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Purpose The aim of this study is to evaluate the safety and efficacy of ex vivo activated and expanded natural killer (NK) cell therapy (SNK01) plus pembrolizumab in a randomized phase I/IIa clinical trial.Materials and Methods Overall, 18 patients with advanced non–small cell lung cancer (NSCLC) and a programmed death ligand 1 tumor proportion score of 1% or greater who had a history of failed frontline platinum-based therapy were randomized (2:1) to receive pembrolizumab every 3 weeks +/– 6 weekly infusions of SNK01 at either 2×109 or 4×109 cells per infusion (pembrolizumab monotherapy vs. SNK01 combination). The primary endpoint was safety, whereas the secondary endpoints were the objective response rate (ORR), progression-free survival (PFS), overall survival, and quality of life.Results Since no dose-limiting toxicity was observed, the maximum tolerated dose was determined as SNK01 4×109 cells/dose. The safety data did not show any new safety signals when SNK01 was combined with pembrolizumab. The ORR and the 1-year survival rate in the NK combination group were higher than those in patients who underwent pembrolizumab monotherapy (ORR, 41.7% vs. 0%; 1-year survival rate, 66.7% vs. 50.0%). Furthermore, the median PFS was higher in the SNK01 combination group (6.2 months vs. 1.6 months, p=0.001).Conclusion Based on the findings of this study, the NK cell combination therapy may consider as a safe treatment method for stage IV NSCLC patients who had a history of failed platinum-based therapy without an increase in adverse events.

Topic Comparative efficacy and safety of different concentrations of atropine for myopia control in children. Clinical relevance Atropine is known to be an effective intervention to delay childhood myopia progression. Nonetheless, there is as yet no well-supported evidence ranking the clinical outcomes of various concentrations of atropine. Methods We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform and ClinicalTrials.gov on Apr 14, 2021. We selected studies involving atropine treatment of at least 1-year duration for control of myopia in children. We performed a network meta-analysis (NMA) of placebo-controlled and head-to-head randomized controlled trials (RCTs) and compared 8 atropine concentrations (1, 0.5, 0.25, 0.1, 0.05, 0.025, 0.02, and 0.01%). We ranked the atropine concentrations for the corresponding outcomes by P-score (estimate of probability of being best treatment). Our primary outcomes were mean annual changes in refraction (diopters/year) and axial length ([AXL] millimeters/year). We also extracted data on the proportion of eyes showing myopia progression and safety outcomes (photopic/mesopic pupil diameter, accommodation amplitude, distance/near best-corrected visual acuity [BCVA]). Results Thirty (30) pairwise comparisons from 16 RCTs (3,272 participants) were obtained. Our NMA ranked the 1, 0.5 and 0.05% atropine concentrations as the 3 most beneficial for myopia control based on P-scores, as assessed for both primary outcomes: 1% atropine (mean difference and 95% CI in refraction compared to control: 0.81 [0.58;1.04]; AXL: -0.35 [-0.46;-0.25]), 0.5% atropine (refraction: 0.70 [0.40;1.00]; AXL: -0.23 [-0.38;-0.07]), 0.05% atropine (refraction: 0.62 [0.17;1.07]; AXL: -0.25 [-0.44;-0.06]). In terms of myopia control as assessed by relative risk (RR) for overall myopia progression, 0.05% was ranked as the most beneficial atropine concentration (RR:0.39 [95% CI: 0.27;0.57]) followed by 1% (0.43 [0.33;0.56]). The ranking probability for adverse effects (photopic/mesopic pupil diameter and accommodation amplitude) tended to decline as the atropine concentration was increased, though this tendency was not evident for distance BCVA. No valid network was formed for near BCVA. Conclusion The ranking probability for efficacy was not proportional to dose (i.e., 0.05% atropine was comparable to that of high-dose [1 and 0.5%]), though those for pupil size and accommodation amplitude were dose-related.

