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Abstract Chimeric antigen receptor T (CAR-T) cells show remarkable efficacy for some hematological malignancies. However, CAR targets that are expressed at high level and selective to tumors are scarce. Several strategies have been proposed to tackle the on-target off-tumor toxicity of CAR-T cells that arise from suboptimal selectivity, but these are complicated, with many involving dual gene expression for specificity. In this study, we show that switchable CAR-T cells with a tumor targeting adaptor can mitigate on-target off-tumor toxicity against a low selectivity tumor antigen that cannot be targeted by conventional CAR-T cells, such as CD40. Our system is composed of anti-cotinine murine CAR-T cells and cotinine-labeled anti-CD40 single chain variable fragments (scFv), with which we show selective tumor killing while sparing CD40-expressing normal cells including macrophages in a mouse model of lymphoma. Simple replacement of the tumor-targeting adaptor with a suicidal drug-conjugated tag may further enhance safety by enabling permanent in vivo depletion of the switchable CAR-T cells when necessary. In summary, our switchable CAR system can control CAR-T cell toxicity while maintaining therapeutic efficacy, thereby expanding the range of CAR targets.

The objectives of fusion surgery for spinal deformities include decompressing neural elements and achieving balanced spinal alignment. Particularly, in cases where spinal deformities coexist with osteoporosis, successful surgery requires careful consideration due to the susceptibility to fixation failure and non-union. Various efforts are being made to restore spinal alignment through surgery in osteoporotic patients. The administration of osteoporosis medications before and after surgery is effective for bony union. Additionally, appropriate selection of fusion range, rigid internal fixation, and utilization of bone substitutes play significant roles in successful fusion surgery. Although surgical treatment for spinal deformities accompanied by osteoporosis remains still challenging, we can anticipate successful outcomes with effective strategies and ongoing advancements in the future.

Background: We identified the uptake of people living with HIV (PLWH) using health-screening services and compared the screening rate with the general population, to identify factors associated with the use of screening services by PLWH. Methods: This population-based study used data from the Korean National Health Insurance, a single mandatory health insurance system covering all residents. The uptake rates for screening for general health, gastric cancer, and colorectal cancer, which were provided by a national health screening program with free of charge or minimal cost in Korea from 2010–2020. Factors associated with general health, gastric cancer, and colorectal cancer screening were also explored. Results: Screening uptake rates for general health, gastric cancer, and colorectal cancer in PLWH increased from 2010–2019 but decreased in 2020. The standardized screening ratio showed lower screening rates for general health, gastric cancer, and colorectal cancer in PLWH with 0.80 (95 % confidence interval (CI) = 0.77–0.83), 0.64 (95 % CI = 0.61–0.67), and 0.67 (95 % CI = 0.64–0.71) in 2019. Increased age, Charlson Comorbidity Index, and years since HIV diagnosis were associated with increased screening uptake in PLWH. Otherwise, PLWH recipients of medical aid programs received less for each screening compared to PLWH who paid insurance premiums higher than 50 %. An increased medication possession ratio of highly active antiretroviral therapy was associated with decreased general health and gastric cancer screening uptake but increased colorectal cancer screening uptake. Conclusions: Significant disparities in health-screening uptake were observed in PLWH compared to the general population in a nationwide organized screening setting without cost barriers.

Abstract Half‐Heusler compounds are promising materials for thermoelectric applications due to their high zT at elevated temperatures. However, their intrinsic high thermal conductivity limits their efficiency. Doping with Hf or Zr can improve the zT of these materials. Recently, a high zT of 1.5 at 1200 K achieved in p‐type Nb1‐xHfxFeSb has attracted much attention. While the effect of doping Hf in thermal conductivity is studied thoroughly, the effect of Hf doping on band parameters is not fully evaluated. This study investigates the effect of Hf and Zr doping on the electronic band parameters and thermoelectric properties of NbFeSb using the Single Parabolic Band model. The results show that Hf doping increases the weighted mobility of the samples, while Zr doping has no significant effect. Hf doping with x = 0.14 is predicted to improve the zT of NbFeSb by 35% at 300 K (0.19 → 0.26). These results show the intricate effects of Hf and Zr doping on the electronic and thermal properties of NbFeSb.

In this study, a 4D trajectory weather (4DT-Wx) prototype system was developed and evaluated for effective weather information integration in trajectory-based operation (TBO) environments. The system has two key distinguishing features: multi-model-based trajectory services and buffer zone information provision. We constructed a distributed processing system using Apache Spark, enabling the efficient processing of large-scale weather data. The performance evaluation demonstrated excellent scalability and efficiency in processing large-scale data. An analysis of the buffer configurations highlighted that buffer zone information is valuable in decision-making processes and has the potential to enhance the system performance. The system’s practical applicability is presented through visualizations of the extracted weather information. This system is expected to enhance aviation safety and operational efficiency, providing a foundation for addressing increasingly complex weather conditions and flight scenarios in the future. The approach presented in this study marks a significant step toward effective TBO implementation and the advancement of future air traffic management. The evaluation of the 4DT-Wx system analyzed the accuracy of weather data processing and the performance of distributed processing, finding that the temperature (T) estimation had the highest accuracy, and that the parallel processing using Apache Spark was most effectively modeled by Ahmed et al.’s model. The findings suggest the potential for further optimization in integrating various weather models and developing algorithms to enhance their utilization.

We present a summary of the evidence on testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and organ procurement from deceased donors and provide recommendations based on current clinical data and the guidelines from major transplant organizations. Because of the limited historical experience with coronavirus disease 2019 (COVID-19), certain recommendations in this document are based on theoretical rationales rather than clinical data. The recommendations in this manuscript may be subject to revision as subsequent clinical studies provide definitive evidence regarding COVID-19 in organ procurement.

