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Despite potential clinical roles of extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) compared to that of conventional cardiopulmonary resuscitation (CCPR), use of ECLS for OHCA is not strongly endorsed by current clinical guidelines.The purpose of this study is to investigate the clinical roles of extracorporeal life support (ECLS) compared with that of conventional cardiopulmonary resuscitation (CCPR) for out-of-hospital cardiac arrest (OHCA) patients.The outcomes of OHCA between 2015 and 2020, enrolled in the Korean Cardiac Arrest Research Consortium (KoCARC), a multicenter OHCA patient registry including 65 participating hospitals throughout the Republic of Korea (ClinicalTrials.gov, number NCT03222999). Differences in clinical features were adjusted by matching the propensity for ECLS. The primary outcome was 30-day neurologically favorable survival with cerebral performance category of 1 or 2. Restricted mean survival time (RMST) was used to compare outcomes between groups.Of 12,006 patients included, ECLS was applied to 272 patients (2.2%). The frequency of neurologically favorable survival was higher in the ECLS group than the CCPR group (RMST difference, 5.5 days [95% CI, 4.1-7.0 days], P 0.001). In propensity score-matched 271 pairs, the clinical outcome of ECLS and CCPR did not differ to a statistically significant extent (RMST difference, 0.4 days [95% CI -1.6 to 2.5 days], P = 0.67). Subgroup analyses revealed that the clinical roles of ECLS was evident in patients with nonshockable rhythm or CPR time ≥20 min (RMST difference, 2.7 days [95% CI 0.5-4.8 days], P = 0.015), but not in patients without these features (RMST difference, -3.7 days [95% CI -7.6 to 0.2 days], P = 0.07).In this real-world data analysis, ECLS compared to CCPR did not result in better overall clinical outcomes of OHCA. The clinical efficacy of ECLS may be limited to a subgroup of high-risk patients.

Patients with acute pancreatitis (AP) may have an increased risk of cardiovascular disease (CVD). Few studies have dealt with the association between AP and the risk of CVD in diabetic patients. This study aimed to investigate the risk of CVD and mortality in patients with diabetes and AP history by analyzing a large-scale national claims database in Korea. Data from the Korean National Health Insurance Service database was analyzed. A total of 2,746,988 participants with type 2 diabetes mellitus that underwent a general health examination between 2009 and 2012 were enrolled. The participants were divided into two groups according to AP history (yes or no) prior to the examination date, and follow-up data until 2018 was analyzed. The primary endpoint was the occurrence of stroke, myocardial infarction (MI), or death. The Cox proportional hazards regression analysis was used to evaluate the association between AP history and the risk of stroke, MI, and mortality. After exclusion, the included number of participants with and without AP history were 3,810 and 2,258,910, respectively. The presence of AP history showed a significantly higher incidence of stroke, MI, and mortality. The adjusted hazard ratios (95% confidence interval) for the risk of stroke, MI, and mortality were 1.534 (1.342–1.753), 1.998 (1.733–2.303), and 2.353 (2.200–2.515), respectively. Age

Synergetic effects in two-dimensional heterostructures have attracted considerable attention in the field of catalysis. Herein, we present a first-principles study of hydrogen adsorption on the vertical heterostructures of graphene and electride (Ca

Electrocatalytic conversion of carbon dioxide into high-value multicarbon (C2+ ) chemical feedstocks offers a promising avenue to liberate the chemical industry from fossil-resource dependence and eventually close the anthropogenic carbon cycle but is severely impeded by the lack of high-performance catalysts. To break the linear scaling relationship of intermediate binding and minimize the kinetic barrier of CO2 reduction reactions, ternary Cu-Au/Ag nanoframes were fabricated to decouple the functions of CO generation and C-C coupling, whereby the former is promoted by the alloyed Ag/Au substrate and the latter is facilitated by the highly strained and positively charged Cu domains. Thus, C2 H4 production in an H-cell and a flow cell occurred with high Faradic efficiencies of 69±5 and 77±2 %, respectively, as well as good electrocatalytic stability and material durability. In situ IR and DFT calculations unveiled two competing pathways for C2 H4 generation, of which direct CO dimerization is energetically favored.

Background This study identified predictors of hospital mortality after successful weaning of patients with cardiogenic shock off venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support.Methods and Results:Adult patients who received peripheral VA ECMO from January 2012 to April 2017 were reviewed retrospectively. After excluding patients who died on ECMO support, predictors for survival to discharge were investigated in patients who were successfully weaned off ECMO. Of 191 patients successfully weaned off ECMO, 143 (74.9%) survived to discharge. The prevalence of a history of stroke and coronary artery disease, as well as ECMO-related complications, including newly developed stroke and sepsis, was a higher in patients who did not survive to discharge than in those who did. On the day of ECMO weaning, Sequential Organ Failure Assessment score and serum lactate were higher in patients who did not survive to discharge, although there was no significant difference in blood pressure and the use of vasoactive drugs between the 2 groups. On multivariable analysis, stroke and sepsis during ECMO support, a lower Glasgow Coma Scale and acute kidney injury requiring continuous renal replacement therapy after weaning were significant predictors for in-hospital mortality. Conclusions Complications that occurred during ECMO and the presence of extracardiac organ dysfunction after weaning were associated with in-hospital mortality in patients with cardiogenic shock who were successfully weaned off ECMO.

