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PURPOSE: The aim of this study was to assess quantitatively whether a symmetric reconstruction of the calvaria could be achieved using 3-dimensional (3D) custom-made implants and to examine any complications caused by the cranioplasty. PATIENTS AND METHODS: Custom-made cranial implants were produced using data obtained from computed tomographic scanning of the defect using computer-aided design and rapid prototyping techniques. Polymethylmethacrylate was used as the reconstruction material and the implant was cast from a silicone rubber mold. These implants were used in 10 patients (9 men and 1 woman) who previously received a craniectomy. The symmetry gained after cranioplasty was quantified by volumetric analysis using 3D reconstructed postoperative computed tomographic imaging. Any complications after cranioplasty also were recorded. RESULTS: The average follow-up was 42.5 months (range, 7 to 85 mo). The esthetic appearance of all patients was much improved. When the volume of the reconstructed right calvaria was compared with the left calvaria, the difference was not statistically significant (P > .05). There were 2 cases of complications. One exhibited a transient seroma collection. Another had a wrinkle formation in the forehead. No infectious episodes or signs of plate rejection were encountered. CONCLUSIONS: The custom-made implants for cranioplasty showed a significant improvement in morphology. The implants may be very useful for repairing large and complex-shaped cranial defects. The technique may be useful for the bone reconstruction of other sites. [ABSTRACT FROM AUTHOR]

Porcine reproductive and respiratory syndrome (PRRS) poses a significant challenge in the global swine industry, leading to substantial economic losses and reproductive and respiratory complications. The causative agent, PRRS virus (PRRSV), with its high mutation rate, complicates the development of universally effective vaccines. Furthermore, current PRRS vaccines are limited by high costs and complex administration methods. Therefore, in this study, we aimed to develop an innovative Bacillus subtilis spore-based oral vaccine targeting PRRS. Their oral administration was evaluated in mice and pigs, and blood, saliva, feces, and bronchoalveolar lavage fluid samples were collected for further analyses. Our vaccine induced IgG and IgA immune responses in both models, with swine demonstrating considerable increase in specific antibody and cytokine levels. These results indicate a high potential for more effective and economically viable control of PRRS in commercial pig farming. The ease of administration and cost-effectiveness of the vaccine also offer a feasible option for widespread application. Our results suggest a new direction in veterinary vaccine development, underscoring the potential of B. subtilis spores in creating effective vaccines for large-scale, real-world applications in animal health management., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Psilocybin, a psychoactive substance, has recently garnered attention for its high therapeutic potential in psychiatry. In this study, we investigated the multifaceted aspects of psilocybin, highlighting its chemical properties, mechanisms of action, and burgeoning role in psychiatric treatment. Furthermore, we examined the clinical applications and potential therapeutic benefits of psilocybin in the treatment of various mental health disorders, supported by accumulating clinical evidence. This review aims to deepen our understanding of the clinical impact of psilocybin, elucidate its therapeutic value, and propose directions for future research, thereby paving the way for its integration into mainstream psychiatric treatments. Psilocybin has been shown to be safe in clinical trials with manageable side effects. However, additional safety measures are required after this discussion, including dosing protocols, patient monitoring, and distress management strategies., Competing Interests: Authors SP and JH were employed by the company NeoCannBio Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Min, Park, Park, Na, Lee, Kim, Ham and Park.)

A 10 yr old spayed female ragdoll cat presented with sudden onset of sneezing, nasal discharge, and stertor. There was no improvement in clinical signs despite treatment with antibiotics, feline interferon, and nebulization. A computed tomography (CT) scan revealed findings consistent with chronic rhinitis, and a tissue biopsy obtained by rhinoscopy led to a histopathologic diagnosis of sinonasal aspergillosis. Polymerase chain reaction amplification identified the causative agent as Aspergillus udagawae. Oral itraconazole therapy was initiated. However, the cat's clinical signs progressed to include left exophthalmos, nictitating membrane protrusion, and lacrimation. A second CT scan revealed a soft-tissue attenuating structure extending into the left retrobulbar space, confirming progression to sino-orbital aspergillosis (SOA). The oral medication was changed to posaconazole and continued for 5 mo, resulting in resolution of the clinical signs. The cat has remained asymptomatic over 24 mo since initial diagnosis. This case represents the first successful treatment of feline SOA caused by A udagawae infection with posaconazole. A udagawae is the second most common cause of SOA and is known to be intractable because of its low susceptibility to antifungal agents and poor response to topical clotrimazole. Posaconazole may be a valuable treatment option for SOA caused by A udagawae., (© 2024 by American Animal Hospital Association.)

Background: Small clinics are important in providing health care in local communities. Accurately predicting their closure would help manage health care resource allocation. There have been few studies on the prediction of clinic closure using machine learning techniques., Objective: This study aims to test the feasibility of predicting the closure of medical and dental clinics (MCs and DCs, respectively) and investigate important factors associated with their closure using machine running techniques., Methods: The units of analysis were MCs and DCs. This study used health insurance administrative data. The participants of this study ran and closed clinics between January 1, 2020, and December 31, 2021. Using all closed clinics, closed and run clinics were selected at a ratio of 1:2 based on the locality of study participants using the propensity matching score of logistic regression. This study used 23 and 19 variables to predict the closure of MCs and DCs, respectively. Key variables were extracted using permutation importance and the sequential feature selection technique. Finally, this study used 5 and 6 variables of MCs and DCs, respectively, for model learning. Furthermore, four machine learning techniques were used: (1) logistic regression, (2) support vector machine, (3) random forest (RF), and (4) Extreme Gradient Boost. This study evaluated the modeling accuracy using the area under curve (AUC) method and presented important factors critically affecting closures. This study used SAS (version 9.4; SAS Institute Inc) and Python (version 3.7.9; Python Software Foundation)., Results: The best-fit model for the closure of MCs with cross-validation was the support vector machine (AUC 0.762, 95% CI 0.746-0.777; P<.001) followed by RF (AUC 0.736, 95% CI 0.720-0.752; P<.001). The best-fit model for DCs was Extreme Gradient Boost (AUC 0.700, 95% CI 0.675-0.725; P<.001) followed by RF (AUC 0.687, 95% CI 0.661-0.712; P<.001). The most significant factor associated with the closure of MCs was years of operation, followed by population growth, population, and percentage of medical specialties. In contrast, the main factor affecting the closure of DCs was the number of patients, followed by annual variation in the number of patients, year of operation, and percentage of dental specialists., Conclusions: This study showed that machine running methods are useful tools for predicting the closure of small medical facilities with a moderate level of accuracy. Essential factors affecting medical facility closure also differed between MCs and DCs. Developing good models would prevent unnecessary medical facility closures at the national level., (©Young-Taek Park, Donghan Kim, Ji Soo Jeon, Kwang Gi Kim. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.08.2024.)

Inflammatory bowel disease (IBD) is a chronic disorder characterized by recurrent gastrointestinal inflammation, lacking a precise aetiology and definitive cure. The gut microbiome is vital in preventing and treating IBD due to its various physiological functions. In the interplay between the gut microbiome and human health, extracellular vesicles secreted by gut bacteria (BEVs) are key mediators. Herein, we explore the role of Roseburia intestinalis (R)-derived EVs (R-EVs) as potent anti-inflammatory mediators in treating dextran sulfate sodium-induced colitis. R was selected as an optimal BEV producer for IBD treatment through ANCOM analysis. R-EVs with a 76 nm diameter were isolated from R using a tangential flow filtration system. Orally administered R-EVs effectively accumulated in inflamed colonic tissues and increased the abundance of Bifidobacterium on microbial changes, inhibiting colonic inflammation and prompting intestinal recovery. Due to the presence of Ile-Pro-Ile in the vesicular structure, R-EVs reduced the DPP4 activity in inflamed colonic tissue and increased the active GLP-1, thereby downregulating the NFκB and STAT3 via the PI3K pathway. Our results shed light on the impact of BEVs on intestinal recovery and gut microbiome alteration in treating IBD., (© 2024 The Author(s). Journal of Extracellular Vesicles published by Wiley Periodicals LLC on behalf of International Society for Extracellular Vesicles.)

