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AbstractBackground The use of a single abnormal finding on electrocardiography (ECG) is not recommended for stratifying the risk of cardiovascular (CV) events in low-risk general populations because of its low discriminative power. However, the value of a scoring system containing multiple abnormal ECG findings for predicting CV death has not been sufficiently evaluated.Methods In a prospective community-based cohort study, 8417 participants without atherosclerotic CV diseases (ASCVDs) and any related symptoms were followed for 18 years. The standard 12-lead ECGs were recorded at baseline and the ECG findings were categorized using the Minnesota code classification. CV deaths were defined as death from myocardial infarction (MI), chronic ischemic heart disease, heart failure, fatal arrhythmia, cerebrovascular event, pulmonary thromboembolism, peripheral vascular disease and sudden cardiac arrest and identified using the Korean National Statistical Office (KOSTAT) database.Results In a multivariate Cox proportional hazard (CPH) model, major and minor ST-T wave abnormalities, atrial fibrillation (AF), Q waves in the anterior leads, the lack of Q waves in the posterior leads, high amplitudes of the left and right precordial leads, left axis deviation and sinus tachycardia were associated with higher risks of CV deaths. The ECG score consisted of these findings showed modest predictive values represented by C-statistics that ranged from 0.632 to 760 during the follow-up and performed better in the early follow-up period. The ECG score independently predicted CV death after adjustment for relevant covariates in a multivariate model, and improved the predictive performance of the 10-year ASCVD risk estimator and a model of conventional risk factors including age, diabetes and current smoking. The combined ECG score (Harrell’s C-index: 0.852, 95% confidence interval [CI], 0.828–0.876) composed of the ECG score and the conventional risk factors outperformed the 10-year ASCVD risk estimator (Harrell’s C-index: 0.806; 95% CI, 0.780–0.833) and the model of the conventional risk factors (Harrell’s C-index: 0.841, 95% CI, 0.817–0.865) and exhibited an excellent goodness of fit between the predicted and observed probabilities of CV death.Conclusions The ECG score could be useful to predict CV death independently and may add value to the conventional CV risk estimators regarding the risk stratification of CV death in asymptomatic low-risk general populations.

In this paper, a nonlinear simulation block for a fish robot was designed using MATLAB Simulink. The simulation block incorporated added masses, hydrodynamic damping forces, restoring forces, and forces and moments due to dorsal fins, pectoral fins, and caudal fins into six-degree-of-freedom equations of motion. To obtain a linearized model, we used three different nominal surge velocities (i.e., 0.2 m/s, 0.4 m/s, and 0.6 m/s). After obtaining output responses by applying pseudo-random binary signal inputs to a nonlinear model, an identification tool was used to obtain approximated linear models between inputs and outputs. Utilizing the obtained linearized models, two-degree-of-freedom proportional, integral, and derivative controllers were designed, and their characteristics were analyzed. For the 0.4 m/s nominal surge velocity models, the gain margins and phase margins of the surge, pitch, and yaw controllers were infinity and 69 degrees, 26.3 dB and 85 degrees, and infinity and 69 degrees, respectively. The bandwidths of surge, pitch, and yaw control loops were determined to be 2.3 rad/s, 0.17 rad/s, and 2.0 rad/s, respectively. Similar characteristics were observed when controllers designed for linear models were applied to the nonlinear model. When step inputs were applied to the nonlinear model, the maximum overshoot and steady-state errors were very small. It was also found that the nonlinear plant with three different nominal surge velocities could be controlled by a single controller designed for a linear model with a nominal surge velocity of 0.4 m/s. Therefore, controllers designed using linear approximation models are expected to work well with an actual nonlinear model.

The LPS-induced inflammation model is widely used for studying inflammatory processes due to its cost-effectiveness, reproducibility, and faithful representation of key hallmarks. While researchers often validate this model using clinical cytokine markers, a comprehensive understanding of gene regulatory mechanisms requires extending investigation beyond these hallmarks. Our study leveraged multiple whole-blood bulk RNA-seq datasets to rigorously compare the transcriptional profiles of the well-established LPS-induced inflammation model with those of several human diseases characterized by systemic inflammation. Beyond conventional inflammation-associated systems, we explored additional systems indirectly associated with inflammatory responses (i.e., ISR, RAAS, and UPR) using a customized core inflammatory gene list. Our cross-condition-validation approach spanned four distinct conditions: systemic lupus erythematosus (SLE) patients, dengue infection, candidemia infection, and staphylococcus aureus exposure. This analysis approach, utilizing the core gene list aimed to assess the model’s suitability for understanding the gene regulatory mechanisms underlying inflammatory processes triggered by diverse factors. Our analysis resulted in elevated expressions of innate immune-associated genes, coinciding with suppressed expressions of adaptive immune-associated genes. Also, upregulation of genes associated with cellular stresses and mitochondrial innate immune responses underscored oxidative stress as a central driver of the corresponding inflammatory processes in both the LPS-induced and other inflammatory contexts.

Background: As excessive caffeine intake may be associated with anxiety disorders, one of the most prevalent mental illnesses among adolescents globally, this study investigated the association between high caffeine consumption and anxiety in a nationally representative sample of South Korean adolescents. Methods: 46,873 participants from the Korea Youth Risk Behavior Web-based Survey (KYRBS) 2022 were included. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire was used to evaluate anxiety symptoms. Survey questions determined the number of times each participant consumed high-caffeine drinks per week. The chi-square test was used to investigate and compare the general characteristics of the study population, and a modified Poisson regression was used to analyze the relationship. Results: Both male and female participants reporting excessive high-caffeine drink consumption exhibited higher anxiety levels (adjusted prevalence ratio [aPR]: 1.19, 95% confidence interval [CI]: 1.08–1.31 in males; aPR: 1.14, CI: 1.05–1.23 in females). This association remained statistically significant in subgroup analyses, particularly among high school students and those with a shorter sleep duration. The relationship between high-caffeine drink consumption and anxiety strengthened with increasing anxiety levels. Additionally, there was a dose-dependent relationship between the prevalence of anxiety and high-caffeine drinks. Conclusion: High caffeine consumption increases anxiety in South Korean adolescents. This association proved consistent regardless of sex or other socioeconomic factors.