Two-dimensional electrides have emerged as a new class of layered materials, in which excess electrons exist in the interlayer spacing. These anionic electrons cause exotic electronic properties, s...

Background The prognostic ability of cardiac troponin I (TnI) has been demonstrated in general populations and among cardiovascular disease patients, but it has not been evaluated in cancer patients. Hypothesis This study assumes to have the prognostic ability of cardiac troponin in cancer patients visiting the emergency department. Methods Cancer patients visiting the emergency department were enrolled in this retrospective cohort study. Patients with previously known coronary artery disease or clinically indicated coronary angiography were not included. The maximal value from Siemens ADVIA Centaur troponin I Ultra assay within 24 hours was assessed. The primary endpoint was 180‐day all‐cause death, including cardiovascular and noncardiovascular death. Results A total of 9135 cancer patients (mean age: 63 years, male gender: 60%) were enrolled. Lowest (0.006 ng/mL), assay‐specific

Preoperative high-sensitivity cardiac troponin (hs-cTn) above the 99th-percentile upper reference limit (URL) is associated with mortality after noncardiac surgery. This study aimed to evaluate whether preoperative hs-cTn concentrations above the lowest limit of detection (LOD) but below the 99th-percentile URL can predict mortality after noncardiac surgery.From January 2010 to April 2019, a total of 12,415 noncardiac surgical patients with preoperative hs-cTn I below the 99th-percentile URL were enrolled. The patients were divided into two groups according to preoperative hs-cTn I concentration: (1) [hs-cTn] below the LOD (6 ng/L), and (2) mildly elevated [hs-cTn] but below the 99th-percentile URL (40 ng/L). The primary outcome was 30-day mortality. Of the 12,415 patients enrolled, 7958 (64.1%) were in the LOD group whereas 4457 (35.9%) were in the mild elevation group. The incidence of 30-day mortality was significantly greater in the mild elevation group (2.1% vs. 4.0% hazard ratio [HR] 1.73; 95% confidence interval [CI] 1.39–2.16; p

Li-polysulfide batteries (LPSBs) involving dissolved polysulfides as the catholyte have been sought as an alternative solution for addressing the problem of inefficient sulfur utilization with conventional lithium-sulfur batteries, but imposes even more stringent requirements on polysulfide immobilization. In this study, a hybrid rGO/CNTs aerogel embedding FeP nanocubes is fabricated by instantly freezing and phosphorizing metal organic frameworks (MOF)-containing precursors, and used as the LPSB cathodes for hosting polysulfides with high affinity. A high specific capacity of 1312.3 mA h g−1 at 0.2 C and prolonged cycling with only 0.037% decay per cycle at 1 C were achieved for over 500 cycles, together with an exceptional high areal capacity up to 8.5 mA h cm−2 at the sulfur loading of 9.6 mg cm−2. This remarkable LPSB performance is ascribed to the strong immobilization of polysulfides by the FeP anchoring material, the conductive and microporous carbon scaffolds in providing adequate interfaces for charge transfer, the homogeneous catholyte distribution for promoting sulfur utilization, as well as a possible catalytic effect of FeP on expediting the redox conversion of polysulfides.

Background The effect of chronic total occlusion (CTO) revascularization on survival remains controversial. Furthermore, data regarding outcome differences for CTO revascularization based on left ventricular systolic function (LVSF) are limited. The differential outcomes from CTO revascularization in patients with preserved LVSF (PLVSF) versus reduced LVSF (RLVSF) were assessed. Methods A total of 2,173 CTO patients were divided into either a PLVSF (n = 1661, Ejection fraction ≥ 50%) or RLVSF (n = 512, Results Patients with RLVSF had a mean 37% ejection fraction (EF) and 19% had EF p p = 0.0019], which was mainly driven by a reduction in cardiac death. The difference in survival probability was greater and became more pronounced over time in patients with RLVSF than with PLVSF (1-year, p = 0.197; 3-years, p = 0.048; 5-years, p = 0.036). Conclusions SCR was associated with better survival benefit than OMT regardless of LVSF. The benefit was greater and became more significant over time in patients with RLVSF versus PLVSF. Graphic abstract

Controllable nucleation sites play a key role in the selective growth of heterostructures. Here, we are the first to report a one-pot strategy to realize the confined and selective growth of large MoS2/WS2 lateral and vertical heterostructures. A hydroxide-assisted process is introduced to control the nucleation sites, thereby realizing the optional formation of lateral and vertical heterostructures. Time-of-flight secondary ion mass spectrometry verifies the critical role of hydroxide groups toward the controllable growth of these heterostructures. The size of the as-grown MoS2/WS2 lateral heterostructures can be as large as 1 mm, which is the largest lateral size reported thus far. The obtained MoS2/WS2 heterostructures have a high carrier mobility of ∼58 cm2 V-1 s-1, and the maximum on/off current ratio is >108. This approach provides not only a pathway for the selective growth of large MoS2/WS2 lateral and vertical heterostructures but also a fundamental understanding of surface chemistry for controlling the selective growth of transition-metal dichalcogenide heterostructures.

