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Chyle leakage after modified radical neck dissection is a rare condition that could be occasionally life-threatening if untreated. We report the first case of successful management of a thoracic duct injury using Viscum album extract (Helixor-M). A 54-year-old woman diagnosed with papillary thyroid cancer of the right lobe of the thyroid with metastasis to cervical lymph node levels II-VI, bilaterally, underwent total thyroidectomy and modified radical neck dissection. Three days postoperatively, the surgical team identified a thoracic duct injury due to drainage of chyle from the Jackson-Pratt drain inserted in the right side of the patient`s neck. Various medical treatments (octreotide, withdrawal of enteral feeding, and total parenteral nutrition) and surgical treatments [lymphatic ligation of cervical lymph node level IV and negative pressure wound therapy (vacuum-assisted closure)] were performed, but the drainage persisted. Viscum album extract (Helixor-M) was then injected through the drain. The dose of Viscum album extract was increased while being cautious of its adverse effects, such as nausea, vomiting, erythema, induration at the injection site, and flu-like symptoms. The injection was effective in stopping the drainage and the patient’s condition improved, without recurrence. The patient was discharged on the 64(th) postoperative day without any further complications. Our results suggest that treatment of thoracic duct injury after neck surgery with Viscum album extract (Helixor-M) may be a novel, less invasive alternative approach to treat cases resistant to standard treatments.

The prognosis of patients with node-negative T1b tumors according to human epidermal growth factor receptor 2 (HER2) status is not known. This group of patients has not been studied in the available randomized trials. The objective of this study was to evaluate the survival of patients in a monoethnic group diagnosed with T1b lymph node-negative breast cancer depending on HER2 status. We analyzed 3110 patients with T1bN0M0 breast cancer whose data were deposited into the Korean Breast Cancer Society Registry database between 2000 and 2009. Overall survival (OS) and breast cancer-specific survival (BCSS) were compared according to HER2 status. Among all patients, 494 (15.9%) had HER2-positive breast cancer. At a mean follow-up of 93 months, 108 deaths and 86 breast cancer-specific deaths were noted among all patients. There was no significant difference in OS between the HER2-negative and HER2-positive groups (p = 0.103). The same result was observed for BCSS. However, in the subgroup of estrogen receptor (ER)-positive women, HER2-negative patients had a better BCSS prognosis than HER2-positive patients (p = 0.025). Multivariate analysis also indicated a significant difference in BCSS in the ER-positive subgroup (HR 2.60; 95% CI 1.15–5.87; p = 0.021). This study analyzed a large nationwide and monoethnic cohort and found a significant difference only in BCSS in the ER-positive subgroup according to HER2 status. Anti-HER2 therapy may be considered in HER2-positive and ER-positive patients with small, node-negative breast cancer.

A multifunctional gate dielectric material based on dual cross-linked aromatic polythiourea (c-PTU) networks for organic field-effect transistors is presented. Tailoring the dual covalent and noncovalent cross-links in the c-PTU gate dielectric enables all the advantageous capabilities of excellent insulating properties, including high capacitance, good solvent resistance and thermal stability, as well as low-temperature solution processing and photo-patterning.

The three-dimensional field-in-field (3-D FIF) technique for radiotherapy is an advanced, state-of-the-art method that uses multileaf collimators to generate a homogeneous and conformal dose distribution via segmental subfields. The purpose of this study is to evaluate the dosimetric reproducibility of 3-D FIF plans using the original simulation computed tomography (iCT) scans and re-simulation CT (rCT) scans for whole breast irradiation (WBI) schedule. This study enrolled a total of 34 patients. The study population underwent iCT scans for standard WBI and took rCT scans after 45 Gy of WBI for cone down boost plans. The dosimetric parameters (V105%, V103%, V100%, V98%, V95%, V90%, V50%), plan quality indices (conformity index, homogeneity index) and clinical parameters (isocenter-breast axis, isocenter-lung axis, soft tissue volumes within radiation field, lung volumes within radiation field) were assessed. The median time interval from surgery to iCT was 33 days and from iCT to rCT was 35 days. All dosimetric parameters exhibited statistically significant differences between iCT and rCT among cohorts with a surgery-iCT interval of p = 0.001) and isocenter-breast axis (p = 0.032) exhibited statistically significant differences among cohorts with surgery-iCT interval

An electrochemical microchip sensor was fabricated through the photolithographic process. The metal paste used in the micro-pattern of the sensor chip contained dendritic and spherical Ag-coated Cu powders, which decreased the electrical resistance of the pattern down to 25.69 Ω·cm by forming a network for electron transfer between particles. The electrode materials were dendritic palladium oxide-nickel oxide powders that showed dramatically high surface area. Also, a synergetic effect on the sensing performance between palladium oxide and nickel oxide was observed. The formation of micro-pattern was investigated through optical microscope and field-emission scanning electron microscope. The body resistance of the conductive paste was calculated using the 4-point probe technique, and the electrochemical characteristics of the sensor were analyzed by cyclic voltammetry and chronoamperometry. The fabricated sensor chip exhibited sensing performance for hydrogen peroxide detection with high sensitivity of 641.75 µA mM−1 cm−2 in a dynamic range between 50 µM and 13 mM. Its long-term stability and high selectivity were also confirmed.

In this paper, describe the fabrication of high strength punch molds that can be applied to ultra-high strength sheet materials after processing. A method for improving the strength of the punching die by additive manufacturing (AM) of a high strength powder material using a metal 3D printer was proposed. Furthermore, a semi-additive technique was proposed to increase the punch strength through partial AM of specific parts of the punch that require high strength. A preprocessing process for predicting the semi-additive shape for the punch function portion is proposed for application of the AM technology of a metal 3D printer to this semi-additive technique. The preprocessing for determining the semi-additive shape consists of the predicting step of the punch strength based on the shear process of the sheet material, analyzing step the stress distribution of the punch, defining step the semi-additive range, designing step the semi-additive shape, and verifying step the additive interface strength. Based on this simulation, the range of shapes for the semi-additive was 1.21 mm and 2.62 mm for sheet material CP1180 and 1.3 mm and 3.2 mm for sheet material 22MnB5. The shape and range determined in the simulation process defines a semi-additive area (volume) for the 3D printing AM technique using a high-strength powder material, and a semi-additive punch was manufactured according to the defined area. The semi-additive punch (HWS powder material) fabricated in this study was performed a durability test for validity verification in the piercing process of high-strength sheet material (CR980). This validation test compared the state of the punch after 1000 piercing processes with a typical cold piercing punch (SKD11 solid material). From this test, the feasibility of the semi-additive punch was confirmed by showing a similar state of scratches and abrasion from the two punches. The simulation analysis processor for the additive shape and the additive range prediction for the semi-additive punch manufacturing presented in this paper can be useful for the additive manufacture of cutting and trimming punch mold.

