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Every year, the U.S. economy loses more than $411 billion because of work performance reduction, injuries, and traffic accidents caused by microsleep. To mitigate microsleeps consequences, an unobtrusive, reliable, and socially acceptable microsleep detection solution throughout the day, every day is required. Unfortunately, existing solutions do not meet these requirements. In this paper, we propose WAKE, a novel behind-the-ear wearable device for microsleep detection. By monitoring biosignals from the brain, eye movements, facial muscle contractions, and sweat gland activities from behind the user's ears, WAKE can detect microsleep with a high temporal resolution. We introduce a Three-fold Cascaded Amplifying (3CA) technique to tame the motion artifacts and environmental noises for capturing high fidelity signals. Through our prototyping, we show that WAKE can suppress motion and environmental noise in real-time by 9.74-19.47 dB while walking, driving, or staying in different environments ensuring that the biosignals are captured reliably. We evaluated WAKE using gold-standard devices on 19 sleep-deprived and narcoleptic subjects. The Leave-One-Subject-Out Cross-Validation results show the feasibility of WAKE in microsleep detection on an unseen subject with average precision and recall of 76% and 85%, respectively.

In Wireless Multimedia Sensor Networks (WMSNs), nodes capable of retrieving video, audio, images, and small scale sensor data, tend to generate immense traffic of various types. The energy-efficient transmission of such a vast amount of heterogeneous multimedia content while simultaneously ensuring the quality of service and optimal energy consumption is indispensable. Therefore, we propose a Power-Efficient Wireless Multimedia of Things (PE-WMoT), a robust and energy-efficient cluster-based mechanism to improve the overall lifetime of WMSNs. In a PE-WMoT, nodes declare themselves Cluster Heads (CHs) based on available resources. Once cluster formation and CH declaration processes are completed, the Sub-Cluster (SC) formation process triggers, in which application base nodes within close vicinity of each other organize themselves under the administration of a Sub-Cluster Head (SCH). The SCH gathers data from member nodes, removes redundancies, and forwards miniaturized data to its respective CH. PE-WMoT adopts a fuzzy-based technique named the analytical hierarchical process, which enables CHs to select an optimal SCH among available SCs. A PE-WMoT also devises a robust scheduling mechanism between CH, SCH, and child nodes to enable collision-free data transmission. Simulation results revealed that a PE-WMoT significantly reduces the number of redundant packet transmissions, improves energy consumption of the network, and effectively increases network throughput.

Background Both predictions and predictors of difficult laryngoscopy are controversial. Machine learning is an excellent alternative method for predicting difficult laryngoscopy. This study aimed to develop and validate practical predictive models for difficult laryngoscopy through machine learning. Methods Variables for the prediction of difficult laryngoscopy included age, Mallampati grade, body mass index, sternomental distance, and neck circumference. Difficult laryngoscopy was defined as grade 3 and 4 by the Cormack-Lehane classification. Pre-anesthesia and anesthesia data of 616 patients who had undergone anesthesia at a single center were included. The dataset was divided into a base training set (n = 492) and a base test set (n = 124), with equal distribution of difficult laryngoscopy. Training data sets were trained with six algorithms (multilayer perceptron, logistic regression, supportive vector machine, random forest, extreme gradient boosting, and light gradient boosting machine), and cross-validated. The model with the highest area under the receiver operating characteristic curve (AUROC) was chosen as the final model, which was validated with the test set. Results The results of cross-validation were best using the light gradient boosting machine algorithm with Mallampati score x age and sternomental distance as predictive model parameters. The predicted AUROC for the difficult laryngoscopy class was 0.71 (95% confidence interval, 0.59–0.83; p = 0.014), and the recall (sensitivity) was 0.85. Conclusion Predicting difficult laryngoscopy is possible with three parameters. Severe damage resulting from failure to predict difficult laryngoscopy with high recall is small with the reported model. The model’s performance can be further enhanced by additional data training.

Background/Aims: This study assessed the efficacy and safety of adalimumab (ADA) and explored predictors of response in Korean patients with ulcerative colitis (UC).Methods: A prospective, observational, multicenter study was conducted over 56 weeks in adult patients with moderately to severely active UC who received ADA. Clinical response, remission, and mucosal healing were assessed using the Mayo score.Results: A total of 146 patients were enrolled from 17 academic hospitals. Clinical response rates were 52.1% and 37.7% and clinical remission rates were 24.0% and 22.0% at weeks 8 and 56, respectively. Mucosal healing rates were 39.0% and 30.1% at weeks 8 and 56, respectively. Prior use of anti-tumor necrosis factor-α (anti-TNF-α) did not affect clinical and endoscopic responses. The ADA drug level was significantly higher in patients with better outcomes at week 8 (P

PurposeMelanoma incidence is rising worldwide along with the associated personal and socioeconomic health expenditures. We investigated the incidence and survival-rate patterns of melanoma in South Korea using nationwide data. Materials and MethodsThis retrospective cohort study included patients with melanoma between 2004 and 2017, based on National Health Insurance (NHI) claims data in South Korea. The incidence, prevalence, and survival rate were analyzed along with baseline demographic characteristics. We collected solar irradiation dose (SID) and healthcare ranking score (HRS) according to the administrative district from the Korea Meteorological Administration and Korea Health Promotion Institute. The incidence and survival rates were assessed using Pearson's correlation, the Kaplan-Meier estimation, multiple linear regression, and multiple logistic regression methods.ResultsTwenty-five thousand, five hundred ninety-one patients with melanoma were diagnosed during the study period. The age-standardized incidence of melanoma steadily increased from 2004 to 2017 from 2.6 to 3.0/100,000/yr. The incidence of melanoma increased with significantly higher income (p < 0.05). The prevalence followed a similar pattern as the incidence. According to multivariate analysis, HRS significantly influenced the incidence of melanoma in high sun-exposed sites (p < 0.001). There was no significant change in annual mortality. Women had a higher 5-year survival rate than men (78.4% vs. 72.8%). Mortality by the administrative district was highly correlated with HRS.ConclusionThe incidence of melanoma is increasing in South Korea. A low HRS is associated with both higher incidence and mortality. The findings of this study could be utilized as a guideline for treating melanoma patients.

