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Objective To evaluate the effect of combined hyperbaric oxygen therapy (HBOT) and steroid therapy in severe idiopathic sudden sensorineural hearing loss (ISSNHL). Methods Between January 2010 and July 2017, we evaluated 218 patients with ISSNHL and divided them into 2 groups: those with hearing loss greater than 80 dB and those with hearing loss of 60-79 dB. Each group was further divided into 3 groups according to the treatment method: oral steroids alone (PO), PO+intratympanic injection (IT), and PO+IT+HBOT. The treatment effect was evaluated for improvement in hearing thresholds at mid-term (3 weeks later) and final term (2 months later). Results When comparing the 3 treatment groups within the group that had a hearing loss greater than 80 dB, no differences were observed in the gaps in hearing thresholds and in the duration of improvement (P = .0764 and .2938, respectively). However, in the group with 60-79 dB hearing loss, the gaps in hearing thresholds at mid-term were 27.50 dB in the PO group, 38.13 dB in the PO+IT group, and 51.25 dB in the PO+IT+HBOT group. The treatment was more effective and faster in the initial period in the PO+IT+HBOT group than in the other groups. In addition, the results of frequency analysis showed greatest treatment efficacy at low frequencies of hearing. Conclusion Patients with ISSNHL above 80 dB are less likely to recover hearing even after PO+IT+HBOT. However, this treatment initially accelerates recovery in patients with a hearing loss below 80 dB. Therefore, the appropriate indication for HBOT benefits in patients with severe or profound ISSNHL should be reviewed.

Objective Infection is one of most devastating complications in ventriculoperitoneal (VP) shunt surgery. Preoperative hair removal has traditionally been performed to reduce infectious complications. We performed VP shunt surgeries and evaluated the prevalence of infection in patients who were shaved and those who were unshaven. Methods A retrospective analysis was conducted of 82 patients with hydrocephalus of various pathologies who underwent VP shunt surgery, with or without having the head shaved, between March 2010 and March 2017. For patients in the non-shaved group (n=36), absorbable suture materials were used for wound closure, and Nylon sutures or staples were used in the shaved group (n=46). We evaluated the infection outcomes of patients in the two groups. Results There was no difference in the average age of patients in the two groups. In the non-shaved group, there were no infections, while two patients in the shaved group required revision because of shunt infection. Conclusion Non-shaved shunt surgery may be safe and effective, with no increase of infection rate. We recommend that shunt procedures could be performed without shaving the hair, which may increase patients' satisfaction without increasing infection risk.

Hernandez, DJ, Healy, S, Giacomini, ML, and Kwon, YS. Effect of rest interval duration on the volume completed during a high-intensity bench press exercise. J Strength Cond Res XX(X): 000-000, 2020-Between-set rest intervals (RIs) are one of the most important variables in resistance training; however, no known research has investigated the effects of RIs greater than 5 minutes during high-intensity strength training. The purpose of this research was to examine the effects of 3 different RIs on repetition sustainability and training volume (sets × reps × resistance) during a high-intensity bench press exercise. Fifteen resistance-trained male subjects (mean ± SD, age = 25.5 ± 4.5 years, and bench press 1 repetition maximum [1RM] ratio [1RM/body mass] = 1.39 ± 0.1) completed 3 experimental sessions, during which 4 sets of the bench press were performed with 85% of 1RM load. Subjects performed the bench press using 3 different RIs in a random counterbalanced design. Data were analyzed using both a one- and two-way analysis of variance with repeated measures. As sets progressed, repetitions were significantly different (p < 0.05) between all RIs, and only the 8-minute RI (p < 0.05) allowed for the complete sustainability of repetitions over 4 consecutive sets. Subjects attained the greatest training volume (p < 0.05) using an 8-minute RI between sets compared with a 2- or 5-minute RI. Similarly, a significantly greater training volume was achieved using the 5-minute RI compared with the 2-minute RI. Resistance-trained men, with the goal of greater volume during strength training, would benefit from longer RIs, specifically using an 8-minute RI between 4 consecutive sets of a bench press exercise.

Jeong Bae Ko,1,&ast; Kwang Bok Kim,1,&ast; Young Sub Shin,1 Hun Han,1 Sang Kuy Han,2 Duk Young Jung,3 Jae Soo Hong1 1Digital Health Care R&D Department, Korea Institute of Industrial Technology, Cheonan, Chuncheongnam-do, South Korea; 2Robotics R&D Department, Korea Institute of Industrial Technology, Ansan, Gyeonggi-do, South Korea; 3Seongnam Senior Experience Complex, Eulji University, Seongnam, Gyeonggi-do, South Korea&ast;These authors contributed equally to this workCorrespondence: Jae Soo HongDigital Health Care R&D Department, Korea Institute of Industrial Technology, Cheonan, Chuncheongnam-do, South KoreaTel +82 41-589-8412Fax +82 41-589-8413Email jshong94@kitech.re.krDuk Young JungSeongnam Senior Experience Complex, Eulji University, Seongnam, Gyeonggi-do, South KoreaTel +82 41-589-8412Email dyjung@eulji.ac.krPurpose: Sarcopenia is a symptom in which muscle mass decreases due to decreasing in the number of muscle fibers and muscle cross-sectional area as aging. This study aimed to develop a machine learning classification model for predicting sarcopenia through a inertial measurement unit (IMU)-based physical performance measurement data of female elderly.Patients and Methods: Seventy-eight female subjects from an elderly population (aged: 78.8± 5.7 years) volunteered to participate in this study. To evaluate the physical performance of the elderly, the experiment conducted timed-up-and-go test (TUG) and 6-minute walk test (6mWT) with worn a single IMU. Based on literature review, 132 features were extracted from collected data. Feature selection was performed through the Kruskal–Wallis test, and features datasets were constructed according to feature selection. Three major machine learning-based classification algorithms classified the sarcopenia group in each dataset, and the performance of classification models was compared.Results: As a result of comparing the classification model performance for sarcopenia prediction, the k-nearest neighborhood algorithm (kNN) classification model using 40 major features of TUG and 6mWT showed the best performance at 88%.Conclusion: This study can be used as a basic research for the development of self-monitoring technology for sarcopenia.Keywords: sarcopenia, physical activity, machine learning, inertial measurement unit

