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Background Many new tools for abdominal aortic aneurysm (AAA) rupture risk evaluation have been developed. These new tools need detailed hemodynamic information in AAA. However, hemodynamic data obtained from in vivo research are lacking. Thus, the objective of this study was to analyze blood flow patterns in an in vivo AAA model to acquire real-time hemodynamic information using AneurysmFlow, a novel flow evaluation system. Methods Digital subtraction angiography images of patients who underwent endovascular aneurysm repair were analyzed using the visualization function of the AneurysmFlow to classify blood flow patterns as laminar or turbulent flow. The presence of boundary layer separation was also evaluated. The time taken for contrast medium to travel from the infrarenal aortic neck to aortic bifurcation was acquired to calculate the flow velocity. Associations between characteristics of aneurysm including lumen occupying ratio of intraluminal thrombus (ILT) and the hemodynamic flow pattern were evaluated. Results A total of 37 AAA patients was enrolled. Their blood flow patterns were evaluated using the AneurysmFlow. Logistic regression analyses with lumen occupying ratio of ILT as an independent variable showed that the larger the lumen occupying ratio of ILT, the more likely the aneurysm was to show a laminar pattern (P = 0.03) and the more likely the boundary layer separation would not exist (P = 0.04). The flow velocity from the infrarenal aortic neck to the aortic bifurcation showed a positive association with the lumen occupying ratio of the ILT in linear regression analysis (P Conclusion Hemodynamic analysis of AAA with the AneurysmFlow using real-time individual patient models showed different flow patterns and flow velocities depending on ILT. This novel analytic approach using AneurysmFlow has potential to play an important role in obtaining clinically meaningful hemodynamic information of AAA.

Background and Purpose Cardiac myxoma is a very rare disease for which resection is the treatment gold standard. There are many neurologic manifestations associated with this disease, including embolic infarctions, arterial aneurysms, and brain metastatic myxomas, but few large-scale studies have addressed this. We here retrospectively analyzed the incidence, type, and prognosis of these neurologic disorders. Methods We enrolled 317 patients who received a cardiac myxoma resection between 2004 and 2019 at our institution. A retrospective review of the medical records and radiologic imaging was performed for each patient, and various clinical factors were compared and analyzed with regard to clinical outcomes and the incidence of adverse events. Results Patients with a neurologic disorder before surgery were found to be more likely to develop new postoperative neurologic complications (p = .003). Patients with neurologic disorder arising at any time before or after surgery had poorer outcomes (p Conclusion The clinical management of cardiac myxoma must take account of neurologic sequelae independently of the surgical intervention to remove the lesion. Cardiac myxoma patients with any neurologic disorder should undergo both neurosurgical follow-up as well as cardiac surgical follow-up, even if myxoma removal surgery has been performed. We suggest that that active neuroimaging during long term follow-up is essential in these cases.

Background: Although it is known that inhaled corticosteroid (ICS) use may increase the risk of respiratory infection, its influence on the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Thus, the aim of this study was to investigate the association between ICS use and the positivity of SARS-CoV-2 infection among patients with chronic respiratory diseases.Methods: Nationwide data of 44,968 individuals with chronic respiratory diseases tested for SARS-CoV-2 until May 15, 2021 were obtained from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The positivity of SARS-CoV-2 infection was retrospectively analysed according to the prescription, type, and dose of ICS taken one year before SARS-CoV-2 test.Results: Among 44,968 individuals tested, 931 (2.1%) were positive for SARS-CoV-2. A total of 7,019 patients (15.6%) were prescribed ICS one year prior to being tested for SARS-CoV-2. Low, medium, and high doses of ICS were prescribed in 7.5%, 1.6%, and 6.5% of total cases, respectively. Among types of ICS, budesonide, fluticasone, beclomethasone, and ciclesonide were prescribed in 3.7%, 8.9%, 2.3%, and 0.6% of total cases, respectively. A multivariate analysis showed no significant increase in infection with ICS use (odds ratio, 0.84; 95% confidence interval, 0.66–1.03). Moreover, there were no associations between the positivity of infection and the dose or type of ICS prescribed.Conclusion: Prior ICS use did not increase the positivity for SARS-CoV-2 infection. Moreover, different doses or types of ICS did not affect this positivity.

Background: Lumbar herniated intervertebral disc (LHIVD) is a frequently presented condition/disease in Korean medical institutions. In this study, the economics of thread embedding acupuncture (TEA) was evaluated in a randomized controlled trial comparing TEA with sham TEA (STEA).Methods: This economic evaluation was analyzed from a limited social perspective, and the per-protocol set was from a basic analysis perspective. The cost-effectiveness analysis was based on the change in visual analog scale score, and the cost-utility analysis was based on the quality-adjusted life years. The final results were expressed as the average cost-effectiveness ratio and incremental cost-effectiveness ratio, and furthermore sensitivity analysis was performed to confirm the robustness of the results observed.Results: The cost-effectiveness analysis showed that TEA was 9,908 won lower than STEA, while the decrease in 100 mm visual analog scale score was 8.5 mm greater in the TEA group compared with the STEA group (p > 0.05). The cost-utility analysis showed that TEA was 9,908 won lower than STEA, while the quality-adjusted life years of TEA was 0.0026 years higher than STEA (p > 0.05). These results were robust in the sensitivity analysis, but were not statistically significant.Conclusion: In treating LHIVD, TEA appeared to have cost-effectiveness and cost-utility compared with STEA. However, there were no significant differences between the groups in terms of cost, effectiveness, and utility indicators. Therefore, results must be interpreted prudently; this study was the 1st to conduct an economic evaluation of TEA for LHIVD.

