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Prior research on online reviews has taken for granted that consumers submit reviews only after they have fully consumed purchased products or services. Contrastingly, this study uncovered the hidden truth that many book consumers post assessments before, during, and after consumption. Interestingly, many provide numerical review ratings, even with no consumption at all. We also found that review comments formed after incomplete product engagement adversely affect subsequent sales. Consequently, online evaluations crafted on the basis of fragmentary encounters can become a new source of challenges to managers and policymakers who are responsible for preserving the accuracy and informativeness of product critiques. Digital platforms may leverage our findings to improve their design of review systems and policies in ways that enhance the trustworthiness of peer evaluations and correct potential inaccuracies from inadequately informed assessments. For example, managers can revise their review “sorting” structure so that consumers can flexibly reposition text-based reviews in accordance with a consumption index. Managers can likewise take advantage of these study’s insights to effectively re-establish review-posting policies and schemes that encourage consumers to submit reviews after a sufficient amount of products have been consumed.

BACKGROUND AND AIMS Some hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients show undetectable serum HBV DNA levels at HCC diagnosis. The risk of HBV reactivation and its impact on clinical outcomes are not well-unknown. METHODS This retrospective cohort study included a total of 985 HBV-related HCC patients with undetectable serum HBV DNA levels (

Lenvatinib is an oral multikinase inhibitor approved for use as first-line treatment for patients with advanced hepatocellular carcinoma (HCC). However, like other agents in this drug class, lenvatinib is associated with clinically important adverse events (AEs) that could adversely affect patient outcomes. Hypertension, diarrhea, decreased appetite/weight, hand-foot skin reaction, and proteinuria are among the most common AEs associated with lenvatinib therapy. This article provides strategies for the effective management of lenvatinib-associated AEs based on the expert opinion of authors and currently available literature. Due to the high risk of AEs in patients receiving lenvatinib, prophylactic measures and regular monitoring for AEs are recommended. Lenvatinib dose interruption, adjustment, or discontinuation of treatment may be required for patients who develop AEs. For grade 1 or 2 AEs, dose interruption is generally not required. For persistent or intolerable grade 2 or 3 AEs, lenvatinib treatment should be interrupted until symptoms improve/resolve to grade 0-1 or baseline levels. Thereafter, treatment should be resumed at the same or a lower dose. Disease progression may occur in patients who do not initially respond to treatment or receive a suboptimal lenvatinib dose following dose reduction, resulting in lack of efficacy. Therefore, to derive maximum treatment benefit and ensure long-term disease control, lenvatinib should be maintained at the highest possible dose when managing AEs. To conclude, lenvatinib-associated AEs can be managed with prophylactic measures, regular monitoring and symptomatic management, which can ensure continued treatment and maximum survival benefit in patients with advanced HCC receiving first-line lenvatinib therapy.

BACKGROUND Adrenoleukodystrophy (ALD) is caused by a deficit in the ABCD1 gene, which leads to demyelination of neurons and dysfunction of the adrenal cortices and testicles. Of the three known phenotypes, 30%-50% of male ALD patients present with the adrenomyeloneuropathy phenotype, characterized by gait disturbance as the initial symptom. CASE SUMMARY A 46-year-old man with a prior diagnosis of ALD was admitted to a Korean medicine hospital for the treatment of gait disturbance. His ability to walk was severely impaired at admission, significantly affecting the patient’s quality of life. He was treated with acupuncture, pharmacopuncture, electroacupuncture, and herbal medicine for 23 d. The 25-Foot Walk test (25FW), timed up and go (TUG), comfortable gait speed (CGS), numeric rating scale (NRS), Berg Balance Scale (BBS), Tinetti test, manual muscle test (MMT), and 3-level version of EuroQol-5 dimension (EQ-5D-3L) were used to evaluate the patient. The outcomes of the 25FW, TUG, and CGS improved during hospitalization. From the time of admission to discharge we observed: A decrease in NRS scores in the lower extremities and the lower back; an increase of 3 points in the BBS; a 1-point increase in the balancing part of the Tinetti Test; MMT and EQ-5D-3L performances remained unchanged. CONCLUSION Traditional Chinese medicine treatments could be a therapeutic option to alleviate issues related to gait disturbance in ALD.

