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Objective To determine the clinical impact of the baseline sagittal imbalance severity in patients with adult spinal deformity (ASD). Methods We retrospectively reviewed patients who underwent ≥ 5-level fusion including the pelvis, for ASD with a ≥ 2-year follow-up. Using the Scoliosis Research Society-Schwab classification system, patients were classified into 3 groups according to the severity of the preoperative sagittal imbalance: mild, moderate, and severe. Postoperative clinical and radiographic results were compared among the 3 groups. Results A total of 259 patients were finally included. There were 42, 62, and 155 patients in the mild, moderate, and severe groups, respectively. The perioperative surgical burden was greatest in the severe group. Postoperatively, this group also showed the largest pelvic incidence minus lumbar lordosis mismatch, suggesting a tendency towards undercorrection. No statistically significant differences were observed in proximal junctional kyphosis, proximal junctional failure, or rod fractures among the groups. Visual analogue scale for back pain and Scoliosis Research Society-22 scores were similar across groups. However, severe group’s last follow-up Oswestry Disability Index (ODI) scores significantly lower than those of the severe group. Conclusion Patients with severe sagittal imbalance were treated with more invasive surgical methods along with increased the perioperative surgical burden. All patients exhibited significant radiological and clinical improvements after surgery. However, regarding ODI, the severe group demonstrated slightly worse clinical outcomes than the other groups, probably due to relatively higher proportion of undercorrection. Therefore, more rigorous correction is necessary to achieve optimal sagittal alignment specifically in patients with severe baseline sagittal imbalance.

Abstract Many studies sought to demonstrate the association between smoking and fracture risk. However, the correlation between smoking and fractures remains controversial. This study aimed to examine the impact of smoking and smoking cessation on the occurrence of fractures using prospective nationwide cohort data. We enrolled those who underwent a National Health Insurance Service (NHIS) health checkup in 2009–2010 who had a previous health checkup 4-year prior (2005–2006). The study population of 4,028,559 subjects was classified into three groups (non-smoker, smoking cessation, current smoker). The study population was also analyzed according to fracture type (all fractures, vertebral fracture, hip fracture). Lastly, the smoking cessation group and current smoker group were divided into four subgroups based on a lifetime smoking amount cut-off of 20 pack-years (PY). Multivariate-adjusted hazard ratios (HRs) of fracture were examined through a Cox proportional hazards model. After multivariable adjustment, non-smokers showed the lowest risk of fracture (HR = 0.818, CI 0.807–0.828, p

Objective To introduce a new sagittal parameter, uppermost instrumented vertebra-pelvic tilt angle (UIVPTA), and to determine the effects on the proximal junctional kyphosis (PJK) development in adult spinal deformity (ASD) surgery. Methods Patients ≥ 60 years with ASD who underwent low thoracic spine to pelvis fusion with a minimum of 2-years of follow-up were included in this study. Two groups were created according to PJK development. Various clinical and radiographic factors were compared between PJK and non-PJK groups to identify the risk factors for PJK. Cutoff value of UIVPTA for PJK development was calculated using receiver operating characteristic curve according to different pelvic incidence groups. Linear regression analysis was performed to identify factors to affect UIVPTA. Results One hundred fifity-one patients were included in this study. There were 135 female patients (89.4%). Mean age was 70.5 years. PJK developed in 65 patients (43.0%). Multivariate analysis showed that overcorrection relative to age-adjusted pelvic incidence (PI) minus lumbar lordosis (LL) (PI–LL) target and lower UIVPTA were independent risk factors for PJK. The cutoff value of UIVPTA for PJK development was calculated as 4.0° in patients with PI less than 45°, 9.5° in patients with PI between 45° and 60°, and 13.0° in patients with PI greater than 60°. Linear regression analysis showed that UIVPTA was positively affected by postoperative values of LL (coefficient = 0.505), PI–LL (coefficient = 0.674), and pelvic tilt (coefficient = 0.286). Conclusion Optimal correction within the age-adjusted PI–LL combined with keeping UIVPTA within optimal range is suggested for the prevention of PJK.

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.

