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Previous studies have shown a relationship between the occurrence and recurrence of prostate cancer; however, this relationship remains controversial. We investigated the relationship between obesity and biochemical recurrence in patients with prostate cancer. Clinicopathological factors were analyzed after dividing the patient population according to the Asian population-specific body mass index (BMI) criteria for “normal” (

Over the years, deep learning algorithms have advanced a lot and any innovation in the algorithms are demonstrated and benchmarked for image classification. Several other field including side-channel analysis (SCA) have recently adopted deep learning with great success. In SCA, the deep learning algorithms are typically working with 1-dimensional (1-D) data. In this work, we propose a unique method to improve deep learning based side-channel analysis by converting the measurements from raw-trace of 1-dimension data based on float or byte data into picture-formatted trace that has information based on the data position. We demonstrate why 'Picturization' is more suitable for deep learning and compare how input and hidden layers interact for each raw (1-D) and picture form. As one potential application, we use a Binarized Neural Network (BNN) learning method that relies on a BNN's natural properties to improve variables. In addition, we propose a novel criterion for attack success or failure based on statistical confidence level rather than determination of a correct key using a ranking system. Published version

This study compared the effects of open versus laparoscopic radical hysterectomy on intraoperative diaphragmatic excursion and lung compliance. We enrolled 20 women per group; Group O’s members underwent open radical hysterectomy, while Group L’s members underwent laparoscopic radical hysterectomy. Diaphragmatic excursion was measured by assessing tidal ventilation using M-mode ultrasonography before intubation (T0), after intubation with mechanical ventilation (T1), 90 min after incision (T2), and at the end of the operation with recovery of muscle relaxation (T3). Peak inspiratory pressure and static lung compliance were measured using an anaesthesia machine combined with a ventilator. Diaphragmatic excursion was significantly lower in Group L than in Group O at T2 (5.3 ± 1.7 mm vs. 7.7 ± 2.0 mm, P Korean clinical trial number: Korean Clinical Trials Registry (KCT0004477) (Date of registration: November 18 2019) (https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=14963&ltype=&rtype=).

Background This study aimed to evaluate the effects of hypercarbia on arterial oxygenation during one-lung ventilation (OLV). Methods Fifty adult patients undergoing elective video-assisted thoracoscopic lobectomy or pneumonectomy were enrolled. Group I patients (n = 25) were first maintained at normocarbia (PaCO2: 38–42 mmHg) for 30 min and then at hypercarbia (45–50 mmHg). In Group II patients (n = 25), PaCO2 was maintained in the reverse order. Arterial oxygen partial pressure (PaO2), respiratory variables, hemodynamic variables, and hemoglobin concentration were compared during normocarbia and hypercarbia. Arterial O2 content and O2 delivery were calculated. Results PaO2 values during normocarbia and hypercarbia were 66.5 ± 10.6 and 79.7 ± 17.3 mmHg, respectively (mean difference: 13.2 mmHg, 95% CI for difference of means: 17.0 to 9.3, P < 0.001). SaO2 values during normocarbia and hypercarbia were 92.5 ± 4.8% and 94.3 ± 3.1% (P = 0.009), respectively. Static compliance of the lung (33.0 ± 5.4 vs. 30.4 ± 5.3 ml/cmH2O, P < 0.001), arterial O2 content (15.4 ± 1.4 vs. 14.9 ± 1.5 ml/dl, P < 0.001) and O2 delivery (69.9 ± 18.4 vs. 65.1 ± 18.1 ml/min, P < 0.001) were significantly higher during hypercarbia than during normocarbia. Conclusions Hypercarbia increases PaO2 and O2 carrying capacity and improves pulmonary mechanics during OLV, suggesting that it may help manage oxygenation during OLV. Therefore, permissive hypercarbia may be a simple and valuable modality to manage arterial oxygenation during OLV.

Since 2002, there have been active discussions on template attacks due to the robust performance of such attacks. There are reports of numerous proposals to improve the accuracy of prediction model in order to identify the point of interest. To date, many researchers have only focused on the performance of template attacks. In this paper, we introduce a new approach to retrieve the secret information in key schedules, without the profiling phase utilizing secret information. The template attack allows us to reveal the correct key even though the encryption/decryption processes have powerful countermeasures. More precisely, if the templates are sufficiently built in loading/saving the public information, in the extraction phase, the templates already created can be applied to the identical operation about secret information, which allows us to retrieve the secret information even if the countermeasures are theoretically robust. This suggestion becomes another backdoor to avoid hardened countermeasures. In order to demonstrate our proposal, we consider the Advanced Encryption Standard key schedule as a target for attack, however, it cannot be the target of non-profiling attacks in general. Finally, the Hamming weight information of the correct key could be recovered in an XMEGA128 chip, without the secret information. Moreover, we concentrate on the potential possibility of our suggestion since the performance cannot outperform the original methods used in such attacks.

Purpose: Despite the necessity, to date, no detailed database of prostate cancer, especially one that includes clinicopathological data, has been created in Korea. For that reason, the Korean Urological Oncology Society (KUOS) decided to create the Korean Prostate Cancer Database (KPCD). Materials and Methods: The KPCD program was introduced in 2010. After considering regional distribution, a total of 20 hospitals participated in the KPCD. The Database consists of 4 domains (demographic, pretreatment, treatment, and follow-up data) and 135 variables. Results: In total, 7,608 men with prostate cancer between 2000 and 2010 were registered in the KPCD. The mean age at the time of diagnosis was 67.6±7.7 years. The mean PSA at diagnosis was 74.0±366.9 ng/mL, and the proportions of patients with Gleason scores of ≤6, 7, and 8–10 were 37.0%, 26.7%, and 34.2%, respectively. At diagnosis, 62.3% of the patients had localized tumors, 14.6% had regional, 12.8% had distant, and 10.4% cases were from unknown diseases. With regards to the initial treatment modality employed, 1.3% of patients were managed with active surveillance, 62.1% underwent surgery, 4.3% underwent radiotherapy, 27.1% had androgen deprivation therapy, and 5.2% underwent unknown therapies. The 5-year cancer-specific survival rate of patients in the KPCD was 98.6% in the localized stage, 94.8% in the regional stage, 74.7% in the distant stage, and 86.9% in the unknown stage. Conclusions: The KUOS created a relatively successful database of patients with prostate cancer in Korea. The KPCD will continue to improve the availability of data regarding prostate cancer.

