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Calcinosis cutis is a very rare disease characterized by insoluble calcium salt deposits in the skin. There are five types of calcinosis, dystrophic type being the most common among them. Dystrophic calcinosis is generally caused by local tissue damage. We present the dystrophic calcinosis cutis case of a patient with no underlying diseases but a burn injury which occurred 10 years ago. She visited the hospital for an ulcerative wound on the same area. She also had sustained a dog bite injury on the same site 9 months ago, which was treated at an oriental clinic with no improvement. Physical examination by palpation revealed a hard mass under the skin. As the mass was of a large size, the possibility of a foreign body was considered. Surgical resection and biopsy of the mass diagnosed it as dystrophic calcinosis cutis. Although clinical features of this case were unlike previous calcinosis cutis cases, performing a biopsy proved helpful towards its diagnosis.

Background The placement of a closed suction drain is indispensable for preventing serious infections; however, closed suction drains are inevitably accompanied by increases in local infections, pain, and length of hospital stay, and delays in breast cancer treatment including postoperative chemotherapy and radiotherapy. We analyzed predictive factors of total drainage volume and duration. Methods Among patients who were diagnosed with primary breast cancer between January 2016 and December 2017, we retrospectively analyzed those who underwent immediate implant-based breast reconstruction. Factors that could affect the total volume and duration of drainage, including lipo-prostaglandin E1 use, preoperative chemotherapy, resected breast issue weight, age, body mass index (BMI), serum white blood cell count, erythrocyte sedimentation rate, and C-reactive protein (CRP) level, were analyzed. Results The mean volume and duration of drainage were 1,213.6 mL and 14.8 days respectively. BMI and CRP on postoperative day (POD) 1 were correlated with the total drainage volume. Age, BMI, and resected breast tissue weight were correlated with the drainage duration. Multiple regression analysis showed that CRP level on POD 1, age, and resected breast tissue weight significantly affected the drainage duration. Multiple regression analysis also showed that the total drainage volume was significantly affected by BMI and CRP level on POD 1. Conclusions The factors found to affect the duration of drainage in patients undergoing implant-based breast reconstruction were CRP on POD 1, age, resected breast tissue weight, and BMI. The CRP level on POD 1 and BMI influenced the total volume of drainage.

Odontogenic cutaneous fistula of dental origin at the alar-facial groove is rarely reported. As many patients present with only skin lesions without dental problems, it is often confused with a cyst, abscess or pyogenic granuloma. We report the case of a 52-year-old man who presented with a relapsing cutaneous ulcer in the left alar-facial groove area. Ultrasonography findings suggested a ruptured epidermal cyst, and an excisional biopsy was performed. At 10 days after the surgery, wound dehiscence and pus discharge were observed. Computed tomography revealed a sinus tract, and a diagnosis of odontogenic cutaneous fistula was made. After consultation with the dental department, endodontic treatment was performed. During reoperation, a remnant fistula from the left alar-facial groove area to the left upper central incisor was observed, for which fistulectomy was performed. The patient remained disease-free postoperatively. With early accurate diagnosis, patients with odontogenic cutaneous fistula can be protected from unnecessary surgical intervention and ineffective antibiotic therapy.

Serologic and molecular surveillance of serum collected from 152 suspected scrub typhus patients in Myanmar revealed Orientia tsutsugamushi of genotypic heterogeneity. In addition, potential co-infection with severe fever with thrombocytopenia syndrome virus was observed in 5 (3.3%) patients. Both scrub typhus and severe fever with thrombocytopenia syndrome are endemic in Myanmar.

After a partial mastectomy, large or ptotic breasts can be reconstructed using breast reduction techniques. Wise-pattern reduction is typically used to remove masses in any quadrant of the breast, but this technique leaves a large inverted T-shaped scar. Instead, the short scar periareolar inferior pedicle reduction (SPAIR) technique involves a periareolar line and does not result in a scar along the inframammary fold (IMF). A 49-year-old patient with macromastia and severely ptotic breasts was diagnosed with invasive cancer of the left breast. Her large breasts caused pain in her back, shoulders, and neck. She also expressed concern about postsurgical scarring along the IMF. In light of this concern, we chose the SPAIR technique, and we designed and performed the procedure as described by Hammond. During surgery, we removed 36 g of breast tumor and 380 g of breast parenchyma from the left breast. To establish symmetry, we also removed 410 g of tissue from the right breast. Postoperatively, the patient reported satisfaction regarding the reduction mammaplasty and, in particular, noted decreased back, shoulder, and neck pain. In summary, we used the SPAIR technique to achieve oncologic and aesthetic success in a patient with macromastia and a tumor located lateral to the nipple-areolar complex.

Crohn’s disease is difficult to diagnose owing to its varied symptoms, among which fistulae are a late-stage symptom that appears mainly in the form of a perianal fistula. A patient who was previously healthy without clinical history visited our hospital with an ulcer of unknown cause at the right flank and gluteal region. Using computed tomography (CT) and colonoscopy, we diagnosed the ulcer as an enterocutaneous fistula caused by Crohn’s disease and successfully treated it with general surgery. In young, lean men with skin lesions of unknown cause, a CT or colonoscopy test may be useful for diagnosing underlying gastrointestinal problems.

