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In this paper, an adaptive least recently frequently used (LRFU) replacement policy is proposed for named data network (NDN) in the industrial internet of things (IIoT) environment. Low-latency network communication has become the main focus in IIoT development. By applying NDN architecture with the proposed replacement policy, the system can minimize the network latency of IIoT due to the NDN router’s capabilities to cache content. The simulation result shows that the proposed adaptive LRFU outperforms other popular replacement policies based on various network performances metrics. In addition, future research trends regarding the testbed implementation NDN replacement policy are suggested.

Background and Objectives Although several studies have compared the characteristics of Ramsay Hunt syndrome (RHS) with Bell’s palsy (BP), the differences in comorbid symptoms and prognosis according to symptoms have not been determined. This study therefore evaluated the differences in otologic symptoms and prognosis between patients with these two conditions.Subjects and Method The medical records of 118 patients with RHS and 215 patients with BP were retrospectively reviewed. Factors compared in these two groups included otologic symptoms, general health condition, electroneurography (ENoG) and House-Brackmann grades.Results Age, sex, body mass index, lipid profiles, ENoG, rate of diabetes, and side of palsy did not differ significantly between patients with RHS and BP (p>0.05). The rates of hearing disturbance, tinnitus, vertigo, and postauricular pain were significantly higher in RHS (p0.05). Additionally, in patients with facial paralysis, diabetes was associated with hearing disturbance and vertigo symptoms and dyslipidemia was associated with postauricular pain (p

With their extensive coverage, marine low clouds greatly impact global climate. Presently, marine low clouds are poorly represented in global climate models, and the response of marine low clouds to changes in atmospheric greenhouse gases and aerosols remains the major source of uncertainty in climate simulations. The eastern North Atlantic (ENA) is a region of persistent but diverse subtropical marine boundary layer clouds, whose albedo and precipitation are highly susceptible to perturbations in aerosol properties. In addition, the ENA is periodically impacted by continental aerosols, making it an excellent location to study the cloud condensation nuclei (CCN) budget in a remote marine region periodically perturbed by anthropogenic emissions, and to investigate the impacts of long-range transport of aerosols on remote marine clouds. The Aerosol and Cloud Experiments in Eastern North Atlantic (ACE-ENA) campaign was motivated by the need of comprehensive in situ measurements for improving the understanding of marine boundary layer CCN budget, cloud and drizzle microphysics, and the impact of aerosol on marine low cloud and precipitation. The airborne deployments took place from 21 June to 20 July 2017 and from 15 January to 18 February 2018 in the Azores. The flights were designed to maximize the synergy between in situ airborne measurements and ongoing long-term observations at a ground site. Here we present measurements, observation strategy, meteorological conditions during the campaign, and preliminary findings. Finally, we discuss future analyses and modeling studies that improve the understanding and representation of marine boundary layer aerosols, clouds, precipitation, and the interactions among them.

Purpose Acute promyelocytic leukemia (APL) is a rare disease in children and there are some different characteristics between children and adult. We aimed to evaluate incidence, clinical characteristics and treatment outcomes of pediatric APL in Korea.Materials and Methods Seventy-nine pediatric APL patients diagnosed from January 2009 to December 2016 in 16 tertiary medical centers in Korea were reviewed retrospectively.Results Of 801 acute myeloid leukemia children, 79 (9.9%) were diagnosed with APL. The median age at diagnosis was 10.6 years (range, 1.3 to 18.0). Male and female ratio was 1:0.93. Thirty patients (38.0%) had white blood cell (WBC) count greater than 10×109/L at diagnosis. All patients received induction therapy consisting of all-trans retinoic acid and chemotherapy. Five patients (6.6%) died during induction chemotherapy and 66 patients (86.8%) achieved complete remission (CR) after induction chemotherapy. The causes of death were three intracranial hemorrhage, one cerebral infarction, and one sepsis. Five patients (7.1%) suffered a relapse during or after maintenance chemotherapy. The estimated 4-year event-free survival and overall survival (OS) rates were 82.1%±4.4%, 89.7%±5.1%, respectively. The 4-year OS was significantly higher in patients with initial WBC < 10×109/L than in those with initial WBC ≥ 10×109/L (p=0.020).Conclusion This study showed that the CR rates and survival outcomes in Korean pediatric APL patients were relatively good. The initial WBC count was the most important prognostic factor and most causes of death were related to serious bleeding in the early stage of treatment.