A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach.To assess the effects of PAE compared to other procedures for treatment of LUTS in men with BPH.We performed a comprehensive search using multiple databases (The Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on language of publication or publication status, up until 25 September 2020.We included parallel-group randomized controlled trials (RCTs), as well as non-randomized studies (NRS, limited to prospective cohort studies with concurrent comparison groups) enrolling men over the age of 40 with LUTS attributed to BPH undergoing PAE versus TURP or other surgical interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies for inclusion or exclusion and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence of RCTs and NRSs. MAIN RESULTS: We found data to inform two comparisons: PAE versus TURP (six RCTs and two NRSs), and PAE versus sham (one RCT). Mean age, IPSS, and prostate volume of participants were 66 years, 22.8, and 72.8 mL, respectively. This abstract focuses on the comparison of PAE versus TURP as the primary topic of interest. PAE versus TURP We included six RCTs and two NRSs with short-term (up to 12 months) follow-up and one RCT with long-term follow-up (13 to 24 months). Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement (mean difference [MD] 1.55, 95% confidence interval [CI] -0.40 to 3.50; 369 participants; 6 RCTs; I² = 75%; low-certainty evidence) measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms. There may be little to no difference in quality of life (MD 0.16, 95% CI -0.37 to 0.68; 309 participants; 5 RCTs; I² = 56%; low-certainty evidence) as measured by the IPSS quality of life question on a scale from 0 to 6, with higher scores indicating worse quality of life between PAE and TURP, respectively. While we are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.71, 95% CI 0.16 to 3.10; 250 participants; 4 RCTs; I² = 26%; very low-certainty evidence), PAE may increase re-treatments (RR 3.64, 95% CI 1.02 to 12.98; 204 participants; 3 RCTs; I² = 0%; low-certainty evidence). Based on 18 re-treatments per 1000 men in the TURP group, this corresponds to 47 more (0 more to 214 more) per 1000 men undergoing PAE. We are very uncertain about the effects on erectile function (MD -0.03, 95% CI -6.35 to 6.29; 129 participants; 2 RCTs; I² = 78%; very low-certainty evidence) measured by the International Index of Erectile Function at 5 on a scale from 1 to 25, with higher scores indicating better function. NRS evidence when available yielded similar results. Based on evidence from NRS, PAE may reduce the occurrence of ejaculatory disorders (RR 0.51, 95% CI 0.35 to 0.73; 260 participants; 1 NRS; low-certainty evidence). Longer-term follow-up: based on RCT evidence, we are very uncertain about the effects of PAE on urologic symptom scores (MD 0.30, 95% CI -3.17 to 3.77; 95 participants; very low-certainty evidence) compared to TURP. Quality of life may be similar (MD 0.20, 95% CI -0.49 to 0.89; 95 participants; low-certainty evidence). We are also very uncertain about major adverse events (RR 1.96, 95% CI 0.63 to 6.13; 107 participants; very low-certainty evidence). We did not find evidence on erectile function and ejaculatory disorders. Based on evidence from NRS, PAE may increase re-treatment rates (RR 1.51, 95% CI 0.43 to 5.29; 305 participants; low-certainty evidence); based on 56 re-treatments per 1000 men in the TURP group. this corresponds to 143 more (25 more to 430 more) per 1000 men in the PAE group. AUTHORS' CONCLUSIONS: Compared to TURP up to 12 months (short-term follow-up), PAE may provide similar improvement in urologic symptom scores and quality of life. While we are very uncertain about major adverse events, PAE may increase re-treatment rates. We are uncertain about erectile function, but PAE may reduce ejaculatory disorders. Longer term (follow-up of 13 to 24 months), we are very uncertain as to how both procedures compare with regard to urologic symptom scores, but quality of life appears to be similar. We are very uncertain about major adverse events but PAE may increase re-treatments. We did not find longer term evidence on erectile function and ejaculatory disorders. Certainty of evidence for the main outcomes of this review was low or very low, signalling that our confidence in the reported effect size is limited or very limited, and that this topic should be better informed by future research.