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Efficient nanoscale light sources are sought after for applications such as sensing, imaging, and the development of photonic circuits. In particular, free electron light sources have gained much attention due to their ability to tune and direct light emission. Here, we show that radiation from free electrons passing through a 100 nm wide nanohole can reach as high as 90% of the theoretical limit. This is accomplished through the introduction of a circular nanoridge around the hole to form a structure we call the nanowell. The power radiated from the nanowell exceeds that of a regular nanohole by over 100 times and that of nanoholes surrounded by other features, such as bullseyes, by similar enhancement factors. Upon varying the structural parameters of the nanowell, the peak output wavelength can be tuned over a broad frequency range from the visible to the near-infrared. This reveals a route to extracting power from free electrons via material nanopatterning.

Abstract In this study repeated cyclic loading tests were carried out on seven shear wall specimens, which were fabricated in a real scale. The purpose of these experiments is to investigate the difference on the seismic performance of the wall depending on two methods of confining longitudinal bars at the wall boundaries and propose relaxed bar arrangement details that could be used in a moderate to high seismicity zone. The results showed that the seismic performance of special shear walls using overlapping loops as transverse reinforcement of the boundary element was similar to that of special shear walls using a closed hoop in strength, stiffness, and energy dissipation. This means the former can serve as an alternative for rational seismic design for moderate to high seismicity zones using overlapping hoops.

Controlling the generation of light in nano-scale systems is a challenging task and is of growing importance. Here, Li et al. propose a means of controlling the wavefront of light emanating from a single nano scale emitter by holographic principles using a plasmonic metasurface.

Abstract The association between self-rated health (SRH) and the development of atrial fibrillation (AF) in the general population remains underexplored. We reviewed the data of 9,895 participants in the Ansung–Ansan cohort study, a community-based Korean study. SRH was categorised as ‘poor’, ‘fair’, or ‘good’. A newly developed AF was identified through biennial electrocardiography examinations and/or a self-reported history of physician-determined diagnoses. Over a median follow-up of 11 years, 149 patients (1.5%) developed AF. Compared with the ‘good’ group, the ‘poor’ group exhibited a higher risk of incident AF (adjusted hazard ratio, 1.85; 95% confidence interval, 1.19–2.87). Old age, female sex, lower educational level, smoking, cardiovascular diseases (hypertension, diabetes mellitus, and coronary artery disease), and inflammation were associated with ‘poor’ SRH. Along with SRH, age, male sex, urban residence, hypertension, and myocardial infarction were also associated with a higher risk of incidental AF. The combined model, which included conventional risk factors and SRH, demonstrated a marginally improved performance in predicting incident AF (concordance index: 0.704 vs. 0.714, P = 0.058). Poor SRH is independently associated with the development of AF in Korean adults. However, it plays a limited role in AF surveillance when combined with conventional AF risk factors.

Introduction: The goal of this study was to evaluate the efficacy and safety of high-dose stereotactic body radiation therapy (SBRT) with an extended (48 hours or more) interfraction interval for hepatocellular carcinoma (HCC) ≤5 cm in size after incomplete response to transarterial chemoembolization (TACE). Methods: This multicenter prospective study included 54 patients with inoperable HCC of ≤5 cm size between July 2012 and June 2015. A total SBRT dose of 60 Gy in 3 fractions was administered within 14 days with ≥48 hours interfraction interval to patients who showed an incomplete response after 1–5 sessions of TACE. Treatment responses were defined according to the modified Response Evaluation Criteria for Solid Tumors. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0. Results: Forty-eight patients were evaluated with a median follow-up period of 66 months (range, 2–126 months). The median tumor size was 2.0 cm (range, 1.0–4.5 cm), and most patients (87.5%) had a single lesion. The 1-, 2-, and 5-year local control (LC) rates were 100%, 94.8%, and 90.7%, respectively. The 1-, 2-, and 5-year progression-free survival (PFS) rates were 63.4%, 56.9%, and 24.9%, respectively. The 1-, 2-, and 5-year overall survival (OS) rates were 95.6%, 90.9%, and 76.5%, respectively. None of the patients experienced grade 3+ gastrointestinal toxicity, while one patient developed non-classic radiation-induced liver disease 2 months after SBRT. Conclusion: High-dose SBRT with a ≥48-hour interfraction interval after incomplete response to TACE is effective for HCC ≤5 cm in size as evidenced by the high rates of LC and OS and acceptable treatment-related toxicity.