ABSTRACTMultilayer ceramic capacitors (MLCCs) for electric vehicles require their room temperature capacitance to change ≤ ±15% at −55°C to 200°C. The dielectric constant (ε) of BaTiO3, a dielectric material widely used in MLCCs, drops at >125°C making its application to electric vehicles difficult. Here, we propose KCa2Nb3O10 (KCNO)-layered perovskite as a strong candidate for electric vehicle MLCCs as its ε does not change abruptly with temperature. The effect of sintering temperature on the temperature coefficient of capacitance (TCC) of KCNO is studied. The KCNO powder calcined at 900–1200°C is sintered at 1200°C–1300°C. Microstructure and temperature-dependent ε are determined by the sintering temperature, while the sintered density is related to the difference between the calcining and sintering temperatures. Only the room temperature ε of the samples sintered at 1300°C (except the one calcined at 900°C) varies ≤ ±15% at 25°C–200°C (ε ~250 at room temperature). The sample calcined at 1100°C and sintered at 1300°C has highly elongated grains and the highest activation energy. These factors are responsible for the TCC of the 1300°C sintered KCNO being ≤ ±15% at 25–200°C.

PurposeTo understand the current practice of radiation oncologists (ROs) and orthopedic surgeons (OSs) regarding spine metastasis.MethodsIn 2022, an internet-based survey was conducted for ROs and OSs who treat spinal metastasis in Korea. Respondents were asked to choose the treatment option for two clinical scenarios. Scenario 1 involved a case displaying symptoms of leg weakness due to spinal cord compression and Scenario 2 involved a case with back pain due to pathologic compression fracture. The survey also included a question that required respondents to rank the importance of 11 clinical factors that affect treatment decisions.ResultsForty-nine ROs and 30 OSs responded to the survey. There were significant differences in treatment choices between two groups for both scenarios (P = 0.001). In Scenario 1, more OSs chose surgical resection than ROs (43.3% vs. 16.7%), while more ROs chose radiotherapy than OSs (83.3% vs. 53.3%). In Scenario 2, a similar proportion of OSs and ROs chose radiotherapy (OSs, 71.4% vs. ROs, 67.3%), while more OSs opted for prophylactic fixation after radiotherapy than ROs (95.0% vs. 42.4%). The top three factors influencing treatment decisions were general performance status, life expectancy, and spinal instability for both ROs and OSs. In both Scenarios 1 and 2, the treatment decisions of ROs changed significantly when clinical conditions related to these top three factors were altered.ConclusionAlthough ROs and OSs share the same factors influencing treatment decisions for spinal metastases, notable differences exist in their actual treatment preferences, with ROs preferring radiotherapy and OSs opting for surgical resection. Multidisciplinary discussions may be necessary to reduce the gap in decision-making.

Abstract The beginning of human immunodeficiency virus (HIV) infection treatment depends on various factors, which are significantly correlated with the initial CD4 cell number. However, a covariate correlation between these factors may not reflect the correct outcome variable. Thus, we evaluated the effects of a combination of fixed factors (reduced dimensions), which determine when to start treatment for the first time, on short-term outcome, long-term outcome, and survival, considering correlations between factors. Multiple correspondence analysis was performed on variables obtained from 925 patients who participated in a Korean HIV/acquired immunodeficiency syndrome cohort study (2006–2017). Five reduced dimension groups were derived according to clinical data, viral load, CD4 cell count at diagnosis, initial antiretroviral therapy, and others. The dimension group with high initial viral loads (55,000 copies/mL) and low CD4 cell counts ( 350 cells/mm3) that did not require immediate treatment according to previous guidelines had a higher failure rate for long-term relative CD4 recovery. Our results highlight the importance of early diagnosis and treatment to positively influence long-term disease outcomes, even if the initial immune status is poor, given the patient’s combination of early diagnostic symptoms.

Background: Teriparatide is an anabolic agent for osteoporosis and is believed to improve the bone healing process. Previous studies showed that teriparatide could enhance not only fracture healing but also spine fusion. It has been reported that use of teriparatide could promote the spine fusion process and decrease mechanical complications. However, there was no consensus regarding optimal treatment duration. The purpose of this study was to compare surgical outcomes between short-duration and long-duration teriparatide treatment after lumbar fusion surgery in elderly patients. Materials and Methods: All consecutive patients older than 60 years who underwent 1-level lumbar fusion surgery for degenerative diseases between January 2015 and December 2019 were retrospectively reviewed. Based on the duration of teriparatide treatment (daily subcutaneous injection of 20 µg teriparatide), patients were subdivided into two groups: a short-duration (SD) group (Results: Ninety-one patients were reviewed in this study, including sixty patients in the SD group and thirty-one patients in the LD group. Their mean age was 72.3 ± 6.2 years, and 79 patients were female. Mean T-score was −3.3 ± 0.8. Cage subsidence (6.7% vs. 3.2%), screw loosening (28.3% vs. 35.5%), and adjacent vertebral fracture (6.7% vs. 9.7%) were not significantly different between the SD and LD groups. Union rate at 1-year postoperative was 65.0% in the SD group and 87.1% in the LD group (p = 0.028). Both groups showed improvement in VAS and ODI after surgery. However, the differences of VAS from preoperative to 6 months and 1 year postoperative were significantly higher in the LD group. Conclusions: Longer teriparatide treatment after lumbar fusion surgery resulted in a higher union rate at 1-year postoperative than the shorter treatment. Also, it could be more beneficial for clinical outcomes.

OBJECTIVES To assess the risk of lymphadenopathy following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. METHODS A self-controlled case series design was used to determine whether the risk of lymphadenopathy was higher in the 1-day to 42-day risk interval after coronavirus disease 2019 (COVID-19) vaccination compared to the control period. In addition, subgroup analyses were conducted according to baseline characteristics, time since vaccination, and sensitivity analyses adjusted for the length of the risk interval. RESULTS The risk of developing lymphadenopathy in the risk interval (1-42 days) after COVID-19 vaccination compared to the control period was significantly increased, with a relative incidence (RI) of 1.17 (95% confidence interval [CI], 1.17 to 1.18) when the first, second, and third doses were combined. The RI was greater on the day of vaccination (1.47; 95% CI, 1.44 to 1.50). In subgroup analyses by baseline characteristics, a significantly increased risk or trend toward increased risk was observed in most subgroups except for those aged 70 years and older, with a significant increase in risk in younger individuals, those with a Charlson’s comorbidity index BNT162b2). Within the 1-day to 42-day post-dose risk period, the relative risk was highest during the 1-day to 7-day post-dose period (1.59; 95% CI, 1.57 to 1.60) compared to the control period, and then the risk declined. In the sensitivity analysis, we found that the longer the risk window, the smaller the RI. CONCLUSIONS SARS-CoV-2 vaccination is associated with a statistically significant increase in the risk of lymphadenopathy, and this risk was observed only with mRNA vaccines.

