Assessment of malignant potential for HPV types 16, 52, and 58 in the uterine cervix within a Korean cohort.

High-risk human papillomavirus (HR-HPV) is the primary carcinogen in uterine cervical carcinoma. While genotype-specific carcinogenic risks have been extensively studied in Western populations, data from Korean are sparse. This study evaluates the malignant potential of the three most prevalent HR-HPVs in Korea: HPV16, HPV52, and HPV58. We analyzed 230 patients who underwent cervical conization and had been tested for HPV within a year prior to the procedure, excluding those with multiple infections. This analysis was confined to patients with single HPV infections and assessed outcomes of CIN3+, which includes carcinoma in situ (CIN3) and invasive carcinoma. The incidence of invasive cervical cancer was 6.7% for HPV16, 1.7% for HPV52, and 2.0% for HPV58; however, these differences were not statistically significant (p = 0.187). The rate of CIN3+ for HPV16, HPV52, and HPV58 were 70.6%, 51.7%, and 58.8%, respectively. Despite the small sample size, which may limit the robustness of statistical analysis, the data suggest a higher observed risk with HPV16. These findings highlight the need for vigilant clinical management tailored to specific HPV genotypes and support the implementation of a nine-valent vaccine in Korea. Physicians should be aware of these genotype-specific risks when treating patients.

Prediction of final pathology depending on preoperative myometrial invasion and grade assessment in low-risk endometrial cancer patients: A Korean Gynecologic Oncology Group ancillary study.

OBJECTIVES: Fertility-sparing treatment (FST) might be considered an option for reproductive patients with low-risk endometrial cancer (EC). On the other hand, the matching rates between preoperative assessment and postoperative pathology in low-risk EC patients are not high enough. We aimed to predict the postoperative pathology depending on preoperative myometrial invasion (MI) and grade in low-risk EC patients to help extend the current criteria for FST. METHODS/MATERIALS: This ancillary study (KGOG 2015S) of Korean Gynecologic Oncology Group 2015, a prospective, multicenter study included patients with no MI or MI <1/2 on preoperative MRI and endometrioid adenocarcinoma and grade 1 or 2 on endometrial biopsy. Among the eligible patients, Groups 1-4 were defined with no MI and grade 1, no MI and grade 2, MI <1/2 and grade 1, and MI <1/2 and grade 2, respectively. New prediction models using machine learning were developed. RESULTS: Among 251 eligible patients, Groups 1-4 included 106, 41, 74, and 30 patients, respectively. The new prediction models showed superior prediction values to those from conventional analysis. In the new prediction models, the best NPV, sensitivity, and AUC of preoperative each group to predict postoperative each group were as follows: 87.2%, 71.6%, and 0.732 (Group 1); 97.6%, 78.6%, and 0.656 (Group 2); 71.3%, 78.6% and 0.588 (Group 3); 91.8%, 64.9%, and 0.676% (Group 4). CONCLUSIONS: In low-risk EC patients, the prediction of postoperative pathology was ineffective, but the new prediction models provided a better prediction.

Impact of coronavirus disease 2019 on cancer care: How the pandemic has changed cancer utilization and expenditures.

PURPOSE: Since identified in December 2019, the novel coronavirus disease 2019 (COVID-19) has had a global impact on medical resource use and costs for patients with cancer in South Korea. This study aimed to identify the medical use and costs among patients with cancer during the COVID-19 pandemic, to predict these patterns in South Korea in the future. METHODS: We conducted a secondary claims data analysis using the National Health Insurance Service database for the calendar period of 2019-2020. Monthly relative percent changes in cancer incidence, medical use, and billing costs for medical care utilization by cancer type were calculated. Then, the medical use and costs after January 2020 were predicted using a time series model with data before the COVID-19 outbreak (2014-2019). RESULTS: The incidence of cancer diagnoses has seen a notable decline since the outbreak of the COVID-19 in 2020 as compared to 2019. Despite the impact of COVID-19, there hasn't been a distinct decline in outpatient utilization when compared to inpatient utilization. While medical expenses for both inpatient and outpatient visits have slightly increased, the number of patients treated for cancer has decreased significantly compared to the previous year. In June 2020, overall outpatient costs experienced the highest increase (21.1%), while individual costs showed the most significant decrease (-4.9%) in June 2020. Finally, the number of hospitalisations and outpatient visits increased slightly from June-July in 2020, reducing the difference between the actual and predicted values. The decrease in the number of inpatient hospitalisations (-22~-6%) in 2020 was also high. CONCLUSIONS: The overall use of medical services by patients with cancer decreased in 2020 compared with that in the pre-COVID-19 pandemic period. In the future, the government should consider how to recover from the COVID-19 pandemic, and establish permanent health policies for patients with cancer.

