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Research groups in the field of PET instrumentation are studying time-of-flight(TOF) technology to improve the signal-to-noise ratio of PET images. Scintillation light transport and collection plays an important role in improving the coincidence resolving time(CRT) of PET detector based on a pixelated crystal array.Four crystal arrays were designed by the different optical reflection configuration such as external reflectors and surface treatment on the CRT and compared with the light output, energy resolution and CRT. The design proposed in the study was composed of 8 × 8 LYSO crystal array consisted of 3 × 3 × 15 mm3 pixels. The entrance side was roughened while the other five surfaces were polished. Four sides of all crystal pixels were wrapped with ESR-film, and the entrance surface was covered by Teflon-tape. The design provided an excellent timing resolution of 210 ps and improved the CRT by 16% compared to the conventional method using a polishing treatment and ESR-film.This study provided a method for improving the light output and CRT of a pixelated scintillation crystal-based brain TOF PET detector. The proposed configuration might be an attractive detector design for TOF brain PET requiring fast timing performance with high cost-effectiveness.

Abstract This study proposes an advanced algorithm for predicting the optimal orientation in human manikin 3D printing. We can print the manikin mesh data on any scale depending on the user’s needs. Once the 3D printing scale was determined, the manikin data were dissected based on the 3D printer’s maximal printing volume using our previous work. Then, we applied the newly proposed algorithm, designated as “per-pixel signed-shadow casting,” to each dissected manikin part to calculate the volumes of the object and the support structure. Our method classified the original mesh triangles into three groups—alpha, beta, and top-covering—to eliminate the need for special hardware such as graphic cards. The result is shown as a two-dimensional bitmap file, designated as “tomograph”. This tomograph represents the local support structure distribution information on a visual and quantitative basis. Repeating this tomography method for the three rotational axes resulted in a four-dimensional (4D) box-shaped graph. The optimal orientation of any arbitrary object is easily determined from the lowest-valued pixel in the 4D box graph. We applied this proposed method to several basic primitive shapes with different degrees of symmetry and complex shapes, such as the famous “Stanford Bunny”. Finally, the algorithm was applied to human manikins using several printing scales. The theoretical values were compared with those obtained from analytical or g-code-based experimental volumes.

OBJECTIVES The purpose of this study was to investigate the association between body mass index (BMI) and self-rated health (SRH) in older adults aged over 65 years while examining the influence of self-perceived body image (SBI) and sex. METHODS Raw data were obtained from the Korea Community Health Survey, which included BMI measurements of Koreans aged over 65 years (n=59,628). Non-linear relationships between BMI and SRH were analyzed separately for each sex using restricted cubic splines while controlling for SBI and other confounding variables. RESULTS Men showed a reverse J-shaped association, while women showed a J-shaped association between BMI and poor SRH. However, including SBI in the model changed this association for men to an inverted U-shape showing a negative direction, with the highest risk of poor SRH observed in the underweight to overweight range. For women, a nearly linear positive relationship was observed. Regardless of BMI, those who perceived their weight as not “exactly the right weight” had a higher risk of poor SRH than those who perceived their weight as “exactly the right weight” in both men and women. Older men who thought they were much too fat or too thin had similar highest risks of poor SRH, whereas older women who thought they were too thin had the highest risk of poor SRH. CONCLUSIONS The findings of this study emphasize the importance of considering sex and body image perceptions when assessing the relationship between BMI and SRH in older adults, especially in men.

IntroductionCognitive impairment is a common feature of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, there is a lack of population-based study of dementia risk in these disorders. In the present study, the risk of dementia in MS and NMOSD patients in Republic of Korea was estimated.MethodsData analyzed in this study were obtained from the Korean National Health Insurance Service (KNHIS) database between January 2010 and December 2017. The study included 1,347 MS patients and 1,460 NMOSD patients ≥40 years of age who had not been diagnosed with dementia within 1 year prior to the index date. Matched controls were selected based on age, sex, and the presence of hypertension, diabetes mellitus, or dyslipidemia.ResultsIn MS and NMOSD patients, the risk of developing any dementia [adjusted hazard ratio (aHR) = 2.34; 95% confidence interval (CI) = 1.84–2.96 and aHR = 2.19; 95% CI = 1.61–3.00, respectively], Alzheimer’s disease [AD; aHR = 2.23; 95% confidence interval (CI) = 1.70–2.91 and aHR = 1.99; 95% CI = 1.38–2.88, respectively], and vascular dementia (aHR = 3.75; 95% CI = 1.91–7.35 and aHR = 3.21; 95% CI = 1.47–7.02, respectively) was higher compared with the matched controls. NMOSD patients had a lower risk of any dementia and AD compared with MS patients after adjusting for age, sex, income, hypertension, diabetes, and dyslipidemia (aHR = 0.67 and 0.62).ConclusionThe risk of dementia increased in MS and NMOSD patients and dementia risk was higher in MS than in NMOSD.