Scrub typhus is an acute infectious disease caused by the bacterium Orientia tsutsugamushi, which is widely distributed in northern, southern, and eastern Asia. Early diagnosis is essential because the average case fatality rate is usually >10% but can be as high as 45% if antimicrobial treatment is delayed. Although an O. tsutsugamushi 56-kDa type-specific antigen (TSA) is commonly used for serological diagnosis of scrub typhus, the 56-kDa TSA shows variations among O. tsutsugamushi strains, which may lead to poor diagnostic results. Therefore, the discovery of new antigenic proteins may improve diagnostic accuracy. In this study, we identified an O. tsutsugamushi 27 kDa antigen through an immunoinformatic approach and verified its diagnostic potential using patient samples. Compared with the O. tsutsugamushi 56-kDa antigen, the new 27-kDa antigen showed better diagnostic specificity with similar diagnostic sensitivity. Therefore, the O. tsutsugamushi 27-kDa antigen shows potential as a novel serological diagnostic antigen for scrub typhus, providing higher diagnostic accuracy for O. tsutsugamushi than the 56-kDa antigen.

Objective Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate.Methods We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide.Results The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p

The coupling of transition metal dichalcogenides (TMDs) and other materials offers significant synergistic effects; however, the fabrication of artificial multiheterojunction (MHJ) TMDs is a signif...

PURPOSE Asthma and bronchiectasis are common chronic respiratory diseases, and their coexistence is frequently observed but not well investigated. Our aim was to study the effect of comorbid bronchiectasis on asthma. METHODS A propensity score-matched cohort study was conducted using the National Health Insurance Service-Health Screening Cohort database. From 2005 to 2008, 8,034 participants with asthma were weighted based on propensity scores in a 1:3 ratio with 24,099 participants without asthma. From the asthma group, 141 participants with overlapped bronchiectasis were identified, and 7,892 participants had only asthma. Clinical outcomes of acute asthma exacerbation(s) and mortality rates were compared among the study groups. RESULTS The prevalence of bronchiectasis (1.7%) was 3 times higher in asthmatics than in the general population of Korea. Patients who had asthma comorbid with bronchiectasis experienced acute exacerbation(s) more frequently than non-comorbid patients (11.3% vs. 5.8%, P = 0.007). Time to the first acute exacerbation was also shorter in the asthmatics with bronchiectasis group (1,970.9 days vs. 2,479.7 days, P = 0.005). Although bronchiectasis was identified as a risk factor for acute exacerbation (adjusted odds ratio, 1.73; 95% confidence interval [CI], 1.05-2.86), there was no significant relationship between bronchiectasis and all-cause or respiratory mortality (adjusted hazard ratio [aHR], 1.17; 95% CI, 0.67-2.04 and aHR, 0.81; 95% CI, 0.11-6.08). CONCLUSIONS Comorbid bronchiectasis increases asthma-related acute exacerbation, but it does not-raise the risk of all-cause or respiratory mortality. Close monitoring and accurate diagnosis of bronchiectasis are required for patients with frequent exacerbations of asthma.

Objectives: The aim of this study was to identify the association between cohabitation status and sleep quality in family members of people with dementia (PwDs).Methods: Data of 190 365 participants aged ≥19 years from the 2018 Korea Community Health Survey were analyzed. Participants were categorized according to their cohabitation status with PwDs. Multiple logistic regression and ordinal logistic regression analyses were performed to evaluate the relationship between the cohabitation status of PwDs’ relatives and sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and PSQI subscales.Results: Compared to participants without PwDs in their families, both cohabitation and non-cohabitation with PwDs were associated with poor sleep quality (cohabitation, male: odds ratio [OR],1.28; 95% confidence interval [CI], 1.08 to 1.52; female: OR, 1.40; 95% CI, 1.20 to 1.64; non-cohabitation, male: OR, 1.14; 95% CI, 1.05 to 1.24; female: OR, 1.23; 95% CI, 1.14 to 1.33). In a subgroup analysis, non-cohabiting family members showed the highest odds of experiencing poor sleep quality when the PwD lived alone (male: OR, 1.48; 95% CI, 1.14 to 1.91; female: OR, 1.58; 95% CI, 1.24 to 2.01). Cohabiting male and female participants had higher odds of poor subjective sleep quality and use of sleeping medications than non-cohabiting male and female participants, respectively.Conclusions: The residence of PwDs and cohabitation status may contribute to poor sleep quality among PwDs’ family members. The circumstances faced by cohabiting and non-cohabiting family members should be considered when evaluating sleep quality in family members of PwDs, and appropriate interventions may be needed to improve sleep quality in both cohabiting and non-cohabiting family members.