Assessment of transcranial Doppler indices after MgSO4 administration in severe preeclamptic women with neurologic symptoms.

PURPOSE: To investigate the effect of intravenous MgSO4 on maternal cerebral hemodynamics as well as the association between altered Doppler indices of the ophthalmic arteries and ocular lesions in patients with preeclampsia. METHODS: After each of the 15 included patients was diagnosed with preeclampsia, MgSO4 was infused followed by transcranial Doppler tests of the indices of the ophthalmic, anterior, middle, posterior cerebral, vertebral, and basilar arteries, followed by a second MgSO4 infusion. The peak, mean, diastolic velocity, and pulsatile and resistance indices of each artery were automatically measured during testing. Based on the emergent data, the cerebral perfusion pressure, resistance-area product, and cerebral flow index were calculated. RESULTS: The cerebral perfusion pressure of the posterior cerebral arteries significantly decreased following the infusion of MgSO4 (p < 0.05). Before the infusion of MgSO4, cerebral perfusion pressure and cerebral flow index of the ophthalmic arteries were significantly increased (p < 0.05) in the preeclamptic pregnant patients with ocular lesions compared those without ocular lesions. After the infusion of MgSO4, the cerebral perfusion pressure and cerebral flow index of both ophthalmic arteries were slightly decreased, but the difference was not significant. CONCLUSIONS: Altered Doppler indices following the infusion of MgSO4 suggest significant changes in the hemodynamics of the posterior cerebral and ophthalmic arteries that are particularly related to the neurological signs and symptoms of women with preeclampsia. These findings may improve the understanding of the mechanism of the cerebral complications of preeclampsia. Advancing comprehension of these underlying mechanisms is postulated to play a pivotal role in the mitigation of hypertensive encephalopathy associated with preeclampsia.

Cost-Effectiveness of Fractional Flow Reserve-Guided Treatment for Acute Myocardial Infarction and Multivessel Disease: A Prespecified Analysis of the FRAME-AMI Randomized Clinical Trial.

Importance: Complete revascularization by non-infarct-related artery (IRA) percutaneous coronary intervention (PCI) in patients with acute myocardial infarction is standard practice to improve patient prognosis. However, it is unclear whether a fractional flow reserve (FFR)-guided or angiography-guided treatment strategy for non-IRA PCI would be more cost-effective. Objective: To evaluate the cost-effectiveness of FFR-guided compared with angiography-guided PCI in patients with acute myocardial infarction and multivessel disease. Design, Setting, and Participants: In this prespecified cost-effectiveness analysis of the FRAME-AMI randomized clinical trial, patients were randomly allocated to either FFR-guided or angiography-guided PCI for non-IRA lesions between August 19, 2016, and December 24, 2020. Patients were aged 19 years or older, had ST-segment elevation myocardial infarction (STEMI) or non-STEMI and underwent successful primary or urgent PCI, and had at least 1 non-IRA lesion (diameter stenosis >50% in a major epicardial coronary artery or major side branch with a vessel diameter of ≥2.0 mm). Data analysis was performed on August 27, 2023. Intervention: Fractional flow reserve-guided vs angiography-guided PCI for non-IRA lesions. Main Outcomes and Measures: The model simulated death, myocardial infarction, and repeat revascularization. Future medical costs and benefits were discounted by 4.5% per year. The main outcomes were quality-adjusted life-years (QALYs), direct medical costs, incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INB) of FFR-guided PCI compared with angiography-guided PCI. State-transition Markov models were applied to the Korean, US, and European health care systems using medical cost (presented in US dollars), utilities data, and transition probabilities from meta-analysis of previous trials. Results: The FRAME-AMI trial randomized 562 patients, with a mean (SD) age of 63.3 (11.4) years. Most patients were men (474 [84.3%]). Fractional flow reserve-guided PCI increased QALYs by 0.06 compared with angiography-guided PCI. The total cumulative cost per patient was estimated as $1208 less for FFR-guided compared with angiography-guided PCI. The ICER was -$19 484 and the INB was $3378, indicating that FFR-guided PCI was more cost-effective for patients with acute myocardial infarction and multivessel disease. Probabilistic sensitivity analysis showed consistent results and the likelihood iteration of cost-effectiveness in FFR-guided PCI was 97%. When transition probabilities from the pairwise meta-analysis of the FLOWER-MI and FRAME-AMI trials were used, FFR-guided PCI was more cost-effective than angiography-guided PCI in the Korean, US, and European health care systems, with an INB of $3910, $8557, and $2210, respectively. In probabilistic sensitivity analysis, the likelihood iteration of cost-effectiveness with FFR-guided PCI was 85%, 82%, and 31% for the Korean, US, and European health care systems, respectively. Conclusions and Relevance: This cost-effectiveness analysis suggests that FFR-guided PCI for non-IRA lesions saved medical costs and increased quality of life better than angiography-guided PCI for patients with acute myocardial infarction and multivessel disease. Fractional flow reserve-guided PCI should be considered in determining the treatment strategy for non-IRA stenoses in these patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02715518.

