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Purpose: Gastroesophageal reflux in infant is a physiological process. However, surgery is performed in high risk infants with severe gastroesophageal reflux disease (GERD) when medical management fails. This study focuses on efficacy and safety of Nissen fundoplication for GERD in infants under age 12 months. Methods: This study was a retrospective case analysis of 11 neonates and infants under 12 months of age who underwent Nissen fundoplication following a failure of medical treatment between June 2010 and June 2013 at Pusan National University Children's Hospital. The records were reviewed to determine the effect of fundoplication on symptoms and post-operative complications. Results: A total of 11 infants consist of four males and seven females. Mean birth weight was 2,305.5±558.6 g (1,390-3,130 g). They had some underlying disease, which are not related with GERD such as congenital heart disease (54.5%), prematurity (45.5%), neurologic disease (18.2%), respiratory disease (18.2%), and other gastrointestinal disease. Mean body weight at surgery was 3,803.6±1,864.9 g (1,938.7-5,668.5 g). Mean age at operation was 99.9±107.6 days (17-276 days). Duration from operation to full enteral feeding was 10.9 days. Symptoms related GERD disappeared in all patients including one who got reoperation. One infant died of congenital heart disease unrelated to surgery. There were no complications related to fundoplication. Conclusion: Fundoplication is effective and safe treatment in the neonates and infants with severe GERD. [ABSTRACT FROM AUTHOR]

PURPOSE. The objective of this study was to evaluate the clinical acceptability of all-ceramic crowns fabricated by the digital veneering method vis-à-vis the traditional method. MATERIALS AND METHODS. Zirconia specimens manufactures by two different manufacturing method, conventional vs digital veneering, with three different thickness (0.3 mm, 0.5 mm, 0.7 mm) were prepared for analysis. Color measurement was performed using a spectrophotometer for the prepared specimens. The differences in shade in relation to the build-up method were calculated by quantifying ΔE* (mean color difference), with the use of color difference equations representing the distance from the measured values L*, a*, and b*, to the three-dimensional space of two colors. Two-way analysis of variance (ANOVA) combined with a Tukey multiple-range test was used to analyze the data (α=0.05). RESULTS. In comparing means and standard deviations of L*, a*, and b* color values there was no significant difference by the manufacturing method and zirconia core thickness according to a two-way ANOVA. The color differences between two manufacturing methods were in a clinically acceptable range less than or equal to 3.7 in all the specimens. CONCLUSION. Based on the results of this study, a carefully consideration is necessary while selecting upper porcelain materials, even if it is performed on a small scale. However, because the color reproducibility of the digital veneering system was within the clinically acceptable range when comparing with conventional layering system, it was possible to estimate the possibility of successful aesthetic prostheses in the latest technology. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the accuracy and precision of polyurethane (PUT) dental arch models fabricated using a three-dimensional (3D) subtractive rapid prototyping (RP) method with an intraoral scanning technique by comparing linear measurements obtained from PUT models and conventional plaster models. Methods: Ten plaster models were duplicated using a selected standard master model and conventional impression, and 10 PUT models were duplicated using the 3D subtractive RP technique with an oral scanner. Six linear measurements were evaluated in terms of x, y, and z-axes using a non-contact white light scanner. Accuracy was assessed using mean differences between two measurements, and precision was examined using four quantitative methods and the Bland-Altman graphical method. Repeatability was evaluated in terms of intra-examiner variability, and reproducibility was assessed in terms of inter-examiner and inter-method variability. Results: The mean difference between plaster models and PUT models ranged from 0.07 mm to 0.33 mm. Relative measurement errors ranged from 2.2% to 7.6% and intraclass correlation coefficients ranged from 0.93 to 0.96, when comparing plaster models and PUT models. The Bland-Altman plot showed good agreement. Conclusions: The accuracy and precision of PUT dental models for evaluating the performance of oral scanner and subtractive RP technology was acceptable. Because of the recent improvements in block material and computerized numeric control milling machines, the subtractive RP method may be a good choice for dental arch models. [ABSTRACT FROM AUTHOR]

PURPOSE. This study aimed to investigate the potential clinical application of digitized silicone rubber impressions by comparing the accuracy of zirconia 3-unit fixed partial dentures (FPDs) fabricated from 2 types of data (working model and impression) obtained from a laser scanner. MATERIALS AND METHODS. Ten working models and impressions were prepared with epoxy resin and vinyl polysiloxane, respectively. Based on the data obtained from the laser scanner (D-700; 3Shape A/S, Copenhagen, Denmark), a total of 20 zirconia frameworks were prepared using a dental CAD/CAM system (DentalDesigner; 3shape A/S, Copenhagen, Denmark / Ener-mill, Dentaim, Seoul, Korea). The silicone replicas were sectioned into four pieces to evaluate the framework fit. The replicas were imaged using a digital microscope, and the fit of the reference points (P1, P2, P3, P4, P5, P6, and P7) were measured using the program in the device. Measured discrepancies were divided into 5 categories of gaps (MG, CG, AWG, AOTG, OG). Data were analyzed with Student's t-test (α=0.05), repeated measures ANOVA and twoway ANOVA (α=0.05). RESULTS. The mean gap of the zirconia framework prepared from the working models presented a narrower discrepancy than the frameworks fabricated from the impression bodies. The mean of the total gap in premolars (P=.003) and molars (P=.002) exhibited a statistical difference between two groups. CONCLUSION. The mean gap dimensions of each category showed statistically significant difference. Nonetheless, the digitized impression bodies obtained with a laser scanner were applicable to clinical settings, considering the clinically acceptable marginal fit (120 μm). [ABSTRACT FROM AUTHOR]

