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Background We aimed to evaluate whether composite blood biomarkers including aldo-keto reductase family 1 member B10 (AKR1B10) and cytokeratin 18 (CK-18; a nonalcoholic steatohepatitis [NASH] marker) have clinically applicable performance for the diagnosis of NASH, advanced liver fibrosis, and high-risk NASH (NASH+significant fibrosis). Methods A total of 116 subjects including healthy control subjects and patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) were analyzed to assess composite blood-based and imaging-based biomarkers either singly or in combination. Results A composite blood biomarker comprised of AKR1B10, CK-18, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) showed excellent performance for the diagnosis of, NASH, advanced fibrosis, and high-risk NASH, with area under the receiver operating characteristic curve values of 0.934 (95% confidence interval [CI], 0.888 to 0.981), 0.902 (95% CI, 0.832 to 0.971), and 0.918 (95% CI, 0.862 to 0.974), respectively. However, the performance of this blood composite biomarker was inferior to that various magnetic resonance (MR)-based composite biomarkers, such as proton density fat fraction/MR elastography-liver stiffness measurement (MRE-LSM)/ALT/AST for NASH, MRE-LSM+fibrosis-4 index for advanced fibrosis, and the known MR imaging-AST (MAST) score for high-risk NASH. Conclusion Our blood composite biomarker can be useful to distinguish progressive forms of NAFLD as an initial noninvasive test when MR-based tools are not available.

Abstract The SUVmax is a measure of FDG uptake and is related with tumor aggressiveness in thyroid cancer, however, its association with molecular pathways is unclear. Here, we investigated the relationship between SUVmax and gene expression profiles in 80 papillary thyroid cancer (PTC) patients. We conducted an analysis of DEGs and enriched pathways in relation to SUVmax and tumor size. SUVmax showed a positive correlation with tumor size and correlated with glucose metabolic process. The genes that indicate thyroid differentiation, such as SLC5A5 and TPO, were negatively correlated with SUVmax. Unsupervised analysis revealed that SUVmax positively correlated with DNA replication(r = 0.29, p = 0.009), pyrimidine metabolism(r = 0.50, p

Background/Aims: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the stomach. We evaluated the clinical outcomes of endoscopic treatment for gastric GISTs. Methods: This is a single center, retrospective study that enrolled 135 cases of gastric subepithelial tumors (SETs) resected by endoscopic procedures and confirmed as GISTs by histopathology from March 2005 to July 2019. The immediate and long-term clinical outcomes were analyzed retrospectively. Results: The mean patient age was 57.9 years, and the mean tumor size was 2.1 cm. Of the tumors, 43.0% were located in the body, followed by the fundus (26.7%) and cardia (17.0%). Most tumors (85.2%) were resected by endoscopic submucosal dissection, followed by endoscopic mucosal resection (6.7%), submucosal tunneling endoscopic resection (5.9%), and endoscopic full-thickness resection (2.2%). Macroperforation occurred in 4.4% and microperforation in 6.7% of the cases. The R0 resection rate was 15.6%. However, the rate of complete resection by the endoscopic view was 90.4%, of which 54.8% of cases were in the very-low-risk group, followed by the low-risk group (28.1%), intermediate-risk group (11.9%), and high-risk group (5.2%). During 36.5 months of follow-up, recurrence was found in four (3.4%) of the 118 patients who were monitored for more than 6 months (low-risk group, 1/37 [2.7%]; intermediate-risk group, 2/11 [18.2%]; high-risk group, 1/6 [16.7%]). Conclusions: Endoscopic treatment of a GIST appears to be a feasible procedure in selected cases. However, additional surgery should be considered if the pathologic results correspond to intermediate- or high-risk groups.

In this paper, we present a digital processing in memory (DPIM) configured as a stride edge-detection search frequency neural network (SE-SFNN) which is trained through spike location dependent plasticity (SLDP), a learning mechanism reminiscent of spike timing dependent plasticity (STDP). This mechanism allows for rapid online learning as well as a simple memory-based implementation. In particular, we employ a ternary data scheme to take advantage of ternary content addressable memory (TCAM). The scheme utilizes a ternary representation of the image pixels, and the TCAMs are used in a two-layer format to significantly reduce the computation time. The first layer applies several filtering kernels, followed by the second layer, which reorders the pattern dictionaries of TCAMs to place the most frequent patterns at the top of each supervised TCAM dictionary. Numerous TCAM blocks in both layers operate in a massively parallel fashion using digital ternary values. There are no complicated multiply operations performed, and learning is performed in a feedforward scheme. This allows rapid and robust learning as a trade-off with the parallel memory block size. Furthermore, we propose a method to reduce the TCAM memory size using a two-tiered minor to major promotion (M2MP) of frequently occurring patterns. This reduction scheme is performed concurrently during the learning operation without incurring a preconditioning overhead. We show that with minimal circuit overhead, the required memory size is reduced by 84.4%, and the total clock cycles required for learning also decrease by 97.31 % while the accuracy decreases only by 1.12%. We classified images with 94.58% accuracy on the MNIST dataset. Using a 100 MHz clock, our simulation results show that the MNIST training takes about 6.3 ms dissipating less than 4 mW of average power. In terms of inference speed, the trained hardware is capable of processing 5,882,352 images per second.

