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Background: To evaluate the effects of teneligliptin on glycosylated hemoglobin (HbA1c) levels, continuous glucose monitoring (CGM)-derived time in range, and glycemic variability in elderly type 2 diabetes mellitus patients.Methods: This randomized, double-blinded, placebo-controlled study was conducted in eight centers in Korea (clinical trial registration number: NCT03508323). Sixty-five participants aged ≥65 years, who were treatment-naïve or had been treated with stable doses of metformin, were randomized at a 1:1 ratio to receive 20 mg of teneligliptin (n=35) or placebo (n=30) for 12 weeks. The main endpoints were the changes in HbA1c levels from baseline to week 12, CGM metrics-derived time in range, and glycemic variability.Results: After 12 weeks, a significant reduction (by 0.84%) in HbA1c levels was observed in the teneligliptin group compared to that in the placebo group (by 0.08%), with a between-group least squares mean difference of –0.76% (95% confidence interval [CI], –1.08 to –0.44). The coefficient of variation, standard deviation, and mean amplitude of glycemic excursion significantly decreased in participants treated with teneligliptin as compared to those in the placebo group. Teneligliptin treatment significantly decreased the time spent above 180 or 250 mg/dL, respectively, without increasing the time spent below 70 mg/dL. The mean percentage of time for which glucose levels remained in the 70 to 180 mg/dL time in range (TIR70–180) at week 12 was 82.0%±16.0% in the teneligliptin group, and placebo-adjusted change in TIR70–180 from baseline was 13.3% (95% CI, 6.0 to 20.6).Conclusion: Teneligliptin effectively reduced HbA1c levels, time spent above the target range, and glycemic variability, without increasing hypoglycemia in our study population.

Hypoxia is the most frequently occurring adverse effect during endoscopic retrograde cholangiopancreatography (ERCP) under sedation; thus, oxygen must be properly supplied to prevent a reduction of oxygen saturation. In this study, we intend to verify the preventive effect for hypoxia during ERCP, using a high-flow nasal cannula (HFNC), in elderly patients. As a multicenter prospective randomized trial, patients who underwent ERCP with propofol-based sedation were randomly assigned into two groups: Patients in the HFNC group were supplied with oxygen via an HFNC, and those in the standard nasal cannula group were supplied with oxygen via a low-flow nasal cannula. The co-primary end points were the lowest oxygen saturation rate and hypoxia during the overall procedure. A total of 187 patients (HFNC group: 95; standard nasal cannula group: 92) were included in the analysis. Unexpected hypoxia events were more frequently observed among patients in the standard nasal cannula group than among patients in the HFNC group (13% vs. 4%, odds ratio 3.41, 95% confidence interval 1.06–11.00, p = 0.031). The mean of the lowest oxygen saturation rate during ERCP was significantly lower in the standard nasal cannula group than in the HFNC group (95% vs. 97%, p = 0.002). Oxygen supplementation with an HFNC can prevent oxygen desaturation and hypoxia events in patients undergoing ERCP under sedation. Trial registration Clinical Research Information Service (CRIS; KCT0004960).

Currently, we are developing an AC/DC conversion technology with the development of power semiconductors. Accordingly, DC is attracting attention because it is advantageous in the current transmission system. However, it has a problem that the cut-off technology required for DC system operation has not been secured yet. We are researching and developing a DC cut-off technology in several ways. We proposed a model that combines a superconducting fault current limiter and a DC circuit breaker. This is a configuration which a superconducting fault current limiter and a mechanical DC circuit breaker are connected in series. The superconducting fault current limiter limits the initial fault current and the mechanical DC circuit breaker cuts off the fault current. The mechanical DC circuit breaker consists of a high-speed DC switch, a LC divergent oscillation circuit and a surge arrester. This creates an artificial zero-point by affecting the blocking of the DC fault current according to the LC diverging oscillation circuit. In this paper, we analyzed the effect of the LC divergent oscillation circuit on the superconducting DC circuit breaker according to Reactor (L) and Capacitor (C). As a result, we analyzed the operating characteristics of the superconducting DC circuit breaker according to the application of the LC divergent oscillation circuit using the PSCAD/EMTDC program. Also, we confirmed the characteristics of the initial fault current limit rate of the superconducting fault current limiter and the possibility of controlling how the LC divergent oscillation circuit affects the DC arc generated at the opening of the mechanical DC contacts.

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

We present an interesting tracing of para-Hisian pacing in a 45-year-old man with an episode of narrow complex tachycardia and past recurrent palpitations.

