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본 논문에서는 시선안정화 3축 김벌을 가진 전자광학추적시스템에 대하여, 제어기를 mLQT(modified Linear Quadratic Tracker)와 외란관측기(Disturbance Observer, DOB)를 이용하여 설계/제안한다. 먼저 플랜트에 대한 모델링을 수행하고, 계측기(Dynamic Signal Analyzer)를 통해 모델링 플랜트를 검증하고, 제어기를 mLQT와 DOB를 통해 설계하고, 제어기의 검증을 위하여 매트랩/시뮬링크에서 제안된 제어기 및 PID, mLQT, PID+DOB, PID+Dual DOB를 함께 설계하여, 개루프 주파수 응답, 토크 외란 주파수 응답 성능을 평가한다. 또한, 내부 시선안정화제어기 플랜트에 대해 동역학 모델링을 수행하고, 매트랩/시뮬링크-다풀 간의 co-simulation을 수행하여, 시선안정화 정확도 성능을 평가한다.

To determine whether 3D-CT imaging technique is valid and reproducible compared to conventional CT measurement technique (CCT) for the detection of a femoropatellar instability.Patients who had undergone surgery for femoropatellar instability (patellar instability group) between 2010 and 2016 (n = 37 knees of 35 patients) were retrospectively enrolled. For the matched control group, patients who had acute anterior cruciate ligament injury (4 weeks previously; n = 30) were recruited. Preoperative CT data had been obtained in all patients. Inter-rater reliability was calculated for both measurement protocols, and inter-method reliability was calculated between the two imaging modalities. The results are reported using intraclass correlation coefficients (ICCs) and Bland-Altman 95% limits of agreement.All patients in the patellar instability group had femoral trochlear dysplasia (Dejour types A: four, B: 19, C: seven, and D: six), but no dysplasia was noted in the control group. In the patellar instability group, the CCT technique showed a poor inter-rater agreement (ICC = 0.74), and the 3D-CT technique still showed excellent inter-rater agreement (ICCs = 0.91). In the sub-analysis of the patellar instability group according to the trochlear dysplasia grade, ICCs were markedly decreased with severe trochlear dysplasia when using CCT technique; however, the 3D-CT technique could provide excellent reliability even with severe trochlear dysplasia.The 3D-CT imaging technique for the measurement of the TT-TG distance can be suggested as a better measurement technique for patellar instability patients with bone abnormality.

Purpose When performing lateral closing wedge high tibial osteotomy (LCWHTO), fibular untethering can be performed with either fibular shaft osteotomy (FSO) or proximal tibiofibular division (TFD). The aim of this study was to compare the degree of varus instability between the two methods after LCWHTO and to analyze the determinants of varus instability. Methods This study retrospectively analyzed 108 consecutive patients with medial compartment osteoarthritis who underwent LCWHTO and had > 2 years of follow-up. Patients who underwent unilateral LCWHTO without a previous history of ligament injury were included. Forty-five patients who received LCWHTO with TFD and 51 patients who received LCWHTO with FSO were finally analyzed. The mean follow-up duration was 5.3 years in LCWHTO with TFD and 4.1 years in LCWHTO with FSO. The shortest distance between the lateral tibial plateaus and the corresponding most distal subchondral bone surface of the lateral femoral condyle was measured on varus stress radiographs and compared with that on the unaffected contralateral knee. Multivariable logistic regression analyses were conducted to identify predictors of varus instability. Results Lateral joint space width showed no significant between-group difference. Multivariable logistic regression analysis revealed that the pre-operative hip-knee-ankle angle was positively correlated with the lateral joint space width. The type of fibular untethering procedure was not associated with postoperative varus instability. Conclusion The degree of pre-operative varus malalignment is associated with postoperative varus instability after LCWHTO. Proximal tibiofibular division is not a variable for postoperative varus instability after LCWHTO. Level of evidence Level III, Retrospective comparative study.

Purpose To evaluate if preoperative sterile pyuria can be a prognostic factor for intravesical recurrence (IVR) and overall survival (OS)in patients with upper tract urothelial carcinoma (UTUC) undergoing surgery. Materials and methods We retrospectively reviewed the medical records of patients who were diagnosed with UTUC from October 2003 to December 2016 at Korea University Medical Center. Sterile pyuria was defined as urine containing five or more white blood cells per high-power field in the absence of bacteria in urine culture. We used a stepwise multivariable Cox proportional hazards model to assess the independent effects of the prognostic factors for IVR and OS. Results We investigated a total of 176 patients who were diagnosed with UTUC. Among them, 91 (51.7%) patients had preoperative sterile pyuria. There were no significant differences in the baseline characteristics between the pyuria and non-pyuria groups concerning tumor grade, T stage, tumor multiplicity, and recurrence history. However, there was a significant difference in the IVR between the two groups. In the multivariable analysis, preoperative sterile pyuria, diabetes mellitus, high-grade tumor, and lymphovascular invasion were revealed as independent risk factors for IVR, and only lymphovascular invasion was identified as an independent risk factor for OS. Conclusions Preoperative sterile pyuria is significantly associated with IVR in patients with UTUC undergoing surgery, but it is not associated with OS. Furthermore, diabetes mellitus, high-grade tumor, and lymphovascular invasion are also independent prognostic factors for these patients.