Background/Aims Proton pump inhibitors (PPIs) increase gastric pH and alter the gut microbiome. An increased risk for infectious diseases has been reported in PPI users. However, little is known about the association of PPI use with pyogenic liver abscess (PLA) incidence risk. Methods We conducted a population-based cohort study using data from a nationwide representative sample of the Korean general population followed up for 10 years (January 1, 2003 to December 31, 2013). We identified PPI prescriptions and considered PPI as a time-varying variable. Proportional hazards regression model was used for incident PLA comparing PPI use versus non-use. Propensity score matching was also conducted. Results During the 4 209 229 person-years of follow-up, 58 595 participants had at least 1 PPI prescription and 541 patients developed liver abscess. The age-, sex-, residential area-, and income-adjusted hazard ratio for PLA incidence with PPI use was 4.19 (95% CI, 2.54-6.92). The association was observed in fully adjusted models (hazard ratio 3.88; 95% CI, 2.33-6.44). The positive association between PPI use and PLA was consistent in all subgroups analyzed and in propensity score matching group. Conclusion The present data indicate that PPI use is associated with an increased PLA risk. Therefore, it is necessary to prescribe PPIs with clear indication and to avoid improper use of PPIs.

A bibliometric approach using network analytical methods was applied to explore the research trends on acupuncture for neck pain treatment. Publications related to acupuncture for neck pain treatment from 2000 to 2020 were retrieved from the Web of Science database. The extracted records were analyzed in terms of publication year, research area, journal title, country, organization, authors, and keywords. The research trends on acupuncture for neck pain treatment were visualized using the VOSviewer program. Analyses of 325 articles revealed that the total number of publications has continually increased over the last 20 years. The most represented research area was integrative complementary medicine. The country producing the most articles was the US, followed by China, England, and the Republic of Korea. By assessing the total link strength of organizations and authors, we identified influential organizations and authors who have contributed to research on acupuncture for neck pain treatment. A network analysis based on the cooccurrence of keywords revealed the following two major study designs: clinical study and research methodology. This study examined the research trends on acupuncture for neck pain treatment using bibliometric methods. Our findings provide useful guidelines for researchers in searching for relevant topics.

OBJECTIVE We aimed to identify a relation between the level of silica exposure and the associated increase in the risk of radiologic usual interstitial pneumonia (UIP) pattern. METHODS We selected data of 796 individuals with pneumoconiosis who had undergone a chest computed tomography (CT). We estimated the silica exposure by comparing their occupational history with the data silica dust exposure. RESULTS Individuals employed as stonemasons demonstrated a 2.30-fold increase in the risk of developing UIP than coal mine workers (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.04 to 5.07). The high silica exposure group was associated with a 2.23-fold increase in the risk of developing UIP than the low silica exposure group (OR, 2.23; 95% CI, 1.07 to 4.69). CONCLUSIONS This study suggests that silica exposure is associated with an increased risk of developing UIP pattern, highlighting a dose-response relationship.

Objectives To characterize the frequency and association of gastrointestinal (GI) symptoms with outcomes in patients with corona virus disease 2019 (COVID-19) admitted to the hospital. Methods Records were retrospectively collected from patients admitted to a tertiary care center in Washington, D.C., with confirmed COVID-19 from March 15, 2020 to July 15, 2020. After adjusting for clinical demographics and comorbidities, multivariate logistic regression analysis was performed. Results The most common presenting symptoms of COVID-19 in patients that were admitted to the hospital were cough (38.4%), shortness of breath (37.5%), and fever (34.3%), followed by GI symptoms in 25.9% of patients. The most common GI symptom was diarrhea (12.8%) followed by nausea or vomiting (10.5%), decreased appetite (9.3%), and abdominal pain (3.8%). Patients with diarrhea were more likely to die (odds ratio [OR] 2.750; p = 0.006; confidence interval [CI] 1.329–5.688), be admitted to the intensive care unit (ICU) (OR 2.242; p = 0.019; CI 1.139–4.413), and be intubated (OR 3.155; p = 0.002; CI 1.535–6.487). Additional outcomes analyzed were need for vasopressors, presence of shock, and acute kidney injury. Patients with diarrhea were 2.738 (p = 0.007; CI 1.325–5.658), 2.467 (p = 0.013; CI 1.209–5.035), and 2.694 (p = 0.007; CI 1.305–5.561) times more likely to experience these outcomes, respectively. Conclusions Screening questions should be expanded to include common GI symptoms in patients with COVID-19. Health care providers should note whether their patient is presenting with diarrhea due to the potential implications on disease severity and outcomes.

Background and aims Controversy exists over whether emergent liver transplantation (LT) should be performed for patients with acute-on-chronic liver failure (ACLF), especially for patients with multiple organ failure. Methods A total of 110 ACLF patients, defined by the European Association for the Study of the Liver (EASL) Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) criteria were analyzed. The primary outcome was overall survival after ACLF diagnosis. Results During follow-up, 76 patients received LT (59 received deceased-donor LT and 17 patients received living-donor LT). The overall survival was better for patients who received LT than patients who did not (82.9% vs. 17.6%, P 32 and ACLF grade progression. Conclusions Emergent LT provided a significant survival benefit to ACLF patients, regardless of the baseline ACLF grade. Post-LT outcomes were associated with baseline MELD scores and ACLF progression during the pre-transplant period, which might be used in the emergent LT plan for patients presenting with ACLF.

