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To evaluate whether insertion of self-biodegradable stent into the pylorus to prevent delayed-gastric emptying after pylorus-preserving gastrectomy is feasible and safe through porcine experiment.Self-biodegradable dumbbell-shaped pyloric stents were designed from absorbable suture materials: poly(glycolide-co-caprolactone) (PGCL) or poly-p-dioxanone (PPDO). After gastrotomy on ten pigs, each stent was inserted: two shams, four PGCL stents, and four PPDO stents. Body weight (Bwt), body temperature (BT), complete blood cell (CBC) count, and plain X-ray were evaluated. On postoperative day (POD) 13, euthanasia was performed for histologic evaluation.Operation was successfully performed in all ten pigs. Without tagging suture, both stents migrated before POD 3. The migration was delayed up to POD 13, when the tagging sutures (-t) were applied between stent and stomach wall. Self-degradation of PGCL started from POD 3, and stents were completely excreted from the abdomen by POD 8. Although PPDO were also weakened as self-degradation progressed, its shape was maintained in gastrointestinal tract for 13 days. Unexpected sudden death occurred in the pig with PPDO-t2 on POD 10, which is more likely due to acute volvulus rather than stent-related complication. There was no significant difference between three groups in terms of Bwt, BT, CBC, and histology (sham vs. PGCL vs. PPDO, all p 0.05).The concept of biodegradable stents made of absorbent suture material seems feasible in porcine experiment. Among them, PGCL which has shown rapid absorption, appears to be a more suitable material for transient pyloric absorbable stent when considering safety aspect.

The effectiveness and safety of low-dose prasugrel (PSG) premedication for endovascular treatment of unruptured intracranial aneurysms (UIAs) have been widely reported. In this study, we evaluated the clinical outcomes of elders patients (≥ 75 years) treated with PSG.A total of 200 patients with 209 UIAs who were administered PSG as premedication (20 mg loading and 5 mg maintenance with 100 mg aspirin) between March 2018 and December 2021 were retrospectively enrolled. Among them, 39 patients were aged 75 years or over (elders group), and 161 patients were aged under 75 years (control group). Patients' clinical data were collected, and outcomes were compared between the two groups.Of the 200 patients with PSG, 9 cases (4.5%) had overall complications (7 ischemic, 2 hemorrhagic). In the comparison between the elders group and the control group, no significant differences were observed in the overall complication rates (elders group vs. control group; 2.6% vs. 5.0%, P = 1.00). Moreover, the rates of poor clinical outcome were comparable (2.6% vs. 1.2%, P = 0.48). The subgroup analysis of patients with stent-assisted procedures revealed no significant differences in complication rates (0% vs. 1.6%, P = 1.00) or poor clinical outcomes (0% vs. 0%, P = 1.00) during maintenance with aspirin 100 mg or PSG 5 mg.The complication rates in the elders treated with low-dose PSG premedication were similar to those in the control. Low-dose PSG premedication could be prescribed without any additional risk for the endovascular treatment of UIAs in elders patients.

Microreactor-Assisted Nanomaterial Deposition (MAND) process offers unique capabilities in achieving large size and shape control levels while providing a more rapid path for scaling via process intensification for nanomaterial production. This review highlights the application of continuous flow microreactors to synthesize, assemble, transform, and deposit nanostructured materials for Solar Photovoltaics, the capabilities of MAND in the field, and the potential outlook of MAND.Microreactor-Assisted Nanomaterial Deposition (MAND) is a promising technology that synthesizes reactive fluxes and nanomaterials to deposit nanostructured materials at the point of use. MAND offers precise control over reaction, organization, and transformation processes to manufacture nanostructured materials with distinct morphologies, structures, and properties. In synthesis, microreactor technology offers large surface-area-to-volume ratios within microchannel structures to accelerate heat and mass transport. This accelerated transport allows for rapid changes in reaction temperatures and concentrations, leading to more uniform heating and mixing in the deposition process. The possibility of synthesizing nanomaterials in the required volumes at the point of application eliminates the need to store and transport potentially hazardous materials. Further, MAND provides new opportunities for tailoring novel nanostructures and nano-shaped features, opening the opportunity to assemble unique nanostructures and nanostructured thin films. MAND processes control the heat transfer, mass transfer, and reaction kinetics using well-defined microstructures of the active unit reactor cell that can be replicated at larger scales to produce higher chemical production volumes. This critical feature opens a promising avenue in developing scalable nanomanufacturing. This paper reviews advances in microreactor-assisted nanomaterial deposition of nanostructured materials for solar photovoltaics. The discussions review the use of microreactors to tailor the reacting flux, transporting to substrate surfaces via controlling process parameters such as flow rates, pH of the precursor solutions, and seed layers on the formation and/or transformation of intermediary reactive molecules, nanoclusters, nanoparticles, and structured assemblies. In the end, the review discusses the use of an industrial scale MAND to apply anti-reflective and anti-soiling coatings on the solar modules in the field and details future outlooks of MAND reactors. Graphical abstract