ackground: Established heart failure in thalassaemia major has a poor prognosis and optimal management remains unclear. Methods: A 1 year prospective study comparing deferoxamine (DFO) monotherapy or when combined with deferiprone (DFP) for patients with left ventricular ejection fraction (LVEF) <56% was conducted by the Thalassemia Clinical Research Network (TCRN). All patients received DFO at 50-60 mg/kg 12-24 hr/day sc or iv 7 times weekly, combined with either DFP 75 at mg/kg/day (combination arm) or placebo (DFO monotherapy arm). The primary endpoint was the change in LVEF by CMR. Results: Improvement in LVEF was significant in both study arms at 6 and 12 months (p = 0.04), normalizing ventricular function in 9/16 evaluable patients. With combination therapy, the LVEF increased from 49.9% to 55.2% (+5.3% p = 0.04; n = 10) at 6 months and to 58.3% at 12 months (+8.4% p = 0.04; n = 7). With DFO monotherapy, the LVEF increased from 52.8% to 55.7% (+2.9% p = 0.04; n = 6) at 6 months and to 56.9% at 12 months (+4.1% p = 0.04; n = 4). The LVEF trend did not reach statistical difference between study arms (p = 0.89). In 2 patients on DFO monotherapy during the study and in 1 patient on combined therapy during follow up, heart failure deteriorated fatally. The study was originally powered for 86 participants to determine a 5% difference in LVEF improvement between treatments. The study was prematurely terminated due to slow recruitment and with the achieved sample size of 20 patients there was 80% power to detect an 8.6% difference in EF, which was not demonstrated. Myocardial T2* improved in both arms (combination +1.9 ± 1.6 ms p = 0.04; and DFO monotherapy +1.9 ± 1.4 ms p = 0.04), but with no significant difference between treatments (p = 0.65). Liver iron (p = 0.03) and ferritin (p < 0.001) both decreased significantly in only the combination group. Conclusions: Both treatments significantly improved LVEF and myocardial T2*. Although this is the largest and only randomized study in patients with LV decompensation, further prospective evaluation is needed to identify optimal chelation management in these high-risk patients. [ABSTRACT FROM AUTHOR]

Background: HIV-infected women, particularly those with advanced disease, may have higher rates of pregnancy loss (miscarriage and stillbirth) and neonatal mortality than uninfected women. Here we examine risk factors for these adverse pregnancy outcomes in a cohort of HIV-infected women in Zambia considering the impact of infant HIV status. Methods: A total of 1229 HIV-infected pregnant women were enrolled (2001-2004) in Lusaka, Zambia and followed to pregnancy outcome. Live-born infants were tested for HIV by PCR at birth, 1 week and 5 weeks. Obstetric and neonatal data were collected after delivery and the rates of neonatal (<28 days) and early mortality (<70 days) were described using Kaplan-Meier methods. Results: The ratio of miscarriage and stillbirth per 100 live-births were 3.1 and 2.6, respectively. Higher maternal plasma viral load (adjusted odds ratio [AOR] for each log10 increase in HIV RNA copies/ml = 1.90; 95% confidence interval [CI] 1.10-3.27) and being symptomatic were associated with an increased risk of stillbirth (AOR = 3.19; 95% CI 1.46-6.97), and decreasing maternal CD4 count by 100 cells/mm3 with an increased risk of miscarriage (OR = 1.25; 95% CI 1.02-1.54). The neonatal mortality rate was 4.3 per 100 increasing to 6.3 by 70 days. Intrauterine HIV infection was not associated with neonatal morality but became associated with mortality through 70 days (adjusted hazard ratio = 2.76; 95% CI 1.25-6.08). Low birth weight and cessation of breastfeeding were significant risk factors for both neonatal and early mortality independent of infant HIV infection. Conclusions: More advanced maternal HIV disease was associated with adverse pregnancy outcomes. Excess neonatal mortality in HIV-infected women was not primarily explained by infant HIV infection but was strongly associated with low birth weight and prematurity. Intrauterine HIV infection contributed to mortality as early as 70 days of infant age. Interventions to improve pregnancy outcomes for HIV-infected women are needed to complement necessary therapeutic and prophylactic antiretroviral interventions. [ABSTRACT FROM AUTHOR]

Objectives: Korean red ginseng (KRG) improves endothelial function and lower blood pressure (BP), which may affect arterial stiffness. The present study evaluated whether KRG treatment could improve arterial stiffness in subjects with hypertension. Subjects and methods: Eighty (80) participants with hypertension who were treated with antihypertensive agents were randomly assigned to an active (KRG 3 g/day) or a placebo treatment group in a double-blind manner. Participants were not allowed to change their antihypertensive medications. Systolic BP (SBP) and diastolic BP (DBP) were measured at baseline, and at 1, 2, and 3 months. Arterial stiffness was assessed by the measurement of brachial-ankle pulse wave velocity (baPWV) at baseline, and at 1 and 3 months. Results: Thirty (30) subjects in the active group (AG) and 34 subjects in the placebo group (PG) completed 3 months of treatment and then a per-protocol analysis was done. SBP and DBP at baseline, and at 1, 2, and 3 months were not different between the AG and PG ( p > 0.05). After 3 months of treatment, SBP of AG was not changed from SBP at baseline. However, DBP of AG, and SBP and DBP of PG after 3 months of treatment were significantly reduced ( p < 0.05). baPWV of both groups was significantly reduced at 1 and 3 months ( p < 0.05), but was not different between the groups at each time point. Analysis after adjustment for age, time-dependent mean arterial BP, heart rate, and levels of fasting blood glucose and triglycerides showed no significant difference between AG and PG in changes of baPWV from baseline to 1 and 3 months ( p > 0.05). Conclusions: Three (3) months' treatment with KRG did not improve arterial stiffness in subjects with hypertension. [ABSTRACT FROM AUTHOR]

