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In this paper, an integrated guidance and control approach is presented to improve the performance of the missile interception. The approach includes damping augmented system with attitude rate feedback to decrease the oscillation during the homing phase for missiles with low damping. In addition, physical constraints, which can affect the performance of the missile interception, such as acceleration limit, seeker’s look angle, and look angle rate constraints are considered. The integrated guidance and control problem is formulated as a convex quadratic optimization problem with equality and inequality constraints, and the solution is obtained by a primal–dual interior point method. The performance of the proposed method is verified through several numerical examples.

Nitrogen oxides (NOx; NO and NO2) are major air pollutants and can cause harmful effects on the human body. Electron Beam Flue Gas Treatment (EBFGT) is a technology that generates electrons with an energy of 0.5–1 MeV using electron accelerators and effectively processes exhaust gases. In this study, NOx was removed using an electron beam accelerator with spraying additives (NaOH and NH4OH). NO and NO2 were 100% and more than 94% removed, respectively, at an electron beam absorbed dose of 20 kGy and an additive concentration of 0.02 M (mol/L). In most cases, NOx was removed better with lower initial NOx concentrations and higher electron beam absorbed doses. As the irradiation strength (mA) of the electron beam increases, the probability of electron impact on the material accordingly rises, which may lead to increase removal efficiency. The results of the present study show that the continuous electron beam process using additives achieved more effective removal efficiency than either individual process (wet-scrubbing or EB irradiation only).

The impact of the severity of sarcopenic obesity (SO) in nonalcoholic fatty liver disease (NAFLD) on the risk of significant liver fibrosis or cardiovascular disease (CVD) remains unclear. We aimed to identify high-risk subjects with SO for significant liver fibrosis or CVD among subjects with SO and NAFLD.This multicenter, retrospective study involved 23,889 subjects with NAFLD who underwent a health screening program (2014-2020). Sarcopenia was defined based on gender-specific sarcopenia index cutoff using multi-frequency bioelectric impedance analysis. High-risk subjects with SO were defined as those with significant liver fibrosis by fibrosis-4 index2.67 or atherosclerotic CVD risk score20%. Multivariable logistic regression analysis for identifying high-risk subjects with SO was performed in a cross-sectional cohort with SO, and further validation was performed in a longitudinal cohort.SO prevalence was 5.4% (n = 1297 of 23,889). Older age (unstandardized beta [β] = 3.23; P.001), male (β = 1.66; P = .027), sarcopenia index (β = -6.25; P = .019), and metabolic syndrome (β = 1.75; P.001) were significant risk factors for high-risk SO. Based on a high-risk SO screening model, high-risk subjects with SO had significantly higher odds of significant liver fibrosis (training: adjusted odds ratio [aOR], 3.72; validation: aOR, 2.38) or CVD (training: aOR, 5.20; validation: aOR, 3.71) than subjects without SO (all P.001). In subgroup analyses, the cumulative incidence of significant liver fibrosis or CVD development was significantly higher in high-risk subjects with SO than in low-risk subjects with SO in a longitudinal cohort considering all-cause mortality and liver transplantation as competing risks (sub-distribution hazard ratio, 5.37; P.001).The high-risk screening model may enable the identification of high-risk subjects with SO with NAFLD.

Background aims IL-2 is a potent cytokine that activates natural killer cells and CD8+ cytotoxic T lymphocytes (CTLs) and has been approved for the treatment of metastatic renal cell carcinoma and metastatic melanoma. However, the medical use of IL-2 is restricted because of its narrow therapeutic window and potential side effects, including the expansion of regulatory T cells (Tregs). Methods In this study, the authors investigated the complementary effects of transforming growth factor-β2 (TGF-β2) anti-sense oligodeoxynucleotide (TASO) on the immunotherapeutic potential of IL-2 in a melanoma-bearing humanized mouse model. Results The authors observed that the combination of TASO and IL-2 facilitated infiltration of CTLs into the tumor, thereby potentiating the tumor killing function of CTLs associated with increased granzyme B expression. In addition, TASO attenuated the increase in Tregs by IL-2 in the peripheral blood and spleen and also inhibited infiltration of Tregs into the tumor, which was partly due to decreased CCL22. Alteration of T-cell constituents at the periphery by TGF-β2 inhibition combined with IL-2 might be associated with the synergistic augmentation of serum pro-inflammatory cytokines (such as interferon γ and tumor necrosis factor α) and decreased ratio of Tregs to CTLs in tumor tissues, which consequently results in significant inhibition of tumor growth Conclusions These results indicate that the application of TASO improves IL-2-mediated anti-tumor immunity, thus implying that blockade of TGF-β2 in combination with IL-2 may be a promising immunotherapeutic strategy for melanoma.

The binding mode to TAP (i.e., the peptide transporter associated with antigen processing) from a viral peptide thus far has been unknown in the field of antiviral immunity, but an interfering mode from a virus-encoded TAP inhibitor has been well documented with respect to blocking the TAP function. In the current study, we predicted the structure of the pig TAP transporter and its inhibition complex by the small viral protein ICP47 of the herpes simplex virus (HSV) encoded by the TAP inhibitor to exploit inhibition of the TAP transporter as the host's immune evasion strategy. We found that the hot spots (residues Leu5, Tyr22, and Leu51) on the ICP47 inhibitor interface tended to prevail over the favored Leu and Tyr, which contributed to significant functional binding at the C-termini recognition principle of the TAP. We further characterized the specificity determinants of the peptide transporter from the pig TAP by the ICP47 inhibitor effects and multidrug TmrAB transporter from the Thermus thermophillus and its immunity regarding its structural homolog of the pig TAP. The specialized structure-function relationship from the pig TAP exporter could provide insight into substrate specificity of the unique immunological properties from the host organism. The TAP disarming capacity from all five viral inhibitors (i.e., the five virus-encoded TAP inhibitors of ICP47, UL49.5, U6, BNLF2a, and CPXV012 proteins) was linked to the infiltration of the TAP functional structure in an unstable conformation and the mounting susceptibility caused by the host's TAP polymorphism. It is anticipated that the functional characterization of the pig TAP transporter based on the pig genomic variants will lead to additional insights into the genotype and single nucleotide polymorphism (SNP) in relation to antiviral resistance and disease susceptibility.