Background Repeated administration of morphine leads to characteristic tolerance. We tested the effects of intrathecal oxcarbazepine (OXC) on spinal morphine tolerance in rats using the tail flick test. Methods Sprague-Dawley rats received intrathecal injections of 10 microliter saline alone, or 10 microliter of solutions containing 100 microgram OXC, 15 microgram morphine, or OXC + morphine for 7 days. Different groups of rats received OXC on days 1-7, 1-3, or 5-7. The tail-flick assay was used to measure acute and chronic nociception. The nociceptive stimulus consisted of dipping the distal 5 cm of the tail into warm water before and 30 min after drug injection. On day 8, an antinociceptive dose-response curve was plotted, and the 50% effective dose for morphine (given alone) was determined for all groups. Results Morphine or OXC both produced acute antinociception; OXC + morphine resulted in a significantly larger response than obtained with morphine alone. Morphine tolerance was produced by intrathecal injection of morphine over 7 days. Co-administration of morphine and OXC completely blocked morphine tolerance, but tolerance developed when OXC injection was stopped, and morphine potency was partially restored by co-administration of OXC in tolerant rats. Conclusions The antinociceptive effect of both acute and chronic morphine therapy is increased with intrathecal OXC, and antinociceptive morphine tolerance is attenuated in rats.

Background: Mechanical allodynia is generally resulted from nerve damage by direct injury or inflammation. Thus, this study was designed to compare the antiallodynic effect of morphine, brimonidine and rilmenidine in two models of neuropathic pain, that is, induced by nerve ligation and neuritis. Methods: Rats were prepared with tight ligation of the L5/L6 spinal nerves (SNL group) or with Freund’s complete adjuvant (FCA) administration evoked sciatic inflammatory neuritis (SIN group). Antiallodynic effects by intrathecal morphine, brimonidine and rilmenidine were measured by applying von Frey filaments to the lesioned hind paw. Thresholds for withdrawal response were assessed and converted to % MPE to obtain an effective dose 50% (ED 50) and a dose response curve. Results: Either SNL group or SIN group showed marked mechanical allodynia in the lesioned hind paw. Antiallodynic effects of morphine were different between two groups. That is ED 50 was 0.16 μg (SIN) and 8.12 μg (SNL), and dose response curve of the SIN group shifted left from that of the SNL group. The difference between SIN and SNL groups was statistically significant (P ＜ 0.05). With the brimonidine or rilmenidine administration, ED 50 s were 0.12 μg (SNL) and 0.37 μg (SIN) and 2.16 μg (SIN) and 11.46 μg (SNL), respectively. And the shift to left of dose response curve from the SNL group is more prominent with rilmenidine administration. Conclusions: These results suggest morphine and rilmenidine showed a better effect on reducing the mechanical allodynia induced by FCA administration. (Korean J Anesthesiol 2009; 56: 425～32)

To compare the pain control efficacies of the pelvic plexus block (PPB), periprostatic nerve block (PNB), and controls during a 14-core basal and apical core prostate biopsy. This randomized controlled study, performed between January 2015 and January 2016, included patients with an abnormal serum prostate-specific antigen (PSA > 3 ng/mL) level or a palpable nodule on digital rectal examination. The enrolled patients were randomized into three groups: Group 1, intrarectal local anesthesia (IRLA, 10 mL of 2% lidocaine jelly) and PPB with 3.0 mL of 2% lidocaine injected at the bilateral pelvic plexus; Group 2, IRLA and PNB with 3.0 mL of 2% lidocaine injected at both periprostatic nerves; and Group 3, only IRLA. Patients answered the visual analog scale (VAS) questionnaire at 6 time points. This study consisted of 163 patients (Group 1 = 55, Group 2 = 55, and Group 3 = 53). Pain at the apical biopsy location was less in Groups 1 and 2 than in Group 3 (p

Rationale: Periurethral abscess is a life-threatening disease, and the occurrence of a urethral defect with periurethral abscess is a rare finding. In this case, the patient had a lengthy urethral defect from the bulbous urethra to the membranous urethra accompanied by periurethral abscess that developed within a short time. Herein, we report a case of a pedicle-sparing tunica vaginalis flap utilized in urethral reconstruction which degenerated due to fibrotic changes and soft tissue defects in the urethral bed. Patient concerns: The patient was a 36-year-old man with fever and lower urinary tract symptoms who had been treated with antibiotics and anti-inflammatory drugs for urinary tract infections 3 days before admission. Purulent necrosis was formed by the urethral abscess, and a long-length urethral defect was formed in the bulbous urethra. Diagnosis: Based on the initial computed tomography and laboratory findings, empirical antibiotics were administered to treat a lower urinary tract infection. On the 7th day of hospitalization, ultrasonography was performed due to the sudden swelling of the scrotum, and the patient was diagnosed with a periurethral abscess that was 10 × 3 cm in size. Intervention: Initial urinary diversion, wide debridement, and a large amount of abscess drainage were performed. Necrosis of the urethral ventral part caused a urethral defect that was 5 cm in size. After treatment with antibiotics, long-term disinfection and intermittent debridement were conducted and urethral reconstruction was performed using a tunica vaginalis flap with preserved vascular structure. Outcomes: No complications occurred until 6 months after urethral reconstruction. Lessons: Urethral reconstruction using a tunica vaginalis flap is a good method for selected patients. Pedicle-sparing tunica vaginalis is an advantageous material for resolving urethral defects, especially when the surrounding circulation conditions are poor.

Major laparoscopic pelvic surgery requires steep Trendelenburg position with pneumoperitoneum for a long time. We investigated the effect of Trendelenburg position with pneumoperitoneum on diaphragmatic excursion and lung compliance during major laparoscopic pelvic surgery using M-mode sonography. Twenty patients undergoing elective pelviscopic radical hysterectomy were included in this study. Diaphragmatic excursion was measured at the following time points; after sedation, after intubation, 90 minutes after Trendelenburg position with pneumoperitoneum, and after operation with recovery of muscle relaxation. And lung compliance was measured using anesthetic machine under general anesthesia; after the intubation, 90 minutes after Trendelenburg position with pneumoperitoneum and after operation with recovery of muscle relaxation. In order to detect postoperative pulmonary complication, postoperative chest radiography was checked. Static lung compliance, dynamic lung compliance and diaphragmatic excursion were decreased during operation (P < 0.001, respectively). At the end of the operation with recovery of muscle relaxation, reduced diaphragmatic movement was not recovered as its excursion after sedation (P < 0.001). In conclusion, lung compliance was decreased following transiently decreased diaphragmatic excursion during major laparoscopic pelvic surgery.