The aim of this study is to determine the optimal indications for preoperative pelvic radiotherapy (RT) in patients with metastatic rectal cancer who underwent curative-intent surgical resection and/or ablation.Between January 2000 and October 2019, 246 patients who met our inclusion criteria were enrolled. Preoperative RT was performed in 22 patients (8.9%). Lower margin below the peritoneal reflection (p0.001), mesorectal fascia (MRF) invasion (p = 0.02), and lateral pelvic lymph node (LPLN) involvement (p = 0.005) were more frequent in the preoperative RT group.During the median follow-up period of 13.3 months (interquartile range [IQR]: 6.0-36.3 months), local recurrence (LR) was identified in 60 patients (24.4%). It was the first site of recurrence in 45 of them (18.3%). Among them, three patients were in the preoperative RT group. On multivariable analysis, lower margin below the peritoneal reflection, MRF invasion, LPLN involvement, carcinoembryonic antigen (CEA) level ≥ 10 ng/mL before treatment, and preoperative RT were significant prognostic factors for LR-free survival (LRFS). In the patient group without any risk factors, the 2-year LRFS rate was 94.9% without preoperative RT. In the patient group with one or more risk factors, the 2-year LRFS was 64.4% without and 95.2% with preoperative RT.LR developed in about 25% of patients within 2 years. Preoperative RT should be considered, especially in patients with a risk factor for LR, including lower margin below the peritoneal reflection, MRF invasion, LPLN involvement, or CEA ≥ 10 ng/mL before treatment.

Several studies have previously reported that laparoscopic surgery using an energy sealing device generates hazardous surgical smoke. However, the droplets appearing on the surface of peritoneal fluid irrigated with saline, after dissection phase of laparoscopic gastrectomy were ignored for a long time. This study aimed to investigate the composition and clinical significance of these droplet particles.This study prospectively enrolled 15 patients with early gastric cancer (cT1NanyM0) who were scheduled for laparoscopic gastrectomy. Floating phases of peritoneal irrigation fluid containing droplets in dissected area were retrieved before and after surgical dissection. Using gas chromatography analysis, the areas under the peak were compared between the samples retrieved before and after surgical dissection. We also analyzed if the area value with significant change was related to the inflammatory response.In gas chromatography, the area values after laparoscopic surgical dissection were significantly increased in 10 out of 37 kinds of fatty acids, compared to those before surgical dissection. The significant increase in area value of α-linoleic and eicosadienoic acids were positively correlated with the elevated level of C-reactive protein at postoperative day 2 (Spearman's ρ = 0.843, P 0.001; Spearman's ρ = 0.785, P = 0.001).The lipid droplets, generated after laparoscopic lymphadenectomy during gastric cancer surgery, contained various types of fatty acids, and some of them have been found to be associated with inflammatory response.

Background Although diabetes is reportedly associated with the occurrence of acute pancreatitis (AP), the risk of AP according to the duration and severity of diabetes is not yet clear. We aimed to investigate the risk of AP based on glycemic status and the presence of comorbidities using a nationwide population-based study. Methods We enrolled 3,912,496 adults who underwent health examinations under the National Health Insurance Service in 2009. All participants were categorized by glycemic status as normoglycemic, impaired fasting glucose (IFG), or diabetes. Baseline characteristics and the presence of comorbidities at the time of health check-up were investigated, and the occurrence of AP was followed up until 31 December 2018. We estimated the adjusted hazard ratios (aHRs) for AP occurrence according to the glycemic status, duration of diabetes (new-onset, duration Results During the observation period of 32,116,716.93 person-years, 8,933 cases of AP occurred. Compared with normoglycemia, the aHRs (95% confidence interval) were 1.153 (1.097–1.212) in IFG, 1.389 (1.260–1.531) in new-onset diabetes, 1.634 (1.496–1.785) in known diabetes Conclusion As glycemic status worsens, the risk of AP increases, and there is a synergistic effect when comorbidities coexist. To reduce the risk of AP, active control of factors that can cause AP should be considered in patients with long-standing diabetes and comorbidities.

Recently, remanufacturing approach/technology, which includes a series of the processes of disassembling, cleaning, inspecting, repairing/reconditioning, reassembling components for resale, is becoming more popular as companies look for a way to combat the current climate crisis, and as it allows companies to reduce environmental impacts and to save energy and resources. This study analyzed the reduction effect of six environmental impacts and the savings effect of energy and resources by turbocharger remanufacturing compared to its newly manufacturing using a life cycle assessment (LCA) methodology. The results show that the most significant benefit of the turbocharger remanufacturing related to environmental impacts was the global warming potential (GWP), which could be reduced by 52.18%, followed by the abiotic depletion potential (ADP), terrestrial ecotoxicity potential (TETP), human toxicity potential (HTP), freshwater aquatic ecotoxicity potential (FAETP) and marine aquatic ecotoxicity potential (MAETP) which could be reduced by 51.93%, 44.76%, 44.23%, 42.59%, and 36.74%, respectively. Also, its resource saving could be obtained from 21.74–73.47% depending on the type of resources. Furthermore, turbocharger remanufacturing offered a significant energy saving of 83.93%. The results obtained from this study could be used for national policy-making to a net-zero carbon transition.

