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Objectives: This study investigated the effect of Korean medicine on an elderly patient with posterior circulation cerebral infarction, chronic kidney disease (CKD), and early neurological deterioration (END).Methods: The patient, who already had CKD, was treated with Korean medicine, comprising herbal medicine, acupuncture, moxa, and cupping combined with Western medicine (antiplatelet, diabetes) and physical therapy. A manual muscle test (MMT) and a modified Barthel index (MBI) were used to observe the treatment effects, and blood tests were performed to check estimated glomerular filtration rate (eGFR), creatinine and blood urea nitrogen (BUN), which represent renal function.Results: After the treatment, MMT, MBI, and renal function scores had increased.Conclusions: This study suggests that Korean medicine can effectively treat posterior circulation cerebral infarction with END in CKD, but further studies should be conducted.

Objectives: Metabolic Syndrome (MetS) is strongly related with central obesity, hypertriglyceridemia, low high-density lipoprotein-cholesterol (HDL-C), hyperglycemia, and hypertension. This study reviewed the potential of Chenpi in treatment of MetS through amelioration of co-related diseases, such as diabetes mellitus, hyperlipidemia, obesity, hepatic steatosis, and inflammation.Methods: Six electronic databases (Oriental Medicine Advanced Searching Integrated System (OASIS), Korean Traditional Knowledge Portal, Korea Institute of Oriental Medicine (KIOM), Research Information Sharing Service (RISS), PubMed, and Embase) were used to search for in vitro, in vivo, and clinical research that discusses the potential effects of Chenpi (Citrus unshiu Markovich, Citrus reticulata Blanco) on diabetes mellitus, hyperlipidemia, obesity, hepatic steatosis, and inflammation.Results: This review suggests the potential of Chenpi as a candidate for the treatment of metabolic syndrome through improvement of co-related diabetes, hyperlipidemia, obesity, hepatic steatosis, and inflammation. However, comparison of the results of each study was limited by a lack of quantification of the experimental materials.

Background and Objectives Functional aphonia refers to in which by presenting whispering voice and almost producing very high-pitched tensed voices are produced. Voice therapy is the most effective treatment, but there is a lack of consensus for application of voice therapy. The purpose of this study was to examine the vocal characteristics of functional aphonia and the effect of voice therapy applied accordingly.Materials and Method From October 2019 to December 2020, 11 patients with functional aphonia were treated using voice therapy which was processing three stages such as vocal hygiene, trial therapy, and behavioral therapy. Of these, 7 patients who completed the voice evaluation before and after voice therapy was enrolled in this study. By retrospective chart review, clinical information such as sex, age, symptoms, duration, social and medical history, process of voice therapy, subjective and objective findings were analyzed. Voice parameters before and after voice therapy were compared.Results In GRBAS study, grade, rough, and asthenic, and in Consensus Auditory-Perceptual Evaluation of Voice, overall severity, roughness, pitch, and loudness were significantly improved after voice therapy. In Voice handicap index, all of the scores of total and sub-categories were significantly decreased. In objective voice analysis, jitter, cepstral peak prominence, and maximum phonation time were significantly improved.Conclusion The voice therapy was effective for the treatment of functional aphonia by restoring patient’s vocalization and improving voice quality, pitch and loudness.

The aim of the present study was to investigate the occurrence of skin complications after mechanochemical ablation with the ClariVein device (Merit Medical, South Jordan, Utah) for incompetent great saphenous veins (GSVs) and compare the results in terms of the target vein characteristics, especially in the presence of an epifascial GSV tributary.A single-center, retrospective study was performed. We reviewed 33 limbs of 32 patients with GSV insufficiency who had undergone mechanochemical ablation with the ClariVein device from December 2017 to February 2020. The 33 limbs were divided into two groups: the epifascial group, comprising 11 limbs of 11 patients, and the nonepifascial group, comprising 22 limbs of 21 patients. The patients underwent postoperative follow-up examinations at 1 week and 1, 3, 6, and 12 months. The skin complication counts and scores on a four-point scale were recorded.Regarding the baseline characteristics, the epifascial group showed a significantly lower GSV depth in the distal thigh region compared with the nonepifascial group (2.64 ± 0.5 mm vs 7.05 ± 2.57 mm; P .001). No statistically significant difference was found between the two groups in terms of the sclerosant (sodium tetradecyl sulfate) volume (5.45 ± 2.02 mL vs 6.59 ± 1.79 mL; P = .109) or ablation length (31.82 ± 3.92 cm vs 32.95 ± 4.05 cm; P = .449). All ClariVein procedures were technically successful (33 of 33 limbs; 100%), and no major complications were reported. The hyperpigmentation score was significantly greater in the epifascial group than in the nonepifascial group (score, 0.18 ± 0.4 vs 0 ± 0; P = .0401), although the hyperpigmentation count was not significantly different between the two groups (2 of 11 limbs [18.2%] vs 0 of 22 limbs [0.0%]; P = .1042). Although marginally higher counts and scores were observed in terms of phlebitis and bruising in the epifascial group, these differences were not statistically significant.Endovenous treatment with the ClariVein device for incompetent GSVs can be performed safely. However, caution should be exercised when the epifascial GSV tributary is treated during the ClariVein procedure because of its predilection to result in hyperpigmentation.

