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To understand the chemical mechanisms of controlling factors in ozone (O3) formation in early summer in Seoul, a comprehensive study encompassing measurement and modeling was conducted under the Megacity Air Pollution Study-Seoul (MAPS-Seoul) campaign. From May 18 to June 12, 2015, O3 and peroxyacetyl nitrate (PAN) were measured, along with their precursors, including NOx and volatile organic compounds (VOCs), at the Korea Institute of Science and Technology, located in northeast Seoul. VOCs were sampled in a canister twice a day (at 09:30 and 15:00) and analyzed via gas chromatography. The meteorological conditions and chemical regimes of the air masses were clearly distinguished during the study period. In May, NOx concentrations were higher with more pronounced diurnal cycles of precursors and O3 under constant westerly winds. By contrast, stagnant conditions developed in June, which reduced the inflow of primary emissions from the downtown area but increased the influence from the neighboring forest under high temperatures. As a result, the ratio of O3 to odd oxygen was higher in June, indicating a less efficient removal of O3 by NOx. In the same context, the air mass was chemically more aged with a higher NO2/NOx ratio and enhanced OH reactivity of oxygenated and biogenic VOCs in June. The overall measurement results suggest that O3 formation is slightly more sensitive to VOCs than to NOx in Seoul during this season, when O3 concentrations are the highest of the year.

Background: A high-flexion posterior-stabilized rotating-platform mobile-bearing prosthesis was designed in an attempt to improve the range of motion after total knee arthroplasty without compromising the theoretical advantages of the posterior-stabilized rotating-platform mobile-bearing system. The aim of this study was to compare the outcomes of standard and high-flexion posterior-stabilized rotating-platform mobile-bearing total knee arthroplasties.Methods: One hundred and seventy knees were randomly allocated to receive either a standard (n = 85) or a high-flexion (n = 85) posterior-stabilized rotating-platform mobile-bearing prosthesis and were followed prospectively for a minimum of two years. Ranges of motion, functional outcomes determined with use of standard scoring systems, and radiographic measurements were assessed. In addition, patients' abilities to perform activities requiring deep knee flexion and patient satisfaction were evaluated with use of questionnaires.Results: The average postoperative maximal flexion was 130° for the knees with the standard design and 128° for those with the high-flexion design, and the difference was not significant. The two prosthetic designs also did not differ significantly with regard to the Knee Society scores; Hospital for Special Surgery (HSS) scores; or the scores on the pain, stiffness, and function subscales of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In addition, the numbers of knees able to perform deep-flexion-related activities and the rates of patient satisfaction were similar in the two study groups.Conclusions: This prospective randomized study revealed no significant differences between standard and high-flexion posterior-stabilized rotating-platform mobile-bearing total knee prostheses in terms of clinical or radiographic outcomes or range of motion at a minimum of two years postoperatively. [ABSTRACT FROM AUTHOR]

Background : FIR therapy is used in various medical settings to treat diseases associated with inflammation and edema. Unlike conventional FIR lamp therapy, this study investigated how body fluids change depending on the intensity and duration of FIR irradiation to the whole body. Method : Subjects in group A ( n = 27) were exposed to FIR emitted from a loess bio-ball mat set at 40 °C for 30 min, and subjects in group B ( n = 27) were exposed to FIR emitted from a loess bio-ball mat set at 30 °C for 7 h during sleep. Changes in bioimpedance parameters and fluid-related values were measured using a body fluid analyzer before and after exposure to FIR. Results : Changes in bioimpedance parameters associated with inflammatory fluids were quantitatively confirmed. In group A, there was a minimal change in fluid-related measurements. However, significant changes in bioimpedance parameters associated with inflammatory fluids were observed in group B exposure to FIR for 7 h during sleep. Conclusions : FIR emitted from loess bio-balls activates biological tissues and lymphatic circulation, gradually reducing the levels of inflammatory fluids over time.

Introduction: This systematic review addressed the length of hospital stay (LOS) and procedure time in patients with small renal masses (SRM) undergoing open, conventional laparoscopic (OPN), and robot-assisted partial nephrectomy (RAPN), as well as percutaneous thermal ablation (PTA) in different geographic areas., Methods: We conducted a comprehensive search in databases (MEDLINE, EMBASE, CINAHL) until July 2023, and we applied random-effect meta-analysis, with evidence certainty assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework., Results: We screened 3456 titles and abstracts, ultimately identifying 60 eligible studies. For the length of LOS (days) following OPN, our pooled estimates revealed means of 5.7 in North America, 7.1 in Europe, and 13.4 in Asia; following laparoscopic partial nephrectomy, means were 3.1, 5.4, and 5.8, respectively; for RAPN, means were 2.7, 3.8, and 7.1; and for PTA, means were 1.2, 1.6, and 1.6. Regarding procedure time (minutes) after OPN, means were 187 in North America, 132 in Europe, and 184 in Asia; after laparoscopic partial nephrectomy, means were 198, 127, and 200; after RAPN, means were 189, 150, and 192; and for PTA, mean was 144 in North America and no studies addressed procedure time in Europe and Asia., Conclusions: Our study provides the most trustworthy available estimates of LOS and procedure time for patients undergoing invasive procedures for the management of SRM. These findings have emphasized the need for context-specific considerations when informing patients and making treatment decisions.

Purpose: This experiment aimed to observe the differences in biological properties by producing BGS-7 + PCL scaffolds with different weight fractions of BGS-7 through 3D printing and to confirm whether using the scaffold for vertical bone augmentation is effective., Materials and Methods: Cube-shaped bioglass (BGS-7) and polycaprolactone (PCL) scaffolds with different weight fractions (PCL alone, PCL with 15% and 30% BGS-7) are produced using 3D printing. The surface hydroxyapatite (HA) apposition, the pH change, proliferation and attachment assays, and various gene expression levels are assessed. After a 7-mm implant was inserted 3 mm into the rabbit calvaria, vertical bone augmentation is performed around the implant and inside the scaffold in four ways: scaffold only, scaffold+bone graft, bone graft only, and no graft. Sacrifice is performed at 6, 12, and 24 weeks, and the various parameters are compared radiographically and histologically., Results: HA apposition, cell proliferation, cell attachment, and expression of osteogenic genes increase as the proportion of BGS-7 increase. In the in vivo test, a higher bone-implant contact ratio, bone volume ratio, bone mineral density, and new bone area are observed when the scaffold and bone grafts were used together., Conclusion: The 3D-printed scaffold, a mixture of BGS-7 and PCL, exhibit higher biological compatibility as the proportion of BGS-7 increase. Additionally, the use of scaffold is effective for vertical bone augmentation., (© 2024 Wiley Periodicals LLC.)