Background Direct-to-implant breast reconstruction following nipple-sparing mastectomy is becoming increasingly common. The weight of the breast specimen informs implant selection. However, specimens of the same weight may have different volume. Therefore, identifying the factors affecting the density of breast specimens may facilitate the selection of implants with an appropriate volume. Methods From December 2015 to May 2018, 108 patients underwent direct-to-implant reconstruction following nipple-sparing mastectomy. The weight of the breast specimens was measured using an electronic scale in the operating room. Furthermore, the volume of specimens was measured using the water displacement technique. Multiple regression analysis was performed on factors that can affect breast density, such as menopause, neoadjuvant chemotherapy (CTx), age, body mass index, and diabetes mellitus. Results The average density of breast specimens in patients older than 50 years (n=36) was 0.96±0.04 g/mL, which was significantly lower than the 1.01±0.08 g/mL observed in patients younger than 50 years (n=72) (P=0.007). The mean density of breast specimens in patients who underwent neoadjuvant CTx (n=25) was 0.96±0.06 g/mL, which was significantly lower than the value of 1.00±0.08 g/mL in those who did not (n=83). Conclusions It is advisable to select an implant slightly larger than the mastectomy specimen weight in patients older than 50 years or in those who have undergone neoadjuvant CTx.

Hepatic solitary fibrous tumors (SFTs) are mostly benign and rare because of information regarding the clinical symptoms, treatment, and prognosis of their malignant forms is currently lacking. A literature review concerning malignant SFTs revealed that there were a few cases where patients experienced abdominal right upper quadrant (RUQ) pain as their first clinical symptom, and metastases were found after being diagnosed with hepatic SFT. Here, we report a patient who was previously healthy without any clinical symptoms such as RUQ pain or weight loss, but had the appearance of a metastatic mass as the first clinical presentation before a primary hepatic SFT was detected (J Liver Cancer 2019;19:143-148)

Summary:. Costochondritis after breast reconstruction and radiation therapy is rarely reported. Moreover, it is difficult to diagnose using computed tomography and magnetic resonance imaging; as such, wound debridement and reconstruction must be performed in several stages. A 51-year-old woman was diagnosed with invasive cancer of the right breast, and she underwent nipple sparing mastectomy and direct-to-implant breast reconstruction in November 2007. Thirteen years later, in September 2020, she experienced pain and swelling on her right breast. Incisional drainage and implant removal were performed in another clinic; however, the infection was not controlled. An implant-induced infection was suspected, and debridement was performed to a level where fresh tissue appeared in the upper layer of the intercostal muscle. Antibiotics and open dressing were used for 10 days; however, yellowish debris was noted, and third to fifth ribs and costal cartilages turned dark brown. Radiation-induced costochondritis was diagnosed based on clinical findings from the intraoperative field, wound course, and cartilage biopsy. Radical chest wall resection and reconstruction was performed using Teflon (Dupont/Chemours, Wilmington, Del.) and latissimus dorsi musculocutaneous flap. The patient was discharged 2 weeks after surgery without any complications. Costochondritis should be clinically diagnosed while performing the first debridement in staged operation. Radical chest wall resection is essential with chest wall reconstruction using Teflon and a latissimus dorsi musculocutaneous flap.

Background:. Upper blepharoplasty in elderly patients has characteristics that differ from those of younger patients. Blepharoptosis in elderly patients causes not only aesthetic problems but also functional problems such as entropion, visual disturbance, and sore eyes. We hypothesized that factors influencing patient satisfaction with upper blepharoplasty in elderly patients include aesthetic outcomes, functional outcomes, and personal factors. Methods:. This study included 57 patients aged >65 years who underwent upper blepharoplasty between April 2018 and March 2019. All surgeries were performed through the “Upper Blepharoplasty Service Project” of the public health center in Geoje City. To evaluate the individual characteristics of the patients, a preoperative questionnaire (including sociodemographic characteristics, main symptoms of discomfort in the upper eyelid, and degree of expectation of surgical results) was administered to the patients. After 6 months, a satisfaction survey was conducted accordingly. Results:. The main symptoms of discomfort were sagging of the skin of the upper eyelid. The mean score for patient satisfaction was 3.84 ± 0.40, and satisfaction with the results of surgery relative to the cost was 4.53 ± 0.63, which was the highest score. Significant verification of the regression coefficients showed that functional improvement and cognitive degree of postsurgery precautions had a significant effect on patient satisfaction, whereas aesthetic outcomes and expectations of surgical results were not correlated with patient satisfaction. Conclusion:. The findings indicated that elderly patients tended to be satisfied with functional improvement that resolved their symptoms of discomfort and personal factors such as cost and cognitive degree of precautions after upper blepharoplasty.

The need for optoelectronic and chemical compatibility between the layers in colloidal quantum dot (CQD) photovoltaic devices remains a bottleneck in further increasing performance. Conjugated polymers are promising candidates as new hole-transport layer (HTL) materials in CQD solar cells (CQD-SCs) owing to the highly tunable optoelectronic properties and compatible chemistries. A diketopyrrolopyrrole-based polymer with benzothiadiazole derivatives (PD2FCT-29DPP) as an HTL in these devices is reported. The energy level, molecular orientation, and hole mobility of this HTL are manipulated through molecular engineering. By levering the polymer's optical absorption spectrum complementary to that of the CQD active layer, EQE across the visible and near-infrared regions is maximized. As a result, a PD2FCT-29DPP-based device exhibits a fill factor of 70% and approximately 35% efficiency enhancement compared to a PTB7-based device.

Monolithically integrated hybrid tandem solar cells (TSCs) that combine solution-processed colloidal quantum dot (CQD) and organic molecules are a promising device architecture, able to complement the absorption across the visible to the infrared. However, the performance of organic/CQD hybrid TSCs has not yet surpassed that of single-junction CQD solar cells. Here, a strategic optical structure is devised to overcome the prior performance limit of hybrid TSCs by employing a multibuffer layer and a dual near-infrared (NIR) absorber. In particular, a multibuffer layer is introduced to solve the problem of the CQD solvent penetrating the underlying organic layer. In addition, the matching current of monolithic TSCs is significantly improved to 15.2 mA cm-2 by using a dual NIR organic absorber that complements the absorption of CQD. The hybrid TSCs reach a power conversion efficiency (PCE) of 13.7%, higher than that of the corresponding individual single-junction cells, representing the highest efficiency reported to date for CQD-based hybrid TSCs.

