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Abstract Background The indications, benefits, and outcomes of percutaneous transluminal renal artery intervention (PTRI) remain controversial. The study purpose was to evaluate the long-term outcomes of PTRI in clinical practice. Methods A retrospective review of 217 subjects (254 renal arteries; mean age, 59.8 years) who underwent PTRI based on medical database. Results The most common cause of renal artery stenosis was atherosclerosis in 217 (85.4%), followed by Takayasu arteritis (TA) in 23 (9.1%), fibromuscular dysplasia in five (2.0%) and others in nine (3.5%). Mean follow-up duration was 5.7 ± 3.7 years. The first restenosis rate was 7.5% (n = 19; highest in TA: n = 9, 47.4%) and second restenosis occurred in six arteries (five TAs, one fibromuscular dysplasia). Follow-up blood pressure improved from 142.0/83.5 to 122.8/73.5 mmHg (P

[This corrects the article DOI: 10.1371/journal.pone.0253640.].

Abstract Background The signs and symptoms of pheochromocytoma can imitate those of many other diseases, which may result in confusion. Therefore, diagnosing and treating secondary hypertension due to pheochromocytoma in deteriorating patients becomes challenging. Case presentation A 63-year-old female patient presented to the emergency room with severe and progressive nausea. The initial diagnosis was an acute myocardial infarction based on ST-segment depression on electrocardiogram and elevated cardiac markers. Elective coronary angiography revealed nonobstructive coronary arteries. However, she suffered from a complicated clinical course for several weeks during her life-or-death crisis. She was subsequently diagnosed with a cerebral hemorrhage and a pheochromocytoma. It is unclear whether her initial presentation was due to the neurogenic stunned myocardium caused by a cerebral hemorrhage or type 2 myocardial infarction caused by a pheochromocytoma, or both. However, this case showed the significance of accurately diagnosing and treating underlying causes in patients presenting with myocardial infarction with nonobstructive coronary arteries. Early diagnosis and treatment of the pheochromocytoma may have prevented the complications experienced by the patient. Conclusions A catecholamine surge and blood pressure fluctuation caused severe complications. When a patient presents with an unusual clinical presentation, secondary hypertension due to pheochromocytoma should be suspected.

BackgroundAlthough many electrocardiography wearable devices have been released recently for the detection of atrial fibrillation (AF), there are few studies reporting prospective data for wearable devices compared to the strategy of the existing guidelines in the detection of atrial fibrillation (AF) after cryptogenic stroke. A tiny single-patch monitor is more convenient than a conventional Holter monitor recording device and, therefore, longer duration of monitoring may be acceptable.Methods and DesignThe CANDLE-AF study is a multicenter, prospective, randomized controlled trial. Patients with transient ischemic attack or ischemic stroke without any history of AF will be enrolled. The superiority of the 72-h single-patch monitor to standard strategy and non-inferiority of the 72-h single-patch monitor to an event-recorder-type device will be investigated. Single-patch monitor arm will repeat monitoring at 1, 3, 6, and 12 months, event-recorder-type arm will repeat monitoring twice daily for 12 months. The enrollment goal is a total of 600 patients, and the primary outcome is the detection of AF which continues at least 30 s during study period. The secondary outcome is the rate of changes from antiplatelet to anticoagulant and major adverse cardiac and cerebrovascular events within 1 year.ConclusionsThe results of CANDLE-AF will clarify the role of a single-lead patch ECG for the early detection of AF in patients with acute ischemic stroke. In addition, the secondary outcome will be analyzed to determine whether more sensitive AF detection can affect the prognosis and if further device development is meaningful. (cris.nih.go.kr KCT0005592).

Background: Acute respiratory viral infections can result in cardiovascular involvement, with such patients having a significantly higher mortality rate than those without cardiovascular involvement. Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, it is important to determine whether cardiovascular risk factors are associated with the severity of COVID-19.Methods: These nationwide data were provided by the Korea Disease Control and Prevention Agency. We defined a patient as having a “critical illness” if they required more than invasive mechanical ventilation and “fatal illness” if they died.Results: Among the total 5,307 patients, 2,136 (40.8%) were male. The critical illness rate was 5.1% (males: 6.7, females: 4.0%) and the fatality rate was 4.54%. The multivariable analysis showed that age ≥60 years, male sex, diabetes mellitus, hypertension, heart failure, chronic kidney disease, cancer, and dementia were independent risk factors for critical illness. The risk scoring model showed the significance of multiple risk factors. Patients with four risk factors; old age (≥60 years), male sex, hypertension, and diabetes mellitus had a more than a 100 times higher risk for severe COVID-19 than those without these risk factors (OR; 95% confidence interval, 104; 45.6–240.6 for critical, 136.2; 52.3–3547.9 for fatal illness).Conclusions: This study demonstrated that cardiovascular risk factors are also significant risk factors for severe COVID-19. In particular, patients who have multiple cardiovascular risk factors are more likely to progress to severe COVID-19. Therefore, early and appropriate treatment of these patients is crucial.

