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Intracranial neurenteric cyst at the anterior craniocervical junction is very rare, and its treatment and prognosis have not been established. We report a case of neurenteric cyst at the anterior craniocervical junction and review the relevant literature. A 16-year-old girl presented with a 2-month history of slowly progressive headache. MRI revealed a well-defined intradural extramedullary cyst in the anterior medulla and brain stem with C1 cord compression. We performed gross total resection of the cyst using a far-lateral transcondylar approach. Surgical resection is the treatment of choice for neurenteric cysts at anterior craniocervical junction, the far-lateral transcondylar approach might be the optimal surgical approach.

Objective: The aim of this nationwide age- and sex- matched longitudinal follow up study is to determine the risk of Parkinson’s disease (PD) associated with ischemic stroke in Korea.Methods: Patient data were collected from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS). PD was identified using the International Classification of Diseases (ICD) 10-CM code G 20. In total, 6,475 patients were enrolled in the PD group from the NHISS. After subtracting 1,039 patients who underwent hospitalization less than once or those who visited an outpatient clinic less than two times, 5,259 patients who were diagnosed after January 1, 2004 ultimately participated in this study. After case-control match was done through 1:5 age- and sex- stratified matching, 26,295 individuals were chosen as control. Kaplan-Meier method and Cox proportional hazard regression analysis were performed to evaluate the risk of ischemic stroke in PD.Results: The hazard ratio of ischemic stroke in the PD group was 3.848 (95% confidence interval (confidence interval [CI]): 3.14-4.70) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in PD group was 3.885 (95% CI: 3.17-4.75) after adjusting for comorbidities. According to subgroup analysis, in male and female and non-diabetes and diabetes and non-hypertension and hypertension and dyslipidemia and non-dyslipidemia subgroups, ischemic stroke incidence rates were significantly higher in the PD group than those in the control group.Conclusions: This nationwide longitudinal study suggests an increased risk of ischemic stroke in PD patients.

Low hemoglobin levels are known to be associated with hematoma expansion (HE) and poor functional outcome in patients with intracerebral hemorrhage (ICH). However, it is not yet known whether low hemoglobin itself causes HE directly or is merely a confounder. Thus, we investigated the mediation effect of the mean Hounsfield unit (HU) of hematoma on the relationship between low hemoglobin and expansion of ICH. Overall, 232 consecutive patients with ICH who underwent non-contrast computed tomography (NCCT) within 12 h since onset were included. The mean HU and hematoma volume on NCCT were investigated using semi-automated planimetry. HE was defined as an increase in hematoma volume > 33% or 6 mL. The respective associations among the hemoglobin level, mean HU, and HE were analyzed using multivariable regression analysis, adjusting for age, sex, and known HE predictors. Mediation analysis was performed to examine the potential causal association among the three. HE occurred in 34.5% of patients; hemoglobin levels were inversely associated with HE occurrence (adjusted odds ratio, 0.90; p = 0.03). The mean HU of the hematoma was lower in patients with HE than in patients without HE (58.5 ± 3.3 vs. 56.8 ± 3.0; p p p = 0.04). The proportion of indirect effect through the mean HU among the total effect was 19% (p = 0.05). The mediation effect became nonsignificant in the when the multivariable model was adjusted with additional covariates (baseline systolic blood pressure and hematoma location). The mean HU of the hematoma mediated the association between hemoglobin levels and HE occurrence. Therefore, the mean HU of the hematoma may be a potential marker of impaired hemostasis in patients with ICH.

Purpose: Determining appropriate ways to assess health care quality within the National Health Insurance System is of interest to both the Korean government and the medical community. However, in the trauma field, the number of indicators used to evaluate surgical quality is limited. Using data collected over 5 years at Wonju Severance Christian Hospital Trauma Center in Korea, this study aimed to determine whether the unplanned reoperation rate in the field of trauma surgery could be used to assess the quality of an institution’s surgical care. Methods: In total, 665 general surgical procedures were performed at the Trauma Center in 453 patients with abdominopelvic injuries from January 2015 to December 2019. Data were collected from the Trauma Center’s data registry and medical records, and included information regarding patients’ demographic characteristics, the type of index operation, and the reason for unplanned reoperations. Results: A total of 453 index operations were evaluated. The proportion of patients with an Injury Severity Score (ISS) >15 was 48-70% over the 5-year period, with an unplanned reoperation rate of 2.1-9.3%. Patients had an average ISS score of 17.5, while the average Abbreviated Injury Scale Score was 2.87. Unplanned reoperations were required in about 7% of patients. The most common complications requiring reoperation were recurrent bleeding (26.9%), wound problems (26.9%), intestinal infarction (15.4%), and anastomosis site leakage (7.7%). The procedures most frequently requiring unplanned reoperations were bowel surgery (segmental resection, primary repair, enterostomy, etc.) (24.5%) and preperitoneal pelvic packing (10.6%). Conclusions: The proportion of reoperations was confirmed to be affected by injury severity.

There are several reports in the literature on the association between non-arteritic retinal artery occlusion (NA-RAO) and acute ischemic stroke. We investigated the burden of small vessel disease (SVD) and cerebral coincident infarction observed on cerebral magnetic resonance imaging (MRI) in patients with newly diagnosed NA-RAO. In this retrospective, observational, case-series study, consecutive patients with NA-RAO who underwent cerebral MRI within one month of diagnosis between September 2003 and October 2018 were included. The classification of NA-RAO was based on ophthalmologic and systemic examinations. We also investigated the co-incident infarction and burden of underlying SVD, which were categorized as white matter hyperintensity lesion (WMH), cerebral microbleeds (CMB), and silent lacunar infarction (SLI). Among the 272 patients enrolled in the study, 18% presented co-incident infarction and 73% had SVD, which included WMH (70%), CMB (14%), and SLI (30%). Co-incident infarction, WMH, and SLI significantly increased with age: co-incident infarction was observed in 8% of young (P = 0.002) and co-incident infarction (30%: 19%: 8%; P = 0.009). Therefore, high co-incidence of acute cerebral infarction and underlying SVD burden warrant careful neurologic examination and appropriate brain imaging, followed by management of NA-RAO. Urgent brain imaging is particularly pertinent in elderly patients with NA-RAO.