Background Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment. Methods For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery. Results There was a positive correlation between dermal thickness and scar score (pl0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (pl0.05). Conclusion Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.

We report a highly effective interface engineering strategy for thermally stable perovskite solar cells (PSCs) by employing a zwitterion-modified SnO2 electron transport layer (ETL) and a dopant-free hole transport layer (HTL). A zwitterionic compound, 3-(1-pyridinio)-1-propanesulfonate, is used to modify the SnO2 ETL. The zwitterion, which forms interfacial dipoles, plays a few important roles: (1) it causes shifts in the work function of SnO2 resulting in more efficient charge extraction and an increase in the built-in potential. (2) It pulls electrons from perovskite layers to the ETL/perovskite interface, enhancing the electron transport ability. (3) Interfacial dipoles prevent back transfer of electrons from the ETL to the perovskite and suppress charge recombination. (4) Positively charged atoms in the zwitterion passivate Pb–I antisite defects, improving the stability of devices. With these desirable properties, the PSC with doped Spiro-OMeTAD obtained a power conversion efficiency of 21.43%. In addition, the PSC with the dopant-free HTL exhibited a record high efficiency of 20.5% among dopant-free polymeric HTLs using green solvents. The resulting PSCs without encapsulation showed excellent thermal stability. Accordingly, this work suggests that the use of a modified ETL and a dopant-free HTL is a promising strategy to overcome the thermal instability of planar-PSCs (P-PSCs).

Typical transcranial approaches are insufficient for adequate visualization and resection of skull base tumors. Different approaches with multiple modifications have been attempted. Here, we describe a new approach for a lesion that is central and hard to treat by conventional craniotomy and successful reconstruction with calvarial bone graft and titanium mesh plate. A 69-year-old female patient presented with recurrent meningioma. The tumor had invaded the frontal lobe, right supraorbital rim, and ethmoidal bone. We performed a modified anterior craniofacial approach that fully exposed the tumor and invaded bone. In consideration of the patient's age and cosmetic result, the tumor and invaded bone was resected and the defect area was reconstructed with titanium mesh and calvarial bone graft. At 6 months postoperative the patient had no complications and was satisfied with the esthetic result. We report this case to demonstrate the successful approach and reconstruction using this technique.

Background Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio. Methods All breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated. Results In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation. Conclusions Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

Severe fever with thrombocytopenia syndrome is a tick-borne viral disease, with a high mortality rate that was first reported in China in 2009. Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi, a bacterium transmitted to humans through chigger mite bites. Severe fever with thrombocytopenia syndrome and scrub typhus are endemic to South Korea. To investigate evidence of severe fever with thrombocytopenia syndrome virus (SFTSV) infection or mixed infection with scrub typhus in South Korea, we examined 2,329 sera samples collected from patients presenting from November 1, 2000, to November 1, 2003, for the diagnosis of rickettisal diseases at Seoul National University, Seoul, South Korea. We found retrospective evidence of SFTSV infection or mixed infection with scrub typhus in South Korea in 2000-2003. Severe fever with thrombocytopenia syndrome virus infections in South Korea occurred before previously reported cases and were more concurrent with those in China. It is important to consider SFTSV infection in patients with scrub typhus.

Orientia tsutsugamushi infection can cause acute lung injury and high mortality in humans; however, the underlying mechanisms are unclear. Here, we tested a hypothesis that dysregulated pulmonary inflammation and Tie2-mediated endothelial malfunction contribute to lung damage. Using a murine model of lethal O. tsutsugamushi infection, we demonstrated pathological characteristics of vascular activation and tissue damage: 1) a significant increase of ICAM-1, VEGFR2, and angiopoietin-2 (Ang2) proteins in inflamed tissues and lung-derived endothelial cells (EC), 2) a progressive loss of endothelial quiescent and junction proteins (Ang1, VE-cadherin/CD144, occuludin), and 3) a profound impairment of Tie2 receptor at the transcriptional and functional levels. In vitro infection of primary human EC cultures and serum Ang2 proteins in scrub typhus patients support our animal studies, implying endothelial dysfunction in severe scrub typhus. Flow cytometric analyses of lung-recovered cells further revealed that pulmonary macrophages (MΦ) were polarized toward an M1-like phenotype (CD80+CD64+CD11b+Ly6G-) during the onset of disease and prior to host death, which correlated with the significant loss of CD31+CD45- ECs and M2-like (CD206+CD64+CD11b+Ly6G-) cells. In vitro studies indicated extensive bacterial replication in M2-type, but not M1-type, MΦs, implying the protective and pathogenic roles of M1-skewed responses. This is the first detailed investigation of lung cellular immune responses during acute O. tsutsugamushi infection. It uncovers specific biomarkers for vascular dysfunction and M1-skewed inflammatory responses, highlighting future therapeutic research for the control of this neglected tropical disease.Author SummaryScrub typhus is a life-threatening disease, infecting an estimated one million people yearly. Acute lung injury is the most common clinical observation; however, its pathogenic biomarkers and mechanisms of progression remain unknown. Here, we used a lethal infection mouse model that parallels certain aspects of severe scrub typhus, primary human endothelial cell cultures, and patient sera to define pathogenic biomarkers following Orientia tsutsugamushi infections. We found a significant increase in the levels of endothelial activation/stress markers (angiopoietins and ICAM-1) in infected mouse lungs and in patient sera, but a progressive loss of endothelium-specific Tie2 receptor and junction proteins (VE-cadherin), at severe stages of disease. These signs of vasculature disruption positively correlated with the timing and magnitude of recruitment/activation of proinflammatory MΦ subsets in infected lungs. Bacterial growth in vitro was favored in M2-like, but not in M1-like, MΦs. This study, for the first time, reveals endothelial malfunction and dysregulated inflammatory responses, suggesting potential therapeutic targets to ameliorate tissue damage and pathogenesis.