We aimed to evaluate the feasibility of multidomain intervention (MI) tailored to the Korean context. In an outcome assessor-blinded, randomized controlled trial, participants without dementia and with one or more modifiable dementia risk factors, aged 60-79 years, were randomly assigned to the facility-based MI (FMI; n=51), the home-based MI (HMI; n=51), or the control group receiving general health advice (n=50). The 24-week intervention comprised vascular risk management, cognitive training, social activity, physical exercise, nutrition guidance, and motivational enhancement. The FMI participants performed all intervention programs at a facility three times a week. The HMI participants performed some programs at a facility once every 1-2 weeks and performed others at home. The primary outcome was feasibility measured through retention, adherence, and at least no differences from the control group in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). In the FMI and HMI groups, the retention rates were 88.2% and 96.1%, and adherence to the intervention was 94.5% and 96.8%, respectively. The RBANS total scale index score improved significantly in the FMI (5.46 ± 7.50, P = 0.004) and HMI (5.50 ± 8.14, P = 0.004) groups compared to the control group (-0.74 ± 11.51). The FMI and HMI are feasible and there are indicators of efficacy.

BACKGROUND: Digital thoracic drainage systems have recently been introduced and widely used in clinical practices in developed countries. These systems can monitor intrathoracic pressure changes and air leaks in real time, and also allow for objective and quantitative analyses, which aid in managing patients with a prolonged persistent air leak into the pleural space. We investigated the feasibility and effectiveness of such a new device versus the traditional vacuum system for treating patients with pneumothorax. METHODS: Closed thoracostomy drainage was carried out on 100 adult patients with primary or secondary pneumothorax between January 2017 and December 2018. All the patients were aged ≥18 years and treated with a chest tube at a single medical center by the same cardiothoracic surgeons and intensivists. Patients who underwent closed thoracostomy drainage using an indwelling 24-French chest tube were divided into 2 groups immediately before closed thoracostomy: the digital thoracic drainage group (digital group, n=50) and the traditional analogue thoracic drainage group (analogue group, n=50). The detailed information about demographic data, treatment outcome, duration of indwelling catheterization., hospital days, cost-effectiveness and patient satisfaction was evaluated. We also evaluated whether digitally recorded intrapleural pressure changes and air leaks would predict chest tube removal timing and outcome. RESULTS: The baseline parameters of the 2 groups were comparable with no significant differences in sex, age, weight or body mass index. The mean hospital day was shorter in the digital group than in the analogue group (17.96±12.23 vs. 18.32±16.64, P=0.902), and there was no statistically significant difference in the hospital length of stay between the 2 groups. Air leaks through the chest tube and duration of chest tube indwelling hours showed no significant statistical differences between the digital and analogue groups (213.47±219.80 vs. 261.94±184.47, P=0.235 and 223.44±218.75 vs 275.29±186.06, P=0.205, respectively). Total drainage amount and ambulation time per day were significantly higher in the digital group than in the analogue group [209.62±139.63 vs. 162.48±80.42 (P=0.042) and 6.42±3.62 vs.3.94±1.74 (P

Background To understand changes in biological responses in nonhuman primate (NHP) recipients of xenotransplantation (XTP), we retrospectively investigated chronological changes in cytokine profiles of NHP recipients after solid-organ XTP. Methods Plasma samples were collected from 7 NHP recipients of pig heart or kidney XTP with α-1,3-galactosyltransferase gene knockout (GTKO) under anti-CD154-based immune suppression at the following time points: immediately before; 2 hours, 3 days, and 7 days after XTP; and weekly thereafter until the graft failed. The plasma levels of the following cytokines were measured: interleukin (IL)-1α, IL-1β, IL-6, IL-12p70, IL-8, IL-10, IL-15, tumor necrosis factor, interferon gamma (IFN-γ), D-dimer, C3a, and histone-complexed DNA fragments. For in vitro experiments, human natural killer (NK) cells were cocultured with wild-type porcine endothelial cells (PECs), GTKO-PECs, and human umbilical vein endothelial cells, with or without anti-CD154 antibody. IFN-γ levels in the culture supernatants were compared. Results IFN-γ levels peaked on day 7 or 10 of XTP and then decreased to basal levels, whereas proinflammatory cytokine levels increased along with the elevation of histone-complexed DNA fragments and were sustained until xenograft failure. In vitro, human NK cells produced more IFN-γ when in contact with wild-type PECs than with human umbilical vein endothelial cells, which was not reduced by the use of GTKO-PECs or addition of anti-CD154 antibody to the mixture. Conclusions In NHP recipients of XTP, the early peak of IFN-γ priming subsequent inflammatory responses may be attributed to NK cell activation in response to xenografts.