پیشینه: طیفی از رویکردهای جراحی کم‌تهاجمی‌تر به‌عنوان گزینه‌های درمانی جایگزین رزکسیون پروستات از طریق مجاری ادراری (transurethral resection of the prostate; TURP) در مدیریت نشانه‌های دستگاه ادراری تحتانی (lower urinary tract symptoms; LUTS) در مردان مبتلا به هیپرپلازی خوش‌خیم پروستات (benign prostatic hyperplasia; BPH) پیشنهاد شده‌اند. آمبولیزاسیون شریانی پروستات (prostatic arterial embolization; PAE) یک روش درمانی نسبتا جدید و کم تهاجمی است. اهداف: ارزیابی اثرات PAE در مقایسه با سایر روش‌های درمان LUTS در مردان مبتلا به BPH. روش‌های جست‌وجو: ما جست‌وجوی جامعی را در بانک‌های اطلاعاتی مختلف (کتابخانه کاکرین، MEDLINE؛ Embase؛ LILACS؛ Scopus؛ Web of Science؛ و Google Scholar)، پایگاه‌های ثبت کارآزمایی‌ها، سایر منابع علمی منتشر نشده، و مجموعه مقالات کنفرانس منتشر شده تا 25 سپتامبر 2020، بدون اعمال محدودیت در زبان یا وضعیت انتشار، انجام دادیم. معیارهای انتخاب: ما کارآزمایی‌های تصادفی‌سازی و کنترل شده (randomised controlled trials; RCTs)، همچنین مطالعات غیر‐تصادفی‌سازی شده (NRS، محدود به مطالعات کوهورت آینده‌نگر با گروه‌های مقایسه همزمان) را با حضور مردان بالای 40 سال مبتلا به LUTS وارد کردیم که نشانه‌هایشان به BPH نسبت داده ‌شد و تحت PAE در مقابل TURP یا سایر مداخلات جراحی قرار گفتند. گردآوری و تجزیه‌وتحلیل داده‌ها: دو نویسنده مرور به‌طور مستقل از هم مطالعات را برای ورود و خروج طبقه‌بندی کرده و داده‌ها را از مطالعات وارد شده خلاصه کردند. ما تجزیه‌وتحلیل آماری را با استفاده از یک مدل اثرات تصادفی انجام دادیم و آنها را مطابق با کتابچه راهنمای کاکرین برای مرورهای سیستماتیک مداخلات تفسیر کردیم. برای ارزیابی قطعیت شواهد RCTها و NRSها از راهنمایی GRADE استفاده شد. نتایج اصلی: ما داده‌هایی را برای آگاهی از دو مقایسه یافتیم: PAE در مقابل TURP (شش RCT و دو NRS)، و PAE در مقابل روش ساختگی (یک RCT). میانگین سنی، IPSS، و حجم پروستات شرکت‌کنندگان، به ترتیب 66 سال، 22.8 و 72.8 میلی‌لیتر بود. این چکیده متمرکز است بر مقایسه PAE در مقابل TURP به عنوان موضوع اصلی مورد نظر. PAE در مقابل TURP ما شش RCT و دو NRS را با پیگیری کوتاه‌مدت (تا 12 ماه) و یک RCT را با پیگیری طولانی‌مدت (13 تا 24 ماه) وارد کردیم. پیگیری کوتاه‌مدت: بر اساس شواهد به دست آمده از RCT، ممکن است تفاوتی اندک یا عدم تفاوت در بهبود نمره نشانه‌های اورولوژیک وجود داشته باشد (تفاوت میانگین [MD]: 1.55؛ 95% فاصله اطمینان [CI]: 0.40‐ تا 3.50؛ 369 شرکت‌کننده؛ 6 RCT؛ I² = 75%؛ شواهد با قطعیت پائین) که با نمره بین‌المللی نشانه‌های پروستات (International Prostatic Symptom Score; IPSS) در مقیاس 0 تا 35 اندازه‌گیری شد، و نمرات بالاتر نشانه‌های بدتر را نشان می‌دهد. در کیفیت زندگی نیز ممکن است تفاوتی اندک یا عدم تفاوت وجود داشته باشد (MD: 0.16؛ 95% CI؛ 0.37‐ تا 0.68؛ 309 شرکت‌کننده؛ 5 RCT؛ I² = 56%؛ شواهد با قطعیت پائین) که توسط سوال کیفیت زندگی IPSS در یک مقیاس 0 تا 6 اندازه‌گیری شد، و نمرات بالاتر نشانگر کیفیت زندگی بدتر به ترتیب بین PAE و TURP است. در حالی که ما در مورد تأثیر PAE بر عوارض جانبی عمده بسیار نامطمئن هستیم (خطر نسبی [RR]: 0.71؛ 95% CI؛ 0.16 تا 3.10؛ 250 شرکت‌کننده؛ 4 RCT؛ I² = 26%؛ شواهد با قطعیت بسیار پائین)، PAE ممکن است نیاز را به درمان مجدد افزایش دهد (RR: 3.64؛ 95% CI؛ 1.02 تا 12.98؛ 204 شرکت‌کننده؛ 3 RCT؛ I² = 0%؛ شواهد با قطعیت بسیار پائین). بر اساس 18 مورد درمان مجدد در هر 1000 مرد در گروه TURP، این عدد متناظر است با 47 مورد دیگر (0 مورد بیشتر تا 214 مورد بیشتر) در هر 1000 مرد تحت درمان با PAE. ما در مورد اثرات درمان بر عملکرد نعوظ بسیار نامطمئن هستیم (MD: ‐0.03؛ 95% CI؛ 6.35‐ تا 6.29؛ 129 شرکت‌کننده؛ 2 RCT؛ I² = 78%؛ شواهد با قطعیت بسیار پائین) که توسط شاخص بین‌المللی عملکرد نعوظ در 5 روی مقیاس 1 تا 25 اندازه‌گیری شد، که نمرات بالاتر نشان دهنده عملکرد بهتر است. شواهد NRS در صورت وجود، نتایج مشابهی را به همراه داشت. براساس شواهد به دست آمده از NRS، روش PAE ممکن است بروز اختلالات انزال را کاهش دهد (RR: 0.51؛ 95% CI؛ 0.35 تا 0.73؛ 260 شرکت‌کننده؛ 1 NRS؛ شواهد با قطعیت پائین). پیگیری طولانی‌مدت‌تر: براساس شواهد RCT، ما در مورد تأثیر PAE بر نمرات نشانه‌های اورولوژیک، در مقایسه با TURP، بسیار نامطمئن هستیم (MD: 0.30؛ 95% CI؛ 3.17‐ تا 3.77؛ 95 شرکت‌کننده؛ شواهد با قطعیت بسیار پائین). کیفیت زندگی ممکن است مشابه باشد (MD: 0.20؛ 95% CI؛ 0.49‐ تا 0.89؛ 95 شرکت‌کننده؛ شواهد با قطعیت پائین). ما همچنین در مورد حوادث عمده جانبی بسیار نامطمئن هستیم (RR: 1.96؛ 95% CI؛ 0.63 تا 6.13؛ 107 شرکت‌کننده؛ شواهد با قطعیت بسیار پائین). ما شواهدی را در مورد عملکرد نعوظ و اختلالات انزال پیدا نکردیم. بر اساس شواهد به دست آمده از NRS، روش PAE ممکن است نرخ درمان مجدد را افزایش دهد (RR: 1.51؛ 95% CI؛ 0.43 تا 5.29؛ 305 شرکت‌کننده؛ شواهد با قطعیت پائین)؛ بر اساس 56 مورد نیاز به درمان مجدد در هر 1000 مرد در گروه TURP. این متناظر است با 143 نفر بیشتر (25 نفر بیشتر تا 430 نفر بیشتر) در هر 1000 مرد در گروه PAE. نتیجه‌گیری‌های نویسندگان: در مقایسه با TURP تا 12 ماه (پیگیری کوتاه‌مدت)، PAE ممکن است میزان بهبودی مشابهی را در نمرات نشانه‌های اورولوژیک و کیفیت زندگی ایجاد کند. در حالی که در مورد عوارض جانبی عمده بسیار نامطمئن هستیم، PAE ممکن است نرخ درمان مجدد را افزایش دهد. ما در مورد عملکرد نعوظ اطمینان نداریم، اما PAE ممکن است اختلالات انزال را کاهش دهد. با پیگیری طولانی‌مدت‌تر (13 تا 24 ماه)، در مورد اینکه هر دو روش با توجه به نمرات نشانه‌های اورولوژیک چگونه مقایسه می‌شوند، بسیار نامطمئن هستیم، اما به نظر می‌رسد کیفیت زندگی مشابه باشد. در مورد عوارض جانبی عمده بسیار نامطمئن هستیم، اما PAE ممکن است نرخ درمان مجدد را افزایش دهد. شواهد طولانی‌مدت‌تری را در مورد عملکرد نعوظ و اختلالات انزال پیدا نکردیم. قطعیت شواهد برای پیامدهای اصلی این مرور، پائین یا بسیار پائین بود، این نشان دهنده آن است که اعتماد ما به اندازه تاثیرگذاری گزارش شده، محدود یا بسیار محدود است، و این موضوع باید در تحقیقات آینده بهتر بررسی شود.

Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.

Purpose: Genital injury is a common pediatric injury. Given the lack of nationwide data, the authors aimed to show age group-related epidemiologic features of genital injury in Korea.Methods:We reviewed the data from 2011-2016 Emergency Department-based Injury In-depth Surveillance registry, which involves 23 emergency departments in Korea. From the dataset, we included children (< 18 years) with the International Classification of Diseases, 10th Revision codes related to genital injury as the final diagnosis with excluding those with other codes or combined injuries. Age groups were defined as follows; infants (< 1 year), toddlers (1-3), preschoolers (4-6), schoolers (7-12), and adolescents (13-17). The clinical features and outcomes were analyzed.Results: A total of 3,030 children were included with the median age of 6 years (interquartile range, 4-10) and the proportion of girls of 53.0%. Only 144 children (4.8%) were transported by the emergency medical service providers. The most common mechanism and place were blunt injury (1,826 [60.3%]) and home (1,535 [50.7%]), respectively. Of the codes, “Contusion of external genital organs (S30.2)” was most common (1,574 [51.9%]). As for outcomes, 2,770 children (91.4%) were discharged, 252 (8.3%) were hospitalized (intensive care units, 1 child [0.03%]), and 108 (3.6%) underwent surgery. Severe injury occurred in 111 children (3.7%) without a mortality. With increasing age in the age groups, non-accidental injury, school and sports-related injuries, hospitalization, and surgery (All Ps < 0.001).Conclusion: Genital injury may occur at evening, in spring and summer, at home, and in the form of accidental or blunt injury. Most children are discharged. Contrary to these general features, older children tend to undergo more frequently non-accidental injury, school and sports-related injuries, hospitalization, and surgery. Thus, we need age-specific strategies for injury prevention.

Purpose: In Korea, the Broselow tape (BT) is widely used to estimate weight in resuscitation. Validation of BT in Korean children is essential because the tool was developed based on children’s weight and height in the United States. The validation was previously performed in a small-scale dataset. The authors aimed to validate BT using the 2005 Korean nationwide anthropometric survey data.Methods: From the population used for the survey, we sampled children aged 0-12 years. The weights estimated by BT were compared with measured weights of the children using Bland-Altman analysis with results recorded as percentage differences. We measured the accuracy of BT, defined as within a 10% error of the measured weight, and the concordance of the color-coded zones derived from the estimated and measured weights. The accuracy and concordance were further assessed according to the age groups and body mass index-for-age Z-score (< -2, underweight; > 2, overweight or obese). Results: A total of 108,128 children were enrolled. The mean age was 55.2 ± 37.5 months. The bias was –5.4% (P < 0.001), and the limits of agreement were –28.3% and 17.6%, respectively. The accuracy and concordance of BT were 64.4% and 67.2%, respectively. Differences of no more than 1 color-coded zone between estimated and measured weights accounted for 89.8% and 84.1% of the under- and overweight (or obese) children, respectively.Conclusion: BT accurately estimates weight in approximately two-thirds of Korean children. In addition, adjustment of 1 color-coded zone may be considered in children with extreme weight.

Objective To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Materials and methods We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT or Rezum); prostatic arterial embolization (PAE); prostatic urethral lift (PUL or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta-analysis. Results We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, PUL and PAE may result in little to no difference in urologic symptoms while WVTT, TUMT, and TIND may result in worse urologic symptoms. MITs may result in little to no difference in the quality of life (QoL), compared to TURP. MITs may result in a large reduction of major adverse events compared to TURP. We are uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We are very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE have the highest likelihood of being the most efficacious for urinary symptoms and QoL, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short-term (three months) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment. Conclusions MITs may result in similar or worse effects concerning urinary symptoms and QoL compared to TURP at short-term follow-up.

Leptoglossus occidentalis Heidemann (Heteroptera: Coreidae) is a notorious pest that causes irreversible damage to coniferous forests in South Korea. However, an effective control strategy is still under development. In this study, we used CLIMEX to analyze the potential distribution of L. occidentalis in relation to climate and host plants in South Korea for the identification of effective control spots. The climate needs of L. occidentalis under current and future climate conditions were analyzed and projected on a map along with the distribution of coniferous forests. The CLIMEX model projected that the area of L. occidentalis distribution would decrease slightly in 2060 compared with that at present. However, it was projected that occurrence in mountainous regions would be sustained, suggesting continued damage to coniferous forests in South Korea.

Background Radial nerve palsy is a common complication associated with humeral shaft fractures. The purposes of this study were 1) to evaluate the status of primary radial nerve palsy in patients with humeral shaft fracture according to injury mechanism, 2) to estimate the risk factors of primary RNP, and 3) to evaluate whether early exploration is helpful for radial nerve recovery. Methods This study analyzed 162 patients with humeral shaft fractures from January 2014 to December 2019. All patients were surgically treated in our hospital. Of these, 109 high-energy injuries were identified and compared with 53 low–energy injuries. The risk factors of radial nerve palsy were analyzed, and the prevalence of radial nerve palsy and status of radial nerve exploration according to injury mechanism were evaluated. Nerve recovery rate according to early nerve exploration was investigated. Results There were 31 cases of radial nerve palsy among 162 patients; 27 in the high-energy humeral shaft fracture group, and four in the low-energy humeral shaft fracture group. Logistic regression analysis for risk factors showed that the injury mechanism was significantly associated with primary radial nerve palsy. Among 31 radial nerve palsy patients, 21 radial nerves were explored and 19 radial nerves were recovered completely (80.6%). In the high-energy humeral shaft fracture group, 18 radial nerves were explored during surgery among 27 radial nerve palsy cases, and 16 cases were recovered (88.9%). The other nine radial nerves were not explored, and only five cases were recovered (55.6%) Conclusions This study confirmed that the incidence of radial nerve paralysis was higher in high-energy humeral shaft fractures than in low-energy fractures. The more common fracture patterns were oblique, transverse, wedge, and comminuted in HE-HSF. This study suggests that these patterns are not directly associated with radial nerve palsy, but that high-energy injury is associated with a specific fracture pattern. Early nerve exploration during surgical treatment in patients with radial nerve palsy associated with humeral shaft fracture was helpful especially after high-energy injury.

