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Tunable and multi-functional nanophotonic devices are used for applications from beam steering to sensing. Yet little is understood about fundamental limits to their functionality. The difficulty lies with the fact that it is a single structure that must exhibit optimal response over multiple scenarios. In this article, we present a general theoretical framework for understanding and computing fundamental limits to multi-functional nanophotonic response. Building from rapid recent advances in bounds to light–matter interactions, we show that after rewriting the design problems in terms of polarization fields, the introduction of suitable cross-correlation constraints imposes the crucial “single-structure” criteria. We demonstrate the utility of this approach for two applications: reflectivity contrast for optical sensing, and maximum efficiency for optical beam switching. Our approach generalizes to any active or multi-functional design in linear optics.

To enhance the performance of the TDMC neutron transport analysis, a new version of McCARD utilizing GPUs, named McCARD/G, is under development. This version introduces an MC neutron tracking module that employs an event-based algorithm and features a generalized lattice geometry treatment module. Additionally, significant adaptations of other major modules have been made to optimize for the GPU architecture. The capabilities of McCARD/G have been verified through the C5G7-TD benchmark, which shows good agreements with the reference results. Furthermore, McCARD/G’s efficacy is also demonstrated via an experimental benchmark conducted at the Kyoto University Critical Assembly.

The newly developed 2D/3D method operating over the unstructured mesh geometry is introduced. Implemented in the NuDEAL code, the method alternates the planar method of characterization (MOC) and the diffusion-based hybrid finite element (HFEM), with planar MOC solving the 2D decoupled fine mesh and HFEM providing 3D coarse mesh flux distributions based on the MOC solution. The consistency between the planar MOC and the diffusion HFEM is made with the devised consistency factors operating on volumetric and surface flux distributions. Furthermore, the consistent HFEM is fully accelerated using GPUs, which results in a 50-speedup in the red-black sweep compared to the runtime of the single CPU core. As a result, the accelerated HFEM takes less than 30 seconds to solve the multigroup benchmark problem, which is 20 times faster with a single gaming GPU than with a single CPU core.

A cross-polarization detection technique was introduced to enhance the signal-to-noise ratio (SNR) of a plasmonic near-field scanning nanoscope (PNSN) using the anisotropic reflection from a metallic ridge nano-aperture. Assuming that the nano-aperture is an resistor-inductor-capacitor-equivalent circuit, we propose an analytic circuit model to quantitatively predict the relationship between the copolarization and cross-polarization signals of the PNSN. It was found that the magnitude of the cross-polarization signal has an opposite trend with respect to the copolarization signal, providing a larger PNSN signal. We demonstrated the PNSN with dual channels for detecting both polarization signals. The performance of the PNSN was characterized by recording images of heterogeneous nanostructures in dynamic random access memory patterns and we enhanced the SNR of the images by a factor of 2.7–4.9.

Abstract The 0D-1D Lithium titanate (Li4Ti5O12) heterogeneous nanostructures were synthesized through the solvothermal reaction using lithium hydroxide monohydrate (Li(OH)·H2O) and protonated trititanate (H2Ti3O7) nanowires as the templates in an ethanol/water mixed solvent with subsequent heat treatment. A scanning electron microscope (SEM) and a high resolution transmission electron microscope (HRTEM) were used to reveal that the Li4Ti5O12 powders had 0D-1D heterogeneous nanostructures with nanoparticles (0D) on the surface of wires (1D). The composition of the mixed solvents and the volume ratio of ethanol modulated the primary particle size of the Li4Ti5O12 nanoparticles. The Li4Ti5O12 heterogeneous nanostructures exhibited good capacity retention of 125 mAh/g after 500 cycles at 1C and a superior high-rate performance of 114 mAh/g at 20C.

The Monte Carlo (MC) neutron transport analysis for a complex nuclear system such as fusion facility may require accurate modeling of its complicated geometry. In order to take advantage of modeling capability of the computer aided design (CAD) system for the MC neutronics analysis, the Seoul National University MC code, McCARD, has been augmented with a CAD-based geometry processing module by imbedding the OpenCASCADE CAD kernel. In the developed module, the CAD geometry data are internally converted to the constructive solid geometry model with help of the CAD kernel. An efficient cell-searching algorithm is devised for the void space treatment. The performance of the CAD-based McCARD calculations are tested for the Korea Superconducting Tokamak Advanced Research device by comparing with results of the conventional MC calculations using a text-based geometry input.

Abstract Introduction Plexiform neurofibroma of the larynx is a rare disease. In this report, we present a plexiform neurofibroma in the arytenoids and neurofibroma in the parapharynx detected coincidently. Case presentation A 56-year-old Asian woman presented with respiratory distress and episodes of apnea at night. A solitary mass from the left arytenoids was found to be nearly obstructing the airway and causing the sleep apnea. There was also a parapharynx mass protruding into the pharynx. The parapharynx tumor was removed with the lateral incision approach, and the arytenoid tumor was removed with a transoral carbon dioxide laser. The pathologic diagnosis was plexiform neurofibroma for the arytenoid mass and neurofibroma for the parapharynx mass. Conclusion We have reported an extremely rare case of plexiform neurofibroma in the arytenoids and neurofibroma in the parapharynx. This entity may be considered in the differential diagnosis of all laryngeal and parapharynx masses.

Abstract Background There is increasing evidence that the presence of an ongoing systemic inflammatory response is associated with poor prognosis in patients with advanced cancers. We evaluated the relationships between clinical status, laboratory factors and progression free survival (PFS), and overall survival (OS) in patients with recurrent or metastatic gastric cancer receiving first-line palliative chemotherapy. Methods We reviewed 402 patients with advanced gastric adenocarcinoma who received first-line palliative chemotherapy from June 2004 and December 2009. Various chemotherapy regimens were used. Eastern Cooperative Oncology Group performance status (ECOG PS), C-reactive protein (CRP), albumin, Glasgow prognostic score (GPS), and clinical factors were recorded immediately prior to first-line chemotherapy. Patients with both an elevated CRP (>1.0 mg/dL) and hypoalbuminemia ( Results According to multivariate analysis, the factors independently associated with PFS were ECOG PS (HR 1.37, 95% CI 1.02-1.84, P = 0.035), bone metastasis (HR 1.74, 95% CI 1.14-2.65, P = 0.009), and CRP elevation (HR 1.64, 95% CI 1.28-2.09, P = 0.001). The factors independently associated with OS were ECOG PS (HR 1.33, 95% CI 1.01-1.76, P = 0.037), bone metastasis (HR 1.61, 95% CI 1.08-2.39, P = 0.017), and GPS ≥ 1 (HR 1.76, 95% CI 1.41-2.19, P = 0.001). Conclusions The results of this study showed that the presence of a systemic inflammatory response as evidenced by the CRP, GPS was significantly associated with shorter PFS and OS in patients with recurrent or metastatic gastric cancer receiving first-line palliative chemotherapy. Bone metastasis and GPS were very useful indicator for survival in patients with recurrent or metastatic gastric cancer receiving palliative chemotherapy.

Abstract In this study, we report the high-yield synthesis of 2-dimensional cupric oxide (CuO) nanodiscs through dehydrogenation of 1-dimensional Cu(OH)2 nanowires at 60°C. Most of the nanodiscs had a diameter of approximately 500 nm and a thickness of approximately 50 nm. After further prolonged reaction times, secondary irregular nanodiscs gradually grew vertically into regular nanodiscs. These CuO nanostructures were characterized using X-ray diffraction, transmission electron microscopy, and Brunauer-Emmett-Teller measurements. The possible growth mechanism of the interlaced disc CuO nanostructures is systematically discussed. The electrochemical performances of the CuO nanodisc electrodes were evaluated in detail using cyclic voltammetry and galvanostatic cycling. Furthermore, we demonstrate that the incorporation of multiwalled carbon nanotubes enables the enhanced reversible capacities and capacity retention of CuO nanodisc electrodes on cycling by offering more efficient electron transport paths.

