of cancer death in men. Hormonal therapies, commonly used for PC, are associated with a range of treatment-emergent adverse events (TEAEs). The population from Japan seems to be at higher risk of developing TEAEs of skin rash compared to the overall global population. This study was conducted to get a better insight into the incidence, management, and risk factors for skin rash during active treatment for advanced PC in Japan. Methods A retrospective cohort of PC patients was identified and subsequently categorized, into non-metastatic and metastatic castration-resistant prostate cancer patients (nmCRPC and mCRPC), and metastatic castration-naïve prostate cancer patients (mCNPC). The analysis was based on a dataset from the Medical Data Vision (MDV) database. Descriptive statistics were determined, and a multivariate Cox proportional hazards model was used to the associated risk factors for the onset of rash. Results Overall, 1,738 nmCRPC patients, 630 mCRPC patients, and 454 mCNPC patients were included in this analysis. The median age was 78 years old and similar across the three cohorts. The skin rash incidence was 19.97% for nmCRPC cohort, 28.89% for mCRPC cohort, and 28.85% for mCNPC cohort. The median duration of skin rash ranged from 29 to 42 days. Statistically significant risk factors for developing skin rash included a history of allergy or hypersensitivity (all cohorts), increased age (nmCRPC and mCRPC), a body mass index (BMI) of Conclusion This study provides a better understanding of the real-world incidence, onset, duration, management and risk factors of skin rash in patients on active PC treatment in Japan. It was observed that approximately 20–30% of PC patients experience skin rash. Development of skin rash was associated with previous allergy or hypersensitivity, BMI of

Purpose: To evaluate the correlations between swept-source optical coherence tomography angiography (SS-OCTA) parameters and clinical outcomes in eyes with neovascular age-related macular degeneration (nAMD) administered a bimonthly intravitreal afliberceptregimen. Methods: This prospective, single-arm, interventional study enrolled 33 patients with treatment-naïve nAMD. The eyes received three monthly aflibercept injections followed by five bi-monthly regimens (total 50 weeks). The structural parameters including central subfield thickness (CST) and 5 mm pigment epithelial detachment (PED) volume and microvascular parameters including macular neovascularization (MNV) area, vessel density (VD), and vessel length density (VLD) were recorded every before and 1 week after treatment. Results: Patients who gained >5 letters of best-corrected visual acuity (BCVA) from the baseline showed greater decreases in VD and VLD during the loading phase. Patients without recurrent or persistent fluid during the maintenance phase showed greater decreases in CST and 5 mm PED volume after the first injection. The decrease in mean VD during the loading phase was significantly correlated with the final BCVA (r = -0.820, p = 0.004). Moreover, the decrease in mean VLD during the loading phase was significantly correlated with the improvement in the final BCVA (r = -0.726, p = 0.017). Conclusions:The initial reductions in CST, VD, and VLD after intravitreal injection were associated with greater BCVA improvement. Therefore, early changes in OCTA microvascular and OCT structural parameters could help predict clinical outcomes in nAMD. The trial was registered with the Clinical Research Information Service (CRIS), which joined the WHO International Clinical Trials Registry Platform (ICTRP) (Registration number: KCT0007375, Date of first trial registration: 10/06/2022).

Objective:Pressure ulcers (PUs) are hard-to-heal, open wounds that affect millions of adults worldwide. Patients experience physical, mental, social and financial impairment. On average, Methods:This case series used retrospective data from patients with stage 2–4 PUs that failed to heal after SoC therapies. Factors examined were: number of dressing changes; time between dressing changes; time to wound closure; and pain level. While data were assessed for all patients, we focused on the six particular cases that most clearly illustrated the effect of TPD on wound healing.Results:Each of the 21 patients treated with TPD experienced successful and expedited wound closure. Stage 4 PUs took an average of 87 days with approximately six dressing changes to closure. Stage 3 PUs took an average of 41 days with approximately four dressing changes, and stage 2 PUs an average of 13 days to closure with approximately one dressing change. In the cases presented herein for which pain scores were reported, each showed a reduction in pain from an 8 or 9/10 to a 1 or 2/10 with the first dressing change.Conclusion:In this case series, TPD effectively reduced pain and healed PUs that had previously failed SoC interventions. We suggest future prospective studies in order to more effectively measure the wound healing capability and healthcare utilisation of TPD for treatment of PUs.

