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Background Variations by hospital and region in the selection of an early invasive strategy (EIS) after non–ST-segment elevation myocardial infarction (NSTEMI) in patients with high-risk criteria are unknown. Methods We evaluated the data of 7037 patients with NSTEMI from 20 hospitals of 3 regions from the Korean Acute Myocardial Infarction Registry–National Institute of Health database. We used hierarchical generalized linear mixed-models to estimate region- and hospital-level variation in the selection of an EIS after adjusting for patient-level high-risk criteria. We explored the variation using the median rate ratio (MRR), which estimates the relative difference in the risk ratios of two hypothetically identical patients at two different sites. Results An EIS was selected in 84.4% of patients. At the hospital level, the median selection rate was 80.4%. At the region level, the median selection rate was 74.9% in the east region, 81.3% in the north region, and 83.9% in the west region, respectively. After adjusting for patient-level covariates, we found significant hospital- (MRR 2.19, 95% confidence interval [CI]: 1.74–3.03) and region-level (MRR 1.88, 95%CI: 1.26–5.44) variation in the selection of an EIS. Among patient-level factors, male sex, ongoing chest pain, history of coronary artery disease or acute heart failure, and GRACE risk score > 140 were independently associated with the selection of an EIS. Conclusions We observed significant hospital- and region-level variation in the selection of an EIS after NSTEMI in high-risk patients. Quality improvement efforts are required to standardize decision making and to improve clinical outcomes.

Electrochromic devices (ECDs) have been drawing great attention due to their high color contrast, low power consumption, and memory effect, and can be used in smart windows, automatic dimming mirrors, and information display devices. As with other electronic devices such as LEDs (light emitting diodes), solar cells, and transistors, the mechanical flexibility of ECDs is one of the most important issue for their potential applications. In this paper, we report on flexible ECDs (f-ECDs) fabricated using an all-in-one EC gel, which is a mixture of electrolyte and EC material. The f-ECDs are compared with rigid ECDs (r-ECDs) on ITO glass substrate in terms of color contrast, coloration efficiency, and switching speed. It is confirmed that the f-ECDs embedding all-in-one gel show strong blue absorption and have competitive EC performance. Repetitive bending tests show a degradation of electrochromic performance, which must be improved using an optimized device fabrication process.

Purpose: As cooling energy accounts for 50.5% of the data center total energy use, it is necessary to reduce cooling energy with optimal control method. Thus, this study aimed at developing an adaptive control algorithm for data center thermal environment based on Artificial Neural Network (ANN). Method: A data center thermal environment model was built to obtain variable data which is used to train and evaluate performance of the prediction model and algorithm. The thermal environment prediction model was developed using ANN and optimization process was conducted by the Bayesian Optimization Algorithm. The adaptive control algorithm, which embedded the prediction model, adopted the Sliding Windows method and was optimized to maximize the control performance. Result: The performance evaluation of the developed algorithm was conducted compared with non-adaptive algorithm. As a result, the adaptive algorithm presented better performance than the non-adaptive with 0.45 of RMSE. Therefore, the developed algorithm secured the stability and accuracy and will be applied to supervisory control platforms.

Identification of predictive neuroimaging markers of pain intensity changes is a crucial issue to better understand macroscopic neural mechanisms of pain. Although a single connection between the medial prefrontal cortex and nucleus accumbens has been suggested as a powerful marker, how the complex interactions on a large-scale brain network can serve as the markers is underexplored. Here, we aimed to identify a set of functional connections predictive of longitudinal changes in pain intensity using large-scale brain networks. We re-analyzed previously published resting-state functional magnetic resonance imaging data of 49 subacute back pain (SBP) patients. We built a network-level model that predicts changes in pain intensity over one year by combining independent component analysis and a penalized regression framework. Connections involving top-down pain modulation, multisensory integration, and mesocorticolimbic circuits were identified as predictive markers for pain intensity changes. Pearson’s correlations between actual and predicted pain scores were r = 0.33–0.72, and group classification results between SBP patients with persisting pain and recovering patients, in terms of area under the curve (AUC), were 0.89/0.75/0.75 for visits four/three/two, thus outperforming the previous work (AUC 0.83/0.73/0.67). This study identified functional connections important for longitudinal changes in pain intensity in SBP patients, providing provisional markers to predict future pain using large-scale brain networks.

The association between blood pressure (BP) defined by the 2017 American College of Cardiology/American Heart Association Hypertension Clinical Practice Guidelines with cardiovascular disease (CVD) and chronic kidney disease in patients with diabetes mellitus remains unclear. This study used the National Health Insurance Database of Korea that has health information of 8 922 940 persons who were screened from 2009 to 2014. We determined the BP status of 490 352 diabetes mellitus: level 1 (systolic

Background/Aims: Low-level viremia (LLV) after nucleos(t)ide analog treatment was presented as a possible cause of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). However, detailed information on patients’ adherence in the real world was lacking. This study aimed to evaluate the effects of LLV on HCC development, mortality, and cirrhotic complications among patients according to their adherence to entecavir (ETV) treatment.Methods: We performed a retrospective observational analysis of data from 894 consecutive adult patients with treatment-naïve CHB undergoing ETV treatment. LLV was defined according to either persistent or intermittent episodes of P=0.031). Good adherence group comprised 617 patients (69.0%). No significant difference was found between maintained virologic response and LLV groups in terms of the incidence of liver-related death or transplantation, HCC, and hepatic decompensation in good adherence group, according to multivariate analyses.Conclusions: In patients with treatment-naïve CHB and good adherence to ETV treatment in the real world, LLV during treatment is not a predictive factor for HCC and cirrhotic complications. It may be unnecessary to adjust their antiviral agent for patients with good adherence who experience LLV during ETV treatment.