Background We evaluated the clinical performance of [-2]proPSA (p2PSA) and its derivatives in predicting the presence and aggressiveness of prostate cancer (PCa) in Korean men. Methods A total of 246 men with total prostate-specific antigen (tPSA) ≥ 3.5 ng/mL who underwent their first prostate biopsy were included in this prospective, multicenter, observational study. Diagnostic accuracy of tPSA, free-to-total PSA ratio (%fPSA), p2PSA, %p2PSA, and the Beckman Coulter prostate health index (PHI) was assessed by receiver operating characteristic curve analyses and logistic regression analyses. Results Overall, PCa was detected in 125 (50.8%) subjects. In men with tPSA 3.5–10 ng/mL, the detection rate of PCa was 39.4% (61/155). In this group, PHI and %p2PSA were the most accurate predictors of PCa and significantly outperformed tPSA and %fPSA; area under the curve for tPSA, %fPSA, %p2PSA, and PHI was 0.56, 0.69, 0.74, and 0.76, respectively. PHI was also the strongest predictor of PCa with Gleason score ≥ 7. Conclusion This study demonstrates the superior clinical performance of %p2PSA and PHI in predicting the presence and aggressiveness of PCa in Korean men. The %p2PSA and PHI appear to improve detection of PCa and provide prognostic information., Graphical Abstract

Purpose To compare perioperative outcomes between running and interrupted vesicourethral anastomosis in open radical prostatectomy (RP). Materials and Methods The medical records of 112 patients who underwent open RP for prostate cancer at our institution from 2006 to 2008 by a single surgeon were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were measured. Results Of 112 consecutive patients, 62 patients underwent vesicourethral anastomosis by use of the running technique, whereas 50 patients underwent anastomosis with the interrupted technique. The groups did not differ significantly in age, body mass index, prostate-specific antigen, prostate volume, or pathologic findings. The intraoperative extravasation rate was significantly lower in the running group (8.1% vs. 24.0%, p=0.01). The mean anastomosis time was 15.1±5.3 and 19.3±4.6 minutes in the running and interrupted groups, respectively (p=0.04). The rates of postoperative extravasation were similar for both groups (6.4% vs. 10.0%, p=0.12). The duration of catheterization was significantly shorter in the running group (9.0±3.0 days vs. 12.9±6.4 days, p

The purpose of this study is to verify the performance of a static mixer for mixing of biogas and town gas by numerical analysis and demonstration test. The reason for designing a static mixer is that there is a need to mix town gas with biogas when there is less production of biogas in biogas sites. Non-uniformity in the outlet section was calculated for investigating the performance of a static mixer. Non-uniformity was based on the mole fraction of methane in a mixture of biogas and town gas. Low non-uniformity means that biogas and town gas are mixed well through this static mixer. Also, pressure drop at the outlet section of a static mixer was calculated. The pressure drop is less than 0.2% in this static mixer. This static mixer is suitable for applying to a 5MW bio-gas turbine through the demonstration test in the field.

A 56-year-old man with a rotator cuff injury, scheduled for arthroscopic reconstruction surgery, had a history of recurrent symptoms of eyeball pain and blurred vision for several years. After close examination, he was diagnosed with Posner-Schlossman syndrome. Three weeks before the scheduled surgery, his intraocular pressure (IOP) increased (> 30 mmHg) and he became extremely anxious about the surgery. We monitored his IOP intraoperatively and successfully completed general anesthesia without any sequelae. As Posner-Schlossman syndrome can present with severe complications that may lead to postoperative visual loss, intraoperative monitoring of intraocular monitoring and careful anesthetic management are crucial to protect vision.

We aimed to evaluate the current nationwide trend, efficacy, safety, and quality of life (QoL) profiles of hormone treatment in real-world practice settings for prostate cancer (PCa) patients in Korea. A total of 292 men with any biopsy-proven PCa (TanyNanyMany) from 12 institutions in Korea were included in this multi-institutional, observational study of prospectively collected data. All luteinizing hormone-releasing hormone (LHRH) agonists were allowed to be investigational drugs. Efficacy was defined as (1) the rate of castration (serum testosterone ≤50 ng dl−1) at 4-week visit and (2) breakthrough (serum testosterone >50 ng dl−1 after castration). Safety assessments included routine examinations for potential adverse events, laboratory tests, blood pressure, body weight, and bone mineral density (BMD, at baseline and at the last follow-up visit). QoL was assessed using the Expanded Prostate Cancer Index Composite-26 (EPIC-26). The most common initial therapeutic regimen was LHRH agonist with anti-androgen (78.0%), and the most commonly used LHRH agonist for combination and monotherapy was leuprolide (64.0% for combination and 58.0% for monotherapy). The castration and breakthrough rates were 78.4% and 6.6%, respectively. The laboratory results related to dyslipidemia worsened after 4 weeks of hormone treatment. In addition, the mean BMD T-score was significantly lower at the last follow-up (mean: −1.950) compared to baseline (mean: −0.195). The mean total EPIC-26 score decreased from 84.8 (standard deviation [s.d.]: 12.2) to 78.3 (s.d.: 8.1), with significant deterioration only in the urinary domain (mean: 23.5 at baseline and 21.9 at the 4-week visit). These findings demonstrate the nationwide trend of current practice settings in hormone treatment for PCa in Korea.