Objective The objective of this study was to evaluate the effectiveness and safety of endovenous cyanoacrylate closure (CAC) of incompetent great saphenous vein (GSV) and to assess the regression of varicose vein following CAC without a concomitant procedure. Methods A total of 63 limbs in 48 patients treated with CAC because of an incompetent GSV between December 2016 and November 2017 were retrospectively evaluated. In five limbs, incompetent GSV and small saphenous vein were treated simultaneously in the same session. Duplex ultrasound, Venous Clinical Severity Score, degree of regression of varicose veins, and adverse events were examined at intervals of 1 week, 1 month, 3 months, 6 months, and 12 months. Results In 63 limbs, of which 60 were available for follow-up, all treated GSVs showed complete closure during the follow-up period (8.4 ± 3.0 months). Venous Clinical Severity Scores at the time of all follow-up visits were significantly lower (P 50% varicose vein regression reached 90.6%. The more that varicosity entry was covered (P = .002) and the farther down the leg the access site was located (P = .024), the more complete resolution of varicose veins was observed. Phlebitis occurred in 10 limbs (16.7%), and hyperpigmentation occurred in 8 limbs (13.3%). Conclusions CAC is safe and effective for the treatment of an incompetent GSV. It also shows a satisfactory result with the regression of varicose veins. Covering the entry of varicosities and accessing lower down the leg are associated with more complete resolution of varicose veins.

Context:A winged scapula (WS) is associated with faulty posture caused by weakness of the serratus anterior (SA), which mainly acts as a scapular stabilizer muscle. It is important to accurately assess and train the SA muscle with a focus on scapula stabilizers during musculoskeletal rehabilitation of individuals with a WS.Objective:The authors examined muscle activity in the SA and pectoralis major (PM), upper trapezius (UT), and anterior deltoid (AD) as well as shoulder protraction strength during isometric shoulder protraction in individuals with and without a WS.Design:Cross-sectional study.Setting:A clinical biomechanics laboratory.Participants:In total, 27 males with no shoulder, neck, or upper-extremity pain participated.Main Outcome Measures:Isometric shoulder protraction strength was collected and surface electromyography used to measure the activity of the SA, PM, UT, and AD muscles and selective SA activity ratio to other shoulder muscles.Results:Electromyography activity of the SA muscle and shoulder protraction strength were significantly lower in individuals with a WS compared with the non-WS group (P P Conclusions:Isometric shoulder protraction for measuring SA strength in individuals with a WS should focus on isolated muscle activity of the SA, and SA strengthening exercises are important for individuals with a WS.

Porcine heart xenotransplantation is a potential treatment for patients with end-stage heart failure. To understand molecular mechanisms of graft rejection after heart transplantation, we transplanted a 31-day-old alpha-1,3-galactosyltransferase knockout (GTKO) porcine heart to a five-year-old cynomolgus monkey. Histological and transcriptome analyses were conducted on xenografted cardiac tissue at rejection (nine days after transplantation). The recipient monkey&rsquo, s blood parameters were analyzed on days &minus, 7, &minus, 3, 1, 4, and 7. Validation was conducted by quantitative real-time PCR (qPCR) with selected genes. A non-transplanted GTKO porcine heart from an age-matched litter was used as a control. The recipient monkey showed systemic inflammatory responses, and the rejected cardiac graft indicated myocardial infarction and cardiac fibrosis. The transplanted heart exhibited a total of 3748 differentially expressed genes compared to the non-transplanted heart transcriptome, with 2443 upregulated and 1305 downregulated genes. Key biological pathways involved at the terminal stage of graft rejection were cardiomyopathies, extracellular interactions, and ion channel activities. The results of qPCR evaluation were in agreement with the transcriptome data. Transcriptome analysis of porcine cardiac tissue at graft rejection reveals dysregulation of the key molecules and signaling pathways, which play relevant roles on structural and functional integrities of the heart.

Introduction: To evaluate the feasibility and safety of the Mynx vascular closure device (VCD) for arteriotomy closure after stent placement near the common femoral artery (CFA) access site. Methods: A total of 88 patients (73 men; mean age, 72 ± 9.2 years; 136 procedures) who underwent closure of CFA arteriotomy using the Mynx VCD after stent placement in proximal superficial femoral artery (SFA) with antegrade approach, or in common or external iliac artery with retrograde approach were retrospectively studied. Technical success and access site complication were evaluated. Body mass index (BMI), platelet count, international normalized ratio, prior history of ipsilateral CFA access, access direction, degree of CFA calcification, stent location and diameter, total procedure time, and sheath size were analyzed to evaluate their relationship with technical failure and development of bleeding complications. Results: Technical success was achieved in 94.9% (129/136) patients. The mean time to hemostasis was 0.7 ± 1.8 min. Technical failure was significantly associated with low BMI ( p = 0.001). Other variables presented no significant relationship with technical failure and development of complications. Ultrasonography on the day after the procedure revealed that 8 (5.9%) patients had hematoma. Conclusions: Mynx VCD for arteriotomy closure is feasible and provides hemostatic safety after stent placement near antegrade or retrograde CFA access. However, Mynx VCD may have a poor technical success rate among patients with low BMI.