Background: This study aimed to investigate the incidences of and risk factors for perioperative events following anticoagulant discontinuation in patients with non-valvular atrial fibrillation (NVAF) undergoing non-cardiac surgery. Methods: A total of 216 consecutive patients who underwent cardiac consultation for suspending perioperative anticoagulants were enrolled. A perioperative event was defined as a composite of thromboembolism and major bleeding. Results: The mean anticoagulant discontinuation duration was 5.7 (±4.2) days and was significantly longer in the warfarin group (p

Adherence to medication and maintained virologic response (MVR) are related to the risk of adverse clinical outcomes. This study aimed to compare the efficacy of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) in relation to the adverse clinical outcomes among chronic hepatitis B (CHB) patients stratified according to adherence to medication and MVR. A total of 1794 treatment-naive CHB patients treated with ETV (n = 894) or TDF (n = 900) for > 1 year were identified. Adherence rates were significantly higher in the TDF than in the ETV (93.4% vs. 89.1%, respectively; P

Purpose: This study aimed at analyzing the building indoor environment conditions and energy performance when DSSC BIPV windows are applied, and building a database to suggest the appropriate performance level of DSSC BIPV windows in future buildings. Method: The DesignBuilder, a building energy analysis program, was used to evaluate indoor illuminance, room temperature, cooling and heating energy, lighting energy, and power generation performance. Result: Simulation results demonstrate that the current characteristics of DSSC BIPVs exhibit an improved U-value but low visible light transmission (VLT) performance in comparison with low-emissivity double glazing windows. Thus, heating energy consumption was reduced, while as the electricity consumption for lighting was significantly increase. This increasement influenced the increase of the cooling energy consumption due to the higher indoor cooling load from lighting fixtures. To satisfy the 13% power generation efficiency suggested by the National Renewable Energy Laboratory, a VLT of 30% is required, which will produce energy savings of 4,861.44 ㎾h/year. For VLTs of ＞50%, energy saving is possible in combination with any generation efficiency.

Background: Calculating the accurate number of nursing personnel based on a patient classification system that clearly reflects the nursing needs of patients is a problem directly related to the nursing unit’s budget management, productivity, etc. This study aimed to calculate the total daily nursing workload and the optimal number of nurses per general unit based on the nursing intensity and direct nursing time per inpatient through patient classification.Methods: Three units at one general hospital were investigated. To calculate nursing intensity, patient classification according to nursing needs was performed for over 10 days in each unit in September 2018. The direct and non-direct nursing time and nursing intensity scores were analyzed using descriptive statistics (e.g. frequency, percentage, and average) generated using Microsoft Excel.Results: For the internal medicine unit, the average direct nursing time per patient was 1.0, 1.5, 2.2, and 2.9 hours for Groups 1, 2, 3 and 4, respectively. For the surgical unit, the average direct nursing time per patient was 0.9, 1.4, 2.1, and 2.6 hours for Groups 1, 2, 3, and 4, respectively. For the comprehensive nursing care unit, the average direct nursing time per patient was 0.8, 1.2, 1.7, and 2.2 hours for Groups 1, 2, 3, and 4. The optimal number of nurses was 25 in the internal medicine unit, 37 in the surgical unit, and 22 in the comprehensive nursing unit. There was a shortage of five nurses in the internal medicine unit and nine in the surgical unit.Conclusion: Based on the nursing time according to patient classification groups, this study confirmed that the optimal number of nurses cannot be secured and that the nursing intensity is very high. The results of this study suggest that long-term efforts, such as improving the nursing environment, should be made to secure an optimal number of nurses in various hospital nursing units.

Many types of cardiac arrhythmias can occur in people with COVID‐19, and these arrhythmias can affect the patient's outcomes. We have experienced paroxysmal complete atrioventricular block in a patient with COVID‐19 and would like to share the course of treatment.