Revealing the Substrate Constraint Effect on the Thermodynamic Behaviour of the Pd-H through Capacitive-Based Hydrogen-Sorption Measurement.

Mechanical constraints imposed on the Pd-H system can induce significant strain upon hydrogenation-induced expansion, potentially leading to changes in the thermodynamic behavior, such as the phase-transition pressure. However, the investigation of the constraint effect is often tricky due to the lack of simple experimental techniques for measuring hydrogenation-induced expansion. In this study, a capacitive-based measurement system is developed to monitor hydrogenation-induced areal expansion, which allows us to control and evaluate the magnitude of the substrate constraint. By using the measurement technique, the influence of substrate constraint intensity on the thermodynamic behavior of the Pd-H system is investigated. Through experiments with different constraint intensities, it is found that the diffefrence in the constraint intensity minimally affects the phase-transition pressure when the Pd-H system allows the release of constraint stress through plastic deformation. These experiments can improve the understanding of the substrate constraint behaviours of Pd-H systems allowing plastic deformation while demonstrating the potential of capacitive-based measurement systems to study the mechanical-thermodynamic coupling of M-H systems.

Low-Cost Angle Sensor for Robotics Applications Using Plastic Optical Fiber Based on Optical Loss Mechanism.

Robotic systems and the human body consist of numerous joint structures, all of which require precise angle adjustments. At present, encoder, strain gauge, and electrical resistance-based sensors are commonly used for angle measurement. However, these sensors have limitations when used in underwater or in environments with strong electromagnetic waves. Therefore, we have developed an angle sensor based on step-index profile plastic optical fiber (SI-POF), which is cost-effective and highly durable, in this study in order to overcome the limitations of existing angle measurement sensors. To this end, the amount of light loss according to the gab and angle changes that occur when the POF angle sensor is applied to the robot arm was experimentally measured, and based on the results, a simulation of the amount of light loss when the two losses occurred at the same time was conducted. In addition, the performance of the POF angle sensor was evaluated by measuring sensitivity and resolution, and comparative verification with a commonly used encoder was conducted to verify the reliability of sensors in extreme environments, such as those with electromagnetic fields and those that are underwater. Through this, the reliability and practicality of the POF angle sensor were confirmed. The results obtained in this study suggest that POF-based angle sensors can contribute to the development of the biomimetic robot industry as well as ordinary robots, especially in environments where existing sensors are difficult to apply, such as areas with underwater or electromagnetic interference (EMI).

QFR Assessment and Prognosis After Nonculprit PCI in Patients With Acute Myocardial Infarction.