The use of mobile-based personal health record (m-PHR) applications at the hospital level has been minimally studied. This study aimed to investigate the relationship between m-PHR use and quality of care. A cross-sectional study design was employed, analyzing data from 99 hospitals. Two data sources were utilized: a previous m-PHR investigation conducted from 26 May to 30 June 2022 and a hospital evaluation dataset on quality of care. The use of m-PHR applications was measured by the number of m-PHR application downloads. Three independent variables were assessed: quality of care in the use of antibiotic drugs, injection drugs, and polypharmacy with ≥6 drugs. A generalized linear model was used for the analysis. The hospitals providing high-quality care, as evaluated based on the rate of antibiotic prescription (relative risk [RR], 3.328; 95% confidence interval [CI], 1.840 to 6.020; p < 0.001) and polypharmacy (RR, 2.092; 95% CI, 1.027 to 4.261; p = 0.042), showed an increased number of m-PHR downloads. Among the hospital covariates, public foundation status and being part of multi-hospital systems were associated with the number of m-PHR downloads ( p < 0.05). This exploratory study found a positive relationship between quality of care and m-PHR use. Hospitals providing high-quality care may also excel in various activities, including m-PHR application use.

The world is fighting infectious diseases. Therefore, effective antimicrobials are required to prevent the spread of microbes and protect human health. Zinc oxide (ZnO) nano-materials are known for their antimicrobial activities. Because of their distinctive physical and chemical characteristics, they can be used in medical and environmental applications. ZnO-based composites are among the leading sources of antimicrobial research. They are effective at killing (microbicidal) and inhibiting the growth (microbiostatic) of numerous microorganisms, such as bacteria, viruses, and fungi. Although most studies have focused on the microbicidal features, there is a lack of reviews on their microbiostatic effects. This review provides a detailed overview of available reports on the microbiostatic activities of ZnO-based nano-materials against different microorganisms. Additionally, the factors that affect the efficacy of these materials, their time course, and a comparison of the available antimicrobials are highlighted in this review. The basic properties of ZnO, challenges of working with microorganisms, and working mechanisms of microbiostatic activities are also examined. This review underscores the importance of further research to better understand ZnO-based nano-materials for controlling microbial growth.

Background: Perfluoroalkyl substances (PFAS) are widely used in industry and daily life due to their useful properties. They have a long half-life, accumulate in the body, and there is evidence that they are associated with biomarkers of lipid metabolism and liver damage. This may suggest non-alcoholic fatty liver disease (NAFLD) caused by PFAS. However, since there has been no study analyzing the relationship between PFAS and NAFLD in the entire population in Korea. We sought to confirm the relationship between serum PFAS concentration and NAFLD prevalence in Korean adults using the Korean National Environmental Health Survey (KoNEHS) cycle 4., Methods: The study was conducted on 2,529 subjects in 2018-2019 among KoNEHS participants. For the diagnosis of NAFLD, the hepatic steatosis index (HSI) was used, and the geometric mean and concentration distribution of serum PFAS were presented. Logistic regression was performed to confirm the increase in the risk of NAFLD due to changes in PFAS concentration, and the odds ratio and 95% confidence interval (CI) were calculated., Results: In both adjusted and unadjusted models, an increased odds ratio was observed with increasing serum concentrations of total PFAS and perfluorooctane sulfonate (PFOS) in the non-obese group. In the adjusted model, the odds ratios for serum total PFAS and PFOS were 6.401 (95% CI: 1.883-21.758) and 7.018 (95% CI: 2.688-18.319)., Conclusions: In this study, a higher risk of NAFLD based on HSI was associated with serum total PFAS, PFOS in non-obese group. Further research based on radiological or histological evidence for NAFLD diagnosis and long-term prospective studies are necessary. Accordingly, it is necessary to find ways to reduce exposure to PFAS in industry and daily life., Competing Interests: Competing interests: The authors declare that they have no competing interests., (Copyright © 2024 Korean Society of Occupational & Environmental Medicine.)

Polymeric foams, also known as three-dimensional (3D) polymeric sponges, are lightweight, flexible, compressible, and possess a high surface area compared with other bulk polymers. These sponges have traditionally been used for mattresses or seat cushions in homes, offices, aircraft, automobiles, and trains, and to insulate against heat, electricity, and noise. Recently, the demand for modern materials has expanded the application of polymeric foams to various high-value technologies, including in areas that need high flame retardancy, flame sensors, oil/water separation, metal adsorption, solar steam generation, piezoresistivity, electromagnetic interference shielding, thermal energy storage, catalysis, supercapacitors, batteries, and triboelectric energy harvesting. Proper modification of foams is a prerequisite for their use in high-value applications. Several new strategies for the surface coating of 3D porous foams and novel emerging applications have been recently developed. Therefore, in this review, current advances in the field of surface coating and the application of 3D polymeric foams are discussed. A brief background on 3D polymeric foams, including the unique properties and benefits of polymeric sponges and their routes of synthesis, is presented. Different coating strategies for polymeric sponges are discussed, and their advantages and drawbacks are highlighted. Different advanced applications of polymeric sponges, in conjunction with specific and detailed examples of the above-mentioned applications, are also described. Finally, challenges and potential applications related to the coating of polymeric foams are discussed. We envisage that this review will be useful to facilitate further research, promote continued efforts on the advanced applications mentioned above, and provide new stimuli for the design of novel polymeric sponges for future modern applications., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships that may have influenced the work reported in this study., (Copyright © 2023. Published by Elsevier B.V.)

Objectives: This study aimed to evaluate the incidence of health insurance claims recording the cancer stage and TNM codes representing tumor extension size (T), lymph node metastasis (N), and distant metastasis (M) for patients diagnosed with cancer and to determine whether this extracted data could be applied to the new ICD-11 codes., Design: A cross-sectional study design was used, with the units of analysis as individual outpatients. Two dependent variables were extraction feasibility of cancer stage and TNM metastasis information from each claim. Expressibility of the two variables in ICD-11 was descriptively analysed., Setting and Participants: The study was conducted in South Korea and study participants were outpatients: lung cancer (LC) (46616), stomach cancer (SC) (50103) and colorectal cancer (CC) (54707). The data set consisted of the first health insurance claim of each patient visiting a hospital from 1 July to 31 December 2021., Results: The absolute extraction success rates for cancer stage based on claims with cancer stage was 33.3%. The rates for stage for LC, SC and CC were 30.1%, 35.5% and 34.0%, respectively. The rate for TNM was 11.0%. The relative extraction success rates for stage compared with that for CC (the reference group) were lower for patients with LC (adjusted OR (aOR), 0.803; 95% CI 0.782 to 0.825; p<0.0001) but higher for SC (aOR 1.073; 95% CI 1.046 to 1.101; p<0.0001). The rates of TNM compared that for CC were 40.7% lower for LC (aOR, 0.593; 95% CI 0.569 to 0.617; p<0.0001) and 43.0% lower for SC (aOR 0.570; 95% CI 0.548 to 0.593; p<0.0001). There were limits to expressibility in ICD-11 regarding the detailed cancer stage and TNM metastasis codes., Conclusion: Extracting cancer stage and TNM codes from health insurance claims were feasible, but expressibility in ICD-11 codes was limited. WHO may need to create specific cancer stage and TNM extension codes for ICD-11 due to the absence of current rules in ICD-11., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: As unpredictable work schedule (UWS) has increased worldwide, various studies have been conducted on the resulting health effects on workers. However, research on the effect of UWS on workers' well-being in Korea is still insufficient. This study aimed to investigate the relationship between UWS and work-family conflict (WFC) using 6th Korean Working Conditions Survey (KWCS)., Methods: Both UWS and WFC were measured using self-reported questionnaires, using data from the 6th KWCS conducted between 2020 and 2021, including 31,859 participants. UWS was measured by questions regarding the frequency of changes in work schedules and limited advanced notice. WFC was measured by questions regarding work to family and family to work conflicts. Logistic regression analysis was conducted to investigate the association between UWS and WFC., Results: The prevalence of UWS was higher among men, those under 40 years old, service and sales workers and blue-collar workers, and those with higher salaries. Workplace size also influenced UWS prevalence, with smaller workplaces (less than 50 employees) showing a higher prevalence. The odds ratio (OR) for WFC was significantly higher in workers with UWS compared to workers without UWS after adjusting for gender, age, marital status, occupation, salary, education, weekly working hours, shift work, company size, and having a child under the age of 18 years, employment status (OR: 3.71; 95% confidence interval: 3.23-4.25)., Conclusions: The analysis of nationwide data revealed that UWS interferes with workers' performance of family roles, which can lead to WFC. Our findings suggest that it is crucial to implement policies to address unfair work schedule management, promoting a healthier work-life balance and fostering a conducive environment for family responsibilities., Competing Interests: Competing interests: The authors declare that they have no competing interests., (Copyright © 2023 Korean Society of Occupational & Environmental Medicine.)