Abstract Optimal blood pressure (BP) for patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear. This study aims to identify the optimal BP by investigating the association between average office BP and future clinical events in patients undergoing PCI. Consecutive patients undergoing PCI from 2012 to 2016 were included. They were divided into five groups according to the average follow-up BP after discharge. The co-primary outcomes were net adverse clinical events (NACE) and major adverse cardiac and cerebrovascular events (MACCE) up to 5 years. NACE was defined as a composite of MACCE (all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke, or any revascularization) or major bleeding. A total of 2845 patients were included, and among them, 787 (27.7%) experienced the NACE during the follow-up period. Patients in the highest SBP group (adjusted hazard ratio [HR] 1.495, confidence interval [CI] 1.189–1.880) and lowest SBP group (adjusted HR 1.625, CI 1.214–2.176) had a significantly higher risk of 5-year NACE. Similar associations were observed between SBP and the risk of MACCE, and similar results based on DBP categories were also observed. There was a J-curve relationship between SBP and DBP with respect to 5-year NACE and MACCE. The nadir point of risk for NACE and MACCE was found at 121.4/74.8 and 120.4/73.7 mmHg. In patients underwent PCI, there is a significant correlation between office BP level and clinical events, indicates the importance of efforts for optimal BP control to reduce ischemic and bleeding events. Trial registration: HanYang University Medical Center (HYUMC) Registry, NCT05935397.

The effect of carbonation on the abrasion resistance of alkali-activated slag (AAS) was investigated. Various activator sets were selected for synthesizing AAS specimens, and the compressive strength was measured before and after carbonation. The abrasion resistance of the specimens was measured in accordance with the ASTM C944 test method. The relationship between the mass loss caused by abrasion and compressive strength was analyzed to understand the effect of matrix strength on abrasion resistance. Test results showed that the decrease in compressive strength of AAS specimens by carbonation reduced their abrasion resistance. In addition, the abrasion resistance of AAS before and after carbonation was sensitively influenced by activator type. It can be concluded that additional caution is required when using AAS where abrasion may have occurred.

Abstract Background Atrial fibrillation (AF) is a prevalent cardiac arrhythmia associated with significant morbidity and mortality, posing a considerable burden on healthcare systems. In Republic of Korea, the prevalence and incidence of AF have increased in recent years. There have also been significant changes in the trends of antiarrhythmic drug (AAD) use and procedural treatments for AF. Objectives This study aims to review the trends in AF treatment strategies in Republic of Korea, particularly focusing on the utilization of antiarrhythmic drugs and catheter ablation. Methods The Korean National Health Insurance Service (K-NHIS) data were used to identify AF patients from 2013 to 2022. AAD usage and catheter ablation procedures were analyzed annually. AADs were classified into Class IC and III drugs. Trends in beta-blockers, calcium channel blockers, and digoxin prescriptions were also examined. The primary endpoint was the trend of AAD use and AF catheter ablation (AFCA) over 10 years. Results In 2022, 940,063 patients had a prior diagnosis of AF. From 2013 to 2022, the use of AADs increased from 12.1 to 16.4% among prevalent AF patients. Beta-blockers were the most commonly prescribed rate control medication, while the use of calcium channel blockers and digoxin declined. The frequency of AFCA procedures also increased, from 0.5% of prevalent AF patients in 2013 to 0.7% in 2022. Younger patients, males, and those with lower CHA2DS2-VASc scores were more likely to receive AFCA. Regional variations in treatment patterns were observed, with Seoul exhibiting higher rates of procedural treatments and AAD prescriptions. Conclusions Over the past decade, there has been a significant increase in the use of AADs and AFCA procedures in Republic of Korea. These trends reflect recent advancements in AF management advocating a refined rhythm control strategy.