Background Although acute hepatitis E is not fatal in healthy individuals, it is unclear whether hepatitis E superinfection increases the mortality in patients with pre-existing liver disease. Thus, we investigated the prognosis of patients with acute hepatitis E according to their cirrhosis diagnosis, and the prognosis according to the development of acute-on-chronic liver failure (ACLF) in patients with cirrhosis and chronic liver disease (CLD). Methods This study included 74 consecutive patients who were diagnosed with acute viral hepatitis E between January 2007 and December 2019. Of them, 39 patients without CLD, 13 patients with non-cirrhotic CLD, and 22 patients with cirrhotic CLD were analyzed. Results Among the 74 patients with HEV infection, 7 (9.5%) died within 180 days: 5 with underlying cirrhosis (71.4%) and 2 without cirrhosis (28.6%). The 180-day mortality was significant higher for patients with cirrhosis than for patients without cirrhosis (22.7% vs. 3.8%, P = 0.013). The age- and sex-adjusted proportional-hazard model revealed an approximately eightfold increase in the 180-day mortality risk in patients with cirrhosis compared to patients without cirrhosis. In addition, development of hepatitis E virus-related ACLF due to acute liver function deterioration in patients with pre-existing CLD or cirrhosis worsened the 180-day mortality rate. Conclusions Our findings suggest that the acute hepatitis E mortality rate was low in healthy individuals but higher in patients with cirrhosis, and especially high in those with ACLF.

Background Stress is a well-known risk factor of suicide. However, there is a lack of research on the best psychobiological markers of stress for monitoring and predicting suicidal behaviors in depressed patients. We aimed to investigate the individual and interactive effects of serum cortisol levels and stress-related parameters, including perceived stress and life stressors, on suicidal behavior in depressed patients. Methods At baseline, serum cortisol levels were measured and stress-related data, i.e., Perceived Stress Scale (PSS) scores and the number of stressful life events (SLEs), were collected from 1,094 patients with a depressive disorder, of whom 884 were followed up for 1 year. Suicidal behaviors evaluated at baseline included previous suicide attempts and baseline suicidal severity, while those at the 1-year follow-up were increased suicidal severity and fatal/non-fatal suicide attempts. Individual and interactive associations of exposure variables with suicidal outcomes were analyzed using logistic regression models after adjusting for relevant covariates. Results Higher serum cortisol levels were significantly associated with suicidal outcomes at the 1-year follow-up. In addition, higher PSS scores were significantly associated with higher baseline severity, whereas the number of SLEs was not associated with any suicidal outcomes. A significant interactive effect of cortisol level and PSS score on suicidal outcomes at the 1-year follow-up was observed. Higher cortisol levels and PSS scores were associated with increased suicidal severity and more fatal/non-fatal suicide attempts. Conclusions The combination of serum cortisol levels and PSS scores may be useful for monitoring and predicting suicidal behaviors in depressed patients.

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 This study investigated the individual and combined effects of self-reported resilience and serum ghrelin levels on 12-week remission in outpatients with depressive disorders who received antidepressant treatment. Methods The Connor-Davidson Resilience Scale (CDRS) score and serum ghrelin levels were assessed at baseline in 1,094 patients. The patients initially received antidepressant monotherapy. Patients with an insufficient response or uncomfortable side effects received alternative treatments every 3 weeks (at 3, 6, and 9 weeks). Subsequently, 12-week remission, defined as a Hamilton Depression Rating Scale (HAMD) score of ≤ 7, was evaluated. The individual and combined effects of the CDRS score (low vs. high) and serum ghrelin level (low vs. high) on 12-week remission were analyzed using logistic regression models after adjusting for relevant covariates. Results The individual effects of the CDRS score and serum ghrelin level on 12-week remission were not statistically significant. However, the high-CDRS, high-ghrelin group had a significantly higher 12-week remission rate compared to the low-CDRS, low-ghrelin group. Conclusions The combination of the CDRS score and serum ghrelin level is useful for predicting 12-week remission in patients with depressive disorders receiving pharmacotherapy.

Background and Objectives One of the most common complaint of tinnitus patients has been sleep disorder. The aim of this study was to evaluate the relationship between sleep disorder and tinnitus.Subjects and Method Patients with tinnitus from July 2018 till August 2019 were enrolled. Subjects who had any acute/chronic disease in the inner and middle ear or external auditory canal, sleep apnea and had more than 3 caffeinated beverages a day was excluded. Study participants completed Beck Depression Inventory (BDI), the tinnitus symptom questionnaire, tinnitus handicap inventory (THI), Pittsburg Sleep Quality Inventory (PSQI), pure tone audiometry, a full otologic examination and an interview on past medical history.Results THI was correlated with PSQI global score and BDI. The PSQI subscale most relevant to THI was PSQI 1 (subjective sleep quality). Hearing impairment was correlated with the THI functional subscale. BDI was individually related to PSQI.Conclusion Tinnitus is found to be highly related to sleep disorder, suggesting a common pathway of aggravation and treatment target. Tinnitus is also more affected by sleep disorder than by depression. A further examination and treatment of comorbid sleep disorder in tinnitus patients is recommended.