Background and Aims: In biliary epithelial cells, two bile acid receptors, sphingosine 1-phosphate receptor 2 (S1PR2) and Takeda G protein-coupled receptor 5 (TGR5) have been reported to trigger cell proliferation, as well as neoplastic cell invasiveness. In this study, we aimed to investigate the clinical significance of S1PR2/ TGR5 expression in extrahepatic cholangiocarcinoma (CCA) patients., Methods: Patients who underwent surgical resection of extrahepatic CCA at Korea University Guro Hospital between 2002 and 2018 were included. Data on immunohistochemical staining and H-score of S1PR2 and TGR5 were evaluated using digital image analysis., Results: A total of 115 cases of invasive CCA were analyzed. The H-score of S1PR2 showed a decrease in invasive CCA (p=0.052) but that of TGR5 showed a significant increase (p=0.02). Overall survival and disease-free survival were significantly lower in the low S1PR2 expression group (p<0.05) than in the control group; however, TGR5 expression was not significant (p=0.096). In multivariate analysis, low S1PR2 was only significant for poor prognosis., Conclusion: Low S1PR2 level was the only independent poor prognostic factor in patients with resected extrahepatic CCA.

Cannabidiol (CBD), a primary constituent in hemp and cannabis, exerts broad pharmacological effects against various diseases, including cancer. Additionally, cabozantinib, a potent multi-kinase inhibitor, has been approved for treating patients with advanced hepatocellular carcinoma (HCC). Recently, there has been an increase in research on combination therapy using cabozantinib to improve efficacy and safety when treating patients. Here, we investigated the effect of a combination treatment of cabozantinib and CBD on HCC cells. CBD treatment enhanced the sensitivity of HCC cells to cabozantinib-mediated anti-cancer activity by increasing cytotoxicity and apoptosis. Phospho-kinase array analysis demonstrated that the apoptotic effect of the combination treatment was mainly related to p53 phosphorylation regulated by endoplasmic reticulum (ER) stress when compared to other kinases. The inhibition of p53 expression and ER stress suppressed the apoptotic effect of the combination treatment, revealing no changes in the expression of Bax, Bcl-2, cleaved caspase-3, cleaved caspase-8, or cleaved caspase-9. Notably, the effect of the combination treatment was not associated with cannabinoid receptor 1 (CNR1) and the CNR2 signaling pathways. Our findings suggest that the combination therapy of cabozantinib and CBD provides therapeutic efficacy against HCC.

The use of mobile personal health records (m-PHR) has been little studied at the organizational level. This study was to investigate the relationships of various hospital-related factors with m-PHR use in Korean hospitals. Downloads of m-PHR applications for 101 hospitals were examined from May 26 to 30 June 2022. The dependent variable was the number of m-PHR downloads, and the major independent variables included six technological, organizational, and environmental factors. As technological factors, the number of computed tomography and magnetic resonance imagery devices were significantly associated with downloads (RR = 1.119, CI = 1.022-1.226, p = 0.016; and RR = 1.155; 95% CI = 1.024-1.302, p = 0.019, respectively). At the organizational level, the number of physicians, adjusting for the number of beds, and the number of medical information management staff showed significant associations (RR = 1.059, CI = 1.019-1.100, p = 0.004; and RR = 1.026, CI = 1.002-1.050, p = 0.033, respectively). From an environmental standpoint, downloads were positively associated with the proportion of the local population of working age (20-59 years) (RR = 1.102, CI 1.022-1.189, p = 0.012). Healthcare policymakers should pay close attention to these factors to advocate for the widespread use of m-PHR applications.

Serious climate changes and energy-related environmental problems are currently critical issues in the world. In order to reduce carbon emissions and save our environment, renewable energy harvesting technologies will serve as a key solution in the near future. Among them, triboelectric nanogenerators (TENGs), which is one of the most promising mechanical energy harvesters by means of contact electrification phenomenon, are explosively developing due to abundant wasting mechanical energy sources and a number of superior advantages in a wide availability and selection of materials, relatively simple device configurations, and low-cost processing. Significant experimental and theoretical efforts have been achieved toward understanding fundamental behaviors and a wide range of demonstrations since its report in 2012. As a result, considerable technological advancement has been exhibited and it advances the timeline of achievement in the proposed roadmap. Now, the technology has reached the stage of prototype development with verification of performance beyond the lab scale environment toward its commercialization. In this review, distinguished authors in the world worked together to summarize the state of the art in theory, materials, devices, systems, circuits, and applications in TENG fields. The great research achievements of researchers in this field around the world over the past decade are expected to play a major role in coming to fruition of unexpectedly accelerated technological advances over the next decade.

Most studies related to hemp are focused on Cannabidiol (CBD) and Tetrahydrocannabinol (THC); however, up to 120 types of phytocannabinoids are present in hemp. Hemp leaves contain large amounts of Cannabidiolic acid (CBDA) and Tetrahydrocannabinolic acid (THCA), which are acidic variants of CBD and THC and account for the largest proportion of CBDA. In recent studies, CBDA exhibited anti-hyperalgesia and anti-inflammatory effects. THCA also showed anti-inflammatory and neuroprotective effects that may be beneficial for treating neurodegenerative diseases. CBDA and THCA can penetrate the blood-brain barrier (BBB) and affect the central nervous system. The purpose of this study was to determine whether CBDA and THCA ameliorate Alzheimer's disease (AD)-like features in vitro and in vivo. The effect of CBDA and THCA was evaluated in the Aβ 1-42 -treated mouse model. We observed that Aβ 1-42 -treated mice had more hippocampal Aβ and p-tau levels, pathological markers of AD, and loss of cognitive function compared with PBS-treated mice. However, CBDA- and THCA-treated mice showed decreased hippocampal Aβ and p-tau and superior cognitive function compared with Aβ 1-42 -treated mice. In addition, CBDA and THCA lowered Aβ and p-tau levels, alleviated calcium dyshomeostasis, and exhibited neuroprotective effects in primary neurons. Our results suggest that CBDA and THCA have anti-AD effects and mitigate memory loss and resilience to increased hippocampal Ca 2+ , Aβ, and p-tau levels. Together, CBDA and THCA may be useful therapeutic agents for treating AD.