Background Global climate change has led to an increase in the prevalence and severity of wildfires. Pollutants released into air, soil and groundwater from wildfires may impact embryo development leading to gastroschisis. Objective The objective of this study was to determine the association between wildfire exposure before and during pregnancy and the risk of foetal gastroschisis development. Methods This was a retrospective cohort study using The California Office of Statewide Health Planning and Development Linked Birth File linked to The California Department of Forestry and Fire Protection data between 2007 and 2010. Pregnancies complicated by foetal gastroschisis were identified by neonatal hospital discharge ICD-9 code. Pregnancies were considered exposed to wildfire if the mother's primary residence zip code was within 15 miles to the closest edge of a wildfire. The exposure was further stratified by trimester or if exposed within 30 days prior to pregnancy. Multivariable log-binomial regression analyses were performed to estimate the association between wildfire exposure in each pregnancy epoch and foetal gastroschisis. Results Between 2007 and 2010, 844,348 (40%) births were exposed to wildfire in California. Compared with births without wildfire exposure, those with first-trimester exposure were associated with higher rates of gastroschisis, 7.8 vs. 5.7 per 10,000 births (adjusted relative risk [aRR] 1.28, 95% confidence interval [CI] 1.07, 1.54). Furthermore, those with prepregnancy wildfire exposure were also found to have higher rates of gastroschisis, 12.5 vs. 5.7 per 10,000 births, (aRR 2.17, 95% CI 1.42, 3.52). In contrast, second- and third-trimester wildfire exposures were not associated with foetal gastroschisis. Conclusions Wildfire exposure within 30 days before pregnancy was associated with more than two times higher risk of foetal gastroschisis, whereas a 28% higher risk was demonstrated if exposure was in the first trimester.

Migraine headache is an episodic phenomenon, and patients with episodic migraine have ictal (headache), peri-ictal (premonitory, aura, and postdrome), and interictal (asymptomatic) phases. We aimed to find the functional characteristics of the migraine brain regardless of headache phase using dynamic functional connectivity analysis. We prospectively recruited 50 patients with migraine and 50 age- and sex-matched controls. All subjects underwent a resting-state functional magnetic resonance imaging. Significant networks were defined in a data-driven fashion from the interictal (48 hours apart from headache phases) patients and matched controls (interictal data set) and tested to ictal or peri-ictal patients and controls (ictal/peri-ictal data set). Both static and dynamic analyses were used for the between-group comparison. A false discovery rate correction was performed. As a result, the static analysis did not reveal a network which was significant in both interictal and ictal/peri-ictal data sets. Dynamic analysis revealed significant between-group differences in 7 brain networks in the interictal data set, among which a frontoparietal network (controlspatients, P = 0.0467), 2 brainstem networks (patientscontrols, P = 0.0467 and0.001), and a cerebellar network (controlspatients, P = 0.0408 and0.001 in 2 states) remained significant in the ictal/peri-ictal data set. Using these networks, migraine was classified with a sensitivity of 0.70 and specificity of 0.76 in the ictal/peri-ictal data set. In conclusion, the dynamic connectivity analysis revealed more functional networks related to migraine than the conventional static analysis, suggesting a substantial temporal fluctuation in functional characteristics. Our data also revealed migraine-related networks which show significant difference regardless of headache phases between patients and controls.

To investigate the antibacterial efficacy of silver-impregnated negative-pressure wound therapy (NPWT) in lower-extremity acute traumatic wounds.Open contaminated wounds caused by high-velocity trauma in the lower extremities were randomly allocated into two groups. The wounds in the control and experimental groups were treated with conventional NPWT (n = 31) and silver-impregnated NPWT (n = 35), respectively.Serial bacterial cultures were obtained from the participants' wounds, polyurethane foam, and suction tubes weekly during the 4-week follow-up to identify bacteria and follow their conversions.Bacterial colonization rates in the silver NPWT group were generally lower than those in the conventional NPWT group, and the difference increased with time. For methicillin-resistant Staphylococcus aureus colonization, wounds treated with silver-impregnated NPWT showed a significant reduction in bacterial load compared with those treated with conventional NPWT.Silver-impregnated NPWT effectively decreases bacterial load in open contaminated wounds of the lower extremities. It can be used as a temporizing measure to manage bacterial colonization while patients and wounds are being prepared for final wound reconstruction.

AIMS We conducted a 4-week randomized, sham-controlled, single-blind, parallel-group trial to examine the effect of repetitive transcranial magnetic stimulation (rTMS) delivered to the left dorsolateral prefrontal cortex (DLPFC) on functional brain connectivity and body weight in adults with obesity. MATERIALS AND METHODS Of the 45 volunteers with obesity, aged between 18 and 70 years (body mass index [BMI] ≥25 kg/m2 according to the obesity criterion for an Asian population), 36 participants (54.1 ± 11.0 years, BMI 30.2 ± 3.5 kg/m2 , 77.8% female) completed the 4 weeks of follow-up, undergoing two resting state fMRI scans (20 in the real stimulation group and 16 in the sham stimulation group). A total of eight sessions of high-frequency rTMS targeting the left DLPFC were provided over a period of 4 weeks (5-second trains with 25-second inter-train intervals, 10 Hz, 110% motor threshold; 2000 pulses over 20 minutes). RESULTS Participants in the real stimulation group showed significantly greater weight loss from baseline following the eight session of rTMS (-2.53 ± 2.41 kg vs 0.38 ± 1.13 kg, P

Objective: Obesity and pregestational diabetes (PGDM) may interact to further increase the risk of stillbirth than either risk factors independently. The objective of this study was to determine th...