Background Proximal femoral fracture (PFF), such as intertrochanteric femoral fracture or femur neck fracture, and its management are crucial issues to surgeons. PFF has been dramatically is becoming exponentially prevalent, and it is at high risk of complication and mortality because it is frequently associated with serious trauma and advanced age, especially in patients treated with anticoagulants or antiplatelet agents. Surgical management is essential for the treatment of PFF. Unfortunately, current surgical procedures have been related to accompanied by vascular complications, including laceration, hemorrhage, thrombosis, embolism, intimal flap tear and pseudoaneurysm. Furthermore, these vascular injuries following surgical management of PFF are potentially limb- and life-threatening. Of the complications after operation of PFF, femoral arteriovenous fistula (AVF) is rare, but remains a challenging problem because it is frequently associated with significantly high mortality and morbidity and is very difficult to treat. Methods A systematic literature review was conducted using the PRISMA guidelines with no language restriction. We searched scientific publications via PubMed, Embase, Cochrane central register of controlled trial, Google Scholar, the KoreaMed and the Research Information Sharing Service database. The goal of this study was to report on the incidence, clinical presentation, diagnosis, treatment, associated complications, morbidity and mortality of femoral AVF caused by PFF and to draw special attention to its prevention and management. Results A total of 7 case reports on femoral AVF associated with operation of PFF were identified, and one our case was added to the systematic analysis. Of the 8 cases, 4 were male and 4 were female under the age of 67.87±18.44; 6 (75.0%) survived without any events, 1 (12.5%) survived with a sequela of peroneal nerve impairment, and 1 (12.5%) died of multi-organ failure and hypovolemia. Conclusions The incidence of femoral AVF associated with PFF is extremely low, though it appears to increase with the rising frequency of PFF. With a very few exceptions, complications following internal fixation are potentially limb- and life-threatening. There is still no definite consensus on the standardized diagnostic or therapeutic modalities. Therefore, surgeons should keep in mind that this serious complication requires early diagnosis and prompt treatment, which should not be underestimated. Femoral AVF following operation of PFF should be meticulously managed, because untreated fistulae result in serious unexpected complications including renin-mediated hypertension, high-output heart failure and venous and/or arterial insufficiency. Surgical treatment is still the gold standard for such cases, but in limited cases endovascular procedures using embolization and closure device can be a good treatment option.

In this paper, we present an instantaneous reverse current elimination method for a capacitor voltage balanced bidirectional resonant converter operating in the backward operation. A conventional high step-up resonant converter with balanced capacitor voltage may suffer from a significant reverse current due to a large fluctuation of the resonant capacitor voltage in the backward operation. By adding a single bidirectional switch in the circuit, we are able to block the reverse current in the backward operation, which dramatically reduces the reverse current and current stress on the switch. A non-complementary modulation strategy for the bidirectional switch is developed to further reduce the conduction loss, which comes from the use of the bidirectional switch. As a result, the proposed bidirectional converter has high step-up/down capability, high efficiency, and balanced capacitor voltage. A 400-W converter prototype has been implemented to show the performance of the converter.

Background and Objective: Since methomyl shows a highly significant toxicity, the clinical outcome of acute methomyl pesticide intoxication is extremely critical. Methomyl is a kind of carbamate poisons. Similar to intoxications with other carbamate insecticides, methomyl intoxication inhibits the activity of acetylcholinesterase, which is contained within synaptic junctions between neurons. Most of the methomyl intoxication cases present with symptoms of cholinergic excess, which provokes respiratory failure, cardiovascular failure, and/or cardiorespiratory failure. Methomyl poisoning in humans has not yet been fully evaluated and most studies have reported sporadic cases or series of intoxication. Methomyl poisoning remains a continuing challenge, because this difficult-to-treat clinical condition is frequently associated with significantly high mortality and morbidity. We evaluated the usefulness of extracorporeal membrane oxygenation in the treatment of methomyl intoxication. Methods: A systematic literature review was conducted using the PRISMA guidelines without language restriction. We searched for scientific publications via PubMed, Embase, Cochrane central register of controlled trial, Google Scholar, the KoreaMed, and the Research Information Sharing Service database. The goal of this study was to report on incidence, associated complications, and morbidity/mortality of methomyl poisoning, and to draw special attention to its management with extracorporeal membrane oxygenation. Results: Only 1 case of a child treated with extracorporeal membrane oxygenation for carbamate or organophosphate intoxication was identified in the literature. After carbamate or organophosphate intoxication, the patient suffered from severe complications including neurological deficits, renal insufficiency, and severe respiratory failure. This child was treated with continuous hemofiltration and extracorporeal membrane oxygenation, but expired after 38 days of extracorporeal membrane oxygenation. In case of our patient, he recovered from the methomyl intoxication after 7 days of VA-ECMO. Conclusions: With only a few exceptions, acute methomyl poisoning is potentially life-threatening and has high incidences of morbidity and mortality. Therefore, physicians should keep in mind the possibility of extracorporeal membrane oxygenation for the quick support of intoxication. Extracorporeal membrane oxygenation support might be an alternative to overcome the cholinergic excess, such as respiratory failure, cardiovascular failure, and/or cardiorespiratory failure, especially in the case of severe acute methomyl intoxication.