Purpose Lamotrigine, a novel anticonvulsant, is a sodium channel blocker that is efficacious in certain forms of neuropathic pain. Recently, microglial and astrocytic activation has been implicated in the development of nerve injury-induced neuropathic pain. We have assessed the effects of continuous intrathecal administration of lamotrigine on the development of neuropathic pain and glial activation induced by L5/6 spinal-nerve ligation in rats. Materials and Methods Following left L5/6 spinal nerve ligation (SNL), Sprague-Dawley male rats were intrathecally administered lamotrigine (24, 72, or 240 µg/day) or saline continuously for 7 days. Mechanical allodynia of the left hind paw to von Frey filament stimuli was determined before surgery (baseline) and once daily for 7 days postoperatively. On day 7, spinal activation of microglia and astrocytes was evaluated immunohistochemically, using antibodies to the microglial marker OX-42 and the astrocyte marker glial fibrillary acidic protein (GFAP). Results Spinal-nerve ligation induced mechanical allodynia in saline-treated rats, with OX-42 and GFAP immunoreactivity being significantly increased on the ipsilateral side of the spinal cord. Continuously administered intrathecal lamotrigine (240 µg/day) prevented the development of mechanical allodynia, and lower dose of lamotrigine (72 µg/day) ameliorated allodynia. Intrathecal lamotrigine (72 and 240 µg/day) inhibited nerve ligation-induced microglial and astrocytic activation, as evidenced by reduced numbers of cells positive for OX-42 and GFAP. Conclusion Continuously administered intrathecal lamotrigine blocked the development of mechanical allodynia induced by SNL with suppression of microglial and astrocytic activation. Continuous intrathecal administration of lamotrigine may be a promising therapeutic intervention to prevent neuropathy.

Glial cells play a critical role in morphine tolerance, resulting from repeated administration of morphine. Both the development and the expression of tolerance are suppressed by the analgesic lamotrigine. This study investigated the relationship between the ability of lamotrigine to maintain the antinociceptive effect of morphine during tolerance development and glial cell activation in the spinal cord. In a rat model, morphine (15 µg) was intrathecally injected once daily for 7 days to induce morphine tolerance. Lamotrigine (200 µg) was co-administered with morphine either for 7 days or the first or last 3 days of this 7 day period. Thermal nociception was measured. OX-42 and GFAP immunoreactivity, indicating spinal microglial and astrocytic activation were evaluated on day 8. Tolerance developed after 7 days of intrathecal morphine administration; however, this was completely blocked and reversed by co-administration of lamotrigine. When lamotrigine was coinjected with morphine on days 5-7, the morphine effect was partially restored. Glial cell activation increased with the development of morphine tolerance but was clearly inhibited in the presence of lamotrigine. These results suggest that, in association with the suppression of spinal glial cell activity, intrathecally coadministered lamotrigine attenuates antinociceptive tolerance to morphine.

Due to the absence of an alternative algorithm SHA-2, NIST (National Institute of Standards and Technology) is proceeding to development project of SHA-3. NIST announced five candidates of the final round at the end of 2010. Side-channel attack scenarios of five candidates for SHA-3 final round have been proposed. In this paper, we prove the possibility of the analysis against 32-bit modular addition by 8-bit blocks from our experiment on ARM chip board with a register size of 32-bit. In total we required 9700 power traces to successfully recover the 128-bit secret key for the attack against.

Tumor necrosis factor-alpha (TNF-α) is a key proinflammatory cytokine. It is generally believed that TNF-α exerts its effects primarily via TNF receptor subtype-1 (TNFR1). We investigated the distinct roles of TNFR1 and TNFR2 in spinal cord synaptic transmission and inflammatory pain. Compared to wild-type (WT) mice, TNFR1- and TNFR2-knockout (KO) mice exhibited normal heat sensitivity and unaltered excitatory synaptic transmission in the spinal cord, as revealed by spontaneous excitatory postsynaptic currents in lamina II neurons of spinal cord slices. However, heat hyperalgesia after intrathecal TNF-α and the second-phase spontaneous pain in the formalin test were reduced in both TNFR1- and TNFR2-KO mice. In particular, heat hyperalgesia after intraplantar injection of complete Freund's adjuvant (CFA) was decreased in the early phase in TNFR2-KO mice but reduced in both the early and later phase in TNFR1-KO mice. Consistently, CFA elicited a transient increase of TNFR2 mRNA levels in the spinal cord on day 1. Notably, TNF-α evoked a drastic increase in spontaneous excitatory postsynaptic current frequency in lamina II neurons, which was abolished in TNFR1-KO mice and reduced in TNFR2-KO mice. TNF-α also increased N-methyl-d-aspartate (NMDA) currents in lamina II neurons, and this increase was abolished in TNFR1-KO mice but retained in TNFR2-KO mice. Finally, intrathecal injection of the NMDA receptor antagonist MK-801 prevented heat hyperalgesia elicited by intrathecal TNF-α. Our findings support a central role of TNF-α in regulating synaptic plasticity (central sensitization) and inflammatory pain via both TNFR1 and TNFR2. Our data also uncover a unique role of TNFR2 in mediating early-phase inflammatory pain. TNF-α is shown to play a critical role in regulating spinal cord synaptic plasticity and central sensitization, and TNFR1 and TNFR2 play a distinct role in regulating different phases of inflammatory pain.

PURPOSE The objective was to investigate the impact of statin use on prognosis after radical nephroureterectomy for upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS A retrospective review of medical records identified 277 patients who underwent radical nephroureterectomy for primary UTUC at Asan Medical Center between January 2006 and December 2011. Information on preoperative statin use was obtained from patient charts in an electronic database. We assessed the impact of statin use on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS Of these 277 patients, 62 (22.4%) were taking statin medications. Compared to the statin nonusers, the statin users were older, had a higher body mass index, and had higher rates of cardiovascular disease and diabetes. The 5-year RFS rates of statin users and nonusers were 78.5% and 72.5%, respectively (p=0.528); the 5-year CSS rates were 85.6% and 77.7%, respectively (p=0.516); and the 5-year OS rates were 74.5% and 71.4%, respectively (p=0.945). In the multivariate analysis, statin use was not an independent prognostic factor for RFS (hazard ratio, 0.47; p=0.056), CSS (hazard ratio, 0.46; p=0.093), or OS (hazard ratio, 0.59; p=0.144) in patients who underwent radical nephroureterectomy for UTUC. CONCLUSIONS Statin use was not associated with improved RFS, CSS, or OS in the sample population of patients with UTUC.