Backgrounds and Objectives Endoscopic ultrasound-guided ethanol ablation (EUS-EA) has recently been introduced for the management of solid pancreatic tumors, including pancreatic neuroendocrine tumors (PNETs) and solid pseudopapillary tumors (SPTs). The study aims to evaluate the efficacy and predictive factors for response of EUS-EA in solid pancreatic tumors. Methods Between October 2015 and July 2021, 72 patients who underwent EUS-EA for solid pancreatic tumors were included. The study outcomes were to evaluate the efficacy of EUS-EA with complete remission (CR) and objective response, and their predictive factors. Results During follow-up, 47 patients were diagnosed with PNETs and 25 with SPTs. Eight cases reached CR and 48 reached objective response. When compared with SPTs, PNETs showed similar duration to reach CR (median not reached; p = 0.319), but shorter duration to reach objective response (PNETs: median 20.6 months, 95%CI 10.26–30.88; SPTs: median 47.7 months, 95%CI 18.14–77.20; p = 0.018). Ethanol dosage > 0.35 ml/cm3 shortened the duration to reach CR (median not reached; p = 0.026) and objective response (median 42.5 months, 95%CI 25.34–59.66 vs. 19.6 months, 95%CI 10.17–29.09; p = 0.006). CR had no significant predictive factors, but PNETs showed significant predictive factors for objective response (HR 3.34, 95%CI 1.07–10.43; p = 0.038). Twenty-seven patients experienced adverse events, and there were two severe cases. Conclusion EUS-EA for pancreatic solid lesions seems feasible as a local treatment for patients who refuse or are unfit for surgery. Additionally, PNETs seem to be the better candidate for EUS-EA.

The objective of this study was to identify predictable maternal serum signatures of cortisol metabolism during the first trimester of women who are expected to deliver small-for-gestational-age (SGA) neonates. This prospective cohort study included 112 pregnant women (with and without SGA, n = 56 each). Maternal serum samples were collected at 10-14 gestational weeks to quantify the levels of cortisol and its precursors and metabolites by liquid chromatography-mass spectrometry. Increased maternal serum levels of tetrahydrocortisol (11.82 ± 8.16 ng/mL vs. 7.51 ± 2.90 ng/mL, P 0.005) and decreased 21-deoxycortisol (2.98 ± 1.36 ng/mL vs. 4.33 ± 2.06 ng/mL, P 0.0001) were observed in pregnant women carrying SGA fetus. In conjunction with individual steroid levels, metabolic ratios corresponding to the activity of related enzymes were calculated. In addition to increased tetrahydrocortisol/cortisol ratio (P 0.006), the SGA group showed a significant increase in the two metabolic ratios including cortisol/11-deoxycortisol (P 0.03) and cortisol/21-deoxycortisol (P 0.0003). The receiver operating characteristic (ROC) curve generated in combination with three variables of 21-deoxycortisol concentration and two metabolic ratios of cortisol/21-deoxycortisol and tetrahydrocortisol/cortisol resulted in an area under the ROC curve = 0.824 (95% confidence interval, 0.713-0.918). A significant decrease in maternal serum levels of 21-deoxycortisol and an increase in two metabolic ratios of cortisol/21-deoxycortisol and tetrahydrocortisol/cortisol, indicating cortisol biosynthetic rate, represent potential biomarkers for the prediction of SGA in the first trimester.

This study is to evaluate the clinical characteristics and outcomes of Enterococcus raffinosus bacteremia in adults. We analyzed the medical records of adult patients with E. raffinosus bacteremia who were diagnosed and treated between 1997 and 2020 at a tertiary care teaching hospital in Seoul, Republic of Korea. The demographic, clinical, and laboratory data were collected and assessed. A total of 49 cases of E. raffinosus bacteremia were identified. E. raffinosus accounted for 0.6% of all enterococcal bacteremia events, and the incidence was 0.02 cases per 1,000 admissions. Of the 49 cases of E. raffinosus bacteremia, 35 (71.4%) had underlying malignancy. The biliary tract was the most common source of infection (81.6%, 40/49) and polymicrobial bacteremia was found in 25 cases (51.0%). The resistance rates of E. raffinosus bacteremia cases to penicillin, ampicillin, vancomycin, and linezolid were 61.2%, 49.0%, 2.0%, and 0%, respectively. In our case series, there was one case of vanA-type vancomycin-resistant E. raffinosus. The all-cause 60-day mortality rate was 22.4% (11/49), and the E. raffinosus bacteremia-related mortality rate was 4.1% (2/49). Cases of E. raffinosus bacteremia mainly originated from biliary tract infection and had a low rate of bacteremia-related mortality.

Regular safety inspections of existing reinforced concrete (RC) structures are required according to the regulations and criteria set by each country. In South Korea, the safety inspection regulations provided by the Korea Infrastructure Safety and Technology Corporation (KISTEC) are followed. These regulations were developed based on fuzzy theory to avoid subjective decisions, and provide standardized deterioration grades for member types, floors, and the entire structure. However, the safety inspection regulation by the KISTEC often provides unconservative evaluation results. In particular, as the importance factors of beam and slab members are set lower than those of other members, there are cases in which deteriorations occurring in beams and slabs are not properly reflected in the floor level evaluation. In this study, to overcome such limitations, case studies were carried out and modified importance factors for structural member types were proposed considering the failure probabilities of each member type based on the reliability theory. The importance modification factor was calculated based on the strength ratio of structural members so that the more dangerous the members are, the more impact they give on the evaluation. Overall, compared to the KISTEC method, the proposed method provided conservative but practical assessment results, and it was found that the proposed importance factors can be very useful to properly reflect the effects of damaged members on the deterioration status evaluation of the floors and the entire structure.

