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Abstract Background This study aimed to identify the healthcare providers’ experience and perspectives toward end-of-life care decisions focusing on end-of-life discussion and physician’s order of life-sustaining treatment documentation in Korea which are major parts of the Life-Sustaining Treatment Act. Methods A cross-sectional survey was conducted using a questionnaire developed by the authors. A total of 474 subjects—94 attending physicians, 87 resident physicians, and 293 nurses—participated in the survey, and the data analysis was performed in terms of frequency, percentage, mean and standard deviation using the SPSS 24.0 program. Results Study results showed that respondents were aware of terminal illness and physician’s order of life-sustaining treatment in Korea well enough except for some details. Physicians reported uncertainty in terminal state diagnosis and disease trajectory as the most challenging. Study participants regarded factors (related to relationships and communications) on the healthcare providers’ side as the major impediment to end-of-life discussion. Study respondents suggested that simplification of the process and more staff are required to facilitate end-of-life discussion and documentation. Conclusion Based on the study results, adequate education and training for better end-of-life discussion are required for future practice. Also, a simple and clear procedure for completing a physician’s order of life-sustaining treatment in Korea should be prepared and legal and ethical advice would be required. Since the enactment of the Life-Sustaining Treatment Act, several revisions already have been made including disease categories, thus continuous education to update and support clinicians is also called for.

Abstract This study was conducted to investigate the pesticide residue concentrations and assess potential human health risks from fruit and vegetable consumption in Incheon. A total of 1,146 samples of 20 different types of fruits and vegetables were collected from the Incheon area in 2020. The pesticide residues were analyzed by the multi-residue method of the Korean Food Code for 400 different pesticides. Among the fruit and vegetable samples, 1,055 samples (92.1%) were free from detectable residues, while 91 samples (7.9%) contained residues and 11 samples (1.0%) had residues exceeding the Korean maximum residue limit. A total of 32 different pesticide residues were found and 8 residues exceeded MRLs. The most frequently detected pesticide residues were chlorfenapyr, procymidone, etofenprox, pendimethalin, fluopyram and azoxystrobin. The highest values of short term and long term exposure were obtained in the case of consumption of lettuce(leaves) with chlorfenpyr. For chronic dietary exposure, the cumulative hazard index (cHI) were below 100%. The results of this study showed that the detected pesticides were not exposed to potential health risks through the consumption of fruits and vegetables.

Background/Aims This study aimed to compare the efficacy of a recently developed clear-cut knife with that of widely used knives for endoscopic submucosal dissection (ESD) in early gastric cancer (EGC). Materials and Methods Data were collected retrospectively from the National Health Insurance Service Ilsan Hospital between May 2017 and April 2019. The study included 105 patients (108 lesions) with EGC who underwent ESD. Fifty-six EGCs were dissected using an insulation-tipped diathermic knife in combination with a needle knife, while 52 EGCs were dissected using a clear-cut knife, a single device with an integrated needle and an insulated-tipped knife. Oncologic outcomes and technical success were compared between the two groups. Results The distribution of the tumor locations, composition of the undifferentiated types of EGCs, and the size of EGCs (14.3±8.0 vs. 16.6±7.3 mm; P=0.130) were not significantly different between the groups. The complete (98.2% vs. 94.2%; P=0.273) and curative (87.5% vs. 88.5%; P=0.878) resection rates were not statistically different. Furthermore, no significant difference between the total procedure times (39±34.1 vs. 35.7±20.1 minutes; P=0.554), areas of the dissected specimen (858.6±406.5 vs. 980.3±393.8 mm2; P=0.119) and dissected areas per minute (32.4±17.9 vs. 35.5±16.2 mm2/min; P=0.345) were noted. Regarding complications, the overall perforation rates (3.6% vs. 4.0%) and bleeding rates (3.6% vs. 8.0%) were not statistically different. Conclusions The newly developed clear-cut knife is as useful as the combination of classical knives for ESD in EGC.

