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Introduction: The explorative scanning movements of the hands have been compared to those of the eyes. The visual process is known to be composed of alternating phases of saccadic eye movements and fixation pauses. Descriptive results suggest that during the haptic exploration of objects short movement pauses occur as well. The goal of the present study was to detect these explorative stops (ES) during one-handed and two-handed haptic explorations of various objects and patterns, and to measure their duration. Additionally, the associations between the following variables were analyzed: a) between mean exploration time and duration of ES, b) between certain stimulus features and ES frequency, and c) the duration of ES during the course of exploration. Methods: Five different experiments were used. The first two experiments were classical recognition tasks of unknown haptic stimuli (A) and of common objects (B). In experiment C space-position information of angle legs had to be perceived and reproduced. For experiments D and E the PHANToM haptic device was used for the exploration of virtual (D) and real (E) sunken reliefs. Results: In each experiment we observed explorative stops of different average durations. For experiment A: 329.50 ms, experiment B: 67.47 ms, experiment C: 189.92 ms, experiment D: 186.17 ms and experiment E: 140.02 ms. Significant correlations were observed between exploration time and the duration of the ES. Also, ES occurred more frequently, but not exclusively, at defined stimulus features like corners, curves and the endpoints of lines. However, explorative stops do not occur every time a stimulus feature is explored. Conclusions: We assume that ES are a general aspect of human haptic exploration processes. We have tried to interpret the occurrence and duration of ES with respect to the Hypotheses-Rebuild-Model and the Limited Capacity Control System theory.

This study investigates a micro light-emitting diode (µLED) pixel circuit using the heterogeneous integration of complementary field-effect transistors (CFETs). The CFETs are fabricated using a semiconductor layer composed of tellurium (Te) and indium-gallium-zinc oxide (IGZO) layers. Te and IGZO layers in the heterostructure IGZO/Te film exhibit hexagonal and amorphous phases, respectively, indicating that each layer maintains independent material characteristics. The fabricated IGZO/Te CFETs exhibit ambipolar behavior with a turn-on voltage of 2.0 V and field-effect mobility of 0.74 and 1.42 cm 2 V -1 s -1 for p-type and n-type channels, respectively. Inverters comprising IGZO/Te CFET and IGZO TFT exhibit inverting behavior. A µLED pixel circuit is designed using IGZO/Te CFETs based on pulse width modulation (PWM). The proposed circuit uses an inverter structure with IGZO/Te and IGZO to control the emission time, suppressing the wavelength shift of µLEDs depending on the µLED current levels. The operation of the proposed pixel circuit is investigated through simulation and measurement of the fabricated circuit. The fabricated µLED pixel circuit successfully exhibits PWM operation, controlling the emission time and luminance. Consequently, IGZO/Te CFETs show promise as devices for high-quality µLED displays., (© 2024 Wiley‐VCH GmbH.)

Background: White forsythia (Abeliophyllum distichum) is an endangered Korean Peninsula endemic that has been subjected to recent population genomics studies using SNPs via RAD sequencing. Here, we primarily employed the often underutilized haplotype information from RAD loci to further describe the species' previously uninvestigated haplotype-based genomic variation and structure, and genetic-geographic characteristics and gene flow patterns among its five earlier identified genetic groups. We also inferred the time of past events that may have impacted the effective population size of these groups, as well as the species' potential future distribution amidst the warming climate and anthropogenic threats., Results: Our findings emphasized the recognition of the species' regional patterns of genetic structure, and the role of topography and its associated gene flow patterns as some of the possible factors that may have influenced the species' present-day fragmented population distribution. The inferred bottleneck events during the Anthropocene, some of which aligned with the time of historical catastrophic events on the Peninsula (e.g., the Korean War), were revealed to have contributed to the generally low effective population size of its five lineages, particularly those with marginal distributional range. Future distribution under both optimistic and pessimistic climatic scenarios suggests unlikely suitable habitats for these populations to expand from their current range limits, at least in the next 80 years., Conclusions: The small effective population size and landscape-driven limited gene flow among white forsythia populations will remain a big challenge for the conservation management of the species' already fragmented population distribution. To help mitigate these impacts, the merging of various research approaches and the use of genomic data to their full potential is recommended to provide the optimized knowledge-based tools for the conservation of this endangered species, and other similar plants under pressure., (© 2024. The Author(s).)

Background Aims: Natural killer (NK) cell-based cancer immunotherapy is effective when combined with other treatment modalities such as irradiation and chemotherapy. NK cell's antitumor function to treat solid tumor, including head and neck squamous cell carcinoma (HNSCC), has been targeted recently. This study assessed NK cell recruitment in response to chemoradiation therapy (CRT) in HNSCC., Methods: Ex vivo expansion of NK cell, flow cytometry, cell viability assay, cytotoxicity assay, immunohistochemistry, and animal model were performed., Results: Mouse NK cells were recruited to the tumor site by CRT in a nude mouse model. Furthermore, expanded and activated human NK cells (eNKs) were recruited to the tumor site in response to CRT, and CRT enhanced the anti-tumor activity of eNK in an NOD/SCID IL-2Rγnull mouse model. Various HNSCC cancer cell lines exhibited different NK cell ligand activation patterns in response to CRT that correlated with NK cell-mediated cytotoxicity., Conclusions: Identifying the activation patterns of NK cell ligands during CRT might improve patient selection for adjuvant NK cell immunotherapy combined with CRT. This is the first study to investigate the NK cell's antitumor function and recruitment with CRT in HNSCC mouse model., Competing Interests: Declaration of Competing Interest The authors have no commercial, proprietary or financial interest in the products or companies described in this article., (Copyright © 2023 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Comprehensive epidemiological data are lacking on the incident atrial fibrillation (AF) in patients with cardiac implantable electronic devices (CIEDs). This study aimed to examine the incidence, risk factors, and AF-related adverse outcomes of patients with CIEDs., Methods: This was an observational cohort study that analyzed patients without prevalent AF who underwent CIED implantation in 2009-2018 using a Korean nationwide claims database. The subjects were divided into three groups by CIED type and indication: pacemaker (n=21,438), implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) with heart failure (HF) (n=3,450), and ICD for secondary prevention without HF (n=2,146). The incidence of AF, AF-associated predictors, and adverse outcomes were evaluated., Results: During follow-up, the incidence of AF was 4.3, 7.3, and 5.1 per 100 person-years in the pacemaker, ICD/CRT with HF, and ICD without HF cohorts, respectively. Across the three cohorts, older age and valvular heart disease were commonly associated with incident AF. Incident AF was consistently associated with an increased risk of ischemic stroke (3.8-11.4-fold), admission for HF (2.6-10.5-fold), hospitalization for any cause (2.4-2.7-fold), all-cause death (4.1-5.0-fold), and composite outcomes (3.4-5.7-fold). Oral anticoagulation rates were suboptimal in patients with incident AF (pacemaker, 51.3%; ICD/CRT with HF, 51.7%; and ICD without HF, 33.8%, respectively)., Conclusions: A substantial proportion of patients implanted CIED developed newly diagnosed AF. Incident AF was associated with a higher risk of adverse events. The importance of awareness, early detection, and appropriate management of AF in patients with CIED should be emphasized., Competing Interests: Eue-Keun Choi reported research grants or speaking fees from Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daiichi-Sankyo, Dreamtech Co., Ltd., Medtronic, Samjinpharm, Sanofi-Aventis, Seers Technology, Skylabs, and Yuhan., (Copyright © 2024. The Korean Society of Cardiology.)