Objectives: We aimed to determine whether knee OA is associated with CVD risk and to evaluate whether the association differs by exercise behavior. Methods: We used Korea National Health Insurance Service (KNHIS) database and included 201,466 participants (7,572 subjects diagnosed with knee OA) who underwent health screening between 2009 and 2015. Those who had been diagnosed with knee OA or CVD before the index year were excluded. Cox proportional hazard models were used after adjusting for sociodemographic and CVD risk factors to evaluate the association between knee OA and CVD risk. Stratification analysis was further performed to determine the effect of exercise behavior on this relationship. Results: During a median follow-up of 7.06 ± 2.24 years, 8,743 CVD (2,510 MI and 6,553 stroke) cases developed. Individuals with knee OA had increased risks of CVD (hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.15–1.38), myocardial infarction (MI) (HR 1.20, 95% CI 1.00–1.44), and stroke (HR 1.29, 95% CI 1.16–1.43) compared with those without knee OA. Those with knee OA who did not exercise had an increased risk of CVD (HR 1.25, 95% CI 1.11-1.40), whereas no significant increased CVD risk was observed in those with knee OA who exercised at least once a week (HR 1.11, 95% CI 0.96-1.28). Conclusion: Knee OA was independently associated with an increased risk of CVD. Lack of exercise might have a synergistic adverse effect on the association between knee OA and CVD.

Background Colorectal cancer is a leading cause of cancer deaths. Several screening tests, such as colonoscopy, can be used to find polyps or colorectal cancer. Colonoscopy reports are often written in unstructured narrative text. The information embedded in the reports can be used for various purposes, including colorectal cancer risk prediction, follow-up recommendation, and quality measurement. However, the availability and accessibility of unstructured text data are still insufficient despite the large amounts of accumulated data. We aimed to develop and apply deep learning-based natural language processing (NLP) methods to detect colonoscopic information. Methods This study applied several deep learning-based NLP models to colonoscopy reports. Approximately 280,668 colonoscopy reports were extracted from the clinical data warehouse of Samsung Medical Center. For 5,000 reports, procedural information and colonoscopic findings were manually annotated with 17 labels. We compared the long short-term memory (LSTM) and BioBERT model to select the one with the best performance for colonoscopy reports, which was the bidirectional LSTM with conditional random fields. Then, we applied pre-trained word embedding using large unlabeled data (280,668 reports) to the selected model. Results The NLP model with pre-trained word embedding performed better for most labels than the model with one-hot encoding. The F1 scores for colonoscopic findings were: 0.9564 for lesions, 0.9722 for locations, 0.9809 for shapes, 0.9720 for colors, 0.9862 for sizes, and 0.9717 for numbers. Conclusions This study applied deep learning-based clinical NLP models to extract meaningful information from colonoscopy reports. The method in this study achieved promising results that demonstrate it can be applied to various practical purposes.

Enchondroma is the most common bone tumor in the hand. While standard surgical procedure is intra-lesional excision and bone grafting, there is a dispute between allogeneic bone, autogenous bone, and synthetic bone substitute grafting. Diverse adjuvant treatments have been introduced to reduce recurrence, but results are mixed with controversies. Meanwhile, whether existing descriptive classification could predict treatment outcome remains unclear. Thus, we reviewed patients with solitary enchondroma of the hand who underwent simple curettage followed by allogeneic cancellous bone chip impaction grafting. Eighty-eight patients with more than 5 years of follow-up were enrolled. Demographic data, local recurrence, and complications were reviewed. Duration of consolidation and the difference according to Takigawa classification were assessed. Range of motion (ROM), and functional scores were also evaluated. There were 51 women and 37 men, with a mean age of 37.9 years. Mean follow-up was 10.2 years. Recurrence occurred only in one patient. There was no complication. Mean postoperative total active motions of fingers and thumb were 239° and 132.9°. Mean modified Disabilities of the Arm, Shoulder, Hand score, and Musculoskeletal Tumor Society Score were 1.63, and 99.2 at the last follow-up. Consolidation, ROM, and functional scores according to Takigawa classification showed no significant differences. This study suggests that simple curettage with impaction grafting of allogeneic cancellous bone chip is a feasible method for treating solitary enchondromas involving short tubular bone of the hand with good long-term outcomes. Postoperative recurrence and complication rates were very low. Radiographic and clinical results were good regardless of the previous radiological classification.

There have been few studies comparing the clinical characteristics and outcomes of SARS-CoV-2 pneumonia in individuals with and without moderately to severely immunocompromised conditions. We reviewed adult patients with SARS-CoV-2 infection who had radiologic evidence of pneumonia at a tertiary hospital in Seoul, South Korea, from February 2020 to April 2022. Moderately to severely immunocompromised status was defined as medical conditions or treatments that resulted in increased risk of severe COVID-19 and weakened immune response to COVID-19 vaccine as recommended by Centers for Disease Control and Prevention. The time to pneumonia development was defined as the time from symptom onset to the time when radiologic evidence of pneumonia was obtained. Viral clearance was defined as a Ct value 30. COVID-19-related death was defined as 90-day death following imaging-confirmed pneumonia without any other plausible cause of death. A total of 467 patients with SARS-CoV-2 pneumonia were analyzed. Of these, 102 (22%) were moderately to severely immunocompromised. The median (IQR) time to pneumonia development was significantly longer in moderately to severely immunocompromised patients (9.5 [6-14] days) than the comparator (6 [3-8] days), p 0.001), as was the median time to viral clearance (21 versus 12 days, p 0.001). Moderately to severely immunocompromised status (aOR, 18.39; 95% CI, 5.80-58.30; p 0.001) was independently associated with COVID-19-related death. Patients with moderately to severely immunocompromised conditions are likely to experience a more protracted course of SARS-CoV-2 pneumonia and a worse outcome than those without these conditions.