Recent studies have revealed the outstanding thermoelectric performance of Bi-doped n-type SnSe. In this regard, we analyzed the band parameters for Sn1−xBixSe (x = 0.00, 0.02, 0.04, and 0.06) using simple equations and the Single Parabolic Band model. Bi doping suppresses the carrier-phonon coupling while increasing the density-of-states effective mass. The n-type SnSe is known to have two conduction bands converge near 600 K. Bi doping changes the temperature at which the band convergence occurs. When x = 0.04, its weighted mobility maximized near 500 K, which indicated the possible band convergence. The highest zT of the x = 0.04 sample at mid-temperatures (473–573 K) can be attributed to the engineered band convergence via Bi doping.

Control of bipolar conduction is essential to improve the high-temperature thermoelectric performance of materials for power generation applications. Recently, Hf(Te1−xSex)2 alloys have gained much attention due to their potential use in thermoelectric power generation. Increasing the Se alloying content significantly increases the band gap while decreasing its carrier concentration. These two factors affect bipolar conduction substantially. In addition, the weighted mobility ratio is estimated from the experimental electronic transport properties of Hf(Te1−xSex)2 alloys (x = 0.0, 0.025, 0.25, 0.5, 1.0) by using the Two-Band model. From the bipolar thermal conductivity also calculated using the Two-Band model, we find that it peaks near x = 0.5. The initial bipolar conductivity increase of x < 0.5 is mostly due to the decrease in the weighted mobility ratio and carrier concentration with increasing x. For x > 0.5, the drop in the bipolar conductivity can be understood with significant band gap enlargement.

ABSTRACTThe effects of varying calcination temperature, K content, and the number of calcination steps in the dielectric performance of KCa2Nb3O10 synthesized via solid-state reaction are investigated. Adding an extra calcination step at 500°C followed by another calcination at 1100°C suppressed the formation of secondary phases while maximizing the relative density (95%) and the average grain area (2.12 μm2). The first calcination at 500°C ensures the formation of intermediate phases (KNbO3 and Ca2Nb2O7), which are prerequisites for single-phase KCa2Nb3O10 synthesis. A significantly high dielectric constant of 352 at 100k Hz is achieved in the two-step calcined sample despite the low sintering temperature of 1250°C. The highest resistivity of the two-step calcined sample (2 × 108 Ω cm) obtained from complex impedance analysis supports its lowest dielectric loss (0.034 at 100k Hz). When the two-step calcined KCa2Nb3O10 powder is exfoliated, much higher dielectric properties of Ca2Nb3O10 nanosheets are expected.

ABSTRACTCalcium phosphate ceramics have been studied as promising materials for biomaterial applications owing to their excellent biocompatibility and osteoconductivity. Herein, we investigated the influence of different mass ratios of hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) in a calcium phosphate mixture (CPM) on the microhardness and microstructural properties of a series of xHA-(100-x)β-TCP (x = 0, 30, 50, 70, 90, and 100) mixture samples. The chemical compositions and structural properties of the CPM samples were characterized using X-ray diffraction, Fourier-transform infrared spectroscopy, field emission scanning electron microscopy, and energy-dispersive X-ray spectroscopy. The porosity of the HA/β-TCP composites decreased with increasing β-TCP content and reached a minimum porosity when the mass ratio of HA/β-TCP is 70/30, and then increased with increasing β-TCP content again. The surface microhardness of the CPM composites was measured and found to be inversely proportional to their porosities. Therefore, the CPM of HA/β-TCP with a mass ratio of 70/30 exhibited a maximum surface microhardness of 86.02 MPa.

Lumbar interbody fusion (LIF) is an excellent treatment option for a number of lumbar diseases. LIF can be performed through posterior, transforaminal, anterior, and lateral or oblique approaches. Each technique has its own pearls and pitfalls. Through LIF, segmental stabilization, neural decompression, and deformity correction can be achieved. Minimally invasive surgery has recently gained popularity and each LIF procedure can be performed using minimally invasive techniques to reduce surgery-related complications and improve early postoperative recovery. Despite advances in surgical technology, surgery-related complications after LIF, such as pseudoarthrosis, have not yet been overcome. Although autogenous iliac crest bone graft is the gold standard for spinal fusion, other bone substitutes are available to enhance fusion rate and reduce complications associated with bone harvest. This article reviews the surgical procedures and characteristics of each LIF and the osteobiologics utilized in LIF based on the available evidence.

WO3 nanostructures with different morphologies and dimensions were fabricated via solvothermal synthesis by adjusting the stirring time of the precursor solution. Ethanol-based solutions of the WCl6 precursor with various colors (dark green, yellow, white, blue, and blue-black) were prepared, and this triggered a significant change in the growth behavior during the evolution of WO3 nanostructures. Controlling the initial state of the precursors in solution enabled sequential nucleation and growth which resulted in the production of zero-to-three-dimensional nanostructures including nanoparticles, a mixture of nanosheets and nanoparticles, jointed-nanosheets, and three-dimensionally clustered jointed-nanosheets. The crystallographic characteristics (preferred orientation along the (002) plane) and the concentration of surface oxygen vacancies were also controllable, suggesting the formation of nanostructures with tuneable surface reactivity. Differing NO2 sensing performances were observed because of the variation in configurations of the WO3 nanostructures.

A terahertz time-domain spectroscopy (THz-TDS) system was used to monitor the crystallinity and moisture content of polyethylene terephthalate (PET) specimens. The crystallinity and moisture content were varied by controlling cooling rate and immersion time. Crystallinity, crystallite size, and moisture content of the PET specimens were measured through differential scanning calorimetry (DSC), x-ray diffraction (XRD), and gravimetric methods, respectively. The THz signal with regard to crystallinity and moisture content was subsequently analyzed within the time and frequency-domain. In addition, optical properties of refractive index and absorption coefficient were derived. Consequently, the crystallinity and moisture content could be simultaneously measured by analyzing the THz signals.