Currently, power semiconductors (IGBT, Thyristor, etc.) are used for the stability and high reliability of DC system operation. However, we have proposed a current limiting DC circuit breaker with superconducting winding to improve the stability of the DC system. This is superior in terms of fast cut-off speed and economy of power semiconductors, and is suitable for changes to the Point to Loads DC system that will be expanded in the future. A superconducting DC circuit breaker is a model in which a superconducting current limiter and a DC circuit breaker are combined. The superconducting fault current limiter uses a superconducting wire made of GdBCO material to limit the initial fault current to lower the current level of the fault current, and the DC circuit breaker blocks the reduced fault current from the superconducting fault current limiter by configuring a mechanical cutoff switch, passive elements L, C and SPD. In this paper, this superconducting DC circuit breaker model was designed and tested by giving two variables, and the operating characteristics were analyzed. The first is the superconducting wire connection method, and the second is the power supply voltage. In addition, the initial fault current, the time when the zero point of the fault current is generated, and the time when the shutdown is completed were compared and analyzed. As a result, it was confirmed that the helical type showed a higher current limiting rate than the spiral type, and the result of reaching a fast current zero point was confirmed.

We have studied the operation of the circuit breaker for 15 kV DC power grid with the combination of the breaker and the HTS Fault Current Limiter (FCL). The HTS FCL limits the fault current by introduce of the impedance under the fault condition, so the circuit breaker with the HTS FCL module can be expected to be able to break the higher prospective fault current successfully. As an attached module to the DC circuit breaker, we performed a design work for a DC resistive HTS FCL module with SuNAM's REBCO conductor with the stainless-steel stabilizer. Considering the operation delay time of the DC circuit breaker, the HTS FCL module should generate a proper impedance for 16 milliseconds at most without any damages. To verify the design results, we designed and make scaled-down model of the HTS FCL module. We also carried out the DC short-circuit test to check the feasibility and the fault current limiting characteristics of the suggested model.

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.

This study sought to obtain large-scale evidence supporting the clinical usefulness of ergonovine echocardiography.The role of noninvasive ergonovine provocation testing with echocardiographic monitoring of ventricular wall motion (ergonovine echocardiography) needs to be defined.Clinical data of patients who underwent ergonovine echocardiography in 3 tertiary referral hospitals in South Korea were analyzed.Ergonovine echocardiography was performed in 14,012 patients (mean age 52.8 ± 11.1 years; 6,213 [44.3%] women) after exclusion of significant coronary arterial stenosis by functional (treadmill or perfusion scan, n = 9,824) or anatomic test (invasive or computerized tomographic coronary angiography, n = 4,188). Premature termination developed in 0.4% (n = 51), and a positive result was observed in 2,144 patients (15.3%), with variable frequencies according to the diagnosis (acute coronary syndrome [38.2%], variant angina [31.8%], effort angina [14.9%], aborted sudden cardiac death [17.6%], syncope [9.9%]). There was no mortality or development of myocardial infarction during the test. During median follow-up of 11.4 (interquartile range: 7.2 to 15.8) years, death of any cause and cardiovascular death occurred in 494 and 143 patients, respectively. The 10-year overall (96.7 ± 0.2% vs. 91.5 ± 0.6%; p 0.0001) and cardiovascular mortality-free (99.2 ± 0.1% vs. 96.7 ± 0.4%; p 0.0001) survival rates were lower in patients with positive ergonovine echocardiography. Regarding patients with positive test results, the functional test group and the anatomic test group did not show a significant difference in the survival rates. After adjustment of age and male sex, a positive test was an independent risk factor associated with all-cause mortality (hazard ratio: 1.879, 95% confidence interval: 1.548 to 2.280; p 0.001) and cardiovascular death (hazard ratio: 2.903, 95% confidence interval: 2.061 to 4.089; p 0.001).Ergonovine echocardiography for coronary vasospasm diagnosis could be safely performed even without angiographic documentation of fixed coronary stenosis depending on the clinical presentation, and provided important prognostic implication. Ergonovine echocardiography can replace the invasive spasm provocation testing, which has been overlooked unfairly.

A reliable assessment of the aquifer contamination vulnerability is essential for the conservation and management of groundwater resources. In this study, a recent technique in artificial intelligence modeling and computational optimization algorithms have been adopted to enhance the groundwater contamination vulnerability assessment. The original DRASTIC model (ODM) suffers from the inherited subjectivity and a lack of robustness to assess the final aquifer vulnerability to nitrate contamination. To overcome the drawbacks of the ODM, and to maximize the accuracy of the final contamination vulnerability index, two levels of modeling strategy were proposed. The first modeling strategy used particle swarm optimization (PSO) and differential evolution (DE) algorithms to determine the effective weights of DRASTIC parameters and to produce new indices of ODVI-PSO and ODVI-DE based on the ODM formula. For strategy-2, a deep learning neural networks (DLNN) model used two indices resulting from strategy-1 as the input data. The adjusted vulnerability index in strategy-2 using the DLNN model showed more superior performance compared to the other index models when it was validated for nitrate values. Study results affirmed the capability of the DLNN model in strategy-2 to extract the further information from ODVI-PSO and ODVI-DE indices. This research concluded that strategy-2 provided higher accuracy for modeling the aquifer contamination vulnerability in the study area and established the efficient applicability for the aquifer contamination vulnerability modeling.