Background & Aims: Bacterial infections can trigger the development of organ failure(s) and acute-on-chronic liver failure (ACLF). Geographic variations in bacteriology and clinical practice could lead to worldwide differences in ACLF epidemiology, phenotypes and associated outcomes. Herein, we aimed to evaluate regional differences in bacterial infection-related ACLF in patients with cirrhosis admitted to hospital. Methods: This post hoc analysis included 1,175 patients with decompensated cirrhosis (with bacterial infection on admission or nosocomial infection) from 6 geographic regions worldwide. Clinical, laboratory and microbiological data were collected from the diagnosis of infection. Patients were followed-up for organ failure(s) and ACLF development according to the EASL-CLIF criteria from enrolment to discharge/death. Results: A total of 333 patients (28%) had ACLF at diagnosis of infection, while 230 patients developed ACLF after diagnosis of infection, resulting in an overall rate of bacterial infection related-ACLF of 48%, with rates differing amongst different geographic regions (38% in Southern Europe vs. 75% in the Indian subcontinent). Bacterial infection related-ACLF more frequently developed in younger patients (55 ± 13 vs. 58 ± 14 years), males (73% vs. 62%), patients with alcohol-related cirrhosis (59% vs. 45%) and those with a higher baseline MELD score (25 ± 11 vs. 16 ± 5) (all p

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers, with high mortality and recurrence rate. In this study, we generated a human immune system mouse model by transplanting human peripheral blood mononuclear cells into NSG-B2m mice followed by xenografting AsPC-1 cells, after which we assessed the role of transforming growth factor-β2 (TGF-β2) in T-cell-mediated anti-tumor immunity. We observed that inhibiting the TGF-β2 production by TGF-β2 antisense oligonucleotide (TASO) combined with IL-2 delays pancreatic cancer growth. Co-treatment of TASO and IL-2 had little effect on the SMAD-dependent pathway, but significantly inhibited the Akt phosphorylation and sequentially activated GSK-3β. Activation of GSK-3β by TASO subsequently suppressed β-catenin and α-SMA expression and resulted in attenuated fibrotic reactions, facilitating the infiltration of CD8 + cytotoxic T lymphocytes (CTLs) into the tumor. TGF-β2 inhibition suppressed the Foxp3 + regulatory T-cells in peripheral blood and tumors, thereby enhancing the tumoricidal effects of CTLs associated with increased granzyme B and cleaved caspase-3. Moreover, changes in the T-cell composition in peripheral blood and at the tumor site by TASO and IL-2 induced the increase of pro-inflammatory cytokines such as IFN-γ and TNF-α and the decrease of anti-inflammatory cytokines such as TGF-βs. These results indicate that the TGF-β2 inhibition by TASO combined with IL-2 enhances the T-cell mediated anti-tumor immunity against SMAD4-mutated PDAC by modulating the tumor-associated fibrosis, suggesting that TASO in combination with IL-2 may be a promising immunotherapeutic intervention for PDAC.

International guidelines recommend physical activity for subjects with nonalcoholic fatty liver disease (NAFLD). This study investigated the association of physical activity with risk of liver fibrosis, sarcopenia, and cardiovascular disease (CVD) in NAFLD.In this multicenter, retrospective study, 11,690 NAFLD subjects who underwent a health screening program and were assessed for physical activity (metabolic equivalent task [MET]-min/week) between 2014 and 2020 were recruited. Liver fibrosis was assessed by using the fibrosis-4 index, NAFLD fibrosis score, and FibroScan-AST score, sarcopenia by using multi-frequency bioelectric impedance analysis, and CVD risk by using atherosclerotic CVD (ASCVD) risk score, and coronary artery calcium (CAC) score were calculated.The prevalence of fibrosis, sarcopenia, high probability of ASCVD, and high CAC score significantly decreased with increasing quartiles of physical activity (all P for trend.001). In a fully adjusted model, physical activity above 600 MET-min/week (≥third quartile) was independently associated with a reduced risk of fibrosis (adjusted odds ratio [aOR] = 0.59; 95% confidence interval [CI], 0.40-0.86), sarcopenia (aOR = 0.72; 95% CI, 0.58-0.88), high probability of ASCVD (aOR = 0.58; 95% CI, 0.46-0.73), and high CAC score (aOR = 0.32; 95% CI, 0.13-0.83; all P.05). In addition, increasing amounts of physical activity were significantly associated with risk reduction between fibrosis, sarcopenia, and high probability of ASCVD (all P for trend.001). In subjects with sarcopenic obesity or lean NAFLD, physical activity was also independently associated with reduced risk of fibrosis and high probability of ASCVD (all P.05).Physical activity showed a protective effect against fibrosis, sarcopenia, and CVD in NAFLD.

Background Recently research on acupuncture for cancer related symptoms has significantly increased. To what extent have medical professionals recommended to use acupuncture in light of that evidence? Methods Evidence of effectiveness and safety was found by searching Pubmed for reviews to identify for what conditions and general results. Publications that recommend acupuncture in oncology were searched in the database of an ongoing general search for publications that recommend acupuncture. This database was developed by searching google for publications that recommend the use of acupuncture with the terms ‘name of symptom’ and ‘clinical practice guideline’ or ‘treatment guideline’. Results Acupuncture is moderately or weakly effective for 19 symptoms in patients with cancer and cancer survivors. Acupuncture is a safe therapy in cancer care if administered by trained acupuncturists. Acupuncture is targeted to improve symptoms associated with the cancer and different cancer treatments, not to treat the cancer itself. More than 350 publications by clinical practice guideline groups and expert groups, including public health statements made by national and government agencies recommended the use of acupuncture for 61 cancer related symptoms many with positive evidence of effectiveness. Conclusion The strength of evidence is weak for many indications, however the evidence for many standard therapies is either not very strong or if stronger, the incidence of adverse events is more, which makes acupuncture a treatment option despite the weak evidence. We have found evidence that many oncologists around the world have started to incorporate acupuncture into the treatment of various cancer related symptoms.