Controlled attenuation parameter (CAP) can evaluate hepatic steatosis in patients with chronic hepatitis B (CHB). However, prognostic implications of CAP value remain unclear. We evaluated the association between CAP and the risk of hepatocellular carcinoma (HCC) in patients with CHB under antiviral therapy and maintained virologic response. A total of 1823 CHB patients who were taking nucleos(t)ide analogue and showing suppressed hepatitis B virus replication were analyzed. The primary outcome was incident HCC during follow-up. Patients were grouped into those with and without advanced chronic liver disease (ACLD) (liver stiffness measurement cutoff: 10 kPa), and those with and without hepatic steatosis (CAP cutoff: 222 dB/m). During 6.4 years of follow-up, 127 patients (7.0%) newly developed HCC. Among patients with ACLD (n = 382), the cumulative HCC incidence rate was lower for those with CAP ≥ 222 (11.0% at 5 years) than those with CAP

The synthesis of uniform low-defect graphene on a catalytic metal substrate is getting closer to the industrial level. However, its practical application is still challenging due to the lack of an appropriate method for its scalable damage-free transfer to a device substrate. Here, an efficient approach for a defect-free, etchant-free, wrinkle-free, and large-area graphene transfer is demonstrated by exploiting a multifunctional viscoelastic polymer gel as a simultaneous shock-free adhesive and dopant layer. Initially, an amine-rich polymer solution in its liquid form allows for conformal coating on a graphene layer grown on a Cu substrate. The subsequent thermally cured soft gel enables the shock-free and wrinkle-free direct mechanical exfoliation of graphene from a substrate due to its strong charge-transfer interaction with graphene and excellent shock absorption. The adhesive gel with a high optical transparency works as an electron doping layer toward graphene, which exhibits significantly reduced sheet resistances without optical transmittance loss. Lastly, the transferred graphene layer shows high mechanical and chemical stabilities under the repeated bending test and exposure to various solvents. This gel-assisted mechanical transfer method can be a solution to connect the missing part between large-scale graphene synthesis and next-generation electronics and optoelectronic applications.

Thyroid cancer is one of the most common cancers, with a global increase in incidence rate for both genders. Ultrasound-guided fine-needle aspiration is the current gold standard to diagnose thyroid cancers, but the results are inaccurate, leading to repeated biopsies and unnecessary surgeries. To reduce the number of unnecessary biopsies, we explored the use of multiparametric photoacoustic (PA) analysis in combination with the American Thyroid Association (ATA) Guideline (ATAP). In this study, we performed in vivo multispectral PA imaging on thyroid nodules from 52 patients, comprising 23 papillary thyroid cancer (PTC) and 29 benign cases. From the multispectral PA data, we calculated hemoglobin oxygen saturation level in the nodule area, then classified the PTC and benign nodules with multiparametric analysis. Statistical analyses showed that this multiparametric analysis of multispectral PA responses could classify PTC nodules. Combining the photoacoustically indicated probability of PTC and the ATAP led to a new scoring method that achieved a sensitivity of 83% and a specificity of 93%. This study is the first multiparametric analysis of multispectral PA data of thyroid nodules with statistical significance. As a proof of concept, the results show that the proposed new ATAP scoring can help physicians examine thyroid nodules for fine-needle aspiration biopsy, thus reducing unnecessary biopsies. Significance: This report highlights a novel photoacoustic scoring method for risk stratification of thyroid nodules, where malignancy of the nodules can be diagnosed with 83% sensitivity and 93% specificity.

Introduction The aim of this study was to analyze and describe the fracture patterns of the acetabular posterior wall based on quantitative measurements of the fracture characteristics. Materials and methods Computed tomography images of 51 patients with acetabular posterior wall fractures from an initial cohort of 216 acetabular fractures were imported into a three-dimensional (3D) virtual software. The reconstructed 3D images were utilized to evaluate the following: (i) fracture line mapping on the inner articular and retro-acetabular surfaces, (ii) common zones of fracture and marginal impaction, and (iii) categorization by location and pattern of comminution. The clock-face position was applied for description: the midpoint of the transverse acetabular ligament served as the +180° reference point, and the 0° reference point was set perpendicular to the ligament. The fracture angle on the articular surface was defined as the intersection between the start and end points. The fracture span on the retro-acetabular surface was defined as the ratio of the perpendicular distance, which is between the fracture beak and acetabular rim, to the entire length, which is from the edge to the rim. Quantitative measurements were performed, and the fracture patterns were analyzed. A color scale bar was used to visualize the common and marginal impaction zones. Results The articular surface mapping of all the cases demonstrated that the average starting point of the fracture line was +6.2° (±12.8°) and the endpoint was 96.7° (±13.3°), and the average fracture angle was 119.6° (±7.6°) with 80.6% of the fragments having angles within 18.7–117°. The retro-acetabular surface mapping demonstrated that the average fracture span was 0.65 ±0.20, and 61.7 % of the fracture lines were located within 0.6 to 0.9. Marginal impaction was found in 21 cases (21/51, 41.2%; range: between +7° and +105°). Conclusion The fracture maps showed fracture patterns and recurrent fracture zones on the articular and retro-acetabular surfaces. However, there was no remarkable pattern of marginal impaction. Level of evidence Retrospective cohort study