Background/Aims: Endoscopic submucosal dissection (ESD) of gastric neoplasm involving the pyloric channel (GNPC) is technically challenging due to difficulty in precise assessment of resection margin and inadequate visualization. The aim of this study was to evaluate the effectiveness and long-term outcome of ESD for GNPC and introduce a noble technique for resection of GNPC. Methods: A total of 97 patients with GNPC underwent ESD from January 2007 to October 2017. We divided them into a conventional anterograde resection group and a retrograde resection group according to the method of procedure. We compared their clinical outcomes and investigated risk factors for postprocedural complications. Results: The en bloc resection rate was 87.6%, and complete resection rate was 83.5%. Postprocedure stenosis occurred in 16 cases (16.5%). GNPCs of the retrograde resection group were more frequently located from antrum to bulb, were significantly larger, were related to ≥75% resection of the circumference, and involved significantly longer procedure times than those in the anterograde resection group. Multivariate analysis showed that resection ≥75% of the circumference was the only significant risk factor for postprocedure stenosis. Conclusions: ESD by retrograde resection method is a novel technique to make the procedure easier, depending on the size, location, and circumference of resection.

ABSTRACT The comparative outcomes of specific aminoglycosides in cavitary type (fibrocavitary or cavitary nodular bronchiectatic type) Mycobacterium avium complex (MAC) pulmonary disease (PD) are unelucidated. We investigated the treatment outcomes with streptomycin or amikacin inclusion in the treatment regimen. From 2006 to 2020, 168 patients with cavitary MAC-PD who received guideline-based therapy (a three-drug oral antibiotic regimen with macrolide, ethambutol, and rifampin with an injectable aminoglycoside) for ≥1 year at a tertiary referral center in South Korea were retrospectively enrolled. We compared the rates of the culture conversion achievement of patients with streptomycin or amikacin use. Of the 168 participants, 127 patients (75.6%) received streptomycin and 41 (24.4%) received amikacin (median [interquartile range] treatment duration of 17.6 [14.2 to 25.2] and 17.0 [14.0 to 19.4] weeks, respectively). The overall culture conversion rate at treatment completion was 75.6% (127/168), and the rates were similar for the streptomycin-treated and amikacin-treated groups (74.8% [95/127] and 78.0% [32/41], respectively; P = 0.674). A multivariate analysis revealed that the achievement of culture conversion did not differ significantly with streptomycin or amikacin use (adjusted odds ratio, 1.086; 95% confidence interval, 0.425 to 2.777). The rate of adverse events was similar in the two groups. In conclusion, in cavitary MAC-PD, treatment with streptomycin-containing and amikacin-containing regimens results in similar rates of culture conversion achievement. IMPORTANCE We found that among the participants with cavitary MAC-PD who received guideline-based treatment for ≥1 year, the selection of either streptomycin or amikacin in the treatment regimen led to similar rates of culture conversion at treatment completion. In addition, the adverse reaction development rate did not differ significantly for streptomycin and amikacin. These findings suggest that either streptomycin or amikacin can be selected for the treatment of MAC-PD, according to the physician’s or patient’s preference, such as the route of administration.

Objective Mindfulness-based stress reduction (MBSR) is a meditation-based therapy originally recommended for stress management. However, it is currently used to alleviate sleep disturbances. Therefore, this contemporary systematic review aimed to elucidate the clinical effects of MBSR on sleep quality and sleep-related daytime impairment in adults with sleep disturbances, including chronic insomnia disorders.Design Systematic review and meta-analysis of randomised controlled trials (RCTs).Methods A comprehensive search was conducted using the following databases: Ovid MEDLINE, AMED, Ovidembase, PsycINFO, Cochrane Library, CINAHL, and four domestic databases: KoreaMed, KISS, KMbase and NDSL. The final search update was performed in June 2022. Two researchers independently selected relevant studies, assessed the risk of bias and extracted the data.Results Of the 7516 records searched, 20 RCTs and 21 reports were included. In the subgroup analysis, MBSR did not improve objective or subjective sleep quality in chronic insomnia and cancers. However, MBSR versus waitlist control might have been effective in improving subjective sleep quality, but with substantial heterogeneity (standardised mean difference=−0.32; 95% CI: −0.56 to –0.08; I2=71%). In addition, MBSR compared with active control did not improve the sleep-related daytime impairments including depression, anxiety, stress, fatigue and quality of life. The overall risk of bias included in this review was a concern because of performance and detection bias.Conclusions MBSR might be ineffective for improving sleep quality in patients with chronic insomnia and cancers. In addition, more than half of the RCTs included in this review had small sample sizes and were vulnerable to performance and detection biases. Therefore, well-designed RCTs with larger sample sizes are required to confirm the clinical effects of MBSR in adults with sleep disturbances.PROSPERO registration number CRD42015027963.