Among many contaminants of emerging concern, perfluorooctanesulfonate (PFOS) is widely known as one of the most difficult to decompose due to a very strong carbon-fluorine bond. Electron beam technology has been used to treat refractory compounds as a radical-based advanced oxidation process. Therefore, the aims of this study were to investigate the degradation efficiencies of PFOS with various initial concentrations and radiolytic products generated by PFOS decomposition using an electron beam, to improve the decomposition efficiency of PFOS using combined persulfate (S2O82−) and hydrogen peroxide (H2O2) with an electron beam, and to propose the radiolysis decomposition pathway of PFOS in aqueous solution. The results showed that the degradation efficiency of PFOS by the electron beam depended on the initial PFOS concentration. The addition of S2O82− with the electron beam increased the decomposition efficiency with increasing absorbed doses. The 0.1 mg/L PFOS (0.19 µM) in the presence of 5 mM S2O82− with the electron beam at a 100 kGy absorbed dose had a similar decomposition efficiency with that using only the electron beam at a 900 kGy absorbed dose. However, the addition of H2O2 was ineffective on the PFOS degradation in aqueous solution. Seven radiolytic products such as perfluorocarboxylic acids (PFCAs) were quantitatively confirmed using authentic standards among eight predicted radiolytic products. The radiolysis decomposition of PFOS can occur spontaneously in aqueous solution with the synergistic effects of e aq - and OH produced by electron beam irradiation. Therefore, the electron beam can be used as a viable process considering the decomposition efficiency and its degradation products.

Since the beginning of the Coronavirus disease 2019 (COVID-19) pandemic, various complementary and alternative medicines (CAMs) have been used in clinical practice. In this overview, we summarized the evidence for CAM interventions in the treatment of COVID-19 patients.For this overview, PubMed, Embase and Cochrane Library were searched from inception to October 2021. Systematic reviews (SRs) on the effectiveness and safety of CAM interventions for COVID-19 patients were located, and the MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) was used to evaluate the reporting quality of the included SRs. Keywords including COVID-19 and CAM interventions were used for locating SRs. For evidence mapping, we created a two-dimensional bubble plot that included the width and strength of the evidence for each CAM intervention and specific outcome.In this overview, we identified 24 SRs (21 for Traditional Chinese Medicine (TCM) medications, two for vitamin D and one for home-based activity). From the included SRs, TCM herbal medications were reported to show good results in decreasing the rate of disease progression (relative risk (RR) 0.30, 95% confidence intervals (CI) [0.20, 0.44]), time to the resolution of fever (standard mean difference (SMD) -0.98, 95% CI [-1.78, -0.17]) and rate of progression to severe COVID-19 cases (RR 0.34, 95% CI [0.18, 0.65]), but the evidence for other interventions did not show effectiveness with certainty. Gastric disturbance was a major adverse event of TCM medications.There is evidence that TCM medications are effective in the symptom management of COVID-19 patients. However, evidence for the effectiveness of most CAM interventions still needs evaluation.

Systematic reviews on traditional Chinese medicine (TCM) are constantly increasing. However, if these reviews are to be of practical value, the evidence needs to be relevant, valid, and adequately reported. Cochrane Systematic Reviews (CSRs) are considered as high-quality systematic reviews that can inform health care decision making. Our aim was to provide an overview of the scope, findings, quality and impact of CSRs on the benefits and harms associated with TCM interventions for the treatment and prevention of disease to provide new information for clinical practice and future research.The Cochrane Database of Systematic Reviews was searched up to May 2021, and descriptive characteristics were extracted. The correspondence between the questions asked in the CSRs and the available evidence, conclusions and certainty of findings (according to GRADE assessment), methodological quality (AMSTAR 2), and impact (Altmetric Attention Score [AAS], total citations by guideline, and total citations in Web of Science [WoS]) of CSRs were extracted. Tabular and graphical summaries of these descriptive characteristics were constructed.Of 104 CSRs on TCM identified, 70 diseases belonged to 16 disease systems and contained 1642 primary studies with 157,943 participants. Interventions included Chinese herbal medicine (n = 70), acupuncture (n = 28), TCM exercises (n = 4), and moxibustion (n = 2). Among 1642 primary studies, 662 studies included an intervention group treated with at least one TCM therapy and 980 studies included a combination of therapies. Promising outcomes from the 104 CSRs were divided into endpoint outcomes (34 diseases), doctor- or patient-reported outcomes (27 diseases), and surrogate outcomes (37 diseases). Despite the presence of promising outcomes, only 5/104 CSRs drew overall positive conclusions, 42 CSRs concluded the evidence was insufficient, and 54 failed to draw firm conclusions. GRADE assessments were reported in 41.3% of the CSRs, and the ratings were mostly low or very low. Comparing the questions asked and results obtained, there was frequently a lack of information about specific outcomes. Only 16 CSRs obtained results for all outcomes listed in the methods section. According to AMSTAR 2, 51 CSRs (49.0%) were of low quality. The total number of citations in the WoS was 2135 (mean ± SD: 20.8 ± 21.2), and 38.5% of the CSRs had been cited in guidelines 95 times.Although TCM is commonly used, evidence of its effectiveness remains largely inconclusive. Rigorous high-quality trials are needed to support the performance of high-quality reviews and to increase the evidence base. It is critical to emphasize quality over quantity in future TCM research.