BACKGROUND To describe a case of bilateral brain infarction associated with iatrogenic ophthalmic artery occlusion after cosmetic facial filler injection and to elucidate the pathogenic mechanism of bilateral brain infarction. METHODS Case report and review of the literature. RESULTS A case of unilateral blindness due to iatrogenic ophthalmic artery occlusion accompanied by bilateral brain infarction after cosmetic facial filler injection is described. Fluorescein angiographic images demonstrate ischemia of the retina and choroid. Associated bilateral brain infarction was observed on MRI. CONCLUSIONS Bilateral embolic events after facial filler injection are very rare. However, several cases of unilateral iatrogenic ophthalmic or retinal artery occlusion accompanied by bilateral brain infarction have been reported. The possible route of filler material to the contralateral cerebral artery is through the anterior communicating artery. Brain infarction, especially contralateral embolic events, should be considered in severe cases of iatrogenic ophthalmic artery occlusion after facial filler injection.

This study aims to analyze South Korea’s experience during the COVID-19 outbreak through a gendered lens. We briefly introduce the COVID-19 outbreak in Korea, scrutinize gendered vulnerability in contracting the virus, and then analyze the gendered aspects of the pandemic response in two phases: quarantine policy and mitigation policy. The authors elicit four lessons from the analysis. First, gender needs to be mainstreamed at all stages of a public health emergency response. Second, in addition to medical care, all formal and informal care work should be considered as an essential component of health care systems. Third, a people-centered approach in health governance should be prioritized to make women’s voices heard at every level. Fourth, medical technology and resources to cope with pandemic should be produced and distributed in an equitable manner, acknowledging differential vulnerability and susceptibility.

ObjectiveStroke is a devastating and costly disease; however, there is a paucity of information on long-term costs and on how they differ according to 3-month modified Rankin scale (mRS) score, which is a primary outcome variable in acute stroke intervention trials.MethodsWe analyzed a prospective multicenter stroke registry (Clinical Research Collaboration for Stroke in Korea) database through linkage with claims data from the National Health Insurance Service with follow-up to December 2016. Healthcare expenditures were converted into daily cost individually, and annual and cumulative costs up to 5 years were estimated and compared according to the 3-month mRS score.ResultsBetween January 2011 and November 2013, 11,136 patients were enrolled in the study. The mean age was 68 years, and 58% were men. The median follow-up period was 3.9 years (range 0–5 years). Mean cumulative cost over 5 years was $117,576 (US dollars [USD]); the cost in the first year after stroke was the highest ($38,152 USD), which increased markedly from the cost a year before stroke ($8,718 USD). The mean 5-year cumulative costs differed significantly according to the 3-month mRS score (p < 0.001); the costs for a 3-month mRS score of 0 or 5 were $53,578 and $257,486 USD, respectively. Three-month mRS score was an independent determinant of long-term costs after stroke.ConclusionsWe show that 3-month mRS score plays an important role in the prediction of long-term costs after stroke. Such estimates relating to 3-month mRS categories may be valuable when undertaking health economic evaluations related to stroke care.

Poststroke complex regional pain syndrome (CRPS) is characterized by swelling, pain, and changes in the skin that appear on the affected wrist and hand. In this retrospective study, we analyzed the relationship between poststroke CRPS and the location of stroke lesion. From all patients admitted to our hospital from 2009 to 2019, we recruited 80 patients affected by their first unilateral stroke who met the inclusion/exclusion criteria. Thirty-eight patients diagnosed with CRPS after stroke were assigned to the experimental group according to the "Budapest criteria" adopted by the International Association for the Study of Pain, and 42 patients without CRPS were included as controls. Regions of interest were manually drawn on T1-weighted magnetic resonance images, and data were normalized to a standard brain template. In the poststroke CRPS group, the relationship between the location of brain lesion and pain severity was analyzed using Freedman-Lane multivariable regression adjusting for Medication Quantification Scale rating, which was the only parameter to show a statistically significant correlation with pain intensity. A threshold of P < 0.01 was considered statistically significant for all voxel-based lesion symptom mapping tests, corrected for multiple comparisons with 5000 permutations. Analyses using voxel-wise subtraction and Liebermeister statistics indicated that the corticospinal tract (CST) was associated with the development of poststroke CRPS. Statistically significant correlations were found between pain intensity and the CST and the adjacent lentiform nucleus. Our results suggest that the CST may be a relevant neural structure for development of poststroke CRPS and the intensity of pain caused by the syndrome.

Molybdenum disulfide (MoS2) counter electrode (CE) is considered one of the most viable alternatives to Pt CE in dye-sensitized solar cells (DSSCs) owing to its abundance, low cost, and superior electrocatalytic activity. However, mostly, MoS2 CEs for DSSCs are prepared by conventional chemical reactions and annealing at a high temperature. By these conventional processes, deposition of sufficiently thin and transparent MoS2 layers is challenging; therefore, bifacial DSSCs employing transparent MoS2 CEs have not been studied. Here, we report transparent few-nanometer-thick MoS2 CEs prepared by atomic layer deposition at a relatively low temperature (98 °C) for bifacial DSSC applications. MoS2 nanofilms with precisely controlled thicknesses of 3–16 nm are conformally coated on transparent conducting oxide glass substrates. With increase in the MoS2 nanofilm thickness, the MoS2 CE electrocatalytic activity for the iodide/triiodide redox couple enhances, but its transparency decreases. Notably, the application of a thinner MoS2 nanofilm in a bifacial DSSC leads to lower conversion efficiency under front-illumination, but higher conversion efficiency under back-illumination. In particular, only the 3 nm-thick MoS2 nanofilm shows reasonable photovoltaic performances under both front- and back-illumination conditions.

The issue of cell-to-cell interferences is a serious problem that has always been raised in digital communication system such as NR. The communication method of NR and LTE is OFDM. OFDM has many advantages, but has fatal disadvantage called ICI (Inter-Cell Interference) because resources among cells are always overlapped. For example, NR’s typical interferences are ICIs among PDSCH (Physical Downlink Shared Channel), PDCCH (Physical Downlink Control Channel), PUSCH (Physical Uplink Shared Channel), PUCCH (Physical Uplink Control Channel), CSI-RS (Channel State Information-Reference Signal) and SRS (Sounding Reference Signal). Among them, it is important to determine the correct beamforming weight factor value by estimating the channel with SRS. Therefore, the ICI of SRS degrades the performance of downlink throughput. This paper analyses the impact of SRS’s ICI in conventional scheme, introduces the proposed AC-CS (Auto-Correlation Cyclic Shift) schemes by the Zadoff-Chu sequence to overcome the ICI of SRS and analyses theirs performance. The method used for performance analysis is determined by the detection abilities, which are missing probability and false alarm probability.