Background: Small vessel disease (SVD) magnetic resonance imaging (MRI) markers including deep and periventricular white matter hyperintensities (PWMH), lacunes, and microbleeds are frequently observed in Alzheimer’s disease (AD) and Lewy body disease (LBD), but their implication has not been clearly elucidated. Objective: To investigate the implication of SVD MRI markers in cognitively impaired patients with AD and/or LBD. Methods: We consecutively recruited 57 patients with pure AD-related cognitive impairment (ADCI), 49 with pure LBD-related cognitive impairment (LBCI), 45 with mixed ADCI/LBCI, and 34 controls. All participants underwent neuropsychological tests, brain MRI, and amyloid positron emission tomography. SVD MRI markers including the severity of deep and PWMH and the number of lacunes and microbleeds were visually rated. The relationships among vascular risk factors, SVD MRI markers, ADCI, LBCI, and cognitive scores were investigated after controlling for appropriate covariates. Results: LBCI was associated with more severe PWMH, which was conversely associated with an increased risk of LBCI independently of vascular risk factors and ADCI. PWMH was associated with attention and visuospatial dysfunction independently of vascular risk factors, ADCI, and LBCI. Both ADCI and LBCI were associated with more lobar microbleeds, but not with deep microbleeds. Conclusion: Our findings suggest that PWMH could reflect degenerative process related with LBD, and both AD and LBD independently increase lobar microbleeds.

Objectives: A critical pathway defines the optimal care process, sequencing and timing of intervention by multi-disciplinary health care teams for a particular diagnosis and procedure. It plays an important role as a cost-effective health care delivery system and a tool for quality control of medical and dental services by means of standardizing medical practices. The aim of this study is to investigate the satisfaction of patients and medical staff after implementation of a critical pathway for Korean medical treatment of lumbar disc herniation in integrative medical. Methods and Results: The pre-critical pathway group included 3 patients who underwent the implementation procedure from October 2020. All three patients have successfully been applied critical pathways during inpatient and outpatient treatment. Additionally, medical staff members were satisfied with the usefulness of the critical pathway. Conclusions: The implementation of critical pathway for the Korean medical treatment with lumbar disc herniation in integrative medical hospital can appraise possible applicability in actual clinical field.

Objective We sought to assess and compare the rate of adjacent segment degeneration (ASDeg), adjacent segment disease, and related reoperations between patients who underwent lumbar interbody fusion surgery using indirect or direct decompression. Methods On the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review and meta-analysis was performed to identify and analyze studies that compared the rate of ASDeg, adjacent segment disease, and related reoperations between indirect and direct decompression techniques. Indirect decompression included anterior lumbar interbody fusion, lateral lumbar interbody fusion, and oblique lateral interbody fusion, whereas direct decompression included posterior or transforaminal lumbar interbody fusion. Results Seven studies including a total of 576 patients (indirect: 314; direct: 262) were identified. The pooled rates of ASDeg were 19.4% (45/232) and 34.9% (66/189) for indirect and direct decompression, respectively. A fixed-effects model showed 0.34 times lower odds of developing ASDeg in the indirect decompression group (odds ratio = 0.34, 95% confidence interval [CI] = 0.20, 0.57). The pooled incidence of reoperation was 2.5% (8/314) and 6.1% (16/262) for indirect and direct decompression, respectively. A fixed-effects model showed 0.40 times lower odds of reoperation from ASDeg in the indirect decompression group (odds ratio = 0.40, 95% CI = 0.18, 0.89). The pooled mean difference for the segmental lordosis angle was 1.80 degrees (95% CI = 0.74, 2.86) and 7.11 degrees (95% CI = 4.47, 9.74) for total lumbar lordosis angle, favoring indirect decompression. Conclusions Indirect decompression showed lower odds of developing ASDeg and undergoing reoperation for ASDeg after lumbar interbody fusion surgery in this meta-analysis. However, the limited number and quality of the included studies should be considered when interpreting the results.

Background Cytomegalovirus (CMV) infection is an important complication after kidney transplantation (KT). Antithymocyte globulin (ATG) increases the risk for CMV infection, and universal prophylaxis is recommended during the first 3 to 6 months after ATG induction in CMV-seropositive recipients. However, following this recommendation is not easy because the cost is high. The aim of this study was to determine who, among high-risk KT recipients, are more vulnerable to CMV infections. Methods We retrospectively analyzed the medical records of patients who underwent KT with ATG induction therapy at a single institute from April 2014 to June 2019. We assessed pretransplant recipient characteristics to determine the CMV infection risk factors. Cell-mediated immunity was evaluated with a lymphocyte subset test before transplantation and at the time of discharge. We included 227 patients in the study. Results CMV-DNAemia was associated with donor type (deceased donor), the duration of renal replacement therapy, and the ATG dose. Multivariable analysis revealed that donor type is the primary risk factor for CMV-DNAemia. We also found that CD4+ cell counts were significantly lower in CMV-DNAemia recipients at the time of discharge. Conclusion The risk for CMV infection in CMV-seropositive KT recipients with ATG induction therapy increases when a graft is received from a deceased donor with renal impairment and when insufficient CD4+ cells are present during recovery.

We present a micrometer-scale, on-chip integrated, plasmonic enhanced graphene photodetector (GPD) for telecom wavelengths operating at zero dark current. The GPD is designed to directly generate a photovoltage by the photothermoelectric effect. It is made of chemical vapor deposited single layer graphene, and has an external responsivity ∼12.2 V/W with a 3 dB bandwidth ∼42 GHz. We utilize Au split-gates to electrostatically create a p-n-junction and simultaneously guide a surface plasmon polariton gap-mode. This increases the light-graphene interaction and optical absorption and results in an increased electronic temperature and steeper temperature gradient across the GPD channel. This paves the way to compact, on-chip integrated, power-efficient graphene based photodetectors for receivers in tele- and datacom modules.