Background: Although the history of psychiatry has been relatively short, psychiatry has been progressively developed through Westernization to assimilate into the psychiatric practices and research of developed countries. Psychiatry in South Korea has followed the above-described rule. In this review, I am describing the picture of psychiatric practice in South Korea for the readership of the Taiwanese Journal of Psychiatry. Methods: In this review, I am planning to introduce a brief history of psychiatry in South Korea first, to describe the current status of mental health-care services, and to highlight special programs to deal with special psychiatric issues in South Korea. Results: A three-layer hierarchical system (including [a] the Ministry of Health and Welfare, [b] the Metropolitan City or Province, as well as [c] the City, County, or District), has been organized in South Korea. With the complete revision of the Act on Mental Health and Welfare in 2016, the processes and requisites of psychiatric hospitalization or admission have been complicated. As a result, based on the Penrose hypothesis, deinstitutionalization has been regarded as one of the causative factors for “trans-institutionalization.” Thus, it has been suggested that the policies for the treatment and prevention of psychiatric persons should be controlled at a national level. South Korea has presented herself to have the highest suicide death rate in 2021 among the Organization for Economic Cooperation and Development (OECD) countries. Hence, “Suicide CARE” has been originally developed as a gatekeeper program in Korea. Furthermore, the economically weak have undergone more severe psychiatric difficulties, even after the COVID-19 pandemic. Thus, proactive care measures to secondary emotional reaction of the COVID-19 pandemic have been required in Korea. Finally, renaming the Korean terms for terminology in psychiatry, epilepsy, and schizophrenia has been done in an attempt to reduce stigma associated with persons of the mentally ill and denote more essential characteristics of mental health fields. Furthermore, it is expected that the detailed description of anger syndrome and fear of interpersonal relationship can enrich the cultural conceptualization of distress in the DSM-5. Conclusion: Despite existences of several problems of the mental health-care system, psychiatry has been progressively developed and steadily established its own originality in South Korea.

In this paper, we propose an improved clustering algorithm for wireless sensor networks (WSNs) that aims to increase network lifetime and efficiency. We introduce an enhanced fuzzy spider monkey optimization technique and a hidden Markov model-based clustering algorithm for selecting cluster heads. Our approach considers factors such as network cluster head energy, cluster head density, and cluster head position. We also enhance the energy-efficient routing strategy for connecting cluster heads to the base station. Additionally, we introduce a polling control method to improve network performance while maintaining energy efficiency during steady transmission periods. Simulation results demonstrate a 1.2% improvement in network performance using our proposed model.

Viruses have evolved sophisticated mechanisms to manipulate host cell processes and utilize intracellular organelles to facilitate their replication. These complex interactions between viruses and cellular organelles allow them to hijack the cellular machinery and impair homeostasis. Moreover, viral infection alters the cell membrane’s structure and composition and induces vesicle formation to facilitate intracellular trafficking of viral components. However, the research focus has predominantly been on the immune response elicited by viruses, often overlooking the significant alterations that viruses induce in cellular organelles. Gaining a deeper understanding of these virus-induced cellular changes is crucial for elucidating the full life cycle of viruses and developing potent antiviral therapies. Exploring virus-induced cellular changes could substantially improve our understanding of viral infection mechanisms.

The present study evaluates the effect of the slinger ring on the forced convection heat transfer in window air conditioners. Slinger rings are fitted around condenser fans to spread the condensate onto the condenser to achieve additional cooling. The single-phase forced convection is simulated to compare the thermal performance of the multiphase flow by the slinger ring. Experiments are performed to validate the numerical results. The numerical results well reconstruct the experimental ones, showing the regional dependent distribution and the discharge of the sprayed condensates by the slinger ring. The slinger ring causes a considerable heat transfer on the condenser coils by spraying the condensates, compared with the single-phase flow. However, the inner region of the slinger ring and the fan is almost the dead zone for the condensate spray, since the strong axial flow protects the entrainment of the splashed condensate, which is explained by the isotherms and velocity vectors. The regions of the occurrence of the additional heat transfer are almost overlapped to those exposed to the condensates sprayed by the slinger ring. The slinger ring contributes to a substantial increase of approximately 17% in the heat transfer on the condenser coils, compared with the single-phase flow.

Hydraulic coupling bolts are used in a wide range of industrial sectors, where ensuring the structural integrity and reliability of shaft systems is of paramount importance. However, research on systematic design methods for these specialized bolts is still lacking. In this study, an integrated design was used on hydraulic coupling bolts with M72 specification, considering both the tightening and untightening processes. First, the second tightening load was determined based on material strength, stress concentration and safety factors. Subsequently, the upper and lower limits of the first tightening loads were calculated using the thick-walled cylinder theory. An appropriate first tightening load maintaining the tightening force in both the axial and radial directions was obtained using finite element analysis. Design variables for the adapter configuration and oil passage shape were selected, and their impact on structural integrity was assessed using finite element analysis. The optimal combination of these design variables was derived. Finally, operational experiments for hydraulic coupling bolts were conducted according to the design results. The test results demonstrated a successful tightening and untightening process, confirming the effectiveness of the proposed design method.

