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Background: Despite thrombocytopenia, patients with sepsis often experience hypercoagulability. However, limited information is available on the prevalence and effect of hypercoagulability in patients with sepsis-induced thrombocytopenia. Hence, we evaluated the prevalence of hypercoagulability and the association between hypercoagulability and clinical outcomes in septic shock patients with thrombocytopenia. Methods: Thromboelastography (TEG) was performed prospectively in 1294 patients with septic shock at the emergency department (ED) between January 2016 and December 2019. After excluding 405 patients who did not require resuscitation, refused enrollment, or developed septic shock after ED presentation, 889 patients were included. We defined thrombocytopenia as an admission platelet count lower than 150,000/μl according to SOFA score. We defined hypocoagulability and hypercoagulability as coagulation index (CI)< -3 and >3 on TEG, respectively. Results: Of the 889 septic shock patients (mean age 65.6± 12.7 years, 58.6% male), 473 (53.2%) had thrombocytopenia. Eighty-five (18.0%) patients showed hypercoagulable TEG and73 (15.4%) patients showed hypocoagulable TEG. The hypercoagulable TEG group had a significantly higher fibrinogen level and a lower 28-day mortality rate than the normal and hypocoagulable TEG groups (518 vs. 347 and 315 mg/dL; 7.1% vs. 21.1% and 36.8%, P < 0.01, respectively). In multivariate analysis, hypercoagulable TEG was associated with a decreased mortality rate (odds ratio: 0.395; 95% confidence interval, 0.162-0.965). Conclusions: In septic shock patients with thrombocytopenia, hypercoagulability was not uncommon. TEG can quickly distinguish the hypercoagulability and hypocoagulability states and serve as a valuable tool for evaluating the degree and risk in septic shock patients with thrombocytopenia. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the effectiveness of pembrolizumab among patients with programmed death-ligand 1 (PD-L1) positive platinum resistant recurrent ovarian cancer (PROC). Methods: We retrospectively reviewed the medical records of patients diagnosed with PROC and treated with pembrolizumab monotherapy. All patients were PD-L1 positive. Fixed does of pembrolizumab 200 mg was administered intravenously every three weeks. The primary endpoint was the objective response rate. Results: In total, 8 patients were included in this study. Median number of pembrolizumab cycles was 3 (range, 1-45). The objective response rate was 37.5%, with one complete response and 2 partial responses. The treatment was generally well tolerated. None of the patients experienced treatment discontinuation or treatment-related death due to adverse events. Conclusion: Pembrolizumab monotherapy showed modest antitumor activity against PROC. Pembrolizumab monotherapy is an alternative treatment option for patients with PROC. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective case-control study.Objective: To investigate the effects of postoperative sagittal alignment on radiographic adjacent segment degeneration (ASD) after lumbar fusion surgery.Summary Of Background Data: ASD is one of inherent problems with fusion surgery. Many confounding factors are related to the development of ASD. Recently, sagittal alignment has been emphasized for its significance on ASD.Methods: Seventy-three patients who underwent four-level lumbar fusion surgery (L2-S1) were divided into two groups according to postoperative sagittal alignment (pelvic incidence-lumbar lordosis [PI-LL] ≥ or <9°): 44 patients (matched group, including 10 patients who underwent pedicle subtraction osteotomy [PSO] at L4) and 29 patients (mismatched group). The general demographics, radiographic parameters, and clinical outcomes were recorded. Preoperative disc degeneration at L1-2 was evaluated by Pfirrmann grade and Kellgren-Lawrence (K-L) grade. Disc degeneration at L1-2 was evaluated by the K-L grade on 2-year postoperative X-rays.Results: The incidence of radiographic ASD (11 [25%] vs. 16 patients [55%], P = 0.02) and Oswestry Disability Index (ODI) scores (36.9 ± 19.9 vs. 49.4 ± 20.7, P = 0.015) at postoperative 2 years were significantly higher in the mismatched group. There were no significant differences in other demographic and radiographic parameters between the two groups. On subgroup analysis between 10 PSO patients and the mismatched group, the mismatched group showed a higher incidence of radiographic ASD (16 [55%] vs. 1 patient [10%], P = 0.041) and worse ODI scores (49.7 ± 20.5 vs. 39.0 ± 20.7, P = 0.040). Preoperative Pfirrmann grade at L1-2 (odds ratio [OR] = 4.191, 95% confidence interval [CI]: 1.754-10.013, P = 0.001) and postoperative PI-LL mismatch (OR = 4.890, 95% CI: 1.550-15.427, P = 0.007) showed significant relationships with the development of radiographic ASD at postoperative 2 years.Conclusion: The restoration of optimal sagittal alignment, even with PSO, may provide a protective effect on the development of radiographic ASD, although the preoperative disc degeneration grade was a risk factor for radiographic ASD.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

The direct current electric voltage induced by the Inverse Spin Hall Effect (ISHE) and Anomalous Hall Effect (AHE) was investigated in the TE011 and TE102 cavities. The ISHE and AHE components were distinguishable through the fitting of the voltage spectrum. The unwanted AHE was minimized by placing the DUT (Device Under Test) at the center of both the TE011 and TE102 cavities. The voltage of ISHE in the TE011 cavity was larger than that in the TE102 cavity due to the higher quality factor of the former. Despite optimized centering, AHE voltage from TE011 cavity was also higher. The reason was attributed to the E-field distribution inside the cavity. In the case of the TE011 cavity, the DUT was easily exposed to the E-field in all directions. Therefore, the parasitic AHE voltage in the TE102 cavity was less sensitive than that in the TE011 cavity to decentering problem. [ABSTRACT FROM AUTHOR]

Background: For Grade I degenerative lumbar spondylolisthesis (DLS), both decompression alone and decompression with fusion are effective surgical treatments. Which of the two techniques is superior is still under debate. The purpose of this study was to compare clinical outcomes after decompression alone versus decompression with fusion for Grade I DLS. Materials and Methods: 139 patients who underwent surgery for Grade I DLS at L4-L5 were prospectively enrolled. Decompression alone was used to treat 74 patients, and decompression with fusion was used to treat 65 patients. Six patients in the first group and four patients in the second group were lost during the 2-year followup. Demographic data were recorded. Operation time, perioperative blood loss, total blood transfusion volume, and length of hospital stay were compared between the two groups. Back pain and functional outcomes were evaluated using the visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively. Results: Baseline demographic data were not different between the two groups. Operation time, blood loss, total blood transfusion volume, and length of hospital stay were all significantly greater in the fusion group than in the decompression group. This would be expected because fusion is the more invasive procedure. VAS scores were not different up until 6 months postoperatively. Twelve months after surgery, however, VAS scores were significantly lower in the fusion group. The same results were shown in terms of ODI. Although ODI decreased in both groups over time, the fusion group showed better functional outcomes than did the decompression group. Conclusions: Although both decompression alone and decompression with fusion improved functional outcomes for Grade I DLS, fusion surgery resulted in better results compared to decompression alone. Therefore, fusion should be considered as the treatment of choice for Grade I DLS. [ABSTRACT FROM AUTHOR]