Introduction: Clinical implications of elevated fasting triglycerides (FTG) and non-fasting triglycerides (NFTG) in acute ischemic stroke (AIS) remain unknown. We aimed to elucidate the correlation and clinical significance of FTG and NFTG levels in AIS patients. Methods Using a multicenter prospective stroke registry, we identified AIS patients hospitalized within 24h of onset with available NFTG results. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all-cause mortality up to one year. Results This study analyzed 2,176 patients. The prevalence of fasting and non-fasting hypertriglyceridemia was 11.5% and 24.6%, respectively. Multivariate analysis revealed that younger age, diabetes, higher body mass index and initial systolic blood pressure were independently associated with both fasting and non-fasting hypertriglyceridemia (all p p

Background: Although chest radiographs have not been utilised well for classifying stroke subtypes, they could provide a plethora of information on cardioembolic stroke. This study aimed to develop a deep convolutional neural network that could diagnose cardioembolic stroke based on chest radiographs. Methods: Overall, 4,064 chest radiographs of consecutive patients with acute ischaemic stroke were collected from a prospectively maintained stroke registry. Chest radiographs were randomly partitioned into training/validation (n = 3,255) and internal test (n = 809) datasets in an 8:2 ratio. A densely connected convolutional network (ASTRO-X) was trained to diagnose cardioembolic stroke based on chest radiographs. The performance of ASTRO-X was evaluated using the area under the receiver operating characteristic curve. Gradient-weighted class activation mapping was used to evaluate the region of focus of ASTRO-X. External testing was performed with 750 chest radiographs of patients with acute ischaemic stroke from 7 hospitals. Findings: The areas under the receiver operating characteristic curve of ASTRO-X were 0.86 (95% confidence interval [CI], 0.83–0.89) and 0.82 (95% CI, 0.79–0.85) during the internal and multicentre external testing, respectively. The gradient-weighted class activation map demonstrated that ASTRO-X was focused on the area where the left atrium was located. Compared with cases predicted as non-cardioembolism by ASTRO-X, cases predicted as cardioembolism by ASTRO-X had higher left atrial volume index and lower left ventricular ejection fraction in echocardiography. Interpretation: ASTRO-X, a deep neural network developed to diagnose cardioembolic stroke based on chest radiographs, demonstrated good classification performance and biological plausibility. Funding Grant No. 14–2020–046 and 08–2016–051 from the Seoul National University Bundang Research Fund and NRF-2020M3E5D9079768 from the National Research Foundation of Korea.

Background and Purpose: Intracranial atherosclerosis-related large-vessel occlusion caused by in situ thrombo-occlusion (ICAS-LVO) has been regarded an important reason for refractoriness to mechanical thrombectomy (MT). To achieve better outcomes for ICAS-LVO, different endovascular strategies should be explored. We aimed to investigate an optimal endovascular strategy for ICAS-LVO.Methods: We retrospectively reviewed three prospective registries of acute stroke underwent endovascular treatment. Among them, patients with ICAS-LVO were assigned to four groups based on their endovascular strategy: (1) MT alone, (2) rescue intracranial stenting after MT failure (MT-RS), (3) glycoprotein IIb/IIIa inhibitor infusion after MT failure (MT-GPI), and (4) a combination of MT-RS and MT-GPI (MT-RS+GPI). Baseline characteristics and outcomes were compared among the groups. To evaluate whether the endovascular strategy resulted in favorable outcome, multivariable analysis was also performed.Results: A total of 184 patients with ICAS-LVO were included. Twenty-four patients (13.0%) were treated with MT alone, 25 (13.6%) with MT-RS, 84 (45.7%) with MT-GPI, and 51 (27.7%) with MT-RS+GPI. The MT-RS+GPI group showed the highest recanalization efficiency (98.0%). Frequency of patent arteries on follow-up (98.0%, p < 0.001) and favorable outcome (84.3%, p < 0.001) were higher in the MT-RS+GPI group than other groups. The MT-RS+GPI strategy remained an independent factor for favorable outcome (odds ratio, 20.4; 95% confidence interval, 1.97–211.4; p = 0.012).Conclusion: Endovascular strategy was significantly associated with procedural and clinical outcomes in acute stroke by ICAS-LVO. A combination of RS and GPI infusion might be an optimal rescue modality when frontline MT fails.

Recently, many studies have focused on the development of humanoid biped robot platforms. Some of the well-known humanoid robots are Honda’s humanoid robots, the WABIAN series of robots from Waseda University, Partner, QRIO, H6 and H7, HRP and JOHNNIE. Given that humanoids are complex, expensive and unstable, designers face difficulties in constructing the mechanical body, integrating the hardware system, and realizing real-time motion and stability control based on human-like sensory feedback. Among the robots, HRP and ASIMO are the most well known humanoid robot platforms. HRP-3P is a humanoid robot developed jointly by the National Institute of Advanced Industrial Science and Technology and Kawada Industries, Inc in Japan. It stands 1.6 m tall, weighs 65 kg, and has 36 degrees of freedom (DOF). Upgraded from HRP-2, the new platform is protected against dust and water. In addition, Honda has unveiled a new type of ASIMO, termed the ASIMO Type-R, which stands 1.3 m tall, weighs 54 kg, and has 34 DOF. With the i-WALK technology, this robot has an impressive walking feature: it can walk at 2.7 km/h, and run at 6 km/h. HUBO is essentially an upgraded version of KHR-2. The objective of the development of HUBO was to develop a reliable and handsome humanoid platform that enables the implementation of various theories and algorithms such as dynamic walking, navigation, human interaction, and visual and image recognition. With the focus on developing a human-friendly robot that looks and moves like humans, one focus was on closely aligning the mechanical design with an artistic exterior design. This chapter also discusses the development of control hardware and the system integration of the HUBO platform. Numerous electrical components for controlling the robot have been developed and integrated into the robot. Servo controllers, sensors, and interface hardware in the robot have been explained. Electrical hardware, mechanical design, sensor technology and the walking algorithm are integrated in this robot for the realization of biped walking. This system integration technology is very important for the realization of this biped humanoid.

Vertically aligned TiO2/ZnO nanotube (NT) arrays were developed for application to photoanodes in mesoscopic solar cells. By a two-step anodic oxidation, vertically aligned TiO2 NT arrays with highly ordered surface structure were prepared, followed by deposition of a ZnO shell with a precisely controlled thickness using atomic layer deposition (ALD). When applied to a photoanode of dye-sensitized solar cells (DSSCs), the photovoltage is gradually enhanced as the ZnO shell thickness of the TiO2/ZnO NT electrodes is increased. Furtheremore, the electron lifetime in photoanodes is significantly enhanced due to the ZnO shell, which is examined by open-circuit voltage decay (OCVD) measurement. Photocurrent density-voltage (J-V) curves under the dark condition and OCVD spectra reveal that a negative shift in TiO2 conduction band potential and an energy barrier effect owing to the ZnO shell concurrently contribute to the enhancement of VOC and electron lifetime.

