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Background/Aims: Sarcopenia is an independent prognostic factor of liver cirrhosis (LC). However, the association between LC-related systemic inflammation and sarcopenia is unclear.Methods: Sprague-Dawley rats were treated with thioacetamide (TAA) or saline as a control. Rifaximin was administered to TAA-induced LC rats. Enzyme-linked immunosorbent assay was performed to measure inflammatory mediators in rat serum. RT-PCR was performed to measure the molecular expression in tissues. Hematoxylin and eosin (H&E) staining and immunohistochemistry were performed to investigate tissue pathology. Serum tumor necrosis factor-α levels, liver stiffness (LS), and the L3 skeletal muscle index (L3SMI) were measured in 60 patients with chronic liver disease.Results: LC and sarcopenia were successfully induced by TAA. Serum TNF-α levels were increased in LC rats and correlated with myostatin expression, muscle weight, and myofiber diameter. The expression of intestinal occludin and zona occludens-1 was reduced in LC rats and associated with serum TNF-α levels and sarcopenia. In patients with LS ≥7 kPa or sarcopenia, serum TNF-α levels were significantly increased, which was also confirmed when we raised the LS cutoff to 10 kPa. The L3SMI was inversely correlated with serum TNF-α levels in patients with LS ≥7 kPa. TNF-α was reduced by rifaximin, which might have resulted in reduced expression of muscular MuRF1 and myostatin and improvements in myofiber diameters within muscle tissues.Conclusions: These results suggest that serum TNF-α is associated with LC-related sarcopenia. Rifaximin might be effective in reducing serum TNF-α levels and improving sarcopenia in LC, but these results need to be validated in future studies.

BACKGROUND: Patients with lumbar disc herniation (LDH) may experience low back pain (LBP) and radiating pain (RP). Currently, there is no substantial clinical benefit (SCB) of assessing both LBP and RP due to LDH. OBJECTIVE: To determine enhanced SCB values by simultaneously assessing LBP and RP. METHODS: We retrospectively evaluated hospitalized LDH patients with concomitant LBP and RP between June 1, 2012, and May 31, 2013, and determined the numeric rating scale (NRS) and Oswestry Disability Index (ODI) scores at admission and discharge. Furthermore, the area under the receiver operating characteristic curve (AUC) was computed to assess diagnostic accuracy. RESULTS: SCB as per NRS for both LBP and RP was -2.50 in the 186 enrolled patients (AUC: 0.699 and 0.704, respectively). SCB as per ODI was -18.78 (AUC: 0.771). SCB for the mean of the two NRS scores for LBP and RP was -2.75 (AUC: 0.757). SCB for NRS score with a larger change in LBP and RP was -3.50 (AUC: 0.767). CONCLUSIONS: SCB may be determined by comprehensively considering LBP and RP and choosing the mean NRS or NRS score with a large change.

Objective : Osteoporosis result from age-related decline in the number of osteoblast progenitors in the bone marrow. Probiotics have beneficial effects on the host, when administered in appropriate amounts. This study investigated the effects of probiotics expressing specific genes, especially the effects of genetically modified bone morphogenetic protein (BMP)-2-expressing Lactobacillus plantarum CJNU 3003 (LP) on ovariectomized rats.Methods : Twenty-eight female Wistar rats (250–300 g, 12 weeks old) were divided into four groups : the sham (control), the ovariectomy (OVX)-induced osteoporosis group (OVX), the OVX and LP (OVX/LP), OVX and genetically modified BMP-2-expressing LP (OVX/LP with BMP) groups. The three groups underwent bilateral OVX and two of these groups were administered two different types of LP via oral gavage daily. At 16 weeks post-OVX, blood was collected from the heart and the bilateral tibiae were extracted and were scanned by ex-vivo micro-computed tomography and stained with hematoxylin-and-eosin (H&E) and Masson’s trichrome stain for pathological assessment. The serum levels of osteocalcin (OC), rat C-telopeptide of type I collagen (CTX-I), BMP-2, and receptor activator of nuclear factor-ĸB ligand (RANKL) were measured.Results : The 3D-micro-computed tomography images showed that the trabecular structure in the OVX/LP with BMP group was maintained compared with OVX and OVX/LP groups. No significant differences were detected in trabecular thickness (Tb.Th) between control and OVX/LP with BMP groups (p>0.05). Furthermore, a tendency toward increased BMD, trabecular bone volume, Tb.Th, and trabecular number and decreased trabecular separation was found in rats in the OVX/LP with BMP groups when compared with the OVX and OVX/LP groups (p>0.05). The H&E and Masson’s trichrome stained sections showed a thicker trabecular bone in the OVX/LP with BMP group compared with the OVX and OVX/LP groups. There was no difference in serum levels of OC, CTX and RANKL control and OVX/LP with BMP groups (p>0.05). In contrast, significant differences were found in OC and CTX-1 levels between the OVX and OVX/LP with BMP groups (p

BACKGROUND: The treatment landscape for advanced nonsmall cell lung cancer (NSCLC) has evolved from 2015 onward, since the introduction of immune checkpoint inhibitors (ICIs). Considering this shif...

Halide perovskites, fascinating memristive materials owing to mixed ionic-electronic conductivity, have been attracting great attention as artificial synapses recently. However, polycrystalline nature in thin film form and instability under ambient air hamper them to be implemented in demonstrating reliable neuromorphic devices. Here, we successfully fabricated vertically aligned 2D halide perovskite films (V-HPs) for active layers of artificial synapses, showing moisture stability for several months. Unlike random-oriented HPs, which exhibit negligible current hysteresis, the V-HPs possess multilevel analog memristive characteristics, programmable potentiation and depression with distinguished multi-states, long-short-term plasticity, paired-pulse facilitation, and even spike-timing-dependent plasticity. Furthermore, high classification accuracy is obtained with implementation in deep neural networks. These remarkable improvements are attributed to the vertically well-aligned lead iodide octahedra acting as the ion transport channel, confirmed by first-principles calculations. This study paves the way for understanding HPs nanophysics and demonstrating their potential utility in neuromorphic computing systems.