Background The striped field mouse Apodemus agrarius is a wild rodent commonly found in fields in Korea. It is a known carrier of various pathogens. Amplicon-based next-generation sequencing (NGS) targeting the 16S ribosomal RNA (rRNA) gene is the most common technique used to analyze the bacterial microbiome. Although many bacterial microbiome analyses have been attempted using feces of wild animals, only a few studies have used NGS to screen for parasites. This study aimed to rapidly detect bacterial, fungal and parasitic pathogens in the guts of A. agrarius using NGS-based metabarcoding analysis. Methods We conducted 18S/16S rDNA-targeted high-throughput sequencing on cecal samples collected from A. agrarius (n = 48) trapped in May and October 2017. Taxa of protozoa, fungi, helminths and bacteria in the cecal content were then identified. Results Among the protozoa identified, the most prevalent was Tritrichomonas sp., found in all of the cecal samples, followed by Monocercomonas sp. (95.8% prevalence; in 46/48 samples) and Giardia sp. (75% prevalence; in 36/48 samples). For helminths, Heligmosomoides sp. was the most common, found in 85.4% (41/48) of samples, followed by Hymenolepis sp. (10.4%; 5/48) and Syphacia sp. (25%; 12/48). The 16S rRNA gene analysis showed that the microbial composition of the cecal samples changed by season (P = 0.005), with the linear discriminant analysis effect size showing that in the spring Escherichia coli and Lactobacillus murinus were more abundant and Helicobacter rodentium was less abundant. Helicobacter japonicus was more abundant and Prevotella_uc was less abundant in males. The microbial composition changed based on the Heligmosomoides sp. infection status (P = 0.019); specifically, Lactobacillus gasseri and Lactobacillus intestinalis were more abundant in the Heligmosomoides sp.-positive group than in the Heligmosomoides sp.-negative group. Conclusions This study demonstrated that bacterial abundance changed based on the season and specific parasitic infection status of the trapped mice. These results highlight the advantages of NGS technology in monitoring zoonotic disease reservoirs. Graphical Abstract

In this study, we present a method to quantitatively analyze the thrombus formation process through image analysis in an in vitro thrombus model with a circular cross section. The thrombus model used was designed based on the mechanism between the physical principle of wall shear rate (WSR) and thrombus formation. Image analysis was used to help visualize the thrombus formation process and calculate the thrombus area. Through this method, the thrombus formation and growth from the channel wall was demonstrated without the use of fluorescence. In addition, by dividing the image into sub-sections, the accuracy of the thrombus growth pattern was improved. The departing blood clots which are called embolus, were observed being separated from the thrombus.

Although the current guidelines recommend bridging thrombolysis (BT) therapy, which is intravenous thrombolysis (IVT) followed by endovascular thrombectomy (EVT), for patients with acute ischemic stroke from large vessel occlusion (AIS-LVO), the effectiveness and safety of IVT remain controversial. We performed a meta-analysis to demonstrate the non-inferiority of direct EVT alone (DEVT) compared to BT for the efficacy and safety in patients with AIS-LVO who were eligible for IVT. The literature was searched in big databases between 1 January 1990 and 1 April 2021. The search included both randomized clinical trials (RCTs) and nonrandomized studies (NRSs) that compared DEVT with BT for patients with AIS-LVO who were eligible for IVT (time from stroke onset ≤ 4.5 h). Only NRSs with good intergroup variable matching were included in the study. Outcomes measured included 90-day functional independence, mortality, symptomatic intracranial hemorrhage (sICH), and successful recanalization. The noninferiority margin for risk difference was set at 5% from the literature review. Three RCTs (n = 1094) and four NRSs (n = 1366) were included in the meta-analysis. There were 1227 patients (49.9%) in the DEVT group and 1233 patients (50.1%) in the BT group. A statistically significant noninferiority of DEVT compared to BT was concluded in 90-day functional independence, mortality and successful reperfusion. Even in the sICH rate, DEVT group showed a superiority (risk difference, −2%; 95% confidence interval, −4 to −0.002%). Evidence from RCTs and observational NRSs supports the use of DEVT (without IVT) as the first choice for treatment of patients with AIS-LVO within a time span of 4.5 h or less from stroke onset.