Background/aims The work environment in which endoscopic retrograde cholangiopancreatography (ERCP) is conducted has influence on its efficacy and safety. We aimed to assess the current status of ERCP work environments and to investigate the trends associated with the basic techniques of ERCP in Korea. Methods The work environment and information on the basic techniques of ERCP were acquired by the Korean Pancreatobiliary Association (KPBA) through a national survey in 2019. The survey was performed at the KPBA conference in 2019. The contents of survey comprised of the current environment of ERCP, preparation before ERCP, and the preferred basic techniques used in ERCP. Results Completed questionnaires were returned from 84 KPBA members. The mean ERCP volume per year was approximately 500. About 60% (50/84) reported that they worked with a dedicated ERCP team with experienced nurses. Two-thirds (57/84, 68%) answered that they had a fluoroscopy room used solely for ERCP procedures. All respondents intravenously hydrated the patient to prevent post-ERCP pancreatitis (84/84, 100%). The preferred procedural sedations were balanced propofol sedation (50%) and midazolam-only sedation (47%). Wire-guided cannulation was most commonly used for selective cannulation (81%). Endoscopic retrograde biliary drainage was preferred over endoscopic nasobiliary drainage (60% vs 22%). The initial method of ampullary intervention was endoscopic sphincterotomy in 60%. Conclusions Data from the survey involving a large number of Korean ERCP doctors revealed considerable variabilities with regard to the work environment and basic techniques of ERCP in Korea. The study provides information regarding the current trends of ERCP that can be used to establish ERCP standards in Korea.

This study aimed to evaluate the utility of the 16-cm axial volume scan technique for calculating the coronary artery calcium score (CACS) using non-enhanced chest CT.This study prospectively enrolled 20 participants who underwent both, non-enhanced chest CT (16-cm-coverage axial volume scan technique) and calcium-score CT, with the same parameters, differing only in slice thickness (in non-enhanced chest CT = 0.625, 1.25, 2.5 mm; in calcium score CT = 2.5 mm). The CACS was calculated using the conventional Agatston method. The difference between the CACS obtained from the two CT scans was compared, and the degree of agreement for the clinical significance of the CACS was confirmed through sectional analysis. Each calcified lesion was classified by location and size, and a one-to-one comparison of non-contrast-enhanced chest CT and calcium score CT was performed.The correlation coefficients of the CACS obtained from the two CT scans for slice thickness of 2.5, 1.25, and 0.625 mm were 0.9850, 0.9688, and 0.9834, respectively. The mean differences between the CACS were -21.4% at 0.625 mm, -39.4% at 1.25 mm, and -76.2% at 2.5 mm slice thicknesses. Sectional analysis revealed that 16 (80%), 16 (80%), and 13 (65%) patients showed agreement for the degree of coronary artery disease at each slice interval, respectively. Inter-reader agreement was high for each slice interval. The 0.625 mm CT showed the highest sensitivity for detecting calcified lesions.The values in the non-contrast-enhanced chest CT, using the 16-cm axial volume scan technique, were similar to those obtained using the CACS in the calcium score CT, at 0.625 mm slice thickness without electrocardiogram gating. This can ultimately help predict cardiovascular risk without additional radiation exposure.관상동맥 칼슘스코어(coronary artery calcium score; 이하 CACS)를 측정하는 데 있어 비 조영증강 흉부 CT에서 16 cm 축상 촬영 기법의 유용성을 알아보고자 하였다.20명의 환자를 대상으로 16 cm 축상 촬영 기법을 이용한 비 조영증강 흉부 CT와 칼슘 스코어 CT를 전향적으로 시행하였다. 흉부 CT는 세 가지 절편 두께(0.625, 1.25, 2.5 mm)로 재구성하여, Agatston 방법을 통해 관상동맥 칼슘스코어를 측정하였다. 다양한 절편 두께의 비 조영증강 흉부 CT와 칼슘스코어 CT의 관상동맥 칼슘스코어를 비교하고, 단면 분석을 통해 CACS의 임상적 중요성에 대한 일치를 확인하였다. 또한 각각의 석회화 병변들을 위치와 크기로 나누어 비 조영증강 흉부 CT와 칼슘스코어 CT에서 일대일 비교를 시행하였다.2.5, 1.25, 0.625 mm 절편 두께의 흉부 CT와 칼슘스코어 CT의 CACS 상관 계수는 각각 0.9850, 0.9688, 0.9834였다. 흉부 CT와 칼슘스코어 CT 간의 CACS 차이는 0.625 mm에서 −21.4%, 1.25 mm에서 −39.4%, 2.5 mm 절편 두께에서 −76.2%였다. CACS 구간별 분석에서 절편 두께별로 16명(80%, 0.625 mm), 16명(80%, 1.25 mm), 13명(65%, 2.5 mm)의 환자가 관상 동맥 질환의 위험도 구간이 일치하였다. 관찰자 간 일치도는 모든 절편 간격에서 높게 나타났다. 세 절편 두께 중에서는 0.625 mm CT에서 석회화 병변에 대한 민감도가 가장 높았다.16 cm 축상 촬영 기법을 이용한 비 조영증강 흉부 CT에서 electrocardiogram 동기화 없이도, 0.625 mm 절편 간격에서 칼슘스코어 CT에서의 CACS와의 유사한 값을 얻을 수 있었다. 이를 통해 추가 방사선 노출 없이, 심혈관 질환 위험을 예측하는 데 도움이 될 수 있다.