The aims of this study were to assess predictors of global self-ratings of oral health (GSROH) and to examine whether they varied by age among Korean adults aged 18-95 years. Data from 4,546 adults aged 18-95 years completing the Korean National Oral Health Survey 2006 were included in the analysis. Subjects' mean age was 43.5 years, with 12.1 percent aged ≥65 years; 47.8 percent were men; and 2.5 percent were edentulous. The predictors of GSROH in adults were number of missing teeth, concern about oral health, and difficulty in chewing. While wearing removable dentures was associated only in elders, perceived treatment need was associated in younger age groups. The number of decayed and filled teeth was significant only in the 18-44 age group. GSROH status was associated with measures of oral disease, oral functional problems, oral health behaviors, concerns, and perceived treatment needs, and it varied by age. [ABSTRACT FROM AUTHOR]

The article discusses a study on Gogu Valley, a potential high-yielding and raw-eating potato cultivar. Gogu Valley has a medium plant height, dark green foliage, medium flowering habit and light purple flowers. The study used cultivar Superior as a standard check and found that Gogu Valley yields processing quality and mineral content. Desirable characteristics of the potato cultivar are mentioned.

Objective The aim of this study was to assess the association of chewing ability to oral health-related quality of life (OHRQoL) measured by the Oral Health Impact Profile-14 (OHIP-14) controlling for clinical oral health status, self-reported health status, demographic factors, and socioeconomic conditions among community-dwelling and institutionalized Korean elders. Methods This cross-sectional study comprised a sample of 307 community-dwelling and 102 institutionalized people over the age of 60, using a cluster sampling procedure. A questionnaire was implemented and a clinical oral examination was completed for each subject. The outcome variable of interest was the OHIP-14 score, and its associations with chewing ability, objective oral health status, self-reported health status, demographic factors, and socioeconomic conditions were assessed. Because of highly-skewed distribution of the OHIP-14 scores, nonparametric analytic methods were used. The final model was developed using a multivariable two-level logistic regression model for a dichotomized OHIP-14 score to account for the cluster sampling method applied to this study. Results The mean age of the participants was 75.4 years, with 67.7% being women. The median OHIP-14 score was 7. Negative oral health impacts were experienced fairly often or very often by a total of 36.4% of elderly. In the final model, elders who could chew none to three and four to six foods among seven indicator foods were 3.4 ( P = 0.010) and 2.0 ( P = 0.040) times more likely, respectively, to have worse OHRQoL compared with elders who could chew all seven food types. Also significant associations with worse OHRQoL were shown for being concerned about oral health [Odds Ratio (OR) = 4.9, P = 0.002], fair or better self-reported oral health (OR = 0.12, P = 0.002), very good/good self-reported general health (OR = 0.38, P = 0.008), being married (OR = 2.0, P = 0.054), and having a favourable economic status (OR = 0.43, P = 0.042). Conclusions This study showed highly significant association between chewing ability and OHRQoL measured by the OHIP-14 score after controlling for related factors. Amelioration of chewing ability might independently contribute to improving the OHRQoL of elders. [ABSTRACT FROM AUTHOR]

We derive the operating characteristics of three-dimensional array-based testing algorithms for case identification in the presence of testing error. The operating characteristics investigated include efficiency (i.e., expected number of tests per specimen) and error rates (e.g., sensitivity, specificity, positive, and negative predictive values). The methods are illustrated by comparing the proposed algorithms with previously studied hierarchical and two-dimensional array algorithms for detecting recent HIV infections in North Carolina. Our results indicate that three-dimensional array-based algorithms can be more efficient and accurate than previously proposed algorithms in settings with test error and low prevalence. [ABSTRACT FROM AUTHOR]

We derive and compare the operating characteristics of hierarchical and square array-based testing algorithms for case identification in the presence of testing error. The operating characteristics investigated include efficiency (i.e., expected number of tests per specimen) and error rates (i.e., sensitivity, specificity, positive and negative predictive values, per-family error rate, and per-comparison error rate). The methodology is illustrated by comparing different pooling algorithms for the detection of individuals recently infected with HIV in North Carolina and Malawi. [ABSTRACT FROM AUTHOR]

This study aims to examine associations between missing teeth with unmet needs (MTUN) and socioeconomic status, represented by income and place of residence. The National Health Insurance Corporation dataset of 822,325 dentate Korean government employees' dental examinations results, questionnaire responses in the year 2000, and basic information collected for administrative purposes was used for this analysis. The main outcome variable was the number of MTUN, categorized into three groups: none, 1-2, and ≥3. Explanatory variables were assessed and a multinomial logistic regression was employed. Seventy percent were men, with a mean age of 39.1 years (range 18 to 74). The mean number of MTUN was 0.34, and 19.1 percent had ≥1 MTUN. After adjusting for other variables, age and income were the most salient independent predictors. Rural residents, men, older adults, persons having smoking experience, and persons visiting a dental clinic in the past year were more likely to have ≥1 MTUN than their counterparts. People performing frequent toothbrushing or having received professional scaling in the past year were less likely to have ≥1 MTUN than their counterparts. Among South Korean government employees with a general dental care insurance benefit, exclusive of prosthetic services, having normative unmet prosthetic need was significantly associated with older age, lower income, and rural residence, taking into account other demographic factors, personal health practices, and dental service utilization. [ABSTRACT FROM AUTHOR]