Ulmus davidiana has been used as food or medicine in oriental due to its safety, including its roots, bark, and fruits. The roots and bark of Ulmus were used as a diuretic and for treatment due to their anti-cancer, antioxidant, and anti-inflammatory effects. Ulmus species are known to contain flavan-3-ols as their main component. In previous research the presence of (+)-catechin 5-O-β-D-apiofuranoside was isolated from the roots of Ulmus davidiana, and (+)-catechin 7-O-β-D-xylopyranoside was confirmed in the bark Ulmus Americana, and the presence of catechin 7-O-β-D apiofuranoside in the stems and bark of Ulmus davidiana var. japonica. The catechin-glycosides of flavan-3-ols have various effects, including antiulcer properties, and have also been used as analgesics. Additionally, chemotaxonomy studies of the Ulmus species have been reported. However, the chemotaxonomy of Ulmus species native to Asia has not been reported. In this study, we report the screening of catechin 7-O-beta-D apiofuranoside from various Ulmus species native to Asia. We confirmed the presence of catechin 7-O-β-D-apiofuranoside in a total of 22 Ulmus samples, including 18 Ulmus species native to China, and 1 sample each from Mongolian, Nicaragua, Vietnam, and Korea through HPLC and LC-MS/MS analysis. We also confirmed the content of the indicator materials. Therefore, the potential of using native Ulmus species from Korea as a natural material has been confirmed.

Background: Platelet–leukocyte aggregates (PLAs) play important roles in cardiovascular disease and sepsis. Red ginseng extract (RGE) has been well-studied for its antiplatelet and anti-inflammatory activities. However, the potential inhibitory effects of RGE on PLA have not been investigated. Methods: Six-week-old ICR mice were given oral gavage of RGE for 7 days, followed by an intraperitoneal injection of 15 mg/kg of lipopolysaccharide. Mice were euthanized 24 h later, and blood samples were collected for further analysis. Flow cytometry was utilized to sort populations of PLAs and platelet–neutrophil aggregates (PNAs). By using confocal microscopy, PNAs were validated. Morphological changes in platelets and leukocytes were visualized with scanning electron microscopy. Expressions of tissue factor (TF) and platelet factor 4 (PF4) were investigated using enzyme-linked immunosorbent assay. Results: Populations of activated platelets, PLAs and PNAs, were significantly increased with LPS-induction. Treatment with 200 and 400 mg/kg of RGE decreased platelet activation. Moreover, the populations of PLAs and PNAs were reduced. PNAs were visible in the blood of septic mice, and this was attenuated by treatment with 400 mg/kg of RGE. Morphologically, sepsisinduced platelet activation and fibrin formation in the blood. This was reduced with RGE treatment. Sepsis-induced increase in the plasma levels of TF and PF4 was also reduced with RGE treatment. Conclusion: This study shows that RGE is a potential therapeutic that reduces the activation of platelets and targets PLA and PNA formation. Detailed inhibitory mechanisms of RGE should be studied.

Polyphenols have been well-established to exert sedative-hypnotic effects in psychopharmacology. Lime (Citrus aurantifolia) peel is rich in biologically active polyphenols; however, the effects of lime peel extract on sleep have not yet been demonstrated. A comparison was conducted in mice, between the sleep-promoting effects of a standardized lime peel supplement (SLPS) and a well-known hypnotic drug, zolpidem, and its hypnotic mechanism was investigated using in vivo and in vitro assays. The effects of SLPS on sleep were assessed using a pentobarbital-induced sleep test and sleep architecture analysis based on recording electroencephalograms and electromyograms. Additionally, a GABAA receptor binding assay, electrophysiological measurements, and in vivo animal models were used to elucidate the hypnotic mechanism. SLPS (200 and 400 mg/kg) was found to significantly decrease sleep latency and increase the amount of non-rapid eye movement sleep without altering delta activity. The hypnotic effects of SLPS were attributed to its flavonoid-rich ethyl acetate fraction. SLPS had a binding affinity to the GABA-binding site of the GABAA receptor and directly activated the GABAA receptors. The hypnotic effects and GABAA receptor activity of SLPS were completely blocked by bicuculline, a competitive antagonist of the GABAA receptor, in both in vitro and in vivo assays. To the best of our knowledge, this study is the first to demonstrate the hypnotic effects of SLPS, which acts via the GABA-binding site of the GABAA receptor. Our results suggest that lime peel, a by-product abundantly generated during juice processing, can potentially be used as a novel sedative-hypnotic.