Objective Sudden traumatic physical injuries often cause psychological distress, which may be associated with chronic disability. Although considerable effort has been expended to identify genetic predictors of post-traumatic stress disorder (PTSD) after traumatic events, genetic predictors of psychological distress in response to severe physical injuries have been yet to be elucidated using whole exome sequencing (WES). Here, the genetic architecture of post-traumatic syndrome (PTS), which encompasses a broad range of psychiatric disorders after traumatic events including depression, anxiety disorder, acute stress disorder, and PTSD, was explored using WES in severely physically injured patients, focusing on secondary findings and potential PTS-related variants. Methods In total, 141 severely physically injured patients were consecutively recruited, and PTS was evaluated within 1 month of the injury. Secondary findings were analyzed according to PTS status. To identify PTS-related variants, genome-wide association analyses and the optimal sequencing kernel association test were performed. Results Of the 141 patients, 88 (62%) experienced PTS. There were 108 disease-causing variants in severely physically injured patients. As secondary findings, the stress- and inflammation-related signaling pathways were enriched in the PTS patients, while the glucose metabolism pathway was enriched in those without PTS. However, no significant PTS-related variants were identified. Conclusion Our findings suggest that genetic alterations in stress and inflammatory pathways might increase the likelihood of PTS immediately after severe physical injury. Future studies with larger samples and longitudinal designs are needed.

Background and Objectives This study was investigated to compare the clinical outcomes and complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) with those of conventional extracapsular tonsillectomy and adenoidectomy (ECTA) in treatment of pediatric obstructive sleep apnea (OSA).Subjects and Method Eighty-one children with adenotonsillar hyperplasia underwent tonsillectomy and adenoidectomy (46 PITA and 35 ECTA) from December 2016 to July 2017 for OSA. The choice of surgical procedure (PITA vs. ECTA) was determined by the number of episodes of acute tonsillitis. The quality of life measurement was performed using Korean Obstructive Sleep Apnea Survey (KOSA-18) score. Postoperative bleeding was assessed as number of revisit or readmission. Postoperative pain was evaluated by visual analog scale (VAS) at postoperative day 1, 3, and 7.Results PITA and ECTA significantly reduced KOSA-18 scores postoperatively (p＜0.01, p＜0.01, respectively) and were equally effective in pediatric OSA treatment. Postoperative bleeding was lower in the PITA group, but there was no statistical difference due to small number of cases. VAS score for postoperative pain was significantly lower in the PITA group at day 1, 3, and 7 (p=0.03, p＜0.01, and p＜0.01, respectively).Conclusion PITA is effective in pediatric OSA treatment with less morbidity, and less complications.

High stiffness is desirable for wire-driven underactuated hyperredundant manipulators used in minimally invasive surgery. However, limited structural stiffness can cause lateral and angular deflections by the lateral force and moment applied to the distal end of the manipulator. This letter proposes a Σ-shaped wire path, which is a combination of parallel and convergent wire paths, for a hyperredundant manipulator with rolling joints. The Σ-shaped wire path applied to the manipulator has the ability to maintain the position and orientation of its distal end for an applied lateral force on the surgical instrument tip. The simple mechanics of deflection of the manipulator with the Σ-shaped wire path are described, and straight-pose experiments were conducted to verify the deflection characteristics of the Σ-shaped wire path. An arbitrary bending-pose experiment was also conducted to verify the stiffness performance. It was observed that the proposed method could enhance the stiffness of the manipulator in both straight and arbitrarily bent poses.

Background Real world predictors of relapse following routine treatment for depression remain under-researched. We sought to investigate this in an outpatient clinical sample with depressive disorders receiving stepwise pharmacotherapy based on early clinical decision-making, applying a naturalistic 24-month prospective design. Methods Patients were recruited at a University hospital in South Korea from March 2012 to April 2017. After 3-week antidepressant monotherapy (N = 1262), next treatment steps (1, 2, 3, and 4 or over) with alternative strategies (switching, augmentation, combination, and mixtures of these approaches) were administered based on measurements and patient preference at 3-week points in the acute treatment phase (3, 6, 9, and 12 weeks) (N = 1246). For those who responded [Hamilton Depression Rating Scale (HAMD) score of≤14] (N = 937), relapse (HAMD>14) was identified every 3 months from 6 to 24 months (N = 816). Predictors of relapse were evaluated using multi-variate Cox proportional hazards models. Results Four independent relapse predictors were identified: higher number of previous depressive episodes, higher anxiety at baseline, higher number of treatment steps, and poor medication adherence. In particular, treatment Step 4 was significantly associated with relapse compared to treatment Step 1, 2, and 3 after adjustment for relevant covariates. Limitation Withdrawal syndromes after discontinuing psychotropic drugs, known to confound the determination of relapse, were not evaluated. The study was conducted at a single site, which maximised consistency but may limit generalizability. Conclusions Predictors of relapse reported from more restricted trial or cohort samples were replicated in this long-term naturalistic prospective design.

