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Background/Aims: We investigated the real-world effectiveness and safety of ustekinumab (UST) as induction treatment for Koreans with Crohn’s disease (CD).Methods: CD patients who started UST were prospectively enrolled from 4 hospitals in Korea. All enrolled patients received intravenous UST infusion at week 0 and subcutaneous UST injection at week 8. Clinical outcomes were assessed using Crohn’s Disease Activity Index (CDAI) scores at weeks 8 and 20 among patients with active disease (CDAI ≥150) at baseline. Clinical remission was defined as a CDAI 2) (odds ratio [OR], 0.085; 95% confidence interval [CI], 0.014–0.498; P=0.006) and elevated C-reactive protein at baseline (OR, 0.133; 95% CI, 0.022–0.823; P=0.030) were inversely associated with clinical remission at week 20.Conclusions: UST was effective and well-tolerated as induction therapy for Korean patients with CD.

It is still unknown whether diabetes mellitus (DM) affects the relative safety and efficacy of ticagrelor vs clopidogrel in East Asian patients with acute coronary syndrome (ACS).The authors sought to assess the safety and efficacy of ticagrelor vs clopidogrel according to the diabetic status of East Asian patients with ACS undergoing invasive management.This prespecified analysis of the TICA KOREA (Clinically Significant Bleeding With Ticagrelor Versus Clopidogrel in Korean Patients With Acute Coronary Syndromes Intended for Invasive Management) trial included 800 Korean patients. The primary safety endpoint was clinically significant bleeding (PLATO [Platelet Inhibition and Clinical Outcomes] major or minor bleeding) at 12 months; the efficacy endpoint was major adverse cardiovascular events (cardiovascular death, myocardial infarction, and stroke).Of 800 patients, 216 (27.0%) had DM. The incidence of clinically significant bleeding within 12 months was significantly higher with ticagrelor than clopidogrel in the nondiabetic group (10.2% vs 4.3%; HR: 2.45; 95% CI: 1.27-4.70;In Korean ACS patients undergoing early invasive management, diabetes status did not affect the relative safety and efficacy of ticagrelor and clopidogrel. (Safety and Efficacy of Ticagrelor Versus Clopidogrel in Asian/Korean Patients With Acute Coronary Syndromes Intended for Invasive Management [TICA KOREA]; NCT02094963).

Biofeedback therapy is widely used to treat patients with chronic constipation, especially those with dyssynergic defecation. Yet, the utility of high-resolution manometry with novel parameters in the prediction of biofeedback response has not been reported. Thus, we constructed a model for predicting biofeedback therapy responders by applying the concept of integrated pressurized volume in patients undergoing high-resolution anorectal manometry.Seventy-one female patients (age: 48-68 years) with dyssynergic defecation who underwent initial high-resolution anorectal manometry and subsequent biofeedback therapy were enrolled. The manometry profiles were used to calculate the 3-dimensional integrated pressurized volumes by multiplying the distance, time, and amplitude during simulated evacuation. Partial least squares regression was performed to generate a predictive model for responders to biofeedback therapy by using the integrated pressurized volume parameters.Fifty-five (77.5%) patients responded to biofeedback therapy. The responders and non-responders did not show significant differences in the conventional manometric parameters. The partial least squares regression model used a linear combination of eight integrated pressurized volume parameters and generated an area under the curve of 0.84 (95% confidence interval: 0.76-0.95,Integrated pressurized volume parameters were better than conventional parameters in predicting the responsiveness to biofeedback therapy, and the combination of these parameters and partial least squares regression was particularly promising. Integrated pressurized volume parameters can more effectively explain the physiology of the anorectal canal compared with conventional parameters.

Background Both temporal changes in imaging characteristics of lymphadenopathy on US scans after COVID-19 vaccination and expected duration of radiologically evident lymphadenopathy remain uncertain. Purpose To longitudinally evaluate COVID-19 vaccine-associated lymphadenopathy on axillary US scans at various time intervals in both messenger (mRNA) and vector vaccine recipients. Materials and Methods This prospective cohort study was conducted between March 2021 and January 2022. The participants were asymptomatic women without breast cancer who had received COVID-19 vaccination. Serial follow-up US was performed in women with lymphadenopathy. The following variables were assessed: cortical thickness, number of lymph nodes, morphologic characteristics, and Doppler signal. Temporal changes in cortical thickness and number of lymph nodes during follow-up were assessed using a linear mixed model. Results Ninety-one women with lymphadenopathy in the vaccinated arm had undergone a total of 215 serial US examinations (mean age, 44 years ± 13 [SD]). Fifty-one participants had received a vector vaccine (ChAdOx1 nCoV-19 vaccine) and 40 had received an mRNA vaccine (BNT162b2 vaccine [