Recently, data-based artificial intelligence technology has been developing dramatically, and we are considering how to model, predict, and control complex systems. Energy system modeling and control have been developed in conjunction with building technology. This study investigates the use of an artificial neural network (ANN) for predicting indoor air temperature in a test room with windows on an entire side. Multilayer perceptron (MLP) models were constructed and trained using time series data obtained at one-second intervals. Several subsampling time steps of 1 s, 60 s, 300 s, 600 s, 900 s, 1800 s, and 3600 s were performed by considering the actual operation control mode in which the time interval is important. The performance indices of the neural networks were evaluated using various error metrics. Successful results were obtained and analyzed based on them. It was found that as the multi-step time interval increases, performance degrades. For system control designs, a shorter prediction horizon is suggested due to the increase in computational time, for instance, the limited computing capacity in a microcontroller. The MLP structure proved useful for short-term prediction of indoor air temperature, particularly when control horizons are set below 100. Furthermore, highly reliable results were obtained at multi-step time intervals of 300 s or less. For the multivariate model, both calculation time and data dispersion increased, resulting in worsened performance compared to the univariate model.

Energy consumption modeling has evolved along with building technology. Modeling techniques can be largely classified into white box, gray box, and black box. In this study, the thermal behavior characteristics of building components were identified through time-series data analysis using LSTM neural networks. Sensors were installed inside and outside the test room to measure physical quantities. As a result of calculating the overall heat transfer coefficient according to the international standard ISO 9869-1, the U value of the multi-window with antireflection coating was 1.84 W/(m2∙K). To understand the thermal behavior of multiple windows, we constructed a neural network using an LSTM architecture and used the measured data-set to predict and evaluate the heat flux through deep learning. From the measurement data, a wavelet transform was used to extract features and to find appropriate control time-step intervals. Performance was evaluated according to multistep measurement intervals using the error metric method. The multistep time interval for control monitoring is preferably no more than 240 s. In addition, multivariate analysis with several input variables was performed. In particular, the thermal behavior of building components can be analyzed through heat flux and temperature measurements in the transient state of physical properties of pre-installed building components, which were difficult to access with conventional steady-state measurement methods.

The Big Data Research Committee of the Korean Society of Gastroenterology conducted activities and researches with three goals. First, it provides the basis for proper and cost-effective treatment of digestive diseases in Korea. Second, it carries out population- level global research by establishing a system of big data analysis related to gastroenterology. Third, it provides the members of the Korean Society of Gastroenterology with the opportunity to plan and assess the public interest related to big data. The studies published by the committee members in this paper were carried out under these objectives, and the findings are believed to have achieved the public interest goals that may be helpful in the current medical and health policy. The construction of the big data infrastructure for digestive drugs is also underway, and we expect to see meaningful results pertaining to important digestive drugs. Research using public health medical big data, such as the National Health Insurance Corporation data base, should ultimately provide a basis for reflecting public messages and policies for the public. To this end, it is necessary for Korean researchers to lead efforts to lower the barriers and to approach relevant information and opportunities using big data research.

Duodenal varices are ectopic in nature and account for 40% of all ectopic bleeding cases. Ectopic variceal bleeding is rare (1%-5% of all variceal bleeding cases). The three principle approaches used to treat duodenal varices are endoscopic procedures, interventional radiological methods, and surgical interventions. A 59-year-old male with alcoholic liver cirrhosis and chronic hepatitis B infection visited our gastroenterology department with melena. Gastroduodenoscopy and computed tomography identified varices in the second part of the duodenum. We performed percutaneous transhepatic obliteration using glue and coil embolization, which obliterated the varices and resulted in immediate hemostasis. However, 3 months later, he re-visited presenting with newly developed duodenal varices and underwent endoscopic injection sclerotherapy.

Pulmonary extraintestinal manifestation is rare in Crohn’s disease and has been reported in only a few cases. Despite the presence of pulmonary abnormalities in a significant proportion of patients with inflammatory bowel disease, there are only few case reports, due to complicated diagnosis and low recognition by clinicians. Currently, treatment guidelines for pulmonary Crohn’s disease have not been established. There are some case reports of pulmonary Crohn’s disease that achieved remission after infliximab treatment. Clinical and radiological remission of pulmonary extraintestinal involvement in Crohn’s disease after adalimumab therapy has not been reported yet. Here, we report one case of lung involvement of Crohn’s disease, which shows radiological and clinical remission after adalimumab treatment.