Abstract Background The aim of this study was to determine the prevalence of human papillomavirus (HPV) and 15 species that cause sexually transmitted infections (STIs) in negative cytology. In addition, we compared the diagnostic performance of multiplex polymerase chain reaction (PCR) with widely available techniques used to detect HPV. Methods We recruited 235 women of reproductive age who had negative cytology findings in a liquid-based cervical smear. STIs were identified by multiplex PCR, and HPV genotypes by multiplex PCR, hybrid capture 2, and DNA microaray; discordant results were analyzed by direct sequencing. Results Approximately 96.6% of patients with negative cytology results were positive for pathogens that cause STIs. The pathogens most frequently detected were Gardnerella vaginalis, Ureaplasma urealyticum. The incidence of HPV in negative cytology was 23.3%. Low-risk HPV infection was significantly correlated with Chalmaydia trachomatis, and high-risk HPV infection was significantly correlated with Group β streptococcus. The analytical sensitivities of the multiplex PCR and DNA microarray were higher than 80%, and the analytical specificity was nearly 100% for all tests. Conclusions Multiplex PCR yielded results that most of patients with negative cytology were positive for pathogens that cause STIs, and were more similar to that of DNA microarray, than that of hybrid capture 2 in terms of analytical sensitivity and prediction value of HPV infection.

Abstract Background Imatinib mesylate has been used for the treatment of unresectable or metastatic gastrointestinal stromal tumors (GIST). The current recommended dose of imatinib is 400 mg/day that is increased to 800 mg/day in cases with disease progression. However, imatinib can be associated with diverse adverse events, which has limited its use. We report a case of severe adverse skin reactions with neutropenic fever during imatinib treatment in a patient with GIST. Case presentation A 71-year-old man was admitted with a one month history of epigastric pain and a palpable mass in the right upper quadrant. An abdominal CT scan revealed a 20 × 19 cm intraabdominal mass with tumor invasion into the peritoneum. Needle biopsy was performed and the results showed spindle shaped tumor cells that were positive for c-KIT. The patient was diagnosed with unresectable GIST. Imatinib 400 mg/day was started. The patient tolerated the first eight weeks of treatment. However, about three months later, the patient developed a grade 4 febrile neutropenia and a grade 3 exfoliative skin rash. The patient recovered from this serious adverse events after discontinuation of imatinib with supportive care. However, the skin lesions recurred whenever the patient received imatinib over 100 mg/day. Therefore, imatinib 100 mg/day was maintained. Despite the low dose imatinib, follow up CT showed a marked partial response without grade 3 or 4 toxicities. Conclusion The recommended dose of imatinib for the treatment of GIST is 400 mg/day but patients at risk for adverse drug reaction may benefit from lower doses. Individualized treatment is needed for such patients, and we may also try sunitinib as a alternative drug.

Abstract Background The breast is a rare extranodal site of non-Hodgkin lymphoma, and primary breast lymphoma (PBL) has been arbitrarily defined as disease localized to one or both breasts with or without regional lymph nodes involvement. The aim of this study was to evaluate the clinical outcomes in patients with diffuse large B cell lymphoma (DLBCL) and breast involvement, and to find the criteria of PBL reflecting the outcome and prognosis. Methods We retrospectively analyzed data from 68 patients, newly diagnosed with DLBCL and breast involvement at 16 Korean institutions between January 1994 and June 2009. Results Median age at diagnosis was 48 years (range, 20-83 years). Forty-three (63.2%) patients were PBL according to previous arbitrary criteria, sixteen (23.5%) patients were high-intermediate to high risk of international prognostic index. The patients with one extranodal disease in the breast (OED) with or without nodal disease were 49 (72.1%), and those with multiple extranodal disease (MED) were 19 (27.9%). During median follow-up of 41.5 months (range, 2.4-186.0 months), estimated 5-year progression-free survival (PFS) was 53.7 ± 7.6%, and overall survival (OS) was 60.3 ± 7.2%. The 5-year PFS and OS was significantly higher for patients with the OED group than those with the MED group (5-year PFS, 64.9 ± 8.9% vs. 27.5 ± 11.4%, p = 0.001; 5-year OS, 74.3 ± 7.6% vs. 24.5 ± 13.0%, p < 0.001). In multivariate analysis, MED (hazard ratio [HR], 3.61; 95% confidence interval [CI], 1.07-12.2) and fewer than four cycles of systemic chemotherapy with or without local treatments (HR, 4.47; 95% CI, 1.54-12.96) were independent prognostic factors for worse OS. Twenty-five (36.8%) patients experienced progression, and the cumulative incidence of progression in multiple extranodal sites or other than breasts and central nervous system was significantly different between the OED group and the MED group (5-year cumulative incidence, 9.7 ± 5.4% vs. 49.0 ± 15.1%, p = 0.001). Conclusions Our results show that the patients included in OED group, reflecting different treatment outcome, prognosis and pattern of progression, should be considered as PBL in the future trial. Further studies are warranted to validate our suggested criteria.

Abstract Background This study was designed to investigate an association between the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and the risk of gastric and colorectal cancer in the Korean population. Methods We conducted a population-based large-scale case-control study involving 2,213 patients with newly diagnosed gastric cancer, 1,829 patients with newly diagnosed colorectal cancer, and 1,700 healthy controls. Genotyping was performed with peripheral blood DNA for MTHFR C677T polymorphisms. The statistical significance was estimated by logistic regression analysis. Results The MTHFR C677T frequencies of CC, CT, and TT genotypes were 35.2%, 47.5%, and 17.3% among stomach cancer, 34%, 50.5%, and 15.5% in colorectal cancer, and 31.8%, 50.7%, and 17.5% in the controls, respectively. The MTHFR 677TT genotype showed a weak opposite association with colorectal cancer compared to the homozygous CC genotype [adjusted age and sex odds ratio (OR) = 0.792, 95% confidence interval (CI) = 0.638-0.984, P = 0.035]. Subjects with the MTHFR 677CT showed a significantly reduced risk of gastric cancer compared whose with the 677CC genotype (age- and sex-adjusted OR = 0.810; 95% CI = 0.696-0.942, P = 0.006). We also observed no significant interactions between the MTHFR C677T polymorphism and smoking or drinking in the risk of gastric and colorectal cancer. Conclusions The T allele was found to provide a weak protective association with gastric cancer and colorectal cancer.