Objectives: The purpose of this study was to identify related factors related to the treatment of diabetic patients.Methods: The subjects of this study were 23,772 diabetic patients aged 30 years and older who participated in the 2016 Community Health Survey. The independent variables were sociodemographic factors, lifestyle and health-related characteristics and diabetes-related characteristics and the dependent variables were related to diabetes treatment. The statistical analysis methods used to find factors related to treatment in diabetic patients were the chi-square test and multiple logistic regression analysis.Results: The drug treatment rate of diabetic patients was 88.7%. Among sociodemographic characteristics, drug treatment for diabetes was significantly related to women, increasing age, higher educational level and living in rural area. Among the characteristics related to lifestyle and health status, walking practice and subjective health status were significantly related and among diabetes related characteristics, there were significant correlations in whether it was blood glucose level, self-cognitive blood glucose control, and diabetes management education.Conclusions: Conclusively, gender, age, education level, residential area, walking practice, self-rated health and knowledge of DM were associated with treatment of DM. An effective diabetes management program that reflects the relevant factors should be applied to the treatment of DM.

Objectives: This study was performed to identify and find the clustering of healthy behaviors and the factors related to the clustering among Korean adults aged 19-64.Methods: The data of 9,519 Korean adults aged between 19 and 64 years who participated in the 6th Korea National Health and Nutrition Examination Survey were used as the analysis target. Following the recommendation of the Health Plan 2020 for health-promoting lifestyle, four variables, including nonsmoking, moderate drinking, sufficient physical activity, and healthy diet, were used in the study. The multinomial logistic regression analysis was performed to analyze the relationships among demographic characteristics, health-related characteristics, and clustering of healthy behaviors.Results: The significant elements of healthy behaviors clustering included sufficient physical activities for males, and non-smoking, moderate drinking, and healthy diet for females. Clustering healthy behaviors were higher for “females, the elderly, people with higher level of education, people with higher household income, people with diabetes, and people who perceive their subjective health status is good.Conclusions: In this study, the factors related to the clustering of healthy behaviors were identified. In order to spread the practice of healthy behaviors, multiple interventions are more effective than individual health behaviors.

Sleep is being emphasized as a factor that improves mental health and quality of life. Here, we aimed to investigate the association between the quality and duration of sleep and subjective cognitive decline in the Korean population. We used the 2018 Korean Community Health Survey data that are nationwide representative data collected by the Korea Centers for Disease Control and Prevention. Sleep quality was measured using the Korean version of Pittsburgh Sleep Quality Index. The study population comprised 206,719 individuals aged 19 years and over. We used multiple logistic regression for the analysis. Individuals of both sexes with poor sleep quality were more likely to experience subjective cognitive decline compared with the reference group (good sleep quality) (men, odds ratio (OR) = 1.97 [95% confidence interval (CI) 1.86–2.09]; women, OR = 1.75 [95% CI 1.67–1.84]). U-shape associations were found between sleep duration and subjective cognitive decline. Additionally, the presence of depressive symptom or stress and health-related behaviors, including smoking, drinking, and not walking, were high-risk factors for subjective cognitive decline. Our results indicate that poor sleep quality might contribute to subjective cognitive decline in the Korean population. We suggest the implementation of intervention measures for poor sleep behaviors to prevent cognitive decline.

Rivoceranib is a selective inhibitor of VEGFR-2 being developed for the treatment of solid tumor. The objective of the study was to evaluate the effect of food on bioavailability as well as single- and multiple-dose pharmacokinetics (PKs) of 81 and 201 mg doses of rivoceranib. The study was conducted as a two-part study. In Part 1 (single ascending dose (SAD), open-label, crossover study design), 2 oral doses of rivoceranib (81 mg or 201 mg) were given to all healthy subjects with a minimum 3-day washout period between dosing. Part 2 was a multiple ascending dose (MAD), open-label, crossover design where subjects were divided based on 81 and 201 mg doses. Both doses were administered with and without food in a crossover manner for the SAD and MAD parts. 24 healthy subjects completed Part 1 and 20 subjects completed Part 2. For the 81 mg dose in the SAD and MAD parts of the study, their food effect was not observed. For the 201 mg dose in both parts, food appeared to increase bioavailability by 20%-30% in Part 1, and 30%-40% in Part 2. Median tmax value was delayed when rivoceranib was administered with food at each dose level in both parts of the study. Dose proportionality was confirmed only for the AUC0-∞ value from Part 1-fasted cohort but inconclusive for Cmax and AUC parameters under other dosing regimens. In conclusion, rivoceranib when taken with food delays tmax appears to increase bioavailability at 201 mg dose.