Many useful statistics equal the ratio of a possibly noncentral chi-square to a quadratic form in Gaussian variables with all positive weights. Expressing the density and distribution function as positively weighted sums of corresponding F functions has many advantages. The mixture forms have analytic value when embedded within a more complex problem. The mixture forms also have computational value. The expansions work well with quadratic forms having few components and small degrees of freedom. A more general algorithm from earlier literature can take longer or fail to converge in the same setting. Many approximations have been suggested for the problem. A positively weighted noncentral quadratic form can always have two moments matched to a noncentral chi-square. For a single quadratic form, the noncentral form performs neither uniformly more or less accurately than older approximations. The approach also gives a noncentral F approximation for any ratio of a positively weighted noncentral form to a positively weighted central quadratic form. The method provides better accuracy for noncentral ratios than approximations based on a single chi-square. The accuracy suffices for many practical applications, such as power analysis, even with few degrees of freedom. Naturally the approximation proves much faster and simpler to compute than any exact method. Embedding the approximation in analytic expressions provides simple forms which correctly guarantee only positive values have nonzero probabilities, and also automatically reduce to partially or fully exact results when either quadratic form has only one term. [ABSTRACT FROM AUTHOR]

The methanol extract of stems of Catalpa ovata G Don exhibits potent in vivo antifungal activity against Magnaporthe grisea (Hebert) Barr (rice blast) on rice plants, Botrytis cinerea Pers ex Fr (tomato grey mould) and Phytophthora infestans (Mont) de Bary (tomato late blight) on tomato plants, Puccinia recondita Rob ex Desm (wheat leaf rust) on wheat plants and Blumeria graminis (DC) Speer f. sp. hordei Marchal (barley powdery mildew) on barley plants. An antifungal substance was isolated and identified as dehydro-α-lapachone from mass and nuclear magnetic resonance spectral data. It completely inhibited the mycelial growth of B. cinerea, Colletotrichum acutatum Simmonds, Colletotrichumgloeosporioides Simmonds, M. grisea and Pythium ultimum Trow over a range of 0.4-33.3mg litre-1. It also controlled the development of rice blast, tomato late blight, wheat leaf rust, barley powdery mildew and red pepper anthracnose (Colletotrichum coccodes (Wallr) S Hughes). The chemical was particularly effective in suppressing red pepper anthracnose by 95% at a concentration of 125mg litre-1. [ABSTRACT FROM AUTHOR]

Purpose: Alimentary tract duplication (ATD) is a rare congenital condition that may occur throughout the intestinal tract. Clinical symptoms are generally related to the involved site, size of duplication, or associated ectopic mucosa. This study aimed to identify clinical implications by anatomical locations and age group and then suggest a relevant management according to its distinct features. Methods: We retrospectively reviewed the clinical data of pediatric patients who received a surgical management due to ATD. Furthermore, data including patients' demographics, anatomical distribution of the duplication, clinical features according to anatomical variants, and outcomes were compared. Results: A total of 25 patients were included in this study. ATD developed most commonly in the midgut, especially at the ileocecal region. The most common clinical presentation was abdominal pain, a sign resulting from intestinal obstruction, gastrointestinal bleeding, and intussusception. The non-communicating cystic type was the most common pathological feature in all age groups. Clinically, prenatal detection was relatively low; however, it usually manifested before the infantile period. A laparoscopic procedure was performed in most cases (18/25, 72.0%), significantly in the midgut lesion ( p=0.012). Conclusion: ATD occurs most commonly at the ileocecal region, and a symptomatic one may usually be detected before the early childhood period. Surgical management should be considered whether symptom or not regarding its symptomatic progression, and a minimal invasive procedure is the preferred method, especially for the midgut lesion. [ABSTRACT FROM AUTHOR]

Purpose: Perforation of choledochal cyst (CC) is a relatively rare clinical presentation in pediatric populations and difficult to predict preoperatively. We assess the clinical implications by comparing clinical parameters based on a single-center experience between perforated and nonperforated CC to facilitate the appropriate management for future interventions. Methods: A total of 92 cases of CC in pediatric patients (aged <18 years) who received surgical management between January 2003 and December 2018 at a Pusan National University Children's Hospital were reviewed. After screening the clinical features of perforated cases, we compared the demographic findings, clinical characteristics, and some laboratory results between the perforated and nonperforated groups. Results: Perforated CC was identified in 8 patients (8.7%), and nonperforated CC in 84 patients (91.3%). Perforation can be classified into three categories: free perforation of cyst (3 cases), pinpoint perforation of cyst (2 cases), and necrotic change of cyst (3 cases). CC perforation occurred significantly more commonly in patients aged <24 months. Clinically, the perforated group showed significantly higher frequency of fever and higher C-reactive protein (CRP) level during the initial visit. Conclusion: Perforation is more likely to be suspected in patients aged <24 months presenting together with fever and high CRP level in the initial visit. It is also necessary to keep in mind that it indicates not only a possibility of complicated disease status regardless of its association with stones but also a difficulty of applying a minimal invasive procedure and relatively increased length of hospital stay. [ABSTRACT FROM AUTHOR]