The utilization of tractors is essential because of both the shortage of agricultural labor forces and the rapid aging of farmers in Korean agriculture. Tractors can be classified into two types: a walking tractor called as a power tiller, and a riding tractor. In this study, diesel emission inventories of tractors were established and variations of air pollutants were analyzed with each other using 2011 and 2019 survey data in Korea. Agricultural tractors including walking and riding types, which were categorized into three levels via the rated output power, were the main sources of diesel emissions. The emission inventory including CO, NOx, SOx, TSP(PM10), PM2.5, VOCs, and NH3 were established using a Tier 3 methodology. The total amount of emissions using agricultural tractors was decreased by about 13% from 2011 to 2019. The number of walking tractors were decreased by about 19% in 8 years; on the other hand, that of riding tractors were increased by about 12%. However, the emission reduction is about 48% for walking tractors, and the emission increment is about 5% for riding tractors. Thus, the total emission from agricultural tractors was decreased by about 16% in those periods. It is due to the decrease of 21% and 15% in the hours of use of walking and riding tractors, respectively, in 2019. Walking tractors mainly emit air pollutants from spraying and transporting. Riding tractors emit about 61% of the total air pollutants mainly from soil preparation and transporting operations. The geographic information system (GIS) was used to visualize the distribution of air pollutants in Korea. High-emission generating regions and the changes of emissions over 8 years were clearly seen in the GIS analysis. High air-pollutant emitting regions are mainly located in the western and southern regions of Korea, which have plenty of arable areas compared to other regions in Korea.

Background Several noninvasive tools are available for the assessment of nonalcoholic fatty liver disease (NAFLD) including clinical and blood biomarkers, transient elastography (TE), and magnetic resonance imaging (MRI) techniques, such as proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE). In the present study, we aimed to evaluate whether magnetic resonance (MR)-based examinations better discriminate the pathophysiologic features and fibrosis progression in NAFLD than other noninvasive methods. Methods A total of 133 subjects (31 healthy volunteers and 102 patients with NAFLD) were subjected to clinical and noninvasive NAFLD evaluation, with additional liver biopsy in some patients (n=54). Results MRI-PDFF correlated far better with hepatic fat measured by MR spectroscopy (r=0.978, P

Background/Aims Small bowel malignancies often present a diagnostic challenge due to their relative rarity and nonspecific clinical symptoms. However, technical developments in endoscopic instruments, including video capsule endoscopy (VCE) and enteroscopy, have allowed for the visualization of the entire small bowel. This study aimed to investigate the clinicopathological features of small bowel malignant tumors diagnosed by VCE and double-balloon enteroscopy (DBE) in a single tertiary center. Methods We retrospectively analyzed VCE and DBE findings from Korea University Guro Hospital from January 2010 through September 2018. Results A total of 510 VCE and 126 DBE examinations were performed in 438 patients. Small bowel malignancies were diagnosed in 28 patients (15 males; mean age, 61.0 years; range, 42 to 81 years). Among them, 8 had lymphoma, 8 had primary adenocarcinoma, 7 had gastrointestinal stromal tumor (GIST) and 5 had metastatic cancer. Abdominal pain and obstructive symptoms were the most common findings in metastatic cancers (4/5, 80%). On the other hand, obscure gastrointestinal bleeding was the most common symptom of GIST (6/7, 85.7%) and adenocarcinoma (3/8, 37.5%). Conclusions Approximately 6% of the patients who underwent either VCE or DBE were diagnosed with small bowel malignancy. These findings demonstrated the different clinical characteristics among small bowel malignancies and merit further study.