Chronic cerebral hypoperfusion (CCH) is caused by reduced blood flow to the brain representing gradually cognitive impairment. CCH induces mitochondrial dysfunction and neuronal cell death in the brain. Exercise is known to have a neuroprotective effect on brain damage and cognitive dysfunction. This study aimed to clarify the neuroprotective effect of low-intensity treadmill exercise (LITE) by enhancing cerebellar mitochondrial calcium retention capacity in an animal model of CCH. Wistar rats were divided into the sham group, the bilateral common carotid arteries occlusion (BCCAO) group, and the BCCAO and treadmill exercise (BCCAO+Ex) group. BCCAO+Ex group engaged the LITE on a treadmill for 30 min once a day for 8 weeks before the BCCAO surgery to investigate the protective effect of LITE on cognitive impairment. CCH induced by BCCAO resulted in mitochondrial dysfunction in the cerebellum, including impaired calcium homeostasis. CCH also decreased cerebellar Purkinje cells including of calbindin D28k and parvalbumin, resulting in cognitive impairment. The impairment of mitochondrial function, loss of cerebellar Purkinje cells, and cognitive dysfunction ameliorated by exercise. The present study showed that LITE hindered the deficit of spatial working memory and loss of Purkinje cell in the cerebellum induced by CCH. We confirmed that the protective effect of LITE on Purkinje cell by enhanced the mitochondrial calcium retention capacity. We suggest that LITE may protect against cognitive impairment, and further studies are needed to develop the intervention for patients who suffered from CCH.

Background/Aims: Because hepatitis B virus (HBV) replication has been known to play an important role in cancer recurrence after curative treatment of HBV-related hepatocellular carcinoma (HCC), we examined whether treatment based on nucleos(t)ide analogues (NAs) might decrease the recurrence rate and improve patient survival. Methods: The retrospective cohort study enrolled 73 patients with chronic hepatitis B who were treated with transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) with curative intent for HCC. Among those, 30 and 43 patients were treated with tenofovir disoproxil fumarate (TDF) and entecavir (ETV), respectively. Results: Of the 73 patients, 51 experienced HCC recurrence, and 14 patients were dead during a follow-up of 73±34 months. Multivariate analyses showed that tumor size (hazard ratio [HR], 1.590; 95% confidence-interval [CI], 1.106-2.285; P=0.012) and Child-Pugh class B (vs. class A/non cirrhosis; HR, 5.794; 95% CI, 2.311-14.523; P=0.001) was significantly associated with HCC recurrence, and Child-Pugh class B (HR, 7.357; 95% CI, 2.100-25.777; P=0.002) was an independent unfavorable prognostic factor for survival. During NAs therapy, TDF was superior to ETV for complete viral response at 1 year after the date of combination of TACE and RFA (P=0.016). However, the risks of HCC recurrence and survival were not significantly different between those treated with TDF versus ETV. Conclusions: TDF was superior to ETV for achieving complete viral response. However, the recurrence and mortality after TACE and RFA for HBV-related HCC were not significantly different between patients treated with TDF versus ETV. (J Liver Cancer 2021;21:155-162)

The red blood cell (RBC) deformability test is the measurement of the ability of RBCs to adapt their shape to the flow conditions. The major determinants of RBC deformability include cell shape, composition of the cell membrane and cytoskeleton, and internal viscosity (mean cell hemoglobin concentration). RBC deformability is primarily regulated by the composition and arrangement of the cell membrane. In cancer patients, chemotherapy and hematopoietic stem transplantation (HSCT) affect the bone marrow microenvironment, which may alter RBC production and deformability. We aimed to evaluate the change in RBC deformability during HSCT. Blood samples were obtained from patients who underwent HSCT. Eleven children were enrolled in this study. RBC deformability was measured with a microfluidic ektacytometer (RheoScan-D, RheoMeditech, Seoul, Korea). All analyses were completed within 24 hours after blood collection. The elongation index of the erythrocytes was measured. The elongation index of RBCs gradually increased from day 5 to day 30 after HSCT. RBC deformability may reflect the bone marrow microenvironment of the patient during HSCT. Further studies investigating the correlation between RBC deformability and the prognosis of HSCT are needed.