Backgrounds and Aims: Etiology of repeat pregnancy loss (RPL) is complex, approximately 50% of cases of RPL had been classified as unexplained. Nowadays, elevated peripheral blood NK cell proportions are supposed to be related to RPL, and IVIG could down-regulate the NK cell levels. However, the efficacy of IVIG in RPL women is still under debates. The aims of this study were to evaluate the clinical outcomes of IVIG in RPL women with elevated peripheral blood NK cell proportions (PbNK), and to analyze the efficacy depending on the levels of PbNK. Methods: In this retrospective study, 916 women suffered two more miscarriages were evaluated from Jan. 2002 to Aug. 2022. After excluding the genetic, anatomic, endocrinologic causes and antiphospholipid antibody syndrome, 383 unexplained RPL women with elevated PbNK were enrolled. IVIG were treated 400 mg/kg in every three weeks, started right after a positive pregnancy test. Clinical pregnancy outcomes and miscarriage were evaluated. Results: Mean age of enrolled women was 35.24±4.31 years old, mean parity was 0.15±0.36 and mean number of miscarriages was 2.79±1.46 (min 2–max 14). Mean PbNK was 17.74±5.82 (12.0–45.3%). During the IVIG infusion, no serious side effects were found. Among 238 pregnant women, 48 women suffered miscarriage unfortunately. Excluding the termination cases related with chromosomal abnormality and congenital anomalies, live birth rate was 80.9%. In 4 subgroups (NK

Abstract Depression in older adults is a global socioeconomic burden. Identifying factors, such as physical activity or exercise that can help prevent depression is important. We aimed to investigate the relationship between changes in handgrip strength and the presence of depression using longitudinal, nationwide data of older Korean adults. Data from the Korean Longitudinal Study of Aging were used in this study. A total of 6783 participants who had undergone a handgrip strength test and completed the short-form Center for Epidemiologic Studies Depression Scale (CESD-10-D) questionnaire from 2006 to 2018 were included. General estimating equations were used to assess the temporal effect of the changes in handgrip strength on depression. A decrease in handgrip strength was associated with high CESD-10-D scores (β = 0.1889 in men, β = 0.1552 in women). As a continuous variable, handgrip strength was negatively correlated with CESD-10-D scores(β = − 0.0166 in men, β = − 0.0196 in women). Changes in the handgrip strength were associated with depressive symptoms in our longitudinal study. Those who experienced a decrease in handgrip strength had severe depressive symptoms compared to those with unchanged or increased handgrip strength. These findings can be used to guide general health policies for the prevention of depression.

Abstract Background Handwashing is important considering the impact of communicable diseases on the public. We aimed to identify the association between years with incidence of communicable diseases during the coronavirus disease 2019 (COVID-19) pandemic and hand hygiene in South Korea. Methods This cross-sectional study evaluated 5 years (2013, 2015, 2017, 2019, and 2020) of data from the Korea Community Health Survey and included 1,034,422 adults. Multinomial logistic regression analysis was performed to assess handwashing frequency by year. Receiver operating characteristic analysis was used to determine the cut-off point for handwashing frequency. Results The always/frequently handwashing rate was 44.7%. This tendency was stronger in adults with each ascending year, with reference to 2013 (2015, odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.08, 1.13; 2017, OR = 1.10, 95% CI = 1.08, 1.13; 2019, OR = 1.17, 95% CI = 1.14, 1.20; 2020, OR = 3.21, 95% CI = 3.14, 3.29). Among women, the OR of frequently/always handwashing was 3.55 times higher (95% CI = 3.45, 3.66) in 2020 than in 2013. This OR was 2.95 among men (95% CI = 2.86, 3.04). In influenza-vaccinated participants, the OR of frequent/always handwashing was 3.25 times higher in 2020 than in 2013 (95% CI = 3.15, 3.36), while in non-vaccinated participants it was 3.17 (95% CI = 3.08, 3.27). Among adults who practiced physical distancing during the COVID-19 pandemic, the OR was 1.36 times higher (95% CI = 1.29, 1.42) with frequent handwashing, 1.64 times higher (95% CI = 1.57, 1.70) than those who did not practice it. Conclusions There was a strong tendency toward frequent handwashing over the years; the trend was even greater in 2020 during the COVID-19 pandemic. Given that communicable diseases and handwashing are closely related, it is necessary to promote hand hygiene for prevention.

Abstract There is a clear relationship between rheumatoid arthritis (RA) and major osteoporotic fracture (MOF), although there is limited evidence on the effect of continuity of care (COC) on MOF in these patients. We investigated the association between COC and risk of MOF, including fractures of the lumbar spine and pelvis, forearm, and hip, among newly diagnosed RA patients aged ≥ 60 years. A total of 8715 incident RA patients from 2004 to 2010 were included from the Korean National Health Insurance Service-Senior cohort database. Participants were categorized into a good and bad COC group according to the COC index. The cumulative incidence of MOF was higher in RA patients with bad than in those with good COC (p

Abstract Circadian misalignment caused by differences in sleep duration between weekends and weekdays may be associated with adolescent mental health and sleep quality may be able to compensate for this problem. This study aimed to investigate the association between weekend catch-up sleep (CUS) ratio and sleep quality with depressive symptoms and suicidal ideation among South Korean adolescents. We used data from the Korea Youth Risk Behavior Web-based Survey 2015–2019 involving 270,619 adolescents. The weekend CUS ratio was calculated by dividing the average weekend sleep duration by the average weekday sleep duration (

Boron nitride nanotubes (BNNTS) have only been shown to dissolve in chlorosulfonic acid (CSA) at low concentrations. Here the authors successfully demonstrate the formation of liquid crystals of BNNTs in CSA that can be used to produce macroscopically aligned neat fibers of BNNTs.