BACKGROUND: There is limited information about non-selective and contemporary data on quality of stroke care and its variation among hospitals at a national level. PATIENTS AND METHODS: We analysed data of the patients admitted to 258 acute stroke care hospitals covering the entire country from the Acute Stroke Quality Assessment Program, which was performed by the Health Insurance Review and Assessment Service from 2008 to 2014 in South Korea. The primary outcome measure was defect-free stroke care (all-or-none), based on six get with the guidelines-stroke performance measures (except venous thromboembolism prophylaxis). RESULTS: Among 43,793 acute stroke patients (mean age, 67 ± 14 years; male, 55%), 31,915 (72.9%) were hospitalised due to ischaemic stroke. At a patient level, defect-free stroke care steadily increased throughout the study period (2008, 80.2% vs. 2014, 92.1%), but there were large disparities among hospitals (mean = 50.7%, SD = 21.7%). Defect-free stroke care was given more frequently in patients being treated in hospitals with 25 or more stroke cases per month (odds ratio [OR] 2.83; 95% confidence interval [CI] 1.69–4.72), delivery of intravenous thrombolysis one or more times per month (OR 2.37; 95% CI 1.44–3.92), or provision of stroke unit care (OR 1.75; 95% CI 1.22–2.52). DISCUSSION: This study shows that the quality of stroke care in Korea is improving over time and is higher in centres with a larger volume of stroke or intravenous thrombolysis cases and providing stroke unit care but hospital disparities exist. CONCLUSION: Reducing large differences in defect-free stroke care among acute stroke care hospitals should be continuously pursued.

Vertically-aligned TiO2 nanotube (NT) arrays prepared by electrochemical anodization are considered promising alternatives to the conventional nanoparticle (NP)-based electrodes for photovoltaic devices. Recently, such NT arrays have been employed in dye-sensitized solar cells (DSSCs) by transferring them onto NP-based electrodes, to obtain multi-layered nanoelectrodes. Here, we comparatively evaluate the photovoltaic and photoelectrochemical properties of TiO2 NP-only electrodes and multi-layered electrodes comprising NP and NT arrays at the same thickness of 15 μm. Although the multi-layered electrodes have a smaller surface area compared to the NP-only electrodes, they show much higher transmittance. In addition, impedance studies reveal that the multi-layered electrodes have lower charge recombination with the electrolyte as well as enhanced electrolyte diffusion when applied as a photoanode in DSSCs. As a result, the multi-layered electrodes exhibit a photovoltaic conversion efficiency (η = 5.37%) comparable to that of the NP-only electrodes (η = 5.80%), despite 36.6% lower dye loading.

Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.

Background Poststroke cricopharyngeal dysfunction has been reported to occur in 50% of brainstem strokes; however, cricopharyngeal dysfunction also occurs commonly in patients with supratentorial stroke. The hemispheric neuroanatomical location of this dysfunction has not been clearly identified. Aim We aimed to analyze the relationship between cricopharyngeal dysfunction and supratentorial lesion location in poststroke patients through this retrospective case–control voxel-based lesion-symptom mapping study. Methods Cricopharyngeal dysfunction was diagnosed when the residue after swallowing (pyriform sinus) accounted for more than 25% of volume of pyriform sinus. Medical records and the video fluoroscopic swallowing studies of first-ever stroke patients who were admitted to our hospital during acute to subacute phase from 2009 to 2019 were reviewed. After propensity score matching to reduce the likelihood of selection bias, 50 patients per group were included in the cricopharyngeal dysfunction and control groups. We used a P threshold of 0.01 corrected for multiple comparisons with permutation thresholding (5000 permutations). Dichotomized diagnosis of cricopharyngeal dysfunction and the magnitude of pyriform sinus were used as dependent variables. Results Analysis using the Liebermeister statistics indicated that lesions of the right lentiform nucleus were associated with the development of cricopharyngeal dysfunction. After adjustment for age and total lesion volume, which are known effectors for the development of dysphagia, statistically significant correlations were found between pyriform sinus and lesions of the right lentiform nucleus and anterior corona radiata beneath the right middle frontal gyrus. Conclusion Thus, our study demonstrated for the first time that damages to the right lentiform nucleus, especially globus pallidus externa, and anterior corona radiata beneath the right middle frontal gyrus are associated with the development and severity of cricopharyngeal dysfunction.

Continuity of care is a core dimension of high-quality care in the management of disease. The purpose of this study was to investigate the association between continuity of care and lumbar surgery in patients with moderate disc herniation. The Korean National Sample Cohort was used. The target population consisted of patients who have had disc herniation more than 6 months and didn’t get surgery and red flag signs within 6 months from onset. The population was enrolled from 2004 to 2013. The Bice-Boxerman Continuity of Care was used in measuring continuity of care. The marginal structural model with time dependent survival analysis was used. In total, 29,061 patients were enrolled in the cohort. High level of continuity of care was associated with a lower risk of lumbar surgery (HR, 0.27; 95% CI, 0.20–0.27). When the index was calculated only with outpatient visits to primary care with related specialty, the HR was 0.49 (95% CI: 0.43–0.57). In exploratory analysis, patients with lumbar stenosis and spondylolisthesis had higher risk of having a low level of continuity of care. These results indicate that continuity of care is associated with lower rates of lumbar surgery in patients with moderate disc herniation.

Background: In-hospital and 30-day mortality, 3-month functional outcome were reported as associated with endovascular treatment (EVT) case volume per hospital, but one-year mortality was unknown. Furthermore, the hospital EVT volume threshold based on one-year mortality was not reported. We aimed to investigate whether there was a correlation between annual EVT case volume per hospital and one-year mortality and suggest volume threshold. Methods: Data from Korean national survey for assessing quality of acute stroke care were used. The survey was conducted since 2005 and the subject was patients with acute stroke who were admitted via emergency rooms within 7 days of onset at hospitals treating 10 or more stroke cases during the three (2013, 2014) or six (2016) month survey period. Ischemic stroke cases treated with EVT during the last available three assessments (2013, 2014, and 2016) were selected for the analysis. Results: A total of 1,746 ischemic stroke cases (age, 69.2 ± 12.4years; male, 56.6%) treated in 120 hospitals with EVT were analyzed. The median annual EVT case volume was 12.0 cases per hospital (interquartile range, 6.0-22.9) and the mortality at one-month, three-month, and one-year were 12.7%, 16.6%, and 23.3%, respectively. When divided into quartiles according to the annual EVT case volume, the lowest quartile group was found to have the highest one-year mortality (odds ratio [95% confidence intervals], 1.49 [1.04-2.13]), adjusted for age, sex, NIHSS, onset to arrival time. Restricted cubic splines performed on the annual EVT case volume per hospital revealed that cut-off value for the probability of one-year mortality was 15 cases per year ( p Conclusions: There was an association between annual EVT case volume and one-year mortality, and the volume threshold per hospital based on the one-year mortality was found to be 15 EVT cases per year.