Background: This study assessed the association between the initial Acute Physiology and Chronic Health Evaluation (APACHE) II score and good neurological outcome in comatose survivors of out-of-hospital cardiac arrest who received targeted temperature management (TTM). Methods: Data from survivors of cardiac arrest who received TTM between January 2011 and June 2016 were retrospectively analyzed. The initial APACHE II score was determined using the data immediately collected after return of spontaneous circulation rather than within 24 hours after being admitted to the intensive care unit. Good neurological outcome, defined as Cerebral Performance Category 1 or 2 on day 28, was the primary outcome of this study. Results: Among 143 survivors of cardiac arrest who received TTM, 62 (43.4%) survived, and 34 (23.8%) exhibited good neurological outcome on day 28. The initial APACHE II score was significantly lower in the patients with good neurological outcome than in those with poor neurological outcome (23.71 ± 4.39 vs. 27.62 ± 6.16, P = 0.001). The predictive ability of the initial APACHE II score for good neurological outcome, assessed using the area under the receiver operating characteristic curve, was 0.697 (95% confidence interval [CI], 0.599 to 0.795; P = 0.001). The initial APACHE II score was associated with good neurological outcome after adjusting for confounders (odds ratio, 0.878; 95% CI, 0.792 to 0.974; P = 0.014). Conclusions: In the present study, the APACHE II score calculated in the immediate post-cardiac arrest period was associated with good neurological outcome. The initial APACHE II score might be useful for early identification of good neurological outcome. [ABSTRACT FROM AUTHOR]

Objective: Patients with hematological malignancies frequently encounter spine-related symptoms, which are caused by disease itself or process of treatment. However, there is still lack of knowledge on their epidemiology and clinical courses. The purpose of this article is to review clinical presentations and surgical results for spinal involvement of hematologic malignancies. Methods: From January 2011 to September 2014, 195 patients (98 males and 97 females) suffering from hematological malignancies combined with spinal problems were retrospectively analyzed for clinical and radiological characteristics and their clinical results. Results: The most common diagnosis of hematological malignancy was multiple myeloma (96 patients, 49.7%), followed by chronic myeloid leukemia (30, 15.2%), acute myeloid leukemia (22, 11.2%), and lymphoma (15, 7.56%). The major presenting symptoms were mechanical axial pain (132, 67.7%) resulting from pathologic fractures, and followed by radiating pain (49, 25.1%). Progressive neurologic deficits were noted in 15 patients (7.7%), which revealed as cord compression by epidural mass or compressive myelopathy combined with pathologic fractures. Reconstructive surgery for neurologic compromise was done in 16 patients. Even though surgical intervention was useful for early paralysis (Frankel grade D or E), neurologic recovery was not satisfactory for the progressed paralysis (Frankel grade A or B). Conclusion: Hematological malignancies may cause various spinal problems related to disease progression or consequences of treatments. Conservative and palliative treatments are mainstay for these lesions. However, timely surgical interventions should be considered for the cases of pathologic fractures with progressive neurologic compromise. [ABSTRACT FROM AUTHOR]

Solid organ transplant recipients need emphases on immunization that result in certainly decrease the risk of vaccine preventable diseases. Organ transplant candidate should complete the recommended full vaccination schedule as early as possible during the courses of underlying disease because the patients with end stage liver or renal disease have reduced immune response to vaccine. Furthermore, live attenuated vaccines are generally contraindicated after transplantation. This review summarizes current information and the evidences regarding the efficacy and safety of immunization in adult solid organ transplant candidates and recipients. [ABSTRACT FROM AUTHOR]

The widespread use of thermoelectric technology is constrained by a relatively low conversion efficiency of the bulk alloys, which is evaluated in terms of a dimensionless figure of merit (zT). The zT of bulk alloys can be improved by reducing lattice thermal conductivity through grain boundary and point-defect scattering, which target low- and high-frequency phonons. Dense dislocation arrays formed at low-energy grain boundaries by liquid-phase compaction in Bi0.5Sb1.5Te3 (bismuth antimony telluride) effectively scatter midfrequency phonons, leading to a substantially lower lattice thermal conductivity. Full-spectrum phonon scattering with minimal charge-carrier scattering dramatically improved the zT to 1.86 ± 0.15 at 320 kelvin (K). Further, a thermoelectric cooler confirmed the performance with a maximum temperature difference of 81 K, which is much higher than current commercial Peltier cooling devices. [ABSTRACT FROM AUTHOR]

Ta-layer thickness (tTa) dependence of the measured DC voltage V from the inverse-spin Hall effect (ISHE) in Ta/CoFeB bilayer structure is experimentally investigated using the ferromagnetic resonance in the TE011 resonant cavity. The ISHE signals excluding the spin-rectified effect (SRE) were separated from the fitted curve of V against tTa. For tTa ≈ λTa (Ta-spin diffusion length = 2.7 nm), the deviation in ISHE voltage VISH between the experimental and theoretical values is significantly increased because of the large SRE contribution, which also results in a large deviation in the spin Hall angle hSH (from 10% to 40%). However, when tTa ≥ λTa, the VISH values are consistent with theoretical values because the SRE terms become negligible, which subsequently improves the accuracy of the obtained θSH within 4% deviation. The results will provide an outline for an accurate estimation of the θSH for materials with small λ value, which would be useful for utilizing the spin Hall effect in a 3-terminal spintronic devices in which magnetization can be controlled by in-plane current. [ABSTRACT FROM AUTHOR]

Context.--The tumor-host interaction in the tumor microenvironment (TME) affects the prognosis of patients with malignant tumors. TME assessed via tumor budding (BD) and tumor-infiltrating lymphocyte (TIL) had a prognostic impact in patients with nonampullary small intestinal and colorectal carcinomas. In ampullary carcinoma (AC), MUC5AC was recently revealed as a significant prognosticator, but studies about the TME have not been conducted. Objective.--To assess TME-based prognostic risk in AC. Design.--We generated a collective TME risk index based on high-grade BD at the invasive front (BD3) and high density of stromal-TIL (.5%) in 64 surgically resected ACs. We evaluated its predictive values for overall survival (OS) and recurrence-free survival (RFS). We also investigated the relationship of TME to MUC5AC expression. Results.--TME prognostic risk index was classified into low-risk (BDLow/TILHigh; 26 of 64; 41%), intermediate-risk (BDLow/TILLow or BDHigh/TILHigh; 23; 36%), and high-risk (BDHigh/TILLow; 15; 23%) groups. Higher TME prognostic risk was associated with higher tumor grade (P ¼ .03), lymphovascular invasion (P ¼ .05), and MUC5AC immunopositivity (P ¼ .02). TME prognostic risk index displayed better predictive ability for both OS (53.9 versus 46.1 versus 42.2) and RFS (24.8 versus 16.9 versus 15.3) than BD or TIL alone. In multivariate analysis, TME prognostic risk index was an independent prognosticator for OS (P = .003) and RFS (P = .03). Conclusions.--TME risk index in combination with BD and TIL was a stronger predictor of prognostic risk stratification than either BD or TIL alone for both OS and RFS in patients with AC. MUC5AC may modulate the interaction between tumor cells and immunity toward enhancing invasiveness in TME. [ABSTRACT FROM AUTHOR]

This paper provides a review of the family Lucanidae in Korea, which consists of 17 species belonging to 9 genera. One new species, Dorcus tenuihirsutus sp. nov., is described and the following taxonomical changes are proposed: Aegus laevicollis Saunders, 1854 is newly identified as Aegus laevicollis subnitidus Waterhouse, 1873; Macrodorcas striatipennis Motschulsky, 1861 is removed from the Korean fauna because this record is thought to have been based on the misinterpretation of locality and misidentification; Neolucanus saundersii Parry, 1864 is removed from the Korean fauna because this record is thought to have been based on misidentification. [ABSTRACT FROM AUTHOR]