Purpose Post-treatment visual deficit is a major concern associated with both microsurgical clipping and endovascular coiling for the treatment of ophthalmic artery (OphA) aneurysms of the internal carotid artery. We aimed to compare the safety and effectiveness of the 2 modalities. Materials and Methods We retrospectively reviewed and compared the baseline characteristics and postoperative visual and angiographic outcomes of OphA aneurysms treated by clipping or coiling between January 2010 and August 2018 at our hospital. In addition, the balloon occlusion test was performed to evaluate the safety of OphA occlusion. Results This study included 56 aneurysms treated by clipping and 82 aneurysms treated by coiling. Both the immediate and follow-up rates of incomplete aneurysm occlusion were comparable between the 2 groups (21.4% vs. 22.0%; 24.4% vs. 23.6%). The incidence of post-treatment visual deficits was higher in the clipping group than in the coiling group (16.1% vs. 2.4%; P=0.010). We observed total ipsilateral OphA occlusion in 6 patients and near occlusion in 3 patients during endovascular coiling; however, only 1 patient with near OphA occlusion showed a post-treatment visual field defect. Conclusion OphA aneurysms treated by endovascular coiling exhibited an aneurysm occlusion rate similar to that of microsurgical clipping with fewer post-treatment visual deficits. The total occlusion of OphA with adequate collaterals did not cause post-treatment visual deficits.

Abstract Home blood pressure (HBP) is useful to decide whether blood pressure (BP) is controlled. However, applying HBP to daily clinical practices is still challenging without easy access to the average HBP. Therefore, we developed a simple method to make a quick decision regarding the controlledness of HBP through high BP counts. We simulated 100 cases of HBP series for each combination of 3 numbers of BP readings (K = 16, 20, 24) and 4 levels of the standard deviations (SDs = 5, 10, 15, 20). A high BP was defined as an individual BP ≥ 135/85 mmHg, and an uncontrolled HBP was defined as a mean HBP ≥ 135/85 mmHg. Validation for the decision method was conducted using actual HBP data. The C-statistics and the accuracy of the high BP counts for the uncontrolled HBP were generally high (> 0.85) for all combinations of Ks and SDs and decreased as SDs increased but remained steady as Ks increased. In validation, the C-statistic of the high BP count-to-total BP reading (C/T) ratio was 0.985, and the C/T ratio ≥ 0.5 showed a sensitivity of 0.957, a specificity of 0.907, and an accuracy of 0.927. The count-based decision method can provide an accurate quick assessment of the controlledness of HBP.

Abstract Although large exciton binding energies of typically 0.6–1.0 eV are observed for monolayer transition metal dichalcogenides (TMDs) owing to strong Coulomb interaction, multilayered TMDs yield relatively low exciton binding energies owing to increased dielectric screening. Recently, the ideal carrier-multiplication threshold energy of twice the bandgap has been realized in multilayered semiconducting 2H-MoTe2 with a conversion efficiency of 99%, which suggests strong Coulomb interaction. However, the origin of strong Coulomb interaction in multilayered 2H-MoTe2, including the exciton binding energy, has not been elucidated to date. In this study, unusually large exciton binding energy is observed through optical spectroscopy conducted on CVD-grown 2H-MoTe2. To extract exciton binding energy, the optical conductivity is fitted using the Lorentz model to describe the exciton peaks and the Tauc–Lorentz model to describe the indirect and direct bandgaps. The exciton binding energy of 4 nm thick multilayered 2H-MoTe2 is approximately 300 meV, which is unusually large by one order of magnitude when compared with other multilayered TMD semiconductors such as 2H-MoS2 or 2H-MoSe2. This finding is interpreted in terms of small exciton radius based on the 2D Rydberg model. The exciton radius of multilayered 2H-MoTe2 resembles that of monolayer 2H-MoTe2, whereas those of multilayered 2H-MoS2 and 2H-MoSe2 are large when compared with monolayer 2H-MoS2 and 2H-MoSe2. From the large exciton binding energy in multilayered 2H-MoTe2, it is expected to realize the future applications such as room-temperature and high-temperature polariton lasing.

46, XY pure gonadal dysgenesis (Swyer syndrome) is usually presented as sexual infantilism with delayed puberty and primary amenorrhea. Rarely, patients can present with spontaneous breast development and/or menstruation. A 32-year-old woman complained of secondary amenorrhea lasting 1 year. Her menarche occurred at the age of 15. On physical examination, her external genitals were completely feminine. Breast development and pubic hair were compatible with Tanner stage V. Pelvic ultrasound showed a small-sized uterus and gonads. Laboratory investigations revealed follicle-stimulating hormone (FSH) 75.86 mIU/mL, estradiol 28.67 pg/mL, testosterone 0.27 ng/mL, dehydroepiandrosterone sulfate (DHEAS) 260.55 ug/dL and anti-Müllerian hormone (AMH) < 0.02 ng/mL. Chromosomal analysis indicated a 46, XY karyotype. She underwent laparoscopic gonadectomy, and pathology revealed dysgenetic gonads without germ cell tumors. Only a few cases of Swyer syndrome, spontaneous breast development or spontaneous vaginal bleeding related with germ cell tumor have been reported in the literature. To my knowledge, this is the first report of Swyer syndrome with unexplained spontaneous breast development and menstruation, despite the absence of hormone-producing gonadal neoplasm.

Purpose To evaluate the various factors that affect renal function following percutaneous radiofrequency ablation (RFA) therapy in patients with renal tumors. Materials and Methods Between 2010 and 2018, 91 patients diagnosed with renal tumors using ultrasonography and CT-guided RFA were enrolled. We retrospectively investigated the serum creatinine (SCr) level and estimated glomerular filtration rates immediately prior to RFA and during post-treatment follow-up. The patients were divided into two groups based on the degree of change in SCr level (0.3 mg/dL). Group comparisons were performed using univariable and multivariable logistic regression analyses to determine the factors impacting renal function. Results Impaired renal function was associated with solitary kidney, chronic kidney disease (CKD) over stage 3, and pyeloureteral injury. Sex, age, other cancers, tumor size, location, growth pattern, and proximity to the collecting system were not significantly associated with impaired renal function. There was a difference in the overall change over time between the association with and without solitary kidney, CKD stage 3, and pyeloureteral injury. Conclusion Among the medical conditions present prior to RFA, solitary kidney and CKD over stage 3 could be considered as risk factors for impaired renal function. Post-procedural pyeloureteral injury can also be considered a risk factor.