Harvesting solar energy and generating steam through solar thermal energy are viable approaches with diverse applications such as power generation, desalination, and water purification. Particularly, for efficient and stable solar desalination, hierarchically porous materials are desired to enable the required multiple functionalities. However, high thermal/chemical energy required and time consumed remain roadblocks. In this study, a facile, fast, and scalable laser-induced photothermal method to achieve flexible monolithic bilayer sheets (MBS) of hierarchically porous graphitic carbon (HPGC) and polymeric foam for use in salt-resistant and flexible solar steam generators is reported. The MBS-based self-floating solar steam generator shows outstanding solar desalination performance with a solar thermal efficiency of 83.2% (1-sun) and a high salt-rejection ratio (99.9%). Efficient solar thermal energy transformation is achieved by the versatile multi-functionalities of the MBS, including broad-spectrum solar light absorption, heat localization, and capillary action. Anisotropic wetting properties of hydrophobic HPGC and hydrophilic polyimide (PI) foam effectively prevent salt accumulation on the HPGC surface. The salt-resistant MBS enable long-term stability for solar desalination with actual seawater. Our laser-based photothermal method has potential in the development of high-performance solar thermal systems with substantial cost reduction by scalable production of multiscale hierarchically structured materials from micro-structured polymers.

Vitrimers have shown advantages over conventional thermosets via capabilities of dynamic network rearrangement to endow repairability as well as recyclability. Based on such characteristics, vitrimers have been studied and have shown promises as a 3D printing ink material that can be recycled with the purpose of waste reduction. However, despite the brilliant approaches, there still remain limitations regarding requirement of new reagents for recycling the materials or reprintability issues. Here, a new class of a 4D printable vitrimer that is translated from a commercial poly(ε‐caprolactone) (PCL) resin is reported to exhibit self‐healability, weldability, reprocessability, as well as reprintability. Thus, formed 3D‐printed vitrimer products show superior heat resistance in comparison to commercial PCL prints, and can be repeatedly reprocessed or reprinted via filament extrusion and a handheld fused deposition modeling (FDM)‐based 3D printing method. Furthermore, incorporation of semicrystalline PCL renders capabilities of shape memory for 4D printing applications, and as far as it is known, such demonstration of FDM 3D‐printed shape memory vitrimers has not been realized yet. It is envisioned that this work can fuel advancement in 4D printing industries by suggesting a new material candidate with all‐rounded capabilities with minimized environmental challenges., A widely utilized commercial 3D printing resin poly(ε‐caprolactone) (PCL) is translated into a PCL‐based vitrimer via end‐group crosslinking and transesterification‐based vitrimerization. The formed vitrimer enables dynamic network rearrangement for self‐healing, welding, reprocessing, and viscoelastic flowing. Furthermore, endowed mechanical strength and shape memory effects in comparison to the commercial PCL resin open up a new era for multifunctional fused deposition modeling (FDM)‐based 4D printing.

Purpose The aim of this study was to investigate the therapeutic efficacy of adjuvant modalities for elderly Asian breast cancer patients using population-based data from the Korean Breast Cancer Registry database. Methods We identified 53,582 patients who underwent curative surgery between January 2005 and December 2010. The primary end point was the comparison of overall survival between the administration or omission of adjuvant treatment modalities, including endocrine treatment, radiation therapy, and chemotherapy, in the elderly group (older than 75 years) compared with the control group (younger than 75 years). Results Of the 53,582 patients analyzed, the total number of elderly patients was 901 (1.7%), and the number of control patients was 52,681 (98.3%). Although elderly patients were found to have larger tumor sizes (p = 0.024) and higher pathological stages (p

The purpose of this study is to develop additive manufacturing fabrication for high-strength punches. After screening the powder material and the manufacturing method, a solution possessing excellent mechanical properties was selected for manufacturing. Additive manufacturing specimens and comparative specimens were fabricated using metal materials while the comparative specimens were produced with bulk materials in the same grade as the powder materials. The specimens were tested to determine their mechanical properties. The additive manufacturing specimens were produced through the PBF method for three kinds of die steel powder materials: H13, M300 and KP4. In the experimental section, tests for density, hardness, and toughness were included. SEM and EDS analysis were also used in this study to analyze and observe the microstructure of the additive manufacturing specimens. Considering the mechanical properties test and the SEM and EDS results, it was easy to determine that M300 was the most suitable material for high-strength punches. It not only possesses better mechanical properties, but also a better microstructure than the other two materials. The punch fabricated by the M300 and PBF additive manufacturing methods exhibited good performance in durability testing. In this study, the use of 3D printing technology to produce high-strength punches with high-strength die steel powder material has become a reality. In the future, the process parameters should be optimized and post-processing of punches should be added to obtain additive-manufacturing punches with better mechanical properties.

PTEN hamartoma tumor syndrome is a spectrum of disorders characterized by unique phenotypic features including multiple hamartomas caused by mutations of the tumor suppressor gene PTEN. Cowden syndrome and Bannayan–Riley–Ruvalcaba syndrome are representative diseases, and both have several common clinical features and differences. Because PTEN mutations are associated with an increased risk of malignancy including breast, thyroid, endometrial, and renal cancers, cancer surveillance is an important element of disease management. We report a germline mutation of the PTEN (c.723dupT, exon 7) identified in a young woman with a simultaneous occurrence of breast cancer, dermatofibrosarcoma protuberans, and follicular neoplasm. This case suggests that it is critical for clinicians to recognize the phenotypic features associated with these syndromes to accurately diagnose them and provide preventive care.