Summary: Background: Gastric cancer (GC) is clinically heterogenous according to location (cardia/non-cardia) and histopathology (diffuse/intestinal). We aimed to characterize the genetic risk architecture of GC according to its subtypes. Another aim was to examine whether cardia GC and oesophageal adenocarcinoma (OAC) and its precursor lesion Barrett’s oesophagus (BO), which are all located at the gastro-oesophageal junction (GOJ), share polygenic risk architecture. Methods: We did a meta-analysis of ten European genome-wide association studies (GWAS) of GC and its subtypes. All patients had a histopathologically confirmed diagnosis of gastric adenocarcinoma. For the identification of risk genes among GWAS loci we did a transcriptome-wide association study (TWAS) and expression quantitative trait locus (eQTL) study from gastric corpus and antrum mucosa. To test whether cardia GC and OAC/BO share genetic aetiology we also used a European GWAS sample with OAC/BO. Findings: Our GWAS consisting of 5816 patients and 10,999 controls highlights the genetic heterogeneity of GC according to its subtypes. We newly identified two and replicated five GC risk loci, all of them with subtype-specific association. The gastric transcriptome data consisting of 361 corpus and 342 antrum mucosa samples revealed that an upregulated expression of MUC1, ANKRD50, PTGER4, and PSCA are plausible GC-pathomechanisms at four GWAS loci. At another risk locus, we found that the blood-group 0 exerts protective effects for non-cardia and diffuse GC, while blood-group A increases risk for both GC subtypes. Furthermore, our GWAS on cardia GC and OAC/BO (10,279 patients, 16,527 controls) showed that both cancer entities share genetic aetiology at the polygenic level and identified two new risk loci on the single-marker level. Interpretation: Our findings show that the pathophysiology of GC is genetically heterogenous according to location and histopathology. Moreover, our findings point to common molecular mechanisms underlying cardia GC and OAC/BO. Funding: German Research Foundation (DFG).

Recent studies suggest that the anticancer activity of β-lapachone (β-Lap) could be improved by different types of bioactive phytochemicals. The aim of this study was to elucidate how the anticancer effect of β-Lap is regulated by polyphenols extracted from Korean Artemisia annua L. (pKAL) in parental HCT116 and oxaliplatin-resistant (OxPt-R) HCT116 colorectal cancer cells. Here, we show that the anticancer effect of β-Lap is more enhanced by pKAL in HCT116-OxPt-R cells than in HCT116 cells via a CCK-8 assay, Western blot, and phase-contrast microscopy analysis of hematoxylin-stained cells. This phenomenon was associated with the suppression of OxPt-R-related upregulated proteins including p53 and β-catenin, the downregulation of cell survival proteins including TERT, CD44, and EGFR, and the upregulation of cleaved HSP90, γ-H2AX, and LC3B-I/II. A bioinformatics analysis of 21 proteins regulated by combined treatment of pKAL and β-Lap in HCT116-OxPt-R cells showed that the enhanced anticancer effect of β-Lap by pKAL was related to the inhibition of negative regulation of apoptotic process and the induction of DNA damage through TERT, CD44, and EGFR-mediated multiple signaling networks. Our results suggest that the combination of pKAL and β-Lap could be used as a new therapy with low toxicity to overcome the OxPt-R that occurred in various OxPt-containing cancer treatments.

This study was conducted to determine the effect of muscle energy technique (MET) on pelvic alignment, leg length, pain, and fatigue in chronic low back pain (CLBP) patients with leg length discrepancy (LLD). Forty-two CLBP patients with LLD volunteered to participate and were randomly assigned to the MET group (n = 21) and placebo group (n = 21). The intervention group performed three METs with 5 s of isometric contraction and 30 s of rest once, and the placebo group performed three times the placebo-MET, maintaining the same posture as the MET group without muscle isometric contraction. X-ray equipment, tape measure, and visual analog scale were used to evaluate pelvic alignment, leg length, pain, and fatigue before and after each intervention. In comparison pre- and postintervention, only the MET group showed significant changes in pelvic alignment, leg length, pain, and fatigue (p < 0.05). In comparison between groups, there were significant differences in all variables (pelvic alignment, leg length, pain, fatigue) (p < 0.05). The results of this study confirmed the therapeutic effect of MET for improving pelvic alignment, functional LLD, pain, and fatigue in CLBP patients with functional LLD. Future research is needed to evaluate the long-term effect on more chronic low back pain patients.

Background : The global public health burden of obesity has increased with socio-economic development. The Korean Society for the Study of Obesity released the 2021 Obesity Fact Sheet to address trends in obesity prevalence and comorbid conditions by different age groups. Methods : Individuals ≥20 years old who underwent a health checkup provided by the Korean National Health Insurance Service between 2009 and 2019 were included. The prevalence of obesity and abdominal obesity was standardized by age and sex based on the 2010 population and housing census. The incidence of obesity-related comorbidities was tracked from 2009 to 2019, and the incidence per 1,000 person-years was calculated using Poisson regression adjusted for age and sex. Results : Obesity and abdominal obesity prevalence has increased for the entire population over the past 11 years. Obesity prevalence has risen rapidly in individuals in their 20s and 80s compared with other age groups. Additionally, class III obesity prevalence in both men and women has significantly increased by nearly threefold. The relative risk of developing type 2 diabetes, myocardial infarction, ischemic stroke, and cancers in people with obesity or abdominal obesity is greater than in people without obesity or abdominal obesity. The relative risk was higher in young and middle-aged individuals than in the older population. Conclusion : The findings based on the 2021 Obesity Fact Sheet suggest the need to better understand obesity characteristics according to age and sex and to establish individualized treatment strategies.

