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Background Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM). Methods From March 2014 to December 2018, data of patients with T2DM, who were treated with quadruple hypoglycemic medications for over 12 months in 11 hospitals in South Korea, were reviewed retrospectively. We compared glycosylated hemoglobin (HbA1c) levels before and 12 months after quadruple treatment with OHAs. The safety, maintenance rate, and therapeutic patterns after failure of the quadruple therapy were also evaluated. Results In total, 357 patients were enrolled for quadruple OHA therapy, and the baseline HbA1c level was 9.0%±1.3% (74.9±14.1 mmol/mol). After 12 months, 270 patients (75.6%) adhered to the quadruple therapy and HbA1c was significantly reduced from 8.9%±1.2% to 7.8%±1.3% (mean change, −1.1%±1.2%; P

Background Sarcopenia is defined as muscle wasting, characterized by a progressive loss of muscle mass and function due to ageing. Diagnosis of sarcopenia typically involves both muscle imaging and the physical performance of people exhibiting signs of muscle weakness. Despite its worldwide prevalence, a molecular method for accurately diagnosing sarcopenia has not been established. Methods We develop an artificial intelligence (AI) diagnosis model of sarcopenia using a published transcriptome dataset comprising patients from multiple ethnicities. For the AI model for sarcopenia diagnosis, we use a transcriptome database comprising 17 339 genes from 118 subjects. Among the 17 339 genes, we select 27 features as the model inputs. For feature selection, we use a random forest, extreme gradient boosting and adaptive boosting. Using the top 27 features, we propose a four‐layer deep neural network, named DSnet‐v1, for sarcopenia diagnosis. Results Among isolated testing datasets, DSnet‐v1 provides high sensitivity (100%), specificity (94.12%), accuracy (95.83%), balanced accuracy (97.06%) and area under receiver operating characteristics (0.99). To extend the number of patient data, we develop a web application (http://sarcopeniaAI.ml/), where the model can be accessed unrestrictedly to diagnose sarcopenia if the transcriptome is available. A focused analysis of the top 27 genes for their differential or co‐expression with other genes implied the potential existence of race‐specific factors for sarcopenia, suggesting the possibility of identifying causal factors of sarcopenia when a more extended dataset is provided. Conclusions Our new AI model, DSnet‐v1, accurately diagnoses sarcopenia and is currently available publicly to assist healthcare providers in diagnosing and treating sarcopenia.

The epitaxial growth of high-quality thin films provides a powerful method for the rapid preparation of new materials and discovery of materials with promising properties. Here, we report the effect of substrate temperature on the epitaxial growth of high-quality and large-area epitaxial CdTe films on GaAs(100) by molecular beam epitaxy. RHEED patterns as a function of the substrate temperature showed sharp streaky lines. A CdTe epilayer grown at 320 °C showed the narrowest full-width at half-maximum (FWHM) of 180 arcsec from (004) reflection in X-ray rocking curve measurements. The smooth and flat surface observed in the AFM image showed the excellent uniformity of the thin film, and the surface roughness decreased monotonically with the substrate temperature. From the substrate temperature dependence of the (A0, X) emission line, the luminescence intensity was found to increase with increasing substrate temperature, while the FWHM decreased with substrate temperature. Our experimental data suggest that the substrate temperature plays an important role in establishing hetero-epitaxial film growth for semiconductor devices.

Background: Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification.Methods: Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). Results: On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. Conclusions: Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.

Background Despite the increasing number of older adults as the population ages, there is a lack of frailty prevention guidelines for community-dwelling older adults. The Korean Frailty and Aging Cohort Study conducted this systematic review of literature on contributors to frailty and developed guidelines on the primary prevention of frailty in community-dwelling older adults. Methods This study updated a previous systematic review of contributors to frailty by adding the most recent articles. Based on this updated systematic review, experts in geriatrics and gerontology developed guidelines for preventing frailty using the Delphi method. Results These guidelines categorized the recommendations into physical activity, resilience, oral health, management of non-communicable diseases, involvement in society, smoking cessation, and eating various kinds of food. Conclusion Unlike previous frailty-related guidelines, this study developed evidence-based frailty prevention guidelines based on a systematic review. The guidelines are expected to contribute to the healthy aging of community-dwelling older adults by the primary prevention of frailty.

BACKGROUND AND PURPOSE There is a scarcity of information regarding the role of prothrombin kringle-2 (pKr-2), which can be generated by active thrombin, in hippocampal neurodegeneration and Alzheimer's disease (AD). EXPERIMENTAL APPROACH To assess the role of pKr-2 in association with the neurotoxic symptoms of AD, we determined pKr-2 protein levels in post-mortem hippocampal tissues of patients with AD and the hippocampi of five familial AD (5XFAD) mice compared with those of age-matched controls and wild-type (WT) mice, respectively. In addition, we investigated whether the hippocampal neurodegeneration and object memory impairments shown in 5XFAD mice were mediated by changes to pKr-2 up-regulation. KEY RESULTS Our results demonstrated that pKr-2 was up-regulated in the hippocampi of patients with AD and 5XFAD mice, but was not associated with amyloid-β aggregation in 5XFAD mice. The up-regulation of pKr-2 expression was inhibited by preservation of the blood-brain barrier (BBB) via addition of caffeine to their water supply or by treatment with rivaroxaban, an inhibitor of factor Xa that is associated with thrombin production. Moreover, the prevention of up-regulation of pKr-2 expression reduced neurotoxic symptoms, such as hippocampal neurodegeneration and object recognition decline due to neurotoxic inflammatory responses in 5XFAD mice. CONCLUSION AND IMPLICATIONS We identified a novel pathological mechanism of AD mediated by abnormal accumulation of pKr-2, which functions as an important pathogenic factor in the adult brain via blood brain barrier (BBB) breakdown. Thus, pKr-2 represents a novel target for AD therapeutic strategies and those for related conditions.

