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Background: Optimal antiplatelet strategy for patients with ischemic stroke who were already on single antiplatelet therapy (SAPT) remains to be elucidated. This study aimed to evaluate the effect of different antiplatelet regimens on vascular and safety outcomes at 1 year after non-cardioembolic stroke in patients previously on SAPT. Methods: We identified 9,284 patients with acute non-cardioembolic ischemic stroke that occurred on SAPT using linked data. Patients were categorized into three groups according to antiplatelet strategy at discharge: 1) SAPT, 2) dual antiplatelet therapy (DAPT), and 3) triple antiplatelet therapy (TAPT). One-year outcomes included recurrent ischemic stroke, composite outcomes (recurrent ischemic stroke, myocardial infarction, intracerebral hemorrhage, and death), and major bleeding. Results: Of 9,284 patients, 5,565 (59.9%) maintained SAPT, 3,638 (39.2%) were treated with DAPT, and 81 (0.9%) were treated with TAPT. Multiple antiplatelet therapy did not reduce the risks of 1-year recurrent stroke (DAPT, hazard ratio [HR] 1.08 [95%confidence interval, CI, 0.92–1.27], P= 0.339; TAPT, HR, 0.71 [95%CI, 0.27–1.91], P = 0.500) and 1-year composite outcome (DAPT, HR, 1.09 [95%CI, 0.68–1.97], P = 0.592; TAPT HR, 1.46 [95%CI, 0.68–1.97], P = 0.592). However, the TAPT groups showed an increased risk of major bleeding complications (DAPT, HR, 1.23 [95%CI, 0.89–1.71], P = 0.208; TAPT, HR, 4.65 [95%CI, 2.01–10.74], P < 0.001). Conclusions: Additional use of antiplatelet agents in patients with non-cardioembolic ischemic stroke who were already on SAPT did not reduce the 1-year incidence of vascular outcomes, although it increased the risk of bleeding complications.

To evaluate the incidence and prognosis of second non-breast primary cancer (SNBPC) among Korean survivors of breast cancer.Data from the Korean National Health Insurance Service were searched to identify women who received curative surgery for initial breast cancer (IBC) between 2003 and 2008 (n=64,340). Among them, patients with the following characteristics were excluded: other cancer diagnosis before IBC (n=10,866), radiotherapy before IBC (n=349), absence of data on sex or age (n=371), or male (n=248). Accordingly, data of 52,506 women until December, 2017 were analyzed. SNBPC was defined as a newly diagnosed SNBPC that occurred five years or more after IBC diagnosis.The median follow-up time of all patients was 12.13 years. SNBPC was developed in 3,084 (5.87%) women after a median 7.61 years following IBC diagnosis. The 10-year incidence of SNBPC was 5.78% (95% CI, 5.56-6.00). Higher SNBPC incidence was found in survivors with the following factors: old age at IBC diagnosis, low household income, and receiving combined chemotherapy with endocrine therapy, whereas receiving radiotherapy was related to a lower incidence of SNBPC (hazard ratio = 0.89, p0.01). Among the patients with SNBPC, the 5-year survival rate was 62.28% (95% CI, 65.53-69.02).Approximately 5% of breast cancer survivors developed SNBPC within 10 years after IBC diagnosis. The risk of SNBPC was associated with patient's age at IBC diagnosis, income level, and a receipt of systemic treatments.

Background: Optimal antithrombotic regimens to prevent recurrent stroke in patients with ischemic stroke due to atrial fibrillation (AF) and atherosclerotic large-vessel stenosis remain unknown. Aims: This study aimed to evaluate the effect of multiple antithrombotic therapies on outcomes at 1 year after ischemic stroke due to two or more causes. Methods: We identified 862 patients with ischemic stroke due to AF and large artery atherosclerosis from the linked data. These patients were categorized into three groups according to antithrombotic therapies at discharge: (1) antiplatelets, (2) oral anticoagulants (OAC), and (3) antiplatelets plus OAC. The study outcomes were recurrent ischemic stroke, composite outcomes for cardiovascular events, and major bleeding after 1 year. Inverse probability of treatment weighting (IPTW) was used to balance the three groups using propensity scores. Results: Among 862 patients, 169 (19.6%) were treated with antiplatelets, 405 (47.0%) were treated with OAC, and 288 (33.4%) were treated with antiplatelets and OAC. After applying IPTW, only OAC had a significant beneficial effect on the 1-year composite outcome (hazard ratio (HR): 0.37, 95% confidence interval (CI): 0.23–0.60, p Conclusion: This study demonstrated that OAC monotherapy was associated with lower risks of composite outcome and death in patients at 1 year after ischemic stroke due to AF and atherosclerotic stenosis. In addition, the combination of an antiplatelet and OAC had a high risk of major bleeding.