Objectives: The COVID-19 pandemic affected healthcare use globally. However, there have been few studies examining how it affected age-specific healthcare use by patients as related to the locations of healthcare institutions. We explore changes in healthcare use while focusing on age-specific patient groups and facility locations after the COVID-19 pandemic., Methods: We compared two databases of cross-sectional outpatient health-insurance claims that have equivalent time points yearly and quarterly both before and after the COVID-19 pandemic. We categorized patients of healthcare institutions into five age groups and two facility locations., Results: The number of claims in 2020 significantly decreased by about 15% compared to 2019. The greatest reduction was for patients aged under 20 (-43.7%), followed by the 20-39 group (-15.0%) and the 40-59 group (-11.9%). Moreover, the number of claims significantly decreased in both urban and rural areas ( p < 0.001); however, the magnitude of this decrease was greater in urban areas (-15.2%) than in rural areas (-10.8%). The annual decrease in healthcare use by age groups and location of facility was still supported even after controlling for institutional covariates, except for the patient group aged 80 or over in rural areas., Conclusions: We found that the COVID-19 pandemic critically affected healthcare use across age-specific population groups and different locations of healthcare institutions. It suggests there is a need for further research and policy implications as to whether the declining healthcare use among those age groups is in core health care, and as to whether there are any unmet healthcare needs., Competing Interests: Authors declare that they have no conflict of interest., (© 2023 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.)

The development of triboelectric nanogenerators (TENGs) technology has advanced in recent years. However, TENG performance is affected by the screened-out surface charge density owing to the abundant free electrons and physical adhesion at the electrode-tribomaterial interface. Furthermore, the demand for flexible and soft electrodes is higher than that for stiff electrodes for patchable nanogenerators. This study introduces a chemically cross-linked (XL) graphene-based electrode with a silicone elastomer using hydrolyzed 3-aminopropylenetriethoxysilanes. The conductive graphene-based multilayered electrode was successfully assembled on a modified silicone elastomer using a cheap and eco-friendly layer-by-layer assembly method. As a proof-of-concept, the droplet-driven TENG with the chemically XL electrode of silicone elastomer exhibited an output power of approximately 2-fold improvement owing to its higher surface charge density than without XL. This chemically XL electrode of silicone elastomer film demonstrated remarkable stability and resistance to repeated mechanical deformations like bending and stretching. Moreover, due to the chemical XL effects, it was used as a strain sensor to detect subtle motions and exhibited high sensitivity. Thus, this cheap, convenient, and sustainable design approach can provide a platform for future multifunctional wearable electronic devices., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Insufficient information exists on the associations between hospitals' adoption of mobile-based personal health record (mPHR) systems and patients' characteristics. This study explored the associations between patients' characteristics and hospitals' adoption of mPHR systems in Korea. This cross-sectional study used 316 hospitals with 100 or more beds as the unit of analysis. Previously collected data on mPHR adoption from May 1 to June 30, 2020 were analyzed. National health insurance claims data for 2019 were also used to analyze patients' characteristics. The dependent variable was mPHR system adoption (0 vs 1) and the main independent variables were the number of patients, age distribution, and proportions of patients with cancer, diabetes, and hypertension among inpatients and outpatients. The number of inpatients was significantly associated with mPHR adoption (adjusted odds ratio [aOR]: 1.174; 1.117-1.233, P < .001), as was the number of outpatients (aOR: 1.041; 1.028-1.054, P  < .001). The proportion of inpatients aged 31 to 60 years to those aged 31 years and older was also associated with hospital mPHR adoption (aOR: 1.053; 1.022-1.085, P  = .001). mPHR system adoption was significantly associated with the proportion of inpatients (aOR: 1.089; 1.012-1.172, P  = .024) and outpatients (aOR: 1.138; 1.026-1.263, P  = .015) with cancer and outpatients (aOR: 1.271; 1.101-1.466, P  = .001) with hypertension. Although mPHR systems are useful for the management of chronic diseases such as diabetes and hypertension, the number of patients, younger age distribution, and the proportion of cancer patients were closely associated with hospitals' introduction of mPHR systems.

A facile new synthetic method for the preparation of a Type-A 1-arylnaphthalene lactone skeleton was developed and used to synthesise justicidin B and several derivatives. Key synthesis steps included Hauser-Kraus annulation of a phthalide intermediate and Suzuki-Miyaura cross coupling between a triflated naphthalene lactone intermediate and various potassium organotrifluoroborates. With two exceptions, the derivatives showed significant inhibitory effect on lipopolysaccharide (LPS)-induced nitric oxide (NO) production in mouse macrophages. Moreover, several compounds, including justicidin B, had marked cytotoxicity towards six human tumour cell lines.

Objectives: Many small-sized healthcare institutions play a critical role in communities by preventing infectious diseases. This study examines how they have been impacted by the global COVID-19 pandemic compared with large hospitals., Design: This study adopted a retrospective study design looking back at the healthcare utilisation of medical facilities according to size after the COVID-19 pandemic. The dependent variable was change in the number of outpatient health insurance claims before and after onset of the COVID-19 pandemic. The independent variable was an observation time point of the year 2020 compared with 2019., Setting and Participants: The study was conducted in Korea having a competitive medical provision environment under the national health insurance system. The units of analysis are hospitals and clinics: tertiary hospitals (42), general hospitals (293), small hospitals (1272) and medical clinics (27 049). This study analysed all the health insurance claim data from 1 January 2019 to 31 December 2020., Results: Compared with 2019, in 2020, there were significant decreases in the number of claims (-14.9%), particularly in small hospitals (-16.8%) and clinics (-16.3%), with smaller decreases in general hospitals (-8.9%) and tertiary hospitals (-5.3%). The reduction in healthcare utilisation increased as the size of institutions decreased. The magnitude of decrease was significantly greatest in small hospitals (absolute risk (AR): 0.8317, 0.7758 to 0.8915, p<0.0001; relative risk (RR): 0.8299, 0.7750 to 0.888, p<0.0001) followed by clinics (AR: 0.8369, 0.8262 to 0.8478, p<0.0001; RR: 0.8362, 0.8255 to 0.8470, p<0.0001) even after controlling institutional covariates., Conclusion: The external impact of the pandemic increased incrementally as the size of healthcare institutions decreased. Healthcare policy-makers need to keep in mind the possibility that small hospitals and clinics may experience reduced healthcare utilisation in the infectious disease pandemic. This fact has political implications for how healthcare policy-makers should prepare for the next infectious disease pandemic., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Sclerosing encapsulating peritonitis (SEP) is a rare clinical syndrome characterised by fibrosis and thickening of the peritoneum with massive adhesions of the abdominal organs. In humans, abdominal tumours, such as pancreatic adenocarcinoma, can be underlying diseases of SEP. This report describes a case of SEP in a dog with pancreatic ductal adenocarcinoma., Case Presentation: An 11-year-old male neutered French Bulldog presented with chronic vomiting. Ultrasonography revealed a mass in the centre of the abdomen. A small amount of ascites, interpreted as modified transudate, was present in the abdominal cavity. Computed tomography (CT) revealed peritoneal effusion with a thickened peritonium. Laparoscopy revealed a large nodular lesion occupying the central portion of the abdomen, continuous with the falciform ligament. Histological examination of the biopsy specimens of the mass, abdominal wall, and gastric peritoneum revealed marked fibroplasia with mild lymphoplasmacytic infiltrates. Based on these results, a tentative diagnosis of early stage sclerosing encapsulating peritonitis (SEP) was made. Prednisolone and tamoxifen were administered with the expectation of ameliorating SEP, however, the dog died 61 days post diagnosis. At autopsy, the intestinal loop and mesentery were encased in the fibrous membrane, which is a typical finding in SEP. Histopathology and immunohistochemistry of the samples obtained at autopsy supported the diagnosis of pancreatic ductal adenocarcinoma with peritoneal dissemination and distant metastasis with desmoplasia. The unexpectedly hardened skin, where previously laparoscopic ports were inserted, histologically contained the same carcinoma cells with desmoplasia., Conclusions: To the best of our knowledge, this is the first report of canine SEP with pancreatic ductal adenocarcinoma that also caused metastasis to port insertion sites as well as distant organs., (© 2022. The Author(s).)