Objective To develop and evaluate the Korean version of a hospital-based transitional rehabilitation program (TRP), using daily living home for spinal cord injury (SCI) patients.Methods In this study, we developed the Korean version of a hospital-based TRP through domestic and overseas surveys and focus group meetings. By applying this to chronic SCI patients, we observed the functional and quality of life (QOL) changes and evaluated the degree of achievement of the core goals set for each patient during hospital-based TRP.Results Hospital-based TRP, for 21.8±3.9 days on average, was applied to four chronic SCI patients (two patients with long-term hospital stays and two homebound disabled individuals) with an average injury period of 736.8±185.4 days. The Korean version of the Spinal Cord Independence Measure (49.3±6.9 vs. 62.5±6.0; p

Avulsion injuries result from the application of a tensile force to a musculoskeletal unit or ligament. Although injuries tend to occur more commonly in skeletally immature populations due to the weakness of their apophysis, adults may also be subject to avulsion fractures, particularly those with osteoporotic bones. The most common sites of avulsion injuries in adolescents and children are apophyses of the pelvis and knee. In adults, avulsion injuries commonly occur within the tendon due to underlying degeneration or tendinosis. However, any location can be involved in avulsion injuries. Radiography is the first imaging modality to diagnose avulsion injury, although advanced imaging modalities are occasionally required to identify subtle lesions or to fully delineate the extent of the injury. Ultrasonography has a high spatial resolution with a dynamic assessment potential and allows the comparison of a bone avulsion with the opposite side. Computed tomography is more sensitive for depicting a tiny osseous fragment located adjacent to the expected attachment site of a ligament, tendon, or capsule. Moreover, magnetic resonance imaging is the best imaging modality for the evaluation of soft tissue abnormalities, especially the affected muscles, tendons, and ligaments. Acute avulsion injuries usually manifest as avulsed bone fragments. In contrast, chronic injuries can easily mimic other disease processes, such as infections or neoplasms. Therefore, recognizing the vulnerable sites and characteristic imaging features of avulsion fractures would be helpful in ensuring accurate diagnosis and appropriate patient management. To this end, familiarity with musculoskeletal anatomy and mechanism of injury is necessary.

Flexible batteries have gained significant attention in recent years, owing to their huge demand for portable wearable electronics and smart fabrics. However, conventional Li-ion batteries (LIBs) have limited device adaptability because of their planar architecture. To address this issue, the LIBs are shrunk to a one-dimensional fiber shape, which provides the freedom and flexibility needed for their integration with wearable electronics and smart fabrics. Herein, we demonstrate a method to fabricate twisted yarn-type (TYT) LIBs by a direct ink writing-based three-dimensional printing technology, using natural graphite and LiNi0.6Co0.2Mn0.2O2 as anode and cathode active materials, respectively, along with vapor-grown carbon fibers as an integrated conductive matrix. The printed electrode fibers are twisted together to create anode and cathode yarns, which are then assembled together to obtain a prototype TYT LIB device. The fabricated device performs significantly better in terms of both electrochemical performance and flexibility. The proposed method thus enables the direct integration of batteries into commercial fabrics either in the form of individual electrodes or full devices, which opens up a new route for developing next-generation energy storage devices for smart fabrics.

Background: Resilience refers to the ability to recover function after encounter with stressors. While psychological resilience refers to the ability to cope with psychological stress, physical resilience refers to functional restoration after biomedical challenges. However, there is no gold standard to assess physical resilience. Accordingly, we explored whether the perceived recovery time from common cold could be used to represent physical resilience.Methods: We analyzed data of individuals aged 72–86 years who had participated in the Korean Frailty and Aging Cohort Study in 2019. Among the 1,455 survey participants, 594 with asthma and chronic obstructive pulmonary disease and missing data were excluded. The remaining 861 participants were divided into three groups according to the number of days required for recovery from common cold (Group 1, 1–4 days; Group 2, 5–7 days; and Group 3, ≥8 days). The relationship between recovery time and psychological resilience scale (Brief Resilience Scale [BRS]) score, physical frailty (Fried’s physical frailty phenotype and the Korean Frailty Index for Primary Care [KFI-PC]), and frailty outcome was investigated.Results: Group 3 comprised individuals more likely to be women, sleep less, be less physically less active, fall more often, and have a low EuroQol visual analogue scale score. BRS scores differed significantly among the three groups (Group 1, 13.29; Group 2, 14.32; Group 3, 15.22; p

Little is known about the association between body proportionality at birth and neonatal outcomes in preterm infants. Body mass index (BMI) is one of the weigh-for-length ratios that represent body proportionality. The objective of this study was to examine whether BMI at birth affects neonatal outcomes in preterm infants. We assessed 4,018 preterm (