Teriparatide is an effective drug for the treatment of osteoporosis. This study examines the relationship between the drug delivery properties of the solid formulation with teriparatide and the pharmacokinetic properties of teriparatide in vivo.Teriparatide microneedles with different dissolution rates were prepared using sucrose and carboxymethylcellulose (CMC). There were three aspects of this study: (1) The dissolution rate of teriparatide from both formulations (sucrose and CMC) was measured in vitro. (2) After administration into porcine skin ex vivo, the diffusion rate of FITC-dextran was observed using a confocal microscope. (3) Pharmacokinetic studies were performed in rats and pharmacokinetic data compared with the release rate and the diffusion pattern.In the in vitro dissolution experiment, 80% of teriparatide was released within 30 min from the CMC MNs, whereas 80% of teriparatide was released within 10 min from the sucrose MNs. After 30 min, the fluorescence intensity on the surface of the MNs was 40% of the initial intensity for sucrose MNs and 90% for CMC MNs. In the pharmacokinetic study, the CWhen teriparatide is delivered into the skin using microneedles, the release rate from the solid formulation determines the drug's pharmacokinetic properties. The diffusion pattern of fluorescence into the skin can be used to anticipate the pharmacokinetic properties of the drug.

To reduce treatment burden and optimise patient outcomes in diabetic macular oedema, we present 1-year results from two phase 3 trials of faricimab, a novel angiopoietin-2 and vascular endothelial growth factor-A bispecific antibody.YOSEMITE and RHINE were randomised, double-masked, non-inferiority trials across 353 sites worldwide. Adults with vision loss due to centre-involving diabetic macular oedema were randomly assigned (1:1:1) to intravitreal faricimab 6·0 mg every 8 weeks, faricimab 6·0 mg per personalised treatment interval (PTI), or aflibercept 2·0 mg every 8 weeks up to week 100. PTI dosing intervals were extended, maintained, or reduced (every 4 weeks up to every 16 weeks) based on disease activity at active dosing visits. The primary endpoint was mean change in best-corrected visual acuity at 1 year, averaged over weeks 48, 52, and 56. Efficacy analyses included the intention-to-treat population (non-inferiority margin 4 Early Treatment Diabetic Retinopathy Study [ETDRS] letters); safety analyses included patients with at least one dose of study treatment. These trials are registered with ClinicalTrials.gov (YOSEMITE NCT03622580 and RHINE NCT03622593).3247 patients were screened for eligibility in YOSEMITE (n=1532) and RHINE (n=1715). After exclusions, 940 patients were enrolled into YOSEMITE between Sept 5, 2018, and Sept 19, 2019, and 951 patients were enrolled into RHINE between Oct 9, 2018, and Sept 20, 2019. These 1891 patients were randomly assigned to faricimab every 8 weeks (YOSEMITE n=315, RHINE n=317), faricimab PTI (n=313, n=319), or aflibercept every 8 weeks (n=312, n=315). Non-inferiority for the primary endpoint was achieved with faricimab every 8 weeks (adjusted mean vs aflibercept every 8 weeks in YOSEMITE 10·7 ETDRS letters [97·52% CI 9·4 to 12·0] vs 10·9 ETDRS letters [9·6 to 12·2], difference -0·2 ETDRS letters [-2·0 to 1·6]; RHINE 11·8 ETDRS letters [10·6 to 13·0] vs 10·3 ETDRS letters [9·1 to 11·4] letters, difference 1·5 ETDRS letters [-0·1 to 3·2]) and faricimab PTI (YOSEMITE 11·6 ETDRS letters [10·3 to 12·9], difference 0·7 ETDRS letters [-1·1 to 2·5]; RHINE 10·8 ETDRS letters [9·6 to 11·9], difference 0·5 ETDRS letters [-1·1 to 2·1]). Incidence of ocular adverse events was comparable between faricimab every 8 weeks (YOSEMITE n=98 [31%], RHINE n=137 [43%]), faricimab PTI (n=106 [34%], n=119 [37%]), and aflibercept every 8 weeks (n=102 [33%], n=113 [36%]).Robust vision gains and anatomical improvements with faricimab were achieved with adjustable dosing up to every 16 weeks, demonstrating the potential for faricimab to extend the durability of treatment for patients with diabetic macular oedema.F Hoffmann-La Roche.