The convective and radiative heat transfer coefficients of clothing are important parameters for human thermoregulation and comfort models. Many researchers have studied convective and radiative heat transfer coefficients of the naked human body. However, there is limited information on convective and radiative heat transfer coefficients for the clothed human body. Therefore, this study aims to confirm whether the convective and radiative heat transfer coefficients vary with different clothing ensembles in addition to clarifying how the difference in clothing heat transfer coefficients affects the prediction of thermal comfort index, such as the predicted mean vote (PMV) index. The convective and radiative heat transfer coefficients for eight sets of clothing ensembles were measured through a manikin experiment. The results demonstrated that (1) the largest difference between convective heat transfer coefficients for various clothing ensembles was 32%, and (2) PMV values differed between the clothing ensembles with the largest value being approximately 0.2, which corresponds nearly 1 °C change in the indoor temperature. Therefore, it is necessary to consider the actual clothing convective heat transfer coefficient for the precise prediction of thermal comfort.

Pedestrian bridges with I-shaped girders exhibit frequent construction errors and difficulties in the construction of curved sections because the bridges are composed of straight girders mounted on piers. Therefore, a pedestrian bridge utilizing circular steel tubes as the main girder, which is easy to construct and more economical, is proposed to resolve these problems. When steel pedestrian bridges are used for long periods, fractures can occur owing to fatigue in the joints between the main girder and the bottom support. Full-scale circular steel tube joint test units were fabricated and subjected to two million cycles of fatigue performance tests and one million cycles of fatigue fracture tests to quantify the fatigue behavior of a new pedestrian bridge design comprising circular steel tubes. Finite element analysis (FEA) was used to verify the results of the fatigue fracture tests. The proposed pedestrian bridge exhibited excellent stability in terms of fatigue behavior. Moreover, the fatigue fracture of the bridge was successfully predicted using FEA.

Using a novel dataset of independent directors’ voting activities on items proposed by managers of Korean firms, we investigate whether independent directors’ dissension in board meetings plays an effective role in enhancing firm value through improved corporate governance. Our results indicate that dissension improves firm value. This finding is robust to different measures of firm value and alternative model specifications including subsample, propensity score matching, and instrumental variable analyses. Overall, we contribute to the understanding of the relation between corporate governance and firm value. Specifically, we provide new evidence that the monitoring by independent directors enhances firm value.

Phosphodiesterase-5 inhibitors (PDE-5i, such as Sildenafil, Tadalafil and Vardenafil, mainly prescribed to treat erectile dysfunction) and their generic drug equivalents have been widely marketed and consumed in Korea. From the concentrations detected in wastewater, we could deduce that relatively large amounts of PDE-5i were consumed without a legal prescription. Thus, PDE-5i’s presence in the environment via sewage is unavoidable, and their environmental fate within a sewage treatment plant (STP) should be evaluated. In this study, we investigated the occurrence of three PDE-5i analogs in the influent and effluent of two STPs and the receiving water bodies. The PDE-5i concentration in total reached 62 ± 12 (STP#1) and 88 ± 37 ng L−1 (STP#2) in the sewage influent; about 70% of it was Sildenafil in both STPs. However, they were hardly removed by the STPs as the removal efficiency of the STPs was less than 10% ± 5%. Therefore, the pharmaceuticals were detected in the receiving water (lower than 7 ng L−1as a total amount) and the concentration slightly increased downstream of the STPs. A simple mass balance model applied for the compounds in the STP effluent and receiving water bodies also confirmed that the discharged PDE-5i were quite persistent. Lastly, we identified temporal and regional patterns in the consumption of the drugs from daily variations of PDE-5i in the influent to these two STPs. For instance, the levels of PDE-5i in the sewage significantly increased on weekends (from Friday to Saturday), and especially in the area where adult-entertainment businesses are common. We estimated that the amount of PDE-5i consumption in this area was 31% higher than that in the area with fewer nightlife spots. Considering that they are pharmaceutically active and resistant to treatment processes within an STP, it is advised that a regular monitoring and management program for PDE-5i should be developed to prevent the discharge of the pharmaceuticals into the water environment.

