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Background: Telmisartan is considered more potent than valsartan. Hemodynamic response during anesthesia induction may be influenced by anti-hypertension (HTN) medication. The present study compared the effect of anti-HTN medications on post-induction hypotension during noncardiac surgeries. Methods: This observational study standardized the anesthetic regimen across patients, with hypotension defined as mean blood pressure (BP) of less than 65 mmHg. The hemodynamic changes within 5 min before and after endotracheal intubation, and within 10 min before and after surgical incision were measured. Transthoracic echocardiographic evaluation of the left ventricle (LV) during anesthesia induction was performed. The primary endpoint was the decline in mean BP after anesthetic administration in telmisartan and valsartan groups. Multivariate logistic regression analysis was used to identify predictors of post-induction hypotension. Results: Data from 157 patients undergoing noncardiac surgery were analyzed. No significant differences were found in mean BP decline between the two groups during anesthesia induction. Hemodynamic changes and LV ejection fraction (EF) during anesthesia induction were similar between the groups. Age and preoperative initial mean BP in operation room (OR) were associated with post-induction hypotension in both groups. Conclusions: The angiotensin receptor blocker (ARB) type did not influence post-induction hypotension during anesthesia induction. Age and preoperative initial mean BP in OR were associated with post-induction hypotension in patients taking ARBs. [ABSTRACT FROM AUTHOR]

Background/Aims: Risk scoring systems for upper gastrointestinal (UGI) bleeding have not been well validated for tumor bleeding. This study aimed to identify risk factors for mortality in patients with UGI cancer bleeding and to develop a predictive model. Methods: Consecutive patients with UGI cancers who underwent esophagogastroduodenoscopy for suspected bleeding were retrospectively included. Patient characteristics, endoscopic findings and 30-day mortality were assessed. A predictive model was made based on risk factors for mortality using logistic regression, and the area under the curve (AUC) of this model was calculated. It was then compared with other risk scoring systems. Results: In a total of 264 patients, 193 had tumor bleeding. Among them, 108 (56.0%), 76 (39.4%), and nine (4.7%) patients received conservative treatment, endoscopic therapy, and non-endoscopic hemostasis, respectively. Rebleeding occurred in 23 (21.3%), 26 (34.2%), and one (11.1%) patient(s), respectively. Our new model is composed of altered mental status, renal failure, rebleeding, age older than 65 years, and low serum albumin (all p<0.05). This model predicted 30-day mortality with an AUC of 0.79 (95% confidence interval, 0.72 to 0.86), which was significantly higher than AUCs of the Glasgow-Blatchford score, Rockall, and AIMS65 score (AUC=0.61, 0.64, and 0.69, respectively, all p<0.05). Conclusions: Our new scoring system provides a better prediction of 30-day mortality than existing scoring systems in patients with UGI cancer bleeding. This new scoring system can be used to predict and prepare these patients who are known to have high mortality. [ABSTRACT FROM AUTHOR]

We conducted systematic review and meta-analysis to evaluate effects of neoadjuvant chemotherapy on survival and histopathological outcomes of variant histology of urothelial carcinoma of bladder. The present study found that bladder cancer patients with variant histology administration of neoadjuvant chemotherapy before surgery had better survival outcomes and higher pathologic down staging rate than those without administration of neoadjuvant chemotherapy before surgery. Purpose: To conduct systematic review and meta-analysis to evaluate effects of neoadjuvant chemotherapy (NAC) on survival and histopathological outcomes of variant histology (VH) of urothelial carcinoma (UC) of bladder. Methods: This systematic review was registered in PROSPERO (CRD42023389115). Literature search was conducted in PubMed/Medline, Embase, and Cochrane Library for studies published up to January 2023. Population, intervention, comparator, outcome, and study design were as follows: bladder cancer patients with VH (population), neoadjuvant chemotherapy (intervention), radical cystectomy only (comparators), oncological survival and pathologic response (outcomes), and retrospective or prospective (study design). Results: Finally, a total of 17 studies were included in the present study (quantitative analysis, n = 17; qualitative analysis, n = 12). Pooled HR was 0.49 (95% CI: 0.31-0.76; P = .002) for OS. Pooled HR was 0.61 (95% CI: 0.38-0.98; P = .04) for CSS. Pooled HR was 0.44 (95% CI: 0.21-0.93; P = .03) in PFS. Pooled OR was 6.61 (95% CI: 4.50-9.73; P < .00001) in complete pathologic response. Pooled OR was 9.59 (95% CI: 3.56-25.85; P < .00001) in any pathologic response. Evidence quality assessments for each 5 comparisons using the GRADE approach were that Certainty was moderate in 1, low in 1, and very low in 3. Conclusions: Administration of NAC before surgery in bladder cancer patients with VH might confer better survival outcomes and higher pathologic down staging rate than no administration of NAC before surgery. [ABSTRACT FROM AUTHOR]