AbstractUpon replication stress, ssDNA, coated by the ssDNA-binding protein RPA, accumulates and generates a signal to activate the replication stress response. Severe replication stress induced by the loss of minichromosome maintenance helicase subunit Mcm4 in the temperature-sensitive Schizosaccharomyces pombemcm4-dg

Objective This study aimed to investigate the clinicopathologic risk factors for type-specific persistence of high-risk human papillomavirus (hrHPV) and residual/recurrent cervical intraepithelial neoplasia (CIN) after surgical treatment. Methods Patients with CIN-2/3 who underwent conization or loop electrosurgical excision procedure (LEEP) at Korea University Hospital were enrolled. All patients underwent hrHPV testing and genotyping before conization or LEEP followed by both hrHPV genotyping and cytology. The significance of associations between patient characteristics and persistence of infection were assessed by multivariate logistic regression analyses. Results Among 398 women with pathologically confirmed CIN-2/3, 154 (38.7%) patients showed hrHPV persistence after surgical treatment. In multivariate analysis, high preoperative hrHPV load (P

Triboelectric nanogenerators (TENGs) that enable the conversion of a given mechanical energy into electrical energy at high efficiency have been very important in practice. Since the given mechanical energy is involuntarily converted to secondary energy sources (light, heat, and sound during triboelectrification), the significant amount of energy being converted is lost. Various studies have thus been continuously carried out to overcome this issue. Since the first TENGs found in 2012, various developments in TENGs have been made: (1) the mechanical-electrical energy conversion characteristics of potential organic/inorganic material groups have been introduced, (2) the integration into the device structure considering the diversity of mechanical energy, and (3) user friendly and industrial application platforms have been aggressively studied. Despite the remarkable progress and improvement of TENGs, their mechanical-electrical conversion efficiency is still quite low. We therefore need to discover and develop materials that can be converted to improve efficiency. Here, we outline the recent progress made in a group of high polarity triboelectric materials that exploit surface charge density and charge transfer properties. We also review the recent boosting powering TENGs. The aim of this work is to provide insight into the future direction and strategies for highly enhanced powering TENGs through material research.

BackgroundBreast cancer is one of the major causes of mortalities noticed in women globally. DDX3 has emerged as a potent target for several cancers, including breast cancer to which currently there are no reported or approved drugs.MethodsTo find effective cancer therapeutics, three compounds were computationally designed tweaking the structure of natural compound butein. These compounds were synthesized and evaluated for their anticancer property in MCF-7 and MDA-MB-231 cell lines targeting DDX3. The in silico molecular docking studies have shown that the compounds have occupied the binding site of the human DDX3 target. Furthermore, to investigate the cell viability effect of 3a, 3b, and 3c on MCF-7 and MDA-MB-231 cell lines, the cell lines were treated with different concentrations of compounds for 24 and 48 h and measured using MTT assay.ResultsThe cell viability results showed that the have induced dose dependent suppression of DDX3 expression. Additionally, 3b and 3c have reduced the expression of DDX3 in MCF-7 and MDA-MD-231 cell lines. 3b or 3c treated cell lines increased apoptotic protein expression. Both the compounds have induced the apoptotic cell death by elevated levels of cleaved PARP and cleaved caspase 3 and repression of the anti-apoptosis protein BCL-xL. Additionally, they have demonstrated the G2/M phase cell cycle arrest in both the cell lines. Additionally, 3c decreased PI3K and AKT levels.ConclusionsOur results shed light on the anticancer ability of the designed compounds. These compounds can be employed as chemical spaces to design new prospective drug candidates. Additionally, our computational method can be adapted to design new chemical scaffolds as plausible inhibitors.

Abstract Background Sarcopenia, the decline of skeletal muscle tissue attributed to primary aging is a major concern in older adults. Flavonoids might have potential benefits by modulating the regulation of satellite cells, thus preventing muscle loss. Sinensetin (SIN), a citrus methylated flavone with anti-inflammatory and anti-proliferative activity, can enhance lipolysis. The objective of the present study was to investigate whether SIN might have sarcopenia-suppressing effect on satellite cells from thigh and calf muscle tissues of young and old rats. Methods Primary muscle cells were obtained from thigh and calf tissues of young and old group rats by dissection. Obtained satellite cells were incubated with indicated concentrations of SIN (50 and 100 μM) treated and untreated condition in differentiation medium. Morphological changes of cells were examined using a phase-contrast microscope. Protein expression levels of myoD and myogenin were analyzed by Western blot. Cells treated with or without SIN under differentiation condition were also immunocytochemically stained for myogenin and 4′,6-diamidino-2-phenylindole (DAPI). Results Morphologically, the differentiation extracted satellite cells was found to be more evident in SIN treated group of aged rat′s cells than that in SIN untreated group. Expression levels of myoD and myogenin proteins involved in myogenesis were increased upon treatment with SIN. Conclusions Collectively, our results indicate that SIN can alleviate age-related sarcopenia by increasing differentiation rate and protein levels of myoD and myogenin.

Papillary meningioma is rare meningeal tumors and is associated with aggressive clinical behavior as compared with other meningiomas. We report a case of papillary meningioma in a 50-year-old woman presented with complaints of headache, nausea and vomiting. MRI revealed a very macrolobulated heterogeneously enhancing solid mass at the right frontal convexity with focal prominent inward infiltrating portion and surrounding moderate brain edema. The localization of the lesion as intra-axial or extra-axial in origin was difficult. Demonstrated diffusion restriction and high relative cerebral blood volume value were similar to conventional meningioma, but hypervascular inward infiltrating portion could be seen in papillary meningioma. The histopathology examination of the resected tissues revealed papillary meningioma with an increased cellularity and high nuclear/cytoplasm ratio. She underwent radical excision of the tumor, followed radiotherapy and tumor recurrence occurred at 12 months later.