BACKGROUND: Complete revascularization using either angiography-guided or fractional flow reserve (FFR)-guided strategy can improve clinical outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, there is concern that angiography-guided percutaneous coronary intervention (PCI) may result in un-necessary PCI of the non-infarct-related artery (non-IRA), and its long-term prognosis is still unclear. OBJECTIVES: This study sought to evaluate clinical outcomes after non-IRA PCI according to the quantitative flow ratio (QFR). METHODS: We performed post hoc QFR analysis of non-IRA lesions of AMI patients enrolled in the FRAME-AMI (FFR Versus Angiography-Guided Strategy for Management of AMI With Multivessel Disease) trial, which randomly allocated 562 patients into either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis >50%) for non-IRA lesions. Patients were classified by non-IRA QFR values into the QFR ≤0.80 and QFR >0.80 groups. The primary outcome was a major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction, and repeat revascularization. RESULTS: A total of 443 patients (552 lesions) were eligible for QFR analysis. Of 209 patients in the angiography-guided PCI group, 30.0% (n = 60) underwent non-IRA PCI despite having QFR >0.80 in the non-IRA. Conversely, only 2.7% (n = 4) among 209 patients in the FFR-guided PCI group had QFR >0.80 in the non-IRA. At a median follow-up of 3.5 years, the rate of MACEs was significantly higher among patients with non-IRA PCI despite QFR >0.80 than in patients with deferred PCI for non-IRA lesions (12.9% vs 3.1%; HR: 4.13; 95% CI: 1.10-15.57; P = 0.036). Non-IRA PCI despite QFR >0.80 was associated with a higher risk of non-IRA MACEs than patients with deferred PCI for non-IRA lesions (12.9% vs 2.1%; HR: 5.44; 95% CI: 1.13-26.19; P = 0.035). CONCLUSIONS: In AMI patients with multivessel disease, 30.0% of angiography-guided PCI resulted in un-necessary PCI for the non-IRA with QFR >0.80, which was significantly associated with an increased risk of MACEs than in those with deferred PCI for non-IRA lesions. (FFR Versus Angiography-Guided Strategy for Management of AMI With Multivessel Disease [FRAME-AMI] ClinicalTrials.gov number; NCT02715518).

Assessment of the proarrhythmic effects of repurposed antimalarials for COVID-19 treatment using a comprehensive in vitro proarrhythmia assay (CiPA).

Due to the outbreak of the SARS-CoV-2 virus, drug repurposing and Emergency Use Authorization have been proposed to treat the coronavirus disease 2019 (COVID-19) during the pandemic. While the efficiency of the drugs has been discussed, it was identified that certain compounds, such as chloroquine and hydroxychloroquine, cause QT interval prolongation and potential cardiotoxic effects. Drug-induced cardiotoxicity and QT prolongation may lead to life-threatening arrhythmias such as torsades de pointes (TdP), a potentially fatal arrhythmic symptom. Here, we evaluated the risk of repurposed pyronaridine or artesunate-mediated cardiac arrhythmias alone and in combination for COVID-19 treatment through in vitro and in silico investigations using the Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative. The potential effects of each drug or in combinations on cardiac action potential (AP) and ion channels were explored using human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and Chinese hamster ovary (CHO) cells transiently expressing cardiac ion channels (Nav1.5, Cav1.2, and hERG). We also performed in silico computer simulation using the optimized O'Hara-Rudy human ventricular myocyte model (ORd model) to classify TdP risk. Artesunate and dihydroartemisinin (DHA), the active metabolite of artesunate, are classified as a low risk of inducing TdP based on the torsade metric score (TMS). Moreover, artesunate does not significantly affect the cardiac APs of hiPSC-CMs even at concentrations up to 100 times the maximum serum concentration (Cmax). DHA modestly prolonged at APD90 (10.16%) at 100 times the Cmax. When considering Cmax, pyronaridine, and the combination of both drugs (pyronaridine and artesunate) are classified as having an intermediate risk of inducing TdP. However, when considering the unbound concentration (the free fraction not bound to carrier proteins or other tissues inducing pharmacological activity), both drugs are classified as having a low risk of inducing TdP. In summary, pyronaridine, artesunate, and a combination of both drugs have been confirmed to pose a low proarrhythmogenic risk at therapeutic and supratherapeutic (up to 4 times) free Cmax. Additionally, the CiPA initiative may be suitable for regulatory use and provide novel insights for evaluating drug-induced cardiotoxicity.

D-π-A Structured Porphyrin and Organic Dyes with Easily Synthesizable Donor Units for Low-Cost and Efficient Dye-Sensitized Solar Cells.