Aims: Frailty in older adults is influenced by various factors, such as poor nutritional status. Mid-upper arm circumference (MUAC) is a validated, simple, and non-invasive tool for assessing nutritional status. Despite its potential, no study has explored the association between MUAC and physical frailty in older adults. This study aims to investigate this association and assess whether MUAC can be used as a screening tool in community and primary clinical practice., Methods: A cross-sectional study was conducted with 1178 participants aged 71.8 to 86.7 years from the 2019 Korean Frailty and Aging Cohort Study (KFACS). Physical frailty was defined using the Fried frailty phenotype criteria. MUAC was measured as the average circumference of both upper arms without compressing the subcutaneous tissue. Odds ratios (ORs) and 95% confidence intervals (CIs) for physical frailty, stratified by sex, were estimated using multiple logistic regression analysis after adjustments., Results: MUAC was lower in physically frail men compared with non-frail men (28.0 ± 2.9 vs. 29.4 ± 2.6 cm, P < 0.001). MUAC was negatively correlated with the Frailty Index (r = -0.155, P < 0.001). Multiple logistic regression analysis revealed that MUAC was an independent factor for physical frailty in men (OR  0.986, 95% CI  0.973-1.000, P = 0.049). The optimal MUAC cutoff for identifying physical frailty in men was 28.2 cm (sensitivity 60.7%, specificity 71.4%, AUC  0.672, 95% CI 0.595-0.749, P < 0.001). No significant results were found for women., Conclusion: Low MUAC is significantly associated with physical frailty in older men, suggesting the potential for MUAC to be utilized as a screening tool for physical frailty in community and primary clinical settings. Geriatr Gerontol Int 2024; 24: 1292-1299., (© 2024 The Author(s). Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

How beta-amyloid accumulation influences brain atrophy in Alzheimer's disease remains contentious with conflicting findings. We aimed to elucidate the correlations of regional longitudinal atrophy with cross-sectional regional and global amyloid in individuals with mild cognitive impairment and no cognitive impairment. We hypothesized that greater cortical thinning over time correlated with greater amyloid deposition, particularly within Alzheimer's disease characteristic regions in mild cognitive impairment, and weaker or no correlations in those with no cognitive impairment. 45 patients with mild cognitive impairment and 12 controls underwent a cross-sectional [ 11 C]-Pittsburgh Compound B PET and two retrospective longitudinal structural imaging (follow-up: 23.65 ± 2.04 months) to assess global/regional amyloid and regional cortical thickness, respectively. Separate linear mixed models were constructed to evaluate relationships of either global or regional amyloid with regional cortical thinning longitudinally. In patients with mild cognitive impairment, regional amyloid in the right banks of the superior temporal sulcus was associated with longitudinal cortical thinning in the right medial orbitofrontal cortex ( P = 0.04 after False Discovery Rate correction). In the mild cognitive impairment group, greater right banks amyloid burden and less cortical thickness in the right medial orbitofrontal cortex showed greater visual and verbal memory decline over time, which was not observed in controls. Global amyloid was not associated with longitudinal cortical thinning in any locations in either group. Our findings indicate an increasing influence of amyloid on neurodegeneration and memory along the preclinical to prodromal spectrum. Future multimodal studies that include additional biomarkers will be well-suited to delineate the interplay between various pathological processes and amyloid and memory decline, as well as clarify their additive or independent effects along the disease deterioration., Competing Interests: The authors report no disclosures relevant to the manuscript. J.T. O’Brien. has no conflicts related to this study; unrelated to this work he has received honoraria for work as DSMB chair or member for TauRx, Axon, Eisai, has acted as a consultant for Roche,and has received research support from Alliance Medical and Merck., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Background: This study is a descriptive correlation survey conducted to understand the effect of attitudes toward death, hospice palliative care perception, and knowledge on homecare hospice use intention for adult men and women aged 65 or older ones., Aim: This study identified factors affecting the intention to use homecare hospice and the perception of hospice·palliative care for adults aged 65 or older., Methods: Researchers used tools which were intention to use homecare hospice, the hospice palliative care knowledge, death orientation, hospice palliative perception., Results: The higher the perception of hospice·palliative care, for men than women, then they are the higher the willingness to use homecare hospice. In addition, the factors influencing the perception of hospice·palliative care of subjects who are willing to use homecare hospice were education and hospice·palliative care knowledge., Conclusion: By improving hospice·palliative care perception by acquiring hospice·palliative care knowledge, people will choose the place where they want to die. In addition, once there is an increasing demand for it, nations and Institutions can help to set up support homecare hospice. For this, campaigns, and education to provide knowledge and improve perception of hospice·palliative care must be continued at the socio-cultural level., Competing Interests: Declaration of competing interest No conflicting interests have been identified by any of the authors., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This study aimed to investigate the association between suicide ideation and health-related behaviors and preventive health service use behaviors. We used data from the 2017 Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative survey. The final sample included 4486 participants aged 40 years or older. Preventive health behaviors were assessed for smoking, high-risk drinking, physical activities, regular meal intake, influenza vaccination, general health examination, and cancer screening. Logistic regression was used to examine the association between suicide ideation and preventive health behaviors with a series of adjustments for covariates. In general, suicide ideation was associated with unfavorable outcomes of preventive health behaviors, except for flu vaccination. For example, the adjusted prevalence of suicide ideation and non-suicide ideation groups were 54.3% vs. 43.7% for flu vaccination, 23.1% vs. 41.6% for physical activity, and 24.8% vs. 18.6% for high-risk alcohol drinking. After adjustment for covariates, the associations of suicide ideation with behaviors remained significant for physical activity (OR 0.52, 95% CI 0.34-0.81) and high-risk alcohol drinking (OR 2.22, 95% CI 1.34-3.69). Suicide ideation leads to the disruption of self-management of health behaviours, especially for physical activity and high-risk alcohol drinking, independently of depressive feelings., (© 2022. The Author(s).)

Background: Obesity is considered a state of enhanced oxidative stress as well as chronic and low-grade inflammation. The copper-zinc ratio in obese individuals has been reported to reflect systemic oxidative stress and inflammatory status. We investigated whether the neutrophil-lymphocyte ratio is related to the copper-zinc ratio in hair, within the context of a normal white blood cell count among overweight or obese Korean individuals., Methods: We included 56 participants aged older than 20 years who voluntarily sought weight reduction treatment and met the inclusion criterion of body mass index of 23 kg/m2 or greater. Intra-abdominal visceral adipose tissue was measured by computed tomography imaging, while the copper and zinc levels were measured by hair mineral analysis. Using multiple linear regression analysis, we examined the associations between the neutrophil-lymphocyte ratio and the copper-zinc ratio., Results: The mean age, body mass index, and visceral adipose tissue were 46.0±10.5 years, 29.0±4.1 kg/cm2 , and 142.9±68.8 cm2 , respectively. Pearson's correlation analysis revealed the association of the neutrophil-lymphocyte ratio with copper level (r=0.475, P<0.001) and copper-zinc ratio (r=0.494, P<0.001). After adjusting for confounding variables, we found the neutrophil-lymphocyte ratio was significantly associated with the level of copper and the copper-zinc ratio in hair (regression coefficient: 0.055±0.015; P<0.001 and regression coefficient: 0.761±0.185; P<0.001, respectively)., Conclusion: A higher copper-zinc ratio in hair is positively and independently associated with the neutrophil-lymphocyte ratio. Thus, a high hair copper-zinc ratio could be a useful parameter for oxidative burden of individuals predisposed to obesity-related comorbidity.

Cerebral microinfarcts (CMIs), a novel cerebrovascular marker, are prevalent in Alzheimer's disease (AD) and associated with cognitive impairment. Nonetheless, the underlying mechanism of how CMIs influence cognition remains uncertain. We hypothesized that cortical-CMIs disrupted structural connectivity in the higher-order cognitive networks, leading to cognitive impairment. We analyzed diffusion-MRI data of 92 AD (26 with cortical-CMIs) and 110 cognitive impairment no dementia patients (CIND, 28 with cortical-CMIs). We compared structural network topology between groups with and without cortical-CMIs in AD/CIND, and tested whether structural connectivity mediated the association between cortical-CMIs and cognition. Cortical-CMIs correlated with impaired structural network topology (i.e. lower efficiency/degree centrality in the executive control/dorsal attention networks in CIND, and lower clustering coefficient in the default mode/dorsal attention networks in AD), which mediated the association of cortical-CMIs with visuoconstruction dysfunction. Our findings provide the first in vivo human evidence that cortical-CMIs impair cognition in elderly via disrupting structural connectivity.

