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As total system bandwidth increased, memory industry has been imposed to satisfy its requirements. At last, innovative next generation memory named high bandwidth memory (HBM) with extremely fine micro-bump pitch of its bottom die is introduced for terabytes/s bandwidth graphics module. To establish HBM based graphics module, it becomes essential to fabricate silicon interposer due to its capability to process narrow signal width and space. Silicon based HBM interposer becomes the key solution to mitigate bandwidth bottleneck of graphics module for high computing system. To design HBM interposer successfully, the signal optimization of HBM interposer channels must be preceded thoroughly. In this paper, design optimization of top metal signals of HBM interposer considering routing feasibility is proposed. In order to analyze channel performance to determine optimal line width and space, frequency domain and time domain simulation are conducted respectively. All the proposed signals in HBM interposer are analyzed by comparing eye-opening voltage and timing jitter with 3D electromagnetic (EM) simulation results. Based on this proposed optimization design, not only HBM interposer can be applied to achieve high bandwidth with a less signal distortion but also it can be designed on the basis of a limited routing area.

Simultaneous switching noise (SSN) is caused by the simultaneous switching of a group of I/O drivers, and is proportional to the total inductance and the rate of change of the switching current. This often leads to signal distortion and degradation of signal and power integrity of systems. Furthermore, with the continuously decreasing operating voltage, susceptibility to SSN keeps on increasing and it becomes increasingly challenging to achieve high performance interfaces. Therefore, it is highly important to perform SSN analysis in order to accurately investigate the noise and timing margin of the devices under test; hence, it is important to know the exact amount of switching current drawn by the ICs. In this paper, we propose TSV-based current probing structure using magnetic coupling, named TSV-based Current Probe (TCP). By capturing the magnetic flux induced by the injected current and processing it through a series of reconstruction steps, we can obtain the original current waveform of interest. Through a series of simulations in frequency and time domains, we verify the performance of the proposed probing structure, TCP. Lastly, TCP is fabricated using TSV fabrication techniques and measured for experimental verification.

Through silicon via (TSV) has been extensively highlighted as the key solution for small form factor wide bandwidth, and low power consumption with compactly integrating multiple chips. Despite the many advantages of TSV based 3-dimensional integrated circuit (3D IC), there are several challenges to be overcome such as noise coupling, fabrication process limits, and failure issues. In this paper, we proposed shielding structures for TSV to active circuit noise coupling in 3D IC. The proposed structures can capture TSV substrate noise by blocking the noise paths to active circuit, LC-VCO in this study. The noise suppression mechanisms are analyzed by the noise coupling coefficient in frequency-domain obtained by 3D electromagnetic simulation. Various shielding structures are investigated and compared with regard to sensitivity of active circuit, such as phase noise of LC-VCO.

Spurred by the industrial demands for terabyte/s bandwidth graphics module, high bandwidth memory (HBM) has been emerged to overcome the limitations of conventional DRAMs. Additionally, due to the fine pitch and high density interconnect routing between GPU and 4 HBMs in 2.5D terabyte/s bandwidth graphics module, HBM interposer has also been to the force. However, several signal integrity issues of the HBM interposer occur due to the manufacturing process constraints. In this paper, we design the HBM interposer using 6 layers redistribution layer (RDL) and TSVs in 2.5D terabyte/s bandwidth graphics module. And then, in the designed HBM interposer, electrical performance of the HBM interposer channels using M1, M3, and M5 layer is analyzed by simulation in the frequency-and time-domain. With the simulation results, it is observed that the designed HBM interposer shows good signal integrity.

In this paper, we measure the noise coupling of metal oxide patch and propose the emulation process for the noise coupling between TSV and active circuit by substituting TSV to metal oxide patch. For that, we utilize the analysis of noise coupling of TSV by dividing frequency range. With this results, the system designer can anticipate the effect of noise coupling between TSV and active circuit without fabricating TSV-included active circuit.

Through silicon via (TSV) based 3-dimensional integrated circuit (3D IC) has become the key solution to satisfy continuously increasing demands for small form factor, wide bandwidth, high performance, and low power consumption on electronic devices. However, there still remain several challenges to be solved; one of the most significant issues in 3D IC is TSV to active circuit noise coupling. In this paper, we analyzed the noise coupling between TSV and LC-VCO, which is an important component in RF communication system. When TSV is located near LC-VCO, the noise can easily travel through silicon substrate to the body of MOSFETs in LC-VCO. The noise coupling mechanisms of TSV to PMOS and NMOS are analyzed by voltage transfer functions in frequency-domain obtained by 3D electromagnetic solver simulation. The voltage transfer function between TSV and MOS is analyzed under variations of several physical parameters to clarify the tendencies of noise coupling. In addition, the noise coupling effect on PMOS and NMOS in LCVCO are investigated and compared in terms of sensitivity, such as phase noise.