We fit a Cox proportional hazards (PH) model to interval-censored survival data by first subdividing each individual's failure interval into nonoverlapping sub-intervals. Using the set of all interval endpoints in the data set, those that fall into the individual's interval are then used as the cut points for the sub-intervals. Each sub-interval has an accompanying weight calculated from a parametric Weibull model based on the current parameter estimates. A weighted PH model is then fit with multiple lines of observations corresponding to the sub-intervals for each individual, where the lower end of each sub-interval is used as the observed failure time with the accompanying weights incorporated. Right-censored observations are handled in the usual manner. We iterate between estimating the baseline Weibull distribution and fitting the weighted PH model until the regression parameters of interest converge. The regression parameter estimates are fixed as an offset when we update the estimates of the Weibull distribution and recalculate the weights. Our approach is similar to Satten et al.'s (1998) method for interval-censored survival analysis that used imputed failure times generated from a parametric model in a PH model. Simulation results demonstrate apparently unbiased parameter estimation for the correctly specified Weibull model and little to no bias for a mis-specified log-logistic model. Breast cosmetic deterioration data and ICU hyperlactemia data are analyzed. [ABSTRACT FROM AUTHOR]

Purpose: Abdominoperineal solid tumors presenting in neonates often require surgical intervention during the neonatal period. Although we report our single-center experience, this study would be meaningful to understand the clinical implications of these neoplasms. Methods: We retrospectively reviewed and analyzed the clinical data and characteristics of 22 patients (≤28 days old) diagnosed with histopathologically confirmed abdominoperineal solid neoplasms (benign or malignant) after surgical resection. Results: The mean gestational age and postnatal age at the time of operation were 38.3±1.8 weeks and 13.5±8.3 days, respectively. Most patients (18/22, 81.8%) were diagnosed during antenatal care visits; however, 4 (18.2%) were identified after birth. The mean tumor size was 6.4×5.3 cm (3.5-17.0 cm), and tumors occurred most frequently within the sacrococcygeal region (8/22, 36.4%). Histopathologically, 14 patients (63.6%) demonstrated benign tumors and 8 (36.4%) demonstrated malignant tumors. Germ cell tumors and hepatoblastomas were the most commonly observed tumors. Fortunately, all patients showed a localized pattern of tumor involvement without distant metastasis. No recurrence or mortality was observed during the follow-up period (mean 66.4±44.2 months). Conclusion: Abdominoperineal solid tumors occurring in neonates show variable clinical patterns during the antenatal and postnatal monitoring/screening periods. We conclude that aggressive and multidisciplinary approaches could achieve good clinical results in these patients. [ABSTRACT FROM AUTHOR]

Aim: Both skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) have been widely adopted. Although postmastectomy radiation therapy (PMRT) can improve clinical outcomes, it can worsen cosmesis following reconstruction. Therefore, identifying risk factors of ipsilateral breast tumor recurrence (IBTR) could help de-escalate PMRT after NSM/SSM in patients with pT1-2 disease. Methods: We retrospectively reviewed patients treated with SSM (N = 400) and NSM (N = 156) in patients with pT1-2N0-1 disease between 2009 and 2016. Seventy-four patients received PMRT with 50–50.4 Gy in 25–28 fractions. The Cox proportional hazards model was used to analyze the prognostic factors of IBTR. Results: With a median follow-up of 66.2 months, 17 IBTR events were observed, with 5-year IBTR-free rate of 97.2%. Although only one IBTR was observed after PMRT, there was no statistical difference in the 5-year IBTR-free rate (PMRT vs. no PMRT, 98.6% vs. 97.0%, p = 0.360). Multivariable analyses demonstrated that age ≤45 years and lymphovascular invasion (LVI) were adverse features of IBTR. The low-risk group (0 risk factor) showed a better 5-year IBTR-free rate than the high-risk group (≥1 risk factor) (100.0% vs. 95.8%, p = 0.003). In the high-risk group, PMRT slightly improved 5-year IBTR-free rate compared with no PMRT (98.6% vs. 95.2%, p = 0.166). In addition, PMRT increased 5-year cumulative incidence of reconstruction failure (10.0% vs. 2.8%, p = 0.001). Conclusion: We identified risk factors (age and LVI) related to IBTR following upfront SSM/NSM with pT1-2 disease. As a hypothesis-generating study, de-escalation of PMRT by omitting chest wall irradiation in selective patients could improve reconstruction-related complications without compromising oncologic outcomes.

Purpose: Spontaneous colon perforations are usually encountered as necrotizing enterocolitis in the neonatal period, but occur rarely in infants and children without pathological conditions. This study was conducted to describe its clinical implication beyond the neonatal period. Methods: Cases of spontaneous colon perforation confirmed after the operation were reviewed retrospectively and the clinicopathological characteristics were analyzed. Clinical data were compared according to the presence of pneumoperitoneum as initial findings. Results: Eleven patients were included in the study period and showed a history of hospitalization before transfer due to management for fever, respiratory or gastrointestinal problems. Six patients showed a sudden onset of abdominal distention and only seven patients showed a pneumoperitoneum as initial radiologic findings, however there were no significant clinicopathological differences. Perforation was found evenly in all segments of the colon, most commonly at the sigmoid colon in four cases. There were no specific pathologic or serologic causes of perforation. Conclusion: When previously healthy infants and children manifest a sustained fever with a sudden onset of abdominal distention during management for fever associated with respiratory or gastrointestinal problems, there is a great likelihood of colon perforation with no pathological condition. Prompt surgical management as timely decision-making is necessary in order to achieve a good progress. [ABSTRACT FROM AUTHOR]

