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Background: Frailty is a prevalent state associated with several aging-related traits and conditions. The relationship between frailty and stroke remains understudied. Here we aim to investigate whether the hospital frailty risk score (HFRS) is associated with the risk of stroke and determine whether a significant association between genetically determined frailty and stroke exists. Design: Observational study using data from All of Us research program and Mendelian Randomization analyses. Methods: Participants from All of Us with available electronic health records were selected for analysis. All of Us began national enrollment in 2018 and is expected to continue for at least 10 years. All of Us is recruiting members of groups that have traditionally been underrepresented in research. All participants provided informed consent at the time of enrollment, and the date of consent was recorded for each participant. Incident stroke was defined as stroke event happening on or after the date of consent to the All of Us study HFRS was measured with a 3-year look-back period before the date of consent for stroke risk. The HFRS was stratified into 4 categories: no-frailty (HFRS=0), low (HFRS ≥1 and Results: Two hundred fifty-three thousand two hundred twenty-six participants were at risk of stroke. In multivariable analyses, frailty status was significantly associated with risk of any (ischemic or hemorrhagic) stroke following a dose-response way: not-frail versus low HFRS (HR, 4.9 [CI, 3.5–6.8]; P P P P value for all comparisons P =0.002). Conclusions: Frailty, based on the HFRS was associated with higher risk of any stroke. Mendelian Randomization analyses confirmed this association providing evidence to support a causal relationship.

To investigate the diagnostic performance of fully automated radiomics-based models for multiclass classification of a single enhancing brain tumor among glioblastoma, central nervous system lymphoma, and metastasis.The training and test sets were comprised of 538 cases (300 glioblastomas, 73 lymphomas, and 165 metastases) and 169 cases (101 glioblastomas, 29 lymphomas, and 39 metastases), respectively. After fully automated segmentation, radiomic features were extracted. Three conventional machine learning classifiers, including least absolute shrinkage and selection operator (LASSO), adaptive boosting (Adaboost), and support vector machine with the linear kernel (SVC), combined with one of four feature selection methods, including forward sequential feature selection, F score, mutual information, and LASSO, were trained. Additionally, one ensemble classifier based on the three classifiers was used. The diagnostic performance of the optimized models was tested in the test set using the accuracy, F1-macro score, and the area under the receiver operating characteristic curve (AUCROC).The best performance was achieved when the LASSO was used as a feature selection method. In the test set, the best performance was achieved by the ensemble classifier, showing an accuracy of 76.3% (95% CI, 70.0-82.7), a F1-macro score of 0.704, and an AUCROC of 0.878.Our fully automated radiomics-based models for multiclass classification might be useful for differential diagnosis of a single enhancing brain tumor with a good diagnostic performance and generalizability.

Background and Purpose Moderate-intensity statin plus ezetimibe versus high-intensity statin alone may provide a greater low-density lipoprotein cholesterol (LDL-C) reduction in patients with recent ischemic stroke.Methods This randomized, open-label, controlled trial assigned patients with recent ischemic stroke P= 0.0003). LDL-C level P=0.0001). Multiple lipid goal achievement rate was 71.1% and 53.7% in the ROS10/EZT10 and ROS20 groups (PP=0.0091). The adverse event rates did not differ between the two groups.Conclusion Moderate-intensity rosuvastatin plus ezetimibe was superior to high-intensity rosuvastatin alone for intensive LDL-C reduction in patients with recent ischemic stroke. With the combination therapy, more than 70% of patients achieved LDL-C reduction ≥50% and 80% had an LDL-C

Objectives. The mitochondrial ribosomal protein L14 (MRPL14) is encoded by a nuclear gene and participates in mitochondrial protein translation. In this study, we aimed to investigate the role of MRPL14 in thyroid cancer.Methods. We investigated the association between MRPL14 expression and clinicopathological features using The Cancer Genome Atlas (TCGA) and Chungnam National University Hospital (CNUH) databases. Functional studies of MRPL14, including proliferation, migration, invasion, mitochondrial oxidative phosphorylation and reactive oxygen species (ROS) production, were performed in papillary thyroid cancer (PTC) cell lines (B-CPAP and KTC-1).Results. Based on the TCGA dataset, PTC tissues lost mitochondrial integrity and showed dysregulated expression of overall mitoribosomal proteins (MRPs) compared with normal thyroid tissues. Of 78 MRPs, MRPL14 was highly expressed in thyroid cancer tissues. MRPL14 overexpression was significantly associated with advanced tumor stage, extrathyroidal extension, and lymph node metastasis. MRPL14 increased cell proliferation of thyroid cancer and promoted cell migration via epithelial-mesenchymal transition-related proteins. Moreover, MRPL14 knockdown reduced the expression of oxidative phosphorylation complex IV (MTCO1) and increased the accumulation of ROS. Cotreatment with a ROS scavenger restored cell proliferation and migration, which had been reduced by MRPL14 knockdown, implying that ROS functions as a key regulator of the oncogenic effects of MRPL14 in thyroid cancer cells.Conclusion. Our findings indicate that MRPL14 may promote cell growth, migration, and invasion by modulating ROS in thyroid cancer cells.