Objectives The aim of this study was to assess whether the effects of ticagrelor monotherapy after 3-month dual-antiplatelet therapy (DAPT) are consistent among patients presenting with ST-segment elevation myocardial infarction (STEMI), non–ST-segment elevation myocardial infarction, and unstable angina treated with drug-eluting stents. Background Ticagrelor monotherapy after short-term DAPT has not been investigated in patients with STEMI. Methods This was a pre-specified, stratified, subgroup analysis of the STEMI cohort from the TICO (Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus Stent for Acute Coronary Syndrome) trial, which constituted 36% of the total population. The primary outcome was a composite of major bleeding and major adverse cardiac and cerebrovascular events (MACCE; death, myocardial infarction, stent thrombosis, stroke, or target vessel revascularization). The secondary outcomes were major bleeding and MACCE. Results The incidence of the primary outcome was 4.4% in patients with STEMI (n = 1,103), 6.0% in those with non–ST-segment elevation myocardial infarction (n = 1,027), and 4.1% in those with unstable angina (n = 926), without statistical significance (p = 0.09). Compared with ticagrelor-based 12-month DAPT, ticagrelor monotherapy after 3-month DAPT showed consistent effects on the primary outcome across clinical presentations (p for interaction [pint] = 0.64). Furthermore, the effect of ticagrelor monotherapy on the reduction of major bleeding was consistent across clinical presentations (pint = 0.36). The effect of ticagrelor monotherapy on MACCE was also consistent in patients with STEMI, without evidence of a higher risk for MACCE (pint = 0.14). Conclusions This pre-specified subgroup analysis revealed no heterogeneity in the effects of ticagrelor monotherapy after 3-month DAPT, compared with 12-month DAPT, for the primary outcome, major bleeding, and MACCE across clinical presentations including STEMI, though larger studies are needed to demonstrate these findings with adequate power. (Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus Stent for Acute Coronary Syndrome [TICO Study]; NCT02494895 )

People living near abandoned mines are at increased risk of exposure to toxic metals. We surveyed 4500 inhabitants with the mean age of 68.5 years old (male: 1768, female: 2732) living near 104 abandoned metal mines from 2013 to 2017 (the 2nd phase health survey in Korea). We conducted personal interviews, blood and urine sampling, and analyzed the concentrations of lead (Pb) and cadmium (Cd) in whole blood and Cd in urine using a graphite furnace atomic absorption spectrometer. The geometric means of blood Pb, blood Cd, and urine Cd were 2.27 μg/dL, 1.42 μg/L, and 1.66 μg/g creatinine, respectively. The level of metal exposure was lower than that reported from the first phase health survey in Korea (2008‒2011) but was higher than in the general population of Korea. Blood Pb was higher in males while blood Cd and urine Cd were significantly higher in females. Blood Pb was highest in the 40‒59 age group, while blood and urine Cd levels continuously increased until age 80 or older. The Cd levels in blood and urine were affected by consumption of locally produced rice and duration of residence near abandoned mines. Furthermore, negative correlations were observed between blood Pb and blood and urine Cd levels. Additionally, 252 of the 4500 subjects exceeded the thresholds of blood Cd or urine Cd levels. Together, these findings suggest that Cd has more sustainable and adverse health effects on the abandoned mine inhabitants, who are mostly aged. Therefore, continuous biomonitoring and risk assessment to environmental health risks are necessary for environmental pollution control and health promotion.

Case Presentation A 21-year-old man was admitted to our hospital with recurrent bilateral pneumothorax and hemoptysis. Three years earlier, he underwent coil embolization due to a subarachnoid hemorrhage caused by an intracerebral aneurysm rupture. Two months after the coil embolization, he underwent an emergent total colectomy due to a massive infarction of the colon. One year after the colectomy, he started to have recurrent hemoptysis, and a few months later, multiple episodes of bilateral pneumothorax that required a chest tube placement began to occur. Notably, he had a history of easy bruising. He was taking Depakote and aspirin to prevent seizure and thromboembolic complications, respectively, both of which he began taking after the coil embolization. He denied the use of any illicit drugs. The histories of his parents and sister were not remarkable.

