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Background/Aims: In 2019, the American Society for Gastrointestinal Endoscopy (ASGE) established clinical predictors for choledocholithiasis. Our study was designed to evaluate these predictors within the Korean clinical context, establish cutoff values, and develop a predictive model. Methods: This retrospective study analyzed patients who underwent laparoscopic cholecystectomy. The relationships between choledocholithiasis and predictors including age, blood tests, and imaging findings were assessed through univariate and multivariate logistic regression analyses. We established Korean cutoff values for these predictors and developed a scoring system for choledocholithiasis using a multivariate logistic regression. The performance of this scoring system was then compared with that of the 2019 ASGE guidelines through a receiver operating characteristic curve. Results: We established Korean cutoff values for age (>70 years), alanine aminotransferase (>26.5 U/L), aspartate aminotransferase (>28.5 U/L), gamma-glutamyl transferase (GGT; >82.5 U/L), alkaline phosphatase (ALP; >77.5 U/L), and total bilirubin (>0.95 mg/dL). In the multivariate analysis, only age >70 years, GGT >77.5 U/L, ALP >77.5 U/L, and common bile duct dilatation remained significant. We then developed a new Korean risk stratification model from the multivariate analysis, with an area under the curve of 0.777 (95% confidence interval, 0.75 to 0.81). Our model was stratified into the low-risk, intermediate-risk, and high-risk groups with the scores being 5.5, respectively. Conclusions: Predictors of choledocholithiasis in cholecystectomy patients and their cutoff values in Korean should be adjusted and further studies are needed to develop appropriate guidelines.

Abstract Background Impact of advanced age on disease characteristics of acute cholecystitis (AC), and surgical outcomes after laparoscopic cholecystectomy (LC) has not been established. Methods This single-center retrospective study included patients who underwent LC for AC between April 2010 and December 2020. We analyzed the disease characteristics and surgical outcomes according to age: Group 1 (age

Background This study aimed to identify the risk factors for postoperative complications of laparoscopic common bile duct exploration (LCBDE) in the oldest old patients aged 80 years or older. Methods From March 2001 to October 2020, 363 patients underwent LCBDE with stone removal. Based on their ages, they were divided into two groups, those younger than 80 years (n=240) and those 80 years old or older (n=123). We compared patient demographics, disease characteristics, surgical outcomes, and postoperative complications based on these groups. Results The older group had a higher proportion of patients with a Charlson Comorbidity Index ≥5 (p2 hours (OR=3.204; 95% CI, 1.802–5.695; p

Purpose Sentinel lymph node biopsy (SLNB) using both a radioactive isotope (RI) and blue dye is considered highly effective; however, there were limitations with the use of both agents in some hospitals, and blue dye has been shown to have some adverse effects. Additionally, preoperative prediction of sentinel lymph node (SLN) status using the maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET-CT) can help avoid unnecessary axillary dissection or SLNB. Thus, we evaluated the efficacy and oncologic safety of SLNB using an RI alone in terms of long-term outcomes and determined the association between SLN metastasis and SUVmax of the primary tumor. Methods This retrospective study was conducted at Konyang University Hospital between March 2011 and May 2018. Overall, 142 patients with breast cancer who underwent SLNB using an RI alone were enrolled. Data on identification and false-negative rates were collected. The SUVmax of primary tumors on PET-CT were analyzed for their association with SLN metastasis. Results The identification and false-negative rates were 98.6% and 0%, respectively. There was no axillary local recurrence in patients with negative SLN findings. The correlation between the SUVmax of the primary tumor and SLN status was significant (r=0.249, P=0.005); the cutoff value for negative SLN metastasis was

Translanguaging theory highlights the dynamic use of multiple languages and communication modes by multilingual people in their daily experiences. Museums are informal family learning spaces where multilingual families use languages and other semiotic resources to create learning opportunities for their children. Using a microethnographic approach to discourse analysis and multimodal interaction analysis, I examined how a multilingual family uses translanguaging practices to organize their family learning in museums and the role of pointing gestures as part of their translanguaging repertoires in multilingual family learning. The analysis of two literacy events highlights that a child and his mother translanguaged with various semiotic resources to organize museum performances, joint attention, and telling, and that pointing gestures played a role in constructing a translanguaging space as they organized the two performances. Pointing involved the family in reading signage texts and allowed the mother to translate them for the child. Viewing translation as part of the translanguaging repertoire, this study recognizes the importance of the role of pointing gestures in constructing family learning at museums, enriching children's schooling and literacy learning in classrooms. I argue that recognizing pointing as a critical component of translanguaging allows educators to develop strategies that leverage families' unique repertoires to support multilingual students' language and literacy learning.