Objective This study investigated the attitude of Korean physicians toward women’s access to emergency contraceptive pills (ECPs) and the reclassification of ECP to a behind-the-counter (BTC) drug. Methods This study involved 946 physicians who had prescribed ECP in South Korea. The written questionnaires were completed by obstetricians and gynecologists, family physicians, internal medicine doctors, and pediatricians. Results Regarding the barriers limiting women’s access to ECP, 24.8% of physicians responded that women lacked information about ECP and 22.5% felt that women were likely to be emotionally burdened by visits to clinics or hospitals to obtain ECP prescriptions. Ninety-two percent of physicians responded that ECP should remain a prescription drug while 6.1% stated preferences for a switch to a BTC drug. Physicians who opposed the switch were concerned about the potential abuse of ECP. In order to prevent ECP abuse, the most important factor to be considered was education on contraception. Conclusion A majority of Korean physicians opposed the reclassification of ECP to a BTC drug owing to their belief in increasing the role of educational initiatives about contraception and contraceptive practices before improving the access to ECP. This study is also of the opinion that contraceptive education for youth and adults in Korea should be more realistic and active, with an emphasis on regular contraception use before reclassification. Furthermore, we believe that efforts are needed to ensure accuracy of information on contraception to facilitate women’s access to ECP.

Objective To investigate the whole-brain resting-state functional connectivity in patients with chronic migraine (CM) using a data-driven method. Methods We prospectively recruited patients with either episodic migraine (EM) or CM aged 18–60 years who visited the headache clinic of the Samsung Medical Center from July 2016 to December 2017. All patients underwent 3 T MRI using an identical scanner. Patients were considered interictal if they did not have a migraine headache at the day and ± 1 days of functional MRI acquisition. Using the group-independent component analysis (ICA), connectivity analysis with a weighted and undirected network model was performed. The between-group differences in degree centrality (DC) values were assessed using 5000 permutation tests corrected with false discovery rate (FDR). Results A total of 62 patients (44 EM and 18 CM) were enrolled in this study. Among the seven functionally interpretable spatially independent components (ICs) identified, only one IC, interpreted as the pain matrix, showed a significant between-group difference in DC (CM > EM, p = 0.046). This association remained significant after adjustment for age, sex, migraine with aura (MWA), allodynia, depression, and anxiety (p = 0.038). The pain matrix was functionally correlated with the hypothalamus (p = 0.040, EM > CM) and dorsal raphe nucleus (p = 0.039, CM > EM) with different levels of strength in EM and CM. Conclusion CM patients have a stronger connectivity in the pain matrix than do EM patients. Functional alteration of the pain network might play a role in migraine chronification.

Objectives In dental clinics, dental hygienists are exposed to aerosolized pathologic bacteria, which can be transmitted to the oral cavity via lip cosmetics. Accordingly, such contamination poses a consistent health risk among staffs. Our study examined the bacterial contamination of lip cosmetics used by dental hygienists while in a clinic setting. Methods Sixteen dental hygienists were surveyed regarding their job assignments and habits associated with lip cosmetic. Subsequently, microorganisms were analyzed in collected samples of the hygienists' lip cosmetics using colony‐forming unit (CFU) assays, 16s‐rDNA polymerase chain reaction, and DNA sequencing. Results Notably, 81.3% of the submitted lip cosmetic samples were contaminated, with bacterial CFUs ranging from undetectable to innumerable. Many samples (43.8%) exceeded the microbial limits of cosmetic contamination. Of the lip cosmetic used for more than 6 months, 60% exceeded the microbial limit. When wearing a mask every time, only one of the six samples exceeded the microbial limit. More frequent dental mask changing was associated with a lower likelihood that the cosmetic sample would exceed the microbial limit. No samples from hygienists who changed their masks four times a day exceeded the microbial limit, compared to 33.3% from hygienists who only changed the mask when it became wet. Most isolated bacteria were gram‐positive, facultative anaerobic, asporogenic, and opportunistically pathogenic, and the most prevalent species were Staphylococcus aureus, Streptococcus salivarius, and Staphylococcus epidermidis. Conclusion Our findings indicate that dental staff, including dental hygienists, should exercise more careful workplace habits, particularly with regard to infection control and cosmetic use.

ObjectiveTo evaluate the association between the cerebrovascular reactivity to carbon dioxide (CO2-CVR) and the deep white matter hyperintensity (WMH) burden in patients with migraine.MethodsA total of 86 nonelderly patients with episodic migraine without vascular risk factors and 35 headache-free controls underwent 3T MRI. Deep WMHs were quantified with a segmentation method developed for nonelderly migraineurs. The interictal CO2-CVR was measured with transcranial Doppler with the breath-holding method. The mean breath-holding index of the bilateral middle cerebral arteries (MCA-BHI) was square root transformed and analyzed with univariate and multivariate logistic regression models to determine its association with the highest tertiles of deep WMH burden (number and volume).ResultsA low MCA-BHI was independently associated with the highest tertile of deep WMH number in patients with migraine (adjusted odds ratio [OR] 0.02, 95% confidence interval [CI] 0.0007–0.63, p = 0.026). In controls, the MCA-BHI was not associated with deep WMH number. Interaction analysis revealed that migraine modified the effect of MCA-BHI on deep WMH number (p for interaction = 0.029). The MCA-BHI was not associated with increased deep WMH volume in both patients and controls. Age was independently associated with deep WMH volume in patients (adjusted OR 1.07, 95% CI 1.004–1.15, p = 0.037).ConclusionsIn this study, we found a migraine-specific association between a reduced CVR to apnea and increased number of deep WMHs in healthy, nonelderly patients with migraine. A dysfunctional vascular response to apnea may predispose migraineurs to an increased risk of WMHs.