In this study, we investigated facile “dragging mode” electrohydrodynamic (EHD) jet printing of a polymer-wrapped semiconducting single-walled carbon nanotube (s-SWCNT) ink, for fabrication of NO gas-sensing field-effect transistors (FETs). The “dragging mode” provides a favorable environment for reliable printing and interconnection between the s-SWCNTs. Printing parameters such as supply voltages, printing speeds, and the number of prints were manipulated to find an optimal printing condition and obtain high-performance FETs. Under optimal conditions, the polymer-wrapped s-SWCNT-based FETs exhibited an average field-effect mobility of 2.939 cm2 (V−1 s−1), a threshold voltage of 2.21 V, an on/off ratio of ∼103, and a subthreshold swing of 0.968 V dec−1. Additionally, we demonstrated the application of FETs as NO sensors with high sensitivity and selectivity. The FET-type NO gas sensor exhibits a dynamic sensing range of 500 ppb–30 ppm and clear selectivity among various analyte gases including ethanol, ammonia, and acetone. Therefore, the “dragging mode” EHD jet printing introduced in this study simplifies patterning processes and is a potential reproducible method for the fabrication of next-generation gas sensors.

Digital pathology (DP) using whole slide imaging (WSI) is becoming a fundamental issue in pathology with recent advances and the rapid development of associated technologies. However, the available evidence on its diagnostic uses and practical advice for pathologists on implementing DP remains insufficient, particularly in light of the exponential growth of this industry. To inform DP implementation in Korea, we developed relevant and timely recommendations. We first performed a literature review of DP guidelines, recommendations, and position papers from major countries, as well as a review of relevant studies validating WSI. Based on that information, we prepared a draft. After several revisions, we released this draft to the public and the members of the Korean Society of Pathologists through our homepage and held an open forum for interested parties. Through that process, this final manuscript has been prepared. This recommendation contains an overview describing the background, objectives, scope of application, and basic terminology; guidelines and considerations for the hardware and software used in DP systems and the validation required for DP implementation; conclusions; and references and appendices, including literature on DP from major countries and WSI validation studies.

When a radial collector well is installed and operated for agricultural purposes, negative impacts may be observed over time due to the clogging of horizontal arms, such as reduced groundwater discharge and water quality deterioration. When radial collector well No. 2 was rehabilitated using the high-pressure impulse generation technique, the specific capacity and transmissivity were increased by 43.1 and 100.6%, respectively. In contrast, according to air surging, the specific capacity and transmissivity increased by 33.8 and 85.8%, respectively, compared to the initial rate before rehabilitation. During the operation of radial collector wells since construction, the time of well rehabilitation can be effectively determined by continuously monitoring the groundwater level and pumping rate of the radial collector wells, thereby preventing a decrease in productivity.

PurposeThe objective of this paper is to investigate how firms react to cybersecurity information sharing environment where government organizations disseminate cybersecurity threat information gathered by individual firms to the private entities. The overall impact of information sharing on firms' cybersecurity investment decision has only been game-theoretically explored, not giving practical implication. The authors therefore leverage the Cybersecurity Information Sharing Act of 2015 (CISA) to observe firms' attitudinal changes toward investing in cybersecurity.Design/methodology/approachThe authors design a quasi-experiment where they set US cybersecurity firms as an experimental group (a proxy for total investment in cybersecurity) and nonsecurity firms as a control group to measure the net effect of CISA on overall cybersecurity investment. To enhance the robustness of the authors’ difference-in-difference estimation, the authors employed propensity score matched sample test and reduced sample test as well.FindingsFor the full sample, the authors’ empirical findings suggest that US security firms' overall performance (i.e. Tobin's Q) improved following the legislation, which indicates that more investment in cybersecurity was followed by the formation of information sharing environment. Interestingly, big cybersecurity firms are beneficiaries of the CISA when the full samples are divided into small and large group. Both Tobin's Q and sales growth rate increased for big firms after CISA.Research limitations/implicationsThe authors’ findings shed more light on the research stream of cybersecurity and information sharing, a research area only explored by game-theoretical approaches. Given that the US government has tried to enforce cybersecurity defensive measures by building cooperative architecture such as CISA 2015, the policy implication of this study is far-reaching.Originality/valueThe authors’ study contributes to the research on the economic benefits of sharing cybersecurity information by finding the missing link (i.e. empirical evidence) between “sharing” and “economic impact.” This paper confirms that CISA affects the cybersecurity industry unevenly by firm size, a previously unidentified relationship.

BackgroundThe mitotic count in breast carcinoma is an important prognostic marker. Unfortunately substantial inter- and intra-laboratory variation exists when pathologists manually count mitotic figures. Artificial intelligence (AI) coupled with whole slide imaging offers a potential solution to this problem. The aim of this study was to accordingly critique an AI tool developed to quantify mitotic figures in whole slide images of invasive breast ductal carcinoma.MethodsA representative H&E slide from 320 breast invasive ductal carcinoma cases was scanned at 40x magnification. Ten expert pathologists from two academic medical centers labeled mitotic figures in whole slide images to train and validate an AI algorithm to detect and count mitoses. Thereafter, 24 readers of varying expertise were asked to count mitotic figures with and without AI support in 140 high-power fields derived from a separate dataset. Their accuracy and efficiency of performing these tasks were calculated and statistical comparisons performed.ResultsFor each experience level the accuracy, precision and sensitivity of counting mitoses by users improved with AI support. There were 21 readers (87.5%) that identified more mitoses using AI support and 13 reviewers (54.2%) that decreased the quantity of falsely flagged mitoses with AI. More time was spent on this task for most participants when not provided with AI support. AI assistance resulted in an overall time savings of 27.8%.ConclusionsThis study demonstrates that pathology end-users were more accurate and efficient at quantifying mitotic figures in digital images of invasive breast carcinoma with the aid of AI. Higher inter-pathologist agreement with AI assistance suggests that such algorithms can also help standardize practice. Not surprisingly, there is much enthusiasm in pathology regarding the prospect of using AI in routine practice to perform mundane tasks such as counting mitoses.