To develop a new prognostic model for the overall survival of patients with clear cell metastatic renal cell carcinoma (mRCC) using Korean Renal Cancer Study Group (KRoCS) database and compared it with 2 renowned prognostic models: the Memorial Sloan Kettering Cancer Center (MSKCC) and the international metastatic renal cell carcinoma database consortium (IMDC) models. Data of 790 patients diagnosed with mRCC and receiving targeted therapy as their first-line treatment were pooled to this study. Data from 4 hospitals (n = 619) were used to develop the new model and those from other 5 hospitals (n = 171) were used for external validation. After detecting prognostic factors in multivariable Cox proportional-hazards regression analysis, patients were classified into 3 risk groups, favorable (0), intermediate (1–2), and poor (3 and more) by the number of prognostic factors. Seven variables such as more than 2 metastasis sites, no prior nephrectomy, Eastern Cooperative Oncology Group performance status ≥2, low hemoglobin, high serum corrected calcium, high neutrophil, high serum alkaline phosphatase were identified as prognostic factors for poor overall survival. Also, risk groups were categorized into 3 groups; median overall survival was 61.1 months in favorable, 26.5 months in intermediate, and 6.8 months in poor group. KRoCS ranked the first in all 3 statistical parameters including akaike information criterion (AIC), concordance index and generalized R2 among other prognostic models. We developed the KRoCS model and validated it externally with demonstrating its superiority over MSKCC and IMDC models. The KRoCS model can provide useful information for counseling patients with clear cell mRCC regarding life-expectancy.

본 연구는 발달장애인의 지역사회 내 독립주거를 위한 지원서비스를 제공한 종사자들을 대상으로 하여 해당 지원서비스 사업에 대한 그들의 다양한 언급들을 분석하여 공통적으로 드러나는 인식들을 도출해내었다. 이를 통해 발달장애인 당사자와 보호자가 지역사회 내에서 성공적으로 독립주거를 실현할 수 있고, 종사자들은 보다 안정적으로 서비스를 제공할 수 있도록 서비스의 발전을 위한 정책적, 실천적 제언의 도출을 목적으로 하였다. 연구 결과 종사자들의 주거지원 서비스 인식은 연구 참여자들의 유의미한 언급들을 범주화하여 하위주제 13개를 도출하고, 이를 다시 한 번 범주화한 결과 ‘부정적 인식’, ‘긍정적 인식’, ‘당사자의 변화’, ‘보호자의 변화’, ‘주거지원 인력의 고충’라는 5개의 상위주제(Themes)로 나타났다. 이러한 분석결과를 토대로 발달장애인 독립주거 지원서비스의 발전과 정착을 위한 실천적 제언을 도출하였다.

Background: Knee osteoarthritis (OA) causes not only pain during walking but also walking disorders. Therefore, intervention for older patients with OA is important. Objective: To study investigated the effects of kinesio taping (KT) on pain and walking ability in elderly persons with knee OA. Design: One group, pre-post design Methods: This study enrolled 12 community-dwelling elderly people with knee OA. KT was applied on the surrounding structures, including the patellar and bilateral lateral ligaments. Assessment was made using the visual analog scale and GAITRite system to measure pain and walking ability during KT and non- KT conditions. Results: In this study, compared to the non-KT condition, the KT condition showed a significant improvement in walking ability and pain reduction during walking (velocity, cadence, step length, and stride length) (p < 0.05). Conclusion: This study demonstrated that knee KT has a positive effect on pain reduction and walking ability of the elderly with OA.

BackgroundMaintenance of optimal knee joint line orientation (KJLO) is important after high tibial osteotomy (HTO). No tools, however, are currently available that could predict the value of postoperative KJLO before surgery. First, this study sought to determine the effects of various preoperative anatomical alignment parameters to postoperative KJLO. Based upon these analyses, we aimed to devise an equation that predicts the value of postoperative KJLO.MethodsA total of 14 radiographic parameters were measured in preoperative and postoperative full-limb standing anteroposterior radiographs on 50 patients who underwent open-wedge HTO. The parameters were analysed using multivariable linear regression to predict KJLO after HTO. External validation of the equation was done with 20 patients who underwent HTO at another institution.ResultsAfter HTO, KJLO increased from − 0.8° to 2.9° (P ConclusionsThis study analysed the effects of preoperative anatomical alignment parameters on the postoperative KJLO. An equation which predicts postoperative KJLO with preoperative anatomical alignment factors was devised and validated. This equation would help in selecting optimal patients for HTO and in selecting the optimal target correction angle in HTO.

Purpose Previous studies have suggested that androgen deprivation therapy (ADT) is associated with cerebral infarction. However, conflicting results have been reported by other researchers. The aim of this study was to evaluate the association between ADT and cerebral infarction in patients with prostate cancer (PC) using big data. Materials and Methods Using information from the National Health Insurance Service database representative of the entire Korean adult PC population (n = 206 735), data regarding ADT and cerebral infarction between 2009 and 2016 were analyzed. Adjusted hazard ratios for cerebral infarction associated with ADT were estimated using propensity score‐matched Cox proportional hazards models and Kaplan‐Meier survival analyses. Results The final cohort comprised 36 146 individuals with PC, including 24 069 men (66.6%) who underwent ADT. During the mean follow‐up of 4.1 years, 2792 patients were newly diagnosed with cerebral infarction. In the unmatched cohort, there was a significant difference in the annual incidence of cerebral infarction between the ADT and non‐ADT groups (22.8 vs 14.6 per 1000 person‐years, respectively). However, there was no significant difference between the ADT and non‐ADT groups in the matched cohort (14.9 vs 14.6 per 1000 person‐years). The adjusted hazard ratio for cerebral infarction for PC patients who underwent ADT was 1.045 (95% CI 0.943‐1.159; P = 0.401) compared with those who did not undergo ADT. In addition, the cumulative duration of ADT was also not associated with an increased risk for cerebral infarction. However, older age, hypertension, diabetes, myocardial infarction, congestive heart failure, peripheral vascular disease, renal disease, dementia, and atrial fibrillation were revealed to be factors contributing to cerebral infarction. Conclusion This nationwide population‐based study revealed that ADT was not associated with cerebral infarction after adjusting for potential confounders.