Background The long‐term incidence of acute myocardial infarction (AMI) in patients with acute ischemic stroke (AIS) has not been well defined in large cohort studies of various race‐ethnic groups. Methods and Results A prospective cohort of patients with AIS who were registered in a multicenter nationwide stroke registry (CRCS‐K [Clinical Research Collaboration for Stroke in Korea] registry) was followed up for the occurrence of AMI through a linkage with the National Health Insurance Service claims database. The 5‐year cumulative incidence and annual risk were estimated according to predefined demographic subgroups, stroke subtypes, a history of coronary heart disease (CHD), and known risk factors of CHD. A total of 11 720 patients with AIS were studied. The 5‐year cumulative incidence of AMI was 2.0%. The annual risk was highest in the first year after the index event (1.1%), followed by a much lower annual risk in the second to fifth years (between 0.16% and 0.27%). Among subgroups, annual risk in the first year was highest in those with a history of CHD (4.1%) compared with those without a history of CHD (0.8%). The small‐vessel occlusion subtype had a much lower incidence (0.8%) compared with large‐vessel occlusion (2.2%) or cardioembolism (2.4%) subtypes. In the multivariable analysis, history of CHD (hazard ratio, 2.84; 95% CI, 2.01–3.93) was the strongest independent predictor of AMI after AIS. Conclusions The incidence of AMI after AIS in South Korea was relatively low and unexpectedly highest during the first year after stroke. CHD was the most substantial risk factor for AMI after stroke and conferred an approximate 5‐fold greater risk.

Congenital interatrial shunt can unload the left atrium (LA) and may lower the risk of new-onset heart failure (HF) or atrial fibrillation (AF). We evaluated the risk of new-onset HF or AF in patients with and without interatrial shunt. We enrolled 2660 consecutive patients with acute stroke or transient ischemic attack (TIA) who underwent transesophageal echocardiography at Seoul National University Bundang Hospital from January 1, 2006 to December 31, 2018. The primary outcomes were 10-year new-onset HF, new-onset AF, and new-onset HF or AF composite. Overall, 466 (17.5%) patients with an interatrial shunt had smaller E velocity (0.66 ± 0.21 vs. 0.69 ± 0.22 m/s, P = 0.037) and smaller E/e′ (9.1 ± 4.0 vs. 10.0 ± 5.0, P = 0.001) than 2194 (82.5%) patients without an interatrial shunt. The 10-year incidence of AF, HF, and AF or HF composite was lower in patients with an interatrial shunt (10-year AF, 11.2 vs. 17.8%, P

Background: Since the global pandemic of coronavirus disease 2019 (COVID-19), the process of emergency medical services has been modified to ensure the safety of healthcare professionals as well as patients, possibly leading to a negative impact on the timely delivery of acute stroke care. This study aimed to assess the impact of the COVID-19 pandemic on the acute stroke care processes and outcomes in tertiary COVID-19-dedicated centers in South Korea. Methods: We included 1,213 patients with acute stroke admitted to three centers in three cities (Seoul, Seongnam, and Daegu) through the stroke critical pathway between September 2019 and May 2020 (before and during the COVID-19 pandemic). In all three centers, we collected baseline characteristics and parameters regarding the stroke critical pathway, including the number of admitted patients diagnosed with acute stroke through the stroke critical pathway, door to brain imaging time, door to intravenous recombinant tissue plasminogen activator time, door to groin puncture time, and door to admission time. We performed an interrupted time series analysis to determine the impact of the COVID-19 outbreak on outcomes and critical pathway parameters. Results: Three centers modified the protocol of the stroke critical pathway during the COVID-19 pandemic. There was an immediate decrease in the number of patients admitted with acute ischemic stroke after the outbreak of COVID-19 in Korea, especially in the center of Daegu, an epicenter of the COVID-19 outbreak. However, the number of patients with stroke soon increased to equal that before the Covid-19 outbreak. In several critical pathway parameters, door to imaging time showed a temporary increase, and door to admission was transiently decreased after the COVID-19 outbreak. However, there was no significant effect on the timely trend. Moreover, there was no significant difference in the baseline characteristics and clinical outcomes between the periods before and during the COVID-19 pandemic. Conclusion: This study demonstrated that the COVID-19 outbreak immediately affected the management process. However, it did not have a significant overall impact on the trends of stroke treatment processes and outcomes. The stroke management process should be modified according to changing situations for optimal acute management.

BackgroundThe optimal first-line mechanical thrombectomy (MT) method in cancer-related stroke (CRS) patients with emergent large vessel occlusion (ELVO) remains largely unknown. The aim of this study is to evaluate the efficacy and safety between contact aspiration (CA) first-line thrombectomy and stent retriever (SR) first-line thrombectomy in CRS patients.MethodsSixty-two CRS patients with ELVO, who underwent MT between January 2013 and October 2019 at our institution, were retrospectively analyzed. Patients were divided into two groups based on the first-line MT method and compared: the CA group (n=28), which included those who received CA alone or combined CA with SR, and the SR group (n=34), which included those who received conventional SR alone.ResultsOverall, reperfusion was successful in 75.8% (47/62) of CRS patients, and a good clinical outcome at 90 days was observed in 17.7%. The CA group showed a higher rate of successful reperfusion (89.3% vs 64.7%, P=0.025) shorter procedure time (22 vs 42 min; P=0.029), higher rate of first pass effect (35.7% vs 11.8%, P=0.025), and lower number of passes (1 vs 3, P=0.023) when compared with the SR group. The procedural and hemorrhagic complication rates were similar between the CA and SR groups. The first-line contact aspiration (OR 11.624, 95% CI 1.041 to 129.752; P=0.046) was an independent predictor of successful reperfusion.ConclusionsAmong patients with CRS, CA – whether alone or in combination with SR – as first-line MT seems to provide more rapid and successful reperfusion when compared with SR.