Objective The use of different expressions between physicians frequently results in confusion in the process of diagnosis and treatment of patients with headaches due to problems in the nose and nasal cavity. The aim of this study was to assess the terminologies that have been used most frequently to standardize these terminologies. Methods Terminologies that are most frequently used in general, including rhinogenic migraine, sinus headache, rhinogenic contact point headache, middle turbinate headache syndrome, and rhinogenic headache, were found by searching PubMed, Web of Science, and Google Scholar. These terminologies were objectively assessed on the basis of existing research and definitions and the range of diagnoses by organizations with public credibility. Results There were many terminologies in use for headache related to nose; however, these were not logical expressions and only partly explained the phenomenon. Among the terms, "rhinogenic headache" was most appropriate in expressing and describing the related symptoms. Conclusion The results indicated that the term "rhinogenic headache" is most appropriate for describing pain in the nose and eyes in patients with deformation within the nose or the nasal cavity due to external injuries or underlying diseases related to nose as observed on computed tomography.

Background Most nasal bone fractures are corrected using non-invasive methods. Often, patients are dissatisfied with surgical outcomes following such closed approach. In this study, we compare surgical outcomes following blind closed reduction to that of ultrasound-guided reduction. Methods A single-institutional prospective study was performed for all nasal fracture patients (n=28) presenting between May 2013 and November 2013. Upon research consent, patients were randomly assigned to either the control group (n=14, blind reduction) or the experimental group (n=14, ultrasound-guided reduction). Surgical outcomes were evaluated using preoperative and 3-month postoperative X-ray images by two independent surgeons. Patient satisfaction was evaluated using a questionnaire survey. Results The experimental group consisted of 4 patients with Plane I fracture and 10 patients with Plane II fracture. The control group consisted of 3 patients with Plane I fracture and 11 patients with Plane II fracture. The mean surgical outcomes score and the mean patient dissatisfaction score were found not to differ between the experimental and the control group in Plane I fracture (p=0.755, 0.578, respectively). In a subgroup analysis consisting of Plane II fractures only, surgeons graded outcomes for ultrasound-guided reduction higher than that for the control group (p=0.007). Likewise, among the Plane II fracture patients, those who underwent ultrasound-guided reduction were less dissatisfied than those who underwent blind reduction (p=0.043). Conclusion Our study result suggests that ultrasound-guided closed reduction is superior to blind closed reduction in those patients with Plane II nasal fractures.

Unwrap mosaic is a method for decomposing a video into a 2D texture and a dense mapping that enable the reconstruction of the video from the texture. This representation is useful in some frameworks because we can edit videos by simply retouching 2D textures. However, the complexity of conventional approaches is too high to be adopted in time-critical applications (it takes up to several hours). In this letter, we focus on face-related applications such as face editing and replacement, and propose a face unwrap approach for these applications. To be precise, we adopt the view-based active appearance model (AAM) trackers and estimate dense mappings from the AAM results. The AAM also provides pose information which is also exploited in building the texture map. Experimental results show that our method is very efficient compared with the conventional unwrap mosaic approach. Moreover, based on the proposed system, we develop face-related applications.

As the incidence of thyroid cancer has increased, hypocalcemia, a common complication of thyroid surgery, has become a serious problem. However, no definite predictor of postoperative hypocalcemia is known. In this study, our purpose was to investigate the potential role of vitamin D as a predictor of postoperative hypocalcemia. A prospective observational study was performed on patients who underwent total thyroidectomy for thyroid cancer performed by a single experienced surgeon between October 2013 and September 2014. Their serum 25-OH vitamin D levels were measured preoperatively. On the day after surgery, serum calcium and intact parathyroid hormone levels were measured, and symptoms of hypocalcemia were recorded. Of the 134 patients, laboratory and symptomatic hypocalcemia developed in 52 patients (39 %) and 25 patients (19 %), on the day after surgery. The preoperative vitamin D level was 16.5 ± 9.2 ng/mL, and this value did not differ according to laboratory or symptomatic hypocalcemia (p = 0.94). The incidence of laboratory or symptomatic hypocalcemia did not differ according to vitamin D deficiency. Only incidental parathyroidectomy was associated with symptomatic hypocalcemia (p = 0.03). Vitamin D level is not a predictor of hypocalcemia after total thyroidectomy for thyroid cancer. Thus, routine preoperative screening for vitamin D is not recommended.

Background Adipose tissue damage of cryopreserved fat after autologous fat transfer is inevitable in several processes of re-transplantation. This study aims to compare and analyze the survivability of adipocytes after thawing fat cryopreserved at -20℃ by using thawing methods used in clinics. Methods The survival rates of adipocytes in the following thawing groups were measured: natural thawing at 25℃ for 15 minutes; natural thawing at 25℃ for 5 minutes, followed by rapid thawing at 37℃ in a water bath for 5 minutes; and rapid thawing at 37℃ for 10 minutes in a water bath. The survival rates of adipocytes were assessed by measuring the volume of the fat layer in the top layers separated after centrifugation, counting the number of live adipocytes after staining with trypan blue, and measuring the activity of mitochondria in the adipocytes. Results In the group with rapid thawing for 10 minutes in a water bath, it was observed that the cell count of live adipocytes and the activity of the adipocyte mitochondria were significantly higher than in the other two groups (P Conclusions It was shown that the survival rate of adipocytes was higher when the frozen fat tissue was thawed rapidly at 37℃. It can thus be concluded that if fats thawed with this method are re-transplanted, the survival rate of cryopreserved fats in transplantation will be improved, and thus, the effect of autologous fat transfer will increase.