This study aimed to develop low-cost D-π-A structured porphyrin and organic dyes with easily synthesizable donor units instead of the conventional complex multistep synthetic donor unit of Hexyloxy-BPFA [bis(7-(2,4-bis(hexyloxy)phenyl)-9,9-dimethyl-9H-fluoren-2-yl)amine] used in SGT-021 and SGT-149 as well-known record cosensitizers with an extremely high power conversion efficiency (PCE). The design strategy concerned the easier synthesis of low-cost donor units with inversion structures in donor groups via donor structural engineering, particularly by changing the position of the fluorene and phenylene units in the donor moiety while keeping the π-bridge and acceptor unit unchanged, leading to the synthesis of two D-π-A structured porphyrins [SGT-021(D0) and SGT-021(D)] and one D-π-A structured organic sensitizer [SGT-149(D)] for dye-sensitized solar cells (DSSCs). Specifically, porphyrin SGT-021(D0) incorporated two hexyl chains into the 9-position of each fluorene, while SGT-021(D) and SGT-149(D) substituted two hexyloxy chain units to the terminal position of each fluorene in the donor groups of porphyrin dyes. The effect of the position of the fluorene and phenylene units in the donor moiety on the photochemical and electrochemical properties, as well as the photovoltaic performance, was compared with the reference dyes of SGT-021 and SGT-149, previously reported by the research group. After optimizing the DSSC devices, SGT-021(D) and SGT-021(D0) achieved a high PCE of 11.6 and 10.5%, respectively, while SGT-149(D) exhibited a little lower PCE of 10.3% under the standard AM 1.5G light intensity. The cell performance of DSSC devices based on SGT-021(D) and SGT-149(D) was inferior to the corresponding reference dyes of SGT-021 and SGT-149 due to their lower donating ability of Hexyloxy-BPFA than Hexyloxy-BFPA.

Rhythm-based assessment and training for children with attention deficit hyperactivity disorder (ADHD): a feasibility study protocol.

Background: The timing-related deficits in individuals with attention deficit hyperactivity disorder (ADHD) contribute to the symptom-related difficulties and cognitive impairments. Current assessment and training measurement only target specific aspects of the timing ability, highlighting the need for more advanced tools to address timing deficits in ADHD. The aim of this study is to develop and validate a rhythm-based assessment and training (RAT) program, which intends to provide a comprehensive understanding of and enhancement to the time-related abilities of children with ADHD, thereby demonstrating its clinical efficacy. Methods: We will use randomized crossover trials in this study, with participants being randomly assigned to either start with the RAT and then proceed to cognitive training or start with cognitive training and then proceed to the RAT. Both groups will undergo pre- and post- evaluations. The evaluation will be administered immediately before and after the 4-week training period using diagnostic questionnaires, cognitive evaluation tools, and resting electroencephalography (EEG) measurements. Notably, EEG measurements will be conducted concurrently with the RAT evaluations. Discussion: This study develops and evaluates the feasibility and effectiveness of a RAT while using EEG measurements to elucidate the underlying therapeutic mechanism of auditory rhythm at varying levels of complexity. The study will investigate the potential of RAT as a supplementary or alternative approach for managing ADHD. The multifaceted data collected will yield valuable insights to customize training agendas based on individual developmental stages and prognoses.

The Incidence of Brain-Dead Donors Based on Screening and Management Led by Intensivists.

BACKGROUND This study aimed to compare the incidence of brain-dead (BD) donors and potential brain-dead (PBD) donors before vs after the introduction of intensivists. MATERIAL AND METHODS This longitudinal retrospective study was performed between January 2012 and December 2020 at Seoul Metropolitan Government-Seoul National University Boramae Medical Center. Four dedicated intensivists were introduced in January 2016. The periods before and after introduction of the intensivists were defined as the pre-introduction period (2012-2015) and post-introduction period (2016-2020), respectively. RESULTS During the study period, there were 2872 discharges in the Intensive Care Unit, of which there were a total of 113 PBD (3.93%) and 36 BD (1.25%) donors. The number of PBD and BD donors increased in the post-introduction period compared in the pre-introduction period (PBD, 47.84 vs 27.14 per 1000 discharges; BD, 13.59 vs 11.03 per 1000 discharges). Poisson regression analysis showed the annual incidence rate of PBD donors significantly increased post-introduction (PBD, 27.53% vs 48.11%, P=0.044), while those of BD donors were similar between the 2 groups (BD, 11.41% vs 13.9%; P=0.743). The annual incidence rate of the total number of organ donations, multi-organ donations (>3 organs), and donation of organs (heart, lung, and kidney) increased in the post-introduction period compared to that in the pre-introduction period. CONCLUSIONS Our findings suggest a beneficial role of a dedicated intensivist, not only in improving actual organ donation and discovering PBD donors, but also in affecting the yield of the heart and lung transplantation in actual organ donation compared to donors without a dedicated intensivist.