This paper studies the growing presence of private equity (PE) acquirers in the hospital industry. We examine employment, operational efficiency and patient outcomes at hospitals acquired by PE firms. While the total employment at target hospitals significantly declines, the proportion of physicians and nurses in the total workforce (skilled worker ratio) increases for hospitals acquired by a publicly traded PE backed hospital. Employment cuts also occur in hospitals acquired by non-PE acquirers, but skilled worker ratio does not increase in those hospitals. PE-backed acquirers, especially publicly traded ones, are also uniquely associated with reductions in overhead costs. Consistent with PE acquirers increasing skilled worker ratio, patient satisfaction scores do not decline at PE-acquired hospitals and even improve along some dimensions. In contrast, patient satisfaction significantly worsens at hospitals acquired by non-PE acquirers. Examining real patient outcomes, we find that PE acquirers are not associated with higher mortality and readmission rates at target hospitals than non-PE acquirers. Overall, our paper provides a comprehensive look at the role of PE acquirers in the hospital industry, and documents nuanced differences between PE and non-PE acquirers, as well as between PE backed acquirers with and without access to public capital markets.

The electronic signature service has been causing various problems due to the rapid growth of e-commerce services. Therefore, in order to create an authentication service suitable for the era of the 4th Industrial Revolution, new security authentication technologies such as the cloud must be utilized. However, there is a lack of prior management studies on the intention to accept digital signatures. Therefore, this study conducted an empirical study to identify factors affecting the intention to adopt cloud-based digital signature services. This research proposed a model based on the technology–organization–environment framework and empirically analyzed the degree of mutual causality and influence between variables using the partial least squares structural equation model. The results show that technical characteristics, organizational characteristics, and environmental characteristics significantly affected the intention to adopt. However, there are still many concerns about the security of cloud-based services. It has been confirmed that solving this problem is the key to the activation of the electronic signature service.

Clozapine is thought to induce obsessive compulsive symptoms (OCS) in schizophrenic patients. However, because OCS are often comorbid with schizophrenia regardless of clozapine treatment, it remains unclear whether clozapine can generate OCS de novo. Thus, it has been difficult to establish a causal link between clozapine and OCS in human studies. To address this question, we asked whether chronic treatment with clozapine can induce obsessive compulsive disorder (OCD)-like behavior in mice. We injected mice with long-term continuous release pellets embedded with clozapine four times at 60-day intervals and then monitored the mice for signs of OCD-like behavior up to 40 wk. of age. We found clozapine increases grooming behavior as early as 30 wk. of age. We also investigated the effect clozapine on grooming behavior in Sapap3 knockout (KO) mice, which are a well-known animal model of OCD. In Sapap3 heterozygous KO mice, clozapine increases grooming behavior much earlier than in wild-type mice, suggesting a clozapine-OCD gene interaction. Fluoxetine, which is often used in the treatment of OCS and OCD, reduced the grooming behavior induced by clozapine. These data demonstrate that chronic clozapine treatment can generate OCD-like behavior in mice and support the hypothesis that clozapine produces de novo OCS regardless of schizophrenia status.

Background We aimed to evaluate the expression of APOBEC3A (A3A), 3B (A3B) mRNA, and germline APOBEC3A/B deletion polymorphism in patients with breast cancers and to investigate the correlation between their expressions and clinicopathological characteristics. Methods RNA and DNA samples were extracted from 138 breast cancer tissues and adjacent normal breast tissues. The levels of A3A and A3B mRNA transcripts were determined using quantitative real-time polymerase chain reaction. Insertion and deletion PCR assays were performed to detect the A3B deletion allele. The serum concentrations of soluble programmed death-ligand 1 (sPD-L1) and interferon gamma were determined using enzyme-linked immunosorbent assays. Results A3B mRNA expression levels were significantly higher in triple-negative breast cancers compared to hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancers. Older age of the patient and high ki-67 expression were associated with increased expression levels of A3A and A3B mRNA. Advanced tumor stage, presence of lymph node involvement, and high histological grade were associated with increased expression levels of A3A mRNA. The APOBEC3A/B deletion allele was found in 77 (55.8%) patients. TP53 and PIK3CA mutations were detected in 62 (44.9%) and 31 (22.5%) patients, respectively. The presence of a PIK3CA mutation was associated with lower A3A mRNA expression levels. There was a weak positive relationship between A3A mRNA expression levels and serum sPD-L1 levels. Conclusions There was a difference in A3B mRNA expression levels according to breast cancer subtypes, and high levels of A3A and A3B mRNA expressions were associated with an aggressive phenotype. There was a high incidence of APOBEC3A/B deletion allele. Further studies are needed to identify the clinical significance of APOBEC in Asian patients with breast cancer.

Batteries for high-rate applications such as electric vehicles need to be efficient at mobilizing charges (both electrons and ions). To this end, choice of the conductive carbon in the electrode can make a significant difference in the performance of the electrode. In this work, graphene nanoribbons (GNRs) are explored as conductive pathways for a silicon-based anode. Water-based electrospinning is employed to directly deposit poly(vinyl alcohol) (PVA)–silicon–graphene nanoribbon composite fibers on a copper current collector. The size of the employed GNRs dictates their placement: either inside each fiber (small GNRs) or as a bridge between multiple fibers (large GNRs). Galvanostatic charge/discharge cycles reveal that fibers with GNRs have higher capacity and overall retention compared to those with corresponding precursor carbon nanotubes (CNTs). To further distinguish the effectiveness of GNRs as the conductive agent, samples with two GNRs and their parent CNTs were subject to rate-capability tests. F...