Background/Aims: Several attempts have been made to incorporate smart glasses in the medical field. We applied wearable display glasses to show the position of an observer during endoscopy and compared students’ responses between the conventional and new methods.Methods: We surveyed 28 medical students regarding the use of wearable display devices. The students used wearable display glasses to observe an endoscopic procedure and answered the prepared questionnaire. Their collected responses were analyzed for statistical correlations between each variable.Results: The survey of medical students revealed disadvantages including dizziness (dissatisfied and very dissatisfied: 21.5%) and eye fatigue (25% dissatisfied) and advantages including concentration (satisfied and very satisfied: 57.2%) and securing patient rights (71.4%). The students showed more positive than negative reviews regarding the new devices (32.1% vs. 21.5%).Conclusions: We investigated the advantages and disadvantages of viewing the endoscope image with new wearable display glasses compared to the conventional method using the survey to record user experience. The results revealed relatively positive responses from the medical students in the survey. If the new device compensates for some shortcomings, its use in the endoscopy room will be feasible.

Objective : Hemorrhagic transformation (HT) can be occurred after acute cerebral infarction. HT can worse symptoms in severe cases and adversely affect long-term prognosis. As bone and vascular smooth muscle are composed of type 1 collagen, we aimed to identify a potential relationship between bone mineral density (BMD) and HT after acute cardioembolic stroke.Methods : As an indicator of BMD, we used mean frontal skull Hounsfield unit (HU) values on brain computed tomography (CT). Multivariative hazard ratios were calculated using Cox regression analysis to identify whether the osteoporotic condition was an independent predictor of HT after acute cardioembolic stroke.Results : This 11-year analysis enrolled 506 patients who diagnosed as acute cardioembolic infarction. The first tertile of skull HU value was an independent predictor of HT development compared to the third tertile (hazard ratio, 2.12; 95% confidence interval, 1.13–3.98; p=0.020). We observed no interactions between age and skull HU with respect to HT statistically.Conclusion : The results of this study revealed an association between osteoporotic conditions and HT development after acute cardioembolic stroke. A convenient method to measure the cancellous bone HU value of the frontal skull using brain CT images may be useful for predicting HT in patients with acute cerebral infarction.

This article proposes an electronic payment architecture named Pure Wallet (PW), which extends the concept of Blockchain cryptocurrency for offline transactions. The process is divided into three steps. The first step requires the use of Internet connection, to convert cryptocurrency into a token at the token manager. The token manager initiates a transaction that requires the information in the token to complete. Then offline transactions step is performed between electronic devices like mobile phones through a secure Near Field Communication (NFC) using the token in senders device. The financial value in the form of a token is encrypted by the sender and sent to the receiver’s device via NFC. In the third step, the receiver converts the received token into cryptocurrency in the presence of Internet connection by sending the information required to complete the transaction to the token manager. The goal is to propose an electronic payment architecture utilizing Blockchain, which will enable financial transactions without instant connection to the Internet. The Blockchain implementation in this work utilizes smart contract in Ethereum Blockchain. The result shows a successful transfer of value without instant Internet connection. The open issues related to Blockchain in offline transactions are listed for further research works.

Olaparib, a potent PARP inhibitor, has been shown to have great anti-tumor effects in some tumor types. Although biliary tract cancer (BTC) is a good candidate for DNA damage response (DDR)-targeted agents, targeted DDR inhibitors, including olaparib, are currently rarely evaluated in BTC. In our project, a total of ten BTC cell lines were used to assess the efficacy of olaparib. Olaparib alone showed moderate anti-proliferative effects in BTC cells and increased p-ATR and PD-L1 expression levels. In combination with an ATR inhibitor (AZD6738, ceralasertib) showed synergistic anti-proliferative effects and increased DNA strand breaks in vitro. PD-L1 induced by olaparib was also downregulated by ceralasertib through p-STAT-3 and YAP reduction with or without human primary peripheral blood mononuclear cells. In SNU478-xenograft models, the combination treatment significantly suppressed tumor growth. PD-L1 and YAP were strongly downregulated, similar to in vitro conditions, and expression of CXCR2 and CXCR4 was further reduced. In the current ongoing clinical trial (NCT04298021), BTC patients treated with olaparib and ceralasertib combination have shown tumor response. In conclusion, co-targeting of PARP and ATR might be a potential therapeutic approach for patients with BTC.

Periodontitis has been associated with many systemic diseases and conditions, including metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur concomitantly and together they increase the risk of cardiovascular disease and double the risk of type 2 diabetes. In this review, we focus on the association between metabolic syndrome and periodontitis; however, we also include information on diabetes mellitus and cardiovascular disease, since these two conditions are significantly intertwined with metabolic syndrome. With regard to periodontitis and metabolic syndrome, to date, the vast majority of studies point to an association between these two conditions and also demonstrate that periodontitis can contribute to the development of, or can worsen, metabolic syndrome. Evaluating the effect of metabolic syndrome on the salivary microbiome, data presented herein support the hypothesis that the salivary bacterial profile is altered in metabolic syndrome patients compared with healthy patients. Considering periodontitis and these three conditions, the vast majority of human and animal studies point to an association between periodontitis and metabolic syndrome, diabetes, and cardiovascular disease. Moreover, there is evidence to suggest that metabolic syndrome and diabetes can alter the oral microbiome. However, more studies are needed to fully understand the influence these conditions have on each other.

