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BackgroundA deep convolutional neural network (DCNN) model that predicts the degree of arteriovenous fistula (AVF) stenosis and 6-month primary patency (PP) based on AVF shunt sounds was developed, and was compared with various machine learning (ML) models trained on patients’ clinical data.MethodsForty dysfunctional AVF patients were recruited prospectively, and AVF shunt sounds were recorded before and after percutaneous transluminal angioplasty using a wireless stethoscope. The audio files were converted to melspectrograms to predict the degree of AVF stenosis and 6-month PP. The diagnostic performance of the melspectrogram-based DCNN model (ResNet50) was compared with that of other ML models [i.e. logistic regression (LR), decision tree (DT) and support vector machine (SVM)], as well as the DCNN model (ResNet50) trained on patients’ clinical data.ResultsMelspectrograms qualitatively reflected the degree of AVF stenosis by exhibiting a greater amplitude at mid-to-high frequency in the systolic phase with a more severe degree of stenosis, corresponding to a high-pitched bruit. The proposed melspectrogram-based DCNN model successfully predicted the degree of AVF stenosis. In predicting the 6-month PP, the area under the receiver operating characteristic curve of the melspectrogram-based DCNN model (ResNet50) (≥0.870) outperformed that of various ML models based on clinical data (LR, 0.783; DT, 0.766; SVM, 0.733) and that of the spiral-matrix DCNN model (0.828).ConclusionThe proposed melspectrogram-based DCNN model successfully predicted the degree of AVF stenosis and outperformed ML-based clinical models in predicting 6-month PP.

Objective: Stent retrieval thrombectomy has recently been the standard treatment for acute ischemic stroke with large artery occlusion. However, the development of catheters for suction thrombectomy has recently led to results comparable to that of stent retrieval thrombectomy (SRT). This study aimed to analyze the safety and efficacy of forced suction thrombectomy (FST) using the SOFIA Plus (MicroVention Terumo, Tustin, CA, USA) device.Methods: We included patients with acute ischemic stroke who underwent FST using the SOFIA Plus device at our institution. Medical records and angiographic data were reviewed, and the results of this study were compared with those of other FST studies.Results: A total of 35 patients were included in this study. The occlusion sites were the internal carotid artery terminal (4), M1 segment (20), and posterior circulation (11). Of the 35 patients, FST was performed in only 21 (60%) patients, and the remaining 14 (40%) patients underwent SRT and FST. In all cases, the recanalization rate was 100%, and the average time from groin puncture to recanalization was 21±4.94 min. In particular, the average time required to reach the SOFIA Plus lesions from the groin puncture was 10.44±5.06 min and about 67% of the FST patients were recanalized at the first attempt. Three-months modified Rankin Scale (mRS) score of ≤2 was observed in 52% of the patients.Conclusions: Forced suction thrombectomy using the SOFIA Plus yielded a high recanalization rate within a shorter time. In particular, the recanalization rate was higher than that reported in previous studies using other types of suction devices.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) represents an effective treatment for severe Parkinson's disease (PD), but little is known about the long-term benefit.To investigate the survival rate and long-term outcome of DBS.We investigated all 81 patients including 37 males and 44 females who underwent bilateral STN DBS from March 2005 to March 2008 at a single institution. The current survival status of the patients was investigated. Preoperative and postoperative follow-up assessments were analyzed.The mean age at the time of surgery was 62 (range 27-82) years, and the median clinical follow-up duration was 145 months. Thirty-five patients (43%) died during the follow-up period. The mean duration from DBS surgery to death was 110.46 ± 40.8 (range 0-155) months. The cumulative survival rate is as follows: 98.8 ± 1.2% (1 year), 95.1 ± 2.4% (5 years), and 79.0 ± 4.5% (10 years). Of the 81 patients, 33 (40%) were ambulatory up to more than 11 years. The Unified Parkinson's Disease Rating Scale (UPDRS) score was significantly improved until 5 years after surgery although it showed a tendency to increase again after 10 years. The patient group with both electrodes located within the STN showed a higher rate of survival and maintained ambulation.STN DBS is a safe and effective treatment for patients with advanced PD. This study based on the long-term follow-up of large patient populations can be used to elucidate the long-term fate of patients who underwent bilateral STN DBS for PD.

Objectives To evaluate the effect of maternal age to the cesarean section rate of twin pregnancies in late preterm and term gestation. Methods A retrospective study was performed on twin pregnancies delivered at Seoul National University Bundang Hospital from June 2003 to December 2020. Preterm births before 34 weeks of gestation were excluded, and only live births were analyzed. The patients were classified into four groups according to maternal age ( Results The median value of maternal body mass index, the rate of assisted reproductive technology, dichorionic twin pregnancy, preeclampsia, and gestational diabetes increased significantly according to the maternal age group (all p Conclusions The rate of cesarean section in twin pregnancies significantly increased as maternal age increased, even in multiparous women.