BACKGROUND Violence in emergency departments poses a threaten to both medical personnel and patients. We investigated the risk factors for high burnout status and the association between the impact of violence and burnout status of paramedics in emergency departments. METHODS We included paramedics of emergency departments in Korea. We conducted a survey on the emotional, physical, and social responses to violence using an assault response questionnaire. Additionally, we evaluated burnout status using the Maslach Burnout Inventory. RESULTS This study included 141 participants (57 females), with a mean age of 25.9 years. The burnout status was positively correlated with physical, emotional, and social responses, and the overall impact of violence (r = 0.576, 0.559, 0.446, and 0.590, respectively). Female sex, specialized centers, and emergency departments with

Geometrically multifunctional structures inspired by nature can address the challenges in the development of soft robotics. A bioinspired structure based on origami and kirigami can significantly enhance the stretchability and reliability of soft robots. This study proposes a novel structure with individual, overlapping units, similar to snake scales that can be used to construct shape-morphing batteries for untethered soft robots. The structure is created by folding well-defined, two-dimensional patterns with cutouts. The folding lines mimic the hinge structure of snakeskin, enabling stable deformations without mechanical damage to rigid cells. The structure realizes multi-axial deformability and a zero Poisson's ratio without off-axis distortion to the loading axis. Moreover, to maximize areal density, the optimal cell shape is designed as a hexagon. The structure is applied to a stretchable Li-ion battery, constructed to form an arrangement of electrically interconnected, hexagonal pouch cells.

Solid-state fiber dye-sensitized solar cells (SS-FDSSCs) have been the subject of intensive attention and development in recent years. Although this field is only in its infancy, metal-organic frameworks (MOFs) are one such material that has been utilized to further improve the power conversion efficiency of solar cells. In this study, MOF-integrated DSSCs were shown to have potential in the development of solar cell devices with efficiency comparable to or better than that of conventional solar cells. The power conversion efficiency (PCE) of SS-FDSSCs was improved by embedding MOF-801 into a mesoporous-TiO2 (mp-TiO2) layer, which was used as a photoanode in SS-FDSSCs, which are inherently flexible. The PCE of the MOF-integrated SS-FDSSCs was 6.50%, which is comparable to that of the reference devices (4.19%). The MOF-801 enhanced SS-FDSSCs decreased the series resistance (Rs) value, resulting in effective electron extraction with improved short-circuit current density (JSC), while also increasing the shunt resistance (Rsh) value to prevent the recombination of photo-induced electrons. The result is an improved fill factor and, consequently, a higher value for the PCE.

Heart disease is one of the largest burdens to human health worldwide and has very limited therapeutic options. Engineered three-dimensional (3D) vascularized cardiac tissues have shown promise in rescuing cardiac function in diseased hearts and may serve as a whole organ replacement in the future. One of the major obstacles in reconstructing these thick myocardial tissues to a clinically applicable scale is the integration of functional vascular networks capable of providing oxygen and nutrients throughout whole engineered constructs. Without perfusion of oxygen and nutrient flow throughout the entire engineered tissue not only is tissue viability compromised, but also overall tissue functionality is lost. There are many supporting technologies and approaches that have been developed to create vascular networks such as 3D bioprinting, co-culturing hydrogels, and incorporation of soluble angiogenic factors. In this state-of-the-art review, we discuss some of the most current engineered vascular cardiac tissues reported in the literature and future directions in the field. IMPACT STATEMENT: The field of cardiac tissue engineering is rapidly evolving and is now closer than ever to having engineered tissue models capable of predicting preclinical responses to therapeutics, modeling diseases, and being used as a means of rescuing cardiac function following injuries to the native myocardium. However, a major obstacle of engineering thick cardiac tissue remains to be the integration of functional vasculature. In this review, we highlight seminal and recently published works that have influenced and pushed the field of cardiac tissue engineering toward achieving vascularized functional tissues.

Makgeolli is a traditional rice wine favored by the general public in Korea. This study investigated the fermentation and sensory characteristics of using wild yeast strains for brewing makgeolli. A non-Saccharomyces cerevisiae strain was isolated from nuruk and termed Y197-13. It showed 98% similarity to Pichia anomala and had an optimal growth temperature of 25 degrees C. Makgeolli was manufactured using koji, jinju nuruk, and improved nuruk as fermentation agents. Y197-13 makgeolli brewed with koji had alcohol and solids contents of 11.1% and 13.9%, respectively. Sweet sensory characteristics were attributed to residual sugars in makgeolli with 6% alcohol. The makgeolli had a fresh sour taste and carbonated taste. Volatile component analysis showed the isoamyl alcohol, phenylethyl alcohol, isoamyl acetate, and fatty acid, including ethyl oleate and ethyl linoleate, relative peak area was higher in Y197-13 makgeolli than in makgeolli with Saccharomyces cerevisiae. These results suggest the wild yeast, Y197-13, as a candidate for brewing makgeolli.

Purpose Despite the increasing use of stereotactic body radiation therapy for non–spine bone metastases (NSBM), there is no established standard for target delineation. The objective of this study was to provide consensus recommendations on clinical target volume (CTV) delineation based on international expert contours. Methods and Materials Eleven cases of NSBM were contoured by 9 international radiation oncologists. For each case, the gross tumor volume was provided on the simulation computed tomography scans with accompanying magnetic resonance imaging. Participants contoured the CTV and completed a clinical survey. Agreement between CTV contours were analyzed with simultaneous truth and performance level estimation using the kappa coefficient and the Dice similarity coefficient (DSC) and summarized to establish contouring recommendations. A direction-dependent analysis was applied to the consensus contours to quantify margins. Results All CTV contours were completed. Six participants used a single-dose level, whereas 3 used a 2-dose level simultaneous integrated boost (SIB) technique. For the SIB cases, the largest volume receiving a stereotactic body radiation therapy (SBRT) dose was used for contour analysis. There was substantial agreement between contours across cases with a mean kappa of 0.72 (mean sensitivity 0.85, mean specificity 0.97). The mean DSC value was 0.77 (range, 0.67-0.87). Consensus CTV contouring recommendations were (1) an intraosseous CTV margin of 5 to 10 mm should be strongly considered within contiguous bone; (2) an extraosseous margin of 5 to 10 mm should be strongly considered where there is soft tissue disease or cortical bone disruption; (3) CTVs should be manually cropped to respect anatomic barriers to spread (eg, peritoneal cavity, pleura, uninvolved joint space and cortical bone). Conclusions CTV contouring recommendations for NSBM-SBRT were established based on analysis of international expert consensus contours with a high level of agreement. These principles may provide guidance to treating physicians and inform future study until prospective clinical data can provide further refinement.