In this study, the internal environment such as the air temperature, humidity, and wall temperature of the underground utility tunnel, was analyzed. The current status and problems of the air conditioning system were examined by analyzing the capacity of the exhaust fan and the air velocity inside the utility tunnel. The field experiment showed that the utility tunnel has a relative humidity of 95% or higher for most sections during summer. The deviation of the internal air temperature was about $4~^{\circ }\text{C}$ depending on the section, and the dew condensation occurred. However, most of the exhaust fans has a capacity below the standard minimum air velocity of 2.5m $\cdot \text{s}^{-1}$ . In particular, in the section where dew condensation occurred, the air velocity was 0.26 to 0.97 $\text{m}\cdot \text{s}^{-1}$ , indicating the presence of stagnant air inside the facility. Therefore, this study attempted to minimize dew condensation by calculating the proper exhaust fan capacity using computational fluid dynamics and installing circulation fans and duct systems in the section where the dew condensation occurred. As a result, when a circulation fan was installed, it was possible to increase the air velocity inside the utility tunnel, and the relative humidity could be reduced by about 78%. By installing a duct, the direct supply of external air or the discharge of internal humid air was simulated for the section where dew condensation occurred. The result showed that the relative humidity could be reduced by about 78% when the duct system was operated in the intake direction.

Osteoporotic vertebral compression fractures (OVCF) can cause severe pain, changes in balance, gait velocity, muscle fatigue, risk of falls, and subsequent fractures. Thus, OVCF significantly lowers the individual's health-related quality of life. Additionally, OVCF may increase patient mortality rates. However, studies on post-OVCF mortality are limited. This study aimed to evaluate mortality risk after the first occurrence of OVCF in the general population using a nationwide dataset from the Korean National Health Insurance System. We identified 291,203 newly diagnosed patients with OVCF and 873,609 patients without OVCF at a ratio of 1:3 matched by sex and age between 2010 and 2012. We investigated the latent characteristics of patients' demographic information and chronic comorbidities that could affect mortality when diagnosed with OVCF. By comparing the cohort data, the hazard ratio for subsequent mortality in patients with OVCF was calculated and adjusted based on several risk factors. Despite adjusting for demographic characteristics and chronic comorbidities, the risk of mortality was 1.22 times higher in the OVCF cohort than in the control group. Multivariate analysis showed that male sex, old age, low-income status, and high Charlson Comorbidity Index were associated with a higher risk of mortality. In addition, the presence of chronic comorbidities, including diabetes mellitus, ischemic heart disease, stroke, chronic obstructive pulmonary disease, cancer, and end-stage renal disease, was shown to increase the risk of mortality. This population-based cohort study showed that newly diagnosed OVCF significantly increased the subsequent risk of mortality. Moreover, post-OVCF mortality is influenced by demographic characteristics and chronic comorbidities.

ObjectiveRheumatoid arthritis (RA) increases the risk of cardiovascular disease. This study aimed to investigate the short-and long-term prognosis of patients with and without RA who underwent percutaneous coronary intervention (PCI).MethodsThe Korean National Health Insurance Service claims database was used to extract data on 236,134 patients (34,493 with RA and 201,641 without RA) who underwent PCI between 2008 and 2019. The primary outcome was major adverse cardiovascular events (MACE), including all-cause mortality, myocardial infarction, stroke, transient ischemic attack, or coronary revascularization with short-term (30-day) and long-term outcomes. The secondary outcomes were the individual components of MACE.ResultsDuring a 10-year follow-up, patients with RA showed a shorter median survival time from MACE than their counterparts (with RA: 4.29 years vs. without RA: 6.10 years). RA was significantly associated with an increased risk of MACEs in long-term outcomes (hazard ratio (HR) 1.07, 95% confidence intervals (CI) 1.06-1.09, pConclusionIn patients who underwent PCI, RA did not increase the risk of short-term cardiovascular outcomes but increased the risk of long-term adverse outcomes.

Abstract Background The “obesity paradox” has not been elucidated in the long-term outcomes of acute coronary syndrome (ACS). We investigated the association between obesity and cardiovascular (CV) outcomes in ACS patients with and without diabetes. Methods We identified 6978 patients with ACS aged 40–79 years from the Korean National Health Insurance Service-Health Screening Cohort between 2002 and 2015. Baseline body mass index (BMI) was categorized as underweight (