Background/aims Several lines of evidence from epidemiologic and laboratory studies have shown that the consumption of Artemisia or green tea extracts (MPGT) is inversely associated with the risk of alcohol-induced damage and other chronic diseases. Supported by previous studies showing that the combined extract of Artemisia and green tea, MPGT, exerted significantly either antioxidative or anti-inflammatory actions against Helicobacter pylori-associated gastric diseases, it was hypothesized that MPGT can offer protection against alcoholic gastritis. Methods Ethanol was administered to induce gastric damage in Wistar rats, which had been pretreated with various doses of MPGT, to measure the rescuing action of a MPGT pretreatment against ethanol-induced gastric damage. In addition, the molecular mechanisms for the preventive effects were examined. Results The MPGT pretreatment (100, 300, and 500 mg/kg) alleviated the ethanol-induced gastric damage, which was evidenced by the significant decrease in calcium-dependent phospholipase A2, MAPKs, and NF-κB levels compared to ethanol alone. Furthermore, the MPGT pretreatment preserved 15-prostaglandin dehydrogenase, whereas cyclooxygenase-2 was decreased significantly. All of these biochemical changes led to the significant alleviation of alcohol-associated gastric mucosal damage. Ethanol significantly increased the TUNEL positivity in the stomach, but MPGT decreased the apoptotic index significantly, which was associated with significantly lower pathological scores of ethanol-induced mucosal ulcerations. The significant protective changes observed alcoholic gastritis with MPGT were related to the increased expression of cytoprotective genes, such as heat-shock protein (HSP)27, HSP60, and PDGF. Conclusions The efficient anti-inflammatory, anti-apoptotic, and regenerative actions of MPGT make it a potential nutrient phytoceutical to rescue the stomach from alcoholic gastritis.

The Long-term Hydrologic Impact Assessment Model with Asymptotic Curve Number Regression Equation and Water Quality model (L-THIA ACN-WQ) has been developed to simulate streamflow as well as instream water quality using fewer parameters, compared to other watershed models. However, since model input parameters (i.e. hydraulic response unit (HRU) map, stream network, database (DB), etc.) should be built by user manually, it is difficult to use the model for a nonprofessional or environmental policy decision-maker. In addition, it is difficult to analyze model outputs in time and space because the model does not provide geographic information system (GIS) information for the simulation results. To overcome the limitations, an advanced version of L-THIA ACN-WQ system which is based on ArcGIS interface was developed in this study. To evaluate the applicability of the developed system, it was applied to the Banbyeon A watershed in which total maximum daily load (TMDL) has been implemented. The required model input datasets were automatically collected in the system, and stream flow, T-N and T-P pollutant loads were simulated for the watershed. Furthermore, flow duration curve (FDC) and load duration curve (LDC) were generated to analyze hot spot areas in the system through automatic processes included in the system. The system can establish the model input data easily, automatically provide the graphs of FDC and LDC, and provide hot spot areas which indicate high pollutant loads. Therefore, this system can be useful in establishing various watershed management plans.

Abundance of the ATPase-binding cassette (ABC) transporters and deranged self-renewal pathways characterize the presence of cancer stem cells (CSCs) in gastrointestinal cancers (GI cancers), which play crucial roles in tumorigenesis, chemotherapy resistance, tumor recurrence, and cancer metastasis. Therefore, in order to ensure high cure rates, chemoquiescence, CSCs should be ablated. Recent advances in either understanding CSCs or biomarker identification enable scientists to develop techniques for ablating CSCs and clinicians to provide cancer cure, especially in GI cancers characterized by inflammation-driven carcinogenesis. Areas covered: A novel approach to ablate CSCs in GI cancers, including esophageal, gastric, and colon cancers, is introduced along with explored underlying molecular mechanisms. Expert commentary: Though CSC ablation is still in the empirical stages and not in clinical practice, several strategies for ablating CSCs in GI cancers had been published, proton-pump inhibitors (PPIs) that regulate the membrane-bound ABC transporters, which underlie drug resistance; chloroquine (CQ) that inhibits autophagy, which is responsible for tumor survival; Hedgehog/Wnt/Notch inhibitors that influence the underlying stem-cell growth, and some natural products including Korean red ginseng, cancer-preventive kimchi, Artemisia extract, EGCG from green tea, and walnut extracts.

Various centrifuge model tests on the pile foundations were performed to investigate fundamental characteristics of a pile-soil-foundation system recently, but it is hard to find numerical analysis results of a pile foundation system considering the nonlinear behavior of soil layers due to the dynamic excitations. Numerical analyses for a pile-soil system were carried out to verify the experimental results of centrifuge model tests. Centrifuge model tests were performed at the laboratory applying 1.5Hz sinusoidal base input motions, and nonlinear numerical analyses were performed utilizing a finite element program of P3DASS in the frequency domain and applying the same input motions with the intensities of 0.05 g~0.38 g. Nonlinear soil properties of soil elements were defined by Ramberg-Osgood soil model for the nonlinear dynamic analyses. Nonlinear numerical analyses with the P3DASS program were helpful to predict the trend of experimental responses of a centrifuge model efficiently, even though there were some difficulties in processing analytical results and to find out unintended deficits in measured experimental data. Also nonlinear soil properties of elements in the system can be estimated adequately using an analytical program to compare them with experimental results.

Seismic analyses of a pile under a large rigid basement foundation embedded in the homogeneous soil layer were performed practically by a response displacement method assuming a sinusoidal wave form. However, it is hard to take into account the characteristics of a large mat foundation and a heterogeneous soil layer with the response displacement method. The response displacement method is relevant to the 2D problems for longitudinal structures such as tunnel, underground cave structure, etc., but might not be relevant with isolated foundations for building structures. In this study, seismic pile analysis by a pseudo 3D finite element method was carried out to compare numerical results with results of the response displacement method considering 3D characteristics of a foundation-soil system which is important for the building foundation analyses. Study results show that seismic analyses results of a response displacement method are similar to those of a pseudo 3D numerical method for stiff and dense soil layers, but they are too conservative for a soft soil layer inducing large soil pressures on the foundation wall and large pile displacements due to ignored foundation rigidity and resistance.