Place awareness is an essential for location-based services that are widely provided to smartphone users. However, traditional GPS-based methods are only valid outdoors where the GPS signal is strong and also require symbolic place information of the physical location. In this paper, environmental sounds and images are used to recognize important aspects of each place. The proposed method extracts feature vectors from visual, auditory and location data recorded by a smartphone with built-in camera, microphone and GPS sensors modules. The heterogeneous feature vectors were then learned by an ensemble learning method that learns each group of feature vectors for each classifier respectively and votes to produce the highest weighted result. The proposed method is evaluated for place recognition using a data group of 3000 samples in six places and the experimental results show a remarkably improved recognition accuracy when using all kinds of sensory data comparing to results using data from a single sensor or audio-visual integrated data only.

Background Lymph node (LN) metastasis is common in papillary thyroid microcarcinoma (PTMC). The aim of this study was to investigate the impact of LN metastasis and its risk stratification on PTMC recurrence. Methods We retrospectively reviewed the data of 336 patients with PTMC who underwent surgery from 2005 to 2006 at a single institution. LN metastasis was stratified according to the number of metastatic LNs, the ratio of metastatic to removed LNs, the size of metastatic foci in LNs, and the presence of extranodal extension and desmoplasia. Results Of the 336 patients, 93 (28%) had LN metastasis. During the follow-up of 5.3 years, 16 (4.8%) experienced locoregional recurrence. Among several clinicopathologic factors, LN metastasis was the most important risk factor for recurrence ( P = .02). Lateral LN metastasis was correlated with recurrence-free survival ( P P = .20). When central LN metastasis was stratified, a high number of metastatic LNs (≥3), larger metastatic foci (≥0.2 cm), and the presence of desmoplasia were associated with recurrence-free survival ( P Conclusion The prognostic significance of central LN metastasis can differ according to the number of metastatic LNs, the size of metastatic foci, and the presence of desmoplasia. Patients with a high number of metastatic LNs, larger metastatic foci, and presence of desmoplasia in LNs should be treated aggressively and supervised carefully for PTMC recurrence.

Recently, cellular operators have started migrating to IPv6 in response to the increasing demand for IP addresses. With the introduction of IPv6, cellular middleboxes, such as firewalls for preventing malicious traffic from the Internet and stateful NAT64 boxes for providing backward compatibility with legacy IPv4 services, have become crucial to maintain stability of cellular networks. This paper presents security problems of the currently deployed IPv6 middleboxes of five major operators. To this end, we first investigate several key features of the current IPv6 deployment that can harm the safety of a cellular network as well as its customers. These features combined with the currently deployed IPv6 middlebox allow an adversary to launch six different attacks. First, firewalls in IPv6 cellular networks fail to block incoming packets properly. Thus, an adversary could fingerprint cellular devices with scanning, and further, she could launch denial-of-service or over-billing attacks. Second, vulnerabilities in the stateful NAT64 box, a middlebox that maps an IPv6 address to an IPv4 address (and vice versa), allow an adversary to launch three different attacks: 1) NAT overflow attack that allows an adversary to overflow the NAT resources, 2) NAT wiping attack that removes active NAT mappings by exploiting the lack of TCP sequence number verification of firewalls, and 3) NAT bricking attack that targets services adopting IP-based blacklisting by preventing the shared external IPv4 address from accessing the service. We confirmed the feasibility of these attacks with an empirical analysis. We also propose effective countermeasures for each attack.

Orientia tsutsugamushi infection can cause acute lung injury and high mortality in humans; however, the underlying mechanisms are unclear. Here, we tested a hypothesis that dysregulated pulmonary inflammation and Tie2-mediated endothelial malfunction contribute to lung damage. Using a murine model of lethal O. tsutsugamushi infection, we demonstrated pathological characteristics of vascular activation and tissue damage: 1) a significant increase of ICAM-1 and angiopoietin-2 (Ang2) proteins in inflamed tissues and lung-derived endothelial cells (EC), 2) a progressive loss of endothelial quiescent and junction proteins (Ang1, VE-cadherin/CD144, occuludin), and 3) a profound impairment of Tie2 receptor at the transcriptional and functional levels. In vitro infection of primary human EC cultures and serum Ang2 proteins in scrub typhus patients support our animal studies, implying endothelial dysfunction in severe scrub typhus. Flow cytometric analyses of lung-recovered cells further revealed that pulmonary macrophages (MΦ) were polarized toward an M1-like phenotype (CD80+CD64+CD11b+Ly6G-) during the onset of disease and prior to host death, which correlated with the significant loss of CD31+CD45- ECs and M2-like (CD206+CD64+CD11b+Ly6G-) cells. In vitro studies indicated extensive bacterial replication in M2-type, but not M1-type, MΦs, implying the protective and pathogenic roles of M1-skewed responses. This is the first detailed investigation of lung cellular immune responses during acute O. tsutsugamushi infection. It uncovers specific biomarkers for vascular dysfunction and M1-skewed inflammatory responses, highlighting future therapeutic research for the control of this neglected tropical disease., Author summary Scrub typhus is a life-threatening disease, infecting an estimated one million people yearly. Acute lung injury is a dangerous clinical development in severe cases; however, its pathogenic biomarkers and mechanisms of progression remain unknown. Here, we used a lethal infection mouse model that parallels certain aspects of severe scrub typhus, primary human endothelial cell cultures, and patient sera to define pathogenic biomarkers following Orientia tsutsugamushi infections. We found a significant increase in the levels of endothelial activation/stress markers (angiopoietins and ICAM-1) in infected mouse lungs and patient sera, but a progressive loss of endothelium-specific Tie2 receptor and junction proteins (VE-cadherin), at severe stages of disease. These signs of vasculature disruption positively correlated with the timing and magnitude of recruitment/activation of proinflammatory MΦ subsets in infected lungs. Bacterial growth in vitro was favored in M2-like, but not in M1-like, MΦs. This study, for the first time, reveals endothelial malfunction and dysregulated inflammatory responses, suggesting potential therapeutic targets to ameliorate tissue damage and pathogenesis.