Objectives: The objective of this study was to investigate the factors associated with website operation among medical facilities., Methods: A cross-sectional study design was employed to investigate 1,519 hospitals, 33,043 medical clinics (MCs), and 18,240 dental clinics (DCs) as of 2020. The main outcome variable was analyzed according to technological, organizational, and environmental factors., Results: The percentages of small hospitals, MCs, and DCs with websites were 26.4%, 9.0%, and 6.6%, respectively. For small hospitals, the nearby presence of a subway station (odds ratio [OR] = 2.772; 95% confidence interval [CI], 1.973-3.892; p < 0.0001) was the only factor significantly associated with website operation status. Among medical and dental clinics, the percentage of specialists-MCs (OR = 1.002; 95% CI, 1.000-1.004; p = 0.0175) and DCs (OR = 1.002; 95% CI, 1.001-1.004; p = 0.0061), the nearby presence of a subway station-MCs (OR = 2.954; 95% CI, 2.613-3.339; p < 0.0001) and DCs (OR = 3.444; 95% CI, 2.945-4.028; p < 0.0001), and the number of clinics in the local area-MCs (OR = 1.029; 95% CI, 1.026-1.031; p < 0.0001) and DCs (OR = 1.080; 95% CI, 1.066-1.093; p < 0.0001)-were significantly associated with website operation., Conclusions: Clinics are critically affected by internal and external factors regarding website operation relative to small hospitals. Healthcare policymakers involved with information technologies may need to pay attention to those factors associated with website dispersion among small clinics.

This paper proposes a development of automatic rib sequence labeling systems on chest computed tomography (CT) images with two suggested methods and three-dimensional (3D) region growing. In clinical practice, radiologists usually define anatomical terms of location depending on the rib's number. Thus, with the manual process of labeling 12 pairs of ribs and counting their sequence, it is necessary to refer to the annotations every time the radiologists read chest CT. However, the process is tedious, repetitive, and time-consuming as the demand for chest CT-based medical readings has increased. To handle the task efficiently, we proposed an automatic rib sequence labeling system and implemented comparison analysis on two methods. With 50 collected chest CT images, we implemented intensity-based image processing (IIP) and a convolutional neural network (CNN) for rib segmentation on this system. Additionally, three-dimensional (3D) region growing was used to classify each rib's label and put in a sequence label. The IIP-based method reported a 92.0% and the CNN-based method reported a 98.0% success rate, which is the rate of labeling appropriate rib sequences over whole pairs (1st to 12th) for all slices. We hope for the applicability thereof in clinical diagnostic environments by this method-efficient automatic rib sequence labeling system.

Faecalibacterium prausnitzii (F. prausnitzii) is one of the most abundant bacteria in the human intestine, with its anti-inflammatory effects establishing it as a major effector in human intestinal health. However, its extreme sensitivity to oxygen makes its cultivation and physiological study difficult. F. prausnitzii produces butyric acid, which is beneficial to human gut health. Butyric acid is a short-chain fatty acid (SCFA) produced by the fermentation of carbohydrates, such as dietary fibre in the large bowel. The genes encoding butyryl-CoA dehydrogenase (BCD) and butyryl-CoA:acetate CoA transferase (BUT) in F. prausnitzii were cloned and expressed in E. coli to determine the effect of butyric acid production on intestinal health using DSS-induced colitis model mice. The results from the E. coli Nissle 1917 strain, expressing BCD, BUT, or both, showed that BCD was essential, while BUT was dispensable for producing butyric acid. The effects of different carbon sources, such as glucose, N-acetylglucosamine (NAG), N-acetylgalactosamine (NAGA), and inulin, were compared with results showing that the optimal carbon sources for butyric acid production were NAG, a major component of mucin in the human intestine, and glucose. Furthermore, the anti-inflammatory effects of butyric acid production were tested by administering these strains to DSS-induced colitis model mice. The oral administration of the E. coli Nissle 1917 strain, carrying the expression vector for BCD and BUT (EcN-BCD-BUT), was found to prevent DSS-induced damage. Introduction of the BCD expression vector into E. coli Nissle 1917 led to increased butyric acid production, which improved the strain's health-beneficial effects., (© 2021 The Authors. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.)

The Korean government has implemented a pilot project that introduces a new type of hospice care program called "Consultative Hospice Care" (COHC) since August 2017. The COHC is a new type of hospice program for terminally ill patients in acute care wards, which is different from the Independent Hospice Unit (IHU) care. This study aimed to compare the characteristics of two groups of hospice patients: COHC care only and both IHU care and COHC groups. Healthcare claim data from 1 April 2018 to 31 March 2020 were retrieved from the HIRA data warehouse system. The main outcome variable was patients receiving COHC only or both COHC and IHU care. The total number of hospice patients was 6482. A multivariate logistic regression analysis was used. Of 6482 hospice care recipients, 3789 (58.5%) received both COHC and IHU care. Those who received both COHC and IHU care were significantly associated with several factors: period from the first evaluation to death (adjusted odds ratio (aOR), 1.026; 95% confidence internal (CI), 1.024-1.029; p < 0.0001), disease severity measured by the Charlson Comorbidity Index (aOR, 1.032; CI, 1.017-1.047; p < 0.0001), consciousness (aOR, 3.654; CI, 3.269-4.085; p < 0.0001), and awareness of end-stage disease (aOR, 1.422; CI, 1.226-1.650; p < 0.0001). The COHC program had a critical role in hospice delivery to terminally ill patients. Policymakers on hospice care need to establish plans that promote efficient hospice care delivery systems.

The automatic segmentation of the pancreatic cyst lesion (PCL) is essential for the automated diagnosis of pancreatic cyst lesions on endoscopic ultrasonography (EUS) images. In this study, we proposed a deep-learning approach for PCL segmentation on EUS images. We employed the Attention U-Net model for automatic PCL segmentation. The Attention U-Net was compared with the Basic U-Net, Residual U-Net, and U-Net++ models. The Attention U-Net showed a better dice similarity coefficient (DSC) and intersection over union (IoU) scores than the other models on the internal test. Although the Basic U-Net showed a higher DSC and IoU scores on the external test than the Attention U-Net, there was no statistically significant difference. On the internal test of the cross-over study, the Attention U-Net showed the highest DSC and IoU scores. However, there was no significant difference between the Attention U-Net and Residual U-Net or between the Attention U-Net and U-Net++. On the external test of the cross-over study, all models showed no significant difference from each other. To the best of our knowledge, this is the first study implementing segmentation of PCL on EUS images using a deep-learning approach. Our experimental results show that a deep-learning approach can be applied successfully for PCL segmentation on EUS images.