Aim: We report real-world treatment patterns and outcomes in patients with PD-L1+ non-small-cell lung cancer (NSCLC). Methods: This retrospective, observational study using the ConcertAI Oncology Dataset (Symphony AI, CA, USA), included patients with PD-L1+ (≥1% expression) metastatic NSCLC who began first-line (1L) treatment between 2016 and 2019. Treatment outcomes were assessed by treatment class (immune checkpoint inhibitor [ICI] monotherapy, ICI combinations or chemotherapy). Results: In total, 128 (25.5%), 237 (47.3%) and 136 patients (27.1%) received 1L chemotherapy, 1L ICI monotherapy and 1L ICI combinations, respectively. ICI combinations and monotherapy had improved clinical outcomes versus chemotherapy. Adjusted analyses showed no significant difference in outcome between ICI monotherapy and ICI combinations. Conclusion: ICI-based treatments are being increasingly adopted into clinical practice and were associated with better outcomes versus chemotherapy.

Phlomis umbrosa has been traditionally used for bone diseases in traditional Korean Medicine. Sweroside (SOS), marker compounds of P. umbrosa, has been known to promote osteoblast differentiation. In this study, ameliorative effects of SOS on osteoporosis and potential target pathway were investigated. Ovariectomized mice were administered three doses of SOS three times a week for 4 weeks after inducing osteoporosis. Bone mineral content (BMC) and bone mineral density (BMD) were analyzed by dual energy X-ray absorptiometry. A human osteosarcoma cell line (SaOS-2) was differentiated to clarify the promoting effects of SOS on osteoblast differentiation and bone formation. Osteoblastic bone-forming markers were evaluated in lumbar vertebrae (LV) and mineralized SaOS-2 cells. SOS markedly elevated BMC and BMD levels and attenuated the bone marrow adipocytes in the femoral shaft. SOS increased the formation of bone matrix in SaOS-2 cells. Bone morphogenetic protein-2 (BMP2) and runt-related transcription factor 2 (CBFA1) in LV and SaOS-2 cells were up-regulated by SOS. SOS increased alkaline phosphatase (ALPL), osteopontin (SPP1), and bone sialoprotein-1 (BSPH1). In conclusion, SOS induced the formation of mineralized bone matrix by regulating BMP2/CBFA1-mediated molecules. Therefore, SOS could be a therapeutic compound of treatment for osteoporosis by producing the new bone matrix.

Background The ideal drug-eluting stent (DES) for the treatment of unprotected left main coronary artery (ULMCA) is unknown. We compared percutaneous coronary intervention (PCI) using durable polymers versus early-generation, thicker strutted and coated bioabsorbable polymers for ULMCA disease. Methods Patients who underwent ULMCA PCI (893 patients) from April 2008 to November 2014 were identified from the Grand-DES registry. The primary end point was 3-year target lesion failure (TLF) after propensity score matching. Results The final analysis included 754 patients (84.4%) and 139 patients (15.6%) in the durable and bioabsorbable polymer group, respectively. The groups differed significantly in lesion and procedural characteristics. Propensity score-matched analysis revealed a trend toward a lower 3-year TLF in the durable polymer group (log rank p=0.071). Independent predictors of 3-year TLF were chronic kidney disease, presentation with acute myocardial infarction, and a two-stenting technique for ULMCA lesions. Definite/probable stent thrombosis rates at 3-years were low in both groups (0.8% vs. 0.7%, p=0.925). Conclusions The safety of ULCMA PCI was excellent, and durable and bioabsorbable polymer DES provided similar clinical outcomes at 3-year follow-up. Landmark analysis revealed that the durable polymer group had a lower TLF rate from 9 months. Further studies are needed to confirm these results.

Objective There are growing interests on suicide risk screening in clinical settings and classifying high-risk groups of suicide with suicidal ideation is crucial for a more effective suicide preventive intervention. Previous statistical techniques were limited because they tried to predict suicide risk using a simple algorithm. Machine learning differs from the traditional statistical techniques in that it generates the most optimal algorithm from various predictors.Methods We aim to analyze the Personality Assessment Inventory (PAI) profiles of child and adolescent patients who received outpatient psychiatric care using machine learning techniques, such as logistic regression (LR), random forest (RF), artificial neural network (ANN), support vector machine (SVM), and extreme gradient boosting (XGB), to develop and validate a classification model for individuals with high suicide risk.Results We developed prediction models using seven relevant features calculated by Boruta algorithm and subsequently tested all models using the testing dataset. The area under the ROC curve of these models were above 0.9 and the RF model exhibited the best performance.Conclusion Suicide must be assessed based on multiple aspects, and although Personality Assessment Inventory for Adolescent assess an array of domains, further research is needed for predicting high suicide risk groups.