Item does not contain fulltext BACKGROUND: Etrolizumab is a gut-targeted anti-β7 integrin monoclonal antibody. In a previous phase 2 induction study, etrolizumab significantly improved clinical remission versus placebo in patients with moderately to severely active ulcerative colitis. We aimed to compare the safety and efficacy of etrolizumab with infliximab in patients with moderately to severely active ulcerative colitis. METHODS: We conducted a randomised, double-blind, double-dummy, parallel-group, phase 3 study (GARDENIA) across 114 treatment centres worldwide. We included adults (age 18-80 years) with moderately to severely active ulcerative colitis (Mayo Clinic total score [MCS] of 6-12 with an endoscopic subscore of ≥2, a rectal bleeding subscore of ≥1, and a stool frequency subscore of ≥1) who were naive to tumour necrosis factor inhibitors. Patients were required to have had an established diagnosis of ulcerative colitis for at least 3 months, corroborated by both clinical and endoscopic evidence, and evidence of disease extending at least 20 cm from the anal verge. Participants were randomly assigned (1:1) to receive subcutaneous etrolizumab 105 mg once every 4 weeks or intravenous infliximab 5 mg/kg at 0, 2, and 6 weeks and every 8 weeks thereafter for 52 weeks. Randomisation was stratified by baseline concomitant treatment with corticosteroids, concomitant treatment with immunosuppressants, and baseline disease activity. All participants and study site personnel were masked to treatment assignment. The primary endpoint was the proportion of patients who had both clinical response at week 10 (MCS ≥3-point decrease and ≥30% reduction from baseline, plus ≥1-point decrease in rectal bleeding subscore or absolute rectal bleeding score of 0 or 1) and clinical remission at week 54 (MCS ≤2, with individual subscores ≤1); efficacy was analysed using a modified intention-to-treat population (all randomised patients who received at least one dose of study drug). GARDENIA was designed to show superiority of etrolizumab over infliximab for the primary endpoint. This trial is registered with ClinicalTrials.gov, NCT02136069, and is now closed to recruitment. FINDINGS: Between Dec 24, 2014, and June 23, 2020, 730 patients were screened for eligibility and 397 were enrolled and randomly assigned to etrolizumab (n=199) or infliximab (n=198). 95 (48%) patients in the etrolizumab group and 103 (52%) in the infliximab group completed the study through week 54. At week 54, 37 (18·6%) of 199 patients in the etrolizumab group and 39 (19·7%) of 198 in the infliximab group met the primary endpoint (adjusted treatment difference -0·9% [95% CI -8·7 to 6·8]; p=0·81). The number of patients reporting one or more adverse events was similar between treatment groups (154 [77%] of 199 in the etrolizumab group and 151 [76%] of 198 in the infliximab group); the most common adverse event in both groups was ulcerative colitis (55 [28%] patients in the etrolizumab group and 43 [22%] in the infliximab group). More patients in the etrolizumab group reported serious adverse events (including serious infections) than did those in the infliximab group (32 [16%] vs 20 [10%]); the most common serious adverse event was ulcerative colitis (12 [6%] and 11 [6%]). There was one death during follow-up, in the infliximab group due to a pulmonary embolism, which was not considered to be related to study treatment. INTERPRETATION: To our knowledge, this trial is the first phase 3 maintenance study in moderately to severely active ulcerative colitis to use infliximab as an active comparator. Although the study did not show statistical superiority for the primary endpoint, etrolizumab performed similarly to infliximab from a clinical viewpoint. FUNDING: F Hoffmann-La Roche.

BACKGROUND: Advancement of optical coherence tomography (OCT) technology allows for better in vivo visualization of the choroidal architecture, which comprises vessels and stroma. However, most OCT studies using image binarization methods have focused only on choroidal vessels represented by dark pixels. This study aimed to compare the distribution of choroidal hyperreflective spots on swept-source OCT (SS-OCT) images between both eyes of normal subjects. METHODS: In this observational comparative study, we included SS-OCT images of healthy subjects, which were prospectively obtained to compare images among the devices. SS-OCT images acquired using PLEX Elite 9000 and DRI-OCT Triton were analyzed. En-face OCT images were obtained at five different depth positions of the inner choroid at the macula. The mean reflectivity of the choroidal slabs, the number, total area, and circularity of hyperreflective spots were quantitatively compared between the devices and between both eyes of the same subjects. RESULTS: In 30 eyes of 15 healthy subjects, the mean reflectivity of the choroidal slabs varied with the scan depth on both devices (P

Background Although surgical treatment is considered reliable for lateral elbow tendinosis, local injection therapy may be preferable, as it avoids surgery. Among a number of local injections, platelet-rich plasma has been used successfully to treat lateral elbow tendinosis. The purpose of this study was to compare the outcomes in patients treated with either platelet-rich plasma injections or surgery for lateral elbow tendinosis using a systematic literature review and meta-analysis. Methods MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 1, 2021, that compared platelet-rich plasma with operative treatment for lateral elbow tendinosis. The pooled analysis was designed to compare the visual analog scale scores and the Patient-Related Tennis Elbow Evaluation scores between the platelet-rich plasma and surgical treatment groups at serial time points. Results We included five studies involving 340 patients with lateral elbow tendinosis, comprising of 154 patients treated with platelet-rich plasma and 186 patients who underwent surgical treatment. The pooled analysis showed no statistically significant differences in the visual analog scale scores at any of the follow-up time points, namely post-intervention 2 months (mean difference = 1.11, 95% confidence interval: −2.51 to 4.74, P = 0.55, I2 = 94%), 6 months (mean difference = 0.80, 95% confidence interval: −2.83 to 4.42, P = 0.67, I2 = 92%), and 12 months (mean difference = −0.92, 95% confidence interval: −4.63 to 2.80, P = 0.63, I2 = 93%) and in the Patient-Related Tennis Elbow Evaluation scores at post-intervention 12 weeks (mean difference = −1.86, 95% confidence interval: −22.30 to 18.58, P = 0.86, I2 = 81%), 24 weeks (mean difference = −3.33, 95% confidence interval: −21.82 to 15.17, P = 0.72, I2 = 74%), and 52 weeks (mean difference = −3.64, 95% confidence interval: −19.65 to 12.37, P = 0.66, I2 = 69%). Conclusions Local platelet-rich plasma injections and surgical treatment produced equivalent pain scores and functional outcomes in patients with lateral elbow tendinosis. Thus, platelet-rich plasma injections may represent a reasonable alternative treatment for patients who are apprehensive to proceed with surgery or for poor surgical candidates.

Background: To prepare for future work stoppages in the medical industry, this study aimed to identify the effects of healthcare worker strikes on the mortality rate of patients visiting the emergency department (ED) at six training hospitals in Daegu, Korea. Methods: We used a retrospective, cross-sectional, multicenter design to analyze the medical records of patients who visited six training hospitals in Daegu (August 21–September 8, 2020). For comparison, control period 1 was set as the same period in the previous year (August 21–September 8, 2019) and control period 2 was set as July 1–19, 2020. Patient characteristics including age, sex, and time of ED visit were investigated along with mode of arrival, length of ED stay, and in-hospital mortality. The experimental and control groups were compared using t-tests, and Mann-Whitney U-test, chi-square test, and Fisher exact tests, as appropriate. Univariate logistic regression was performed to identify significant factors, followed by multivariate logistic regression analysis. Results: During the study period, 31,357 patients visited the ED, of which 7,749 belonged to the experimental group. Control periods 1 and 2 included 13,100 and 10,243 patients, respectively. No significant in-hospital mortality differences were found between study periods; however, the results showed statistically significant differences in the length of ED stay. Conclusion: The ED resident strike did not influence the mortality rate of patients who visited the EDs of six training hospitals in Daegu. Furthermore, the number of patients admitted and the length of ED stay decreased during the strike period.