This study aimed to identify the perinatal risk factors of severe acute kidney injury (AKI) occurring after the first week of birth in very low birth weight (VLBW) infants who survived up to the first week. We conducted a single-center, retrospective cohort study on VLBW infants (birth weight,

Abstract Severe intraventricular hemorrhage (IVH) in premature infants can lead to serious neurological complications. This retrospective cohort study used the Korean Neonatal Network (KNN) dataset to develop prediction models for severe IVH or early death in very-low-birth-weight infants (VLBWIs) using machine-learning algorithms. The study included VLBWIs registered in the KNN database. The outcome was the diagnosis of IVH Grades 3–4 or death within one week of birth. Predictors were categorized into three groups based on their observed stage during the perinatal period. The dataset was divided into derivation and validation sets at an 8:2 ratio. Models were built using Logistic Regression with Ridge Regulation (LR), Random Forest, and eXtreme Gradient Boosting (XGB). Stage 1 models, based on predictors observed before birth, exhibited similar performance. Stage 2 models, based on predictors observed up to one hour after birth, showed improved performance in all models compared to Stage 1 models. Stage 3 models, based on predictors observed up to one week after birth, showed the best performance, particularly in the XGB model. Its integration into treatment and management protocols can potentially reduce the incidence of permanent brain injury caused by IVH during the early stages of birth.

Alkali-activated ground granulated blast-slag (AAS) is the most obvious alternative material for ordinary Portland cement (OPC). However, to use it as a structural material requires the assessment and verification of its durability. The most important factor for a durability evaluation is the degree of carbonation resistance, and AAS is known to show lower performance than OPC. A series of experiments was conducted with a view to investigate the carbonation characteristics of AAS binder. As a consequence, it was found that the major hydration product of AAS was calcium silicate hydrate (CSH), with almost no portlandite, unlike the products of OPC. After carbonation, the CSH of AAS turned into amorphous silica gel which was most likely why the compressive strength of AAS became weaker after carbonation. An increase of the activator dosage leads AAS to react more quickly and produce more CSH, increasing the compaction, compressive strength, and carbonation resistance of the microstructure.

Epilepsy, a complex neurological disorder, is characterized by recurrent seizures caused by aberrant electrical activity in the brain. Central to this study is the role of lysosomal dysfunction in epilepsy, which can lead to the accumulation of toxic substrates and impaired autophagy in neurons. Our focus is on phosphodiesterase-4 (PDE4), an enzyme that plays a crucial role in regulating intracellular cyclic adenosine monophosphate (cAMP) levels by converting it into adenosine monophosphate (AMP). In pathological states, including epilepsy, increased PDE4 activity contributes to a decrease in cAMP levels, which may exacerbate neuroinflammatory responses. We hypothesized that amlexanox, an anti-inflammatory drug and non-selective PDE4 inhibitor, could offer neuroprotection by addressing lysosomal dysfunction and mitigating neuroinflammation, ultimately preventing neuronal death in epileptic conditions. Our research utilized a pilocarpine-induced epilepsy animal model to investigate amlexanox's potential benefits. Administered intraperitoneally at a dose of 100 ​mg/kg daily following the onset of a seizure, we monitored its effects on lysosomal function, inflammation, neuronal death, and cognitive performance in the brain. Tissue samples from various brain regions were collected at predetermined intervals for a comprehensive analysis. The study's results were significant. Amlexanox effectively improved lysosomal function, which we attribute to the modulation of zinc's influx into the lysosomes, subsequently enhancing autophagic processes and decreasing the release of inflammatory factors. Notably, this led to the attenuation of neuronal death in the hippocampal region. Additionally, cognitive function, assessed through the modified neurological severity score (mNSS) and the Barnes maze test, showed substantial improvements after treatment with amlexanox. These promising outcomes indicate that amlexanox has potential as a therapeutic agent in the treatment of epilepsy and related brain disorders. Its ability to combat lysosomal dysfunction and neuroinflammation positions it as a potential neuroprotective intervention. While these findings are encouraging, further research and clinical trials are essential to fully explore and validate the therapeutic efficacy of amlexanox in epilepsy management.