Background: Prophylactic immunization is important for human immunodeficiency virus (HIV)-infected patients; however, there are insufficient data on the burden of vaccine-preventable diseases (VPDs), vaccination rates, and factors influencing vaccination. Materials and Methods: The incidence and prevalence of VPDs in HIV-infected patients between 2006 and 2017 were estimated using the Korean HIV/acquired immune deficiency syndrome (AIDS) cohort database. In addition, we evaluated the vaccination rates and influencing factors for vaccination in HIV-infected patients through multilevel analysis of clinico-epidemiological factors, immune status, and psychological status. A questionnaire survey was conducted among experts to determine whether they recommend vaccination for HIV-infected patients. Results: The incidence rates of hepatitis B virus (HBV) infection, herpes zoster, and anogenital warts were 1.74, 7.38, and 10.85 per 1,000 person-years, respectively. The prevalence of HBV infection and anogenital warts at enrollment was 4.8% and 8.6%, respectively, which increased to 5.3% and 12.0%, respectively, by 2017. In HIV-infected patients, HBV (21.7% in 2008, 56.3% in 2013, and 75.4% in 2017) and pneumococcal vaccination rates (3.0% in 2015, 7.6% in 2016, and 9.6% in 2017) increased annually, whereas the influenza vaccination rate remained similar by season (32.7 - 35.6%). In the multilevel analysis, peak HIV viral load (≥50 copies/mL: odds ratio [OR] = 0.64, 95% confidence interval [CI]: 0.44 - 0.93; reference, <50 copies/mL) was an influencing factor for pneumococcal vaccination, while nadir CD4 T-cell counts (200 - 350 cells/mm3 : OR = 0.54, 95% CI: 0.38 - 0.76; <200 cells/mm3 : OR = 0.89, 95% CI: 0.62 - 1.28; reference, ≥350 cells/mm3 ) was an influencing factor for HBV vaccination. Influenza vaccination was associated with male sex (OR = 1.94) and the number of antiretroviral therapy (ART) regimen change (OR = 1.16), but was not significantly associated with HIV viral load or CD4 T-cell counts. Most experts responded that they administer hepatitis A virus, HBV, pneumococcal, and influenza vaccines routinely, but not human papillomavirus (12.9%) or herpes zoster vaccines (27.1%). Conclusion: The burden of vaccine-preventable diseases was quite high in HIV-infected patients. Nadir CD4 T-cell counts, peak HIV viral loads, and the number of ART regimen change are significant factors related to vaccination. Considering the low vaccination rates for VPDs, there was a discordance between experts' opinions and real clinical practice in the medical field. [ABSTRACT FROM AUTHOR]

A linear magnetic-field sensor utilizing a MgO-based spin-transfer torque magnetic tunnel junction (STT-MTJ) is demonstrated in this study. In order to obtain a linear field sensor, the behaviour of the resistance, R, versus the magnetic field, H, is controlled by the application of bipolar voltage pulses. The R(H) loops are collapsed completely and show a linear response to the applied field with a sensitivity of 4.21%/Oe in the sensing mode. This loop-collapsing method, i.e. eliminating coercivity, is an important technique in the design of STT-MTJ sensors. The bipolar pulse-driven STT-MTJ sensor was observed to have adjustable sensitivity. Furthermore, the linear response region could be intentionally shifted by applying a varying direct current voltage. This bipolar pulse-driving method for realizing a tunable field sensor is a good candidate for embedded multifunctional sensing devices. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effectiveness of pembrolizumab among patients with recurrent cervical cancer. We retrospectively reviewed the medical records of patients diagnosed with recurrent cervical cancer and treated with pembrolizumab. Fixed does of pembrolizumab 200 mg was administered intravenously every three weeks. The primary endpoint was the objective response rate. In total, 14 patients were included in this study. Median number of pembrolizumab cycles was five (range, 1-28). The objective response rate was 28.6%, with one complete response and three partial responses. The treatment was generally well tolerated. None of the patients experienced treatment discontinuation or treatment-related death due to adverse events. Pembrolizumab monotherapy showed modest antitumor activity against recurrent cervical cancer. Pembrolizumab monotherapy is an alternative treatment option for patients with recurrent cervical cancer. [ABSTRACT FROM AUTHOR]

Background Owing to antiretroviral therapy (ART), acquired immune deficiency syndrome (AIDS)-related mortality has significantly decreased. Retaining in care is an essential step for human immunodeficiency virus (HIV) care cascade. This study investigated the incidence of and risk factors for loss to follow-up (LTFU) in Korean people living with HIV (PLWH). Materials and Methods Data from the Korea HIV/AIDS cohort study (including prospective interval cohort and retrospective clinical cohort) were analyzed. LTFU was defined as not visiting the clinic for more than 1 year. Risk factors for LTFU were identified using the Cox regression hazard model. Results The study enrolled 3,172 adult HIV patients (median age, 36 years; male 92.97%). The median CD4 T cell count at enrollment was 234 cells/mm³ (interquartile range [IQR]: 85 - 373) and the median viral load at enrollment was 56,100 copies/mL (IQR: 15,000 - 203,992). The total follow-up duration was 16,487 person-years, and the overall incidence rate of LTFU was 85/1,000 person-years. In the multivariable Cox regression model, subjects on ART were less likely to have LTFU than subjects not on ART (hazard ratio [HR] = 0.253, 95% confidence interval [CI]: 0.220 - 0.291, P <0.0001). Among PLWH on ART, female sex (HR = 0.752, 95% CI: 0.582 - 0.971, P = 0.0291) and older age (>50: HR = 0.732, 95% CI: 0.602 - 0.890; 41 - 50: HR = 0.634, 95% CI: 0.530 - 0.750; 31 - 40: HR = 0.724, 95% CI: 0.618 - 0.847; ≤30: reference, P <0.0001) were associated with high rate of retention in care. The viral load at ART initiation ≥1,000,001 (HR = 1.545, 95% CI: 1.126 - 2.121, ≤10,000: reference) was associated with a higher rate of LTFU. Conclusion Young and male PLWH may have a higher rate of LTFU, and an increased rate of LTFU may induce virologic failure. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess the risk of lymphadenopathy following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. METHODS: A self-controlled case series design was used to determine whether the risk of lymphadenopathy was higher in the 1-day to 42-day risk interval after coronavirus disease 2019 (COVID-19) vaccination compared to the control period. In addition, subgroup analyses were conducted according to baseline characteristics, time since vaccination, and sensitivity analyses adjusted for the length of the risk interval. RESULTS: The risk of developing lymphadenopathy in the risk interval (1-42 days) after COVID-19 vaccination compared to the control period was significantly increased, with a relative incidence (RI) of 1.17 (95% confidence interval [CI], 1.17 to 1.18) when the first, second, and third doses were combined. The RI was greater on the day of vaccination (1.47; 95% CI, 1.44 to 1.50). In subgroup analyses by baseline characteristics, a significantly increased risk or trend toward increased risk was observed in most subgroups except for those aged 70 years and older, with a significant increase in risk in younger individuals, those with a Charlson's comorbidity index <5, and those who received mRNA vaccines (mRNA-1273>BNT162b2). Within the 1-day to 42-day post-dose risk period, the relative risk was highest during the 1-day to 7-day post-dose period (1.59; 95% CI, 1.57 to 1.60) compared to the control period, and then the risk declined. In the sensitivity analysis, we found that the longer the risk window, the smaller the RI. CONCLUSIONS: SARS-CoV-2 vaccination is associated with a statistically significant increase in the risk of lymphadenopathy, and this risk was observed only with mRNA vaccines. [ABSTRACT FROM AUTHOR]

Lumbar interbody fusion (LIF) is an excellent treatment option for a number of lumbar diseases. LIF can be performed through posterior, transforaminal, anterior, and lateral or oblique approaches. Each technique has its own pearls and pitfalls. Through LIF, segmental stabilization, neural decompression, and deformity correction can be achieved. Minimally invasive surgery has recently gained popularity and each LIF procedure can be performed using minimally invasive techniques to reduce surgery-related complications and improve early postoperative recovery. Despite advances in surgical technology, surgery-related complications after LIF, such as pseudoarthrosis, have not yet been overcome. Although autogenous iliac crest bone graft is the gold standard for spinal fusion, other bone substitutes are available to enhance fusion rate and reduce complications associated with bone harvest. This article reviews the surgical procedures and characteristics of each LIF and the osteobiologics utilized in LIF based on the available evidence. [ABSTRACT FROM AUTHOR]