Faricimab is a bispecific antibody that acts through dual inhibition of both angiopoietin-2 and vascular endothelial growth factor A. We report primary results of two phase 3 trials evaluating intravitreal faricimab with extension up to every 16 weeks for neovascular age-related macular degeneration (nAMD).TENAYA and LUCERNE were randomised, double-masked, non-inferiority trials across 271 sites worldwide. Treatment-naive patients with nAMD aged 50 years or older were randomly assigned (1:1) to intravitreal faricimab 6·0 mg up to every 16 weeks, based on protocol-defined disease activity assessments at weeks 20 and 24, or aflibercept 2·0 mg every 8 weeks. Randomisation was performed through an interactive voice or web-based response system using a stratified permuted block randomisation method. Patients, investigators, those assessing outcomes, and the funder were masked to group assignments. The primary endpoint was mean change in best-corrected visual acuity (BCVA) from baseline averaged over weeks 40, 44, and 48 (prespecified non-inferiority margin of four letters), in the intention-to-treat population. Safety analyses included patients who received at least one dose of study treatment. These trials are registered with ClinicalTrials.gov (TENAYA NCT03823287 and LUCERNE NCT03823300).Across the two trials, 1329 patients were randomly assigned between Feb 19 and Nov 19, 2019 (TENAYA n=334 faricimab and n=337 aflibercept), and between March 11 and Nov 1, 2019 (LUCERNE n=331 faricimab and n=327 aflibercept). BCVA change from baseline with faricimab was non-inferior to aflibercept in both TENAYA (adjusted mean change 5·8 letters [95% CI 4·6 to 7·1] and 5·1 letters [3·9 to 6·4]; treatment difference 0·7 letters [-1·1 to 2·5]) and LUCERNE (6·6 letters [5·3 to 7·8] and 6·6 letters [5·3 to 7·8]; treatment difference 0·0 letters [-1·7 to 1·8]). Rates of ocular adverse events were comparable between faricimab and aflibercept (TENAYA n=121 [36·3%] vs n=128 [38·1%], and LUCERNE n=133 [40·2%] vs n=118 [36·2%]).Visual benefits with faricimab given at up to 16-week intervals demonstrates its potential to meaningfully extend the time between treatments with sustained efficacy, thereby reducing treatment burden in patients with nAMD.F Hoffmann-La Roche.

Introduction: The incidence and clinical significance of postoperative urinary retention (POUR) remain high. This study aimed to evaluate the incidence of POUR and related risk factors in patients who underwent total mesorectal excision (TMR) for low rectal cancer. Methods: This study is a retrospective review of a prospectively collected colorectal database from a single center. Data from patients who underwent surgery for low rectal cancer between September 2006 and May 2017 were analyzed to assess the risk factors of POUR. POUR was considered inability to void after urinary catheter removal requiring catheter reinsertion and difficulty in bladder emptying requiring intermittent catheterization. Results: Of 555 patients with low rectal cancer, 78 (14.1%) developed POUR. Based on multivariate logistic regression analysis, laparoscopic TMR (odds ratio [OR]; 2.114, 95% confidence interval [CI]; 1.212–3.689, p = 0.008) and postoperative ileus (OR; 2.389, 95% CI; 1.282–4.450, p = 0.006) were independent risk factors of POUR. Male gender, advanced age, neoadjuvant chemoradiation, longer operative time, abdominoperineal resection, and lateral pelvic lymph node dissection were not associated with POUR. Advanced age over 65 years also failed to show statistical significance (OR; 1.604, 95% CI; 0.965–2.668, p = 0.068). Conclusion: Laparoscopic approach and postoperative ileus are risk factors for POUR after low rectal cancer surgery. We postulate that the benefits of robotic surgical systems compared to a laparoscopic approach may reduce the incidence of POUR.