Background: Despite efforts to treat critically ill patients who require continuous renal replacement therapy (CRRT) due to acute kidney injury (AKI), their mortality risk remains high. This condition may be attributable to complications of CRRT, such as arrhythmias. Here, we addressed the occurrence of ventricular tachycardia (VT) during CRRT and its relationship with patient outcomes. Methods: This study retrospectively enrolled 2,397 patients who started CRRT due to AKI from 2010 to 2020 at Seoul National University Hospital in Korea. The occurrence of VT was evaluated from the initiation of CRRT until weaning from CRRT. The odds ratios (ORs) of mortality outcomes were measured using logistic regression models after adjustment for multiple variables.Results: VT occurred in 150 patients (6.3%) after starting CRRT. Among them, 95 cases were defined as sustained VT (i.e., lasting ≥30 seconds), and the other 55 cases were defined as non-sustained VT (i.e., lasting

The recent decline in pollinator abundance is a cause of concern for sustaining global food production. Several common weeds of managed turfgrass systems attract honey bees and other wild pollinators. Since turfgrass often requires treatment with insecticides that harm bees, best practices are needed to prevent bees from visiting weed-infested turf areas that will be treated for insect pests. Weed control tactics can protect pollinator exposure to insecticides by reducing the floral resources afforded to bees from turfgrass weeds. Three field studies were conducted in 2021 and 2022 to evaluate the effect of various herbicides and herbicide-formulation constituent on pollinator foraging and white clover floral morphology in managed tall fescue turfgrass. Treatments included a nontreated control; MCPP; 2,4-D; dicamba; Trimec Classic™ (2,4-D, MCPP, dicamba); Speedzone™ (carfentrazone, 2,4-D, MCPP, dicamba); and a herbicide-formulation consituent (inert ingredients of Speedzone™). All response variables were evaluated for 8 days, starting from one day before treatment and ending 6 days after treatment (DAT). The herbicide-formulation constituent did not alter white clover flower density, floral discoloration, floral quality, or insect visitation compared to nontreated plots. Herbicides reduced flower density and floral quality equivalently, but MCPP discolored white clover floral tissue 16% d-1 and less than all other herbicides except dicamba. Floral quality completely declined in approximately 5 d following any herbicide treatment. Bee visitation to white clover infested turf increase three bees min-1 for every 100 white clover blooms m-2. Honey bees and other insects vacated herbicide-treated areas in less than 2 d, despite minimal effects on floral quality and density at that time. The data suggest that practitioners could apply insecticides 2 d after auxin herbicide treatment and avoid harm to pollinators, but additional work is needed to directly measure pollinator exposure following such treatments.

In this paper, the modeling of SJ-MOSFETs beyond the voltage class of 3.3 kV simulated with verified deep aluminum box-like shaped profiles by using TCAD simulation is described. The simulation results are used to investigate the influence of ion implantation parameters on electrical characteristics. For the formation of pillar regions, high energy implantation is performed through energy filter with a multi epitaxial growth method using a patterned mask. While high thickness of epitaxial layer is indispensable for obtaining a high blocking capability, it is revealed that the optimization of doping concentration of p-pillar and drift layer parameters yields similar on-state-resistance by charge compensations of SJ-structure.