Purpose This study was performed to evaluate the risk of readmission in the first year after low anterior resection (LAR) for patients with rectal cancer and to identify the contributing factors for readmission related to dehydration specifically. Methods This was a retrospective analysis of 570 patients who underwent LAR for rectal cancer at National Cancer Center, Republic of Korea. A diverting loop ileostomy was performed in 357 (62.6%) of these patients. Readmission was defined as an unplanned visit to the emergency room or admission to the ward. The reasons for readmission were reviewed and compared between the ileostomy (n = 357) and no-ileostomy (n = 213) groups. The risk factors for readmission and readmission due to dehydration were analyzed using multivariable logistic and Cox proportional hazard model. Results Dehydration was the most common cause of readmission in both groups (ileostomy group, 6.7%, and no-ileostomy group, 4.7%, P = 0.323). On multivariable analysis, risk factors for readmission were an estimated intraoperative blood loss of ≥400 mL (odds ratio [OR], 1.757; 95% confidence interval [CI], 1.058-2.918; P = 0.029), and postoperative chemotherapy (OR, 2.914; 95% CI, 1.824-4.653; P < 0.001). On multivariable analysis, postoperative chemotherapy, and not a diverting loop ileostomy, was an independent risk factor for dehydration-related readmission (OR, 5.102; 95% CI, 1.772-14.688; P = 0.003). Conclusion The most common cause of readmission after LAR for rectal cancer was dehydration, as reported previously. Postoperative chemotherapy, not the creation of a diverting ileostomy, was identified as the risk factor associated with readmission related to dehydration.

Since the introduction of Enhanced Recovery After Surgery (ERAS), early diet after surgery has been emphasized and clinical outcomes have improved, though vomiting has been reported frequently. We defined diet failure based on clinical manifestation and images after colon cancer surgery and attempted to analyze underlying risk factors by comparing the early diet group with the conventional diet group. All consecutive patients underwent colectomy with curative intent at a single institution between August 2015 and July 2017. The early diet group was started on soft diet on the second day after surgery, while the conventional group started the same after flatulence. The primary outcome was the difference in the incidence of diet failure between the two groups. Secondary outcomes were analyzed to determine risk factors for diet failure and readmission due to ileus. Overall, 293 patients were included in the conventional diet group and 231 in the early diet group. There were no significant differences between the two groups, except for shorter hospital stays in the early diet group (median 8 days, p

Metal (M) contact with a semiconductor (S) introduces metal-induced gap states (MIGS), which makes it difficult to study the intrinsic electrical properties of S. A bilayer of metal with graphene (Gr), i.e., a M/Gr bilayer, may form a contact with S to minimize MIGS. However, it has been challenging to realize the pristine M/Gr/S junctions without interfacial contaminants, which result in additional interfacial states. Here, we successfully demonstrate the atomically clean M/Gr/n-type silicon (Si) junctions via all-dry transfer of M/Gr bilayers onto Si. The fabricated M/Gr/Si junctions significantly increase the current density J at reverse bias, compared to those of M/Si junctions without a Gr interlayer (e.g., by 105 times for M = Au in Si(111)). The increase of the reverse J by a Gr interlayer is more prominent in Si(111) than in Si(100), whereas in M/Si junctions, J is independent of the type of Si surface. The different transport data between M/Gr/Si(111) and M/Gr/Si(100) are consistent with Fermi-level pinning by different surface states of Si(111) and Si(100). Our findings suggest the effective way to suppress MIGS by an introduction of the clean Gr interlayer, which paves the way to study intrinsic electrical properties of various materials.

Aim The study aimed to identify social factors predicting improvement of frailty in community-dwelling older adults after 2 years using a population-based cohort study. Methods We analyzed data from the 2016 and 2018 Korean Frailty and Aging Cohort Study. The participants of this study were 1428 community-dwelling older adults aged 70-84 years who were recruited from 10 medical centers across different regions. Frailty was measured using the five-item FRAIL scale, which evaluates fatigue, resistance, ambulation, illness and weight loss. Multilevel logistic regression analysis was used to examine baseline social factors that predict frailty improvement after 2 years by frailty status. Results In frail older adults, higher participation in social activities (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02-1.34) was significantly associated with frailty improvement. In pre-frail older adults, there were no significant social factors predicting the improvement of frailty status; however, other modifiable factors such as high and moderate levels of physical activity (OR 1.17, 95% CI 1.07-1.28, OR 1.13, 95% CI 1.03-1.25, respectively) and low depressive symptoms (OR 0.88, 95% CI 0.84-0.91) were associated with pre-frail improvements. High levels of physical activity (OR 1.16, 95% CI 1.02-1.33) were also associated with improvements of frailty. Conclusions Different strategies depending on the level of frailty are necessary to improve frailty status. Timely and appropriate interventions can promote frailty improvement and prevent negative health outcomes in community-dwelling older adults. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; ••: ••-••.