Background: Integrated management of general, mental, and oral health is necessary to improve an individual’s quality of life. This study aimed to identify the effects of mental and oral health behaviors on metabolic syndrome.Methods: A total of 4,227 Korean adults aged 20 years or older were selected as study subjects using raw data from the first year (2019) of the 8th period of the Korea National Health and Nutrition Examination Survey (KNHANES). A complex sample chi-square test and a complex sample logistic regression analysis were performed using the PASW Statistics ver. 18.0 program.Results: The effect on metabolic syndrome was significantly higher in male than in 1.833 times in male, 2.914 times in 30∼49 years old, and 3.855 times in 50∼64 years old, and 3.929 times in people over 65 years old compared to 20∼29 years old, and compared to those with a college degree or higher, those with a middle school degree or lower are 2.116 times, those with lower income levels are 1.507 times higher, those with middle-lower are 1.359 times higher, those with middle-high are 1.401 times. Compared to non-smokers, smokers were 1.570 times higher than non-smokers and compared to those without speech problem and chewing difficulty, they were 1.717 times and 1.397 times higher, respectively and 1.973 times higher in those with 0∼1 brushing times per day. Mental health did not affect prevalence of metabolic syndrome.Conclusion: It is necessary to improve maintain a healthy lifestyle to lower the risk of metabolic syndrome. It is necessary to establish effective dental hygiene customized education and an efficient health management system at the national level that can induce improvement of oral health behavior for the prevention and management of metabolic syndrome.

Breast ultrasound is the most important tool for breast cancer surveillance after surgery. In particular, when a breast reconstruction is performed for patients with breast cancer, the sonographer should be provided with surgical information to distinguish between a benign lesion and cancer recurrence. This article describes the sonographic changes after breast reconstruction for breast cancer, which vary, but may be typical. Therefore, if breast surgeons and sonographers are aware of the typical sonographic findings, it would be helpful for the early detection and management of postoperative complications.

This study seeks to understand how environmental, social, and corporate governance (ESG) affects business performance and the diversification effect of cross-border mergers and acquisitions (M&A) by examining 129 events on cross-border M&A in the Korean Stock Price Index (KOSPI) market representing emerging capital markets between 2012 and 2018 in 38 target countries. The findings indicate that better ESG engagement has a positive effect on the business performance of cross-border M&A, supporting stakeholder theory and confirming that ESG can serve as a strategy for boosting business efficiency in cross-border M&A. The findings also confirm that diversification in cross-border M&A leads to a diversification discount on business performance, negatively affecting acquiring firms, but that ESG engagement can mitigate the diversification discount as a friendly channel. The study's main contribution is providing empirical evidence that ESG can serve as a friendly channel through which to address the diversification discount issue.

Background We investigated whether low high-density lipoprotein cholesterol (HDL-C) and isolated and non-isolated low HDL-C levels are associated with the risk of cardiovascular diseases and all-cause mortality among Korean adults. Methods We included 8,665,841 individuals aged ≥20 years who had undergone a health examination provided by the Korean National Health Insurance Service (NHIS) in 2009 and were followed up until the end of 2018. The hazard ratios (HRs) and 95% confidence intervals (CIs) for study outcomes were calculated using multivariable Cox proportional hazard regression analysis. Results During the 8.2 years of mean follow-up, myocardial infarction (MI), stroke, and all-cause mortality occurred in 81,431, 110,996, and 244,309 individuals, respectively. After adjusting for confounding variables (model 3), individuals with low HDL-C and lower HDL quartiles were associated with significantly increased risks of all three outcomes, compared to those with normal HDL-C and highest HDL-C quartile (all P

Abstract Background Respiratory infections among children, particularly community-acquired pneumonia (CAP), is a major disease with a high frequency among outpatient and inpatient visits. The causes of CAP vary depending on individual susceptibility, the epidemiological characteristics of the community, and the season. We performed this study to establish a nationwide surveillance network system and identify the causative agents for CAP and antibiotic resistance in Korean children with CAP. Methods The monitoring network was composed of 28 secondary and tertiary medical institutions. Upper and lower respiratory samples were assayed using a culture or polymerase chain reaction (PCR) from August 2018 to May 2020. Results A total of 1023 cases were registered in patients with CAP, and PCR of atypical pneumonia pathogens revealed 422 cases of M. pneumoniae (41.3%). Respiratory viruses showed a positivity rate of 65.7% by multiplex PCR test, and human rhinovirus was the most common virus, with 312 cases (30.5%). Two hundred sixty four cases (25.8%) were isolated by culture, including 131 cases of S. aureus (12.8%), 92 cases of S. pneumoniae (9%), and 20 cases of H. influenzae (2%). The cultured, isolated bacteria may be colonized pathogen. The proportion of co-detection was 49.2%. The rate of antibiotic resistance showed similar results as previous reports. Conclusions This study will identify the pathogens that cause respiratory infections and analyze the current status of antibiotic resistance to provide scientific evidence for management policies of domestic respiratory infections. Additionally, in preparation for new epidemics, including COVID-19, monitoring respiratory infections in children and adolescents has become more important, and research on this topic should be continuously conducted in the future.