Flexible hydrogels are receiving significant attention for their application in wearable sensors. However, most hydrogel materials exhibit weak and one-time adhesion, low sensitivity, ice crystallization, water evaporation, and poor self-recovery, thereby limiting their application as sensors. These issues are only partly addressed in previous studies. Herein, a multiple-crosslinked poly(2-(methacryloyloxy)ethyl)dimethyl-(3-sulfopropyl)ammonium hydroxide-co-acrylamide) (P(SBMA-co-AAm)) multifunctional hydrogel is prepared via a one-pot synthesis method to overcome the aforementioned limitations. Specifically, ions, glycerol, and 2-(methacryloyloxy)ethyl)dimethyl-(3-sulfopropyl)ammonium hydroxide are incorporated to reduce the freezing point and improve the moisture retention ability. The proposed hydrogel is superior to existing hydrogels because it exhibits good stretchability (a strain of 2900%), self-healing properties, and transparency through effective energy dissipation in its dynamic crosslinked network. Further, 2-(methacryloyloxy)ethyl)dimethyl-(3-sulfopropyl)ammonium hydroxide as a zwitterion monomer results in an excellent gauge factor of 43.4 at strains of 1300–1600% by improving the ion transportability and achieving a strong adhesion of 20.9 kPa owing to the dipole–dipole moment. The proposed hydrogel is promising for next-generation biomedical applications, such as soft robots, and health monitoring.

Telomere length maintenance is essential for cellular immortalization and tumorigenesis. 5% − 10% of human cancers rely on a recombination-based mechanism termed alternative lengthening of telomeres (ALT) to sustain their replicative immortality, yet there are currently no targeted therapies. Through CRISPR/Cas9-based genetic screens in an ALT-immortalized isogenic cellular model, here we identify histone lysine demethylase KDM2A as a molecular vulnerability selectively for cells contingent on ALT-dependent telomere maintenance. Mechanistically, we demonstrate that KDM2A is required for dissolution of the ALT-specific telomere clusters following recombination-directed telomere DNA synthesis. We show that KDM2A promotes de-clustering of ALT multitelomeres through facilitating isopeptidase SENP6-mediated SUMO deconjugation at telomeres. Inactivation of KDM2A or SENP6 impairs post-recombination telomere de-SUMOylation and thus dissolution of ALT telomere clusters, leading to gross chromosome missegregation and mitotic cell death. These findings together establish KDM2A as a selective molecular vulnerability and a promising drug target for ALT-dependent cancers.

Objectives: An attention to psychological aspects can clarify the understanding and management of patients with unresolved dizziness/vertigo. Thus, we study the locus of control and the mediation effect of self-efficacy for assessing the relationship between locus of control and dizziness/vertigo in a referral-based dizziness clinic.Methods: We analyzed the dizziness-specific locus of control and self-efficacy using the modified questionnaire in 117 consecutive dizzy patients (34 males; age range, 20–74 years). In addition to the visual analogue scale-dizziness for evaluation of subjective dizziness, the following items were further evaluated; Korean Dizziness Handicap Inventory, Korean Beck Depression Inventory II, and Korean Beck Anxiety Inventory. According to the verification procedure proposed by Hayes, the mediation effect of self-efficacy verifies the relationship between the locus of control and dizziness through analysis.Results: Except the scale of emotion such as anxiety and depression, sex, age, duration of illness, and diagnosis all did not significantly affect the dependent variables. Vestibular migraine (39.3%), vestibulopathy (15.4%), and dizziness associated with anxiety and depression (14.5%) were the most common diagnoses. On all scales, Cronbach’s α ranged from 0.72 to 0.94. In the direct effect, the internal locus of control had a tendency of aggravation of dizziness/vertigo, but in the indirect effect, the higher the internal locus of control, the higher the self-efficacy, and the higher the self-efficacy, the lower the dizziness.Conclusions: In our study, we can assume that the locus of control can impart ambivalent effects on dizziness/vertigo. And the modulation of self-efficacy could be another treatment for patients with unresolved dizziness.