Purpose Spinal muscular atrophy (SMA) is a genetic progressive neuromuscular disorder, and nusinersen has shown to improve its symptoms. Scoliosis is a frequent symptom in patients with SMA and complicates the intrathecal injection of nusinersen. The aim of this study was to investigate the safety and effectiveness of fluoroscopy-guided intrathecal injections in patients with SMA with severe scoliosis. Methods We retrospectively reviewed the medical records of 11 patients with SMA treated with nusinersen intrathecal injections at the Samsung Medical Center from 2018 to 2020. We assessed the type of SMA, genetic results, spine computed tomography or fluoroscopy findings, and adverse effects associated with the injection. Results Of 11 patients with SMA, six were diagnosed with severe scoliosis, four of whom underwent an operation for scoliosis. The six patients with severe scoliosis started receiving the nusinersen injection at a median age of 15.7 years. A total of 25 injections were completely performed with the interlaminar approach (ILA) at the lumbar level under C-arm fluoroscopy guidance. No adverse effects other than mild headache occurred. In one patient who underwent the complete fusion operation for scoliosis, laminectomy was performed for the nusinersen injection, and 3 doses were administered intrathecally via the interlaminar route at the lumbar level. Conclusion Fluoroscopy-guided ILA is a safe method for the intrathecal injection of nusinersen in patients with SMA with severe scoliosis. When defining the route, laminectomy might be necessary to open the window for the ILA route at the lumbar level.

Carbon dioxide (CO2) emissions from the livestock industry are expected to increase. A response strategy for CO2 emission regulations is required for pig production as this industry comprises a large proportion of the livestock industry and it is projected that per capita pork consumption will rise. A CO2 emission response strategy can be established by accurately measuring the CO2 concentrations in pig facilities. Here, we compared and evaluated the performance of three different machine learning (ML) models (ElasticNet, random forest regression (RFR), and support vector regression (SVR)) designed to predict CO2 concentration and internal air temperature (Ti) values in the pig house used to regulate a heating, ventilation, and air conditioning (HVAC) control system. For each ML model, the hyperparameter was optimised and the predictive accuracy was evaluated. The order of predictive accuracy for the ML models was ElasticNet < SVR < RFR. Hence, random forest regression provided superior prediction performance. Based on the test dataset, for Ti prediction by RFR, R2 ≥ 0.848 and the root mean square error (RMSE) and mean absolute error (MAE) were 0.235 °C and 0.160 °C, respectively, whilst for CO2 concentration prediction by RFR, R2 ≥ 0.885 and the RMSE and MAE were 64.39 ppm and ≤ 46.17 ppm, respectively.

Purpose Pseudoarthrosis and metal failure at L5-S1 following long fusion surgery for adult spinal deformity (ASD) remain major issues. Few studies report on which anterior column support technique is better in terms of achieving fusion and avoiding metal failures. Our study aimed to evaluate the fusion status and metal failure rate at L5-S1 after anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF). Methods The study population included patients aged >50 years who underwent surgery for ASD. Anterior column supports at L5-S1 using ALIF and TLIF were compared with ≥ 2-year follow-up. Fusion status on 2-year computed tomography (CT) scan, metal failure, visual analog scale (VAS), and Oswestry disability index (ODI) were evaluated. Results 98 patients were included in this study (53 ALIF group and 45 TLIF group). We achieved solid fusion on 2-year CT scans in 88.9% and 69.8% patients in the TLIF and ALIF group, respectively. Metal failure developed in nine (17.0%) and six (13.3%) patients in the ALIF and TLIF group, respectively. The most common failure type was unilateral L5-S1 rod fracture (7 and five patients in the ALIF and TLIF group, respectively). Only one patient with bilateral rod fractures in the ALIF group required revision surgery. There were no differences in the VAS and ODI scores at the last follow-up. Conclusions TLIF showed a better fusion rate than ALIF at L5-S1 after long instrumented fusion for ASD. However, the capacity to restore sagittal parameters was greater in the ALIF group. There were no differences between the groups regarding metal failure rate, revision surgery, or clinical outcomes.

We aimed to identify the browning of white adipocytes using partial least squares regression (PLSR), infrared spectral biomarkers, and partial least squares discriminant analysis (PLS-DA) with FTIR spectroscopy instead of molecular biology. PLSR helps distinguish human beige adipocytes treated with norepinephrine and rosiglitazone. When PLSR was based on the selected regions of 3997–3656 and 1618–938 cm−1, PLSR achieved an R2 of cross-validation of 88.95, a root mean square error of cross validation (RMSECV) of 2.13, and a ratio performance deviation (RPD) of 3.01. Infrared spectral biomarkers [1635 cm−1 (β-sheet amide I), 879–882, 860–3 cm−1 (A-form helix), and 629–38 cm−1 (OH out-of-plane bending)] were identified in human beige adipocytes based on spectral differences between human beige adipocytes and human white adipocytes, principal component analysis-linear discriminant analysis (PCA-LDA) cluster vector, U-test, and Fisher’s score per wavenumber. PLS-DA yielded a useful classification of adipocytes and expression distribution of adipogenesis genes in adipocytes. PLSR, infrared spectral biomarkers, and PLS-DA using FTIR spectroscopy are proposed as effective tools for identifying specific biological activities in a limited environment through features that do not require labeling and are relatively inexpensive in terms of time and labor.