High expression of cluster of differentiation (CD)39 and CD73 has cardio-protective effects. We hypothesised that the expression of CD39 and CD73 would differ between propofol- and volatile anaesthetic-based anaesthesia in patients undergoing open heart surgery (OHS). The objective of this prospective randomized trial was to compare the changes in CD39 and CD73 levels in CD4+ T cells between propofol- and sevoflurane-based anaesthesia during OHS. The study randomly allocated 156 patients undergoing OHS to a propofol or sevoflurane group. Blood was obtained preoperatively and up to 48 hours after weaning from cardiopulmonary bypass (CPB). The expression levels of CD39 and CD73 in circulating CD4+ T cells, serum cytokines and other laboratory parameters were analysed. The primary outcome was the expression of CD39 and CD73 on CD4+ T cells. Demographic data and perioperative haemodynamic changes did not show significant differences between the two groups. The expression of CD39 and CD73 in the sevoflurane group was significantly lower than in the propofol group (P + T cells compared to sevoflurane-based anaesthesia during OHS.

This study proposes a bidirectional grid-connected single-power-conversion converter with low-input battery voltage. The proposed bidirectional converter consists of a bidirectional dc–dc converter and an unfolding bridge, and the power conversion stage only corresponds to a bidirectional dc–dc converter. The bidirectional dc-dc converter can perform bidirectional power conversion between the low input battery voltage and a rectified sine wave due to its step-up/down voltage regulation functions. The unfolding bridge unfolds the rectified sine wave into the grid voltage and provides a current path to the grid. The study also proposes a control algorithm to regulate the grid current through a single power-processing stage. The control algorithm is comprised of a feed-forward nominal voltage compensator and a repetitive control scheme. The feed-forward nominal voltage compensator presets the operating point to lighten the burden of the grid current control, and the repetitive controller provides precise control of the grid current. Thus, the proposed bidirectional grid-connected single-power-conversion converter results in high power quality and high efficiency. Experimental results based on a 250-W prototype module are conducted to evaluate the performance of the converter and to verify the analysis.

This paper proposes a high-efficiency two-stage three-level grid-connected photovoltaic (PV) inverter. The proposed two-stage inverter comprises a three-level step-up converter and a three-level inverter. The three-level step-up converter not only improves the power-conversion efficiency by lowering the voltage stress but also guarantees the balancing of the dc-link capacitor voltages using a simple control algorithm; it also enables the proposed inverter to satisfy the VDE 0126-1-1 standard of leakage current. The three-level inverter minimizes the overall power losses with zero reverse-recovery loss. Furthermore, it reduces harmonic distortion, the voltage ratings of the semiconductor device, and the electromagnetic interference by using a three-level circuit configuration; it also enables the use of small and low-cost filters. To control the grid current effectively, we have used a feed-forward nominal voltage compensator with a mode selector; this compensator improves the control environment by presetting the operating point. The proposed high-efficiency two-stage three-level grid-connected PV inverter overcomes the low efficiency problem of conventional two-stage inverters, and it provides high-power quality with maximum efficiency of 97.4%. Using a 3-kW prototype of the inverter, we have evaluated the performance of the model and proved its feasibility.

We investigated the effects of intentional breath-holding also known as a valsalava maneuver on the kinematics of the lumbar spine, pelvis, hips, and knees, as well as electromyographic (EMG) activity of the trunk muscle during patient transfer with and without knee flexion. The kinematics of the lumbar spine, pelvis, hip, and knee were recorded using a synchronized 3-D motion capture system. Surface EMG was used to assess the activity of the external oblique (EO), internal oblique (IO), erector spinae (ES), and rectus femoris (RF). There was a significant difference in the peak angle of the lumbar spine (η2 = 0.644–0.600), pelvis (η2 = 0.514–0.294), hips (η2 = 0.897–0.746), and knees (η2 = 0.977–0.870), as well as in normalized EMG activity of the EO (η2 = 0.543–0.501), IO (η2 = 0.619–0.460), ES (η2 = 0.567–0.195), and RF (η2 = 0.607–0.144) (except for the RF in the lowering phase, p = 0.10), between the different types of patient transfer, in both the lifting and lowering phases (p

As technology has evolved, cities have become increasingly smart. Smart mobility is a crucial element in smart cities, and autonomous vehicles are an essential part of smart mobility. However, vulnerabilities in autonomous vehicles can be damaging to quality of life and human safety. For this reason, many security researchers have studied attacks and defenses for autonomous vehicles. However, there has not been systematic research on attacks and defenses for autonomous vehicles. In this survey, we analyzed previously conducted attack and defense studies described in 151 papers from 2008 to 2019 for a systematic and comprehensive investigation of autonomous vehicles. We classified autonomous attacks into the three categories of autonomous control system, autonomous driving systems components, and vehicle-to-everything communications. Defense against such attacks was classified into security architecture, intrusion detection, and anomaly detection. Due to the development of big data and communication technologies, techniques for detecting abnormalities using artificial intelligence and machine learning are gradually being developed. Lastly, we provide implications based on our systemic survey that future research on autonomous attacks and defenses is strongly combined with artificial intelligence and major component of smart cities.