Background/Aims: Administrative databases provide valuable information for large-cohort studies. This study aimed to evaluate the diagnostic accuracy of an administrative database for resected gastric adenomas. Methods: Data of patients who underwent endoscopic resection for benign gastric lesions were collected from three hospitals. Gastric adenoma cases were identified in the hospital database using International Classification of Diseases (ICD) 10-codes. The non-adenoma group included patients without gastric adenoma codes. The diagnostic accuracy for gastric adenoma was analyzed based on the pathological reports of the resected specimen. Results: Among 5,095 endoscopic resections with codes for benign gastric lesions, 3,909 patients were included in the analysis. Among them, 2,831 and 1,078 patients were allocated to the adenoma and non-adenoma groups, respectively. Regarding the overall diagnosis of gastric adenoma with ICD-10 codes, the sensitivity, specificity, positive predictive value, and negative predictive value were 98.7%, 88.5%, 95.2%, and 96.8%, respectively. There were no significant differences in these parameters between the tertiary and secondary centers. Conclusions: Administrative codes of gastric adenoma, according to ICD-10 codes, showed good accuracy and can serve as a useful tool to study prognosis of these patients in real-world data studies in the future. [ABSTRACT FROM AUTHOR]

The neocortex, the center for higher brain function, first emerged in mammals and has become massively expanded and folded in humans, constituting almost half the volume of the human brain. Primary microcephaly, a developmental disorder in which the brain is smaller than normal at birth, results mainly from there being fewer neurons in the neocortex because of defects in neural progenitor cells (NPCs). Outer radial glia (oRGs), NPCs that are abundant in gyrencephalic species but rare in lissencephalic species, are thought to play key roles in the expansion and folding of the neocortex. However, how oRGs expand, whether they are necessary for neocortical folding, and whether defects in oRGs cause microcephaly remain important questions in the study of brain development, evolution, and disease. Here, we show that oRG expansion in mice, ferrets, and human cerebral organoids requires cyclin-dependent kinase 6 (CDK6), the mutation of which causes primary microcephaly via an unknown mechanism. In a mouse model in which increased Hedgehog signaling expands oRGs and intermediate progenitor cells and induces neocortical folding, CDK6 loss selectively decreased oRGs and abolished neocortical folding. Remarkably, this function of CDK6 in oRG expansion did not require its kinase activity, was not shared by the highly similar CDK4 and CDK2, and was disrupted by the mutation causing microcephaly. Therefore, our results indicate that CDK6 is conserved to promote oRG expansion, that oRGs are necessary for neocortical folding, and that defects in oRG expansion may cause primary microcephaly. [ABSTRACT FROM AUTHOR]