Purpose This study aimed to develop a model for predicting pathologic extracapsular extension (ECE) and seminal vesicle invasion (SVI) while integrating magnetic resonance imaging-based T-staging (cTMRI, cT1c-cT3b).Materials and Methods A total of 1,915 who underwent radical prostatectomy between 2006-2016 met the inclusion/exclusion criteria. We performed a multivariate logistic regression analysis as well as Bayesian network (BN) modeling based on possible confounding factors. The BN model was internally validated using 5-fold validation.Results According to the multivariate logistic regression analysis, initial prostate-specific antigen (iPSA) (β=0.050, p < 0.001), percentage of positive biopsy cores (PPC) (β=0.033, p < 0.001), both lobe involvement on biopsy (β=0.359, p=0.009), Gleason score (β=0.358, p < 0.001), and cTMRI (β=0.259, p < 0.001) were significant factors for ECE. For SVI, iPSA (β=0.037, p < 0.001), PPC (β=0.024, p < 0.001), Gleason score (β=0.753, p < 0.001), and cTMRI (β=0.507, p < 0.001) showed statistical significance. BN models to predict ECE and SVI were also successfully established. The overall area under the receiver operating characteristic curve (AUC)/accuracy of the BN models were 0.76/73.0% and 0.88/89.6% for ECE and SVI, respectively. According to internal comparison between the BN model and Roach formula, BN model had improved AUC values for predicting ECE (0.76 vs. 0.74, p=0.060) and SVI (0.88 vs. 0.84, p < 0.001).Conclusion Two models to predict pathologic ECE and SVI integrating cTMRI were established and installed on a separate website for public access to guide radiation oncologists.

Transition metal dichalcogenide (TMD) monolayers, such as MoS2, possess a direct optical bandgap and are useful for emerging ultrathin optoelectronics in the visible light range, whereas their thickness limits light absorption and emission properties. To address this drawback, one promising approach is to hybridize plasmonic nanostructures with monolayer TMDs to utilize local field enhancement effects owing to localized surface plasmon resonance (LSPR). Herein, we propose a strong enhancement of the local light–matter interaction in MoS2 monolayers on naturally generated nanoscale grooves. The nanogrooves are formed at grain boundaries (GBs) of template-stripped metal film substrates that are fabricated by mechanically stripping Ag films deposited on an ultra-flat Si substrate, wherein the nanogroove densities are systematically modulated by the Ag film thickness. We observe an effective photoluminescence enhancement factor of 758 and a Raman spectroscopy intensity enhancement of approximately 5 times in MoS2 on the subwavelength-scale nanogrooves, compared with that on grain planes, which is attributed to a strong local field enhancement of the LSPR effect. Moreover, this plasmonic enhancement effect is elucidated by dark-field scattering spectroscopy and optical simulations. Our results can facilitate the utilization of density-controllable plasmonic nanogrooves synthesized without nanopatterning techniques for plasmonic hybrids on 2D semiconductors.

Background/Aims: Pleural fluid adenosine deaminase (ADA) levels are useful in discriminating tuberculous pleural effusions (TPEs) from malignant pleural effusions (MPEs). However, some patients with MPE exhibit high-ADA levels, which may mimic TPEs. There is limited data regarding the differential diagnosis between high-ADA MPE and high-ADA TPE. This study aimed to identify the predictors for distinguishing high-ADA MPEs from high-ADA TPEs.Methods: Patients with TPE and MPE with pleural f luid ADA levels ≥ 40 IU/L were included in this study. Clinical, laboratory, and radiological data were compared between the two groups. Independent predictors and their diagnostic performance for high-ADA MPEs were evaluated using multivariate logistic regression analysis and receiver operating characteristic curve.Results: A total of 200 patients (high-ADA MPE, n = 30, and high-ADA TPE, n = 170) were retrospectively included. In the multivariate analysis, pleural fluid ADA, pleural f luid carcinoembryonic antigen (CEA), and pleural nodularity were independent discriminators between high-ADA MPE and high-ADA TPE groups. Using pleural ADA level of 40 to 56 IU/L (3 points), pleural CEA level ≥ 6 ng/mL (6 points), and presence of pleural nodularity (3 points) for predicting high-ADA MPEs, a sum score ≥ 6 points yielded a sensitivity of 90%, specificity of 96%, positive predictive value of 82%, negative predictive value of 98%, and area under the receiver operating characteristic curve of 0.965.Conclusions: A scoring system using three parameters may be helpful in guiding the differential diagnosis between high-ADA MPEs and high-ADA TPEs.

Introduction Patients with aspiration pneumonia (AP) exhibit higher mortality than those with non-AP. However, data regarding predictors of short-term prognosis in patients with community-acquired AP are limited. Methods Patients hospitalized with community-acquired pneumonia (CAP) were retrospectively classified into aspiration pneumonia (AP) and non-AP groups. The AP patients were further divided into nonsurvivors and survivors by 30-day mortality, and various clinical variables were compared between the groups. Results Of 1249 CAP patients, 254 (20.3%) were classified into the AP group, of whom 76 patients (29.9%) died within 30 days. CURB-65, pneumonia severity index (PSI), and Infectious Diseases Society of America/American Thoracic Society criteria for severe CAP (SCAP) showed only modest prognostic performance for the prediction of 30-day mortality (c-statistics, 0.635, 0.647, and 0.681, respectively). Along with the PSI and SCAP, Eastern Cooperative Oncology Group performance status (ECOG-PS) and blood biomarkers, including, N-terminal of prohormone brain natriuretic peptide (NT-proBNP) and albumin, were independent predictors of 30-day mortality. In models based on clinical prediction rules, including CURB-65, PSI, and SCAP, the addition of ECOG-PS further improved their c-statistics compared to the clinical prediction rules alone. In the four combinations based on SCAP, ECOG-PS, and two blood biomarkers (NT-proBNP and albumin), the c-statistics further increased to reach approximately 0.8. Conclusions CURB-65, PSI, and SCAP exhibited only modest discriminatory power in predicting the 30-day mortality of patients with community-acquired AP. The addition of performance status and blood biomarkers, including NT-proBNP and albumin, further increased prognostic performance, showing good predictive accuracy in the SCAP-based model.