Digital, Background: Two glucagon-like peptide-1 (GLP-1) receptor agonists reduced renal outcomes in people with type 2 diabetes at risk for cardiovascular disease. We assessed the long-term effect of the GLP-1 receptor agonist dulaglutide on renal outcomes in an exploratory analysis of the REWIND trial of the effect of dulaglutide on cardiovascular disease. Methods: REWIND was a multicentre, randomised, double-blind, placebo-controlled trial at 371 sites in 24 countries. Men and women aged at least 50 years with type 2 diabetes who had either a previous cardiovascular event or cardiovascular risk factors were randomly assigned (1:1) to either weekly subcutaneous injection of dulaglutide (1·5 mg) or placebo and followed up at least every 6 months for outcomes. Urinary albumin-to-creatinine ratios (UACRs) and estimated glomerular filtration rates (eGFRs) were estimated from urine and serum values measured in local laboratories every 12 months. The primary outcome (first occurrence of the composite endpoint of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes), secondary outcomes (including a composite microvascular outcome), and safety outcomes of this trial have been reported elsewhere. In this exploratory analysis, we investigate the renal component of the composite microvascular outcome, defined as the first occurrence of new macroalbuminuria (UACR >33·9 mg/mmol), a sustained decline in eGFR of 30% or more from baseline, or chronic renal replacement therapy. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01394952. Findings: Between Aug 18, 2011, and Aug 14, 2013, 9901 participants were enrolled and randomly assigned to receive dulaglutide (n=4949) or placebo (n=4952). At baseline, 791 (7·9%) had macroalbuminuria and mean eGFR was 76·9 mL/min per 1·73 m2 (SD 22·7). During a median follow-up of 5·4 years (IQR 5·1-5·9) comprising 51 820 person-years, the renal outcome developed in 848 (17·1%) participants at an incidence rate of 3·5 per 100 person-years in the dulaglutide group and in 970 (19·6%) participants at an incidence rate of 4·1 per 100 person-years in the placebo group (hazard ratio [HR] 0·85, 95% CI 0·77-0·93; p=0·0004). The clearest effect was for new macroalbuminuria (HR 0·77, 95% CI 0·68-0·87; p, Ciencias Médicas y de la Salud

Digital, Background Three different glucagon-like peptide-1 (GLP-1) receptor agonists reduce cardiovascular outcomes in people with type 2 diabetes at high cardiovascular risk with high glycated haemoglobin A1c (HbA1c) concentrations. We assessed the effect of the GLP-1 receptor agonist dulaglutide on major adverse cardiovascular events when added to the existing antihyperglycaemic regimens of individuals with type 2 diabetes with and without previous cardiovascular disease and a wide range of glycaemic control. Methods This multicentre, randomised, double-blind, placebo-controlled trial was done at 371 sites in 24 countries. Men and women aged at least 50 years with type 2 diabetes who had either a previous cardiovascular event or cardiovascular risk factors were randomly assigned (1:1) to either weekly subcutaneous injection of dulaglutide (1·5 mg) or placebo. Randomisation was done by a computer-generated random code with stratification by site. All investigators and participants were masked to treatment assignment. Participants were followed up at least every 6 months for incident cardiovascular and other serious clinical outcomes. The primary outcome was the first occurrence of the composite endpoint of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes (including unknown causes), which was assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01394952. Findings Between Aug 18, 2011, and Aug 14, 2013, 9901 participants (mean age 66·2 years [SD 6·5], median HbA1c 7·2% [IQR 6·6–8·1], 4589 [46·3%] women) were enrolled and randomly assigned to receive dulaglutide (n=4949) or placebo (n=4952). During a median follow-up of 5·4 years (IQR 5·1–5·9), the primary composite outcome occurred in 594 (12·0%) participants at an incidence rate of 2·4 per 100 person-years in the dulaglutide group and in 663 (13·4%) participants at an incidence rate of 2·7 per 100 person-years in the placebo group (hazard ratio [HR] 0·88, 95% CI 0·79–0·99; p=0·026). All-cause mortality did not differ between groups (536 [10·8%] in the dulaglutide group vs 592 [12·0%] in the placebo group; HR 0·90, 95% CI 0·80–1·01; p=0·067). 2347 (47·4%) participants assigned to dulaglutide reported a gastrointestinal adverse event during follow-up compared with 1687 (34·1%) participants assigned to placebo (p, Ciencias Médicas y de la Salud

10566 Background: Since the COVID-19 pandemic began in early 2020, there have been many reports that it has had a significant impact on screening, case identification and referral in cancer diagnosis. We investigated the diagnostic and therapeutic status of breast malignancy before and after the COVID-19 pandemic at the multi-institution level. Methods: We have reviewed the records of patients with breast cancer from February 2019 to July 2020 in six university hospitals in Korea. The patients were divided into two groups according to the initial date of cancer diagnosis: Period A, from February to April and Period B, from May to July in 2020. The two groups were compared for the same periods in 2019. The goals were to determine whether breast cancer screening and diagnosis have been delayed and thus resulted in stage migration. We also examined the difference in the number of surgeries in patients diagnosed with breast cancer during those periods. Results: The total of 1,669 breast malignancy diagnosis was made in the grouped periods of 2019, and 1,369 diagnoses in 2020. All patients were screened by PCR test for COVID-19 prior to hospitalization, and none of them tested positive. Overall, there was a 9.9% reduction in the number of diagnoses than in 2019 and the decrease was more significant in Period A (11.1% vs. 8.7%). According to the age, there was no difference until the 30s but decreased from those in their 40s and above. The decline was more pronounced in the elderly. The COVID-19 pandemic has affected breast cancer screening (decreased by 27.4%) and more diminished in Period A (41.0% vs. 19.0%). Invasive breast cancer stage was not statistically different in Period A compare with 2019 (p = 0.170). But the stage in Period B was different (p = 0.032), and more patients were observed in advanced stages in 2020. The decrease in surgery was noticeably observed in Period A (4.6%, from 480 to 438 surgeries) and not in Period B. The analysis of reconstruction surgery was similar. Conclusions: Patients with COVID-19 increased exponentially from late February in Korea. However, the number of patients per day decreased to less than 100 on March 15 and then flattened. The health care system for cancer was not overloaded and restrictions on visiting hospital were minimal. Analysis in the pandemic period of the 6-month showed that the number of breast cancer screening, diagnosis and surgeries decreased compared with the previous year. Those decreases were prominent in Period A when the COVID-19 patient surged. The upstage migration of breast cancer was generally insignificant but slightly occurred in Period B. The outbreak of infectious disease makes patients reluctant to come to the hospital, especially in the elderly. We need to discuss the potential long-lasting deleterious effect of the COVID-19 pandemic on cancer diagnosis and management. And we should prepare for how to deal with the backlog caused by the COVID-19 pandemic.