There is an urgent need to find antidepressants that can be administered for long periods without inducing severe side effects to replace conventional antidepressants that control monoamine levels, such as tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRI). We sought to determine the antidepressant effects of Fraxinus rhynchophylla Hance (F. rhynchophylla Hance, FX) and its components on a reserpine-induced mouse model. One hour after oral administration of FX (30, 50, and 100 mg/kg), esculin (50 mg/kg), esculetin (50 mg/kg), fraxin (50 mg/kg), and fluoxetine (20 mg/kg), reserpine was delivered intraperitoneally to mice. Behavioral experiments were conducted to measure anxiety and depressive-like behaviors after 10 days of administration. FX and its components increased the number of entries into the center of an open field as well as distance traveled within it and decreased immobility duration in the forced swim and tail suspension tests. Reserpine-induced increases in plasma corticosterone concentrations were attenuated by the administration of FX and its components, which were also found to decrease the reserpine-induced enhancement of mRNA levels of interleukin (IL)-12 p40, IL-6, and tumor necrosis factor (TNF)-α, pro-inflammatory cytokines. Finally, the diminished expressions of hippocampal phosphorylated cAMP response element-binding protein (pCREB) and brain-derived neurotrophic factor (BDNF) by reserpine were increased by FX and its components. Our results suggest that FX and its components regulate anxiety and depressive-like behaviors through stress hormones, immune regulation, and the activation of neuroprotective mechanisms, further supporting the potential of FX and its components as antidepressants.

Natural white silk cocoons exhibit strong broadband optical scattering by Anderson localization within the silk fibers, providing a low‐light environment to the pupae inside. This scattering effect is due to thousands of densely packed parallel fibrillar nanovoids running within each fiber along the fiber axis. Herein, to enhance sunlight rejection from white silk, conventional diffusive optical transport without Anderson localization is used. For optical diffusion, natural white silk is restructured by electrospinning to destroy the fibrillar nanovoids. Sunlight rejection power of the electrospun structures is controlled by the fiber diameters. Relative to a nonwoven raw silk fabric, a restructured silk film with a mean fiber diameter of a quarter micron substantially increases optical scattering strength in the visible spectrum and emissivity in the mid‐infrared atmospheric transparency window. The restructured silk fibrous film can reduce the average temperature of a substrate, on which the film is coated, by 7.5 °C relative to a nonwoven raw silk fabric during daytime under solar radiation. The results suggest that artificially processed polymeric fiber mats can achieve substantially stronger sunlight rejection than natural silk, by using optical diffusion without Anderson localization. These polymeric mats are useful as sunshades in various applications.

Background It is difficult to evaluate the risk of patients with severe renal dysfunction before surgery due to various limitations despite high postoperative cardiac events. This study aimed to investigate the value of a newly reclassified Revised Cardiac Risk Index (RCRI) that incorporates QRS fragmentation (fQRS) as a predictor of postoperative cardiac events in patients with severe renal dysfunction. Methods Among the patients with severe renal dysfunction, 256 consecutive patients who underwent both a nuclear stress test and noncardiac surgery were evaluated. We reclassified RCRI as fragmented RCRI (FRCRI) by integrating fQRS on electrocardiography. We defined postoperative major adverse cardiac event (MACE) as a composite of cardiac death, nonfatal myocardial infarction, and pulmonary edema. Results Twenty-eight patients (10.9%) developed postoperative MACE, and this was significantly frequent in patients with myocardial perfusion defect (41.4% vs. 28.0%, p = 0.031). fQRS was observed 84 (32.8%) patients, and it was proven to be an independent predictor of postoperative MACE after adjusting for the RCRI (odds ratio 3.279, 95% confidence interval (CI) 1.419–7.580, p = 0.005). Moreover, fQRS had an incremental prognostic value for the RCRI (chi-square = 7.8, p = 0.005), and to the combination of RCRI and age (chi-square = 9.1, p = 0.003). The area under curve for predicting postoperative MACE significantly increased from 0.612 for RCRI to 0.667 for FRCRI (p = 0.027) and 23 patients (32.4%) originally classified as RCRI 2 were reclassified as FRCRI 3. Conclusions A newly reclassified FRCRI that incorporates fQRS, is a valuable predictor of postoperative MACE in patients with severe renal dysfunction undergoing noncardiac surgery.