Background It has not been determined which specific 2-stenting strategy is the best for bifurcation lesions. Our aim was to investigate the clinical outcomes of various 2-stenting strategies in the era of 2nd-generation drug-eluting stents (2G-DES).Methods and Results:We analyzed 454 patients who finally underwent 2-stenting for a bifurcation lesion, from among 2,648 patients enrolled in the COBIS III registry. The primary outcome was target lesion failure (TLF). Patients were analyzed according to stenting sequence (provisional [main vessel stenting first] vs. systemic [side branch stenting first]) and stenting technique (crush vs. T vs. culotte vs. kissing/V stenting). Overall, 4.4 years' TLF after 2-stenting treatment for bifurcation lesion was excellent: TLF 11.2% and stent thrombosis 1.3%. There was no difference in TLF according to 2-stenting strategy (11.1% vs. 10.5%, P=0.990 for provisional and systemic sequence; 8.6% vs. 14.4% vs. 12.9% vs. 12.2%, P=0.326 for crush, T, culotte, kissing/V technique, respectively). Only left main (LM) disease and a shorter duration of dual antiplatelet therapy (DAPT) were associated with TLF. The distribution of DAPT duration differed between patients with and without TLF, and the time-point of intersection was 2.5 years. Also, the side branch was the most common site of restenosis. Conclusions The stenting sequence or technique did not affect clinical outcomes, but LM disease and shorter DAPT were associated with TLF, in patients with bifurcation lesions undergoing 2-stenting with 2G-DES.

Optimal dual antiplatelet therapy (DAPT) duration for patients undergoing percutaneous coronary intervention (PCI) for coronary bifurcations is an unmet issue. The BIFURCAT registry was obtained by merging two registries on coronary bifurcations. Three groups were compared in a two-by-two fashion: short-term DAPT (≤ 6 months), intermediate-term DAPT (6-12 months) and extended DAPT (>12 months). Major adverse cardiac events (MACE) (a composite of all-cause death, myocardial infarction (MI), target-lesion revascularization and stent thrombosis) were the primary endpoint. Single components of MACE were the secondary endpoints. Events were appraised according to the clinical presentation: chronic coronary syndrome (CCS) versus acute coronary syndrome (ACS). 5537 patients (3231 ACS, 2306 CCS) were included. After a median follow-up of 2.1 years (IQR 0.9-2.2), extended DAPT was associated with a lower incidence of MACE compared with intermediate-term DAPT (2.8% versus 3.4%, adjusted HR 0.23 [0.1-0.54], p

In this study, we aimed to investigate the time course of new-onset complete atrioventricular block (CAVB) and its reversibility after transcatheter aortic valve implantation (TAVI). We analyzed 206 consecutive patients without baseline CAVB who underwent successful TAVI. The incidence of new-onset CAVB was determined to be 12.6% (26/206). Among these patients, 14 recovered from CAVB within 2 weeks (6.8%, 14/206), while the remaining 12 (5.8%, 12/206) underwent permanent pacemaker (PPM) insertion. Among the 12 patients who received the PPM, 4 were able to recover from CAVB within 4 months. Thus, only 8 among 206 patients (3.8%) showed persistent CAVB. Early-onset CAVB on the day of the procedure was the strongest predictor of PPM implantation (OR = 127). The electrocardiographic changes that occurred after TAVI were mostly recovered after 1 month. The most critical procedural factor that predicts CAVB and PPM insertion is the deep implantation (>4 mm) of a big valve (oversizing index >5.9%). In conclusion, the incidence of CAVB after TAVI was estimated to be at 12.6%. Two-thirds of these patients recovered from CAVB within 3 days, resulting in a final rate of persistent CAVB of 4%. To prevent CAVB, we have to implant an appropriate valve type with an optimal size and depth.

Positive displacement hydraulic turbine (PDT) is a new class of turbine, capable of effectively generating micro and Pico hydro power for low specific speed applications. This type of turbine is not very popular and hence, it is interesting to research on it. With the rising concerns of environmental pollution, climate change and global warming, emphasis is laid to harness power from renewable energy sources. Micro and Pico hydro turbines are actively researched to generate clean power in addition to the existing conventional turbines. PDT was designed and developed to replace the pressure differential control valves in the hot water supply system and utilize the surplus differential head to generate power and make the system energy efficient. In the present work, experimental studies were conducted on the developed PDT at the designed rotational speed with water at 15, 50 and 110 °C and various differential heads ranging from low to high. The performance data showed the effect of fluid properties on the performance of the PDT due to the change in the temperature of the working fluid. Also, empirical co-relation was developed based on dependent variables using Buckingham π-theorem to predict the flowrate through the PDT at various heads and temperatures. This could help engineers, in future, for designing a new turbine for harnessing micro and Pico hydropower for any application.

Background: Prurigo nodularis (PN) is a highly pruritic disease that significantly impairs patient quality of life. Although the mechanism that causes pruritus is not clear, one hypothesis argues that neural hyperplasia, mast cell, and Merkel cell neurite complexes may be associated with PN pathogenesis. Objective: The objective of this study was to analyze whether special staining outcomes differed depending on the presence of atopic dermatitis (AD) and treatment response. Methods: A total of 209 patients diagnosed with PN was analyzed retrospectively. Patients were divided into two groups according to presence or past history of AD and by treatment response. Histopathologic features were obtained using the following stains: Giemsa, S-100, neuron-specific enolase, cytokeratin (CK)-20, CAM5.2, and CK8/CK18. Results: A total of 126 patients (60.29%) had AD, and 68 (32.54%) showed clinical improvement. There were no statistically significant differences in the staining results between the PN groups with AD (PN c AD) and without AD (PN s AD). Additionally, there were no statistically significant differences in staining results between the improved and non-improved groups. Conclusion: Implementing the special stains helped to identify PN pathogenesis. Because there were no statistically significant differences in the special stain results between the improved and non-improved groups, we conclude that mast cell proliferation, neural hyperplasia, and Merkel cell hyperplasia may not have a significant effect on treatment response. (Ann Dermatol 33(4) 333∼338, 2021)