Few studies have examined why some hospitals operate independent hospice units (IHUs) and others do not. This study aims to investigate the organizational factors of hospitals having IHU. The units of analysis were individual hospitals. The study had a cross-sectional design and used health insurance claims data of 349 hospitals in Korea from January 1 to December 31, 2019. The dependent variable was whether a hospital operated an IHU. The independent variables were the percentage of patients with cancer, overall severity of patients, percentage of patients 60 years and older, health care cost per patient, percentage of inpatients, and nurse staffing level. Independent hospice units were present at 21.2% of the hospitals (74/349). The odds of having an IHU were significantly associated with the following factors: the percentage of patients with cancer (odds ratio [OR], 1.228; 95% confidence interval [CI], 1.071-1.408; P = .003), disease severity (OR, 5.129; 95% CI, 2.477-10.622; P < .001), percentage of patients 60 years and older (OR, 1.053; 95% CI, 1.015-1.092; P = .006), health care cost per patient (OR, 1.018; 95% CI, 1.009-1.027; P < .001), and nurse staffing level (OR, 0.439; 95% CI, 0.292-0.661; P < .001). The organizational factors of hospitals operating IHUs were similar to those of hospice facilities., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Healthcare organizations have begun to adopt personal health records (PHR) systems to engage patients, but little is known about factors associated with the adoption of PHR systems at an organizational level. The objective of this study is to investigate factors associated with healthcare organizations' adoption of PHR systems in South Korea., Methods: The units of analysis were hospitals with more than 100 beds. Study data of 313 hospitals were collected from May 1 to June 30, 2020. The PHR adoption status for each hospital was collected from PHR vendors and online searches. Adoption was then confirmed by downloading the hospital's PHR app and the PHR app was examined to ascertain its available functions. One major outcome variable was PHR adoption status at hospital level. Data were analysed by logistic regressions using SAS 9.4 version., Results: Out of 313 hospitals, 103 (32.9%) hospitals adopted PHR systems. The nurse-patient ratio was significantly associated with PHR adoption (OR 0.758; 0.624 to 0.920, p = 0.005). The number of health information management staff was associated with PHR adoption (OR 1.622; 1.228 to 2.141, p = 0.001). The number of CTs was positively associated with PHR adoption (OR 5.346; 1.962 to 14.568, p = 0.001). Among the hospital characteristics, the number of beds was significantly related with PHR adoption in the model of standard of nursing care (OR 1.003; 1.001 to 1.005, p < 0.001), HIM staff (OR 1.004; 1.002 to 1.006, p < 0.001), and technological infrastructure (OR 1.050; 1.003 to 1.006, p < 0.001)., Conclusions: One-third of study hospitals had adopted PHR systems. Standard of nursing care as well as information technology infrastructure in terms of human resources for health information management and advanced technologies were significantly associated with adoption of PHR systems. A favourable environment for adopting new technologies in general may be associated with the adoption and use of PHR systems., (© 2021. The Author(s).)

The global COVID-19 pandemic is creating challenges to manage staff ratios in clinical units. Nurse staffing level is an important indicator of the quality of care. This study aimed to identify any changes in the nurse staffing levels in the general wards of hospitals in Korea during the COVID-19 pandemic. The unit of analysis was the hospitals. This longitudinal study observed the quarterly change of the nurse staffing grades in 969 hospitals in 2020. The nurse staffing grades ranged from 1 to 7 according to the nurse-patient ratio measured by the number of patients (or beds) per nurse. The major dependent and independent variables were the change of nurse staffing grades and three quarterly observation points being compared with those during the 1st quarter (1Q) of 2020, respectively. A generalized linear model was used. Unexpectedly, the nurse staffing grades significantly improved (2Q: RR, 27.2%; 95% confidence interval (CI), 15.1-27.6; p < 0.001; 3Q: RR, 95% CI, 20.2%; 16.9-21.6; p < 0.001; 4Q: RR, 26.6%; 95% CI, 17.8-39.6; p < 0.001) quarterly, indicating that the nurse staffing levels increased. In the comparison of grades at 2Q, 3Q, and 4Q with those at 1Q, most figures improved in tertiary, general, and small hospitals ( p < 0.05), except at 3Q and 4Q of general hospitals. In conclusion, the nurse staffing levels did not decrease, but nursing shortage might occur.

The use of halogen-based materials has been regulated since toxic substances are released during combustion. In this study, polyurethane foam was coated with cationic starch (CS) and montmorillonite (MMT) nano-clay using a spray-assisted layer-by-layer (LbL) assembly to develop an eco-friendly, high-performance flame-retardant coating agent. The thickness of the CS/MMT coating layer was confirmed to have increased uniformly as the layers were stacked. Likewise, a cone calorimetry test confirmed that the heat release rate and total heat release of the coated foam decreased by about 1/2, and a flame test showed improved fire retardancy based on the analysis of combustion speed, flame size, and residues of the LbL-coated foam. More importantly, an additional cone calorimeter test was performed after conducting more than 1000 compressions to assess the durability of the flame-retardant coating layer when applied in real life, confirming the durability of the LbL coating by the lasting flame retardancy.

Objectives: This review article examines international examples of personal health records (PHRs) in advanced countries and discusses the implications of these examples for the establishment and utilization of PHRs in South Korea., Methods: This article synthesized PHR case reports of Organization for Economic Co-operation and Development (OECD) member countries, the Global Digital Health Partnership website on PHRs, and patient portals of individual countries to review the status of PHR services. The concept and significance of PHRs were also discussed with respect to PHR utilization status in European Union and OECD countries., Results: A review of international PHR services showed that the countries shared common points regarding the establishment of Electronic Health Records and national health information infrastructure. In addition, the countries provided services centered on primary healthcare institutions and public hospitals. However, promoting more positive participation and increasing the PHR acceptance rate requires workflow integration, including Electronic Medical Records, the provision of incentives, and the preparation of a supportive legal framework., Conclusions: South Korea is also conducting a national-level PHR project. Since the scope of PHRs is extensive and a wide range of PHR services must be connected, an extensive trial-and-error process will be necessary. A long-term strategy should be prepared, and necessary resources should be secured to establish national-level PHRs.

Background: Many features of health care organizations (HCOs) have been identified to be associated with health information exchange (HIE), but subcategories of organizational factors focusing on nurse workforces still need to be identified. The objective of this study is to investigate the association of number of nurses with HIE use in Korea., Methods: This study had a retrospective study design and used health insurance claim data from June 1, 2016 to June 30, 2018. The unit of analysis was the HCO, and any health insurance claims having HIE were counted by HCO. There were a total of 1490 HCOs having any HIE and 24 026 HCOs not having HIE. For statistical analysis, two-part model was used: logistic regression for HIE participation and the generalized linear model for the volume of HIE use., Results: HIE was used by 44.6% of general hospitals, and 8.6% and 5.3% of small hospitals and clinics, respectively. Both HIE use and its volume were significantly positively associated with nurse variables. The use of HIE was significantly positively associated with nurse-to-bed ratio in general hospitals (OR 1.028; 1.016 to 1.041) and in small hospitals (OR 1.021; 1.016 to 1.027), and with the number of nurses (OR 1.041; 1.028 to 1.054) in clinics (P<.001). The volume of HIE use was also positively associated with nurse-to-bed ratio in general hospitals (OR 1.010; 1.004 to 1.017) and in small hospitals (OR 1.014; 1.006 to 1.022), and with the number of nurses (OR 1.055; 1.037 to 1.073) in clinics (P<.01)., Conclusion: This study found that there was a low rate of HIE use in small hospitals and clinics. The number of nurses was critically associated with the use of HIE and the volume of HIE claims. HIE policy makers need to be aware of this factor in seeking to accelerate HIE.

Background: Lung cancer has a high incidence worldwide, and most lung cancer-associated deaths are attributable to cancer metastasis. Although several medicinal properties of Panax ginseng Meyer have been reported, the effect of ginsenosides Rk1 and Rg5 on epithelial-mesenchymal transition (EMT) stimulated by transforming growth factor beta 1 (TGF- β1) and self-renewal in A549 cells is relatively unknown., Methods: We treated TGF-β1 or alternatively Rk1 and Rg5 in A549 cells. We used western blot analysis, real-time polymerase chain reaction (qPCR), wound healing assay, Matrigel invasion assay, and anoikis assays to determine the effect of Rk1 and Rg5 on TGF-mediated EMT in lung cancer cell. In addition, we performed tumorsphere formation assays and real-time PCR to evaluate the stem-like properties., Results: EMT is induced by TGF-β1 in A549 cells causing the development of cancer stem-like features. Expression of E-cadherin, an epithelial marker, decreased and an increase in vimentin expression was noted. Cell mobility, invasiveness, and anoikis resistance were enhanced with TGF-β1 treatment. In addition, the expression of stem cell markers, CD44, and CD133, was also increased. Treatment with Rk1 and Rg5 suppressed EMT by TGF-β1 and the development of stemness in a dose-dependent manner. Additionally, Rk1 and Rg5 markedly suppressed TGF-β1-induced metalloproteinase-2/9 (MMP2/9) activity, and activation of Smad2/3 and nuclear factor kappa B/extra-cellular signal regulated kinases (NF-kB/ERK) pathways in lung cancer cells., Conclusions: Rk1 and Rg5 regulate the EMT inducing TGF-β1 by suppressing the Smad and NF-κB/ERK pathways (non-Smad pathway)., Competing Interests: The authors have no conflicts of interests to disclose., (© 2020 The Korean Society of Ginseng. Publishing services by Elsevier B.V.)