The present study examined how the microstructure and plasma-resistant characteristics of CaO–Al2O3–SiO2 (CAS) glass layers coated on sintered alumina substrates were affected by the applied sintering conditions. Coated layers were formed using a bar-coating method, subsequently subjected to the de-binding process, and then finally sintered at temperatures lower than the crystallization temperature of the glass, ranging from 950 to 1000 °C, for varying durations. The coated layer composed solely of CAS glass exhibited an etch rate approximately four times lower than that of alumina. The lowest etch rate of the CAS glass layer was 13.25 nm/min at 950 °C 15 min, showing the best plasma resistance. It was also found that the glass layers became increasingly crystallized with increasing temperature and duration, and this then reduced their plasma resistance. The etch rate of glass when crystalline phases were present was found to be 35.31 nm/min.

Although released only for drainage of pseudocyst and walled-off necrosis (WON) with ≤ 30% solid debris, the utilization of lumen-apposing metal stent (LAMS) in “real-world” practice has deviated from approved indications. We evaluated the contemporary use of LAMS and associated clinical, procedural outcomes in the setting of a tertiary referral center in the USA. Data from 303 consecutive patients who underwent LAMS placement were analyzed. Outcomes included technical and clinical success rates and adverse events. Of 303 patients, 190 (62.7%) received LAMS for off-label indications. The latter included gallbladder drainage (n = 56, 18.5%), gastroenterostomy (n = 52, 17.2%), treatment of gastrointestinal strictures (n = 37, 12.2%), biliary drainage (n = 20, 6.6%), temporary gastric access for endoscopy (n = 13, 4.3%), symptomatic WON with > 30% solid debris (n = 8, 2.6%), and miscellaneous (n = 4, 1.3%). Technical success rates in the on- and off-label arm were 98.2% and 95.8%, respectively (P = .331; 95% CI 0.08 to 1.96). Clinical success rates in the on- and off-label arm were 89.4% and 83.2%, respectively (P = .137; 95% CI 0.28 to 1.19). The rate of adverse events was 20.5% (n = 39) in the off-label arm and 16.8% (n = 19) in the on-label arm (P = .242; 95% CI 0.69 to 2.34). Off-label use of LAMS out-numbered on-label use in our practice. The safety profile between the groups was similar and with the exception of refractory stricture treatment, efficacy was comparable.

This study aims to develop a general model to examine the weathering-induced degradation of a polycarbonate/acrylonitrile–butadiene–styrene (PC/ABS) blend under various temperatures and UV irradiance levels. The carbonyl index (CI) was measured with respect to the diverse conditions by Fourier-transform infrared (FT-IR) spectroscopy. Then, a response surface model for the CI with respect to the temperature and UV irradiance was established. The glossiness, tensile properties, and Izod impact resistance were measured under various weathering conditions. The fracture properties were also tested using the essential work of fracture (EWF) method. The correlations between these properties and the CI were determined. The results show that the fracture toughness and crack growth resistance measured by the EWF tests were significantly reduced even at a low CI level, i.e., the early degradation stage, whereas the tensile properties and impact resistance did not noticeably change. Although the tensile properties and impact resistances maintained their initial properties until a certain CI value, the fracture characteristics degraded rapidly, even at the initial degradation level. The model was verified by comparison with samples weathered outdoors for four and six months in Seoul, Republic of Korea. It was confirmed that the model for the Izod impact strength (IZOD) with a CI function can predict the experimental IZOD data for the outdoor-weathered specimens using the predicted CI values, with an error of 5.6%.

Ketonization of carboxylic acids is one of the crucial reactions to produce sustainable bio-fuel and bio-chemicals from the pyrolysis oil of wood. Ketonization using different mixed solutions of carboxylic acids, furfural, and hydroxyacetone has been explored to understand the influence of co-feed reactants on the performance of ketonization of carboxylic acid over the selected CeZrOx catalyst. Furfural (7% in water) inhibited the catalytic activity for ketonization of acetic acid (20% solution) with reversible blocking of active sites, but for a mixed solution of hydroxyacetone (7%) and acetic acid (20%), both reactants influenced each other, resulting in very low conversions and slow and uncompleted recovery to 50% after removing hydroacetone from the mixture. For the mixed solution (20% acetic acid + 7% furfural + 7% hydroxyacetone in water), hydroxyacetone was the most reactive compound on CeZrOx and the conversions of reactants reached below 10%, due to the inhibition of co-existing carbonyl components. This work provides guidance for ketonization of carboxylic acids in the aqueous-phase pyrolysis oil.

In this study, sustained and pH-responsive delivery of drugs were conducted using sealed microcontainers (MCs). The MCs were fabricated using a polydimethylsiloxane (PDMS) stencil. The polymer solution was filled into holes of the stencil space; then, the organic solvent was evaporated to obtain MCs. Poly(lactic-co-glycolic acid) (PLGA) was used as the material for the MCs. The MCs were sealed by covering them with a lid layer after filling the model drug—metronidazole—into the MCs. The diameter and height of the fabricated MCs were 500 and 350 µm, respectively. The drug delivery of sealed MCs was analyzed using the absorbance of the released drug while varying the pH and observing the FE-SEM image, before and after drug release. MCs are expected to be useful in various biomedical applications of drug delivery and microfluidic systems by supporting various functional materials in pH-responsive MCs.