Quantitative susceptibility mapping (QSM) for 61 patients with dissecting intramural hematomas (n = 36) or atherosclerotic calcifications (n = 25) in intracranial vertebral arteries were collected to assess intra- and interobserver reproducibility in a 3.0-T MR system between January 2015 and December 2017. Two independent observers each segmented regions of interest for lesions twice. The reproducibility was evaluated using intra-class correlation coefficients (ICC) and within-subject coefficients of variation (wCV) for means and concordance correlation coefficients (CCC) and ICC for radiomic features (CCC and ICC > 0.85) were used. Mean QSM values were 0.277 ± 0.092 ppm for dissecting intramural hematomas and − 0.208 ± 0.078 ppm for atherosclerotic calcifications. ICCs and wCVs were 0.885–0.969 and 6.5–13.7% in atherosclerotic calcifications and 0.712–0.865 and 12.4–18.7% in dissecting intramural hematomas, respectively. A total of 9 and 19 reproducible radiomic features were observed in dissecting intramural hematomas and atherosclerotic calcifications, respectively. QSM measurements in dissecting intramural hematomas and atherosclerotic calcifications were feasible and reproducible between intra- and interobserver comparisons, and some reproducible radiomic features were demonstrated.

Background: Tofacitinib is a small molecule that inhibits Janus kinase and has been reported to be effective in Western patients with ulcerative colitis (UC). However, the real-life data on tofacitinib in Asian UC patients are limited. Objective: To investigate the real-life effectiveness and safety of tofacitinib induction and maintenance treatment in Korean patients with UC. Design: This was a retrospective study on patients with UC who received tofacitinib treatment at 12 hospitals in Korea between January 2018 and November 2020. Methods: Clinical remission at week 52, defined as a partial Mayo score of ⩽2 with a combined rectal bleeding subscore and stool frequency subscore of ⩽1, was used as the primary outcome. Adverse events (AEs), including herpes zoster and deep vein thrombosis, were also evaluated. Results: A total of 148 patients with UC were started on tofacitinib. Clinical remission rates of 60.6%, 54.9%, and 52.8% were reported at weeks 16, 24, and 52, respectively. Clinical response rates of 71.8%, 67.6%, and 59.9% were reported at weeks 16, 24, and 52, respectively. Endoscopic remission rates at weeks 16 and 52 were 52.4% and 30.8% based on the Mayo endoscopic subscore and 20.7% and 15.2% based on the UC endoscopic index of severity (UCEIS), respectively. A higher UCEIS at baseline was negatively associated with clinical response [adjusted odds ratio (aOR): 0.774, p = 0.029] and corticosteroid-free clinical response (aOR: 0.782, p = 0.035) at week 52. AEs occurred in 19 patients (12.8%) and serious AEs in 12 patients (8.1%). Herpes zoster occurred in four patients (2.7%). One patient (0.7%) suffered from deep vein thrombosis. Conclusions: Tofacitinib was an effective induction and maintenance treatment with an acceptable safety profile in Korean patients with UC. Plain language summary Real-life effectiveness and safety of tofacitinib treatment in Korean patients with ulcerative colitis Ulcerative colitis (UC) is an idiopathic, chronic inflammatory disorder of the colonic mucosa that usually presents with bloody diarrhea and abdominal pain. Tofacitinib is a small molecule that inhibits Janus kinase and has been reported to be effective in Western patients with UC. However, real-life data on the effectiveness of tofacitinib in Asian patients with UC are limited. To investigate the real-life effectiveness and safety of tofacitinib treatment in Korean patients with UC, we retrospectively analyzed the data of 148 patients with UC who received tofacitinib treatment at 12 hospitals in Korea between January 2018 and November 2020. Clinical remission (i.e. complete improvement of symptoms) was achieved in 60.6% and 52.8% of patients at weeks 16 and 52, respectively. Endoscopic remission was achieved in 52.4% and 30.8% of patients at weeks 16 and 52, respectively. A higher baseline score of the UC endoscopic index of severity, which is one of the endoscopic indices that evaluate the severity of inflammation of the colon, was negatively associated with clinical response (i.e. partial improvement of symptoms). Adverse events (AEs) including herpes zoster and deep vein thrombosis occurred in 19 patients (12.8%) and serious AEs occurred in 12 patients (8.1%). Our real-life study shows that tofacitinib is a clinically effective treatment for Korean patients with UC, and the incidence of AEs was also similar to those observed in other real-world studies.

This article examines the reasons why the level of alliance cohesion between the United States and the Republic of Korea (rok) was suboptimal during the Second North Korean Nuclear Crisis (2002–2006). Existing studies on this phenomenon primarily attribute its causes to factors like the rise of anti-Americanism in the rok and/or the increasing divergence in the two nations’ respective threat perceptions of the North Korea and their resulting policy preferences. However, these explanations are partial at best. The main finding here is that one should understand the frictions in the U.S.-rok alliance in terms of the rok’s status concerns. In particular, the rok, with a sense of entitlement to its solid middle power status, had set out to cooperate closely with the United States in seeking to answer the nuclear problem, based on the spirit of horizontal, equitable alliance relations. However, the United States failed overall to reciprocate, thereby leading the rok to boldly pursue its own set of policies at the expense of eroding alliance cohesion. These events demonstrate that (dis)respect for status concerns in international politics can make a major contribution towards facilitating (or impeding) interstate cooperation.