Graphical abstract, Background In the potent new antiplatelet era, it is important issue how to balance the ischemic risk and the bleeding risk. However, previous risk models have been developed separately for in-hospital mortality and major bleeding risk. Therefore, we aimed to develop and validate a novel combined model to predict the combined risk of in-hospital mortality and major bleeding at the same time for initial decision making in patients with acute myocardial infarction (AMI). Methods Variables from the Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database were used to derive (n = 8955) and validate (n = 3838) a multivariate logistic regression model. Major adverse cardiovascular events (MACEs) were defined as in-hospital death and major bleeding. Results Seven factors were associated with MACE in the model: age, Killip class, systolic blood pressure, heart rate, serum glucose, glomerular filtration rate, and initial diagnosis. The risk model discriminated well in the derivation (c-static = 0.80) and validation (c-static = 0.80) cohorts. The KAMIR-NIH risk score was developed from the model and corresponded well with observed MACEs: very low risk (0.9%), low risk (1.7%), moderate risk (4.2%), high risk (8.6%), and very high risk (23.3%). In patients with MACEs, a KAMIR-NIH risk score ≤ 10 was associated with high bleeding risk, whereas a KAMIR-NIH risk score > 10 was associated with high in-hospital mortality. Conclusion The KAMIR-NIH in-hospital MACEs model using baseline variables stratifies comprehensive risk for in-hospital mortality and major bleeding, and is useful for guiding initial decision making.

Geekbench is one of the most referenced cross-platform benchmarks in the mobile world. Most of its workloads are synthetic but some of them aim to simulate real-world behavior. In the mobile world, its microarchitectural behavior has been reported rarely since the hardware profiling features are limited to the public. As a popular mobile performance workload, it is hard to find Geekbench&rsquo, s microarchitecture characteristics in mobile devices. In this paper, a thorough experimental study of Geekbench performance characterization is reported with detailed performance metrics. This study also identifies mobile system on chip (SoC) microarchitecture impacts, such as the cache subsystem, instruction-level parallelism, and branch performance. After the study, we could understand the bottleneck of workloads, especially in the cache sub-system. This means that the change of data set size directly impacts performance score significantly in some systems and will ruin the fairness of the CPU benchmark. In the experiment, Samsung&rsquo, s Exynos9820-based platform was used as the tested device with Android Native Development Kit (NDK) built binaries. The Exynos9820 is a superscalar processor capable of dual issuing some instructions. To help performance analysis, we enable the capability to collect performance events with performance monitoring unit (PMU) registers. The PMU is a set of hardware performance counters which are built into microprocessors to store the counts of hardware-related activities. Throughout the experiment, functional and microarchitectural performance profiles were fully studied. This paper describes the details of the mobile performance studies above. In our experiment, the ARM DS5 tool was used for collecting runtime PMU profiles including OS-level performance data. After the comparative study is completed, users will understand more about the mobile architecture behavior, and this will help to evaluate which benchmark is preferable for fair performance comparison.

BackgroundPerinatal exposure to air pollution and immune system dysregulation are two factors consistently associated with autism spectrum disorders (ASD) and other neurodevelopmental outcomes. However, little is known about how air pollution may influence maternal immune function during pregnancy.ObjectivesTo assess the relationship between mid-gestational circulating levels of maternal cytokines/chemokines and previous month air pollution exposure across neurodevelopmental groups, and to assess whether cytokines/chemokines mediate the relationship between air pollution exposures and risk of ASD and/or intellectual disability (ID) in the Early Markers for Autism (EMA) study.MethodsEMA is a population-based, nested case–control study which linked archived maternal serum samples collected during weeks 15–19 of gestation for routine prenatal screening, birth records, and Department of Developmental Services (DDS) records. Children receiving DDS services for ASD without intellectual disability (ASD without ID;n= 199), ASD with ID (ASD with ID;n= 180), ID without ASD (ID;n= 164), and children from the general population (GP;n= 414) with no DDS services were included in this analysis. Serum samples were quantified for 22 cytokines/chemokines using Luminex multiplex analysis technology. Air pollution exposure for the month prior to maternal serum collection was assigned based on the Environmental Protection Agency’s Air Quality System data using the maternal residential address reported during the prenatal screening visit.ResultsPrevious month air pollution exposure and mid-gestational maternal cytokine and chemokine levels were significantly correlated, though weak in magnitude (ranging from − 0.16 to 0.13). Ten pairs of mid-pregnancy immune markers and previous month air pollutants were significantly associated within one of the child neurodevelopmental groups, adjusted for covariates (p< 0.001). Mid-pregnancy air pollution was not associated with any neurodevelopmental outcome. IL-6 remained associated with ASD with ID even after adjusting for air pollution exposure.ConclusionThis study suggests that maternal immune activation is associated with risk for neurodevelopmental disorders. Furthermore, that prenatal air pollution exposure is associated with small, but perhaps biologically relevant, effects on maternal immune system function during pregnancy. Additional studies are needed to better evaluate how prenatal exposure to air pollution affects the trajectory of maternal immune activation during pregnancy, if windows of heightened susceptibility can be identified, and how these factors influence neurodevelopment of the offspring.