We report the genome sequences of two GH clade severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains isolated from nasopharyngeal swabs from patients with coronavirus disease 2019 (COVID-19) in South Korea. These strains had two mutations in the untranslated regions and seven nonsynonymous substitutions in open reading frames, compared with Wuhan/Hu-1/2019, showing 99.96% sequence identity.

Background Neurocritical care by dedicated neurointensivists may improve outcomes of critically ill patients with severe brain injury. In this study, we aimed to validate whether neurointensive care could improve the outcome in patients with critically ill acute ischemic stroke using the linked big dataset on stroke in Korea. Methods We included 1,405 acute ischemic stroke patients with mechanical ventilator support in the intensive care unit after an index stroke. Patients were retrieved from linking the Clinical Research Center for Stroke Registry and the Health Insurance Review and Assessment Service data from the period between January 2007 and December 2014. The outcomes were mortality at discharge and at 3 months after an index stroke. The main outcomes were compared between the centers with and without dedicated neurointensivists. Results Among the included patients, 303 (21.6%) were admitted to the centers with dedicated neurointensivists. The patients treated by dedicated neurointensivists had significantly lower in-hospital mortality (18.3% vs. 26.8%, P = 0.002) as well as lower mortality at 3-month (38.0% vs. 49.1%, P < 0.001) than those who were treated without neurointensivists. After adjusting for confounders, a treatment without neurointensivists was independently associated with higher in-hospital mortality (odds ratio [OR], 1.59; 95% confidence intervals [CIs], 1.13–2.25; P = 0.008) and 3-month mortality (OR, 1.48; 95% CIs, 1.12–1.95; P = 0.005). Conclusion Treatment by dedicated neurointensivists is associated with lower in-hospital and 3-month mortality using the linked big datasets for stroke in Korea. This finding stresses the importance of neurointensivists in treating patients with severe ischemic stroke., Graphical Abstract

Prediction of outcome after stroke may help clinicians provide effective management and plan long-term care. We aimed to develop and validate a score for predicting good functional outcome available for hospitals after ischemic stroke using linked data. A total of 22,005 patients with acute ischemic stroke from the Clinical Research Center for Stroke Registry between July 2007 and December 2014 were included in the derivation group. We assessed functional outcomes using a modified Rankin scale (mRS) score at 3 months after ischemic stroke. We identified predictors related to good 3-month outcome (mRS score ≤ 2) and developed a score. External validations (geographic and temporal validations) of the developed model were performed. The prediction model performance was assessed using the area under the receiver operating characteristic curve (AUC) and the calibration test. Stroke severity, sex, stroke mechanism, age, pre-stroke mRS, and thrombolysis/thrombectomy treatment were identified as predictors for 3-month good functional outcomes in the S-SMART score (total 34 points). Patients with higher S-SMART scores had an increased likelihood of a good outcome. The AUC of the prediction score was 0.805 (0.798–0.811) in the derivation group and 0.812 (0.795–0.830) in the geographic validation group for good functional outcome. The AUC of the model was 0.812 (0.771–0.854) for the temporal validation group. Moreover, they had good calibration. The S-SMART score is a valid and useful tool to predict good functional outcome following ischemic stroke. This prediction model may assist in the estimation of outcomes to determine care plans after stroke.

Purpose The purpose of this study was to estimate the clinical utilization of radiation therapy (RT) in Korea between 2011 and 2015. Materials and methods We analyzed the claims data from the Health Insurance Review and Assessment Service to estimate the clinical utilization of RT. The source population consisted of all patients who had any of the International Classification of Diseases 10th revision cancer diagnoses (C00-C97) and those with diagnostic codes D00-D48, who were also associated with at least one of the procedure codes related to RT. Results The total number of patients who received RT in 2011, 2012, 2013, 2014, and 2015 were 54,810, 59,435, 61,839, 64,062, and 66,183, respectively. Among them, the total numbers of male and female patients were 24,946/29,864 in 2011, 27,211/32,224 in 2012, 28,111/33,728 in 2013, 29,312/34,750 in 2014, and 30,266/35,917 in 2015. The utilization rate of RT in cancer patients has also increased steadily over the same period from 25% to 30%. The five cancers that were most frequently treated with RT between 2011 and 2012 were breast, lung, colorectal, liver, and uterine cervical cancers. However, the fifth most common cancer treated with RT that replaced uterine cervical cancer in 2013 was prostate cancer. More than half of cancer patients (64%) were treated with RT in the capital area (Seoul, Gyeonggi, and Incheon). Conclusion The total number of patients who underwent RT increased steadily from 2011 to 2015 in Korea. The utilization rate of RT in cancer patients is also increasing.