Cast A356(Al-Si-Mg) alloys are widely used in automotive and general applications because of their mechanical properties and castability. Al-Si-Mg-(Cu) alloys typically lose their strength above 170 o C due to coarsening of precipitates, which limits their application to components. To maintain their strength at elevated temperature, Al-Si-Mg-(Cu) alloys are modified by adding transitional metals. Several studies have been carried out to evaluate the effect of Zr addition on the high temperature mechanical properties of cast Al-Si alloys because Zr can form thermally stable phases such as Al3Zr. Despite the relative studies on the influence of Cu and Zr on the mechanical properties of cast Al-Si-Mg-(Cu) alloys, investigations of the effect of Zr on the phase transformations and the mechanical properties during heat treatment remains limited. In this study, the effects of added Cu and Zr on the phase transformations and the mechanical performance during heat treatment of A356 cast alloy were investigated. Needle-like and block-like (Al,Si)3(Ti,Zr) dispersoids formed as some Si and Ti replaced Al and Zr in Al3Zr crystal structures were generally observed. Furthermore, with increasing solution treatment time, the size of Zr dispersoids was reduced, and smaller Zr particles were precipitated at the same time, which caused a decrease in the area fraction of the Zr dispersoids. In addition, the metastable L12 structures of Zr dispersoids in Al-Si-Mg-Cu-Zr alloys were transformed into stable D023 during solution heat treatment as the Cu addition accelerated the transformation. Tensile and low-cycle fatigue (LCF) tests were performed to reveal the effects of (Al,Si)3(Ti,Zr) dispersoids on mechanical properties. As a result, elongation at elevated temperature was highly increased, while maintaining strength, according to the increase in solution heat treatment time, which improved low-cycle fatigue properties.

Background: Limited data are available on short-term dual antiplatelet therapy (DAPT) after percutaneous coronary intervention using third-generation drug-eluting stents with ultrathin struts and advanced polymer technology. We investigated whether 3- to 6-month DAPT was noninferior to 12-month DAPT after implantation of drug-eluting stents with ultrathin struts and advanced polymer technology. Methods: We performed an open-label, randomized trial at 37 centers in South Korea. We enrolled patients undergoing percutaneous coronary intervention using the Orsiro biodegradable-polymer sirolimus-eluting stents or the Coroflex ISAR polymer-free sirolimus-eluting stents. Patients with ST-segment–elevation myocardial infarction were excluded. Patients were randomly assigned to receive either 3- to 6-month or 12-month DAPT after percutaneous coronary intervention. The choice of antiplatelet medications was at the physician’s discretion. The primary outcome was a net adverse clinical event, a composite of cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization, stent thrombosis, or major bleeding, defined as Bleeding Academic Research Consortium type 3 or 5 at 12 months. The major secondary outcomes were target lesion failure, a composite of cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization, and major bleeding. Results: A total of 2013 patients (mean age, 65.7±10.5 years; 1487 males [73.9%]; 1110 [55.1%] presented with acute coronary syndrome) were randomly assigned to 3- to 6-month DAPT (n=1002) or 12-month DAPT (n=1011). The primary outcome occurred in 37 (3.7%) patients in the 3- to 6-month DAPT group and 41 (4.1%) in the 12-month DAPT group. The noninferiority of the 3- to 6-month DAPT group to the 12-month DAPT group was met (absolute risk difference, –0.4% [1-sided 95% CI, –∞% to 1.1%]; P P =0.94) or major bleeding (hazard ratio, 0.82 [95% CI, 0.41–1.61], P =0.56) between the 2 groups. Across various subgroups, the treatment effect of 3- to 6-month DAPT was consistent for net adverse clinical event. Conclusions: Among patients undergoing percutaneous coronary intervention using third-generation drug-eluting stents, 3- to 6-month DAPT was noninferior to 12-month DAPT for net adverse clinical event. Further research is needed to generalize this finding to other populations and to determine the ideal regimen for 3- to 6-month DAPT. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02601157.

Autonomous Vehicles (AVs) have the potential to increase efficiency, safety, environmental benefits, and equity in the transportation area. However, these benefits are not guaranteed until design, planning, policy, and implementation frameworks play their roles in bringing these benefits to the community. This paper presents a bibliometric and systematic review of the legislation on AVs in the U.S. to analyze the definition, evolution, and enacted legislation to help understand the current status of this research area and provide the future research direction. Investigation of existing legislation mainly focuses on 33 states in the U.S. that have enacted legislation, and the information from 2012 to 2022 was collected. Then, the collected information was categorized into seven categories for further analysis. From this study, the authors found out that state rules primarily govern testing rather than its general use. Even though testing is currently the top priority, the National Highway Traffic Safety Administration (NHTSA) anticipates AV legislation to evolve rapidly and desires to issue new regulations annually in preparation for deployment. There is a trend in going through the state governments implementing AV legislation by evaluating current laws and regulations to address unnecessary impediments to testing and deployment. This trend should have cooperated with all states to avoid a patchwork of inconsistent state laws. This study shows that the states have been moving toward passing legislation to test and enact policies to be ready to implement AVs on the highways.