Parity has been reported as a risk factor for cervical cancer. However, no study has investigated the risk of neoplasms of the uterine cervix according to the delivery type. We carried out a retrospective cohort study using nationwide data from the Korean Health Insurance Review and Assessment Database to investigate whether cesarean delivery might be associated with less development of neoplasms of the uterine cervix than a vaginal delivery in women of childbearing age. Women aged 20-44 years, who had undergone vaginal or cesarean deliveries in 2009 were included as subjects. Two individual datasets for carcinoma in situ (CIS) and cancer of the cervix were followed for 8 years until either disease outcomes or 31 December 2016. In total, 260 438 and 132 232 women had undergone vaginal only and cesarean only deliveries, respectively. There were 1505 and 423 new cases of CIS and cervical cancer, respectively, with median follow-up durations of 89.9 and 90.0 months for vaginal delivery and cesarean delivery, respectively. The unadjusted CIS risk ratio for cesarean delivery compared with vaginal delivery was 0.90 [95% confidence interval, (CI), 0.80-1.00]. After adjusting for categorical age, residential area, facility types, and number of visits to obstetrics and gynecology clinics, it was 0.83 (95% CI, 0.75-0.93). The unadjusted and adjusted risk ratios for cervical cancer for cesarean delivery were 0.98 (95% CI, 0.80-1.20) and 0.87 (95% CI, 0.71-1.08), respectively. Cesarean delivery may be more protective against CIS than vaginal delivery in women of childbearing age.

Hippocampal atrophy and abnormal β-Amyloid (Aβ) deposition are established markers of Alzheimer's disease (AD). Nonetheless, longitudinal trajectory of Aβ-associated hippocampal subfield atrophy prior to dementia remains unclear. We hypothesized that elevated Aβ correlated with longitudinal subfield atrophy selectively in no cognitive impairment (NCI), spreading to other subfields in mild cognitive impairment (MCI). We analyzed data from two independent longitudinal cohorts of nondemented elderly, including global PET-Aβ in AD-vulnerable cortical regions and longitudinal subfield volumes quantified with a novel auto-segmentation method (FreeSurfer v.6.0). Moreover, we investigated associations of Aβ-related progressive subfield atrophy with memory decline. Across both datasets, we found a converging pattern that higher Aβ correlated with faster CA1 volume decline in NCI. This pattern spread to other hippocampal subfields in MCI group, correlating with memory decline. Our results for the first time suggest a longitudinal focal-to-widespread trajectory of Aβ-associated hippocampal subfield atrophy over disease progression in nondemented elderly., (© 2020 The Authors. Human Brain Mapping published by Wiley Periodicals, Inc.)

Optimal levels of intrinsic Blood-Oxygenation-Level-Dependent (BOLD) signal variability (variability hereafter) are important for normative brain functioning. However, it remains largely unknown how network-specific and frequency-specific variability changes along the Alzheimer's disease (AD) spectrum and relates to cognitive decline. We hypothesized that cognitive impairment was related to distinct BOLD variability alterations in two brain networks with reciprocal relationship, i.e., the AD-specific default mode network (DMN) and the salience network (SN). We examined variability of resting-state fMRI data at two characteristic slow frequency-bands of slow4 (0.027-0.073 Hz) and slow5 (0.01-0.027 Hz) in 96 AD, 98 amnestic mild cognitive impairment (aMCI), and 48 age-matched healthy controls (HC) using two commonly used pre-processing pipelines. Cognition was measured with a neuropsychological assessment battery. Using both global signal regression (GSR) and independent component analysis (ICA), results generally showed a reciprocal DMN-SN variability balance in aMCI (vs. AD and/or HC), although there were distinct frequency-specific variability patterns in association with different pre-processing approaches. Importantly, lower slow4 posterior-DMN variability correlated with poorer baseline cognition/smaller hippocampus and predicted faster cognitive decline in all patients using both GSR and ICA. Altogether, our findings suggest that reciprocal DMN-SN variability balance in aMCI might represent an early signature in neurodegeneration and cognitive decline along the AD spectrum.

Purpose: This study was conducted to identify the effect of a multicomponent cognitive stimulation program (MCSP) on the improvement of older people's cognitive abilities. It also aimed to determine whether the effectiveness of the MCSP is related to age., Methods: A one-group pretest-posttest design was used. The program was conducted once a week for 10 weeks. The Korean-Montreal Cognitive Assessment (K-MoCA) was used to measure cognitive functions before and after the MCSP. Participants included 37 people aged over 65 years with normal cognitive functions and living in I city. A paired t-test was used to compare K-MoCA scores before and after the MCSP, and a two-way analysis of variance was performed to confirm whether there is an interaction between the MCSP and age., Results: It was found that the MCSP had a significant effect on improving cognitive functions (t = -5.15, p < .001). Regarding the subdomains, visuospatial/executive ability, recall, naming, and language ability showed significant effects; however, abstractive ability-which was not a focus of the program-showed no significant effect. There were differences in visuospatial/executive functions, language skills, and memory between the 65-79 years age group and the aged over 80 group. Further, regarding the relationship between the MCSP and age, it was found that their interaction was significant only with regard to visuospatial/executive ability., Conclusion: The MCSP helps to improve the cognitive functions of the elderly; however, its effect differs between the young-old group and the old-old group. Therefore, age should be considered when developing MCSPs., (Copyright © 2019. Published by Elsevier B.V.)

Objective: Late-life depression involves the disconnection of white matter tracts that regulate mood. A pathogenic link between poor tract integrity and depressive symptoms is believed to be white matter lesions (WML), however the mechanisms linking tract integrity, WML, and depression remains unexplored. The authors sought to identify whether the association between reduced tract integrity and depressive symptoms is mediated by WML in patients with Alzheimer disease (AD), and whether individual characteristics moderate this effect., Methods: This was a cross-sectional study in a tertiary memory clinic. A total of 91 patients with mild AD and 79 healthy elderly, comparable in depressive symptoms, white matter hyperintensities (WMH) volume, cardiovascular risk, age, and sex were chosen. Tract integrity was assessed using diffusion tensor imaging, WML were indexed as WMH, measured using fluid-attenuation inversion recovery imaging, and depressive symptoms were measured with the informant-based Geriatric Depression Scale., Results: In patients with mild AD, reduced tract integrity in right hemispheric cortical-subcortical tracts and the genu of the corpus callosum was moderately associated with depressive symptoms. This association was fully mediated by WML. Moderation analysis indicated that old age strengthened the association between all tracts and depressive symptoms, as mediated by WML. In cognitively healthy elderly, neither tracts nor WML were related to depressive symptoms., Conclusion: Reduced tract integrity may be important but not sufficient for the manifestation of depressive symptoms in mild AD. Instead, WML may drive the pathogenic link between reduced tract integrity and depressive symptoms., (Copyright © 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Although it is well known that employment conditions exert considerable effects on health and health equity, the association between employment conditions and the use of preventative health services has rarely been studied. We explored whether inequities in the use of preventative services were associated with employment conditions. We used gastric cancer screening as a surrogate for the use of preventative health services., Methods: The study population was derived from the Korea National Health and Nutrition Survey IV (2007-2009), which included data on 5626 individuals over 40 years of age. Employment conditions were grouped by employment status, work hours, employment contract term, and salary source. Participants who had undergone gastroscopy or an upper gastrointestinal series within the past 2 years were considered to have used cancer screening services according to the National Cancer Screening Program guidelines. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multiple logistic regression analysis. As the survey procedure incorporated sample weights, we adjusted our calculations to consider the complex sample design., Results: Self-employed workers were less likely to participate in regular cancer screening than were wage workers (OR = 0.79, 95% CI = 0.68-0.92), and part-time workers were less likely to participate than were full-time workers (OR = 0.81, 95% CI = 0.67-0.99). Among wage workers, temporary workers and daily workers exhibited lower participation rates than did regular workers (OR = 0.81, 95% CI = 0.63-1.05 and OR = 0.58, 95% CI = 0.44-0.76, respectively). Dispatched workers also exhibited lower participation rates (OR = 0.45, 95% CI = 0.25-0.80)., Conclusions: We found obvious inequities in the use of preventative health services associated with various employment conditions. Self-employed, irregular, and dispatched workers were significantly less likely to participate in cancer screening than were other workers. Political efforts should be made to reduce employment insecurity and to improve participation in preventative screening services by vulnerable employees so as to resolve the evident health inequities.