A 10-year-old, spayed, female Cocker Spaniel was referred to our hospital with a history of a cough and dyspnea. The patient was tentatively diagnosed with a chemodectoma based on clinical features evident on echocardiography and computed tomography. Metronomic chemotherapy utilizing toceranib phosphate as well as medications for congestive heart failure were administered. During the period chemotherapy was administered (nine months from the time of diagnosis), clinical improvement was noted without the development of any adverse effects. However, clinical signs recurred after chemotherapy was discontinued at the owner’s request. When the patient was reevaluated via computed tomography, it was found that the size of the mass had increased. The patient developed severe dyspnea secondary to recurrent pleural effusion and was euthanized 65 days after clinical signs reappeared. A necropsy was performed and the patient was definitively diagnosed with a chemodectoma based on histopathologic and immunohistochemical analysis. This case report describes the clinical application of metronomic chemotherapy with toceranib phosphate, which is a tyrosine kinase inhibitor, in the treatment of a chemodectoma. We propose that this treatment may improve the quality of life and result in a prolonged survival time compared to treatment with medications for congestive heart failure alone.

A high-efficiency bridgeless three-level power factor correction (PFC) rectifier is proposed. The circuit configuration of the proposed rectifier consists of four metal oxide semiconductor field-effect transistor (MOSFET) switches, and the reverse recovery problems of the switches are eliminated. Also, the proposed rectifier with three voltage levels reduces the power losses, harmonic components, voltage ratings, and electromagnetic interference. To control the grid current and the output voltage effectively, a feed-forward nominal voltage compensator with the mode selector is developed; by presetting the operating point of the grid voltage, this compensator improves the control environment. Thus, the proposed three-level PFC rectifier with developed control algorithm provides high power quality and high efficiency of 99.05%. Experimental results based on a 1-kW prototype are provided to evaluate its performance and verify the analysis.

The aim of this study is to describe the long-term results of 980-nm endovenous laser ablation (EVLA) combined with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter into varicose tributaries. This report reviewed experiences with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter followed by EVLA, from July 2005 to November 2007. The sclerosing foam was injected through the microcatheter using 1% polidocanol or sodium tetradecyl sulfate. Patients were evaluated clinically and with duplex ultrasound from 1 week to 3 years to assess treatment efficacy and adverse reactions. Technical success was seen in 460 of 461 limbs (99.8%). Continued closure of the saphenous veins and complete sclerosis of varicose tributaries were noted in 351 of 408 limbs (86%) at 1-month follow-up, all 328 limbs at 3-month follow-up, all 299 limbs at 6-month follow-up, all 146 limbs at 1-year follow-up, all 94 limbs at 2-year follow-up, and all 32 limbs at 3-year follow-up. No serious complications were noted. Bruising was noted in 79.0%, and pain or tightness was noted in 68.4%. Hyperpigmentation was noted in 54.2%. EVLA for incompetent saphenous vein combined with endovenous foam sclerotherapy appears to offer the obvious benefits of less additional percutaneous sclerotherapy. However, many problems, like long-lasting pain and hyperpigmentation, can lessen the value of this procedure.

This study proposes a monitoring chart for anomaly detection of non-linear process signals generated by semiconductor manufacturing processes. In these manufacturing processes, fault detection and classification (FDC) and statistical process control (SPC) have been established as fundamental techniques to improve production efficiency and yield. Non-linear process signals are collected through automatic sensing during each operation cycle of a manufacturing process. As these cyclic signals non-linearly vary on the process state, the usage of the prevalent SPC chart is limited. Therefore, we propose a more efficient monitoring chart considering non-linear and time-variant characteristics. Using the principal curve, a non-linear smoothing algorithm, we construct a time-variant centerline that represents the standard pattern of the process. Then, control limits are calculated with time-variant variances over the course of the process. To evaluate performance, the proposed method was applied to industrial data for chemical vapor deposition (CVD), a semiconductor manufacturing process. We employed the misdetection ratio of signals to evaluate the performance. The proposed method demonstrated superior performance compared to other existing methods.