The internal rearing environment of livestock houses has become an important issue in the last few years due to the rapid increase in meat consumption. As the number of days of heat waves increase continuously, problems caused by abnormal weather changes steadily occurred. Thus, the main goal of this study is to develop a technology that can automatically calculate heat stress for livestock by considering weather forecast data. Specifically, a web-based heat stress forecasting system for the evaluation of heat stress in broilers was developed. The field experiments were carried out at the selected broiler house to measure and analyze the external weather, the internal environment, and the ventilation flow rate of fans used in tunnel ventilation. The developed model was validated by comparing the field and simulated thermal environment values. Based on a reliable model, Land-Atmosphere Modeling Package (LAMP) weather forecast data was used to show the stress index on the internal rearing environment with a heat stress index suitable for South Korea. When the users input the farm location, structure and equipment, and rearing information, users responded after receiving heat stress from the broiler raised in a mechanically ventilated broiler house.

Objectives: This analysis was performed to evaluate the incidence of vertebral compression fracture (VCF) and determine the contributing factors for VCF in patients undergoing single-fraction stereotactic body radiotherapy (SBRT) for spinal bone metastases (SBM). Methods: A retrospective review of medical records was conducted for patients undergoing SBRT for SBM at our institution between January 2010 and December 2018. Patients who had undergone neither pre-SBRT surgical excision nor post-SBRT prophylactic fixation were included. The effects of clinical and dosimetric parameters were analyzed with respect to VCF risk. The following dosimietric parameters of the planning target volume (PTV) were calculated: mean/minimum/maximum dose, radiation dose to 10–90% volume, and irradiated volume receiving more than 10–25 Gy (PTV_V10 – 25 Gy). Results: Among 163 patients (179 vertebrae), 21 (12.8%) experienced VCF. The 1-year and 2-year VCF rates were 12.1% and 13.2%, respectively. Among dosimetric parameters, PTV_V15 Gy was the most significant for VCF prediction. In a univariate analysis, breast or prostate primary, no vertebral body collapse, and PTV_V15 Gy ≤42 cm3 were significantly associated with a lower incidence rate of VCF. In a multivariate analysis, PTV_V15 Gy was the only significant factor for VCF risk. The 1-year VCF rate was 3.8% in patients with PTV_V15 Gy ≤42 cm3, while it was 22.1% in those with PTV_V15 Gy > 42 cm3 (p

A Venlo-type greenhouse with a continuous roof vent (CR-Venlo greenhouse) was proposed by the Ministry of Agriculture, Food and Rural Affairs, South Korea (2019) for natural ventilation even during summers. It is ventilated through the buoyancy effect of the heated air using the high eave elevation. However, the CR-Venlo greenhouse was not distributed domestically, and its ventilation efficiency was not quantitatively evaluated. We aimed to analyze the natural ventilation efficiency of the greenhouse according to the eave height, using computational-fluid-dynamics. The simulation model was analyzed for hot summer conditions. The target greenhouse is ventilated only through the roof vent with all roof windows open; therefore, the air introduced through the roof window is easily exhausted. To evaluate the efficiency of ventilation, the external air entering through the roof window was calculated and evaluated. The amount of incoming air varied greatly with the location of the span and average temperature of the greenhouse; The temperature of the crop zone decreased lognormally with increasing height of the eave. Moreover, the ventilation efficiency of CR-Venlo greenhouse could be increased by improving the ventilation structure such as a shape, position or combination of roof window.

As the pig industry develops rapidly, various problems are appearing both inside and outside the pig houses. In particular, in the case of pig houses, it is difficult to solve the main problems even if automation and mechanization are applied with ICT technology. The main current issues are: (1) preventing infectious diseases amongst livestock, (2) reducing the emission of harmful gas and odors, (3) improving the growth environment inside the pig house, (4) reducing energy costs, (5) improving the farm management and operating system, and 6) improving the livestock product quality. Air recirculation technology can be applied as a technology that can solve these typical problems in the pig industry. An air-recirculated ventilation system can minimize the inflow of air from outdoors and recycle the internal thermal energy of the pig house. The air-recirculated ventilation system consists of (1) an air scrubber module, (2) external air-mixing module, (3) UV cleaning module, (4) solar heat module, and (5) air-distribution module. First, in this study, the field data were collected to analyze the main problems of the target piglet house for the application of the air-recirculated ventilation system. In addition, a computational fluid dynamics (CFD) model was developed and validated for seasonal aerodynamic analysis. The applicability of the air-recirculated ventilation system was evaluated based on the CFD computed results for various environmental conditions. As a result of evaluating the internal environment according to the ventilation rates and external-air-mixing ratio of the air-recirculated ventilation system, the required ventilation rate and external air-mixing ratio to maintain the proper temperature and gas concentration were determined.