Aging is associated with cellular senescence followed by bone loss leading to bone fragility in humans. However, the regulators associated with cellular senescence in aged bones need to be identified. Hypoxia-inducible factor (HIF)−2α regulates bone remodeling via the differentiation of osteoblasts and osteoclasts. Here, we report that HIF-2α expression was highly upregulated in aged bones. HIF-2α depletion in male mice reversed age-induced bone loss, as evidenced by an increase in the number of osteoblasts and a decrease in the number of osteoclasts. In an in vitro model of doxorubicin-mediated senescence, the expression of Hif-2α and p21, a senescence marker gene, was enhanced, and osteoblastic differentiation of primary mouse calvarial preosteoblast cells was inhibited. Inhibition of senescence-induced upregulation of HIF-2α expression during matrix maturation, but not during the proliferation stage of osteoblast differentiation, reversed the age-related decrease in Runx2 and Ocn expression. However, HIF-2α knockdown did not affect p21 expression or senescence progression, indicating that HIF-2α expression upregulation in senescent osteoblasts may be a result of aging rather than a cause of cellular senescence. Osteoclasts are known to induce a senescent phenotype during in vitro osteoclastogenesis. Consistent with increased HIF-2α expression, the expression of p16 and p21 was upregulated during osteoclastogenesis of bone marrow macrophages. ChIP following overexpression or knockdown of HIF-2α using adenovirus revealed that p16 and p21 are direct targets of HIF-2α in osteoclasts. Osteoblast-specific (Hif-2αfl/fl;Col1a1-Cre) or osteoclast-specific (Hif-2αfl/fl;Ctsk-Cre) conditional knockout of HIF-2α in male mice reversed age-related bone loss. Collectively, our results suggest that HIF-2α acts as a senescence-related intrinsic factor in age-related dysfunction of bone homeostasis., Bone remodeling: Protein linked to age-related bone loss Drugs directed at a protein called HIF-2α may help combat cellular aging processes in bone. Je-Hwang Ryu from Chonnam National University in Gwangju, South Korea, and colleagues have linked the expression of HIF-2α, a known regulator of bone remodeling, to aging and senescence, a state of irreversible growth arrest in which cells remain metabolically active yet cease dividing. Experimentally targeting HIF-2α in mice, either in bone-forming osteoblast cells or in bone-resorbing osteoclast cells, reversed the gradual and progressive decline of bone tissue associated with aging, showing that senescence-induced HIF-2α activity contributes to imbalances in bone cell turnover. HIF-2α blockers are already in clinical testing for the treatment of cancer; these findings suggest that this class of drugs should now be considered for the treatment of osteoporosis and other bone diseases as well.

The main purpose of this study is to analyze different types of information that may have diverse effects on the travel decision-making process. We collected the most frequently used words related to “Northern European travel” from Korean news sources and blogs, to determine whether there were any systematic differences through network text analysis and CONCOR analysis. We found that Koreans are exposed to words such as “nature” and “cruise activities”, which may lead them to perceive traveling in Northern Europe as a special experience. While political and diplomatic issues are frequently discussed in the news, practical information is discussed in blogs.

Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a malignant primary liver carcinoma characterized by the unequivocal presence of both hepatocytic and cholangiocytic differentiation within the same tumor. Recent research has highlighted that cHCC-CCAs are more heterogeneous than previously expected. In the updated consensus terminology and WHO 2019 classification, “classical type” and “subtypes with stem-cell features” of the WHO 2010 classification are no longer recommended. Instead, it is recommended that the presence and percentages of various histopathologic components and stem-cell features be mentioned in the pathologic report. The new terminology and classification enable the exchange of clearer and more objective information about cHCC-CCAs, facilitating multi-center and multinational research. However, there are limitations to the diagnosis of cHCC-CCA by imaging and biopsy. cHCC-CCAs showing typical imaging findings of HCC could be misdiagnosed as HCC and subjected to inappropriate treatment, if other clinical findings are not sufficiently considered. cHCC-CCAs showing at least one of the CCA-like imaging features or unusual clinical features should be subjected to biopsy. There may be a sampling error for the biopsy diagnosis of cHCC-CCA. An optimized diagnostic algorithm integrating clinical, radiological, and histopathologic information of biopsy is required to resolve these diagnostic pitfalls. (J Liver Cancer 2021;21:12-24)

This paper investigated the impact of the type of title on the price of the artwork effects using the hammer price of the paintings auctioned in Korea during a two-year period from December 2017 to November 2019. The results of the analysis showed that a descriptive title had a negative effect on the prices fetched, whereas a more elaborate title had a positive effect on auction prices. Also, it was found that elaborate titles for abstract paintings had a significant positive impact on the hammer price. In the case of unknown artists, a descriptive title had a negative effect on the auction price, while the absence of a title had a positive impact. The findings of this study suggest that artists must make careful decisions when titling their work because the title of the work affects the purchase decisions of art collectors.