This study validates behavior development screening for toddlers (BeDevel), which utilizes a combination of short caregiver interviews (BeDevel-I) and semistructured play observations (BeDevel-P). The data of 431 toddlers (male 66.2%; mean age (SD) = 29.11 (8.59) months; ASD, n = 201; developmental delay, n = 46; typically developing, n = 184), aged 18 ~ 42 months, were included in the validation of BeDevel. The best clinical estimate diagnosis, screening rate, validity, sensitivity, and reliability of BeDevel were determined based on data cross-sectionally collected using BeDevel and existing diagnostic/screening instruments: autism diagnostic observation schedule (ADOS), autism diagnostic interview (ADI-R), Vineland adaptive behavior scales-II (VABS-II), social response scales (SRS), sequenced language scale for infants (SELSI), Korean childhood autism rating scale (K-CARS), and Korean social communication questionnaire (K-SCQ). The k values of BeDevel-I and BeDevel-P were 0.055 ~ 0.732 and 0.291 ~ 0.752, respectively. Items related to social referencing in BeDevel-P had a particularly high diagnostic validity (k = 0.483 ~ 0.684). Reliabilities of BeDevel-I and BeDevel-P were sufficient (Cronbach's alpha = 0.86 ~ 0.88 and 0.92 ~ 0.95, respectively). BeDevel-I and BeDevel-P showed high sensitivity (BeDevel-I: 85.00 ~ 89.29%; BeDevel-P: 85.00 ~ 91.75%), specificity (BeDevel-I: 77.55 ~ 89.55%; BeDevel-P: 85.09 ~ 97.01%), PPV (BeDevel-I: 70.83 ~ 88.54%; BeDevel-P: 81.52 ~ 94.68%), and NPV (BeDevel-I: 76.00 ~ 95.24%; BeDevel-P: 84.62 ~ 95.45%). The agreement between the composite BeDevel score and ADOS, ADI-R, K-CARS, and K-SCQ was >67.6% (range = 67.6 ~ 90.8%). Combining a short caregiver interview and direct play observation is a valid and reliable screening process. More studies on social referencing as an important early marker are needed. BeDevel can be utilized as a secondary screening instrument before diagnostic confirmation in clinical and community settings. LAY SUMMARY: BeDevel, which consists of a short caregiver interview and direct play observation, is a valid and reliable screening instrument for autism spectrum disorder (ASD). We suggest that BeDevel can be utilized as a secondary instrument before administering diagnostic assessments in clinical and community settings. More studies examining social referencing as a potential behavioral marker of ASD are needed.

The World Health Organization (WHO) recently endorsed the proposal for a Decade of Healthy Ageing (2020-2030). The WHO defines "healthy aging" as "the process of developing and maintaining the functional ability that enables wellbeing in older age." Among the strategies for the Decade of Healthy Ageing, the WHO has suggested enhancing intrinsic capacity, promoting functional ability, and implementing the Integrated Care for Older People (ICOPE) package. The WHO has defined steps for ICOPE evaluation and scale-up and is performing a prospective study in 2-3 countries (low and middle income, high income) to test its feasibility in 2021-2022 and a multinational randomized study to validate its clinical efficacy and effectiveness in 2022-2024. Intrinsic capacity and frailty represent two faces of the same coin, with one indicating the reserves of the individual and the other indicating the deficits that accumulate with age. The Integrated Care of Older Patients with Frailty in Primary Care (ICOOP_Frail) study is the first integrated care program for frailty or functional decline in primary care in Korea. The results suggest that the ICOOP_Frail study can be utilized as a reference for ICOPE studies in Korea or at least to provide important findings for the forthcoming ICOPE implementation study in Korea.

Background Ginsenoside Rb1 (G-Rb1), one of the major active compounds in Panax ginseng, has already been shown to reduce inflammation in various diseases. Osteoarthritis (OA) has traditionally been considered a degenerative disease with degradation of joint articular cartilage. However, recent studies have shown the association of inflammation with OA. In the present study, we investigated whether Rb1 had an antiinflammatory effect on monoiodoacetate (MIA)-induced OA in ovariectomized rats as a model of postmenopausal arthritis. Methods G-Rb1 at a dosage of 3 and 10 μg/kg body weight was administered every 3 days intraarticularly for a period of 4 weeks to observe antiarthritic effects. Diclofenac (10 mg/kg) served as a positive control. Results The administration of Rb1 significantly ameliorated OA inflammatory symptoms and reduced serum levels of inflammatory cytokines. Furthermore, G-Rb1 administration considerably enhanced the expression of bone morphogenetic protein-2 and collagen 2A and reduced the levels of matrix metalloproteinase-13 genes, indicating a chondroprotective effect of G-Rb1. G-Rb1 also significantly reduced the expression of several inflammatory cytokines/chemokines (interferon gamma (IFN-γ), monocyte chemoattractant protein-1 (MCP-1)/CCL-2, interleukin [IL]-1β, and IL-6). Histological analysis demonstrated that G-Rb1 significantly attenuated the pathological changes in MIA-induced OA in ovariectomized rats. Safranin O and toluidine blue staining further demonstrated that G-Rb1 effectively prevented the degradation of cartilage and glycosaminoglycans, respectively. Conclusion Overall, our results suggest that G-Rb1 exerts cartilage protective effect on MIA-induced ovariectomized OA rats, by inhibiting inflammatory mediators such as IL-6, IL-1β, MCP-1/CCL-2, cyclooxygenase-2 (COX-2), and prostaglandin E2 (PGE2). These results shed a light on possible therapeutic application of G-Rb1 in OA.

Purpose: Gastric cancer remains the leading cause of cancer-related deaths in Northeast Asia. Population-based endoscopic screenings in the region have yielded successful results in early detection of gastric tumors. Endoscopic screening rates are continuously increasing, and there is a need for an automatic computerized diagnostic system to reduce the diagnostic burden. In this study, we developed an algorithm to classify gastric epithelial tumors automatically and assessed its performance in a large series of gastric biopsies and its benefits as an assistance tool. Experimental Design: Using 2,434 whole-slide images, we developed an algorithm based on convolutional neural networks to classify a gastric biopsy image into one of three categories: negative for dysplasia (NFD), tubular adenoma, or carcinoma. The performance of the algorithm was evaluated by using 7,440 biopsy specimens collected prospectively. The impact of algorithm-assisted diagnosis was assessed by six pathologists using 150 gastric biopsy cases. Results: Diagnostic performance evaluated by the AUROC curve in the prospective study was 0.9790 for two-tier classification: negative (NFD) versus positive (all cases except NFD). When limited to epithelial tumors, the sensitivity and specificity were 1.000 and 0.9749. Algorithm-assisted digital image viewer (DV) resulted in 47% reduction in review time per image compared with DV only and 58% decrease to microscopy. Conclusions: Our algorithm has demonstrated high accuracy in classifying epithelial tumors and its benefits as an assistance tool, which can serve as a potential screening aid system in diagnosing gastric biopsy specimens.