Objective This study aimed to investigate trends in hospital utilization of patients with schizophrenia during the last 10 years in Korea and to predict future trends using time series analysis.Methods We determined the numbers of patients receiving outpatient or inpatient treatment for schizophrenia per month between 2010 and 2019, using National Health Insurance claims data. Facebook’s Prophet was used to fit time series models based on observations for the previous 120 months, and to predict trends over the next 36 months.Results The number of hospitalized patients per month has declined rapidly since 2015, but the monthly number of outpatient visits has steadily increased. Monthly hospital utilization has increased in patients aged ≤29 and ≥50 years, but has declined rapidly since 2014–2015 in patients in their 30s and 40s. The upward trend in overall hospital utilization has slowed considerably in recent years. These trends are expected to continue over the next few years.Conclusion This study revealed some notable changes in the hospital utilization patterns of patients with schizophrenia in recent years. There is a need to closely monitor and anticipate potential problems caused by these changing trends.

Objective To identify factors predicting remission of depression during acute (12 weeks) and continuation treatment (12 months) using a 1-year, naturalistic prospective study design. Methods Patients with depressive disorders were recruited from Chonnam National University Hospital in South Korea from March 2012 to April 2017. At baseline, 1,262 patients received outpatient therapy, and sociodemographic and clinical data were obtained. Clinical visits took place every 3 weeks during the acute treatment phase (at 3, 6, 9, and 12 weeks; n = 1,246), and every 3 months during the continuation treatment phase (at 6, 9, and 12 months; n = 1,015). Remission was defined as a Hamilton Depression Rating Scale score ≤ 7. Results The remission rate was 43.3% at 12 weeks and 70.4% at 12 months. In multivariate analyses, remission during the acute treatment phase was more likely in patients with a shorter-duration present episode, higher functioning, and good social support. Remission during the continuation treatment phase was more likely in patients with fewer previous depressive episodes and/or a lower baseline stress score. Conclusion Factors predicting depressive disorder remission may differ between the acute and continuation treatment phases.

Background Pertussis, is an infectious respiratory disease caused by Bordetella pertussis. The incidence of pertussis has been increasing in South Korea to due to waning vaccine-induced immunity. Culture has a low sensitivity and a long turnaround time (TAT). Recently, a rapid multi-polymerase chain reaction (mPCR) test with a TAT of about 1 h was developed for the detection of respiratory pathogens (17 viruses and three bacteria), including B. pertussis. This study aimed to investigate the effectiveness of mPCR for early diagnosis and treatment of pertussis. Methods We performed a retrospective study of patients with pertussis diagnosed from May 2017 to June 2019 at a university hospital in South Korea. Nasopharyngeal swab specimens were tested using mPCR. Data were extracted from medical records. Results A total of 27 patients with a median age of 48.9 years (range: 3.3–82.2 years) were diagnosed with pertussis, of whom 9 (33.3%) were male. Eleven (40.7%) had fever, 12 (44.4%) had dyspnea, three (11.1%) had paroxysmal cough, and nine (33.3%) had inspiratory whooping. The median interval from symptom onset to diagnosis was 9.0 days (range: 1–31 days). Twenty-four patients (81.5%) were diagnosed within 2 weeks from symptom onset. All but one patient was prescribed macrolide antibiotics. Twenty-two patients (81.5%) required hospitalization, including three (11.1%) who required intensive care unit care for ventilation. Conclusion Testing patients with respiratory symptoms using mPCR can improve early diagnosis of pertussis, ensure proper treatment, and may help with outbreak control.

Background/Aims: The study aimed to investigate the current practice patterns in the management of pancreatic cystic neoplasms in Korea.Methods: An electronic survey was systematically distributed by email to members of the Korean Pancreatobiliary Association from December 2019 to February 2020.Results: In total, 115 (110 gastroenterologists, five surgeons) completed the survey, 72.2% of whom worked in a tertiary/academic medical center. Most (65.2%) followed the 2012/2017 International Association of Pancreatology guidelines for the management of pancreatic cystic neoplasms. A gadolinium-enhanced magnetic resonance imaging/magnetic resonance cholangiopancreatography was the most common first-line diagnostic modality (42.1%), but a contrast-enhanced computed tomography scan was preferred as a subsequent surveillance tool (58.3%). Seventy- four percent of respondents routinely performed endoscopic ultrasound-guided fine needle aspiration for pancreatic cystic neoplasms with suspicious mural nodules. Endoscopic ultrasound-guided fine needle aspiration cytology (94.8%) and cystic fluid carcinoembryonic antigen (95.7%) were used for cystic fluid analysis. Most (94%) typically recommended surgery in patients with high-risk stigmata, but 18.3% also considered proceeding with surgery in patients with worrisome features. Most (96.5%) would continue surveillance of pancreatic cystic neoplasms for more than 5 years.Conclusions: According to this survey, there was variability in the management of pancreatic cystic neoplasms among the respondents. These results suggest that the development of evidence-based guidelines for pancreatic cystic neoplasms that fit the Korean practice is needed to create an optimal approach to the management of pancreatic cystic neoplasms.