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic disrupted the emergency medical care system worldwide. We analyzed the changes in the management of intracerebral hemorrhage (ICH) and compared the pre-COVID-19 and COVID-19 eras. MATERIALS AND METHODS: From March to October of the COVID-19 era (2020), 83 consecutive patients with ICH were admitted to four comprehensive stroke centers. We retrospectively reviewed the data of patients and compared the treatment workflow metrics, treatment modalities, and clinical outcomes with the patients admitted during the same period of pre-COVID-19 era (2017-2019). RESULTS: Three hundred thirty-eight patients (83 in COVID-19 era and 255 in pre-COVID-19 era) were included in this study. Symptom onset/detection-to-door time [COVID-19; 56.0 min (34.0-106.0), pre-COVID-19; 40.0 min (27.0-98.0), p=0.016] and median door to-intensive treatment time differed between the two groups [COVID-19; 349.0 min (177.0-560.0), pre-COVID-19; 184.0 min (134.0-271.0), p

In this paper, we analyze the radar cross section (RCS) of an integrated mast and present the optimized mast shape for RCS reduction. The RCS is simulated using commercial electromagnetic (EM) software based on the shooting and bouncing rays (SBR) method and the diffraction fields at the edges are also considered. Threat frequencies, threat regions and cardinal points are first defined considering the operational environments of a naval vessel. We calculate and analyze the RCS of the integrated mast in terms of the threat frequencies, the shapes of the integrated mast and the direction and polarization of the incident waves. The shape of the integrated mast is optimized based on the shaping technique. The optimized mast has low RCS properties in the primary threat sectors except for the exceptional angle regions.

Objective: To evaluate the clinicopathological characteristics of grade group 1 (GG1) prostate cancer in Korean populations.Methods: We retrospectively analyzed 492 consecutive radical prostatectomy specimens from our institution, which included those from 322 men with clinical GG1 and 170 with clinical GG2 tumors between years 2009 and 2018. The incidence of Gleason score (GS) upgrading, extraprostatic extension (EPE), and seminal vesicle invasion (SVI) were evaluated in patients with clinical GG1. In pathological GG1 cases, the distribution of adverse pathological features including EPE, lymphovascular invasion (LVI), perineural invasion (PNI), and biochemical recurrence (BCR) was analyzed.Results: Altogether, 78 (24.2%) out of 322 men in the clinical GG1 group demonstrated upgrading of GS, including 19 men with pathological Gleason score 4 + 3 = 7 and 6 with ≥ pathological Gleason score 4 + 4 = 8 cases. EPE was found in 37 (11.5%) and 22 (8.9%) men in clinical GG1 and pathological GG1 group, respectively. The incidence of LVI and PNI in the pathological GG1 cases was 2.8% (n = 7) and 28.6% (n = 71), respectively. BCR was observed in 4 men in pathological GG1 T2 (n = 226) and 2 men in GG1 T3 (n = 22) group. When we compared the pathological features between pathological GG1 T3 vs. GG2 T2, there was no statistical differences in the incidence of LVI and PNI between the two groups.Conclusions: Contrary to the current concept that GG1 is almost always clinically insignificant, it seems that GG1 still possess its respectable position as a group of cancer with aggressiveness. These findings should be kept in mind when deciding on treatment options for prostate cancer patients in the Asian populations.

Objective To determine whether modified constraint-induced movement therapy (mCIMT) with continuous restraint is feasible and effective in improving the use of the paretic arm in the real world among infants and toddlers with unilateral cerebral palsy (CP). Design Single-blind randomized controlled trial. Setting Tertiary hospital. Participants Children aged 7 to 36 months with unilateral CP (N = 24; 16 boys, 8 girls). Intervention The experimental group received 2-hour clinic-based mCIMT sessions (5 days per week for 3 weeks), and a continuous restraint was applied. Main Outcome Measures Standardized assessments were conducted. Peabody Developmental Motor Scales-2 (PDMS-2), Gross Motor Function Measure-66, Pediatric Motor Activity Log (PMAL), and Pediatric Evaluation of Disability Inventory were measured pre- and postintervention. Children who agreed to participate in the accelerometer study additionally wore accelerometers on both their wrists for 3 days before and after the intervention. Results The mCIMT group exhibited greater improvement in PMAL-how often (p = 0.048; ηp2 = 0.173), PMAL-how well (p = 0.008; ηp2 = 0.289), and PDMS-2 visual motor integration (p = 0.014; ηp2 = 0.256) posttreatment than the control group. The percentage of time in moderate-to-vigorous physical activity (z = –2.24; p = 0.03) and vector magnitude average counts (z = –2.52; p = 0.01) significantly increased in children in who wore accelerometers (N = 8) after the 3-week mCIMT protocol. Conclusion mCIMT with continuous restraint applied to infants and toddlers with unilateral CP appeared to have a positive effect on paretic hand use in the real world. Clinical Trial Registration Number NCT03418519