Abstract Objectives The diagnosis and treatment of cancer are stressful events that could trigger psychological distress in a large number of cancer patients. The aim of this study was to examine the association between gastric cancer and the risk of new onset of depression among South Korean adults. Methods Data from 12,664 participants aged over 40 years was derived from the National Health Service National Sample Cohort (2002–2013). The case cohort consists of patients who received a diagnosis of gastric cancer between 2002 and 2009, and the corresponding control group was selected through 1:1 propensity score matching (case: 6332, control: 6332). The new onset of depression was considered as the dependent variable. A Cox proportional hazards regression model was built to analyze the associations between variables in consideration. Results Individuals with gastric cancer had a higher risk of new onset of depression than those without cancer (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.13–1.45.) Female gastric patients had a higher risk of depression compared to male patients (Female; HR = 1.89, 95% CI = 1.66–2.16, Male; HR = 1.25, 95% CI = 1.10–1.41). Gastric cancer patients in their 60s had the highest risk of new onset of depression compared to other age groups and no cancer group (HR = 1.61, 95% CI = 1.40–1.85). Gastric cancer patients who were previously diagnosed with depression prior to their diagnosis of cancer had a higher risk of new onset of depression than gastric cancer patients without antecedent diagnosis of depression (Past Depression (Yes); HR = 5.17, 95% CI = 4.10–6.51, Past Depression (No); HR = 1.35, CI = 1.21–1.51). Conclusions The study identified a significant relationship between gastric cancer and depression among South Korean adults, suggesting that the diagnosis and treatment of gastric cancer increases the risk of new onset of depression, especially among female patients between 60 and 69 years old of high income and living in metropolitan regions. Pre-existing health conditions also appeared to be a risk factor. Thus, in consideration of treatment efficacy and patients’ quality of life, the results of the study emphasizes the need for attentive intervention, while distinguishing the most vulnerable groups.

The acquisition speed of two-photon fiberscopes is currently suboptimal. Here the authors report advances, including a high-speed scanner and down-sampling scheme as well as a two-stage deep learning (DL) algorithm, to allow high-speed, high-resolution imaging in freely moving mice.

Objective: We evaluated the role of subgaleal closed suction drains in postoperative epidural hematoma (EDH) and wound complications following pterional craniotomy for cerebral aneurysm. Methods: We reviewed 5,280 pterional craniotomies performed on 5,139 patients between January 2006 and December 2020. A drain was placed subgalealy and tip of drain was positioned between the bone flap and the deep temporalis. 1,637 cases (31%) had a subgaleal suction drain. We analyzed demographic and clinical variables related to EDH requiring evacuation and wound complications in patients with and without drains. Univariate and multivariate logistic regression analyses were performed to determine the associated risk factors. Results: Fourteen cases (0.27%) of EDH requiring evacuation and 30 cases (0.57%) of wound complications were identified. Univariate analysis found that drain insertion, subarachnoid hemorrhage (SAH), and operation time were associated with EDH, while drain insertion, SAH, male gender, older age, and longer operation time were associated with wound complications. Multivariate analysis found no significant association between drain use and EDH (OR=1.62, p=0.402) or wound complications (OR=1.45, p=0.342). Conclusions: Routine use of subgaleal closed suction drains may not be necessary after pterional craniotomy, as drain insertion was not associated with a reduced risk of EDH requiring evacuation or wound complications. [ABSTRACT FROM AUTHOR]

Abstract Diabetes is an ambulatory care sensitive condition that quality of care can prevent complications development and hospitalization needs. However, diabetes patients with disability face greater challenges with receiving quality diabetes care than those without disabilities. This study examined diabetes-related avoidable hospitalizations (DRAH) focusing on the association with disability. We used nationally representative health insurance cohort data from 2002 to 2013. The study population is people who were newly diagnosed with type 2 diabetes. We measured the cumulated number of DRAH using the Prevention Quality Indicators (PQIs). The variables of interest were disability severity and type. We performed a recurrent events analysis using Cox proportional hazard regression model. Among 49,410 type 2 diabetes patients, 12,231 (24.8%) experienced DRAHs at least once during the follow-up period. Among the total population, 5924 (12.0%) diabetes patients were registered as disabled. The findings report that disability severity was significantly associated with higher risks for DRAH, where severely disabled diabetes patients showed the highest hazard ratio of 2.24 (95% CI 1.80–2.79). Among three DRAH indicators, severely disabled diabetes patients showed increased risks for long-term (AHR 2.21, 95% CI 1.89–2.60) and uncontrolled (AHR 2.28, 95% CI 1.80–2.88) DRAH. In addition, intellectual (AHR 5.52, 95% CI 3.78–8.05) and mental (AHR 3.97, 95% CI 2.29–6.89) disability showed higher risks than other types of disability. In conclusion, diabetes patients with disability are at higher risk for DRAH compared to those without disabilities, and those with intellectual and mental disabilities were more likely to experience DRAH compared to those with physical or other types of disability. These findings call for action to find the more appropriate interventions to improve targeted diabetes primary care for patients with disability. Further research is needed to better understand determinants of increasing risks of DRAH.

Lower urinary tract symptoms (LUTS) associated with storage, voiding, and post-micturition reduce quality of life and cause mental health problems. In traditional medicine, Baliao points have been empirically used to treat urinary system diseases. In this review, randomized controlled trials (RCTs) using sacral acupuncture on Baliao points with sham treatment, other remedies, or other acupoints were retrieved from 8 electronic databases up to June 2021. Sixteen RCTs met the inclusion criteria. The quality of the included studies was assessed using a risk-of-bias (ROB) tool. Most of the evaluation indicators used in the included RCTs showed that sacral acupuncture had a significant therapeutic effect compared with the sham control intervention groups, and other remedies. However, all studies using acupoints (other than the Baliao points) as a control intervention had a “high” ROB and only reported secondary processed information, making it difficult to evaluate the efficacy of sacral acupuncture treatment for LUTS. No serious adverse effects were reported for sacral acupuncture, and only a low number of minor side effects were observed. These results suggest that sacral acupuncture could be considered as an alternative to existing treatments, with the added benefit of low cost. Large-scale, long-term RCTs are required in the future.