Endogeneity is often regarded as a key barrier in establishing the causal relationship between the third sector and its societal impact in empirical research. Through a systematic literature review of the quantitative studies on the third sector’s impact in the last two decades, we find that most quantitative studies of the third sector’s societal impact are published in journals outside main third sector journals. We also offer specific examples of how recent methodological advancements in addressing endogeneity help third sector researchers better solve this problem. Based on the analysis of this literature review, we recommend that third sector scholars should (1) refocus on the big question of the third sector’s impact on society, (2) catch up with the methodological advancement in addressing endogeneity, (3) be creative and transparent about addressing endogeneity, and (4) build better theories to link the third sector to broad societal outcomes.

Whether moderate-intensity statins plus ezetimibe could be an alternative to high-intensity statins in patients with atherosclerotic cardiovascular disease is unclear. We compared the risk of adverse cardiovascular events in patients receiving moderate-intensity statins plus ezetimibe vs. high-intensity statins after a coronary revascularization procedure using data from a large cohort study. Population-based cohort study using nationwide medical insurance data from Korea. Study participants (n = 20,070) underwent percutaneous coronary intervention or coronary artery bypass graft surgery between January 1, 2015, and December 31, 2016, and received moderate-intensity statins (atorvastatin 10–20 mg or rosuvastatin 5–10 mg) plus ezetimibe (n = 922) or high-intensity statins (atorvastatin 40–80 mg or rosuvastatin 20 mg; n = 19,148). The primary outcome was a composite of cardiovascular mortality, hospitalization for myocardial infarction (MI), hospitalization for stroke, or revascularization. At 12 months, the incidence rates of the primary outcome were 138.0 vs. 154.0 per 1000 person-years in the moderate-intensity stains plus ezetimibe and the high-intensity statins group, respectively. The fully adjusted hazard ratio [HR] for the primary outcome was 1.11 (95% confidence interval [CI] 0.86–1.42; p = 0.43). The multivariable-adjusted HR for a composite of cardiovascular mortality, hospitalization for MI, or hospitalization for stroke was 1.05 (95% CI 0.74–1.47; p = 0.80). During follow-up, the proportion of patients maintaining their initial lipid-lowering therapy was significantly higher in the moderate-intensity statins plus ezetimibe group than in the high-intensity statins group. Patients undergoing a coronary revascularization procedure who received moderate-intensity statins plus ezetimibe showed similar rates of major adverse cardiovascular events as patients who received high-intensity statins.

Melosira nummuloides is a type of diatom in the family Melosiraceae. Diatoms are unicellular microalgae widely distributed in aquatic environments. Diatoms are known to be suitable for many industrial and biomedical applications because of their high biocompatibility and ease of use. In this study, we investigated the hepatoprotective effect of diatom frustule silica (DFS) extracted from Melosira nummuloides on hepatotoxicant-induced liver injury. Hepatoprotective effects of DFS were examined using acetaminophen-induced acute liver injury (ALI) mouse model. We evaluated the hepatoprotective effects through hepatotoxicity, pro-inflammatory cytokines, transcriptional factors, upstream signaling pathways, and histopathological analysis by DFS in an animal model of acetaminophen-induced ALI. Our results showed serum alanine aminotransferase/aspartate aminotransferase activity and hepatic malondialdehyde formation were significantly attenuated upon DFS administration. DFS also ameliorated glutathione depletion and down-regulated acetaminophen-induced CYP2E1. DFS administration also down-regulated expressions of pro-inflammatory cytokines through preventing NF-κB activation by JNK1/2 phosphorylation inhibition. These findings demonstrate that the hepatoprotective effect of DFS is associated with suppression of inflammatory responses in an animal model of acetaminophen-induced ALI.

Boron neutron capture therapy (BNCT) has been attracting interest as a new radiation modality for cancer therapy because it can selectively destroy cancer cells while maintaining the healthy state of surrounding normal cells. Many experimental trials have demonstrated significant BNCT treatment efficacy using neutron beams from research reactors. However, nuclear reactor technology cannot be scaled to sites in hospitals delivering patient treatment. Therefore, compact accelerator-based neutron sources that could be installed in many hospitals are under development or have even been commissioned at many facilities around the world. In Korea, a radio-frequency (RF) linac-based BNCT (A-BNCT) facility is under development by DawonMedax (DM). It provides the highly efficient production of an epithermal neutron beam with an optimized neutron energy spectrum range of 0.1~10 keV. With a 2-mA 10-MeV proton beam from the accelerator, the irradiation port epithermal neutron flux is higher than 1 × 109 n/cm2⋅s. Comprehensive verification and validation of the system have been conducted with the measurement of both proton and neutron beam characteristics. Significant therapeutic effects from BNCT have been confirmed by DM in both in vitro and in vivo non-clinical trials. Further, during exposure to epithermal neutrons, all other unintended radiation is controlled to levels meeting International Atomic Energy Agency (IAEA) recommendations. Recently, the Korean FDA has accepted an investigational new drug (IND) and the first-in-human clinical trial of BNCT is now being prepared. This paper introduces the principles of BNCT and accelerator-based neutron sources for BNCT and reports the recent advances of DM A-BNCT facility which is the main part of this paper.