Climatic fluctuations and geological events since the LGM are believed to have significantly impacted the population size, distribution, and mobility of many species that we observe today. In this paper, we determined the processes driving the phylogeographic structure of the Korean endemic white forsythia by combining the use of genome-wide SNPs and predicting paleoclimatic habitats during the LGM (21 kya), Early Holocene (10 kya), Mid-Holocene (6 kya), and Late Holocene (3 kya). Using a maximum of 1897 SNPs retrieved from 124 samples across nine wild populations, five environmental predictors, and the species' natural occurrence records, we aimed to infer the species' demographic history and reconstruct its possible paleodistributions with the use of approximate Bayesian computation and ecological niche models, respectively. Under this integrated framework, we found strong evidence for patterns of range shift and expansion, and population divergence events from the onset of the Holocene, resulting in the formation of its five distinct genetic units. The most highly supported model inferred that after the split of an ancestral population into the southern group and a larger central metapopulation lineage, the latter gave rise to the eastern and northern clusters, before finally dividing into two sub-central groups. While the use of molecular data allowed us to identify and refine the (phylo)genetic relationships of the species' lineages and populations, the use of ecological data helped us infer a past LGM refugium and the directions of post-glacial range dynamics. The time frames of these demographic events were shown to be congruent with climatic and geological events that affected the central Korean Peninsula during these periods. These findings gave us a better understanding of the consequences of past spatiotemporal factors that may have resulted in the current fragmented population distribution of this endangered plant., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Objective: We analyzed and compared the clinical characteristics of benign and malignant parotid gland tumors., Patients and Methods: A total of 992 patients who underwent surgical treatment for parotid gland tumors from January 2010 to December 2020 were included in this study. This study population was subdivided into benign (n = 812, 81.9 %) and malignant parotid gland tumors (n = 180, 18.1 %)., Results: Pleomorphic adenoma is the most common benign tumor and mucoepidermoid carcinoma is the most common malignant tumor. The patients with malignant parotid gland tumors were older than the patients with benign lesions. The duration of symptoms was longer in patients with benign parotid gland tumors compared to those with malignant lesions. The size of the malignant tumors was larger than that of the benign lesions. Preoperative fine-needle aspiration cytology had a diagnostic sensitivity of 50.3 %, diagnostic specificity of 98.7 %, a positive predictive value of 89.5 %, a negative predictive value of 89.9 %, and accuracy of 89.9 % for diagnosing malignant parotid gland tumors. For benign parotid gland tumors, superficial parotidectomy was most frequently performed, and for malignant parotid gland tumors, total parotidectomy was most frequently performed. Facial palsy was observed in 19.4 % of the patients with malignant parotid gland tumors compared to 5.4 % of those with benign tumors., Conclusion: The clinical features of benign and malignant parotid gland tumors showed differences in age, symptoms, duration of symptoms, size and site of the parotid tumors, surgical procedures, and postoperative facial nerve palsy., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Pharyngocutaneous fistula (PCF) caused by a previous anterior cervical spine fixation plate more than a decade ago has not been reported yet. A 70-year-old man with dysphagia was diagnosed as supraglottic cancer. After partial laryngectomy and concurrent chemoradiation, due to increasing arytenoid lesion, total laryngectomy was followed. Pharyngocutaneous fistula occurred but resolved spontaneously. However, retropharyngeal granulation tissue emerging from the anterior cervical spine fixation plate caused delayed PCF. Dysphagia and PCF resolved after fixation plate removal., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)

Objectives: The objective of this study was to determine factors affecting the survival of pedicled latissimus dorsi (LD) flap., Materials and Methods: Medical records of 20 pedicled LD flap patients for head and neck reconstruction by a single operator from 2015 to 2019 in a tertiary hospital were reviewed. Factors including flap size and pedicle's length from the most distal end of the flap to the axilla (Fp) and from the most distal end of the defect to the axilla (Dfp) were assessed. Partial flap loss requiring procedures and total loss were considered as failure. Descriptive statistics, the Pearson χ 2 test, and linear-by-linear association analysis were performed., Results: Seventy percent of patients showed success. There was no significant difference in various factors including preoperative body mass index, underlying diseases such as hypertension and diabetes, preoperative treatment either radiation or chemotherapy, lab results, and operation time between the survival and the failure group. Rotation arc (Dfp/Fp) showed significant difference between 2 groups ( P =0.001). Unlike Fp, Dfp tend to be shorter on the success group ( P =0.053)., Conclusions: Low rotation arc through shorter Dfp affects survival of pedicled LD flap significantly., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)

Background: The use of natural killer (NK) cells is a promising approach in the field of cancer immunotherapy; however, combination treatments are required to enhance the effects of NK cell immunotherapy. In this study, we assessed the potential of irradiation and cisplatin as a chemoradiotherapy (CRT) regimen to augment the effects of NK cell immunotherapy in head and neck squamous cell carcinoma (HNSCC)., Methods: NK cells were expanded using our recently established K562-OX40 ligand and membrane-bound interleukin (IL)-18 and IL-21 feeder cells in the presence of IL-2/IL-15 from peripheral blood of healthy donors., Results: The results showed an increase in the purity of NK cells and expression of activation markers such as NKG2D and lymphocyte function-associated antigen 1 during the expansion process, which is positively correlated to the NK cell infiltration and overall survival in patients with HNSCC. CRT induced NK cell activation ligand (ULBP2) and adhesion molecules (ICAM-1, -2 and -3) on HNSCC, leading to enhanced cytotoxicity of NK cells against HNSCC., Conclusions: Our findings suggest that the NK cells have a potent anti-tumor effect in combination with CRT against HNSCC., Competing Interests: Declaration of Competing Interest The authors have no commercial, proprietary, or financial interest in the products or companies described in this article., (Copyright © 2022 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.)

Metastases to the vocal cord from a distant organ are extremely rare. This case showed metastatic adenocarcinoma on the vocal cord of lung origin in a 75-year-old nonsmoking female with a history of lung adenocarcinoma surgery 2 years earlier. The vocal cord mass was surgically removed, and the biopsy confirmed metastatic adenocarcinoma of lung origin with thyroid transcription factor (TTF)-1 positivity. A further evaluation found recurrence in the lung. The patient received gefitinib. Here, we report an extremely rare case of metastatic adenocarcinoma on the vocal cord from the lung which is the first report to our knowledge.