Osteoarthritis (OA) is a leading cause of chronic pain in the elderly worldwide. Yet current diagnosis and therapy for OA pain are subjective and nonspecific with significant adverse effects. Here, we introduced a theranostic nanoprobe based on molybdenum disulfide nanosheet-coated gold nanorods (MoS2-AuNR) targeting never growth factor (NGF), a key player in pain sensation, for photoacoustic pain imaging and near-infrared (NIR) imaging-guided photothermal analgesic therapy. MoS2 coating significantly improved the photoacoustic and photothermal performance of AuNR. Functionalization of MoS2-AuNR nanoprobes by conjugating with NGF antibody enabled active targeting on painful OA knees in a surgical OA murine model. We observed that our functional nanoprobes accumulated in the OA knee rather than the contralateral intact one, and the amount was correlated with the severity of mechanical allodynia in our mouse model. Under imaging guidance, NIR-excited photothermal therapy could mitigate mechanical allodynia and walking imbalance behavior for both subacute and chronic stages of OA in a preclinical setting. This molecular theranostic approach enabled us to specifically localize the source of OA pain and efficiently block peripheral pain transmission.

The process of ultra-thin single crystal gold film irradiated by femtosecond laser is simulated by the combination of improved two-temperature model (TTM) and molecular dynamics (MD). The results i...

Background Optimal antiplatelet monotherapy during the chronic maintenance period in patients who undergo coronary stenting is unknown. We aimed to compare head to head the efficacy and safety of aspirin and clopidogrel monotherapy in this population. Methods We did an investigator-initiated, prospective, randomised, open-label, multicentre trial at 37 study sites in South Korea. We enrolled patients aged at least 20 years who maintained dual antiplatelet therapy without clinical events for 6-18 months after percutaneous coronary intervention with drug-eluting stents (DES). We excluded patients with any ischaemic and major bleeding complications. Patients were randomly assigned (1:1) to receive a monotherapy agent of clopidogrel 75 mg once daily or aspirin 100 mg once daily for 24 months. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater, in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02044250. Findings Between March 26, 2014, and May 29, 2018, we enrolled 5530 patients. 5438 (98·3%) patients were randomly assigned to either the clopidogrel group (2710 [49·8%]) or to the aspirin group (2728 [50·2%]). Ascertainment of the primary endpoint was completed in 5338 (98·2%) patients. During 24-month follow-up, the primary outcome occurred in 152 (5·7%) patients in the clopidogrel group and 207 (7·7%) in the aspirin group (hazard ratio 0·73 [95% CI 0·59-0·90]; p=0·0035). Interpretation Clopidogrel monotherapy, compared with aspirin monotherapy during the chronic maintenance period after percutaneous coronary intervention with DES significantly reduced the risk of the composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and BARC bleeding type 3 or greater. In patients requiring indefinite antiplatelet monotherapy after percutaneous coronary intervention, clopidogrel monotherapy was superior to aspirin monotherapy in preventing future adverse clinical events. Funding ChongKunDang, SamJin, HanMi, DaeWoong, and the South Korea Ministry of Health and Welfare.

AimsThe optimal immunosuppressive therapy (IST) in patients with myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON) remains uncertain. This study aimed to observe the disease course of MOG-ON and evaluate the therapeutic efficacy and tolerability of conventional immunosuppressants through Chinese cohort analysis.MethodsThis bidirectional cohort study included 121 patients with MOG-ON between January 2015 and December 2018. The clinical features and annualised relapse rate (ARR) of patients with and without IST were analysed.ResultsThe median age at onset was 17.5 years, and the sex ratio (F:M) was 1.24. Of 121 patients, 77 patients relapsed and 61 patients were younger than 18 years at disease onset. The overall median ARR of 63 patients in the non-IST group was 0.5, with 46.0% patients showing relapse at a median follow-up of 33.5 months. In the IST group, the ARR decreased from 1.75 pre-IST to 0.00 post-IST in 53 patients who received IST exceeding 6 months, with 20.8% patients showing relapse at a median follow-up of 23.8 months. The relapse rates of patients treated with rituximab (RTX) and mycophenolate mofetil (MMF) were not statistically different, but the rate of discontinuation was significantly lower in the RTX-treated group (18.2% vs 57.7%, p=0.0017).ConclusionThis study provides Class III evidence that both MMF and RTX may lower disease activity in patients with MOG-ON, and RTX showed better tolerability than MMF. However, observation after a single attack remains a good option because less than half of patients not on treatment suffered a relapse.

Background/aims Besifovir dipivoxil maleate (BSV), an acyclic nucleotide phosphonate, shows potent antiviral activity against hepatitis B virus (HBV). Our previous 48-week trial revealed that BSV has comparable antiviral efficacy to tenofovir disoproxil fumarate (TDF) and better safety profiles in terms of improved renal and bone safety. This extension study evaluated the prolonged efficacy and safety of BSV in treatment-naive chronic hepatitis B patients. Methods Patients continued to participate in an open-label BSV study after an initial 48-week double-blind comparison of BSV and TDF treatment. The antiviral efficacy and drug safety was evaluated up to 192 weeks in two groups: patients continuing BSV treatment (BSV-BSV) and patients switching from TDF to BSV after 48 weeks (TDF-BSV). Results Among 197 patients receiving randomized treatments, 170 (86%) entered the open-label phase and 152 (77%) entered the 192-week extension study. Virological response rates over 192 weeks were 92.50% and 93.06% in the BSV-BSV and TDF-BSV groups, respectively (p = 0.90). Hepatitis B envelop antigen seroconversion and alanine aminotransferase normalization rates were similar between the groups (p = 0.75 and p = 0.36, respectively). There were no drug-resistant mutations to BSV. Bone mineral density and renal function were well preserved in the BSV-BSV group, whereas these initially worsened then recovered after switching therapy in the TDF-BSV group. Conclusions BSV maintained potent antiviral efficacy after 192 weeks and showed no evidence of drug resistance. BSV was safe, well tolerated, and effective in patients who switched from TDF to BSV. Trial Registration Number: NCT01937806 (Date: September 10, 2013).