Rapunzel syndrome is caused by gastric trichobezoar with extended tail and small bowel obstruction. Patients with gastric trichobezoar can be asymptomatic until the bezoar increases in size. We report a case of a girl who visited the emergency department with abdominal pain. She was finally diagnosed with Rapunzel syndrome that causes multiple small bowel intussusceptions associated with trichophagia. Surgery was needed to reduce the multiple intussusceptions, and to remove the large trichobezoar. This case highlights to consider the possibility of Rapunzel syndrome when diagnosing the main cause of intussusceptions.

Summary: Background: The aim of the study is to present surgical techniques and treatment outcomes for re-banding and sleeve gastrectomy as a revisional surgery after removing eroded adjustable gastric bands. Methods: A retrospective analysis was performed to study laparoscopic re-banding or sleeve gastrectomy as revisional surgery for band erosion. Main outcome measures were success of therapeutic strategies, morbidity, body mass index, and percentage total excess weight loss before and after revision. Results: From March 2013 to June 2017, a total of 11 patients underwent the revisional surgery. Six patients underwent sleeve gastrectomy at median 15.7 months (13.2–73.3 months) after band removal, and 5 patients gastric re-banding at median 5.4 months (3.1–43.8 months). One of the six patients that underwent sleeve gastrectomy was diagnosed to have a minor leak. No other critical postoperative complication was observed in each group. Median BMI at revision in the sleeve gastrectomy group was 32.7 kg/m2 (31.2–40.8 kg/m2). Median follow-up after revision was 33.8 months (15.5–63.7 months), and at last follow-up, median BMI was 26.4 kg/m2 (23.6–34.6 kg/m2), and median %TWL was 17.6% (9.5–31.5%). In the rebanding group, median BMI at revision was 30.7 kg/m2 (27.0–41.4 kg/m2). Median follow-up after revision was 25.5 months (13.5–45.4 months), and at last follow-up, median BMI was 23.5 kg/m2 (22.0–30.1 kg/m2) and median %TWL was 23.9% (9.1–29.0%). Conclusion: Given the surgical techniques adopted, both re-banding and sleeve gastrectomy were found to be safe and effective revisional surgery after removal of eroded gastric band. Keywords: Adjustable gastric band, Complication, Revisional surgery, Sleeve gastrectomy

We performed targeted metabolomics with machine learning (ML)-based interpretation to identify metabolites that distinguish the progression of nonalcoholic fatty liver disease (NAFLD) in a cohort. Plasma metabolomics analysis was conducted in healthy control subjects (n = 25) and patients with NAFL (n = 42) and nonalcoholic steatohepatitis (NASH, n = 19) by gas chromatography-tandem mass spectrometry (MS/MS) and liquid chromatography-MS/MS as well as RNA sequencing (RNA-seq) analyses on liver tissues from patients with varying stages of NAFLD (n = 12). The resulting metabolomic data were subjected to routine statistical and ML-based analyses and multi-omics interpretation with RNA-seq data. We found 6 metabolites that were significantly altered in NAFLD among 79 detected metabolites. Random-forest and multinomial logistic regression analyses showed that eight metabolites (glutamic acid, cis-aconitic acid, aspartic acid, isocitric acid, α-ketoglutaric acid, oxaloacetic acid, myristoleic acid, and tyrosine) could distinguish the three groups. Then, the recursive partitioning and regression tree algorithm selected three metabolites (glutamic acid, isocitric acid, and aspartic acid) from these eight metabolites. With these three metabolites, we formulated an equation, the MetaNASH score that distinguished NASH with excellent performance. In addition, metabolic map construction and correlation assays integrating metabolomics data into the transcriptome datasets of the liver showed correlations between the concentration of plasma metabolites and the expression of enzymes governing metabolism and specific alterations of these correlations in NASH. Therefore, these findings will be useful for evaluation of altered metabolism in NASH and understanding of pathophysiologic implications from metabolite profiles in relation to NAFLD progression.