Background/Aims We aimed to evaluate the clinical characteristics and long-term prognosis of elderly-onset ulcerative colitis (EOUC) in Korean patients over a 30-year period using a well-established population-based cohort in the Songpa-Kangdong district of Seoul, Korea. Methods Clinical characteristics and prognosis were compared between two groups EOUC, defined as UC diagnosed in individuals aged ≥60 years and non-EOUC (N-EOUC), defined as UC diagnosed in individuals aged 18 to 59 years. Results We identified 99 patients with EOUC (10.3%) and 866 patients with N-EOUC (89.7%) between 1986 and 2015. During the median follow-up of 104.5 months, the overall exposure to medications was comparable between patients with EOUC and N-EOUC (p=0.091 for corticosteroids, p=0.794 for thiopurines, and p=0.095 for anti-tumor necrosis factor agents). The cumulative risks of disease outcomes were also comparable between patients with EOUC and N-EOUC (22.4% vs 30.4% for proximal disease extension [p=0.351], 11.9% vs 18.1% for hospitalization [p=0.240], and 2.3% vs 1.8% for colectomy [p=0.977]) at 10 years after diagnosis. Multivariate Cox regression analysis revealed that corticosteroid use at diagnosis was an independent predictor of proximal disease extension (hazard ratio [HR], 6.216; 95% confidence interval [CI], 1.314 to 28.826) and hospitalization (HR, 11.241; 95% CI, 3.027 to 41.742) in patients with EOUC. Conclusions In this population-based study from Korea, the pattern of medication use seemed comparable between the EOUC and N-EOUC groups. Moreover, patients with EOUC and those with N-EOUC have a similar disease course in terms of proximal disease extension, hospitalization, and colectomy. (Gut Liver 2021;15-751)

Purpose: We aimed to investigate the benefit of a screening tool in selecting head-injured children who can potentially cooperate with computed tomography (CT).Methods: The study population consisted of head-injured children aged 36 months or younger who visited the emergency department (ED) and underwent CT from January 2013 through December 2020. Procedural sedation and analgesia (PSA) using per os chloral hydrate or per rectal thiopental was implemented to children presumed less cooperative for CT as per a clinical screening tool for cooperative candidates for CT (e.g., ability to lie still on bed for 10 seconds without a guardian). According to the PSA and the first attempt success of CT, we compared baseline characteristics, CT findings, clinically important traumatic brain injury, ED length of stay (EDLOS), and ED disposition.Results: Among the 247 children, PSA was used in 102 (41.3%). The PSA group showed a higher proportion of 3-36 months of age (PSA, 96.1% vs. non-PSA, 82.8%; P = 0.001) and longer median EDLOS (PSA, 127.0 [interquartile range, 101.0-172.0] vs. non-PSA, 85.0 minutes [63.0-130.0]; P < 0.001). The number of children undergoing the first attempt success was 213 (86.2%) without a difference in both groups (PSA, 84.3% vs. non-PSA, 87.6%; P = 0.645). In the 213 children, the implementation of PSA was associated with longer median EDLOS (PSA, 121.0 [99.0-156.0] vs. non-PSA, 77.0 minutes [60.0-122.0]; P < 0.001). In the non-PSA group (n = 145), the first attempt failure was associated with the presence of skull fracture (success, 7.1% vs. failure, 27.8%; P = 0.009).Conclusion: This study suggests a potential benefit of the screening tool in selecting cooperative candidates for CT, i.e., those who could forgo PSA using oral chloral hydrate or per rectal thiopental, in young children with head injury.

Surgical resection with lymphadenectomy and perioperative chemotherapy is the universal mainstay for curative treatment of gastric cancer (GC) patients with locoregional disease. However, GC survival remains asymmetric in West- and East-world regions. We hypothesize that this asymmetry derives from differential clinical management. Therefore, we collected chemo-naïve GC patients from Portugal and South Korea to explore specific immunophenotypic profiles related to disease aggressiveness and clinicopathological factors potentially explaining associated overall survival (OS) differences. Clinicopathological and survival data were collected from chemo-naïve surgical cohorts from Portugal (West-Europe cohort [WE-C]; n = 170) and South Korea (East-Asia cohort [EA-C]; n = 367) and correlated with immunohistochemical expression profiles of E-cadherin and CD44v6 obtained from consecutive tissue microarrays sections. Survival analysis revealed a subset of 12.4% of WE-C patients, whose tumors concomitantly express E-cadherin_abnormal and CD44v6_very high, displaying extremely poor OS, even at TNM stages I and II. These WE-C stage-I and -II patients tumors were particularly aggressive compared to all others, invading deeper into the gastric wall (P = .032) and more often permeating the vasculature (P = .018) and nerves (P = .009). A similar immunophenotypic profile was found in 11.9% of EA-C patients, but unrelated to survival. Tumours, from stage-I and -II EA-C patients, that display both biomarkers, also permeated more lymphatic vessels (P = .003), promoting lymph node (LN) metastasis (P = .019), being diagnosed on average 8 years earlier and submitted to more extensive LN dissection than WE-C. Concomitant E-cadherin_abnormal/CD44v6_very-high expression predicts aggressiveness and poor survival of stage-I and -II GC submitted to conservative lymphadenectomy.

Purpose: To evaluate the changes in eyelid parameters after the endonasal approach compared with transcaruncular medial wall decompression combined with the transconjunctival inferior wall decompression approach with inferomedial strut preservation.Methods: In total, 71 patients with thyroid eye disease who underwent orbital decompression were retrospectively evaluated. The data collected included Hertel exophthalmometry, marginal reflex distance 1, marginal reflex distance 2, interpalpebral fissure, levator function test measures, and complications related to surgery.Results: Proptosis reduction produced a statistically significant improvement across all decompression groups. Lower eyelid retraction produced a statistically significant improvement in the two-wall decompression groups but not in the one-wall decompression groups. No statistical difference was observed in the upper eyelid retraction and levator function after surgery across all decompression groups. In the post-hoc analysis, statistical improvement was not observed in the lower eyelid retraction between the endonasal and transcaruncular approach in the one-wall and two-wall decompression groups, although statistically significant exophthalmos reduction and improvement in the lower eyelid retraction was noted in the two-wall decompression subgroups compared with one-wall decompression subgroups.Conclusions: Our study showed no differences in eyelid parameters between the endonasal and transcaruncular decompression approaches in one-wall and two-wall decompression. In the two-wall decompression group, proptosis reduction was greater with the endonasal approach than with the transcaruncular approach when the strut was preserved; however, it does not lead to a significant difference in the improvement of lower eyelid retraction.