Objective To identify the center of extensor indicis (EI) muscle through cadaver dissection and compare the accuracy of different techniques for needle electromyography (EMG) electrode insertion. Methods Eighteen upper limbs of 10 adult cadavers were dissected. The center of trigonal EI muscle was defined as the point where the three medians of the triangle intersect. Three different needle electrode insertion techniques were introduced: M1, 2.5 cm above the lower border of ulnar styloid process (USP), lateral aspect of the ulna; M2, 2 finger breadths (FB) proximal to USP, lateral aspect of the ulna; and M3, distal fourth of the forearm, lateral aspect of the ulna. The distance from USP to the center (X) parallel to the line between radial head to USP, and from medial border of ulna to the center (Y) were measured. The distances between 3 different points (M1– M3) and the center were measured (marked as D1, D2, and D3, respectively). Results The median value of X was 48.3 mm and that of Y was 7.2 mm. The median values of D1, D2 and D3 were 23.3 mm, 13.3 mm and 9.0 mm, respectively. Conclusion The center of EI muscle is located approximately 4.8 cm proximal to USP level and 7.2 mm lateral to the medial border of the ulna. Among the three methods, the technique placing the needle electrode at distal fourth of the forearm and lateral to the radial side of the ulna bone (M3) is the most accurate and closest to the center of the EI muscle.

Ulnar neuropathy at the wrist is an uncommon disease and pure ulnar sensory neuropathy at the wrist is even rarer. It is difficult to diagnose pure ulnar sensory neuropathy at the wrist by conventional methods. We report a case of pure ulnar sensory neuropathy at the hypothenar area. The lesion was localized between 3 cm and 5 cm distal to pisiform using orthodromic inching test of ulnar sensory nerve to stimulate at three points around the hypothenar area. Ultrasonographic examination confirmed compression of superficial sensory branch of the ulnar nerve. Further, surgical exploration reconfirmed compression of the ulnar nerve. This case report demonstrates the utility of orthodromic ulnar sensory inching test.

Abstract There has been controversy regarding the clinical utility of fecal occult blood test (FOBT) as a screening tool for colorectal cancer (CRC) in the general population. The purpose of this study was to examine the results of Korea national CRC screening using FOBT from 2006 to 2013 and to evaluate the implementation of the program. We analyzed the results of FOBT, colonoscopy, and the side effects during colonoscopy for the subjects (n = 20,609,909) from the Korea National Health Insurance Cancer Screening database. For evaluation of Korea national CRC screening program implementation over the 8-year period, we calculated uptake rate, FOBT positivity rate, and subsequent test compliance rate. The overall uptake rate was 30.1%, with an increasing pattern from 2006 to 2011. A relatively higher FOBT positivity rate (6.4%) and lower subsequent test compliance rate (46.6%) were observed in comparison to the results previously reported in Western countries. Side effects reported within 3 months period after colonoscopy accounted for 0.17% of all procedures, with bleeding being the most prevalent type. Although the implementation of CRC screening program using FOBT in Korea seems successful, trends in key indicators for Korea national CRC screening program should be monitored continuously.

Polymer foams are expanding their applications into functional materials. Partial foam structure has been fabricated in polyethylene terephthalate–polyethylene naphthalate (PET–PEN) copolymer by solid state foaming. Through SEM image analyses, a potential to fabricate gradient foam structures with micropores and unfoamed skin layers has been identified. The post-foaming temperature Tf tune the pore size distribution. Radial distribution of micromechanical properties, indentation hardness and elastic modulus were measured for the partial foam and their values were around 0.12 GPa and 2.0 GPa, respectively, for the outer foamed region. Foaming temperature affects the glass transition temperature Tg, the coefficient of thermal expansion and the flame spreading rate. For the range of Tf ≤ 60°C, thermal expansion coefficients for T > Tg are about 0.5 m/m°C (steep expansion group, SEG). When Tf is above 80 °C, they are around 0.02 m/m°C (mild expansion group, MEG). The burning rate of SEG is 2.8 times higher than that of MEG.