Introduction: Neoplasms of the tongue base are rare, but they range from benign neoplasms to congenital diseases and malignant neoplasms. The purpose of this study is to analyze the clinical features and recurrence factors of benign tumors of the tongue base., Methods: The study included 27 cases of benign neoplasms of the tongue base from January 2010 to February 2022., Results: Of these 27 patients, 19 were male and 8 were female. Most cases were found incidentally without any specific symptoms, and squamous papilloma was the most common tumor. We performed microscopic or endoscopic transoral resection of benign neoplasms of the tongue base under general anesthesia in all patients without any complications. The recurrence rate was 14.8%, and we found that the younger the patient, the higher the recurrence rate (p < 0.001)., Conclusion: We performed transoral resection of benign neoplasms of the tongue base in all patients without any complications. The recurrence of benign neoplasms of the tongue base was statistically significant only in terms of age., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Without vaccines or pharmaceutical treatments for a viral pandemic, non-pharmaceutical interventions (NPIs) such as washing hands and wearing masks are likely the most effective ways to control infections at airports and on airplanes. Although the aviation market is a major entry point for viruses, little is known about how flight attendants view the risk of COVID-19 and whether they follow individual-organizational-governmental NPI protocols. Guided by protection motivation theory (Rogers, 1975), this study proposed an NPI model tailored specifically to the airline industry and examined how an extended NPI would affect job satisfaction and customer orientation of Korean flight attendants (n = 371). Results revealed that perceptions of COVID-19 are positively related to three types of NPIs, which in turn positively influenced job satisfaction and customer orientation. Given that the examined three types of NPIs had not been paid attention in previous research, the study's proposed conceptual model should better guide the airline industry in protecting its flight attendants with NPI strategies inside and outside aircraft., (© 2022 Elsevier Ltd. All rights reserved.)

Objective: To analyse the treatment results of bilobed flap reconstruction performed for skin defects after parotid carcinoma surgery., Method: Ten patients who underwent bilobed flap reconstruction for skin defects after parotid carcinoma surgery in our hospital, from 2014 to 2020, were retrospectively enrolled., Results: All patients underwent bilobed flap reconstruction for skin defects after parotid carcinoma surgery. The size of the skin defect was 2.7 × 2.2 cm in the smallest dimension and 9.0 × 6.3 cm in the largest dimension. All bilobed flaps except one healed without any problems. One patient developed partial flap necrosis in the retroauricular region, and was treated with skin grafts after removal of the necrotic tissue under local anaesthesia. All bilobed flaps, including the cases in which skin grafts were performed, survived after post-operative radiotherapy or chemotherapy., Conclusion: A bilobed flap is a good reconstruction option for skin defects after parotid carcinoma surgery in some cases.

Background: We designed a new 1-handed chest compression method, the "elbow-lock" chest compression (ELCC), for a single rescuer in pediatric cardiopulmonary resuscitation (CPR). Then, we compared the effectiveness between the ELCC and standard chest compression (SCC) method., Methods: This prospective, randomized controlled, crossover simulation trial studied 34 emergency medical professionals, including physicians, nurses, and EMTs. We compare the quality of chest compression and fatigue point time between the ELCC and the SCC., Results: Participants who performed the ELCC method maintained a proper depth of compression compared with SCC method (50.0 ± 0.3 mm vs 40.5 ± 0.4 mm, P < 0.001). However, the 2 methods did not differ in terms of compression velocity since neither reached the standard velocity (96.7 ± 7.1/minutes vs 91.7 ± 7.0/minutes, P < 0.016). With respect to the overall score, ELCC was more effective than the SCC (91.6 ± 3.7% vs 85.3 ± 8.8%, P = 0.002). In addition, the fatigue point time was slower in the ELCC group than the SCC group (7.3 ± 0.3/minutes vs 6.1 ± 0.4/minutes, P < 0.001)., Conclusions: The single rescuer ELCC method is an effective alternative to the SCC method for pediatric CPR because the ELCC method can prevent elbow flexion.Trial registration: Our research is simulation manikin study. So we do not need to "trial registration"., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: A decline in serum carbohydrate antigen 19-9 (CA19-9) levels during systemic chemotherapy is considered as a prognostic marker for patients with advanced pancreatic cancer. Neutrophil-to-lymphocyte ratio (NLR) has been extensively studied as a simple and useful indicator of prognosis in various cancers including pancreatic cancer., Aim: To assess the prognostic significance of NLR and CA19-9 in patients with advanced pancreatic adenocarcinoma received first-line chemotherapy according to CA19-9 positivity., Methods: We retrospectively analyzed patients diagnosed with advanced pancreatic cancer who received first-line chemotherapy between January 2010 and July 2017 at the Catholic University of Seoul St. Mary's Hospital. Patients were divided according to CA19-9 positivity (CA19-9-positive vs -negative groups) and pre-and post-treatment NLR levels. To determine cut-off value of NLR and CA19-9 reduction, time-dependent receiver operating characteristic curve was applied. We evaluated overall survival (OS) and progression-free survival (PFS) for each group using Kaplan-Meier method, and we performed multivariate analyses on the entire cohort., Results: We included 271 patients in this study. Cut-off value of NLR and CA19-9 reduction was determined as 2.62 and 18%. Multivariate analysis showed that post-treatment NLR < 2.62 and reduction of ≥ 18% of baseline CA19-9 were significantly associated with OS and PFS. Post-treatment NLR ≥ 2.62 showed hazard ratio (HR) of 2.47 [95% confidence interval (CI): 1.84-3.32, P < 0.001] and CA19-9 decline (≥ 18%) showed HR of 0.51 (95%CI: 0.39-0.67, P < 0.001) for OS. When CA19-9-positive patients were divided into groups according to CA19-9 response (responder vs non-responder) and post-treatment NLR (< 2.62 vs ≥ 2.62), CA19-9 responder and post-treatment NLR < 2.62 group showed better survival than CA19-9 non-responder and post-treatment NLR ≥ 2.62 group (OS 11.0 mo vs 3.9 mo, P < 0.001; PFS 6.3 mo vs 2.0 mo, P < 0.001). The combination of CA19-9 decline and post-treatment NLR showed a significant correlation with clinical response in CA 19-9 positive group. Within the CA19-9-negative group, the post-treatment NLR < 2.62 group showed better survival than the post-treatment NLR ≥ 2.62 group (OS 12.7 mo vs 7.7 mo, P < 0.001; PFS 6.7 mo vs 2.1 mo, P < 0.001), and post-treatment NLR showed correlation with clinical response., Conclusion: In advanced pancreatic cancer patients positive for CA19-9 and treated with systemic chemotherapy, the combination of post-treatment NLR < 2.62 and 18% decline of CA19-9 at the first response evaluation is a good prognostic marker. Post-treatment NLR < 2.62 alone could be used as a prognostic marker and an adjunctive tool for response evaluation in CA19-9-negative patients., Competing Interests: Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Actinomycosis of the parotid gland is very rare. We sought to examine the clinical features, treatment methods, and treatment results of actinomycosis of the parotid gland in our hospital., Methods: We retrospectively enrolled 5 patients with histopathologically identified actinomycosis of the parotid gland from January 2010 to May 2020., Results: This study included 3 male and 2 female subjects. All patients had a common complaint of the mass in the parotid gland. Skin necrosis was observed in one patient. However, skin necrosis and fistula track occurred in the other 2 patients after fine-needle aspiration cytology (FNAC). Based on the result of FNAC two cases of inflammation and abscess were identified. Four patients with suspicion of parotid tumors before surgery underwent parotidectomy, and one patient with consideration of parotid abscess underwent incision and drainage. After surgery, intravenous administration of antibiotics was performed for an average of 6 days and oral antibiotics were prescribed for about 2 months for patients with actinomycosis of the parotid gland., Conclusions: In case of skin necrosis of the parotid lesion without evidence of a malignant tumor, or if FNAC does not reveal the presence of cancerous cells, and fistula tract or skin necrosis occurs after the FNAC, then actinomycosis of the parotid gland should be suspected. If the actinomycosis of the parotid gland was localized to the parotid gland and removed surgically, it would be sufficient to treat the patients with antibiotics for about 2 months while observing the clinical response.