The parallel combination of a switching and a linear amplifier in the supply modulator for RF power amplifiers (PAs) has the potential to enhance energy efficiency while achieving wider bandwidth and lower ripple output voltage. In this paper, a linear amplifier that features a buffered-switching Class-AB bias scheme is presented for the supply modulator in polar-transmitter structures achieving 500 MHz of small-signal 3-dB bandwidth at a 1.2-V supply. The linear amplifier absorbs and cancels up to 60 mA of ripple current from the switching amplifier. As such, the ripple in the output voltage of the hybrid linear-switching supply modulator is less than 7.5 mVpp. The switching amplifier provides most of the signal current for greatest efficiency owing to a proposed rail-to-rail current-sensing circuit. Current feedback in the switching amplifier achieves 1.68-MHz unity-gain bandwidth at 6-MHz switching frequency. Harmonic distortion in the output voltage of the supply modulator is below 40 dBc at 0.8 Vpp sinusoidal input up to 9 MHz. The peak efficiency is 87.7% for a 8.25- $\Omega $ load, while the maximum output power is 23.6 dBm for a 4.99- $\Omega $ load. The chip measures 1.35 mm2 in a 65-nm standard bulk CMOS process.

Medial femoral torsion (MFT) is a common pathologic gait in cerebral palsy (CP) children that can be corrected by femoral derotational osteotomy (FDO). It is not clearly known as to how much various gait parameters change after FDO. The aim of this study was to quantify changes in gait parameters after FDO. The study group included 19 young CP patients (28 limbs, age

The purpose of this study was to develop a sports-specific anaerobic capacity test for soccer players that could be administered on commercial treadmills found in most exercise facilities. The Anaerobic Speed Test (AST) is an anaerobic capacity test on a treadmill, however the testing protocol (20% incline, 214 meter/min) cannot be completed on commercial treadmills because they have a maximum incline setting of 15%. This study newly developed the modified Anaerobic Speed Test (mAST) protocol (15% incline, 244 meter/min) through the use of an ACSM metabolic equation to predict energy expenditure equivalent to that of the AST. Fifteen NCAA Division II male soccer players (mean ± SD, age = 20 ± 1.9 yr; height = 181.3 ± 7.9 cm; weight = 74.8 ± 5.2 kg) participated in this study. Subjects participated in three testing days, one AST trial and two mAST trials all done on separate days, and total run time in seconds was recorded for each trial. Mean AST run times (60.5 ± 10.6) had a significantly positive correlation (p

Introduction The purposes of this study were to compare the asymmetry index using panoramic radiography and cone-beam computed tomography for detecting mandibular posterior asymmetry and to evaluate the diagnostic value of the asymmetry index on panoramic radiography. Methods A total of 43 patients were included in this study. Ten mandibular posterior distances were measured using panoramic radiography and cone-beam computed tomography, and 10 asymmetry index values were calculated. The reliability of each asymmetry index was assessed. For evaluating validity of each asymmetry index using panoramic radiography, the paired t test and the Bland-Altman analysis were used. The accuracy of the asymmetry index and the area under the curve of receiver operator characteristic were calculated. Results The asymmetry index of total ramal height showed good reliability (ICC, >0.888). In condylar height 1, specificity and negative predictive value were low (0.08 and 0.17, respectively), 95% limits of agreement were ±17.9%, and area under the curve was 0.484. In total, ramal height accuracy was 0.86, and areas under the curve were 0.926 to 0.957. Conclusions For detecting asymmetry of the condyle region, the asymmetry index using panoramic radiography had little diagnostic value, and we recommend using cone-beam computed tomography images. However, the asymmetry index for total ramal height showed good reliability and relatively higher validity, and its diagnostic value was excellent.

The prostatic hyperplasia in benign prostatic hyperplasia (BPH) leads to obstructive micturition symptoms. Previous studies showed that pontine micturition center (PMC), ventrolateral periaqueductal gray (vlPAG), and medial preopticnucleus (MPA) regions in the brain have been known to regulate the urinary bladder function. The present study shows the influences of Panax ginseng on nerve growth factor (NGF) expressions in PMC, vlPAG, and MPA regions in the brain. Wistar rats were used for the present study. The rats split into four groups; 4 groups (n=6) in control group, BPH-induced group, BPH-induced and P. ginseng-treated group, and BPH-induced and finasteride-treated group. BPH in rats was induced by testosterone and the animals were evaluated for NGF expression in PMC, vlPAG, and MPA regions in the brain. The NGF expression was identified using immunohistochemistry (IHC). The NGF expression by IHC showed spots with dark brown color. In our results, NGF expressions in PMC, vlPAG, and MPA regions in the brainstem of the BPH-induced group showed increase than the control animal. These increased NGF expressions in three regions were decreased using treatment with P. ginseng (200mg/kg). These results suggest that P. ginseng has therapeutic effects on the symptoms of BPH and is associated with the regulation of NGF expression in the brain. In conclusion, the administration of P. ginseng helps nerve growth factor activation.

18F-FDG Positron Emission Tomography (PET) is used to monitor tumor response to 131I-therapy, but is confounded by prompt emissions (284, 364, 637, and 723 keV) from 131I, particularly in animal PET imaging. We propose a method for correcting this emission in 18F-FDG PET. The 131I prompt emission effect was assessed within various energy windows and various activities. We applied a single gamma correction method to a phantom and in vivo mouse model. The 131I prompt emission fraction was 12% when 300 &micro, Ci of 131I and 100 &micro, Ci of FDG were administered, and increased exponentially with escalating 131I activity for all energy windows. The difference in spill-over ratio was reduced to &lt, 5% after 131I prompt emission correction. In the mouse model, the standard uptake value (SUV) did not differ significantly between FDG PET only (gold standard) and FDG PET after 131I prompt emission-correction, whereas it was overestimated by 38% before correction. Contrast was improved by 18% after 131I prompt emission correction. We first found that count contamination on 18F-FDG follow-up scans due to 131I spilled-over count after 131I rituximab tumor targeted therapy. Our developed 131I prompt emission-correction method increased accuracy during measurement of standard uptake values on 18F-FDG PET.