The US–ROK alliance during the First Korean Nuclear Crisis provides the most likely case of high alliance cohesion. Curiously, however, instead of dancing to the American tune in their joint management of the Democratic People's Republic of Korea (DPRK) threat, the Republic of Korea (ROK) caused frequent policy collisions – supporting the US–DPRK negotiations at one point and opposing it at another – at the risk of jeopardizing its physical security. The main finding here is that the variations in the South Korean behavior were a function of their experience of status inconsistency. In particular, the ROK became compliant with the US–DPRK talks when it believed that its desired status marker of taking the leadership role in crisis management was within reach, and unyielding otherwise. These fluctuations ended up not only eroding the US–ROK alliance cohesion but also inhibiting a successful resolution of the crisis. All this bears directly on the fundamental question of whether international politi...

This article looks at Chinese foreign policy through the lens of Social Identity Theory (SIT). It aims to show how that approach can give us new insight into a whole series of issues relating to the rise of China. It also tries to show, more generally, how SIT can serve as a useful tool for understanding international politics. In substantive terms, the main claim here is that China has consistently pursued a social creativity strategy (one of the three standard SIT strategies) from the Deng Xiaoping era until the present. The article argues that the concepts of respect and disrespect can provide us with a useful framework for better understanding the conditions for an outbreak of a conflict given a social creativity strategy; it then examines the Taiwan Strait Crisis of 1995–1996 as a plausibility probe. All this supports the basic conclusion that overall China’s rise would be more peaceful than threatening.

In SDN and NFV technologies, performance of a virtual switch is important to provide network functionalities swiftly. Since the lookup operation of the virtual switch has been considered a major bottleneck of performance, we need to devise an efficient way to reduce the lookup time. To improve the lookup speed, previous research has suggested a compact lookup table in a fast memory, but the issue of collision in a hash table has not been addressed well enough. This paper proposes a new scheme that mitigates collisions by utilizing empty slots of the hash table. We propose to insert a new element that may collide to an empty slot instead of linking it with a pointer. According to an evaluation on our experiments, about 20% of elements that could have experienced collisions in the conventional scheme are inserted into empty slots in each bucket. Moreover, the access time of collided elements has halved by avoiding unnecessary memory accesses.

To determine normal reference values of liver elasticity and measurement reliability by using real-time shear-wave elastography (SWE) in patients with a range of ages and body mass index (BMI) measurements, with presence or absence of hepatic steatosis.The institutional review board approved this study, and informed consent was waived because of the retrospective nature of the study. Two hundred thirty-eight patients who underwent SWE and ultrasonography-guided liver biopsies on the same day were identified retrospectively. The median kilopascal value of three consecutive measurements was used as a representative value for each subject. One hundred ninety-six patients who were potential donors for living-donor liver transplantation and had biopsy-proven normal (123 nonsteatotic and 73 steatotic) livers as the only histologic abnormality were included in the study. Reference ranges of normal hepatic elasticity were calculated by using lower and upper limits at the 2.5 and 97.5 percentiles. With the upper value of the reference range as a cutoff value, the sensitivity and specificity for the diagnosis of hepatic fibrosis were calculated. Measurement reliability was evaluated by using the intraclass correlation coefficient (ICC). To investigate the effects of potential confounding factors (age, hepatic steatosis, and BMI) on liver elasticity, the Pearson correlation test and the Student t test were performed.The reference range of normal hepatic elasticity was 2.6-6.2 kPa. With 6.2 kPa as a cutoff value, the sensitivity and specificity for the diagnosis of hepatic fibrosis were 91% (20 of 22 subjects) and 95.9% (188 of 196 subjects), respectively. The overall ICC for the elasticity measurements was 0.924. The potential confounding factors that we considered had negligible effects on the elasticity values.Hepatic elasticity values measured with SWE in histologically proven normal livers ranged from 2.6 to 6.2 kPa, with high measurement reliability. The effect of the potential confounding factors on liver elasticity was negligible.

Prognostic significance of macroscopic appearance of clear cell renal cell carcinoma (ccRCC) has not yet been studied. This study aimed to define the prognostic significance of macroscopic appearance and to propose a prognostic model for post-operative metastasis in ccRCC. A total of 1,025 patients with ccRCC were analyzed for the development dataset. A separate cohort of 399 such patients was used as an external validation dataset. Macroscopic appearances were initially divided into four groups, but were later divided into two groups: a simple nodular group (700 cases, 68.3%) and an irregular outline group (325 cases, 32.7%). During the 66.1-month mean follow-up period, 98 patients (9.6%) developed metastasis. Univariate analysis revealed that metastasis was associated with older age, radical nephrectomy, larger tumor size, higher tumor grade and stage, and the irregular outline group. On multivariate analysis, age, tumor size, and macroscopic appearance remained as independent prognostic factors. These factors were used to build a prognostic model, which divided into three risk groups. The probabilities of 5-year metastasis-free survival in the low-, intermediate-, and high-risk groups were 98%, 83%, and 53%, respectively. The results showed prognostic significance of macroscopic appearance in ccRCC and propose a prognostic model to guide post-operative management of patients with ccRCC.