A 34-year-old man developed severe hypoxemia and hypercapnia due to acute respiratory distress during ventilator care after surgery with acute intracranial hemorrhage. Severe hypoxemia had not been corrected even with maximum extracorporeal membrane oxygenation (ECMO) flow and full ventilator settings. We applied a novel technique for the serial connection of two veno-venous ECMO circuits for optimal oxygen delivery and CO2 removal and could wean VV ECMO. The use of serial connection of two VV ECMO circuits may be considered worthwhile when severe hypoxemia or hypercapnia are not improved and the use of protective ventilators is not permitted.

Background: To improve the rehabilitation team’s awareness of patient mobility and participation by enhancing communication between therapists and nurses and conducting patient education.Methods: This study used a non-equivalent control group with a non-synchronized design. To facilitate communication between therapists and nurses, we used a manual for mobility management to improve the sharing of information on the functional status of patients. We also implemented patient education to improve their awareness of mobility and participation. Finally, we conducted newly devised surveys related to patient functional status and awareness that were applied by therapists and nurses.Results: The nurses reported significantly lower functional levels of patients compared to those assessed by therapists. After the intervention, the kappa values representing the concordance between therapists and nurses improved to almost perfect agreement for transfer ability (κ=0.836), mobility (κ=0.664), and toileting (κ=1.000). We also observed a statistically significant increase in questionnaire scores with respect to nurses’ awareness (p

The air charged through the air charger must be pure and free from impurities; hence, the role of a filter that removes pollutants, such as moisture, oil, and carbides is very important. The lifespan of the filter is approximately 50 h, and if exceeded, the purification function decreases rapidly. Therefore, it must be replaced periodically. However, economic and environmental problems occur in the process of replacing the filter. This study investigated the extension of the filter lifespan (60 h) and enhancement of the purification function. An auto drain system was installed. The pollutant discharge, maximum noise, and lifespan were confirmed through experiments and commissioned inspections to check the performance. The compatibility of the pollutant discharge function and the structure of the auto drain system was verified by checking the discharge of pollutants. In addition, the maximum noise was certified to be less than 80 dB according to the performance-standard. Finally, the charged air quality was analyzed after 60 h of use, and all the analyzed values were confirmed to be within the performance-standard range.

Objectives To assess the changes in alveolar bone of the mandibular second molars following molar protraction and investigate the factors associated with the alveolar bone changes. Materials and Methods Cone-beam computed tomography of 29 patients (mean age 22.0 ± 4.2 years) who had missing mandibular premolars or first molars and underwent molar protraction were reviewed. Alveolar bone level was measured as the distance from the cementoenamel junction at six points, buccal, lingual, mesiobuccal (MB), mesiolingual (ML), distobuccal (DB), and distolingual (DL), of the second molars at pretreatment (T0) and after molar protraction (T1). Factors associated with alveolar bone changes at the distal and mesial of the second molars were assessed. Results Mean alveolar bone changes ranged from −1.2 mm (bone apposition) to 0.8 mm (bone resorption). The presence of a third molar impaction at T0 (P < .001), third molar angulation at T0 (P < .001), and Nolla's stage of third molar at T0 (P = .005) were significantly associated with alveolar bone level changes distal to the second molars. Treatment duration (P = .028) was significantly associated with alveolar bone level changes mesial to the second molar. Conclusions Patients with impacted third molars, third molars at an earlier stage of development, and mesially angulated third molars at pretreatment may have less alveolar bone resorption distal to the second molars following protraction. Patients with increased treatment time may have reduced alveolar bone resorption mesial to the second molars.

This paper proposes a multi-beam search method based on an active phased array antenna system using digital beamforming. It includes initial beamforming, valid beam selection, and beam angle estima...

Background Unwanted submental fat (SMF) is aesthetically unappealing, but methods of reduction are either invasive or lack evidence of their use. Objective The authors sought to evaluate the safety and efficacy of a novel triple-layer high-intensity focused ultrasound (HIFU) regimen for SMF reduction. Methods Forty Korean subjects with moderate/severe SMF were evaluated after receiving a session of triple-layer HIFU treatments (using 3.0-, 4.5-, and 6.0-mm focusing transducers). The objective evaluation based on the 5-point Clinician-Reported Submental Fat Rating Scale (CR-SMFRS) and patients' satisfaction based on the 7-point Subject Self-Rating Scale (SSRS) were determined 8 weeks after treatment. Three-dimensional image analysis was also performed. Results At the follow-up visit, the proportion of treatment responders defined as subjects with ≥1-point improvement in CR-SMFRS was 62.5%, and the proportion of patients satisfied with appearance of their face and chin (score ≥4 on the SSRS) was 67.5% of the total patients. The results of 3-dimensional analysis were consistent with clinical observations. Only mild and transient side effects were observed for some patients with no serious adverse effects. Conclusion The triple-layer HIFU regimen including the novel 6.0-mm transducer has benefits for tightening and rejuvenation of the area with unwanted SMF, showing reasonable safety profiles.

Purpose To assess the effects of Serenoa repens alone or in combination with other phytotherapy compared to placebo in men with LUTS due to benign prostatic enlargement. Materials and methods Following a registered protocol (CRD42021226655), we searched (December 2020) MEDLINE, CENTRAL, Embase, ClinicalTrials.gov, WHO-ICTRP trials platform and other sources with no restrictions on language, publication date or status. We included randomized controlled trials, and we critically appraised them using the Cochrane Tool for Risk of Bias Assessment (RoB 2). We conducted random-effects meta-analysis when appropriate. The primary outcomes included urinary symptoms score, quality of life, and adverse events. The certainty of the evidence was rated using GRADE. Results We included 27 trials with 4,853 participants. S. repens results in little to no difference in urinary symptoms, quality of life, and adverse events at short- and long-term follow-up. S. repens combined with other phytotherapy may slightly reduce urinary symptoms at short-term follow-up, but the results are uncertain. The results on quality of life and adverse events are also very uncertain. Conclusions S. repens alone may result in no clinical benefits for men with LUTS. There is greater uncertainty in the effects of S. repens in combination with other phytotherapy.