Anaplastic thyroid cancer (ATC) is characterized by a rapid and aggressive course of progression. Despite significant advances in surgery, radiotherapy and chemotherapy, the disease‑specific mortality due to ATC is approximately 100%. New strategies, such as molecular targeted therapies, are imperative for improving survival. Livin, a member of the human inhibitor of apoptosis protein family, has been found to be associated with tumor progression and poor prognosis in various human cancers. The aim of the present study was to evaluate the role of Livin in cancer progression and chemoradioresistance of ATC and to investigate its potential as a therapeutic target. Endogenous Livin expression in the human BHT101 ATC cell line was silenced by Livin‑specific small interfering RNA. To assess the impact of Livin on cancer cell behavior in human ATC cells, various methods such as cell invasion, cell viability and cell apoptosis assays were applied. To assess the expression of Livin and the change of apoptosis‑related proteins associated with Livin expression, reverse transcription‑quantitative PCR and western blotting were performed. Immunohistochemistry was performed to detect Livin protein expression in human ATC tissues. The association between Livin expression and apoptotic/proliferation index was analyzed in human ATC cells. Livin‑knockdown suppressed tumor cell invasion; and conversely, it enhanced cell apoptosis, with elevated expression levels of cleaved caspase‑3 and ‑7 and cleaved PARP. Livin‑knockdown enhanced radiation‑induced apoptosis, while reducing cell viability following radiotherapy, as well as lenvatinib treatment. In addition, human ATC tissues with high Livin‑expression exhibited a high Ki‑67 labeling index and low apoptotic index. In summary, these findings indicate the contribution of Livin to tumor progression and chemoradioresistance in ATC.

Competition and collaboration are strategies that can be used to optimize the outcomes of social interactions. Research into the neuronal substrates underlying these aspects of social behavior has been limited due to the difficulty in distinguishing complex activation via univariate analysis. Therefore, we employed multivoxel pattern analysis of functional magnetic resonance imaging to reveal the neuronal activations underlying competitive and collaborative processes when the collaborator/opponent used myopic/predictive reasoning. Twenty-four healthy subjects participated in 2 × 2 matrix-based sequential-move games. Searchlight-based multivoxel patterns were used as input for a support vector machine using nested cross-validation to distinguish game conditions, and identified voxels were validated via the regression of the behavioral data with bootstrapping. The left anterior insula (accuracy = 78.5%) was associated with competition, and middle frontal gyrus (75.1%) was associated with predictive reasoning. The inferior/superior parietal lobules (84.8%) and middle frontal gyrus (84.7%) were associated with competition, particularly in trials with a predictive opponent. The visual/motor areas were related to response time as a proxy for visual attention and task difficulty. Our results suggest that multivoxel patterns better represent the neuronal substrates underlying the social cognition of collaboration and competition intermixed with myopic and predictive reasoning than do univariate features., (© 2020 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.)

Early [stage I and II (T2N0M0)] laryngeal cancer types are currently recommended to be treated with a single modality, consisting of definitive radiation therapy or larynx-preserving surgery. Although the treatment outcomes of stage I are good, the frequency of successful outcomes decreases with T2N0M0. Therefore, the present study investigated the treatment outcomes of different treatment methods in T2N0M0 laryngeal cancer. In total, 83 patients with previously untreated T2N0M0 laryngeal squamous cell carcinoma were enrolled. Patients were grouped by treatment method: Radiation therapy (RT; 27 patients); chemoradiotherapy (CRT; 46 patients) with cisplatin base; and surgery-based therapy (SBT; ten patients). The recurrence rates of the RT, CRT and SBT groups were 44.4, 19.6 and 50%, respectively. Moreover, the local control rates of the RT, CRT and SBT groups were 55.6, 87.0 and 80%, respectively. The CRT group had a significantly lower recurrence rate and higher local control rate compared with the RT group (P<0.05). In the survival analysis, overall and disease-specific survival rate did not differ significantly among the treatment groups. However, 3- and 5-year disease-free survival rates (DFS) of the RT group were both 55%, those of the SBT group were both 50% and those of the CRT group were both 80%. Furthermore, the DFS was significantly higher in CRT group compared with the other groups (P=0.02). Using multivariate analysis with Cox regression, it was found that the treatment method was the most important factor for DFS and had a significant impact in the CRT group. In addition, in patients with glottic cancer with anterior commissure and subglottic invasion, the CRT group had significantly improved DFS compared with the RT group, whereas there was no significant difference between the two groups in patients without subglottic invasion. According to National Cancer Institution Common Toxicity Criteria (version 5.0), more patients had toxicity in the CRT group compared with the RT group. However, in the RT and CRT groups, no patients demonstrated mortality due to toxicity, and treatment-related toxicities were manageable. Collectively, although definitive conclusions could not be established, due to the limitations of this retrospective study, the results suggest that CRT had a positive impact on the local control and DFS rates with manageable toxicity in patients with T2N0M0 laryngeal cancer., (Copyright © 2020, Spandidos Publications.)

Objective: To determine the clinical characteristics and treatment results of benign and malignant tumors of the hard palate in our hospital., Patients and Methods: A total of 25 patients who underwent surgical treatment for hard palate tumors between 2008 and 2018 were included in this study. Their demographic characteristics, smoking status, alcohol consumption, symptoms, duration of symptoms, size and localization of hard palate tumor, status of mucosal surface, radiologic examinations, surgery, reconstruction method, histopathologic results, treatment outcomes, oral intake start time, adjuvant treatment, postoperative complications, and recurrence were reviewed., Results: Of the 25 patients with hard palate tumors, 15 (60.0%) had benign tumors and 10 (40.0%) had malignant tumors. Both benign and malignant tumors of the hard palate occurred more frequently in females than in the males. The most common symptom of hard palate tumor was palate mass. The most common benign tumor was pleomorphic adenoma (n = 13). The most common malignant tumors were squamous cell carcinoma and carcinoma ex pleomorphic adenoma (n = 3 for each). All patients were operated via transoral approach without external incision. We did not experience any recurrence in this study. The oral intake start time was late in malignant hard palate tumors (p < 0.05)., Conclusion: The comparison of clinical features of benign and malignant hard palate tumors showed a statistical significance only for oral intake start time. Transoral surgical removal with clear margin is a safe and effective procedure for benign and malignant hard palate tumors.