Objectives: This study aimed to investigate the impact of adjuvant radiotherapy (RT) on survival outcomes in patients with intermediate-risk, early-stage cervical cancer who underwent radical hysterectomy (RH). Methods: From the cervical cancer cohorts of two tertiary hospitals, patients with 2009 FIGO stage IB-IIA who underwent primary RH between 2010 and 2018 were identified. Patients with intermediate-risk factors that met the Sedlis criteria were included. Survival outcomes were compared between the patients who received adjuvant RT (study group; n=53) and those who did not receive adjuvant treatment (control group; n=30). Results: Compared to the control group, the study group showed significantly better recurrence-free survival (RFS; 5-year survival rate, 85.6% vs. 61.0%; p=0.009). In multivariate analysis, adjuvant RT was associated with a significantly lower risk of disease recurrence (adjusted HR, 0.241; 95% CI, 0.082-0.709; p=0.010). In a subgroup that underwent open RH (n=33), adjuvant RT showed a trend toward improved RFS with borderline statistical significance (adjusted HR, 0.098; 95% CI, 0.009-1.027; p=0.053). However, in a subgroup of minimally invasive surgery (n=50), adjuvant RT did not improve RFS. Conclusions: In conclusion, the implementation of adjuvant RT significantly reduced the disease recurrence rate in patients with intermediate-risk, stage IB-IIA cervical cancer treated primarily with surgery. A survival benefit from adjuvant RT differed according to the surgical approach.

Objectives: To determine whether prognostic impact of lymph node ratio (LNR), defined as the ratio between the number of positive lymph nodes and removed lymph nodes, is different by the surgical approach of radical hysterectomy (RH) in node-positive, early-stage cervical cancer. Methods: We retrospectively identified 2009 FIGO stage IB1-IIA2 patients who underwent primary Type C RH between 2010 and 2018 at two tertiary hospitals. Among them, only those with pathologically proven lymph node metastases and received adjuvant radiation therapy were included. Each patient's LNR was calculated, and its prognostic significance was investigated according to the two surgical approaches, open surgery, and minimally invasive surgery (MIS). Results: In total, 55 patients were included in this analysis. All patients received concurrent chemoradiation therapy after surgery, and the median LNR (%) was 9.524 (range, 2.083-62.500). Based on receiver operating characteristic-curve analysis, the cut-off value for LNR (%) was determined as 8.831. Overall, patients with high LNR (≥8.831%; n=29) showed worse disease-free survival (DFS) than those with low LNR ( Conclusions: In patients with node-positive, early-stage cervical cancer, high LNR was associated with a significantly higher disease recurrence rate. This relationship was further consolidated among patients who received MIS RH.

Graves’ disease (GD) is the most common cause of hyperthyroidism. Anti-thyroid drugs, including methimazole, are the most commonly selected treatment option for this condition. But for decades, no additional drug option has been added. Anemarrhena Bunge has been used in many herbal decoctions for patients who had hyperthyroidism-like symptoms, such as sweating, heat intolerance, and anxiety. In this case study, a patient with GD who had once achieved therapeutic goals with methimazole but then re-developed hyperthyroidism was treated with only herbal decoctions, and achieved euthyroidism, normalization of T3, T4 levels for 13 months and maintenance of thyroid stimulating hormone (TSH) levels for 8 months and TSH binding inhibitory immunoglobulins (TBII)-negative status for 13 months (TSH and TBII level before treatment: 0.01 μIU/mL, 10.94 IU/L; TSH level normalization after 14 months from the initiation of the treatment: 0.75 μIU/mL, TBII level normalization after 9 months from the initiation of the treatment: 0.8 IU/L). The patient did not report any adverse effects related to this treatment. A herbal decoction with Anemarrhena Bunge might be effective in patients who are resistant to methimazole treatments, a finding which needs further investigation in future.

Perfluorooctane sulfonate (PFOS) has been found in wastewater treatment plants (WWTPs) and in surface water as a result of domestic uses of textiles, electronics, and surfactants. The detection of PFOS in the aqueous environment has been linked to hazardous biological effects including estrogenicity and genotoxicity. To provide an alternative to conventional processes, one of the radical-based advanced oxidation and reduction processes being tested for treatment of refractory compounds in water, involves the use of an electron beam. Therefore, the aims of this study were to investigate the degradation efficiency of PFOS (100mg/L) by electron beam, to evaluate the predicted toxicity of the radiolysis products using the ECOSAR model, and to identify the radiolytic products of PFOS. As a result of using the ECOSAR model, the toxicity levels of by-products after electron beam treatment were reduced by decreasing the carbon-chain number of PFOS. The molecular structures of the radiolytic products were elucidated using authentic standards via liquid chromatography and tandem mass spectrometry, and by the interpretation of MS2 fragmentation patterns of each product using liquid chromatography with quadrupole time of-flight mass spectrometry (LC-QTOF-MS). In total, ten radiolytic products were confirmed by LC-MS/MS, HPLC, and IC data matching with commercial standards. The two radiolytic substances produced during irradiation with an electron beam were predicted by LC-QTOF-MS. This study led to an understanding of the role of electron beams in the transformation of parent compounds and to the decomposition products created when an electron beam is applied to treat perfluorinated compounds.

In this study, a single-domain antibody against negative regulatory factor (anti-NEF scFv) was autodisplayed on the outer membrane of Escherichia coli and used to detect NEF in an immunoassay based on fluorescence-activated cell sorting, enzyme-linked immunosorbent assay, and surface plasmon resonance biosensors. Next, the autodisplayed single-domain antibody was oxidized to form disulfide bonds by using glutathione, and the change in NEF-binding activity of anti-NEF scFv was analyzed by fluorescence-activated cell sorting-based immunoassay, chromogenic immunoassay, and surface plasmon resonance biosensor. For each type of immunoassays the anti-NEF scFv on the isolated outer membrane showed more NEF binding activity after the disulfide bond formation by glutathione. To determine the role of cysteines in anti-NEF scFv, three mutants were prepared, and the NEF binding activity of mutants was compared with that of wild-type anti-NEF scFv in a competitive immunoassay based on FACS. In these mutant studies, the refolding process of autodisplayed anti-NEF scFv by following oxidation via GSH/GSSG revealed that disulfide bonds formed and increased NEF binding activity.