Alzheimer’s disease (AD) is a neurodegenerative disease that affects the elderly and leads to cognitive decline and memory loss. Treatments for stopping or slowing the progression of AD have not been discovered yet; therefore, delaying the progression of AD is the only option, which makes early diagnosis of AD crucial. Additionally, although $\text{A}\beta $ plaques and tau proteins are considered the causes of early AD, few studies have used this information to diagnose early AD. In this study, a middle-fusion multimodal model is proposed for the diagnosis of early AD. The proposed multimodal model extracts features without loss using a depthwise separable convolution block without an activation function. Subsequently, middle fusion is applied using mix skip connection and sharing weight convolution blocks, both designed to learn the complex relationships between modalities. In contrast to other studies, the proposed approach has three main novelties. 1) A middle-fusion multimodal model is proposed for the early diagnosis of AD. 2) The proposed model is evaluated using the entire ADNI series, including T1-weighted magnetic resonance imaging (T1w MRI) and 18F-FluoroDeoxyGlucose positron emission tomography (FDG PET) from the ADNI1 dataset, as well as $\text{A}\beta $ PET and tau protein PET from ADNI2 and ADNI3 datasets. 3) A novel region-of-interest (ROI) extraction method is proposed for the hippocampus, middle temporal, and inferior temporal regions, which are known to be affected in the early stages of AD. In the experimental results, the proposed multimodal model achieved a balanced accuracy of 1.00, for the task of Alzheimer’s disease vs cognitive normal (CN) and 0.76 for the task of mild cognitive impairment vs cognitive normal.

Purpose Several studies demonstrated that obesity and underweight were negatively associated with outcomes of breast cancer. However, the results are still controversial, and the impact of body mass index (BMI) on distant metastasis-free survival (MFS), which might directly affect mortality, was less well evaluated. Our study aimed to verify the prognostic effect of BMI in breast cancer. Methods A retrospective analysis of 504 patients with stage I–III breast cancer who underwent surgery from January 2005 to December 2013 was performed. The patients were divided into three groups according to preoperative BMI: underweight

Background: Artificial intelligence (AI) is changing our life, including the medical field. Repeated machine learning using big data made various fields more predictable and accurate. In medicine, IBM Watson for Oncology (WFO), trained by Memorial Slone Kettering Cancer Center (MSKCC), was first introduced and applied in 14 countries worldwide.Our study was designed to assess the feasibility of WFO in actual clinical practice. We aimed to investigate the concordance rate between WFO and multidisciplinary tumor board (MTB) in Urologic cancer patients. Materials and methods: We reviewed retrospectively collected data for consecutive patients who underwent WFO and MTB simultaneously in the diagnosis of urologic malignancy before determining further treatment between August 2017 and September 2020. We compared the recommendation of the AI system, WFO (IBM Watson Health, Cambridge, MA), with the opinion of MTB for further managing all patients diagnosed with urologic malignancies such as prostate, bladder, and kidney cancer. Results: A total of 55 patients were enrolled in our study. The number of patients with prostate cancer was 48. The number of bladder and kidney cancer patients was 5 and 2, respectively. The overall concordance rate between WFO and MTB was 92.7%. Three patients could not suggest proper treatment options using WFO, and the recommended choice of WFO was not feasible in the Korean Health Insurance Review and Assessment Service. Conclusions: The decision of WFO showed a high concordance rate with a multidisciplinary tumor board for urologic oncology. However, some recommendations of WFO were not feasible in actual practice, and WFO still has some points to improve and modify. Interestingly, applying WFO is likely to facilitate a multidisciplinary team approach.