Germinal matrix-intraventricular hemorrhage (GM-IVH) is among the devastating neurological complications with mortality and neurodevelopmental disability rates ranging from 14.7% to 44.7% in preterm infants. The medical techniques have improved throughout the years, as the morbidity-free survival rate of very-low-birth-weight infants has increased; however, the neonatal and long-term morbidity rates have not significantly improved. To this date, there is no strong evidence on pharmacological management on GM-IVH, due to the limitation of well-designed randomized controlled studies. However, recombinant human erythropoietin administration in preterm infants seems to be the only effective pharmacological management in limited situations. Hence, further high-quality collaborative research studies are warranted in the future to ensure better outcomes among preterm infants with GM-IVH.

Context: Ball velocity for baseball pitchers is influenced by a multitude of factors along the kinetic chain. While a vast amount of data currently exist exploring lower-extremity kinematic and strength factors in baseball pitchers, no previous study has systematically reviewed the available literature. Objective: The aim of this systematic review was to perform a comprehensive assessment of the available literature investigating the association between lower-extremity kinematic and strength parameters and pitch velocity in adult pitchers. Evidence Acquisition: Cross-sectional studies that investigated the association between lower-body kinematic and strength factors and ball velocity in adult pitchers were selected. A methodological index for nonrandomized studies checklist was used to evaluate the quality of all included studies. Evidence Synthesis: Seventeen studies met the inclusion criteria comprising a total of 909 pitchers (65%, professional, 33% college, and 3% recreational). The most studied elements were hip strength and stride length. The mean methodological index for nonrandomized studies score was 11.75 of 16 (range = 10–14). Pitch velocity was found to be influenced by several lower-body kinematic and strength factors including the following: (1) hip range of motion and strength of muscles around the hip and pelvis, (2) alterations in stride length, (3) alterations in lead knee flexion/extension, and (4) several pelvic and trunk spatial relationships throughout the throwing phase. Conclusions: Based on this review, we conclude that hip strength is a well-established predictor of increased pitch velocity in adult pitchers. Further studies in adult pitchers are needed to elucidate the effect of stride length on pitch velocity given mixed results across multiple studies. This study can provide a basis for trainers and coaches to consider the importance of lower-extremity muscle strengthening as a means by which adult pitchers can improve pitching performance.

Purpose: We developed a virtual reality (VR) program for use in pediatric nursing practicums to help nursing students learn to measure vital signs in children.Methods: The analysis, design, development, implementation, and evaluation model was employed between July 2021 and December 2021 at a university in South Korea. In the analysis phase, in-depth interviews were conducted with four nursing students, two nursing school graduates, and four experts. The topic and contents of the VR program were settled in the design phase. The VR program was developed and subsequently used and evaluated by 20 nursing students and four experts.Results: The contents of the VR program for pediatric nursing practicums included the measurement of vital signs in a newborn baby and a young child, as well as an evaluation system. The mean score for the nursing students' satisfaction with practice was 4.02 out of 5 points. The mean scores for overall satisfaction with the VR program were 4.15 and 4.79 out of 5 points for nursing students and experts, respectively.Conclusion: The VR program developed in this study allows nursing students to practice measuring vital signs in children, thus improving the students' clinical performance in pediatric nursing.

Objectives: We aimed to examine the relationship between alexithymia and sleep, independent of depression and anxiety.Methods: This cross-sectional study included participants who visited our sleep clinic between 2016 and 2022. In total, 142 participants (98 males and 44 females) were included, and they completed the Toronto Alexithymia Scale-20 (TAS-20). Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI) scores were also recorded. The relationship between alexithymia and sleep (PSQI, ISI, and ESS scores) was determined after controlling for demographic and psychological (Beck Depression Inventory and State Trait Anxiety Inventory-Trait) variables.Results: Individuals with alexithymia had significantly higher PSQI, ESS, and ISI scores than those without alexithymia. Correlation analysis showed significant correlations between the total TAS-20 score and ISI (r=0.321) and ESS (r=0.253) scores. In multivariate linear regression analysis, the total TAS-20 score (β=0.201; p=0.022) was significantly associated with the ESS score.Conclusions: Alexithymia was associated with the severity of insomnia and daytime sleepiness in adults. However, when considering depression and anxiety in multivariate analysis, alexithymia was significantly associated with daytime sleepiness; however, its relationship with the severity of insomnia was not significant.

Invasive Klebsiella pneumoniae syndrome is defined as community-acquired liver abscess and metastatic infections in the lung, soft tissue, and central nervous system (CNS) caused by hypervirulent Klebsiella pneumoniae. Metastatic CNS infection in invasive Klebsiella pneumoniae syndrome shows rapid clinical deterioration and a high mortality rate. We present a case of ventriculitis caused by invasive Klebsiella pneumoniae syndrome successfully treated with a timely diagnosis, immediate surgical intervention, and administration of antibiotics.