Background : Infections are a major cause of morbidity, graft failure, and mortality in solid organ transplant recipients. Preventive measures have greatly reduced the burden of posttransplant infections. However, little is known about the practice patterns of infection prevention in South Korea. Methods : A questionnaire-based cross-sectional survey was conducted. The questionnaire was developed by a multidisciplinary discussion. From the Korean Network for Organ Sharing data, a list of hospitals that performed kidney, liver, heart, and lung transplantations in 2019 was selected. We invited participants to respond to the questionnaire via email from January to March 2022. Results : The response rates for each organ were as follows; 41% (31/76 hospitals) for kidney, 49% (25/51) for liver, 40% (8/20) for heart, and 89% (8/9) for lung transplantations. The median duration of antibacterial prophylaxis after transplant ranged from 5 to 7 days. Prophylaxis was commonly applied in cytomegalovirus (CMV) D+/R– recipients. For non-lung CMV R+ recipients, a preemptive strategy was the most common method. The duration of viral load monitoring for preemptive or hybrid strategies varied. All lung transplant programs used mold-active antifungal agents for a median of 6 months. An interferon-gamma release assay was most commonly used to screen for latent tuberculosis infections. Conclusions: The infection prevention protocols in most transplant programs in Korea were generally in accordance with the guidelines. However, some variability was observed regarding antibacterial prophylaxis and CMV prevention. Our results provide useful insights into practice patterns and will assist in the development of national guidelines.

Post-metal chalcogenides, including InSe, In2Se3, and In4Se3, have attracted considerable attention as potential thermoelectric materials because of their intrinsically low thermal conductivity, which is attributed to their layered structure with weak van der Waals bonds. In this study, we examined the electrical and thermoelectric properties of Si-doped In2Se3 (In2−xSixSe3, x = 0, 0.005, 0.01, 0.015, and 0.02) polycrystalline samples. Hexagonal α(2H)-In2Se3 phase was synthesized without any impurity, and gradual changes in the lattice parameters were observed with Si doping. Drastic changes were observed for the measured electrical and thermal transport properties at 450–500 K, due to the phase transition from α to β at 473 K. The highest power factors were achieved by the sample with x = 0.015 for both α and β phases, exhibiting the values of 0.137 and 0.0884 mW/mK2 at 450 and 750 K, respectively. The total thermal conductivities of the α phase samples decreased gradually with increasing Si doping content, which is attributed to the point defect phonon scattering by Si doping. The total thermal conductivities of the β phase samples significantly decreased compared to those of the α phase samples. Therefore, the sample with x = 0.015 (In1.985Si0.015Se3) showed the maximum thermoelectric figure of merit values of 0.100 and 0.154 at 450 and 750 K, which are enhanced by 152 and 48% compared with those of the undoped α- and β-In2Se3 samples, respectively.

Post-transition metal chalcogenides, such as SnSe, SnSe2, InSe, In2Se3, and In4Se3, are recently suggested as good candidates for high performance thermoelectric materials. In this present study, we investigated the influence of Cl doping on the electrical and thermal transport of n-type polycrystalline InSe samples in an effort for searching new thermoelectric materials. A series of InSe1-xClx (x = 0, 0.01, 0.03, and 0.05) were synthesized by a conventional solid–state reaction. By Cl doping in the Se site, the power factor is significantly increased to 0.13 mW/mK2 for InSe0.97Cl0.03 from 0.044 mW/mK2 of undoped InSe, primarily owing to the unconventional simultaneous increase in both electrical conductivity and magnitude of Seebeck coefficient. The increase of power factor is discussed in regard with substantial increase of effective mass and weighted mobility by the Cl doping, along with the electronic dispersions calculated by density functional theory. As a result, the thermoelectric figure of merit zT is increased to 0.052 at 690 K in InSe0.97Cl0.03, which is improved by 208% compared to the undoped InSe sample.

Bi2O2Se has an intrinsically low thermal conductivity and a high Seebeck coefficient, which suggests as potential thermoelectric materials. However, pristine Bi2O2Se polycrystalline exhibits very low electrical conductivity. In this study, we investigated the influence of I doping in enhancing electrical conductivity of Bi2O2Se by synthesizing a series of Bi2O2Se1-xIx polycrystalline samples (x = 0, 0.0025, 0.005, and 0.0075). By I doping, the electrical conductivity was enhanced by significant increase in carrier concentration. The carrier concentration was increased more than 10 times 2.1–4.6 × 1019 cm-3 from 2.1 × 1018 of the undoped sample. As results, the maximum power factor was enhanced to 0.24 mW/mK2 for x = 0.0025 from 0.086 mW/mK2 of undoped Bi2O2Se at 300 K. The maximum power factor of 0.42 mW/mK2 was achieved for x = 0.05 sample at 790 K. These increases are discussed in terms of the increase in effective mass and weighted mobility. Additionally, the moderate reduction of thermal conductivity was observed in the I doped samples due to the point defect scattering. As a result, a maximum zT value was enhanced to 0.32, 0.35, and 0.33 for x = 0.0025, 0.005, and 0.0075) at 790 K, representing an improvement of more than 50% compared to 0.21 of the undoped Bi2O2Se (x = 0).

Recent electric vehicle multilayer ceramic capacitors (MLCCs) adopt submicron-sized solid-state synthesized BaTiO3 for dielectric layers for high reliability. Unlike BaTiO3 nanoparticles synthesized by the hydrothermal method, particle size distribution control becomes demanding with the solid-state synthesis. Here, BaTiO3 with 260 and 390 nm average particle sizes were synthesized using a solid-state method, and the dielectric properties of the samples sintered at 1100, 1150, and 1200°C were studied in terms of particle size distributions. Notably, BaTiO3 samples sintered with 260 nm particles with smaller grain sizes and lower tetragonality exhibited higher dielectric properties than those prepared with 390 nm particles. The reasons behind the high dielectric performance were found in the lower skewness of the 260 nm particles, which produced a higher density of the sintered sample. For electric vehicle MLCC BaTiO3, engineering their skewness is as important as controlling their grain size or tetragonality for high dielectric performance.