Abstract Background With advances in pulp preservation procedures (PPP), indications for PPP extend to exposed pulp with symptoms in teeth with carious lesions. Scenario/text-based questionnaire studies report a high preference for PPP for exposed pulp with no pulpal symptoms. However, negative perceptions towards PPP for exposed pulp in carious teeth are prevalent among dentists. Identifying the differences in PPP preference rates in questionnaire studies and actual clinical situations is necessary to determine the current status of PPP. In this study, a clinical case/photo-based design was devised to overcome the limitations of scenario/text-based questionnaires. This study aimed to evaluate the reasons dentists prefer root canal treatment (RCT) in cases where PPP is potentially indicated. Methods A questionnaire containing three cases of PPP with successful results was administered to dentists. The cases were selected to elicit comprehensive responses from the dentists. Clinical photos of the pulp exposure sites were presented to dentists without describing the tooth conditions, including the extent of pulp exposure and tooth decay, pulpal surface conditions, or restorability. The questions were focused on the reasons for selecting RCT in cases where was practiced. Questionnaire data were collected using Google e-forms. Chi-squared and Fisher’s exact test (P

Using the Monte Carlo method, the impact of the angular distribution of the electron source on the dose distribution for the 2.5 MeV ELV electron accelerator was explored. The experiment measured the 3-D dose distribution in the irradiation chamber for electron energies of 1.0 MeV and 2.5 MeV. The simulation used the MCNP6.2 code to evaluate three angular distribution models of the source: a mono-directional beam, a cone shape, and a triangular shape. Of the three models, the triangular shape with angles θ = 30°, φ = 0° best represents the angle of the scan hood through which the electron beam exits. The MCNP6.2 simulation results demonstrated that the triangular model is the most accurate representation of the angular distribution of the electron source for the 2.5 MeV ELV electron accelerator.

Abstract Cu2ZnSn(S,Se)4 (CZTSSe) solar cells have resource distribution and economic advantages. The main cause of their low efficiency is carrier loss resulting from recombination of photo‐generated electron and hole. To overcome this, it is important to understand their electron‐hole behavior characteristics. To determine the carrier separation characteristics, we measured the surface potential and the local current in terms of the absorber depth. The elemental variation in the intragrains (IGs) and at the grain boundaries (GBs) caused a band edge shift and bandgap (Eg) change. At the absorber surface and subsurface, an upward Ec and Ev band bending structure was observed at the GBs, and the carrier separation was improved. At the absorber center, both upward Ec and Ev and downward Ec‐upward Ev band bending structures were observed at the GBs, and the carrier separation was degraded. To improve the carrier separation and suppress carrier recombination, an upward Ec and Ev band bending structure at the GBs is desirable.

The bandgap widening of Ag-alloyed Cu(In,Ga)Se2 (ACIGS) thin films poses a significant challenge in enhancing their photocurrent. This study demonstrates correlations between element diffusion behavior and notch-point formation in ACIGS films, which ultimately influence the resulting current circuit voltage and fill factor. Our findings delineate a novel approach for fabricating a suitably tailored band gap grading in ACIGS, which serves as a bottom subcell in tandem configuration. This was achieved by modulating a wide range of process temperatures from 340 to 470 °C, which were measured by pyrothermal, to assess the GGI profile during deposition. Experiments were undertaken to variate the second-stage conditions, striving to sustain the photocurrent, mitigate defects, and enhance crystallinity, achieving an impressive performance of 17.7 % without applying post-deposition treatments or anti-reflection coatings. The efficiencies surpassing 8 % were achieved as we measured these cells under a 715 nm long-pass filter, which corresponds to the bandgap of a typical top cell in tandem applications (1.73 eV photon energy). These results emphasize the significance of understanding the deposition temperature and its impact on the properties of ACIGS films, paving the way for further advancements in solar-cell technology.