Objectives : We implemented a stratified risk analysis to predict the development of active tuberculosis (TB) in liver transplantation (LT) recipients based on IGRA and chest images in the TB-endemic area. Methods In this retrospective cohort study, LT recipients who tested for IGRA between May 2008 and December 2017 were included. Chest images compatible with old TB lesions were considered as positive images. LT recipients were divided into six groups: LT recipients with history of treated TB, image (+)/IGRA (+), image (+)/IGRA (-), image (-)/IGRA (+), image (-)/IGRA (-) and LTBI treated. The Cox regression model was used to analyze risk groups. Results Among the 717 eligible LT recipients included in this study, 21 patients developed active TB. Incidence rates of TB were 2,261, 724, and 119 cases/100,000 person-years in the 1st, 2nd, and ≥ 3rd year after transplantation, respectively. History of treated TB (HR 18.92; 95% CI 4.10–87.25) and image (+)/IGRA (+) (HR 10.86; 95% CI 2.75–42.89) were independent risk factors for developing active TB. IGRA (+) with a negative image was not a risk factor. Conclusions Our findings suggested that both IGRA and chest images should be considered to identify risk groups for LTBI treatment.

Purpose: This study was a prospective single-arm clinical trial aimed at assessing the efficacy and toxicity of subcutaneous interleukin (IL)-2 monotherapy in patients with metastatic renal cell carcinoma (RCC).Materials and Methods: We enrolled 26 patients with metastatic RCC in this multicenter controlled trial. The patients received subcutaneous injections of recombinant IL-2 (BMI-rh-IL2, an aldesleukin biosimilar, BMIKOREA Co., Ltd.) in 5-week cycles. In the first week, the patients received a subcutaneous IL-2 loading dose of 18×106 IU once on treatment days 1–5, followed by 2 days of rest. In the following 3 weeks, they received a dose of 18×106 IU via subcutaneous injection once on treatment days 1 and 2. Then, the patients received a dose of 9×106 IU via subcutaneous injection once on treatment days 3, 4, and 5, followed by 2 days of rest. The primary end point was the objective response rate; the secondary end points were progressionfree survival (PFS) and safety.Results: Overall, 22 patients were included in the final per-protocol analysis. The objective response and the disease control rates were 13.64% (3 of 22), and 90.9% (20 of 22), respectively. The mean PFS was 5.55 months (95% confidence interval, 2.71–8.4). The proportion of patients who experienced a treatment-related grade 3 or 4 adverse event was 3.85% (1 of 26). There were no treatment-related deaths.Conclusions: In this study, the subcutaneous IL-2 monotherapy regimen demonstrated efficacy and safety comparable to those reported in previous studies of subcutaneous IL-2 monotherapy and was effective in Korean patients with metastatic RCC.

Background/Aims Few studies have investigated terminal ileal lesions and their prognostic value in patients with ulcerative colitis (UC). We evaluated the clinical significance of these lesions as a prognostic factor in patients with UC who were in clinical remission. Methods We retrospectively selected 567 of 4,066 colonoscopy reports that included positive findings from orificial observations of the terminal ileum (TI) and appendix in patients with UC. We finally recruited patients who were in clinical remission (n=204). We compared the clinical courses, including relapse and other prognostic parameters associated with UC, between the groups. Results The baseline patient characteristics were not significantly different between patients with (n=69, TI+ group) and without TI lesions (n=135, TI– group), although there were more never-smokers in the TI+ group (n=57 [82.6%] in the TI+ group; n=86 [63.7%] in the TI– group; p=0.005). Of note, appendiceal orifice inflammation (AOI) was less frequently found in the TI+ group (14.5%) than in the TI– group (71.9%, p

Material private information transmits through social networks. Using manually collected information on networks of alumni reunion cohorts, we show that hedge fund managers connected to directors of firms engaged in merger deals increase call-option holdings on target firms before deal announcements. Effects are larger when reunion events for connected cohorts occur just before announcements. Independent directors, directors with short tenure, and directors with low stock ownership are more likely to transmit information. Our results are robust to confounding factors and alternative specifications. These findings highlight the role of social networks as channels of private-information dissemination.

BACKGROUND & AIMS This multicenter cohort study aimed to compare the real-world biochemical response rates during tenofovir alafenamide (TAF), tenofovir disoproxil fumarate (TDF), and entecavir (ETV) treatment in chronic hepatitis B virus (HBV) infection patients. METHODS Overall, 1282 treatment-naive patients with CHB who commenced TAF (n = 270), TDF (n = 617), or ETV (n = 395) were analysed for biochemical response rates during the antiviral treatment using a time-dependent Cox proportional hazard model after the inverse probability of treatment weighting (IPTW). RESULTS Patients treated with ETV were older (55.1 ± 11.5 years) than TAF or TDF (P

Objectives We investigated differences in the ascending reticular activating system (ARAS) between vegetative state (VS) and minimally conscious state (MCS) in patients with traumatic brain injury (TBI) by using diffusion tensor tractography. Methods We recruited TBI patients and normal subjects. We reconstructed the lower ARAS and five parts of upper ARAS [prefrontal cortex (PFC), premotor cortex, primary motor cortex, primary somatosensory cortex, and posterior parietal cortex]. Results Significant differences were observed in the fractional anisotropy (FA) and fiber number (FN) values of the five parts of upper ARAS between the VS and control groups and between the MCS and control groups (P < 0.05), but no differences were detected in the lower ARAS (P > 0.05). The FA and FN values of the PFC in the upper ARAS were significantly different between the VS and MCS groups (P < 0.05). No other significant differences in FA and FN values were detected among the other segments of the upper ARAS or in the lower ARAS (P > 0.05). Conclusion The results indicate that the prefrontal portion of the upper ARAS is the critical area for distinguishing between VS and MCS in patients with TBI.

In subjects with functional ankle instability, lumbopelvic instability causes instability of the hip and lower extremities. The purpose of this study is to determine whether an ankle exercise program with hip strengthening exercise and lumbopelvic stabilization exercise affects spine and ankle stability through muscle activity in adults with functional ankle instability. Thirty adults with functional ankle instability were randomly assigned to a hip joint strengthening exercise group and a lumbopelvic stabilization exercise group. The subjects participated in the designated program three times a week for 40 minutes a day. In the hip joint strengthening exercise group, a general hip joint strengthening exercise was used, and in the lumbopelvic stabilization exercise group, a lumbopelvic stabilization exercise using a sling was added. The intervention lasted 4 weeks, and both groups were instructed to refrain from other exercise during the 4-week intervention period. The muscle activity of the tibialis anterior, gluteus maximus, external oblique and contralateral latissimus dorsi was measured. Data were collected from the 30 patients. The results showed that the muscle activity of the tibialis anterior, gluteus maximus, lateral oblique muscle, and contralateral latissimus dorsi was significantly increased in both groups. This suggests that the existing hip joint strengthening exercise and lumbopelvic stabilization exercise are effective approaches which not only help reduce hip joint pain and improve function, but also reduce functional ankle instability. Therefore, if an appropriate exercise program is provided for subjects with functional ankle instability, it is expected that it will help improve pain and function by reducing ankle instability and the frequency of re- injury.