Energy management of a building-integrated rooftop greenhouse (BiRTG) is considered one of the important factors. Accordingly, the interest in energy simulation models has increased. Energy load computed from the simulation model can be used for appropriate capacity calculation and optimal operation of the environmental control system. In particular, because the thermal environment of greenhouses is sensitive to the external weather environment, dynamic energy simulations, such as building energy simulation (BES), play an essential role in understanding the complex mechanisms of heat transfer in greenhouses. Depending on the type and crop density, there is a significant difference in the thermal energy loads of greenhouses. Furthermore, ventilation is also an important factor affecting the energy input of the greenhouse. Therefore, this study aimed to design and validate BES models considering the crop and ventilation characteristics of a naturally ventilated greenhouse before designing and evaluating a BES model for the BiRTG. First, the BES module for the greenhouse and crop models was designed using field-measured data, and the ventilation characteristics were analysed using computational fluid dynamics (CFD). The greenhouse BES model was designed and then validated by comparing air temperature (Ta) and relative humidity (RH) measured at the greenhouse with the BES-computed results of the greenhouse model. The results showed that the average absolute error of Ta was 1.57 °C and RH was 7.7%. The R2 of the designed BES model for Ta and RH were 0.96 and 0.89, respectively. These procedures and sub-modules developed were applied to the energy load calculation of BiRTG.

Brown/beige adipocyte thermogenesis is a process that is important for energy balance. The thermogenesis of brown/beige adipocytes occurs in the mitochondria, which is modulated by the dynamic balance between mitochondrial fusion and fission. Mitophagy is also involved in mitochondrial dynamics. The sorting and assembly machinery (SAM) complex protein, SAMM50, plays a key role in mitochondrial dynamics and quality control through regulating mitophagy. However, the roles of SAMM50 in the thermogenesis of beige adipocytes remain unknown. Thus, the objective of this study was to conduct functional analyses of SAMM50. The expression of mitochondrial fusion genes was repressed by SAMM50 knockdown but was not altered by SAMM50 overexpression. These results agreed with the distribution of the fluorescence-stained mitochondria and an mtDNA copy number. In contrast, the expression of mitochondrial fission genes showed an opposite outcome. As a result, suppression by the SAMM50 shRNA inhibited the expression of thermogenic genes (UCP1, PPARGC1A, DIO2, ELOVL3, CIDEA, and CIDEC) and mitochondrial-related genes (CYCS, COX7A1, TFAM, CPT1B, and CPT2). Conversely, SAMM50 overexpression promoted the expression of the thermogenic genes and mitochondrial genes. Thus, SAMM50 links the balance between the mitochondrial dynamics and thermogenesis of beige adipocytes.

Purpose: Previous studies have shown conflicting results regarding the factors affecting the clinical outcome after fusion for degenerative spondylolisthesis. However, no study has compared the best and worst clinical outcome groups using patient-reported outcome measures. We aimed to compare the characteristics of patients with best and worst outcomes following single-level lumbar fusion for degenerative spondylolisthesis. Methods: 200 patients underwent single-level interbody fusion with a minimum 2-years follow-up were included. We excluded patients with surgical complications already-known to be associated with poor postoperative outcomes, including pseudoarthrosis and postoperative infection. According to 2-year postoperative Oswestry disability index scores, patients were divided into two groups; Best and Worst. Demographic, clinical and radiographic variables were compared between the two groups. Results: Compared with patients in the Best group, those in the Worst group were older (59.5 and 67.0 years, respectively; p = 0.012; odds ratio [OR], 1.143; 95% confidence interval [CI], 1.030–1.269) and had a longer duration of pain from onset (2.6 and 7.2 years, respectively; p = 0.041; OR, 1.021; 95% CI, 1.001–1.041). The cutoff value of pain duration from onset was measured as ≥3.5 years on Receiver operating characteristic analysis. Patients in the Worst group had a lower preoperative angular motion compared to those in the Best group (12.7° and 8.3°, respectively; p = 0.016; OR, 0.816; 95% CI, 0.691–0.963). Conclusions: Degenerative spondylolisthesis patients of good clinical outcome after single-level lumbar interbody fusion were relatively young, had a short symptom duration before surgery, and a high preoperative instability compared with the patient having poor postoperative clinical outcome. Therefore, these findings should be considered preoperatively when deciding the appropriate individual treatment plan.