Effect of short-term fattening period and castration method on productivity, serum testosterone, and economic efficacy in Hanwoo cattle.

The purpose of this study was to evaluate the effects of castration method and short-term fattening periods on Hanwoo cattle. Thirty-two Hanwoo calves (average body weight: 148.4 ± 19.8 kg) were used. The calves were randomly assigned in a 2 × 2 factor according to two castration methods (castration or hemi-castration) and two short-term finishing periods (24 months or 26 months). The final body weight increased significantly as the fattening period increased (p < 0.05), and the average daily weight gain was higher in the hemi-castration groups than in the castration groups (p < 0.05). After surgical castration, testosterone concentration was higher in the hemi-castration group than in the castration group during the entire experimental period (p < 0.05). The rib eye area was wider in the hemi-castration group than in the castration group (p < 0.01).An interaction effect was observed between the castration method and short-term fattening period (p < 0.05). Marbling and auction price scores differed between castration methods and were higher in the castration group than in the hemi-castration group (p < 0.01). Gross receipts and net income increased in the castration group compared to the hemi-castration group (p < 0.01) and showed a tendency to increase with the short-term fattening period, but there was no significant difference. Thus, castration to remove both testicles is essential for economic profit through producing high-quality Korean beef meat, and short-term fattening for 26 months, rather than 24 months, can benefit more by increasing carcass weight and meat quality.

Angiography-derived functional assessment of left main coronary stenoses.

OBJECTIVES: We aimed to evaluate the diagnostic accuracy of quantitative flow ratio (QFR) in left main (LM) coronary stenoses, using Fractional Flow Reserve (FFR) as reference. BACKGROUND: QFR has demonstrated a high accuracy in determining the functional relevance of coronary stenoses in non-LM. However, there is an important paucity of data regarding its diagnostic value in the specific anatomical subset of LM disease. METHODS: This is a retrospective, observational, multicenter, international, and blinded study including patients with LM stenoses. Cases with significant ostial LM disease were excluded. QFR was calculated from conventional angiograms at blinded fashion with respect to FFR. RESULTS: Sixty-seven patients with LM stenoses were analyzed. Overall, LM had intermediate severity, both from angiographic (diameter stenosis [%DS] 43.8 ± 11.1%) and functional perspective (FFR 0.756 ± 0.105). Mean QFR was 0.733 ± 0.159. Correlation between QFR and FFR was moderate (r = 0.590). Positive and negative predictive value, sensitivity and specificity were 85.4%, 64%, 85.4%, and 69.6% respectively. Classification agreement of QFR and FFR in terms of functional stenosis severity was 78.1%. Area under the receiver operating characteristics of QFR using FFR as reference was 0.82 [95% confidence interval [CI], 0.71-0.93], and significantly better than angiographic evaluation including %DS (area under the receiver-operating characteristic curve [AUC] 0.45 [95% CI, 0.32-0.58], p < 0.001) and minimum lumen diameter (AUC 0.60 [95% CI, 0.47-0.74], p < 0.001). CONCLUSIONS: Compared with FFR, QFR has acceptable diagnostic performance in determining the functional relevance of LM stenosis, being better than conventional angiographic assessment. Nonetheless, caution should be taken when applying functional angiography techniques for the assessment of LM stenosis given its particular anatomical characteristics.

Performance and economic efficiency analysis of an integrated, outdoor fan-ventilated cooling device.