Quantum dots with excellent luminescence properties are being studied in a wide range of fields, such as displays, sunlight, and bio-imaging; although quantum dots are the same material, unlike bulk materials, as their size decreases their optical and electrical properties change due to the quantum confinement effect. In this study, CdSe quantum dots were synthesized by a well-known hot-injection method and a ZnS shell layer was formed on the surface of the CdSe quantum dot core to enhance the properties, thereby synthesizing the CdSe/ZnS core/shell structure. At this time, the quantum yield increased more than twice, and the emission line width decreased. When anti-counterfeiting ink was made using quantum dots with enhanced luminescence characteristics and applied to a bank note, it was impossible to check with the naked eye, but letters and emblems could be confirmed under UV light. In addition, a composite made by mixing with a silicon-based polymer showed excellent flexibility; and, when applied on a blue LED chip, a single wavelength and bright light peculiar to quantum dots were realized.

Lung carcinoma is the main reason for cancer-associated deaths in the world. In a previous study, FCH domain only 1 (FCHo1) which is managed by protein kinase B (AKT), was shown to be activated in lung cancer. FCHo1 knockdown has previously been shown to cause cell death in lung cancer. However, the specific roles of FCHo1 in lung carcinoma remain elusive. Herein, we propose that FCHo1’s intracellular mechanism targets the G1 to S phase transition, following the M phase. We demonstrated that F-BAR and mu homology domains exist separately in human lung tissues and that one truncated form is not detected in patients with lung cancer. Furthermore, quantitative global proteome analysis of FCHo1 indicated that the inhibition of G1/S phase transition and FCHo1 RNAi led to the death of cells in the G1/S phase. Noninvasive viral aerosol-mediated delivery of FCHo1 shRNA suppressed cancer progression in mice with non-small-cell lung cancer (NSCLC), suggesting that the delivery of FCHo1 shRNA could be a meaningful therapeutic strategy in lung cancer. Additional studies are needed to make clear the detailed mechanism of action of FCHo1.

Manufacturing quality control (QC) in plastic injection moulding is of the upmost importance since almost one third of plastic products are manufactured via the injection moulding process. Moreover, smart manufacturing technologies are enabling the generation of huge amounts of data in production lines. This data can be used for predicting the quality of manufactured plastic products using machine learning methods, allowing companies to save costs and improve their production efficiency. However, high-performance machine learning models are usually too complicated to be understood by human intuition. Therefore, we have introduced a rule-based explanations (RBE) framework that combines several machine learning interpretation methods to help to understand the decision mechanisms of accurate and complex predictive models – specifically tree ensemble models. These generated rules can be used to visually and easily understand the main factors that affect the quality in the manufacturing process. To demonstrate the applicability of RBE, we present two experiments with real industrial data gathered from a plastic injection moulding machine in a Singapore model factory. The collected datasets contain condition data for several manufacturing processes as well as the QC results for sink mark defects in the production of small plastic products. The experiments revealed that it is possible to extract meaningful explanations in the form of simple decision rules that are enhanced with partial dependence plots and feature importance rankings for a better understanding of the underlying mechanisms and data relationships of accurate tree ensembles.

Background This study aimed to present a simple method for evaluating transient eye closure (TEC) evoked by bright light and find the agreement between TEC and photosensitivity. We also assessed the associated factors with TEC in the patients with intermittent exotropia (IXT). Methods In this retrospective study, IXT patients were exposed to different brightness: darkness, low-intensity white light, and high-intensity white light using a near-infrared camera vision monitor system (Mon CV3, Metrovision, France). TEC was considered to be present if the subject closed his or her eyes immediately, and for more than half of the scotopic lid fissure distance in response to the high-intensity or low-intensity photopic stimulus of light, compared with lid fissure distance in the scotopic phase. We assessed the presence of photosensitivity using a questionnaire and evaluated the agreement between TEC and photosensitivity. We also investigated the sensory fusion, motor fusion, and pupil dynamic components for the existence of TEC in IXT patients. Results Sixty-one patients with IXT were included. With the new method to evaluate TEC under different light intensities, 27 (44.3%) of the 61 IXT patients showed TEC, and 34 (55.7%) did not demonstrate TEC. TEC under high-intensity white light had a strong correlation with self-reporting photosensitivity (r = 0.77). The smaller angle of deviation at near was associated with the presence of TEC, with statistical significance (p = 0.04). Normal sensory status at a distance was significantly associated with TEC (p p = 0.02). Conclusions The test using a near-infrared camera vision monitor system was a simple and objective tool in identifying TEC evoked by bright light. The presence of TEC strongly correlated with self-reporting photosensitivity in patients with IXT. However, TEC may be an independent phenomenon with motor alignment, stereopsis, and pupil reflex pathway in patients with IXT.

Biopharmaceutical drugs have strong therapeutic effect in various diseases such as autoimmune diseases, rheumatism and cancer due to their target specific recognition and low side effects. In particular, the most representative antibodies among biopharmaceuticals are widely used for targeted drug delivery, diagnosis and treatment. Moreover, antibody-drug conjugate (ADC) have been developed by many researchers and biopharmaceutical companies. An antibody-drug conjugate, one of the new bio anticancer drugs is composed of an antibody, cytotoxic drug and chemical linker. Antibodies accurately recognize the target cancer, and drugs induce apoptosis or death of the cancer cells. Linkers stably connects the antibody and drug until ADC go to the target cancer cells. In order to develop an ADC, it is important to correctly configure each component. Recently, the 9th ADC was approved by food and drug administration (FDA) and a lot of development of new ADC is underway. The development of ADC is expected through the introduction of new antibodies including bi-specific and drugs with new anticancer mechanisms.