Objectives: Little is known about the platforms and functionalities of mobile-based personal health record (PHR) applications. The objective of this study was to investigate these two features of PHR systems., Methods: The unit of analysis was general hospitals with more than 100 beds. This study was based on a PHR survey conducted from May 1 to June 30, 2020 and the National Health Insurance administrative data as of March 31, 2020. The study considered the platform, Android and iPhone operation system (iOS), and types of functionalities of PHR systems. Among the 316 target hospitals, 103 hospitals had adopted PHR systems. A logistic regression analysis was used., Results: This study found that 103 hospitals had adopted mobile-based PHR systems for their patients. Sixty-four hospitals (62.1%) were adopting both Android and iOS, but 36 (35.0%) and 3 (2.9%) hospitals were adopting Android only or iOS only, respectively. The PHR systems of hospitals adopting both platforms were more likely to have functions for viewing prescriptions, clinical diagnostic test results, and upcoming appointment status compared to those adopting a single platform (p < 0.001). The number of beds (odds ratio [OR] = 1.004; confidence interval [CI], 1.001-1.007; p = 0.0029) and the number of computed tomography systems (CTs) per 100 beds (OR = 6.350; CI, 1.006-40.084; p = 0.0493) were significantly associated with the adoption of both platforms., Conclusions: More than 60% of hospitals had adopted both Android and iOS platforms for their patients in Korea. Hospitals adopting both platforms had additional functionalities and significant association with the number of beds and CTs.

Recently, triboelectric nanogenerators (TENGs) have been widely utilized to address the energy demand of portable electronic devices by harvesting electrical energy from human activities or immediate surroundings. To increase the surface charge and surface area of negative TENGs, previous studies suggested several approaches such as micro-patterned arrays, porous structures, multilayer alignment, ion injections, ground systems and mixing of high dielectric constant materials. However, the preparation processes of these nanocomposite TENGs have been found to be complex and expensive. In this work, we report a simple, efficient and inexpensive modification of poly(dimethylsiloxane) (PDMS) using graphene nanoplatelets (GNPs) fillers and a Na 2 CO 3 template. This GNP-PDMS was chemically bonded using 3-aminopropylethoxysilane (APTES) as a linker with an electrode multilayer made by layer-by-layer deposition of polyvinyl alcohol (PVA) and poly(4-styrene-sulfonic acid) (PSS)-stabilized GNP (denoted as [PVA/GNP-PSS] n ). A 33 wt.% Na 2 CO 3 and 0.5 wt.% of GNP into a PDMS-based TENG gives an open-circuit voltage and short-circuit current density of up to ~270.2 V and ~0.44 μA/cm 2 , which are ~8.7 and ~3.5 times higher than those of the pristine PDMS, respectively. The higher output performance is due to (1) the improved surface charge density, 54.49 μC/m 2 , from oxygen functional moieties of GNP, (2) high surface roughness of the composite film, ~0.399 μm, which also increased the effective contact area, and (3) reduced charge leakage from chemical bonding of GNP-PDMS and [PVA/GNP-PSS] 3 via APTES. The proposed TENG fabrication process could be useful for the development of other high-performance TENGs.

Introduction: This report describes the treatment of an immature mandibular molar by combining vital pulp therapy (VPT) and regenerative endodontic procedures (REPs). It details the use of REP to regain functionality and continued root development of an immature root with pulp necrosis and VPT for an immature root containing vital pulpal tissues., Methods: An 8-year old male presented for evaluation of a mandibular first right molar with mild buccal swelling and a nontraceable sinus tract. He recently had received a restoration. After intraoral and radiographic examination, a diagnosis of pulp necrosis and chronic apical abscess was made. After access, pulp necrosis was confirmed in the distal root; however, vital pulp tissues were present in the mesial canals. It was decided on pulpotomy (VPT) in the mesial and REP in the distal root. At the initial visit, pulpotomy was completed in the mesial root, and REP was initiated in the distal root. Three weeks later, the patient was asymptomatic and the sinus tract absent. REP was completed in the distal root, and the tooth was restored., Results: At the 6-, 12-, and 18-month follow-up, the patient presented without symptoms, and the tooth responded positively to pulp sensibility tests. Radiographic examinations showed resolution of the apical radiolucency and completed root development., Conclusions: Combined treatment using both VPT and REP for immature molars with different pulpal status in individual roots may be a preferable treatment option because preservation of vital pulp tissues and regeneration of new vital tissues allow for continued root development and functionality., (Copyright © 2020 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Two trimellitic anhydride-functionalized, thermally reduced graphenes with different aspect ratios, A f , and the same C/O ratio (8:1) were prepared and melt-mixed into poly(ethylene terephthalate) (PET), and the mechanical properties of the resulting nanocomposites were studied with a focus on plastic deformation behavior. A slight increase in the G ' of the melt was observed for the surface-modified low- A f graphene composites ( A f = 20) below the percolation threshold, whereas a significant enhancement in G ' was observed for higher- A f graphene composites ( A f = 80) at all graphene loadings, both below and above the percolation concentration. Furthermore, the use of modified low- A f graphene caused an improvement both in Young's modulus and elongation at break of the resulting PET nanocomposites because of enhancement of interfacial adhesion between filler and matrix which resulted in the formation of a coupled network via covalent bonding and the suppression both of strain-induced orientation and strain-induced crystallization. By contrast, the use of modified higher- A f surface graphene in nanocomposites caused a drastic improvement in Young's modulus but lower elongation-at-break than with the unmodified counterpart; the former effect is due to the formation of denser coupled networks and stronger interfacial adhesion as a result of graphene surface modification and the latter is due to the added geometrical restriction in unentangling chains from the PET matrix in the presence of higher- A f graphene. The preceding observations demonstrate the potential impacts of tuning both surface chemistry and aspect ratio of graphene in the fabrication of PET/graphene composites., Competing Interests: The authors declare no competing financial interest., (Copyright © 2020 American Chemical Society.)

Objectives: We investigated associations between full Electronic Medical Record (EMR) system adoption and drug use in healthcare organizations (HCOs) to explore whether EMR system features such as electronic prescribing, medicines reconciliation, and decision support, might be related to drug use by using the relevant nation-wide data., Methods: The study design was cross-sectional. Survey data of the level of adoption of EMR systems were collected for the Organization for Economic Co-operation and Development benchmarking information and communication technologies (ICT) study between November 2013 and January 2014, in Korea. Survey respondents were hospital chief information officers and medical practitioners in primary care clinics. From the national health insurance administrative dataset, two outcomes, the rate of antibiotic prescription and polypharmacy with ≥6 drugs, were extracted., Results: We found that full EMR adoption showed a 16.1% lower antibiotic drug prescription than partial adoption including paper-based medical charts in the hospital only ( p = 0.041). Between EMR adoption status and polypharmacy prescription, only those clinics which fully adopted EMR showed significant associations with higher polypharmacy prescriptions (36.9%, p = 0.001)., Conclusions: The findings suggested that there might be some confounding effects present and sophisticated ICT may provide some benefits to the quality of care even with some mixed results. Although a negative relationship between full EMR system adoption and antibiotic drug use was only significant in hospitals, EMR system functions searching drugs or listing specific patients might facilitate antibiotic drug use reduction. Positive relationships between full EMR system adoption and polypharmacy rate in general hospitals and clinics, but not hospitals, require further research., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (© 2020 The Korean Society of Medical Informatics.)