Background While transarterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, the clinical outcomes according to door-to-embolization (DTE) time are unclear. This study investigated how DTE time affects outcomes in patients with severe pelvic fracture. Methods Using a trauma database between November 1, 2015 and December 31, 2019, trauma patients undergoing TAE were retrospectively reviewed. The final study population included 192 patients treated with TAE. The relationships between DTE time and patients’ outcomes were evaluated. Multiple binomial logistic regression analyses, multiple linear regression analyses, and Cox hazard proportional regression analyses were performed to estimate the impacts of DTE time on clinical outcomes. Results The median DTE time was 150 min (interquartile range, 121–184). The mortality rates in the first 24 h and overall were 3.7% and 14.6%, respectively. DTE time served as an independent risk factor for mortality in the first 24 h (adjusted odds ratio = 2.00, 95% confidence interval [CI] = 1.20–3.34, p = 0.008). In Cox proportional hazards regression analyses, the adjusted hazard ratio of DTE time for mortality at 28 days was 1.24 (95% CI = 1.04–1.47, p = 0.014). In addition, there was a positive relationship between DTE time and requirement for packed red blood cell transfusion during the initial 24 h and a negative relationship between DTE time and ICU-free days to day 28. Conclusion Shorter DTE time was associated with better survival in the first 24 h, as well as other clinical outcomes, in patients with complex pelvic fracture who underwent TAE. Efforts to minimize DTE time are recommended to improve the clinical outcomes in patients with pelvic fracture treated with TAE.

Background Animal studies have shown that a leukocyte influx precedes the development of bronchopulmonary dysplasia (BPD) in premature sheep. The CXC chemokine receptor 2 (CXCR2) pathway has been implicated in the pathogenesis of BPD because of the predominance of CXCR2 ligands in tracheal aspirates of preterm infants who later developed BPD. Purpose To test the effect of CXCR2 antagonist on postnatal systemic and pulmonary inflammation and alveolarization in a newborn Sprague-Dawley rat model of BPD. Methods Lipopolysaccharide (LPS) was injected intraperitoneally (i.p.) into the newborn rats on postnatal day 1 (P1), P3, and P5 to induce systemic inflammation and inhibit alveolarization. In the same time with LPS administration, CXCR2 antagonist (SB-265610) or vehicle was injected i.p. to investigate whether CXCR2 antagonist can alleviate the detrimental effect of LPS on alveolarization by attenuating inflammation. On P7 and P14, bronchoalveolar lavage fluid (BALF) and peripheral blood (PB) were collected from the pups. To assess alveolarization, mean linear intercept and alveolar surface area were measured on four random non-overlapping fields per animal in two distal lung sections at 100× magnification. Results Early postnatal LPS administration significantly increased neutrophil counts in BALF and PB and inhibited alveolarization, which was indicated by a greater mean cord length and lesser alveolar surface area. CXCR2 antagonist significantly attenuated the increase of neutrophil counts in BALF and PB and restored alveolarization as indicated by a decreased mean cord length and increased alveolar surface area in rat pups exposed to early postnatal systemic LPS. Conclusion CXCR2 antagonist preserved alveolarization by alleviating pulmonary and systemic inflammation induced by early postnatal systemic LPS administration. These results suggest that CXCR2 antagonist can be considered a potential therapeutic agent for BPD that results from disrupted alveolarization induced by inflammation.

In this article, a feasibility study on an optically transparent planar dipole antenna using liquid salt water at wide ultra-high frequency (UHF) band (470–771 MHz) for application in external antenna of ultra-high-definition television (UHD TV) is presented. The most significant reason behind using liquid salt water for transparent antenna applications is its excellent average optical transparency (OTav) (>95% at salinity of 40 ppt) compared with other typical solid transparent thin-film electrodes such as indium tin oxide (>73%) or multilayer films (>78%). Each conductive arm of the proposed dipole is constructed from a salt-water layer held between two clear planar acrylic layers ( $\varepsilon _{r} = 2.61$ , tan $\delta = 0.01$ , OTav > 90%) (acrylic/salt water/acrylic; ASA) due to surface tension. To investigate the electrical and optical properties of the ASA structure, we analyze the surface tension to determine the thickness of the salt-water layer that finalizes its sheet resistance and OTav. The average gain and efficiency of the antenna are 1.72 dBi and 74%, respectively, in the operating UHF band. This makes the proposed antenna a good candidate for application as a transparent external antenna in UHD TVs and proves that it is possible to use salt water for high-frequency devices.