Background: The intraoperative parathyroid hormone (IOPTH) assay is widely used in patients with primary hyperparathyroidism (PHPT). We investigated the usefulness of the IOPTH assay in Korean patients with PHPT. Methods: We retrospectively reviewed the data of 33 patients with PHPT who underwent parathyroidectomy. Neck ultrasonography (US) and 99m Tc-sestamibi scintigraphy (MIBI scan) were performed preoperatively and IOPTH assays were conducted. Results: The sensitivity of neck US and MIBI scans were 91% and 94%, respectively. A 50% decrease in parathyroid hormone (PTH) levels 10 minutes after excision of the parathyroid gland was obtained in 91% (30/33) of patients and operative success was achieved in 97% (32/33) of patients. The IOPTH assay was 91% true-positive, 3% true-negative, 0% false-positive, and 6% falsenegative. The overall accuracy of the IOPTH assay was 94%. In five cases with discordant neck US and MIBI scan results, a sufficient decrease in IOPTH levels helped the surgeon confirm the complete excision of the parathyroid gland with no additional neck exploration. Conclusion: The IOPTH assay is an accurate tool for localizing hyperfunctioning parathyroid glands and is helpful for evaluating cases with discordant neck US and MIBI scan results.

Background Liposuction is a procedure to reduce the volume of subcutaneous fat by physical force. Intracellular storage fat is composed of triglyceride, whereas circulating fat particles exist as cholesterol or triglycerol bound to carrier proteins. It is unavoidable that the storage form of fat particles enters the circulation system after these particles are physiologically destroyed. To date, however, no studies have clarified the fatal characteristics of fat embolism that occurs after the subclinical phase of free fat particles. Methods A mixture of human lipoaspirate and normal saline (1:100, 0.2 mL) was injected into the external jugular vein of rats, weighing 200 g on average. Biopsy specimens of the lung and kidney were examined at 12-hour intervals until postoperative 72 hours. The deposit location and transport of the injected free fat particles were confirmed histologically by an Oil Red O stain. Results Inconsistent with previous reports, free fat particles were transported from the intravascular space to the parenchyma. At 24 hours after infusion, free fat particles deposited in the vascular lumen were confirmed on the Oil Red O stain. At 72 hours after infusion, free fat particles were accumulated compactly within the parenchymal space near the perivascular area. Conclusions Many surgeons are aware of the fatal results and undiscovered pathophysiologic mechanisms of free fat particles. Our results indicate that free fat particles, the storage form of fat that has been degraded through a physiological process, might be removed through a direct transport mechanism and phagocytotic uptake.

Background: Several comparative studies have documented the outcomes of negative pressure drain use after thyroidectomy. However, these previous studies did not focus on scar formation. The aim of this study was to compare thyroidectomy outcomes with and without negative pressure drain use in terms of scar formation.Methods: Nine hundred seventy-five patients who underwent thyroidectomy between January 2012 and December 2013, at Kosin University Gospel Hospital were enrolled in this study. Patients were assigned to one of two groups at the surgeon's discretion: the negative pressure drain group (n=515) or the no drain group (n=460). Medical records were reviewed, and the incidence and severity of scar formation were compared. We estimated patient satisfaction seven months postoperatively based on aesthetic and functional outcomes using the patient and observer scar assessment scale.Results: The incidence of mild scarring was higher in the no drain group, but this difference was not statistically significant (p=0.069). The incidence of severe scarring was significantly higher in the negative pressure drain group (5.83%, p

Ectopic adrenocorticotropic hormone (ACTH) syndrome is caused most frequently by a bronchial carcinoid tumor or by small cell lung cancer. Medullary thyroid carcinoma (MTC) is a rare etiology of ectopic ACTH syndrome. We describe a case of Cushing syndrome due to ectopic ACTH production from MTC in a 48-year-old male. He was diagnosed with MTC 14 years ago and underwent total thyroidectomy, cervical lymph node dissection and a series of metastasectomies. MTC was confirmed by the pathological examination of the thyroid and metastatic mediastinal lymph node tissues. Two years after his last surgery, he developed Cushingoid features, such as moon face and central obesity, accompanied by uncontrolled hypertension and new-onset diabetes. The laboratory results were compatible with ectopic ACTH syndrome. A bilateral adrenalectomy improved the clinical and laboratory findings that were associated with Cushing syndrome. This is the first confirmed case of ectopic ACTH syndrome caused by MTC in Korea.

To achieve high-resolution images from satellites, the dimensional-stability effect of telescope structure on optical performance should be considered in the operating environment. In this paper, the dimensional stability of composite telescope structure and optical performance degradation resulting from its dimensional instability have been evaluated under operating conditions. Dimensional-stability evaluation of the composite structure was achieved by a combination of precise deformation measurement and finite-element analysis of the composite-structure model. Thermal deformation of composites was measured by interferometer, and a brand-new dilatometer using an optical-scale sensor was developed for outgassing deformation measurement. The thermal/outgassing deformation of the telescope structure was interpreted as despace of the two-mirror Cassegrain telescope, and the optical-performance change resulting from despace was calculated in terms of the module transfer function (MTF) value. The MTF v...

