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Abstract Low-molecular-weight heparin (LMWH), derived from unfractionated heparin (UFH), has enhanced anticoagulant efficacy, long duration of action, and extended half-life. Patients receiving LMWH for preventive therapies would strongly benefit from its long-term effects, however, achieving this is challenging. Here, we design and evaluate a nanoengineered LMWH and octadecylamine conjugate (LMHO) that can act for a long time while maintaining close to 97 ± 3% of LMWH activity via end-specific conjugation of the reducing end of LMWH. LMHO can self-assemble into nanoparticles with an average size of 105 ± 1.7 nm in water without any nanocarrier and can be combined with serum albumin, resulting in a lipid-based albumin shuttling effect. Such molecules can circulate in the bloodstream for 4–5 days. We corroborate the self-assembly capability of LMHO and its interaction with albumin through molecular dynamics (MD) simulations and transmission electron microscopy (TEM) analysis. This innovative approach to carrier-free polysaccharide delivery, enhanced by nanoengineered albumin shuttling, represents a promising platform to address limitations in conventional therapies.

Postoperative colorectal imaging studies play an important role in the detection of surgical complications and disease recurrence. In this pictorial essay, we briefly describe methods of surgery, imaging findings of their early and late complications, and postsurgical recurrence of cancer and inflammatory bowel disease.

This research focuses on modifying the D $^{\ast }$ algorithm for path optimization of autonomous robots moving on sidewalks. The existing D $^{\ast }$ algorithm is designed to make the autonomous robots recognize and avoid obstacles. However, in real-world pedestrian settings, observations indicate that passersby on sidewalks tend to notice robots and avoid them themselves. By analyzing people’s trajectory data collected through lidar sensors, this study identified the average distance and angle of avoidance at which people start to avoid autonomous robots. Based on this, we proposed a modified D $^{\ast }$ algorithm that allows the robot to maintain the existing optimal path when people are willing to maneuver around while adopting an avoidance path only when they are not. Experimental results showed that the autonomous robot using the modified D $^{\ast }$ algorithm outperformed the conventional method regarding driving efficiency and time. This research is expected to contribute to optimizing autonomous robots’ walking paths by enabling efficient driving even under limited battery capacity.

Background: Recently, open pose estimation using artificial intelligence (AI) has enabled the analysis of time series of human movements through digital video inputs. Analyzing a person's actual movement as a digitized image would give objectivity in evaluating a person's physical function. In the present study, we investigated the relationship of AI camera-based open pose estimation with Harris Hip Score (HHS) developed for patient-reported outcome (PRO) of hip joint function. Method: HHS evaluation and pose estimation using AI camera were performed for a total of 56 patients after total hip arthroplasty in Gyeongsang National University Hospital. Joint angles and gait parameters were analyzed by extracting joint points from time-series data of the patient's movements. A total of 65 parameters were from raw data of the lower extremity. Principal component analysis (PCA) was used to find main parameters. K-means cluster, X-squared test, Random forest, and mean decrease Gini (MDG) graph were also applied. Results: The train model showed 75% prediction accuracy and the test model showed 81.8% reality prediction accuracy in Random forest. “Anklerang_max”, “kneeankle_diff”, and “anklerang_rl” showed the top 3 Gini importance score in the Mean Decrease Gini (MDG) graph. Conclusion: The present study shows that pose estimation data using AI camera is related to HHS by presenting associated gait parameters. In addition, our results suggest that ankle angle associated parameters could be key factors of gait analysis in patients who undergo total hip arthroplasty.