Objective This study aimed to examine the association between normal-but-low folate levels and cognitive function in the elderly population using a prospective cohort study. Methods We analyzed 3,910 participants whose serum folate levels were within the normal reference range (1.5-16.9 ng/mL) at baseline evaluation in the population-based prospective cohort study named the "Korean Longitudinal Study on Cognitive Aging and Dementia." The association between baseline folate quartile categories and baseline cognitive disorders [mild cognitive impairment (MCI) or dementia] was examined using binary logistic regression analysis adjusting for confounding variables. The risks of incident MCI and dementia associated with the decline of serum folate level during a 4-year follow-up period were examined using multinomial logistic regression analysis. Results The lowest quartile group of serum folate (≥1.5, ≤5.9 ng/mL) showed a higher risk of cognitive disorders than did the highest quartile group at baseline evaluation (odds ratio 1.314, p=0.012). Over the 4 years of follow-up, the risk of incident dementia was 2.364 times higher among subjects whose serum folate levels declined from the 2nd-4th quartile group to the 1st quartile than among those for whom it did not (p=0.031). Conclusion Normal-but-low serum folate levels were associated with the risk of cognitive disorders in the elderly population, and a decline to normal-but-low serum folate levels was associated with incident dementia. Maintaining serum folate concentration above 5.9 ng/mL may be beneficial for cognitive status.

Objectives The optimal treatment strategy for metastatic non‐clear cell renal cell carcinoma (mNCCRCC) is still elusive and mainly extrapolated from evidence available for metastatic clear cell renal cell carcinoma. The aim of the study was therefore to investigate the survival outcomes and prognostic factors affecting survival in patients with mNCCRCC treated with targeted therapy. Materials and methods We analyzed a total of 156 patients (8.1%) with mNCCRCC among the total cohort of 1922 patients in the Korean metastatic RCC registry. We used Kaplan‐Meier curve analysis to calculate the survival estimates for first‐line progression‐free survival (PFS), total PFS, and cancer‐specific survival (CSS). We also used the log‐rank test to compare the different groups and multivariate Cox‐proportional hazard regression analyses to evaluate the prognostic factors for survival. Results The mNCCRCC group had significantly inferior survival outcomes in terms of first‐line PFS, total PFS, and CSS (all P

Laminar-to-turbulent transition is simulated with large-eddy simulation (LES) coupled with parabolized stability equations (PSE). A canonical transition on a flat plate is computed. The PSE-coupled approach accurately reproduces the subharmonic resonance and subsequent turbulent boundary layer using the solver OpenFOAM. Various LES inlet locations are simulated to reduce the computational domain. Nonlinear PSE provides appropriate instabilities at various inlet locations. The computational cost and domain are reduced by 30% with the LES inlet close to the final stage of the nonlinear transition region, compared to the baseline, upstream LES inlet. Current LES results are compared with relevant data in the literature.

The Merchant of Venice is well-known primarily for its story about the rancor between Antonio and Shylock and the clash between Christianity and Judaism. If we consider the structure of the play, h...

Purpose The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and the Memorial Sloan Kettering Cancer Center (MSKCC) risk models were developed predominantly with clear cell renal cell carcinoma (RCC). Accordingly, whether these two models could be applied to metastatic non-clear cell RCC (mNCCRCC) as well has not been well-known and was investigated herein. Materials and Methods From the Korean metastatic RCC registry, a total of 156 patients (8.1%) with mNCCRCC among the entire cohort of 1,922 patients were analyzed. Both models were applied to predict first-line progression-free survival (PFS), total PFS, and cancer-specific survival (CSS). Results The median first-line PFS, total PFS, and CSS were 5, 6, and 24 months, respectively. The IMDC risk model reliably discriminated three risk groups to predict survival: the median first-line PFS, total PFS, and CSS for the favorable, intermediate, and poor risk groups were 9, 5, and, 2 months (p=0.001); 14, 7, and 2 months (p < 0.001); and 41, 21, and 8 months (p < 0.001), all respectively. The MSKCC risk model also reliably differentiated three risk groups: 9, 5, and, 2 months (p=0.005); 10, 7, and 3 months (p=0.002); and 50, 21, and 8 months (p < 0.001), also all respectively. The concordance indices were 0.632 with the IMDC model and 0.643 with the MSKCC model for first-line PFS: 0.748 and 0.655 for CSS. Conclusion The current IMDC and MSKCC risk models reliably predict first-line PFS, total PFS, and CSS in mNCCRCC.

This study developed a torque vectoring control algorithm to improve the handling performance of an electric vehicle and to evaluate the performance of the vehicle dynamics for enhanced controllability and stability. First, this study configured the control algorithm with a supervisory controller that decides the control mode by checking the current driving status of the vehicle and a target yaw rate calculator that reflects the steady-state and transient-state response characteristics according to the control mode, as well as the reference yaw rate calculation, desired yaw moment calculation, and transferred torque calculation. The control mode consists of the agile mode that controls the torque vectoring to improve controllability, and the safe mode that controls the torque vectoring to improve stability. Second, this study performed the modeling of the dual motor type torque vectoring system and an EV AWD vehicle. Finally, this study defined the driving test scenario and evaluation method, as well as the quantitative performance index for each vehicle test, and established a co-simulation environment for the handling test evaluation. It was found that when a vehicle is controlled by applying the torque vectoring system, the handling performance improved according to controllability and safe mode by verifying the simulation.