Background and Aims: Robotic rehabilitation therapy has been tried as a novel technology in field of upper extremity rehabilitation of stroke patients. However, the previous trial revealed the additional effect of robotic therapy compared to conservative therapy. We aimed to investigate whether the same intensity robot-assisted arm training(RAT) was more effective on the recovery of motor and improvement of upper limb function than conventional occupational therapy(COT) in subacute first-ever hemiplegic stroke patients (Fig.1). Methods: The clinical assessment included Fugl-Meyer Assessment(FMA), Motricity Index(MI), Functional Independence Measure(FIM), Motor Function Test(MFT), Wolf Motor Function Test(WMFT), Trunk Control Test(TCT), Maximal Voluntary Torques(MVT), Visual Analogue Scale(VAS) for pain, and Active Range of Motion(AROM). The repeated measures ANOVA was used to compare the results of longitudinal analyses between two groups (SPSS Inc., Chicago, IL, USA). Results: The all parameters measured at baseline did not differ between two groups. Both groups showed significant improvements in FMA, MI, FIM, MFT, WMFT, TCT, MVT, and AROM after treatment (P Conclusions: This study did not agree that robot-assisted arm training combined with conventional occupational therapy in subacute post-stroke hemiplegic patients may be superior to the same intensity conventional occupational therapy.

Background: Recent endovascular treatment (EVT) trials suggest the presence of target mismatch profiles up until 24 hours after stroke symptom onset. We aim to a) demonstrate the presence of target mismatch in patients presenting beyond these recent time thresholds and b) potential benefit with EVT in these patients. Methods: Between 01/2012 and 12/2018, patients with AIS with ICA or MCA occlusion and baseline NIHSS score ≥6 arriving ≥16 hours from last known well were identified. CT or MR perfusion images at presentation were evaluated using RAPID software; ischemic core was defined as rCBF Results: Of 154 patients [55% male, mean age 70 ± 13 years, median baseline NIHSS 13 [IQR 8 - 18], 76 (49%) had unwitnessed onset. Median last known well to arrival in hospital time was 42.2 [22.8 - 76.9]. CTP or MR perfusion were obtained in 115 (75%). Median ischemic core volume i.e., 11.0 ml [iqr 0 - 40 ml], and penumbra volume (Tmax >6 s) i.e., 57 ml [16 - 133 ml] and a median mismatch ratio 4.0 [iqr 0.9 - 18.0] were noted. When inclusion criteria of the following trials, namely, ESCAPE, DAWN and DEFUSE3 trial were applied, DAWN-eligible patients were n=45 (29%), DEFUSE3 n= 61 (40%) and ESCAPE n=59 (43%). Figure 1a shows trial eligibility by time from last known well. 24 (16%) patients had EVT. EVT was associated with better functional recovery at 3 months (Figure 1b) for 90-day mRS 0-2 (adjusted OR [95% CI], 8.11 [2.49 - 30.44]) and 90-day mRS shift (common adjusted OR 5.50 [2.33 - 13.29]). Treatment effect with EVT was seen from 16 to 240 hours since last known well (Figure 1c). Parenchymal Hemorrhage type 2 was seen in 13 % offered EVT vs. 3% (adjusted OR 4.11 [0.73 - 21.72]). Conclusions: Patients with anterior circulation LVO presenting very late, even days from last known well, may potentially benefit from EVT.

Introduction: There have been few reports on status of acute stroke management at a national level worldwide, and none in Korea. This study is aimed to describe the current status and disparities of acute stroke management in Korea. Methods: Data from 5th (2013) and 6th (2014) national surveys for assessing quality of acute stroke care were used. Patients with principal diagnosis codes indicating subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic stroke (IS), who were admitted via emergency rooms within 7 days of onset at hospitals treating 10 or more stroke cases during the each 3-month survey period were selected. Results: A total of 19,608 stroke cases (age, 67.7±13.5years; female, 45%; IS, 76%; ICH, 15%; SAH, 9%) treated in 216 hospitals were analyzed. Thirty-one percent of hospitals had stroke units and 41% of stroke cases were treated at hospitals without stroke units. In IS, IV thrombolysis (IVT) and endovascular treatment (EVT) rates were 10.7% and 3.6%, respectively. Thirty-nine percent of IVT and fifty-two percent of EVT cases were performed in hospitals with annual volume of Conclusions: This study is the first report on the status of acute stroke care in Korea on a national level. Large number of recanalization therapies were performed in low-volume-hospitals. Expansion of stroke unit service, stroke center certification or accreditation, and connections between stroke centers and EMS are highly recommended.

Background This study aimed to describe the current status of acute stroke care in Korea and explore disparities among hospitals and regions. Methods The 2013 and 2014 national stroke audit data and the national health insurance claims data were linked and used for this study. Stroke patients hospitalized via emergency rooms within 7 days of stroke onset were selected. Results A total of 19,608 patients treated in 216 hospitals were analyzed. Among them 76% had ischemic stroke; 15%, intracerebral hemorrhage (ICH); and 9%, subarachnoid hemorrhage (SAH). Of the hospitals, 31% provided inpatient stroke unit care. Ambulances were used in 56% of cases, and the median interval from onset to arrival was 4.5 hours. One-quarter of patients were referred from other hospitals. Intravenous thrombolysis (IVT) and endovascular treatment (EVT) rates were 11% and 4%, respectively. Three-quarters of the analyzed hospitals provided IVT and/or EVT, whereas 47% of hospitals providing IVT and 67% of hospitals providing EVT had less than one case per month. Decompressive surgery was performed on 28% of ICH patients, and clipping and coiling were performed in 17.2% and 14.3% of SAH patients, respectively. There were noticeable regional disparities between the various interventions, ambulance use, arrival time, and stroke unit availability. Conclusion This study describes the current status of acute stroke care in Korea. Despite quite acceptable quality of stroke care, it suggests regional and hospital disparities. Expansion of stroke units, stroke center certification or accreditation, and connections between stroke centers and emergency medical services are highly recommended., Graphical Abstract

Background To track triage, routing, and treatment status regarding access to endovascular treatment (EVT) after acute ischemic stroke (AIS) at a national level. Methods From national stroke audit data, potential candidates for EVT arriving within 6 hours with National Institute of Health Stroke Scale score of ≥ 7 were identified. Acute care hospitals were classified as thrombectomy-capable hospitals (TCHs, ≥ 15 EVT cases/year) or primary stroke hospital (PSH, < 15 cases/year), and patients' initial routes and subsequent inter-hospital transfer were described. Impact of initial routing to TCHs vs. PSHs on EVT and clinical outcomes were analyzed using multilevel generalized mixed effect models. Results Out of 14,902 AIS patients, 2,180 (14.6%) were EVT candidates. Eighty-one percent of EVT candidates were transported by ambulance, but only one-third were taken initially to TCHs. Initial routing to TCHs was associated with greater chances of receiving EVT compared to initial routing to PSHs (33.3% vs 12.1%, P < 0.001; adjusted odds ratio [aOR], 2.21; 95% confidence interval [CI], 1.59–2.92) and favorable outcome (38.5% vs. 28.2%, P < 0.001; aOR, 1.52; 95% CI, 1.16–2.00). Inter-hospital transfers to TCHs occurred in 17.4% of those initially routed to a PSH and was associated with the greater chance of EVT compared to remaining at PSHs (34.8% vs. 7.5%, P < 0.001), but not with better outcomes. Conclusion Two-thirds of EVT candidates were initially routed to PSHs despite greater chance of receiving EVT and having favorable outcomes if routed to a TCH in Korea. Process improvement is needed to direct appropriate patients to TCHs., Graphical Abstract