Objective To evaluate the effectiveness of poloxamer-based thermo-sensitive sol-gel instillation, after transurethral resection of the prostate (TURP), for preventing urethral stricture. Patients and methods In all, 198 patients underwent TURP for benign prostatic hyperplasia. Recruited patients were randomly divided into two groups: groups A and B. Patients in Group A (100 patients, experimental group) received poloxamer-based thermo-sensitive sol-gel instillation and patients in the Group B (98 patients, control group) received lubricant instillation after TURP. Each patient was evaluated at 4 (V1), 12 (V2), and 24 weeks (V3) after TURP. The effectiveness of poloxamer-based thermo-sensitive sol-gel instillation was evaluated based on the International Prostate Symptom Score (IPSS), IPSS-Quality of Life (QoL), Overactive bladder questionnaire (OAB-q), maximum urinary flow rate (Qmax ), post-void residual urine volume (PVR), and cystoscopy. Results Amongst the initial 198 participants, 80 patients in Group A and 83 in Group B completed the study. There were no significant differences in IPSS-QoL and OAB-q between the groups. However, Qmax was significantly different between groups A and B, at a mean (SD) of 18.92 (9.98) vs 15.58 (9.24) mL/s (P = 0.028) at 24 weeks after TURP. On cystoscopic examination, urethral stricture after TURP was found in two of the 80 patients in Group A and 10 of 83 in Group B (P = 0.023). Conclusions Poloxamer-based thermo-sensitive sol-gel instillation after TURP lowered the incidence of urethral stricture.

INTRODUCTION AND OBJECTIVES:A thermo-sensitive anti-adhesive with a property of sol-gel transition was manufactured by a physical mixture of Poloxamer, Chitosan and Gelatin. Poloxamer-based thermo-...

This paper presents a single power-conversion AC-DC converter with noncomplementary active-clamp circuit that can achieve high power conversion efficiency. We adopted the active-clamp circuit with noncomplementary modulation strategy to suppress a voltage spike of the main switch and minimize the power losses caused by high turn-off switching current and circulating current. To achieve 1-kW power capacity, we used a series resonant circuit which provides zero-current switching turn-off of the output diodes. Moreover, it has a benefit of bidirectional core excitation, thereby that this circuit transfers the energy in resonant and linear way during a single switching period. The proposed converter is analyzed theoretically and verified experimentally using 1-kW prototype.

Objectives To investigate polypharmacy and potentially inappropriate medications (PIMs) in elderly patients visiting the urology department for lower urinary tract symptoms (LUTS). Methods We retrospectively analyzed digital medical records of individuals over the age of 65 who visited the urology department for LUTS. This cross-sectional study was conducted in 10 hospitals located in South Korea, between September 2017 and December 2017. All prescribed medications were analyzed using electronic medical records. The updated 2015 Beers criteria were used to identify and assess the appropriateness of the prescribed drugs in elderly patients. Results We analyzed a total of 2143 patients aged over 65 years from 10 institutions. The mean age was 74.2 ± 6.26 years (65–97), 1634 (76.2%) were men. Patients took a mean of 6.48 ± 2.46 medications (range 0–18), and polypharmacy was found in 1762 patients (82.2%). The number of patients who received PIMs at least once was 1579 (73.7%). The average number of PIMs used per patient was 1.31 ± 1.25 (0–7). PIM use ratio was 18.9 ± 0.15% (0–67%). The number of chronic diseases, and concurrent medication and polypharmacy were predictive factors associated with PIM use. Conclusion Our multi-institutional results show that a substantial proportion of elderly patients took PIMs when visiting the urology department. Factors associated with PIMs were the number of chronic diseases and polypharmacy. Medication use in elderly patients, especially in urology, should be monitored carefully.

A Turkish angora cat with a one-week history of anorexia and vomiting was diagnosed with hepatic lipidosis. During hospitalization and treatment, the cat suddenly showed respiratory-related clinical signs, including coughing and dyspnea, 13 days after initial diagnosis. Due to the poor response to treatment, the patient was euthanized at the owner’s request. A postmortem histopathologic examination of the cat’s heart showed dilation and wall thinning of the right atrium and ventricle, with fibrofatty infiltration corresponding to an arrhythmogenic right ventricular cardiomyopathy (ARVC). This is a case report of ARVC concurrent with hepatic lipidosis in a cat; both diseases are related to disturbances in lipid metabolism.

Background Aortic valve calcification quantification using cardiac computed tomography (CCT) is a reliable marker for aortic stenosis (AS) in patients with bicuspid aortic valve (BAV) disease. Purpose To determine the association of Agatston aortic valve calcium score (AVCS) with morphological and hemodynamic characteristics of BAV and define cut-off AVCS for optimizing the grade of AS in patients with bicuspid AS. Material and Methods This study included 161 BAV patients with AS regardless of aortic regurgitation who underwent transthoracic echocardiography and CCT. BAVs were classified according to orientation of cusps and presence of raphe. Associations of AVCS with characteristics of BAV morphology and functional variables were determined by linear regression analysis. Area under the receiver operating characteristic curve (AUC) was used to determine the cut-off AVCS greater than which the diagnosis of severe AS was optimized. Results AVCS was significantly different according to sex ( P Conclusions In patients with bicuspid AS, AVCS was significantly higher in men and those with severe AS. However, AVCS was not significantly associated with morphological characteristics of BAV or the type of valvular dysfunction.