The role of coronary arteries is to supply sufficient blood to myocardium. Obstruction of coronary arteries limits blood supply and causes myocardial ischemia or acute myocardial infarction, a major cause of human death. Hence, the quantification of the regional amount of heart muscle subtended by obstructed coronary arteries is of critical value in clinical medicine. However, conventional methods are inaccurate and frequently disagree with clinical practice. This study proposes a novel medial-axis-based correspondence (Medial-ABC) algorithm to find the correspondence between myocardium and coronary artery in order to segment regional myocardium at risk subtended by any potentially obstructed coronary artery. Given the triangular mesh models of coronary artery and myocardium, the proposed algorithm (i) computes the medial axis of coronary artery, (ii) finds the correspondence using the medial axis of coronary artery, and (iii) segments the coronary artery and myocardium. The proposed algorithm provides a robust mathematical linkage between myocardium at risk and supplying coronary arteries so that ischemic myocardial regions can be accurately identified. Hence, both the extent and severity of myocardial ischemia can be quantified effectively, efficiently, and accurately. Furthermore, the constructed mesh model of segmented coronary artery and myocardium can be post-processed for applications such as building optimization models of cardiac systems. The CardiacVis program, which implements the Medial-ABC algorithm, is freely available at Voronoi Diagram Research Center (http://voronoi.hanyang.ac.kr/software/cardiacvis) and will be an invaluable tool for quantitative patient-specific risk stratification in clinical practice.

Aims To investigate the association between long-term β-blocker therapy and clinical outcomes in patients without heart failure (HF) after acute myocardial infarction (AMI). Method and results Between 2010 and 2015, a total of 28 970 patients who underwent coronary revascularization for AMI with β-blocker prescription at hospital discharge and were event-free from death, recurrent myocardial infarction (MI), or HF for 1 year were enrolled from Korean nationwide medical insurance data. The primary outcome was all-cause death. The secondary outcomes were recurrent MI, hospitalization for new HF, and a composite of all-cause death, recurrent MI, or hospitalization for new HF. Outcomes were compared between β-blocker therapy for ≥1 year (N = 22 707) and β-blocker therapy for Conclusion In this nationwide cohort, β-blocker therapy for ≥1 year after MI was associated with reduced all-cause death among patients with AMI without HF.

Background Isolated gonadotropin-releasing hormone (GnRH) deficiency (IGD) has a wide phenotypic spectrum including Kallmann syndrome (KS) and normosmic idiopathic hypogonadotropic hypogonadism (nIHH). FGFR1 mutations have been identified in 3–10% of patients with KS or nIHH. This study was performed to investigate clinical phenotypes and functional characteristics of FGFR1 mutations in patients with IGD. Methods This study included 8 patients (from 7 families) with FGFR1 mutations identified by targeted gene panel sequencing or whole exome sequencing (WES). The impact of the identified mutations on FGFR1 function was assessed using in vitro studies. Results Seven heterozygous mutations in FGFR1 were identified in 8 patients from 7 independent families. The patients exhibited a wide spectrum of pubertal development, including anosmia in a prepubertal boy (n=1), delayed puberty (n=2), nIHH (n=3), and KS (n=2). Four of the mutations were classified as likely pathogenic, and the other three were variants of uncertain significance. FGF8-FGFR1 signaling activities for the novel FGFR1 variants (p.Y339H, p.S681I, and p.N185Kfs*16) were reduced by in vitro functional assay, indicating loss-of-function mutations. Conclusions This study identified seven rare sequence variants in FGFR1 in patients with KS and nIHH. Probands with an FGFR1 mutations displayed a wide phenotypic spectrum ranging from KS to anosmia. A prepubertal male with anosmia should be followed up to assess pubertal development because they can manifest hypogonadotropic hypogonadism after puberty. These results expand the phenotypic spectrum of FGFR1 mutations and suggest a broader biologic role of FGFR1 in reproduction.

Compared to van der Waals two-dimensional (2D) layers with lateral covalent bonds, metallic bonding systems favor close-packed structures, and thus, free-standing 2D metals have remained, for the most part, elusive. However, a number of theoretical studies suggest a number of metals can exist as 2D materials and a few early experiments support this notion. Here we demonstrate free-standing single-atom-thick crystalline chromium (Cr) suspended membranes using aberration-corrected transmission electron microscopy and image simulations. Density functional theory studies confirm the 2D Cr membranes have an antiferromagnetic ground state making them highly attractive for spintronic applications. Moreover, the work also helps consolidate the existence of a new family of 2D metal layers.