Building-integrated rooftop greenhouses (BiRTGs) are innovative vertical farms consisting of a greenhouse on the roof of a building. BiRTGs can provide environmental benefits by recycling energy, carbon dioxide, and water between the greenhouse and the building. Moreover, BiRTGs can reduce cooling and heating loads by reducing the exposure of the building surface to heat gains/losses through the roof. However, the benefits of BiRTGs have not yet been completely elucidated from an energy perspective. This study aimed to analyse the energy-saving efficiency of BiRTGs using building energy simulations (BES) and computational fluid dynamics (CFD) techniques. BES is a calculation method for analysing the heating and cooling loads of buildings; however, it was difficult to consider time-dependent changes in the ventilation characteristics in the BES model. CFD can be used to calculate more detailed ventilation characteristics of an experimental facility. Thus, CFD and the BES were combined to obtain more accurate BES-based data. The BES-computed annual energy load for a single-span greenhouse in which tomatoes were grown was 490,128 MJ, whereas the annual energy load for growing tomatoes in a BiRTG resulted in a 5.2% reduction, on average (464,673 MJ). The energy-saving effects were positive from October to April because the BiRTG helped transmit heat energy transmitted from the building to the greenhouse. Regarding the total energy load in the BiRTG after alternating the air temperature management (ATM), the heating energy load was reduced in the winter. ATM was expected to apply from November to March, with average energy savings of 11.8%.

Browning of adipocytes using herbal extracts is an attractive and realistic strategy for obesity treatment. Ephedra sinica Stapf (E. sinica) is an Asian traditional medicine known to activate brown adipocytes. To evaluate the effect of E. sinica (EEs) on the browning of white adipocytes, expression levels of browning markers, including uncoupling protein 1 (UCP1), were determined using qPCR, Western blot, and immunocytochemistry after mature mouse inguinal preadipocyte (mIPA) and human adipose-derived stem cells (hADSCs) were treated with EEs. In addition, mitochondrial activity was determined by analyzing MitoTracker staining, mtDNA copy number, and oxygen consumption rate (OCR). Treatment with EEs suppressed lipid accumulation and expression levels of adipogenic markers, including Pparg, during mIPA differentiation. In mature mIPA and hADSCs browning markers, including Ucp1, were up-regulated by EEs. In addition, EEs increased expression of mitochondrial genes, mtDNA copy number, and OCR. EEs showed a dual function: inhibiting adipogenesis in immature preadipocytes, and promoting thermogenesis via browning in mature white adipocytes. Therefore, E. sinica is a potential herb for regulating energy metabolism by inducing the browning process.

A substantial reduction in the environmental impacts related to the construction and operation of agricultural buildings is needed to adapt to the continuing development of agriculture. The life cycle assessment (LCA) is a methodology used to quantify the environmental impact of different processes involved in the production and therefore has been increasingly applied to assess the environmental burden. However, most LCA-related research studies have focused on the overall environmental impact of the entire system without considering the energy load of the agricultural buildings. By integrating the LCA tool with other design tools such as the building energy simulation (BES), the identification of environmental hotspots and the mitigation options become possible during the design process. Thus, the objective of the paper was to identify the current integration approaches used to combine BES and LCA results to assess the environmental impact of different heating systems such as absorption heat pump (AHP) using energy from thermal effluent, electricity-powered heat pump and kerosene-powered boilers used in a conventional multi-span Korean greenhouse. The assessment result revealed that the environmental impact caused using a kerosene-powered boiler is largest in terms of the acidification potential (AP), global warming potential (GWP) and Eutrophication Potential (EP) of 1.15 × 100 kg SO2-eq, 1.13 × 102 kg CO2-eq and 1.62 × 10−1 kg PO4-eq, respectively. Detailed analysis of the result showed that the main contributor for greenhouse gas emission was caused by the type, amount and source of energy used to heat the greenhouse, which contributed to a maximum of 86.59% for case 1, 96.69% for case 2 and a maximum of 96.47% for case 3, depending on the type of greenhouse gas being considered.