In this paper, crosstalk included eye diagram of high-speed and wide I/O interposer channels are simulated and analyzed. To analyze the crosstalk effect of various substrate channels, silicon, glass, and organic interposers are simulated and compared under the same physical dimensions. In addition, crosstalk included eye diagrams are accurately estimated in short time using 8 worst case input signals. The estimated eye diagrams are investigated at data rate of 10 Gbps.

Background The role of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) as a prognostic factor in patients admitted to the intensive care unit (ICU) is not yet fully established. We aimed to determine whether NT-pro-BNP is predictive of ICU mortality in a multicenter cohort of critically ill patients. Methods A total of 1440 patients admitted to 22 ICUs (medical, 14; surgical, six; multidisciplinary, two) in 15 tertiary or university-affiliated hospitals between July 2010 and January 2011 were assessed. Patient data, including NT-pro-BNP levels and Simplified Acute Physiology Score (SAPS) 3 scores, were recorded prospectively in a web-based database. Results The median age was 64 years (range, 53–73 years), and 906 (62.9%) patients were male. The median NT-pro-BNP level was 341 pg/mL (104–1,637 pg/mL), and the median SAPS 3 score was 57 (range, 47–69). The ICU mortality rate was 18.9%, and hospital mortality was 24.5%. Hospital survivors showed significantly lower NT-pro-BNP values than nonsurvivors (245 pg/mL [range, 82–1,053 pg/mL] vs. 875 pg/mL [241–5,000 pg/mL], respectively; p Conclusions The NT-pro-BNP level was more elevated in nonsurvivors in a multicenter cohort of critically ill patients. However, there was little additional prognostic power when adding NT-pro-BNP to SAPS 3 score.

Purpose The purpose of this study is to evaluate factors associated with the mortality of patients admitted to intensive care units (ICUs) after in-hospital cardiopulmonary resuscitation (CPR) and the impact of a hospital rapid response system (RRS) on patient mortality in Korea. Materials and Methods A prospective multicenter cohort study was done in 22 ICUs of 15 centers from July 1, 2010, to January 31, 2011. We only enrolled patients admitted to ICUs after in-hospital CPR and divided eligible patients into 2 groups—survivors and nonsurvivors. Results Among 4617 patients, 150 patients were admitted post-CPR, 76 died, and 74 survived. At 24 hours, the Sequential Organ Failure Assessment score, Simplified Acute Physiology Score II, and the best Glasgow Coma Scale were significantly lower in the nonsurvivors than in the survivors. In multivariate analysis, the Simplified Acute Physiology Score II and presence of lower respiratory infection were both independently associated with mortality. At the first hour after admission, lowest serum potassium and highest heart rate were associated with mortality. At 24 hours after admission, lowest mean arterial pressure, HCO3 level, and venous oxygen saturation level; highest heart rate; and use of vasoactive drugs were associated with mortality. The mortality of patients in hospitals with an RRS was not significantly different from that of hospitals without an RRS. Conclusion Various physiologic and laboratory parameters were associated with the mortality of post-CPR ICU admitted patients, and the presence of an RRS did not reduce mortality of these patients in our study.

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

To externally validate the simplified acute physiology score 3 (SAPS3) and to customize it for use in Korean intensive care unit (ICU) patients.This is a prospective multicentre cohort study involving 22 ICUs from 15 centres throughout Korea. The study population comprised patients who were consecutively admitted to participating ICUs from 1 July 2010 to 31 January 2011.A total of 4617 patients were enrolled. ICU mortality was 14.3%, and hospital mortality was 20.6%. The patients were randomly assigned into one of two cohorts: a development (n = 2309) or validation (n = 2308) cohort. In the development cohort, the general SAPS3 had good discrimination (area under the receiver operating characteristics curve = 0.829), but poor calibration (Hosmer-Lemeshow goodness-of-fit test H = 123.06, P 0.001, C = 118.45, P 0.001). The Australasia SAPS3 did not improve calibration (H = 73.53, P 0.001, C = 70.52, P 0.001). Customization was achieved by altering the logit of the original SAPS3 equation. The new equation for Korean ICU patients was validated in the validation cohort, and demonstrated both good discrimination (area under the receiver operating characteristics curve = 0.835) and good calibration (H = 4.61, P = 0.799, C = 5.67, P = 0.684).General and regional Australasia SAPS3 admission scores showed poor calibration for use in Korean ICU patients, but the prognostic power of the SAPS3 was significantly improved by customization. Prediction models should be customized before being used to predict mortality in different regions of the world.