Background Glycogen storage disease (GSD) Ia, caused by mutations in the glucose-6-phosphatase (G6PC) gene, is characterized by hepatomegaly, hypoglycemia, lactic acidosis, dyslipidemia, and hyperuricemia. This study aimed to investigate clinical and molecular features and late complications in Korean patients with GSD Ia. Results Fifty-four Korean patients (33 males and 21 females) from 47 unrelated families, who were diagnosed with GSD Ia, based on genetic and biochemical data, between 1999 and 2017, were included in this study. The median age at diagnosis was 3.9 years (range: 5 months to 42 years), and the follow-up period was 8.0 ± 6.8 years. Most patients presented with hepatomegaly during infancy, but hypoglycemic symptoms were not predominant. Genetic analysis showed that all the patients had at least one c.648G > T allele. Homozygous c.648G > T mutations in the G6PC gene were identified in 34 families (72.3%), and compound heterozygotes with c.648G > T were found in the other families. The allele frequency of c.648G > T was 86.2% (81/94), and p.F51S, p.R83H, p.G122D, p.Y128*, p.G222R, and p.T255A were identified. Of 26 adult patients, 14 had multiple hepatic adenomas, and two were diagnosed with hepatocellular carcinoma. Thirteen patients showed renal complications, and seven patients presented gout, despite preventive allopurinol treatment. Twelve patients had osteoporosis, and two patients had pulmonary hypertension. The final heights were 157.9 cm (standard deviation score: − 3.1) in males and 157.8 cm (standard deviation score: − 0.6) in females. Conclusion In our Korean patients with GSD Ia, the most common mutation in the G6PC gene was c.648G > T, suggesting a founder effect. Because of only mild hypoglycemia, the patients tended to be diagnosed late. Thus, adult patients with GSD Ia eventually developed diverse and serious complications, which indicates a need for careful monitoring and proper management of this disease.

Background and study aims During endoscopic ultrasound (EUS), patients may experience severe discomfort. The radial echoendoscope has a balloon around its tip. Balloon inflation prior to insertion may reduce contact injury and pharyngeal pain. The purpose of this study was to investigate the effect of balloon inflation on pharyngeal pain during insertion. Patients and methods Patients who underwent radial EUS for pancreatobiliary disease were randomized into standard insertion or balloon-inflated insertion. The primary outcome was the proportion of moderate-to-severe pharyngeal pain. Secondary outcomes were the degree of pharyngeal pain, risk factors for moderate pharyngeal pain, procedure-related adverse events, and pharyngeal pain depending on the experience of the endoscopist. Results A total of 481 patients were randomized into two groups: standard insertion (238) and balloon inflation (243). No statistically significant differences in proportion of moderate-to-severe pain were found (26.5 % vs. 20.2 %, P = 0.107). Balloon inflation (HR 0.65; 95 % CI (0.42–0.98, P = 0.041) was a protective factor against moderate pain. Balloon inflation reduced the proportion of patients with moderate-to-severe pain when performed by physicians with less than 3months of experience with EUS (44.7 % vs. 25.3 %, P = 0.012). Conclusion Balloon inflation did not reduce the absolute degree of post-procedural pain with EUS, but it reduced the number of patients with moderate-to-severe pain when performed by physicians with less than 3 months of experience.

Based on first-principles density functional theory calculations, we investigated a modified routine using hydroxyl adsorption that recently demonstrated the controlled growth of MoS2 monolayers. The new growth approach impedes the deposition of a second MoS2 layer; however, the hydroxyl adsorption and its effects have been mostly unexplored. Through this study, we first explored the adsorption behaviors of the hydroxyl radical (OH) on monolayer MoS2 and briefly discussed its effects on the stability and electronic structure. Monolayer MoS2 repels charged OH–, whereas the adsorption of the neutral OH radical is energetically favorable; the corresponding adsorption energies are 0.09 eV and −1.35 eV, respectively. The diffusion barrier of the OH radical on MoS2 is 0.52 eV, indicating that the molecule can quickly diffuse. Next, the study demonstrated that for multiple OH adsorptions, a concerted reaction including OH dissociation and H2O formation is more energetically favorable than the adsorption of two OH molecules by 2.50 eV, which in turn results in a mixed adsorption configuration of O and OH. In addition, we revealed that the OH adsorption creates a mid-gap state and facilitates the reconstruction of the MoS2 edge.

This study was evaluated on time of occurrence and tissue characteristics in fruit cracking of mid-season cultivar Whansan Asian pears (Pyrus pyrifolia Nakai) with high amount of precipitation from 60 to 120 days after full bloom (DAFB). Fruit cracking was observed at different topographic ‘Whansan’ pear orchards as a pre-experiment. Pear trees at mountainous orchards received low amount of precipitation in June, between 50 and 80 DAFB, and had a high defoliation and low average of fruit weight and fruit cracking (2.5%) compared to those of pears grown at plain and middle-mountainous orchards. In a main experiment, cracked fruit contained lower concentrations of Ca and higher water soluble pectin in flesh or peel than those of values observed on the intact fruit. Fruit diameter rapidly increased at 40 DAFB and mostly 70–80 DAFB under repeated fluctuation of soil water potential between − 28 and − 67 kPa. Fruit were early completed their cell division and converted into cell enlargement phase between 30 and 50 DAFB, advancing formation of cork cells, while the number of large stone clusters significantly increased at 50 DAFB. Besides of less Ca uptake, both formation of cork and stone cells reduced cell flexibility in the flesh, causing initiation of internal micro-cracking under repetition of rapid change of soil water potential. Fruit cracking was visually progressed at 75 DAFB when fruit were mostly enlarged.