Genome-wide association studies (GWASs) have been extensively utilized to identify economically important trait loci in livestock animals. We performed a GWAS on Yorkshire sows for reproduction traits (the number of piglets born alive;NBA, the total number of piglets born;TNB, the weight shortfall number, the total number of suckling piglets, and the number of pigs weaned). A total of 1061 sows were genotyped using the Illumina PorcineSNP60 BeadChip. Principal component analysis revealed no significant population stratification. We identified a total of 15 single nucleotide polymorphisms (SNPs) of which only one reached the Bonferroni level of significance (P

Acute compartment syndrome (ACS) after tibial fracture carries a risk of various complications, including infection, delayed union, nonunion, nerve damage, and poor prognosis. For the treatment of fractures with ACS, fasciotomy is conducted, and the method to stabilise the fracture has to be considered. Thirty-five patients who underwent surgery for ACS with tibial shaft fractures were evaluated, and the results of initial internal fixation (Group I, 20 patients) and initial external fixation (Group II, 15 patients) were analysed. The mean age was 41 years. Five patients needed additional surgery for bone union. Complications occurred in 4 cases, but no deep infection was reported. The time to bone union, the need for additional surgery, and the incidence of complications in Group I and Group II were not statistically different. For the treatment of ACS with tibial fracture, immediate internal fixation and changing from external fixation to internal fixation did not affect the clinical course.

Introduction The number of published systematic review protocols (SRPs) has been increasing and is emerging as a new research trend. The aims of this study were (1) to investigate current publication practice regarding SRPs using acupuncture as an example and (2) to evaluate whether or not publication of an SRP reduces reporting bias and promotes publication of a systematic review (SR). Methods SRPs on acupuncture in non-Cochrane medical journals were located through Ovid MEDLINE and EMBASE databases searching (up to January 2020) and corresponding published SRs were hand-searched. The publication trends and differences between published SRPs and SRs subsequently published was evaluated in a descriptive manner. Results The annual number of published SRPs has increased since 2014. An electronic database search yielded 153 published SRPs; however, only 20 of these (about 13%) were followed up with SRs in the journals with a median interval between the SRP and SR of about 8 months (interquartile range 6, 22.5). Publication year was a significant predictor of publication of a completed SR after publication of an SRP (p = 0.001); the odds of publication of an SR were estimated to decrease by 47.7% annually. The reporting quality of SRPs was not related to the publication of completed review. Many published SRs deviated from the SRP without explanation. Conclusion Although the number of SRPs being published is increasing, few are followed by a completed SR and often include unexplained deviations in methodology. Research in other disciplines is necessary to confirm the generalizability of our findings.

The doxorubicin-conjugated O -carboxymethyl chitosan (OCAD) was synthesized by hydrazone bond and transferrin was introduced to OCAD for targeted cancer therapy. The OCAD was analyzed by 1 H NMR and, diameter of OCAD and TPOCAD were confirmed 230 nm and 250 nm by DLS, respectively. The release profile of OCAD showed that acidic pH was rapidly released than neutral pH. To compare cellular uptake of OCAD and TPOCAD, its internalization was analyzed by CLSM. In addition, cytotoxicity of TPOCAD was accomplished by MTT assay. Therefore, TPOCAD-polymeric drug has a potential ability as drug delivery system for effective chemotherapy against cancer cells.

Introduction Evidence-based medicine (EBM) has become an important part of medical education. Students’ perception and demand are important in education. The aim of our study was to conduct a nationwide online survey about EBM in traditional Korean Medicine (KM) education. Methods An online questionnaire was developed, comprising categories about EBM education in KM. Student’s experience, achievement, satisfaction, understanding and expectation in EBM education were surveyed. Face validity of the developed questionnaire was tested before survey and online links were sent through SurveyMonkey to all KM college students in Korea. Results Among the total 4649 students nationwide, 1292 agreed to participate in the survey (response rate: 27.8%) within 10 days. Self-appraisals about the achievement, satisfaction, and understanding of EBM were relatively low. In addition to this, 30% of students answered they did not learn about EBM in regular school curriculum. Expectation of extension of further EBM education curriculum was comparatively high. Most respondents agreed that EBM knowledge would be useful for clinical practice and the undergraduate curriculum. Barriers to enhance EBM education were perceived to be lack of resources and appropriate contents. Conclusion This first nationwide survey in Korea investigated the experience, perception, and demand for EBM education by KM college students. The importance of EBM education in the KM curriculum needs further improvement and curriculum development based on the students' experiences and perceptions. Additionally, online survey in smartphone environment, which was conducted thorough involvement of student’s representatives seems to be an eligible strategy for a survey of students.

Introduction Moxibustion is the burning of mugwort used to stimulate acupuncture points on the skin. In traditional East-Asian medicine, moxibustion is often used as a non-drug treatment for idiopathic Parkinson's disease (IPD). The aim of this systematic review was to evaluate the effectiveness and safety of moxibustion therapy to treat IPD. Methods The following electronic databases were searched for studies published in or before December 2016: Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, OASIS (Korean database), and CNKI (Chinese database). Two researchers conducted the data extraction and risk of bias assessments. Results From the results, a total of 10 studies (644 IPD patients) were included in this review. Overall methodological quality was not high and all studies included small numbers of participants which could not ensure the rigor of the synthesized evidence. There was a considerable clinical heterogeneity in terms of patient’s population, moxibustion types and control group interventions. Compared with control group, moxibustion did not show significant difference in the overall effectiveness ratio (RR 1.20, 95% CI [1.00, 1.44]). About the total unified Parkinson’s disease rating scale (UPDRS) score, however, there was significant difference between moxibustion and control interventions (MD −8.75, 95% CI [−12.54, −4.95]). Adverse events related to moxibustion treatment were not reported in most of the studies. Conclusions Evidence on the benefit and harm of moxibustion therapy for IPD was not conclusive due to methodological problems and small sample sizes among the included studies. More rigorous clinical studies will be necessary in future.