Background and purposeThe ticlopidine/Ginkgo biloba ext. combination drug (Yuclid) is used as an antiplatelet agent for prevention of vascular events since its approval in 2008. The purpose of this study is to explore the safety of ticlopidine/Ginkgo biloba combination, mainly regarding the incidence of neutropenia, through a post-marketing surveillance study.MethodsFrom March 2009 to October 2015, a total of 4839 subjects had been enrolled in this study. The enrollments were conducted by 152 doctors of 89 hospitals according to the regulations for post-marketing surveillance programs in Korea. If a subject was administered the drug once, he/she was included in the safety analysis set for any adverse events and bleedings, and the primary safety evaluation regarding neutropenia was conducted in subjects who completed 3-month blood test follow-up. We predefined that 1% reduction in neutropenia incidence by ticlopidine/Ginkgo biloba ext. combination from the previously reported incidence of ticlopidine of 2.3% was clinically meaningful.ResultsAmong the safety analysis set of 4831 patients (99.8% of the enrolled subjects), 3150 (65.1%) completed evaluation for neutropenia at 3 months which is the primary safety endpoint. The major causes of dropout were no follow-up visit at 3 months (n = 1016) and violation of the follow-up period (n = 503). Nine patients experienced neutropenia (Absolute neutrophil count [ANC] ≤ 1200mm3) and the estimated cumulative incidence at 3 months is 0.29% (95% confidence interval, 0.13%- 0.54%). Severe neutropenia (ANC ≤ 450mm3) did not occur in any patients.ConclusionsThe incidence of neutropenia with addition of Ginkgo biloba ext. to ticlopidine may be lower than the previously reported incidence of neutropenia with ticlopidine, which needs to be confirmed in randomized controlled trials.

In this paper, the concerned existing blind equalizer convergence rate and residual inter-symbol interference using constellation reduced and cost function by separation the real part and an imaginary part, the dual structure CR-CMA(constellation Reduction CMA). The CMA methed compensates amplitude but does no compensate phase, On the other hand, The CMA method compensates both the amplitude and the phase but it has the convergence rate problem, and the MCMA method is a way to solve the phase problem of CMA method compensates both the amplitude and the phase after respectively calculating the real part and imaginary part components. Proposal a new method that the dual structure of CR-CMA, the cost function and error function and respectively calculating the real part and imaginary part components can advantages by improving the CMA and the MCMA algorithms so that the amplitude and phase retrieval and constellation reduce the residual ISI and faster convergence rate and performance is good SER (Symbol Error Ratio) was confirmed by computer simulations.

Ce dispositif servira a mesurer les seuils de deterioration par un faisceau laser des verres optiques

A manufacturable 2 Gb NAND flash memory with 0.044 /spl mu/m/sup 2/ cell size, which is the smallest cell size ever reported in semiconductor memory, is successfully developed with 90 nm NAND flash technology for high density file storage application. The three main key technology features of 90 nm NAND flash technology are advanced KrF lithography with off-axis illumination system equipped with a dipole aperture, reduced stack height of cell, and optimized gate reoxidation affecting tunnel oxide profile.

Two reflective-mode, π/4-twisted-nematic liquid crystal cells were prepared using E7 and ZLI 4801-000 liquid crystals and their electrooptic responses were measured in the voltage regions close to and distant from the Freedericksz transition threshold. Our reflectivity data distant from the threshold voltage (V th) could not be described by the model that assumed a linearized distribution of the twist angle across the cell and considered the voltage dependency of the tilt angle to follow the equation suggested by Lu and Saleh [Appl. Opt. 30 (1991) 2354], although the fit is good near V th. We determined that the reflectivity in the voltage region distant from V th should be calculated using the model that considers the distributions of the tilt angle and the twist angle. The director-axis distributions were obtained from the numerical integration of the Ericksen-Leslie equation.

A new calorimetric interferometry using a pulsed high power Nd‐glass laser was developed to determine small absorption coefficients of the order of 10−3 cm−1 or less at the wavelength of 1.06 μm. The absorption coefficients of the liquid specimens, C6H6, C6H5Cl, 0‐C6H4Cl2, and 1,2,4‐C6H3Cl3, were determined by the fast acquisition of an interferogram, accurate microcalorimetry, and the measurement of the laser beam radius.