Research shows that using computer-aided mapping tools improves critical thinking skills, but prior research provides limited evidence to show how the use of specific critical thinking skills increases map quality. This qualitative study observed 4 experts and 5 novices use a computer-aided mapping tool to construct argument maps. The analysis of video recordings with think-aloud protocols and retrospective interviews revealed the use of a five-step argument mapping process (read claims, position conclusion, position claims, link claims, revise links) with the experts using a more sequential application of the five-step process and producing more accurate maps than novices. The novices showed the tendency to position and link claims as a joint action, making map revision more cumbersome. The experts exhibited the tendency to work backward from conclusion to claim while the novices exhibited the reverse tendency. This study’s findings identify processes that differentiate experts from novices and validate specific thinking skills that can be used to improve map quality, and how these processes can be operationalized in terms of discrete mapping behaviors performed on screen that can be mined and analyzed in mapping tools to assess and diagnose students’ mapping skills.

Objective To identify the prevalence and characteristics of neuropathic pain (NP) in patients with spinal cord injury (SCI) and to investigate associations between NP and demographic or disease-related variables. Methods We retrospectively reviewed medical records of patients with SCI whose pain was classified according to the International Spinal Cord Injury Pain classifications at a single hospital. Multiple statistical analyses were employed. Patients aged

Wandering spleen is a rare condition in which the spleen is not found in its usual location or presentation. Its vascular pedicle can be twisted easily, and compromised vasculature of spleen. Consequently, it may result in splenic infarction requiring diagnosis and treatment. Here we present 2 cases of splenic infarction due to torsion of wandering spleen in 2 adolescent girls who visited the emergency department presenting with abdominal pain. Prompt computed tomography scan led early diagnosis and successful laparoscopic splenectomy. We also reviewed the literature on this entity briefly.

Objective To compare the energy efficiency of gait with knee-ankle-foot orthosis (KAFO) and robot-assisted gait and to develop a usability questionnaire to evaluate the satisfaction of walking devices in paraplegic patients with spinal cord injuries. Methods Thirteen patients with complete paraplegia participated and 10 completed the evaluation. They were trained to walk with KAFO (KAFO-gait) or a ReWalk robot (ReWalk-gait) for 4 weeks (20 sessions). After a 2-week wash-out period, they switched walking devices and underwent 4 additional weeks of training. Two evaluations were performed (after 2 and 4 weeks) following the training periods for each walking device, using the 6-minute walking test (6MWT) and 30-minute walking test (30MWT). The spatiotemporal variables (walking distance, velocity, and cadence) and energy expenditure (heart rate, maximal heart rate, the physiologic cost index, oxygen consumption, metabolic equivalents, and energy efficiency) were evaluated duringthe 6MWT and 30MWT. A usability evaluation questionnaire for walking devices was developed based on the International Organization for Standardization/International Electrotechnical Commission guidelines through expert consultation. Results The ReWalk-gait presented significant advantages in energy efficiency compared to KAFO-gait in the 6MWT and 30MWT; however, there were no differences in walking distance or speed in the 30MWT between ReWalk-gait and KAFO-gait. The usability test demonstrated that ReWalk-gait was not superior to KAFO-gait in terms of safety, efficacy, efficiency, or patient satisfaction. Conclusion The robot (ReWalk) enabled patients with paraplegia to walk with lower energy consumption compared to KAFO, but the ReWalk-gait was not superior to KAFO-gaitin terms of patient satisfaction.

Objective To confirm the effects of combined upper limb robotic therapy (RT) as compared to conventional occupational therapy (OT) in tetraplegic spinal cord injury (SCI) patients and to suggest the optimized treatment guidelines of combined upper limb RT. Methods After subject recruitment and screening for eligibility, the baseline evaluation for outcome measures were performed. We evaluated the Graded and Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), the American Spinal Injury Association upper extremity motor score, grip and pinch strength, and the Spinal Cord Independence Measurement III (SCIM-III). In this study, the pre-tested participants were divided randomly into the RT and OT group. The utilized interventions included combined upper limb RT using ArmeoPower and Amadeo (RT group), or conventional OT (OT group) in addition to daily inpatient rehabilitation program. The participants underwent 40 minutes×3 sessions×5 weeks of interventions. Results A total of 30 tetraplegic SCI patients completed entire study program. After 5 weeks of intervention, both groups demonstrated increases in GRASSP-strength and SCIM-III. The manual muscle test scores of elbow flexion, elbow extension, 2-5th metacarpophalangeal extension, and SCIM-III subscores of bathing-upper, dressing-upper, and grooming as well as the GRASSP-qualitative prehension score were noted to have been significantly increased in the RT group as evaluated. The OT group showed improvements in the GRASSP-quantitative prehension score and some items in grip and pinch strength. There was no significant difference between the two groups in almost all measurements except for the SCIM-III bathing-upper subscore. Conclusion Combined upper limb RT demonstrated beneficial effects on the upper limb motor function in patients with tetraplegic SCI, which were comparable with conventional OT.

A vast disparity exists between science and practice for CT radiation dose. Despite high-level evidence supporting the use of low-dose CT (LDCT) in diagnosing appendicitis, a recent survey showed that many care providers were still concerned that the low image quality of LDCT may lead to incorrect diagnoses. For successful implementation of LDCT practice, it is important to inform and educate the care providers not only of the scientific discoveries but also of concrete guidelines on how to overcome more practical matters. Here, we discuss CT imaging techniques and other practical issues for implementing LDCT practice.