Treatment of acute triangular fibrocartilage complex (TFCC) tear using arthroscopic suture repair has been used as a general treatment method, but it is difficult to obtain perfect results in all cases. We evaluated clinical and radiologic outcomes of the acute TFCC tear with distal radioulnar joint instability using the arthroscopic suture repair with pronator quadratus (PQ) advancement. Altogether, 80 patients (48 male, 32 female; mean ± SD age, 37.3 ± 11.5 years; mean ± SD follow-up, 23.7 ± 11.4 months) were enrolled in the study. Follow-up was at least 12 months (range, 12-38 months). Patients were divided into group 1 with arthroscopic suture repair alone (34 patients; 17 male, 17 female; mean ± SD age, 35.2 ± 10.8 years; mean ± SD follow-up, 28.1 ± 15.1 months) and group 2 with additional PQ advancement (46 patients; 29 male, 17 female; mean ± SD age, 38.9 ± 11.9 years; mean ± SD follow-up, 18.4 ± 6.2 months), and clinical and radiological assessment was performed. We also compared the ulnar translation of the injured wrist with that of the uninjured wrist using the Push Pull gauge.There was no difference in the range of motion and the grip strength between the 2 groups. However, the disabilities of the arm, shoulder, and hand score (P = 0.042) at 6-month follow-up and disabilities of the arm, shoulder, and hand score (P = 0.015) and patient-rated wrist evaluation score (P = 0.012) at 12-month follow-up were improved in group 2, and patients' satisfaction (P = 0.032) was also higher in group 2. The ulnar translation rate was also improved in group 2 at 6-month follow-up (P = 0.015) and 12-month follow-up (P = 0.045).Arthroscopic suture repair with PQ advancement provided more clinical improvement and proper stability; therefore, it will be an acceptable effective treatment option for acute TFCC tear with distal radioulnar joint instability.

Background Bisphosphonates are widely used as bone stabilizers, which can cause major side effects including bisphosphonate-related osteonecrosis of the jaw (BRONJ) that occurs more frequently in the mandible. Consequently, there is a need for a detailed investigation of BRONJ of the maxilla and, in particular, of involvement of the maxillary sinus. Objective Our aim was to evaluate the characteristic radiologic and clinical manifestations in patients with maxillary sinusitis and a history of long-term bisphosphonate use. Methods Between January 2015 and July 2018, 55 patients with symptoms consistent with chronic rhinosinusitis who underwent a paranasal sinus computed tomography (CT) and had a history of >12 months of bisphosphonate therapy were included in the analysis. Results Radiologically and clinically evident chronic rhinosinusitis was noted in 24 of the 55 patients, of whom more than half (14/24, 58.3%) had BRONJ. The CT studies demonstrated that the maxillary sinus was involved in all 24 patients, characterized by unilateral involvement (70.8%) and bony remodeling in the posterior maxillary region (90.5%). The evidence of osteitis on CT and/or single-photon emission CT was observed in the majority of cases (19/21, 90.5%) and 12 patients (50.0%) had oroantral fistula. However, there were no differences in the clinical appearance of the diseases with respect to the radiologic aspects. Conclusions Besides its well-known effects on the mandible, long-term bisphosphonate use can also affect the maxillary sinus, with typical clinical and radiological manifestations.

Objective The LiquoGuard® system is a new ventricular-type monitoring device that facilitates intracranial pressure (ICP)-controlled or volume-controlled drainage of cerebrospinal fluid (CSF). The purpose of this study is to report the authors' experience with the LiquoGuard® ICP monitoring system, as well as the clinical safety, usefulness, and limitations of this device in the management of patients with traumatic brain injury (TBI). Methods Intraventricular ICP monitoring was performed on 10 patients with TBI using the LiquoGuard® monitoring system. ICP measurements, volume of drained CSF, and clinical outcomes were analyzed and discussed. Results ICP monitoring was performed on 10 patients for a mean duration of 6.9 days. With a mean 82,718 records per patient, the mean initial ICP was 16.4 mm Hg and the average ICP across the total duration of monitoring was 15.5 mm Hg. The mean volume of drained CSF was 29.2 cc/day, with no CSF drained in 4 patients. Seven of 10 patients showed 1 or 2 episodes of abnormal ICP measurements. No patient exhibited complications associated with ICP monitoring. Conclusion The LiquoGuard® system is a versatile tool in the management of TBI patients. Its use is both reliable and feasible for ICP monitoring and therapeutic drainage of CSF. However, episodes of abnormal ICP measurements were frequently observed in patients with slit ventricles, and further study may be needed to overcome this issue.

Neurilemmomas, also known as schwannomas, are benign, slow-growing tumors that arise from Schwann cells of nerve roots. They can occur anywhere in the body, but those arising in the head and neck account for 25% to 45% of the cases [1]. Primary neurilemmomas of the thyroid gland are very rare. Only 20 cases of primary thyroid neurilemmoma have been documented in the English literature [2]. They were usually asymptomatic, and only two cases were found in children [3,4]. Here we report this rare tumor in a 14-year-old girl, which was clinically mistaken for a malignant thyroid nodule.

Arteriovenous graft for hemodialysis vascular access is a widely used technique with many advantages. However, it has crucial complications with graft thrombosis and infection. We recently experienced an unusual case of arteriovenous graft complication involving graft thrombosis related to fistula formation between the graft and the natural vein with infection. We diagnosed this condition using Doppler ultrasound and computed tomography angiography. Successful surgical treatment including partial graft excision and creation of a secondary arteriovenous fistula using an inadvertently dilated cephalic vein was performed. The dialysis unit staff should keep this condition in mind and try to prevent this complication.