Background: To analyze topographic progression of geographic atrophy with different concentric circles centered on the fovea in correlation with decrease of visual acuity. Methods: We retrospectively analysed 36 eyes of 26 patients diagnosed with geographic atrophy and followed at least 1 year. 1mm circular area at the foveal center were defined as Zone 1, and doughnut shape areas from between 1 and 2 mm to between 5 and 6 mm were defined as Zone 2 to Zone 6. Then, changes of geographic atrophy area in each zone were measured with semi-automatic software. Correlation analysis and regression analysis were performed to determine the relationship between changes in visual acuity and atrophic area in each zone. Result: Mean age was 76.9 years and follow-up period were 3.38 years. The mean atrophic area increased from 8.09 to 16.34 mm2 and visual acuity decreased from 0.39 to 0.69 on logMAR. Mean change of total geographic atrophy area was not significantly correlated with visual acuity decrease. While geographic atrophy progression within Zone 1, Zone 2 and Zone 3 showed significant causal relationship with decrease of visual acuity (all p Conclusion: In contrast to the total geographic atrophy area, progression of geographic atrophy in parafoveal area was significantly correlated with decrease of visual acuity.

Supporting transfers of science big data over Wide Area Networks (WANs) with Data Transfer Nodes (DTNs) requires optimizing multiple parameters within the underlying infrastructure. New solutions for such data movement require new paradigms and technologies, such as NVMe over Fabrics, which provides high-performance data movement with direct remote NVMe device access over traditional fabrics. However, recent NVMe over Fabrics studies have been limited to local storage fabrics. To support increasing demands for the large volume of science data movement during Supercomputing (SC) conferences, we proposed a SCinet DTN-as-a-Service framework orchestrating the desired optimization to meet users, applications, and providers’ requirements. Furthermore, we extend the SCinet DTN-as-a-Service framework to incorporate new techniques, solve optimization issues in data-intensive science and evaluate NVMe over Fabrics with multiple WAN testbeds to examine its performance and discover new opportunities for optimization.

Esculetin is a coumarin-derived compound with antioxidant and anti-inflammatory properties. The current study aims to evaluate the therapeutic implications of esculetin on retinal dysfunction and uncover the underlying mechanisms.

Purpose To evaluate the peripapillary microvasculature changes in patients with epiretinal membrane (ERM) following pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling using swept-source optical coherence tomography angiography (SS-OCTA). Method Medical records and multimodal imaging data of 33 eyes after PPV for ERM were retrospectively reviewed. Peripapillary SS-OCTA images of 6×6 mm2 were recorded at at pre- and post-operatively every 6 months for 1 year. A semi-automated method was used to analyzed SS-OCTA images, excluding the optic disc area, using the MATLAB software. The peripapillary vessel density (pVD) of superficial capillary plexus (SCP) and deep capillary plexus (DCP) was quantified in four quadrants (superior, inferior, nasal and temporal). Result The mean pVD in SCP and DCP decreased at 6- and 12-months follow-up. In sectoral analysis, superior, inferior, and temporal quadrants pVD in SCP and DCP were significantly reduced at 1 year after vitrectomy (all p < 0.05). Meanwhile, inferior quadrants pVD in SCP and DCP showed the earliest significant reduction at 6-months (p = 0.022 and 0.048, respectively). A reduction of post-operative mean pVD in DCP was significantly greater in patients with diabetic retinopathy (p = 0.043). Conclusion Peripapillary capillary density significantly decreased after surgical removal of ERM. Vitrectomy with ILM peeling can cause peripapillary microvascular damage starting in inferior sector.