Introduction: Studies have shown that there is a significantly higher concentration of interleukin 6 (IL-6) in inflamed pulp tissues compared with healthy pulp tissues. The aims of this study were to investigate the baseline differences between mesenchymal stem cells (MSCs) isolated from healthy human dental pulp stem cells (H-DPSCs) and inflamed dental pulp stem cells (I-DPSCs) and their correlation to IL-6 and to determine whether IL-6 can affect the differentiation potentials of these cells., Methods: MSCs isolated from healthy and inflamed pulp tissues were cultured and characterized in vitro. The levels of secreted IL-6 in the culture supernatants from H-DPSCs and I-DPSCs were measured by enzyme-linked immunosorbent assay. IL-6 and neutralizing IL-6 were added to H-DPSCs and I-DPSCs, respectively. Immunofluorescence staining, alizarin red staining, and Western blotting were performed to assess the differentiation potentials of H-DPSCs and I-DPSCs. The independent unpaired 2-tailed Student's t-test was performed after quantification analysis., Results: H-DPSCs and I-DPSCs showed a similar expression of MSC-associated markers including CD44, CD73, CD90, and CD105, whereas H-DPSCs showed a lower level of IL-6, lower osteogenic differentiation potentials, and higher neurogenic differentiation potentials compared with I-DPSCs. The addition of IL-6 to H-DPSCs increased osteogenic potentials and decreased neurogenic potentials, whereas the neutralization of IL-6 for I-DPSCs led to decreased osteogenic potentials and increased neurogenic potentials., Conclusions: The findings of this study indicated IL-6 has the capacity to enhance osteogenesis while hindering neurogenesis of DPSCs., (Copyright © 2019 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: Ankle arthroscopy has been used as a standard tool by foot and ankle surgeons. To overcome the narrowness of ankle joint, a noninvasive distraction technique is used for the successful visualization in ankle arthroscopy. The aim of this study was to investigate the incidence and type of complications associated with ankle arthroscopy using a noninvasive distraction technique and to report a troublesome complication., Methods: We reviewed 514 patients' charts from 2003 to 2011. The same noninvasive distraction technique was used. Patients' demography, duration of follow-up, diagnoses, procedures, and complications related to ankle arthroscopy were analyzed., Results: There were 388 male and 126 female; mean age was 37.2 years; mean follow-up duration was 33 months. The diagnoses were osteochondral lesion of talus, chronic ankle instability, anterolateral soft tissue impingement syndrome, and anterior bony impingement. We performed arthroscopic synovectomy, osteochondral procedure, bony spur excision, and loose body removal. The mean time of arthroscopic procedure was 47 min. There were neurologic complications (eight cases), skin necrosis of posterior thigh (three cases), instrument breakage (two cases), and superficial wound infection (one case). All complications were well resolved. The total duration of distraction plus tourniquet inflation exceeded 120 min in the three cases of skin necrosis. Skin necrosis was deemed to be resulted from the long tourniquet time., Conclusion: The noninvasive distraction technique is safe and effective for ankle arthroscopy. However, the distraction plus tourniquet requires attention because it can cause high pressure on posterior thigh resulting in soft tissue injury.

Background: Our hypothesis was that minimally invasive plate osteosynthesis (MIPO) using long philos plate (LPP) would show better clinical and radiological outcomes and less complications than narrow locking compression plate (NLCP) for spiral humerus shaft fractures with or without metaphyseal fracture extension., Methods: From January 2009 to May 2016, we retrospectively studied 35 patients who underwent MIPO for spiral humerus shaft fractures with or without metaphyseal fracture extension (AO classification 12 A, B, C except A3). Eighteen patients underwent MIPO with a 4.5 mm NLCP (group I) in the early period of this study, while 17 patients underwent MIPO with LPP (group II) in the later period. Range of motion (ROM), pre- and post-operative anteroposterior (AP) and lateral angulation of the fracture, operation time, amount of bleeding, and functional outcomes including American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, and Simple Shoulder Test score were analyzed at the final follow up., Results: All patients had complete bony union and achieved satisfactory functional outcomes except 2 patients. In LPP group, better outcomes in postoperative fracture angulation on X-ray and operation time (p < 0.05) were shown. But, two revision surgery with NLCP and bone graft was performed owing to 2 metal failures., Conclusions: In spiral humeral shaft fractures, LPP group showed better fracture reduction on X-ray and shorter operation time except metal failure owing to weak fixation. Even though MIPO technique using LPP is easier and more accurate reduction method, rigid fixation should be considered.

The total synthesis of nocarbenzoxazoles F (1) and G (2), originally obtained from the marine-derived halophilic bacterial strain Nocardiopsis lucentensis DSM 44048, was achieved via a simple and versatile route involving microwave-assisted construction of a benzoxazole skeleton, followed by carbon-carbon bond formation with the corresponding aryl bromides. Unfortunately, the 1 H and 13 C NMR spectra of natural nocarbenzoxazole G did not agree with those of the synthesized compound. In particular, the spectra of the isolated and synthesized compounds showed considerable differences in the signals from the protons and carbons in the aryl group. The revised structure was validated by the total synthesis of the actual nocarbenzoxazole G (8c) molecule, which is a regioisomer of the compound that was reported earlier as nocarbenzoxazole G. The synthesized derivatives showed specific cytotoxicity to the human cervical carcinoma cell line, HeLa, but did not have any remarkable effect on the other cell lines.

The first total synthesis of pactalactam was accomplished using substrate-controlled stereoselective aziridination and regioselective aziridine ring-opening to construct three continuous amino groups on an octasubstituted cyclopentane core. The cyclopentane framework was obtained by ring-closing metathesis and aldol coupling using a l-threonine-derived oxazoline compound. Cyclic urea formation, m-acetylphenyl group introduction by Chan-Lam coupling, and primary alcohol-selective acylation yielded the reported pactalactam structure. The presence of pactalactam in the fermentation broth of pactamycin-producing bacteria was also confirmed.

The association between adverse effects of PPI and gut microbiota in old age has yet to be elucidated. We assessed changes in the gut microbiota and butyrate levels following the long-term administration of PPIs to old rats and investigated their associations. F344 aged male rats were fed a PPI-supplemented diet for 50 weeks. The ileal microbiota was analysed by metagenomic sequencing of the 16S rRNA, while the butyrate concentration was measured by high-performance liquid chromatography. We observed a significant decrease in microbial diversity following PPI administration in the 2-year-old rats but not in the 74-week-old rats. PPI treatment reduced both commensal bacteria and opportunistic pathogens, particularly in the 2-year-old rats. Enterotypes comprising the majority of the control samples were enriched in Lactobacillus, while other enterotypes in the PPI group were dominated by Turicibacter or Romboutsia. The PPI treatment reduced the butyrate concentrations in the intestines and colons of 74-week-old rats compared to the control group. The abundance of Lactobacillus significantly correlated with butyrate concentrations in 74-week-old rats. In conclusion, long-term administration of PPIs alters the gut microbiota and butyrate concentrations in rats, particularly in old age, which may be an underlying mechanism of PPI-induced adverse effects such as pseudomembranous colitis.

We investigated broad-spectrum light emitting diodes appropriate for special lighting applications in terms of their optical behaviors and device performances according to the chirped multi-quantum well structures. As the well thickness was increased from 6 to 15 nm, the electroluminescent spectrum was broadened by 43%, the forward bias voltage was lowered by 7% and the light output power was showed similar values in comparison to light emitting diodes having conventional multiquantum well structures. In the case of the chirped multi-quantum well structures having sequentially decreasing the well thickness from 15 nm to 6 nm, the optical output power was decreased by 38% due to the spreading problems of holes into the n -side active region.