Slag foaming is a key factor in terms of quality and productivity in the electric arc furnace (EAF) steelmaking process. Optimal control of slag foaming is required, but is difficult due to the absence of practical on-line measuring methods and the broad process variability. In this study, a soft sensor model, which correlates the influential process variables with the slag foaming height, was developed by using machine learning based long short-term memory (LSTM) networks for modeling sequential and nonlinear data. The developed model was validated using actual steelmaking dataset in terms of performance metrics such as the root mean square error (RMSE), coefficient of determination (R2), and correlation coefficient corresponding to a value for a SS400 carbon steel grade to be 42.3, 0.905, and 0.963, respectively. In order to evaluate the general applicability of the developed model for other steel grades, data for A615 and S355 steel grades were also applied and found to satisfy the benchmark standards indicating that the developed model can be applied to the broad range of other steel grades. Sensitivity-based Pruning (SBP) on the model shows that electricity, carbon and oxygen are the most influential process variables to the slag foaming height and could potentially be used to promote enhanced optimization in terms of energy saving and cost-efficiency for the EAF steelmaking process.

Leveraging omnichannel has become a new norm of strategic marketing in the retail industry, with many vendors foregrounding the value of customers who wish to maximize their shopping experiences ac...

Objective The purpose of this study was to conduct a systematic review and meta-analysis of the effects of acupuncture on humeral fractures. Methods Randomized controlled trials were searched systematically from inception to January 2020 using the Cochrane Central Register of Controlled Trials, Embase, PubMed, Web of Science, China National Knowledge Infrastructure, and 7 Korean databases. Pain scale and Japanese Orthopaedic Association scores were the primary and secondary measurements. A risk-of-bias assessment and meta-analysis were conducted. Results Seven randomized controlled trials were included in the systematic review; the quality of the studies was ambiguous. The meta-analysis showed that acupuncture improved the pain severity score compared with conventional therapies (standard mean difference = −4.55, 95% confidence interval, −7.48 to −1.61, I2 = 98%, P Conclusion Our meta-analysis shows that acupuncture reduced pain after proximal humeral fracture, in addition to common rehabilitative modalities. However, the conclusion of this review should be cautiously applied in clinical practice owing to the low quality of the included studies.

Background It is uncertain whether the prognosis of Barcelona Clinical Liver Cancer (BCLC) stage 0 hepatocellular carcinoma (HCC) has improved. Aims To evaluate whether the outcomes of BCLC stage 0 patients has improved, and if so, what are the reasons behind the noted improved outcome. Methods A total of 591 patients with BCLC stage 0 HCC diagnosed at Samsung Medical Center, Seoul, Korea were grouped based on year of diagnosis (earlier cohort; 2007–2009 and later cohort; 2013–2015) and compared. Results The overall survival (OS) was improved for BCLC stage 0 patients at later cohort (5-year survival rate: 82.1% vs. 92.0% for earlier cohort and later cohort, p = 0.015). However, after adjustment, the treatment period was not an independent factor for OS, especially when the albumin-bilirubin (ALBI) grade was adjusted. The incidence of liver cirrhosis (LC)-related death was increased from 10.4% to 33.3%, while the incidence of HCC-related death decreased from 57.5% to 28.6% in the latter cohort. Conclusions The survival improvement of BCLC stage 0 patients was largely explained by better liver function at diagnosis. Mortality from LC-related death was increasing, which calls for careful attention for finding strategies for preserving the liver function for BCLC stage 0 patients.

Background/aim To evaluate the predictive value of metabolic activity assessed by 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with hepatocellular carcinoma (HCC) undergoing Yttrium-90 (Y-90) transarterial radioembolization (TARE). Methods Between 2009 and 2013, a total of 40 patients with HCC were treated with Y-90 TARE. Before each treatment, 18 F-FDG PET/CT was performed. Maximum standardized uptake value (SUVmax) and tumor-to-non-tumorous liver uptake ratio (TLR; tumor SUVmax/non-tumorous liver mean SUV) were measured for each patient. Tumor response was evaluated in accordance with modified RECIST criteria at 3-month intervals after Y-90 TARE. Statistical analysis was performed using the chi-squared test, Kaplan-Meier analysis, and the Cox proportional hazards model. Results The median patient age was 56.5 years. Twenty-nine patients (72.5%) were men; 36 patients (90.0%) were classified as Child-Pugh class A. Thirty-three patients (82.5%) showed disease control in treated lesions at 3 months after Y-90 TARE. Eleven patients (27.5%) showed progression-free survival. However, low and high TLR (relative to the median value of 2.1) did not affect rates of disease control, progression-free survival, or overall survival. No predictive factors could be identified for disease progression or death in patients with HCC undergoing Y-90 TARE. Conclusions TLR-based stratification is a simple method, but it may not be useful in treatment planning for HCC patient undergoing Y-90 TARE. Further studies with large number of patients are needed.