Alterations in parietal and temporal white matter microstructure derived from diffusion tensor imaging occur in preclinical and clinical Alzheimer's disease. Amyloid beta (Aβ) deposition and such white matter alterations are two pathological hallmarks of Alzheimer's disease. However, the relationship between these pathologies is not yet understood, partly since conventional diffusion MRI methods cannot distinguish between cellular and extracellular processes. Thus, we studied Aβ-associated longitudinal diffusion MRI changes in Aβ-positive (N = 21) and Aβ-negative (N = 51) cognitively normal elderly obtained from the Alzheimer's Disease Neuroimaging Initiative dataset using linear mixed models. Aβ-positivity was based on Alzheimer's Disease Neuroimaging Initiative amyloid-PET recommendations using a standardized uptake value ratio cut-off of 1.11. We used free-water imaging to distinguish cellular and extracellular changes. We found that Aβ-positive subjects had increased baseline right uncinate fasciculus free-water fraction (FW), associated with worse baseline Alzheimer's disease assessment scale scores. Furthermore, Aβ-positive subjects showed faster decrease in fractional anisotropy (FW-corrected) in the right uncinate fasciculus and faster age-dependent right inferior longitudinal fasciculus FW increases over time. Right inferior longitudinal fasciculus FW increases were associated with greater memory decline. Importantly, these results remained significant after controlling for gray and white matter volume and hippocampal volume. This is the first study to illustrate the influence of Aβ burden on early longitudinal (in addition to baseline) white matter changes in cognitively normal elderly individuals at-risk of Alzheimer's disease, thus underscoring the importance of longitudinal studies in assessing microstructural alterations in individuals at risk of Alzheimer's disease prior to symptoms onset., (© 2019 Wiley Periodicals, Inc.)

Instead of assuming a constant relationship between brain abnormalities and memory impairment, we aimed to examine the stage-dependent contributions of multimodal brain structural and functional deterioration to memory impairment in the Alzheimer's disease (AD) continuum. We assessed grey matter volume, white matter (WM) microstructural measures (free-water (FW) and FW-corrected fractional anisotropy), and functional connectivity of the default mode network (DMN) in 54 amnestic mild cognitive impairment (aMCI) and 46 AD. We employed a novel sparse varying coefficient model to investigate how the associations between abnormal brain measures and memory impairment varied throughout disease continuum. We found lower functional connectivity in the DMN was related to worse memory across AD continuum. Higher widespread white matter FW and lower fractional anisotropy in the fornix showed a stronger association with memory impairment in the early aMCI stage; such WM-memory associations then decreased with increased dementia severity. Notably, the effect of the DMN atrophy occurred in early aMCI stage, while the effect of the medial temporal atrophy occurred in the AD stage. Our study provided evidence to support the hypothetical progression models underlying memory dysfunction in AD cascade and underscored the importance of FW increases and DMN degeneration in early stage of memory deficit.

Background: This study was conducted from an occupational health perspective to document cancer survivors' ability to return to work, the role of clinical care, and the current status of effective return-to-work., Methods: This cross-sectional study was conducted to evaluate the experiences and opinions of occupational health physicians (OHPs) regarding cancer survivors' return-to-work. A self-reported survey was conducted from December 30, 2015, to January 30, 2016, targeting 337 OHPs. Questions included: 1) treatment experiences of survivors in the words of OHPs, 2) current status of the assessments of fitness for work of cancer survivors, 3) experiences associated with workplace and treatment, and 4) problems of returning to work and overcoming system., Results: Only 25% of the respondents said that they had experience treating cancer survivors, and the average number of patients was 12.6 per annum, which indicated that few cancer survivors were treated. Eleven cases included conducting assessment of fitness for work. There were 17 respondents who did not treat cancer survivors. Both those who had and did not have experience in treating survivors showed higher musculoskeletal system disorders (53.8 vs. 63.5) than cancer (15.5 vs. 11.2) in terms of frequency of the diseases in the assessment of fitness for work. Most respondents said that OHPs evaluate the current role appropriately and preferred OHPs in the future. They responded that OHPs found it difficult to treat cancer survivors, and it was psychologically tough to communicate with them (61.4%). Regarding the association of patient rehabilitation with workplaces, 48.9% said that workplaces provide inadequate support., Conclusion: As a preliminary study, we found that OHPs were found to have little experience in treating cancer survivors and undergo difficulties owing to poor collaboration with workplaces and communication with patients. This study will provide basic data for future studies to promote cancer survivors' return to workplaces., Competing Interests: Disclosure: The authors have no potential conflicts of interest to disclose.

Background: Hemodialysis patients experience physical and psychosocial symptoms caused by comorbid illnesses, treatment-related side effects, lifestyle alteration, and the psychosocial impacts of living with end-stage renal disease. The Dialysis Symptom Index (DSI) is the most frequently used instrument to assess symptoms of chronic kidney disease and end-stage renal disease in patients., Purpose: The aims of this study were to develop the Korean version of the DSI, to verify the reliability and validity of the developed tool, and to use the tool to evaluate the symptoms of hemodialysis patients in Korea., Methods: A methodological study was performed on 230 hemodialysis patients from three hospitals who agreed to participate in the study from October 1 to 30, 2015. The Symptom Checklist-90-Revised was used to verify the convergent validity, whereas the total score of Kidney Disease Quality of Life Questionnaire-Short Form, Version 1.3, was used to verify the divergent validity. Data were analyzed using descriptive analysis, Cronbach's alpha, confirmatory factor analysis, and Pearson's correlation analysis., Results: The internal consistency reliability of the Korean DSI assessed by Cronbach's alpha was .90. The Korean DSI showed a high positive correlation coefficient of .80 with symptom severity using the Symptom Checklist-90-Revised, which confirmed the convergent validity. Finally, the correlation coefficient with the quality of life of the participants using the Kidney Disease Quality of Life Questionnaire-Short Form, Version 1.3, was -.68, which confirmed the divergent validity., Conclusions/implications for Practice: This study developed the Korean version of the DSI and verified its validity and reliability. The Korean version of the DSI showed good properties and may be used to assess the symptoms of hemodialysis patients. Nurses may use this self-report tool to better understand and help relieve the prevalence and severity of symptoms in hemodialysis patients in Korea.