Iatrogenic ophthalmic artery occlusion (IOAO) is a rare but devastating ophthalmic disease that may cause sudden and permanent visual loss. Understanding the possible etiologic modalities and pathogenic mechanisms of IOAO may prevent its occurrence. There are numerous medical etiologies of IOAO, including cosmetic facial filler injection, intravascular procedures, intravitreal gas or drug injection, retrobulbar anesthesia, intraarterial chemotherapy in retinoblastoma. Non-ocular surgeries and vascular events in arteries that are not directly associated with the ophthalmic artery, can also cause IOAO. Since IOAO has a limited number of treatment modalities, which lead to poor final visual prognosis, it is imperative to acknowledge the information regarding medical procedures that are etiologically associated with IOAO. We accumulated all searchable and available IOAO case reports (our cases and previous reported cases from the literature), classified them according to their mechanisms of pathogenesis, and summarized treatment options and responses of each of the causes. Various sporadic cases of IOAO can be categorized into three mechanisms as follows: intravascular event, orbital compartment syndrome, and increased intraocular pressure. Embolic IOAO, which is considered the primary cause of the condition, was classified into three subgroups according to the pathway of embolic movement (retrograde pathway, anterograde pathway, pathway through collateral channels). Despite the practical limitations of treating spontaneous (non-iatrogenic) retinal artery occlusion, this article will contribute in predicting and improving the prognosis of IOAO by recognizing the treatable factors. Furthermore, it is expected to provide clues to future research associated with the treatment of retinal artery occlusion.

Stroke severity of 1 hospital is a crucial information when assessing hospital performance. We aimed to determine the effect of stroke severity in the association between hospital patient volume and outcome after acute ischemic stroke.Data from National Acute Stroke Quality Assessment in 2013 and 2014 were analyzed. Hospital patient volume was defined as the annual number of acute ischemic stroke patients who admitted to each hospital. Comparisons among hospital patient volume quartiles before and after adjusting age, sex, onset to arrival and stroke severity were made to determine the associations between hospital patient volume and mortality at 30 days, 90 days and 1 year. Assessments for the nonlinear associations, with treating hospital patient volume as a continuous variable, and the associations between hospital patient volume and quality of care were also made.A total of 14,666 acute ischemic stroke patients admitted to 202 hospitals were analyzed. In the crude analysis, patients admitted to hospitals with lower patient volume showed higher mortality with a non-linear inverse association with a cut-off value of 227 patients/year. While the associations remained significant after adjusting age, sex and onset to arrival time (P's.05), they disappeared when stroke severity was further adjusted (P's.05). In contrary, hospital patient volume showed a nonlinear positive association with a plateau for summary measures of quality indicators even after adjustments for covariates including stroke severity (P.001).Our study implicates that stroke severity should be considered when assessing hospital performance regarding outcomes of acute stroke care.

PURPOSE To compare the characteristics of patients with surgically overcorrected intermittent exotropia treated with alternate patching. METHODS The medical records of 51 patients who underwent bilateral lateral rectus muscle recession for intermittent exotropia and required alternate patching to correct postoperative overcorrection were retrospectively reviewed. Patients with postoperative esodeviation ≥18 prism diopters (PD) were started on alternate patching on postoperative day 1, whereas those with postoperative esodeviation of 10 to 17 PD were started after 2 weeks. Postoperative esodeviation

Among the various renewable sources of energy, solar energy conversion systems have been regarded as a promising way to satisfy the growing energy demand. For superior solar energy conversion performance, it is important to utilize efficient photosensitizers that have excellent light-harvesting capability. In this regard, quantum dots (QDs) are promising photosensitizer candidates owing to their high absorption coefficient, band gap tunability, and potential multiple exciton generation. Here, we report an effective and straightforward approach to improve the loadings of nanocomposite PbS/CdS QDs in a mesoporous electrode, for highly efficient solar energy conversion. By controlling the surface charge of TiO2 during the successive ionic layer adsorption and reaction process, both the PbS and CdS QD loadings are distinctly increased, leading to a highly enhanced light-harvesting capability of the photoelectrodes. This enhancement is effectively applied not only for solar-to-electrical but also for solar-to-chemical energy conversion, resulting in a ∼33% increased conversion efficiency of the QD solar cells and an unprecedented photocurrent of 22.1 mA/cm2 (at 0.6 V vs. RHE) for hydrogen production from photoelectrochemical water splitting. These results provide significant insight into the application of QD photosensitizers in solar energy conversion.

BACKGROUND Currently no study has evaluated the effect of the novel 1064-nm picosecond neodymium-doped:yttrium aluminium garnet laser (ps-Nd:YAG) for reducing Hypertrophic scarring (HS). OBJECTIVE The aim of this study was to verify the efficacy and safety of a 1064-nm ps-Nd:YAG in the management of HS. MATERIALS AND METHODS A retrospective chart review and photographic analysis were conducted on patients treated with a low-fluence 1064-nm ps-Nd:YAG for HS improvement. The Vancouver Scar Scale (VSS), 5-point Global Assessment Score (GAS), and patient satisfaction score were used to determine the effect of scar improvement. RESULTS A total of 24 Korean patients (9 males and 15 females; mean age of 33.25 ± 15.50 years) were retrospectively evaluated. Mean treatment settings were 1064-nm wavelength, 750 ps pulse duration, 7.94 mm spot size, 0.93 J/cm2 fluence, and 9.69 Hz frequency. The average VSS score decreased significantly (from 5.33 to 2.71) after laser treatment (p