Background: Tailoring healthcare to patients' individual needs is a central goal of precision medicine. Combining smartphone-based interventions with machine learning approaches may help attaining this goal. The aim of our study was to explore the predictability of the success of smartphone-based psychotherapeutic micro-interventions in eliciting mood changes using machine learning., Methods: Participants conducted daily smartphone-based psychotherapeutic micro-interventions, guided by short video clips, for 13 consecutive days. Participants chose one of four intervention techniques used in psychotherapeutic approaches. Mood changes were assessed using the Multidimensional Mood State Questionnaire. Micro-intervention success was predicted using random forest (RF) tree-based mixed-effects logistic regression models. Data from 27 participants were used, totaling 324 micro-interventions, randomly split 100 times into training and test samples, using within-subject and between-subject sampling., Results: Mood improved from pre- to post-intervention in 137 sessions (initial success-rate: 42.3%). The RF approach resulted in predictions of micro-intervention success significantly better than the initial success-rate within and between subjects (positive predictive value: 0.732 (95%-CI: 0.607; 0.820) and 0.698 (95%-CI: 0.564; 0.805), respectively). Prediction quality was highest using the RF approach within subjects (rand accuracy: 0.75 (95%-CI: 0.641; 0.840), Matthew's correlation coefficient: 0.483 (95%-CI: 0.323; 0.723))., Limitations: The RF approach does not allow firm conclusions about the exact contribution of each factor to the algorithm's predictions. We included a limited number of predictors and did not compare whether predictability differed between psychotherapeutic techniques., Conclusions: Our findings may pave the way for translation and encourage scrutinizing personalized prediction in the psychotherapeutic context to improve treatment efficacy., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019. Published by Elsevier B.V.)

Objectives: Sound field (SF) audiometry tests are usually conducted in audiometric booths measuring greater than 2×2 m in size. However, most private ENT clinics carry about 1×1-m-sized audiometric booths, making SF audiometry testing difficult to perform. The aims of this study were to develop an SF audiometry system for use in smaller audiometric booths and compare its performance with traditional system., Methods: The newly developed SF audiometry system can yield an SF signal at a distance of about 30 cm from the subject's ears. Its height can be adjusted according to the subject's head height. We compared SF hearing results between the new SF system and the traditional SF audiometry system in 20 adults with normal hearing (40 ears) and 24 adults with impaired hearing levels (38 ears) who wore hearing aids. Comparative parameters included warble tone audiometry threshold, a speech reception threshold (SRT), and a speech discrimination score (SDS). For statistical analysis, paired t-test was used. The equivalence of both SF systems was tested using two one-sided test (TOST) with a margin of 5 dB (normal hearing participants) and 10 dB (hearing aids wearing participants)., Results: Among participants with normal hearing, warble tone hearing thresholds of 0.5, 1, 2, and 4 kHz, average values of these four frequencies, and SRT were similar between the two systems (all P>0.05). Participants with hearing aids showed similar warble tone threshold and SRT (P>0.05) in both systems except for threshold of 4 kHz (P=0.033). SDS was significantly higher in the newly developed system (P<0.05). TOST results showed equivalent SF audiometry results using either system., Conclusion: Audiometric results of the newly developed SF audiometry system were equivalent to those of a traditional system. Therefore, the small SF audiometry system can be used at small audiometric booths present in most private ENT clinics.

Introduction: To overcome the limited readability of the conventional drug induced sleep endoscopy (DISE) system which only records flexible endoscopy images, we devised the Multimodality DISE System (MDS). MDS encompasses the monitoring systems for oxygen saturation, electrocardiogram, blood pressure, snoring intensity, and patient's position. It enabled to record comprehensive situation of patients who underwent DISE. In this study, we compared the efficacy of MDS with that of the conventional DISE system., Methods and Materials: Ten patients underwent DISE at a tertiary hospital. DISE evaluated the airway of each patient in four positions; supine, supine with jaw thrust, right lateral decubitus, and left lateral decubitus. In addition, every examination was recorded by using both single monitoring system and MDS system. Five otolaryngologists interpreted the recorded examinations without knowledge of patient information (10 conventional DISE and 10 MDS). The visual analogue scale (VAS) scores for readability, reading times, ease of patient explanation and the ease of decision making were analyzed., Results: Mean VAS scores for readability of conventional DISE and MDS were 4.41+2.56 and 8.42+2.07 (p<0.001). Mean reading times for conventional DISE and MDS were 238.80+61.26 sec and 81.00+44.99 sec, respectively (p<0.001). MDS showed superiority in patient communication (p<0.001). MDS was helpful in decision making regarding patients with obstructive sleep apnea (p<0.001)., Conclusions: MDS enhanced the readability of previously recorded DISE and enabled easier doctor-patient communication. In addition, MDS is more effective in decision making regarding patients with OSA. MDS has laid the groundwork for separating the DISE prescriber from the DISE performer., Competing Interests: The authors have declared that no competing interests exist.

Introduction: There have been few population-based studies reporting medical, lifestyle and psychological factors associated with irregular menstrual cycles. This study aimed to elucidate the prevalence and related factors of irregular menstrual cycles in Korean women., Methods: Cross-sectional data from the 5th Korean National Health and Nutrition Examination Survey were used. Eligible women were 19-40 years old, not currently taking oral contraceptives or using intrauterine devices, and not currently pregnant or breast feeding, and had no medical history of hysterectomy, thyroid diseases, cancers or renal failure. Finally, 3194 premenopausal women were recruited in this study. The prevalence and related factors of irregular cycles were obtained using a general linear model and logistic regression analyses in a complex sampling design., Results: The prevalence of irregular cycles was 14.3%. Age and high-education level were associated with lower odds ratios (ORs) for irregular cycles (OR 0.91, 95% confidence interval (95% CI) 0.87-0.96, and OR 0.58, 95% CI 0.38-0.88, respectively). The ORs of body mass index, perceived stress and depressive mood were 1.05 (95% CI 1.01-1.10), 1.46 (95% CI 1.11-1.92) and 2.07 (95% CI 1.18-3.63), respectively., Conclusions: Age, perceived stress, body mass index, depressive mood and education level, rather than obstetric factors or metabolic diseases were significant factors associated with irregular menstrual cycles in Korean women. Of these factors, perceived stress is the most significant factor associated with increased irregular menstrual cycles.

Background: Medicare reimbursements have been tied to patient satisfaction measures. Despite these measures' influence on reimbursements, the relationship between pain management and patient satisfaction remains unclear. This study aims to evaluate the relationship between traditional patient perception of pain control and their overall satisfaction after joint replacement., Methods: This study is a retrospective review of consecutive primary total hip and total knee replacements. A total of 286 patients who underwent primary total hip (N = 106) and total knee (N = 196) replacements with completed Hospital Consumer Assessment of Healthcare Providers and Systems surveys were evaluated. Pain control, communication, and hospital satisfaction were stratified into satisfactory or unsatisfactory groups. These 2 groups were compared in terms of visual analog scale (VAS), opioid use in morphine equivalents, length of hospital stay, anesthesia type, and demographics., Results: Average VAS and opioid use did not differ between patient groups for any of the questions evaluated. Those who responded "always" to pain domain questions had a statistically shorter length of stay compared to patients with other response. On average, those who endorsed "always" on communication question were younger., Conclusions: Patients who endorsed satisfactory pain control and communication with staff had shorter lengths of stay. There was no relationship between survey scores and traditional pain control measures such as VAS and opioid use. This questions the relevance of our primary pain measures in assessing patient perception of pain control. Length of stay may be a better surrogate marker for patient satisfaction of pain control.