Abstract Background Despite the effectiveness of glucagon-like peptide-1 agonist (GLP-1A) in the treatment of diabetes, its large molecular weight and high hydrophilicity result in poor cellular permeability, thus limiting its oral bioavailability. To address this, we developed a chimeric GLP-1A that targets transporter-mediated endocytosis to enhance cellular permeability to GLP-1A by utilizing the transporters available in the intestine, particularly the apical sodium-dependent bile acid transporter (ASBT). Methods In silico molecular docking and molecular dynamics simulations were used to investigate the binding interactions of mono-, bis-, and tetra-deoxycholic acid (DOCA) (monoDOCA, bisDOCA, and tetraDOCA) with ASBT. After synthesizing the chimeric GLP-1A-conjugated oligomeric DOCAs (mD-G1A, bD-G1A, and tD-G1A) using a maleimide reaction, in vitro cellular permeability and insulinotropic effects were assessed. Furthermore, in vivo oral absorption in rats and hypoglycemic effect on diabetic db/db mice model were evaluated. Results In silico results showed that tetraDOCA had the lowest interaction energy, indicating high binding affinity to ASBT. Insulinotropic effects of GLP-1A-conjugated oligomeric DOCAs were not different from those of GLP-1A-Cys or exenatide. Moreover, bD-G1A and tD-G1A exhibited improved in vitro Caco-2 cellular permeability and showed higher in vivo bioavailability (7.58% and 8.63%) after oral administration. Regarding hypoglycemic effects on db/db mice, tD-G1A (50 μg/kg) lowered the glucose level more than bD-G1A (50 μg/kg) compared with the control (35.5% vs. 26.4%). Conclusion GLP-1A was conjugated with oligomeric DOCAs, and the resulting chimeric compound showed the potential not only for glucagon-like peptide-1 receptor agonist activity but also for oral delivery. These findings suggest that oligomeric DOCAs can be used as effective carriers for oral delivery of GLP-1A, offering a promising solution for enhancing its oral bioavailability and improving diabetes treatment. Graphical Abstract

Background and Objectives: Rectal cancer is considered cured if no recurrence is found during the 5-year follow-up period after treatment. After this period, patients often believe that the cancer is completely eradicated. However, in modern society, where lifespans have become longer, it is important to recognize that metastatic cancer may occur long after the initial treatment has concluded. This highlights the necessity of continued vigilance and the long-term follow-up of cancer survivors. Case report: We present a case of metastatic cancer of the coccyx in an 87-year-old female patient. This patient had undergone successful surgery and treatment for rectal cancer 10 years prior. She was considered cured after the standard 5-year follow-up period as she showed no signs of recurrence. The patient presented with simple coccygeal pain as the main complaint, without any other accompanying symptoms such as weight loss, fever, or changes in bowel habits, typically associated with cancer recurrence. During the clinical evaluation, irregularities in the bone cortex were detected while performing a nerve block using ultrasound. Given these findings, further diagnostic evaluations were performed. Advanced imaging techniques including MRI and CT scans led to a diagnosis of coccygeal metastasis. Conclusions: While the 5-year mark post-treatment is a significant milestone for rectal cancer patients, it does not guarantee the absolute eradication of the disease. Long-term monitoring and a thorough evaluation of new symptoms are essential for the early detection and management of late metastatic recurrences. This approach ensures that patients receive timely and appropriate care, potentially improving outcomes and quality of life.

This paper proposes a novel method to impart intelligence to metal parts using additive manufacturing. A sensor-embedded metal bracket is prototyped via a metal powder bed fusion process to recognise partial screw loosening or total screw missing or identify the source of vibration with the assistance of artificial intelligence (AI). The digital metal bracket can recognise subtle changes in the screw fixation state with 90% accuracy and identify unknown sources of vibration with 84% accuracy. The von Mises stress distribution in the prototyped metal bracket is evaluated using a finite element analysis, which is learned by AI to match the real-time deformation analysis of the metal bracket in augmented reality. The proposed prototype can contribute to hyper-connectivity for developing next-generation metal-based mechanical components.

Pipe-in-pipe (PIP) system is essential for high thermal and high pressure fluid transportation. However, in the existing PIP systems, fluid leakage between inner and outer pipe has been difficult to discover or detect, which has worked as bottle neck to utilize PIP system in high risk industries as nuclear reactor, chemical plant or oil drilling systems. Here, we propose a noble PIP leakage detection system utilizing distributed temperature sensing (DTS) with Machine Learning (ML). With the Fourier transformed spectrogram data from DTS, the ML assisted system was able to detect 0.2∼7 ml/min liquid leakage between inner and outer pipe with the accuracy of 91.67% with a single embedded optical fiber. Under varying operating temperature, the system successfully distinguished leakage and non-leakage states using the optimized convolutional neural network. Our developed PIP leakage detection system can be deployed in safety-critical industrial systems for autonomous leakage detection.