The present study aimed to compare 2- and 5-year outcomes of ACL reconstruction between patients with and without generalized joint laxity and to perform comparative evaluation between two types of grafts used for ACL reconstruction in patients with generalized joint laxity. Two hundred and thirty-seven patients who underwent ACL reconstruction from 2001 to 2008 were included. Patients were classified into two groups according to the presence or the absence of generalized joint laxity, and further subdivided into two subgroups based on the type of graft used: bone–patellar tendon–bone (BPTB) or hamstring. Generalized joint laxity was assessed with the Beighton and Horan criteria using a point scoring system. Stability reflected by the Lachman test, pivot-shift test, and anterior translation measured with KT-2000, and functional outcomes reflected by Lysholm knee score, and International Knee Documentation Committee (IKDC) subjective score were investigated. IKDC objective grade and radiographic grade were also assessed. Clinical assessments were conducted preoperatively and at 2 and 5 years after operation. Two-year follow-up results showed that patients with generalized joint laxity receiving hamstring grafts had poorer outcomes than those without generalized joint laxity. Five-year follow-up results showed that patients with generalized joint laxity experienced poorer outcomes than patients without generalized joint laxity, irrespective of the type of graft. Comparison of grafts used showed that, in patients with generalized joint laxity, BPTB graft provided significantly better stability and functional outcomes than hamstring graft at both 2- and 5-year follow-ups. Comparisons between serial outcomes measured at 2 and 5 years demonstrated that stability and functional outcomes deteriorated over time in patients with generalized joint laxity. Less satisfactory stability and functional outcomes were noted in patients with generalized joint laxity, compared to patients without generalized joint laxity. Comparisons of stability and functional outcomes after ACL reconstruction in patients with generalized joint laxity between two different grafts demonstrated that BPTB graft achieves better results than hamstring graft. III, a retrospective cohort study.

As human location and movement data are becoming easily accessible, owing to the prevalence of mobile devices, the use of such mobility data is gaining an increasing amount of interest. In our work, we establish a relationship between human mobility and personality, and attempt to model and predict movement patterns. Deep-neural-network and deep-belief-network models of deep learning are used in conjunction, for training the neural network. Both passive positioning information and active location information are used for the mobility information dataset, and the big five factors are used for the personality data. Both mobility information and personality information are split into training and verification groups, and are subsequently used to train and verify the neural network. The results are expressed in terms of hit ratios according to model factors comparing the predicted and observed values, and the parameters for the neural networks for the highest accuracy are identified. We use this optimal neural network to show the correlation between human personality and mobility patterns. Actual prediction is attempted, and is found meaningful in some conditions.

In this research, the authors propose a self‐biased relaxation oscillator that outputs a constant 1.2 MHz clock over a wide temperature range. Excluding any external bias, the proposed oscillator embodies a self‐bias circuit that generates a bias current from a precisely trimmed resistor. To minimise the power consumption, a switched‐bias technique was applied to the two comparators in the oscillator. The proposed circuit was fabricated in a 180 nm CMOS process. It consumes 17.9 µW from a 1.5 V supply, and its temperature coefficient is 16.8 ppm/°C in the range of −20–80°C.

Objective The short- and mid-term outcomes of endovascular aortic aneurysm repair have made it a standard treatment of abdominal aortic aneurysms. However, newer generation devices have yet to demonstrate improved long-term rates for complications, reinterventions, and survival. The TREO stent graft is a latest generation device and was evaluated for approval in the United States. Methods In a multicenter, nonrandomized, investigational device exemption clinical trial, we assessed the safety and effectiveness of the TREO device, with core laboratory assessment of the imaging studies and an independent adjudication of safety. The primary effectiveness endpoint was successful aneurysm treatment at 1 year. The primary safety endpoint was the incidence of major adverse events (MAE) at 30 days. Results A total of 150 patients (132 men; 88.0%) with infrarenal abdominal aortic (87.3%) or aortoiliac (12.7%) aneurysms were enrolled. The data were normally distributed. The mean age was 71.7 ± 7.4 years. The MAE incidence at 30 days was 0.7%. One subject experienced two MAE: myocardial infarction and procedural blood loss of 1000 mL. The proportion of successful aneurysm treatment at 1 year was 93.1%. Longer term follow-up continues, with no aneurysm-related mortality at the latest follow-up. At 3 years, the cumulative all-cause mortality and incidence of type I and type III endoleaks was 10.7% (n = 16), 2.7% (n = 4), and 0% (n = 0), respectively. In addition, aneurysm sac shrinkage >5 mm at 3 years had occurred in 54.3% of patients, and 9.3% had required a secondary intervention (n = 14). Conclusions The safety and effectiveness of endovascular repair of abdominal aneurysms with TREO were demonstrated, with 93.1% successful aneurysm treatment at 1 year and aneurysm sac shrinkage >5 mm at 3 years in 54.3% of patients. Long-term follow-up continues to determine whether these favorable outcomes will be sustained.

This paper describes a walking pattern generation algorithm for a robotic transfemoral prosthesis that is synchronized with the walking motion of a transfemoral amputee, and posture stabilization for ground adaptation and maintaining balance on inclined grounds. The developed robotic transfemoral prosthesis in this study has a knee joint and ankle roll/pitch joints for walking on complex slopes. The walking motion data obtained from the motion capture system are used as the standard walking pattern data to accurately imitate the inherent gait of the wearer. Walking intention, percent of gait cycle (PGC), and walking stride are predicted through two inertial sensors attached at both thighs, and the joint angles of the robotic transfemoral prosthesis are then generated in real-time from the PGC and the standard walking pattern data. Additionally, variable impedance control and zero moment point (ZMP) control are carried out with a force/torque sensor for posture stabilization against variable ground...

Background and Objectives Melasma is a common acquired, chronic hypermelanosis and still remains a therapeutic challenge. The low-fluence 1 064 nm Q-switched Nd:YAG laser is the most widely used for the treatment of moderate to severe melasma in Asia. Recently, the picosecond laser has been introduced for various pigmentary disorders such as melasma. We evaluated the efficacy and safety of a picosecond laser with dual-wavelengths (1 064 and 595 nm) and topical 2% hydroquinone (HQ) combination therapy on patients with melasma, and compared results with those obtained with 2% HQ alone. Study Design/Materials and Methods This was a prospective, randomized, split-face, controlled trial comparing two treatments with combined 7 week 2% HQ (daily) and 5 week picosecond laser (weekly) versus 7 week 2% HQ. The primary efficacy variable was the change rate of the relative lightness values (RL*I) at week 7 from baseline. RL*I at a follow-up visit, modified melasma severity score (mMASI), and satisfaction were assessed. Results Picosecond laser and 2% HQ had superior efficacy to 2% HQ alone: 30/39 (76.92%) subjects on combination treatment achieved ≥51% improvement of RL*I versus 1/39 (2.56%) subjects on 2% HQ. The mMASI, RL*I, and satisfaction on the laser-treated side at week 7 supported these results. Aside from RL*I, no difference between the laser-treated versus control side was found after follow-up. No serious adverse events were reported. Conclusion A 750 picosecond laser using 1 064 and 595 nm was effective and safe for the treatment of Korean melasma patients. The picosecond laser with dual-wavelength used in this study can reduce the photothermal effect generated during the removal of pigment and total duration of the procedure, and can be expected to reduce the occurrence of adverse events. Lasers Surg. Med. © 2017 Wiley Periodicals, Inc.