Background: A number of surgical options exist for decompressing lumbar foraminal stenosis. Flexible shaver foraminotomy is a recent addition to this armamentarium. While the foraminotomy device has been incorporated into clinical practice, the literature on its safety and efficacy remain limited. We aimed to evaluate nerve safety, pain relief, and patient satisfaction in a series of patients treated with the iO-Flex shaver system (Amendia, Inc., Marietta, Georgia)., Methods: Thirty-one consecutive patients with lumbar foraminal stenosis underwent foraminal decompression using the flexible microblade shaver system at 62 neuroforamina. The shavers were inserted into each foramen using an open hemilaminotomy and fluoroscopic guidance. Nerve mapping via mechanomyography (MMG) was used to ensure nerve safety. Perioperative charts were reviewed to find the incidence of neurologic complications and to quantify pain relief. Average office-based follow-up was 5.3 months. A 3-item questionnaire was administered to assess patient satisfaction during late follow-up, which occurred at an average of 21 months., Results: No planned iO-Flex foraminotomies were aborted. Neurologic complications included transient dysesthetic pain in 1 patient (3.2%, n  = 31), and transient numbness in 3 patients (9.7%, n  = 31). There were no motor deficits. The composite nerve complication rate was 12.7%. Preoperative visual analog scale scores decreased from a mean of 7.1 ( n  = 31, standard deviation [SD] 2.0) to a mean of 3.5 ( n  = 30, SD 2.5). If asked to repeat their decision to do surgery, 81% of patients would redo the procedure. The rate of patient dissatisfaction was 19%., Conclusions: Decompression of lumbar foramina using the flexible shaver system and MMG nerve mapping is safe and effective, although the short-term sensory complication with this technique may be higher than previously reported. Patient satisfaction with iO-Flex foraminotomy is comparable to reported satisfaction outcomes for traditional lumbar decompression., Level of Evidence: 4., Competing Interests: Disclosures and COI: Stephen Bartol, MD, has a private investment in Sentio, LLC (20%, paid directly to the author), and is an advisor to the Musculoskeletal Transplant Foundation (paid directly to the author and his institution). For the remaining authors, none were declared.

Aim: The aim of the present study was to investigate the association between the activities of daily living and the oral health-related quality of life and dementia in older adults., Methods: Over a period of 18 months, we visited 12 elderly care facilities and recruited 375 participants, 345 of whom were selected to undergo oral health examinations and oral health-related surveys. Each investigation was carried out face-to-face by a professional worker., Results: Cognitive ability was found to be good when the results of the activities of daily living and the oral health-related quality of life examinations were good. If the results of the activities of daily living examination were bad, the odds ratio of dementia was 2.66, and adjusted odds ratio for age, sex, residence type, education level and denture was 2.99, representing a significant difference (P < 0.05)., Conclusions: Most oral problems are not simply the outcome of aging, with oral hygiene management being the most important determining factor. Oral health problems can be prevented, and in order to improve the quality of life of older adults, attention must be paid to oral healthcare. Geriatr Gerontol Int 2018; 18: 943-949., (© 2018 Japan Geriatrics Society.)

Purpose: To determine if patients treated with a single-shot femoral nerve block have strength and functional deficits at 9-month follow-up., Methods: Forty-three patients who underwent primary anterior cruciate ligament reconstructions were randomized to receive either a preoperative single-shot femoral nerve block or local infiltration anesthesia for primary pain control. All patients underwent a standardized comprehensive rehabilitation program postoperatively. Isokinetic strength and function was tested using a Biodex machine at 9 months or more postoperatively comparing the operative and nonoperative extremity., Results: No significant difference in strength was found at an average of 10.6 months postoperatively (range, 9-15 months) between the femoral nerve block and control groups. In comparing strength deficits, we found no difference in slow isokinetic extension strength (22.4% vs 27.8%, P = .51), fast isokinetic extension strength (18.5% vs 12.5%, P = .41), slow isokinetic flexion strength (11.0% vs 15.1%, P = .55), and fast isokinetic flexion strength (8.2% vs 4.9%, P = .56) in the femoral nerve block versus control groups, respectively. In terms of functional outcomes, there also was no difference in deficits for single-leg hop distance (P = .12), timed single-leg hop (P = .74), and single-leg triple hop distance (P = .94). Maximal strength noted to be within 15% of the contralateral limb was achieved in 40% of patients and maximal function in 63% of patients at an average of 10.6 months postoperatively. A 13% complication rate was found in patients who received a femoral nerve block (1 with prolonged quadriceps inhibition and 2 with prolonged sensory disturbances)., Conclusions: Our study found a 13% motor/sensory complication rate in patients who underwent femoral nerve block for pain control after anterior cruciate ligament reconstruction. Although these deficits may persist, they are not permanent and are not different when compared with controls at 9-month follow-up. However, maximal strength and function are not fully restored at normal return to play time and rehabilitation should continue long term to maximize recovery., Level of Evidence: Level I, prospective randomized trial., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

WNT1-inducible-signaling pathway protein-1 (WISP-1) belongs to the family of cysteine rich 61/connective tissue growth factor/nephroblastoma overexpressed matricellular proteins, which are involved in various biological processes, including cell adhesion, proliferation, differentiation, angiogenesis and carcinogenesis. In the present study, the expression of WISP-1 was investigated, and its association with clinicopathological factors and prognosis in patients with oral squamous cell carcinoma (OSCC) was evaluated. Additionally, the role of WISP-1 in invasion and apoptosis of human OSCC cells was evaluated. Immunoreactivity of WISP-1 was increased in OSCC tissue compared with adjacent normal tissue samples. High expression of WISP-1 protein was observed in 24/84 (28.57%) OSCC specimens. Additionally, high WISP-1 expression was significantly associated with treatment failure (P=0.042). The 5-year overall survival rate was 33% in patients with high WISP1 expression, and 66% in patients with low WISP-1 expression. WISP-1 expression in the human OSCC SCC-1483 cell line was observed. Furthermore, WISP-1 knockdown using small interfering (si)RNA significantly reduced cell invasion and induced apoptosis compared with control siRNA-transfected cells. These findings suggested that WISP-1 is associated with tumor progression and poor prognosis by increasing tumor cell invasion and inhibiting cell apoptosis in human OSCC.

Rationale: Solitary fibrous tumor (SFT) is a rare benign soft tissue mesenchymal neoplasm. There have been a few reports of extrapleural SFTs although it can occur anywhere in the body., Patient Concerns: A 30-year-old male presented with an anterior neck mass since one month., Diagnoses: Based on physical and radiologic examination, preliminary differential diagnosis was thymic neoplasm or intrathoracic goiter., Interventions: We performed surgical excision of the neck mass., Outcomes: The histopathological examination revealed an extrapleural SFT LESSONS:: We present a case of extrapleural SFT in the thymus which was misdiagnosed as thymoma based on radiologic findings.