Renal insufficiency is one of the common issues in people living with human immunodeficiency virus (PLHIV). We studied the incidence and risk factors for renal insufficiency in male PLHIV using the Korea HIV/acquired immunodeficiency syndrome (AIDS) Cohort Study. Among the 830 enrolled patients, 32 (3.9%) cases of renal insufficiency occurred over 9576 patient-years of follow-up. The incidence of renal insufficiency in HIV-[infected men in this study was 3.3 per 1000 patient-years. Diabetes mellitus, dyslipidemia, tenofovir or non-nucleoside reverse transcriptase inhibitor exposure for >1 year, and AIDS-defining illness were risk factors for renal insufficiency. [ABSTRACT FROM AUTHOR]

Background: We investigated cardiovascular disease (CVD), risk factors for CVD, and applicability of the three known CVD risk equations in the Korean human immunodeficiency virus/ Acquired Immune Deficiency Syndrome (HIV/AIDS) cohort. Materials and Methods: The study parcitipants were HIV-infected patients in a Korean HIV/ AIDS cohort enrolled from 19 hospitals between 2006 and 2017. Data collected at entry to the cohort were analyzed. The 5-year CVD risk in each participant was calculated using three CVD risk equations: reduced CVD prediction model of HIV-specific data collection on adverse effects of anti-HIV drugs (R-DAD), Framingham general CVD risk score (FRS), and Korean Coronary Heart Disease Risk Score (KRS). Results: CVD events were observed in 11 of 586 HIV-infected patients during a 5-year (median) follow-up period. The incidence of CVD was 4.11 per 1,000 person-years. Older age (64 vs. 41 years, P = 0.005) and diabetes mellitus (45.5% vs. 6.4%, P <0.001) were more frequent in patients with CVD. Using R-DAD, FRS, and KRS, 1.9%, 2.4%, and 0.7% of patients, respectively, were considered to have a very high risk (≥10%) of 5-year CVD. The discriminatory capacities of the three prediction models were good, with c-statistic values of 0.829 (P <0.001) for R-DAD, 0.824 (P <0.001) for FRS, and 0.850 (P = 0.001) for KRS. Conclusion: The FRS, R-DAD, and KRS performed well in the Korean HIV/AIDS cohort. A larger cohort and a longer period of follow-up may be necessary to demonstrate the risk factors and develop an independent CVD risk prediction model specific to Korean patients with HIV. [ABSTRACT FROM AUTHOR]

The thermoelectric properties of Zn-, In-, and I-doped Cu1.7Bi4.7Se8 pavonite homologues were investigated in the temperature range from 300 to 560 K. On the basis of the comprehensive structural analysis using Rietveld refinement of synchrotron radiation diffraction for Cux+yBi5-ySe8 compounds with the inherently disordered crystallographic sites, we demonstrate a doping strategy that provides a simultaneous control for enhanced electronic transport properties by the optimization of carrier concentration and exceptionally low lattice thermal conductivity by the formation of point defects. Substituted Zn or In ions on Cu site was found to be an effective phonon scattering center as well as an electron donor, while doping on Bi site showed a moderate effect for phonon scattering. In addition, we achieved largely enhanced power factor in small amount of In doping on Cu site by increased electrical conductivity and moderately decreased Seebeck coefficient. Coupled with a low lattice thermal conductivity originated from intensified point defect phonon scattering by substituted In ions with host Cu ions, a thermoelectric figure of merit ZT of 0.24 at 560 K for Cu1.6915In0.0085Bi4.7Se8 was achieved, yielding 30% enhancement compared with that of a pristine Cu1.7Bi4.7Se8 at the same temperature. [ABSTRACT FROM AUTHOR]

Study Design: This is a retrospective comparative cohort study. Purpose: To investigate the prevalence of anterior resorption of the cervical spine in ankylosing spondylitis (AS) and its relationship with sagittal alignment. Overview of Literature: This study believes that no published reports exist regarding the relationship between anterior resorption and spinopelvic alignment. Methods: This retrospective study included 238 patients with AS who underwent surgical correction for thoracolumbar kyphosis. Of these, 80 patients with complete subaxial ankylosis were selected and divided into two groups: groups 1 (consisting of 28 patients with anterior bony resorption) and 2 (consisting of 52 patients without anterior resorption). Cervical sagittal parameters were analyzed and compared between the two groups. Results: The average lateral diameter measured in patients with C5 anterior resorption was 84.2%±7.8% (62.4%-96.8%). Cervical lordosis was 8.7°±13.4° and 10.9°±11.5° in groups 1 and 2 ( p=0.556), respectively. No significant differences were noted between the two groups on spinopelvic alignment in the T1 slope (52.2°±11.1° and 53.3°±9.9° in groups 1 and 2, respectively; p=0.742), C2- C7 sagittal vertical axis (SVA; 6.2±1.7 cm and 6.2±1.8 cm in groups 1 and 2, respectively; p=0.978), C7 SVA (14.3±4.9 cm and 14.6±6.2 cm in groups 1 and 2, respectively; p=0.823), or T1 pelvic angle (27.1°±8.9° and 31.6°±11.2° in groups 1 and 2, respectively; p=0.382). Correlation analyses were significant between the extent of anterior resorption and sagittal parameters, C2--C7 lordosis ( R²=-0.428, p=0.021), and T1-T4 kyphosis ( R&#178=-0.375, p=0.045). Conclusions: Anterior bony resorption could develop by stress concentration. However, the development was not related to the sagittal alignment. The particular segments involved in developing anterior resorption varied, possibly because of their dependence on the preceding pattern of ankylosis. [ABSTRACT FROM AUTHOR]

Proximal junctional problems are among the potential complications of surgery for adult spinal deformity (ASD) and are associated with higher morbidity and increased rates of revision surgery. The diverse manifestations of proximal junctional problems range from proximal junctional kyphosis (PJK) to proximal junctional failure (PJF). Although there is no universally accepted definition for PJK, the most common is a proximal junctional angle greater than 10° that is at least 10° greater than the preoperative measurement. PJF represents a progression from PJK and is characterized by pain, gait disturbances, and neurological deficits. The risk factors for PJK can be classified according to patient-related, radiological, and surgical factors. Based on an understanding of the modifiable factors that contribute to reducing the risk of PJK, prevention strategies are critical for patients with ASD. [ABSTRACT FROM AUTHOR]

We herein report the electronic and thermal transport properties of p-type Bi0.5Sb1.5Te3 polycrystalline bulks with dense pore structure. Dense pore structure was fabricated by vaporization of residual Te during the pressureless annealing of spark plasma sintered bulks of Te coated Bi0.5Sb1.5Te3 powders. The lattice thermal conductivity was effectively reduced to the value of 0.35Wm-1 K-1 at 300K mainly due to the phonon scattering by pores, while the power factor was not significantly affected. An enhanced ZT of 1.24 at 300K was obtained in spark plasma sintered and annealed bulks of 3wt.% Te coated Bi0.5Sb1.5Te3 by these synergetic effects. [ABSTRACT FROM AUTHOR]