Recently, the importance of mechanical facilities in charge of the safety and comfort of occupants in buildings has once again been highlighted in accordance with global social issues such as the spread of COVID-19. In response, various ventilation systems are being developed to improve indoor air quality, and efforts are being made to satisfy the indoor comfort of the occupants. Such advanced facilities allow occupants to secure indoor air quality, while frequent ventilation systems can affect the cooling and heating load in the building, and there is also a problem that it can occupy a relatively large amount of space in the building. This study proposes an integrated, outdoor fan-ventilated cooling device and analyzes its performance and economic efficiency. The EnergyPlus simulation program was used to model two types of systems for comparison: an existing (base) model with a condenser located in the outdoor unit, and a developed model with the condenser integrated within the cooling system. The state of the air passing through the condenser was analyzed prior to comparing the efficiency of the integrated, outdoor fan-ventilated cooling device, followed by an in-depth analysis of the performance and economic efficiency based on total energy consumption. In Case 1, the air passing through the cooling system was approximately 5  °C lower than the base model and showed 11% peak load reduction in comparison to the maximum energy consumption. Additionally, a comparison between regions with different outdoor air temperatures showed an average cost reduction of 16% in Daejeon and Busan City.

Intraoperative Assessment of Gap Balancing in Total Knee Arthroplasty Using Navigation with Joint Stability Graphs.

The purpose of this study was to assess continuous gaps in the replaced knee throughout the full range of motion (ROM) after total knee arthroplasty (TKA) using a joint stability graph, and to analyze the gap laxity in the mid-flexion range. Ninety-three TKAs were performed using imageless navigation with a joint stability graph. While positioning guides for each respective cut, the surgeon can safely preview the resection's impact for the resulting joint gaps and control the soft tissue balance at the knee flexion of 0° (extension) and 90° (flexion). The gaps between the femoral component and insert were evaluated throughout the full ROM using the joint stability graph. The mechanical axis (MA) and change of joint line height were radiographically evaluated. Posthoc power analyses using a significant α value of 0.05 were performed on the proportion of the mid-flexion instability as a primary outcome to determine whether the sample had sufficient power. The power was determined to be sufficient (100%). The flexion-extension gap differences in each medial and lateral compartment and the mediolateral gap differences in flexion and extension were all ≤3 mm. None of the knees had mid-flexion instability, which is defined by a peak mid-flexion gap that is 3 mm greater than the smaller value of flexion or extension gap. The average MA was well corrected from varus 11.4° to varus 1.0° postoperatively. The proportion of postoperative well-aligned knees (MA ≤ 3°) was 87.1%. The joint line height was well preserved (14.7 vs. 14.8 mm, p = 0.751). The joint stability graph in TKA using the navigation can effectively evaluate the continuous gap throughout the ROM, including the mid-flexion range. Mid-flexion instability was uncommon in primary TKAs with appropriate alignment and proper preservation of the joint line. The Level of evidence for the study is IV.

Mid-flexion laxity could be identified with continuous flexion-arc gap assessment in patients with a large preoperative convergence angle.

PURPOSE: To analyze the incidence of intraoperative mid-flexion laxity using continuous flexion-arc gap assessment, risk factors for mid-flexion laxity, and clinical results in navigation-assisted total knee arthroplasty (TKA). METHODS: Ninety posterior-stabilized TKAs were performed under navigation guidance for patients with degenerative arthritis and varus deformity. Intraoperatively, the gap between the trial femoral component and insert was evaluated in the navigation system with continuous flexion-arc gap assessment. Each medial and lateral gap at flexion (90°) and extension (0°) were made to be less than 3 mm. Mid-flexion laxity was determined when the gap in the flexion range between 15° and 60° was 3 mm or more. The proportion of knees with mid-flexion laxity was investigated. The factors affecting mid-flexion laxity were identified in terms of demographics, preoperative convergence angle, and change in joint line height and posterior femoral offset. The Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were evaluated. RESULTS: There were 31 cases (34.4%) of lateral mid-flexion laxity (average peak mid-flexion gap = 3.7 mm). The other 59 cases did not show mid-flexion laxity. The preoperative convergence angle was the only significant factor affecting lateral mid-flexion laxity (odds ratio = 1.466, p = 0.002). There were no significant differences in the clinical results between the groups with and without mid-flexion laxity. CONCLUSIONS: The continuous flexion-arc gap assessment was useful in evaluating mid-flexion laxity using navigation-assisted TKA. The preoperative convergence angle, reflecting soft-tissue laxity, can be a practical and simple radiographic finding for predicting lateral mid-flexion laxity. LEVEL OF EVIDENCE: IV.

Analysis of medical service utilization for post-stroke sequelae in Korea between 2016 and 2018: a cross-sectional study.