Both Q-fever and Toxoplasmosis are zoonosis. Q-fever occurs due to intracellular bacteria, while Toxoplasmosis is created by protozoan. Both of them have a wide range of host including livestock and wild animals and occur sporadically all over in the world. In this study, seroprevalence of Q-fever and Toxoplasmosis was investigated on cows bred in the area of Seoul where there was a fairly high possibility to occur, while vaccine was not used in Korea. As for experiment materials, cattle blood collected from 190 cows from February to September in 2014 was used ELISA. According to the result, there was a positive reaction on Q-fever from 18 cows out of total 190 cows (9.5%) and on Toxoplasmosis from 32 cows (16.8%). Seroprevalence of both diseases per age was turned out to be negative for those aged less than 2. In addition, it was shown to be positive on 4 cows out of 87 (4.6%) cows aged from 3 to 5, on 7 cows out of 30 cows (23.3%) aged from 6 to 7. Finally, it was shown to be positive on 7 cows out of 17 cows (41.2%) aged 8 or above. Toxoplasmosis was turned out to be positive on 1 cow out of 56 cows (1.8%) aged less than 2, on 6 cows out of 87 cows (6.9%) aged from 3 to 5, on 17 cows out of 30 cows (56.7%) aged from 6 to 7. In addition, it was turned out to be 8 cows out of 17 cows (47.1%) aged 8 or above. Seroprevalence of both diseases was turned out to be higher as age increased. Therefore, it seems that a wide range of investigation on the entire disease spreaders as well as livestock is required since infection of Q-fever and Toxoplasmosis, types of zoonosis, has continuously occurred, and the number of insects, wild animals, and stray animals serving as a role of spreading diseases by changes in seasons and environments has been gradually increasing in Korea.

Analysis of existing kettle and its heating system has been the topic for localization technology development. Test pieces are made, polished and etched for existing kettle analysis. Surface of test pieces is observed using SEM, the kettle is verified to be made by deep drawing process from Ferrite-Perlite material. The kettle is also identified to be plated of thickness with Nickel(16%). Also heat transfer characteristics based on hot wire arrangement is investigated and optimal hot wire system is developed. Developed control system detects overheating and stops the whole system on the long operating time. Developed kettle takes the performance evaluation test for volume expansion and satisfied for standard 'KS G3602'.

Background: The elderly have been reported to show anatomical and physiologic changes in the upper airway, which might affect the supraglottic airway (SGA) performance in geriatric populations. This study aimed to evaluate the clinical efficacy of the classic laryngeal mask airway (LMA-C) in the elderly compared with young adult patients. Methods: Fifty patients aged 65.85 years (elderly group) and 50 patients aged 20.40 years (young group) who were scheduled for surgery using the LMA-C for general anesthesia were enrolled in this prospective, non-randomized, comparative study. Manipulations required during insertion, success rate, insertion time, oropharyngeal leak pressure, gastric insufflation, and intraoperative inadequate ventilation with the LMA-C were assessed. Fiberoptic evaluation was used to determine the position of the LMA-C. Results: In the elderly group, the insertion success rate on the first attempt was significantly lower than that in the young group (84 vs. 96%, P = 0.02). The insertion time in the elderly group was significantly longer than that in the young group (28.5 ± 19.6 vs. 22.2 ± 6.4 seconds, P = 0.001). However, there was no difference in oropharyngeal leak pressure or fiberoptic grade between the two groups after proper placement of the LMA-C. During the surgery, inadequate ventilation events occurred more frequently in the elderly group than in the young group (31.3 vs. 4.0%, P < 0.001). Conclusions: The clinical efficacy of the LMA-C in elderly patients was inferior to that in young adult patients. Therefore, further studies are required to determine the type of SGA that can provide excellent clinical efficacy in the geriatric population.

Zirconium-89 (t(1/2)=78.41 hours) is an ideal metallic radioisotope for immuno-positron emission tomography (PET), given that its physical half-life closely matches the biological half-life of monoclonal antibodies. In this study, the authors measured the spatial resolution and image quality of Zr-89 PET and compared the results against those obtained using F-18 PET, which is widely regarded as the gold standard for comparison of imaging characteristics.The spatial resolution and image qualities of Zr-89 were measured on the Siemens Biograph Truepoint TrueV PET/CT scanner, partly according to NEMA NU2-2007 standards. For spatial resolution measurement, the Zr-89 point source was located at the center of the axial field of view (FOV) and offset 1/4 axial FOV from the center. For image quality measurements, an NEMA IEC Phantom was used. The NEMA IEC Phantom consists of six hot spheres that were filled with Zr-89 solution. Spatial resolution and image quality (%contrast, %background variability [BV], and source to background ratio [SBR]) were assessed to compare the imaging characteristics of F-18 with those of Siemens Biograph Truepoint TrueV.The transverse and axial spatial resolutions at 1 cm were 4.5 and 4.7 mm for Zr-89, respectively. The %contrast of Zr-89 was 25.5% for the smallest 10 mm sized sphere and 89.8% for the largest 37 mm sized sphere, and for F-18, it was 32.5% for the smallest 10 mm sized sphere and 103.9% for the largest 37 mm sized sphere using the ordered subset expectation maximization (OSEM) reconstruction method. The %BV of F-18 PET was 6.4% for the smallest 10 mm sized sphere and 3.5% for the largest 37 mm sized sphere using the OSEM reconstruction. The SBR of Zr-89 was 1.8 for the smallest 10 mm sized sphere and 3.7 for the largest 37 mm sized sphere, and for F-18, it was 2.0 for the smallest 10 mm sized sphere and 4.1 for the largest 37 mm sized sphere using the OSEM reconstruction method.This study assessed Zr-89 imaging characteristics using a Siemens Biograph Truepoint TrueV PET/CT scanner and compared the results with those obtained for F-18 PET. Although spatial resolution and image quality of Zr-89 PET were lower compared with F-18 PET, due to longer positron range and low positron branching ratio, Zr-89 is advantageous for immuno-PET due to well-matched half-life with monoclonal antibodies.