Background Data regarding the association between preexisting cardiovascular risk factors (CVRFs) and cardiovascular diseases (CVDs) and the outcomes of patients requiring hospitalization for coronavirus disease 2019 (COVID-19) are limited. Therefore, the aim of this study was to investigate the impact of preexisting CVRFs or CVDs on the outcomes of patients with COVID-19 hospitalized in a Korean healthcare system. Methods Patients with COVID-19 admitted to 10 hospitals in Daegu Metropolitan City, Korea, were examined. All sequentially hospitalized patients between February 15, 2020, and April 24, 2020, were enrolled in this study. All patients were confirmed to have COVID-19 based on the positive results on the polymerase chain reaction testing of nasopharyngeal samples. Clinical outcomes during hospitalization, such as requiring intensive care and invasive mechanical ventilation (MV) and death, were evaluated. Moreover, data on baseline comorbidities such as a history of diabetes, hypertension, dyslipidemia, current smoking, heart failure, coronary artery disease, cerebrovascular accidents, and other chronic cardiac diseases were obtained. Results Of all the patients enrolled, 954 (42.0%) had preexisting CVRFs or CVDs. Among the CVRFs, the most common were hypertension (28.8%) and diabetes mellitus (17.0%). The prevalence rates of preexisting CVRFs or CVDs increased with age (P < 0.001). The number of patients requiring intensive care (P < 0.001) and invasive MV (P < 0.001) increased with age. The in-hospital death rate increased with age (P < 0.001). Patients requiring intensive care (5.3% vs. 1.6%; P < 0.001) and invasive MV (4.3% vs. 1.7%; P < 0.001) were significantly greater in patients with preexisting CVRFs or CVDs. In-hospital mortality (12.9% vs. 3.1%; P < 0.001) was significantly higher in patients with preexisting CVRFs or CVDs. Among the CVRFs, diabetes mellitus and hypertension were associated with increased requirement of intensive care and invasive MV and in-hospital death. Among the known CVDs, coronary artery disease and congestive heart failure were associated with invasive MV and in-hospital death. In multivariate analysis, preexisting CVRFs or CVDs (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.07–3.01; P = 0.027) were independent predictors of in-hospital death after adjusting for confounding variables. Among individual preexisting CVRF or CVD components, diabetes mellitus (OR, 2.43; 95% CI, 1.51–3.90; P < 0.001) and congestive heart failure (OR, 2.43; 95% CI, 1.06–5.87; P = 0.049) were independent predictors of in-hospital death. Conclusion Based on the findings of this study, the patients with confirmed COVID-19 with preexisting CVRFs or CVDs had worse clinical outcomes. Caution is required in dealing with these patients at triage., Graphical Abstract

There is insufficient information on the relationship between the N-terminal pro-brain natriuretic peptide (NT-proBNP) level and collateral circulation (CC) formation after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction. We analyzed 857 patients who underwent primary PCI. The serum NT-proBNP levels were measured on the day of admission, and the CC was scored according to Rentrop’s classification. Log-transformed NT-proBNP levels were significantly higher in patients with good CC compared to those with poor CC (6.13 ± 2.01 pg/mL versus 5.48 ± 1.97 pg/mL, p p p = 0.001). The incidence of left ventricular (LV) dysfunction (p p p = 0.003). The association between NT-proBNP and collateral formation was not influenced by pre-TIMI flow and LV function. NT-proBNP appears to reflect the degree of collateral formation in the early phase of STEMI and might have a new role as a useful surrogate biomarker for collateral formation in patients undergoing primary PCI.

INTRODUCTION This study aimed to observe changes in working posture by measuring the REBA (Rapid Entire Body Assessment) score of dental hygiene students according to digital sound feedback linked with a smartphone application. METHODS This study was conducted on 28 fourth-year dental hygiene students who received theoretical and practical training on dental posture in the second year and then practised on mannequins and patients for about four semesters. Periodontal instrumentation was performed freely by applying digital sound notification feedback for four weeks after baseline, 30 minutes per week. REBA was measured after performing periodic structure construction without providing digital sound notification feedback for the last 1-2 minutes. Follow-up was conducted the same way 2-3 weeks after the intervention period. RESULTS The REBA score for total, neck and trunk of all subjects showed statistically significant decreases post-intervention compared with the baseline scores (total p

An all-in-one device composed of microplungers can capture biofluids and adhere to skin for intelligent care of skin disease., Recent advances in bioinspired nano/microstructures have received attention as promising approaches with which to implement smart skin-interfacial devices for personalized health care. In situ skin diagnosis requires adaptable skin adherence and rapid capture of clinical biofluids. Here, we report a simple, all-in-one device consisting of microplungers and hydrogels that can rapidly capture biofluids and conformally attach to skin for stable, real-time monitoring of health. Inspired by the male diving beetle, the microplungers achieve repeatable, enhanced, and multidirectional adhesion to human skin in dry/wet environments, revealing the role of the cavities in these architectures. The hydrogels within the microplungers instantaneously absorb liquids from the epidermis for enhanced adhesiveness and reversibly change color for visual indication of skin pH levels. To realize advanced biomedical technologies for the diagnosis and treatment of skin, our suction-mediated device is integrated with a machine learning framework for accurate and automated colorimetric analysis of pH levels.