Bond–slip is an important characteristic that determines the stiffness, displacement, and load-bearing capacity of a reinforced concrete (RC) beam. It is essential for performing a precise numerical analysis of the beam. In most cases, bond–slip models can define the bond–slip curve only when there are experimental data. However, many bond test data have been obtained from pull-out tests, and the dominant view is that the bond–slip behavior observed in the pull-out test is quite different from that in an actual RC beam. Therefore, a mapping function that makes it possible to estimate the bond–slip behaviors of beam specimens using those of pull-out specimens was developed in this study. A total of 255 pull-out specimen data and 75 beam specimen data were collected from previous studies, and the importance and influence of each feature of the two groups were analyzed using random forest and K-means clustering. The mapping function was derived using genetic programming, and its accuracy was verified through a comparison with existing models. The proposed model exhibits a high degree of accuracy in estimating bond–slip and bond strength in beam specimens and can provide useful information for understanding the difference in bond–slip behaviors between the two groups.

This study aimed to elucidate whether low-density lipoprotein cholesterol (LDL-C) levels differentially affect functional outcomes after intravenous thrombolysis (IVT) depending on prestroke statin use. Patients with acute ischemic stroke treated with IVT were categorized into low, intermediate, and high LDL-C groups based on LDL-C levels at admission ( 130 mg/dl, respectively). Multivariable logistic regression analyses were performed to explore the relationships between LDL-C and clinical outcomes (good outcomes at 3 months, modified Rankin Scale scores 0–2). The interaction between LDL-C levels and prestroke statin use regarding functional outcomes was investigated. Among the 4711 patients (age, 67 ± 12 years; males, 62.1%) who met the eligibility criteria, compared with the high LDL-C group, the low and intermediate LDL-C groups were not associated with good outcomes at 3 months according to the multivariable analysis. A potential interaction between the LDL-C group and prestroke statin use on good outcomes at 3 months was observed (Pinteraction = 0.07). Among patients with prestroke statin use, low (aOR 1.84 [1.04–3.26]) and intermediate (aOR 2.31 [1.20–4.47]) LDL-C groups were independently associated with a greater likelihood of having a 3-month good outcome. Our study showed that LDL-C was not associated with a 3-month good outcome, but prestroke statin use could modify the influence of LDL-C levels on functional outcomes after IVT.

Vocal cord paralysis caused by recurrent laryngeal nerve (RLN) injury during thyroidectomy results in hoarseness, aspiration, and dyspnea. We evaluated the usefulness of nerve guidance conduits (NGCs) constructed from an asymmetric polycaprolactone (PCL)/Pluronic F127 porous membrane and filled with platelet-rich plasma (PRP) for functional RLN regeneration. We evaluated the proliferation and migration of Schwann cells (SCs) after PRP treatment in vitro. For the in vivo study, rabbits were divided into a non-loaded NGC group and a PRP-loaded NGC group. The left RLNs were resected and interposed with the NGCs. Functional and histological examinations of the vocal cords were performed. SC proliferation and migration increased in a PRP dose-dependent manner, with the PRP increasing the levels of neurotrophic factors, myelin-associated glycoprotein, and ERK. In vivo, the PRP group showed significantly better vocal cord mobility and less vocalis muscle atrophy than the non-loaded NGC group. Histologically, the ingrowth of nerve endings occurred more rapidly in the PRP group, and acetylcholinesterase, neurofilament, and S-100 expression in neural endings were significantly higher in the PRP group. Furthermore, transmission electron microscopy showed that myelinated axons were more tightly packed in the PRP group. This study shows that PRP-loaded NGCs provide a favorable environment for neural regeneration and suggests that this technique has therapeutic potential for promoting RLN recovery.

Ambient temperature-associated stress has been shown to affect the normal physiological functions of birds. The recent literature indicated that both, embryonic thermal manipulation (ETM) and in ovo feeding (IOF) of γ-aminobutyric acid (GABA) can mitigate the deleterious effects of heat stress (HS) in young broiler chicks. Therefore, this study intended to assess the effects of cyclic HS (32 ± 1 °C, 4 h/day from day 29 to 35) on rectal temperatures (RTs) and survival in broiler chickens after ETM and in IOF of GABA. A total of 275 RT data points and survival data were collected from chicks assigned to the following five treatments: chicks hatched from control eggs (CON); chicks hatched from control eggs but exposed to HS (CON + HS); chicks hatched from eggs injected at 17.5 days of incubation with 0.6 mL of 10% GABA and exposed to HS (G10 + HS); chicks hatched from thermally manipulated eggs (39.6 °C, 6 h/day from embryonic days 10 to 18) and exposed to HS (TM + HS); chicks hatched from eggs that received both previous treatments during incubation and exposed to HS (G10 + TM + HS). Under thermoneutral conditions, RTs increased quadratically from 39.9 ± 0.2 °C at hatching to 41.4 ± 0.1 °C at 8 days of age. When exposed to cyclic HS during the last week of rearing, the birds’ RTs tended to decrease at the end of the heat stress challenge (from 43.0 ± 0.2 °C on day 29 to 42.4 ± 0.1 °C on day 35). A stepwise Cox regression indicated that treatment was predictive of birds’ survival. Hazard ratios (HR) and their confidence intervals (CI) were calculated to assess the likelihood of death during the trial. The birds, belonging to the G10 + TM + HS group, were less likely to die under HS (HR 0.11, 95% CI 0.02 to 0.91, P = 0.041) compared to the CON + HS birds. Taken together, the combination of ETM and GABA IOF may help mitigate the drawbacks of cyclic HS by improving the survival of broilers.