Duy-Thuc Nguyen,1 Min-Hwan Kim,1 Na-Young Yu,1 Min-Jun Baek,1 Kyung-Sun Kang,2 Ki Won Lee,3 Dae-Duk Kim1 1College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea; 2Adult Stem Cell Research Center and Research Institute for Veterinary Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea; 3Department of Agricultural Biotechnology, Seoul National University, Seoul, Republic of KoreaCorrespondence: Dae-Duk Kim, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea, Tel +82-2-880-7870, Fax +82-2-873-9177, Email ddkim@snu.ac.krPurpose: Orobol is an isoflavone that has a potent skin protection effect. The objective of this study was to prepare a novel bentonite-based composite formulation of orobol to enhance topical skin delivery.Methods: The composition was optimized based on the orobol content in the composite and the in vitro release studies, followed by the in vitro and in vivo hairless mouse skin deposition studies. Physicochemical characterizations of the composite formulation were performed by powder X-ray refractometry (XRD) and scanning electron microscopy (SEM). The in vitro cytotoxicity and in vivo toxicity studies were conducted in human keratinocytes and in hairless mouse, respectively.Results and Discussions: The in vitro release of orobol from the bentonite composites was higher than that from the suspension, which was further increased with the addition of phosphatidylcholine. The composite formulation significantly enhanced the in vitro and in vivo skin deposition of orobol in hairless mouse skin compared to the orobol suspension. Moreover, the addition of phosphatidyl choline not only improved the dissolution and incomplete release of orobol from the bentonite composite but also enhanced the deposition of orobol in the skin. XRD histograms and SEM images confirmed that the enhanced dissolution of orobol from the composite was attributed to its amorphous state on bentonite. The in vitro and in vivo toxicity studies support the safety and biocompatibility of the orobol-loaded bentonite composite formulation.Conclusion: These findings suggest that the orobol-loaded bentonite composite formulation could be a potential topical skin delivery system for orobol.Keywords: orobol, bentonite, composite, phosphatidylcholine, skin, topical delivery

Purpose: This study aimed to explore the lived experiences of breastfeeding women with gestational diabetes and to understand the meaning of breastfeeding for them and its encompassing context. Methods: Qualitative data were collected by interviewing 15 mothers with gestational diabetes. The transcript data from 5 focus group interviews and 2 individual interviews were analyzed using thematic analysis. Results: A core theme and 10 sub-themes emerged. The core theme that emerged was "the maternal commitment enabled for a limited time a way to compensate for guilt." Because mothers had to control their blood sugar levels before childbirth, they were worried about whether it would harm the newborn baby and thus searched for dietary information. After the babies were born and separated from their mothers, they were free from gestational diabetes. Mothers then felt guilty about their unhealthy bodies when they were pregnant. This regret provides a motivational context for breastfeeding. However, the mothers realized that breastfeeding requires commitment and dedication and that they need breastfeeding support, such as being provided practical help. Conclusion: The results showed that the breastfeeding intention of women with gestational diabetes might originate from their feelings of guilt. Therefore, an integrated breastfeeding program that combines the empathetic support of women with similar experiences and that shares practical information from experts should be implemented in a structured and systematic way.

BACKGROUND: During one-leg standing (OLS), optimum activity of the gluteus medius (Gmed), multifidus (MF), and quadratus lumborum (QL) muscles relies upon maintaining neutral lumbopelvic alignment. However, no studies have examined how using pressure biofeedback during OLS affects the activity of these muscles and the concomitant alignment of the pelvis and trunk. OBJECTIVES: The purpose of this study was to investigate the effect of pressure biofeedback on the activity of the Gmed, MF, and QL and the femoropelvic and trunk lean angles during OLS. METHODS: Twenty-four healthy males performed OLS with (PB+) and without (PB-) pressure biofeedback. For all OLS conditions, a pressure sensor was placed between the lateral surface of the humerus on the non-supporting side and the wall. Under the PB- condition, participants performed preferred OLS while the examiner measured the maximum pressure caused by trunk lean. Under the PB+ condition, participants were asked to perform at a threshold of 50% of the maximal pressure (PB+ 1 condition) and with minimal change in pressure (PB+ 2 condition). Muscle activities of MF, QL, and Gmed as well as the femoropelvic and trunk lean angles were measured under various OLS conditions. RESULTS: The activity of the Gmed, MF, and QL was greater under both PB+ conditions than under the PB- condition (p< 0.05). Also, both PB+ conditions resulted in a greater femoropelvic angle and reduced trunk lean angle. There were no significant differences in muscle activity, femoropelvic angle, or trunk lean angle between PB+ 1 and PB+ 2 (p> 0.05). CONCLUSIONS: These results suggest that pressure biofeedback is a useful modality for increasing the activity of the Gmed and trunk muscles, especially the MF muscle on the non-supporting leg side, and for preventing compensatory movements such as trunk deviation and pelvic lateral deviation during OLS.