Study Design This is a retrospective comparative cohort study. Purpose To investigate the prevalence of anterior resorption of the cervical spine in ankylosing spondylitis (AS) and its relationship with sagittal alignment. Overview of Literature This study believes that no published reports exist regarding the relationship between anterior resorption and spinopelvic alignment. Methods This retrospective study included 238 patients with AS who underwent surgical correction for thoracolumbar kyphosis. Of these, 80 patients with complete subaxial ankylosis were selected and divided into two groups: groups 1 (consisting of 28 patients with anterior bony resorption) and 2 (consisting of 52 patients without anterior resorption). Cervical sagittal parameters were analyzed and compared between the two groups. Results The average lateral diameter measured in patients with C5 anterior resorption was 84.2%±7.8% (62.4%–96.8%). Cervical lordosis was 8.7° ±13.4° and 10.9°±11.5° in groups 1 and 2 (p=0.556), respectively. No significant differences were noted between the two groups on spinopelvic alignment in the T1 slope (52.2°±11.1° and 53.3°±9.9° in groups 1 and 2, respectively; p=0.742), C2–C7 sagittal vertical axis (SVA; 6.2±1.7 cm and 6.2±1.8 cm in groups 1 and 2, respectively; p=0.978), C7 SVA (14.3±4.9 cm and 14.6±6.2 cm in groups 1 and 2, respectively; p=0.823), or T1 pelvic angle (27.1°±8.9° and 31.6°±11.2° in groups 1 and 2, respectively; p=0.382). Correlation analyses were significant between the extent of anterior resorption and sagittal parameters, C2–C7 lordosis (R2=−0.428, p=0.021), and T1–T4 kyphosis (R2=−0.375, p=0.045). Conclusions Anterior bony resorption could develop by stress concentration. However, the development was not related to the sagittal alignment. The particular segments involved in developing anterior resorption varied, possibly because of their dependence on the preceding pattern of ankylosis.

Proximal junctional problems are among the potential complications of surgery for adult spinal deformity (ASD) and are associated with higher morbidity and increased rates of revision surgery. The diverse manifestations of proximal junctional problems range from proximal junctional kyphosis (PJK) to proximal junctional failure (PJF). Although there is no universally accepted definition for PJK, the most common is a proximal junctional angle greater than 10° that is at least 10° greater than the preoperative measurement. PJF represents a progression from PJK and is characterized by pain, gait disturbances, and neurological deficits. The risk factors for PJK can be classified according to patient-related, radiological, and surgical factors. Based on an understanding of the modifiable factors that contribute to reducing the risk of PJK, prevention strategies are critical for patients with ASD.

Coronary artery spasm after heart transplantation is a very rare complication. In one observational study and many anecdotal reports, most cases of coronary artery spasm occurred more than 1 year after surgery and had good outcomes. However, cases of intractable coronary artery spasm during the early postoperative period resulting in fatality are limited. This report presents a case of two cardiac arrests caused by coronary artery spasms within a short period of time after heart transplantation.

Objective: This study was aimed to compare the oncologic outcomes of patients with non-endometrioid endometrial cancer who underwent minimally invasive surgery with the outcomes of patients who underwent open surgery. Method: This is a retrospective, multi-institutional study of patients with non-endometrioid endometrial cancer who were surgically staged by either minimally invasive surgery or open surgery. Oncologic outcomes of the patients were compared according to surgical approach. Results: 113 patients met the inclusion and exclusion criteria. 57 underwent minimally invasive surgery and 56 underwent open surgery. Patients who underwent minimally invasive surgery had smaller tumors (median size, 3.3 vs. 5.2%, p = 0.0001) and a lower lymphovascular space invasion rate (29.8% vs. 48.2%, p = 0.045). In the overall population, the numbers and rate of recurrence were significantly higher in the open surgery group (p = 0.016). In multivariate analysis, disease stage and tumor size were associated with DFS in contrast to surgical procedure. Conclusion: Minimally invasive surgery showed similar survival outcomes when compared to open surgery in non-endometrioid endometrial cancer patients, irrespective of disease stage. When minimally invasive surgery is managed by expert surgeons, non-endometrioid histological subtypes should not be considered a contraindication for minimally invasive surgery.

Adverse events following vaccination with the ChAdOx1 COVID-19 vaccine may be associated with the titer of neutralizing antibodies (NAbs) against SARS-CoV-2. In this cross-sectional study, a total of 82 HCWs who received the ChAdOx1 COVID-19 vaccine and did not have previous COVID-19 history were enrolled during March 2021. Blood samples were collected from HCWs 3 weeks after the first and second doses of vaccine, and NAbs were estimated using two types of commercially available kits, the cPass™ SARS-CoV-2 NAbs Kit (Genscript Biotech, Piscataway, NJ, USA) and R-FIND SARS-CoV-2 NAbs ELISA (SG Medical, Seoul, Korea). Median percent signal inhibition of NAbs was significantly higher after the second than after the first dose of vaccine, as determined using both the Genscript (median 43.1[IQR 71.2] vs. 93.6[83.1], p = 0.004) and R-FIND (53.2[82.6] vs. 76.8 [90.6], p = 0.03) kits. The percent signal inhibition of NAbs after the second dose of vaccine was higher in HCWs with than without systemic adverse events after the second dose, as determined using both the Genscript (p = 0.03) and R-FIND (p = 0.07) kits. The two doses of the ChAdOx1 vaccine induced high value of NAbs 3 weeks after vaccination. Immune responses were stronger in HCWs with than without adverse reactions after the second dose of ChAdOx1 vaccine.

Abstract Zintl compounds are promising thermoelectric materials for power generation as their electronic and thermal transport properties can be simultaneously engineered with anion/cation alloying. Recently, a peak thermoelectric figure‐of‐merit, zT, of 1.4 was achieved in a (Yb0.9Mg0.1)Cd1.2Mg0.4Zn0.4Sb2 Zintl phase at 700 K. Although the effects of alloying Zn in lattice thermal conductivity had been studied thoroughly, how the Zn alloying affects its electronic transport properties has not yet been fully investigated. This study evaluates how the Zn alloying at Cd sites alters the band parameters of (Yb0.9Mg0.1)Cd1.6−xMg0.4ZnxSb2 (x=0‐0.6) using the Single Parabolic Band model at 700 K. The Zn alloying increased the density‐of‐states effective mass (md*) from 0.87 to 0.97 m0. Among Zn‐alloyed samples, the md* of the x=0.4 sample was the lowest (0.93 m0). The Zn alloying decreased the non‐degenerate mobility (μ0) from 71 to 57 cm2 s−1 V−1. Regardless of Zn alloying content, the μ0 of the Zn‐alloyed samples were similar (∼57 cm2 s−1 V−1). Consequently, the x=0.4 with the highest zT exhibited the lowest weighted mobility (μW). The lowest μW represents the lowest theoretical electronic transport properties among other x. The highest zT at x=0.4 despite the lowest μW was explained with a significant lattice thermal conductivity reduction achieved with Zn alloying with x=0.4, which outweighed the deteriorated electronic transport properties also due to the alloying.