We examine whether the combination of agency costs of debt and managerial optimism in high-tech IPOs creates inefficient R&D investment, thus undermining corporate value. We find that high-tech IPO...

Background: Lenvatinib has been recently approved as a first-line treatment option for patients with unresectable hepatocellular carcinoma (HCC) in Korea. We aimed to study the efficacy and safety of lenvatinib therapy in a real-world practice and to find prognostic factors related to survival and disease progression. Methods: A hospital-based retrospective study was conducted on 111 consecutive patients who had unresectable HCC and were treated with lenvatinib at Samsung Medical Center from October 2018 to March 2020. Efficacy was determined using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria in 111 patients who completed 1st tumor assessment. Safety was evaluated in 116 HCC patients including 5 patients who discontinued lenvatinib due to adverse events (AEs) before 1st tumor assessment using Common Terminology Criteria for AEs version 5.0. Results: A total of 111 patients with a median age of 59 years were analyzed during a median follow-up duration of 6.2 (4.4–9.0) months. The Kaplan-Meier estimate of overall survival was 10.5 months, and the median progression-free survival was 6.2 months. Based on mRECIST criteria, the objective response rate was 18.9% and disease control rate was 75.7%. AEs developed in 86/116 (74.1%) patients, and grade ≥3 AEs developed in 16/116 (13.8%) patients. Diarrhea, hand-foot skin rash, abdominal pain, hypertension, and anorexia were identified as the AEs with the highest frequencies of any grade. REFLECT eligibility criteria including tumor extent ≥50% liver occupation or inadequate bone marrow function and occurrence of anorexia were prognostic factors for survival, and occurrence of diarrhea was a favorable factor for disease progression. Conclusion: Lenvatinib therapy showed a favorable efficacy and safety in a real-world practice. The REFLECT eligibility criteria and specific AEs could be one of the prognostic markers.

Photoacoustic imaging (PAI) has attracted great attention as a medical imaging method. Typically, photoacoustic (PA) images are reconstructed via beamforming, but many factors still hinder the beamforming techniques in reconstructing optimal images in terms of image resolution, imaging depth, or processing speed. Here, we demonstrate a novel deep learning PAI that uses multiple speed of sound (SoS) inputs. With this novel method, we achieved SoS aberration mitigation, streak artifact removal, and temporal resolution improvement all at once in structural and functional in vivo PA images of healthy human limbs and melanoma patients. The presented method produces high-contrast PA images in vivo with reduced distortion, even in adverse conditions where the medium is heterogeneous and/or the data sampling is sparse. Thus, we believe that this new method can achieve high image quality with fast data acquisition and can contribute to the advance of clinical PAI.

Background The Breslow depth is an important parameter to determine the excision margin and prognosis of melanoma. However, it is difficult to accurately determine the actual Breslow depth before surgery using the existing ocular micrometer and biopsy technique. Objectives To evaluate the use of 3D wide-field multispectral photoacoustic imaging to non-invasively measure depth and outline the boundary of melanomas for optimal surgical margin selection. Methods Six melanoma patients were examined in vivo using the 3D multispectral photoacoustic imaging system. For five cases of melanomas (one in situ, three nodular, and one acral lentiginous type melanoma), the spectrally unmixed photoacoustic depths were calculated and compared against histopathological depths. Results Spectrally unmixed photoacoustic depths and histopathological depths match well within a mean absolute error of 0.36 mm. In particular, the measured minimum and maximum depths in the in situ and nodular type of melanoma were 0.6 and 9.1 mm, respectively. In the 3D photoacoustic image of one metastatic melanoma, feeding vessels were visualized in the melanoma, suggesting the neovascularization around the tumour. Conclusions The 3D multispectral photoacoustic imaging not only provides well-measured depth and sizes of various types of melanomas, it also visualizes the metastatic type of melanoma. Obtaining accurate depth and boundary information of melanoma before surgery would play a useful role in the complete excision of melanoma during surgery.

Depth sensing has been widely used in many applications over the past several decades. However, conventional depth sensing platforms are not suitable for mobile devices due to their large size and computation complexity. In this paper, we propose a compact system for depth and image sensing with offset pixel apertures (OPA). Specifically, we design an enhanced depth map processing (EDMP) and an OPA-dedicated image signal processing (OISP). The EDMP significantly improves the depth quality on excessively dark or light regions, greatly mitigates false depth aggregation at object boundaries, and increases depth precision with a very small overhead. Shot-noise-modeling and two-pass cost aggregation significantly reduce depth errors with reasonable hardware costs. Also, the OISP provides primary image processing while using white pixels to further improve color quality over conventional image sensors. Both EDMP and OISP are integrated on a single-chip. Our system shares the common hardware engine through time-multiplexing, taking advantage of the temporal margin caused by the sparsity of the OPA pixels. Compared to state-of-the-art OPA system, the proposed system reduces the depth error by 71.79%, increases the depth precision by 5.1 times, and reduces the angular error of color image by 54.08% on average.