Backgrounds: Few reports have explored the extent to which physical activity is affected by pain severity in knee osteoarthritis (KOA) patients. We used national representative data to investigate the physical activity of KOA patients compared to the general population to determine what proportion of patients met physical activity recommendations and to explore how the proportion changes with pain severity., Methods: We used data from the fifth Korean National Health and Nutrition Examination Survey (KNHANES V; 2010-2012). In total, 1279 participants aged ≥50 years who had radiographic KOA and who evaluated knee pain on a numerical rating scale were selected. KOA was assessed using the Kellgren-Lawrence system. The Korean short version of the International Physical Activity Questionnaire was used to measure physical activity status. We used the physical activity recommendations of the American College of Rheumatology Work Group Panel when evaluating the extent of activity in KOA patients., Results: Only 18.6% of KOA patients met the osteoarthritis expert panel recommendations, lower than in the general population (23.2%; p = 0.003). The percentages that met the recommendations in the none to mild pain group, moderate pain group, and severe pain group were 23.4%, 17.6%, and 18.3%, respectively (p = 0.341). In terms of flexibility, a somewhat higher percentage of those with moderate pain engaged in physical activity compared to those with little or no pain (17.1% vs. 12.3%), but the difference was not significant (p = 0.585)., Conclusions: Regardless of pain severity, overall physical activity was suboptimal in Korean KOA patients. It is important to emphasize to osteoarthritis patients in clinical settings the need for physical activity, and a policy-based effort is required to facilitate appropriate exercise.

Background: Patients with amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) show functional and structural connectivity alterations in the default mode network (DMN) while cerebrovascular disease (CeVD) shows functional and structural connectivity changes in the executive control network (ECN). Such disruptions are associated with memory and executive function impairment, respectively. Concurrent AD and CeVD pathology is associated with a higher rate of cognitive decline and differential neurodegenerative patterns. Together, such findings are likely reflective of different underlying pathology in AD with and without CeVD. However, few studies have examined the effect of CeVD on network functional connectivity (task-free functional magnetic resonance imaging (fMRI)) and structural connectivity (diffusion MRI) of the DMN and ECN in aMCI and AD using a hypothesis-driven multiple seed-based approach., Methods: We examined functional and structural connectivity network changes in 39 aMCI, 50 aMCI+CeVD, 47 AD, 47 AD+CeVD, and 65 healthy controls (HCs) and their associations with cognitive impairment in the executive/attention and memory domains., Results: We demonstrate divergent DMN and ECN functional connectivity changes in CeVD and non-CeVD subjects. Compared with controls, intra-DMN hippocampal functional connectivity reductions were observed in both AD and AD+CeVD, while intra-DMN parietal and medial prefrontal-parietal functional connectivity was higher in AD+CeVD and aMCI+CeVD, but lower in AD. Intra-ECN frontal functional connectivity increases and fronto-parietal functional connectivity decreases occurred in CeVD but not non-CeVD subjects. Such functional connectivity alterations were related with cognitive impairment in a dissociative manner: intra-DMN functional connectivity changes were associated with worse cognition primarily in non-CeVD groups, while intra-ECN functional connectivity changes were associated with worse cognition primarily in CeVD groups. Additionally, CeVD and non-CeVD groups showed overlapping and distinct alterations in inter-network DMN-ECN functional connectivity depending on disease severity. In contrast to functional connectivity, CeVD groups had greater network structural connectivity damage compared with non-CeVD groups in both aMCI and AD patients. Network structural connectivity damage was associated with worse cognition., Conclusions: We demonstrate differential functional and structural network changes between aMCI and AD patients with and without CeVD through diverging and deleterious network-based degeneration underlying domain-specific cognitive impairment.

Since shoulder have a higher proportion of muscle which would have low electrical resistance, there could be more electrical damage to the rotator cuff muscles. We present a patient with acute rotator cuff tear by sudden uncontrolled jerking contractions caused by an electrical shock. A case of 42-year-old man with acute rotator cuff tear due to electrical injury to the shoulder was presented. Magnetic resonance imaging showed a full thickness tear and an undulating appearance of the peripheral end of the torn supraspinatus and infraspinatus muscle, suggesting an acute complete rupture. By arthroscopic surgery, the torn rotator cuff tendons were repaired with a suture bridge technique. At the final follow-up, the patient had a full, pain-free range of motion and had fully recovered shoulder muscle power., Competing Interests: Conflict of interest None., (Copyright © 2018 Korean Shoulder and Elbow Society.)

Aims and Objectives: To identify the characteristics in each symptom cluster and factors influencing the quality of life of haemodialysis patients in Korea according to cluster., Background: Despite developments in renal replacement therapy, haemodialysis still restricts the activities of daily living due to pain and impairs physical functioning induced by the disease and its complications., Design: Descriptive survey. Two hundred and thirty dialysis patients aged >18 years. They completed self-administered questionnaires of Dialysis Symptom Index and Kidney Disease Quality of Life instrument-Short Form 1.3., Methods: To determine the optimal number of clusters, the collected data were analysed using polytomous variable latent class analysis in R software (poLCA) to estimate the latent class models and the latent class regression models for polytomous outcome variables. Differences in characteristics, symptoms and QOL according to the symptom cluster of haemodialysis patients were analysed using the independent t test and chi-square test. The factors influencing the QOL according to symptom cluster were identified using hierarchical multiple regression analysis., Results: Physical and emotional symptoms were significantly more severe, and the QOL was significantly worse in Cluster 1 than in Cluster 2. The factors influencing the QOL were spouse, job, insurance type and physical and emotional symptoms in Cluster 1, with these variables having an explanatory power of 60.9%. Physical and emotional symptoms were the only influencing factors in Cluster 2, and they had an explanatory power of 37.4%., Conclusions: Mitigating the symptoms experienced by haemodialysis patients and improving their QOL require educational and therapeutic symptom management interventions that are tailored according to the characteristics and symptoms in each cluster., Relevance to Clinical Practice: The findings of this study are expected to lead to practical guidelines for addressing the symptoms experienced by haemodialysis patients, and they provide basic information for developing nursing interventions to manage these symptoms and improve the QOL of these patients., (© 2017 John Wiley & Sons Ltd.)

Purpose: Few studies have addressed gonadal and sexual dysfunctions in childhood cancer survivors. We evaluated the prevalence rates and risk factors for gonadal failure among adolescent/young adult childhood cancer survivors and their sexual function., Materials and Methods: Subjects were childhood cancer survivors aged 15-29 years who had completed therapy more than 2 years ago. Demographic and medical characteristics were obtained from the patients' medical records. In addition, hormonal evaluation and semen analysis were performed and sexual function was evaluated via questionnaire., Results: The study included 105 survivors (57 males, 48 females), of which 61 were adults (age > 19 years) and 44 were adolescents. In both males and females, the proportion of survivors with low sex hormone levels did not differ among age groups or follow-up period. Thirteen female subjects (27.1%) needed sex hormone replacement, while five males subjects (8.8%) were suspected of having hypogonadism, but none were receiving sex hormone replacement. Of 27 semen samples, 14 showed azospermia or oligospermia. The proportion of normospermia was lower in the high cyclophosphamide equivalent dose (CED) group (CED ≥ 8,000 mg/m2) than the low CED group (27.3% vs. 62.5%, p=0.047). Among adults, none were married and only 10 men (35.7%) and eight women (34.3%) were in a romantic relationship. Though a significant proportion (12.0% of males and 5.3% of females) of adolescent survivors had experienced sexual activity, 13.6% had not experienced sex education., Conclusion: The childhood cancer survivors in this study showed a high prevalence of gonadal/sexual dysfunction; accordingly, proper strategies are needed to manage these complications.