Herein, we report a simple and scalable synthesis route to prepare Ag-functionalized porous ZnO sheets and their enhanced NO2 gas sensing properties. Porous ZnO sheets functionalized with well-dispersed submicron Ag particles were prepared by using a hydrothermal method-based one-pot synthesis route from Zn and Ag precursors. NO2 gas sensing performance (response, selectivity, response time, and recovery time) was optimized at 200°C in the gas sensor fabricated with 3 at% Ag-functionalized porous ZnO sheets. We demonstrated a response (Rg/Ra) of 17.18 to 10 ppm NO2 gas and also obtained a high response of 14.05 even at 60% relative humidity due to the synergetic effect of improved NO2 gas adsorption in the presence of Ag particles and increased resistance by the formation of Schottky barrier at Ag-ZnO heterojunctions.

Study Design This study is a retrospective analysis of a case. Purpose The purpose of this study is to investigate the fracture patterns and risk factors of sacral insufficiency fractures (SIFs) to improve their diagnosis in clinical practice. Overview of Literature SIFs occur when normal stresses are applied to a bone with decreased density, most often due to osteoporosis. Individuals who receive lumbosacral fusion procedures may also suffer from increased incidents of SIFs because of decreased bone density related to aging. Methods In total, 55 patients with SIFs were retrospectively investigated in this study. The study population was divided into lumbosacral fusion (n=20) and non-fusion (n=35) groups. Subsequently, the patients’ demographic characteristics, comorbidities, medication history, results of diagnostic imaging studies, and bone mineral density were assessed. The fracture patterns were classified either according to the five typical types (H-pattern bilateral vertical plus horizontal component, unilateral vertical only, bilateral vertical only, unilateral vertical plus horizontal component, and horizontal only fracture) or atypical types. Results In total, 44 of 55 patients (80%) suffered from more than one senile disease and received corresponding medications that caused secondary osteoporosis. A total of 12 patients had S1 lumbosacral fixation. Moreover, three of these 12 patients who developed a SIF immediately after a lumbosacral fracture had an unstable sacral U fracture. The remaining nine patients showed fracture patterns similar to the non-fusion patients. Single-photon emission computed tomography (SPECT)/computed tomography (CT) can identify fracture recurrence in previously healed fractures. In total, 24 patients (43.6%) had fractures of the pelvis, femur, and thoracolumbar spine. Conclusions SIF develops in elderly patients with multiple adult diseases that can induce secondary osteoporosis. Such fractures may occur in the patients with instrumented lumbosacral fusion. Importantly, some patients showed stress fractures after multilevel instrumented lumbosacral fusion, whereas others showed insufficiency fractures. The different fracture patterns correspond to different grades of SIF, and SPECT/CT can easily identify the fracture status.

Herein, we investigated the influence of sulfur (S) addition on the phase formation behavior and thermoelectric transport properties of n-type Cu0.008Bi2Te3. A complete single phase of rhombohedral Bi2Te3 was formed in Cu0.008Bi2Te2.8S0.2, whereas a mixture of Bi2Te3 and Bi2Te2S1 phases was generated at higher S contents. We elucidated the complex effects of S substitution at Te-site on transport properties of Cu0.008Bi2Te3; (1) increase in density-of-states effective mass, (2) decrease in weighted mobility ratio, (3) reduction in lattice thermal conductivity, and (4) reduction in bipolar thermal conductivity. Despite the slight deterioration in electronic transport properties, a maximum thermoelectric figure of merit (zT) of 0.82 was achieved at 400 K in Cu0.008Bi2Te2.8S0.2 due to the synergetic effect of intensified point defect phonon scattering in a wide temperature range and suppressed bipolar thermal conduction at elevated temperatures.

Abstract During lateral lumbar interbody fusion (LLIF), unintended intraoperative endplate injury (IEPI) can occur and thereafter lead cage subsidence. The aim of this study was to investigate the incidence of IEPI during LLIF, and its predisposing factors. A retrospective review was conducted on consecutive patients (n = 186; mean age, 70.0 ± 7.6 years) who underwent LLIF at 372 levels. Patient’s demographic and surgical data were compared between patients with and without IEPI. Also, the radiographic data of each level were compared between intact and IEPI segments. IEPI was identified at 76 levels (20.4%) in 65 patients. The incidences of IEPI at every 100 consecutive segments were not different. When 372 segments were analyzed independently, sagittal disc angle (DA) in the extended position (4.3° ± 3.6° at IEPI segments vs. 6.4° ± 4.0° at intact segments), the difference between sagittal DA in the extended position and cage angle (− 2.2° ± 4.0° vs. 0.0° ± 3.9°), and the difference between preoperative disc height and cage height (− 5.4 mm ± 2.4 mm vs. − 4.7 mm ± 2.0 mm) were different significantly. Also, endplate sclerosis was more common at intact segments than IEPI segments (33.2% vs. 17.3%). Multivariate analysis showed that male sex (odds ratio [OR] 0.160; 95% confidence interval [CI] 0.036–0.704), endplate sclerosis (OR 3.307; 95% CI 1.450–8.480), and sagittal DA in the extended position (OR 0.674; 95% CI 0.541–0.840) were significant associated factors for IEPI. IEPI was correlated not with surgeon’s experience, but with patient factors, such as sex, preoperative disc angle, and endplate sclerosis. Careful surgical procedures should be employed for patients with these predisposing factors.