Coverage by National Health Insurance (NHI) was expanded in the abdominal imaging area as follows: upper abdominal ultrasound on April 1, 2018, lower abdominal ultrasound on February 1, 2019, and abdominal MRI on November 1, 2019. Many patients can benefit from the expansion of NHI coverage. Newly included diseases for NHI coverage includes liver cirrhosis, gallbladder polyps, hepatic adenoma/dysplastic nodules, pancreatic cysts, autoimmune pancreatitis and bile duct stone disease. However, the expansion of coverage made each examination more complex, including indications, follow-up strategy, the number of examination per patients, the standard images to be acquired, and the standard forms of the radiological report. Therefore, more careful consideration is mandatory when an abdominal imaging examination is prescribed and conducted.

In this study, decomposition and densification behavior of PbAlNbO3-PbZrTiO3 (PAN-PZT) ceramics were characterized for powder injection molding process. Thermal gravity analysis and in-situ dilatometer experiment were carried out to construct master curve. Based on master curve model approach, one-combined master debinding curve (MDC) and master sintering curve (MSC) were constructed for piezoelectric PAN-PZT ceramics. Derived curves matched well with the experimental data. Process optimization and material development will be conducted based on characterization of master curve parameters.

Abstract Background There has been scanty data regarding the clinical significance of tumor conspicuity in pancreatic cancer. In this study, we attempted to investigate the prognostic significance of pancreatic tumor conspicuity and determine prognostic factors for postoperative recurrence in patients with surgically resected pancreatic cancer. Methods Between January 2011 and September 2019, 62 patients who underwent preoperative computed tomography (CT) for pancreatic cancer were retrospectively included. Two reviewers evaluated various clinical, imaging, and pathologic variables and reviewed all available medical records to determine patient outcomes after surgery. Tumor conspicuity was defined as the attenuation ratio between normal parenchyma and tumor lesions on dynamic-enhanced CT images and represented the conspicuity score. Recurrence-free survival and overall survival were investigated using Cox regression analysis. Results Patient mean age was 65.9 (±11.6) years, and 56.5% were male. The median follow-up period was 11 months (range 2–138). Forty patients (64.5%) experienced postoperative recurrence, and the median time to recurrence was 6 months (range 1–101). Tumor conspicuity scores were positively correlated with both radiologic and pathologic tumor sizes (r = 0.252, 0.321, p

Background: Crohn’s disease (CD) manifests a heterogeneous clinical spectrum and disease course, and it is challenging to predict the disease outcome based on initial presentation. Objective: To analyze the long-term disease course and factors leading to poor prognosis of CD. Methods: In total, 112 patients with CD who were initially diagnosed and treated at our institution from January 2009 to August 2020 were included. We analyzed their clinical data, disease characteristics according to the Montreal classification, and the endoscopic and computed tomography (CT) examinations at the initial visit and at 2-year, 5-year, and last follow ups. We categorized the disease course into the following four categories: remission, stable, chronic refractory, and chronic relapsing. Significant factors associated with a poorer prognosis were analyzed. Results: The median follow-up period was 107 (range, 61–139) months. Complicated disease behavior increased slightly over the follow-up period (20.5% to 26.2%). An unfavorable disease course was defined as chronic refractory (19.6%) and relapsing (16.1%) courses. The 2-year disease characteristics were significant factors for unfavorable disease course, and the combination of 2-year perianal disease and 2-year moderate-to-severe CT activity could predict unfavorable disease course with the highest accuracy (0.722; area under the curve: 0.768; p < 0.0001). Conclusions: One-third of the patients with CD showed an unfavorable disease course (35.7%), and 2-year disease characteristics were significant factors for an unfavorable disease course.