Decomposition of SF6 and its by-products by ionizing radiation were investigated. The SF6 concentration was decreased as the ionizing radiation intensity increased. When the initial concentration of SF6 increased, the removal efficiency of SF6 was decreased. As a result, the ionizing radiation intensity and initial concentration were the influencing factor in the treatment process. The deposited particles and aerosol particles on effluent pipeline and HEPA filters were characterized by scanning electron microscopy (SEM) with the energy dispersion spectrum analysis (EDS), attenuated total reflectance/Fourier transform infrared spectroscopy (FTIR-ATR) and X-ray photoelectron spectroscopy (XPS). The amount of aerosol particles in the HEPA filter was influenced by the ionizing radiation intensity. The detected species in the HEPA filter are S-S, SF5, SOF2, SF4, SO2F2, S=O and SOF4 by FTIR-ATR. This means that the SFx compounds formed by ionizing irradiation still existed. When we compared with results of removal characteristics using plasma, the input energy of ionizing radiation process was 3–37 times higher than that of plasma. However, the required energy of ionizing radiation process for 1 g of SF6 removal was 16–160 times lower than the other processes. It is evident that the ionizing radiation process was more efficient process than that of plasma.

Background Pediatric patients with olecranon fractures are uncommon. The tension band suture technique was introduced to reduce the burden of implant removal and other complications. However, to our knowledge, early range of motion (ROM) exercise has not been introduced in this population of patients. Double Vicryl loops and knots with 2 cross-pins are used to maintain the benefits of the tension band suture technique and to enhance fixation tensile strength. We believe that early ROM exercises could be achieved without nonunion or fixation failure. Methods Twelve pediatric patients with olecranon fractures were treated with tension band suture with double loops and knots between 2004 and 2015. Vicryl No. 1 was used for wiring. ROM exercises were initiated 1 week postoperatively with a customized functional brace. Early functional outcomes were evaluated by the Mayo Elbow Performance Score at every visit after 8 weeks postoperatively. Results Nine boys and 3 girls (average age, 10.6 years; range, 5 years 7 months–16 years 2 months) were included in the study. Initial displacement and angulation of the fractures were 5 mm (2-7 mm) and 12° (4°-25°), respectively. Two cases had radial neck fractures of the ipsilateral elbow. All patients had a perfect Mayo Elbow Performance Score after 8 weeks postoperatively. Pin removals were performed at 13.1 weeks. No complications, including growth arrest, were observed. Discussion/Conclusion Tension band suture with double loops and knots, combined with early ROM exercise, may be a complete alternative to tension band wiring.

This study examined the use of microbial community structure as a bio-indicator of decomposition levels. High-throughput pyrosequencing technology was used to assess the shift in microbial community of leachate from animal carcass lysimeter. The leachate samples were collected monthly for one year and a total of 164,639 pyrosequencing reads were obtained and used in the taxonomic classification and operational taxonomy units (OTUs) distribution analysis based on sequence similarity. Our results show considerable changes in the phylum-level bacterial composition, suggesting that the microbial community is a sensitive parameter affected by the burial environment. The phylum classification results showed that Proteobacteria (Pseudomonas) were the most influential taxa in earlier decomposition stage whereas Firmicutes (Clostridium, Sporanaerobacter, and Peptostreptococcus) were dominant in later stage under anaerobic conditions. The result of this study can provide useful information on a time series of leachate profiles of microbial community structures and suggest patterns of microbial diversity in livestock burial sites. In addition, this result can be applicable to predict the decomposition stages under clay loam based soil conditions of animal livestock.

PURPOSE . To evaluate the prognostic value of metabolic parameters derived from serial 18 F fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with advanced epithelial ovarian cancer (EOC). METHODS . Thirteen patients with advanced EOC who received surgical staging and adjuvant platinum-based combination chemotherapy were prospectively enrolled. 18 F–FDG PET/CT was performed before and after the surgical staging, and after third cycle of chemotherapy. Tumor glucose metabolism at baseline and its change after operation and third cycle of chemotherapy such as changes of maximum standardized uptake values (ΔSUV max ) via 18 F–FDG PET/CT were measured, and assessed regarding their ability to predict recurrence. RESULTS . Median duration of progression-free survival (PFS) was 25 months (range, 13–34), and although optimal debulking was performed in 10 patients, 5 (38.5%) patients experienced recurrence. Univariate analyses showed significant associations between recurrence and low ΔSUV max after surgical staging, and low SUV max change after third cycle of chemotherapy. Multivariate analysis identified low ΔSUV max after third cycle of chemotherapy as an independent risk factor for recurrence ( P =.047, hazard ratio (HR) 16.375, 95% CI 1.041–257.536). Kaplan–Meier survival curves showed that PFS significantly differed in groups categorized based on ΔSUV max after chemotherapy ( P= .001, log-rank test). CONCLUSIONS . 18 F–FDG PET/CT allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after chemotherapy. The metabolic response measured as ΔSUV max after third cycle of chemotherapy appears to be promising predictor of recurrence in patients with advanced EOC.