Background/AimsThe use of laparoscopic adjustable gastric banding (LAGB) is increasing proportionally with the obesity epidemic. However, some postoperative complications have been highlighted as major problems associated with LAGB. There is no consensus concerning the endoscopic management of these adverse events. The aim of this study was to retrospectively review the feasibility and effectiveness of endoscopic treatment for LAGB complications.Methods : We retrospectively evaluated 352 patients who underwent LAGB between 2011 and 2015. LAGB-associated complications developed in 26 patients (7.4%). This study involved six patients (1.7%) who received endoscopic treatment.Results : Types of LAGB-induced complications in our series included intragastric migration (n=3), gastric leaks (n=2), and gastric fistulas (n=1). The endoscopic treatment of these complications was successful in four of the six patients. Endoscopic band removal was successful in two patients. All gastric leaks were successfully closed via an endoscopic procedure. In two cases (intragastric migration and gastric fistula), endoscopic treatment was not sufficient, and surgery was performed.Conclusion : sEndoscopic procedures afforded acceptable treatment of band migration and gastric leaks after LAGB. However, the results were poor in patients with gastric fistula.

ObjectivesThis research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems.MethodsWe focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively.ResultsUsing queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%.ConclusionsIt is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process.

Chondroblastomas are rare benign cartilaginous neoplasms found in young patients. These tumors typically arise in the epiphysis or apophysis of a long bone. Chondroblastomas arising in the skull and facial bones are extremely rare. We describe a rare case of a patient presenting with chondroblastoma with secondary aneurysmal bone cyst in the sphenoid sinus that mimicked invasive sinusitis or malignant bone tumor.

PurposeThis study examined the risk factors of a delayed diagnosis of acute appendicitis in children undergoing an appendectomy.MethodsThis retrospective study involved children aged below 18 years, who underwent an appendectomy. After dividing them into a delayed diagnosis group and nondelayed diagnosis group according to the time interval between the initial hospital visit and final diagnosis, the risk factors of delayed diagnosis were identified using logistic regression analysis.ResultsAmong 712 patients, 105 patients (14.7%) were classified in the delayed diagnosis group; 92 patients (12.9%) were diagnosed using ultrasonography (US), and both US and computed tomography were performed in 38 patients (5.3%). More patients in the delayed diagnosis group underwent US (P=0.03). Spring season and prior local clinic visit were significantly associated with a delayed diagnosis. Fever and diarrhea were more common in the delayed diagnosis group (fever: odds ratio [OR], 1.37; 95% confidence interval [CI], 1.05–1.81; diarrhea: OR, 1.94; 95% CI, 1.08–3.46; P

Melanocytic nevus is the benign proliferation of melanocytes. The most common location of melanocytic nevus is the skin of the extremities; however, there are few case reports of melanocytic nevus at the rectal mucosa. No prior case of malignant melanoma from melanocytic nevus at the rectal mucosa has been reported; therefore, it is unclear whether resection should be performed or close observation is sufficient. However, the potential malignant transformation of melanocytic nevus should be considered, including melanocytic nevus on the rectum. Melanocytic nevus of the skin can be removed by surgical excision; however, due to rare incidence on the mucosa of the gastrointestinal tract, the optimal treatment for rectal melanocytic nevus remains controversial. Here, we report the first case of melanocytic nevus on the rectal mucosa that was removed by endoscopic submucosal dissection. This case report provides useful information about the optimal management of rectal melanocytic nevus.

Purpose To compare the usefulness of Doppler ultrasonography and renal scintigraphy in the assessment of short- and long-term function of transplanted kidneys. Materials and Methods We retrospectively reviewed the cases of 79 patients who underwent Doppler ultrasonography and technetium-99m diethylene triamine pentaacetic acid renal scintigraphy on the same day, within 4 days of renal transplantation. Image parameters were evaluated for statistical differences. Results There was a strong positive correlation between the glomerular filtration rate (GFR) as measured by renal scintigraphy and the estimated GFR (eGFR) based on serum creatinine levels (correlation coefficient = 0.71). Scan grade according to the time-activity curve, resistive index, and end diastolic velocity showed moderate correlations with the eGFR (correlation coefficients = -0.557, -0.329, and 0.370, respectively) in the early post-transplantation period. The mean survival time was longer in patients with lower resistive indices (≤ 0.68, 54.9 months vs. > 0.68, 29.5 months) and lower pulsatility indices (≤ 1.32, 53.8 months vs. > 1.32, 28.7 months); however, there were no statistically significant differences in the long-term follow-up period (p = 0.121 for resistive index and p = 0.074 for pulsatility index). Conclusion Renal scintigraphy is a more sensitive method than Doppler ultrasonography for assessing transplanted kidney function in the early post-transplantation period. Doppler ultrasonography might reflect the long-term survival time. However, it is difficult to predict long-term renal function using either method.