Jun Yeon Kim, Byung Kwan Seo, Yeon Cheol Park, Jung-Hyun Kim, Bonhyuk Goo, Yong Hyeon Baek Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, Seoul, Republic of KoreaCorrespondence: Yong Hyeon BaekDepartment of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of KoreaTel +82 2 440 8642Fax +82 2 440 7770Email byhacu@khu.ac.krPurpose: The prevalence of non-specific posterior neck pain (NPNP) has been increasing yearly. There are several treatments for NPNP, but in this review, we will focus on thread-embedded acupuncture (TEA). TEA is used in the Republic of Korea, Taiwan, and China for managing musculoskeletal diseases, obesity, and sequelae of facial palsy. However, there is insufficient evidence on its effectiveness and safety. This study aims to assess the efficacy and safety of TEA for NPNP.Methods: We will search the following nine electronic databases, from their inception to May 2020: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Citation Information by the National Information infrastructure, Korean Studies Information Service System, National Digital Science Library, Oriental Medicine Advanced Searching Integrated System, and Research Information Service System. Only randomized controlled trials of TEA for NPNP will be included. The methodological quality of the included trials will be assessed using the Cochrane risk-of bias tool. To conduct the meta-analysis, the risk ratio and mean difference with the 95% confidence interval will be used. Sensitivity analyses will be conducted based on this protocol.Results: The results of this study will be submitted to a peer-reviewed journal for publication.Conclusion: The results of this study would provide the evidence of whether TEA can be effective for treating NPNP.Registration Number: PROSPERO CRD42020188346.Keywords: posterior neck pain, polydioxanone, randomized controlled trials, systematic review

To evaluate the implication of 18F-fluorodeoxyglucose (FDG)- and dopamine transporter (DAT)-positron emission tomography (PET) in the diagnosis and clinical symptoms of dementia with Lewy bodies (DLB), 55 DLB patients and 49 controls underwent neuropsychological evaluation and FDG-, DAT-, and 18F-Florbetaben (FBB) PET. DAT- and FDG-uptake and FDG/DAT ratio were measured in the anterior and posterior striatum. The first principal component (PC1) of FDG subject residual profiles was identified for each subject. Receiver operating characteristic curve analyses for the diagnosis of DLB were performed using FDG- and DAT-PET biomarkers as predictors, and general linear models for motor severity and cognitive scores were performed adding FBB standardized uptake value ratio as a predictor. Increased metabolism in the bilateral putamen, vermis, and somato-motor cortices, which characterized PC1, was observed in the DLB group, compared to the control group. A combination of posterior putamen FDG/DAT ratio and PC1 showed the highest diagnostic accuracy (91.8% sensitivity and 96.4% specificity), which was significantly greater than that obtained by DAT uptake alone. Striatal DAT uptake and PC1 independently contributed to motor severity and language, memory, frontal/executive, and general cognitive dysfunction in DLB patients, while only PC1 contributed to attention and visuospatial dysfunction.

Background In the past decade, the Korean smoking rate has only decreased by 3%, despite several smoking control policies. There is a need for such policies to take smokers’ psychological characteristics into account. Depression is a well-known contributor to failed smoking cessation. This study aimed to examine the effect of smokers’ depression status changes on their daily cigarette smoking amount (DCA). Methods This study used a sample drawn from the Korea Welfare Panel Study (KoWePS) waves 3 (2008) to 13 (2018). The DCA refers to the number of the cigarettes smoked per day at the time of the survey. Depression was measured using an 11-item version of the Center for Epidemiologic Studies Depression Scale (CESD-11). A generalized estimating equation (GEE) model was employed to analyse the effect of change of depression status on DCA. Results The 2008 baseline included a total of 1821 participants: 1645 males and 176 females. The Yes→No male depression status group had lower DCA (β = − 0.631, p-value = 0.0248) than the No→No group. The Yes→No male depression status group that began smoking before age 19 had lower DCA (β = − 0.881, p-value: 0.0089) than the No→No group that started smoking before 19. Conclusions We found that a change from depressed to non-depressed and non-depressed to depressed status is associated with decreasing and increasing DCA among men, respectively. Also, for smokers who began smoking before 19 years of age, the subgroup that went from depressed to non-depressed had much a lower DCA than general smokers. Thus, when treating people participating in smoking cessation programs, counsellors should check for depression symptoms and encourage individuals to pursue depression treatment simultaneously.

Cancer‐related fatigue (CRF) is one of the most common chronic symptoms experienced by cancer patients. As moxibustion is a popular traditional therapy for managing fatigue, it can be an alternative strategy to treat CRF as well. Therefore, we rigorously designed a full‐scale, multicenter, assessor‐blinded, randomized controlled trial to evaluate the efficacy and safety of moxibustion treatment for CRF. Ninety‐six subjects suffering from CRF were recruited and randomly assigned to moxibustion group, sham moxibustion group, or usual care group. Both the moxibustion group and the sham group received moxibustion treatment for 8 weeks and the usual care group did not. Brief fatigue inventory (BFI) score and Functional Assessment of Cancer Therapy‐Fatigue score were used to assess CRF at baseline and weeks 5, 9, and 13. Questionnaires for the assessment of cognitive impairment, quality of life, and Cold–Heat and Deficiency–Excess patterns were also evaluated. BFI scores significantly decreased in moxibustion group compared to the usual care group (mean difference of −1.92, p, Moxibustion is widely used treatment method for stimulating acupuncture points and has been used for symptom management in cancer patients in East Asia. However, scientific evidence of moxibustion for the treatment of cancer‐related fatigue is still lacking. Through this full‐scale, multicenter, assessor‐blinded, randomized controlled trial, we found that 8 weeks of moxibustion treatment decreased cancer‐related fatigue more effectively than usual care.