Purpose Alpha-fetoprotein (AFP) is a prognostic marker for hepatocellular carcinoma (HCC). We investigated the prognostic value of AFP levels in patients who achieved complete response (CR) to transarterial chemoembolization (TACE) for HCC. Materials and methods Between 2005 and 2018, 890 patients with HCC who achieved a CR to TACE were recruited. An AFP responder was defined as a patient who showed elevated levels of AFP (>10 ng/mL) during TACE, but showed normalization or a >50% reduction in AFP levels after achieving a CR. Results Among the recruited patients, 569 (63.9%) with naive HCC and 321 (36.1%) with recurrent HCC after complete resection were treated. Before TACE, 305 (34.3%) patients had multiple tumors, 219 (24.6%) had a maximal tumor size >3 cm, and 22 (2.5%) had portal vein tumor thrombosis. The median AFP level after achieving a CR was 6.36 ng/mL. After a CR, 473 (53.1%) patients experienced recurrence, and 417 (46.9%) died [median progression-free survival (PFS) and overall survival (OS) of 16.3 and 62.8 months, respectively]. High AFP levels at CR (>20 ng/mL) were independently associated with a shorter PFS [hazard ratio (HR)=1.403] and OS (HR=1.284), together with tumor multiplicity at TACE (HR=1.518 and 1.666, respectively). AFP non-responders at CR (76.2%, n=359 of 471) showed a shorter PFS (median 10.5 months vs. 15.5 months, HR=1.375) and OS (median 41.4 months vs. 61.8 months, HR=1.424) than AFP responders (all p=0.001). Conclusion High AFP levels and AFP non-responders were independently associated with poor outcomes after TACE. AFP holds clinical implications for detailed risk stratification upon achieving a CR after TACE.

Objective: To determine whether methyl bromide (MB) fumigation work for plants imported in Korea affects workers’ health by assessing heart rate variability (HRV). Methods: We measured HRV indices (TP, VLF, LF, HF, HR, SDNN, pNN50 and HRV-index) and urinary bromide ion (Br−) in 62 fumigators (study group) and 34 inspectors (the control group) before and after fumigation work. In addition, the relationship between Br− concentration and HRV indices was analysed. Results: The fumigators’ post-work HRV indices and Br− level were changed compared with their pre-work values (P

PURPOSE: The precise quantification of dopamine transporter (DAT) density on N-(3-[(18)F]Fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl) nortropane positron emission tomography ([(18)F]FP-CIT PET) imaging is crucial to measure the degree of striatal DAT loss in patients with parkinsonism. The quantitative analysis requires a spatial normalization process based on a template brain. Since the spatial normalization method based on a delayed-phase PET has limited performance, we suggest an early-phase PET-based method and compared its accuracy, referring to the MRI-based approach as a gold standard. METHODS: A total of 39 referred patients from the movement disorder clinic who underwent dual-phase [(18)F]FP-CIT PET and took MRI within 1 year were retrospectively analyzed. The three spatial normalization methods were applied for quantification of [(18)F]FP-CIT PET-MRI-based anatomical normalization, PET template-based method based on delayed PET, and that based on early PET. The striatal binding ratios (BRs) were compared, and voxelwise paired t tests were implemented between different methods. RESULTS: The early image-based normalization showed concordant patterns of putaminal [(18)F]FP-CIT binding with an MRI-based method. The BRs of the putamen from the MRI-based approach showed higher agreement with early image- than delayed image-based method as presented by Bland-Altman plots and intraclass correlation coefficients (early image-based, 0.980; delayed image-based, 0.895). The voxelwise test exhibited a smaller volume of significantly different counts in putamen between brains processed by early image and MRI compared to that between delayed image and MRI. CONCLUSION: The early-phase [(18)F]FP-CIT PET can be utilized for spatial normalization of delayed PET image when the MRI image is unavailable and presents better performance than the delayed template-based method in quantitation of putaminal binding ratio.