Transition metal carbonates as represented by FeCO3 have been widely evaluated as attractive anode alternatives for high-energy lithium ion batteries (LIBs), owing to their high practical lithium storage capacity approximately three times that of a conventional graphite anode. However, capacity-decay upon cycling and unsatisfactory rate performance have been the critical issues hindering their practical applications. We report here a structural reconstruction protocol, coupled with compositing with conductive MXene materials to address the above issues. Specifically, sonication-induced electrostatic assembly (SIEA) is exploited to convert a hybrid consisting of FeCO3 microparticles and multilayered Ti3C2 stacks into reshaped FeCO3 nanorods that are uniformly anchored at the surface of highly exfoliated Ti3C2 monolayers. Through the X-ray photoelectron spectroscopy (XPS) and zeta potential analysis, it was seen that the surface Fe2+ to Fe3+ oxidation plays a critical role in positively charging the particle surface of FeCO3 nanorods, resulting in desired composite construction with the negatively charged Ti3C2 substrate. Within such a composite material, charge transfer to active FeCO3 particles is effectively facilitated during lithiation/delithiation processes, which has been predicted by density functional theory (DFT) calculations and further verified by in situ electrochemical impedance spectroscopy (EIS) measurements. Concurrent implementation of nano-engineering and the MXene-support through the SIEA results in remarkably enhanced cycling stability and rate capability of the FeCO3 anode material. This work offers an effective material engineering strategy to boost the lithium storage performance for transition metal carbonate anode materials.

Developing low-cost and high-performance hydrogen evolution reaction (HER) electrocatalysts is a key research area for scalable hydrogen production from water electrolysis. Here, a hybrid of nitrogen-doped carbon encapsulated Mo2C nanodots on Ti3C2Tx MXene (Mo2C/Ti3C2Tx@NC) is developed through in situ polymerization of dopamine and a Mo precursor on the Ti3C2Tx MXene surface. During the annealing treatment, the polydopamine plays multiple roles in forming N-doped carbon, confining MoO42− ions into ultrasmall Mo2C nanodots, and stabilizing the MXene flakes against spontaneous oxidation. The as-synthesized hybrid exhibits excellent HER activity in acidic electrolyte with an overpotential of 53 mV at 10 mA cm−2 and excellent stability over 30 hours. The combination of experiments and simulations demonstrates that pyridinic N-doped carbon coated Mo2C nanodots serve as the active sites and Ti3C2Tx MXene facilitates the charge transfer, synergistically contributing to the superior HER performance.

Owing to the synergetic effects of different two-dimensional (2D) materials, 2D heterostructures have recently attracted much attention in the field of catalysis. We present a first-principles study of hydrogen adsorption on the lateral heterostructure of graphene and h-BN, and its potential application in the hydrogen evolution reaction. The density functional theory calculations in this study show that substantial charge transfer occurs at the heterostructure interfaces, which can enhance the H adsorption on the interfacial atoms. Consequently, the adsorption free energy ΔGH* of the interfaces becomes close to zero, which is optimal for the hydrogen evolution reaction. The results also demonstrate that ΔGH* decreases monotonically with increase in the p-band center, indicating that s–p hybridization plays a crucial role in determining the adsorption strength. These findings are expected to be broadly applicable to other 2D lateral heterostructures, providing a new strategy for hydrogen production.

The ruthenium(ii)-catalyzed cross-coupling reaction between 2-aryl quinazolinones and activated aldehydes is described. This method enables the site-selective hydroxyalkylation under redox-neutral conditions. Moreover, this protocol provides a facile access to various tetracyclic isoindoloquinazolinones by using Cu(OAc)2 as an external oxidant via C-H addition and subsequent intramolecular cyclization. A wide substrate scope and a high level of chemoselectivity as well as broad functional group tolerance are observed.

Background Endoscopic retrograde biliary drainage (ERBD) is the treatment of choice for patients with malignant distal common bile duct (CBD) obstruction. Self-expandable metal stents (SEMS), which are commonly used in unresectable cases, have many clinical advantages, including longer stent patency. Although the expected patency of SEMS is around 8 months, it has recently been reported that the duration of SEMS’ patency in patients using aspirin is prolonged. Our study, therefore, aims to investigate the effect of aspirin on SEMS’ patency. Methods/design This is an investigator-initiated, prospective, multicenter, double-blind, randomized placebo-controlled trial that will be conducted from November 2017 in four tertiary centers in South Korea. We intend to include in our study 184 adult (aged ≥ 20 years) patients with malignant distal CBD obstruction for whom ERBD with SEMS was successfully performed. The patients will be randomly allocated to two groups, which will comprise patients who have either taken 100 mg aspirin or a placebo for 6 months after index ERBD. The primary outcome will be the rate of stent dysfunction, and the secondary outcomes will be the duration of patency, the rate of reintervention, and the occurrence of adverse events. Discussion The aspirin for metal stents in malignant distal common bile duct obstruction (AIMS) study should determine the efficacy of aspirin in maintaining metal-stent patency in patients with malignant distal CBD obstructive. Trial registration ClinicalTrials.gov, ID: NCT03279809. Registered on 5 September 2017.