This paper describes polidimethylsiloxane(PDMS) based bonding for assembly of microstructure device, an UV lithography applications for fabricating a 3-dimensional (3D) feed-horn-shaped structure mold array, and obtaining parallel light by using a mirror-reflected parallel-beam illuminator (MRPBI) system. A 3D feed-horn-shaped micro-electro-mechanical systems (MEMS) antenna has some attractive features for array applications, which can be used to improve microbolometer performance and to enhance the optical efficiency for thin film transistor-liquid crystal display (TFT-LCD) and other display devices but currently, MEMS technology has faced many difficulties in the fabrication of a 3D feed-horn-shaped MEMS antenna array itself. The purpose of this paper is to propose a new fabrication method to realize a 3D feed-horn-shaped MEMS antenna array by using a mirror-reflected parallel-beam illuminator (MRPBI) System with a very slowly rotated, inclined x-y-z stage. With a conventional UV lithography apparatus, it is very difficult to fabricate high-aspect-ratio structures (HARS) because a typical UV lithography apparatus cannot produce perfectly parallel light. From a theoretical analysis, a columnar illuminator over 6 m in height is required to achieve parallel light, but generally a laboratory height is not 6 m. Also, a novel method of lithography was tried to make a 3D structure array by exposing a planar wafer to the generated parallel light and rotating an inclined x-y-z stage at an ultra-slow rate. An optimization of the 3D structure array can be achieved by simulating a 3D feed-horn MEMS antenna. The feasibility of fabricating both a 3D feed horn MEMS antenna and assembly of detector with 3D feed-horn MEMS antenna was demonstrated. As a result, it seems possible to use a 3D feed-horn-shaped MEMS antenna to improve microbolometer performance and to fabricate several optical microstructure applications.

In this paper, we proposed a microbolometer coupled with 3D feed horn antenna. It is a new device that enhances the performance of the microbolometer by coupling 3D horn shape antenna. We designed the optimum horn antenna size that has 20.08 dB directivity. And we designed the microbolometer as a circular shape in order to reduce the coupling loss between the horn antenna. We confirmed that the detectivity of the designed microbolometer would be improved as the noise characteristics of the microbolometer are enhanced by coupling feed horn antenna which acts as a cold shield. The detectivity of the designed 3D antenna-coupled microbolometer was improved about seven times more than that of the conventional microbolometer in state of background limited infrared performance. Fabrications of the microbolometer are carried out by a surface micromachining method. We achieved the thermally good isolated floating structure. And the 3D feed horn antenna was constructed by using a mirror-reflected parallel beam illuminator (MRPBI) system which is invented for rotating and tilted illumination. Using this method, we acquired the feed horn shape antenna mold. And we also acquired antenna plate by using PDMS injection method. Finally, to couple the antenna and the microbolometer, we proposed the PDMS injection bonding method.

Since white box cryptography was proposed, many meaningful research has been studying on many fields. In fact, many companies provide services with WBC (White Box Cryptography) solutions. However, most of them are used in only services related to DRM, there is no basic approach that is attached to system or platform itself. This paper explains WBC research trends and some important problems, shows how to efficiently use WBC with mobile environment.

Although achievements in modern medicine have enabled mankind to cure or control many diseases, numerous challenges remain. Acute kidney injury (AKI), a serious illness causing significant mortality and morbidity, is one such challenge [1]. AKI occurs in the perioperative period and is diagnosed by laboratory abnormalities, such as elevated blood urea nitrogen and creatinine, or by a drop in urine output. AKI may lead to a number of complications, including metabolic acidosis, high potassium levels, uremia, changes in body fluid balance, and effects on other organ systems. The current treatment for AKI consists of supportive care such as renal replacement therapy as well as treatment of the underlying disorder. Over the past few years, international guideline groups have attempted to establish consistent definitions and staging systems for AKI. The staging system known as Risk, Injury, Failure, Loss, End (RIFLE) was established in 2004 [2]. This was modified to create the Acute Kidney Injury Network (AKIN) [3], and then further modified to create the Kidney Disease: Improving Global Outcomes (KDIGO) system in 2012 [4]. These systems are based on serial creatinine measurements. National Institute for Health and Care Excellence (NICE) guidelines published in 2013 suggest that these systems need further development and simplification to be useful for clinicians. Recent studies have found several biomarkers for AKI that reflect glomerular filtration rate decrease and renal tubular injury early after cardiac surgery, including urinary neutrophil gelatinase associated lipocalin (NGAL) [5], liver-type fatty acid-binding protein (L-FABP) [6], kidney injury molecule-1 (KIM-1) [7], interleukin-18 (IL-18) [8], and serum cystatin C [9]. However, controversies regarding the accuracies of these biomarkers in the clinical setting still exist. No therapeutic modalities to date have shown efficacy for treating AKI. In severe cases, hemodialysis can be used. However, hemodialysis is difficult and time-consuming, and can cause complications including low blood pressure, fatigue, chest pains, leg-cramps, nausea, headache, and sepsis. Patients undergoing hemodialysis have trouble remaining employed, and face severe economic difficulties. Although kidney transplantation is an effective treatment method, patients are rarely able to find a suitable kidney donor. Even after a kidney transplant, patients may suffer from transplant rejection, infection, sepsis and side effects of medications. Therefore, prevention of AKI is more important than treatment. Anesthesiologists must strive to avoid hypotension and drugs with renal toxicity during surgical procedures. Recently, it was reported that human liver tissue was built using a three-dimensional printer. Perhaps in 20 or 30 years, it will be possible to replace non-functional human organs with artificially created organs at relatively low cost. However, until that day arrives, medical doctors, including anesthesiologists, must strive to cure or control AKI and other severe diseases.