This study aims to investigate the independent influence of maternal age on the risk of emergency cesarean section (CS) due to nonreassuring fetal heart rate or arrest disorder.This was a cross-sectional study on women with nulliparous pregnancies, who are attempting vaginal delivery at term and have a cephalic presentation without the indication of elective CS at the onset of labor. The primary outcome was the rate of emergency CS. Independent risk factors were elucidated using multivariate logistic regression analysis.Of 3513 women, 541 (15.4%) delivered by emergency CS during a trial of vaginal delivery, with theses being due to nonreassuring fetal heart rate (N = 150) or arrest disorder (N = 391). In univariate analysis, both individual CS rate due to nonreassuring fetal heart rate or arrest disorder and total emergent CS rate increased with maternal age. The risk of emergency CS was also significantly higher when labor induction was performed (odds ratio (OR) 2.489, 95% confidence interval (CI) 2.043-3.033), while fetal weight was heavier (neonatal weight ≥3.5 kg; OR 2.396, 95% CI 1.956-2.934), and maternal BMI was higher (before pregnancy ≥25 kg/mAdvanced maternal age is an independent risk factor of emergency CS due to nonreassuring fetal heart rate or arrest disorder during the trial of vaginal delivery. The risk of emergency CS was also increased when labor induction was performed. Therefore, the risk of emergency CS needs to be considered, especially when the labor induction is planned, in women aged 40 or more.

Purpose: This study aims to examine the influence of beauty care regimens of adult men on their well-being-oriented behaviors and well-aging behaviors in order to explore the creation and/or maintenance of mental and physical health, thereby improving overall quality of life. Method: The collected data was analyzed by an SPSS program. The main analytical methods used were frequency and percentage. These were calculated to grasp the general characteristics of the subjects, and one-way ANOVA, t -tests and regression analyses were conducted to determine the efficacy of beauty care on well-being-oriented and well-aging behaviors. Results: Beauty care regimens of adult men had a significant positive correlation with both well-being-oriented and well-aging behaviors (r=0.507, p

Purpose To describe our initial experience with a novel method of adenoma retrieval using a pneumovesicum (PNV) after Holmium laser enucleation of the prostate (HoLEP). Methods From January 2016 to April 2018, a total of 93 consecutive patients treated with HoLEP were enrolled in this study. For tissue morcellation, we used the PNV morcellation technique for an initial series of 21 patients and the conventional technique (Lumenis VersaCut) for a consecutive series of 72 patients. We compared efficiency and safety between the novel technique and the traditional technique. Subgroup analysis was performed to assess the effectiveness of the current technique in the large prostate (>70 mL). Results There were significant differences in mean age and prostate volume between the 2 groups. However, there were no significant differences in the baseline characteristics and preoperative parameters in the subgroup analysis of large prostates (>70 mL). The mean morcellation efficiency was higher (8.50±1.94 minutes vs. 1.76±0.45 minutes, P

Copper metallization is a key issue for high performance thin film transistor technology. Hydrogen peroxide-based copper etchants are widely used in copper metallization. Recently, a hydrogen peroxide-based copper etchant for a copper/molybdenum double layer was investigated for its versatile use in both amorphous silicon TFTs and in metal-oxide TFTs. However, little is known about the etching mechanism for molybdenum and copper in a hydrogen peroxide solution containing fluorine ions. In this paper, it is shown that the amount of fluorine ions in the hydrogen peroxide-based copper etchant plays an important role in controlling the galvanic reaction between the copper and the molybdenum. A new mechanism of molybdenum dissolution in the presence of fluoride ions in 1.5 M hydrogen peroxide solution is suggested. The concentration of the fluoride ions is also important in eliminating the residue of molybdenum after wet patterning.

Popliteal artery injury is a rare but devastating complication of open-wedge high tibial osteotomy (OWHTO). The objectives of this study were: to document the location of the artery in the virtual osteotomy plane (VOP), to measure the minimal distance between the popliteal artery and three virtual saw-progression lines (VSLs), and to present a safe sawing technique for OWHTO. In total, 45 computed tomography angiographies were reconstructed and virtual osteotomy was simulated using 3D image-processing software. The VOP was defined as an inclined plane commencing 3.5 cm below the articular plane towards the fibular head. VSLs were defined as saw-progression guidelines that lie on the VOP: “VSL-mid” runs from the midpoint of the tibial medial cortex towards the fibular head; “VSL-ant” starts from the same point as VSL-mid, but runs 10° anterior to the fibular head; and “VSL-post” runs 10° posterior to the fibular head. The distances between the popliteal artery and the three VSLs were measured, and the risk of injury was assessed. The popliteal artery was located 20.7° posterior to VSL-mid and 51 mm from the starting point. The minimum distance between the popliteal artery and VSL-mid was 18 mm (99% confidence interval 9–27 mm). When the saw was moved along VSL-mid, 42% of the arteries were susceptible to injury. However, when it followed VSL-ant, there was no risk of injury. Sawing toward the fibular head carries a risk of popliteal artery injury and should not be performed. When sawing in OWHTO, the recommended target should be 10° anterior to the fibular head. This technique eliminates the risk of popliteal artery injury.

This study hypothesized that the use of bisphosphonates (BPs) after total joint arthroplasty (TJA) is associated with a lower implant revision rate. This study aimed (1) to investigate the association between BP use and the revision rate of TJA and (2) to determine the relationship between the medication period and the revision rate of TJA. National Health Insurance Service data on surgeries, medications, diagnoses, and screenings of 50 million Koreans were reviewed. People who underwent TJA in the period from 2002 to 2012 were identified and followed until 2016. During that period, 331,660 patients underwent total knee arthroplasty (TKA), and 56,043 patients underwent total hip arthroplasty (THA). Among them, 8447 knee patients (2.5%) and 2851 hip patients (5.0%) required revision surgery due to aseptic loosening. Demographic data, the duration of BP medication, and comorbidities were identified. The rate of revision surgery according to BP medication was investigated. The extended Cox proportional hazard model was used to evaluate the effect of the medication period. The rate of TKA revision was 1.4% for BP users and 2.9% for BP non-users (p