Sanger sequencing, also known as dideoxy sequencing, is a widely used method for DNA sequencing, particularly for cloned plasmids and clinical samples. This technique requires a combination of essential biochemistry skills, such as a chain-termination reaction, gel electrophoresis, and fluorescence detection. Unfortunately, there is a lack of activities that replicate the Sanger sequencing process for students to learn and practice these skills. To address this issue, a manipulative-based Sanger sequencing activity was developed that incorporates colorful pop beads to demonstrate a chain-termination reaction, separation of products, and fluorescence detection. The beads represent deoxynucleotides and dideoxynucleotides, allowing for a visual representation of DNA fragment generation. This kinesthetic learning activity offers a high visual impact for students, aiding in their understanding of the Sanger sequencing process, and can also be used to illustrate polymerase chain reaction (PCR)-based techniques.

Purpose This study aimed to clarify the association between human epidermal growth factor receptor 2 (HER-2) status and the clinicopathologic factors of patients who underwent curative intent gastrectomy. Methods From June 2011 to May 2015, curative intent gastrectomy was performed in 441 patients at Konyang University Hospital. Among them, we evaluated the HER-2 status in 113 patients. Data on clinicopathologic parameters such as age, sex, histological subtype, endoscopic Lauren classification, tumor location, size, presence of lymphovascular invasion, invasion depth, pathologic stage, HER-2 overexpression, recurrence and survival were obtained. In this study, pathological HER-2 intensity scores of 0, 1+, and 2+ were assumed to be negative, 3+ only was to be positive for overexpression. Results In a total of 113 cases who underwent curative intent gastrectomy with HER-2 testing, 16 (14.2%) cases had positivity of HER-2 overexpression. HER-2 overexpression had significant associations with tumor stage (19.0% in I-IIIb vs. 2.9% in IIIc-IV, P=0.036). Survival analysis of HER2 overexpression has no significant difference. Conclusion In this study, HER-2 overexpression rate was 14.2% and patient tumor stage had significant association with HER-2 overexpression.

As the capabilities of mobile devices and mobile communication techniques expand, vehicular ad hoc networks (VANETs) play an increasingly significant role in transportation and traffic management, particularly in Intelligent Transportation Systems (ITS). However, the rapid topology changes, high vehicle mobility, and frequent link disconnections make routing in VANETs a challenging task, necessitating the development of efficient routing protocols. Moreover, as VANET services provided in our daily lives become more extensive and situations in which they are provided simultaneously to an increasing number of users become more frequent, numerous data delivery optimization algorithms have been researched to address these issues. Alongside this, the research related to Unnamed Aerial Vehicles (UAVs) has also been utilized as a solution to solve the physical data link disconnection problem of VANETs. In this paper, we propose a routing protocol called PSUV (Particle Swarm UAV-VANET). First, we have solved the software-related issues of VANETs by measuring data transmission availability of vehicles existing in the topology and conducting topology optimization by creating a vehicle routing table, utilizing a mathematical value calculation formula that combines Particle Swarm Optimization (PSO) from Swarm Intelligence (SI) and the directional vector information of the vehicle. Furthermore, by utilizing UAVs, we address the physical disconnectivity issues that arise during data transmission in VANETs, thereby minimizing the delay and maximizing the total data rate under realistic conditions. Finally, extensive simulations are conducted to validate the superiority of the proposed protocol in various circumstances in an NS-3 simulation. Simulation results indicate that the proposed protocol solves the challenging issues in realistic VANET with significant improvement.