If a firm announces an investment in IT security, how the market value of its competitors reacts to the announcement? We try to shed light on this question through an event study design. To test the relationship, we collected 143 announcements on cybersecurity investment and measured the subsequent impact on 533 competitors’ abnormal returns, spanning from 2000 to 2019. Our estimation results present that, on average, the announcements have no observable impact on the market value of announcing firms and competitors as well, which is consistent with findings of a prior study. Interestingly, however, the impact becomes evident when we classify our samples by industries (Finance vs. non-Finance or ICT vs. non-ICT) and firm size (Big vs. Small). We interpret our empirical findings through the lenses of contagion effect and competition effect between announcing firms and their competitors. Key finding of our study is that, for financial service firms, the effect resulting from the announcement on cybersecurity investment transfers to competitors in the same direction (i.e., contagion effect).

We research team has proposed a current-limiting superconducting DC circuit breaker that combines a High-temperature superconducting wire (HTS) with a DC circuit breaker, and secured its operation performance in our previous study via simulation. In this paper, we designed and produced an actual current-limiting superconducting DC circuit breaker, as well as analyzed its current limiting and breaking performance. In addition, the operation characteristics at different lengths of the HTS with increasing voltage were analyzed. The operation reliability of the proposed DC circuit breaker was demonstrated by a simulation system that was built similar to the actual system.

Studies on coaxial magnetic gears (CMGs) have been actively conducted. CMGs can replace mechanical gears because they can perform noncontact power transfer minimizing loss and damage from friction. In the design stage of a CMG, 2D electromagnetic finite element analysis (FEA), which is a highly reliable and cost-saving tool, is widely used. However, during prototyping and testing in the review phase of a project, the prototype's pull-out torque is lower than the pull-out torque predicted from 2D electromagnetic FEA, with up to a 40% difference. One explanation for this phenomenon is that the torsional stiffness of the pole-piece structure is low, causing the electrical angle to skew. There are high-frequency magnetic fluxes in the pole-piece structure in which magnetic losses are expected to be high. In many studies, non-metal pole-piece supports that can minimize this magnetic loss were used. The disagreement between analysis and experiment has been demonstrated, but no detailed examination of this effect has been conducted. In this study, metal pole-piece supports are used to remove the torsion possibility. Results from 3D-FEA and experiments are compared, and the results reveal that when torsion is accounted for, the analysis data can be reproduced the experimental data well or not. Furthermore, the magnetic loss on metal supports is analyzed in detail.

In this study, a new type of arc-induced DC (direct current) circuit breaker is proposed as a mechanical circuit breaker suitable for DC systems. It consists of mechanical contacts, induction needles, an induction ring, and a ground line. Powerful DC arcs are generated by the movement of the mechanical contact, but they are induced to the ground by the induction needles, and are exhausted. In this study, the cut-off characteristics of the arc-induced DC circuit breaker were analyzed using the Maxwell software. A simulation model was designed, and the electrical field distribution was analyzed according to the contact pole length. In addition, a prototype was fabricated based on the simulation results, and basic cut-off operation experiments were per-formed. As a result, it was possible to investigate the blocking characteristics of the arc-induced DC circuit breaker through the simulation and experiment. Moreover, it was confirmed that the induction needles can induce DC arcs.

AIMS Outcomes according to the status of renal insufficiency have not been fully evaluated in left main coronary artery disease (LMCAD). In the present study therefore, we sought to evaluate clinical outcomes in patients with significant LMCAD stratified by the degree of renal insufficiency and the relative clinical outcomes after PCI and CABG stratified by the differential levels of renal function using data from the large multinational "all-comers" Interventional Research Incorporation Society-Left MAIN Revascularization (IRIS-MAIN) registry. METHODS AND RESULTS Among 4,894 patients with LMCAD, renal insufficiency was graded according to the estimated glomerular filtration rate (eGFR). The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as death, myocardial infarction, stroke, or any revascularisation. The patients were stratified into three groups according to eGFR: 3,824 (78%) in group 1 (eGFR ≥60 ml·min-1·1.73 m2), 838 (17%) in group 2 (eGFR ≥30 and