Background The timing of soft tissue reconstruction for soft-tissue defect in patients with open fractures in the lower extremity is known to be critical for successful outcomes. However, medical advances, including development of dressing materials and refinement in the microsurgical techniques, might have undergone modifications in this “critical period.” There have been no studies on the role of timing on reconstructive outcomes. Thus, we have analyzed the effect of reconstruction timing on optimal surgical outcomes and complication rates in a single type of lower extremity injury.Methods Data of patients who underwent microvascular free tissue transfer with an open fracture in the lower extremity from 2014 through 2016 were retrospectively reviewed (n = 103). Surgical outcomes, including flap complication rate, flap revision rate, and long-term bony complications, were analyzed serially in accordance with time interval until coverage using the receiver operating characteristic (ROC) curve analysis. Significant factors with a p Results A total of 46 patients (33 males and 13 females) were finally included in the study. Based on the association between surgical timing and flap-related complication rate, the best cutoff period for surgery was 33 days, with an area under the curve of 0.658 (p = 0.040). Further, in the revision rate, the cutoff period was identified as 10 days (p = 0.016). Regarding the incidence of bony complications, ROC curve showed that the maximal period until operation was 91 days with no influence on the occurrence of bony complications (p = 0.029).Conclusion Although the best method is an early reconstruction, many modalities such as negative pressure wound therapy play a role as a temporary measure. Our study suggests that the acute or early period for successful reconstruction might be extended compared with previous studies.

Purpose Maternal obesity has been consistently associated with offspring risk for ASD, as well as lipid metabolism derangements. However, few ASD studies have examined maternal lipids in conjunction with maternal prepregnancy body mass index (BMI). Methods This nested case-control study was based on the Boston Birth Cohort, a prospective cohort study of mother-child dyads recruited at the Boston Medical Center. Maternal blood samples were collected shortly after delivery and analyzed for total plasma cholesterol, HDL, and triglyceride (TG) concentrations. Low-density lipoprotein (LDL) was subsequently calculated by the Friedewald equation. Cases were identified using ASD diagnoses in children’s medical records. The odds of ASD were estimated with continuous lipid levels for a linear relationship, and we further explored the nonlinear relationship using the tertile of each lipid analyte with the highest tertile as the reference group. Logistic regression was used to estimate the risk of ASD adjusting for potential confounders. The analyses were performed separately for mothers with normal weight and overweight/obese based on maternal prepregnancy BMI. Results One standard deviation decrease in postpartum maternal LDL was associated with increased odds of ASD aOR 1.35 [1.04–1.75]. There was no association between postpartum maternal HDL and TG levels and ASD risk. Decreasing levels of LDL were not associated with ASD risk in normal-weight mothers (aOR 1.2 [0.83–1.75]), but the ASD risk was more pronounced in overweight and obese mothers (aOR 1.54 [1.03–2.27]). Follow-up analysis of nonlinear association models showed that, when compared to the highest tertile, lower maternal LDL concentrations were associated with approximately two times increased risk of ASD (first tertile: aOR 2.49 [1.27–4.87] and second tertile: aOR 2.79 [1.42–5.48]). A similar pattern was observed with overweight/obese mothers but not in normal-weight mothers. Conclusions Lower maternal postpartum plasma LDL concentration was associated with increased odds of ASD in offspring among children born to overweight and obese mothers. Our findings suggest that both maternal BMI and lipids should be considered in assessing their role in offspring ASD risk, and additional longitudinal studies are needed to better understand maternal lipid dynamics during pregnancy among normal-weight and overweight/obese mothers.

Summary:. The treatment of lower extremity trauma with extensive soft tissue defects requires a multidisciplinary approach. Following precise bone fixation, appropriate soft tissue reconstruction is a major requisite. We present a case of a severe lower extremity injury caused by an excavator bucket that fell on the patient’s foot, which was reconstructed with multiple perforator flaps after concise bone fixation. During the treatment, we repeatedly experienced threatened flaps, which could not be recovered with emergent re-explorations. Although vascular occlusion after a free flap surgery may be rare, it poses a major challenge. It necessitates urgent re-exploration, but there are logistical challenges with providing sufficient resources for endovascular revascularization. We attempted an immediate postoperative angioplasty after the failure of surgical re-exploration as a salvage option and achieved successful flap survival. As the flap completely survived without complications, the patient could walk, with bearing his full weight without the use of any orthosis. Despite the development of new techniques for flap revision, which have increased the possibility of limb salvage, immediate postoperative endovascular revascularization can be considered as a salvage option in cases of a compromised flap.

Objectives The aim of effective data quality control and management is to minimize the impact of errors on study results by identifying and correcting them. This study presents the results of a data quality control system for the Korea HIV/AIDS Cohort Study that took into account the characteristics of the data. Methods The HIV/AIDS Cohort Study in Korea conducts repeated measurements every 6 months using an electronic survey administered to voluntarily consenting participants and collects data from 21 hospitals. In total, 5,795 sets of data from 1,442 participants were collected from the first investigation in 2006 to 2016. The data refining results of 2015 and 2019 were converted into the data refining rate and compared. Results The quality control system involved 3 steps at different points in the process, and each step contributed to data quality management and results. By improving data quality control in the pre-phase and the data collection phase, the estimated error value in 2019 was 1,803, reflecting a 53.9% reduction from 2015. Due to improvements in the stage after data collection, the data refining rate was 92.7% in 2019, a 24.21%p increase from 2015. Conclusions Despite this quality management strategy, errors may still exist at each stage. Logically possible errors for the post-review refining of downloaded data should be actively identified with appropriate consideration of the purpose and epidemiological characteristics of the study data. To improve data quality and reliability, data management strategies should be systematically implemented.