Objective:We conducted this study to evaluate the clinical characteristics and treatment patterns of elderly hypertensive patients in Korea.Design and method:We analyzed Korea National Health Insurance Claims Database from 2006 to 2016. The patients aged 65 years or older with disease codes for hype

본 연구는 만병초와 구상나무 추출물의 항알러지 효과에 대해 조사하였다. 비만세포 RBL-2H3에 concanavalin A (Con A)를 처리하여 면역반응을 유도한 후 만병초와 구상나무 추출물을 농도별로 처리하여 real-time PCR을 이용하여 IL-4, IL-13의 mRNA 발현량을 확인하였다. 또한 β-hexosaminidase 분비를 측정하여 탈과립 유도효과를 평가하였다. IL-4의 발현은 만병초 10-7, 10-5, 10-3% 농도와 구상나무의 모든 농도에서 유의성 있게 감소하였으며, IL-13의 발현은 만병초와 구상나무 모든 농도에서 유의성 있게 감소되었다. 만병초 추출물과 구상나무 추출물의 10-5, 10-3% 농도에서는 β-hexosaminidase 분비가 유의성 있게 감소하였다. 이러한 결과를 통해 만병초와 구상나무 추출물이 면역반응 표적유전자의 발현을 감소시키고 면역반응에 의해 유도되는 탈과립유도 효과도 감소시킴을 확인할 수 있었다. 이는 만병초와 구상나무 추출물이 항알러지 효과가 있음을 제시하는 결과이다.

Background Although intraoral resection of small-sized tonsil cancer achieves excellent tumor control, the extent of local invasion and adequate safety margin in resection have not been studied. Thus, we aim to determine the extent of local invasion in terms of mucosal spread and deep infiltration in stage T1–2 tonsil cancer. Methods We re-analyzed the surgical specimens from 49 cT1–2 tonsil cancers. Microscopic tumor cell extension from the tumor gross boundary of specimens was assessed in representative sections of each tumor. We also tested whether local extension correlates with human papilloma virus (HPV) status of tumors. Results The extent of microscopic deep invasion from the gross tumor border was 0.52 ± 0.41 mm, which was significantly less than that of mucosal spread (0.83 ± 0.61 mm, P = 0.01) in cT1–2 tonsil cancer. The microscopic deep invasion correlated with tumor size (rho = 0.703, P

Network administrators can make their own programmable network by using an SDN infrastructure with the OpenFlow protocol. Through the OpenFlow protocol, a SDN controller instructs an OpenFlow switch to perform specific actions, such as service chaining, according to header fields of incoming packets. Our main goal is to support an extended view of the OpenFlow architecture by inspecting not only the packet header but also the payload information in the packets. For this purpose, we address a sophisticated packet forwarding scheme using DPI to inspect effectively all incoming packets. According to the results of our experiments, we choose the inside of a virtual switch as the most suitable position of the DPI module. In our scheme, there are a log server, a monitoring application, and DPI function for monitoring and managing network traffic. When the DPI module detects a predefined string pattern of bits in an incoming packet, the switch sends the matching information to the log server that stores logs that contain the detected pattern and resource usage. Then, the monitoring application periodically gathers log information on the log server to compare that information with predefined network policies. Finally, we show that the packets are dealt with in a more effective and efficient way in our sophisticated packet forwarding scheme.

OBJECTIVE: This study aimed to identify factors that predict clearance of high-risk human papillomavirus (HPV) infection and progression to cervical intraepithelial neoplasia (CIN) 2 or higher, in women with normal cervical histology or CIN 1. METHODS: A retrospective analysis was performed on 817 high-risk HPV-infected women with histologically verified CIN 1 or normal cervical histology. Patients were followed-up for a maximum of 24 months. Cervical HPV DNA tests were performed at every visit. RESULTS: At the end of follow-up, 648/817 (79.3%) patients were free from HPV infection and 66/817 patients (8.1%) progressed to CIN 2 or higher. Age, parity, cytology and viral load at diagnosis were significantly and inversely associated with HPV clearance. Cytology, viral load and presence of CIN 1 lesions were significantly associated with lesion progression. CONCLUSIONS: Cytology and high-risk HPV viral load may be useful markers for the likelihood of high-risk HPV clearance and lesion progression. Histological status, parity and marital status may also be useful factors to consider when predicting progression.