Objectives: To analyze serial changes in body composition and investigate the association between body composition changes and disease activity changes in patients with Crohn’s disease (CD). Methods: Seventy-one patients with CD who had been treated and followed-up at our institution were included. Two to four computed tomography images were acquired at baseline, and the 2–5-year, 5–8-year, and last follow-ups were selected per patient for body composition and disease activity analyses. Visceral fat area (VFA), skeletal muscle index (SMI; skeletal muscle area/height2), and subcutaneous fat area (SFA) were assessed using an artificial-intelligence-driven fully automated method. Disease activity was assessed using a modified computed tomography scoring system and the Simple Endoscopic Score for Crohn’s Disease. The associations between body composition, disease activity, and remission were investigated. Results: The mean age was 29.83 ± 11.27 years; most patients were men (48/71, 67.6%); and the median follow-up was 144 (12–264) months. Overall, VFA and SFA gradually increased, while SMI decreased during the follow-up. Sarcopenia was associated with the female sex, higher disease activities at baseline (p = 0.01) and the last follow-up (p = 0.001). SMI and SFA inversely correlated with the disease activity, i.e., the more severe the disease activity, the lower the SMI and SFA (p < 0.05). SMI at the last follow-up was the only significant predictor of remission (OR = 1.21, 95% confidence interval: 1.03–1.42, p = 0.021). Conclusion: SMI decreased while VFA and SFA increased during the treatment follow-up in patients with CD. Sarcopenia was associated with higher disease activity, and SMI and SFA inversely correlated with disease activity. SMI at the last follow-up was the significant factor for remission.

Purpose Here, this study verifies that cancer-associated thrombosis (CAT) accelerates hypoxia, which is detrimental to the tumor immune microenvironment by limiting tumor perfusion. Therefore, we designed an oral anticoagulant therapy to improve the immunosuppressive tumor microenvironment and potentiate the efficacy of immunotherapy by alleviating tumor hypoxia.Experimental design A novel oral anticoagulant (STP3725) was developed to consistently prevent CAT formation. Tumor perfusion and hypoxia were analyzed with or without treating STP3725 in wild-type and P selectin knockout mice. Immunosuppressive cytokines and cells were analyzed to evaluate the alteration of the tumor microenvironment. Effector lymphocyte infiltration in tumor tissue was assessed by congenic CD45.1 mouse lymphocyte transfer model with or without anticoagulant therapy. Finally, various tumor models including K-Ras mutant spontaneous cancer model were employed to validate the role of the anticoagulation therapy in enhancing the efficacy of immunotherapy.Results CAT was demonstrated to be one of the perfusion barriers, which fosters immunosuppressive microenvironment by accelerating tumor hypoxia. Consistent treatment of oral anticoagulation therapy was proved to promote tumor immunity by alleviating hypoxia. Furthermore, this resulted in decrease of both hypoxia-related immunosuppressive cytokines and myeloid-derived suppressor cells while improving the spatial distribution of effector lymphocytes and their activity. The anticancer efficacy of αPD-1 antibody was potentiated by co-treatment with STP3725, also confirmed in various tumor models including the K-Ras mutant mouse model, which is highly thrombotic.Conclusions Collectively, these findings establish a rationale for a new and translational combination strategy of oral anticoagulation therapy with immunotherapy, especially for treating highly thrombotic cancers. The combination therapy of anticoagulants with immunotherapies can lead to substantial improvements of current approaches in the clinic.

We aimed to evaluate and compare the diagnostic performances of ultrasonography (US) and magnetic resonance enterography (MRE) in assessing active bowel lesions in patients with Crohn’s disease (CD). Materials and Methods: We searched PubMed and EMBASE for studies in which US and MRE were used to assess active bowel lesions in CD patients. Bivariate random effect meta-analytic methods were used to estimate pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves. We performed a meta-regression analysis to explore the source of study heterogeneity. Results: Eleven studies involving 752 patients were included. US exhibited a pooled sensitivity of 86% (95% confidence interval (CI) 72–94), pooled specificity of 88% (95% CI 78–94), and HSROC of 0.93 in 10 studies. MRE exhibited a pooled sensitivity of 88% (95% CI 76–95), pooled specificity of 87% (95% CI 73–95), and an HSROC of 0.94 in eight studies. In seven studies comparing the diagnostic performances of US and MRE, the summary sensitivity of US and MRE were 86% (95% CI 65–96, I2 = 92.1) and 86% (95% CI 72–93, I2 = 88.1) (p = 0.841), respectively. The summary specificity of US and MRE were 87% (95% CI 78–93, I2 = 79.8%) and 84% (72–90, I2 = 72.5%) (p = 0.431), respectively, which showed no statistical differences. On meta-regression analysis, studies from Europe (p = 0.002), those that used linear US probes (p = 0.012), those on small bowel lesions (p = 0.01), and those with outcomes as combined features (active inflammation) reported higher US sensitivity than those from other regions, those that used both linear and convex US probes, those on small and large bowels, and those with outcome as one feature (bowel wall thickening or ulcer). Studies with pediatric patients (p = 0.001), those with reference standards including US (p = 0.001), and outcomes as combined features (p = 0.01) reported higher MRE specificity than those with adult populations, reference standards other than the US, and outcomes as one feature. Conclusions: In spite of considerable heterogeneity in the included studies, both US and MRE can diagnose active bowel lesions with comparable diagnostic accuracy in patients with CD. The study region, type of US probe, lesion location, investigated outcome for US sensitivity and study population, reference standards, and investigated outcomes for MRE specificity were potential sources of heterogeneity.