By analyzing Leslie Marmon Silko’s Ceremony primarily from an ecological perspective, this study tries to find the cause of the ecological disaster that contemporary civilization faces and argues that Ceremony is a text of resistance aiming at a gradual subversion of the corrupt white capitalist culture. By suggesting a life-centered ecological perspective, this essay clarifies that Ceremony is a practical and revolutionary text designed to present methods for achieving ecological justice which was devastated by white people’s commercial and capitalistic greed and violence upon nature. This essay also shows that Ontological equality and interdependence among the members of the ecosystem are at the core of Silko’s eco-vision, and it reflects the ancient Laguna Pueblo’s inclusive vision of the world. To understand “self/other as interpenetrating part/part and part/whole relationships rather than dichotomy” is fundamental for understanding Silko’s eco-community (Murphy 9).

With the increase in upward social comparison occurring on social networking sites (SNSs) globally, SNS researchers have examined the impact of upward social comparison. However, they focused mainly on psychological outcomes (e.g., well-being). To extend the existing studies, this study investigates the behavioral consequences of upward social comparison through the underlying mechanisms of emotions. Drawing on Smith’s typology of social comparison-based emotions, we developed a conceptual model that integrates upward social comparison on Instagram, upward comparison emotions (upward contrastive emotions and upward assimilative emotions), and the behavioral responses (SNS discontinuance, posting of comments). A structural equation modeling analysis revealed that upward social comparison in Instagram usage provoked upward contrastive emotions including anger, depression, and envy, which, in turn, induced Instagram discontinuance and the posting of malicious comments on Instagram. Additionally, upward assimilative emotions including admiration, optimism, and inspiration triggered the posting of favorable comments on Instagram. This study enhances our understanding of SNS social comparison by revealing how upward social comparison on Instagram is related to behavioral consequences.

Multiple pregnancies are prone to gestational diabetes mellitus (GDM). This study investigated the association between pregravid liver enzyme levels and the development of GDM in a twin pregnancy. Women who had the National Health Screening Examination and delivered their twin babies within one year were enrolled. Pregravid liver enzyme levels were divided into high and low level. Risks for developing GDM by high levels of liver enzymes were analyzed, in subgroups by pregravid obesity or metabolic syndrome. Among the 4348 twin pregnancies, 369 women (8.5%) developed GDM not requiring insulin treatment (GDM − IT), and 119 women (2.7%) developed GDM requiring insulin treatment(GDM + IT). High levels of pregravid GGT and ALT were related to risks of GDM + IT not only in women with obesity or metabolic syndrome (odds ratio[OR] 6.348, 95% confidence interval [CI] 2.579–15.624 and OR 6.879, 95% CI 2.232–21.204, respectively), but also in women without obesity (OR 3.05, 95% CI 1.565–5.946) or without metabolic syndrome (OR 3.338, 95% CI 1.86–5.992), compared to in women with low levels of those. However, there were no significant associations in the pregravid ALT and GGT levels and risks for development of GDM − IT, unrelated to pregravid obesity or metabolic syndrome. Therefore, this study suggests that women with high levels of pregravid GGT and ALT need to recognize their increased risk of GDM + IT, regardless of pregravid obesity or MetS, when they get pregnant twin.

We developed a statistical method that can be applied to overlay metrology tools to improve performance and time-to-results (TTR) of multi-cycle optimization based on the brute force method. First, we evaluated full response surfaces for each combination of the discrete equipment settings and calculated desirability scores using a normalization function. Second, we combined gradient optimization techniques and response surface methodologies to find the important local maxima (center of the islands in quadratic contour) and stationary response points. Once all the stationary response points have been identified, users can choose to rank the solutions by quality or can choose to use analysis of variance (ANOVA) methods to determine which main effects and/or interactions are of interest. Two separate layers were evaluated and compared to the process of reference (POR) brute force method of optimization. Results showed that the best residuals values from recipes optimized using 1-cycle SPOC-based automatic recipe optimization (ARO) and ARO based on the 2- cycle Brute-Force strategy were comparable to known residuals values from the POR recipes. Moreover, SPOC-based ARO was performed with a TTR of under 2 hours, while a 2-cycle Brute-Force ARO typically took 6~ 20 hours depending on specific configurations. The vast reduction in optimization time is primarily attributed to the elimination of multi-cycle refinement, whose data collection dominated the previously observed TTR. In conclusion, we demonstrated the ability to reduce time to solution by a factor of 3 while maintaining or improving on overlay residuals compared to existing brute force methodologies.

BACKGROUND: Transforming growth factor beta 1 (TGFβ1) plays an essential role in maintaining cartilage homeostasis. TGFβ1 is known to upregulate anabolic processes in articular cartilage, but the role of TGFβ1 in chondrocyte catabolism remains unclear. Thus, we examined whether TGFβ1 increases catabolic processes in the osteoarthritic joint via transglutaminase 2 (TG2). In this study, we investigated whether interplay between TGFβ1 and TG2 mediates chondrocyte catabolism and cartilage degeneration in osteoarthritis. METHODS: To investigate the role of TGFβ1 and TG2 in osteoarthritis, we performed immunostaining to measure the levels of TGFβ1 and TG2 in 6 human non-osteoarthritic and 16 osteoarthritic joints. We conducted quantitative reverse transcription polymerase chain reaction and western blot analysis to investigate the relationship between TGFβ1 and TG2 in chondrocytes and determined whether TG2 regulates the expressions of matrix metalloproteinase (MMP)-13, type II, and type X collagen. We also examined the extent of cartilage degradation after performing anterior cruciate ligament transection (ACLT) and destabilization of the medial meniscus (DMM) surgery in TG2 knock-out mice. RESULTS: We confirmed the overexpression of TGFβ1 and TG2 in human osteoarthritic cartilage compared with non-osteoarthritic cartilage. TGFβ1 treatment significantly increased the expression of TG2 via p38 and ERK activation. TGFβ1-induced TG2 also elevated the level of MMP-13 and type X collagen via NF-κB activation in chondrocytes. Cartilage damage after ACLT and DMM surgery was less severe in TG2 knock-out mice compared with wild-type mice. CONCLUSION: TGFβ1 modulated catabolic processes in chondrocytes in a TG2-dependent manner. TGFβ1-induced TG2 might be the therapeutic target for treating cartilage degeneration and osteoarthritis.