(1) Background: Recently, Escherichia coli-derived recombinant human bone morphogenetic protein-2 (E. coli-derived rhBMP-2) has been increasingly applied to different types of spinal surgeries and reported to achieve successful fusion. This pilot study aimed to evaluate the clinical efficacy and safety of rhBMP-2 in patients undergoing posterior instrumented fusions for unstable spinal fractures. (2) Methods: This study included ten consecutive patients undergoing spinal surgery using E. coli-derived rhBMP-2 with more than one year of follow-up. Radiologic outcomes were compared, including the average fracture healing period, local kyphosis correction, and clinical outcomes between preoperative and the last follow-up. (3) Results: The average time of radiographic union was 99.9 ± 45.4 (62–192) days, with an average use of 5.2 ± 3.9 months of anabolic agents. Radiologic parameters such as anterior vertebral height and vertebral wedge angle were significantly corrected postoperatively and at the last follow-up. Clinical outcomes other than leg pain were significantly improved after the surgery. In addition, four patients with preoperative neurologic deficits showed improved neurologic status. (4) Conclusions: Combined with the anabolic agents, applying E. coli-derived rhBMP-2 to the fractured vertebral body could be an effective surgical treatment for unstable spinal fractures. Further trials are needed to validate this result.

Bi2Te3 is a good candidate to be used in thermoelectric generators. For a higher efficiency of the generators, shifting the temperature at which Bi2Te3 performs best to higher temperatures is required. Bipolar thermal conductivity suppression is the most effective approach to improve high-temperature thermoelectric performance. However, characterization of the bipolar thermal conductivity is challenging because it is related to individual contribution to Seebeck coefficient and electrical conductivity from the majority and minority carriers. Two-band model calculations are performed using reported band parameters of n-type Bi2Te3 to estimate the effects of band gap and minority to majority carrier concentration ratio in the bipolar thermal conductivity suppression. Individual Seebeck coefficient, electrical conductivity, and carrier concentrations from the majority and minority carriers are evaluated while varying chemical potential with a different band gap. It was demonstrated that increasing the band gap and chemical potential increased the individual Seebeck coefficient from minority carriers while decreasing the individual electrical conductivity and concentration from minority carriers. As a result, it was shown that the band gap increase and especially the magnitude of the minority to majority carrier concentration ratio decrease was effective in the bipolar thermal conductivity suppression.

Bi–Te-based alloys are potential candidates for use in thermoelectric (TE) modules for low-mid-temperature energy harvesting. However, n-type Bi–Te–Se alloys are inferior to their p-type counterparts in terms of TE performance. It has been found that doping Cu atoms into n-type Bi–Te–Se alloys is effective in improving the TE properties; however, different studies have reported contrasting roles of Cu dopants in the transport properties of Bi–Te–Se alloys. This is attributed to the complex doping behaviors of Cu atoms. In this study, it is demonstrated that employing an appropriate fabrication technique can enable more Cu dopants to be directed to specific atomic sites than others. As part of the study, two n-type polycrystalline Cu0.01Bi1.99Te2.7Se0.3 bulk samples are respectively fabricated via melt-spinning followed by spark plasma sintering, and via ball-milling followed by spark plasma sintering. The majority of Cu dopants in the melt-spun sample are suspected to exist in between Te1–Te1 atomic layers (van der Waals gap), given the elongated c-axis, increased Hall carrier concentration, and improved non-degenerate mobility (intercalated Cu generates one electron and acts as an electric connector). Resultantly, a ~30% enhancement in the TE figure-of-merit (~0.92 at 360–400 K) is achieved in the melt-spun sample, relative to the ball-milled sample, wherein Cu atoms substitute Bi atoms.

Abstract Background Gas forming infection of the spine is a consequence of vertebral osteomyelitis, necrotizing fasciitis, or a gas-forming epidural abscess, which is very rare and fatal conditions. This is the rare case of necrotizing fasciitis that rapidly progressed from the lumbar area to upper thoracic area. Case presentation A 58-year-old male complained of lower back pain with fever and chills. The patient had a history of uncontrolled diabetes mellitus without diabetic medication over the previous 3 months, and he had received several local injections around the lumbar area. Laboratory data revealed white blood cell count of 19,710 /mm3, erythrocyte sedimentation of 40 mm/h, and C-reactive protein of 30.7 mg/L. Radiological findings revealed a small amount of air bubbles in the paraspinal area and lumbar epidural spaces. The patient refused emergency surgery and was discharged from the hospital. The patient re-visited the emergency department two days after discharge complaining of more severe back pain with persistent fever, and his vital signs had deteriorated, with low blood pressure and tachycardia. K. pneumoniae was isolated in cultures from ultrasound-guided aspirates and peripheral blood. The follow-up radiographs revealed aggressive dissemination of innumerable air bubbles from the lumbar area to the T5 level. The patient underwent emergent decompressive laminectomy and debridement of infected paravertebral fascia and musculature. Despite intensive care for deteriorated vital signs and his back wound, the patient died on postoperative day 3 due to multi-organ failure. Conclusions Necrotizing fasciitis involving the spine is a very rare disease with life-threatening conditions, rapid progression, and a high mortality rate. Therefore, prompt surgical treatment with a high index of suspicion is imperative to prevent potentially fatal conditions in similar extremely rare cases.

Introduction We aimed to evaluate the efficacy and toxicity of the combination of 6 cycles of chemotherapy and radiation therapy compared with chemotherapy alone as postoperative adjuvant therapy for patients with stage III endometrial cancer. Methods This retrospective cohort study included patients with stage III endometrial cancer who received postoperative chemoradiotherapy or chemotherapy alone at 6 hospitals between January 2009 and December 2019. The progression-free survival (PFS) and overall survival (OS) for each treatment group were analyzed using the Kaplan–Meier method. We also assessed differences in toxicity profiles between the treatment groups. Results A total of 133 patients met the inclusion criteria. Of these, 80 patients (60.2%) received adjuvant chemoradiotherapy and 53 (39.8%) received chemotherapy alone. The PFS and OS did not differ significantly between the groups. For patients with stage IIIC endometrioid subtype, the chemoradiotherapy group had significantly longer PFS rate than did the chemotherapy alone group (log-rank test, P = .019), although there was no significant difference in the OS (log-rank test, P = .100). CRT was identified as a favorable prognostic factor for PFS in multivariate analysis (adjusted HR, .37; 95% CI, .16-.87; P = .022). Patients treated with chemoradiotherapy more frequently suffered from grade 4 neutropenia (73.8% vs 52.8%; P = .018) and grade 3 or worse thrombocytopenia (36.3% vs 9.4%; P = .001) compared with the chemotherapy alone group. There were no differences between the 2 treatment groups in the frequency of toxicity-related treatment discontinuation or dose reduction. Conclusion We confirmed that chemoradiotherapy yields longer progression-free survival than does chemotherapy alone for patients with stage IIIC endometrioid endometrial cancer, with an acceptable toxicity profile.