This study investigated the hypothesis that Portulaca oleracea L. exerts antiobesity and antidiabetic effects by evaluating blood lipid profiles, blood glucose control factors, protein expression of lipid metabolism, and insulin sensitivity improvement. Three groups of high-fat diet (HFD) induced obese C57BL/6 mice (n = 8) received treatment with low (5%; HFD + PO5%) or high (10%; HFD + PO10%) concentrations of P. oleracea powder for 12 weeks or no treatment (HFD) and were compared with each other and a fourth control group. Weight gain was reduced by 34% in the HFD + PO10% group compared to the HFD group. Moreover, the perirenal and epididymal fat contents in the HFD + PO10% group were 6.3-fold and 1.5-fold, respectively, lower than those in the HFD group. The atherogenic index (AI) and cardiac risk factor (CRF) results in the P. oleracea-treated groups were significantly lower than those in the HFD group. The homeostasis model assessment of insulin resistance (HOMA-IR) levels was lower in the HFD + PO10% group than in the HFD group. The protein expression levels of the proliferator-activated receptor (PPAR)-α, glucose transporter (GLUT) 4 and PPAR-γ were upregulated in the HFD + PO10% group compared to the HFD group. However, the protein expression levels of tumor necrosis factor (TNF)-α were lower in the P. oleracea-treated groups than in the HFD group. Our results demonstrate that P. oleracea powder could be effectively used to treat and prevent obesity and diabetes-associated diseases through suppression of weight gain and reduction in body fat and blood glucose levels.

The longhorn crazy ant (Paratrechina longicornis) is a globally distributed ant species with a high invasion risk, suggesting the need to use species distribution modeling to evaluate its potential distribution. Therefore, this study aimed to predict the potential distribution of longhorn crazy ants in response to climate change by using CLIMEX and Maxent and identifying the climatic factors that influence their habitat. Then, the model outcomes were used to construct an ensemble map to evaluate invasion risk in South Korea. The results indicated that temperature-related variables mainly affect the distribution of the longhorn crazy ant, and the two models showed consensus regions in South America, Africa, Australia, and Southeast Asia. Due to climate change, it was expected that the northern limit would somewhat rise. In South Korea, high-risk areas were predicted to be located along the coasts, but they would expand as a consequence of climate change. Since the invasion of longhorn crazy ants has occurred via commercial trades, a relatively high risk in coastal areas demands a high level of attention. We expect that this study will provide initial insight into selecting areas for longhorn crazy ant quarantine with ensemble species distribution modeling.

Meningiomas are common intracranial neoplasms with benign features, and extracranial metastases are very rare. There have been no previous reports of solitary mediastinal lymph node metastasis from benign meningiomas without pulmonary lesions. Here, we present a case of an 82‐year‐old female who visited our department for mediastinal lymphadenopathy with a history of meningioma treated with total surgical resection six years prior. Endobronchial ultrasound‐guided transbronchial needle aspiration of the left lower paratracheal lymph node revealed a benign meningothelial meningioma. In patients with a history of meningioma, extracranial metastasis should be considered in the differential diagnosis of mediastinal lymphadenopathy., (a) Contrast‐enhanced computed tomography (CT) revealed a bulky lymphadenopathy in the left lower paratracheal area compressing the lower trachea and left main pulmonary artery. (b) On an axial section of the enhanced CT scan, a mediastinal mass compressing the left main bronchus was observed. (c), (d) 18F‐fluorodeoxyglucose‐positron emission tomography (FDG‐PET) showed high uptake of FDG with a maximal standardized uptake value of 9.2 by the tumor.

Objective Rheumatoid arthritis (RA) and chronic obstructive pulmonary disease (COPD) are both chronic inflammatory diseases; the prevalence of COPD in RA patients is known to be high. However, the prevalence of both RA and COPD differs according to sex; the relationship between RA and COPD may also vary according to sex. Therefore, we investigated the prevalence of COPD and its association in patients with RA in Korea by sex. Methods We conducted a nationwide cross-sectional study using data from the Korea National Health and Nutrition Examination Survey. A total of 12 417 men and 15 878 women were included. In this study, RA was defined as physician diagnosed or currently under RA treatment. COPD was defined based on spirometry results, chronic symptoms, and smoking history. Multivariable logistic regression models were employed and we calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for COPD prevalence in patients with RA. Results The prevalence of COPD was 15.5% in men with RA, 3.5% in women with RA, 7.8% in men without RA, and 2.2% in women without RA. After adjustment for potential confounding variables, including smoking status, RA was significantly associated with COPD in men (OR 2.16, 95% CI 1.06-4.40), but not in women (OR 1.58, 95% CI 0.81-3.10). Conclusions In Korea, the prevalence of COPD was high in patients with RA of both sexes; RA and COPD was significantly likely to be associated in men, but not in women.