Abstract Objective Infertility is associated with obesity. The Body Roundness Index (BRI) is a body measurement index related to obesity that more accurately assesses body and visceral fat levels. However, the relationship between BRI and infertility remains unclear. Therefore, this study aims to determine the relationship between BRI and infertility. Methods This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018 and included 3,528 women aged 18–45 years. Multivariate logistic regression was employed to investigate the association between BRI and infertility. Restricted cubic spline (RCS) analysis explored the linear or non-linear relationship between BRI and infertility. Interaction analyses were conducted on subgroups to validate the findings. To verify the robustness of the results, we performed several sensitivity analyses, including propensity score matching(PSM) and multiple imputations for missing data. Furthermore, the predictive capabilities of various anthropometric indices—including BRI, weight-adjusted waist index (WWI), body mass index (BMI), and weight—on infertility incidence were assessed using Receiver Operating Characteristic (ROC) curve analysis. Results There was a significant positive association between BRI and infertility. After adjusting for covariates, for each unit increase in BRI, there was a 12% increase in the probability of infertility (P

Abstract Background Recent studies have identified hearing loss (HL) as a primary risk factor for Alzheimer’s disease (AD) onset. However, the mechanisms linking HL to AD are not fully understood. This study explored the effects of drug-induced hearing loss (DIHL) on the expression of proteins associated with AD progression in mouse models. Methods DIHL was induced in 5xFAD and Tg2576 mice aged 3 to 3.5 weeks using kanamycin (700 mg/kg, subcutaneous) and furosemide (600 mg/kg, intraperitoneal). The accumulation and expression of beta-amyloid (Aβ), ionized calcium-binding adaptor molecule 1 (Iba1), and glial fibrillary acidic protein (GFAP) were measured through immunohistochemistry and immunoblotting. Additionally, the expression of proteins involved in the mammalian target of rapamycin (mTOR) pathway, including downstream effectors p70 ribosomal S6 kinase (p70S6K) and S6, as well as proinflammatory cytokines, was analyzed. Results Compared to control conditions, HL led to a significant increase in the accumulation of Aβ in the hippocampus and cortex. Elevated levels of neuroinflammatory markers, including Iba1 and GFAP, as well as proinflammatory cytokines such as interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-alpha (TNF-α), were observed. Moreover, DIHL enhanced phosphorylation of mTOR, p70S6K, and S6, indicating activation of the mTOR pathway. Conclusions HL significantly increases Aβ accumulation in the brain. Furthermore, HL activates astrocytes and microglia, leading to increased neuroinflammation and thereby accelerating AD progression. These findings strongly suggest that HL contributes autonomously to neuroinflammation, highlighting the potential for early intervention in HL to reduce AD risk.

Purpose: Myelosuppression, particularly neutropenia, is one of the most frequent and serious toxicity seen in patients with breast cancer undergoing systemic chemotherapy. However, the predictive factors for development of severe neutropenia in chemotherapy remain unknown. We therefore evaluated predictive factors for excessive myelosuppression. Methods: We retrospectively analyzed 341 patients with breast cancer treated with chemotherapy from 2000 to 2012. Clinicopathological characteristics, number of using of granulocyte colony-stimulating factor (G-CSF), and pretreatment hematologic values were extracted from the electronic medical record system. Patients were sorted 2 groups by number of using G-CSF in each chemotherapeutic regimens; group 1 is more G-CSF (within high 20 percentile) and 2 less G-CSF using group (within lower 20 percentile). Results: Number of using G-CSF was ranged 0–83 (mean 10.76). One hundred one patients were in group 1 and 65 patients were in group 2. Mean of number of G-CSF using was 0.21 in group 1 and 28.02 in group 2. Pretreatment white blood cell, hemoglobin and platelet count were lower in group 2 than in group 1 (6.88×103/μL vs. 5.97×103/μL, 12.63 g/dL vs. 11.90 g/dL, and 275.95×104 μL vs. 227.37×104μL). There were no statistically differences in other clinicopathologic characteristics such as age, body mass index or comorbidities, hormonal receptor, stage, and other pretreatment hematologic values. Conclusion: Pretreatment white blood cell count, hemoglobin and platelet count can be used to identify patients at increased risk of significant myelosuppression undergoing chemotherapy with breast cancer. This information can be used to target high-risk patients for prophylactic treatment.

Some plant RNA viruses in the family Betaflexiviridae encode a nucleic acid-binding protein (NABP) that facilitates infection by suppressing the host RNA silencing response. Previously, no members of the genus Tepovirus within this family were known to possess a NABP homolog. In this study, we identified the genome sequences of 21 novel Betaflexiviridae viruses: 17 represent new members of Tepovirus, and four may be founding members of a new genus closely related to the genus Vitivirus. Notably, five of these newly identified tepoviruses contain a NABP-like open reading frame (ORF). Sequence comparison and phylogenetic analysis of NABP homologs suggest these tepoviruses independently acquired a NABP-like ORF from diverse sources. The identification of 17 novel viruses substantially enhances our understanding of the genetic diversity within the genus Tepovirus. This study further highlights the role of recombination in the genome evolution and diversity of Betaflexiviridae.