Anesthesiologists daily use a range of drugs, including intravenous anesthetics, neuromuscular-blocking drugs and their antagonists, opioids, and local anesthetics. Antagonists of neuromuscular-blocking drugs are used to reverse the action of neuromuscular-blocking drugs. However, rarely paradoxical muscle weakness [1,2], nausea, vomiting [3], bradyarrhythmias [4,5], and bronchoconstriction [6,7] occur with acetylcholinesterase inhibitors. Sugammadex is a recently introduced antagonist of neuromuscular-blocking drugs. It binds and inactivates neuromuscular-blocking agents, particularly rocuronium and vecuronium. Complex formation between sugammadex and rocuronium or vecuronium results in the rapid reversal of neuromuscular blockade compared to anticholinesterase drugs [8]. In clinical practice and during an unexpectedly difficult airway (cannot intubate, cannot ventilate situation), a rocuronium neuromuscular blockade can be immediately reversed using sugammadex to restore spontaneous ventilation [9]. This is probably the most significant benefit of sugammadex. The ability of sugammadex to reverse rocuronium-induced neuromuscular blockade is not influenced by the choice of anesthetic (e.g., propofol versus sevoflurane) [10,11]. Therefore, when using sugammadex as the antagonist of neuromuscular-blocking drugs, there is a small risk of incomplete neuromuscular recovery or the reoccurrence of neuromuscular blockade following surgery. No dose adjustments are required in older patients [12]. When using antagonists of neuromuscular-blocking drugs, anticholinesterase drugs and anticholinergics (glycopyrrolate and atropine) are coadministered to reduce the cholinergic action of anticholinesterase drugs. In this particular treatment, a side effect is dry mouth. Some patients complain of dry mouth and a gritty taste after general anesthesia and surgery. However, should we select sugammadex as the antagonist of neuromuscular-blocking drugs, we could avoid these problems. Although sugammadex has some benefits, it also has several side effects. Hypersensitivity to sugammadex is the major concern. However, hypersensitivity reactions rarely occur. In patients with known sugammadex hypersensitivity, it is contraindicated. Other reported side effects include coughing, movement of a limb or the body, parosmia (abnormal sense of smell), and elevated urine levels of N-acetyl-glucosaminidase [13]. Theoretically, sugammadex can bind to endogenous and pharmaceutical molecules other than steroidal neuromuscular-blocking drugs, therefore reducing the efficacy of these molecules. When sugammadex has a very high affinity for another molecule, this molecule may displace rocuronium or vecuronium from the complex with sugammadex, resulting in the reoccurrence of neuromuscular blockade [14]. Sugammadex may interact with hormonal contraceptive drugs via unwanted binding, therefore, possibly reducing their clinical efficacy [15]. It should be explained to female patients using hormonal contraceptives that the effectiveness of such drugs could be reduced by the administration of sugammadex. The efficacy and safety of sugammadex in obstetric anesthesia have not been determined. To date, no serious adverse event in the mother or neonate after sugammadex has been reported. Because sugammadex is expensive, this is an important factor that may limit its use as a routine antagonist of neuromuscular-blocking drugs. In this issue of the Korean Journal of Anesthesiology, there are three interesting papers on muscle relaxants [16,17], and sugammadex [18]. The study of sugammadex and its influence on bleeding is quite novel [18]. If you wish to use an antagonist of neuromuscular-blocking drugs, which would you choose between sugammadex and acetylcholinesterase inhibitors? This depends on the decision and experience of the anesthesiologists regarding the benefits and risks of sugammadex, with which they should therefore be well acquainted.

59-YEAR-OLD woman weighing 52.5 kg and 158.7 cm tall was admitted with a diagnosis of mitral regurgitation and atrial fibrillation. A routine laboratory examination produced no significant preoperative findings except for severe rheumatic mitral regurgitation, mild mitral stenosis, and atrial fibrillation. Surgery was scheduled for mitral valvuloplasty and the Maze operation using a robotically controlled camera (AESOP3000; Computer Motion, Santa Barbara, CA) for minimally invasive robot-assisted thoracotomy, with a preoperative plan to perform single-lung ventilation, continuous monitoring of mixed venous saturation and cardiac output with the pulmonary artery (PA) catheter, and insertion of a superior vena cava (SVC) cannula via the right internal jugular vein. No medication was administered on the day of surgery. Blood pressure, cardiac rhythm, and oxygen saturation were monitored in the operating room. Anesthesia was induced with intravenous midazolam (0.2 mg/kg), sufentanil (1 g/kg), and vecuronium (0.15 mg/kg). The trachea was intubated using a 35F left double-lumen tube (Broncho-cath; Mallinckrodt, Dublin, Ireland). The patient was placed in the Trendelenburg position, and an 8.5F PA catheter sheath (AVA 3Xi; Edwards Lifescience, Irvine, CA) was inserted via the right subclavian vein. The correct position of the catheter was confirmed by the aspiration of blood. A 21F SVC cannula (Medtronic, Minneapolis, MN) was inserted uneventfully in the right internal jugular vein, and its correct position was also confirmed by blood aspiration. A 7.5F PA catheter (Swan-Ganz CCOmbo V, Edwards) was then inserted approximately 10 cm into the PA catheter sheath but could not be advanced further and no blood could be aspirated through the PA catheter sheath and the PA catheter. A chest x-ray was taken (Fig 1). What is the diagnosis?

We review a wide range of absorbers based on patterned resistive sheets for use in mid-wave and long-wave infrared microbolometers. These structures range from wavelength selective dielectric coated Salisbury screens to patterned resistive sheets to stacked multi-spectral devices. For basic three color devices in the LWIR band we have designed and fabricated wavelength selective dielectric coated Salisbury screen (DSS) absorbers suitable for use in microbolometers. In order to produce wavelength selective narrowband absorption, the general design rules for DSS microbolometers show that the thickness of the air gap should be a half wavelength and the optical thickness of the dielectric support layer should be a quarter wavelength. This structure is also air gap tunable; i.e., by varying only air gap thickness, the center wavelength of the absorption curve is shifted. FTIR microscope measurements have been made on a number of the different devices demonstrating three color capability in the LWIR while maintain very high efficiency absorption. We have also shown that the use of a patterned resistive sheet consisting of a properly sized array of cross-shaped holes acts as a polarization independent frequency-selective absorber allowing a three-color system spanning the 7-14 micron band. For realistic metal layers the skin effect produces complex surface impedance that can be quite large in the LWIR band. We have shown that metal layers of thickness between one and three skin depths can act as the absorber layer, and have shown that thick metal layers can still produce excellent absorption in the LWIR. Holes in the dielectric support layer also reduce the thermal mass in the system without compromising spectral selectivity. Broadband designs using rectangular holes that produce substantially reduced thermal mass (over 50%) while maintaining efficient spectral absorption have also been found. Finally, we have considered multispectral stacked structures, including Jaumann absorbers and stacked dipole/slot patterned resistive sheets. These structures promise either two band (MWIR/LWIR) or two to three color LWIR in a multi-layer stacked pixel.