Objective: With the scenario of limited labeled dataset, this paper introduces a deep learning-based approach that leverages Diabetic Retinopathy (DR) severity recognition performance using fundus images combined with wide-field swept-source optical coherence tomography angiography (SS-OCTA). Methods: The proposed architecture comprises a backbone convolutional network associated with a Twofold Feature Augmentation mechanism, namely TFA-Net. The former includes multiple convolution blocks extracting representational features at various scales. The latter is constructed in a two-stage manner, i.e., the utilization of weight-sharing convolution kernels and the deployment of a Reverse Cross-Attention (RCA) stream. Results: The proposed model achieves a Quadratic Weighted Kappa rate of 90.2% on the small-sized internal KHUMC dataset. The robustness of the RCA stream is also evaluated by the single-modal Messidor dataset, of which the obtained mean Accuracy (94.8%) and Area Under Receiver Operating Characteristic (99.4%) outperform those of the state-of-the-arts significantly. Conclusion: Utilizing a network strongly regularized at feature space to learn the amalgamation of different modalities is of proven effectiveness. Thanks to the widespread availability of multi-modal retinal imaging for each diabetes patient nowadays, such approach can reduce the heavy reliance on large quantity of labeled visual data. Significance: Our TFA-Net is able to coordinate hybrid information of fundus photos and wide-field SS-OCTA for exhaustively exploiting DR-oriented biomarkers. Moreover, the embedded feature-wise augmentation scheme can enrich generalization ability efficiently despite learning from small-scale labeled data.

The infraspinatus muscle has a crucial role in shoulder stability. Although axial shoulder rotation is useful for selective activation of the infraspinatus, no study has examined the influence of exercise position on axial shoulder rotation during shoulder external rotation (ER) exercises. Thus, this study investigated the muscle activity in the infraspinatus, posterior deltoid, and middle trapezius during shoulder ER exercises performed with and without controlled axial shoulder rotation in 2 different positions.Twenty healthy subjects performed prone external rotation (PER) exercises with and without pressure biofeedback and seated external rotation (SITER) exercises with and without posterior humeral head gliding. Muscle activity during each ER exercise was measured using surface electromyography.Exercise strategy (P.001) and position (P.001) had a significant main effect on muscle activity in the infraspinatus and posterior deltoid. However, no significant interaction between strategy and position was observed. For muscle activity in the middle trapezius, strategy and position had a significant interaction effect (P = .014). Muscle activity in the infraspinatus increased significantly with the use of strategies to control axial shoulder rotation, whereas muscle activity in the posterior deltoid and middle trapezius decreased significantly. For all 3 muscles, greater activity was observed in the prone position than the seated position.We suggest that PER with pressure biofeedback can be useful to improve selective activation of the infraspinatus muscle while further eliciting infraspinatus muscle activity.

Purpose: To investigate the baseline characteristics in patients with diabetic macular edema (DME) during 7 years according to the need for additional treatments after intravitreal ranibizumab (RBZ) loading injections.Methods: The medical records of 32 patients treated with intravitreal RBZ loading for DME during 7 years were reviewed. After three-consecutive monthly RBZ injections, additional treatment was decided according to the patient’s response to RBZ loading. Based on whether the patients received treatment with or without additional injections, including intravitreal antivascular endothelial factor or steroid injection, they were divided into the “no add (NA)” or “add” groups, respectively. The baseline best-corrected visual acuity (BCVA), macular volume (MV), central subfoveal thickness, and other clinical factors were analyzed, and their 7-year changes were compared between the two groups.Results: The BCVA of the NA group was better than that of the add group at 2, 3, 5, and 7 years (year 2, 3, and 5; p < 0.01, respectively). Baseline MV was significantly smaller in the NA group than in the add group (10.72 ± 0.88 μm vs. 11.98 ± 1.64 μm, p = 0.008). The DME duration before treatment in the NA group was significantly shorter than in the add group (1.03 ± 0.98 years vs. 1.91 ± 1.33 years, p = 0.042). The proportion of patients with serous retinal detachment or cystic macular edema was significantly lower in the NA group than in the add group (35.3% vs. 73.3%, p = 0.042). The NA group had smaller MV until 2 years than the add group (year 1, p = 0.002; year 2, p = 0.006).Conclusions: The DME pat ients without additional treatments during 7 years after the initial loading treatment had shorter duration of DME and diffuse retinal thickening morphologic type with lower MV at baseline, and better long-term visual prognosis.