Double-tiered subchondral support (DSS) procedures with optimal distal dorsal cortical distance (DDD) have been reported to be effective in treating distal radius fractures, but there have been no studies of osteoporotic distal radius fractures in elderly patients. In this study, we demonstrated the efficacy of the DSS procedure with optimal DDD using a variable-angle volar locking-plate system for the treatment of osteoporotic distal radius fractures in elderly patients.One hundred and twenty-two patients (mean age, 73.3 years; age range, 65-88 years) with distal radius fracture were treated using a variable-angle volar locking-plate system with DSS. Patients were divided into DSS and non-DSS groups based on postoperative and 12-month follow-up radiographs, and radiological and clinical assessment was performed. Finally, we divided all 122 patients into two groups based on volar tilt of 6° on 12-month follow-up radiographs, and postoperative DDD values were compared.Volar tilt decreased (p=0.02), and ulnar variance increased (p=0.01) more in the non-DSS group. The non-DSS group showed a significant correlation between postoperative DDD value and change in DDD value (p=0.00). The mean postoperative DDDs in the group with final volar tilt6° and in the group with final volar tilt≥6° were 6.4mm (SD±1.7mm) and 4.6mm (SD±1.4mm) respectively (p=0.02). At 4-month follow-up, pronation (p=0.05) and supination (p=0.04) were improved, and at 12-month follow-up, supination (p=0.05) was improved in the DSS group.The use of the DSS procedure and reduction of DDD to 4.6mm or less using a variable-angle volar locking-plate system was effective in maintaining anatomical reduction for the treatment of osteoporotic distal radius fractures in elderly patients.III Therapeutic study.

Spindle cell ductal carcinoma in situ (DCIS) is a recently recognized subtype of DCIS, which is associated with a very rare and unique morphology. Although the histologic features have been relatively well described in a few reports, the cytologic features have not. Even though the distinction of this lesion from usual DCIS is not crucial clinically, it should be noted that this lesion might simulate the features of metaplastic carcinoma on fine needle aspiration cytology. Here, we report a case of spindle cell DCIS in a 45-year-old female, with the detailed cytologic features, both on conventional and liquid-based preparations, along with some useful immunohistochemical staining markers for the differential diagnosis.

Background Lead (Pb), mercury (Hg), and cadmium (Cd) are well-known environmental pollutants. They are unnecessary in the biological processes of humans. This study was performed to estimate the representative background exposure levels to the metals by measuring concentrations in whole blood of the Korean general population. Methods This population-based cross-sectional study included 4,000 subjects (1,886 males and 2,114 females) 0–83 years of age in 2010 and 2011. Adult subjects (≥ 19 years of age) were collected by sex- and age-stratified probability method, and preschool- and school-aged subjects were recruited by a cluster sampling method. Written consent was provided prior to blood sampling. Pb and Cd blood concentrations were determined by a flameless atomic absorption spectrophotometry, and blood Hg was analyzed by a direct Hg analyzer. Results The geometric mean, median and 95th percentile of blood Pb was 1.82 µg/dL, 1.83 µg/dL, and 3.78 µg/dL, respectively. The respective values were 2.92 µg/L, 2.87 µg/L, 9.12 µg/L for Hg, and 0.56 µg/L, 0.59 µg/L, 2.20 µg/L for Cd. Blood Pb and Hg were higher in males than in females, but no sex difference was observed, respectively, in subjects 0–4 years of age for Pb and in subjects less than 20 years for Hg. However, blood Cd was higher in females than in males and no sex difference was observed in subjects < 30 years of age. Conclusion This study provides representative data of human exposure to Pb, Hg, and Cd covering whole age groups of the general population in Korea., Graphical Abstract

An overview and comparison is provided of the different emerging wireless standards and their circuit solutions, which target low data-rate IoT applications, featuring ultra-low-power and/or long-range. Different RF transceiver implementations are presented, including proprietary solutions in license-free spectrum, WLAN-based IEEE802.11ah solutions and mobile operators' alternatives based on emerging long-term evolution (LTEM) standards. The different approaches coming to the market and their circuit design aspects will be discussed.

Rationale Epithelial-myoepithelial carcinoma is an extremely rare, malignant neoplasm that occurs most frequently in the major salivary glands and accounts for approximately 1% of all salivary gland neoplasms. Few reports have described the presence of epithelial-myoepithelial carcinoma in the sinonasal region; hence, the treatment guideline and prognosis remain unclear. Patient concerns We reported a case of a 75-year-old woman with complaint of nasal obstruction and frequent epistaxis for 3 years. During the nasal endoscopic examination, a mass in the left nasal cavity originating from the left nasal septum that caused bleeding on touch was observed. Diagnoses A diagnosis of epithelial-myoepithelial carcinoma was made based on the features of histopathology and immunohistochemistry of the surgical specimens. The patient was treated by surgical removal of the septal mass using the endonasal endoscopic approach. Outcomes In the serial follow-up paranasal sinus imaging and endoscopic inspection, evidence of recurrence was absent for 18 months after surgery. Lessons This report highlights a case of epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum, one of the most unusual locations. Diagnosis of epithelial-myoepithelial carcinoma should be made based on the findings of immunohistochemistry of the operative specimen. Clinicians should consider complete surgical resection as the effective treatment of choice.