The maturity of tomato fruit is normally characterized by external color, and it is often difficult to know when fruit have achieved commercial maturity or become over-mature. The internal structure of tomato fruit changes during development and this study investigates the utility of nondestructive measurement of tomato fruit structure as a function of maturity using magnetic resonance imaging (MRI). The objective of this work is to use analysis of internal tomato fruit structural measurements to characterize maturity. Intact cherry tomato fruit were harvested at six different maturity stages. At each stage of maturity, the internal structure of the fruit was measured using a series of two-dimensional (2D) magnetic resonance (MR) images. Qualitative and quantitative image analyses were performed to correlate internal fruit structure with maturity. Internal structural changes observed in the pericarp region of the tomato fruit are highly correlated with fruit maturity. MR image information combined with classical analysis techniques provides a more complete understanding of structure and physicochemical changes in tomato fruit during maturation. This study demonstrates that MRI is a useful analytical tool to characterize internal changes in agricultural produce as the produce matures. This technique can be applied to almost any agricultural produce to monitor internal physical changes due to external impact, maturity stage, variation in climate, storage time, and condition, or other factors impacting quality.

Gastric cancer is the common type of malignancy positioned at second in mortality rate causing burden worldwide with increasing treatment options. Prunetin (PRU) is an O-methylated flavonoid that belongs to the group of isoflavone executing beneficial activities. In the present study, we investigated the anti-proliferative and cell death effect of the compound PRU in AGS gastric cancer cell line. The in vitro cytotoxic potential of PRU was evaluated and significant proliferation was observed. We identified that the mechanism of cell death was due to necroptosis through double staining and was confirmed by co-treatment with inhibitor necrostatin (Nec-1). We further elucidated the mechanism of action of necroptosis via receptor interacting protein kinase 3 (RIPK3) protein expression and it has been attributed by ROS generation through JNK activation. Furthermore, through computational analysis by molecular docking and dynamics simulation, the efficiency of compound prunetin against RIPK3 binding was validated. In addition, we also briefed the pharmacokinetic properties of the compound by in silico ADMET analysis.

Meat consumption has shifted from a quantitative to a qualitative growth stage due to improved living standards and economic development. Recently, consumers have paid attention to quality and safety in their decision to purchase meat. However, foreign substances which are not normal food ingredients are unintentionally incorporated into meat. These should be eliminated as a hazard to quality or safety. It is important to find a fast, non-destructive, and accurate detection technique of foreign substance in the meat processing industry. Hyperspectral imaging technology has been regarded as a novel technology capable of providing large-scale imaging and continuous observation information on agricultural products and food. In this study, we considered the feasibility of the short-wave near infrared (SWIR) hyperspectral reflectance imaging technique to detect bone fragments embedded in chicken meat. De-boned chicken breast samples with thicknesses of 3, 6, and 9-mm and 5 bone fragments with lengths of about 20–30-mm are used for this experiment. The reflectance spectra (in the wavelength range from 987 to 1701-nm) of the 5 bone fragments embedded under the chicken breast fillet are collected. Our results suggested that these hyperspectral imaging technique is able to detect bone fragments in chicken breast, particularly with the use of a subtraction image (corresponding to image at 1153.8-nm and 1480.2-nm). Thus, the SWIR hyperspectral reflectance imaging technique can be potentially used to detect foreign substance embedded in meat.

DDX3 belongs to RNA helicase family that demonstrates oncogenic properties and has gained wider attention due to its role in cancer progression, proliferation and transformation. Mounting reports have evidenced the role of DDX3 in cancers making it a promising target to abrogate DDX3 triggered cancers. Dual pharmacophore models were generated and were subsequently validated. They were used as 3D queries to screen the InterBioScreen database, resulting in the selection of curcumin that was escalated to molecular dynamics simulation studies. In vitro anti-cancer analysis was conducted on three cell lines such as MCF-7, MDA-MB-231 and HeLa, which were evaluated along with exemestane. Curcumin was docked into the active site of the protein target (PDB code 2I4I) to estimate the binding affinity. The compound has interacted with two key residues and has displayed stable molecular dynamics simulation results. In vitro analysis has demonstrated that both the candidate compounds have reduced the expression of DDX3 in three cell lines. However, upon combinatorial treatment of curcumin (10 and 20 μM) and exemestane (50 μM) a synergism was exhibited, strikingly downregulating the DDX3 expression and has enhanced apoptosis in three cell lines. The obtained results illuminate the use of curcumin as an alternative DDX3 inhibitor and can serve as a chemical scaffold to design new small molecules.

ObjectivesThis study was conducted to evaluate the adoption behavior of a newly developed Electronic Medical Record (EMR)-based information system (IS) at three public hospitals in Korea with a focus on doctors and nurses.MethodsUser satisfaction scores from four performance layers were analyzed before and two times after the newly develop system was introduced to evaluate the adoption process of the IS with Rogers' diffusion theory.ResultsThe 'intention to use' scores, the most important indicator for determining whether or not to adopt the IS in Rogers' confirmation stage for doctors, were very high in the third survey (4.21). In addition, the scores for 'reduced medication errors', which is the key indicator for evaluating the success of the IS, increased in the third survey for both doctors and nurses. The factors influencing 'intention to use' with a high odds ratio (>1.5) were the 'frequency of attendance of user training sessions', 'mandatory use of system', 'reduced medication errors', and 'reduced medical record documentation time' for both doctors and nurses.ConclusionsThese findings show that the new EMR-based IS was well accepted by doctors. Both doctors and nurses also positively considered the effects of the new IS on their clinical environments.

Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT insertion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT.

We theoretically investigate external surface charge effects on piezoelectric potential of ZnO and AlN nanowires (NWs) and nanotubes (NTs) under uniform compression. The free carrier depletion caused by negative surface charges via surface functionalization on vertically compressed ZnO and AlN NWs/NTs is simulated using finite element calculation; this indicates the enhancement of piezoelectric potential is due to the free carriers (electrons) being fully depleted at the critical surface charge density. Numerical simulations reveal that full coverage of surface charges surrounding the NTs increases the piezoelectric output potential exponentially within a relatively smaller range of charge density compared to the case of NWs for a typical donor concentration (∼1017 cm−3). The model can be used to design functional high-power semiconducting piezoelectric nanogenerators.

Nutritional markers are important predictors of morbidity and mortality in dialysis patients. We investigated dialysis efficiency indicators and nutritional parameters of 82 elderly patients who started to receive hemodialysis treatment and lasted more than a year in our hospital for last 5 years. 20 patients were expired during treatment period and 62 patients are alive. The indicators were measured at one year after the initiation of dialysis and the most recent time or the most recent time before death. Differences in the means between the groups were evaluated by un-paired Student’s t-test. In survival group, urea reduction rate (URR), Kt/V/week, normalized protein catabolic rate (nPCR), serum total cholesterol were higher than those of death group. Post-hemodialysis 1 year Survival group Death group p value URR (%) 69.86±4.85 66.07±12.09 0.05 Kt/V/week 4.78±1.35 3.91±0.75 0.01 nPCR (g/kg/day) 1.10±0.25 0.96±0.16 0.01 Hemoglobin (g/dL) 10.70±0.77 9.97±0.93 0.00 T. cholesterol (mg/dL) 168.52±37.22 145.80±54.02 0.04 The most recent time Survival group Death group p value URR (%) 72.44 ± 3.77 68.47±5.90 0.00 Kt/V/week 4.95±1.24 4.19±0.68 0.01 nPCR (g/kg/day) 1.20±0.60 0.85±0.30 0.02 Hemoglobin (g/dL) 10.47±1.49 9.79±1.25 0.07 T. cholesterol (mg/dL) 159.52±31.97 130.20±32.79 0.00 In conclusion, these results imply that elderly hemodialysis patients may require adequate dialysis manage and special nutritional support.

The prevalence of malnutrition is high in patients on maintenance dialysis treatment in relation to low protein and energy intakes, metabolic disorders. We investigated the evolution of nutritional status during the first year after ABO incompatible living donor kidney transplantation (ABOI-LKT) in our hospital through assessment of chemical markers. A total of 16 kidney transplant recipients were followed during the first post-transplant year. Biochemical nutritional markers were assessed at 12 months later after ABOI-LKT. Differences in the means between the pre-transplant and post-transplant chemical markers were evaluated by paired Student’s t-test. Pre-transplant Post-transplant p value Body weight (kg) 57.74 ± 8.00 54.43 ± 7.62 0.00 S. hemoglobin (g/dL) 10.44 ± 1.32 12.04 ± 1.87 0.03 S. BUN (mg/dL) 46.55 ± 22.52 18.13 ± 5.88 0.00 S. creatinine (mg/dL) 8.06 ± 3.39 1.15 ± 0.57 0.00 S. calcium (mg/dL) 8.70 ± 1.10 9.12 ± 0.72 0.04 S. phosphate (mg/dL) 5.20 ± 2.05 2.50 ± 1.05 0.00 S. albumin (g/dL) 3.59 ± 0.52 4.06 ± 0.33 0.00 S. globulin (g/dL) 2.83 ± 0.52 2.49 ± 0.35 0.00 HDL (mg/dL) 47.80 ± 12.36 63.45 ± 16.97 0.00 Total bilirubin (mg/dL) 0.45 ± 0.13 0.78 ± 0.39 0.00 AST (IU/L) 14.20 ± 6.30 20.90 ± 8.78 0.01 ALT (IU/L) 12.75 ± 5.63 22.10 ± 12.53 0.01 By the end of the first year, serum hemoglobin, calcium, albumin, HDL, bilirubin, AST, ALT were increased statistically. But serum phosphate, globulin were decreased statistically. In conclusion, successful ABO incompatible living donor kidney transplantation would restore a normal nutritional status even though the patients were performed plasmapheresis during the pre-transplant period.