Objective Acute kidney injury is a serious postoperative complication following cardiac surgery. The aortic arch repair technique using antegrade selective cerebral perfusion has been used, but it is unclear whether subdiaphragmatic organs such as the kidneys are perfused adequately. The authors compared intraoperative renal regional oxygen saturation using near-infrared spectroscopy between infants with and without postoperative acute kidney injury after undergoing aortic arch reconstruction. Design Retrospective medical records review. Setting University medical center. Participants Elective cardiac surgical infants. Interventions The author reviewed the perioperative clinical records of infants who underwent aortic arch reconstruction surgery using antegrade selective cerebral perfusion. During the operation, prestenotic (right radial or right brachial artery) and poststenotic (femoral or umbilical artery) invasive arterial blood pressure and cerebral and renal regional oxygen saturation were monitored continuously. Development of acute kidney injury within 72 hours of surgery was investigated. Results A total of 47 patients were enrolled in this study. Postoperative acute kidney injury occurred in 19 patients (40.4%). Intraoperative renal regional oxygen saturation was similar between patients with and without acute kidney injury. Intraoperative prestenotic and poststenotic mean arterial blood pressure and cerebral regional oxygen saturation also were similar between the 2 groups. Conclusions The intraoperative renal tissue oxygen saturation was not different between the groups with or without postoperative acute kidney injury in infants who underwent aortic arch repair using antegrade selective cerebral perfusion.

We present fabrication and characterization of wavelength selective germanium dielectric supported microbolometers using a self-alignment technique to help insure a flat microbolometer membrane. The fabricated microbolometer consists of a resistive absorber sheet on a quarter wavelength germanium layer above a half wavelength air gap, producing dielectric interference [1]. We use a self-aligned process without a polyimide patterning process that helps eliminate deformation and stress in the structure membrane. We demonstrated that the fabricated wavelength selective microbolometers have flat, robust membranes and produce excellent tunable narrowband absorption in MWIR/LWIR band with efficient multi-color IR spectral response using wavelength selective pixels.

RSA is one of the most widely used public key algorithms, and the RSA-CRT variation is applied to improve efficiency of operations. Since Power analysis attacks were introduced, many researchers have studied not only power analysis attacks of RSA but also CRT specified attacks. Boer et al. [3] proposed a new analysis method for finding r = x mod p with equidistant chosen plaintexts. From the knowledge of r, we can compute a secret prime number p. As this method is based on equidistant messages, unlike general power analysis methods, it is called MRED (Modular reduction on equidistant data) power analysis or ECMPA (Equidistant Chosen Message Power Analysis). Since there are various novel characteristics in equidistant messages, there exist unusual properties of ghost keys that are not seen in general power attacks. In this paper, we describe unknown and interesting characteristics of ghost key patterns using real experiments.

comes of patients undergoing radical cystectomy with and without prior pelvic radiation. METHODS: A retrospective review of patients who underwent RC at our institution since 2000 was performed. Patients were stratified into two groups, those having received pelvic radiation prior to surgery (RPS) and an age/stage-matched control group without prior pelvic irradiation. Complications within 90 days of surgery were assigned a Clavien classification. RESULTS: 515 RCs were performed over the decade, of which 50 (9.7%) patients had received prior pelvic radiation. These 50 patients were compared to 50 age/stage-matched controls. There were no demographic differences between the two groups (Table 1). There was no significant difference in preoperative T stage, with the majority of each group having T2 disease (60.0% vs. 61.2%, p 0.274). The RPS group, however, had a significantly higher requirement for transfusion, at a rate of 79% compared with 45% in the controls (p 0.001). Postoperative complications as classified by the Clavien system did not differ between the groups, with a rate of 86% in the RPS group vs. 81.6% in the controls (p 0.777) (Table 2). Final pathology revealed a trend towards a higher rate of T4 lesions in the RPS group (31.3% vs 16.3%), but this value was not statistically significant (p 0.08). Rates of progression to metastatic disease were equivalent (57.1% vs. 55.8%, p 1). There was no significant difference in overall survival rates (1061 and 737 days, p 0.89) at a median follow up of 19.6 and 23.9 months. CONCLUSIONS: The majority of patients have a complication after RC using the Clavien system. Prior pelvic radiation did not appear to significantly increase intraoperative or postoperative complication rates using the Clavien classification system. Blood transfusion rate was higher in the radiated group.

White box cryptography is the new technique against attacks on white box attack environments. In white box attack model, the attacker is even stronger than in black box attack model, and the attacker can monitor all intermediate values. Therefore, safety algorithms are needed against all operation steps being exposure. Chow introduced secure white box cryptography with AES DES implementations against white box attack model [1,2]. However, slower performance by operating too many look up tables is a problem of practical use of white box cryptography. Also key updating on dynamic situations of white box cryptography is much harder than key updating of black box cryptography. Thus, this paper suggests using a specific mode of operation to improve speed of white box implementations, and show concrete examples of enhancement of performance. Also, it suggests a technique of key updating with dynamic and static tables in practically.

Past work has discussed infrared absorption using a patterned thin resistive sheet as the frequency-selective absorber for use in wavelength-selective long wave infrared (LWIR) microbolometer focal planes arrays. These patterned resistive sheets are essentially slot antennas formed in a lossy resistive ground plane layer placed a quarter-wavelength in front of a mirror. Design studies have shown that for efficient IR absorption cross-shaped slots require a lossy sheet with the optimized sheet resistance. For realistic metal layers, however, the skin effect produces a complex surface impedance that can be quite large in the LWIR band. In this paper we consider metal layers of thickness between one and three skin depths as the absorber layer instead of a thin resistive sheet layer, and show that the thick metal layers can still produce excellent absorption in the LWIR.

This paper describes the microfabrication process and characterization of wavelength selective germanium dielectric supported microbolometers, which should be compatible with standard microbolometer fabrication processes. Here we have demonstrated a micro fabricated robust germanium dielectric structure layer that replaces the usual silicon nitride structural layer in microbolometers. The fabricated microbolometers consist of a chromium resistive sheet as an absorber layer above an air-gap/germanium dielectric structure.

We investigated the effects of head rotation on the cross-sectional area of the right internal jugular vein and its relative position to the carotid artery. Eighty-eight subjects were divided into infants and children groups. The cross-sectional area of the right internal jugular vein and the degree of the carotid artery overlap were measured at 0 degrees (neutral), 40 degrees and 80 degrees of head rotation. The cross-sectional area of the right internal jugular vein was significantly larger at 40 degrees and 80 degrees head rotation compared with the neutral position in both infants and children (p < 0.001). As the head was rotated, the percentage overlap of the carotid artery increased significantly (p < 0.001). We suggest that 40 degrees head rotation appears to be optimal for right internal jugular vein cannulation in paediatric patients.