Compared with conventional hydrogen-air combustion, catalytic hydrogen combustion (CHC) exhibits higher safety and efficiency and ultra-low NOx emissions. Significant advances in CHC have been achieved in recent years through fundamental research. Therefore, the state-of-the-art CHC technology is comprehensively reviewed herein, including catalyst development, catalytic reactors, and the factors impacting the kinetics of various CHC systems. Furthermore, the progress made in CHC catalyst design over the years is examined, and detailed information regarding their synthesis, structure, and characteristics are presented. The comparison of several types of CHC reactors, including fixed-bed, monolithic, and microchannel reactors, is presented in terms of their operational features and performances. The effects of several operating parameters, including the reaction temperature, hydrogen-to-oxygen stoichiometric ratio, space velocity, residence time, and operating pressure, of the CHC processes are reviewed. The catalytic reaction pathways and the kinetics of the CHC processes are also summarized, advancing the understanding of the underlying chemistry on the catalyst surfaces. This review analyzes the various catalysts, reactor types, operating factors, and underlying mechanisms involved in CHC to better understand the mass transfer, heat transfer, and chemistry during this process. Finally, future research directions are proposed to explore the design of catalytic reactors for CHC.

Purpose To assess the safety and retrieval rate of a predischarge inferior vena cava (IVC) filter retrieval strategy based on contrast computed tomography (CT). Methods IVC filter insertion for trauma patients from 2010 to 2018 were reviewed. An active filter retrieval strategy was established in March 2017. The strategy sought early evaluation of venous thromboembolism (VTE) status and filter retrieval before a patient's discharge. The possibility of early IVC filter retrieval was evaluated by a multidisciplinary team based on pre-filter retrieval VTE-CT findings. Overall VTE-CT findings, retrieval rate, indwelling time, and recurrence of venous thromboembolic events were compared before and after the filter retrieval strategy setup. Results 177 IVC filters were inserted in trauma patients. All patients underwent pre-filter retrieval VTE-CT. VTE-CT findings were as follows: completely resolved VTE, n = 108 (61%); partially improved, n = 58 (33%); no change, n = 8 (5%); aggravated, n = 3 (2%). The overall retrieval rate was 84% with a mean indwelling time of 32 days. In subgroup analyses, 95 (53%) had filter retrieval with the before strategy (BS) setup and 82 (47%) with the after strategy (AS) setup. The retrieval rate was significantly higher in the AS group [81/82 (99%) vs. 68/95 (72%), (p Conclusions The active strategy of VTE-CT-based filter retrieval during the hospital stay markedly improved the filter retrieval rate from 72% to 99% without evidence of recurrence of VTE. Hazards of low retrieval rate versus CT-related radiation exposure should be studied in the future.

Background An association has been identified between mitral valve prolapse (MVP) and sudden cardiac arrest (SCA), and ventricular arrhythmias (VA). This study aimed to elucidate predictive factors for SCA or VA in MVP patients. Methods MVP patients who underwent cardiac magnetic resonance (CMR) were retrospectively included. Patients with other structural heart disease or causes of aborted SCA were excluded. Clinical characteristics (sex, age, body mass index, histories of diabetes, hypertension, and dyslipidemia) and electrocardiographic (PR interval, QRS duration, corrected QT interval, inverted T wave in the inferior leads, bundle branch block, and atrial fibrillation), echocardiographic [mitral regurgitation grade, prolapsing mitral leaflet, and right ventricular systolic pressure (RVSP)], and CMR [left atrial volume index, both ventricular ejection fractions, both ventricular end-diastolic and systolic volume indexes, prolapse distance, mitral annular disjunction, systolic curling motion, presence of late gadolinium enhancement (LGE), LGE volume and proportion] parameters were analyzed. Results Of the 85 patients [age, 54.0 (41.0–65.0) years; 46 men], seven experienced SCA or VA. Younger age and wide QRS complex were observed more often in the SCA/VA group than in the no-SCA/VA group. The SCA/VA group exhibited lower RVSP, more systolic curling motion and LGE, greater LGE volume, and higher LGE proportion. The presence of LGE [hazard ratio (HR), 19.8; 95% confidence interval (CI) 2.65–148.15; P = 0.004], LGE volume (HR 1.08; 95% CI 1.02–1.14; P = 0.006) and LGE proportion (HR 1.32; 95% CI 1.08–1.60; P = 0.006) were independently associated with higher risk of SCA or VA in MVP patients together with systolic curling motion in each model. Conclusions The presence of systolic curling motion, high LGE volume and proportion, and the presence of LGE on CMR were independent predictive factors for SCA or VA in MVP patients.

Aim To develop and validate a model for the early prediction of long-term neurological outcome in patients with non-traumatic out-of-hospital cardiac arrest (OHCA). Methods We analysed multicentre OHCA registry data of adult patients with non-traumatic OHCA who experienced return of spontaneous circulation (ROSC) and had been admitted to the intensive care unit between 2013 and 2017. We allocated 1329 (2013–2015) and 1025 patients (2016–2017) to the derivation and validation sets, respectively. The primary outcome was the dichotomized cerebral performance category (CPC) at 90 days, defined as good (CPC 1–2) or poor (CPC 3–5). We developed 2 models: model 1 included variables without laboratory data, and model 2 included variables with laboratory data available immediately after ROSC. Logistic regression with least absolute shrinkage and selection operator regularization was employed for model development. Measures of discrimination, accuracy, and calibration (C-statistics, Brier score, calibration plot, and net benefit) were assessed in the validation set. Results The C-statistic (95% confidence intervals) of models 1 and 2 in the validation set was 0.947 (0.930–0.964) and 0.950 (0.934–0.966), respectively. The Brier score of models 1 and 2 in the validation set was 0.0622 and 0.0606, respectively. The calibration plot showed that both models were well-calibrated to the observed outcome. Decision curve analysis indicated that model 2 was similar to model 1. Conclusion The prediction tool containing detailed in-hospital information showed good performance for predicting neurological outcome at 90 days immediately after ROSC in patients with OHCA.

Eales’ disease is an idiopathic disorder induced by ischemic retinal vasculitis, usually affecting the peripheral retina. We encountered a young patient diagnosed as cerebral infarction with a history of Eales’ disease. The patient’s middle cerebral artery showed multifocal stenosis with contrast enhancement, suggesting vasculitis. These findings might give clues to a rare cause of cerebral artery stenosis.