Background/Aims Gallstone pathogenesis is linked to mucin hypersecretion and bacterial infection. Several mucin genes have been identified in gallbladder epithelial cells (GBECs). We investigated MUC expression in cholesterol-associated gallbladder disease and evaluated the relationship between mucin and bacterial infection. Methods The present study involved 20 patients with cholesterol stones with cholecystitis, five with cholesterol stones with cholesterolosis, six with cholesterol polyps, two with gallbladder cancer, and six controls. Canine GBECs treated with lipopolysaccharide were also studied. MUC3, MUC5AC, MUC5B, and MUC6 antibodies were used for dot/slot immunoblotting and immunohistochemical studies of the gallbladder epithelial tissues, canine GBECs, and bile. Reverse-transcription polymerase chain reaction was performed to evaluate MUC3 and MUC5B expression. Results MUC3, MUC5AC, MUC5B, and MUC6 were expressed in the normal gallbladder epithelium, and of those, MUC3 and MUC5B exhibited the highest expression levels. Greatly increased levels of MUC3 and MUC5B expression were observed in the cholesterol stone group, and slightly increased levels were observed in the cholesterol polyp group; MUC3 and MUC5B mRNA was also upregulated in those groups. Canine GBECs treated with lipopolysaccharide also showed upregulation of MUC3 and MUC5B. Conclusions The mucin genes with the highest expression levels in gallbladder tissue in cholesterol-associated diseases were MUC3 and MUC5B. Cholesterol stones and gallbladder infections were associated with increased MUC3 and MUC5B expression.

Background: Urgent surgery performed for appendicitis is hypothesized to avoid complications such as perforation or abscess. This study aimed to evaluate the effect of the timing of surgery on the complications of laparoscopic appendectomy. Methods: A retrospective review of 4,065 patients who underwent a laparoscopic appendectomy was conducted. The demographic data, time of presentation, physical findings, diagnostic data and complications were recorded. The patients were divided into 4 groups (Group A, 0-6 h; Group B, 6-12 h; Group C, 12-18 h; Group D, over 18 h) based on the time elapsed from the evaluation at the emergency room to the appendectomy. Results: Group A consisted of 2,084 (51.3%) patients, Group B consisted of 1,553 (38.2%) patients, Group C consisted of 388 (9.5%) patients and Group D consisted of 40 (1.8%) patients. A perforated appendicitis was observed in 560 (13.8%) patients. Postoperative complications developed in 293 (7.2%) patients. No significant differences in perforation and postoperative complications were observed between the 4 groups. Conclusion: The timing of surgery did not affect the incidence of complications or perforated appendicitis.

Studies suggest that long-chain ω-3 polyunsaturated fatty acid (LCω3PUFA) intake and its primary food source—fish—may have beneficial effects on the individual components of metabolic syndrome (MetS). We examined the longitudinal association between fish or LCω3PUFA intake and MetS incidence. We prospectively followed 4356 American young adults, free from MetS and diabetes at baseline, for incident MetS and its components in relation to fish and LCω3PUFA intake. MetS was defined by the National Cholesterol Education Program/Adult Treatment Panel III criteria. Cox proportional hazards model was used for analyses, controlling for socio-demographic, behavioral, and dietary factors. During the 25-year follow-up, a total of 1069 incident cases of MetS were identified. LCω3PUFA intake was inversely associated with the incidence of MetS in a dose–response manner. The multivariable adjusted hazards ratio (HR) [95 % confidence interval (CI)] of incident MetS was 0.54 (95 % CI 0.44, 0.67; P for linear trend

Differential diagnosis of posterior neck pain is very challenging based on symptoms and physical examination only. Retropharyngeal calcific tendinitis is a rare and frequently misdiagnosed entity in various causes of neck pain. It results from calcium hydroxyapatite deposition in the longus colli muscle which is characterized by severe neck pain, painful restriction of neck movement, dysphagia, and odynophagia. We herein report a case of a patient with acute retropharyngeal calcific tendinitis, who complained of posterior neck pain, initially diagnosed and treated as a myofascial neck pain syndrome.

The post-processing (punching or trimming) of high-strength parts reinforced by hot stamping requires punch molds with improved mechanical properties in hardness, resistance to wear, and toughness. In this study, a semi-additive manufacturing (semi-AM) method of heterogeneous materials was proposed to strengthen these properties using high wear resistance steel (HWS) powder and directed energy deposition (DED) technology. To verify these mechanical properties as a material for the punch mold for cutting, specimens were prepared and tested by a semi-AM method of heterogeneous material. The test results of the HWS additive material by the semi-AM method proposed in this study are as follows: the hardness was 60.59&ndash, 62.0 HRc, which was like the Bulk D2 specimen. The wear resistance was about 4.2 times compared to that of the D2 specimen, the toughness was about 4.0 times that of the bulk D2 specimen, the compressive strength was about 1.45 times that of the bulk D2 specimen, the true density showed 100% with no porosity. Moreover, the absorption energy was 59.0 J in a multi-semi-AM specimen of heterogeneous materials having an intermediate buffer layer (P21 powder material). The semi-AM method of heterogeneous materials presented in this study could be applied as a method to strengthen the punch mold for cutting. In addition, the multi-semi-AM method of heterogeneous materials will be able to control the mechanical properties of the additive material.

The aim of this study was to assess tissue computed tomography (CT) number changes and corresponding dosimetric shifts in repeatedly performed simulation CT (re-sim CT) scans after conventionally fractionated irradiation in breast cancer patients. A total of 28 breast cancer patients who underwent breast-conserving surgery were enrolled in this study. All the patients had received 50.4 Gy of conventional whole-breast irradiation (WBI) and underwent re-sim CT scans for tumor bed boost. For evaluation of dosimetric shifts between initial and re-sim CT scans, electron boost plans in the same field size with the same monitor unit with source-to-skin distance of 100 cm were conducted. Dosimetric parameters (V105%, V103%, V100%, V98%, V95%, V90%: Vx% indicates volumes which receive X% of prescribed doses) between initial and re-sim CT scans were compared. The CT number data (CTmean, CTmax, CTmin) of the original and irradiated CT (re-sim CT) scans from each representative structure (lung, rib bone, soft tissue, muscle, etc.) were examined and recruited. CT numbers showed highly variable changes. Soft tissue CTmean and muscle CTmax/CTmin showed statistically and significantly increased values in the CT (re-sim CT) compared to the original CT scans. Rib bone CTmean/CTmin showed statistically and significantly decreased values in the re-sim CT compared to the original CT scans. Other CT number values showed no statistically significant changes. Among the dosimetric parameters, only V105% (p = 0.015, mean = 3.07 cc versus 1.63 cc) and V103% (p = 0.017, mean = 13.8 cc versus 11.9 cc) exhibited statistically increased values in the re-sim CT compared to the original CT scans. CT number changes after conventional WBI were different according to tissue component. For electron boost plans, the implementation of a re-sim CT might be helpfully considered because significant dosimetric factor changes were observed especially in the high-dose areas (hot spots: V105% and V103%).