Study abroad (SA) has long been regarded as a key component of internationalization efforts in higher education and much scholarship has investigated the practices and outcomes of SA from varied perspectives. More recently, scholars have paid growing attention to ways to increase the participation of historically marginalized students in SA, to design SA programs to meet those students' needs, and to document their experiences abroad. Despite recent scholarship in these areas, relatively little research has employed an equity lens to address research on language-focused SA. This article puts forward language-focused SA as a possible venue to pursue equity and to provide quality education for all students, especially for historically underserved students. More specifically, we address three overarching questions: (1) What theoretical frameworks could be implemented to research SA through an equity lens?; (2) What methodological approaches could inform SA research with an equity lens?; and (3) What topics could be examined to research SA through an equity lens? Drawing on equity as a guiding principle, we discuss relevant research tasks that demonstrate specific ways to address these overarching questions in future research on language-focused SA.

ObjectiveObesity has been reported as a risk factor for severe coronavirus disease 2019 (COVID-19) in recent studies. However, the relationship between body mass index (BMI) and COVID-19 severity and fatality are unclear.Research design and methodsThis study included 4,141 COVID-19 patients who were released from isolation or had died as of April 30, 2020. This nationwide data was provided by the Korean Centers for Disease Control and Prevention Agency. BMI was categorized as follows; < 18.5 kg/m2, 18.5-22.9 kg/m2, 23.0-24.9 kg/m2, 25.0-29.9 kg/m2, and ≥ 30 kg/m2. We defined a fatal illness if the patient had died.ResultsAmong participants, those with a BMI of 18.5-22.9 kg/m2 were the most common (42.0%), followed by 25.0-29.9 kg/m2 (24.4%), 23.0-24.9 kg/m2 (24.3%), ≥ 30 kg/m2 (4.7%), and < 18.5 kg/m2 (4.6%). In addition, 1,654 (41.2%) were men and 3.04% were fatalities. Multivariable analysis showed that age, male sex, BMI < 18.5 kg/m2, BMI ≥ 25 kg/m2, diabetes mellitus, chronic kidney disease, cancer, and dementia were independent risk factors for fatal illness. In particular, BMI < 18.5 kg/m2 (odds ratio [OR] 3.97, 95% CI 1.77-8.92), 25.0-29.9 kg/m2 (2.43, 1.32-4.47), and ≥ 30 kg/m2 (4.32, 1.37-13.61) were found to have higher ORs than the BMI of 23.0-24.9 kg/m2 (reference). There was no significant difference between those with a BMI of 18.5-22.9 kg/m2 (1.59, 0.88-2.89) and 23.0-24.9 kg/m2.ConclusionsThis study demonstrated a non-linear (U-shaped) relationship between BMI and fatal illness. Subjects with a BMI of < 18.5 kg/m2 and those with a BMI ≥ 25 kg/m2 had a high risk of fatal illness. Maintaining a healthy weight is important not only to prevent chronic cardiometabolic diseases, but also to improve the outcome of COVID-19.

This study examined how Korean teacher candidates' understanding of English and their use of the L2 (second language) and other semiotic resources for meaning making could be mediated through a mobile application, Band during study abroad. Drawing on the sociocultural perspective of L2 learning, the teacher candidates' weekly reflections, which were composed in L2 English along with other semiotic resources (e.g., emoticons, images, and videos) on curricular activities were analyzed and triangulated with focus group and individual interviews. Content analysis of the reflection posts indicated how the mobility and connectivity of Band mediated sojourners' understanding of variation in English and the host culture during study abroad. The analysis further suggests that the interactive and multimodal features of the mobile application helped L2 learners engage in enhanced learning opportunities through which they shared and negotiated each other's ideas, by using the L2 and other semiotic meaning-making resources, such as images and videos.