Abstract Artificial superlattices composed of perovskite oxides serves as an essential platform for engineering coherent phonon transport by redefining the lattice periodicity, which strongly influences the lattice‐coupled phase transitions in charge and spin degrees of freedom. However, previous methods of manipulating phonons have been limited to controlling the periodicity of superlattice, rather than utilizing complex mutual interactions that are prominent in transition metal oxides. In this study on oxide superlattices composed of ferromagnetic metallic SrRuO3 and quantum paraelectric SrTiO3, phonon modulation by controlling the geometry of superlattice in atomic‐scale precision is realized, demonstrating the coherent phonon engineering using structural and magnetic phase transitions. By modulating the interface density, coherent‐incoherent crossover of the phonon transport at room temperature is observed, which is coupled with a change in interfacial structural continuity. Upon cooling, the close relation between phonon transport and multiple phase transitions is identified. In particular, the enhancement of the polar state in SrTiO3 layer at ≈200 K leads to the weakening of phonon coherence and a further reduction of thermal conductivity in superlattices compared to the bulk limit. These findings provide a guide to developing future thermoelectric nanodevices by engineering the coherence of phonons via the design of complex oxide heterostructures.

ObjectiveThis study assessed the effects of transcranial direct current stimulation (tDCS) on cue reactivity and craving for game-related cues using event-related potentials (ERPs) in internet gaming disorder (IGD) patients.MethodsAt baseline, a series of game-related and neutral pictures were shown to both IGD and healthy controls (HCs) while ERPs were recorded. Late positive potentials (LPP) were used to investigate cue reactivity. During intervention, IGD patients received 10 sessions (two sessions/day for 5 consecutive days, 2 mA for 20 min/session) of tDCS to the left (anode stimulation) and right (cathode) dorsolateral prefrontal cortex. Subjectively assessed craving and LPP component was analyzed before stimulation and at the 1-month follow-up after tDCS in IGD.ResultsAt baseline, patients with IGD showed higher LPP amplitudes for game-related cues in the centro-parietal and parietal regions than HCs. After 10 sessions of tDCS, increased LPP amplitudes decreased significantly at 1-month follow-up., as well as subjective craving for gaming.ConclusionThese findings suggest that neurophysiological arousal in response to game-related cues in the IGD group could be modulated by the effects of tDCS. LPP was a significant neurophysiological marker of the neuroplastic response of cue reactivity underlying the therapeutic effect of tDCS on IGD. Based on the present findings, tDCS could be expanded to the treatment of other addictive disorders, including substance use disorder and behavioral addictions.

This study predicted the performance of an inlet guide vane to be installed later by applying an absolute flow angle (ß) at the axial pump inlet. The pump’s performance was predicted based on changes in inlet ß, and the influence of variations in inlet ß on the low-flow area was analyzed. For turbulence flow analyses, the Reynolds-averaged Navier–Stokes equations were discretized based on the finite volume method. The internal flow was analyzed in detail through transient analysis. Furthermore, the impact of changes in the absolute flow angle at the inlet on the rotating stall occurring inside the pump in the low-flow-rate region was analyzed. The analysis of the internal flow field confirmed that the absolute flow angle at the inlet affects the stability of the internal flow. Results showed that energy reduction and efficient operation scenarios can be established compared with the existing valve control method by changing inlet ß. Through fast Fourier-transform analysis, it was confirmed that when the inlet angle (θ) is changed in the low-flow-rate region, a more stable operation is possible compared with the existing one.

Abstract The effectiveness of dual‐doping as a method of improving the conductivity of sulfide solid electrolytes (SEs) is not in doubt; however, the atomic‐level mechanisms underpinning these enhancements remain elusive. In this study, we investigate the atomic mechanisms associated with the high ionic conductivity of the Li7P3S11 (LPS) SE and its response to Ag/Cl dual dopants. Synthesis and electrochemical characterizations show that the 0.2 M AgCl‐doped LPS (Li6.8P3Ag0.1S10.9Cl0.1) exhibited an over 80% improvement in ionic conductivity compared with the undoped LPS. The atomic‐level structures responsible for the enhanced conductivity were generated by a set of experiment and simulation techniques: synchrotron X‐ray diffractometry, Rietveld refinement, density functional theory, and artificial neural network‐based molecular dynamics simulations. This thorough characterization highlights the role of dual dopants in altering the structure and ionic conductivity. We found that the PS4 and P2S7 structural motifs of LPS undergo transformation into various PSx substructures. These changes in the substructures, in conjunction with the paddle‐wheel effect, enable rapid Li migration. The dopant atoms serve to enhance the flexibility of PS4–P2S7 polyhedral frameworks, consequently enhancing the ionic conductivity. Our study elucidates a clear structure–conductivity relationship for the dual‐doped LPS, providing a fundamental guideline for the development of sulfide SEs with superior conductivity.