Background: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities strongly associated with risks of cardiovascular diseases. However, a relationship between MetS and aneurysmal disease as compared with occlusive disease has not been confirmed. Therefore, correlations of MetS and abdominal aortic aneurysm (AAA) were evaluated. Methods: Between March 2011 and February 2020, 354 patients diagnosed with AAA were enrolled and divided into the MetS (n = 164) and the no-MetS (n = 190) groups. Individual components of MetS, characteristics of AAA, rupture rate, and survival rate were evaluated for both groups. Additionally, correlations between MetS and AAA were evaluated with focusing on effects of diabetes mellitus (DM). Results: The size of AAA was significantly larger in the MetS group compared with the no-MetS group (P 0.05). Conclusions: Although larger prospective studies are necessary, we suggest that MetS proportionally aggravates the status of AAA and survival rate. Therefore, surveillance for MetS and individual components may help to restrict the expansion of AAA.

Abstract Background Cardiac resynchronization therapy (CRT) is an effective treatment option for patients with heart failure (HF) and left ventricular (LV) dyssynchrony. However, the problem of some patients not responding to CRT remains unresolved. This study aimed to propose a novel in silico method for CRT simulation. Methods Three-dimensional heart geometry was constructed from computed tomography images. The finite element method was used to elucidate the electric wave propagation in the heart. The electric excitation and mechanical contraction were coupled with vascular hemodynamics by the lumped parameter model. The model parameters for three-dimensional (3D) heart and vascular mechanics were estimated by matching computed variables with measured physiological parameters. CRT effects were simulated in a patient with HF and left bundle branch block (LBBB). LV end-diastolic (LVEDV) and end-systolic volumes (LVESV), LV ejection fraction (LVEF), and CRT responsiveness measured from the in silico simulation model were compared with those from clinical observation. A CRT responder was defined as absolute increase in LVEF ≥ 5% or relative increase in LVEF ≥ 15%. Results A 68-year-old female with nonischemic HF and LBBB was retrospectively included. The in silico CRT simulation modeling revealed that changes in LVEDV, LVESV, and LVEF by CRT were from 174 to 173 mL, 116 to 104 mL, and 33 to 40%, respectively. Absolute and relative ΔLVEF were 7% and 18%, respectively, signifying a CRT responder. In clinical observation, echocardiography showed that changes in LVEDV, LVESV, and LVEF by CRT were from 162 to 119 mL, 114 to 69 mL, and 29 to 42%, respectively. Absolute and relative ΔLVESV were 13% and 31%, respectively, also signifying a CRT responder. CRT responsiveness from the in silico CRT simulation model was concordant with that in the clinical observation. Conclusion This in silico CRT simulation method is a feasible technique to screen for CRT non-responders in patients with HF and LBBB.

Background Although it is known that inhaled corticosteroid (ICS) use may increase the risk of respiratory infection, its influence on the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Thus, the aim of this study was to investigate the association between ICS use and the positivity of SARS-CoV-2 infection among patients with chronic respiratory diseases. Methods Nationwide data of 44,968 individuals with chronic respiratory diseases tested for SARS-CoV-2 until May 15, 2021 were obtained from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The positivity of SARS-CoV-2 infection was retrospectively analysed according to the prescription, type, and dose of ICS taken one year before SARS-CoV-2 test. Results Among 44,968 individuals tested, 931 (2.1%) were positive for SARS-CoV-2. A total of 7,019 patients (15.6%) were prescribed ICS one year prior to being tested for SARS-CoV-2. Low, medium, and high doses of ICS were prescribed in 7.5%, 1.6%, and 6.5% of total cases, respectively. Among types of ICS, budesonide, fluticasone, beclomethasone, and ciclesonide were prescribed in 3.7%, 8.9%, 2.3%, and 0.6% of total cases, respectively. A multivariate analysis showed no significant increase in infection with ICS use (odds ratio, 0.84; 95% confidence interval, 0.66–1.03). Moreover, there were no associations between the positivity of infection and the dose or type of ICS prescribed. Conclusion Prior ICS use did not increase the positivity for SARS-CoV-2 infection. Moreover, different doses or types of ICS did not affect this positivity.

Abstract Background Social phobia shares symptoms with arrhythmias, such as palpitations and chest discomfort. However, it is unclear how social phobia is associated with the actual risk of arrhythmia. This study aimed to investigate whether social phobia is associated with the risk of arrhythmia using a nationally representative sample cohort. Methods This retrospective cohort study assessed data from the 2002–2013 Korean National Health Insurance Service National Sample Cohort. Using 1:3 propensity score matching for sex, age, income, and insurance status, 1514 patients with social phobia and 4542 control group patients were included in the study. Social phobia and arrhythmia were defined per the International Classification of Diseases, 10th revision. Using cox proportional hazard regression, hazard ratios (HRs) were calculated to estimate the risk of arrhythmia in patients with social phobia. Results There were statistically significant associations between social phobia history and elevated risks of arrhythmia. Patients with social phobia had a higher risk of arrhythmia after adjusting with covariates (HR = 1.78, 95%CI = 1.25–2.55). Among different types of arrhythmias, atrial fibrillation and flutter presented the highest risk (HR = 2.20, CI = 1.06–4.57) compared to paroxysmal tachycardia (HR = 1.07, CI = 0.39–2.91) and other cardiac arrhythmias (HR = 1.83, CI = 1.16–2.89). Conclusion This study identified the association between social phobia and the risk of arrhythmia in a South Korean representative cohort. These results suggest that social phobia should be treated properly to reduce arrhythmia risks.