Background The double fold operation is one of the most common aesthetic surgeries in Korea. There are many methods to make double fold using non-incision, incision and partial incision. Patients seeking double folds prefer natural appearance, less downtime, minimal scarring technique. The most favorable method is the minimal invasive but long-lasting fold formation technique. Methods From October 2003 to September 2016, this procedure was applied in 7,963 patients who worried about surgical scar or preferred non-incision method with puffy eyelids. Five stab incisions including two small incisions were taken in the upper eyelid. Through the small incision lines, the pretarsal muscle and the orbital fat were removed to facilitate tissue adhesion. The double fold line was made with the continuous buried suture. The suture was tied in the fifth stab incision site and the knot was placed deeply to prevent granuloma formation. Results This method was performed in all patients. The complications were asymmetry (52 cases), fold loosening (43 cases), granuloma (12 cases), conjunctival hemorrhage (5 cases), and scar (4 cases). Especially 74% of fold loosening cases were developed in mild ptotic patients. Conclusions This method achieves good cosmetic result, shorter operation time, less morbidity, faster recovery in puffy eyelids than the other method.

Background Patients with deviated nose frequently present concomitant nasal bone as well as septal deviation. Many surgical methods have been developed to address such septal deviation, along with various osteotomy techniques to correct bone deviation. The authors performed medial and paramedian osteotomies to treat deviated nose with mild hump, and utilized the acquired wedge shaped bone graft to achieve septal reposition and bony vault correction. Methods From October 2014 through June 2015, 10 patients with nasal bone deviation that showed sufficient lateral nasal wall angle but deviated dorsum and septum on their preoperative facial computed tomography were included in this study. The authors performed open rhinoplasty to expose the planned osteotomy site, and conducted medial and paramedian osteotomy that resulted in the separation of a wedge-shaped bone fragment. Bony septum deviation was then treated with the swing door maneuver, and the resected 2 to 3 mm portion of the nasal bone was stabilized by inserting the wedge-shaped bone graft acquired from the previous osteotomy procedures. Consecutive clinical examinations were followed on postoperative 1, 3, and 6 months to observe any recurrences. Results All patients were satisfied with their surgical results, and no recurrent deviations were noted. Conclusions Precise bone resection and transposition is essential for a successful corrective rhinoplasty. However, medial and lateral osteotomy are not mandatory procedures in all cases, and the nasal wedge bone graft that was utilized to support the treated septal bone may have aided in sustaining the surgical correction.

This qualitative case study examines, through an educational equity lens, the motivation, challenges, and assessment associated with international program development as appraised by the faculty and administrators in a district of multiple community colleges. To this end, semi-structured interviews were conducted with four faculty members and three administrators. Policy documents at the state, district, and college levels and website program descriptions were further used to triangulate the data sources. Thematic analysis suggests the faculty and administrators' motivation for developing international programs was often shaped by their personal backgrounds and their equity-minded visions to provide students with opportunities that every student deserves. Included in the reported challenges were institutional-level difficulties with recruiting students able and willing to study abroad, getting paperwork approved, and finding a faculty colleague willing to devote time to program development. The participants further described the success of education abroad in relation to their state's prescribed learning outcomes, add-on global learning outcomes at the institution level, and skills needed for students' future employment. Findings from this case study shed light on the needs of planning education abroad that are unique to community colleges, as a locus to help make education abroad a more accessible option for student learning.

The present study examined the relative effects of discourse-based and sentence-level grammar instruction on the learning of English present perfect in academic writing, using a sequential explanatory mixed-methods design. Participants were 37 multilingual graduate students enrolled in different sections of an ESL-writing course at a U.S. university. Prior to two 35-minute instruction sessions, the participants completed a pretest composed of acceptability-judgment, forced-choice, and fill-in-the-blank tasks. The same tasks, with different but comparable items, were administered immediately after and four weeks after the completion of the instructions. Retrospective verbalizations were elicited after completion of the delayed post-test to elicit the learners' awareness of the target form and other related tenses in academic writing. While results of the acceptability-judgment and forced-choice tasks show non-significant differences among the treatment and control groups on the pre-post-delayed post-tests, the discourse-based, fill-in-the-blank task results reveal that the discourse-based instruction group outperformed the other groups immediately after instruction. Results from the retrospective interviews corroborate these findings. Implications for discourse-based grammar instruction are discussed.