Abstract Background To investigate the association between diabetic retinopathy (DR) and myocardial dysfunction in patients with type 2 diabetes and dilated cardiomyopathy (dCMP). Methods Data were collected retrospectively from 89 patients with dCMP (46 with type 2 diabetes and 43 without diabetes) and no evidence of coronary artery disease. Echocardiographic parameters and laboratory data, including lipid profiles and fundus findings, were obtained from medical records. A left ventricular ejection fraction (LVEF) less than 40% was considered impaired systolic function, while an E/E′ ratio greater than 15 was considered elevated left ventricular (LV) filling pressure. Results Baseline characteristics show that LVEF was not significantly different between patients with and without diabetes or between diabetic patients with and without DR. Among the diastolic function parameters, patients with DR exhibited higher E/E′ ratios (left ventricular filling pressures) than patients without DR (23.75 ± 13.37 vs 11.71 ± 3.50, P = 0.022). Logistic regression analysis revealed that statin use lowered the risk of impaired systolic dysfunction in all patients (odds ratio (OR) 0.33, 95% confidence interval (CI) 0.12–0.92, P = 0.034) and in patients with diabetes (OR 0.273, 95% CI 0.08–0.99, P = 0.049), while the presence of DR was associated with a higher risk of elevated LV filling filling pressure in patients with diabetes (OR 18.00, 95% CI 1.50–216.62, P = 0.023). Conclusions In conclusion, DR was associated with elevated LV filling pressure in patients with dCMP. DR may not only represent microvascular long-term complications in patients with diabetes but may also be associated with more advanced form of diastolic dysfunction among diabetic patients with cardiomyopathy.

Study DesignProspective observational study.PurposeTo introduce the techniques and present the surgical outcomes of mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segments of the spine combined with lateral lumbar interbody fusion (LLIF) for the correction of adult spinal deformityOverview of LiteratureAlthough LLIF is increasingly used to correct adult spinal deformity, the correction of sagittal plane deformity with LLIF alone is reportedly suboptimal.MethodsThirty-two consecutive patients with adult spinal deformity underwent LLIF combined with mini-open ALIF at the L5–S1 or L4–S1 levels followed by 2-stage posterior fixation. ALIF was performed for a mean 1.3 levels and LLIF for a mean 2.7 levels. Then, percutaneous fixation was performed in 11 patients (percutaneous group), open correction with facetectomy with or without laminectomy in 16 (open group), and additional pedicle subtraction osteotomy (PSO) in 5 (PSO group). Spinopelvic parameters were compared preoperatively and postoperatively. Hospitalization data and clinical outcomes were recorded.ResultsNo major medical complications developed, and clinical outcomes improved postoperatively in all groups. The mean postoperative segmental lordosis was greater after ALIF (17.5°±5.5°) than after LLIF (8.1°±5.3°, p

The purpose of this study was to investigate the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on the progression of diabetic retinopathy (DR) in patients with type 2 diabetes. The medical records of 21 type 2 diabetic patients who used a SGLT2i and 71 patients with sulfonylurea (control) were reviewed retrospectively. The severity of DR was assessed using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Fewer patients who used a SGLT2i than control patients with sulfonylurea showed progression of DR based on ETDRS scale (44% versus 14%, P=0.014). Moreover, treatment with a SGLT2i was associated with a significantly lower risk of DR progression (P=0.021), and this effect remained significant after adjusting for the age, duration of diabetes, initial DR grade, and HbA1c level by propensity score matching (P=0.013). Treatment of type 2 diabetic patients with a SGLT2i slowed the progression of DR compared to sulfonylurea, which is independent of its effect on glycemic control. This study provides a foundation for further evaluation of the effect of SGLT2i on the progression of DR.

BACKGROUND AND OBJECTIVE:The distribution of body fat is closely related to cardiovascular disease and outcomes, although its impact on patient prognosis after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) has not been evaluated. We investigated the impact of truncal fat distribution on long-term clinical outcomes after DES treatment. METHODS:In 441 DES-treated patients, dual energy X-ray absorptiometry was performed to assess total and regional body fat distribution after index PCI. The ratio of truncal fat to total body fat mass (%FMtrunk/FMtotal) was calculated as a representative parameter for truncal fat distribution. The primary endpoint was major adverse cardiac events (MACE), a composite of ischemia-driven target vessel revascularization (TVR), non-procedural myocardial infarction, cardiac death at 5 years. RESULTS:During the median follow-up duration of 1780 days, MACE occurred in 22.0% of patients, with the highest-quartile group of %FMtrunk/FMtotal having a higher rate than the lowest quartile group (27.8% vs. 15.3%; log rank p = 0.026). The difference was driven by a higher rate of ischemia-driven TVR (25.9% vs. 9.9%; log rank p = 0.008). In multivariable Cox regression analyses, %FMtrunk/FMtotal was independently associated with MACE (hazard ratio: 1.075; 95% CI: 1.022-1.131; p = 0.005), but body mass index (BMI) was not. CONCLUSIONS:In DES-treated patients, truncal fat distribution is associated with unfavorable clinical outcomes and is more clinically relevant than BMI.