We report a case of methicillin-resistant Staphylococcus aureus (MRSA) otorrhea with impression material of hearing aid in the middle ear. The patient had chronic otitis media in the right ear with sensorineural hearing loss in both ears. The silicone flowed into the middle ear through a tympanic membrane perforation during the process of making an ear mold. Several days after hearing aid fitting, the patient had severe otalgia, intractable otorrhea, aggravated hearing loss, and dizziness. The pus culture and sensitivity test revealed MRSA. After topical treatment using diluted vinegar irrigation and ototopical vancomycin solution, intractable otorrhea was controlled. The infected silicone impression was removed by canal wall-up mastoidectomy, and hearing was saved. We present here a review of the literature regarding silicone impression in the middle ear after hearing aid mold fitting., Competing Interests: Conflicts of interest: The authors have no financial conflicts of interest.

Drynaria fortunei (D. fortunei), widely used in traditional Korean medicine, is reportedly effective in treating inflammation, hyperlipidemia, bone fractures, oxidative damage, arteriosclerosis, rheumatism, and gynecological diseases. The objective of this study was to evaluate the antibacterial effects of the chloroform fraction of D. fortunei (DFCF) and assess the synergistic effects of DFCF with antibiotics against bacterial pathogens. This was carried out by calculating the minimal inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) and performing checkerboard dilution test and time-kill assays. The MICs/MBCs for DFCF, ampicillin, and gentamicin against all oral strains were >39-2,500/5,000 μg/mL, 0.25-64/0.25-64 µg/mL, and 0.5-256/1-512 µg/mL, respectively. DFCF exhibited the highest activity against the periodontic pathogens Prevotella intermedia and Porphylomonas gingivalis. DFCF in combination with ampicillin showed a strong synergistic effect against oral bacteria (fractional inhibitory concentration (FIC) index ≤0.5), whereas on combining with gentamicin, it reduced the on half-eighth times than used alone (FICI ≤ 0.5). DFCF combined with ampicillin or gentamicin killed 100% of most tested bacteria within 3-4 h. The results of this study demonstrate the antimicrobial and synergistic activity of DFCF and antibiotics against oral pathogens.

Background: Anterior cruciate ligament (ACL) reconstruction is a common outpatient procedure that is accompanied by significant postoperative pain., Purpose: To determine differences in acute pain levels between patients undergoing ACL reconstruction with bone-patellar tendon-bone (BTB) versus hamstring tendon (HS) autograft., Study Design: Cohort study; Level of evidence, 2., Methods: A total of 70 patients who underwent primary ACL reconstruction using either BTB or HS autografts consented to participate. The primary outcome of the study was postoperative pain levels (visual analog scale), which were collected immediately after surgery and for 3 days postoperatively. Secondary outcome measures included opioid consumption (intravenous morphine equivalents), hours slept, patient satisfaction, reported breakthrough pain, and calls to the physician., Results: Patients treated with BTB had increased pain when compared with those treated with HS in the acute postoperative period (mean ± SD: day 0, 6.0 ± 1.7 vs 5.2 ± 2.0 [ P = .066]; day 1, 5.9 ± 1.7 vs 4.9 ±1.7 [ P = .024]; day 2, 5.2 ± 1.9 vs 4.1 ± 2.0 [ P = .032]; day 3, 4.8 ± 2.1 vs 3.9 ± 2.3 [ P = .151]). There were also significant increases in reported breakthrough pain (day 0, 76% vs 43% [ P = .009]; day 1, 64% vs 35% [ P = .003]) and calls to the physician due to pain (day 1, 19% vs 0% [ P = .041]) in the BTB group. There were no significant differences in narcotic requirements or sleep disturbances. Overall, the BTB group reported significantly less satisfaction with pain management on days 0 and 1 ( P = .024 and .027, respectively)., Conclusion: A significant increase in acute postoperative pain was found when performing ACL reconstruction with BTB compared with HS. Patients treated with BTB were more likely to have breakthrough pain, decreased satisfaction with their pain management, and to contact their physician due to pain. These findings suggest a difference in early postoperative pain between the 2 most common graft options for ACL reconstruction. Patients should be informed of the differences in acute postoperative pain when deciding on graft choice with their physician., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

The enantioselective synthesis of 2,3-disubstituted benzomorpholines, analogues of 1,4-benzodioxane natural products, has been achieved via addition of electron-rich aromatic donors to acyl-iminium ions derived from benzomorpholine aminols. Subsequent modification of the benzomorpholine scaffold allows side chains mimicking those found in 1,4-benzodioxane lignans to be added. Antiproliferative testing of the prepared analogues showed promising results against MDA-MB-231 and HCT116 cancer cell lines.