Abstract Background Muscular function, such as handgrip strength, has been suggested as an associated factor for cognitive impairment. This study investigated the association between temporal change in handgrip strength and cognitive function using longitudinal, nationwide data from Korean older adults. Methods Our study used data from the Korean Longitudinal Study of Aging (KLoSA). The analysis covered 6696 participants who had taken the handgrip strength test and Mini-Mental State Examination (MMSE) from 2006 to 2018. We adopted general estimating equations to assess the temporal effect of handgrip strength change on cognitive function. Results After adjusting for covariates, we observed an association between handgrip strength and low MMSE scores (β = − 0.3142 in men, β = − 0.2685 in women). Handgrip strength as a continuous variable was positively correlated with MMSE scores after adjustment (β = 0.0293 in men, β = 0.0347 in women). The group with decreased handgrip strength over time also showed greater odds for mild cognitive impairment (OR = 1.23, 95%CI = 1.05–1.27 in men, OR = 1.15, 95%CI = 1.05–1.27 in women) and dementia (OR = 1.393, 95%CI = 1.18–1.65 in men, OR = 1.19, 95%CI = 1.08–1.32 in women). Conclusions This study identified the relationship between handgrip strength change and cognitive function among South Korean adults. According to our large, longitudinal sample, decreasing handgrip strength was associated with decline in cognitive function.

Abstract Background Sleep problems increase the risk of premature illness and death. We evaluated the association between sedentary time and sleep quality among South Korean adults. Methods The data of adults (aged ≥ 19 years) from the 2018 Korea Community Health Survey were analyzed. Sedentary time, which included hours spent sitting or lying down daily, was categorized into four standardized groups. Poor sleep quality was defined using the global cutoff point (> 5 points) of the Pittsburg Sleep Quality Index. Multiple logistic regression analyses were performed to identify the association between sedentary time (≤ 3.9, 4.0–5.9, 6.0–7.9, and ≥ 8 hours /day) and sleep quality, by sex. Results Of the 224,118 participants, 35,784/100,454 men (35.6%) and 58,271/123,664 women (47.1%) had poor sleep quality. Compared with ≤ 3.9 h/day, sedentary times 4.0–5.9, 6.0–7.9, and ≥ 8 h/day were associated with worse sleep quality among men (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.08–1.16; OR: 1.19, 95% CI: 1.14–1.25; OR: 1.30, 95% CI: 1.25–1.34, respectively) and women (OR: 1.06, 95% CI: 1.03–1.10; OR: 1.12, 95% CI: 1.08–1.16; OR: 1.22, 95% CI: 1.18–1.26, respectively). In subgroup analyses of sleep quality, subjective sleep quality, latency, disturbance, use of sleeping medication, and daytime dysfunction showed a strong dose-response relationship with increasing sedentary time in both sexes. Conclusions Regardless of sex, the longer the sedentary time, the stronger the association with poor sleep quality. Nationwide efforts are required to recommend standards for sedentary time and develop evidenced-based healthy behavior guidelines.

Abstract Background Inflammation is recognized as a critical process in expansion of abdominal aortic aneurysm (AAA). A relationship between effects of cholesterol and statin in this process have been suggested, but remain untested. Therefore, current study aimed to examine the effects of hypercholesterolism on expansion of AAA in a rat model. Methods A total of 16 male rats were divided into 4 groups as follows: group I, normocholesterol diet and saline infusion, group II, normocholesterol diet and porcine pancreatic elastase (PPE) infusion, group III, hypercholesterol diet and PPE infusion, and group IV, hypercholesterol diet, PPE infusion and statin administration. At the 3rd week, saline was infused intraluminally in group I and PPE in groups II-IV to induce AAA. At the 5th week, blood and aortic tissue were obtained from each rat for evaluation of lipid profiles, aortic diameters (ADs), and characteristics of stains. Results Post-procedural aortic diameter (AD3) and AD3/pre-procedural aortic diameter (AD1) were significantly different among four groups (P = 0.042, P = 0.028, respectively). AD3 was significantly larger in group II than group I, and group III than group IV (P = 0.012, P = 0.043, respectively). AD3/AD1 was significantly higher in group II than group I, and group III than group II (P = 0.008, P = 0.030, respectively). Group III showed the highest cellularity for inflammatory cells. Conclusions Though larger experimental and clinical studies are necessary, authors suggest that hypercholesterolism can aggravate expansion of AAA, and that statin therapy can reduce it. Therefore, monitoring for hypercholesterolism and instituting statin therapy may be helpful to suppress expansion of AAA.

Abstract Background Counseling for adolescents who consider or attempt suicide may help reduce suicide rates. However, the impact of the type of counselor (e.g., father, mother, sibling, friend, teacher, other) on suicidal ideation/suicide attempts remains unclear. Therefore, we examined this association in Korean adolescents. Methods Using data from the 2015 Korea Youth Risk Behavior Web-based Survey of 65,485 adolescents, we examined risk factors for suicidal ideation/suicide attempts according to sex using a multiple logistic regression analysis. In a subgroup analysis, we investigated the associations between counselor type and suicidal ideation/suicide attempts stratified by the cause of stress for both sexes. Results Male participants were less likely to consider suicide when counseled by their mother (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.70–0.90) or friend (OR 0.89; 95% CI 0.80–0.99) and to attempt suicide when counseled by a friend (OR 0.74; 95% CI 0.60–0.92) than were those who did not receive any counseling. Female participants were less likely to attempt suicide when counseled by their mother (OR 0.66; 95% CI 0.53–0.82) or friends (OR 0.70; 95% CI 0.58–0.83) than when not counseled. Furthermore, adolescents with achievement/career choice-related and family problems were at a lower risk of suicide ideation/suicide attempts when counseled by their mother or friend than when they received no counseling. Conclusions Suicidal ideation/suicide attempts showed different associations for both sexes in accordance with the type of counselor. Even if counseling by specialists for issues such as achievement/career choice-related or family matters is needed, the risk of suicide could be reduced through counseling by the people around them. Therefore, adolescents should form mutually supportive relationships through active communication with surrounding people.