Periurethral bulking agent injection (or transurethral submucosal injection) is a comparatively less invasive procedure for the treatment of stress urinary incontinence in patients who develop incontinence after radical prostatectomy, and who are more frequently being treated with transurethral submucosal injection. However, as the radiologic findings of bulking agents are not very well known, they can be mistaken for local recurrence in prostate cancer patients who have undergone prostatectomy. Unlike some of the literatures, in which the radiologic features of collagen injections have been reported, the radiologic findings of silicone injections are yet to be determined. Thus, it is our intention to report this case along with the literature review as the authors have experienced an actual case of a silicone injection mistaken as local recurrence.

Granular cell tumors (GCTs) are extremely rare mesenchymal neoplasms of Schwann cell origin. Malignant GCTs (MGCTs) comprise 0.5–2% of all GCTs. In the present report, we describe a case of a 66-year-old man with MGCT of the abdominal wall. The patient visited our hospital due to a recently growing palpable soft tissue mass in the abdominal wall. Computed tomography scan revealed a 4.3 × 4.1 × 2.9 cm sized mass arising from the left abdominal wall, which was contemplated as a desmoid tumor before surgical excision. Histopathological examination confirmed MGCT.

In this research, a Ni-Fe mold insert for the efficient replication of high aspect-ratio microstructure arrays was fabricated via hard X-ray lithography and an electroforming process. For the X-ray exposure on a photoresist, a gold-based X-ray mask was prepared with conventional UV photolithography. The gold thickness was designed to be over 15 μm to prevent development underneath the absorber and to enhance the adhesion strength between the photoresist and substrate. By using the X-ray mask, a positive-type photoresist was selectively exposed to X-ray under an exposure energy of 4 kJ/cm3. Thereafter, the exposed region was developed in a downward direction to effectively remove the residual photoresist from the substrate. During the evaporation process, deionized water mixed with a surface additive prevented the bending and clustering of the photoresist microstructure arrays by lowering the capillary force, resulting in a defect-free mother structure for electroforming. Lastly, the mother structure was uniformly Ni-Fe electroformed on a conductive substrate without the formation of any pores or detachment from the substrate. Based on the proposed microfabrication process, a Ni-Fe mold insert with a 183 μm pattern size, 68 μm gap size, 550 μm height, 2116 microcavities and a hardness of 585 Hv was precisely manufactured. It can be utilized for the mass production of high aspect ratio metal and ceramic microstructure arrays in micro molding technologies.

Gastric gastrointestinal stromal tumor (GIST) is one of the most common mesenchymal tumors of the stomach, which may be asymptomatic or cause symptoms such as pain, gastrointestinal bleeding, and obstruction. Hemoperitoneum due to spontaneous rupture of the tumor is an extremely rare complication. We described a case of a 52-year-old man with a large pedunculated GIST causing loculated hematoma within the gastrocolic ligament. The patient visited our hospital due to a 3 week history of epigastric pain. A computed tomography scan revealed a 10.3 × 7.5 × 9.4 cm sized mass that was growing exophytically from the greater curvature of the stomach and was surrounded by loculated hematoma within the gastrocolic ligament. Laparotomy revealed a large stalked gastric mass surrounded by loculated hematoma within the gastrocolic ligament and blood fluid in the peritoneal cavity. Pathologic examination confirmed a GIST, of the high risk group.