OBJECTIVE To compare long-term outcomes between robotic and LG approaches using propensity score weighting based on a generalized boosted method to control for selection bias. SUMMARY OF BACKGROUND DATA Minimally invasive surgical approaches for GC are increasing, yet limited evidence exists for long-term outcomes of robotic gastrectomy (RG). METHODS Patients (n = 2084) with GC stages I-III who underwent LG or RG between 2009 and 2017 were analyzed. Generalized boosted method was used to estimate a propensity score derived from all available preoperative characteristics. Long-term outcomes were compared using the adjusted Kaplan-Meier method and the weighted Cox proportional hazards regression model. RESULTS After propensity score weighting, the population was balanced. Patients who underwent RG showed reduced blood loss (16 mL less, P = 0.025), sufficient lymph node harvest from the initial period, and no changes in surgical outcomes over time. With 52-month median follow-up, no difference was noted in 5-year overall survival in unweighted [91.5% in LG vs 94% in RG; hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.46-1.1; P = 0.126] and weighted populations (94.2% in LG vs 93.2% in RG; HR, 0.88; 95% CI, 0.52-1.48; P = 0.636). There were no differences in 5-year recurrence-free survival (RFS), with unweighted 5-year RFS of 95.4% for LG and 95.2% for RG (HR, 0.95; 95% CI, 0.55-1.64; P = 0.845) and weighted 5-year RFS of 96.3% for LG and 95.3% for RG (HR, 1.24; 95% CI, 0.66-2.33; P = 0.498). CONCLUSIONS After balancing covariates, RG demonstrated reliable surgical outcomes from the beginning. Long-term survival after RG and LG for GC was similar.

OBJECTIVES: This study aims to compare the changes in lower limb muscle activities after stair ascending and descending training at two different heights of stairs in patients with chronic stroke and to suggest a stair height which is more effective in improving the strength and balancing ability of these patients. PATIENTS AND METHODS: Between November 2016 and February 2017, a total of 20 patients (14 males, 6 females; mean age 56 years; range, 52 to 61 years) with hemiparesis were included in this randomized-controlled study. The patients were randomly assigned to the 10- or 15-cm stair height group (10- and 15-cm groups, respectively; n=10 in each). Both groups received comprehensive rehabilitation therapy and additionally performed stair gait training for 30 min four times per week for a total of six weeks. Balancing abilities and the activities of the paralyzed lower limb’s rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius during stair ascending were measured before and after the stair gait training. RESULTS: During stair ascent, the 15-cm group showed significantly greater muscle activities of the rectus femoris, biceps femoris, and tibialis anterior than the 10-cm group (p

BACKGROUND We aimed to evaluate the safety and efficacy of a clinical pathway (CP) for enhanced recovery after surgery (ERAS) in gastric cancer patients, including early oral feeding and discharge on postoperative day 4. METHODS We performed a prospective, single-center, phase II clinical trial. Based on proposed indications for an ERAS CP in our retrospective study, we enrolled 133 patients younger than 65 years who were undergoing minimally invasive subtotal gastrectomy. The primary endpoint was the ERAS CP completion rate. Secondary endpoints included complication, mortality, hospital stay, and readmission. RESULTS Among 133 patients, six patients were dropped out from this study. The ERAS CP completion rate (77.2%, 98 of 127) was comparable to the historical control group that completed a conventional CP (85.4%, P = .085). The postoperative complication incidence (13.4%, 15 of 127) was also similar to that of the conventional CP group (9.5%, P = .174). We identified reduced hospital stays (4.7 ± 1.3 vs 7.2±2.3 days; P

Regurgitant volume (RVol) calculated using the proximal flow convergence method (proximal isovelocity surface area [PISA]) has been accepted as a key quantitative parameter for the diagnosis of and clinical decision-making with regard to severe mitral regurgitation (MR). However, a recent prospective study showed a significant overestimation of RVol by the echocardiographic PISA method compared with the MR volume measured using magnetic resonance imaging. We aimed to evaluate the frequency of overestimation of RVol by the PISA method and the clinical conditions that require a different quantitative method to correct the overestimation.We retrospectively enrolled 166 consecutive patients with degenerative MR and chordae rupture, in whom RVol was measured using both the PISA and two-dimensional Doppler volumetric methods. The volumetric method was used to measure total stroke volume using the two-dimensional Simpson biplane method, and forward stroke volume was measured using pulsed Doppler tracing at the left ventricular (LV) outflow tract. RVol by the volumetric method was calculated using total stroke volume - forward stroke volume. Severe MR was defined as an RVol60 mL.All patients had severe MR based on RVol by the PISA method, but 68 (41.1%) showed RVol by the volumetric method values of60 mL, resulting in discordant results. The patients with discordant results were characterized by a higher prevalence of female sex, lower body surface area, smaller LV diastolic and systolic dimensions and volumes, smaller left atrial volume, smaller PISA angle, and lower frequency of flail leaflets (39.7% vs 62.2%, P = .004). Multivariate analysis revealed that LV end-diastolic volume (LVEDV) and PISA angle were independent factors, with the best cutoff LVEDV and PISA angle being 173 mL and 103°, respectively. During follow-up (median, 3.4 years; interquartile range, 2.0-4.8 years), mitral valve repair and replacement were performed in 103 and six patients, respectively. The 2-year mitral valve surgery-free survival rate was higher in the discordant group (51.8% ± 0.06% vs 31.2% ± 0.05%, P .001).Even in the patients with documented chordae rupture, the PISA method alone resulted in inappropriate overestimation of MR severity in a significant proportion of patients. Thus, an additive quantitative method is absolutely necessary in patients with a small LVEDV or narrow PISA angle.