Purpose To analyze the prescription pattern for benign prostatic hyperplasia (BPH) based on the clinician's urology specialty. Methods We analyzed the data of patients treated with BPH from the National Health Insurance Database-Cohort (NHIDB) from 2002 to 2013. The information including the accompanying drugs, characteristics and medication treatment status of patients with BPH in Korea were analyzed; this included the type and number of medications prescribed, the ratios of prescriptions to other medications, and the underlying diseases. Results The prescription rates of alpha-blockers by non-urological clinicians were 40.5% in 2002 and 36.9% in 2013. In addition, the rates of anticholinergic and 5-alpha-reductase inhibitors prescribed by non-urological clinicians were 25% and 30%. The rates of BPH medication prescription by non-urologic experts were highest from internal medicine specialists (58.4%), and dermatology (8.3%), and general surgery (7.2%). With regards to anticholinergics, propiverine was prescribed most frequently followed by tolterodine, solifenacin succinate, fesoterodine, oxybutynin, and trospium. The proportion of prescriptions by non-urologists to urologists was 11.7% for solifenacin and 12.2% for fesoterodine. The prescription frequency of dutasteride was much lower than finasteride (56147 versus 262930), and the proportion of prescriptions by non-urologists to urologists was much lower in dutasteride (15.7%) versus finasteride (39.3%). Conclusions BPH prescriptions by non-urologists in Korea require to be verified by proper scientific values and more attention should be given to improve the quality of BPH care. Data from this study will ultimately lead to the evidence-based medication that could lead to more advanced BPH management.

The incidence of revision anterior cruciate ligament (ACL) reconstruction is increasing. For a successful revision ACL reconstruction, the cause of failure must first be identified. Then, the surgeon must make effort to resolve the cause of failure. Tunnel position and widening and bone quality are essential factors the surgeon must keep in mind when performing revision surgery.

Despite their great utility in synthetic and materials chemistry, Diels-Alder (DA) and retro Diels-Alder (rDA) reactions have been vastly unexplored in promoting self-assembly processes. Herein we describe the first example of a retro Diels-Alder (rDA) reaction-triggered self-assembly method. Release of the steric bulkiness associated with the bridged bicyclic DA adduct by the rDA reaction allowed generation of two building blocks that spontaneously self-assembled to form a supramolecular polymer. By employing photopolymerizable lipid building blocks, we demonstrated the efficiency of the rDA-based self-assembly strategy. Generation of reactive functional groups (maleimide and furan) that can be used for further modification of the supramolecular polymer is an additional meritorious feature of the rDA-based approach. Advantage was taken of reactive functional groups to fabricate stimulus-responsive selective and tunable colorimetric sensors. The strategy developed in this study should be useful for the design of systems that participate in triggered molecular assembly., Despite their great utility in synthetic and materials chemistry, Diels-Alder and retro Diels-Alder reactions have been vastly unexplored in promoting self-assembly processes. Here the authors show the release of steric bulkiness associated with a bridged bicyclic Diels Alder adduct by the retro Diels-Alder reaction that allowed generation of two building blocks that spontaneously self-assembled to form a supramolecular polymer.

Background To develop a nomogram for identifying nulliparous women at high risk of unplanned cesarean delivery (CD) during labor at term pregnancyMethods This retrospective cohort study involves singleton pregnancies delivered between October 2008 and October 2017 at a tertiary center. We included nulliparous women at term conducting a trial of labor. We identified the risk factors for CD during labor based on logistic regression analysis and created a predictive nomogram. We assessed predictive performance with respect to calibration and validation using C-statics and calibration plot. Results Overall, a total of 3237 nulliparous women met our inclusion criteria and were randomly divided into a training set (n = 1618) and a validation set (n = 1619). The risk due to the five preselected parameters for emergent CD during labor was as follows: advanced maternal age [adjusted odds ratio (aOR), 1.101; 95% confidence interval (CI) 1.058-1.146], higher maternal height [aOR, 0.955; 95% CI 0.928-0.983], increasing BMI [aOR, 1.147; 95% CI 1.098-1.199], fetal head circumference [aOR, 1.116; 95% CI 0.976-1.276], and fetal abdominal circumference [aOR, 1.161; 95% CI 1.055-1.276]. A nomogram was developed to indicate the individual risk of emergency CD during labor, with excellent calibration and discriminative ability, and the C-indices were 0.714 and 0.703 in the training and validation sets, respectivelyConclusions We developed a validated nomogram using five variables to identify nulliparous Asian women at high risk for CD during labor at term pregnancy. This model might be useful for counseling of individual women at risk of CD and to modify the current management protocols.