Keloid is a scar tissue that undergoes recovery and excessive growth over the origi- nal wounds when the collagen is excessively accumulated in the dermis during the wound healing process. The common sites of keloid occurrence include the anterior thorax, shoulder, upper extremities and ear. To our knowledge, however, there are few cases of keloid that occurs in the axilla. In addition, there are fewer cases of ke- loid that bilaterally occurs at the operated sites postoperatively in individuals with no past or family history. 21-year-old male had undergone subdermal shaving for the management of osmidrosis but had not received appropriate scar management dur- ing the military service. He visited us with a keloid-like scar formed in the bilateral ax- illae. We excised the scar tissue and treated it with local steroid injection and postop- erative axilla compression. In histopathological report, no flattening of the overlying epidermis, and presence of keloid collagen which confirms diagnosis of keloid. We report our clinical experience with a rare case of keloid occurring in the axilla and treatment process.

It has been known that the post-burn scar may cause symptoms including pigmentation, pruritus, pain, and contracture, and result in psychosocial depression of individuals due to the loss of physical functions and dysmorphia depending on the location and severity of the burn scar, leading to substantial disruption in social life. In the particular case of hand and extremities where burn occurs frequently, although there have been a great deal of literature concerning the recovery of functional loss due to the burn contracture, the interest in the aesthetic recovery of the burning scar on the hand tends to be gradually increasing lately, reflecting the words “the hand is the secondary face”. The aesthetic treatments of the post-burn scar on the hand include tattoo, punch grafting, epidermal graft after dermabrasion, chip skin graft and thin sheet skin graft [1-6]. However, the tattoo generated different skin color, and the simple skin graft may result in regrettable outcomes such as prominent scar around the boundary of the burn site, collapse of skin graft site, donor site scar, and pigmentary degeneration over time. Accordingly, we aim to confirm the outcomes of the thin splitthickness skin graft with a thickness of less than 8/1,000 inches that was carried out following the tangential excision of burn scar using an electrical dermatome for the aesthetic improvement of the post-burn scar of the hand.

In cases of follicular neoplasm identified by thyroid fine-needle aspiration (FNA), surgery is required to achieve a precise diagnosis. We investigated potential clinical factors for the preoperative prediction of malignancy in thyroid nodules with a cytological diagnosis of follicular neoplasm. We retrospectively reviewed the data of 97 patients who were diagnosed with follicular neoplasm by FNA and had undergone surgery at the Korea Cancer Center Hospital between April 2010 and April 2012. Age, sex, laboratory data (such as thyroid-stimulating hormone, free T4, thyroglobulin (Tg), and Tg antibody), and ultrasonographic findings were reviewed from the electronic medical records. Of 97 patients, 50 (51.5 %) were diagnosed with benign nodules, 16 (16.5 %) with follicular thyroid carcinoma (FTC), and 31 (32.0 %) with papillary thyroid carcinoma (PTC). In comparison with the features of benign nodules, FTC presented with a large nodule size, high serum Tg level, isoechogenicity, calcifications, and peripheral halo, whereas PTC exhibited traits similar to those of benign nodules, except for high serum Tg level and the presence of calcifications on ultrasonography. Therefore, a high serum Tg level (≥75 ng/mL) and calcification were the only significant predictive factors for malignancy in case of follicular neoplasm (p

Accurate and fair data charging in cellular networks is an important issue because of its large impacts on profits of operators and bills for users. In this study, we analyze the data charging policies and mechanisms for protocols and applications. The analysis shows that all operators in South Korea did not charge the payload of Internet Control Message Protocol (ICMP) echo request/reply messages, as well as the payload attached to Transmission Control Protocol (TCP) SYN and TCP RST packets. In addition, the operators only utilize IP addresses to verify whether the traffic comes from the expected application. By misusing the findings with consideration of Network Address Translator (NAT) in IPv4 cellular networks, we validate with empirical experiments the feasibility of free-riding attack, which enables an adversary to use the cellular data service for free, and propose effective countermeasures.

This paper introduces a fiber Bragg grating (FBG) based arrayed sensor system for use in the measurement of strain and bending deflection of an 1.5 MW wind turbine tower, and describes the results of field tests of structural monitoring of turbine start and feathering load conditions. A wavelength division multiplexing (WDM) FBG interrogator was developed with a spectrometer-type demodulator based on a linear photo detector for high-speed strain sensing. Real-time shape estimation of the wind turbine tower was accomplished using strain data gathered by surface mounted fiber Bragg grating sensors. The finite element model of the wind turbine tower was created and the displacement-strain transformation (DST) matrix on the basis of the modal approach was obtained. To monitor the dynamic structural behavior of the wind turbine, 10 FBG sensors were arrayed and installed on the inner surface of the tower located at the primary wind direction. The time histories of the strain were gathered using the FBG sensors and the deflections of the tower top position were simultaneously transformed using the DST matrix. Finally, the full deflection shapes of the tower were successfully estimated using arrayed FBG sensors.

When transverse strain is much larger than the longitudinal one, conventional fiber Bragg grating measurement model presents significant errors in the longitudinal strain measurement. The present authors presented a fiber Bragg grating measurement model to consider transverse strain effects and numerically demonstrated the effectiveness of the model. This article experimentally validates the fiber Bragg grating measurement model by measuring thermal expansion of anisotropic composite specimens and an isotropic invar specimen. The longitudinal thermal expansion of the specimens is measured by using fiber Bragg grating sensors and compared with a reference measurement result using an optical interferometer. The proposed fiber Bragg grating model shows good agreement with the reference measurement for the longitudinal strain while large discrepancy (~22%) is observed according to the conventional one-dimensional fiber Bragg grating model.

An active compensation method for the deformation of composite structures using additional controllable metal parts is proposed, and its feasibility is experimentally investigated in a simulated space environment. Composite specimens are tested in a vacuum chamber, which is able to maintain pressure on the order of 10-3 torr and interior temperature in the range of ±30 ˚C. The displacement-measuring interferometer system, which consists of a heterodyne HeNe laser and an interferometer, is used to measure the displacement of the whole structure. Meanwhile, the strain of the composite part and temperature of both parts are measured by fiber Bragg grating sensors and thermistors, respectively. The displacement of the composite structure is maintained within a tolerance of ±1 μm by controlling the elongation of the metal part, which is bonded to the end of the composite part. Also, the possibility of fiber Bragg grating sensors as control input sensors is successfully demonstrated using a proper corrective factor based on the specimen temperature gradient data.