Summary Self-powered wearable systems that rely on bioenergy harvesters commonly require excessive energy inputs from the human body and are highly inefficient when accounting for the overall energy expenses. A harvester independent from the external environment for sedentary states has yet to be developed. Herein, we present a touch-based lactate biofuel cell that leverages the high passive perspiration rate of fingertips for bioenergy harvesting. Powered by finger contact, such a bioenergy-harvesting process can continuously collect hundreds of mJ of energy during sleep without movements, representing the most efficient approach compared to any reported on-body harvesters. To maximize the energy harvesting, complementary piezoelectric generators were integrated under the biofuel cell to further scavenge mechanical energy from the finger presses. The harvesters can rapidly and efficiently power sensors and electrochromic displays to enable independent self-powered sensing. The passive perspiration-based harvester establishes a practical example of remarkably high energy return on investment for future self-sustainable electronic systems.

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.

This paper focuses on URLLC (Ultra-Reliable Low Latency Communication) technology of 3GPP (The 3rd Generation Partnership Project), which will be covered in 5G and beyond 5G. After URLLC technology is reviewed in wired communication and wireless communication, URLLC in mobile communication is discussed in detail covering physical layer, link layer and upper layer including network layer. In order to deploy vertical services-smart city, factory automation, transport industry, and etc. URLLC related technology is introduced and important patents are shown in each section.

Background/aims Irreversible electroporation (IRE) is a relatively new ablation method. However, the application of IRE ablation in the treatment of biliary disease has not been attempted. A minimally invasive approach using endoscopic retrograde cholangiopancreatography (ERCP) can be a novel therapeutic modality for IRE ablation. In this study, we aimed to investigate the feasibility of endoscopic IRE for the biliary tract using an animal model. Methods A new catheter-type electrode was developed for endoscopic IRE ablation of the biliary tract. We performed ERCP and endoscopic IRE ablations in the normal common bile duct of Yorkshire pigs. The experimental setting of IRE was 500 V/cm (50 pulses, 100-µs length). The animals were sacrificed after 24 hr, and the ablated bile duct was examined. Results Well-demarcated focal color changes were observed on the mucosa of the common bile duct. The depth of change after IRE was confined to the mucosal and submucosal layers. Apoptotic changes in the bile duct were observed only around the IRE ablation area. Immunohistochemistry assay showed cell death in the bile duct along the electrode. Conclusions Endoscopic IRE ablation using ERCP was successfully performed in the common bile duct. It can be a potential option for the treatment of biliary tumors.

We report the case of a 16-month-old patient with chronic immune thrombocytopenia (ITP) patient who experienced delayed treatment-free response (TFR) after romiplostim treatment. He received intravenous immunoglobulin every month to maintain a platelet count above 20,000/μL for 2 years. Thereafter, he received rituximab and cyclosporine as second-line therapy, with no response, followed by romiplostim. After 4 weeks of treatment, the platelet count was maintained above 50,000/μL. Following 7 months of treatment, he discontinued romiplostim, and the platelet count decreased. His platelet counts remained above 50,000/μL, without any bleeding symptoms, 2 years after romiplostim discontinuation. This is the first report of TFR after romiplostim treatment in pediatric chronic ITP.

In recent years, two-dimensional transition metal dichalcogenides (TMDs) have been attracted promising candidates for imminent electrical and optical device applications owing to their remarkable properties and unique structures. In this study, we report the optical and electrical characteristics of the newest member of the TMD family, i.e. monolayer of rhenium disulfide (ReS2) field effect transistor on a SiO2/Si substrate developed using the chemical vapor deposition technique. The quality of the as-grown monolayer of ReS2 was evaluated through Raman spectroscopy, whereas the surface elemental composition was analyzed thorough X-ray photoelectron spectroscopy. The optical properties of this monolayer TMD were analyzed using photoluminescence spectroscopy, and the contact resistance between the as-grown semiconducting monolayer and the metal electrodes was examined using the transmission line modeling method. Ti/Au electrodes form an excellent ohmic contact with the monolayers of the ReS2 film. The electron mobility of the monolayer ReS2 FETs fabricated through transmission line patterning was investigated at room temperature (300 K) and found to be $$2.91\hspace{0.17em}\times \hspace{0.17em}$$ 10–2 cm2 V−1 s−1 whereas the on/off ratio of the device was 9.8 × 102.