IntroductionDespite the risk of incident chronic kidney disease among the patients with rheumatoid arthritis (RA), the association of RA and the risk of end-stage renal disease (ESRD) has not been clearly elucidated. We aimed to investigate the association of RA and the risk of ESRD.Materials and methodsA total of 929,982 subjects with (n = 154,997) or without (n = 774,985) RA from the National Health Insurance Service (NHIS) database in Koreas (corresponding to the period between 2009 and 2017) were retrospectively analyzed. RA was defined by the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), codes plus any dispensing of disease-modifying anti-rheumatic drugs. The primary outcome was incident ESRD, identified by a combination of the ICD-10-CM codes and a special code assigned to patients receiving maintenance dialysis for ≥ 3 months or those with a transplant kidney.ResultsCompared to the subjects without RA, the subjects with RA resulted in an increased incidence of ESRD (incidence rates of 0.374 versus 0.810 cases per 1,000 person-years). Accordingly, compared to the subjects without RA, the risk of ESRD was significantly increased among the subjects with RA (adjusted hazard ratio 2.095, 95% confidence interval 1.902–2.308). Subgroup analyses revealed that the risk of ESRD imposed by RA is relatively higher in relatively young and healthy individuals.ConclusionRheumatoid arthritis (RA) increase the risk of ESRD. As the risk of ESRD imposed by RA is relatively higher in relatively young and healthy individuals, kidney-protective treatment, such as biologic agents, should be preferentially considered among these patients with RA.

PurposeTo investigate the association between insomnia and the risk of various cancers using the Korean National Health Insurance Service database.Materials and methodsPatients who underwent a national health examination in 2009 were followed-up until 2018. Newly-diagnosed cancers were collected one year after the baseline. Insomnia was defined as having a diagnosis of F510 or G470 within one year prior to enrollment. The incidence of various cancers was compared between patients with and without insomnia.ResultsIn the overall study population (N = 3,982,012), the risk for any type of cancer was not different between controls and insomnia patients (adjusted hazard ratio [aHR]: 0.990). However, it was different by age; insomnia increased the risk of any cancer in younger age groups (20-39y and 40-59y, aHR:1.310 and 1.139, respectively) but it significantly decreased the risk in the 60-79y age group (aHR: 0.939). In cancer type, colorectal cancer risk was lower (aHR: 0.872, P < 0.0001), whereas leukemia risk was higher (aHR: 1.402, P < 0.0001) in patients with insomnia than in those without it, regardless of sex. In men, the risk of stomach cancer was lower (aHR: 0.882, P = 0.0003), and the risks of lung (aHR:1.114, P = 0.0005), kidney (aHR 1.226, P = 0.0107), and prostate (aHR:1.101, P = 0.0028) cancers were higher in insomnia patients than in control patients. In women, insomnia patients compared to control patients showed a lower risk of ovarian cancer (aHR:0.856, P = 0.0344, respectively), while they had a higher risk of oral (aHR:1.616, P = 0.002), thyroid (aHR:1.072, P = 0.0192), and nerve (aHR: 1.251, P = 0.016) cancers.ConclusionInsomnia is associated with an increased or decreased risk of some cancers, depending on age, cancer type and sex.

Until recently, the most standard treatment for sensorineural or sudden hearing loss, which is caused by inner ear damage or deterioration, has been systemic oral steroid administration. In recent, intratympanic steroid injections such as dexamethasone have been used for the treatment of sudden hearing loss as well. It is injected into the tympanic cavity through its membrane and is expected to diffuse over the round window located between the tympanic cavity and the inner ear. However, in clinical situations, the delivery time of steroids to the inner ear is shorter than 24 h, which does not allow for a sufficient therapeutic effect. Therefore, we applied a previously invented dual viscosity mixture vehicle (DVV) for intratympanic dexamethasone to a guinea pig model, which could reduce the side effects of systemic steroid administration with sufficient dwelling time for the treatment of hearing loss, and we investigated the physiological changes with a global proteomic approach. In this study, we extracted perilymph in three different conditions from guinea pigs treated with dexamethasone-embedded DVV, dexamethasone mixed in saline, and control groups to compare proteomic changes using tandem mass spectrometry analysis. After liquid chromatography coupled tandem mass spectrometry (LC-MS/MS) analysis, we first identified 46 differentially expressed proteins (DEPs) that were statistically significant after one-way ANOVA multiple-sample test. We also performed pairwise comparisons among each group to identify DEPs closely related to the treatment response of dexamethasone-embedded DVV. Gene ontology enrichment analysis showed that these DEPs were mostly related to inflammation, immune, actin remodeling, and antioxidant-related processes. As a result, the proteome changes in the DVV-treated groups revealed that most upregulated proteins activate the cell proliferation process, and downregulated proteins inhibit apoptosis and inflammatory reactions. Moreover, the reactive oxygen process was also regulated by DEPs after DVV treatment.