Backgroud The goal of this study was to evaluate the clinical and radiological outcomes of arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon and to identify prognostic factors affecting rotator cuff healing in patients with irreparable large to massive posterosuperior rotator cuff tears. Methods Between July 2012 and March 2016, 42 patients with irreparable large to massive posterosuperior rotator cuff tears underwent an arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon. All patients had a minimum of 2-year follow-up (mean, 35.4 ± 7.3 months). Clinical evaluation was performed using the visual analog scale, the University of California, Los Angeles shoulder rating scale, Constant score, and active range of motion. Radiological evaluation was performed using magnetic resonance imaging and simple radiography. Results Clinical outcomes at the final follow-up improved significantly compared with the preoperative values (all p < 0.001). The failure rate was 23.8% (10/42); however, clinical outcomes significantly improved regardless of cuff healing (all p < 0.001). The mean acromiohumeral distance was 6.5 ± 1.7 mm (range, 3.2–9.7 mm) before surgery and 6.3 ± 1.6 mm (range, 2.8–9.5 mm) at the final follow-up. Preoperative acromiohumeral distance was associated with failure of cuff healing in the univariate analysis (p = 0.043) and multivariate analysis (p = 0.048). A receiver operating characteristic curve was used to determine the predictive cutoff value for the smallest preoperative acromiohumeral distance for successful healing, which was calculated as 5.3 mm. Conclusions Despite healing failure, arthroscopic partial repair with medialization can be a possible treatment option for irreparable large to massive posterosuperior rotator cuff tears because of the improvement in clinical outcome. The shorter preoperative acromiohumeral distance was the single most important factor negatively affecting cuff healing, and the likelihood of success of healing might be improved if a repair is performed when the preoperative acromiohumeral distance is < 5.3 mm.

Immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis, defined as focally or diffusely thickened dura mater and lymphoplasmacytic infiltration with increased IgG4 bearing plasma cells, is a rare disease. Moreover, cases involving bone are even rarer. In this report, the authors describe a case of IgG4-related hypertrophic pachymeningitis involving the skull in a 65-year-old man presenting with generalized tonic seizures. There is a 2.4 cm diameter extra-axial mass at the vertex of the left frontal convexity and thickened dura mater with contrast enhancement on magnetic resonance (MR) imaging. In addition, the skull adjacent to the mass was focally enhanced. He underwent surgical resection of the enhanced mass and skull. Histopathological findings revealed chronic inflammation with fibrosis, and idiopathic hypertrophic intracranial pachymeningitis was considered. However, eight months after surgery, partial seizures developed and brain MR imaging revealed a recurrence adjacent to the previous mass. We decided to perform additional immunohistochemical staining of the previous specimen, instead of a re-excision. Immunohistochemical staining showed markedly increased IgG4 (+) plasma cells. Consequently, IgG4-related hypertrophic meningitis was confirmed. Since then, steroids and immunosuppressant medications were started. Follow-up MR imaging at 3 months after medication initiation demonstrated complete remission. In conclusion, IgG4-related hypertrophic pachymeningitis should be considered in the differential diagnosis of hypertrophic cranial pachymeningitis.

AIMS Urinary cystatin C has been suggested as a useful biomarker for diagnosis of acute kidney injury (AKI). Multiple myeloma is often complicated by AKI. Therefore, we investigated whether the urinary cystatin C was available for diagnosis of AKI in multiple myeloma. MATERIALS AND METHODS This study included 39 patients with monoclonal gammopathy of undetermined significance (MGUS) or multiple myeloma. We reviewed the medical records retrospectively and investigated whether urinary γ-globulin and myeloma progression had effects on urinary cystatin C excretion. RESULTS Spearman's correlation analysis showed that serum β2-microglobulin and serum cystatin C had a significant positive correlation with the urinary cystatin C excretion (r = 0.513, p = 0.001, r = 0.659, p < 0.001) and FEcystatinC (r = 0.585, p = 0.002, r = 0.711, p < 0.001). The GFRcr also had a significant negative correlation with the urinary cystatin C excretion (r = -0.582, p < 0.001) and FEcystatinC (r = -0.474, p = 0.002). In addition, the urinary γ-globulin had a significant positive correlation with the urinary cystatin C excretion (r = 0.678, p < 0.001) and FEcystatinC (r = 0.731, p < 0.001). Urinary γ-globulin was the most significant factor to influence urinary cystatin C excretion in multiple regression test. CONCLUSION These results indicate that urinary γ-globulin and myeloma progression can increase the fractional and total excretion of urinary cystatin C. Therefore, it is believed that the urinary cystatin C can be affected by urinary γ-globulin and myeloma progression in the diagnosis of AKI in multiple myeloma. In addition, urinary γ-globulin is believed to be the most significant factor to influence on urinary cystatin C.