Objective: To assess the awareness of past medical history and long-term care issues of childhood cancer survivors (CCS) in Korea., Methods: A nationwide survey was conducted on CCS and their parents in 10 regional cancer centers in Korea. Answers regarding cancer diagnosis and treatment history were compared with the treatment summary and categorized into three ('specific,' 'general,' and 'no') or two ('yes' and 'no') groups., Results: Out of 343 contacts, 293 dyads completed the survey, and 281 dyads were analyzed. Awareness of cancer diagnosis was mostly specific for parents (76.5%) and CCS (35.2%). Awareness of anti-cancer treatment exposure was mostly general (84.6% for surgery, 67.9% for chemotherapy, and 53.9% for hematopoietic stem cell transplantation) rather than specific. In particular, more than half of the parents were not aware of the exposure to cardiotoxic agents (72.9%) or radiation therapy (56.3%). Providing information about long-term side effects and prevention of secondary cancer was significantly correlated only with more concern and more follow-up visits (P ≤ 0.001, respectively), without correlation with more specific awareness of exposure to cardiotoxic agents or radiation., Conclusion(s): Most of the parents of CCS were not aware of treatment-related risk factors necessary for long-term care. Providing information was significantly correlated with more concern and more follow-up visits, without improving corresponding knowledge about their past medical history. Effort aimed towards improving awareness about risk factors, the manner of providing information, and the patient referral system within which we use this information is warranted., (© The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Purpose: Hospice and palliative care services (HPC) are not commonly utilized in Korea; however, palliative care teams (PCTs) have been found to be effective at addressing the shortcomings in HPC. In this study, we attempted to outline unmet palliative care needs of terminal cancer patients and the potential benefits of PCTs as perceived by doctors in Korea., Materials and Methods: We surveyed 474 doctors at 10 cancer-related academic conferences from June to November 2014 with a self-report questionnaire to assess their perceptions of end-of-life care needs and the expected effects of PCTs on caring for terminal cancer patients. Among those surveyed, 440 respondents who completed the entire questionnaire were analyzed., Results: In all domains, fewer participants reported satisfaction with palliative care services than those reporting needs (p < 0.001). The surveyed participants also reported difficulties with a shortage of time for treatment, psychological burden, lack of knowledge regarding hospice care, lengths of stay, and palliative ward availability. Multivariate logistic regression analysis revealed that female doctors (odds ratio [OR], 2.672; 95% confidence interval [CI], 1.035 to 6.892), doctors who agreed that referring my patients to a HPC means I must give up on my patient (OR, 3.075; 95% CI, 1.324 to 7.127), and doctors who had no experience with HPC education (OR, 3.337; 95% CI, 1.600 to 7.125) were associated with higher expected effectiveness of PCT activities., Conclusion: The PCT activities were expected to fill the doctor's perceived unmet HPC needs of terminal cancer patients and difficulties in communications.

Purpose: Early diagnosis and an improved survival rate have emerged as important issues for cancer survivors returning to work during the prime of their working life. This study investigated the attitudes of the general public towards cancer survivors returning to work in Korea and attempted to identify the factors influencing this negative attitude., Materials and Methods: A general public perception survey regarding cancer survivors returning to work, targeting 2,000 individuals between 40-70 years of age, was conducted as face-to-face home visit., Results: The public expressed a negative attitude towards cancer survivors returning to work, in terms of both perception and acceptance. Negative perception was higher among those in metropolitan areas compared with urban/rural areas (odds ratio [OR], 1.71), with monthly incomes < $2,000 compared with > $4,000 (OR, 1.54), and with patient care experience compared with those without (OR, 1.41). Negative acceptance was higher among those with monthly incomes < $2,000 compared with > $4,000 (OR, 1.71) and those with patient care experience compared with those without (OR, 1.54). The common factors between acceptance and perception that influenced negative attitude included area of residence, patient care experience, and monthly income., Conclusion: This study identified negative attitudes towards cancer survivors returning to work in South Korea and the factors influencing the reintegration of cancer survivors into society. It is necessary to promote community awareness and intervention activities to enable access to community, social, and individual units for the social reintegration of cancer survivors.

Evidence of visual-auditory cross-modal plasticity in deaf individuals has been widely reported. Superior visual abilities of deaf individuals have been shown to result in enhanced reactivity to visual events and/or enhanced peripheral spatial attention. The goal of this study was to investigate the association between visual-auditory cross-modal plasticity and speech perception in post-lingually deafened, adult cochlear implant (CI) users. Post-lingually deafened adults with CIs (N = 14) and a group of normal hearing, adult controls (N = 12) participated in this study. The CI participants were divided into a good performer group (good CI, N = 7) and a poor performer group (poor CI, N = 7) based on word recognition scores. Visual evoked potentials (VEP) were recorded from the temporal and occipital cortex to assess reactivity. Visual field (VF) testing was used to assess spatial attention and Goldmann perimetry measures were analyzed to identify differences across groups in the VF. The association of the amplitude of the P1 VEP response over the right temporal or occipital cortex among three groups (control, good CI, poor CI) was analyzed. In addition, the association between VF by different stimuli and word perception score was evaluated. The P1 VEP amplitude recorded from the right temporal cortex was larger in the group of poorly performing CI users than the group of good performers. The P1 amplitude recorded from electrodes near the occipital cortex was smaller for the poor performing group. P1 VEP amplitude in right temporal lobe was negatively correlated with speech perception outcomes for the CI participants (r = -0.736, P = 0.003). However, P1 VEP amplitude measures recorded from near the occipital cortex had a positive correlation with speech perception outcome in the CI participants (r = 0.775, P = 0.001). In VF analysis, CI users showed narrowed central VF (VF to low intensity stimuli). However, their far peripheral VF (VF to high intensity stimuli) was not different from the controls. In addition, the extent of their central VF was positively correlated with speech perception outcome (r = 0.669, P = 0.009). Persistent visual activation in right temporal cortex even after CI causes negative effect on outcome in post-lingual deaf adults. We interpret these results to suggest that insufficient intra-modal (visual) compensation by the occipital cortex may cause negative effects on outcome. Based on our results, it appears that a narrowed central VF could help identify CI users with poor outcomes with their device.

We investigated the effect of chikusetsusaponin IVa (CS) and chikusetsusaponin IVa methyl ester (CS-ME) from the roots of Achyranthes japonica NAKAI on lipopolysaccharide (LPS)-induced nitric oxide (NO) and prostaglandin E2 (PGE2) production in RAW264.7 macrophages. CS-ME more potently inhibited LPS-induced NO and PGE2 production than CS. CS-ME concentration-dependently inhibited LPS-induced tumor necrosis factor (TNF)-α and interleukin (IL)-6 and IL-1β production in RAW264.7 macrophages and mouse peritoneal macrophages. Consistent with these findings, CS-ME suppressed LPS-induced expression of inducible NO synthase (iNOS) and cyclooxygenase (COX)-2 at protein level as well as iNOS, COX-2, TNF-α, IL-6, and IL-1β at mRNA level. In addition, CS-ME suppressed LPS-induced transcriptional activity of nuclear factor (NF)-κB and activator protein (AP)-1. The anti-inflammatory properties of CS-ME might result from suppression of iNOS, COX-2, TNF-α, IL-6, and IL-1β expression through downregulation of NF-κB and AP-1 in macrophages.

Following the implementation of a long-term care insurance system for the elderly in Korea, many nursing homes have been established and many more patients than ever before have been living at nursing homes. Despite the fact that this is a high-risk group vulnerable to hip fractures, no study has yet been conducted in Korea on hip fracture incidence rates and prognoses among patients residing at nursing homes. We recently studied 46 cases of hip fracture in nursing homes; more specifically, we investigated the most common conditions under which fractures occur, and examined the degree of recovery of ambulatory ability and the mortality within 1 yr. Among those who had survived after 1 yr, the number of non-functional ambulators increased from 8 hips before hip fracture to 19 hips at final post-fracture follow-up. These individuals showed poor recovery of ambulatory ability, and the number who died within one year was 11 (23.9%), a rate not significantly different from that among community-dwelling individuals. It was evident that hip-joint-fracture nursing home residents survived for similar periods of time as did those dwelling in the community, though under much more uncomfortable conditions. The main highlight of this report is that it is the first from Korea on nursing home residents' ambulatory recovery and one-year mortality after hip fracture. The authors believe that, beginning with the present study, the government should collect and evaluate the number of hips fractured at nursing facilities in order to formulate criteria that will help to enable all patients to select safer and better-quality nursing facilities for themselves or their family members.