Objective This study was performed to determine the effects of stress after road transportation and oral administration of chromium and meloxicam on growth performance, plasma cortisol, serum metabolites, and behavior in dairy calves. Methods A total of 50 Holstein heifers (average body weight [BW]: 172±4.19 kg; average age: 5.53±0.12 months) were randomly assigned to five groups including NL (not transported + D-lactose; 1 mg/kg BW), TL (transported + D-lactose; 1 mg/kg BW), TC (transported + chromium; 0.5 mg/kg dry matter [DM] feed), TM (transported + meloxicam; 1 mg/kg BW), and TMC (transported + combination of meloxicam and chromium; 1 mg/kg BW and 0.5 mg/kg DM, respectively). Doses of D-lactose monohydrate, meloxicam, and chromium were prepared for oral administration by suspension in 15 mL of water in a 20-mL dosing syringe. Blood was collected before transportation, immediately after 120 km of transportation (IAT), and at 6, 24, and 48 h after transportation. Results Neither transportation nor administration of meloxicam and/or chromium affected (p = 0.99) average daily gain and feed intake. Plasma cortisol concentrations in the NL group (average 0.13 and 0.18 nmol/L, respectively) were lower (p

Background/Aims The diagnosis of intestinal tuberculosis (ITB) is often challenging. Therapeutic anti-tubercular trial (TATT) is sometimes used for the diagnosis of ITB. We aimed to evaluate the changing pattern of fecal calprotectin (FC) levels during TATT in patients with ITB. Methods A retrospective review was performed on the data of 39 patients who underwent TATT between September 2015 and November 2018 in five university hospitals in Daegu, South Korea. The analysis was performed for 33 patients with serial FC measurement reports. Results The mean age of the participants was 48.8 years. The final diagnosis of ITB was confirmed in 30 patients based on complete mucosal healing on follow-up colonoscopy performed after 2 months of TATT. Before starting TATT, the mean FC level of the ITB patients was 170.2 μg/g (range, 11.5-646.5). It dropped to 25.4 μg/g (range, 11.5-75.3) and then 23.3 μg/g (range, 11.5-172.2) after one and two months of TATT, respectively. The difference in mean FC before and one month after TATT was statistically significant (p

Abstract The pathogenic variant (PV) or likely pathogenic variant (LPV) BRCA1/2 gene is strongly associated with hereditary breast or ovarian cancer. Therefore, it is important to screen blood relatives to establish preventive modalities and surveillance. This study evaluated the feasibility of targeted cascade genetic testing for family members of BRCA1/2 gene PV or LPV carriers. We screened 18 families for BRCA1/2 gene status via the conventional cascade genetic test (n = 9) and targeted cascade genetic test (n = 9), which targeted the exon region wherein the index patient showed PV or LPV. The pedigree and clinicopathologic characteristics were reviewed and analyzed. All index patients were diagnosed with breast cancer, while the third family members were all healthy. In the conventional cascade test group, 3 index patients and 3 family members had the BRCA1/2 gene PV or LPV. In the targeted cascade test group, 5 family members had same type of BRCA1/2 gene PV or LPV as their index patients. Two families had an identical string of BRCA1/2 gene PV or LPV. Although the targeted cascade genetic test cannot completely characterize the BRCA1/2 gene, it is sufficient for determining its PV or LPV status. This limited genetic test can be used for family members of PV or LPV carriers.

Abstract Revascularization procedures, including percutaneous coronary intervention (PCI), for coronary artery disease (CAD) are increasingly performed in Korea. However, studies on blood pressure control targets in these patients remain insufficient. To assess the relationship between baseline blood pressure and all-cause mortality in CAD patients who underwent PCI. A population-based retrospective cohort study based on the national claims database of the Korean National Health Insurance System, which represents the entire Korean population. A total 38,330 patients with a history of PCI for CAD between 2005 and 2008 were recruited and followed up for all-cause mortality until December 31, 2017. Baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and they were classified into eight SBP and DBP groups each. The hazard ratios (HRs) for all-cause mortality were measured for each group. The pattern of SBP and DBP in this population followed a J-curve relationship for all-cause mortality, with the nadir point at 119 and 74 mmHg, respectively. In subjects aged > 60 years, high SBP (≥ 160 mmHg) and high DBP (≥ 90 mmHg) were significantly related to death. Moreover, in subjects aged > 60 years, low DBP (