In this study, an optimal curing method was established for very-early-strength latex-modified concrete (VES-LMC), which is frequently used in partial-depth repair (PDR) of deteriorated concrete pavements. The appropriate starting time of curing, when the surface of the VES-LMC was not damaged, was found for various curing conditions such as ambient air, polyethylene (PE) sheet, blanket, curing membrane, PE sheet on curing membrane, and blanket on curing membrane. The hydration characteristics of the VES-LMC and ordinary portland cement concrete (OPCC) were then compared by evaluating their respective properties such as water loss, bleeding, autogenous shrinkage, and compressive strength. In addition, the optimal curing method was investigated by determining the water loss, water absorption, drying shrinkage, and compressive strength of the VES-LMC specimens cured under the aforementioned conditions. The test results revealed that VES-LMC performed better than OPCC as a PDR material. In addition, covering the VES-LMC with a PE sheet 3 minutes after placement was observed to be the most effective curing method in PDR. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical factors associated with successful gastrostomy tube weaning in patients with prolonged dysphagia after stroke. Methods This study involved a retrospective medical chart review of patients diagnosed with prolonged dysphagia after stroke who underwent gastrostomy tube insertion between May 2013 and January 2020. Forty-seven patients were enrolled and consequently divided into gastrostomy tube sustaining and weaning groups. The numbers of patients in the sustaining and weaning groups were 31 and 16, respectively. The patients' demographic data, Korean version of Mini-Mental State Examination (K-MMSE) score, Korean version of the Modified Barthel Index (K-MBI), Functional Dysphagia Scale (FDS) score, and Penetration-Aspiration Scale (PAS) score were compared between the two groups. A videofluoroscopic swallowing study was performed before making the decision of gastrostomy tube weaning. The clinical factors associated with gastrostomy tube weaning were then investigated. Results There were significant differences in age; history of aspiration pneumonia; K-MMSE, FDS, and PAS scores; and K-MBI between the groups. In the multiple logistic regression analysis, the FDS (odds ratio [OR]=0.791; 95% confidence interval [CI], 0.634--0.987) and PAS scores (OR=0.205; 95% CI, 0.059--0.718) were associated with successful gastrostomy tube weaning. In the receiver operating characteristic curve analysis, the FDS and PAS were useful screening tools for successful weaning, with areas under the curve of 0.911 and 0.918, respectively. Conclusion In patients with prolonged dysphagia, the FDS and PAS scores are the only factors associated with successful gastrostomy tube weaning. An evaluation of the swallowing function is necessary before deciding to initiate gastrostomy tube weaning. [ABSTRACT FROM AUTHOR]

Objective To determine the immediate and short-term impact of the application of wearable balance compensation system (BCS) on balance impairment in patients with spinocerebellar ataxia (SCA). Methods The study enrolled 6 participants with SCA with varying degrees of balance impairment. After adjustment for individual fitting, wearable BCS with up to 3% body weight was placed in a garment on the trunk. Sway direction and magnitude were measured with sensors placed posteriorly at the lumbosacral junction, immediately before and after, and at day 1, day 2, and day 7 after wearing the BCS. Timed Up & Go test (TUG) and 25-foot timed walk test were performed, and static foot pressure was measured. Results A significant improvement in static and dynamic balance was found during the 25-foot timed walk and in static foot pressure measurement results after wearing the BCS, when compared with that at baseline (p=0.044 vs. p=0.011). Anterior and posterior sway showed improvements from baseline after wearing the BCS. Improvement in the lateral swaying movement control was also seen. Conclusion Application of the BCS might be beneficial in the improvement ofthe static and dynamic balance in patients with SCA. Further research on long-term effects and with a larger sample size is indicated. [ABSTRACT FROM AUTHOR]

The security risk management used by some service providers is not appropriate for effective security enhancement. The reason is that the security risk management methods did not take into account the opinions of security experts, types of service, and security vulnerability-based risk assessment. Moreover, the security risk assessment method, which has a great influence on the risk treatment method in an information security risk assessment model, should be security risk assessment for fine-grained risk assessment, considering security vulnerability rather than security threat. Therefore, we proposed an improved information security risk management model and methods that consider vulnerability-based risk assessment and mitigation to enhance security controls considering limited security budget. Moreover, we can evaluate the security cost allocation strategies based on security vulnerability measurement that consider the security weight. [ABSTRACT FROM AUTHOR]

Membrane fouling in seawater reverse osmosis (SWRO) occurs on the membrane surface to reduce the membrane performance. In particular, biofouling, silica scale, and calcium deposition are hardened with time and not easily removed because SWRO is continuously operated without shutdown. This study aimed to evaluate the performance of the SWRO membrane process by periodically applying forward osmotic backwashing (FOB) which is one of the physical cleaning methods. Dissolved organic carbon (DOC), UV254, and fluorescence excitation-emission matrix (FEEM) were analyzed by sampling the circulating water before and after FOB. As a result, when sodium alginate (SA) as a hydrophilic substance was fouled, its cleaning efficiency was superior to that of humic acid (HA) as a hydrophobic material. This is because SA was effectively removed due to its low adhesion force between organic matter and membrane. In addition, FEEM of cleaning wastewater was analyzed after performing clean-in-place (CIP) of the membranes with and without FOB. The peak intensity with FOB was lower than that without FOB, and SA showed relatively large differences in the peak intensity with and without FOB. The effect of FOB on SA was larger than the cleaning efficiency for HA. In conclusion, FOB can extend the CIP cycle of SWRO. In particular, although the adhesion force between organic matter is high, FOB can mitigate membrane fouling by SA with small adhesion force with membranes. [ABSTRACT FROM AUTHOR]