BACKGROUND & AIMS Elevated liver enzymes are associated with later development of type 2 diabetes mellitus. The objective of this study was to assess the association between prepregnancy liver enzyme levels and subsequent risk of gestational diabetes mellitus. METHODS Data from a total of 236,109 women who participated in the National Health Screening Examination between 2011 and 2015 was analysed. Multivariate logistic regression analyses were performed to estimate the risk of developing gestational diabetes mellitus in relation to pregravid liver enzyme levels. Subgroup analyses were performed according to pregravid obesity and metabolic syndrome (MetS). RESULTS Approximately 5.7% and 1.1% of women developed gestational diabetes mellitus with and without insulin treatment requirement respectively. Pregravid gamma-glutamyl transferase and alanine aminotransferase levels with greater than or equal to the 4th quartile were associated with significantly increased risks of gestational diabetes mellitus requiring insulin treatment in women with obesity and with MetS, (odds ratios [ORs] with 6.228 and 9.505, respectively, P

Background Tourniquet use is associated with complications such as thigh pain, skin problems, and deep vein thrombosis (DVT). This prospective study aimed to evaluate the efficacy and safety of the pneumatic tourniquet system using an elastic cuff and limb occlusion pressure (LOP) in total knee arthroplasty (TKA). The hypothesis of this study was that an elastic cuff tourniquet would result in less postoperative thigh pain after TKA. Methods This prospective randomized controlled trial involved a total of 98 patients who underwent primary TKA. They were randomized into two groups: tourniquet system using an elastic cuff and LOP group (Group E) and tourniquet system using a conventional-cuff and LOP group (Group C). Outcomes including postoperative thigh pain assessed using a visual analog scale (VAS), serum muscle enzymes, recommended tourniquet pressure (RTP), bloodlessness of surgical field, surgical time, incidence of DVT, and the frequency of rescue analgesic use after surgery, were compared between groups. Results Patients in Group E experienced significantly less thigh pain compared to those in Group C on postoperative day 4 (P = 0.01) and day 7 (P = 0.04). The difference between RTP and systolic blood pressure was significantly lower in Group E (P = 0.045). One case of thigh DVT was found in Group E, while no such cases were found in Group C. One and two cases of poor bloodless surgical fields were observed in Group E and Group C, respectively. There was no significant difference in surgical time, levels of serum muscle enzymes, and the frequency of rescue analgesic use between the two groups. Conclusions The pneumatic tourniquet system using an elastic cuff and LOP reduced early postoperative thigh pain more effectively than did the tourniquet system using a conventional cuff and LOP. Trial registration #KCT0003149. Registered August 17, 2018 - Retrospectively registered.

Background and objectives Metastatic renal cell carcinoma to the pancreas (PM-RCC) is infrequent; we sought to describe the characteristics of PM-RCC and analyze the outcome following treatment. Methods Data of 3107 mRCC patients treated between 1992 and 2007 from the Korean Renal Cancer Study Group database were obtained to identify 300 (9.7%) PM-RCC patients. Characteristics and survival were analyzed and compared to the rest of the mRCC, according to the timing of metastasis and surgical treatments received. Results PM-RCC was younger at initial diagnosis (55.0 vs. 58.2 years), more frequently in women (30.3% vs. 22.3%), and metachronous (65.3% vs. 41.9%) with a longer disease-free period (82.0 vs. 33.0 months). Overall survival (OS) was significantly better in PM-RCC but pancreas metastasectomy was associated with improved OS only among metachronous PM-RCC. In the 132 metachronous PM-RCC with pancreas metastasectomy, median recurrence-free survival was 17.2 months and we found Heng risk group (hazard ratio [HR] = 2.384, 95% confidence interval [CI] = 1.213-4.684), younger age (HR = 0.965, 95% CI = 0.945-0.987), shorter interval to pancreas metastasis (HR = 0.993, 95% CI = 0.986-0.999), and Eastern Cooperative Oncology Group performance status to be predictive of early progression following pancreas metastasectomy. Conclusion Compared to the other mRCC, PM-RCC demonstrated a favorable prognosis. Pancreas metastasectomy was associated with prolonged survival in the metachronous PM-RCC with a long progression-free period.

Treatment strategies for metastatic urothelial carcinoma (mUC) have evolved dramatically over the last decade. The emergence of immunotherapeutic agents, especially immune checkpoint inhibitors, has been the most significant development. Immunotherapy increased the overall survival rate of patients with mUC and provided a durable response. The success of immune checkpoint inhibitors further led to the development of novel agents that regulate the immune system within the tumor microenvironment. However, despite some success with immune checkpoint inhibitors, researchers are still developing new agents, including small molecule tyrosine kinase inhibitors, mammalian target of rapamycin (mTOR) inhibitors, and novel fusion proteins, tailored for targets other than immune checkpoint inhibitors. Novel treatment strategies are being developed rapidly with ongoing pre-clinical trials. Here, we outline promising new therapies that are expected to improve survival rates for patients with mUC.

Purpose To investigate the influence of medial and lateral posterior tibial slope (PTS) on long-term clinical outcomes and survivorship after anterior cruciate ligament (ACL) reconstruction using hamstring autografts. Methods A total of 232 patients (mean age, 28.2 ± 8.9 years) who underwent primary ACL reconstruction from October 2002 to July 2007 were retrospectively reviewed. Patients with multiple ligament reconstruction, total meniscectomy, contralateral knee surgery before ACL reconstruction, open growth plate, and less than 10-year follow-up were excluded in the study. The medial and lateral PTS were measured from preoperative magnetic resonance imaging. Based on Li et al.’s previous study, the patients were divided into 2 groups according to their medial PTS (≤5.6° vs >5.6°) and lateral PTS (≤3.8° vs >3.8°), respectively. Clinical outcomes (clinical scores, stability tests and failure rate) were compared between the groups at the last follow-up. Furthermore, survival analysis was performed using the Kaplan–Meier method. Results All clinical scores (International Knee Documentation Committee subjective, Lysholm, and Tegner activity scores) and stability tests (physical examinations and side-to-side difference in Telos stress radiographs) were insignificantly different between the 2 groups classified based on medial or lateral PTS. However, the failure rate was significantly higher in patients with medial PTS >5.6° (16.1% vs 5.1%, P = .01) or lateral PTS >3.8° (14.5% vs 4.7%; P = .01). The odds ratios of graft failure due to increased medial and lateral PTS were 3.18 (95% confidence interval, 1.22–8.28; P = .02) and 3.43 (95% confidence interval, 1.29–9.09; P = .01), respectively. In addition, the 10-year survivorship was significantly lower in patients with medial PTS >5.6° (83.9% vs 94.9%, P = .01) or lateral PTS >3.8° (85.5% vs 96.0%; P = .01). Conclusions Increased medial (>5.6°) and lateral (>3.8°) PTS were associated with higher failure rate and lower survivorship at a minimum of 10-year follow-up after primary ACL reconstruction using hamstring autografts. Level of Evidence Level III, retrospective comparative trial.