Objective: Recently, minimally invasive transcanal myringotomy (MITM), which is a useful surgical technique for early stage congenital cholesteatoma (CC) in children, was introduced. The purpose of this study is to evaluate the short-term surgical results of MITM in pediatric early stage CC., Materials and Methods: We retrospectively reviewed the charts of 24 patients who underwent MITM between January 2013 and October 2015., Results: The patients' ages ranged from 1 to 16 years (mean, 2.6 years). There were 17 male and 7 female patients. The right side (n = 13) was affected twice as often as the left side (n = 11). The most common site was the anterosuperior quadrant (15 cases). The diameter of the CC on axial computed tomography images ranged from 2.8 to 5.7 mm (mean, 3.9 mm). CCs were graded according to Potsic's system: 18 cases were classified as stage I, 3 case as stage II, and 3 cases as stage III. AllCCs except 1 were closed type. In21 patients, the tympanic membrane closed naturally without recurrence. Three patients showed small persistent dry perforation. Natural closure occurred in these patients, who were treated with paper patches., Conclusion: MITM is a simple, effective technique for removing an early stage CC from the middle ear, and it can minimize operative time, length of hospitalization, and postoperative morbidity., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To compare femoral nerve block (FNB) versus local liposomal bupivacaine (LB) for pain control in patients undergoing anterior cruciate ligament (ACL) reconstruction., Methods: Eighty-five patients undergoing primary ACL reconstruction were assessed for participation. We performed a prospective randomized trial in accordance with the CONSORT (Consolidated Standards of Reporting Trials) 2010 statement. The study arms included either intraoperative local infiltration of LB (20 mL of bupivacaine/10 mL of saline solution) or preoperative FNB with a primary outcome of postoperative pain levels (visual analog scale) for 4 days. Secondary outcomes assessed included opioid consumption (intravenous morphine equivalents), hours slept, patient satisfaction, and calls to the physician. Randomization was by a computerized algorithm. The observer was blinded and the patient was not blinded to the intervention., Results: One patient declined participation; 2 patients were excluded after randomization. A total of 82 patients were analyzed. Outcomes showed a significant increase in pain in the LB group between 5 and 8 hours postoperatively (mean ± standard deviation, 6.3 ± 2.0 versus 4.8 ± 2.6; P = .01). There were no significant differences between the groups in mean daily pain levels, morphine equivalents, or patient satisfaction when we controlled for graft type, age, body mass index, and sex. Patients receiving an FNB had a nonsignificant increase in number of sleep disturbances on the day of surgery (mean ± standard deviation, 4.4 ± 3.7 v 3.1 ± 2.1; P = .09) and were more likely to call their doctor the following day because of pain (29% v 8%, P = .04). Six patients in the FNB group had either prolonged quadriceps inhibition or sensory disturbance. One patient in the LB group required reoperation for a flexion contracture., Conclusions: An increase in acute postoperative pain was found with LB compared with FNB for post-ACL reconstruction pain control. After the acute postoperative period, there were no significant differences in opioid consumption or pain control. The occurrence of nerve irritation postoperatively was found to be higher in the FNB group., Level of Evidence: Level I, prospective randomized trial., (Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background & Objective: External auditory canal cholesteatoma (EACC) is caused by an invasion of squamous tissue into a localized area of periosteitis in the bony canal wall. The clinical characteristics of pediatric EACC are still unknown because of its rare occurrence. To date, only a single paper has reported that pediatric EACC has a less aggressive growth pattern compared to adult EACC. Further studies are required to understand the clinical behavior of EACC, i.e., its aggressiveness. The purpose of this study was to evaluate the clinical characteristics of pediatric EACC., Materials and Methods: The clinical records of all patients diagnosed with EACC in our department from January 1, 2012 to February 29, 2016 were retrospectively reviewed, focusing on the extension of bone erosion, symptoms, and clinical findings., Results: Seven patients had primary pediatric EACC (age range, 5-17 years). All patients showed unilateral EACC. Otalgia and intermittent otorrhea were common symptoms. Bacterial cultures were performed for four patients with otorrhea, which was controlled by diluted vinegar irrigation with a topical antibiotic solution. The most common bone destruction sites were the inferior and posterior walls. All patients required surgical treatment. Four patients (patient nos. 1, 3, 4, and 5) were treated via a postauricular transcanal approach. Three patients (patient nos. 2, 6, and 7) required mastoidectomy., Conclusion: Pediatric EACC is not less aggressive than adult EACC. Therefore, early diagnosis and adequate treatment are necessary. Further studies are required to elucidate the clinical features of pediatric spontaneous EACC., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Using mobile communication technology as new personalized approach to treat mental disorders or to more generally improve quality of life is highly promising. Knowledge about intervention components that target key psychopathological processes in terms of transdiagnostic psychotherapy approaches is urgently needed. We explored the use of smartphone-based micro-interventions based on psychotherapeutic techniques, guided by short video-clips, to elicit mood changes., Method: As part of a larger neurofeedback study, all subjects-after being randomly assigned to an experimental or control neurofeedback condition-underwent daily smartphone-based micro-interventions for 13 consecutive days. They were free to choose out of provided techniques, including viscerosensory attention, emotional imagery, facial expression, and contemplative repetition. Changes in mood were assessed in real world using the Multidimensional Mood State Questionnaire (scales: good-bad, GB; awake-tired, AT; and calm-nervous, CN)., Results: Twenty-seven men participated on at least 11 days and were thus included in the analyses. Altogether, they underwent 335, generally well-tolerated, micro-intervention sessions, with viscerosensory attention (178 sessions, 53.13%) and contemplative repetition (68 sessions, 20.30%) being the most frequently applied techniques. Mixed models indicated that subjects showed better mood [GB: b = 0.464, 95%confidence interval (CI) [0.068, 0.860], t (613.3) = 2.298, p = 0.022] and became more awake [AT: b = 0.514, 95%CI [0.103, 0.925], t (612.4) = 2.456, p = 0.014] and calmer [CN: b = 0.685, 95%CI [0.360, 1.010], t (612.3) = 4.137, p < 0.001] from pre- to post-micro-intervention. These mood improvements from pre- to post-micro-intervention were associated with changes in mood from the 1st day until the last day with regard to GB mood (r = 0.614, 95%CI [0.297, 0.809], p < 0.001), but not AT mood (r = 0.279, 95%CI [-0.122, 0.602], p = 0.167) and CN mood (r = 0.277, 95%CI [0.124, 0.601], p = 0.170)., Discussion: Our findings provide evidence for the applicability of smartphone-based micro-interventions eliciting short-term mood changes, based on techniques used in psychotherapeutic approaches, such as mindfulness-based psychotherapy, transcendental meditation, and other contemplative therapies. The results encourage exploring these techniques' capability to improve mood in randomized controlled studies and patients. Smartphone-based micro-interventions are promising to modify mood in real-world settings, complementing other psychotherapeutic interventions, in line with the precision medicine approach. The here presented data were collected within a randomized trial, registered at ClinicalTrials.gov (Identifier: NCT01921088) https://clinicaltrials.gov/ct2/show/NCT01921088.

A series of pyrrole analogues of combretastatin (CA-4) were synthesized and tested for their anti-proliferative activity. The highly diastereoselective acyl-Claisen rearrangement was used to provide 2,3-syn disubstituted morpholine amides which were used as precursors for the various analogues. This synthesis allows for the preparation of 1,2- and 2,3-diaryl-1H-pyrroles which are both geometrically similar to CA-4. These pyrrolic analogues were tested for their anti-proliferative activity against two human cell lines, K562 and MDA-MB-231 with 2,3-diaryl-1H-pyrrole 35 exhibiting the most potent activity with IC50 value of 0.07μM against MDA-MB-231 cell line., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: The number of Major League Baseball (MLB) pitchers requiring ulnar collateral ligament (UCL) reconstructions is increasing. Recent literature has attempted to correlate specific stresses placed on the throwing arm to risk for UCL injury, with limited results., Methods: Eighty-three MLB pitchers who underwent primary UCL reconstruction were evaluated. Pitching velocity and percent of pitch type thrown (fastball, curve ball, slider, and change-up) were evaluated 2 years before and after surgery. Data were compared with control pitchers matched for age, position, size, innings pitched, and experience., Results: The evaluation of pitch velocity compared with matched controls found no differences in pre-UCL reconstruction pitch velocities for fastballs (91.5 vs. 91.2 miles per hour [mph], P = .69), curveballs (78.2 vs. 77.9 mph, P = .92), sliders (83.3 vs. 83.5 mph, P = .88), or change-ups (83.9 vs. 83.8 mph, P = .96). When the percentage of pitches thrown was evaluated, UCL reconstructed pitchers pitch significantly more fastballs than controls (46.7% vs. 39.4%, P = .035). This correlated to a 2% increase in risk for UCL injury for every 1% increase in fastballs thrown. Pitching more than 48% fastballs was a significant predictor of UCL injury, because pitchers over this threshold required reconstruction (P = .006)., Conclusion: MLB pitchers requiring UCL reconstruction do not pitch at higher velocities than matched controls, and pitch velocity does not appear to be a risk factor for UCL reconstruction. However, MLB pitchers who pitch a high percentage of fastballs may be at increased risk for UCL injury because pitching a higher percent of fastballs appears to be a risk factor for UCL reconstruction., (Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

We report a case of a 23-year-old female immigrant from China who was diagnosed with multidrug-resistant tuberculosis affecting her lung and brain, resistant to the standard first-line therapeutics and streptomycin. She was treated with prothionamide, moxifloxacin, cycloserine, and kanamycin. However, her headache and brain lesion worsened. After the brain biopsy, the patient was confirmed with intracranial tuberculoma. Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response. Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered. To our knowledge, this case is the first multidrug-resistant tuberculosis that disseminated to the brain in Korea.