Objectives To assess the effects of Retzius-sparing (RS) robotic-assisted laparoscopic prostatectomy (RALP) compared to standard RALP for the treatment of clinically localized prostate cancer. Methods We performed a systematic search of multiple databases and the grey literature with no restrictions on the language of publication or publication status, up until June 2020. We included randomized controlled trials (RCTs) comparing RS-RALP with standard RALP. We performed a meta-analysis using a random-effect model. The quality of evidence was assessed on an outcome basis according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results Our search identified six records of five unique RCTs, of which two were published studies, one was in press, and two were abstract proceedings. There were 571 randomized participants, of whom 502 completed the trials. The mean age of participants was 64.6 years and the mean prostate-specific antigen level was 6.9 ng/mL. Approximately 54.2% of participants had cT1c disease, 38.6% had cT2a-b disease, and 7.1% had cT2c disease. RS-RALP probably improves continence within 1 week after catheter removal (risk ratio [RR] 1.74, 95% confidence interval [CI] 1.41-2.14; I2 = 0%; studies = 4; participants = 410; moderate-certainty evidence). Assuming 335 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 248 more men per 1000 (137 more to 382 more) reporting continence recovery. RS-RALP may increase continence at 3 months after surgery compared to standard RALP (RR 1.33, 95% CI 1.06-1.68; I2 = 86%; studies = 5; participants = 526; low-certainty evidence). Assuming 750 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 224 more men per 1000 (41 more to 462 more) reporting continence recovery. We are very uncertain about the effects of RS-RALP on serious adverse events compared to standard RALP (RR 1.40, 95% CI 0.47-4.17; studies = 2; participants = 230; very low-certainty evidence). Conclusions The findings of this review indicate that RS-RALP may result in better continence outcomes than standard RALP up to 6 months after surgery. Continence outcomes at 12 months may be similar. The disadvantages of RS-RALP may be higher positive surgical margin rates. We are very uncertain about the effect on biochemical recurrence-free survival and potency outcomes. Longer-term oncological and functional outcomes are lacking, and no preplanned subgroup analyses could be performed to explore the observed heterogeneity. Surgeons should discuss these trade-offs and the limitations of the evidence with their patients when considering this approach.

The through-silicon via (TSV) 3D integration method has become one of the most widely used techniques for achieving system-level integration for applications that require smaller package sizes, higher interconnection density and high performance. This is because the TSV fabrication technology provides the mechanism for facilitating communications between various layers of the 3D integration system and for interconnecting stacked devices at wafer-level. Although there are several reported studies on TSV 3D integration R&D, with most of these studies focused on the improvement of TSV fabrication process, there are very limited in-depth studies associated with the TSV reliability issues and challenges. In this paper, we investigate the effect of TSV geometries on the associated TSV reliability factors. Different TSV geometries including I-type, tapered, elliptical, triangular, quadrangular and circular shapes (with same volume) are investigated to find the most reliable structure under annealing process. The results show that the tapered TSV shape releases thermo-mechanical stress more uniformly than other shapes and larger top surface shows better reliability.

Cadmium-based quantum dot nanocrystals are promising optoelectronic materials due to their core/shell structure, excellent properties, and fascinating potential applications in LED, display, and photovoltaics. However, those materials are very sensitive to moisture, temperature, UV light, and polar solvents, and this greatly hinders their practical applications. Here, highly luminescent CdSeS/ZnS quantum dots-polystyrene composite beads with uniform morphology are prepared via a simple swelling–shrinking strategy. This process is carried out only in nonpolar toluene and hexane without the addition of any polar reagents. In addition, a Si-Al oxidation layer is coated on the hybrid beads for further protection. As a result, the as-prepared composite beads not only retain high luminescence but also exhibit superior water, temperature, and UV-O3-resistant properties.

White-emitting hexagonal boron nitride (h-BN) nanophosphors were synthesized via pyrolysis (1200 °C). The nanoparticle phosphors were prepared by chemical mixed molecular adduction in which the sta...

Pupil palsy has been a frequent finding in Miller Fisher syndrome (MFS), but its clinical characteristics have not been clearly defined. The basis for differential diagnosis with other diseases with pupil palsy has also remained vague. We report cases of four MFS patients with bilateral pupil palsy and specify pupil characteristics of light-near dissociation (LND), cholinergic super-sensitivity, vermiform movements, and prognosis. We conducted a literature review to compare with our cases and investigate common findings of pupil palsy in MFS patients. We suggest that the acute generalized pupil palsy without vermiform movements can serve as a key finding for the diagnosis of pupil palsy associated with MFS. However, the presence of LND and cholinergic super-sensitivity was not distinctive clinical findings in MFS patients who had pupil palsy and did not prove useful for differential diagnosis. The prognosis of pupil palsy in MFS patients was good in our 4 cases and the literature review.

Background Artificial grafts such as polyethylene terephthalate (Dacron) and expanded polytetrafluoroethylene (ePTFE) are used for various cardiovascular surgical procedures. The compliance properties of prosthetic grafts could affect hemodynamic energy, which can be measured using the energy-equivalent pressure (EEP) and surplus hemodynamic energy (SHE). We investigated changes in the hemodynamic energy of prosthetic grafts. Methods In a simulation test, the changes in EEP for these grafts were estimated using COMSOL MULTIPHYSICS. The Young modulus, Poisson ratio, and density were used to analyze the grafts' material properties, and pre- and post-graft EEP values were obtained by computing the product of the pressure and velocity. In an in vivo study, Dacron and ePTFE grafts were anastomosed in an end-to-side fashion on the descending thoracic aorta of swine. The pulsatile pump flow was fixed at 2 L/min. Real-time flow and pressure were measured at the distal part of each graft, while clamping the other graft and the descending thoracic aorta. EEP and SHE were calculated and compared. Results In the simulation test, the mean arterial pressure decreased by 39% for all simulations. EEP decreased by 42% for both grafts, and by around 55% for the native blood vessels after grafting. The in vivo test showed no significant difference between both grafts in terms of EEP and SHE. Conclusion The post-graft hemodynamic energy was not different between the Dacron and ePTFE grafts. Artificial grafts are less compliant than native blood vessels; however, they can deliver pulsatile blood flow and hemodynamic energy without any significant energy loss.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with frequent hospitalizations, higher mortality, and healthcare costs. Low-income COPD patients have higher rates of emergency department visits and hospitalization due to COPD exacerbation. However, other causes of admissions and their economic burden have not been well-elucidated. METHODS: We analyzed the Korean National Health and Nutrition Examination Survey (KNHANES) dataset for 2007–2015. The diagnosis and staging of COPD were based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. RESULTS: Among the 97,622 participants in KNHANES for 2007–2015, we selected 33,963 participants (4,430 with and 29,533 without COPD) aged ≥40 years, who underwent spirometry, and provided the admission history for the previous year. Participants with COPD had a higher admission rate than those without COPD (12.8% vs. 10.4%, P