Purpose: This study aimed to test the clinical efficacy of a portable smartphone-based App assisted semen analysis (SA) system, O'VIEW-M PRO® to clinically accurate in comparison with results of laboratory-based conventional semen analyses including manual microscopic and computer-assisted semen analysis (CASA) for self-evaluation of seminal parameters. Materials and Methods: From January to May 2021, a total of 39 semen samples were analyzed for the sperm concentration and motility with new smartphone-based App assisted semen analyzer, O'VIEW-M PRO®, and results compared with those from laboratory-based manual microscopic SA with Makler Counting Chamber and CASA. Results: The coefficient factors among the results of the measurement with Makler chamber and laboratory-based CASA comparing to O'VIEW-M PRO® were 0.666 and 0.655 for sperm density, 0.662 and 0.658 for sperm motility, respectively. There were no particular problems with clinical use of the O'VIEW-M PRO®. Device performance in classifying samples is positive (15×106 sperm/mL) for sperm concentration criteria, and positive (40%) for sperm motility criteria. The smartphone-based App assisted SA O'VIEW-M PRO® showed a sensitivity of 92.6%, a specificity of 66.7%, and overall accuracy rate of 84.6%. Conclusions: This study shows a novel smartphone-based App assisted SA system. O'VIEW-M PRO® can easily obtain semen parameter information through self-diagnosis at home and induce infertile men's treatment and help patients after receiving infertile men's treatment before receiving treatment.

Abstract In this cohort study, we assessed the association between depression and the risk of Alzheimer’s disease from data obtained from the 2002 to 2013 Korean National Health Insurance Service-Elderly Cohort Database, which accounts for 10% of the South Korean population aged > 60 years. A total 518,466 patients were included in the analysis and followed up, unless they were excluded due to death or migration. Patients who sought treatment for depression or dementia within 1 year of the washout period and who were diagnosed with dementia within the 1-year period of the diagnosis of depression were excluded from the study. The risk of dementia was analysed using Cox proportional hazards models. Patients with a history of depression during the follow-up period were at a higher risk of Alzheimer’s disease than those without a history of depression (HR 3.35, CI 3.27–3.42). The severe-depression group exhibited the highest risk of Alzheimer’s disease (HR 4.41, CI 4.04–4.81), while the mild-depression group exhibited a relatively lower risk of Alzheimer’s disease (HR 3.31, CI 3.16–3.47). The risk of Alzheimer’s disease was associated with depression history and an increased severity of depression increased the risk of Alzheimer’s disease.

Abstract Background The effect of menopausal hormone therapy (MHT) on gastrointestinal (GI) cancers is controversial, and no research has been conducted in the East. This study investigates the association between MHT and GI cancer risks in South Korea. Methods A prescription-based cohort study was conducted using the NHIS Sample Cohort (2002–2013) of Korea. We used 1:5 propensity score matching, and 22,577 MHT users and 111,113 non-users were selected. Kaplan–Meier survival curves with log-rank tests were used. Cox proportional hazard models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Landmark analysis was used to determine dose–response relationship. Results The median follow-up was 79.6 of months. Kaplan–Meier survival curve showed less frequent GI cancer diagnoses in MHT users compared to non-users (0.13 vs. 0.16 per 100,000 person-years). Menopausal hormone therapy was associated with decreased incidence of GI cancer (HR = 0.809, 95%CI = 0.691–0.946) and colorectal cancer (CRC) (HR = 0.757, 95%CI = 0.577–0.995). Gastric cancer (GC) incidence showed marginal significance (HR = 0.787, 95%CI = 0.605–1.023). The mortality from GI cancer was lower in MHT users than in non-users (HR = 0.737, 95%CI = 0.547–0.993). The relationship between MHT and GI cancer was stronger with increasing MHT dose in terms of both incidence (P trend = 0.0002) and mortality (P trend = 0.0064). Conclusions The association between MHT use and reduced risks of GI cancers was attributed to CRC and GC and showed a dose–response relationship in a population-based cohort study.

Background Lumbar herniated intervertebral disc (LHIVD) is a frequently presented condition/disease in Korean medical institutions. In this study, the economics of thread embedding acupuncture (TEA) was evaluated in a randomized controlled trial comparing TEA with sham TEA (STEA). Methods This economic evaluation was analyzed from a limited social perspective, and the per-protocol set was from a basic analysis perspective. The cost-effectiveness analysis was based on the change in visual analog scale score, and the cost-utility analysis was based on the quality-adjusted life years. The final results were expressed as the average cost-effectiveness ratio and incremental cost-effectiveness ratio, and furthermore sensitivity analysis was performed to confirm the robustness of the results observed. Results The cost-effectiveness analysis showed that TEA was 9,908 won lower than STEA, while the decrease in 100 mm visual analog scale score was 8.5 mm greater in the TEA group compared with the STEA group (p > 0.05). The cost-utility analysis showed that TEA was 9,908 won lower than STEA, while the quality-adjusted life years of TEA was 0.0026 years higher than STEA (p > 0.05). These results were robust in the sensitivity analysis, but were not statistically significant. Conclusion In treating LHIVD, TEA appeared to have cost-effectiveness and cost-utility compared with STEA. However, there were no significant differences between the groups in terms of cost, effectiveness, and utility indicators. Therefore, results must be interpreted prudently; this study was the 1st to conduct an economic evaluation of TEA for LHIVD.