The purpose of this study is to develop an autonomous lane change control system that adapts to variable surrounding conditions, to ensure vehicle safety and traffic flow stability. In this paper, we propose decision-making and control procedures for realizing autonomous lane changing; to this end, we consider not only behaviors for changing lanes but also those involved in approaching the lane changing state, with a focus on the controller design. A decoupled control structure and longitudinal trajectory-free control approach are suggested. We design a novel inter-vehicle spacing policy and a 3DOF lateral error vehicle dynamics model. To verify the effectiveness of our system, simulation experiments are performed for 12 scenarios, and system assessments are conducted based on four evaluation perspectives. The results confirm that our system can safely control the vehicle amidst various surrounding vehicle conditions and can also ensure vehicle motion stability. Furthermore, we solve the existing dynamic instability problem of lateral control, which arises through longitudinal acceleration variability. Another significant advantage of this model is that the controlled vehicle does not interfere with the target-lane traffic flow and smoothly synchronizes with the flow during lane changing.

Contrast-induced acute kidney injury (CI-AKI) is one of the leading causes of new-onset renal failure in hospitalized patients. Statin has been evaluated for its protective effect against CI-AKI but rarely in patients receiving intravenous (IV) administrations of iodine-based contrast media for enhanced computed tomography (CT). In total, 12,371 patients who underwent contrast-enhanced abdominopelvic CT were retrospectively reviewed and stratified into statin users and statin nonusers. Subgroup analyses comparing high-intensity statins with low- to moderate-intensity statins were conducted within statin users and similar comparisons were performed within statin users stratified based on baseline eGFR. Overall, CI-AKI events did not occur less in statin users compared with non-statin users (p = 0.342). Within statin users, CI-AKI events did not decrease in high-intensity statin users compared with low- to moderate-intensity statin users (p = 0.355). Moreover, no significant difference in CI-AKI events was found between high-intensity statin users and low- to moderate-intensity statin users even after stratifying the patients with baseline eGFR. Collectively, statin was not significantly associated with the risk of CI-AKI events in patients undergoing contrast-enhanced abdominopelvic CT and high-intensity statins did not show significant association with CI-AKI over low- to moderate-intensity statins in the subgroup analysis. • Statin is not associated with risk of CI-AKI events in patients undergoing intravenous administration of contrast-enhanced CT. • CI-AKI incidence among high-intensity statin users was not significantly different from that of low- to moderate-intensity statin users.

Vehicle emissions are largely determined by the details of driving behaviours. Accordingly, emissions are often estimated by integrating micro-scale emission models into traffic simulations. Under this approach, it is essential to replicate the actual traffic situation being considered in an emission evaluation using a proper calibration procedure. Most previous research with respect to traffic flow has primarily focused on adjusting the complex combinations of parameters evaluated in these models, but it is not guaranteed that the use of widely used calibration measures can lead more accurate emissions estimates. Accordingly, we propose a systematic guideline for calibration to ensure reliable micro-scale emissions estimates. A calibration procedure is thus established in this paper based on various measure of effect (MOE) compositions (i.e., calibration levels) consisting of aggregated traffic data to identify the level that most reliably estimates micro-scale emissions. Five calibration levels of progressively more detailed measurements are first defined, valid calibration levels are identified, and the reliable calibration level is finally selected based on the available traffic data. The effect of vehicle type (i.e., light vs. heavy vehicles) composition on the estimated emissions is also evaluated for a well-calibrated simulation. We expect that a highly reliable estimation of emissions is possible using this more detailed traffic simulation calibration measurement.

Decompressive craniectomy is a potentially life-saving neurosurgical procedure. In cases of insufficient decompression, uncontrolled intracranial pressure even after sufficient decompression, or when the intracranial pressure is increased due to external factors such as intramuscular hematoma in the temporal muscle, additional temporalis resection may be necessary. However, the hollowing of the supratemporal fossa that occurs after additional temporalis resection can create a major cosmetic problem. Several alternatives are available to fill the hollowing of the supratemporal fossa during cranial reconstruction, but each has a disadvantage, whether it is expensive or difficult to shape for bilateral symmetry. The author solved the cosmetic problem by using a properly carved silicone block to fill the supratemporal fossa while conducting cranioplasty, and here reports it with a literature review.

Background Although long-term dopamine agonist (DA) therapy is recommended as a first-line treatment for prolactinoma, some patients may prefer surgical treatment because of the potential adverse effects of long-term medication, or the desire to become pregnant. This study aimed to determine whether surgical treatment of prolactinomas could be an alternative to DA therapy. Methods In this retrospective study, 96 consecutive patients (74 female, 22 male) underwent primary pituitary surgery without long-term DA treatment for prolactinomas at a single institution from 1990 to 2010. All patients underwent primary surgical treatment in the microscopic transsphenoidal approach (TSA). Results The median age and median follow-up period were 31 (16–73) years and 139.1 (12.2–319.6) months, respectively. An initial overall remission was accomplished in 47.9% (46 of 96 patients, 33 macroadenomas, and 13 microadenomas) of patients. DA dose reduction was achieved in all patients after TSA. A better remission rate was independently predicted by lower diagnostic prolactin levels and by a greater extent of surgical resection. Overall remission at the last follow-up was 33.3%, and the overall recurrence rate was 30.4%. The permanent complication rate was 3.1%, and there was no mortality. Conclusion TSA can be considered a safe and potentially curative treatment for selective microprolactinomas as an alternative to treatment with a long-term DA., Graphical Abstract