Despite recent advances in next-generation sequencing, the underlying etiology of adult-onset leukoencephalopathy has been difficult to elucidate. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a representative hereditary adult-onset leukoencephalopathy associated with vasculopathy. Leukoencephalopathy in spastic paraplegia type 4 (SPG4) is known to be rare, but it might be underestimated because most spastic paraplegia with leukoencephalopathy is rarely considered. We report a case of co-occurring SPG4 and CADASIL. A 61-year-old male presented with sudden visual impairment after a headache. He showed a spastic gait and had a family history with similar symptoms. An SPG4 gene mutation and a pathogenic variant in the NOTCH3 gene were found. This case shows that the diverse and complex clinical manifestations of patients with extensive leukoencephalopathy are related to more than one gene mutation. We also suggest the necessity for relevant genetic tests in the diagnosis of adult-onset leukoencephalopathy.

An electrochemical sensor sensitive to coenzyme A (CoA) was designed using a CoA-responsive polyallylamine–manganese oxide–polymer dot nanogel coated on the electrode surface to detect various genetic models of osteoarthritis (OA). The CoA-responsive nanogel sensor responded to the abundance of CoA in OA, causing the breakage of MnO2 in the nanogel, thereby changing the electroconductivity and fluorescence of the sensor. The CoA-responsive nanogel sensor was capable of detecting CoA depending on the treatment time and distinguishing the response towards different OA genetic models that contained different levels of CoA (wild type/WT, NudT7 knockout/N7KO, and Acot12 knockout/A12KO). The WT, N7KO, and A12KO had distinct resistances, which further increased as the incubation time were changed from 12 h (R12h = 2.11, 2.40, and 2.68 MΩ, respectively) to 24 h (R24h = 2.27, 2.59, and 2.92 MΩ, respectively) compared to the sensor without treatment (Rcontrol = 1.63 MΩ). To simplify its application, the nanogel sensor was combined with a wireless monitoring device to allow the sensing data to be directly transmitted to a smartphone. Furthermore, OA-indicated anabolic (Acan) and catabolic (Adamts5) factor transcription levels in chondrocytes provided evidence regarding CoA and nanogel interactions. Thus, this sensor offers potential usage in simple and sensitive OA diagnostics. [ABSTRACT FROM AUTHOR]

A coenzyme A (CoA-SH)-responsive dual electrochemical and fluorescence-based sensor was designed utilizing an MnO2-immobilized-polymer-dot (MnO2@D-PD)-coated electrode for the sensitive detection of osteoarthritis (OA) in a peroxisomal β-oxidation knockout model. The CoA-SH-responsive MnO2@D-PD-coated electrode interacted sensitively with CoA-SH in OA chondrocytes, triggering electroconductivity and fluorescence changes due to cleavage of the MnO2 nanosheet on the electrode. The MnO2@D-PD-coated electrode can detect CoA-SH in immature articular chondrocyte primary cells, as indicated by the significant increase in resistance in the control medium (R24h = 2.17 MΩ). This sensor also sensitively monitored the increase in resistance in chondrocyte cells in the presence of acetyl-CoA inducers, such as phytol (Phy) and sodium acetate (SA), in the medium (R24h = 2.67, 3.08 MΩ, respectively), compared to that in the control medium, demonstrating the detection efficiency of the sensor towards the increase in the CoA-SH concentration. Furthermore, fluorescence recovery was observed owing to MnO2 cleavage, particularly in the Phy- and SA-supplemented media. The transcription levels of OA-related anabolic (Acan) and catabolic factors (Adamts5) in chondrocytes also confirmed the interaction between CoA-SH and the MnO2@D-PD-coated electrode. Additionally, electrode integration with a wireless sensing system provides inline monitoring via a smartphone, which can potentially be used for rapid and sensitive OA diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: The incidence of early-onset colorectal cancer (EoCRC) is increasing worldwide. The association between hypertriglyceridemia (HTG) and EoCRC risk remains unclear. Materials and Methods: We conducted a nationwide cohort study of 3,340,635 individuals aged 20-49 years who underwent health checkups between 2009 and 2011 under the Korean National Health Insurance Service. HTG was defined as serum triglyceride (TG) level ≥ 150 mg/dL. According to the change in TG status, participants were categorized into persistent normotriglyceridemia (NTG; group 1), NTG to HTG (group 2), HTG to NTG (group 3), and persistent HTG (group 4) groups. The EoCRC incidence was followed up until 2019. Results: In total, 7,492 EoCRC cases developed after a mean of 6.05 years of follow-up. Group 4 had the highest risk of EoCRC (adjusted hazard ratio [aHR], 1.097; 95% confidence interval [CI], 1.025 to 1.174). While the risk of rectal cancer was significantly increased in groups 3 and 4 (aHR [95% CI], 1.236 [1.076 to 1.419] and 1.175 [1.042-1.325], respectively), no significant risk differences were observed in right colon cancer. In group 4, male sex and diabetes were associated with a further increased risk of EoCRC (aHR [95% CI], 1.149 [1.082 to 1.221] and 1.409 [1.169 to 1.699], respectively). In addition, there was a dose-response relationship between serum TG levels and the risk of EoCRC (p for trends < 0.0001). Conclusion Persistent HTG increased the risk of EoCRC, which was significantly higher only for rectal cancer and marginally higher for other colonic subsites. [ABSTRACT FROM AUTHOR]