Lithium-rich cathodes (LRCs) show great potential to improve the energy density of commercial lithium-ion batteries owing to their cationic and anionic redox characteristics. Herein, a complete conductive network using carbon nanotubes (CNTs) additives to improve the poor kinetics of LRCs is fabricated. Ex situ X-ray photoelectron spectroscopy first demonstrates that the slope at a low potential and the following long platform can be assigned to the transition metal and oxygen redox, respectively. The combination of galvanostatic intermittent titration technique and electrochemical impedance spectroscopy further reveal that a battery with CNTs exhibited accelerated kinetics, especially for the O-redox process. Consequently, LRCs with CNTs exhibit a much better rate and cycling performance (approximate to 89% capacity retention at 2 C for over 200 cycles) than the Super P case. Eventually, TEM results imply that the improved electrochemical performance of the CNTs case also benefits from its more stable bulk and surface structures. Such a facile conductive additive modification strategy also provides a universal approach for the enhancement of the electron diffusion properties of other electrode materials. Web of Science 6 7 art. no. 2200449

Objective Minimizing residual tumors is one of the most important prognostic factors in the management of advanced ovarian cancer [1]. In ovarian cancer patients with cardiophrenic lymph node (LN) metastases, transabdominal cardiophrenic lymph node dissection (CPLND) has been performed along with the surgery on the primary site [2]. However, CPLND for the complicated locations in the thoracic cavity is still technically challenging. This video aims to share our surgical technique for the transabdominal CPLND. Methods A 60-year-old woman who presented with suspicious bilateral ovarian cancer was hospitalized for cytoreductive surgery. Preoperative CT demonstrated peritoneal seeding and multiple LN metastases including right anterior, lateral, posterior, and left anterior cardiophrenic LNs. The gynecology and general surgery team underwent hysterectomy, bilateral salpingo-oophorectomy, supracolic omentectomy, lower anterior resection, right diaphragmatic and bladder peritonectomy, pelvic and paraaortic LN dissection, and appendectomy. The thoracic surgeon took over the operation because the pelvic cavity was regarded as R0. CPLND was performed by transabdominal, subxiphoid approach. The procedure is narrated in the video. Results Complete clearance of CPLN leaving no gross residual disease was possible without complication. A long, transverse incision of the anterior diaphragm was closed with a 1-0 polypropylene in the way of double layered continuous running suture and 8 times ties for the final knot. Conclusion Transabdominal CPLND can be used safely and effectively without change of patient's position and with minimal diaphragmatic injury. However, this approach may be unfeasible for metastatic internal mammary LN dissection and still needs meticulous surgical skills to avoid complications.

The global spread of the COVID-19 pandemic has increased the number of frontline medical staff complaining of problems such as anxiety, depression, and insomnia, thereby requiring urgent psychological support. Nurses are particularly exposed to various stressors and difficult environments, witnessing patients’ pain, frustration, and death, while helping them recover. Music is known to be effective in inducing psychological stability by activating brain waves, relaxing the body, and alleviating negative reactions. This study examines how musical activities affect embitterment and psychological well-being among nurses and nursing students who suffer from various psychological difficulties. This study finds that musical activity helps nurses’ psychological stability by lowering their embitterment index and increasing their psychological well-being. Further, the greater the music listening time is, the higher is the psychological well-being, indicating the necessity of increasing the music listening time and encouraging more musical activities for the psychological stability of nurses in the future.

Purpose Patients with ovotesticular disorder of sex development (DSD) and mixed gonadal dysgenesis (MGD) usually present with asymmetric gonads and have wide phenotypic variations in internal and external genitalia. The differential diagnosis of these conditions is based on karyotype and pathological findings of the gonads. This study investigated the clinical features at presentation, karyotype, sex of rearing, and pubertal outcomes of patients with ovotesticular DSD and MGD. Methods The study comprised 23 patients with DSD who presented with asymmetric gonads. The presenting features, karyotype, sex of rearing, and pubertal outcomes were reviewed retrospectively. Results All 23 patients presented with ambiguous genitalia at a median age of 1 month (range, 1 day-1.6 years). Mullerian duct remnants were identified in 15 of 23 patients (65.2%). Fourteen patients were diagnosed with ovotesticular DSD, whereas the other 9 were diagnosed with MGD. Eight of 14 patients (57.1%) with ovotesticular DSD were raised as males, while 7 of 9 patients with MGD (77.8%) were assigned as males. One male-assigned patient with ovotesticular DSD changed to female sex at age 20 years. Conclusion Patients with ovotesticular DSD and MGD manifest overlapping clinical presentations and hormonal profiles. It is difficult to determine the sex of rearing and predict long-term pubertal outcomes. Therefore, long-term follow-up is required to monitor spontaneous puberty, sex outcome, and urological and gynecological complications.