In this retrospective cross-sectional observational study, the medical service utilization of post-stroke sequelae patients was examined using a national patient sample. The Korean Health Insurance Review and Assessment Service-National Patients Sample database was used to investigate the medical service utilization of 19,562 patients, diagnosed with post-stroke sequelae of cerebrovascular disease (I69) in Korea between January 2016 and December 2018. We compared the demographic characteristics, diagnosis code subtypes, frequency of healthcare utilization, medical costs, and comorbidities of standard care (SC) and Korean medicine (KM) users. Overall, patients aged ≥ 65 years accounted for the highest percentage, and utilization of medical services increased among patients aged ≥ 45 years. Outpatient care was higher among SC (79.23%) and KM (99.38%) users. Sequelae of cerebral infarction accounted for the highest percentage of diagnosis subtypes. Physical therapy and rehabilitation therapy were most frequent in SC, whereas injection/procedure and acupuncture were most frequent in KM. Cerebrovascular circulation/dementia drugs were prescribed most frequently in SC. Circulatory, digestive, endocrine, and metabolic disorders were the most common comorbidities in SC, whereas musculoskeletal and connective tissue disorders were most common in KM. Overall, SC and KM users showed differences in the number of medical service claims, cost of care, and comorbidities. Our findings provide basic research data for clinicians, researchers, and policy makers.

Clinical Characteristics and Disease Burden of Severe Asthma According to Oral Corticosteroid Dependence: Real-World Assessment From the Korean Severe Asthma Registry (KoSAR).

PURPOSE: Oral corticosteroids (OCS) are commonly used in patients with severe asthma, but they are associated with several adverse events. We estimated the prevalence of patients with OCS-dependent asthma in a large nationwide registry for severe asthma and delineated their clinical characteristics. METHODS: This cross-sectional study analyzed enrollment data of the patients recruited in the Korean Severe Asthma Registry (KoSAR) from 2010 to 2019. The clinical characteristics of patients were compared according to OCS dependency, which was defined as maintenance OCS treatment lasting at least 6 months during the 12 months prior to enrollment. RESULTS: Among the 562 patients with severe asthma, 121 (21.5%) patients were defined as having OCS-dependent asthma. Compared with the OCS-independent group, the OCS-dependent group was older at symptom onset and had a higher prevalence of anxiety, worse lung function, and used more medication than the control group. Despite the higher doses of daily ICS and 6-month cumulative OCS, the OCS-dependent group reported greater consumption of relievers and a higher prevalence of unscheduled emergency room visits and repeated OCS bursts. Although anti-interleukin-5 was more commonly prescribed for patients with OCS-dependent asthma, only a limited proportion of patients with severe asthma received biologics. CONCLUSIONS: One-fifth of patients with severe asthma had OCS-dependency, which was associated with a greater disease burden compared to those with OCS-independent asthma. Active intervention including initiation of biologics and regular assessment of OCS-induced morbidities is warranted to reduce the use of OCS and its potential adverse effects.

A method for the tribological assessment of oral pharmaceutical liquids.

OBJECTIVE: Patient acceptance of pediatric formulations is critical to compliance and consequently therapeutic outcomes; thus, having an in vitro method to evaluate sensory perception of pharmaceutical products would be beneficial. The objective of this research is to develop a sensitive and reproducible tribological method to characterize pharmaceutical suspensions at low force and sliding speeds. METHODS: The discriminating potential of the method was examined using tribology profiles (coefficient of friction (COF) vs. sliding speed) for commercially available products and products made for this study with widely varying sweetness, thickness, and grittiness; these formulations were used to judge the sensitivity of the method. Samples were measured using 3M Transpore™ surgical tape to simulate the tongue surface, steel half ring geometry, constant gap setting, target axial force of 2 N in a 600 s exponential ramp for rotation speed. RESULTS: The COF ranged from 0.1 to 0.6. For the speeds studied, the high viscosity commercial suspension ibuprofen drops and acetaminophen suspension show a classic Stribeck curve with an increasing COF at the higher rotation speeds, which indicates these formulations entered the hydrodynamic lubrication phase, while the lower viscosity suspensions only reached the mixed lubrication phase. CONCLUSION: The contribution of particles affects the COF in a dynamic tribologic pattern compared to products that are categorized as either low gritty or high viscosity. These results are important as they provide a potentially rapid in vitro method for screening pediatric medications and help to identify the factors that affect the palatability of pediatric formulations.