Admission hyperglycaemia is associated with a poor outcome in patients with ischaemic stroke. However, its prognostic effects after intracerebral haemorrhage (ICH) are still unclear.We prospectively enrolled patients with ICH at 33 centres in Korea between October 2002 and March 2004. A total of 1,387 patients who had ICH and underwent brain computed tomography within 48 h of symptom onset were included in the study (n = 1,387). Clinical information and radiological findings were collected at admission. Glucose levels were examined in relation to early (up to 30 days after ictus) and long-term (after 30 days) mortality rates using Cox regression analysis. To eliminate short-term effects, long-term mortality rate analysis was performed on surviving patients for more than 30 days.The long-term mortality rate was 21.1% after a mean follow-up of 434.3 +/- 223.2 days and was found to increase significantly with glucose quartile (p0.001). Admission glucose level was an independent risk factor for early mortality (per mmol/l; adjusted HR 1.10 [95% CI 1.01-1.19]), but not for long-term mortality. Moreover, when analysis was restricted to patients without diabetes, glucose level was found to be an independent risk factor for post-ICH mortality (n = 1,119; adjusted HR 1.10 [95% CI 1.03-1.17]) and had marginal significance for early (p = 0.053) and long-term mortality (p = 0.09).We found that admission glucose levels were associated with early mortality after ICH. In patients without diabetes, admission glucose levels were associated with long-term mortality. We therefore suggest that intensive lowering of glucose level should be further investigated in ICH patients.

The score test statistics for testing zero inflation and covariance parameter are proposed in the bivariate zero-inflated Poisson (BZIP) regression model. The Monte Carlo studies show that the score test and likelihood ratio test for testing zero inflation underestimate the nominal significance level, while the score test for covariance parameter keeps the significance level close to the nominal one. To overcome this nominal level underestimation, we propose a bootstrap method of the score test for the testing problem of zero inflation. An empirical example with covariates is provided to illustrate the results. In addition, score test for zero inflation is also proposed in the BZIP model, which allows a flexible dependence structure using copula.

The purpose of this survey was to obtain information on the prevalence, costs, and patterns of use of complementary and alternative medicine (CAM) in a general population in the Republic of Korea. In 2006, we conducted nationwide and population-weighted personal interviews with 6,021 adults ranging from 30 to 69 yr of age; the final sample consisted of 3,000 people with a 49.8% response rate. In addition to their general socio-demographics, the respondents were asked about their use of CAM during the previous 12-month period, costs, sources of information, and reasons for use. The prevalence of use overall was 74.8%, while biologically based CAM therapies were the most likely type of use (65.4%). The median annual out-of-pocket expenditures for CAM therapies was about US$203. The primary reason for using CAM was for disease prevention and health promotion (78.8%). The main source of advice about CAM therapies use was most likely to be from family and friends (66.9%). Our study suggests that CAM use has been and continues to be very popular in South Korea. Conventional western medical doctors and governments should obtain more evidence and become more interested in CAM therapies.

In this study, score test statistics for testing independence in the zero-truncated bivariate Poisson distributions are proposed. The Monte Carlo study shows that the score tests proposed in this article keep the significance level close to the nominal one, but the LR and Wald tests over-reject the null hypothesis when it is true. The score tests for testing independence in the zero-truncated bivariate Poisson regression models are also derived in this study.

Objective The present study was performed to determine whether high levels of trait-anger (T-Anger) are independently associated with sleep disturbances and quantitative and qualitative measurements of sleep in middle-aged adults. Methods Enrolled in the study were 2404 men and 2291 women derived from the Korean Health and Genome Study (KHGS), which is an ongoing population-based prospective study. The Spielberger Trait Anger Scale was used to measure T-Anger. Results Sleep disturbances, including difficulty in initiating and maintaining sleep (DIS and DMS, respectively) and early morning awakening (EMA), significantly increased with increasing levels of T-Anger (P

OBJECTIVES To determine prevalence, awareness, treatment, and control of hypertension, and its risk factors in an urban Korean population. DESIGN AND SETTING A cross-sectional survey in Ansan-city, Korea. SUBJECTS AND METHODS Population-based samples of people aged 18-92 years in Ansan-city, Korea, were selected, yielding 2278 men and 1948 women, and their blood pressures were measured using a highly standardized protocol. Hypertension was defined as a systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or reported treatment with antihypertensive medications, and subclassified according to 1999 WHO-ISH guidelines. Isolated systolic hypertension (ISH) defined as a systolic BP > or = 140 mmHg and diastolic BP < 90 mmHg was also examined. Data were stratified by age and sex. RESULTS The overall prevalence of hypertension in this study was 33.7%. Among these, 64.9% had Grade 1 hypertension, 22.5% Grade 2, and 12.5% Grade 3. Age-specific prevalence of hypertension increased progressively with age, from 14.19% in 18 to 24 year-olds to 71.39% in those 75 years or older. Hypertension prevalence was significantly higher in men (41.5%) than in women (24.5%) (P < 0.001). Isolated systolic hypertension had significantly lower prevalence (4.33%) within the population, although in the elderly aged 55 years or more it rose by 11.13%. Overall, 24.6% of hypertensive individuals were aware that they had high blood pressure, as much as 78.6% were being treated with antihypertensive medications, and 24.3% were under control. Hypertension awareness as well as treatment and control rates varied by sex, with women higher in all three rates. Multivariate analysis revealed that age, body mass index and abdomen circumference were significantly associated with prevalence of hypertension both in men and women. CONCLUSIONS Hypertension is highly prevalent in Korea. Despite the high rate of treatment, the rates of awareness and control are relatively low, suggesting the nationwide demand for preventing and controlling high blood pressure in Korea in order to avert an epidemic of cardiovascular disease.