Background: Anatomic anterior cruciate ligament reconstruction (ACLR) is preferred over nonanatomic ACLR. However, there is no consensus on which point the tunnels should be positioned among the broad anatomic footprints. Purpose/Hypothesis: To identify the ideal combination of tibial and femoral tunnel positions according to the femoral and tibial footprints of the anteromedial (AM) and posterolateral (PL) anterior cruciate ligament bundles. It was hypothesized that patients with anteromedially positioned tunnels would have better clinical scores, knee joint stability, and graft signal intensity on follow-up magnetic resonance imaging (MRI) than those with posterolaterally positioned tunnels. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 119 patients who underwent isolated single-bundle ACLR with a hamstring autograft from July 2013 to September 2018 were retrospectively investigated. Included were patients with clinical scores and knee joint stability test results at 2-year follow-up and postoperative 3-dimensional computed tomography and 1-year postoperative MRI findings. The cohort was divided into 4 groups, named according to the bundle positions in the tibial and femoral tunnels: AM-AM (n = 33), AM-PL (n = 26), PL-AM (n = 29), and PL-PL (n = 31). Results: There were no statistically significant differences among the 4 groups in preoperative demographic data or postoperative clinical scores (Lysholm, Tegner, and International Knee Documentation Committee subjective scores); knee joint stability (anterior drawer, Lachman, and pivot-shift tests and Telos stress radiographic measurement of the side-to-side difference in anterior tibial translation); graft signal intensity on follow-up MRI; or graft failure. Conclusion: No significant differences in clinical scores, knee joint stability, or graft signal intensity on follow-up MRI were identified between the patients with anteromedially and posterolaterally positioned tunnels.

Objective We investigated the outcomes of repeat stereotactic radiosurgery (SRS) for metastatic brain tumors that locally recurred despite previous SRS, focusing on the tumor control. Methods A total of 114 patients with 176 locally recurring metastatic brain tumors underwent repeat SRS after previous SRS. The mean age was 59.4 years (range, 33 to 85), and there were 68 male and 46 female patients. The primary cancer types were non-small cell lung cancer (n=67), small cell lung cancer (n=12), gastrointestinal tract cancer (n=15), breast cancer (n=10), and others (n=10). The number of patients with a single recurring metastasis was 95 (79.8%), and another 19 had multiple recurrences. At the time of the repeat SRS, the mean volume of the locally recurring tumors was 5.94 mL (range, 0.42 to 29.94). We prescribed a mean margin dose of 17.04 Gy (range, 12 to 24) to the isodose line at the tumor border primarily using a 50% isodose line. Results After the repeat SRS, we obtained clinical and magnetic resonance imaging follow-up data for 84 patients (73.7%) with a total of 108 tumors. The tumor control rate was 53.5% (58 of the 108), and the median and mean progression-free survival (PFS) periods were 246 and 383 days, respectively. The prognostic factors that were significantly related to better tumor control were prescription radiation dose of 16 Gy (p=0.000) and tumor volume less than both 4 mL (p=0.001) and 10 mL at the repeat SRS (p=0.008). The overall survival (OS) periods for all 114 patients after repeat SRS varied from 1 to 56 months, and median and mean OS periods were 229 and 404 days after the repeat SRS, respectively. The main cause of death was systemic problems including pulmonary dysfunction (n=58, 51%), and the identified direct or suspected brain-related death rate was around 20%. Conclusion The tumor control following repeat SRS for locally recurring metastatic brain tumors after a previous SRS is relatively lower than that for primary SRS. However, both low tumor volume and high prescription radiation dose were significantly related to the tumor control following repeat SRS for these tumors after previous SRS, which is a general understanding of primary SRS for metastatic brain tumors.

This study aims to improve the long-term creep life extrapolation of Grade 91 (Gr. 91) steel using a new master curve of a hyperbolic sine (“sinh”) form. In the master curve for extrapolating creep rupture life, a controversial point of a polynomial form, which has usually been used in time–temperature parametric methods, was preliminarily indicated. The validity of the new master curve was verified. A large body of creep rupture data for Gr. 91 steel was prepared from different sources of available worldwide data at 500 °C to 700 °C for Gr. 91 steel. The material constants of the Larson–Miller, Orr–Sherby–Dorn, and Manson–Harferd parameters were obtained using the polynomial and sinh forms on the basis of the rupture data. Long-term creep rupture life was extrapolated for up to 60 years using the two forms that defined the master curves. Results of long-term creep life extrapolation showed that the master curve of the polynomial form exhibited overestimation due to the divergent curves in the low stress ranges, whereas the master curve of the sinh form revealed goodness in the low stress ranges beyond the experimental data. The proposed sinh form was superior to the polynomial form. The sinh form could be applied to extrapolate the long-term creep rupture life of other heat-resistant steels. The creep rupture stresses predicted by the sinh function were comparable to those of RCC-MRx code.