* School of Mechanical Engineering, Pusan Nat’l Univ. (Received November 16, 2013 ; Revised January 22, 2014 ; Accepted January 22, 2014)Key Words: Contact Angle(접촉각), Contact Line(접촉선), Droplet(액적), Neighbor Frequency(주변부 주파수), Resonance Frequency(공진 주파수), Secondary Droplet(미소 액적), Shape Oscillation (형상 진동), Waggling Motion (좌우 흔들림)초록: 본 연구는 주기적 강제 진동이 가해지는 표면의 액적 모드 특성과 표면에 놓인 액적의 제거에 대한 조건을 실험적으로 이해하는 것을 목적으로 하고 있다. 액적의 거동을 명확하게 관찰하기 위해 아크릴 표면에 Teflon 코팅을 진행하여 접촉각을 높였고, 히스테리시스는 25도 이내로 진행하여 액적의 거동이 보다 쉽게 진행되도록 하였다. 본 실험은 먼지가 적은 청정실에서 실험이 진행되었다. 제작된 소수성 표면에 놓인 액적의 실제 공진 주파수를 예측하기 위해 이론 및 실험적 해석을 통해 두 접근방법의 타당성을 파악하였으며, 두 개의 초고속카메라를 액적의 상면과 측면에 설치하여 2가지 측면에서 액적의 다양한 형상 변형 특성- 모드 형상, 분리, 미소 액적의 발생, 그리고 좌우 비틀림의 특성을 관찰하였다. 이론 값 비교결과 실제 공진 주파수 값들의 차이가 약 18% 이하로 관찰되었으며, 이러한 차이는 접촉선 마찰, 비선형 벽 고착, 실험의 불확실성 등에 가장 큰 영향을 받는 것으로 판단된다. 사용된 스피커에 상대적으로 낮은 전압을 인가할 경우 액적의 접촉선은 고정된 상태에서 좌우 대칭적인 액적 형상진동이 나타났다. 반면, 높은 전압을 인가할 경우 액적의 접촉선은 비고정된 상태가 되면서 더 활발한 형상 진동이 나타났다. 가진 주파수가 모드 주파수와 일치할 경우에는 액적의 로브 크기가 주변부 주파수 일 때 보다 비교적으로 컸으며, 같은 전압을 인가 할 경우, 표면에 놓인 액적의 미소 액적 발생 및 완전한 제거는 2차 모드에서만 진행되는 것을 실험을 통해 규명하였다.Abstract: This study aimed to understand the mode characteristics of a droplet subject to periodic forced vibration and the detachment of a droplet placed on a plate surface. An surface was coated with Teflon to clearly observe the behavior of a droplet. The contact angle between the droplet and surface and the hysteresis were found to be approximately 115° and within 25°, respectively. The coating process was performed in a clean room that had an environment with a low level of contaminants and impurities such as air dust, detergents, and particles. To predict the resonance frequency of a droplet, theoretical and experimental approaches were applied. Two high-speed cameras were configured to acquire side and top views and thus capture different characteristics of a droplet: the mode shape, the detachment, the separated secondary droplet, and the waggling motion. A comparison of the theoretical and experimental results shows no more than 18 discrepancies when predicting the resonance frequency. These differences seem to be caused by contact line friction, nonlinear wall adhesion, and the uncertainty of the experiment. For lower energy inputs, the contact line of the droplet was pinned and the oscillation pattern was axisymmetric. However, the contact line of the droplet was de-pinned as the oscillation became more vigorous with increased energy input. The size of each lobe at the resonance frequency is somewhat larger than that at the neighboring frequency. A droplet in mode 2, one of the primary mode frequencies, exhibits vertical periodic movement as well as detachment and secondary ejection from the main droplet.

* School of Mechanical Engineering, Pusan Nat’l Univ.(Received November 13, 2013 ; Revised February 4, 2014 ; Accepted February 4, 2014)Key Words: Hydrophobic Surface(소수성 표면), Deionized Water(탈이온수), Flow Visualization(유동가시화), Contact Angle(접촉각), Resonance Frequency(공진 주파수), Lobe(둥근 돌출부)초록: 본 연구의 목표는 주기적으로 강제 진동하는 소수성 표면위에 놓인 액적의 내부유동 특성을 이해하는 것이다. 액적의 공진주파수를 예측하기 위해서 고속카메라와 매크로렌즈를 사용하여 진동하는 소수성 표면위의 액적의 내부유동 특성을 확인하였다. 그 결과 특정 모드에서의 액적은 다양한 형상을 갖고 있으며 또한, 각각의 액적 내부에서 와류가 관찰 되었다. 일반적으로 유동흐름이 대칭축을 따라 위로 이동하고 액적상단에서 표면을 따라 접촉선부근으로 이동하였다. 반면에 모드 6과 모드 8에서는 아주 큰 와류가 생성되었다. 또한 유동속도가 모드 2보다 모드 4에서 더 빠르고 반면에 모드 6와 모드 8은 거의 비슷하였다.Abstract: This study aimed to understand the internal flow characteristics of a liquid droplet subject to periodic forced vibration. In order to predict the resonance frequency of a droplet, a high-speed camera and macro lens were used to capture internal flow characteristics of a droplet placed on a vibrating hydrophobic surface. Results showed that the droplet assumed a variety of shapes depending on the resonance mode of free droplet, particularly in modes 2, 4, 6, and 8. In addition, the induced internal vortex flow inside the droplet was also observed in each mode. Typically, the induced flow moved upwards along the axis of symmetry and downwards along the surface of the droplet, that is, from the apex to the contact line in modes 2 and 4, after which it broke into a smaller vortex. On the other hand, the large-scale vortex always remained steady in modes 6 and 8. The speed of the flow in mode 4 was always greater than that in mode 2, but those in modes 6 and 8 were similar.

The Siemens Biograph TruePoint TrueV (B-TPTV) positron emission tomography (PET) scanner performs 3D PET reconstruction using a system matrix with point spread function (PSF) modeling (called the True X reconstruction). PET resolution was dramatically improved with the True X method. In this study, we assessed the spatial resolution and image quality on a B-TPTV PET scanner. In addition, we assessed the feasibility of animal imaging with a B-TPTV PET and compared it with a microPET R4 scanner. Spatial resolution was measured at center and at 8 cm offset from the center in transverse plane with warm background activity. True X, ordered subset expectation maximization (OSEM) without PSF modeling, and filtered back-projection (FBP) reconstruction methods were used. Percent contrast (% contrast) and percent background variability (% BV) were assessed according to NEMA NU2-2007. The recovery coefficient (RC), non-uniformity, spill-over ratio (SOR), and PET imaging of the Micro Deluxe Phantom were assessed to compare image quality of B-TPTV PET with that of the microPET R4. When True X reconstruction was used, spatial resolution was