The performance of deep learning algorithm (DLA) to that of radiologists was compared in detecting low contrast objects in CT phantom images under various imaging conditions. For training, 10,000 images were created using American College of Radiology CT phantom as the background. In half of the images, objects of 3–20 mm size and 5–30 HU contrast difference were generated in random locations. Binary responses were used as the ground truth. For testing, 640 images of Catphan® phantom were used, half of which had objects of either 5 or 9 mm size with 10 HU contrast difference. Twelve radiologists evaluated the presence of objects on a five-point scale. The performances of the DLA and radiologists were compared across different imaging conditions in terms of area under receiver operating characteristics curve (AUC). Multi-reader multi-case AUC and Hanley and McNeil tests were used. We performed post-hoc analysis using bootstrapping and verified that the DLA is less affected by the changing imaging conditions. The AUC of DLA was consistently higher than those of the radiologists across different imaging conditions (p < 0.0001), and it was less affected by varying imaging conditions. The DLA outperformed the radiologists and showed more robust performance under varying imaging conditions.

A growth scheme at a low processing temperature for high crystalline-quality of ZnO nanostructures can be a prime stepping stone for the future of various optoelectronic devices manufactured on transparent plastic substrates. In this study, ZnO nanorods (NRs) grown by the hydrothermal method at 150 °C through doping of transition metals (TMs), such as Co, Ni, or Co-plus-Ni, on polyethylene terephthalate substrates were investigated by various surface analysis methods. The TM dopants in ZnO NRs suppressed the density of various native defect-states as revealed by our photoluminescence and X-ray photoelectron spectroscopy analysis. Further investigation also showed the doping into ZnO NRs brought about a clear improvement in carrier mobility from 0.81 to 3.95 cm2/V-s as well as significant recovery in stoichiometric contents of oxygen. Ultra-violet photodetectors fabricated with Co-plus-Ni codoped NRs grown on an interdigitated electrode structure exhibited a high spectral response of ~137 A/W, on/off current ratio of ~135, and an improvement in transient response speed with rise-up and fall-down times of ~2.2 and ~3.1 s, respectively.

To retrospectively investigate whether texture features obtained from preoperative CT images of advanced gastric cancer (AGC) patients could be used for the prediction of occult peritoneal carcinomatosis (PC) detected during operation.51 AGC patients with occult PC detected during operation from January 2009 to December 2012 were included as occult PC group. For the control group, other 51 AGC patients without evidence of distant metastasis including PC, and whose clinical T and N stage could be matched to those of the patients of the occult PC group, were selected from the period of January 2011 to July 2012. Each group was divided into test (n = 41) and validation cohort (n = 10). Demographic and clinical data of these patients were acquired from the hospital database. Texture features including average, standard deviation, kurtosis, skewness, entropy, correlation, and contrast were obtained from manually drawn region of interest (ROI) over the omentum on the axial CT image showing the omentum at its largest cross sectional area. After using Fisher's exact and Wilcoxon signed-rank test for comparison of the clinical and texture features between the two groups of the test cohort, conditional logistic regression analysis was performed to determine significant independent predictor for occult PC. Using the optimal cut-off value from receiver operating characteristic (ROC) analysis for the significant variables, diagnostic sensitivity and specificity were determined in the test cohort. The cut-off value of the significant variables obtained from the test cohort was then applied to the validation cohort. Bonferroni correction was used to adjust P value for multiple comparisons.Between the two groups, there was no significant difference in the clinical features. Regarding the texture features, the occult PC group showed significantly higher average, entropy, standard deviation, and significantly lower correlation (P value < 0.004 for all). Conditional logistic regression analysis demonstrated that entropy was significant independent predictor for occult PC. When the cut-off value of entropy (> 7.141) was applied to the validation cohort, sensitivity and specificity for the prediction of occult PC were 80% and 90%, respectively.For AGC patients whose PC cannot be detected with routine imaging such as CT, texture analysis may be a useful adjunct for the prediction of occult PC.

Esophageal atresia (EA) with proximal tracheoesophageal fistula (TEF; gross type B) is a rare defect. Although most patients have long-gap EA, there are still no established surgical guidelines. A premature male infant with symmetric intrauterine growth retardation (birth weight, 1,616 g) was born at 35 weeks and 5 days of gestation. The initial diagnosis was pure EA (gross type A) based on failure to pass an orogastric tube and the absence of stomach gas. A "feed and grow" approach was implemented, with gastrostomy performed on postnatal day 2. A fistula was detected during bronchoscopy for recurrent pneumonia; thus, we confirmed type B EA and performed TEF excision and cervical end esophagostomy. As the infant's stomach volume was insufficient for bolus feeding after reaching a body weight of 2.5 kg, continuous tube feeding was provided through a gastrojejunal tube. On the basis of these findings, esophageal reconstruction with gastric pull-up was performed on postnatal day 141 (infant weight, 4.7 kg), and he was discharged 21 days postoperatively. At 12 months after birth, there was no catch-up growth; however, he is currently receiving a baby food diet without any complications. In patients with EA, bronchoscopy is useful for confirming TEF, whereas for those with long-gap EA with a small stomach volume, esophageal reconstruction with gastric pull-up after continuous feeding through a gastrojejunal tube is worth considering. [ABSTRACT FROM AUTHOR]

Herein, a study on a new lower critical solution temperature (LCST) polymer in an organic solvent by an electrochemical technique has been reported. The phase-transition behavior of poly(arylene ether sulfone) (PAES) was examined on 1,2-dimethoxyethane (DME). At a temperature above the LCST point, polymer molecules aggregated to create polymer droplets. These droplets subsequently collided with an ultramicroelectrode (UME), resulting in a new form of staircase current decrease. The experimental collision frequency and collision signal were analyzed in relation to the concentration of the polymer. In addition, the degree of polymer aggregation associated with temperature change was also observed. [ABSTRACT FROM AUTHOR]