Objective: Although radiotherapy (RT) is recommended for multiple myeloma (MM) involving spine, the treatment of choice between reconstructive surgery with RT and RT alone for pathologic vertebral fractures (PVFs) associated with structural instability or neurologic compromises remains controversial. The purpose of this study was to evaluate the clinical efficacies of reconstructive surgery with adjuvant RT for treatment of MM with PVFs by comparing with matched cohorts treated with RT alone. Methods: Twenty-eight patients underwent reconstructive surgery followed by RT between 2008 and 2015 in a single institution, for management of PVFs associated with structural instability of the spine and/or neurologic compromises (group I). Twentyeight patients were treated with RT alone (group II) after propensity score matching in a 1-to-1 format based on instability of the spine, as well as age and performance. Clinical outcomes including the overall survival rates, duration of independent ambulation, neurological status, and numeric rating scale (NRS) for back pain were compared. Results: Clinical and radiological features before treatment were similar in both groups. The median survival period was similar between the two groups. However, the mean duration of independent ambulation was significantly longer in group I (88.8 months; 95% confidence interval [CI], 66.0-111.5) than in group II (39.4 months; 95% CI, 25.2-53.6) (log rank test; p=0.022). Deterioration of Frankel grade (21.4% vs. 60.7%, p=0.024) and NRS for back pain (2.7±2.2 vs. 5.0±2.7, p=0.000) at the last follow-up were higher in the group II. Treatment-related complications were similar in both groups. Conclusion: In patients with unstable PVFs due to MM, reconstructive surgery may yield superior clinical outcomes compared with RT alone in maintaining independent ambulation and neurological status, as well as pain control despite similar median survival and complications. [ABSTRACT FROM AUTHOR]

Study Design: This study is a retrospective analysis of a case. Purpose: The purpose of this study is to investigate the fracture patterns and risk factors of sacral insufficiency fractures (SIFs) to improve their diagnosis in clinical practice. Overview of Literature: SIFs occur when normal stresses are applied to a bone with decreased density, most often due to osteoporosis. Individuals who receive lumbosacral fusion procedures may also suffer from increased incidents of SIFs because of decreased bone density related to aging. Methods: In total, 55 patients with SIFs were retrospectively investigated in this study. The study population was divided into lumbosacral fusion (n=20) and non-fusion (n=35) groups. Subsequently, the patients' demographic characteristics, comorbidities, medication history, results of diagnostic imaging studies, and bone mineral density were assessed. The fracture patterns were classified either according to the five typical types (H-pattern bilateral vertical plus horizontal component, unilateral vertical only, bilateral vertical only, unilateral vertical plus horizontal component, and horizontal only fracture) or atypical types. Results: In total, 44 of 55 patients (80%) suffered from more than one senile disease and received corresponding medications that caused secondary osteoporosis. A total of 12 patients had S1 lumbosacral fixation. Moreover, three of these 12 patients who developed a SIF immediately after a lumbosacral fracture had an unstable sacral U fracture. The remaining nine patients showed fracture patterns similar to the non-fusion patients. Single-photon emission computed tomography (SPECT)/computed tomography (CT) can identify fracture recurrence in previously healed fractures. In total, 24 patients (43.6%) had fractures of the pelvis, femur, and thoracolumbar spine. Conclusions: SIF develops in elderly patients with multiple adult diseases that can induce secondary osteoporosis. Such fractures may occur in the patients with instrumented lumbosacral fusion. Importantly, some patients showed stress fractures after multilevel instrumented lumbosacral fusion, whereas others showed insufficiency fractures. The different fracture patterns correspond to different grades of SIF, and SPECT/CT can easily identify the fracture status. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective study.Objective: The aim of this study was to investigate proximal junctional kyphosis (PJK) after lumbosacral long fusion according to preoperative Roussouly and lumbar degenerative kyphosis (LDK) types.Summary Of Background Data: Although previous studies have suggested some risk factors for PJK, the effects of preoperative grade of sagittal imbalance and paraspinal muscles degeneration on PJK remain unclear.Methods: Eighty-seven patients who had undergone lumbosacral fusion more than five levels with available clinical and radiological data were enrolled. The presence of PJK defined as sagittal Cobb angle ≥20° between the uppermost instrumented vertebra (UIV) and two supra-adjacent vertebrae at postoperative 2-year radiographs was recorded. Its occurrence was compared according to preoperative Roussouly and LDK types (Takemistu type) and the degree of paraspinal muscle degeneration at the upper level of UIV. Other sagittal radiographic parameters were also measured.Results: In this series, 28 patients (group I, 32.2%) showed radiological PJK, whereas 59 patients did not show radiological PJK (non-PJK patients, group II, 67.8%) at postoperative 2 years. PJK presented more prevalence in type III and type IV of LDK types (26/27, 96.3%). However, Roussouly types did not show any significant difference in PJK prevalence. In radiological parameters, a larger preoperative SVA (P = 0.018) and PI-LL (P = 0.015) were associated with PJK. Also, smaller quantity and lower quality of paraspinal muscles at T12-L1 level showed significant (P < 0.001) relationship with PJK. On multivariate logistic regression, higher LDK type (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.24-3.56), smaller quantity (OR: 1.03, 95% CI: 1.00-1.07), and higher degree of paraspinal muscle degeneration (OR: 1.46, 95% CI: 0.92-2.31) were independent predictors of postoperative PJK.Conclusion: Although various factors are related to PJK following long segment fusion, preoperative conditions such as LDK types and degree of paraspinal muscle degeneration might be related to the development of PJK.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

OBJECTIVES: As HIV/AIDS is becoming a chronic disease, the risk of developing cardiovascular disease (CVD) among people living with HIV/AIDS is rising. Anxiety and depression, which are common among people living with HIV/AIDS, have been linked with CVD. This study investigated the risk of CVD in people living with HIV/AIDS and explored the effects of depression and anxiety on CVD risk. METHODS: Data were collected for 457 people enrolled in the Korea Cohort HIV/AIDS study after 2010. Framingham risk scores were calculated to quantify the 10-year risk of developing CVD. Depression and anxiety variables were re-coded as a single combined variable. Multivariable logistic regression analysis was performed, adjusting for age, body mass index, low-density lipoprotein (LDL) cholesterol, triglycerides (TG), duration of human immunodeficiency virus (HIV) positivity after entry into the cohort, and depression/anxiety. RESULTS: Participants with both depression and anxiety were 2.28 times more likely than those with neither depression nor anxiety to have moderate/high-risk CVD risk. The 10-year risk of developing CVD was affected by LDL cholesterol, TG, age, and duration of HIV infection. LDL cholesterol and TG levels change according to the duration of HIV infection, and metabolic disorders affect the risk of CVD. Thus, a longer duration of HIV infection is associated with a higher risk of developing CVD. CONCLUSIONS: Screenings for depression and anxiety need to be provided regularly to assess the severity of those symptoms. To help decrease their risk of developing CVD, people living with HIV/AIDS should be offered behavioral modification interventions aimed at developing healthy lifestyle habits. [ABSTRACT FROM AUTHOR]

Lumbar interbody fusion (LIF) is an effective and popular surgical procedure for the management of various spinal pathologies, especially degenerative diseases. Currently, LIF can be performed with posterior, transforaminal, anterior, and lateral approaches by open surgery or minimally invasive surgery (MIS). Each technique has its own advantages and disadvantages. In general, posterior LIF is a well-established procedure with good fusion rates and low complication rates but is limited by the possibility of iatrogenic injury to the neural structures and paraspinal muscles. Transforaminal LIF is frequently performed using an MIS technique and has an advantage of reducing these iatrogenic injuries. Anterior LIF (ALIF) can restore the disk height and sagittal alignment but has inherent approach-related challenges such as visceral and vascular complications. Lateral LIF and oblique LIF are performed using an MIS technique and have shown postoperative outcomes similar to ALIF; however, these approaches carry a risk of injury to psoas, lumbar plexus, and vascular structures. Herein, we provide a detailed description of the surgical procedures of each LIF technique. We shall then consider the pearls and pitfalls, as well as propose surgical indications and contraindications based on the available evidence in the literatures. [ABSTRACT FROM AUTHOR]