Abstract EGFR mutations are a major prognostic factor in lung adenocarcinoma. However, current detection methods require sufficient samples and are costly. Deep learning is promising for mutation prediction in histopathological image analysis but has limitations in that it does not sufficiently reflect tumor heterogeneity and lacks interpretability. In this study, we developed a deep learning model to predict the presence of EGFR mutations by analyzing histopathological patterns in whole slide images (WSIs). We also introduced the EGFR mutation prevalence (EMP) score, which quantifies EGFR prevalence in WSIs based on patch‐level predictions, and evaluated its interpretability and utility. Our model estimates the probability of EGFR prevalence in each patch by partitioning the WSI based on multiple‐instance learning and predicts the presence of EGFR mutations at the slide level. We utilized a patch‐masking scheduler training strategy to enable the model to learn various histopathological patterns of EGFR. This study included 868 WSI samples from lung adenocarcinoma patients collected from three medical institutions: Hallym University Medical Center, Inha University Hospital, and Chungnam National University Hospital. For the test dataset, 197 WSIs were collected from Ajou University Medical Center to evaluate the presence of EGFR mutations. Our model demonstrated prediction performance with an area under the receiver operating characteristic curve of 0.7680 (0.7607–0.7720) and an area under the precision‐recall curve of 0.8391 (0.8326–0.8430). The EMP score showed Spearman correlation coefficients of 0.4705 (p = 0.0087) for p.L858R and 0.5918 (p = 0.0037) for exon 19 deletions in 64 samples subjected to next‐generation sequencing analysis. Additionally, high EMP scores were associated with papillary and acinar patterns (p = 0.0038 and p = 0.0255, respectively), whereas low EMP scores were associated with solid patterns (p = 0.0001). These results validate the reliability of our model and suggest that it can provide crucial information for rapid screening and treatment plans.

BackgroundWhile prior research has established a correlation between dietary choline intake and bone density in the elderly, the relationship in adolescents remains ambiguous. This study seeks to examine the association between dietary choline intake and bone density in American adolescents.MethodsData from the National Health and Nutrition Examination Survey (NHANES) for 2005 to 2018 were used in this study, encompassing participants aged 12–19 years. The relationship between dietary choline intake and bone density was assessed using multivariate linear regression models and restricted cubic spline (RCS) models. Subgroup analyses were also performed to investigate differences across various subgroups.Results3,800 participants with an average age of 15 years were included in this study. After adjusting for relevant confounding factors, a positive correlation was observed between dietary choline intake and total bone density in adolescents (95% CI: 0.03–0.17, p = 0.010). Gender-specific analysis indicated a significant positive correlation between dietary choline intake and total bone density in males (95% CI: 0.07–0.23, p

The aim of the study is to formulate an injectable nanocrystalline suspension (NS) of dutasteride (DTS), a hydrophobic 5α-reductase inhibitor used to treat benign prostatic hyperplasia and scalp hair loss, for parenteral long-acting delivery. A DTS-loaded NS (DTS-NS, 40 mg/mL DTS) was prepared using a lab-scale bead-milling technique. The optimized DTS-NS prepared using Tween 80 (0.5% w/v) as a nano-suspending agent, was characterized as follows: rod/rectangular shape; particle size of 324 nm; zeta potential of −11 mV; and decreased drug crystallinity compared with intact drug powder. The DTS-NS exhibited a markedly protracted drug concentration-time profile following intramuscular injection, reaching a maximum concentration after 8.40 days, with an elimination half-life of 9.94 days in rats. Histopathological observations revealed a granulomatous inflammatory response at the injection site 7 days after intramuscular administration, which significantly subsided by day 14 and showed minimal inflammation by day 28. These findings suggest that the nanosuspension system is a promising approach for the sustained release parenteral DTS delivery, with a protracted pharmacokinetic profile and tolerable local inflammation.