To evaluate the effects of bariatric surgery on patients with type 2 diabetes through comparing Asian and non-Asian populations according to follow-up time. In this meta-analysis of randomized controlled trials (RCTs), we searched PubMed databases for relevant articles. A meta-analysis was undertaken of 37 eligible RCTs. Diabetes remission rates among Asian populations were similar to those of non-Asian populations at 1 year (95% confidence interval (CI) 0.519 [0.417, 0.619] vs 0.571 [0.316, 0.794], respectively) but were found to be higher in Asian populations at 2 years compared to non-Asian populations (95% CI 0.672 [0.469, 0.826] vs 0.563 [0.220, 0.855], respectively). Asian populations showed greater reductions in HbA1c (− 3.512 [− 2.726, − 4.299], − 3.001 [− 1.433, − 4.569], and − 3.345 [− 2.267, − 4.423]) than non-Asian populations (− 2.129 [− 1.821, − 2.438], − 2.301 [− 1.881, − 2.722], and − 2.107 [− 1.941, − 2.273]) at 1, 2, and 5 years, respectively. Asian populations also showed greater reductions of fasting plasma glucose than non-Asian populations, and these effects were prominent at 3- and 5-year follow-up (Asian populations, − 83.297 [− 73.264, − 93.331]; non-Asian populations, − 54.288 [− 37.409, − 71.166] at 3 years; Asian populations, − 99.014 [− 82.239, − 115.788]; non-Asian populations, − 45.756 [− 21.892, − 69.621] at 5 years). Bariatric surgery is more successful in diabetes remission and glucose outcome improvement in Asian populations with type 2 diabetes than in non-Asian populations, even over long-term follow-up periods. Bariatric surgery can be considered an effective treatment option and may present an appropriate opportunity to improve the prognosis for Asian patients with type 2 diabetes.

Purpose This cross-sectional study aimed to assess the effect of environmental cadmium (Cd) exposure and essential metal imbalance on renal tubular damage and oxidative stress in 979 adults living in a Cd-polluted area near an abandoned copper (Cu) refinery. Methods We analyzed urinary Cd concentrations, renal tubular damage and oxidative stress markers, such as beta-2 microglobulin (β2-MG) and N-acetyl-β-d-glucosaminidase (NAG) activity and urine malondialdehyde (MDA) levels. The serum copper-to-zinc ratio (CZR) was used as an essential metal imbalance indicator. We divided the subjects into two Cd exposure groups based on the reference level of urinary Cd for renal dysfunction (2 μg/g creatinine). Results The geometric mean concentration of urinary Cd in all subjects was 2.25 μg/g creatinine. In both low and high Cd exposure groups, urinary Cd levels were positively correlated with urinary NAG activity, but not with serum CZR. After multivariate adjustment, serum CZR was strongly associated with urinary β2-MG levels in the low Cd exposure group (β = 1.360, P = 0.019) and was significantly associated with urinary MDA levels, regardless of Cd exposure level. In addition, the risk of renal tubular damage was significantly associated with urinary Cd level, particularly in the lowest or highest CZR tertile groups. Conclusions Essential metal imbalance may be a determinant of oxidative stress and renal tubular damage in a chronically Cd-exposed population, and proper zinc supplementation will be effective in preventing adverse health effects due to Cd exposure.