Case: A 73-year-old man with instrumented fusion of L3-4-5 underwent the removal of previous pedicle screws and posterior instrumented fusion of L1-2-3. The solid dorsal fusion mass of L3-5 was identified intraoperatively and preoperatively. At 3 years after the second surgery, he presented with abrupt radiating pain in the left leg. Plain radiographs showed a collapse of the intervertebral disc space, and magnetic resonance imaging showed disc herniation of L3-4. Conclusions: Disc herniation even insolid fused segments may occur. Removal of pedicle screws and cranial extension of interbody fusion may increase the intradiscal stress associated with physiologic cantilever motion of the disc. [ABSTRACT FROM AUTHOR]

Objective: The efficacy of preoperative embolization for hypervascular metastatic spine disease (MSD) such as renal cell and thyroid cancers has been reported. However, the debate on the efficacy of preoperative embolization for non-hypervascular MSD still remains unsettled. The purpose of this study is to determine whether preoperative embolization for non-hypervascular MSD decreases perioperative blood loss. Methods: A total of 79 patients (36 cases of preoperative embolization and 43 cases of non-embolization) who underwent surgery for metastatic spine lesions were included. Representative hypervascular tumors such as renal cell and thyroid cancers were excluded. Intraoperative and perioperative estimated blood losses (EBL), total number of transfusion and calibrated EBL were recorded in the embolization and non-embolization groups. The differences in EBL were also compared along with the type of surgery. In addition, the incidence of Adamkiewicz artery and complications of embolization were assessed. Results: The average age of 50 males and 29 females was 57.6±13.5 years. Lung (30), hepatocellular (14), gastrointestinal (nine) and others (26) were the primary cancers. The demographic data was not significantly different between the embolization and the non-embolization groups. There were no significant differences in intraoperative EBL, perioperative EBL, total transfusion and calibrated EBL between two groups. However, intraoperative EBL and total transfusion in patients with preoperative embolization were significantly lower than in non-embolization in the corpectomy group (1645.5 vs. 892.6 mL, p=0.017 for intraoperative EBL and 6.1 vs. 3.9, p=0.018 for number of transfusion). In addition, the presence of Adamkiewicz artery at the index level was noted in two patients. Disruption of this major feeder artery resulted in significant changes in intraoperative neuromonitoring. Conclusion: Preoperative embolization for non-hypervascular MSD did not reduce perioperative blood loss. However, the embolization significantly reduced intraoperative bleeding and total transfusion in corpectomy group. Moreover, the procedure provided insights into the anatomy of tumor and spinal cord vasculature. [ABSTRACT FROM AUTHOR]

Metal chalcogenide materials, including indium selenide (InSe), have attracted attention as potential thermoelectric materials due to their intrinsically low thermal conductivity, which is due to their layered structure with weak atomic bonding. However, their low electrical conductivity should be increased for application as thermoelectric materials. In this study, we examined the electrical and thermal transport properties of 7% S- or Te-doped InSe polycrystalline alloys (InSe0.93S0.07 and InSe0.93Te0.07). These anion substitutions increased the electrical conductivity of InSe, while the enhancement was larger for the Te-doped InSe with a smaller bandgap. The negative Seebeck coefficient did not change significantly upon doping, resulting in enhancement of the power factor. Doping caused a relatively large reduction of thermal conductivity due to additional point defect phonon scattering. Consequently, the thermoelectric figure of merit (zT) increased by 62% and 230% to a maximum of 0.13 and 0.28 at 735 K for InSe0.93S0.07 and InSe0.93Te0.07, respectively, which offers the possibility of InSe-based thermoelectric materials. Cation doping could increase the zT of S/Te-doped InSe further. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective cohort study.Objective: To evaluate the clinical and radiological efficacies of supplementing minimally invasive lateral lumbar interbody fusion (LLIF) with open posterior spinal fusion (PSF) in adult spinal deformity (ASD).Summary Of Background Data: Minimally invasive techniques have been increasingly applied for surgery of ASD. Few reports have been published that directly compare LLIF combined with PSF to conventional PSF for ASD.Methods: To evaluate the advantages of minimally invasive LLIF for ASD, patients who underwent minimally invasive LLIF followed by open PSF (combined group) were compared with patients who only underwent PSF (only PSF group). The clinical and radiological outcomes for deformity correction and indirect decompression were assessed. The occurrence of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) were also evaluated.Results: No significant differences were observed in the clinical outcomes of the Oswestry Disability Index (ODI), visual analog scale, and major complications including reoperations between the groups. No additional advantage was found for coronal deformity correction, but the restoration of lumbar lordosis in the combined group was significantly higher postoperatively (15.3° vs. 8.87°, P = 0.003) and last follow-up (6.69° vs. 1.02°, P = 0.029) compared to that of the only PSF group. In the subgroup analysis for indirect decompression for the combined group, a significant increase of canal area (104 vs. 122 mm) and foraminal height (16.2 vs. 18.5 mm) was noted. The occurrence of PJK or PJF was significantly higher in the combined group than in the only PSF group (P = 0.039).Conclusion: LLIF has advantages of indirect decompression and greater improvements of sagittal correction compared to only posterior surgery. LLIF should be conducted considering the above-mentioned benefits and complications including PJK or PJF in ASD.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Study Design: Animal experimental study OBJECTIVES.: The purpose of this study is to investigate the effects of extracorporeal shock waves (ESWs) on endogenous neural stem cells (NSCs) proliferation after spinal cord injury (SCI).Summary Of Background Data: Exogenous stem cell transplantation for SCI still has many limitations to be addressed such as ideal cell sources, timing of transplantation, and fate of the transplanted cells. Moreover, the efficacy is another issue owing to a peculiar pathologic condition in the chronic phase of SCI.Methods: Contusive SCI was made using 24 Sprague-Dawley rats, and ESWs were applied at post-injury 4 weeks in rats. Proliferation and differentiation of endogenous NSCs (DCX, Sox-2) and axonal sprouting (GAP-43 and MAP-2) were observed at 6 weeks after application of ESWs. Differentiation of the activated neural stem cells was also investigated by coexpression of neuronal/glial cell markers (GFAP, Neu N, and CC-1). Immunofluorescence staining and western blotting were performed for quantitative analysis, and these results were compared with those in the control group. For clinical assessment, the BBB locomotor rating scale was performed.Results: More proliferation of endogenous neural stem cells was noted in the experimental groups, and these activated cells were mainly founded in the ependymal layer of the central canal and the injured posterior horn. Differentiation into neuronal and glial cells was also noted in a limited number of cells. With respect to axonal regeneration, GAP-43 and MAP-2 expressions in the experimental groups were also significantly higher than those in the control group. During 6 weeks' clinical observation following ESWs application, functional improvement of the hindlimb was observed without clinical deterioration by trials.Conclusion: Collectively, these findings indicate that ESWs on the chronic phase of SCI induce activation of endogenous NSCs and consequent functional improvement.Level Of Evidence: N/A. [ABSTRACT FROM AUTHOR]

We aimed to determine the initial adherence of HIV cohort patients to ART (antiretroviral therapy), and reasons for non-adherence. Patients who received ART at the time of enrollment in the Korea HIV/AIDS Cohort were included in this study. Treatment adherence was determined at the baseline interview by self-reported questionnaire. Eight-hundred thirty two HIV-infected patients received ART. Of these, 253 (30.4%) patients skipped ART more than once a month. The most common reason of skipping medication was “simply forgot” (60.4%). [ABSTRACT FROM AUTHOR]