The purpose of our study was to assess the diagnostic performance of breast MRI in evaluating residual disease in patients after excisional biopsy for breast cancer on the basis of both morphologic and kinetic features.Of 5304 breast MRI examinations performed between January 2007 and December 2011, 308 evaluated postoperative sites after excisional biopsy of breast cancer. Among these, 203 patients who were not treated with chemotherapy or radiotherapy before MRI and underwent definitive surgery within 30 days after MRI were enrolled. MRI findings were analyzed on the basis of contrast-enhanced subtraction images. The enhancement patterns were classified into four categories: no enhancement (P1), thin regular rim enhancement (P2), thick or irregular rim enhancement (P3), and nodular or nonmasslike enhancement (P4) around the postoperative sites. The enhancement kinetics were assessed as follows: persistent, plateau, and washout pattern.From 207 breast MRI examinations in 203 patients, 144 breasts had residual breast cancer at histopathologic examination after definitive surgery. When P1 and P2 were considered negative for residual cancer and P3 and P4 were considered positive, the sensitivity, specificity, positive and negative predictive values, and accuracy were 79.9%, 73.0%, 87.1%, 61.3%, and 77.8%, respectively. The specificity and positive predictive value improved to 90.5% and 91.7%, when analyzed with washout enhancement kinetics as another positive finding for residual cancer. A statistically significant trend of decreasing specificity and positive predictive value (p0.05) was found with the passage of a time interval between excision and breast MRI.Although the overlapping features of the postsurgical changes and malignant lesions remain as the limitations, dynamic contrast-enhanced breast MRI is a useful tool for residual disease prediction after excisional biopsy for breast cancer. Combined use of morphologic and kinetic evaluation parameters improved the diagnostic performance. We do not recommend that MRI be unreasonably delayed after excisional biopsy considering the risk of prolonging definitive surgery.

Conducting poly (3,4-ethylenedioxythiophene) nanowires were synthesized by using an electrochemical polymerization method with a nanoporous template. Scanning and transmission electron microscopy confirmed the formation of conducting polymer nanowires (CPNWs) with an open end. The formation and the electrical properties of the CPNWs formed were dependent on synthetic conditions, such as the doping level, the polymerization time, and the applied current. The measured electrical conductivity of a single strand of CPNW was ∼3.4×10−3 S/cm at room temperature. From the ultraviolet and visible absorbance spectra, we observed a π–π* transition at ∼2.1 eV for the de-doped systems. A field emission cell of CPNW nanotips was fabricated. The turn-on field of the CPNWs was 3.5∼4 V/μm at 10 μA/cm2, and the current density increased up to 100 μA/cm2 at ∼4.5 V/μm. The field enhancement factor of CPNW nanotips was ∼1200, which is comparable to those of carbon nanotubes.

Background: Both vertebrobasilar dolichoectasia (VBD) and cerebral microbleeds (CMBs) are related with the risk of intracerebral hemorrhage. We aimed to examine the relationship between the VBD and CMB in ischaemic stroke patients. Methods: A consecutive series of 182 patients hospitalized because of ischaemic stroke or transient ischaemic attack (TIA), and who underwent gradient echo brain magnetic resonance imaging were retrospectively recruited from a prospective stroke registry. CMB locations were categorized into anterior and posterior circulation. Ectasia was defined as basilar artery (BA) diameter > 4.5 mm, and dolichosis, as either BA bifurcation above the suprasellar cistern or lateral to the margin of the clivus or dorsum sellae. Whether VBD is associated with CMB anywhere in the brain or in anterior or posterior circulation territories was analysed using binary and multinomial logistic regression models. Results: Twenty-four subjects (13.2%) had VBD and 48 (26.4%) had CMBs. CMBs were more frequently observed in patients with VBD than without (66.7% vs. 20.3%, P < 0.001). VBD was significantly associated with CMBs in any location (crude odds ratio, 7.88; 95% confidence interval, 3.10–20.02), in the posterior circulation territory only (9.63; 2.60–34.94), and in both territories (9.25; 3.40–26.29), but not in the anterior circulation only (1.14; 0.009–11.20). These associations remained unchanged after adjusting for age, gender, hypertension, leukoaraiosis and stroke subtype. Conclusions: VBD in patients with ischaemic stroke or TIA is independently associated with CMBs, especially in the posterior circulation territory.