Contrary to general microfiltration (MF) and ultrafiltration (UF), reverse osmosis (RO) processes are affected by various osmotic pressures according to the raw water characteristics because they use semi-permeable membranes. Thus, the net driving pressure applied when operating RO processes changes. This net driving pressure greatly affects energy consumption and operating efficiency and particularly changes fouling tendencies of RO process. In this paper, seawater reverse osmosis (SWRO) processes were operated by changing the salt concentration of raw water and operating pressure to analyze the fouling characteristics at various net driving pressures. Here, the result of the experiment showed that, the flux increased with increasing net driving pressure. When fouling occurred, the operation time was reduced to a flux decline rate (FDR) of 10% according to the net driving pressure, and the accumulation of organic matter on the membrane surface increased. The fouling index increased with increasing net driving pressure, and the specific cake resistance decreased. The fouling layers formed by this decreased cake resistance were considered easy to remove for a short period by cleaning because they had a slightly loose structure. By performing forward osmotic backwashing (FOB) which is a maintenance cleaning methods for RO processes, the cleaning efficiency and organic matter removal efficiency increased in proportion to the net driving pressure. It was confirmed that the organic matter removal efficiency was higher than the cleaning efficiency because most of the fouling layers had a loose structure. In addition, the organic matter forming dense fouling layers that decreased the actual permeate flux was small. The fouling index decreased after FOB, and the specific cake resistance increased. This rendered it easier to remove fouling layers that had a loose structure and low density in FOB and to clean the fouling layers formed at high net driving pressure. [ABSTRACT FROM AUTHOR]

This study aimed to explore the possibility of a new cleaning technique for which air flushing and forward osmotic backwashing (FOB), from among the maintenance-cleaning techniques and the reverse-osmosis (RO) processes, were combined for high-salinity wastewater reuse. Therefore, this study analyzed the cleaning efficiency in the effluent organic matter (EfOM), which is the major source of fouling for the RO membranes in terms of wastewater reuse. When non-dissolved gas and FOB are simultaneously injected into the RO membrane at a 10 % flux decline rate (FDR), the injected gas reduced the cleaning efficiency by interrupting the FOB. Although the nitrogen gas (N2) and air did not generate bubbles via the low solubility in the FOB for which a gas-dissolved NaCl solution was used, the carbon dioxide (CO2) generated bubbles by high-solubility showed a high cleaning efficiency. Although the pH was lowered when the CO2 was dissolved, only a slight effect occurred in the organic-fouling cleaning; in this case, the physical effects increased the cleaning efficiency. The experiment also comprises the cleaning efficiency according to the dissolved pressure of the CO2, and as a result, the bubble volumes was increased grew by the dissolved pressure, but the cleaning efficiency was reduced through the FOB interruption. In particular, the highest cleaning efficiency was observed at the dissolved pressure of 200 kPa because the gas/liquid ratio became 1:1. [ABSTRACT FROM AUTHOR]

The purpose of this study is to compare fouling index of reverse osmosis fed in MBR-RO systems at different operating conditions in MBRs. Lab. scale reactor of MBRs was operated at different flux and temperature and permeate was measured SDI15 to predict RO fouling rate. The results suggest that formed cake layer in membrane surface, higher flux and lower temperature in MBRs, led to lower RO fouling rates and SDI15 value was decreased, because of cake layer attached greater amounts of organic substances such as polysaccharide and protein. [ABSTRACT FROM AUTHOR]