Cation substitutional doping is an effective approach to modifying the electronic and thermal transports in Bi2Te3-based thermoelectric alloys. Here we present a comprehensive analysis of the electrical and thermal conductivities of polycrystalline Pb-doped p-type bulk Bi0.48Sb1.52Te3. Pb doping significantly increased the electrical conductivity up to ~2700 S/cm at x = 0.02 in Bi0.48-xPbxSb1.52Te3 due to the increase in hole carrier concentration. Even though the total thermal conductivity increased as Pb was added, due to the increased hole carrier concentration, the thermal conductivity was reduced by 14-22% if the contribution of the increased hole carrier concentration was excluded. To further understand the origin of reduction in the thermal conductivity, we first estimated the contribution of bipolar conduction to thermal conductivity from a two-parabolic band model, which is an extension of the single parabolic band model. Thereafter, the contribution of additional point defect scattering caused by Pb substitution (Pb in the cation site) was analyzed using the Debye-Callaway model. We found that Pb doping significantly suppressed both the bipolar thermal conduction and lattice thermal conductivity simultaneously, while the bipolar contribution to the total thermal conductivity reduction increased at high temperatures. At Pb doping of x = 0.02, the bipolar thermal conductivity decreased by ~30% from 0.47 W/mK to 0.33 W/mK at 480 K, which accounts for 70% of the total reduction. [ABSTRACT FROM AUTHOR]

A simple, rapid, and reliable UPLC-MS/MS method was developed and validated for the determination of tadalafil in human plasma. The plasma samples were deproteinized with acetonitrile. Chromatographic separation was performed on a Shiseido C18 (100 X 2.1 mm, 2.7 µm) column with isocratic elution using 2.0 μM ammonium acetate and acetonitrile (55:45, v/v) with 0.1% formic acid at a flow rate of 0.7 mL/min. The total run time was 1 min per sample. The quantitative analysis was performed using multiple reaction monitoring at transition of m/z 390.4 ￫ 268.3 for tadalafil and m/z 475.3 → 283.3 for sildenafil as an internal standard. The method was fully validated over a concentration range of 5-1,000 ng/mL with a lower quantification limit of 5 ng/mL. Intra- and inter-day precision (relative standard deviation, %RSD) were within 8.4% and accuracy (relative error, %RE) was lower than -3.2%. The developed and validated method was successfully applied to a pharmacokinetic study of tadalafil (20 mg) in Korean healthy male subjects (n = 12). [ABSTRACT FROM AUTHOR]

Background: Skin cancer is the most common type of cancer. Of the 4 million skin lesions excised annually worldwide, approximately 2 million are considered cancerous. In this study, we aimed to describe a regional experience with skin cancers treated by a single senior surgeon and to provide a treatment algorithm. Methods: The medical records of 176 patients with head and neck non-melanocytic skin cancer (NMSC) who were treated by a single surgeon at our institution between January 2010 and May 2016 were retrospectively reviewed, and their data (age, sex, pathological type, tumor location/size, treatment modality) were analyzed. Patients with cutaneous squamous cell carcinoma (cSCC) who were classified as a high-risk group for nodal metastasis underwent sentinel node mapping according to the National Comprehensive Cancer Network guidelines. Results: Among the patients with NMSC who were treated during this period, basal cell carcinoma (BCC; n=102, 57.9%) was the most common pathological type, followed by cSCC (n=66, 37.5%). Most lesions were treated by complete excision, with tumor-free surgical margins determined via frozen section pathology. Thirty-one patients with high-metastasisrisk cSCC underwent sentinel node mapping, and 17 (54.8%) exhibited radiologically positive sentinel nodes. Although these nodes were pathologically negative for metastasis, 2 patients (6.5%) later developed lymph node metastases. Conclusion: In our experience, BCC treatment should comprise wide excision with tumorfree surgical margins and proper reconstruction. In contrast, patients with cSCC should undergo lymphoscintigraphy, as nodal metastases are a possibility. Proper diagnosis and treatment could reduce the undesirably high morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

Background: The purported value of empirical therapy to cover methicillin-resistant Staphylococcus aureus (MRSA) has been debated for decades. The purpose of this study was to evaluate the effects of inappropriate empirical antibiotic therapy on clinical outcomes in patients with healthcare-associated MRSA bacteremia (HA-MRSAB).Methods: A prospective, multicenter, observational study was conducted in 15 teaching hospitals in the Republic of Korea from February 2010 to July 2011. The study subjects included adult patients with HA-MRSAB. Covariate adjustment using the propensity score was performed to control for bias in treatment assignment. The predictors of in-hospital mortality were determined by multivariate logistic regression analyses.Results: In total, 345 patients with HA-MRSAB were analyzed. The overall in-hospital mortality rate was 33.0 %. Appropriate empirical antibiotic therapy was given to 154 (44.6 %) patients. The vancomycin minimum inhibitory concentrations of the MRSA isolates ranged from 0.5 to 2 mg/L by E-test. There was no significant difference in mortality between propensity-matched patient pairs receiving inappropriate or appropriate empirical antibiotics (odds ratio [OR] = 1.20; 95 % confidence interval [CI] = 0.71-2.03). Among patients with severe sepsis or septic shock, there was no significant difference in mortality between the treatment groups. In multivariate analyses, severe sepsis or septic shock (OR = 5.45; 95 % CI = 2.14-13.87), Charlson's comorbidity index (per 1-point increment; OR = 1.52; 95 % CI = 1.27-1.83), and prior receipt of glycopeptides (OR = 3.24; 95 % CI = 1.08-9.67) were independent risk factors for mortality.Conclusion: Inappropriate empirical antibiotic therapy was not associated with clinical outcome in patients with HA-MRSAB. Prudent use of empirical glycopeptide therapy should be justified even in hospitals with high MRSA prevalence. [ABSTRACT FROM AUTHOR]

Spin–torque nano–oscillators (STNOs) have outstanding advantages of a high degree of compactness, high–frequency tunability, and good compatibility with the standard complementary metal–oxide– semiconductor process, which offer prospects for future wireless communication. There have as yet been no reports on wireless communication using STNOs, since the STNOs also have notable disadvantages such as lower output power and poorer spectral purity in comparison with those of LC voltage–controlled oscillators. Here we show that wireless communication is achieved by a proper choice of modulation scheme despite these drawbacks of STNOs. By adopting direct binary amplitude shift keying modulation and non–coherent demodulation, we demonstrate STNO–based wireless communication with 200–kbps data rate at a distance of 1 m between transmitter and receiver. It is shown, from the analysis of STNO noise, that the maximum data rate can be extended up to 1.48 Gbps with 1–ns turn–on time. For the fabricated STNO, the maximum data rate is 5 Mbps which is limited by the rise time measured in the total system. The result will provide a viable route to real microwave application of STNOs. [ABSTRACT FROM AUTHOR]

Purpose To date, the risk factors for central venous port-related bloodstream infection (CVPBSI) in solid cancer patients have not been fully elucidated. We conducted this study in order to determine the risk factors for CVP-BSI in patients with solid cancer. Materials and Methods A total of 1,642 patients with solid cancer received an implantable central venous port for delivery of chemotherapy between October 2008 and December 2011 in a single center. CVP-BSI was diagnosed in 66 patients (4%). We selected a control group of 130 patients, who were individually matched with respect to age, sex, and catheter insertion time. Results CVP-BSI occurred most frequently between September and November (37.9%). The most common pathogen was gram-positive cocci (n=35, 53.0%), followed by fungus (n=14, 21.2%). Multivariate analysis identified monthly catheter-stay as a risk factor for CVP-BSI (p=0.000), however, its risk was lower in primary gastrointestinal cancer than in other cancer (p=0.002). Initial metastatic disease and long catheter-stay were statistically significant factors affecting catheter life span (p=0.005 and p=0.000). Results of multivariate analysis showed that recent transfusion was a risk factor for mortality in patients with CVP-BSI (p=0.047). Conclusion In analysis of the results with respect to risk factors, prolonged catheter-stay should be avoided as much as possible. It is necessary to be cautious of CVP-BSI in metastatic solid cancer, especially non-gastrointestinal cancer. In addition, avoidance of unnecessary transfusion is essential in order to reduce the mortality of CVP-BSI. Finally, considering the fact that confounding factors may have affected the results, conduct of a well-designed prospective controlled study is warranted. [ABSTRACT FROM AUTHOR]