To date, no meta-analysis of the relationship between hospital readmission after total joint arthroplasty (TJA) and preoperative depression has been conducted. Hence, this systematic review and meta-analysis aimed to evaluate the association of preoperative depression with the readmission rate following TJA.We systematically searched MEDLINE, EMBASE, and Cochrane Library for studies published before March 28, 2021, which compared readmission rates in patients with or without preoperative depression who underwent TJA. The primary outcome was the relationship between preoperative depression and 30-day and 90-day readmission rates after TJA. We also performed surgery type subgroup analyses for total hip arthroplasty, total knee arthroplasty (TKA), total shoulder arthroplasty, and total ankle arthroplasty.We included 9 studies with 395,815 TJA cases, of which 49,402 were diagnosed with preoperative depression and 346,413 were not. In pooled TJA analysis, the 30-day and 90-day readmission rates were significantly higher in the depression group than in the no-depression group (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.26-2.73, P = .002 and OR 1.27, 95% CI 1.14-1.43,; P.001, respectively). In the subgroup analyses, the 90-day readmission rate was higher in the depression group than in the no-depression group after TKA (OR 1.28, 95% CI 1.15-1.42, P.001). There were no differences in other surgery types.Based on available evidence, preoperative depression increases the readmission rate after TJA, particularly TKA. As depression is a modifiable risk factor, screening for depression and referring patients for proper psychiatric management are important.Level III, meta-analysis.

We investigate the nanogap and polarization-resolved excitation of gap plasmon modes using terrace-stepped hexagonal boron nitride (hBN) sandwiched between Ag nanowires and Au substrates for a metal–insulator–metal gap structure. The gap plasmon modes in the proposed hybrid structure are dominantly excited by a P-polarized incident light, which is supported by full-wave numerical simulations. Plasmon mode evolution for various hBN spacer thicknesses ranging from 5 to 90 nm shows that optical signals acquired via unpolarized dark-field mapping spectroscopy are primarily due to the optical scattering of the P-polarized incident light. Moreover, this plasmonic mode changes significantly from gap plasmon mode to Fabry–Perot-type resonance in a hBN thickness of 50–90 nm. Our analysis reveals that the proposed hybrid structure based on Ag nanowires and stepped hBN provides a well-defined gap thickness and is a robust platform for analyzing gap plasmon modes.

Background. Successful reconstruction of the feet and ankles remains challenging due to limited quantities of soft tissue and laxity. The free lateral arm flap (LAF) is an alternative to conventional flaps and has been widely used due to advancements in its flap characteristics. This study is aimed at utilizing the advantages of this flap to validate its increased applications for foot and ankle defects. Methods. Twenty patients with various LAF types between May 2011 and May 2020 were enrolled. Clinical data was retrospectively collected, and defect sites were classified according to the subunit principle. We utilized various LAF types, such as LAFs with sensate, extended, osteomyocutaneous, or myocutaneous flaps, as necessary. A two-point discrimination test was performed, and results were statistically compared between flaps. Results. Among the diverse etiologies of skin defects, chronic inflammation was the most common cause of defects. Various LAF types, including LAFs with fasciocutaneous, extended fasciocutaneous, musculocutaneous, and osteomyocutaneous flaps, were used. The versatility of free LAF helped successfully cover various defects in all cases. Results of the two-point discrimination test were statistically significant between groups. Conclusions. Free LAF is a unique soft tissue free flap that is more versatile than other flaps, allowing flaps to be continuously modified and applied to various foot and ankle defects under different clinical conditions.

Objective: Dual energy X-ray absorptiometry (DXA) is a standard tool for measuring the bone mineral density (BMD), but it sometimes provides inaccurate results. In contrast, quantitative computed tomography (QCT) measures the BMD more accurately by directly measuring the trabecular bone. This study examined the factors that cause the discrepancy between DXA and QCT with advanced spinal imaging.Methods: The medical records of 59 patients who underwent DXA, QCT, and a lumbar spine magnetic resonance imaging (MRI) were reviewed retrospectively. The following values were measured on plain radiographs, computed tomography, and MRI: lumbar lordosis, segmental scoliosis, compression fracture, spondylosis, abdominal aortic calcification, facet joint degeneration, and Modic change. The significant parameters contributing to the discordance results between DXA and QCT were evaluated by logistic regression analysis.Results: QCT identified osteoporosis in 43 patients (72.88%). DXA identified 15 osteoporotic patients (25.42%). Of the 44 patients not diagnosed with osteoporosis by DXA, 30 patients (68.18%) were diagnosed with osteoporosis by QCT. Multivariate logistic regression analysis showed that the result of DXA might be overestimated by a degenerated facet joint (odds ratio [OR] 4.58; 95% confidence interval [CI], 1.1-19.07) and measurements at a fracture site (OR, 1.63; 95% CI, 1.23-2.15).Conclusion: DXA might miss a diagnosis of osteoporosis. Facet joint hypertrophy due to degeneration revealed a stronger association with the overestimation of the BMD by DXA than the formation of osteophytes at the vertebral body. Therefore, the results of DXA should be interpreted carefully, considering the possibility of interruption.

Background: This case study suggests the potential usefulness of Korean medicine treatment with herbal medicines for shoulder pain and improving the quality of life of patients with frozen shoulder.Case Summary: A patient had shoulder pain and decreased daily living function due to frozen shoulder. Korean medicine treatments, including herbal medicine; acupuncture at points TE14, HT1, BL11, SI10, and LI15; and pharma-acupuncture containing Sinbaro, were applied for 31 days. The Numeric Rating Scale scores for shoulder pain decreased from 7 to 4, and the Shoulder Pain and Disability Index scores decreased from 71.54 to 66.15, with an increase in range of motion from 30° flexion, 60° abduction, and 10° external rotation to around the normal range of motion.Conclusion: Korean medicine treatment can be considered an effective conservative management option for pain and decreased daily living function in patients with frozen shoulder.

Objective: This study investigated two cases of Korean medical treatment for visual field impairment after stroke: Case 1, a 56-year-old male with a posterior cerebral artery infarction and right homonymous hemianopsia, and Case 2, a 46-year-old male with an intracerebral hemorrhage in the left parietal lobe and right homonymous hemianopsia.Methods: Case 1 was treated with acupuncture, electroacupuncture, and herbal medicine (Mangeum-tang) for two months, and Case 2 was treated with acupuncture, electroacupuncture, and herbal medicine (Oryeong-san) for 40 days.Results: Following treatment, for Case 1, the Humphrey visual field test showed improvement. The visual field indexes (VFIs) for the left and right eyes improved from 44% to 55% and 49% to 64% respectively, and the mean deviations (MDs) for the left and right eyes improved from -21.11 dB to -19.91 dB and -17.45 dB to -13.89 dB, respectively. The mean visual sensitivities (MVSs) of the left and right eyes also improved from 8.67 dB to 11.33 dB and 1.67 dB to 9.67 dB, respectively, with no side effects. For Case 2, the VFI for the left eye improved from 36% to 64% and that for the right eye remained unchanged. The MDs for the left and right eyes also improved from -22.02 dB to -14.47dB and -22.11 dB to -21.34 dB, respectively, with no side effects.Conclusions: This study suggests that Korean medical treatment may improve visual impairment after stroke, but further research is needed.