XRD diffraction and IR absorption were investigated for raw loess powder and heat-treated loess powder. Raw loess retains its useful minerals, but loses their beneficial properties when calcined at 850 °C and 1050 °C. To utilize the useful minerals, loess balls were made using a low-temperature wet-drying method. The radiant energy and transmittance were measured for the loess balls. Far-infrared ray (FIR) emitted from loess bio-balls is selectively absorbed as higher vibrational energy by water molecules. FIR can raise the body's core temperature, thereby improving blood flow through the body's thermoregulatory mechanism. In an exploratory study with 40 participants, when the set temperature of the loess ball mat was increased from 25 °C to 50 °C, blood flow increased by 39.01%, from 37.48 mL/min to 52.11 mL/min, in the left middle finger; in addition, it increased by 39.62%, from 37.15 mL/min to 51.87 mL/min, in the right middle finger. The FIR emitted from loess balls can be widely applied, in various forms, to diseases related to blood flow, such as cold hands and feet, diabetic foot, muscle pain, and menstrual pain.

This study investigates the secondary bonding of aircraft skin/stiffener assemblies using press conduction welding with carbon fiber/polyetherketoneketone thermoplastic composites and polyetherimide adhesive. Recognizing the challenges posed by conventional welding methods in maintaining material integrity and uniformity, this research explores an alternative methodology that mitigates these issues while ensuring high-strength bonds. The press conduction welding parameters were selected based on single-lap shear tests and applied in the bonding of skin and omega stiffener components. The temperature range was determined using differential scanning calorimetry. The pressure was held at 1 MPa for 180 s. The welding temperature that produced a high-bonding strength was identified experimentally; these key variables were then used in the welding process of the skin and omega stiffener. By analyzing how the fibers tear and the effectiveness of interdiffusion between the plies, we were able to gain insights into the bonding strength and fractured surface. The findings suggest that press conduction welding provides a viable route for secondary bonding in thermoplastic composite structures, highlighting its advantages in terms of processing efficiency and integrity. This study contributes to the understanding of the mechanical behaviors of bonded joints and underscores the significance of temperature control in the welding process.

This study aimed to measure masticatory performance (MP) using β-carotene gummy jelly to investigate its relationship with skeletal properties in decompensated patients diagnosed with skeletal class III malocclusion. The study included 78 patients (38 men and 40 women) diagnosed with skeletal class III malocclusion without temporomandibular joint disorder and periodontal disease. MP was measured using a new masticatory measuring device and β-carotene in the gummy jelly. Lateral and posteroanterior cephalograms were obtained, and skeletal properties (Me deviation, ANB, SNB, APDI, Wits, ODI, facial axis, body length, ramus length, SN-GoGn, anterior facial height, posterior facial height, saddle angle, articular angle, and gonial angle) were evaluated. MP differences according to age and sex and the effect of skeletal properties on MP were analyzed using multiple linear regression analysis. The MP of all patients was 3690.55±1428.77 mm², MP of the male group was 4043.05±1498.09 mm², and MP of the female group was 3355.68±1272.19 mm². Among the items investigated, the variable that affected MP was posterior facial height. Posterior facial height showed a positive correlation (P=0.022). There was no significant difference between MP and other skeletal properties (P>0.05). The severity of the hypodivergency in skeletal class III could affect MP. The relationship between facial asymmetry or skeletal relation and MP could not be explained in this study., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Diagnosis of eutrophication requires evidence of disturbance to the balance of organisms. We describe a tool, the Plankton Community Integrity Index (PCII), derived from the Plankton Index (PI) for tracking change in the seasonal patterns of abundance of diatom and dinoflagellate lifeforms when plotted in state space. The tool uses a nutrient-minimum reference period to interpret PCII values as status indicators, with values close to 1 indicating "High" status and 0.6 a Biological Water Quality Criterion (BioWQC) target set at the "Fair"/"Good" status boundary. It has been applied to Hong Kong marine waters, using data from monthly samples from 1995 through 2021. A preliminary analysis, required for the PI method, confirmed monsoonal seasonality in the diatom lifeform. In 5 of the 9 water bodies examined, PCII time series correlated with those of Total Inorganic Nitrogen (TIN). Since 2020, all Water Control Zones met the operationally defined BioWQC target., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Specifications are available to quantify flexural performance of steel-fiber reinforced concrete beams with several parameters. Each specification provides different results. This study comparatively evaluates existing flexural beam test standards that are used to evaluate the flexural toughness of SFRC beam specimens. Two standards, EN-14651 and ASTM C1609, were followed to test SFRC beams under the three-point bending test (3PBT) and the four-point bending test (4PBT), respectively. Both normal tensile strength steel fiber (1200 MPa) and high tensile strength steel fiber (1500 MPa) in high-strength concrete were considered in this study. The reference parameters recommended in the two standards, which include equivalent flexural strength, residual strength, energy absorption capacity, and flexural toughness, were compared based on the tensile strength (normal or high) of the steel fiber in high-strength concrete. The 3PBT and 4PBT results indicate that both standard test methods yield similar results to quantify the flexural performance of SFRC specimens. However, unintended failure modes were observed for both standard test methods. The adopted correlation model shows that the flexural performance of SFRC is similar for 3PBTs and 4PBTs, but the residual strength obtained from the 3PBTs tends to be greater than that obtained from 4PBTs with an increase in the tensile strength of steel fiber.

UV-curable coatings have numerous advantages, including environmental sustainability due to 100% solid content, economic feasibility attributable to relatively fast curing time, decent appearance, mechanical properties, chemical resistance, and abrasion resistance. However, UV-curable polyurethane acrylate coatings on metals apparently restrict their engineering applications owing to low mechanical properties and poor thermal stability, giving UV-curable coatings less flexibility and formability. In this study, we evaluated the property change of films according to the type of reactive diluents that lowers the viscosity of UV-curing coatings for pre-coated metal and has a substantial effect on the curing rate, viscoelastic properties, adhesive properties, and flexibility of the film. Moreover, there are many changes in the properties of coatings according to varied curing conditions in order to evaluate the oxygen inhibition phenomenon during the curing process in the atmosphere. In particular, to evaluate the effect of reactive diluents on forming formability, which is the most crucial property for the pre-coated metal, this study used conventional formability tests, such as t-bending or the Erichsen test. Moreover, a cross-die cup drawing mold with a similar form as failure and Safety Zone was utilized in order to obtain clearer information on its actual formability. The analysis on the effect of failure and safety zone on the material used in press forming was conducted by assessing limit punch height and forming a limit diagram of the manufactured film according to varied reactive diluents.

Dynein inactivates the spindle assembly checkpoint (SAC) by transporting checkpoint proteins away from kinetochores toward spindle poles in a process known as "stripping." We find that inhibition of Aurora A kinase, which is localized to spindle poles, enables the accumulation of the spindle checkpoint activator Mad1 at poles where it is normally absent. Aurora kinases phosphorylate the dynein activator NudE neurodevelopment protein 1 like 1 (Ndel1) on Ser285 and Mad1 accumulates at poles when Ndel1 is replaced by a nonphosphorylatable mutant in human cells. The pole focusing protein NuMA, transported to poles by dynein, also accumulates at poles in cells harboring a mutant Ndel1. Phosphorylation of Ndel1 on Ser285 is required for robust spindle checkpoint activity and regulates the poles of asters in  Xenopus  extracts. Our data suggest that dynein/SAC complexes that are generated at kinetochores and then transported directionally toward poles on microtubules are inhibited by Aurora A before they reach spindle poles. These data suggest that Aurora A generates a spatial signal at spindle poles that controls dynein transport and spindle function.

The aim of this study was to determine the three-dimensional soft tissue changes after reduction malarplasty. Soft tissue changes relative to the amount of movement of the zygomatic bone were studied. Pre- and postoperative cone beam computed tomography images of 21 female patients were superimposed. The anterior-most point of the body osteotomy (point A), arch osteotomy site (point D), and points dividing line A-D into thirds (points B and C) were marked on lateral view images. The vertical distances from the midsagittal line to the centre of the zygomatic bone and the outer prominence of the soft tissue were measured on the coronal view of each image. The proportion of the change in soft tissue to that of the bone before and after surgery was calculated for each point. The relationship between body mass index and the soft tissue change ratio, and the differences in soft tissue changes at each point were analysed. Mean soft tissue changes for points A, B, C, and D were 53.43%, 66.66%, 63.67%, and 57.23%, respectively. The amount of soft tissue change at point B was greater than that at points A and D, which were osteotomy sites. There was no statistical correlation between body mass index and the soft tissue change ratio at each point., Competing Interests: Competing interests None., (Copyright © 2022 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

A self-powered, color-filter-free blue photodetector (PD) based on halide perovskites is reported. A high external quantum efficiency (EQE) of 84.9%, which is the highest reported EQE in blue PDs, is achieved by engineering the A-site monovalent cations of wide-bandgap perovskites. The optimized composition of formamidinium (FA)/methylammonium (MA) increases the heat of formation, yielding a uniform and smooth film. The incorporation of Cs + ions into the FA/MA composition suppresses the trap density and increases charge-carrier mobility, yielding the highest average EQE of 77.4%, responsivity of 0.280 A W -1 , and detectivity of 5.08 × 10 12 Jones under blue light. Furthermore, Cs + improves durability under repetitive operations and ambient atmosphere. The proposed device exhibits peak responsivity of 0.307 A W -1 , which is higher than that of the commercial InGaN-based blue PD (0.289 A W -1 ). This study will promote the development of next-generation image sensors with vertically stacked perovskite PDs., (© 2022 Wiley-VCH GmbH.)

The spread of the COVID-19 pandemic was spatially heterogeneous around the world; the transmission of the disease is driven by complex spatial and temporal variations in socioenvironmental factors. Spatial tools are useful in supporting COVID-19 control programs. A substantive review of the merits of the methodological approaches used to understand the spatial epidemiology of the disease is hardly undertaken. In this study, we reviewed the methodological approaches used to identify the spatial and spatiotemporal variations of COVID-19 and the socioeconomic, demographic and climatic drivers of such variations. We conducted a systematic literature search of spatial studies of COVID-19 published in English from Embase, Scopus, Medline, and Web of Science databases from 1 January 2019 to 7 September 2021. Methodological quality assessments were also performed using the Joanna Briggs Institute (JBI) risk of bias tool. A total of 154 studies met the inclusion criteria that used frequentist (85%) and Bayesian (15%) modelling approaches to identify spatial clusters and the associated risk factors. Bayesian models in the studies incorporated various spatial, temporal and spatiotemporal effects into the modelling schemes. This review highlighted the need for more local-level advanced Bayesian spatiotemporal modelling through the multi-level framework for COVID-19 prevention and control strategies.

The objective of this retrospective study is to verify the effectiveness and safety of patient-specific titanium implants on maxillofacial bones, with a long-term follow-up. Total 16 patients with various maxillofacial defects underwent reconstruction using patient-specific titanium implants. Titanium implants, manufactured by electron beam melting, selective laser sintering, or milling, were inserted into the maxilla, mandible, or zygoma. Long-term follow-up (36.7 ± 20.1 months) was conducted after the surgery. Bone fusion of the titanium implant body, postoperative infection, implant malunion, functional results, patient satisfaction, subsidence, osteolysis around the implants, and complications were recorded and analyzed at the last follow-up. Of the 28 implants, only one failed to unite with the bone; therefore, revision surgery was performed. No osteolysis or subsidence around the titanium implants nor adverse events were observed; the mean VAS score for satisfaction was 9. All patients enrolled in this trial were esthetically and functionally satisfied with their surgical results, and fixation failure and esthetic dissatisfaction complications were well resolved. Patient-specific titanium showed satisfactory outcomes when used to treat various oral and maxillofacial defects. A 3D printed titanium implant can be effectively used in the reconstruction of the zygoma and mandible instead of autogenous bone without donor site morbidity., (© 2022. The Author(s).)

There is a dearth of evidence synthesis on the prevalence of anxiety among university students even though the risk of psychological disorders among this population is quite high. We conducted a quantitative systematic review to estimate the global prevalence of anxiety among university students during the COVID-19 pandemic. A systematic search for cross-sectional studies on PubMed, Scopus, and PsycINFO, using PRISMA guidelines, was conducted from September 2020 to February 2021. A total of 36 studies were included, using a random-effects model to calculate the pooled proportion of anxiety. A meta-analysis of the prevalence estimate of anxiety yielded a summary prevalence of 41% (95% CI = 0.34-0.49), with statistically significant evidence of between-study heterogeneity (Q = 80801.97, I 2 = 100%, p ≤ 0.0001). A subgroup analysis reported anxiety prevalence in Asia as 33% (95% CI:0.25-0.43), the prevalence of anxiety in Europe as 51% (95% CI: 0.44-0.59), and the highest prevalence of anxiety in the USA as 56% (95% CI: 0.44-0.67). A subgroup gender-based analysis reported the prevalence of anxiety in females as 43% (95% CI:0.29-0.58) compared to males with an anxiety prevalence of 39% (95% CI:0.29-0.50). University students seem to have a high prevalence of anxiety, indicating an increased mental health burden during this pandemic.

Steel fiber has been used successfully in concrete mixtures to control volumetric changes, including shrinkage. However, the feasibility of the use of steel fiber has been restricted to nonstructural construction, such as 'slab on ground'. Recently, researchers have attempted to expand the applications of steel fiber to replace structural reinforcement (rebar) and have shown promising results in its substitution for shear reinforcement. Few studies have been conducted to ensure the feasibility of using steel fiber in structural components, however. This experimental study was designed to investigate the shear performance of steel fiber-reinforced concrete beams using the tensile strength of steel fiber and the shear span-to-depth ratio as variables. The experimental results indicate that the tensile strength of steel fiber significantly affects the shear strength of steel fiber-reinforced concrete beams, regardless of the shear span-to-depth ratio, and that steel fiber can play a role in shear reinforcement of concrete beams.

Magnetic domain wall (DW) motion in perpendicularly magnetized materials is drawing increased attention due to the prospect of new type of information storage devices, such as racetrack memory. To augment the functionalities of DW motion-based devices, it is essential to improve controllability over the DW motion. Other than electric current, which is known to induce unidirectional shifting of a train of DWs, an application of in-plane magnetic field also enables the control of DW dynamics by rotating the DW magnetization and consequently modulating the inherited chiral DW structure. Applying an external bias field, however, is not a viable approach for the miniaturization of the devices as the external field acts globally. Here, the programmable exchange-coupled DW motion in the antiferromagnet (AFM)/ferromagnet (FM) system is demonstrated, where the role of an external in-plane field is replaced by the exchange bias field from AFM layer, enabling the external field-free modulations of DW motions. Interestingly, the direction of the exchange bias field can also be reconfigured by simply injecting spin currents through the device, enabling electrical and programmable operations of the device. Furthermore, the result inspires a prototype DW motion-based device based on the AFM/FM heterostructure, that could be easily integrated in logic devices., (© 2021 The Authors. Advanced Science published by Wiley-VCH GmbH.)

The purpose of this study was to evaluate the clinical efficacy and safety of patient-specific additive-manufactured CaOSiO 2 -P 2 O 5 -B 2 O 3 glass-ceramic (BGS-7) implants for reconstructing zygomatic bone defects at a 6-month follow-up. A prospective, single-arm, single-center, clinical trial was performed on patients with obvious zygoma defects who needed and wanted reconstruction. The primary outcome variable was a bone fusion between the implant and the bone evaluated by computed tomography (CT) at 6 months post surgery. Secondary outcomes, including implant immobilization, satisfaction assessment, osteolysis, subsidence of the BGS-7 implant, and safety, were assessed. A total of eight patients were enrolled in the study. Two patients underwent simultaneous reconstruction of the left and right malar defects using a BGS-7 3D printed implant. Cone beam CT analysis showed that bone fusion at 6 months after surgery was 100%. We observed that the average fusion rate was 76.97%. Osteolysis around 3D printed BGS-7 implants was not observed. The mean distance displacement of all 10 implants was 0.4149 mm. Our study showed no adverse event in any of the cases. The visual analog scale score for satisfaction was 9. All patients who enrolled in this trial were aesthetically and functionally satisfied with the surgical results. In conclusion, this study demonstrates the safety and promising value of patient-specific 3D printed BGS-7 implants as a novel facial bone reconstruction method.

Differences between Oriental and Caucasian eyelids have been explained in great detail in several reports in the past. The purpose of this article is to discuss the functional aspects of Asian double fold upper blepharoplasty and to present techniques that help to improve both the functional and cosmetic outcomes and satisfaction after surgery. The eyes of Asians are relatively small with thick skin in the eyelids and periorbital area. They typically lack the upper eyelid crease (creating the so-called double eyelid) due to burden factors like thick skin, hypertrophied orbicularis oculi muscle (OOM), submuscular fibroadipose tissue, thick orbital septum, abundant preaponeurotic fat, and lower positioned transverse ligament. Asian eyes may also have a superior visual field defect due to skin overriding the upper lid margin (skin-OOM-fat complex slide down). These burden factors result in the eyelashes appearing short and becoming misdirected and pressed toward the globe, causing functional discomfort. As a compensatory mechanism, Asian people tend to engage the frontalis muscle to lift the eyebrow to help them open their eyes. Along with aesthetic enhancement, double-eyelid surgery in Asian burden lids can improve the functional deficiencies helping the patients to open the eyes more easily. In addition, treatment of the Mongolian fold (medial epicanthal fold), caused by medial hypertrophy of preseptal OOM, augments the surgical results. In this report, we present the appropriate preoperative assessment, surgical technique, and postoperative care that should be employed to achieve consistently good functional and aesthetic outcomes in these patients., Competing Interests: None declared., (Thieme. All rights reserved.)

Background/aims: A diagnosis of hepatorenal syndrome (HRS) is based on a differential evaluation of acute kidney injury (AKI), which may aggravate the clinical course. This study assessed the clinical significance of the urinary neutrophil gelatinase- associated lipocalin (u-NGAL) levels in a differential diagnosis of AKI in patients with liver cirrhosis (LC)., Methods: Patients with LC who developed AKI were enrolled prospectively. Clinically, patients with AKI were classified into prerenal azotemia (PRA), HRS, and acute tubular necrosis (ATN) groups., Results: Fifty-five patients (male, 74.5%) with LC who exhibited AKI upon admission were enrolled; 28, 9, and 18 patients were included in the PRA, HRS, and ATN groups, respectively. The baseline model for end-stage liver disease (MELD) scores was similar in the subgroups. The median event creatinine level, measured at the time of the AKI diagnosis, was similar in the HRS and ATN subgroups. On the other hand, the median event u-NGAL level differed significantly between the three subgroups (PRA, HRS, and ATN: 37 vs. 134 vs. 2,625 ng/mL, p=0.003). In particular, the median u-NGAL level of the HRS group was clearly different from those of the PRA (p<0.001) and ATN (p<0.001) groups. Multivariable analysis revealed the natural logarithm of the u-NGAL level (hazard ratio [HR] 1.77, p=0.031) and the MELD score (HR 1.17, p=0.027) to be independent prognostic factors for in-hospital mortality in patients with LC and AKI., Conclusions: The median u-NGAL level differentiated HRS from ATN and served as a clinical indicator of in-hospital mortality for patients with LC and AKI.

Objectives: The purpose of this study was to compare the lip line cant (LLC) changes after 1 and 2-jaw surgery, and to evaluate the correlations of the craniofacial factors affecting LLC., Methods: The study subjects were selected (LLC amount within 1.5-6.0°) from among the patients diagnosed with Class III malocclusion who underwent one (n = 20) or 2-jaw surgery (n = 20). Cone beam computed tomography images were obtained immediately before the operation (T1) and 6 months after the operation (T2). Preoperative and postoperative craniofacial measurements were obtained., Results: The study subjects showed 3.12° LLC on average before undergoing 1-jaw surgery, and their LLC changed to 1.27° after the surgery. As for 2-jaw surgery, the subjects showed 3.38° LLC on average before the surgery and 0.98° after the surgery. LLC at pre-treatment may be more affected by a cant of the occlusal plane in the mandible than maxilla. In the comparison of the value of changes of LLC, the value of 2-jaw surgery was bigger than the value of 1-jaw surgery but the difference was statistically insignificant., Limitations: This study had a limitation in that the muscles were not considered. And the metal bracket or metal crown and bridge, however, can cause noise and blurring artifacts in CT, which can lead to a low resolution. And the limited number of the patients should be considered., Conclusions: In correlation analysis, both pre-surgery LLC and change of LLC have correlation with almost all the craniofacial measurement. Lip-line cant of patients with facial asymmetry has higher correlation with mandibular cant than with other cants. To improve the LLC, a surgical plan should be established to minimize the mandibular cant using the computer simulation as well as the maxillary cant.

Steel fiber embedded in concrete serves to reduce crack development and prevent crack growth at the macroscopic level of the concrete matrix. Steel fiber-reinforced concrete (SFRC) with high compressive concrete strength is affected primarily by the dimensions, shape, content, aspect ratio, and tensile strength of the embedded steel fiber. In this study, double-ended hook steel fiber was used in SFRC with a concrete compressive strength of 80 MPa. This fiber was used for the study variables with two aspect ratios (64, 80) and tensile strength values up to 1600 MPa. The flexural performance of the SFRC specimens was evaluated using crack mouth open displacement tests, and the test results were compared with code provisions. A modified reinforcement index was also used to quantify the flexural performance based on comparisons with fracture energy.

The global trend in increasing plant-based protein diets due to health and ideological reasons, has created an increased demand for food legumes that exceeds current production. To meet this demand, it is timely to reduce relying solely on soybean, and explore the potential of the underutilised legumes that are cultivated regionally. Underutilised legumes are rich in protein, carbohydrates and other nutrients that are essential for consumer. However, relatively little is known about their anti-nutritional properties and processing methods. Anti-nutritional factors (ANFs) such as enzyme inhibitors are prevalent in legumes and may interfere with digestibility and nutrient absorption. Nevertheless, an optimised food processing method will overcome this challenge and warrant a safe inclusion of legume in plant-based protein diets. Hence current study aimed to optimise the food processing methods (soaking, wet heating, autoclaving and freezing) and evaluate their efficiency in eliminating the enzyme inhibitors [trypsin, chymotrypsin (CIA) and α-amylase (AIA) inhibitors] present in seven underutilised legumes. Current study showed that autoclaving at 121 °C for 15 min reduced the AIA in all underutilised legumes tested. The AIA and CIA of bambara groundnut were successfully inactivated by wet heating at 50 °C for 60 min, and by autoclaving at 121 °C for 15 min. While the CIA of chickpea was successfully inactivated by freezing at - 80 °C for 24 h., Competing Interests: Compliance with ethical standardsThe authors declared that they have no conflict of interest.

Objectives: We aimed to assess the clinical significance of the intensity of transcutaneous vagus nerve stimulation (tVNS) in chronic tinnitus., Materials and Methods: Four sessions of tVNS were performed over a 2-week period for 24 patients with unilateral, non-pulsatile chronic tinnitus. The cavum, cymba, and tragus were sequentially stimulated to the maximal sensory thresholds. One month later, after the four sessions, the level of tinnitus distress and changes in stimulus intensity were assessed., Results: The stimulus intensity did not differ according to sex or laterality. However, a moderate positive correlation between tinnitus distress and the initial stimulus intensity was observed. This correlation was not observed during the subsequent sessions. The stimulus intensity at the cavum changed significantly (p=0.018), and notable differences in tinnitus annoyance were observed between the responders and non-responders (p=0.006)., Conclusion: The effect of stimulus intensity on the treatment outcome seems to be limited. An increasing trend in the stimulus intensity for tinnitus annoyance at the cavum was observed in the responders. Therefore, the cavum may be an optimal stimulation site for tVNS.

Background: Until now, various types of combined therapy with nucleotide analogs and pegylated interferon (Peg-INF) in patients with hepatitis B patients have been tried. However, studies regarding the benefits of de novo combination, late-add on, and sequential treatment are very limited. The objective of the current study was to identify the efficacy of sequential treatment of Peg-INF after short-term antiviral treatment., Methods: Between June 2010 and June 2015, hepatitis B e antigen (HBeAg)-positive patients (n = 162) received Peg-IFN for 48 weeks (mono-treatment group, n = 81) and entecavir (ETV) for 12 weeks with a 48-week course of Peg-IFN starting at week 5 of ETV therapy (sequential treatment group, n = 81). The primary endpoint was HBeAg seroconversion at the end of follow-up period after the 24-week treatment. The primary endpoint was analyzed using Chi-square test, Fisher's exact test, and regression analysis., Results: HBeAg seroconversion rate (18.2% vs. 18.2%, t = 0.03, P = 1.000) and seroclearance rate (19.7% vs. 19.7%, t = 0.03, P = 1.000) were same in both mono-treatment and sequential treatment groups. The rate of alanine aminotransferase (ALT) normalization (45.5% vs. 54.5%, t = 1.12, P = 0.296) and serum hepatitis B virus (HBV)-DNA <2000 U/L (28.8% vs. 28.8%, t = 0.10, P = 1.000) was not different in sequential and mono-treatment groups at 24 weeks of Peg-INF. Viral response rate (HBeAg seroconversion and serum HBV-DNA <2000 U/L) was not different in the two groups (12.1% vs. 16.7%, t = 1.83, P = 0.457). Baseline HBV-DNA level (7 log 10 U/ml vs. 7.5 log 10 U/ml, t = 1.70, P = 0.019) and hepatitis B surface antigen titer (3.6 log 10 U/ml vs. 4.0 log 10 U/ml, t = 2.19, P = 0.020) were lower and predictors of responder in mono-treatment and sequential treatment groups, respectively., Conclusions: The current study shows no differences in HBeAg seroconversion rate, ALT normalization, and HBV-DNA levels between mono-therapy and sequential therapy regimens., Trial Registration: ClinicalTrials.gov, NCT01220596; https://clinicaltrials.gov/ct2/show/NCT01220596?term=NCT01220596&rank=1., Competing Interests: There are no conflicts of interest

[This corrects the article DOI: 10.1186/s40902-017-0120-6.].

Expansion of chondrocytes for repair of articular cartilage can lead to dedifferentiation, making it difficult to obtain a sufficient quantity of chondrocytes. Although previous studies have suggested that culture in a three-dimensional environment induces redifferentiation of dedifferentiated chondrocytes, its underlying mechanisms are still poorly understood in terms of metabolism compared with a two-dimensional environment. In this study, we demonstrate that attenuation of transglutaminase 2 (TG2), a multifunctional enzyme, stimulates redifferentiation of dedifferentiated chondrocytes. Fibroblast-like morphological changes increased as TG2 expression increased in passage-dependent manner. When dedifferentiated chondrocytes were cultured in a pellet culture system, TG2 expression was reduced and glycolytic enzyme expression up-regulated. Previous studies demonstrated that TG2 influences energy metabolism, and impaired glycolytic metabolism causes chondrocyte dedifferentiation. Interestingly, TG2 knockdown improved chondrogenic gene expression, glycolytic enzyme expression, and lactate production in a monolayer culture system. Taken together, down-regulation of TG2 is involved in redifferentiaton of dedifferentiated chondrocytes through enhancing glucose metabolism., Competing Interests: The authors declare no conflict of interest.

Purpose: The study aim was to evaluate gap healing after medial open-wedge high tibial osteotomy (MOWHTO) using novel injectable beta-tricalcium phosphate (β-TCP) as gap filler. We also aimed to evaluate radiographic and clinical outcome of MOWHTO using injectable β-TCP., Methods: Consecutive 28 patients underwent MOWHTO using anatomical locking plate fixation, and β-TCP was injected as gap filler. Serial radiographs and computed tomography were taken at postoperative 3 and 12 months, and gap healing was assessed. Lower extremity alignment was measured on radiographs, and clinical outcome was evaluated by determining International Knee Documentation Committee, Western Ontario and McMaster Universities Arthritis Index, and visual analogue scales for pain scores., Results: Progress of bone union was found on plain radiographs, and the mean ratio (β-TCP/host bone) of computed tomography attenuation values significantly changed from postoperative 3 months to 12 months, which indicates maturation of β-TCP. The average mechanical femoro-tibial angle changed from 4.1° varus (preoperative) to 4.8° valgus (3 months) and maintained until 12 months (4.3° valgus). All clinical outcome scores were significantly improved and no significant complication occurred., Conclusion: Using injectable β-TCP as gap filler for MOWHTO resulted in satisfactory gap healing without complication. Radiographic and clinical results were satisfactory. The injectable β-TCP can be a safe and effective option for gap filling after MOWHTO.

Background: Two-jaw surgery including mandibular and maxillary backward movement procedures are commonly performed to correct class III malocclusion. Bimaxillary surgery can reposition the maxillofacial bone together with soft tissue, such as the soft palate and the tongue base. We analyzed changes of pharyngeal airway narrowing to ascertain clinical correlations with the prevalence of snoring after two-jaw surgery., Methods: A prospective clinical study was designed including a survey on snoring and three-dimensional (3D) computed tomography (CT) in class III malocclusion subjects before and after bimaxillary surgery. We conducted an analysis on changes of the posterior pharyngeal space find out clinical correlations with the prevalence of snoring., Results: Among 67 subjects, 12 subjects complained about snoring 5 weeks after the surgical correction, and examining the 12 subjects after 6 months, 6 patients complained about the snoring. The current findings demonstrated the attenuation of the largest transverse width (LTW), anteroposterior length (APL), and cross-sectional area (CSA) following bimaxillary surgery given to class III malocclusion patients, particularly at the retropalatal level. The average distance of maxillary posterior movements were measured to be relatively higher (horizontal distance 3.9 mm, vertical distance 2.6 mm) in case of new snorers., Conclusions: This study found that bimaxillary surgery could lead to the narrowing of upper airway at the retropalatal or retroglossal level as well as triggering snoring in subjects with class III malocclusion. Based on the current clinical findings, we also found that upper airway narrowing at retropalatal level may contribute to increasing the probability of snoring and that polysonography may need to be performed before orthognathic surgery in subjects with class III malocclusion.

Background: Studies on the results of arthroscopic repair of massive rotator cuff tears have reported widely varied prognoses. Among other factors, the sizable discrepancy can be attributable to the fact that the current definition of massive rotator cuff tears covers an extensive area of tendons., Hypothesis: Functional and radiological results according to subgroups would show significant inter-subgroup differences preoperatively and postoperatively., Study Design: Cohort study; Level of evidence, 2., Methods: A total of 104 patients who required arthroscopic repair for massive rotator cuff tears were prospectively evaluated. The patients were allocated into 3 groups according to tendon involvement as diagnosed by preoperative magnetic resonance imaging: group 1 (anterosuperior type involving the subscapularis and supraspinatus), group 2 (posterosuperior type involving the infraspinatus and supraspinatus), and group 3 (anteroposterior type involving the subscapularis, supraspinatus, and infraspinatus). We compared functional results (at 2 years postoperatively) and radiological findings (at 1 year postoperatively) for each group., Results: There were 34 patients in group 1, 54 in group 2, and 16 in group 3. In all 3 groups, functional results significantly improved after surgery. There were no statistically significant intergroup differences in functional results among the 3 groups. On the radiological evaluations, each group (groups 1, 2, and 3) showed a significantly different result in the preoperative acromiohumeral distance (AHD) (7.19, 5.44, and 5.22 mm, respectively), tear size (38.8, 39.3, and 46.4 mm, respectively), extent of retraction (33.9, 40.0, and 41.4 mm, respectively), postoperative AHD (8.92, 7.37, and 6.71 mm, respectively), and retear rate (23.5%, 51.9%, and 56.2%, respectively) ( P < .001 for all)., Conclusion: Massive rotator cuff tears can be divided into 3 types: anterosuperior (group 1), posterosuperior (group 2), and anteroposterior (group 3). Each group has distinctive characteristics and shows different results in the preoperative AHD, tear size, extent of retraction, postoperative AHD, and retear rate, which provide a reasonable basis for categorization. So far, massive rotator cuff tears have only been broadly defined, consequently being understood as a single category by many. However, to clearly understand and evaluate this injury, we suggest identifying differences within the category through proper subclassification.

Purpose: We evaluated the tolerability and efficacy of endoscopic dacryocystorhinostomy (Endo-DCR) in patients treated in the leaning position and under local anesthesia with minimal sedation (LAS)., Study Design: Questionnaire to determine subjective success of Endo-DCR., Methods: From May 2013 to August 2014, a total of 95 eyes with epiphora presented to the Myoung Eye Plastic Surgery Clinic in Seoul, Korea, and were treated with Endo-DCR under LAS. Three nerve blocks were administered to achieve local anesthesia. Postoperatively, the wound site was packed with Nasopore to control bleeding and promote wound healing. Outcome measures included a patient questionnaire completed on postoperative day 7 to evaluate intraoperative and postoperative pain based on the VAS (0 to 10)., Results: Mean intraoperative and postoperative pain scores were 1.03 and 1.64, respectively, for 95 eyes. Of the 95 eyes treated, the patients in 82 eyes (86.31%) reported that they would prefer LAS over GA for a repeat Endo-DCR. The subjective and objective surgical success rates were 90.14% and 95.77%, respectively., Conclusions: Endo-DCR carried out under LAS with the patient in the leaning position is more useful, efficient, and feasible than Endo-DCR performed under GA with the patient in the supine position.

This study was conducted to evaluate the prevalence of tooth discolouration and to examine the factors that may pose a higher risk for tooth discolouration after orthognathic surgery. This was a retrospective study of 1455 orthognathic surgeries. The following data were collected for analysis: presence of discoloured teeth, sex, age at operation, the extent of the surgical displacement of the maxilla, and whether patients had undergone genioplasty, zygomaplasty, or descending palatine artery (DPA) ligation. Out of 1339 patients who underwent double-jaw surgery, 49 received root canal treatment due to tooth discolouration. No tooth discolouration was found in the 116 patients undergoing single-jaw surgery. DPA ligation, genioplasty, and mandibular sub-apical osteotomy were associated with a significant risk of tooth discolouration. Patients should be informed preoperatively of the possibility of tooth discolouration. Additionally, the DPA should be preserved during Le Fort I osteotomy to reduce the risk of tooth discolouration., (Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: The ultimate goal of craniofacial reconstructive surgery is to achieve the most complete restoration of facial functions. A bioabsorbable fixation system which does not need secondary operation for implant removal has been developed in the last decade. The purpose of this study is to share the experience of authors and to demonstrate the efficacy of bioabsorbable mesh in a variety of craniofacial trauma operations., Methods: Between October 2008 and February 2015, bioabsorbable meshes were used to reconstruct various types of craniofacial bone fractures in 611 patients. Any displaced bone fragments were detached from the fracture site and fixed to the mesh. The resulting bone-mesh complex was designed and molded into an appropriate shape by the immersion in warm saline. The mesh was molded once again under simultaneous warm saline irrigation and suction., Results: In all patients, contour deformities were restored completely, and bone segments were fixed properly. The authors found that the bioabsorbable mesh provided rigid fixation without any evidence of integrity loss on postoperative computed tomography scans., Conclusion: Because bioabsorbable meshes are more flexible than bioabsorbable plates, they can be molded and could easily reconstruct the facial bone in three dimensions. Additionally, it is easy to attach bone fragments to the mesh. Bioabsorbable mesh and screws is effective and can be easily applied for fixation in various craniofacial trauma reconstructive scenarios., Competing Interests: No potential conflict of interest relevant to this article was reported.

A pressure sensor based on irregular microhump patterns has been proposed and developed. The devices show high sensitivity and broad operating pressure regime while comparing with regular micropattern devices. Finite element analysis (FEA) is utilized to confirm the sensing mechanism and predict the performance of the pressure sensor based on the microhump structures. Silicon carbide sandpaper is employed as the mold to develop polydimethylsiloxane (PDMS) microhump patterns with various sizes. The active layer of the piezoresistive pressure sensor is developed by spin coating, Pedot: PSS on top of the patterned PDMS. The devices show an averaged sensitivity as high as 851 kPa(-1) , broad operating pressure range (20 kPa), low operating power (100 nW), and fast response speed (6.7 kHz). Owing to their flexible properties, the devices are applied to human body motion sensing and radial artery pulse. These flexible high sensitivity devices show great potential in the next generation of smart sensors for robotics, real-time health monitoring, and biomedical applications., (© 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Human adipose-derived stem cells (hASCs) have a capacity to undergo adipogenic, chondrogenic, and osteogenic differentiation. Recently, hASCs were applied to various fields including cell therapy for tissue regeneration. However, it is hard to predict the direction of differentiation of hASCs in real-time. Matrix metalloproteinases (MMPs) are one family of proteolytic enzymes that plays a pivotal role in regulating the biology of stem cells. MMPs secreted by hASCs are expected to show different expression patterns depending on the differentiation state of hASCs because biological functions exhibit different patterns during the differentiation of stem cells. Here, we investigated proteolytic enzyme activity, especially MMP-2 activity, in hASCs during their differentiation. The activities of proteolytic enzymes and MMP-2 were higher during chondrogenic differentiation than during adipogenic and osteogenic differentiation. During chondrogenic differentiation, mRNA expression of MMP-2 and the level of the active form of MMP-2 were increased, which also correlated with Col II. It is concluded that proteolytic enzyme activity and the level of the active form of MMP-2 were increased during chondrogenic differentiation, which was accelerated in the presence of Col II protein. According to our findings, MMP-2 could be a candidate maker for real-time detection of chondrogenic differentiation of hASCs.

We aimed to evaluate the prevalence of antineuronal antibodies in a nationwide cohort of patients with encephalopathy of unknown etiology. We screened 1699 patients with idiopathic encephalopathy who were referred from 70 hospitals across Korea for autoimmune synaptic and classic paraneoplastic antibodies. Those with cerebellar degeneration, sensory polyneuropathy or other paraneoplastic syndromes without encephalopathy were not included in this study. One-hundred and four patients (6.12%) had antibody-associated autoimmune encephalopathy. Autoimmune synaptic antibodies were identified in 89 patients (5.24%) and classic paraneoplastic antibodies were identified in 16 patients (0.94%). The patients with antibody-associated autoimmune encephalopathy comprised a small but significant portion of the total number of patients with encephalopathy of unknown cause., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: To evaluate the seizure characteristics and outcome after immunotherapy in adult patients with autoimmune encephalitis (AE) and new-onset seizure., Methods: Adult (age ≥18 years) patients with AE and new-onset seizure who underwent immunotherapy and were followed-up for at least 6 months were included. Seizure frequency was evaluated at 2-4 weeks and 6 months after the onset of the initial immunotherapy and was categorized as "seizure remission", "> 50% seizure reduction", or "no change" based on the degree of its decrease., Results: Forty-one AE patients who presented with new-onset seizure were analysed. At 2-4 weeks after the initial immunotherapy, 51.2% of the patients were seizure free, and 24.4% had significant seizure reduction. At 6 months, seizure remission was observed in 73.2% of the patients, although four patients died during hospitalization. Rituximab was used as a second-line immunotherapy in 12 patients who continued to have seizures despite the initial immunotherapy, and additional seizure remission was achieved in 66.6% of them. In particular, those who exhibited partial response to the initial immunotherapy had a better seizure outcome after rituximab, with low adverse events., Conclusion: AE frequently presented as seizure, but only 18.9% of the living patients suffered from seizure at 6 months after immunotherapy. Aggressive immunotherapy can improve seizure outcome in patients with AE.

A new approach was adopted to improve the corrosion resistance of CrN hard coatings by inserting a Al2O3 layer through atomic layer deposition. The influence of the addition of a Al2O3 interlayer, its thickness, and the position of its insertion on the microstructure, surface roughness, corrosion behavior, and mechanical properties of the coatings was investigated. The results indicated that addition of a dense atomic layer deposited Al2O3 interlayer led to a significant decrease in the average grain size and surface roughness and to greatly improved corrosion resistance and corrosion durability of CrN coatings while maintaining their mechanical properties. Increasing the thickness of the Al2O3 interlayer and altering its insertion position so that it was near the surface of the coating also resulted in superior performance of the coating. The mechanism of this effect can be explained by the dense Al2O3 interlayer acting as a good sealing layer that inhibits charge transfer, diffusion of corrosive substances, and dislocation motion.

After 2-jaw surgery, difficulty in breathing through the mouth and the nose is common due to nasal airway obstruction, intraoral bleeding, and sometimes maxillomandibular fixation. A partially withdrawn nasotracheal tube can be used economically with equal efficacy to the nasopharyngeal airway to provide supplemental oxygen after 2-jaw surgery.

Consumer products including naturally occurring radioactive material have been distributed widely in human life. The potential hazard of the excessively added technically enhanced naturally occurring radioactive material (TENORM) in consumer products should be assessed. The aim of this study is to evaluate the organ equivalent dose and the annual effective dose with the usage of the TENORM added in paints. The activities of gammas emitted from natural radionuclides in the five types of paints were measured with the high-purity germanium detector, and the annual effective dose was assessed with the computational human phantom and the Monte Carlo method. The results show that uranium and thorium series were mainly measured over the five paints. Based on the exposure scenario of the paints in the room, the highest effective dose was evaluated as <1 mSv y(-1) of the public dose limit., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Purpose: The aim of this study was to validate a computational fluid dynamics (CFD) simulation of flow-diverter treatment through Doppler ultrasonography measurements in patient-specific models of intracranial bifurcation and side-wall aneurysms., Methods: Computational and physical models of patient-specific bifurcation and sidewall aneurysms were constructed from computed tomography angiography with use of stereolithography, a three-dimensional printing technology. Flow dynamics parameters before and after flow-diverter treatment were measured with pulse-wave and color Doppler ultrasonography, and then compared with CFD simulations., Results: CFD simulations showed drastic flow reduction after flow-diverter treatment in both aneurysms. The mean volume flow rate decreased by 90% and 85% for the bifurcation aneurysm and the side-wall aneurysm, respectively. Velocity contour plots from computer simulations before and after flow diversion closely resembled the patterns obtained by color Doppler ultrasonography., Conclusion: The CFD estimation of flow reduction in aneurysms treated with a flow-diverting stent was verified by Doppler ultrasonography in patient-specific phantom models of bifurcation and side-wall aneurysms. The combination of CFD and ultrasonography may constitute a feasible and reliable technique in studying the treatment of intracranial aneurysms with flow-diverting stents.

Aim: To analyze whether prompt and appropriate empirical antibiotic (AEA) use is associated with mortality in cirrhotic patients with bacteremia., Methods: A total of 102 episodes of bacteremia in 72 patients with cirrhosis were analyzed. AEA was defined as a using or starting an antibiotic appropriate to the isolated pathogen at the time of bacteremia. The primary endpoint was 30-d mortality., Results: The mortality rate at 30 d was 30.4% (31/102 episodes). Use of AEA was associated with better survival at 30 d (76.5% vs 46.9%, P = 0.05), and inappropriate empirical antibiotic (IEA) use was an independent factor associated with increased mortality (OR = 3.24; 95%CI: 1.50-7.00; P = 0.003, adjusted for age, sex, Child-Pugh Class, gastrointestinal bleeding, presence of septic shock). IEA use was more frequent when the isolated pathogen was a multiresistant pathogen, and when infection was healthcare-related or hospital-acquired., Conclusion: AEA use was associated with increased survival of cirrhotic patients who developed bacteremia. Strategies for AEA use, tailored according to the local epidemiological patterns, are needed to improve survival of cirrhotic patients with bacteremia.

An intracranial aneurysm, abnormal swelling of the cerebral artery, may lead to undesirable rates of mortality and morbidity upon rupture. Endovascular treatment involves the deployment of a flow-diverting stent that covers the aneurysm orifice, thereby reducing the blood flow into the aneurysm and mitigating the risk of rupture. In this study, computational fluid dynamics analysis is performed on a bifurcation model to investigate the change in hemodynamics with various side branch diameters. The condition after the deployment of a pipeline embolization device is also simulated. Hemodynamic factors such as flow velocity, pressure, and wall shear stress are studied. Aneurysms with a larger side branch vessel might have greater risk after treatment in terms of hemodynamics. Although a stent could lead to flow reduction entering the aneurysm, it would drastically alter the flow rate inside the side branch vessel. This may result in side-branch hypoperfusion subsequent to stenting. In addition, two patient-specific bifurcation aneurysms are tested, and the results show good agreement with the idealized models. Furthermore, the peripheral resistance of downstream vessels is investigated by varying the outlet pressure conditions. This quantitative analysis can assist in treatment planning and therapeutic decision-making.

Purpose: To introduce easy and useful methods using 3D navigation system with skin-fixed dynamic reference frame (DRF) in anterior cervical surgery and to validate its accuracy., Methods: From September 2012 to May 2013, 31 patients underwent anterior cervical surgery and a total of 48 caspar distraction pins were inserted into each cervical vertebra. Every operation was performed using O-arm® navigation system with skin-fixed DRF. To validate the accuracy of these methods, a custom-made metal sleeve was used. In surgical field, through the metal sleeve, the tip of a navigation probe promptly contacts to the tip of caspar pin. We measured the vertical and horizontal distances and the angular deviation in sagittal plane between the caspar pin and the navigation probe on the virtual images and evaluated accuracy of navigation system with skin fixed DRF., Results: Total 31 (males 20, females 11) patients and 48 caspar pins were included in this study. The mean horizontal distance between the caspar pin and the navigation probe displayed in navigation monitor was 0.49 ± 0.71 mm. The mean vertical distance between the caspar pin and the navigation probe displayed in navigation monitor was 0.88 ± 0.93 mm. And the mean angular deviation in sagittal plane between the caspar pin and the navigation probe displayed in navigation monitor was 0.59 ± 0.55°., Conclusions: 3D navigation system with skin-fixed DRF in anterior cervical surgery is a simple and reliable method and it can be a helpful supplement to a spine surgeon's judgement.