Introduction Based on a structured, rigorous methodology developed for creating evidence-based clinical practice guidelines (CPGs), the Korean Institute of Oriental Medicine and Korean Acupuncture and Moxibustion Medicine Society developed a guideline for treating acute ankle sprain using acupuncture which is part of Korean medicine (KM). Methods Using a revised Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, the committee based these recommendations on a systematic review of randomized controlled trials on any form of acupuncture used for ankle sprains published up to July 2015. Accessible sources relating to ankle sprain were collected, and a systematic review and meta-analysis were applied to the collected data. The quality of evidence was graded, and the recommendations were drafted and then finalized after official approval. Results For this CPG, six clinical questions and recommendations that were primarily related to manual acupuncture methods were addressed. Four were related to manual acupuncture alone, of which one focused on electroacupuncture and another on pharmacopuncture. Clinical outcomes evaluated were pain reduction using a visual analogue scale (VAS) or the numeric rating scale and improved cure rates, joint position sense, kinesthesia, and range of motion. Manual acupuncture was thus recommended as grade A treatment for alleviating VAS-graded pain. Conclusions The guideline for treating ankle sprain establishes a standard procedure to ensure high-quality medical care for ankle sprain that could be applied globally to patients seeking KM. It also supports international traditional medicine research methodology. When further clinical research is conducted, this CPG can be updated, adding value to its content.

Sulfamethoxazole (SMX) is a widely prescribed pharmaceutical compound to treat bacterial infections in both human and animals. As an alternative treatment process for non-degradable pharmaceuticals by conventional water treatment processes, radiolysis using gamma radiation has been applied as one of the radical-based advanced oxidative processes. However, further information was limited with regard to the production mechanism and fate of radiolytic products after treatment. Therefore, the degradation characteristics of SMX using ionizing radiation were investigated in this study. In addition, some radiolytic products of SMX were identified, and a degradation pathway as a result of the radiolysis of SMX was proposed. The radiolytic products were analyzed using liquid chromatography quadrupole time-of-flight mass spectrometry, liquid chromatography tandem mass spectrometry, and ion chromatography. Molecular structures of the radiolytic products were elucidated by the interpretation of MS2 fragmentation patterns of each product. In total, fifteen products were elucidated as a result of ionizing radiation treatment of aqueous SMX in the range 0.1–5.0 kGy. Hydroxylation, bond-cleavage, and the combined mechanism of cleavage and transformation were proposed as the predominant mechanisms, inducing the various radiolytic products. In particular, based on the comparison of the relative intensity and the quantified concentration using authentic standards, RP270-1 (hydroxylated SMX) and RP172 (sulfanilic acid), RP99 (3-amino-5-methylisoxazole), and RP96 (sulfate) were the most abundant products. Chromatographic profiles of radiolytic products also revealed the change of major products with increasing absorbed doses, from compounds that have high molecular weight (MW), to relatively lower MW. The results of this study lead to an understanding of the role of ionizing radiation on the fate of the parent compound and its degradation products when applied to pharmaceutical pollutants.

Electron beams are a promising technology for treating a large amount of air pollutants with high energy for a fast reaction time. For these reasons, the electron beams have been employed to control NOx (NO and NO2) and SO2 generated from stationary emission sources. In recent years, NH3 was commonly added in the electron beam process to achieve a high removal performance for NOx and SO2. However, the development of economically efficient and effective additives is still required to overcome relatively low removal ability for NOx. In this study, various experimental parameters that affect the removal efficiency of NOx and SO2 based on electron beam technology were investigated. To obtain an optimal removal efficiency, three different types of parameters such as additives, absorbed doses, and initial concentrations were evaluated. The average removal efficiency of 200 ppm NOx and SO2 was 46.7% at an absorbed dose of 20 kGy when NH4OH was used as an additive. However, the average removal efficiency (80.6%) of NOx and SO2 increased additionally up to 33.9% when the NaOH additive was added in an electron beam process. The removal efficiency of NOx and SO2 increased systematically with an increasing absorbed dose or decreasing initial concentration. Among the various experimental parameters, the type of additives was the most influential factor on the removal efficiency, especially for NOx, in an electron beam process.

Introduction Signs/symptoms of blood stasis syndrome (BSS) in standard instruments from China, Korea and Japan show variability but there are reasons to suspect that there may be differences between non-Asian and Asian patients. A literature review was conducted to investigate these issues. Methods Two searches were conducted: Searching for texts describing BSS signs/symptoms ensuring inclusion of Asian origin texts (principally Chinese) and Western origin texts (Study one). Electronic databases were searched to identify BSS scientific studies describing BSS signs/symptoms (Study two). More commonly mentioned signs/ were compared. Results Study one: From the 21 included texts, six signs/symptoms were generally agreed upon, two more commonly mentioned in Western origin texts, three more commonly mentioned in Chinese origin texts. Study two: Comparing signs/symptoms only three were mentioned by more than half of the 13 studies. In a comparison of signs/symptoms most commonly mentioned across the Western and Chinese origin texts and the Asian instruments/studies, only dark tongue was generally agreed upon, with five others more weakly agreed upon. Three were commonly agreed upon by two of the three source types with one more commonly mentioned in texts of Chinese and one by Western origin and five by Asian instruments/studies. Conclusion English language texts and studies describing BSS signs/symptoms were examined. Evidence of agreement on a few signs/symptoms were identified. English origin texts showed differences to texts originating from Asia, which may support the hypothesis that BSS may manifest differently among Western and Asian patients.

To investigate the mutual effects of knowledge management (KM) strategies on firm performance, we categorize the portfolios of KM strategies into four patterns: unrelated (scope- and type-based), related, extended, and high diversity portfolios. An inverted U-shaped relationship of KM diversity and firm performance is proposed across the portfolios based on the underlying cost–benefit tradeoffs. Supermodularity test results indicate that strategies of unrelated diversity portfolios show substitutable effects, whereas strategies of related diversity portfolios have complementary effects on firm performance. While strategies of extended diversity portfolios exhibit mixed results with complementary and substitutable effects, strategies of high diversity portfolio exhibit a substitutable effect. Our findings indicate that multiple KM strategies, as a firm’s portfolio, mutually generate complementarities or cause substitutabilities in improving firm performance. We also discuss practical implications for managerial decisions on successful KM.