In March 2020, the World Health Organization declared the coronavirus disease (COVID-19) outbreak as a pandemic due to its uncontrolled global spread. Reverse transcription polymerase chain reaction is a laboratory test that is widely used for the diagnosis of this deadly disease. However, the limited availability of testing kits and qualified staff and the drastically increasing number of cases have hampered massive testing. To handle COVID19 testing problems, we apply the Internet of Things and artificial intelligence to achieve self-adaptive, secure, and fast resource allocation, real-time tracking, remote screening, and patient monitoring. In addition, we implement a cloud platform for efficient spectrum utilization. Thus, we propose a cloud based intelligent system for remote COVID-19 screening using cognitive radio-based Internet of Things and deep learning. Specifically, a deep learning technique recognizes radiographic patterns in chest computed tomography (CT) scans. To this end, contrast-limited adaptive histogram equalization is applied to an input CT scan followed by bilateral filtering to enhance the spatial quality. The image quality assessment of the CT scan is performed using the blind/referenceless image spatial quality evaluator. Then, a deep transfer learning model, VGG-16, is trained to diagnose a suspected CT scan as either COVID-19 positive or negative. Experimental results demonstrate that the proposed VGG-16 model outperforms existing COVID-19 screening models regarding accuracy, sensitivity, and specificity. The results obtained from the proposed system can be verified by doctors and sent to remote places through the Internet.

The menopausal syndrome caused by rapid changes in hormone levels greatly influences the quality of life of women. Though hormone replacement therapy (HRT) is widely used to treat the menopausal syndrome, it exhibits many side effects, including the risk of thrombosis, cardiovascular diseases, and increased incidence of breast cancer; thus, diversifying the interest for phytotherapy-based materials as alternatives to HRT. Here, we isolated a crude polysaccharide fraction (CWPF) from Cynanchum wilfordii root that alleviated the ovariectomy-induced uterine atrophy and bone loss without changes in plasma estradiol concentration in mice. Increased plasma levels of follicle-stimulating hormone (FSH), alkaline phosphatase (ALP), osteocalcin (OC) in ovariectomized mice were also reduced to normal levels by CWPF administration. We found that the inhibitory effects of CWPF on menopausal symptoms were mediated by the estrogen receptor β (ER-β) specific activation, not ER-α. Moreover, CWPF treatment suppressed the phosphorylation of Akt, suggesting that CWPF alleviates post-menopausal symptoms by regulating ER-β related Akt signaling pathway. These results demonstrate that the polysaccharides corresponding to CWPF among the water-soluble extracts of CW could be used as a beneficial herbal alternative for the development of therapeutic agents to prevent menopausal syndrome in women.

Small cell lung cancer (SCLC) is a unique tumor that has a distinct clinical behavior and dismal prognosis. If untreated, it can become aggressively malignant, and life expectancy could be limited to weeks. Spontaneous regression of lung cancer has rarely been reported, and among them SCLC is even rarer. The underlying mechanisms of spontaneous regression are poorly understood. Here, we report a case of complete spontaneous SCLC remission in an elderly patient., An 80‐year‐old man presented with hemoptysis and hoarseness and was diagnosed with small cell lung cancer. He refused treatment and consumed beet juice for 2 years. Complete spontaneous remission was confirmed in subsequent examinations.

Background A diabetic foot is the most common cause of non-traumatic lower extremity amputations (LEA). The study seeks to assess the risk factors of amputation in patients with diabetic foot ulcers (DFU). Methods The study was conducted on 351 patients with DFUs from January 2010 to December 2018. Their demographic characteristics, disease history, laboratory data, ankle-brachial index, Wagner classification, osteomyelitis, sarcopenia index, and ulcer sizes were considered as variables to predict outcome. A chi-square test and multivariate logistic regression analysis were performed to test the relationship of the data gathered. Additionally, the subjects were divided into two groups based on their amputation surgery. Results Out of the 351 subjects, 170 required LEA. The mean age of the subjects was 61 years and the mean duration of diabetes was 15 years; there was no significant difference between the two groups in terms of these averages. Osteomyelitis (hazard ratio [HR], 6.164; 95% confidence interval [CI], 3.561-10.671), lesion on percutaneous transluminal angioplasty (HR, 2.494; 95% CI, 1.087-5.721), estimated glomerular filtration rate (eGFR; HR, 0.99; 95% CI, 0.981-0.999), ulcer size (HR, 1.247; 95% CI, 1.107-1.405), and forefoot ulcer location (HR, 2.475; 95% CI, 0.224-0.73) were associated with risk of amputation. Conclusion Osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location were risk factors for amputation in diabetic foot patients. Further investigation would contribute to the establishment of a diabetic foot risk stratification system for Koreans, allowing for optimal individualized treatment.

With aging, there is a loss of skeletal muscle mass and function, which leads to an increased risk of falls, fractures, long-term institutional care, cardiovascular and metabolic diseases, and even mortality. Sarcopenia has been defined as a condition characterized by low muscle mass together with low muscle strength and/or low muscle performance. In 2019, the Asian Working Group for Sarcopenia (AWGS) published a consensus paper on the diagnosis and treatment of sarcopenia. The AWGS 2019 guideline, in particular, presented strategies for case-finding and assessment, which could aid in the diagnosis of possible sarcopenia in primary care settings. AWGS 2019 proposed an algorithm that recommends calf circumference measurement (cut-off

Purpose : This case report describes the successful results of vision therapy (VT) in divergence insufficiency esotropia (DI). Methods : A 19-year-old woman had diplopia with visual discomfort in daily life. At the first visit, she was judged intermittent DI with distance diplopia from binocular visual function tests. The VT program was designed to improve the patient’s negative fusional vergence including focus control, coordination training, ocular movement training, and visual function tests such as refraction, eye deviation, fusional ability, vergence facility, convergence near point, Bagolini lens test, Worth 4 dot test, and stereoacuity. Results : The deviation of eyes changed from 16 prism diopter(△) esotropia to 3 △ esophoria at distance after 9 months. At near, the deviation also changed from 7△ esotropia to 1 △ esophoria after VT. Fusional ability improved from X/4/1 to X/4/3 at distance and from BI X/8/2 to BI X/16/14 at near after VT of 9 months. Homonymous diplopia improved to single binocular vision by Bagolini striated glasses test. In the Bagolini striated glasses test, diplopia that appeared before VT was improved to single vision at all distances after training. The diplopia at distance, which complained severely at the first visit, gradually improved over the 9 months of VT, resulting in a stable single binocular vision. Conclusion : The binocular functions of the DI were successfully improved after VT of 9 months.