Background: Large-scale randomized comparison of drug-eluting stents (DES) based on durable polymer versus biodegradable polymer technology is currently insufficient in patients with acute coronary syndrome (ACS). The present study aimed to prove the noninferiority of the durable polymer DES (DP-DES) compared with the biodegradable polymer DES (BP-DES) in such patients. Methods: The HOST-REDUCE-POLYTECH-ACS (Harmonizing Optimal Strategy for Treatment of Coronary Artery Diseases—Comparison of Reduction of Prasugrel Dose or Polymer Technology in ACS Patients) trial is an investigator-initiated, randomized, open-label, adjudicator-blinded, multicenter, noninferiority trial comparing the efficacy and safety of DP-DES and BP-DES in patients with ACS. The primary end point was a patient-oriented composite outcome (a composite of all-cause death, nonfatal myocardial infarction, and any repeat revascularization) at 12 months. The key secondary end point was device-oriented composite outcome (a composite of cardiac death, target-vessel myocardial infarction, or target lesion revascularization) at 12 months. Results: A total of 3413 patients were randomized to receive the DP-DES (1713 patients) and BP-DES (1700 patients). At 12 months, patient-oriented composite outcome occurred in 5.2% in the DP-DES group and 6.4% in the BP-DES group (absolute risk difference, –1.2%; P non inferiority P =0.038), mostly because of a reduction in target lesion revascularization. The rate of spontaneous nonfatal myocardial infarction and stent thrombosis were extremely low, with no significant difference between the 2 groups (0.6% versus 0.8%; P =0.513 and 0.1% versus 0.4%; P =0.174, respectively). Conclusions: In ACS patients receiving percutaneous coronary intervention, DP-DES was noninferior to BP-DES with regard to patient-oriented composite outcomes at 12 months after index percutaneous coronary intervention. Registration: URL: https://wwwclinicaltrials.gov ; Unique identifier: NCT02193971.

AIMS: We aimed to understand the association between stent length and clinical outcomes after percutaneous coronary intervention (PCI) using newer-generation drug-eluting stents (DES). METHODS AND RESULTS: We analysed 9,217 patients who underwent stenting for a single lesion from the GRAND-DES registry, a patient-level pooled registry including five Korean multicentre DES registries. The median follow-up duration was 730 days (interquartile range 708 to 752 days). A total of 8,035 patients were classified into the short stenting group (≤40 mm), and 1,182 into the long stenting group (>40 mm). The primary endpoint was target lesion failure (TLF). Long stenting (>40 mm) was significantly associated with higher TLF (IPTW adjusted HR 1.88, 95% CI: 1.67-2.13; p

Flexible and transparent artificial synapses with extremely low energy consumption have potential for use in brain-like neuromorphic electronics. However, most of the transparent materials for flexible memristive artificial synapses were reported to show picojoule-scale high energy consumption with kiloohm-scale low resistance, which limits the scalability for parallel operation. Here, we report on a flexible memristive artificial synapse based on Cs3Cu2I5 with energy consumption as low as 10.48 aJ (= 10.48 × 10−18 J) μm−2 and resistance as high as 243 MΩ for writing pulses. Interface-type resistive switching at the Schottky junction between p-type Cu3Cs2I5 and Au is verified, where migration of iodide vacancies and asymmetric carrier transport owing to the effective hole mass is three times heavier than effective electron mass are found to play critical roles in controlling the conductance, leading to high resistance. There was little difference in synaptic weight updates with high linearity and 250 states before and after bending the flexible device. Moreover, the MNIST-based recognition rate of over 90% is maintained upon bending, indicative of a promising candidate for highly efficient flexible artificial synapses.

Lead-based halide perovskites have been proposed as potential candidates for resistive switching memristors due to the high ON/OFF ratio along with millivolt-level low operational voltage. However, lead-free perovskites with 3-dimensional structures, such as Cs2AgBiBr6, were reported to suffer from low ON/OFF ratios. We report here that reduction of dimensionality is an effective method to improve remarkably the ON/OFF ratio in lead-free perovskites. Introduction of butylammonium (BA) into the double perovskite Cs2AgBiBr6 forms 2-dimensional BA2CsAgBiBr7, which is confirmed by the well-developed (00l) peaks from powder X-ray diffraction. A 230 nm thick BA2CsAgBiBr7 film is sandwiched in between Ag and Pt electrodes, which demonstrates bipolar resistive switching behavior with a potential ON/OFF ratio up to 107. Reliable and reproducible SET and RESET processes occur at +0.13 V and -0.20 V, respectively. Endurance of 1000 cycles and a retention time of 2 × 104 s are measured. Multi-level storage capability is confirmed by controlling the compliance current. Schottky conduction at the high resistance state (HRS) and ohmic conduction at the low resistance state (LRS) are found to be responsible for resistive switching. The stability test at 85 °C or for 22 days under ambient conditions indicates that BA2CsAgBiBr7 is durably operable.

Rheumatoid arthritis (RA), as a chronic autoimmune disease, damages the bone and cartilage of patients, and even leads to disability. Therefore, the diagnosis and treatment of RA is particularly important. However, due to the complexity of RA, it is difficult to make effective early diagnosis of RA, which is detrimental to RA treatment. Besides, long-term intake of anti-RA drugs can also cause damage to patients’ organs. The emergence of nanotechnology provides the new train of thoughts for the diagnosis and treatment of RA. And the combination of diagnosis and therapy is an ideal method to solve the problem of disease management of RA patients. In this review, we summarize the mechanism and microenvironment of RA, discuss the commonly used diagnostic techniques and therapeutic drugs for RA, and review their advantages and disadvantages. New nanotherapy strategies such as drug-carrying nanoparticles, PTT, PDT are listed, and their applications in RA treatment are also summarized. In addition, multimodal imaging, combined therapy and responsive diagnosis and treatment are also summarized as important contents. At last, we also review typical nanocarriers that can be used in the integration of diagnosis and therapy, and discussed their potential applications in RA theranostics.