Introduction Traditional Korean medicine (TKM) has a long history in the treatment of infertility. Many infertile couples are choosing TKM as a primary or adjuvant therapeutic tool to treat infertility in Korea. The purpose of this review was to summarize and evaluate the results on effectiveness and safety from literature published on traditional Korean medicine (TKM) infertility support programs with regards to spontaneous pregnancy rates (SPR) in infertile women in Korea. Methods Pertinent studies and reports conducted from 2009 to 2015 were collected from the Association of Korean Medicine. The primary outcome was live birth rate (LBR); the secondary outcomes were clinical pregnancy rate (CPR), ongoing pregnancy rate (OPR), adverse events (AEs). Results Seven prospective studies (324 participants) were identified. We found that the total LBR (three studies, n = 90) was 21.1%, OPR (five studies, n = 236) was 18.6%, and CPR (six studies, n = 277) was 24.9% after TKM treatment for three to six months. Only one study reported mild AEs of constipation, nausea, and heartburn. Conclusions This review suggests that TKM could be an effective option for infertile women. Further rigorously designed studies are needed to confirm the effectiveness and safety of TKM treatment in infertile women.

Multigenerational bioaccumulation and biotransformation activity and short-term kinetics (e.g., uptake and depuration) of propranolol in Daphnia magna were investigated at environmental concentration. The body burden and the major metabolite, desisopropyl propranolol (DIP), of propranolol were quantified using LC-MS/MS at the end of each generation after exposure for 11 generations. The accumulation of propranolol in D. magna at an environmental concentration of 0.2 μg/L was not much different between the parent (F0) and the eleventh filial (F10) generation. However, at 28 μg/L, its accumulation was 1.6 times higher-up to 18.9 μg/g-in the F10 generation relative to the F0. In contrast to propranolol, DIP intensity gradually increased from F0 to F10 at 0.2 μg/L, reflecting an increase in detoxification load and biotransformation performance; no increasing trend was observed at 28 μg/L. The bioaccumulation factor (BAF) showed higher values with a lower concentration and longer period of exposure. The average values of the BAF for 21 days of long-term exposure in successive 11 generations were 440.4 ± 119.7 and 1026.5 ± 208.6 L/kg for 28 μg/L and 0.2 μg/L, respectively. These are comparable to the BAF of 192 for the short-term 72-h exposure at 28 μg/L in the parent generation. It is also recommended that future studies for pharmaceutical ingredients be conducted on drug-drug interaction and structural characteristics on the prediction of biotransformation activity and bioaccumulation rate.

Inhibition of xanthine oxidase (XO) has obviously been a central concept for controlling hyperuricemia, which causes serious and painful inflammatory arthritis disease such as gout. We discovered a series of novel 2-(indol-2-yl)thiazole derivatives as XO inhibitors at the level of nanomolar activity. Structure-guided design using molecular modeling program (Accelrys Software program) provided an excellent basis for optimization of 2-(indol-2-yl)thiazole compounds. Structure-activity relationship indicated that hydrophobic alkoxy group (isopropoxy, cyclopentoxy) at 5-position and hydrogen binding acceptor (NO2, CN) at 7-position of indole ring appear as critical functional groups. Among the compounds, 2-(7-nitro-5-isopropoxy-indol-2-yl)-4-methylthiazole-5-carboxylic acid (9m) exhibits the most potent XO inhibitory activity (IC50 value: 5.1 nM) and the excellent uric acid lowering activity in potassium oxonate induced hyperuricemic rat model.

Background This study aims to review the current quantity and quality of case reports and case series published by clinical doctors who worked in local Korean medicine clinics. Methods Seven electronic databases, one in English and six in Korean, were searched for case studies authored by clinically-based Korean Medicine doctors (KMDs) and published in academic journals between January 2000 and December 2018. The following data were extracted: the number of cases per article, authorship order, types of academic journals, the number of articles published in the domestic or international academic journals by publication year, citation counts, and classification of diseases. We assessed the quality of the reports based on 28 items from the CAse REport (CARE) checklist. Results A total of 266 case reports or case series met the inclusion criteria. There were 125 articles (47.0%) in which all authors consist of who worked in Korean medicine clinics. The overall increase in the number of published articles by year showed a sharp increase after 2010. Articles were focused primarily on Korean medicine therapeutic and diagnostic approaches. The most commonly reported cases were diseases of the skin (346 or 40.9%). Overall, the quality of the reports was acceptable (75.3%) but several items such as diagnostic challenges, patient perspective, informed consent, intervention adherence and tolerability, and adverse events were substantially underreported. Conclusions To improve disease diagnosis and treatment, KMDs in clinical practice should be encouraged to report and publish case studies, using the CARE checklist to ensure quality.

Introduction Thread-embedding acupuncture (TEA) has characteristics that use absorbable medical threads and stimulate tissues and muscles in mechanical and chemical ways. Various studies have proven its therapeutic effect in experimental, as well as clinical trials. However, there remains insufficient evidence to clarify its efficacy and safety for the treatment of lumbar herniated intervertebral disc (LHIVD). Methods An electronic search for randomized controlled trials that compared the effects of TEA on LHIVD with other conventional treatments from its inception to October 2019 was conducted. Outcome measures were defined as the change in pain intensity and functional status or disability. A quality assessment by the Cochrane’s risk of bias tool and a Meta-analysis by Review Manager software was performed. Results Eighteen articles with 2237 participants were identified. Twelve articles compared the single effect of TEA with other therapy and showed significant improvement in visual analogue scale and curative rates. Six articles compared the added effect of TEA with other single therapies and also showed significant improvement in curative rates. Both single and combined TEA treatments showed significant improvement over other therapy including various types of acupuncture, integrative treatments, herbal medicine, chuna, traction, and injections. There were no reports of serious adverse events. Conclusions Our results indicated that TEA showed potential benefits on LHIVD. However, it is difficult to draw a conclusion with certainty due to the poor quality of the identified articles. More rigorously designed studies would be needed. Registration PROSPERO (CRD42019133060).