The importance of the reliability of gate oxide materials is increasing continuously as CMOS technology advancing. Joule heating to induce localized high temperature via a built-in gate heater has recently been introduced as a rapid and efficient method to cure instances of gate oxide damage, including damaged interface traps and bulk traps in the gate oxide. In this paper, spatially distributed deep oxide traps were generated by Fowler-Nordheim (FN) stress, and a recovery process by electrothermal annealing (ETA) using local Joule heat was clearly demonstrated with low-frequency (LF) noise characteristics. The generation and recovery of the oxide traps were quantitatively analyzed with LF noise, and the results showed that the border traps generated by the FN stress were cured by ETA. The recovery process was predominantly affected by the applied gate voltage and the duration. Excessive gate voltage beyond the critical value permanently destroyed the gate oxide. The effect of a forming gas annealing (FGA) process on the gate oxide traps was also analyzed with LF noise and compared with that of ETA. Although electrical Joule heating was applied under a condition of ambient air, not hydrogen-rich atmosphere, the passivation effect was superior to that of a FGA process conducted in diluted H2 ambient. [ABSTRACT FROM AUTHOR]

The self-heating effects (SHEs) in gate-all-around (GAA) MOSFETs with vertically stacked silicon nanowire (SiNW) channels are investigated. Direct observations using thermal images, electrical proof measurements, and supportive numerical simulations are carried out to verify the SHEs. This paper examines the location of hot spots as well as heat dissipation paths (heat sink) depending on the device geometry, and the electrical degradation produced by the SHEs. It also includes the estimation of the surface temperature of the GAA MOSFET and the average temperature across the bulk channel. Design parameters for improved management of the heat dissipation in a device are suggested. This investigation can contribute to improve the device performance and reliability of a 3-D stacked structure. [ABSTRACT FROM AUTHOR]

Shiga toxins (Stxs) produced by Shiga toxin-producing bacteria Shigella dysenteriae serotype 1 and select serotypes of Escherichia coli are the most potent known virulence factors in the pathogenesis of hemorrhagic colitis progressing to potentially fatal systemic complications such as acute renal failure, blindness and neurological abnormalities. Although numerous studies have defined apoptotic responses to Shiga toxin type 1 (Stx1) or Shiga toxin type 2 (Stx2) in a variety of cell types, the potential significance of Stx-induced apoptosis of photoreceptor and pigmented cells of the eye following intoxication is unknown. We explored the use of immortalized human retinal pigment epithelial (RPE) cells as an in vitro model of Stx-induced retinal damage. To the best of our knowledge, this study is the first report that intoxication of RPE cells with Stxs activates both apoptotic cell death signaling and the endoplasmic reticulum (ER) stress response. Using live-cell imaging analysis, fluorescently labeled Stx1 or Stx2 were internalized and routed to the RPE cell endoplasmic reticulum. RPE cells were significantly sensitive to wild type Stxs by 72 h, while the cells survived challenge with enzymatically deficient mutant toxins (Stx1A- or Stx2A-). Upon exposure to purified Stxs, RPE cells showed activation of a caspase-dependent apoptotic program involving a reduction of mitochondrial transmembrane potential (Δψm), increased activation of ER stress sensors IRE1, PERK and ATF6, and overexpression CHOP and DR5. Finally, we demonstrated that treatment of RPE cells with Stxs resulted in the activation of c-Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (p38MAPK), suggesting that the ribotoxic stress response may be triggered. Collectively, these data support the involvement of Stx-induced apoptosis in ocular complications of intoxication. The evaluation of apoptotic responses to Stxs by cells isolated from multiple organs may reveal unique functional patterns of the cytotoxic actions of these toxins in the systemic complications that follow ingestion of toxin-producing bacteria. [ABSTRACT FROM AUTHOR]