Free tissue transfer is a useful method to cover soft tissue defects following trauma or tumor excision. At the time of transfer of the pedicle, its status is not investigated. Therefore, kinking of the pedicle can occur, and pedicle injuries can result from surgical instruments. The authors would like to introduce a simple, safe, and effective method to overcome these problems using a Penrose drain. The present method can help reconstructive microsurgeons with the transfer of pedicle vessels through a tunnel without torsion or injury.

This research is to find a way to improve level of management performance and power of competition against other competitors in the same field. especially, outsourcing closely related management performance has been studied. In this research, 250 questionnaires for super delux hotel were distributed and analyzed 236 with Path Analysis. finally, the most important things impacting financial performance have shown contract cost, skills, inner management skills, clarity of contract conditions, etc... controllable outsourcing factors and cooperation between outsourcing company and hotel as well is important to improve service quality based on work efficiency. In conclusion, hotel industry has to continue to work on building stronger relationship with outsourcing companies based on controllable outsourcing factors. it will bring positive effect to management performance through customer satisfaction.

The effects of transverse strain on the wavelength shifts of surface-mounted fiber Bragg grating (FBG) sensors are investigated. A new FBG model including the concept of strain transmissibility coefficients along the longitudinal and transverse directions of the sensors is proposed. The finite element method is applied to obtain the strain transmissibility coefficients between the FBG sensor and surface of the base structure. The wavelength shifts of each FBG sensor are calculated with respect to the assumed thermal strain condition of the base structures; the estimated strains by the proposed FBG model are compared with the results from conventional FBG model. The numerical results show that the surface strains of the composite structure can be predicted well using the proposed FBG model, while the conventional FBG model results in a larger error when the transverse strain of the base structure is much larger than longitudinal strain of the base structure, as in composite structures under thermal loadings.

A measurement system using stereo pattern recognition (SPR) method was configured to measure the rotor blade deformations and motions. An SPR-based measurement system was prepared using six stereo cameras. Through a series of experiments to evaluate the system measurement uncertainty, it was verified that the SPR system had less than 0.2mm standard uncertainty. The combined standard uncertainties for the lead-lag, flapping, and pitching motions were estimated as 0.296mm, 0.209mm, and , respectively. The SPR system was installed at a general small-scaled rotor test system at Korea Aerospace Research Institute. The blade motions and elastic deformation were successfully measured under the conditions with rotating speeds of 360rpm or 589rpm, and collective pitch angles of , , or . The advantages of the SPR system was analyzed in comparison with the measurement system used in Higher Harmonic Control Aeroacoustic Rotor Test -II.

Background Chronic exposure to elevated levels of free fatty acids contributes to pancreatic β-cell dysfunction. Although it is well known that metformin induces cellular energy depletion and a concomitant activation of AMP-activated protein kinase (AMPK) through inhibition of the respiratory chain, previous studies have shown inconsistent results with regard to the action of metformin on pancreatic β-cells. We therefore examined the effects of metformin on pancreatic β-cells under lipotoxic stress. Methods NIT-1 cells and mouse islets were exposed to palmitate and treated with 0.05 and 0.5 mM metformin. Cell viability, glucose-stimulated insulin secretion, cellular adenosine triphosphate, reactive oxygen species (ROS) levels and Rho kinase (ROCK) activities were measured. The phosphorylation of AMPK was evaluated by Western blot analysis and mRNA levels of endoplasmic reticulum (ER) stress markers and NADPH oxidase (NOX) were measured by real-time quantitative polymerase chain reaction analysis. Results We found that metformin has protective effects on palmitate-induced β-cell dysfunction. Metformin at a concentration of 0.05 mM inhibits NOX and suppresses the palmitate-induced elevation of ER stress markers and ROS levels in a AMPK-independent manner, whereas 0.5 mM metformin inhibits ROCK activity and activates AMPK. Conclusion This study suggests that the action of metformin on β-cell lipotoxicity was implemented by different molecular pathways depending on its concentration. Metformin at a usual therapeutic dose is supposed to alleviate lipotoxic β-cell dysfunction through inhibition of oxidative stress and ER stress.

Concern regarding lightning activity as a precursor of severe weather is increasing. Atmospheric electricity, including lightning phenomena, is one of most serious threats to successful space launch operations. The objective of this study was to evaluate the performance of two different lightning detection networks using a time–range correlation method. Understanding lightning detection network performance enables the weather forecaster to support decisions made regarding space launch operations. The relative detection efficiency (ReDE), observation ratio, ellipse area for 50% probability of location, number of sensors reporting (NSR), time difference, and distance, as parameters that predict system performance, were calculated with the time-range correlation method using cloud-to-ground (CG) flash data from the Korea Aerospace Research Institute Total Lightning Detection System (KARITLDS) and from the Korean Meteorology Administration Lightning Detection Network (KLDN). In this study, 15 thunderstorms were selected from 2008–09 data. A total of 41 192 and 28 976 CG flashes were recorded by KARITLDS and KLDN, respectively. In all, 19 044 CG flashes were correlated as being the same flash. The observation ratios, ReDEKARITLDS, and ReDEKLDN were calculated as 1.42, 0.66, and 0.46, respectively. Eighty percent of CG flashes detected by the KARITLDS (KLDN) had elliptical areas less than 5 km2 (12 km2), where the elliptical areas were defined as having a 50% probability of containing the CG flash. Two regions showing a high observation ratio were due to high KARITLDS detection efficiency and to the blocking of electromagnetic wave propagation by Mount Hanla at 1950 m above sea level.