This paper presents the design, analysis, and control of a dual transformer-based bidirectional DC/DC resonant converter featuring balanced voltage stress across all the resonant capacitors. Compared to existing topologies, the proposed converter has a dual-rectifier structure on the secondary side, which allows operation over a wide load range with balanced voltage stress across all resonant components. The transformer stress is greatly reduced by employing two small transformers, thus greatly lowering thermal as well electrical stresses on the transformers’ windings. Furthermore, by operating the primary-side interleaved converter at a fixed 50% duty, input current ripples are significantly reduced. The proposed controller consists of a feedforward control part for effective system uncertainty compensation and a feedback control part for the convergence of system error dynamics. Notably, state-plane trajectory theory is employed to derive accurate feedforward compensation terms. Additionally, the effect of resonant elements’ parameter mismatch is analyzed in detail. The designed controller was implemented using the TI TMS320F28377D DSP on a 3.3 kW prototype hardware board. Detailed experimental investigations under tough, practical operating conditions corroborate an effective bidirectional power transfer operation with a balanced voltage stress distribution in each resonant element.

Purpose Genital injury is a common pediatric injury. Given the lack of nationwide data, the authors aimed to show age group-related epidemiologic features of genital injury in Korea. Methods We reviewed the data from 2011-2016 Emergency Department-based Injury In-depth Surveillance registry, which involves 23 emergency departments in Korea. From the dataset, we included children (< 18 years) with the International Classification of Diseases, 10th Revision codes related to genital injury as the final diagnosis with excluding those with other codes or combined injuries. Age groups were defined as follows; infants (< 1 year), toddlers (1-3), preschoolers (4-6), schoolers (7-12), and adolescents (13-17). The clinical features and outcomes were analyzed. Results A total of 3,030 children were included with the median age of 6 years (interquartile range, 4-10) and the proportion of girls of 53.0%. Only 144 children (4.8%) were transported by the emergency medical service providers. The most common mechanism and place were blunt injury (1,826 [60.3%]) and home (1,535 [50.7%]), respectively. Of the codes, “Contusion of external genital organs (S30.2)” was most common (1,574 [51.9%]). As for outcomes, 2,770 children (91.4%) were discharged, 252 (8.3%) were hospitalized (intensive care units, 1 child [0.03%]), and 108 (3.6%) underwent surgery. Severe injury occurred in 111 children (3.7%) without a mortality. With increasing age in the age groups, non-accidental injury, school and sports-related injuries, hospitalization, and surgery (All Ps < 0.001). Conclusion Genital injury may occur at evening, in spring and summer, at home, and in the form of accidental or blunt injury. Most children are discharged. Contrary to these general features, older children tend to undergo more frequently non-accidental injury, school and sports-related injuries, hospitalization, and surgery. Thus, we need age-specific strategies for injury prevention.

Although the individual channel readout method can improve the performance of PET detectors with pixelated photo-sensors, such as silicon photomultiplier (SiPM), this method leads to a significant increase in the number of readout channels. In this study, we proposed a novel multiplexing method that could effectively reduce the number of readout channels to reduce system complexity and development cost. The proposed multiplexing circuit was designed to generate bipolar pulses with different zero-crossing points by adjusting the time constant of the high-pass filter connected to each channel of a pixelated photo-sensor. The channel position of the detected gamma-ray was identified by estimating the width between the rising edge and the zero-crossing point of the bipolar pulse. In order to evaluate the performance of the proposed multiplexing circuit, four detector blocks, each consisting of a 4 × 4 array of 3 mm × 3 mm × 20 mm LYSO and a 4 × 4 SiPM array, were constructed. The average energy resolution was 13.2 ± 1.1% for all 64 crystal pixels and each pixel position was accurately identified. A coincidence timing resolution was 580 ± 12 ps. The experimental results indicated that the novel multiplexing method proposed in this study is able to effectively reduce the number of readout channels while maintaining accurate position identification with good energy and timing performance. In addition, it could be useful for the development of PET systems consisting of a large number of pixelated detectors.