Gangliosides have been known to play a role in the regulation of apoptosis in cancer cells. This study has employed disialyl-ganglioside GD1b to apoptosis in human breast cancer MCF-7 cells using exogenous treatment of the cells with GD1b and endogenous expression of GD1b in MCF-7 cells. First, apoptosis in MCF-7 cells was observed after treatment of GD1b. Treatment of MCF-7 cells with GD1b reduced cell growth rates in a dose and time dependent manner during GD1b treatment, as determined by XTT assay. Among the various gangliosides, GD1b specifically induced apoptosis of the MCF-7 cells. Flow cytometry and immunofluorescence assays showed that GD1b specifically induces apoptosis in the MCF-7 cells with Annexin V binding for apoptotic actions in early stage and propidium iodide (PI) staining the nucleus of the MCF-7 cells. Treatment of MCF-7 cells with GD1b activated apoptotic molecules such as processed forms of caspase-8, -7 and PARP (Poly(ADP-ribose) polymerase), without any change in the expression of mitochondria-mediated apoptosis molecules such as Bax and Bcl-2. Second, to investigate the effect of endogenously produced GD1b on the regulation of cell function, UDP-gal: β1,3-galactosyltransferase-2 (GD1b synthase, Gal-T2) gene has been transfected into the MCF-7 cells. Using the GD1b synthase-transfectants, apoptosis-related signal proteins linked to phenotype changes were examined. Similar to the exogenous GD1b treatment, the cell growth of the GD1b synthase gene-transfectants was significantly suppressed compared with the vector-transfectant cell lines and transfection activated the apoptotic molecules such as processed forms of caspase-8, -7 and PARP, but not the levels of expression of Bax and Bcl-2. GD1b-induced apoptosis was blocked by caspase inhibitor, Z-VAD. Therefore, taken together, it was concluded that GD1b could play an important role in the regulation of breast cancer apoptosis. [ABSTRACT FROM AUTHOR]

Background/Aims: The aim of this study was to investigate the frequency of disseminated gastric mucosa-associated lymphoid tissue (MALT) lymphoma and the role of bone marrow study in the initial staging work-up. Methods: A total of 194 patients with gastric MALT lymphoma was enrolled. The incidence of disseminated disease was evaluated in the initial staging work-up. The demographic data and tumor characteristics were compared according to Helicobacter pylori infection status. Results: Localized disease of Lugano stage I accounted for 97.4% of the enrolled cases. Abdominal computed tomography revealed abdominal lymph node metastasis in five patients (2.6%). Bone marrow (BM) involvement was found in only one patient without H. pylori infection (0.5%). No patient showed positive findings on chest computed tomography or positron emission tomography. H. pylori -negative cases showed a significantly higher frequency of advanced-stage disease than H. pylori -positive cases (10.0% vs 0.6%). In patients achieving complete remission, no extragastric recurrence occurred during follow-up. Conclusions: The incidence of disseminated disease, including BM involvement, was very low in Korean gastric MALT lymphoma patients. It might be beneficial to perform BM aspiration and biopsy as a part of staging work-up only in patients with risk factors for advanced disease such as H. pylori negativity. [ABSTRACT FROM AUTHOR]

The outstading mechanical properties of bimodal ultrafine eutectic composites (BUECs) containing length scale hierarchy in eutectic structure were demonstrated by using AFM observation of surface topography with quantitative height measurements and were interpreted in light of the details of the deformation mechanisms by three different interface modes. It is possible to develop a novel strain accommodated eutectic structure for triggering three different interface-controlled deformation modes; (I) rotational boundary mode, (II) accumulated interface mode and (III) individual interface mode. A strain accommodated microstructure characterized by the surface topology gives a hint to design a novel ultrafine eutectic alloys with excellent mechanical properties. [ABSTRACT FROM AUTHOR]

Background/Aims: Inflammatory pseudotumor (IPT) of the liver is a rare disease characterized by chronic infiltration of inflammatory cells. However, the clinical characteristics and outcomes of IPT remain uncertain. Methods: Clinical features, image findings, and outcomes of 55 patients with histologically proven IPT were evaluated. Results: They consisted of 26 men and 19 women with median age of 65 years. Serum carcinoembryonal antigen and carbohydrate antigen 19-9 levels were normal in 42 patients (93.3%). Enhanced CT scans indicated poorly defined peripheral enhancement (82.5%) at the arterial phase and poorly defined hyperattenuating lesions with internal hypoattenuating areas at the equilibrium phase (77.0%). Gadolinium-enhancement MRI revealed poorly defined peripheral rim-like enhancement (77.8%). Ten patients underwent surgical resection and 35 were treated conservatively with or without antibiotics. No recurrence was noted after surgical resection during follow-up (1 to 48 months). In all patients who received conservative treatment, complete resolution or size reduction was noted during follow-up (1 to 192 months). Conclusions: CT and MRI provide clues to the diagnosis of IPT in patients with liver masses and normal tumor markers. However, due to the lack of pathognomonic findings, the clinician’s suspicion and histological diagnosis are necessary to make an accurate diagnosis of IPT. [ABSTRACT FROM AUTHOR]