We have described herein a 39-year-old male patient with hepatitis B virus-related cirrhosis (Child class C), showing a prolonged corrected QT interval, who developed torsades de pointes (TdP) in the neohepatic stage of liver transplantation (LT). There was no arrhythmia in the pre-anhepatic and anhepatic stages. Multiple premature ventricular complexes, ventricular tachycardia, and TdP suddenly developed at 16 minutes after graft reperfusion without any prodromal arrhythmia; they persisted for 118 seconds. Laboratory tests showed that serum potassium, calcium, and magnesium concentrations of 4.7 mmol/L, 1.05 mmol/L, and 1.85 mg/dL, respectively were within normal ranges. Likely causative factors for TdP in this patient included a prolonged corrected QT interval (553 msec), a low hematocrit (21%), and a low arterial blood pressure (systolic blood pressure, 80-90 mm Hg; diastolic blood pressure; 20-26 mm Hg) in the neohepatic stage. This case demonstrated the importance of optimal maintenance of coronary perfusion, with an adequate hematocrit level and electrolyte concentrations, to prevent the development of TdP in cirrhotic patients with a prolonged corrected QT interval during LT.

Background: Although low central venous pressure (CVP) anesthesia has been used to minimize blood loss during hepatectomy, the efficacy of this technique remains controversial. We therefore assessed the association between blood loss and CVP during hepatic resection, and examined significant determinants associated with intraoperative hemorrhage during hepatectomy in living donors. Methods: Between April 2004 and April 2008, 984 living donors who underwent a hepatic resection were assessed retrospectively. Univariate and multivariate analyses were performed to explore the relationships between intraoperative blood loss and several variables including CVP. Results: The mean intraoperative blood loss was 691.3 ± 365.5 ml. Only four donors required packed red blood cell transfusions (mean, 1.5 U). The mean duration of hepatic resection was 92.1 ± 26.3 min. The mean, maximum, and minimum values of CVP measured during hepatectomy were 4.6 ± 1.7, 5.3 ± 1.8, and 4.0 ± 1.8 mmHg, respectively, and were not significantly correlated with intraoperative blood loss. On multivariate analysis, predictors of hemorrhage were liver fatty change, gender, and body weight, but none of the mean CVP, surgeons, anesthesiologists, anesthesia duration, resected liver volume, hepatectomy type, systolic blood pressure, heart rate, or body temperature were significant. Conclusions: CVP during hepatic resection was not associated with intraoperative blood loss in living liver donors, suggesting that CVP may not be an important factor in predicting blood loss during hepatectomy in healthy subjects.

The use of a cross-shaped patterned resistive sheet as an infrared-selective absorber, including the effects of a SiNx mechanical support dielectric layer is discussed. These cross patterned resistive sheets are a modified form of classical Salisbury Screens that utilize a resistive absorber layer placed a quarter-wavelength in front of a mirror. In comparison with previously designed patterned resistive sheets that have only a single resistive layer with rectangular patterned holes, here we consider a resistive absorber layer and a support dielectric layer with cross patterned holes through both the resistive absorption layer and the support layer.

To evaluate the differences in tumor characteristics and prognosis according to age at presentation in patients with newly diagnosed Stage Ta, T1 urothelial carcinoma of the bladder.From 1998 to 2002, 1587 patients with newly diagnosed nonmuscle-invasive bladder cancer treated with transurethral resection were enrolled in this study. The median age was 63 years (range 21-98), and the median follow-up duration was 44 months (range 12-97). The study cohort was subdivided into 3 age groups: age60 years (group 1, n = 614), ageor = 60 but70 years (group 2, n = 566), and ageor = 70 years (group 3, n = 398).Comparing the clinical and pathologic characteristics, the tumor size (chi(2)(trend) = 4.01, P = .045), multiplicity (chi(2)(trend) = 14.50, P.001), T category (chi(2)(trend) = 17.11, P.001), and tumor grade (chi(2)(trend) = 31.36, P.001) tended to increase in the older age groups. The presence of carcinoma in situ and squamous differentiation, however, did not differ among the age groups (P.05). The 5-year recurrence-free probability was 63.6%, 52.1%, and 43.9% for groups 1, 2, and 3, respectively (P.001). The 5-year progression-free probability was 95.7%, 91.1%, and 84.2% for groups 1, 2, and 3, respectively (P.001).Stage Ta, T1 bladder urothelial carcinoma in the younger patients tended to be smaller, have fewer lesions, be less invasive, and have a more favorable tumor grade at the initial presentation. Furthermore, younger patients appeared to have a more favorable prognosis than older patients.

We investigated the detection rate of prostate cancer in Korean men through a population based mass screening test.In June 2007 serum prostate specific antigen was examined in 3,943 residents in the Gangneung (1,429), Daegu (1,396) and Jeonju (1,118) areas who were 55 years or older with prostate specific antigen 3.0 ng/ml or greater considered the criterion for 12-site transrectal biopsy recommendation. The serum prostate specific antigen distribution and the cancer detection rate were analyzed according to participant regions and age groups.Mean +/- SD serum prostate specific antigen in the entire cohort was 2.4 +/- 8.6 ng/ml. It significantly increased with increasing age, that is 1.2, 2.2, 3.4 and 4.7 ng/ml in the groups 55 to 64, 65 to 74, 75 to 84 and 85 years or older, respectively (p0.0001). However, no regional differences were noted among Gangneung, Daegu and Jeonju (2.2, 2.7 and 2.3 ng/ml, respectively, p = 0.290). Biopsy candidates represented 7.3% (48 men), 17.7% (395), 25.5% (240) and 32.7% (36) of the 55 to 64, 65 to 74, 75 to 84 and 85 years or older groups, respectively, or 18.2% of the entire cohort of 719. Of biopsy candidates 268 (37.3%) had undergone biopsy, of whom cancer was detected in 76 (28.4%) for a cancer detection rate and estimated cancer detection rate of 1.93% and 5.17%, respectively. The age adjusted estimated cancer detection rate (55 years or older) was 3.36%. Cancer detection increased significantly with increasing prostate specific antigen, that is 12.3% at 3.0 to 4.0 ng/ml, 27.3% at 4.1 to 10.0 and 64.1% at greater than 10.0. The Gleason score was 2-6 in 41 men (53.9%), 7 in 14 (18.4%) and 8-10 in 21 (27.6%).The estimated cancer detection rate in Korean men 55 years or older was 3.36%. The significance of the high rate in this population should be determined through repeat screening and further surveillance in the future.