Background: Lenalidomide combined with low-dose dexamethasone (Len-dex) is an effective treatment for the patients with refractory/relapsed multiple myeloma (RRMM). The anti-myeloma effect of lenalidomide is associated with activation of the immune system, but the exact immunomodulatory mechanisms in vivo and clinical impact of Len/dex in RRMM patients remains unclear. In this study, we analyzed immune cell populations in patients receiving Len-dex for the treatment of RRMM. Methods: Peripheral blood samples from 90 RRMM patients were taken on day 1 of cycles 1 (baseline), 2, 3, and 4 of Len/dex therapy. CD3+, CD4+, CD8+, CD161+ T cells, natural killer (NK) cell (CD16+/CD56+), NKT-like cell (CD3+/CD56+) and myeloid-derived suppressor cell (MDSC) including granulocytic (G-MDSC) and monocytic (M-MDSC) were analyzed by flow cytometry. In addition, response was assessed in 81 patients receiving more than 4 cycles of Len-dex and the comparison of cell populations according to an achievement of ≥very good partial response (VGPR) was performed. Results: Forty-eight men and 42 women were enrolled in this study. The median age was 61 years (range, 29-84 years). At baseline, peripheral blood CD3+ cell frequency was 51.65 ± 1.79% which was significantly decreased to 41.67 ± 2.44% (P=0.001) and 39.72 ± 2.90% (P Conclusion: Our data demonstrate that Len-dex therapy in patients with RRMM is associated with decreased frequency of T cells with a trend of increased NK cell frequency. Change in CD8+ cell and M-MDSC frequency can correlate with the quality of response to Len-dex. Baseline NKT-like cell frequency and change in CD3+ and CD8+ cells early after treatment may predict continuation of anti-myeloma effect of Len-dex therapy. Disclosures No relevant conflicts of interest to declare.

Tube thoracostomy is known to cause complications such as bleeding or infection, but the incidence of chylothorax secondary to tube thoracostomy is under-reported, and therefore, we report this case. A patient was diagnosed as systemic lupus erythematosus with pleural and pericardial involvement. During repeated therapeutic thoracentesis, which were performed because of poor response to steroids and cylophosphamide, hemothorax developed and we therefore inserted a chest tube. The pleural effusion changed from red to milky color in several hours and we diagnosed the pleural effusion as chylothorax. Total parenteral nutrition based on medium-chain triglycerides was supplied to this patient and chylothorax was improved after 4 days.

Background: The increasing rate of drug-resistant tuberculosis (TB) is a threat to the public health and TB control. In Korea, about 75∼80% of TB patients are treated in private hospitals and the rate has been continuously increasing since 2000. Methods: On a retrospective basis, we enrolled 170 newly diagnosed with or retreated for multidrug-resistant TB (MDR-TB) in 2004 from 21 private hospitals. We extracted the following demographics and treatment history from patient medical records: initial treatment outcomes, cumulative survival rates, treatment outcomes, and prognostic factors. Results: Of the 170 patients, the majority were male (64.1%), the mean age was 44.5 years old, and mean body- mass-index was 20.2 kg/m 2 . None of the patients tested positive for HIV. Eleven (6.5%) were confirmed to have extensively drug-resistant TB (XDR-TB) at treatment initiation. Treatment success rates were not different between XDR-TB (36.4%, 4/11) and non-XDR MDR-TB (51.6%, 82/159). Default rate was high, 21.8% (37/170). Far advanced disease on X-ray was a significant negative predictor of treatment success; advanced disease and low BMI were risk factors for all-cause mortality. Conclusion: In private hospitals in Korea, the proportion of XDR-TB in MDR-TB was comparable to previous data. The treatment success rate of MDR-/XDR-TB remains poor and the failure rate was quite high. Adequate TB control policies should be strengthened to prevent the further development and spread of MDR-/XDR-TB in Korea.