The early sound film and "classical-style" Hollywood film periods were important representatives in the history of Hollywood films, producing many classic films as well as many famous film music composers. Among them, Bernard Herrmann was a unique and distinctive representative with his own personal compositional style, and was also the representative composer for thriller, horror, mystery and science fiction films during this period. When analyzing film music, especially Bernard Herrmann's works, using tonal music analysis, many harmonic progressions cannot be accurately expressed. Harmonic function analysis emphasizes the principles of tonality, while neo-Riemannian theory breaks away from the framework of tonality and harmonic functions, emphasizing the spatial progression between chords. For Bernard Herrmann's music, using neo-Riemannian theory can reasonably analyze the characteristics and patterns of musical progression, and explain many chord progressions that harmonic functions cannot. One of the films that can be given as an example of this situation is The Day the Earth Stood Still (1951). The Day the Earth Stood Still is a Hollywood science fiction film made in 1951. This work played an important role in the development of later science fiction films. Bernard Herrmann chose to abandon the traditional orchestral instrumentation and used a specific instrumental ensemble to form Herrmann's unique science fiction film music space. Transformational analysis shows that the music uses modes, hexatonic scales and octatonic scales to form melodies and harmonies with ambiguous characteristics, and the use of these modes and scales also provides important color elements for film music of specific styles. Neo-Riemannian theory has been around for less than 50 years. As an emerging music theory system, it is not yet mature and complete, and is still expanding and improving. However, as an analysis tool for nonfunctional tonal film music, it can provide a brand new perspective. This researcher also believes that neo-Riemannian theory can provide theoretical basis for analyzing various styles of film music as an analytical tool. [ABSTRACT FROM AUTHOR]

Background and Aims. Endoscopic submucosal dissection (ESD) is routinely performed in treating gastric neoplasia and requires long-term higher levels of sedation. Endoscopist-directed nurse-administered sedation (EDNAS) has not been well studied in ESD. This study aimed to evaluate the safety and effectiveness of EDNAS for ESD. Methods. Patients treated with ESD for gastric tumors between 2013 and 2015 were retrospectively collected. Patients were divided into a midazolam-treated group (M group) and a midazolam plus propofol-treated group (MP group). Clinical outcome, safety, effectiveness, adverse events of ESD, and adverse events of sedation were analyzed. Results. Of 209 collected patients, 83 were in the M group and 126 were in the MP group. Of all patients, 67 patients had the circulatory adverse event during the ESD procedure. Sedation method was the only significant risk factor (M versus MP: 2.17 (1.14–4.15), p=0.019). In analysis of MP subgroups, 47 patients suffered an adverse event from sedation, and current smoking was the only significant association factor for adverse event (0.15 (0.03–0.68), p=0.014). Conclusions. In performing ESD, the effect of sedation is reduced in smoking patients. EDNAS may be acceptable for ESD under careful monitoring of vital sign and oxygen saturation.

Multiscale structured polymers have been considered as a promising category of functional materials with unique properties. We combined rapid prototyping and gas foaming technologies to fabricate multiscale functional materials of superior mechanical and thermal insulation properties. Through scanning electron microscope based morphological characterization, formation of multiscale porous structure with nanoscale cellular pores was confirmed. Improvement in mechanical strength is attributed to rearrangement of crystals within CO2 saturated grid sample. It is also shown that a post-foaming temperature higher than the glass transition temperature deteriorates mechanical strength, providing process guidelines. Thermal decomposition of filament material sets the upper limit of temperature for 3D printed features, characterized by simultaneous differential scanning calorimetry and thermogravimetric analysis. Porosity of the fabricated 3D structured polylactic acid (PLA) foam is controllable by suitable tuning of foaming conditions. The fabricated multiscale 3D structures have potential for thermal insulation applications with lightweight and reasonable mechanical strength.

Evaluation of motor symptoms in Parkinson’s disease (PD) is still based on clinical rating scales by clinicians. Reaction time (RT) is the time interval between a specific stimulus and the start of muscle response. The aim of this study was to identify the characteristics of RT responses in PD patients using electromyography (EMG) and to elucidate the relationship between RT and clinical features of PD. The EMG activity of 31 PD patients was recorded during isometric muscle contraction. RT was defined as the time latency between an auditory beep and responsive EMG activity. PD patients demonstrated significant delays in both initiation and termination of muscle contraction compared with controls. Cardinal motor symptoms of PD were closely correlated with RT. RT was longer in more-affected side and in more-advanced PD stages. Frontal cognitive function, which is indicative of motor programming and movement regulation and perseveration, was also closely related with RT. In conclusion, greater RT is the characteristic motor features of PD and it could be used as a sensitive tool for motor function assessment in PD patients. Further investigations are required to clarify the clinical impact of the RT on the activity of daily living of patients with PD.