To assess the factors affecting health-related quality of life (HRQOL) after ear surgery in patients with chronic otitis media (COM).Prospective questionnaire-based outcome study.Tertiary care institution.The study population comprised 205 patients aged 21 to 67 years referred for ear surgery owing to COM with or without cholesteatoma between November 2009 and March 2011.The ear surgery for COM included tympanoplasty, with or without mastoidectomy. The Korean version of the Chronic Ear Survey (K-CES), a disease-specific outcome survey, was administered before and 12 months after surgery.The primary outcome measures were the total score and subscale score, including an activity restriction-based subscale, symptom subscale, and medical resource utilization subscale. The scores were analyzed with disease- and patient-related factors affecting health-related quality of life.Of the 205 patients enrolled, complete data from 156 patients were available for this study. The K-CES score in patients with COM improved after ear surgery in total and in all subscales of the K-CES (P.001). In univariable analysis, poor improvement in total K-CES score was more likely to occur after ear surgery in patients with postoperative complications, diabetes mellitus, hearing loss as a chief complaint, lower air conduction threshold in postoperative audiometry, and a high level of education and in those who underwent canal wall down mastoidectomy (P.05). Multivariable analysis using multiple linear regression revealed that the occurrence of complications, presence of diabetes mellitus, level of education, and postoperative air conduction thresholds were independent factors for poor improvement in total K-CES score (P.05).Recognition of factors that have significant relation with subjective outcomes may help surgeons to identify patients who are prone to have a lower satisfaction and provide useful information in preoperative counseling.

In longitudinal studies investigators frequently have to assess and address potential biases introduced by missing data. New methods are proposed for modeling longitudinal categorical data with nonignorable dropout using marginalized transition models and shared random effects models. Random effects are introduced for both serial dependence of outcomes and nonignorable missingness. Fisher-scoring and Quasi-Newton algorithms are developed for parameter estimation. Methods are illustrated with a real dataset.

The in vivo relationship between human tumor cells and interacting normal cells in their local environment is poorly understood. Here, using a uniquely developed in vitro co-culture system for human embryonic stem cells (hESCs), we examined the interactions between transformed and normal human stem cells. Co-culture of transformed-hESCs (t-hESCs) with normal hESCs led to enhanced self-renewal and niche independence in normal hESCs. Global gene expression analysis of normal hESCs after timed exposure to t-hESCs indicated a transition of the molecular network controlling the hESC state, which included epigenetic changes, towards neoplastic features. These included enhanced pluripotent marker expression and a differentiation blockade as major hallmark changes. Functional studies revealed a loss in normal terminal differentiation programs for both hematopoiesis and neural lineages after normal stem cell co-culture with transformed variants. This transmission of neoplastic properties from t-hESCs to normal hESCs was dependent on direct cell-cell contact. Our study indicates that normal human stem cells can co-opt neoplastic cancer stem cell properties, raising the possibility that assimilation of healthy cells towards neoplastic behavior maybe a contributing feature of sustained tumorigenesis in vivo.

SUMMARY Obstructive sleep apnoea (OSA) is a common syndrome, which is associated with a number of medical problems that impact morbidity and mortality. Although the precise mechanisms that underlie these associations are not fully understood, previous studies have suggested that patients with OSA show elevations of several biomarkers that are associated with cardiovascular risk. This study was undertaken to identify serum proteins associated with OSA by using a proteomics technique and to examine changes in identified protein levels after continuous positive airway pressure treatment. The study participants consisted of 40 male patients (aged 40–49 years) with severe OSA and 34 male control subjects matched for age and body mass index. All subjects underwent polysomnography. Using a proteomics approach, we identified nine proteins that were differentially expressed in patients with severe OSA and controls. Three of these nine proteins, haptoglobin, paraoxonase-1 and apolipoprotein M, were quantified by using enzyme-linked immunosorbent assays, kinetic assays and by using Western blotting. Multiple regression analysis showed that haptoglobin and apolipoprotein M levels are independently related to apnoea–hypopnoea index (P < 0.01). A further study is required to determine the nature of associations between these identified proteins and OSA in a large population.

Asymmetric polarization switching of Pb(Zr,Ti)O3 (PZT) thin films with different electrode configuration has been studied in (La,Sr)CoO3/Pb(Zr,Ti)O3/(La,Sr)CoO3 (LSCO) heterostructures in which the conducting oxide (La,Sr)CoO3 and/or LaCoO3 (LCO) have been used as an electrode. Polarization-voltage (P-V) hysteresis loop of LSCO/PZT/LSCO was symmetric. However, LCO/PZT/LSCO showed a largely asymmetric P-V hysteresis loop and large relaxation of the remanent polarization at the negatively poled state, eventually leading to an imprint failure. On the other hand, LSCO/PZT/LCO exhibited large relaxation of the positively poled state. The asymmetric behavior of the polarized states implies the presence of an internal electric field inside the PZT layer. It is suggested that the internal electric field is caused by built-in voltages at LCO/PZT and LSCO/PZT interfaces. The built-in voltages at LCO/PZT and LSCO/PZT interfaces were 0.6 V and 0.12 V, respectively.