Background: Discontinuing growth hormone (GH) treatment during the transition to adulthood has been associated with adverse health outcomes in patients with childhood-onset growth hormone deficiency (CO-GHD). This study investigated the metabolic changes associated with interrupting GH treatment in adolescents with CO-GHD during the transition period.Methods: This study included 187 patients with CO-GHD who were confirmed to have adult GHD and were treated at six academic centers in Korea. Data on clinical parameters, including anthropometric measurements, metabolic profiles, and bone mineral density (BMD) at the end of childhood GH treatment, were collected at the time of re-evaluation for GHD and 1 year after treatment resumption.Results: Most patients (n=182, 97.3%) had organic GHD. The median age at treatment discontinuation and re-evaluation was 15.6 and 18.7 years, respectively. The median duration of treatment interruption was 2.8 years. During treatment discontinuation, body mass index Z-scores and total cholesterol, low-density lipoprotein, and non-high-density lipoprotein (HDL) cholesterol levels increased, whereas fasting glucose levels decreased. One year after GH treatment resumption, fasting glucose levels, HDL cholesterol levels, and femoral neck BMD increased significantly. Longer GH interruption (>2 years, 60.4%) resulted in worse lipid profiles at re-evaluation. The duration of interruption was positively correlated with fasting glucose and non-HDL cholesterol levels after adjusting for covariates.Conclusion: GH treatment interruption during the transition period resulted in worse metabolic parameters, and a longer interruption period was correlated with poorer outcomes. GH treatment should be resumed early in patients with CO-GHD during the transition period.

Objective Heterozygous CHD7 mutations cause a broad spectrum of clinical phenotypes ranging from typical CHARGE syndrome to self-limited delayed puberty. This study aimed to investigate the clinical characteristics of endocrine dysfunction in patients with CHD7 mutations. Methods The clinical features and endocrine findings from 30 patients with CHD7 variants were retrospectively reviewed. A diagnosis of CHARGE syndrome was based on the Verloes diagnostic criteria. Results Seventeen patients fulfilled the criteria for typical CHARGE syndrome, one patient for partial/incomplete CHARGE, and the remaining eleven patients had atypical CHARGE syndrome. One patient was diagnosed with Kallmann syndrome and unilateral deafness. The most frequently observed features were inner ear anomalies (80.0%), intellectual disability (76.7%), and external ear anomalies (73.3%). The mean height and weight SDSs at diagnosis were −2.6 ± 1.3 and −2.2 ± 1.8, respectively. Short stature was apparent in 18 patients (60%), and 1 patient was diagnosed with growth hormone deficiency. Seventeen males showed genital hypoplasia, including micropenis, cryptorchidism, or both. Seven patients after pubertal age had hypogonadotropic hypogonadism with hyposmia/anosmia and olfactory bulb hypoplasia. Truncating CHD7 mutations were the most common (n = 22), followed by missense variants (n = 3), splice-site variants (n = 2), and large deletion (n = 2). Conclusions A diverse phenotypic spectrum was observed in patients with CHD7 variants, and endocrine defects such as short stature and delayed puberty occurred in most patients. Endocrine evaluation, especially for growth and pubertal impairment, should be performed during diagnosis and follow-up to improve the patient’s quality of life.

Elevated cardiac troponin (cTn) showed associations with mortality even in stable patients, but management has not been established. We aimed to investigate whether consultation to cardiologists could reduce mortality of stable patients with cTn elevation at admission. We identified 1329 patients with elevated cTn level at hospitalization from outpatient clinic to any department other than cardiology or cardiac surgery between April 2010 and December 2018. The patients were divided into two groups according to cardiologist consultation at admission. For primary outcome, mortality during one year was compared in the crude and propensity-score-matched populations. In 1329 patients, 397 (29.9%) were consulted to cardiologists and 932 (70.1%) were not. Mortality during the first year was significantly lower in patients consulted to cardiologists compared with those who were not (9.8% vs. 14.2%; hazard ratio (HR), 0.50; 95% confidence interval (CI), 0.35–0.72; p < 0.001). After propensity-score matching, 324 patients were in the cardiologist consultation group and 560 patients were in the no cardiologist consultation group. One-year mortality was consistently lower in the cardiologist consultation group (10.5% vs. 14.6%; HR, 0.58; 95% CI, 0.39–0.86; p = 0.01). Cardiologist consultation may be associated with lower mortality in stable patients with cTn elevation at admission. Further studies are needed to identify effective management strategies for stable patients with elevated cTn.

Background: To identify the magnitude and temporal relationship between cardiac troponin I (TnI) and the risk of cardiac or non-cardiac death. Methods: Consecutive patients were included with maximal TnI value within 24 hours of their emergency department visit. Multivariate analyses using parameters selected by Bayesian information criterion was performed to investigate the impact of TnI on the event rate, time-dependent risk, and dose-dependent risk of cardiac or non-cardiac death within 360 days. We investigated the association between cardiac troponin I (TnI) and the risk of cardiac or non-cardiac death according to period. Results: A total of 36806 patients were included. There were 5,472 (14.9%) all-cause deaths including 881 (2.4%) cardiac and 4,591 (12.5%) non-cardiac deaths. In patients with positive TnI defined as the ≥99 th percentile of upper normal limit, the cumulative risk of cardiac and non-cardiac death were 4.4- and 1.4- fold higher compared to negative TnI, respectively. In competing risk analysis, positive TnI was linked to 2.4- and 1.2-fold higher risks of cardiac and non-cardiac death, respectively. TnI value showed positive relationship with the risk of both cardiac and non-cardiac death. In time-dependent risk analysis, the excess risk of cardiac death was concentrated in early few weeks. Conclusions: Even a small increase in TnI was associated with increased risk of both cardiac and non-cardiac death, which was concentrated in the early period after emergency department visit.