As a developing technology for flexible electronic device fabrication, ultra-violet (UV) photodetectors (PDs) based on a ZnO nanostructure are an effective approach for large-area integration of sensors on nonconventional substrates, such as plastic or paper. However, photoconductive ZnO nanorods grown on flexible substrates have slow responses or recovery as well as low spectral responsivity R because of the native defects and inferior crystallinity of hydrothermally grown ZnO nanorods at low temperatures. In this study, ZnO nanorod crystallites are doped with Cu or Ni/Cu when grown on polyethylene terephthalate (PET) substrates in an attempt to improve the performance of flexible PDs. The doping with Ni/Cu or Cu not only improves the crystalline quality but also significantly suppresses the density of deep-level emission defects in as-grown ZnO nanorods, as demonstrated by X-ray diffraction and photoluminescence. Furthermore, the X-ray photoelectron spectroscopy analysis shows that doping with the transition metals significantly increases the oxygen bonding with metal ions with enhanced O/Zn stoichiometry in as-grown nanorods. The fabricated flexible PD devices based on an interdigitated electrode structure demonstrates a very high R of ~123 A/W, a high on-off current ratio of ~130, and a significant improvement in transient response speed exhibiting rise and fall time of ~8 and ~3 s, respectively, by using the ZnO nanorods codoped by Ni/Cu.

Taxifolin is a potent flavonoid that exerts anti-oxidative effect, and cilostazol increases intracellular cAMP levels by inhibiting phosphodiesterase 3 that shows antiinflammatory actions. BACE1 (β-site APP cleaving enzyme 1) is the rate-limiting enzyme responsible for the β-cleavage of amyloid precursor proteins to Aβ peptides. In this study, endogenous Aβ and C99 accumulation was explored in N2a Swe cells exposed to 1% FBS medium. Increased Aβ and C99 levels were significantly attenuated by taxifolin alone and in combination with cilostazol. Increased phosphorylated JAK2 at Tyr1007/1008 (P-JAK), phosphorylated STAT3 at Tyr 705 (P-STAT3) expressions and increased expressions of BACE1 mRNA and protein in the activated N2a Swe cells were significantly attenuated by taxifolin (10~50 μM), cilostazol (10~50 μM) alone and in combination at minimum concentrations. In these cells, decreased cytosol IκBα expression was elevated, and increased nuclear NF-κB p65 level and nuclear NF-κB p65 DNA binding activity were significantly reduced by taxifolin and cilostazol in a similar manner. Following STAT3 gene (~70% reduction) knockdown in N2a cells, Aβ-induced nuclear NF-κB and BACE1 expressions were not observed. Taxifolin, cilostazol, or resveratrol significantly stimulated SIRT1 protein expression. In SIRT1 gene-silenced (~50%) N2a cells, taxifolin, cilostazol, and resveratrol all failed to suppress Aβ1-42-stimulated P-STAT3 and BACE1 expression. Consequently, taxifolin and cilostazol were found to significantly decrease lipopolysaccharide (1-10 μg/ml)-induced iNOS and COX-2 expressions, and nitrite production in cultured BV-2 microglia cells and to increase N2a cell viability. In conclusion, taxifolin and cilostazol strongly inhibited amyloidogenesis in a synergistic manner by suppressing P-JAK2/P-STAT3-coupled NF-κB-linked BACE1 expression via the up-regulation of SIRT1.

Ineffective erythropoiesis, the hallmark of ß-thalassemia, is a result of α/non-α globin chain imbalance.1 One strategy to redress globin-chain imbalance is to induce γ-globin gene (HBG) expression. Repression of HBG in adult erythroid cells involves DNA methylation and other epigenetic changes. Therefore, the cytosine analog decitabine, which can deplete DNA methyltransferase 1 (DNMT1), can potentially activate HBG. In 5 patients with ß-thalassemia intermedia, a dose and schedule of decitabine intended to deplete DNMT1 without causing significant cytotoxicity (0.2 mg/kg subcutaneous 2 times per week for 12 weeks) increased total hemoglobin from 7.88 ± 0.88 g/dL to 9.04 ± 0.77 g/dL (P = .004) and absolute fetal hemoglobin from 3.64 ± 1.13 g/dL to 4.29 ± 1.13 g/dL (P = .003). Significant favorable changes also occurred in indices of hemolysis and red blood cell densitometry. Consistent with a noncytotoxic, differentiation altering mechanism of action, the major side effect was an asymptomatic increase in platelet counts without erythrocyte micronucleus or VDJ recombination assay evidence of genotoxicity. [ABSTRACT FROM AUTHOR]

The progression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Africa has so far been heterogeneous, and the full impact is not yet well understood. In this study, we describe the genomic epidemiology using a dataset of 8746 genomes from 33 African countries and two overseas territories. We show that the epidemics in most countries were initiated by importations predominantly from Europe, which diminished after the early introduction of international travel restrictions. As the pandemic progressed, ongoing transmission in many countries and increasing mobility led to the emergence and spread within the continent of many variants of concern and interest, such as B.1.351, B.1.525, A.23.1, and C.1.1. Although distorted by low sampling numbers and blind spots, the findings highlight that Africa must not be left behind in the global pandemic response, otherwise it could become a source for new variants.