Purpose Triple-positive breast cancer is defined by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) positivity. Several systemic breast cancer therapies target hormonal and HER2 responsiveness. We compared clinical outcomes of triple-positive disease with those of HER2-enriched and luminal HER2-negative disease and investigated the clinical efficacy of anti-HER2 therapy for triple-positive disease. Methods We retrospectively compared overall and recurrence-free survival among cases included in the Korean Breast Cancer Society (KBCS) and Seoul St. Mary's Hospital breast cancer registries and the therapeutic efficacy of trastuzumab for triple-positive and HER2-enriched cases. Results KBCS registry data (2006–2010; median follow-up, 76 months) indicated that patients with triple-positive breast cancer had intermediate survival between those with luminal A and HER2-enriched subtypes (p

PURPOSES : It is desirable for buses to be parallel to the face of the bus shelter at a bus stop. In this way, passengers can safely use the buses without moving into the vehicle area. The study was a review of the current bus bay geometric guidelines, to determine whether they lead buses to stop parallel to the face of the bus shelter by analyzing vehicle trajectory. METHODS : A commercial software program for vehicle trajectory analysis was used under our assumptions about bus dimensions and geometric values. The final position of the bus was analyzed for multiple trajectory simulations, reflecting various geometric alternatives. RESULTS : Within the scope of the study, we concluded that the current design guidelines need to be revised by the design values suggested by the study. CONCLUSIONS : The results of the study suggested alternative design values for bus bay geometry, based on the assumption that buses should be parallel to the face of the bus shelter in order to prevent passengers from moving into the vehicle area.

Purpose CD133 and aldehyde dehydrogenase 1 (ALDH1) expression are reliable poor-prognosis markers associated with the presence of adverse biomarkers and subtypes of breast cancer. The aim of our study was to investigate and compare the clinical impact of CD133 and ALDH1 expression in invasive breast cancer. Methods A total of 291 consecutive patients with invasive breast cancer who underwent breast cancer operations from 2005 to 2010 at a single institution were included in this retrospective review. CD133 and ALDH1 expression were determined by immunohistochemistry. Results CD133 and ALDH1 expression were positive in 24.7% and 22.0% of the patients, respectively, and were associated with tumor size, cancer stage, estrogen receptor negativity, nonluminal subtype, triple-negative breast cancer, and recurrence. CD133 expression was significantly associated with lymph node metastasis, progesterone receptor negativity, human epidermal growth factor receptor 2 positivity, chemotherapy, and poor disease-free (p=0.002) and overall survival (p=0.014), but ALDH1 expression was not. Cancer stage (p

Objective To determine whether different methods of hemostasis and pathologic subtypes would lead to significant differences regarding ovarian reserve after laparoscopic ovarian cystectomy. Study design Data were prospectively collected from 129 patients who underwent laparoscopic ovarian cystectomy with either a hemostatic sealant (FloSeal or TachoSil) or bipolar coagulation to achieve hemostasis. Serum anti-Mullerian hormone (AMH) levels as measured by enzyme immunoassay. Measurements were made preoperatively and at 3 months postsurgery in each group [bipolar coagulator group ( n =43), FloSeal group ( n =46), and TachoSil group ( n =40)]. Results Age, BMI, parity, sociodemographic variables, and preoperative AMH levels were similar between the three groups of patients. At 3 months post-surgery, the AMH decline rate was significantly greater in the bipolar coagulation group compared with the two hemostatic sealant groups (41.2% [IQR, 16.7–52.4] vs. 15.4% [IQR, 5.2–41.9], respectively; P =0.003). However, the AMH decline rates of the two hemostatic sealant groups (FloSeal and TachoSil) were not significantly different (15.4% [IQR, 7.8–44.6] vs. 15.9% [IQR, 0.7–41.1], P =0.962). Also, subgroup analysis according to ovarian cyst type revealed no significant differences in the rate of serum AMH decline regardless of the hemostatic method (bipolar group, P =0.30; FloSeal group, P =0.47, and TachoSil group, P =0.79). Conclusion The two hemostatic sealants (FloSeal and Tachosil) did not exhibit any significant differences regarding the preservation of ovarian reserve regardless of ovarian cyst type.

In recently, the Korea government is concerning on non-point source pollution management to improve water quality. The objective of this paper is to investigate the improvement measurement for management of livestock wastes. As a result, we find that the National Pollution Source Survey is necessary to establish the unified database system with the Korea Statistics(KOSAT) in order to minimize the difference between relevant data. The investigation for environmental impact of livestock manure should be supported the designation of control areas and establishment of the technical guidelines including target material, monitoring site, standard method, etc. In addition, it should be followed by appropriate nutrient recycling and proper fertilizer usage based on social consultation and cost-benefit analysis. Key words : Environmental Impact Investigation, Livestock manure, National Pollution Source Survey, Systems Improve-ment , Water quality management 1. Introduction 1)우리나라의 유량변동계수는 타국가에 비해 매우 크고, 홍수기에 집중된 강수량을 이용하여 수자원을 관리 및 개발하고 있다. 이와 같은 가용수자원의 시간적 변동성은 물관리를 어렵게 하고 있고 특히 도시화, 산업화의 가속화로 인한 토지용도 변경, 높은 인구밀도, 다양하게 분산되어 있는 오염배출원 등 수질관리 역시 유리한 상황이 아니다 . 그러나 식수원의 대부분이 하천이고 산업 및 농축산업과의 밀접한 관련성으로 물 분야에 대한 투자는 간과할 수 있는 문제가 아니다. 이에 정부는 주요하천에 대해 수질개선 특별종합대책 등 지속적인 투자를 실시하여 오염이 심했던 주요 도심하천의 경우 생화학적 산소요구량이 과거에 비해 평균 76.9mg/L에서 3.8mg/L로 약 95%까지 낮아지는 등 수질이 많이 개선되었다(MOE, 2015). 특히 1978년 ｢환경보전법｣이 제정된 이후 수십 년간 환경기초시설의 집중적인 투자와 입지규제를 통해 공공수역에서의 유기물질 관리지표인 BOD는 지속적으로 감소 중에 있다.그러나 기후변화로 인한 기상이변과 그 결과로 나타나는 가뭄과 홍수 그리고 강우빈도 및 강우강도 등의 변화는 도