Abstract Background Substantial evidence supports an association between physical activity and cognitive function. However, the role of muscle mass and function in brain structural changes is not well known. This study investigated whether sarcopenia, defined as low muscle mass and strength, accelerates brain volume atrophy. Methods A total of 1284 participants with sarcopenic measurements and baseline and 4-year follow-up brain magnetic resonance images were recruited from the Korean Genome and Epidemiology Study. Muscle mass was represented as appendicular skeletal muscle mass divided by the body mass index. Muscle function was measured by handgrip strength. The low mass and strength groups were defined as being in the lowest quintile of each variable for one’s sex. Sarcopenia was defined as being in the lowest quintile for both muscle mass and handgrip strength. Results Of the 1284 participants, 12·6%, 10·8%, and 5·4% were classified as the low mass, low strength, and sarcopenia groups, respectively. The adjusted mean changes of gray matter (GM) volume during 4-year follow-up period were − 9·6 mL in the control group, whereas − 11·6 mL in the other three groups (P

Abstract Background In the very elderly, “the lower the better” hypothesis has constantly been contradicted by randomized control trials and various cohort studies, but inconsistency in results led to unclear blood pressure treatment targets. This study aimed to assess the relationship between baseline blood pressure (BP) and ischemic stroke, myocardial infarction, and all-cause mortality in very elderly people treated for hypertension. Methods This large population-based retrospective cohort study was based on the national claims database of the Korean National Health Insurance System, which covers the entire Korean population. 374,250 participants aged ≥ 75 years taking antihypertensive agents were recruited, excluding patients with a history of previous ischemic stroke or myocardial infarction. Results Systolic BP (SBP) followed a J curve for ischemic stroke and a U curve for all-cause mortality, with nadir ranges of 120 to 129 mmHg and 140 to 149 mmHg, respectively. While increasing diastolic BP (DBP) generally resulted in higher HRs for ischemic stroke, HRs for myocardial infarction and all-cause mortality significantly increased only when DBP was ≥ 80 mmHg and ≥ 90 mmHg, respectively. The SBP/DBP combination analysis showed that even with SBP < 130 mmHg, higher DBP ≥ 90 mmHg had higher HRs for all three outcomes compared to the reference group (130 to 149 / < 80 mmHg). Conclusions There were no further benefits or even harm below certain BP levels for ischemic stroke, myocardial infarction, and all-cause mortality in very elderly hypertensive patients.

An accurate understanding of ultrasound findings of post-operative changes in breast cancer would be one of the most important areas of breast cancer surveillance. This is especially true when the ultrasound is performed by breast surgeons who have in-depth knowledge of oncoplastic breast surgery as it would be easier for them to distinguish between true recurrence of breast cancer and post-operative changes. In this article, the various but typical post-operative changes in breast cancer are described. These findings would be truly helpful to breast surgeons for the detection of early recurrence and treatment of post-operative complications.

Abstract We aimed to develop a novel prediction model for early neurological deterioration (END) based on an interpretable machine learning (ML) algorithm for atrial fibrillation (AF)-related stroke and to evaluate the prediction accuracy and feature importance of ML models. Data from multicenter prospective stroke registries in South Korea were collected. After stepwise data preprocessing, we utilized logistic regression, support vector machine, extreme gradient boosting, light gradient boosting machine (LightGBM), and multilayer perceptron models. We used the Shapley additive explanation (SHAP) method to evaluate feature importance. Of the 3,213 stroke patients, the 2,363 who had arrived at the hospital within 24 h of symptom onset and had available information regarding END were included. Of these, 318 (13.5%) had END. The LightGBM model showed the highest area under the receiver operating characteristic curve (0.772; 95% confidence interval, 0.715–0.829). The feature importance analysis revealed that fasting glucose level and the National Institute of Health Stroke Scale score were the most influential factors. Among ML algorithms, the LightGBM model was particularly useful for predicting END, as it revealed new and diverse predictors. Additionally, the effects of the features on the predictive power of the model were individualized using the SHAP method.

Fusarium head blight (FHB) of wheat, mainly caused by Fusarium graminearum Schwabe, is an emerging threat to wheat production in Korea under a changing climate. The disease occurrence and accumulation of associated trichothecene mycotoxins in wheat kernels strongly coincide with warm and wet environments during flowering. Recently, the International Panel for Climate Change released the 6th Coupled Model Intercomparison Project (CMIP6) climate change scenarios with shared socioeconomic pathways (SSPs). In this study, we adopted GIBSIM, an existing mechanistic model developed in Brazil to estimate the risk infection index of wheat FHB, to simulate the potential FHB epidemics in Korea using the SSP245 and SSP585 scenarios of CMIP6. The GIBSIM model simulates FHB infection risk from airborne inoculum density and infection frequency using temperature, precipitation, and relative humidity during the flowering period. First, wheat heading dates, during which GIBSIM runs, were predicted over suitable areas of winter wheat cultivation using a crop development rate model for wheat phenology and downscaled SSP scenarios. Second, an integrated model combining all results of wheat suitability, heading dates, and FHB infection risks from the SSP scenarios showed a gradual increase in FHB epidemics towards 2100, with different temporal and spatial patterns of varying magnitudes depending on the scenarios. These results indicate that proactive management strategies need to be seriously considered in the near future to minimize the potential impacts of the FHB epidemic under climate change in Korea. Therefore, available wheat cultivars with early or late heading dates were used in the model simulations as a realistic adaptation measure. As a result, wheat cultivars with early heading dates showed significant decreases in FHB epidemics in future periods, emphasizing the importance of effective adaptation measures against the projected increase in FHB epidemics in Korea under climate change.