A compact ethanol fuel processor with an all-in-one design of the auto-thermal reforming (ATR) and water-gas-shift (WGS) reactors was developed. The fuel processor has unique features, such as the ...

Study design A retrospective observational study. Objective To identify the difference between patients with and without healthcare-associated infection (HAI) after spinal cord injury (SCI), changes in the quantity of rehabilitation after HAI, and resistance to and application of empirical antibiotics. Setting University hospital-affiliated rehabilitation center. Methods Altogether, 338 patients with SCI receiving inpatient rehabilitation from January 2015 to March 2018 were categorized into two groups based on the presence or absence of HAI. Demographic and clinical characteristics, amount of rehabilitation performance between before and after HAI, resistance to antibiotics, and empirical antibiotic change rates were investigated. Results In 79 patients, 117 HAI cases occurred, with an overall incidence of 34.6%. Male sex, complete SCI, and trauma history were more frequent in the HAI group than in the non-HAI group. Length of stay (LOS) was longer at 28.9 days in the HAI group. The incidence of lower respiratory tract infections (LRIs) and urinary tract infections (UTIs) was 5.0 and 16.9%, respectively. The rehabilitation loss rates due to LRIs and UTIs were 40.0 and 20.2%, respectively, which were not statistically significant. The rates of resistance to recommended empirical antibiotics for LRIs and UTIs were 26.9-57.7% and 54.2-67.8%, respectively. The rates of empirical antibiotic changes for LRIs and UTIs were 35.3 and 43.9%, respectively. Conclusions HAI after SCI was more common in men, complete SCI and trauma history. LOS was prolonged in the HAI group. A quantitative reduction of rehabilitation treatment after HAI was observed, but further research is needed for validation.

Various perinatal morbidities may adversely affect postnatal nephrogenesis in preterm infants. Kidney ultrasonographic findings following acute kidney injury (AKI) have not been well described in preterm infants. Herein, we describe three cases of extremely preterm infants who showed abnormal kidney ultrasonographic findings resembling dysplasia of the kidneys following AKI. Their median gestational age and birth weight were 25+6 (range 23+3–26+6) weeks and 620 (480–840) g, respectively. All infants suffered severe AKI during their third to seventh week of life. Their kidney function recovered with conventional management. Kidney ultrasonographies performed after AKI revealed increased kidney echogenicity, loss of corticomedullary differentiation, and multiple cortical cysts, which were similar to cystic dysplasia of the kidneys and were absent in previous kidney imaging. Three infants eventually developed at least one of the long-term kidney sequelae following AKI, including proteinuria, hypertension, and elevated levels of serum creatinine or cystatin C as determined during the last follow-up at the corrected age of 9–18 months. Based on these cases, we can infer that AKI occurring during the early postnatal period may result in dysplasia of the kidneys with cortical cysts in extremely preterm infants, which may lead to chronic kidney disease in their later life. It is useful to follow up not only laboratory parameters but also kidney ultrasonographic findings in extremely preterm infants who suffered AKI during their early postnatal periods.

Lymphoma is a common cause of nontraumatic chylothorax. Clinical success rates of thoracic duct embolization are lower in patients with nontraumatic chylothorax compared to patients with traumatic chylothorax. Herein, we report a case of nontraumatic chylothorax and lymphoma in a 77-year-old man managed with thoracic duct embolization. The chest tube drainage decreased but not was sufficient to enable removal of the chest tube. Therefore, a second embolization was performed through a direct puncture of the lymphatic mass in the lung, following which the chyle leakage ceased, and the chest tube was removed. The treatment strategy discussed in this report may be an effective therapeutic option for select patients with nontraumatic chylothorax.

Gastrointestinal graft-versus-host disease (GVHD) is a common complication after hematopoietic stem cell transplantation. Concomitant cytomegalovirus (CMV) enteritis worsens the prognosis of this condition. We report a case of small bowel perforation associated with gastrointestinal GVHD and CMV enteritis in a patient with leukemia who was successfully treated surgically. A 39-year-old man presented with intestinal perforation necessitating emergency surgical intervention. He was diagnosed with T-cell acute lymphoblastic leukemia and developed severe gastrointestinal GVHD and CMV enteritis after hematopoietic stem cell transplantation. His terminal ileum showed a perforation with diffuse wall thinning, and petechiae were observed over long segments of the distal ileum and the proximal colon. Small bowel segmental resection and a subtotal colectomy with a double-barreled ileocolostomy were performed. The patient recovered uneventfully after the operation. Based on reports described in the literature, surgery plays a minor role in the management of gastrointestinal GVHD; however, timely surgical intervention could be effective in selected patients.