BACKGROUND AND OBJECTIVES The relationship between operator volume and outcomes of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has not been fully investigated. We aimed to investigate the relationship between operator PCI volume and in-hospital outcomes after primary PCI for STEMI. METHODS Among the total of 44,967 consecutive cases of PCI enrolled in the Korean nationwide, retrospective registry (K-PCI registry), 8,282 patients treated with PCI for STEMI by 373 operators were analyzed. PCI volumes above the 75th percentile (>30 cases/year), between the 75th and 25th percentile (10-30 cases/year), and below the 25th percentile (

Primary malignant melanoma (PMM) of the gastrointestinal tract is rare. Reported cases of PMM of the lower gastrointestinal tract typically describe anal and rectal involvement rather than colonic lesions. This report describes a rare case of a 50-year-old woman with PMM originating in the colon. The patient presented to Inje University Busan Paik Hospital with a 3-day history of blood-tinged stools. She underwent colonoscopy for a diagnosis of hematochezia. The colonoscopic examination revealed a large-sized semi-pedunculated sigmoid colon polyp with a reddish-colored mucosal surface. Endoscopic mucosal resection was performed, and the final histopathological findings were consistent with a diagnosis of malignant melanoma. Systemic work-up was performed for assessment of metastasis and to identify the primary tumor considering the high metastatic rate of gastrointestinal malignant melanoma; however, no other malignant lesion was detected. Thus, she was diagnosed with colonic PMM. She underwent laparoscopic low anterior resection and lymph node dissection and has been recurrence-free for > 2 years.

We hypothesized that a deep-learning algorithm using HE images might be capable of predicting the benefits of adjuvant chemotherapy in cancer patients. HE slides were retrospectively collected from 1343 de-identified breast cancer patients at the Samsung Medical Center and used to develop the Lunit SCOPE algorithm. Lunit SCOPE was trained to predict the recurrence using the 21-gene assay (Oncotype DX) and histological parameters. The risk prediction model predicted the Oncotype DX score 25 and the recurrence survival of the prognosis validation cohort and TCGA cohorts. The most important predictive variable was the mitotic cells in the cancer epithelium. Of the 363 patients who did not receive adjuvant therapy, 104 predicted high risk had a significantly lower survival rate. The top-300 genes highly correlated with the predicted risk were enriched for cell cycle, nuclear division, and cell division. From the Oncotype DX genes, the predicted risk was positively correlated with proliferation-associated genes and negatively correlated with prognostic genes from the estrogen category. An integrative analysis using Lunit SCOPE predicted the risk of cancer recurrence and the early-stage hormone receptor-positive breast cancer patients who would benefit from adjuvant chemotherapy.

Laparoscopic surgery is rapidly evolving with technological advances, but there are several drawbacks. An articulating device, with freedom of a perfect 360°, is attractive as a solution to overcome the restriction of instrument movement caused by straight tools. Its usefulness or efficacy should be supported by relevant scientific evidence. However, it is sometimes difficult to prove it because the factors influencing the surgical outcomes are complex and closely related to each other.

Arsenic is a human carcinogen. Data on urinary arsenic species analyses of Koreans is limited. This study evaluated the arsenic exposure level, contributing factors, and health effects in Korean adults. Dietary intake information and urine samples were obtained from 2,044 participants. Arsenic exposure was assessed based on urinary concentrations of arsenic species, such as inorganic arsenic, As(III) and As(V), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), and arsenobetaine (AsB), using high-performance liquid chromatography with inductively coupled plasma mass spectrometry, followed by determination of biomarkers, malondialdehyde and c-peptide. The geometric mean concentrations were 30.9 ㎍/L for the sum of inorganic arsenic and their metabolites, and 84.7 ㎍/L for the total sum of arsenic measured. Urinary concentrations of arsenic species were influenced by age, inhabitant area (inland or coastal), and seafood intake, which was positively correlated with inorganic arsenic, DMA, and AsB. Rice intake was positively correlated with inorganic arsenic and its metabolites but not with AsB. Additionally, malondialdehyde and c-peptide levels were significantly associated with urinary concentrations of various arsenic species. Seafood and rice are major sources of organic/inorganic arsenic exposure in Korean adults; however, it is necessary to evaluate whether their overconsumption could have a potentially detrimental effect on human health.

DC systems are modernly starting to come into the spotlight again due to the carbon-neutral policy, the development of semiconductor devices for power, and the increase in digital loads. We need to prepare in advance solutions to problems that may arise from fault currents due to transients for future DC power grid models. In the case of DC, there is no current zero-point because there is no frequency. Therefore, a large switching surge is generated when the circuit breaker cuts off the fault current. The possibility of insulation breakdown is greater than that of AC in severe cases. We consider power semiconductors or superconducting current limiters as an alternative. However, DC breaking cannot be safely achieved by itself. For reliable DC breaking, mechanical circuit breakers must be used with them. Among the mechanical shut-off methods, we adopted the divergence oscillation method. It has the biggest advantage compared to other methods in that it has a simple structure by composing passive elements and can artificially create zero current. In addition, it can be applied to a power semiconductor and a superconducting current limiter to perform a high-reliability cut-off operation. In this paper, we conducted simulation analysis by configuring the DC power grid and DC cut-off system through the PSCAD/EMTDC program. Results confirmed that the application of the LC divergence oscillation circuit can reduce the cut-off time and reduce the power burden of the mechanical DC circuit breaker (MCB).