To support the emerging vehicle-to-everything (V2X) communication for autonomous vehicles and smart transportation services, 3rd Generation Partnership Project (3GPP) has recently introduced cellular V2X (C-V2X) standards. In C-V2X, radio resources can be managed not only centrally by the cellular network base station, but also in a completely distributed manner ( Mode 4 ) without any cellular support. However, Mode 4 may suffer significant collisions and interference in a dense environment since each vehicle selects its own resources to transmit V2X messages autonomously without adapting appropriately to vehicle density. To address this challenge, we propose ATOMIC , an Adaptive Transmission pOwer and Message Interval Control scheme for C-V2X Mode 4 , in which each vehicle utilizes real-time channel sensing and neighbor information to reduce channel contention for improved reliability and latency. Through analysis and extensive simulations, we show that ATOMIC outperforms the standard Mode 4 in both urban and highway scenarios especially in highly dense environments.

In this paper, we report stable polarization switching in metal-HfZrOx (HZO)-metal capacitors when pulses are repeatedly applied from the initial state. By examining various process parameters including annealing method, annealing temperature, and annealing time, we investigated the optimal conditions for realizing ferroelectricity in HZO layers deposited by sputtering systems. More specifically, we examined how polarization behaviors evolved as a function of annealing temperatures. Our results showed that annealing HZO capped by a top electrode, when annealing temperature was higher than 850 °C, drives the transformation to large quantities of orthorhombic phases, and enables constant remnant polarization without the fluctuations caused by wake-up and fatigue. We continued to observe stable polarization up to 108 cycles with a pulse width of 5 μs.

Background Coronary vasospasm is primarily characterized by transient and reversible vasoconstriction causing myocardial ischaemia and can manifest with various clinical features, including syncope. Case summary A 50-year-old man presented with recurrent episodes of syncope for 3 days. The last syncope history occurred during an early morning walk, accompanied by dizziness and loss of consciousness. There was no clear history of chest pain at the time. He smoked one pack of cigarettes daily and frequently consume alcohol. Approximately 3 h after admission, echocardiography initially revealed normal systolic function; however, during the examination, the patient suddenly complained of dizziness and regional wall motion abnormalities (RWMA) of the left anterior descending artery (LAD) territory were observed. Both RWMA and dizziness spontaneously improved within a few minutes. Emergency coronary angiography (CAG) was performed to confirm vasospasm. Coronary angiography revealed mild atherosclerosis of proximal LAD. After 3 min, he complained of dizziness and vague chest discomfort, and electrocardiogram revealed ST-segment elevation. We immediately performed angiography of the left coronary artery, and CAG revealed total occlusion of the proximal LAD without any provocation. After administration of intracoronary nitroglycerine, coronary flow was restored completely and ST-segment deviation normalized along with relief in chest discomfort. The patient’s symptoms have not recurred for 3 months while being on calcium channel blocker and long-acting nitrates. Discussion Coronary vasospasm can present as transient and dynamic myocardial ischaemia along with angina. Coronary vasospasm should always be considered in the differential diagnosis for syncope.

Resumen Introduccion y objetivos La reserva fraccional de flujo o el indice instantaneo en el periodo libre de ondas se han convertido en criterios estandar para la revascularizacion. Se busco evaluar la asociacion entre las caracteristicas cuantitativas de placa valoradas por ecocardiografia intravascular (IVUS) o tomografia de coherencia optima (OCT) y la gravedad de la estenosis fisiologica. Metodos Se evaluaron un total de 365 estenosis en 330 pacientes. Se exploro la asociacion entre los parametros derivados de la IVUS o la OCT y los indices fisiologicos en reposo (indice instantaneo en el periodo libre de ondas, reposo de ciclo cardiaco completo y relacion de presion diastolica) y la reserva fraccional de flujo. Resultados Entre el total de lesiones, 50,7% y 58,1% mostraron indice instantaneo en el periodo libre de ondas ≤ 0,89 y reserva fraccional de flujo ≤ 080, respectivamente. Los parametros derivados de la IVUS o de la OCT mostraron correlaciones significativas con los indices fisiologicos en reposo (p Conclusiones Los indices fisiologicos en reposo mostraron una correlacion identica con las caracteristicas cuantitativas de la placa definidas por IVUS u OCT. La reserva fraccional de flujo mostro una correlacion mas fuerte con los parametros IVUS u OCT que los indices fisiologicos en reposo. La precision diagnostica y la capacidad de discriminacion de los parametros anatomicos fueron modestas para predecir la significacion funcional definida por los indices fisiologicos invasivos hiperemicos y de reposo. Ensayo clinico registrado en ClinicalTrials.gov (Identificador: NCT03795714).