Introduction: We investigated the 10-year trends in the clinical outcome of percutaneous coronary intervention (PCI) in an unselected all-comer nationwide cohort. Hypothesis: Mortality following PCI is a key quality measurement in clinical practice and should be investigated within the context of the changing clinical comorbidities. Methods: Patients undergoing PCI for the first time between 2006 and 2015 from database of the National Health Insurance Service of Korea were included and followed until death or being censored by December 2016. Results: A total of 437,436 patients was included. Patients were divided into quartile subgroups according to a clinical score that predicting 1-year death risk. Over the decade, the annual number of PCI increased from 32,098 to 51,990 (p Conclusions: This real-world data analysis showed that the number, proportion, and the risk of high-risk patients increased over the decade in Korea.

Introduction: The efficacy of telemedicine in cancer survivors is uncertain. The Smart After-care Program (SAP), which is an interactive, smartphone-based remote health monitoring system, was developed to help individual patients manage their health after leaving the hospital. This study aims to evaluate the efficacy of our remote health care program for lung cancer patients. Methods We enrolled 50 lung cancer patients. Self-monitoring devices were supplied to all patients, who were instructed to enter their daily vital signs and subjective symptoms to the Smart After-care app. The app also provided information about rehabilitation exercises and a healthy diet for lung cancer patients. All patients received telephone health counseling once a week and visited an outpatient clinic on the 6th and 12th week to assess satisfaction with the SAP and changes in quality of life and physical performance. Results Overall satisfaction with the SAP was very high (very good, 61.9%; good, 26.2%). In the multivariate analysis for factors affecting satisfaction, the distance between the patient’s residence and the hospital was the only independent factor (p = 0.013). Quality of life was improved in all functional scales (p p = 0.012). Two-minute walk distance was also significantly improved (p = 0.028). Conclusion This study demonstrated that the SAP was acceptable among and supportive of patients with reduced pulmonary function after lung cancer treatment. The study proved that the SAP was more useful for patients living far away from a hospital.

Background: Hyperglycemia in surgical candidates is associated with increased mortality and morbidity. We aimed to evaluate the effect of intraoperative blood glucose level on the incidence of myocardial injury after non-cardiac surgery (MINS) in diabetic patients. Methods: Diabetic patients with available intraoperative blood glucose measurement during non-cardiac surgery were enrolled in this study. Based on the highest intraoperative blood glucose level, patients were stratified into two groups: the blood sugar glucose (BST) &lt, 180 group (intraoperative peak glucose &lt, 180 mg/dL) and BST ≥ 180 group (intraoperative peak glucose ≥ 180 mg/dL). The primary outcome was the incidence of MINS, and secondary outcomes were in-hospital and 30-day mortalities. Results: Of the 11,302 diabetic patients, 8337 were in the BST &lt, 180 group (73.8%) and 2965 in the BST ≥ 180 group (26.2%). After adjustment with inverse probability weighting, MINS was significantly higher in the BST ≥ 180 group (24.0% vs. 17.2%, odds ratio (OR), 1.26, 95% confidence interval (CI), 1.14–1.40, p &lt, 0.001). In addition, in-hospital and 30-day mortalities were also higher in the BST ≥ 180 group compared to the BST &lt, 180 group (4.2% vs. 2.3%, hazard ratio (HR), 1.39, 95% CI, 1.07–1.81, p = 0.001, and 3.1% vs. 1.8%, HR, 1.76, 95% CI, 1.31–2.36, 0.001, respectively). Receiver-operating characteristic plots showed that the threshold of glucose level associated with MINS was 149 mg/dL. Conclusion: Intraoperative hyperglycemia was associated with an increased MINS incidence and postoperative mortality in diabetic patients. Close monitoring of intraoperative blood glucose level may be helpful in detection and management of MINS.

Myocardial injury after non-cardiac surgery (MINS) is a well-known and relevant indicator of early postoperative mortality, but factors related to increased mortality in MINS patients are as yet unknown. The Charlson Comorbidity Index (CCI) is widely used to classify various comorbid conditions and underlying diseases. Our study aimed to determine the prognostic value of CCI with regard to mortality of patients with MINS. This study comprises 5633 patients who had MINS as diagnosed by a rise of postoperative cardiac troponin I above the normal range (≥ 0.04 ng/mL) from January 2010 to June 2019. Patients were divided into two groups according to median weighted CCI score: low CCI (≤ 2) and high CCI (> 2) groups. The primary outcome was 30-day mortality after surgery, and secondary outcomes were 1-year and overall mortalities. Of the 5633 patients, 3428 (60.9%) were in the low CCI group (1.21 ± 0.84) and 2205 (39.1%) were in the high CCI group (4.17 ± 1.82). After propensity score matching, mortality during the first 30 days after surgery was significantly greater in the high CCI group than the low CCI group (9.4% vs. 6.0%, respectively; hazard ratio 1.56, 95% confidence interval 1.23–1.98, p