Objectives Pregabalin is used to treat neuropathic pain and has shown analgesic properties in postoperative pain. The aim of this study was to investigate the effectiveness and safety of pregabalin in reducing postoperative pain in patients after septoplasty. Methods Forty-seven patients scheduled for elective septoplasty were randomly assigned to groups that received either pregabalin (150 mg) or placebo, both one hour before surgery and 12 hours after the initial dose. Pain (verbal numerical rating scale, VNRS) and side effect assessments were performed at 6, 12, 12 to 24, and 24 to 48 hours postoperatively. Results From 1 to 12 hours postoperatively, VNRS scores for pain were lower in the pregabalin group (n=24) than in the placebo group (n=23; P

Parotid gland swellings are usually caused by viral and bacterial infections. Among the causes of non-infectious swellings, pneumoparotid is a rare condition which refers to the pathologic state of air within the parotid gland. This condition has been described in the medical literature under several names such as pneumoparotid, pneumoparotitis, pneumosialadenitis, wind parotitis, and pneumatocele glandulae parotis. The mechanism that causes the air reflux is an excessive increase in intraoral pressure. Patients typically present with painless swelling in the parotid region. There is crepitus on palpation of the gland, and frothy saliva or air bubbles may be observed emanating from Stensen’s duct during massage of the gland. Here, we report an unusual case of pneumoparotid initially presented with viral parotitis in the epidemic area of mumps.

Received May 17, 2012 Revised July 25, 2012 Accepted August 13, 2012 Address for correspondence Han-Sin Jeong, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel +82-2-3410-3579 Fax +82-2-3410-6987 E-mail hansin.jeong@gmail.com Background and ObjectivesZZTo determine the diagnostic clues to differentiate tuberculous lymph node infection from nodal metastasis in patients with both papillary thyroid carcinoma and cervical tuberculous lymphadenitis. Subjects and MethodZZWe retrospectively reviewed 11 patients suffering concurrently from papillary thyroid carcinomas with cervical tuberculous lymphadenitis. Nine of the 11 patients underwent preoperative neck ultrasonography (US) and seven CT scans. Using the surgical pathology as the reference standards, the results of the preoperative diagnostic tools were re-evaluated according to lymph node level-based analysis. US and CT features were also compared between metastatic nodes and tuberculous lymphadenitis. ResultsZZPreoperative CT could localize the involved lymph node levels and differentiate tuberculous infection from metastasis of thyroid carcinoma in only two of seven patients. The site of the involved lymph nodes, the presence of pulmonary tuberculosis, and the tumor volume of the thyroid carcinoma were the clues to diagnose the lymph node status. However, in five of seven cases, CT could not differentiate tuberculosis from metastasis in the lymph nodes. The morphological characteristics of lymph nodes seen on CT and US did not differ between tuberculous infection and metastasis of papillary thyroid carcinomas. ConclusionZZPre-operative CT or US does not provide differential information about lymph node status between tuberculous infection and metastasis in patients with concurrent papillary thyroid carcinomas and cervical tuberculous lymphadenitis. Rather, clinical characteristics such as the site of the involved lymph nodes, the primary tumor burden, and the associated clinical features can help the physician differentiate between them. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:571-7

Background To develop a Korean version of the Integrative Medicine Attitude Questionnaire (IMAQ) in order to evaluate physician attitudes toward integrative medicine/complementary and alternative medicine (CAM). Methods We developed a Korean IMAQ through careful translation of the 28-item questionnaire developed by Schmidt et al. A web-based survey was sent via email to 118 primary care physicians in Korea. The complete respose rate wasa 52.5%. The questionnaire's reliability and validity were verified using Cronbach's α, factor analysis, and discriminant analysis. Results Although the Korean IMAQ exhibited excellent internal consistency, its validity was insufficient. Our results suggest that Western and Korean physicians may have different understandings of CAM and the concept of holism, as factor analysis showed that incorrectly classified items were mainly part of the holism conceptual domain. Furthermore, the sum of the items within the holism conceptual domain was not significantly different for physicians who had previously received CAM education. Conclusion This study developed and tested the first Korean IMAQ. We found that this version of the questionnaire lacks sufficient validity and requires further modification.

Microscopic environments and dynamics in LiCoO2 systems were probed by L7i nuclear magnetic relaxation measurements with regard to the structural defects as revealed by x-ray diffraction and electron spin resonance measurements. Thus, the structural defects of differing degrees, associated with Li vacancies, were well accounted for in the temperature-dependent spin-lattice relaxation rate analysis, and in the structural and dynamical inhomogeneity as derived from the relaxation patterns.

This study examined the efficacy and safety of nifedipine sustained release (nifedipine SR) compared with Ginkgo biloba extract as treatment for primary Raynaud's phenomenon (RP) in Korea. Primary RP were screened and assigned to either the nifedipine SR group (Group N) or the Ginkgo biloba extract group (Group G) in the ratio of 2:1. After a run-in period of 2 weeks, patients received treatment for 8 weeks. We observed the percent improvement of the RP attack rate between before and after the 8-week treatment. Ninety-three subjects were randomly assigned. The percent improvement in Group N was 50.1% at 8 weeks after treatment, while it was 31.0% in Group G (p = 0.03). No serious adverse events occurred, and almost adverse events were mild and improved without specific treatment. nifedipine SR was more effective than Ginkgo biloba extract for treatment of primary RP in Korean patients. Both drugs were tolerable with primary RP patients.