Background/Aims: This study examined the risk factors associated with mortality in cirrhotic patients hospitalized with variceal bleeding, and evaluated the effects of acute-on-chronic liver failure (ACLF) on the prognosis of these patients.Methods: This study was retrospectively conducted on patients registered in the Korean acute-on-chronic liver failure study cohort, and on 474 consecutive cirrhotic patients hospitalized with variceal bleeding from January 2013 to December 2013 at 21 university hospitals. ACLF was defined as described by the European Association for the Study of Liver-Chronic Liver Failure Consortium.Results: Among a total of 474 patients, 61 patients were diagnosed with ACLF. The cumulative overall survival (OS) rate was lower in the patients with ACLF than in those without (PPPP

Fractional flow reserve or instantaneous wave-free ratio has become a standard criterion for revascularization. We sought to evaluate the association between intravascular ultrasound (IVUS) or optical coherence tomography (OCT)-derived quantitative plaque characteristics and the severity of physiologic stenosis.A total of 365 stenoses from 330 patients were evaluated. The association between IVUS or OCT-derived parameters and resting physiologic indices (instantaneous wave-free ratio, resting full-cycle ratio, and diastolic pressure ratio) and fractional flow reserve were explored.Among the total number of lesions, 50.7% and 58.1% showed an instantaneous wave-free ratio ≤ 0.89 and fractional flow reserve ≤ 0.80, respectively. IVUS or OCT-derived parameters showed significant correlations with resting physiologic indices (P values.005). The best cutoff values of IVUS minimum lumen area (MLA), plaque burden, OCT-MLA, and OCT-area stenosis to predict functional significance were the same (IVUS-MLA: 3.4 mmThe resting physiologic indices showed an identical relationship with IVUS or OCT-defined quantitative plaque characteristics. The diagnostic accuracy and discrimination ability of anatomical parameters were modest in predicting functional significance defined by resting and hyperemic invasive physiologic indices. This trial is registered at ClinicalTrials.gov (Identifier: NCT03795714).

Objective Somatic symptoms in psychiatry include underlying depression, anxiety, or other psychiatric disorders. This study aimed to conduct a validation study of a Korean version of the Somatic Symptom Scale-8 (K-SSS-8), and to utilize the K-SSS-8 effectively in clinical settings.Methods For reliabilty, test-retest reliability and internal consistency were analyzed. For construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted. Known-group validity was verified, Jonckheere-Terpstra test (J-T statistic) were used.Results Maternal Cronbach’s alpha was 0.85 and r value of test-retest reliability was 0.777. In the EFA, 2-, 3- and 4-factor model showed cumulative percentile for variance of 60% or more. In the CFA, the 3-factor model was found to be the most appropriated and simplest (χ2=10.992, df=17, CFI=1.000, TLI=1.022, RMSEA=0.000). The verifying the difference in K-SSS-8 also showed significant difference. (J-T statistic=-2.510, p

BACKGROUND/AIMS: The occurrence of gastrointestinal symptoms and the presence of small intestinal bacterial overgrowth (SIBO) could be determined after ingestion of substrate with highly concentrated glucose for glucose breath test (GBT), after which endoscopic images for acute gastric injury have not been clarified. The aims of this study were to investigate the prevalence and relationship of acute gastric injury with SIBO after GBT. MATERIALS AND METHODS: A cohort of 235 patients with functional gastrointestinal symptoms undergoing breath test with 50 g glucose solution, immediately followed by upper endoscopy were surveyed. The acute gastric injury in endoscopic images and the GBT for hydrogen (H(2)) or methane (CH(4)) were assessed. RESULTS: The prevalence of acute gastric injury was 28.1% (66/235) after GBT. There were significant differences in GBT positivity (+) with and without gastric injury (25.8% vs 40.8%, p=0.03). In subtypes, GBT (H(2)) + was significantly lower in group with gastric injury than in the group without. No differences were seen in GBT (CH(4)) + between two groups. On multivariate analysis, the subtype of GBT (H(2)) + (Odds ratio (OR)=0.42; 95% Confidence interval (CI)=0.20–0.90; p=0.03) inversely and female (OR=2.11; 95% CI=1.11–4.00; p=0.02) were significantly related with gastric injury. Whereas gastric injury was the only independent related factor for GBT + inversely (OR=0.51; 95% CI=0.27–0.97; p=0.04). CONCLUSION: Highly concentrated glucose might provoke acute gastric injury, which could predict the absence of SIBO.

Background Several neuroimaging studies demonstrated that optic neuritis (ON) leads to functional and anatomical architecture changes in the brain. The alterations of interhemispheric functional connectivity (IFC) in patients with AQP4-ON and myelin oligodendrocyte glycoprotein (MOG)-ON are not well understood. Purpose To investigate the differential patterns of VMHC in patients with AQP4-ON and MOG-ON. Material and Methods Twenty-one patients with AQP4-ON, 11 patients with MOG-ON, and 34 healthy controls underwent resting-state MRI scans. One-way ANOVA was used to identify regions in which the zVMHC differed among the three groups. Post hoc two-sample t-tests were then conducted to compare zVMHC values between pairs of groups. Pearson correlation analysis was conducted to reveal relationships between mean zVMHC values and clinical variables in the AQP4-ON and MOG-ON groups. Results The results revealed significant differences in zVMHC values in the PreCG among the three groups. Compared to the control group: the AQP4-ON group showed significantly lower VMHC values in the superior temporal gyrus, inferior frontal gyrus, and PreCG; and the MOG-ON group showed significantly higher zVMHC values in the PostCG. Compared to the AQP4-ON group, the MOG-ON group showed significantly lower zVMHC values in the PreCG/PostCG (voxel-level PConclusion Patients with AQP4-ON and those with MOG-ON showed abnormal VMHC in the motor cortices, sensorimotor cortices, and frontal lobe, possibly indicating impaired sensorimotor function in patients with ON. Moreover, differential patterns of VMHC in patients with AQP4-ON, compared to patients with MOG-ON, might serve as a clinical indicator for classification of ON.