In this paper, we report the fabrication of a polyimide/polyvinyl alcohol (PVA) bilayer gate insulator for low-voltage organic thin-film transistors (TFTs). The introduction of a PVA layer to form a bilayer structure improves the dielectric and insulating properties of the gate insulator. Organic TFTs with 150 nm-thick polyimide and PVA gate insulators were inactive at low operation voltages below 5 V. Conversely, organic TFTs with 150 nm-thick polyimide/PVA bilayer gate insulators exhibited excellent device performances. Our results suggest that the introduction of a PVA layer with a high dielectric constant could be a simple and efficient way to improve the device performance of low-voltage organic TFTs.

In this paper, we developed a Web App that operates in a mobile device. Also, we designed and developed an electronic dictionary of English words and sentences are expressed by English pronunciation with hangeul. The database using English words, Hangeul code with pictures, vocabulary definitions, speech sound files, and many sentences are created in this system. We developed the English learning system using HTML5 and m-Bizmaker software tools.

Response spectra of a building are made with a SDOF system taking into account a first mode shape, even though higher modes may affect on the dynamic responses of a high-rise building. A soft soil layer under a building also affects on the responses of a building. In this study, seismic responses of a MDOF system were investigated to examine the effects of higher modes on the response of a tall building by comparing them with those of a SDOF system including the kinematic interaction effect. Study was performed using a pseudo 3D finite element program with seven bedrock earthquake records downloaded from the PEER database. Effects of higher modes on the seismic responses of a tall building were investigated for base shear force and base moment of a MDOF system including story shear forces and story moments. Study results show that higher modes of a MDOF system contribute to a reduction of base shear force up to 1/4-1/5 of KBC and base moment. The effect of higher modes is more significant on the base shear force than on the base moment. Maximum story shear force and moment occurred at the top part of a building rather than at a base in the cases of tall buildings differently from short buildings, and higher modes of a tall building affected on the base forces making them almost constant at the base. A soft soil layer also affects some on the base shear force of a high-rise building independently on the soft soil type, but a soft soil effect is prominent on the base moment.

In Korea, Total Maximum Daily Loads(TMDLs) has been enforced to restore and manage water quality in the watersheds. However, some assesment of implementation plan of TMDLs showed that the achievement of the target water quality is not related to the proper allocation loads because difference of flow duration interval. In the United States, the discharge loads are determined by water quality modeling considering standard flow conditions according to purpose. Therefore, this study tried to develop the allocation method considering economical efficiency using water quality model. For this purpose, several allocation methods being used in the management of TMDLs is investigated and develope an allocation criteria considering regional equality and uniformity. Since WARMF(Watershed Analysis Risk Management Framework) model can simulate the time varying behavior of a system and the various water quality variables, it was selected for a decision support system in this study. This model showed fairly good performance by adequately simulating observed discharge and water quality in Miho watershed. Furthermore, the scenario simulation results showed that the effect of annual average water quality improvement to remove 1kg BOD is more than 25 times, even if point pollutants treatment facility is six times more expensive to operate than non-point pollutants treatment facility.

Spatially variable ground motions can be significant on the seismic response of a structure due to the incoherency of the incident wave. Incoherence of the incident wave is resulted from wave passage and wave scattering. In this study, wave passage effect on the response spectrum of a building structure built on a soft soil layer was investigated utilizing a finite element program of P3DASS (Pseudo 3-dimensional Dynamic Analysis of a Structure-soil System). P3DASS was developed for the axisymmetric problem in the cylindrical coordinate, but it is modified to apply anti-symmetric input earthquake motions. Study results were compared with the experimental results to verify the reliability of P3DASS program for the shear wave velocity of 250 m/s and the apparent shear wave velocities of 2000-3500 m/s. Studied transfer functions of input motions between surface mat foundation and free ground surface were well-agreed to the experimental ones with a small difference in all frequency ranges, showing some reductions of the transfer function in the high frequency range. Also wave passage effect on the elastic response spectrum reduced the elastic seismic response of a SDOF system somewhat in the short period range.

Fish and long-chain ω-3 polyunsaturated fatty acid (LCω3PUFA) intake in relation to the risk of cardiovascular diseases have been well studied. However, studies that directly link fish consumption or LCω3PUFA intake to the risk of metabolic syndrome (MetS) are sparse and the results are inconsistent. We reviewed literature through December 2014 and used random-effects or fixed-effects models, as appropriate, to pool the associations of fish or LCω3PUFA intake with the risk of MetS. Nine independent cross-sectional samples (seven cross-sectional studies) and three independent prospective cohorts (two prospective cohort studies) were identified as eligible for this meta-analysis. By pooling data from the prospective cohorts (7860 participants and 1671 incident cases), a significant inverse association between fish consumption and incidence of MetS was found. The pooled RR (95% CI) was 0.71 (0.58, 0.87), comparing the highest to the lowest category of fish consumption, and 0.94 (0.90, 0.98) for one serving/week increment. Consistent results were found for LCω3PUFA intake. Non-significant inverse association of fish or LCω3PUFA intake with risk of MetS was found when pooling the cross-sectional studies. By quantitatively summarizing the literature, a modest inverse association between fish or LCω3PUFA intake and risk of MetS cannot be excluded.