Purpose: This study aimed to determine and compare the prevalences of diabetes awareness, treatment, and adequate glycemic control among cancer survivors in a Korean population and two non-cancer control groups, comprising individuals without a history of cancer but with other chronic diseases (non-cancer, chronic disease controls) and individuals without a history of cancer or any other chronic disease (non-cancer, non-chronic disease controls)., Methods: We analyzed data from 2,660 subjects with prevalent diabetes (aged ≥30 years), who had participated in the 2007-2011 Korea National Health and Nutrition Examination Survey. Awareness was defined as a subject having been diagnosed with diabetes by a clinician. Treatment was defined as a subject who was taking anti-diabetic medicine. Adequate glycemic control was defined as a hemoglobin A1c level of <7%. Multivariable logistic regression and predictive margins were used to evaluate whether awareness, treatment, or adequate glycemic control differed among cancer survivors and the two non-cancer control groups., Results: Cancer survivors had greater awareness compared with the non-cancer, chronic disease and non-cancer, non-chronic disease control groups (85.1%, 80.4%, and 60.4%, respectively). Although the prevalences of treatment and adequate glycemic control were higher for survivors compared with the non-cancer, non-chronic disease controls, they were lower compared with the non-cancer, chronic disease controls. The prevalence of diabetes treatment was 67.5% for cancer survivors, 69.5% for non-cancer, chronic disease controls, and 46.7% for non-cancer, non-chronic disease controls; the prevalences of adequate glycemic control in these three groups were 31.7%, 34.6%, and 17.8%, respectively., Conclusions: Cancer survivors were less likely than the non-cancer chronic disease subjects to receive diabetes management and to achieve adequate glycemic targets. Special attention and education are required to ensure that this population receives optimal diabetes care, and the systematic roles for primary care and specialist physicians need to be determined.

Purpose: We assessed the accuracy of communication between doctors and patients by evaluating the consistency between patient perception of cancer stage and the medical records, and analyzed the most influential factors of incongruence among cancer patients at 10 cancer centers across Korea., Methods: Information was gathered from cancer patients at the National Cancer Center and nine regional cancer centers located in every province of Korea between 1 July 2008 and 31 August 2008. Data were analyzed using Pearson's χ2 test and multivariate logistic regression analysis., Results: The stages of cancer reported by the 1,854 patients showed a low degree of congruence with the stages given in medical records (k = 0.35, P<0.001). Only 57.1% of the patients had accurate knowledge of their cancer stage. In total, 18.5% underestimated their stage of disease, and the more advanced the cancer stage, the more likely they were to underestimate it, in order of local (14.2%), regional (23.7%), and distant (51.6%). Logistic regression analysis showed that congruence was lower in patients with cervical cancer (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.30-0.87), recurrence (OR = 0.64, 95% CI = 0.50-0.83), and treatment at the National Cancer Center (OR = 0.53, 95% CI = 0.39-0.72)., Conclusion: There are knowledge gaps between patients' perceived and actual stage of cancer. Patients with cervical cancer, recurrence, and who received treatment at a regional cancer center showed less understanding of their cancer stage.

Background: Dexmedetomidine extends the duration of nerve block when administered perineurally together with local anesthetics by central and/or peripheral action. In this study, we compared the duration of nerve block between dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in infraclavicular brachial plexus block., Methods: Thirty patients, scheduled for upper limb surgery were assigned randomly to 3 groups of 10 patients each. We performed brachial plexus block using a nerve stimulator. In the control group (group C), patients received 40 ml of 1% mepivacaine. In group E, patients received 40 ml of 1% mepivacaine containing 200 µg of epinephrine as an adjuvant. In group D, patients received 40 ml of 1% mepivacaine containing 1 µg/kg of dexmedetomidine as an adjuvant. Sensory block duration, motor block duration, time to sense pain, and onset time were assessed. We also monitored blood pressure, heart rate, oxygen saturation and bispectral index., Results: In group D and group E, sensory block duration, motor block duration and time to sense first pain were prolonged significantly compared to group C. However, there was no significant difference between group D and group E., Conclusions: Perineural 1 µg/kg of dexmedetomidine similarly prolonged nerve block duration compared to 200 µg of epinephrine, but slowed heart rate. Thus, dexmedetomidine is expected to be a good alternative as an adjuvant to local anesthesia in patients who are cautioned against epinephrine.

Background: Lidocaine has been used widely to prevent propofol injection pain. Various methods of administration exist, such as lidocaine premixed with propofol or lidocaine pretreatment using a tourniquet, but it is unclear which method of lidocaine administration is more effective for the prevention of injection pain of propofol LCT/MCT. The purpose of this study was to compare pretreatment of lidocaine with a tourniquet and a premixed injection of lidocaine to prevent injection pain of propofol-LCT/MCT., Methods: Patients were randomly allocated into the pretreatment group (n = 117) or the premixed group (n = 117). The pretreatment group was pretreated with 2 ml of lidocaine 2%, held with a tourniquet, before propofol-LCT/MCT injection. The premixed group was injected with a premixed solution of propofol-LCT/MCT and 2 ml of lidocaine 2%. To evaluate the incidence and severity of pain, spontaneous verbal expressions of pain, movement of hand, frowning, and moaning were recorded, and the patients were asked to recall their pain with the visual analogue score (VAS) 30 minutes after awakening from anesthesia., Results: Overall, injection pain occurred in 13.7% of the pretreatment group and 15.4% of the premixed group, without any statistical difference (P = 0.71). There was no difference in spontaneous verbal expressions of pain, movement of hand, frowning, and moaning between the two groups. The pain intensity (VAS) also showed no difference between the two groups (P = 0.49)., Conclusions: Pretreatment of lidocaine with a tourniquet showed no more benefit to prevent injection pain of propofol LCT/MCT compared to a premixed injection with lidocaine.

Sciatic nerve injury after stretching exercise is uncommon. We report a case of an 18-year-old female trained dancer who developed sciatic neuropathy primarily involving the tibial division after routine stretching exercise. The patient presented with dysesthesia and weakness of the right foot during dorsiflexion and plantarflexion. The mechanism of sciatic nerve injury could be thought as hyperstretching alone, not caused by both hyperstretching and compression. Electrodiagnostic tests and magnetic resonance imaging revealed evidence of the right sciatic neuropathy from the gluteal fold to the distal tibial area, and partial tear of the left hamstring origin and fluid collection between the left hamstring and ischium without left sciatic nerve injury. Recovery of motor weakness was obtained by continuous rehabilitation therapy and some evidence of axonal regeneration was obtained by follow-up electrodiagnostic testing performed at 3, 5, and 12 months after injury.

The mechanism by which host factors contribute to hepatitis B virus (HBV) capsid formation during the viral life cycle remains unclear. This study analyzed the interaction between heat shock protein 90 (Hsp90), a host factor, and the HBV core protein. Hsp90 was found to bind to HBV core protein dimers, which was then encapsidated into the HBV capsid. Furthermore, activated Hsp90 may facilitate the formation of the human HBV capsid by catalyzing core assembly and reducing the degree of capsid dissociation at various temperatures, both in vitro and in vivo, and when subjected to detergent treatments in vitro. In addition, inhibition or downregulation of Hsp90 reduced HBV production in HepG2.2.15 cells. These results showed that Hsp90 plays an important role in HBV capsid stabilization and HBV formation., (Copyright © 2010 Elsevier Inc. All rights reserved.)