Abstract Coagulopathy is frequent in septic shock and plays a key role in multiple organ dysfunction. The aim of this study is to investigate application values of thromboelastography (TEG) for outcome in septic shock patients with a normal value of prothrombin time (PT) and active partial thromboplastin time (aPTT). Prospective observational study using 1298 consecutive septic shock patients with TEG at admission was conducted at the emergency department (ED) of a tertiary care hospital in South Korea between 2016 and 2019. After excluding overt-disseminated intravascular coagulation (DIC) defined by scoring system, we included patients with a normal value of international normalized ratio ≤ 1.3 and aPTT ≤ 34 s. The primary outcome was 28-day mortality. 893 patients were included and 129 patients with overt DIC were excluded. Of the 764 remaining patients, 414 (54.2%) patients showed normal PT and aPTT (28-day mortality rate, 11.4%). TEG values such as reaction time, kinetic time (K), alpha angle (α), maximum amplitude (MA) and lysis index (LY 30) showed no significant mean difference between the survivor and non-survivor groups. However, hypocoagulable TEG values such as α 3 and α

Abstract In Korea, subtype B is the predominant variant of HIV-1, but full genome sequencing and analysis of its viral variants are lacking. We performed near full-length genome (NFLG) sequencing and phylogenetic and recombination analyses of fifty plasma samples from HIV-positive men who have sex with men (MSM) from a Korea HIV/AIDS cohort study. Viral genomes were amplified and the near-full-length sequences were determined using next-generation sequencing (NGS) and Sanger sequencing. We focused on the HIV-1 subtype classification and identification of HIV recombinants. Twelve HIV-1 NFLGs were determined: ten were subtyped as pure HIV-1 subtype B and two recombinant strains as a common subtype CRF07_BC, and a novel subtype CRF43_02G recombined with CRF02_AG again, or a new CRF02_AG and subtype G recombinant. For the ten NFLGs determined by NGS, “the novel recombinant emerged at approximately 2003 and the other nine subtype B about 2004 or 2005”. This is the first report analyzing HIV-1 NFLG, including recombinants and clinical characteristics, by subtype among MSM in Korea. Our results provide novel insights for understanding the recombinants in the HIV-1 epidemic in Korea.

Double half‐Heuslers comprising two aliovalent half‐Heuslers are promising candidates for thermoelectric materials because of their intrinsically low lattice thermal conductivity; however, poor electronic transport properties need to be overcome. Herein, the effects of Sn doping on the electronic and thermal transport properties of p‐type Ti2FeNiSb2 to enhance the thermoelectric performance via the compositional tuning route are investigated. The power factor is significantly improved owing to the synergetic effect of the increase in the density‐of‐states effective mass and the carrier concentration. In addition, the lattice thermal conductivity is slightly reduced, benefitted from intensified phonon scattering due to lattice disordering by Sn substitution at the Sb‐site. A peak figure of merit (zT) of ≈0.28 is obtained at 973 K in Ti2FeNiSb1.8Sn0.2, which is almost twice higher than that of the pristine Ti2FeNiSb2.

Objective Rapid determination of acute coronary syndrome (ACS) in the emergency department (ED) is very important for patients presenting with ischemic symptoms. The aim of this study was to determine the predictive value of HEART score for ACS and significant coronary artery stenosis (SCS). Methods We retrospectively analyzed data of patients who visited the ED with chest discomfort and were admitted to the cardiology department. Enrolled patients were classified into ACS and non-ACS groups according to their discharge diagnosis. Patients who underwent imaging were further divided into SCS and non-SCS groups according to study results. We compared age, sex, vital signs, risk factors, electrocardiogram, troponin, and HEART score for each group. For ACS and SCS predictive performance, the test characteristics of HEART score was calculated using sensitivity, specificity, predictive value, likelihood ratio, and receiver operating characteristic (ROC) curve analysis. Results Of 207 patients, 112 had ACS. Among enrolled patients, 155 underwent imaging workup, of whom 67 had SCS. HEART score ≤3 had 93% sensitivity for ACS and 97% for SCS. HEART score ≥7 had 82% specificity for ACS and 83% for SCS. HEART score area under ROC curve for ACS was 0.706 (95% confidence interval, 0.627–0.776) and 0.737 (95% confidence interval, 0.660–0.804) for SCS. Conclusion HEART score was a fair predictor of ACS and SCS in ED patients who presented with chest symptoms and were admitted to the cardiology department. The predictive power of HEART score was better for SCS than for ACS.

Lumbar interbody fusion (LIF) is an effective and popular surgical procedure for the management of various spinal pathologies, especially degenerative diseases. Currently, LIF can be performed with posterior, transforaminal, anterior, and lateral approaches by open surgery or minimally invasive surgery (MIS). Each technique has its own advantages and disadvantages. In general, posterior LIF is a well-established procedure with good fusion rates and low complication rates but is limited by the possibility of iatrogenic injury to the neural structures and paraspinal muscles. Transforaminal LIF is frequently performed using an MIS technique and has an advantage of reducing these iatrogenic injuries. Anterior LIF (ALIF) can restore the disk height and sagittal alignment but has inherent approach-related challenges such as visceral and vascular complications. Lateral LIF and oblique LIF are performed using an MIS technique and have shown postoperative outcomes similar to ALIF; however, these approaches carry a risk of injury to psoas, lumbar plexus, and vascular structures. Herein, we provide a detailed description of the surgical procedures of each LIF technique. We shall then consider the pearls and pitfalls, as well as propose surgical indications and contraindications based on the available evidence in the literatures.