A typical microwave oven generates an electromagnetic wave in an ISM band of 2.45 GHz. To prevent this unwanted microwave leakage through its front door, a circular perforated metal sheet is typically used with low shielding effectiveness ( RS ) and optical transparency (OT) for electrical and optical performance of two transparent electrodes (TEs) including metal mesh film (MMF) and indium tin oxide (ITO) and compare those to the currently used perforated copper sheet (PCS) in commercial microwave oven. The measured RS and average OT in visible spectrum of MMF is 0.11 Ω/sq and 68.4%, and its figure of merit (FoM) is 203.8 which is the highest among them. The measured shielding effectiveness of MMF, ITO, and PCS at 2.45 GHz are 31.4, 21.0, and 25.5 dB, respectively. The results indicate that MMF has highest FoM and the best EMC performance among the TEs and PCS, which makes it the most suitable candidate for microwave ovens.

Background: In recent years, the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft source for ligament reconstruction has gained popularity. However, no reports are available regarding tendon regeneration after harvesting of the AHPLT. Hypothesis: When half of the tendon is preserved during tendon harvesting, the quality of the regenerated tendon is better than that of the regenerated tendon after full-thickness harvesting. Study Design: Case series; Level of evidence, 4; controlled laboratory study. Methods: A total of 21 patients who underwent AHPLT harvesting for lower extremity ligament reconstruction participated in the magnetic resonance imaging (MRI) study to evaluate tendon regeneration 1 year after the harvesting. An in vivo animal study was performed to compare the quality of the regenerated tendon after partial-thickness and full-thickness tendon harvesting. A total of 30 adult female Sprague-Dawley rats were allocated to 2 groups—15 rats underwent partial-thickness Achilles tendon harvesting (partial-thickness harvesting [PTH] group), and 15 rats underwent full-thickness Achilles tendon harvesting (full-thickness harvesting [FTH] group). The quality of the regenerated tendons was compared 180 days after tendon harvesting. Results: All 21 patients showed regeneration of the peroneus longus tendon (PLT) (homogeneously dark on both T1- and T2-weighted sequences). The cross-sectional area of the regenerated tendon divided by that of the preoperative tendon was 92.6% and 84.5% at 4 cm and 9 cm proximal to the tip of the distal fibula, respectively. In the animal study, the mean histologic score was better for the PTH group compared with the FTH group (9.17 ± 1.35 vs 14.72 ± 0.74; P < .001). The ultimate strength and the stiffness of the regenerated Achilles tendon were significantly higher for the PTH group compared with the FTH group (35.5 ± 8.3 vs 22.4 ± 8.3 N, P = .004; and 31.6 ± 7.7 vs 23.5 ± 4.8 N/mm, P = .016). Conclusion: The PLT was found to regenerate after partial-thickness harvesting on MRI. In the animal study, the quality of the regenerated tendon when half of the tendon was preserved during tendon harvesting was better than that after full-thickness tendon harvesting.

Background This study aimed to identify adverse events and mortality in adults aged 75 years and older who were initially prescribed statins for primary prevention. Methods This retrospective study analyzed the data from the National Health Insurance Corporation-Senior Cohort from 2002 to 2015. An exact block matched model was constructed from statin user and statin non-user groups. Results The study sample comprised 1,370 older adults (mean age, 78 years), with 685 statin non-users matched to 685 new statin users. Compared to non-users, the adjusted hazard ratios (HRs) of new statin users were 0.83 (p=0.04) for all-cause mortality, 1.24 (p=0.03) for major adverse cardiovascular events, and 1.18 (p=0.06) for new-onset diabetes mellitus. In a sub-analysis of statin use duration, longer statin use (>5 years) was associated with a significantly lower risk of all-cause mortality (HR=0.76, p=0.01) but not with major adverse cardiovascular events (HR=0.88, p=0.36) or new-onset diabetes mellitus (HR=0.95, p=0.78) after adjusting for age, sex, body mass index, diabetes mellitus, hypertension, aspirin use, and antiplatelet use. Conclusion Our findings suggested that statins started for primary prevention in older adults aged 75 years and older had an advantageous effect on all-cause mortality only if used for at least 5 years.

Purpose : To evaluate the anterior segment parameters (anterior chamber depth: ACD and anterior chamber angle: ACA) according to sex and age in Korean adults. Methods : The average age of the 92 subjects(160 eyes) was 35.38±15.75(20∼68) years old. The anterior segment parameters was measured by a rotating Scheimpflug camera(Pentacam, Oculus, Wetzlar, German). The ACD and ACA at 4 quadrants(superior, inferior, nasal and temporal) were measured and their averages were evaluated. Results : The total ACD was 2.97±0.39 mm in average. As the age increased, the ACD became shallower. The ACD for the nasal(1.87±0.39 mm) and the superior(1.85±0.39 mm) showed the significantly shallow depth than the ones for temporal(2.29±0.40 mm) and inferior (2.20±0.41 mm). In all 4 quadrants, the ACD gradually became shallower as the age increased 20s to 60s. The total ACA was 36.44±6.76°in average. As the age increased, the ACA became narrower. The ACA for superior(34.23±7.52°) and inferior(33.27±6.76°) showed the significantly narrow angle than the ones for the nasal(38.28±7.28°) and temporal (39.98±7.13°). In all 4 quadrants, the ACA gradually became narrower as the age increased 20s to 60s. Conclusion : As the age increases, the ACD and ACA become shallow and narrow but the decreases for 4 quadrants appeared different in tendency.