Study DesignRetrospective analysis.PurposesTo introduce the mini-open lateral approach for the anterior lumbar interbody fusion (ALIF), and to investigate the advantages, technical pitfalls and complications by providing basic knowledge on extreme lateral interbody fusion (XLIF) or direct lumbar interbody fusion (DLIF).Overview of LiteratureRecently, minimally invasive lateral approach for the lumbar spine is revived and receiving popularity under the name of XLIF or DLIF by modification of mini-open method when using the sequential tubular dilator and special expandable retractor system.MethodsSeventy-four patients who underwent surgery by the mini-open lateral approach from September 2000 to April 2008 with various disease entities were included. Blood losses, operation times, incision sizes, postoperative time to mobilization, length of hospital stays, technical problems and complications were all analyzed.ResultsThe blood losses and operation times of patients who underwent simple ALIF were 61.2 mL and 86 minutes for one level, 107 mL and 106 minutes for two levels, 250 mL and 142.8 minutes for three levels, and 400 mL and 190 minutes for four levels of fusion. The incision sizes were on average 4.5 cm for one level, 6.3 cm for two levels, 8.5 cm for three levels and 10.0 cm for four levels of fusion. The complications were retroperitoneal hematoma (2 cases), pneumonia (1 case) and transient lumbosacral plexus palsy (3 cases).ConclusionsTrials of mini-open lateral approach would be helpful before the trial of XLIF or DLIF. However, special attention is required for complications such as transient lumbosacral plexus palsy.

This study proposes an efficient position estimation method for localizing a mobile node in indoor environment. Although several conventional methods have been successfully applied for position estimation, they have some drawbacks such as low extendibility in an indoor space, intensive computation, and estimation errors. We propose a precise estimation approach based on a localization sensor and artificial landmarks. In our approach, a mobile node autonomously measures the location of landmarks attached to the ceiling with a localization sensor while moving across the landmarks and building a landmark map. And then, the node estimates its location under the ceiling using the map. In this process, we use a landmark histogram and a Kalman filter to reduce estimation errors. Several experiments performed using a mobile robot successfully demonstrated the feasibility of our proposed approach.

Background: Despite numerous studies identifying risk factors for proximal junctional failure (PJF), risk factors for recurrent PJF (R-PJF) are still not well established. Therefore, we aimed to identify the risk factors for R-PJF following adult spinal deformity (ASD) surgery. Methods: Among 479 patients who underwent ≥5-level fusion surgery for ASD, the focus was on those who experienced R-PJF at any time or did not experience R-PJF during a follow-up duration of ≥1 year. PJF was defined as a proximal junctional angle (PJA) ≥28° plus a difference in PJA ≥22° or performance of revision surgery regardless of PJA degree. The patients were divided into 2 groups according to R-PJF development: no R-PJF and R-PJF groups. Risk factors were evaluated focusing on patient, surgical, and radiographic factors at the index surgery as well as at the revision surgery. Results: Of the 60 patients in the final study cohort, 24 (40%) experienced R-PJF. Significant risk factors included greater postoperative sagittal vertical axis (OR = 1.044), overcorrection relative to age-adjusted pelvic incidence-lumbar lordosis (PI- LL; OR = 7.794) at the index surgery, a greater total sum of the proximal junctional kyphosis severity scale (OR = 1.145), and no use of the upper instrumented vertebra cement (OR = 5.494) at the revision surgery. Conclusions: We revealed that the greater postoperative sagittal vertical axis and overcorrection relative to age-adjusted pelvic incidence-lumbar lordosis at the index surgery, a greater proximal junctional kyphosis severity scale score, and no use of upper instrumented vertebra cement at the revision surgery were significant risk factors for R-PJF. Clinical Relevance: To reduce the risk of R-PJF after ASD surgery, avoiding under- and overcorrection during the initial surgery is recommended. Additionally, close assessment of the severity of PJF with timely intervention is crucial, and cement augmentation should be considered during revision surgery. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]