Context Insulin resistance is a determinant of diabetes. With the increasing popularity of electronic smoking, the number of dual smokers (smoking both cigarettes and electronic cigarettes [e-cigarettes]) is increasing. However, few studies have assessed the association between insulin resistance and smoking behavior, including dual smoking. Objective This work aims to investigate the association between smoking behaviors and insulin resistance. Methods This prospective, cross-sectional study took place among the general community. A total of 11 653 participants (4721 male and 6932 female) aged 19 years or older from the 2016 to 2018 Korea National Health and Nutrition Examination Survey were divided based on their smoking behaviors: dual smokers (both cigarettes and e-cigarettes), single smokers (cigarette smokers), previous smokers, and nonsmokers. Insulin resistance was determined based on the triglyceride-glucose index. Multiple logistic regression analysis was performed to investigate the association between smoking behavior and insulin resistance. Results Among the participants, 164 males (3.5%) and 33 females (0.5%) were dual-smokers, and 1,428 males (30.2%) and 308 females (4.4%) were single-smokers. Male and female smokers (dual and single) both had higher odds of being in a group with higher insulin resistance than nonsmokers (male, dual: OR = 2.19; 95% CI, 1.39-3.44; single: OR = 1.78; 95% CI, 1.43-2.22; female, dual: OR = 2.32; 95% CI, 1.01-5.34; single: OR = 1.76; 95% CI, 1.28-2.42). Conclusion This study suggests that single and dual smoking both may increase the risk of insulin resistance in the general population. Education on the adverse effects of smoking behaviors may be an important strategy to improve the health of the population.

PurposeThe purpose of this paper is to analyze the relationship between customer engagement in social media (CESM), brand equity and corporate performance and investigated whether these relationships differed according to cultural factors in the United States and South Korea.Design/methodology/approachWe collected customer engagement on social media data on Facebook and brand equity data from Interbrand for listed companies in the United States and Korea. A total of 405 data sets were analyzed by partial least squares structural equation modeling (PLS-SEM).FindingsResults revealed that CESM did not affect financial performance through a direct path but was found to have a positive indirect path via the mediation of brand equity. In addition, this relationship was found to differ between the United States and South Korea.Originality/valueThis study contributed to the literature on social media and international management by verifying the relationship between CESM, brand equity and financial performance, and by presenting exploratory research results to ascertain if these relationships differ according to the cultural dimension of the country.

Background: Hypnotics, including benzodiazepines, are extensively and inappropriately prescribed for older people to treat anxiety and sleep disorders, despite the adverse health outcomes associated with their use. Objective: This study aimed to examine the association of the use of long- and short-acting hypnotics with the risk of Alzheimer’s disease. Methods: Data from 234,634 participants, derived from the Korean National Health Insurance Service National Sample Cohort from 2002 to 2013, were examined. Individuals over the age of 50 years were included in the study. The dependent variable was the risk of Alzheimer’s disease. Hypnotics were categorized by the period of the prescription of benzodiazepines, i.e., either till the participants were diagnosed with Alzheimer’s disease or the end of the study period (December 31, 2013). Cox regression model was built to analyze the association between variables. Results: Individuals who used long-acting hypnotics were found to have a higher risk of Alzheimer’s disease than non-users. Moreover, among individuals with sleep disorders, those who used hypnotics had a higher risk of Alzheimer’s disease than those who did not. Conclusion: This study identified an association between the use of hypnotics and the risk of Alzheimer’s disease among South Korean middle-aged and older people.

Deep neural network (DNN)-based object detection has been investigated and applied to various real-time applications. However, it is hard to employ the DNNs in embedded systems due to their high computational complexity and deep-layered structure. Although several field-programmable gate array (FPGA) implementations have been presented recently for real-time object detection, they suffer from either low throughput or low detection accuracy. In this article, we propose an efficient computing system for real-time SSDLite object detection on FPGA devices, which includes novel hardware architecture and system optimization techniques. In the proposed hardware architecture, a neural processing unit (NPU) that consists of heterogeneous units, such as band processing, scaling, and accumulating, and data fetching and formatting units is designed to accelerate the DNNs efficiently. In addition, system optimization techniques are presented to improve the throughput further. A task control unit is employed to balance the workload and increase the utilization of heterogeneous units in the NPU, and the object detection algorithm is refined accordingly. The proposed architecture is realized on an Intel Arria 10 FPGA and enhances the throughput by up to $13.6\times $ compared to the state-of-the-art FPGA implementation.

Background The importance of SA (Successful aging) has been emphasized in recent years, with focus shifting towards attaining healthier aging rather than longevity. However, the influence of SA and its changes on mental health such as depression remains a relatively unexplored area in gerontology. Therefore, we investigated the longitudinal association between changes in SA and depressive symptoms in Korean older adults. Methods This study comprised a longitudinal sample of older adults aged ≥ 45 years, drawn from the Korean Longitudinal Study of Aging (2006–2018). Changes in SA status was determined using the Rowe and Kahn model over two consecutive years. Using an adjusted generalized estimating equation model, we examined the association between changes in successful aging status, namely SA and NSA (Non-successful aging), and depressive symptoms. Results Compared to the SA→SA group, depressive symptom risk in the NSA→NSA and SA→NSA groups were higher in men [(OR, 1.16; 95 % CI, 1.13–1.18), (OR, 1.11; 95 % CI, 1.08–1.13), respectively] and in women [(OR, 1.15; 95 % CI, 1.13–1.18), (OR, 1.11; 95 % CI, 1.09–1.14), respectively]. Subgroup analysis of the dimensions of successful aging revealed that low or worsening criteria of successful aging status in men and women were associated with depressive symptoms. Conclusions Korean older adults who continuously failed to attain or maintain successful aging status had the highest risk of depressive symptoms. These results could further assist in establishing policies and interventions that promote successful aging and subsequently protect the mental health of the Korean older adult population.