In this study, a fabrication method of tapered microstructures with high aspect ratio was proposed by deep X-ray lithography. Tapered microstructures with several hundred micrometers and high aspect ratio are demanded owing to the high applicability in the fields of various microelectromechanical systems (MEMS) such as optical components and microfluidic channels. However, as the pattern and gap size were downsized to smaller micro-scale with higher aspect ratio over 5, microstructures were easily deformed or clustered together due to capillary force during the drying process. Here, we describe a novel manufacturing process of tapered microstructures with high aspect ratio. To selectively block the deep X-ray irradiation, an X-ray mask was prepared via conventional ultraviolet (UV) lithography. A double X-ray exposure process with and without X-ray mask was applied to impose a two-step dose distribution on a photoresist. For the clear removal of the exposed region, the product was developed in the downward direction, which encourages a gravity-induced pulling force as well as a convective transport of the developer. After a drying process with the surface additive, tapered microstructures were successfully fabricated with a pattern size of 130 μm, gap size of 40 μm, and aspect ratio over 7.

In this study, two kinds of copper micro-patterned surfaces with different heights were fabricated by using a powder injection molding (PIM) process. The micro-pattern’s size was 100 μm, and the gap size was 50 μm. The short micro-pattern’s height was 100 μm, and the height of the tall one was 380 μm. A copper powder and wax-polymer-based binder system was used to fabricate the micro-patterned surfaces. The critical heat flux (CHF) and heat transfer coefficient (HTC) during pool-boiling tests were measured with the micro-patterned surfaces and a reference plain copper surface. The CHF of short and tall micro-patterned surfaces were 1434 and 1444 kW/m2, respectively, and the plain copper surface’s CHF was 1191 kW/m2. The HTC of the plain copper surface and the PIM surface with short and tall micro-patterned surfaces were similar in value up to a heat flux 1000 kW/m2. Beyond that value, the plain surface quickly reached its CHF, while the HTC of the short micro-patterned surface achieved higher values than that of the tall micro-patterned surface. At CHF, the maximum values of HTC for the short micro-pattern, tall micro-pattern, and the plain copper surface were 68, 58, and 57 kW/m2 K.

In a computed tomography (CT) scan, fat deposition in the urinary bladder wall is seen as a linear hypoattenuating band surrounded by soft tissue density. It is uncommon, but is often seen in normal cases. However, there is no report of fat deposition in the urinary bladder wall in Korea. The authors encountered a 62-year-old male patient who showed an incidental hypoattenuating band in the urinary bladder wall on abdominal CT. The patient showed no clinical signs related to fat deposition in the urinary bladder wall. When the patient's previous abdominal CT was retrospectively reviewed, the same CT finding was seen. This linear hypoattenuating band within the urinary bladder wall should be considered as a normal CT finding, although it is uncommon.

Metal injection molding (MIM) with the space holder technique is becoming one of the important fabrication methods for a net-shape production of micro-sized, porous, complex-shaped metal parts. For a successful injection molding step, rheological behavior of MIM feedstock is essential, which includes peculiar characteristics, such as a wall slip phenomenon. SUS 316L stainless steel powder, binder systems (paraffin wax, polypropylene, polyethylene, stearic acid) and three different sizes of spherically-shaped polymethyl methacrylate (PMMA) as a space-holder were used for this study. The porosity was controlled by varying the volume fraction of the space holder and a total of six different feedstocks were prepared. Rheological characteristics of the feedstock was investigated, especially on viscosities, including wall slip quantification by using a capillary rheometer. By thermogravimetric analysis, the debinding process for completely removing the space holder was proposed. Finally, the shrinkage and porosity of the tensile specimen produced through the sintering process were analyzed and the ultimate tensile strength was obtained.

The authors developed a two-factor preseason hope scale and examined the moderation effects of preseason hope and state hope on the chain of effects from team identification and attendance intention to subjective well-being. A moderated moderated-mediation model was tested (n = 224). Consequently, attendance intention mediated the relationship between team identification and well-being. The effect of team identification on attendance intention was stronger for those with lower preseason hope and state hope. The effect of attendance intention on well-being was stronger for those with higher preseason hope. Interaction effects by levels of hope were found among the conditional indirect effects. [ABSTRACT FROM AUTHOR]