Recently, serotype K1 Klebsiella pneumoniae has been a major agent of an invasive syndrome characterized by liver abscess and its metastatic infection. Extrahepatic infection and its characteristics in patients with renal abscess caused by K. pneumoniae are poorly understood, and few cases of central nervous system infection have been reported. This is a report of 80-year-old wom an with uncontrolled type 2 diabetes mellitus with renal abscess caused by serotype K1 K. pneumoniae, complicated with ventriculitis despite of appropriate use of antibiotics. Physicians need to be aware of possibility f metastatic infection in patients with serotype K1 K. pneumoniae infection, if they develop neurologic symptom and focus of infection is still present. [ABSTRACT FROM AUTHOR]

Background Whether the combination of antimicrobial therapy is a factor in mortality in Pseudomonas aeruginosa bacteremia remains to be elucidated. This study investigated the risk factors for mortality in P. aeruginosa bacteremia patients and the influence of adequate antimicrobial therapy and combination therapy on clinical outcomes. Methods This retrospective study analyzed data of 234 patients with P. aeruginosa bacteremia at a 1,200-bed tertiary teaching university hospital in South Korea between January 2010 and December 2012. Factors associated with mortality were determined. Mortality was compared in patients with adequate empirical and targeted combination therapy, and monotherapy, and inappropriate therapy. Results A total of 141 (60.3%) patients were given appropriate empirical antibiotic treatment (combination therapy in 38 and monotherapy in 103). Among 183 patients (78.2%) who finally received appropriate targeted treatment, 42 had combination therapy and 141 had monotherapy. The percentage of patients receiving empirical combination therapy was slightly, but not significantly higher, in the survivor group than in the nonsurvivor group (17.0% [31/182] vs. 13.5% [7/52], p = 0.74). A similar tendency was demonstrated for targeted combination therapy (19.8% [36/182] vs. 11.5% [6/52], respectively; p = 0.31). However, in a subgroup analysis of data from patients (n = 54) with an absolute neutrophil count less than 500/mm³, the patients who had appropriate empirical or targeted combination therapy showed better outcomes than those who underwent monotherapy or inappropriate therapy (p < 0.05). Mechanical ventilation (odds ratio [OR], 6.93; 95% confidence interval [CI], 2.64-18.11; p = 0.0001), the use of a central venous catheter (OR, 2.95; 95% CI, 1.35- 6.43; p = 0.007), a high Acute Physiology and Chronic Health Evaluation II score (OR, 4.65; 95% CI, 1.95-11.04; p = 0.0001), and presence of septic shock (OR, 2.91; 95% CI, 1.33- 6.38; p = 0.007) were independent risk factors for 14-day mortality. Conclusions Disease severity was a critical factor for mortality in our patients with P. aeruginosa bacteremia. Overall, combination therapy had no significant effect on 14-day mortality compared with monotherapy. However, appropriate combination therapy showed a favorable effect on survival in patients with febrile neutropenia. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study that evaluated the effects of red blood cell transfusions in patients suffering from sepsis and septic shock on mortality. The study showed that patients who underwent transfusions have higher 28-day and in-hospital mortality rates as well as longer hospital stay. It concludes that red blood cell transfusions on patients with community-acquired severe sepsis and septic shock were associated with lower risk of mortality.

The article discusses a study regarding hospital-acquired infections in several hospitals in South Korea. It mentions that the hospital-acquired infections are a countrywide problem even in the most developed countries such as South Korea, Great Britain and the U.S. while pneumonia and septicemia remains the most common causes of death. Several charts drawing the data gathered from the study is also presented.

Thermoelectric energy harvesting—the transformation of waste heat into useful electricity—is of great interest for energy sustainability. The main obstacle is the low thermoelectric efficiency of materials for converting heat to electricity, quantified by the thermoelectric figure of merit, ZT. The best available n-type materials for use in mid-temperature (500–900 K) thermoelectric generators have a relatively low ZT of 1 or less, and so there is much interest in finding avenues for increasing this figure of merit. Here we report a binary crystalline n-type material, In4Se3-δ, which achieves the ZT value of 1.48 at 705 K—very high for a bulk material. Using high-resolution transmission electron microscopy, electron diffraction, and first-principles calculations, we demonstrate that this material supports a charge density wave instability which is responsible for the large anisotropy observed in the electric and thermal transport. The high ZT value is the result of the high Seebeck coefficient and the low thermal conductivity in the plane of the charge density wave. Our results suggest a new direction in the search for high-performance thermoelectric materials, exploiting intrinsic nanostructural bulk properties induced by charge density waves. [ABSTRACT FROM AUTHOR]

The prevalence of aac(6′)-Ib-crand its associated genes and mobile elements was investigated in Serratia marcescenscollected from 12 hospitals in Korea in 2005 and 2006. A total of 215 isolates (from 166 and 149 isolates collected in 2005 and 2006, respectively) were included in the study. Aac(6′)-Ib-crwas detected in only two isolates collected in 2005 and in 12 isolates collected from three hospitals in 2006. All 12 isolates carried class 1 integron and coharbored blaCTX-Mand armA. BlaOXA-1and ISCR1were detected in 10 and 8 isolates, respectively. All 12 isolates carried IncL/M type plasmid and 6 of them also carried IncA/C type plasmid. Conjugal transfer was successful for 9 of 12 aac(6′)-Ib-cr, all 12 blaCTX-M, 8 of 12 armA, and 6 of 10 blaOXA-1. Of the 12 transconjugants, IncL/M type plasmid, IntI1,ISEcp1, and ISCR1were detected in 12, 9, 12, and 8, respectively. The transferability of aac(6′)-Ib-cr, armA,and blaOXA-1was 100% for isolates harboring ISCR1, against 25%, 0%, and 0%, respectively, for isolates not harboring ISCR1. Both clonal and horizontal transfer were demonstrated by pulsed-field gel electrophoresis and plasmid profile analysis, respectively. Stringent infection control practices and further investigation of association between mobile elements and resistance genes are warranted. [ABSTRACT FROM AUTHOR]

We demonstrate the stability-enhanced novel flexible liquid crystal display (LCD) mode by using the micro-structure of rigid columnar spacer array and a micro-contact printing (µCP) assembling method. Specially designed multi-column structure induces self-collected structure of adhesion material which resulted in the good adhesion properties of device to an external deformation as well as enhanced mechanical stability of electro-optic characteristics for flexible display application. Moreover, suggested method can easily inherit most advantages of conventional LCD technology such as low driving scheme, established process and LC mode selection freedom within a simple fabrication procedure. This novel technique can be highly applicable for realizing practical flexible display with enhanced mechanical stability and high performance. [ABSTRACT FROM AUTHOR]

We propose a bistable liquid crystal mode based on switching of the twist direction in a conventional π/2-twisted nematic cell. Switching between the -π/2 and +π/2 twist states can be performed by applying vertical and/or in-plane electric fields. The proposed bistable mode has an infinite memory time because the two stable twist states have the same elastic free energy. [ABSTRACT FROM AUTHOR]

We report the high thermoelectric figure-of-merit (ZT) on the Se-deficient polycrystalline compounds of In4Se3-x (0.02≤x≤0.5) and the anisotropic electronic band structure. The Se-deficiency (x) has the effect of decreasing the semiconducting band gap and increasing the power factor. The band structure calculation for In4Se3-x (x=0.25) exhibits localized hole bands at the Γ-point and Y-S symmetry line, whereas the significant electronic band dispersion is observed along the c-axis. Here, we propose that the high ZT values on those compounds are originated from the anisotropic electronic band structure as well as Peierls distortion. [ABSTRACT FROM AUTHOR]