Transarterial radioembolization (TARE) with yttrium-90 microspheres has become widely utilized in managing hepatocellular carcinoma (HCC). The utility of TARE is expanding with new insights through experiences from real-world practice and clinical trials, and recently published data suggest that TARE in combination with sorafenib may improve the overall survival in selected patients. Here, we report a case of advanced stage HCC that was successfully treated with TARE and sorafenib. The patient achieved complete response (CR) at 12 months after the initial treatment with TARE and sorafenib, followed by additional transarterial chemoembolization and proton beam therapy for local tumor recurrence at 19-month post-TARE. The patient was followed up every 3 months thereafter and still achieved CR both biochemically and radiologically for the following 12 months. A combination strategy of TARE and systemic therapy may be a useful alternative treatment option for selected patients with advanced stage HCC. (J Liver Cancer 2020;20:160-166)

OBJECTIVE The aim of this study was to investigate the relationship between neck pain and radiological findings in ankylosing spondylitis (AS) patients. METHODS The study groups comprised 257 AS and 50 normal patients. Of the AS patients, 91 had axial neck pain (group 1) and 166 did not (group 2). Full-length radiographs of the spine in the anteroposterior and lateral planes were taken. Radiographic parameters such as the chin brow vertical angle (CBVA), McGregor slope (McGS), slope of the Line of Sight (SLS), C2 slope, C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (C2-C7 SVA), and T1 slope were measured. Statistical analysis was performed. RESULTS The AS and normal patients were found to have significantly different CBVA, McGS, C2 slope, C2-C7 SVA, and T1 slope. However, no significant difference was observed for SLS and CL. Between groups 1 and 2, there were significant differences in the McGS, CL, and T1 slope. However, no significant difference between these two groups was observed for CBVA, SLS, C2 slope, and C2-C7 SVA. Logistic regression analysis was performed to identify statistically significant predictors of neck pain in AS patients and it revealed that the T1 slope and McGS were two such predictors. The T1 slope showed superior discriminatory power to McGS and CL in the receiver operating characteristic curve analysis. CONCLUSIONS This study shows that a high T1 slope and McGS are independent radiological predictors of neck pain in AS. Further well-designed studies would be necessary to substantiate our results.

This research investigates how a shift from traditional loyalty cards to mobile-driven loyalty apps affects consumers’ reward redemption patterns, purchase behaviors, and store-level competition. The findings indicate that loyalty app adoption is associated with increased expenditure and purchase frequency as well as more active point redemption. In a multivendor loyalty program (MVLP) context, the use of loyalty apps is associated with spillover effects in which case customers visit more stores that they had not previously considered and exhibit diminished allegiance to their focal shop after they adopt a loyalty app. Finally, the adoption of loyalty apps is related to deal-prone behaviors because informed consumers tend to selectively purchase highly discounted products. Our findings provide several valuable implications for managers and platform owners who are considering launching mobile loyalty programs (LPs) and participating in an MVLP market. Although the merits of loyalty app adoption are apparent, we caution against potential downsides at individual store levels. Many customers are likely to succumb to deals, selectively purchasing highly discounted products with low margins through loyalty apps. The thrust of LPs should be directed toward fostering a strong connection with a brand, going beyond the promise of deals and promotions.

PURPOSE: EGFR-mutation (EGFR-mt) is a major oncogenic driver mutation in lung adenocarcinoma (ADC) and is more often observed in Asian population. In lung ADC, some radiomics parameters of FDG PET have been reported to be associated with EGFR-mt. Here, the associations between EGFR-mt and PET parameters, particularly asphericity (ASP), were evaluated in Asian population. METHODS: Lung ADC patients who underwent curative surgical resection as the first treatment were retrospectively enrolled. EGFR mutation was defined as exon 19 deletion and exon 21 point mutation and was evaluated using surgical specimens. On FDG PET, image parameters of maximal standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and ASP were obtained. The parameters were compared between EGFR-mt and wild type (EGFR-wt) groups, and the relationships between these PET parameters and EGFR-mt were evaluated. RESULTS: A total of 64 patients (median age 66 years, M:F = 34:30) were included in the analysis, and 29 (45%) patients showed EGFR-mt. In EGFR-mt group, all the image parameters of SUVmax, MTV, TLG, and ASP were significantly lower than in EGFR-wt group (all adjusted P

Light-weight flexible materials are needed to enable batteries that are safer, flexible, and smaller. However, the metal current collectors that are employed in current batteries are rigid, heavy, and slow in transporting electrons and ions. In this work, we demonstrate a flexible mesofiber that features an ordered mesoporous carbon scaffold threading a carbon nanotube. A facile hydrothermal synthesis method was developed to directly grow the highly ordered mesoporous carbon layer onto the surface of carbon nanotubes. The synergistic effect of these two materials in the designed meso-architecture yields excellent electrical conductivity, fast ion diffusion, and good mass loading of high-capacity active materials. We show that MnO2-loaded-mesofiber electrodes can achieve a capacitance of 160 F g−1 at a current density of 0.2 A g−1 and a capacitance retention of 58% after being cycled between 0.2 and 100 A g−1. The enhanced performance persists even at a scan rate as high as 2000 mV s−1. This fast current collector may find applications in flexible, wearable batteries and electronics.