Machine learning technology is recently being applied to various fields. However, in the field of online consumer conversion, research is limited despite the high possibility of machine learning application due to the availability of big data. In this context, we investigate the following three research questions. First, what is the suitable machine learning model for predicting online consumer behavior? Second, what is the good data sampling method for predicting online con-sumer behavior? Third, can we interpret machine learning’s online consumer behavior prediction results? We analyze 374,749 online consumer behavior data from Google Merchandise Store, an online shopping mall, and explore research questions. As a result of the empirical analysis, the performance of the ensemble model eXtreme Gradient Boosting model is most suitable for pre-dicting purchase conversion of online consumers, and oversampling is the best method to mitigate data imbalance bias. In addition, by applying explainable artificial intelligence methods to the context of retargeting advertisements, we investigate which consumers are effective in retargeting advertisements. This study theoretically contributes to the marketing and machine learning lit-erature by exploring and answering the problems that arise when applying machine learning models to predicting online consumer conversion. It also contributes to the online advertising literature by exploring consumer characteristics that are effective for retargeting advertisements.

OBJECTIVE The current grading system for moyamoya disease (MMD) is focused on angiographic studies with limited clinical application. The authors aimed to determine relevant factors that may impact postoperative outcome and establish a scoring system to predict the functional outcome. METHODS Adult patients with MMD who underwent treatment between 1998 and 2016 were included. Factors such as age, sex, comorbidity, smoking, MMD family history, initial presentation, multimodal imaging modalities, and types of surgical revascularization were thoroughly reviewed. These factors were analyzed to determine possible risk factors related to unfavorable 6-month postoperative outcomes using the modified Rankin Scale (mRS) (unfavorable: mRS score ≥ 3). A scoring system was developed using these independent risk factors to predict the outcome and validated using prospectively collected data from multiple centers between 2017 and 2018. RESULTS Of 302 patients for whom applications were submitted, 260 patients (321 hemispheres) met the diagnostic criteria. In multivariate analysis, hyperlipidemia, smoking, cerebral infarction on preoperative CT or MRI, and moderately to severely reduced regional cerebrovascular reserve results from Diamox SPECT were significantly related to unfavorable outcome. The authors developed a scoring system and stratified patients into risk groups according to their scores: low-risk (score 0–3), intermediate-risk (score 4–6), and high-risk (score 7–9) groups. This model demonstrated both good discrimination and calibration using C-statistics and the Hosmer-Lemeshow goodness-of-fit test showing 0.812 (95% CI 0.743–0.881) (p = 0.568) for the development and 0.954 (95% CI 0.896–1) (p = 0.097) for the temporal and external validation cohort. CONCLUSIONS The authors’ scoring system is readily adoptable to predict the postoperative outcome for MMD. Their data revealed the importance of smoking and hyperlipidemia, which were the only modifiable factors included in the scoring system. The authors validated their scoring system both internally and externally and maintained good performance, highlighting the system’s generalizability and reliability.

Background/Aims Connective tissue growth factor (CTGF) is a profibrotic factor implicated in pressure overload-mediated myocardial fibrosis. In this study, we determined the role of predicted CTGF-targeting microRNAs (miRNAs) in rat models of aortic stenosis and reverse cardiac remodeling. Methods Minimally invasive ascending aortic banding was performed in 24 7-week-old male Sprague-Dawley rats, which were divided into three groups. The banding group consisted of eight rats that were sacrificed immediately after 6 weeks of aortic constriction. The debanding group underwent aortic constriction for 4 weeks and was sacrificed 2 weeks after band removal. The third group underwent sham surgery. We investigated the expression of CTGF, transforming growth factor-β1 (TGFβ1), and matrix metalloproteinase-2 using ELISA and examined miRNA-26b, miRNA-133a, and miRNA-19b as predicted CTGF-targeting miRNAs based on miRNA databases in 24-hour TGFβ-stimulated and TGFβ- washed fibroblasts and myocardial tissues from all subjects. Results CTGF was elevated in 24-hour TGFβ-stimulated fibroblasts and decreased in 24-hour TGFβ-washed fibroblasts. miRNA-26b was significantly increased in TGFβ-washed fibroblasts compared with control and TGFβ-stimulated fibroblasts (p < 0.05). CTGF expression was significantly higher in the banding group than that in the sham and debanding groups. The relative expression levels of miRNA-26b were higher in the debanding group than in the banding group. Conclusions The results of our study using models of aortic banding and debanding suggested that miRNA-26b was significantly increased after aortic debanding. The in vitro model yielded the same results: miRNA-26b was upregulated after removal of TGFβ from fibroblasts.