Background During maximal isometric protraction, it is important to determine the optimal resistance intensity in subjects with a winged scapula, for inducing isolated activity of the serratus anterior against the pectoralis major, which is activated as a synergistic muscle. The aim of the present study was to determine electromyographic activities of the serratus anterior and pectoralis major muscles during isometric shoulder protraction at different levels in subjects with and without a winged scapula. Methods Thirty male subjects performed isometric shoulder protraction in a sitting position at different resistance intensity levels (100%, 80%, and 60% of maximal protraction strength). Surface electromyographic data of the serratus anterior and pectoralis major muscles were gathered simultaneously using fixed instrumentation to measure isometric shoulder protraction. Findings Muscle activity of the serratus anterior in subjects without a winged scapula was significantly greater than that of subjects with a winged scapula across all three conditions, whereas muscle activity of the pectoralis major was lower in subjects without a winged scapula. In addition, winged scapula muscle activity corresponding to maximal protraction was significantly greater than that in the submaximal condition. Interpretation In a clinical setting, submaximal resistance can be more optimal than maximal effort during isometric shoulder protraction in individuals with a winged scapula.

Recently, malicious mining using CPUs has become a trend - mining which the task is not detected by the users is even more of a threat. In this paper, we focused on discovering a new IA-32\footnoteIt stands for Intel Architecture-32bit. It is the 32-bit version of the x86 instruction set architecture which supports 32-bit computing. vulnerability and found an undetectable task using hardware task switching method. The created task is undetectable by the operating system and thus hidden from the system user. Although hardware task switching methods are replaced by more convenient software switching methods in the recent years, they still exist on modern computer systems. By manually manipulating hardware task switching, which is directly managed by the CPU, we show that it is possible to create a hidden scheduler aside from the ones created by the operating system. We demonstrate using a simple CPU consumption example that these hidden tasks have potential to evolve into more sophisticated malicious attacks that can go unnoticed by users.

Objective To investigate whether prostate-specific antigen (PSA) fluctuation correlates with a prostate cancer and to assess whether PSA fluctuation could be used for diagnosis of prostate cancer. Materials and Methods Our study included 229 patients who were performed a prostate biopsy (non-cancer group, 177; prostate cancer group, 52). Enrolled patients were provided twice PSA tests within 6 months. PSA fluctuation (%/month) was defined as a change rate of PSA per a month. Independent t test was used to compare between two groups. Receiver operator characteristic curve was used to assess the availability as a differential diagnostic tool and the correlation. Simple linear regression was performed to analyze a correlation between PSA fluctuation and other factors such as age, PSA, PSA density, and prostate volume. Results There were significant differences in PSA, PSA density, percentage of free PSA, and PSA fluctuation between two groups. PSA fluctuation was significantly greater in non-cancer group than prostate cancer group (19.95±23.34%/month vs 9.63±8.57%/month, P=0.004). The most optimal cut-off value of PSA fluctuation was defined as 8.48%/month (sensitivity, 61.6%; specificity, 59.6%; AUC, 0.633; P=0.004). In a simple linear regression model, only PSA level was significantly correlated with PSA fluctuation. Conclusion Patients with wide PSA fluctuations, although baseline PSA levels are high, might have a low risk of diagnosis with prostate cancer. Thus, serial PSA measurements could be an option in patients with an elevated PSA level.

Objectives Development of acute kidney injury (AKI) after cardiopulmonary bypass (CPB) is relatively common and associated with increased mortality. Recently, plasma neutrophil gelatinase-associated lipocalin (NGAL) was used for the prediction of AKI. We evaluated the clinical usefulness of plasma NGAL. Design and methods One hundred twelve adult patients undergoing cardiovascular surgery with CPB were included. Blood samples were obtained at baseline, at intensive care unit (ICU) admission, and 24 h after ICU admission. The development of AKI, which is defined as an increase in serum creatinine by more than 50% within 3 postoperative days, was monitored. NGAL levels were analyzed by a Biosite Triage meter (Alere Medical, USA). Diagnostic performance of NGAL was analyzed using the area under the receiver operating characteristic curve. Results In AKI patients (n = 13), plasma NGAL levels at ICU admission were significantly higher than those at baseline [177 (122–402) vs. 121 (74–158) ng/mL, median (interquartile range), p = 0.028], whereas serum creatinine showed no significant change. The predictive value of NGAL at ICU admission was 0.812 [95% confidence interval (CI), 0.68 to 0.95] with a cut-off value of 168.5 ng/mL (sensitivity, 61.5%; specificity, 88.9%). After the exclusion of 35 patients with preoperative decreased renal function, the predictive value was increased to 0.911 (95% CI, 0.82 to 1.00). Conclusions This study showed that plasma NGAL may serve as a useful biomarker for the early detection of AKI in adult patients following CPB.

In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm2/m2. The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure.