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Abstract Background This study aimed to determine the proportion of organ donors suitable for donation after circulatory death and investigate the current process followed by critical care physicians for declaring circulatory death to establish organ donation. Methods This observational study involved potential organ donors who had recently died after discontinuation of life support. We conducted an online survey of intensivists to determine how these deaths were confirmed. Results Among the 177 patients who died after withdrawal of life-sustaining treatment across 19 intensive care units in 11 institutions, 49 (27.7%) were considered potential donors. According to general medical criteria for organ donation, 20 (11.3%) patients were identified as medically suitable donors. Notably, 116 (73.9%) patients exhibited a flat electrocardiogram within 5 min after the loss of pulse. In the survey, 90 physicians (59.2%) agreed to implement the concept of the 5-min no-touch period for the declaration of circulatory death. Conclusions This study found that 11.3% of the patients who died following the withdrawal of life-sustaining treatment in the intensive care units were identified as suitable donors after circulatory death. Most of critical care physicians agree with the concept of a 5-min no-touch period for the declaration of circulatory death.

(Hf,Zr)O2 offers considerable potential for next-generation semiconductor devices owing to its nonvolatile spontaneous polarization at the nanoscale. However, scaling this material to sub-5 nm thickness poses several challenges, including the formation of an interfacial layer and high trap concentration. In particular, a low-k SiO2 interfacial layer is naturally formed when (Hf,Zr)O2 films are directly grown on a Si substrate, leading to high depolarization fields and rapid reduction of the remanent polarization. To address these issues, we conducted a study to significantly improve ferroelectricity and switching endurance of (Hf,Zr)O2 films with sub-5 nm thicknesses by inserting a TiO2 interfacial layer. The deposition of a Ti film prior to Hf0.5Zr0.5O2 film deposition resulted in a high-k TiO2 interfacial layer and prevented the direct contact of Hf0.5Zr0.5O2 with Si. Our findings show that the high-k TiO2 interfacial layer can reduce the SiO2/Si interface trap density and the depolarization field, resulting in a switchable polarization of 60.2 μC/cm2 for a 5 nm thick Hf0.5Zr0.5O2 film. Therefore, we propose that inserting a high-k TiO2 interfacial layer between the Hf0.5Zr0.5O2 film and the Si substrate may offer a promising solution to enhancing the ferroelectricity and reliability of (Hf,Zr)O2 grown on the Si substrate and can pave the way for next-generation semiconductor devices with improved performance.

Since therapy‐induced senescence (TIS) can either support or inhibit cancer progression, identifying which types of chemotherapeutic agents can produce the strongest anti‐tumor TIS is an important issue. Here, cyclin‐dependent kinase4/6 inhibitors (CDK4/6i)‐induced senescence was compared to the TIS induced by conventional DNA‐damaging agents. Despite both types of agents eliciting a similar degree of senescence, we observed increased expression of the senescence‐associated secretory phenotype (SASP) and ligands related to pro‐tumor immunity (IL6, CXCL8, TGFβ, CD274, and CEACAM1) and angiogenesis (VEGFA) mainly in TIS induced by DNA‐damaging agents rather than by CDK4/6i. Additionally, although all agents increased the expression of anti‐tumor immunomodulatory proteins related to antigen presentation (MHC‐I, B2M) and T cell chemokines (CXCL9, 10, 11), CDK4/6i‐induced senescent cells still maintained this expression at a similar or even higher intensity than cells treated with DNA‐damaging agents, despite the absence of nuclear factor‐kappa‐B (NF‐κB) and p53 activation. These data suggest that in contrast with DNA‐damaging agents, which augment the pro‐tumorigenic microenvironment via pro‐inflammatory SASP, CDK4/6i can generate TIS only with antitumor immunomodulatory proteins.

Abstract HfO2 shows promise for emerging ferroelectric and resistive switching (RS) memory devices owing to its excellent electrical properties and compatibility with complementary metal oxide semiconductor technology based on mature fabrication processes such as atomic layer deposition. Oxygen vacancy (Vo), which is the most frequently observed intrinsic defect in HfO2-based films, determines the physical/electrical properties and device performance. Vo influences the polymorphism and the resulting ferroelectric properties of HfO2. Moreover, the switching speed and endurance of ferroelectric memories are strongly correlated to the Vo concentration and redistribution. They also strongly influence the device-to-device and cycle-to-cycle variability of integrated circuits based on ferroelectric memories. The concentration, migration, and agglomeration of Vo form the main mechanism behind the RS behavior observed in HfO2, suggesting that the device performance and reliability in terms of the operating voltage, switching speed, on/off ratio, analog conductance modulation, endurance, and retention are sensitive to Vo. Therefore, the mechanism of Vo formation and its effects on the chemical, physical, and electrical properties in ferroelectric and RS HfO2 should be understood. This study comprehensively reviews the literature on Vo in HfO2 from the formation and influencing mechanism to material properties and device performance. This review contributes to the synergetic advances of current knowledge and technology in emerging HfO2-based semiconductor devices. Graphical Abstract

Point-of-care ultrasound (POCUS) is a rapidly developing technology that has the potential to revolutionize emergency and critical care medicine. The use of POCUS can improve patient care by providing real-time clinical information. However, appropriate usage and proper training are crucial to ensure patient safety and reliability. This article discusses the various applications of POCUS in emergency and critical care medicine, the importance of training and education, and the future of POCUS in medicine.

Summary: In this study, we explore the dynamic process of colorectal cancer progression, emphasizing the evolution toward a more metastatic phenotype. The term “evolution” as used in this study specifically denotes the phenotypic transition toward a higher metastatic potency from well-formed glandular structures to collective invasion, ultimately resulting in the development of cancer cell buddings at the invasive front. Our findings highlight the spatial correlation of this evolution with tumor cell senescence, revealing distinct types of senescent tumor cells (types I and II) that play different roles in the overall cancer progression. Type I senescent tumor cells (p16INK4A+/CXCL12+/LAMC2−/MMP7−) are identified in the collective invasion region, whereas type II senescent tumor cells (p16INK4A+/CXCL12+/LAMC2+/MMP7+), representing the final evolved form, are prominently located in the partial-EMT region. Importantly, type II senescent tumor cells associate with local invasion and lymph node metastasis in colorectal cancer, potentially affecting patient prognosis.

Background Cellular senescence is defined as an irreversible cell cycle arrest caused by various internal and external insults. While the metabolic dysfunction of senescent cells in normal tissue is relatively well-established, there is a lack of information regarding the metabolic features of senescent tumor cells. Methods Publicly available single-cell RNA-sequencing data from the GSE166555 and GSE178341 datasets were utilized to investigate the metabolic features of senescent tumor cells. To validate the single-cell RNA-sequencing data, we performed senescence-associated β-galactosidase (SA-β-Gal) staining to identify senescent tumor cells in fresh frozen colorectal cancer tissue. We also evaluated nicotinamide adenine dinucleotide dehydrogenase–tetrazolium reductase (NADH-TR) and succinate dehydrogenase (SDH) activity using enzyme histochemical methods and compared the staining with SA-β-Gal staining. MTT assay was performed to reveal the complex 1 activity of the respiratory chain in in-vitro senescence model. Results Single-cell RNA-sequencing data revealed an upregulation in the activity of complexes 1 and 2 in oxidative phosphorylation, despite overall mitochondrial dysfunction in senescent tumor cells. Both SA-β-Gal and enzyme histochemical staining using fresh frozen colorectal cancer tissues indicated a high correlation between SA-β-Gal positivity and NADH-TR/SDH staining positivity. MTT assay showed that senescent colorectal cancer cells exhibit higher absorbance in 600 nm wavelength. Conclusions Senescent tumor cells exhibit distinct metabolic features, characterized by upregulation of complexes 1 and 2 in the oxidative phosphorylation pathway. NADH-TR and SDH staining represent efficient methods for detecting senescent tumor cells in colorectal cancer.

Objective This study aimed to evaluate the treatment of spinal stenosis with spondylolisthesis using bilateral-contralateral unilateral biportal endoscopic (UBE) decompression to minimize facet joint damage. Methods We retrospectively evaluated 42 patients with grade 1 spondylolisthesis who underwent bilateral-contralateral UBE decompression between July 2018 and September 2019. To identify segmental instability, static and dynamic images from preoperative and postoperative procedures and final follow-up radiographs were reviewed. Lateral radiograph slippage ratio, sagittal motion, and facet joint preservation were evaluated. Clinical assessments were conducted using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. Results The average final follow-up period was 26.5 ± 1.3 months. The average preoperative slip percentage was 15.70% ± 5.25%, which worsened to 18.80% ± 5.41% at the final follow-up (p < 0.005). The facet joint preservation rate was 95.6% ± 4.1% on the contralateral side. Improvements in the VAS scores (leg pain: from 7.9 ± 2.2 to 3.1 ± 0.7; p < 0.005; back pain: from 7.2 ± 3.0 to 2.8 ± 1.0; p < 0.005) were observed at the final follow-up. The mean preoperative ODI was 26.19 ± 3.42, which improved to 9.6 ± 1.0 (p < 0.005). Thirteen patients exhibited delayed focal segmental instability following decompression. Despite the absence of symptoms or improvement with conservative treatment in the majority of patients with delayed instability, two patients required fusion surgery to address the instability. Additionally, 2 patients developed facet synovial cysts, while 2 experienced spinous process fractures. Conclusion Bilateral decompression with a contralateral UBE approach could be an effective and alternative treatment method to reduce instability in spinal stenosis with grade 1 spondylolisthesis.

Abstract Background Retrospective studies have demonstrated that the deep learning-based cardiac arrest risk management system (DeepCARS™) is superior to the conventional methods in predicting in-hospital cardiac arrest (IHCA). This prospective study aimed to investigate the predictive accuracy of the DeepCARS™ for IHCA or unplanned intensive care unit transfer (UIT) among general ward patients, compared with that of conventional methods in real-world practice. Methods This prospective, multicenter cohort study was conducted at four teaching hospitals in South Korea. All adult patients admitted to general wards during the 3-month study period were included. The primary outcome was predictive accuracy for the occurrence of IHCA or UIT within 24 h of the alarm being triggered. Area under the receiver operating characteristic curve (AUROC) values were used to compare the DeepCARS™ with the modified early warning score (MEWS), national early warning Score (NEWS), and single-parameter track-and-trigger systems. Results Among 55,083 patients, the incidence rates of IHCA and UIT were 0.90 and 6.44 per 1,000 admissions, respectively. In terms of the composite outcome, the AUROC for the DeepCARS™ was superior to those for the MEWS and NEWS (0.869 vs. 0.756/0.767). At the same sensitivity level of the cutoff values, the mean alarm counts per day per 1,000 beds were significantly reduced for the DeepCARS™, and the rate of appropriate alarms was higher when using the DeepCARS™ than when using conventional systems. Conclusion The DeepCARS™ predicts IHCA and UIT more accurately and efficiently than conventional methods. Thus, the DeepCARS™ may be an effective screening tool for detecting clinical deterioration in real-world clinical practice. Trial registration This study was registered at ClinicalTrials.gov ( NCT04951973 ) on June 30, 2021.

Displacement mapping is a computer graphics technique that enables the design of components with regularly or randomly textured surfaces that can be quickly materialized on a three-dimensional (3D) printer when needed. This approach is, in principle, more flexible, faster, and more economical compared to conventional texturing methods, but the accuracy of the texture depends heavily on the parameters used. The purpose of this study is to demonstrate how to produce a surface-textured part using polygonal (mesh) modeling software and a photopolymerizable resin and to develop a universal methodology to predict the dimensional accuracy of the model file log combined with a resin 3D printer. The printed components were characterized on a scanning confocal microscope. In the setup used in this study, the mesh size had to be reduced to 10% of the smallest feature size, and the textured layer had to be heavily (×4.5) overexposed to achieve the desired accuracy. As a practical application, two functional stamps with a regular (honeycomb) and a random texture, respectively, were successfully manufactured. The insights gained will be of great benefit for quickly and cost-effectively producing components with innovative patterns and textures for a variety of hobby, industrial, and biomedical applications.

Developing an artificial olfactory system that can mimic the biological functions remains a challenge. Here, the authors develop an artificial chemosensory synapse based on a flexible organic electrochemical transistor gated by the potential generated by the interaction of gas molecules with ions in a chemoreceptive ionogel.

Anhydrous ammonia is a commonly used chemical in industry. Ammonia gas inhalation causes thermal injuries and alkali burns in the airway and lung parenchyma. Previous case reports have stated that respiratory sequelae after acute ammonia inhalation burns were associated with structural lung disease, such as bronchiectasis or interstitial lung disease. We herein report two cases of long-term sequelae with persistent airflow limitation after ammonia inhalation burns.

Bottom-gate thin-film transistors (TFTs) with n-type amorphous indium-gallium-zinc oxide (a-IGZO) active channels and indium-tin oxide (ITO) source/drain electrodes were fabricated. Then, an ultraviolet (UV) nanosecond pulsed laser with a wavelength of 355 nm was scanned to locally anneal the active channel at various laser powers. After laser annealing, negative shifts in the threshold voltages and enhanced on-currents were observed at laser powers ranging from 54 to 120 mW. The energy band gap and work function of a-IGZO extracted from the transmittance and ultraviolet photoelectron spectroscopy (UPS) measurement data confirm that different energy band structures for the ITO electrode/a-IGZO channel were established depending on the laser annealing conditions. Based on these observations, the electron injection mechanism from ITO electrodes to a-IGZO channels was analyzed. The results show that the selective laser annealing process can improve the electrical performance of the a-IGZO TFTs without any thermal damage to the substrate.

A condensation heat transfer model is essential to accurately predict the performance of the passive containment cooling system (PCCS) during an accident in an advanced light water reactor. However, most of existing models tend to predict condensation heat transfer very well for a specific range of thermal-hydraulic conditions. In this study, a new correlation for condensation heat transfer coefficient (HTC) is presented using machine learning technique. To secure sufficient training data, a large number of pseudo data were produced by using ten existing condensation models. Then, a neural network model was developed, consisting of a fully connected layer and a convolutional neural network (CNN) algorithm, DenseNet. Based on the hold-out cross-validation, the neural network was trained and validated against the pseudo data. Thereafter, it was evaluated using the experimental data, which were not used for training. The machine learning model predicted better results than the existing models. It was also confirmed through a parametric study that the machine learning model presents continuous and physical HTCs for various thermal-hydraulic conditions. By reflecting the effects of individual variables obtained from the parametric analysis, a new correlation was proposed. It yielded better results for almost all experimental conditions than the ten existing models.

Abstract Salt anions with a high donor number (DN) enable high sulfur utilization in lithium‐sulfur (Li‐S) batteries by inducing three‐dimensional (3D) Li2S growth. However, their insufficient compatibility with Li metal electrodes limits their cycling stability. Herein, a new class of salt anion, thiocyanate (SCN−), is presented, which features a Janus character of electron donor and acceptor. Due to a strong Li+ coordination by SCN− and the direct interaction of SCN− with polysulfide anions, the LiSCN electrolyte has a remarkably high lithium polysulfide solubility. This electrolyte induces 3D Li2S formation and ameliorates cathode passivation, even more than Br−, a typical high DN anion. Moreover, SCN− forms a Li3N‐enriched stable SEI layer at the surface of the Li metal electrode, enhancing cycling stability. A Li‐S battery with the LiSCN electrolyte shows high current density operation (2.54 mA cm⁻2) with high discharge capacity (1133 mAh g⁻1) and prolonged cycle life (100 cycles). This work demonstrates that the cathode and anode performance in a Li‐S battery can be simply and concurrently enhanced by the single salt anion.

Diabetic retinopathy (DR) is a disease that causes visual deficiency owing to vascular leakage or abnormal angiogenesis. Pericyte apoptosis is considered one of the main causes of vascular leakage in diabetic retina, but there are few known therapeutic agents that prevent it. Ulmus davidiana is a safe natural product that has been used in traditional medicine and is attracting attention as a potential treatment for various diseases, but its effect on pericyte loss or vascular leakage in DR is not known at all. In the present study, we investigated on the effects of 60% edible ethanolic extract of U. davidiana (U60E) and catechin 7-O-β-D-apiofuranoside (C7A), a compound of U. davidiana, on pericyte survival and endothelial permeability. U60E and C7A prevented pericyte apoptosis by inhibiting the activation of p38 and JNK induced by increased glucose and tumor necrosis factor alpha (TNF-α) levels in diabetic retina. Moreover, U60E and C7A reduced endothelial permeability by preventing pericyte apoptosis in co-cultures of pericytes and endothelial cells. These results suggest that U60E and C7A could be a potential therapeutic agent for reducing vascular leakage by preventing pericyte apoptosis in DR.

Molybdenum disulfide (MoS2) has great potential for next-generation electronic devices. On the other hand, stable doping methods are required to adjust its physical properties so MoS2 can be utilized in practical applications, such as transistors and photodetectors. On the other hand, a conventional doping method based on ion implantation is incompatible with 2D MoS2 because of the damage to the lattice structures of MoS2. This paper presents an n-type doping method for MoS2 field-effect transistors (FETs) using a poly (vinylidene fluoride-co-trifluoroethylene) (P (VDF-TrFE)) and polar polymer. The dipole moment of P (VDF-TrFE) provides n-type doping on MoS2 FETs. The polar phase formation in dopant films enhances the doping effects, and the relationship between phase transition and n-type doping states was investigated using optical and electrical characterization methods. Under the optimal doping conditions, the doped MoS2 FET achieved an improved field effect mobility of 34.4 cm2 V−1s–1, a negative shift in the threshold voltage by −25.6 V, and a high on-current of 21 μA compared to the pristine MoS2 FET.

Functionally enhanced mesenchymal stromal cells participate in the repair of intervertebral disc. This study aimed to assess the safety and tolerability of intradiscal administration of matrilin-3-primed adipose-derived stromal cell (ASC) spheroids with hyaluronic acid (HA) in patients with chronic discogenic low back pain (LBP). In this single-arm, open-label phase I clinical trial, eight patients with chronic discogenic LBP were observed over 6 months. Each patient underwent a one-time intradiscal injection of 1 mL of 6.0 × 106 cells/disc combined with HA under real-time fluoroscopic guidance. Safety and feasibility were gauged using Visual Analogue Scale (VAS) pain and Oswestry Disability Index (ODI) scores and magnetic resonance imaging. All participants remained in the trial, with no reported adverse events linked to the procedure or stem cells. A successful outcome-marked by a minimum 2-point improvement in the VAS pain score and a 10-point improvement in ODI score from the start were observed in six participants. Although the modified Pfirrmann grade remained consistent across all participants, radiological improvements were evident in four patients. Specifically, two patients exhibited reduced high-intensity zones while another two demonstrated decreased disc protrusion. In conclusion, the intradiscal application of matrilin-3-primed ASC spheroids with HA is a safe and feasible treatment option for chronic discogenic LBP.

Background Percutaneous dilatational tracheostomy (PDT) is a common procedure in intensive care units (ICUs). Although it is thought to be safe and easily performed at the bedside, PDT usually requires endotracheal guidance, such as bronchoscopy. Here, we assessed the clinical outcomes and safety of PDT conducted without endotracheal guidance. Methods In the ICU and coronary ICU at a tertiary hospital, PDT was routinely performed without endotracheal guidance by a single medical intensivist using the Griggs technique PDT kit (Portex Percutaneous Tracheostomy Kit). We retrospectively reviewed the electronic medical records of patients who underwent PDT without endotracheal guidance. Results From January 1 to December 31, 2018, 78 patients underwent PDT without endotracheal guidance in the ICU and coronary ICU. The mean age of these subjects was 71.9±11.5 years, and 29 (37.2%) were female. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 25.9±5.8. Fifty patients (64.1%) were on mechanical ventilation during PDT. Failure of the initial PDT attempt occurred in four patients (5.1%). In two of them, PDT was aborted and converted to surgical tracheostomy; in the other two patients, PDT was reattempted after endotracheal reintubation, with success. Minor bleeding at the tracheostomy site requiring gauze changes was observed in five patients (6.4%). There were no airway problems requiring therapeutic interventions or procedure-related sequelae. Conclusions PDT without endotracheal guidance can be considered safe and feasible.

Abstract A continuous exponential rise has been observed in the storage and processing of the data that may not curtail in the foreseeable future. The required data processing speed and power consumption are restricted by the buses between the logic and memory devices that are characteristic of the von Neumann computing architecture. Bio‐mimicking neuromorphic computing has garnered considerable academic and industrial interest to resolve these challenges. Additionally, devices based on emerging nonvolatile memories capable of mimicking the behaviors of synapses and neurons, which are the main elements in biological computing systems (brains), are attracting significant interest from the device community. With the discovery of ferroelectricity in fluorite‐structured oxides, such as HfO2 and ZrO2, which are compatible with the state‐of‐the‐art complementary‐metal‐oxide‐semiconductor processes, ferroelectric devices have rapidly evolved as the main direction of these research and development activities. Fundamental science related to fluorite‐structured ferroelectrics has been intensively studied over the last decade. At present, the focus is gradually moving to practical applications, including neuromorphic computing and advanced classical processing or memory units in the conventional von Neumann architecture. However, despite its rapid development, the wealth of recent progress in neuromorphic computing devices based on fluorite‐structured ferroelectrics has not been reviewed and systemized. This progress report comprehensively reviews and systemizes the recent progress in artificial synaptic and spiking neuron devices for neuromorphic computing based on fluorite‐structured ferroelectrics.

Oxygen vacancies are a major factor that controls the electrical characteristics of the amorphous indium-gallium-zinc oxide transistor (a-IGZO TFT). Oxygen vacancies are affected by the composition ratio of the a-IGZO target and the injected oxygen flow rate. In this study, we fabricated three types of a-IGZO TFTs with different oxygen flow rates and then investigated changes in electrical characteristics. Atomic force microscopy (AFM) was performed to analyze the surface morphology of the a-IGZO films according to the oxygen gas rate. Furthermore, X-ray photoelectron spectroscopy (XPS) analysis was performed to confirm changes in oxygen vacancies of a-IGZO films. The optimized a-IGZO TFT has enhanced electrical characteristics such as carrier mobility (μ) of 12.3 cm2/V·s, on/off ratio of 1.25 × 1010 A/A, subthreshold swing (S.S.) of 3.7 V/dec, and turn-on voltage (Vto) of −3 V. As a result, the optimized a-IGZO TFT has improved electrical characteristics with oxygen vacancies having the highest conductivity.

Purpose: Treatment options for urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms are limited other than carbapenem. Accordingly, clinicians should investigate alternative antimicrobial options for limited infection. This study was performed to assess the efficacy of single-dose amikacin and a 7-day oral regimen of amoxicillin/clavulanate for the treatment of acute cystitis caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae. Materials and Methods: A single-dose amikacin and 7-day oral amoxicillin/clavulanate regimen was given to all patients with acute cystitis or recurrent cystitis between May 2016 and October 2018. We conducted a retrospective cohort study assessing the efficacy of this regimen for the treatment of UTI due to ESBL-producing organisms. Both clinical and laboratory efficacy were assessed a minimum of 7 days and a maximum of 14 days after the completion of treatment. Results: A total of 47 patients were enrolled in this study. E. coli and K. pneumoniae were isolated in 44 patients (93.6%) and 3 patients (6.4%), respectively. Of the 47 enrolled, 39 patients (83.0%) showed sterile culture results on follow-up. Thirty-seven patients (78.7%) showed improvement of symptoms. Of 8 patients who showed bacterial persistence, 4 patients showed ESBL-producing E. coli, whereas 4 patients showed non-ESBL E. coli on follow-up cultures. During follow-up, 12 patients experienced the recurrence of acute cystitis with a median recurrence period of 2.5 months. Conclusions: The combination of amoxicillin/clavulanate and amikacin may be an alternative to carbapenem treatment in patients with acute cystitis caused by ESBL-producing Enterobacteriaceae.

Background Intrapleural urokinase is one of the most widely used fibrinolytic agents in the treatment of complicated parapneumonic effusion (CPPE). However, little research has been performed on the optimal urokinase dosage. The aim of this study was to evaluate the treatment efficacy of half dose urokinase compared with conventional dose urokinase. Methods We retrospectively enrolled 92 patients with CPPE or empyema who underwent intrapleural urokinase treatment at two tertiary hospitals. Patients received antibiotics, chest tube drainage, and other treatments as part of routine care. The primary outcome was the treatment success rate in the half dose urokinase group (50,000 IU daily for maximal 6 days) and the conventional dose urokinase group (100,000 IU daily). Treatment success was defined as clinical and radiological improvements without surgical treatment or re-admission within one month. Results Forty-four patients received half dose urokinase, whereas 48 patients were treated with conventional dose urokinase. Both groups were relatively well matched at baseline, excluding higher serum white blood cell count and higher empyema prevalence in the half dose urokinase group. The treatment success rate was not different between the two groups (p=0.048). There were no differences in the rate of in-hospital death and surgical treatment, hospitalization duration, and indwelling catheter duration. In the multivariate analysis, urokinase dose was not a predictor of treatment success. Conclusion Half dose intrapleural urokinase is equally effective conventional dose urokinase in treating patients with CPPE or empyema.

(1) Background: We compared the diagnostic and prognostic performance of serum amyloid A (SAA), procalcitonin (PCT), delta neutrophil index (DNI), and C-reactive protein (CRP) in patients with hematologic diseases; (2) Methods: We retrospectively collected the remaining serum samples from patients with hematologic diseases, analyzed their clinical data, and measured the levels of PCT, DNI, CRP, and SAA. Performances for infection diagnosis were evaluated using a receiver operating characteristic curve analysis, and 90-day mortality was analyzed using Kaplan–Meier estimation; (3) Results: The levels of all markers were significantly higher in the infected group (N = 27) than those in the uninfected group (N = 100) (p < 0.0001 for all markers). The areas under the curve for diagnosing infection for PCT, DNI, CRP, and SAA were 0.770, 0.817, 0.870, and 0.904, respectively. Increased PCT levels were associated with higher mortality (p = 0.0250); this association was not observed with other examined markers; (4) Conclusions: CRP and SAA exhibited greater discriminative power for infection than PCT. However, only PCT levels were positively associated with 90-day mortality. Herein, we evaluated the diagnostic performance of the four markers. Additional studies are needed to confirm the findings of the present study and validate the potential of these markers in clinical practice.

Abstract Pneumonia is related to oral health of the elderly and intensive care unit patients. However, studies on the relationship between overall oral health and pneumonia in the general population have been limited. The purpose of this study was to investigate the association between oral health and pneumonia using a nationwide population-based Korean cohort database. Data from 122,251 participants who underwent health screening and oral examinations in 2004 or 2005 were analyzed. Cox proportional hazard regression analysis was performed to evaluate the association between oral health and pneumonia. The risk of pneumonia increased significantly in groups with a higher number of dental caries and missing teeth, with respective adjusted hazard ratios (HRs) and 95% confidence interval (CI) of 1.265 (1.086–1.473; p = 0.0025) and 1.218 (1.113–1.332; p

Metastases to the thyroid gland have rarely been reported in clinical settings, and the thyroid gland is an uncommon site for breast carcinoma metastasis. We report a case of a 64-year-old breast cancer patient diagnosed with metastatic breast carcinoma in the thyroid gland after performing ultrasonography (US)-guided core needle biopsy (CNB) and subsequent total thyroidectomy. On US, the thyroid lesion appeared to be mildly enlarged with multiple internal hypoechoic lines and a few microcalcifications without mass formation. Under US-guidance, CNB was performed by targeting the area with microcalcifications and subsequently diagnosed as metastatic breast carcinoma. Total thyroidectomy revealed that the patient had metastatic invasive ductal carcinoma of the breast with lymphatic spread involving both lobes and the isthmus of the thyroid gland. Although the thyroid gland is an uncommon metastatic site, the unusual features of thyroid metastasis can be observed on US; thus, US-guided CNB effectively aids the diagnosis of thyroid metastasis.

Purpose: To evaluate the efficacy and safety of penile elongation featuring simple scrotal septum detachment from the penile base to compensate for the loss of penile length during penile plication in patients with Peyronie's disease compared with conventional penile plication. Materials and Methods: We conducted a retrospective analysis of 38 patients (24–75 years of age) with Peyronie's disease who underwent penile plication with or without our novel technique from January 2009 to May 2018. Penile elongation was achieved by release and detachment of the scrotal septum from the penile base to the level of the scrotal fat tissue. The objective outcome of change in stretched penile length (SPL) and the subjective outcome of patient perception of postoperative penile length were compared between groups. Any postoperative complications were recorded. Results: Of the 38 patients, 16 underwent penile plication with scrotal septum detachment (elongation group) and 22 underwent penile plication only (conventional group). The postoperative mean SPL was increased in the elongation group and decreased in the conventional group (1.2±1.3 cm vs. −0.5±0.3 cm, p

Purpose: The primary aim of this study was to assess treatment persistence with a fixed-dose combination (FDC) of tadalafil (5 mg) and tamsulosin (0.4 mg). This study also evaluated the reasons for early treatment discontinuation. Materials and Methods: This retrospective observational study included patients with benign prostatic hyperplasia and erectile dysfunction who started an FDC treatment of tadalafil (5 mg) and tamsulosin (0.4 mg) between July 2017 and February 2018. Treatment persistence and reasons for early discontinuation were evaluated during the first 6 months. The cumulative discontinuation rate and differences in various parameters were assessed using Kaplan–Meier analysis and the log-rank test, respectively. Factors related to persistence were analyzed using a Cox proportional hazard model. Results: Overall, 97 patients were included in the study. The cumulative persistence rate at 30, 90, and 180 days was 88.7%, 66.0%, and 54.6%, respectively. The cumulative persistence over 6 months differed significantly according to the administration of FDC therapy (log-rank p=0.005) and age (log-rank p=0.024). Younger patients (odds ratio, 2.049; p=0.021) and treatment-naive patients (odds ratio, 2.461; p=0.006) were more likely to discontinue therapy within 6 months. The common reasons for discontinuing therapy were side effects (63.6%) and perceived poor efficacy (22.7%). Conclusions: Side effects were reported to be the main reason for treatment discontinuation. Thus, to improve compliance for a once-daily FDC of tadalafil (5 mg) and tamsulosin (0.4 mg), it is recommended to select patients who show adaptation to a combination of α-blockers and phosphodiesterase type 5 inhibitors prior to FDC treatment.

Background Oxygen supplementation through a high-flow nasal cannula (HFNC) is a powerful technique that promotes the absorption of air by delivering high concentrations of oxygen to patients who are not intubated, and may be a viable treatment option for pneumocephalus. Case Report A 75-year-old female presented in a stuporous state. She had received an epidural injection due to back pain 2 hours ago. Non-contrast brain computed tomography revealed a pneumocephalus at the interhemispheric fissure and the prepontine cistern. HFNC oxygen therapy at 60 L/min with a fraction of inspired oxygen of 1 was started. By the next morning, her mental status had recovered and a repeat brain computed tomography 15 hours later revealed complete absorption of the pneumocephalus. Conclusion Supplemental high oxygen via HFNC can be successfully used in patients with pneumocephalus who are not intubated and mechanically ventilated.

BackgroundFat fraction values obtained from magnetic resonance imaging (MRI) can be used to obtain an accurate diagnosis of fatty liver diseases. However, MRI is expensive and cannot be performed for everyone. ObjectiveIn this study, we aim to develop multi-view ultrasound image–based convolutional deep learning models to detect fatty liver disease and yield fat fraction values. MethodsWe extracted 90 ultrasound images of the right intercostal view and 90 ultrasound images of the right intercostal view containing the right renal cortex from 39 cases of fatty liver (MRI–proton density fat fraction [MRI–PDFF] ≥ 5%) and 51 normal subjects (MRI–PDFF < 5%), with MRI–PDFF values obtained from Good Gang-An Hospital. We obtained combined liver and kidney-liver (CLKL) images to train the deep learning models and developed classification and regression models based on the VGG19 model to classify fatty liver disease and yield fat fraction values. We employed the data augmentation techniques such as flip and rotation to prevent the deep learning model from overfitting. We determined the deep learning model with performance metrics such as accuracy, sensitivity, specificity, and coefficient of determination (R2). ResultsIn demographic information, all metrics such as age and sex were similar between the two groups—fatty liver disease and normal subjects. In classification, the model trained on CLKL images achieved 80.1% accuracy, 86.2% precision, and 80.5% specificity to detect fatty liver disease. In regression, the predicted fat fraction values of the regression model trained on CLKL images correlated with MRI–PDFF values (R2=0.633), indicating that the predicted fat fraction values were moderately estimated. ConclusionsWith deep learning techniques and multi-view ultrasound images, it is potentially possible to replace MRI–PDFF values with deep learning predictions for detecting fatty liver disease and estimating fat fraction values.

Gas detectors have attracted considerable attention for monitoring harmful gases and air pollution because of industry development and the ongoing interest in human health. On the other hand, conventional high−temperature gas detectors are unsuitable for safely detecting harmful gases at high activation temperatures. Photo−activated gas detectors improve gas sensing performance at room temperature and enable low−power operation. This review presents a timely overview of photo−activated gas detectors that use illuminated light instead of thermal energy. Illuminated light assists in gas detection and is classified as visible or ultraviolet light. The research on photo−activated gas detectors is organized according to the type of gas that can be intensively detected. In addition, a development strategy for advancing photo−activated gas detectors is discussed.

Background: Acute eosinophilic pneumonia (AEP) is a rare acute respiratory disease accompanied by fever, shortness of breath, and cough. Although the pathogenesis of the disease is not yet established, the patient’s condition improves with a rapid therapeutic response to systemic corticosteroids. Conventional cigarettes or heat-not-burn cigarettes are the most common cause of AEP among young people. Case Presentation: A 22-year-old woman with dyspnea, cough, and fever did not improve after visiting the local medical center and was admitted to the emergency room. The patient denied having any recent travel history or insect bites. She was treated with appropriate antibiotics according to the community acquired pneumonia, but there was no improvement. Chest radiography showed bilateral patches of pulmonary infiltration, and chest computed tomography revealed bilateral multifocal patchy consolidations with multiple small nodular ground-glass opacities and interlobular septal thickening. The bronchoalveolar lavage result was dominantly eosinophilic. The patient’s condition improved rapidly after the use of intravenous methylprednisolone and then a change to oral methylprednisolone. Finally, the patient was hospitalized for 9 days, and the duration of use of methylprednisolone including outpatient visits was 14 days. Results: The early treatment of AEP yields a good prognosis, but since the symptoms of AEP are similar to those of infectious diseases such as community-acquired pneumonia, physicians should be meticulous in differentiating AEP from other diseases. Conclusions: Since AEP shows a good response to steroids, early detection using an appropriate diagnostic method is recommended. In addition, there should be strong education against smoking in any form.

Abstract Background Ovarian mature cystic teratomas comprise tissues derived from all three germ layers. In rare incidences, malignant tumors may arise from ovarian mature cystic teratoma, which occurs in 0.2–1.8% of cases. A variety of tumors can arise within mature cystic teratoma, among which malignant melanoma is exceedingly rare. Case presentation A 42-year-old woman presented with abdominal pain. Transvaginal ultrasonography showed mixed echogenic cystic masses in both ovaries. Her serum cancer antigen (CA19–9) level was elevated at 29,770 U/ml. Surgical excision was performed. Histologic examination showed infiltrating nests of pleomorphic cells with prominent nucleoli and black pigments in the background of a mature cystic teratoma. These pleomorphic cells showed strong immunoreactivity for Melan-A and HMB-45. The patient was re-evaluated and the possibility of a melanoma at any other site was ruled out. Based on these findings, we concluded that the malignant melanoma originated from the ovarian mature cystic teratoma. Conclusion We report a rare case of primary malignant melanoma derived from an ovarian mature cystic teratoma.

Henoch-Schönlein purpura (HSP) is a systemic vasculitis characterized by purpura, arthritis, abdominal pain, and nephritis. Gastrointestinal involvement can manifest as pain, intussusception, intestinal bleeding, and intestinal perforation. We report a case of fulminant HSP at an age of eight in 1994, with multiple complications of intra-thoracic bleeding, massive intestinal perforation, nephritis, and various skin rashes. The brisk bleeding findings of intestinal on Technetium-99m-labeled red blood cell scan (99mTc RBC scan) were well matched to those of the emergency laparotomy and the resected intestine. The patient’s abdominal conditions improved gradually but nodular skin eruptions developed newly apart from improving preexisting lower limb rashes and the urine findings continued abnormal, so skin and kidney biopsy were done for the diagnosis. After cyclosporine therapy, skin eruptions and urine findings returned to normal gradually. On a follow-up after 25 years in 2019, the patient is 33-year-old, healthy without any abnormality on blood chemistries and urine examination.

There have been several reports of patients with isolated lesions of the cerebellar vermis presenting with clinical features similar to those of peripheral vestibulopathy. We report a case of small, isolated hematoma in the cerebellar vermis in a patient who presented with vertigo, ipsilesional nystagmus, and body lateropulsion to the contralesional side without the usual signs or symptoms of cerebellar dysfunction. Although they present with symptoms that mimic those of peripheral vestibulopathy, and brain computed tomography shows no abnormality, as there may be a small, isolated hematoma or infarction in the cerebellar vermis. Thus, brain magnetic resonance imaging should be performed in elderly patients with vascular risk factors.

Purpose: We aimed to determine the impact of de novo vesicoureteral reflux (VUR) on postoperative urinary tract infection (UTI) and renal function in pediatric patients with ureteroceles. Materials and Methods: We retrospectively reviewed the medical records of 34 patients (36 renal units) with ureteroceles that were treated endoscopically. Perioperative radiologic and clinical data regarding de novo VUR, UTI, and renal function were analyzed. Logistic regression analysis was used to identify factors that predicted unfavorable surgical outcomes, such as primary surgical failure, postoperative UTI, and deterioration of renal function. Results: Of the 36 renal units, 22 had a duplex system (61.1%). Preoperative VUR was noted in 9 units (25.0%), including 3 units without renal duplication. Endoscopic surgery successfully decompressed the ureterocele and hydronephrosis in 28 units (77.8%). De novo VUR developed in 18 renal units (50.0%) postoperatively. The absence or presence of de novo VUR was not related to unfavorable surgical outcomes in univariate or multivariate analyses. Even after selection for the 28 renal units without preoperative VUR, the occurrence of de novo VUR had no predictive value for unfavorable surgical outcomes. Moreover, among the 14 renal units without renal duplication, de novo VUR had no predictive value for any of these adverse outcomes. Conclusions: After endoscopic ureterocele puncture, de novo VUR is not significantly associated with postoperative UTI or deterioration in renal function in the long term. It may not, therefore, be necessary to reconstruct lower urinary tract routinely to correct de novo VUR after endoscopic puncture of the ureterocele.

Identification of patients with a high risk of gastric cancer during gastric cancer surveillance is highly important. Most gastric cancers develop in the background of chronic gastritis associated with Helicobacter pylori (H. pylori) infection. Pathological evaluation using biopsy specimen was proposed to stratify gastric cancer risk in the operative link for gastritis assessment and operative link for gastric intestinal metaplasia assessment staging systems from the West. However, biopsy specimens cannot represent the whole stomach, and endoscopic biopsy confers a risk of bleeding in certain patients. In the Kyoto classification of gastritis proposed by a Japanese study group, five endoscopically visible findings (atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness) were selected, which are closely related to gastric cancer development due to H. pylori infection. Furthermore, the gastric cancer risk grading system based on the Kyoto classification of gastritis was suggested to identify patients with an increased risk of developing gastric cancer. Although this grading system needs validation to prove its efficacy, it is expected to be useful for most endoscopists who are involved in gastric cancer surveillance.

Background The neurological manifestations of Sjögren’s syndrome (SjS) are nonspecific and may precede the onset of sicca symptoms. Hence, the diagnosis of SjS is often delayed. Recurrent aseptic meningitis is an uncommon neurological manifestation of primary SjS; only few cases have been reported in the medical literature. Case ReportA 54-year-old woman was admitted for recurrent aseptic meningitis. The patient had a history of two episodes of aseptic meningitis, which had occurred 12 and 7 years before this presentation. The patient had overt sicca symptoms for 5 years. SjS was diagnosed based on the results of serum autoantibody tests, Schirmer’s test, and salivary scintigraphy. We concluded that recurrent aseptic meningitis occurred as an initial presentation of primary SjS. ConclusionThis case suggest that SjS should be included in the differential diagnosis of recurrent aseptic meningitis.

In patients with inflammatory bowel disease (IBD), ocular extraintestinal manifestations (EIM) are less common than EIM of other systems, but they are clinically important because they can lead to complications that can cause catastrophic damage to the visual acuity and ocular structure. Anterior uveitis and episcleritis are the most common ocular EIM. Involvement of the orbit, posterior segment, and optic nerve can also occur. A variety of treatments are available ranging from topical steroids to systemic immunosuppressive therapies. The treatment of IBD is also essential if the activity of inflammatory bowel disease affects the ocular symptoms.

Electrophysiological signals are collected to characterize human health and applied in various fields, such as medicine, engineering, and pharmaceuticals. Studies of electrophysiological signals have focused on accurate signal acquisition, real-time monitoring, and signal interpretation. Furthermore, the development of electronic devices consisting of biodegradable and biocompatible materials has been attracting attention over the last decade. In this regard, this review presents a timely overview of electrophysiological signals collected with biodegradable polymer electrodes. Candidate polymers that can constitute biodegradable polymer electrodes are systemically classified by their essential properties for collecting electrophysiological signals. Moreover, electrophysiological signals, such as electrocardiograms, electromyograms, and electroencephalograms subdivided with human organs, are discussed. In addition, the evaluation of the biodegradability of various electrodes with an electrophysiology signal collection purpose is comprehensively revisited.

To increase the human lifespan, healthcare monitoring devices that diagnose diseases and check body conditions have attracted considerable interest. Commercial AgCl-based wet electrodes with the advantages of high conductivity and strong adaptability to human skin are considered the most frequently used electrode material for healthcare monitoring. However, commercial AgCl-based wet electrodes, when exposed for a long period, cause an evaporation of organic solvents, which could reduce the signal-to-noise ratio of biosignals and stimulate human skin. In this context, we demonstrate a dry electrode for a poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS)-based blended polymer electrode using a combination of PEDOT:PSS, waterborne polyurethane (WPU) and ethylene glycol (EG) that could be reused for a long period of time to detect electrocardiography (ECG) and electromyography (EMG). Both ECG and EMG are reliably detected by the wireless real-time monitoring system. In particular, the proposed dry electrode detects biosignals without deterioration for over 2 weeks. Additionally, a double layer of a polyimide (PI) substrate and fluorinated polymer CYTOP induces the strong waterproof characteristics of external liquids for the proposed dry electrodes, having a low surface energy of 14.49 mN/m. In addition, the proposed electrode has excellent degradability in water; it dissolves in hot water at 60 °C.

Floating-Harbor syndrome is a rare autosomal dominant genetic disorder associated with SRCAP mutation. To date, approximately 50 cases of Floating-Harbor syndrome have been reported, but none have been reported in Korea yet. Floating-Harbor syndrome is characterized by delayed bony maturation, unique facial features, and language impairment. Here, we present a 6-year-old boy with a triangular face, deep-set protruding eyes, low-set ears, wide nose with narrow nasal bridge, short philtrum, long thin lips, clinodactyly, and developmental delay that was transferred to our pediatric clinic for genetic evaluation. He showed progressive delay in the area of language and cognition-adaption as he grew. He had previously undergone chromosomal analysis at another hospital due to his language delay, but his karyotype was normal. We performed targeted exome sequencing, considering several syndromes with similar phenotypes. Library preparation was performed with the TruSight One sequencing panel, which enriches the sample for about 4,800 genes of clinical relevance. Massively parallel sequencing was conducted with NextSeq. An identified variant was confirmed by Sanger sequencing of the patient and his parents. Finally, the patient was confirmed as the first Korean case of Floating-Harbor syndrome with a novel SRCAP (Snf2 related CREBBP activator protein) mutation (c.7732dupT, p.Ser2578Phefs*6), resulting in early termination of the protein; it was not found in either of his healthy parents or a control population. To our knowledge, this is the first study to describe a boy with Floating-Harbor syndrome with a novel SRCAP mutation diagnosed by targeted exome sequencing in Korea.

Recurrent pericarditis is rare in children and is considered idiopathic in most cases. Its course is chronic, and preventing recurrences is important for the patient’s quality of life. Although a treatment strategy in pediatric recurrent pericarditis has not yet been established, non-steroidal anti-inflammatory drugs (NSAIDs) are the most common treatment for management of this condition, followed by corticosteroids, colchicine, immunosuppressive agents, immunoglobulins, and interleukin-1β receptor antagonists (e.g. anakinra). Herein, we report a case of recurrent pericarditis with pericardial effusion in a 5-year-old child who presented with fever and epigastric pain. He responded poorly to NSAIDs and corticosteroid therapy, but was successfully treated with colchicine.

The purpose of this longitudinal follow-up study was to investigate the risk of ischemic stroke nationwide in patients with seropositive rheumatoid arthritis (RA) and controls who were matched in age and sex. Patient data were collected from the National Health Insurance Service (NHIS) Health Screening (HEALS) cohort. Using the International Classification of Diseases code M05 (seropositive RA), with a prescription of any disease-modifying anti-rheumatic drug (DMARD), RA was identified. A total of 2,765 patients and 13,825 control subjects were included in our study. The 12-year incidence of ischemic stroke in each group was calculated using the Kaplan-Meier method. The risk ratio of ischemic stroke was estimated using Cox proportional hazards regression. Sixty-four patients (2.31%) in the seropositive RA group and 512 (3.70%) in the control group experienced ischemic stroke (P < 0.001) during the follow-up period. The hazard ratio of ischemic stroke in the seropositive RA group was 1.32 (95% confidence interval (CI), 1.02-1.73) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in the seropositive RA group was 1.40 (95% CI, 1.07-1.82) after adjusting for demographics and comorbid medical disorders. According to the subgroup analysis, the hazard ratios of ischemic stroke risks in the female and hypertensive subgroups were 1.44 (95% CI, 1.05-1.97) and 1.66 (95% CI, 1.16-2.38), respectively. In the non-diabetes and non-dyslipidemia subgroups, the corresponding hazard ratios of ischemic stroke were 1.47 (95% CI, 1.11-1.95) and 1.43 (95% CI, 1.07-1.91). Seropositive RA patients have an increased risk of ischemic stroke. In female, hypertension, non-diabetes, and non-dyslipidemia RA subgroups, even without the traditional risk factors for stroke (except for hypertension), increased the risk, which could be potentially attributed to RA.

BackgroundAccording to the rapid response system's team composition, responding teams were named as rapid response team (RRT), medical emergency team (MET), and critical care outreach. A RRT is often a nurse-led team, whereas a MET is a physician-led team that mainly plays the role of an efferent limb. As few multicenter studies have focused on physician-led METs, we comprehensively analyzed cases for which physician-led METs were activated.MethodsWe retrospectively analyzed cases for which METs were activated. The study population consisted of subjects over 18 years of age who were admitted in the general ward from January 2016 to December 2017 in 9 tertiary teaching hospitals in Korea. The data on subjects' characteristics, activation causes, activation methods, performed interventions, in-hospital mortality, and intensive care unit (ICU) transfer after MET activation were collected and analyzed.ResultsIn this study, 12,767 cases were analyzed, excluding those without in-hospital mortality data. The subjects' median age was 67 years, and 70.4% of them were admitted to the medical department. The most common cause of MET activation was respiratory distress (35.1%), followed by shock (11.8%), and the most common underlying disease was solid cancer (39%). In 7,561 subjects (59.2%), the MET was activated using the screening system. The commonly performed procedures were arterial line insertion (17.9%), intubation (13.3%), and portable ultrasonography (13.0%). Subsequently, 29.4% of the subjects were transferred to the ICU, and 27.2% died during hospitalization.ConclusionsThis physician-led MET cohort showed relatively high rates of intervention, including arterial line insertion and portable ultrasonography, and low ICU transfer rates. We presume that MET detects deteriorating patients earlier using a screening system and begins ICU-level management at the patient's bedside without delay, eventually preventing the patient's condition from worsening and transfer to the ICU.

Purpose: To investigate programmed cell death-ligand 1 (PD-L1) expression status and the clinical and pathological factors related to its expression in urothelial carcinoma (UC) patients.Materials and Methods: Data from 761 UC patients who underwent testing for PD-L1 expression using the VENTANA (SP-142 immunohistochemistry assay) for measuring PD-L1 expression according to the manufacturer's protocol between February 2016 and July 2019 were retrospectively reviewed. Patients were categorized into three groups based on the percentage of tumor area covered by PD-L1-expressing tumor-infiltrating immune cells (ICs) as follows: IC0 (

Objective To determine the possibility of a new measurement tool using electromyography and ultrasonography for quantitative spasticity assessment in post-stroke patients. Methods Eight hemiplegic stroke patients with ankle plantarflexor spasticity confirmed by a Modified Ashworth Scale (MAS) were enrolled. Spasticity was evaluated using the MAS and Modified Tardieu Scale (MTS). Each subject underwent surface electromyography (sEMG) using the Brain Motor Control Assessment (BMCA) protocol and was compared with a healthy control group. Using ultrasonography, muscle architecture and elasticity index were measured from the medial gastrocnemius muscle (GCM) on the affected and unaffected sides. Results MAS and MTS revealed significant correlation with sEMG activity. The fascicle length and pennation angle were significantly decreased in the medial GCM on the hemiplegic side compared with the unaffected side. The elasticity index of the spastic medial GCM was significantly increased compared with the unaffected side. The MTS X and R2–R1 values were significantly correlated with the elasticity index in the hemiplegic GCM. The relationship between clinical evaluation tools and both BMCA and sonoelastography was linear, but not statistically significant in the multiple regression analysis. Conclusion The BMCA protocol and ultrasonographic evaluation provide objective assessment of post-stroke spasticity. Further studies are necessary to conduct accurate assessment and treatment of spasticity.

Background Percutaneous dilatational tracheostomy (PDT) is one of the most commonly performed procedures on critically ill patients, and many studies have shown the safety and feasibility of PDT, but there is limited data of PDT in neurocritical care units. We described our experience on PDT performed by neurointensivist. Methods The PDTs were performed by a neurointensivist at the bedside using the Griggs guide wire dilating forceps technique. To confirm a secure puncture site, the PDT was done under fiberoptic bronchoscopic guidance. From September 2015 to August 2017, procedural data were prospectively collected, and the patients’ demographic and clinical characteristics were retrospectively reviewed. We analyzed immediate complications of PDT as the primary outcome. Results The PDTs were performed for 46 patients; and the mean age was 65.9 years, 26 (56.5%) were male, and the mean acute physiology and chronic health evaluation II score was 20.5. Overall, the procedural success rate was 100%, and the mean procedural time was 19.7±9.3 minutes. Periprocedural complications occurred in 13 (28.3%) patients; with 10 having minor bleeding and three having a tracheal ring fracture. There were no serious periprocedural complications of PDT. Conclusion From our experience, the PDT in the neurocritical care unit was safe and feasible and was implemented without serious complications.

Abstract Background Korea’s rapidly aging population has led to a rise in the prevalence of knee osteoarthritis (which reached upwards of 21.3% in 2017) in elderly people aged 65 years and over. Most patients with knee osteoarthritis require ongoing management in the community or through primary care. Continuity of care is a desirable attribute of primary care. However, previous studies on the association between continuity of care and health outcomes have focused on specific disease populations, particularly diabetes mellitus and hypertension. The objectives of this study were to determine whether there is an association between continuity of care for outpatients with knee osteoarthritis and health outcomes. Methods We conducted a cohort study using claims data from 2014. The study population included 131,566 patients. We measured hospital admission and medical costs during the final 3 months and the continuity of care by Most Frequent Provider Continuity (MFPC), Modified Modified Continuity Index (MMCI), and Continuity of Care (COC) index in the 9 preceding months, using multiple logistic regression analyses to determine which index best explains continuity. We evaluated the relationship between COC and hospital admissions, using negative binomial regression analysis due to over-dispersion. Finally, multiple regressions were used to examine the relationship between the COC and medical costs. Results We selected the COC index to determine the association between hospital admission and cost; the area under the receiver operating characteristic curve (AUC) of the COC was the largest (0.904), while those for the MFPC (0.894) and MMCI (0.893) were similar. The negative binomial regression analysis showed that continuity of care was significantly related to hospitalization, with the relative risk (RR) of hospital admission being low for patients with high continuity of care [RR = 27.17 for those with the reference group COC (0.76–1.00); 95% CI, 3.09–3.51]. Continuity of care was significantly related to medical costs after considering other covariates. A higher COC index was associated with a lower cost. Conclusions Higher continuity of care for knee osteoarthritis patients might decrease hospital admission and medical costs.