Introduction It is unclear whether smokers are more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to evaluate the association between smoking and the risk of SARS-CoV-2 infection. Methods A matched case–control study was conducted using a large nationwide database. The case group included patients with SARS-CoV-2 infection confirmed by the Korea Centers for Disease Control and Prevention, and the control group was randomly sampled from the general Korean population in the National Health Insurance Service database by matching sex, age, and region of residence. Conditional logistic regression models were used to investigate whether the risk of infection with SARS-CoV-2 was affected by smoking status. Results A total of 4167 patients with SARS-CoV-2 infection and 20 937 matched controls were enrolled. The proportion of ex-smokers and current smokers was 26.6% of the total participants. In multivariate analysis, smoking was not associated with an increased risk of SARS-CoV-2 infection (odds ratio [OR] = 0.56, confidence interval [CI] = 0.50–0.62). When ex-smokers and current smokers were analyzed separately, similar results were obtained (current smoker OR = 0.33, CI = 0.28–0.38; ex-smoker OR = 0.81, CI = 0.72–0.91). Conclusions This study showed that smoking may not be associated with an increased risk of SARS-CoV-2 infection. Smoking tends to lower the risk of SARS-CoV-2 infection; however, these findings should be interpreted with caution. Implications It is unclear whether smokers are more vulnerable to coronavirus disease 2019. In this large nationwide study in South Korea, smoking tended to lower the risk of infection with severe acute respiratory syndrome coronavirus 2. However, these findings should be interpreted with caution, and further confirmatory studies are required.

Background and Purpose: Patients with intracerebral hemorrhage (ICH) have oxidative stress. Oxidative stress contributes to the development and progression of perihematomal edema (PHE) in brain hemorrhage patients. We hypothesized that reactive oxygen species (ROS) scavengers might have a neuroprotective role in the acute period of patients with ICH. Methods: This prospective, multicenter, single-blind, randomized study was conducted between June 2017 and October 2019. Intracranial bleeding, including spontaneous ICH, secondary ICH due to vascular anomalies, venous thrombosis, neoplasms, or hemorrhagic infarction, were included in our study. These ROS scavengers were given for 14 days with a dose of N-acetylcysteine 2000 mg/d and selenium 1600 µg/d intravenously. Other patients received a placebo. The primary outcome was hemorrhage and PHE volume changes in 2-week follow-up computed tomography between ROS scavenger versus placebo groups. Results: In total, 448 patients were enrolled with 123 patients remaining after applying the inclusion and exclusion criteria. There were no significant differences in baseline characteristics between the ROS scavenger (n=57) and placebo (n=66) groups. No significant differences in baseline hematoma and PHE volumes were observed but 2 weeks follow-up computed tomography showed significant differences in PHE volume (21.90±17.63 versus 30.66±32.35, P P P P Conclusions: ROS scavenger showed a significantly reduced PHE volume, time to reach target Richmond Agitation Sedation Scale, and shortened length of intensive care unit stay in patients with acute ICH. Early and high doses of ROS scavengers in a combination regimen may have played a key role in obtaining a favorable outcome in our study. Registration: URL: https://cris.nih.go.kr/cris/en ; Unique identifier: KCT0004628.

Existing elastic analysis methods cannot be adhered to in order to assess the structural integrity of a reactor vessel and internals for a beyond design basis earthquake. Elasto-plastic analysis methods are required, and the factors that affect the elasto-plastic behavior of reactor materials should be taken into account. In this study, a material behavior model was developed that considers the irradiation embrittlement effect, which affects the elasto-plastic behavior of the reactor material. This was used to perform the elasto-plastic time history analyses of the reactor vessel and its internals for beyond design basis earthquake. For this investigation, appropriate beyond design basis earthquakes and reliable finite element models were used. Based on the analysis results, consideration was given to the load reduction effect and the margin change. These were transferred to the internals due to the plastic deformation of the reactor vessel.

Background and Objective Microsurgical clipping, along with endovascular treatment, has evolved in the treatment of unruptured intracranial aneurysms (UIA), and these developments have resulted in a reduction of the complication rate. We discuss the need for a central venous catheter (CVC) insertion as an anesthetic preparation for microsurgical clipping. Methods Between January 2019 and September 2019, 722 patients with UIA were treated at our institution. We excluded patients with a history of endovascular treatment or bypass surgery, recurrent aneurysms after coil embolization, brain tumors, or subarachnoid hemorrhages. A total of 272 patients were enrolled. Eighty-four patients underwent CVC insertion, and 188 patients underwent clipping surgery without CVC insertion. Outcome-related factors were compared between the 2 groups. We performed propensity score matching of the 2 groups to increase comparability. Results There were no significant differences in outcome, sex, aneurysm location, aneurysm multiplicity, aneurysm size, or comorbid disease between the 2 groups. The mean age at the time of surgery was higher in the non-CVC insertion group than in the CVC insertion group. There were no meaningful differences in primary outcomes, including premature rupture and intraoperative motor evoked potential/somatosensory evoked potential change, and secondary outcomes, including estimated blood loss, duration of intensive care unit stay, duration of hospitalization, and Glasgow Outcome Scale score at discharge. Conclusions CVC insertion for clipping surgery for UIA is not mandatory. Considering the possible complications associated with CVCs, we cautiously suggest aneurysm surgery with CVC insertion in patients with serious medical comorbidities, aneurysm sizes >10 mm, and difficult proximal parent artery control.

Children are at risk of exposure to secondhand smoke. We aimed to evaluate the extent of their exposure to it in relation to their parents’ smoking status by using biomarkers relevant to smoking. We evaluated 847 school-age children (6–12 years) who lived with their parents, using data from the Korea National Health and Nutrition Examination Survey 2016–2018. Secondhand smoke exposure in children of non-smoking and smoking parents was assessed by measuring urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and cotinine concentrations. Overall, the parents of 482 (55.1%) children smoked and those of 392 (44.9%) children did not smoke. After adjusting for covariates, significantly higher concentrations of NNAL (β = 0.482, standard error [S.E.] = 0.065, P