The pollutant load discharged in Dongbok lake watershed was estimated as BOD 893.4 kg/day, TN 729.3 kg/day and TP 55.9 kg/day in 2017 year. The largest amount of the load was the livestock and land-based pollutants, but the domestic wastewater-based amount also accounted for 12.4%, most of which were originated from the non-treated sewage in the living system. The number of public sewage treatment facilities installed to Dongbok lake watershed was 34, and the average removal efficiency of pollutant by them was BOD 90.6%, T-N 53.9% and T-P 58.7%. As a result, the load discharged from the facilities accounted for 1.0% of BOD, 13.2% of T-N and 12.3% of T-P in the total amount discharged from point sources. Meanwhile, 7 artificial wetland facilities for non-point pollutant treatment were installed and operated in the watershed. The average removal efficiency of the wetland during rainfall was BOD 2.8%, COD -14.9%, SS 71.7%, T-N 42.5%, and T-P 22.1%, but the contribution rate of water quality improvement during normal (non-rainy) day by these facilities was very low: BOD -1.5%, T-N 3.0%, and T-P 0.4%.

Corona Virus Disease 2019 (COVID-19) is caused by the novel coronavirus SARS-CoV-2. Emerging genetic and clinical evidence suggests similarities between COVID-19 patients and those with severe acute respiratory syndrome and Middle East respiratory syndrome. Hematological changes such as lymphopenia and thrombocytopenia are not rare in COVID-19 patients, and a smaller population of these patients had leukopenia. Thrombocytopenia was detected in 5–41.7% of the patients with COVID-19. Analyzing the dynamic decrease in platelet counts may be useful in the prognosis of patients with COVID-19. However, the mechanisms underlying the development of thrombocytopenia remain to be elucidated. This review summarizes the hematological changes in patients infected with SARS-CoV-2 and possible underlying mechanisms of thrombocytopenia development., Highlights • Early diagnosis and treatment of COVID-19 patients can reduce mortality. • There is no laboratory test index to predict disease progression and prognosis. • Progressive decline in platelets may be a prognostic factor for COVID-19 patients. • Monitoring platelet count may be an effective index for COVID-19 progression.

INTRODUCTION: Chronic hepatitis B (CHB) remains a major worldwide public health concern. Besifovir dipivoxil maleate (BSV) is a new promising treatment for CHB. However, long-term efficacy and safety have not yet been evaluated. Therefore, the goal of the study is to determine the antiviral efficacy and safety of BSV treatment over a 144-week duration (BSV-BSV) in comparison with those of a sequential treatment with tenofovir disoproxil fumarate (TDF) followed by a 96-week duration BSV administration (TDF-BSV). METHODS: After 48 weeks of a double-blind comparison between BSV and TDF treatments, patients continued the open-label BSV study. We evaluated antiviral efficacy and drug safety up to 144 weeks for BSV-BSV and TDF-BSV groups. The primary endpoint was a virological response (hepatitis B virus DNA < 69 IU/mL). RESULTS: Among the 197 patients enrolled, 170 and 158 patients entered the second-year and third-year open-label phase extensional study, respectively, whereas 153 patients completed the 144-week follow-up. The virological response rate over the 144-week period was 87.7% and 92.1% in BSV-BSV and TDF-BSV groups, respectively (P = 0.36). The rates of ALT normalization and HBeAg seroconversion were similar between the groups. No drug-resistant mutations to BSV were noted. Bone mineral density and renal function were well preserved in the BSV-BSV group and were significantly improved after switching therapy in TDF-BSV patients. DISCUSSION: This extensional study of a phase 3 trial (NCT01937806) suggests that BSV treatment is efficacious and safe for long-term use in treatment-naïve and TDF-experienced patients with CHB.

An anastomosis stricture with a total obstruction is rare and treatment options are variable. We describe our experience with a combination of a single port transanal laparoscopic approach and intraoperative colonoscopic balloon dilatation. The patient was a 48-year-old man with rectal cancer. A laparoscopic single port lower anterior resection and diverting ileostomy were performed followed by a colon study and ileostomy takedown. The colon study and sigmoidoscopy revealed total obstruction of the rectum at the anastomosis level. We employed a transanal approach using a single port to correct this. We located the anastomosis stricture site and generated a lumen using a dissector and electocautery method to insert the balloon device. Colonoscopic balloon dilatation was subsequently successful. The patient was discharged with no postoperative complications. A laparoscopic single port transanal approach with an intraoperative colonoscopic balloon dilatation is a viable alternative approach to treating an anastomosis stricture of the rectum.

Objectives Mood disorder is highly comorbid with attention deficit/hyperactivity disorder (ADHD), and comorbid ADHD symptoms are associated with suicide risk. The aim of this study was to examine the association between comorbid ADHD symptoms and the number of suicide attempts among patients with unipolar and bipolar depression. Methods In this cross-sectional study, 100 patients with either unipolar or bipolar depression constituted the final sample. Pearson's correlation and multiple regression analyses were conducted to examine the association between comorbid ADHD symptoms and suicide risk. Results Among patients with bipolar depression, the number of suicide attempts was significantly correlated with ADHD symptoms (r=0.324, p

Groin lesions can be classified as neoplastic or non-neoplastic. Neoplastic lesions include lipoma, epidermoid cyst, angiomyofibroblastoma-like tumor, liposarcoma, and synovial sarcoma, as well as metastases from lymphoma, neuroendocrine carcinoma, and carcinomas of the lung, breast, urinary bladder, ovary, vulva, and colon. Non-neoplastic lesions include hernias, round ligament varices, endometriosis, Kimura disease, Castleman disease, hematoma, and inflammation. Because the clinical implications and therapeutic strategies for groin lesions vary depending on the cause, the ability to noninvasively differentiate among etiologies is very important. Although there is substantial overlap in ultrasonographic findings across various groin lesions, some ultrasonographic features, along with clinical characteristics, may suggest a specific diagnosis. Familiarity with the ultrasonographic and clinical features of various groin lesions facilitates accurate diagnosis and treatment.