Income variability and incident cardiovascular disease in diabetes: a population-based cohort study.

BACKGROUND AND AIMS: Longitudinal change in income is crucial in explaining cardiovascular health inequalities. However, there is limited evidence for cardiovascular disease (CVD) risk associated with income dynamics over time among individuals with type 2 diabetes (T2D). METHODS: Using a nationally representative sample from the Korean National Health Insurance Service database, 1 528 108 adults aged 30-64 with T2D and no history of CVD were included from 2009 to 2012 (mean follow-up of 7.3 years). Using monthly health insurance premium information, income levels were assessed annually for the baseline year and the four preceding years. Income variability was defined as the intraindividual standard deviation of the percent change in income over 5 years. The primary outcome was a composite event of incident fatal and nonfatal CVD (myocardial infarction, heart failure, and stroke) using insurance claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for potential confounders. RESULTS: High-income variability was associated with increased CVD risk (HRhighest vs. lowest quartile 1.25, 95% CI 1.22-1.27; Ptrend < .001). Individuals who experienced an income decline (4 years ago vs. baseline) had increased CVD risk, which was particularly notable when the income decreased to the lowest level (i.e. Medical Aid beneficiaries), regardless of their initial income status. Sustained low income (i.e. lowest income quartile) over 5 years was associated with increased CVD risk (HRn = 5 years vs. n = 0 years 1.38, 95% CI 1.35-1.41; Ptrend < .0001), whereas sustained high income (i.e. highest income quartile) was associated with decreased CVD risk (HRn = 5 years vs. n = 0 years 0.71, 95% CI 0.70-0.72; Ptrend < .0001). Sensitivity analyses, exploring potential mediators, such as lifestyle-related factors and obesity, supported the main results. CONCLUSIONS: Higher income variability, income declines, and sustained low income were associated with increased CVD risk. Our findings highlight the need to better understand the mechanisms by which income dynamics impact CVD risk among individuals with T2D.

Mid- and long-term risk of atrial fibrillation among breast cancer surgery survivors.

BACKGROUND: The risk of incident atrial fibrillation (AF) among breast cancer survivors, especially for younger women, and cancer treatment effects on the association remain unclear. This study aimed to investigate the risk of AF among breast cancer survivors and evaluate the association by age group, length of follow-up, and cancer treatment. METHODS: Using data from the Korean Health Insurance Service database (2010-2017), 113,232 women newly diagnosed with breast cancer (aged ≥ 18 years) without prior AF history who underwent breast cancer surgery were individually matched 1:5 by birth year to a sample female population without cancer (n = 566,160) (mean[SD] follow-up, 5.1[2.1] years). Sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) considering death as a competing risk were estimated, adjusting for sociodemographic factors and cardiovascular/non-cardiovascular comorbidities. RESULTS: BCS had a slightly increased AF risk compared to their cancer-free counterparts (sHR 1.06; 95% CI 1.00-1.13), but the association disappeared over time. Younger BCS (age < 40 years) had more than a 2-fold increase in AF risk (sHR 2.79; 95% CI 1.98-3.94), with the association remaining similar over 5 years of follow-up. The increased risk was not observed among older BCS, especially those aged > 65 years. Use of anthracyclines was associated with increased AF risk among BCS (sHR 1.57; 95% CI 1.28-1.92), which was more robust in younger BCS (sHR 1.94; 95% CI 1.40-2.69 in those aged ≤ 50 years). CONCLUSIONS: Our findings suggest that younger BCS had an elevated risk of incident AF, regardless of the length of follow-up. Use of anthracyclines may be associated with increased mid-to-long-term AF risk among BCS.

Time-asymmetric loop around an exceptional point over the full optical communications band.

Topological operations around exceptional points1-8-time-varying system configurations associated with non-Hermitian singularities-have been proposed as a robust approach to achieving far-reaching open-system dynamics, as demonstrated in highly dissipative microwave transmission3 and cryogenic optomechanical oscillator4 experiments. In stark contrast to conventional systems based on closed-system Hermitian dynamics, environmental interferences at exceptional points are dynamically engaged with their internal coupling properties to create rotational stimuli in fictitious-parameter domains, resulting in chiral systems that exhibit various anomalous physical phenomena9-16. To achieve new wave properties and concomitant device architectures to control them, realizations of such systems in application-abundant technological areas, including communications and signal processing systems, are the next step. However, it is currently unclear whether non-Hermitian interaction schemes can be configured in robust technological platforms for further device engineering. Here we experimentally demonstrate a robust silicon photonic structure with photonic modes that transmit through time-asymmetric loops around an exceptional point in the optical domain. The proposed structure consists of two coupled silicon-channel waveguides and a slab-waveguide leakage-radiation sink that precisely control the required non-Hermitian Hamiltonian experienced by the photonic modes. The fabricated devices generate time-asymmetric light transmission over an extremely broad spectral band covering the entire optical telecommunications window (wavelengths between 1.26 and 1.675 micrometres). Thus, we take a step towards broadband on-chip optical devices based on non-Hermitian topological dynamics by using a semiconductor platform with controllable optoelectronic properties, and towards several potential practical applications, such as on-chip optical isolators and non-reciprocal mode converters. Our results further suggest the technological relevance of non-Hermitian wave dynamics in various other branches of physics, such as acoustics, condensed-matter physics and quantum mechanics.

Past, current, and future of holographic video display [Invited].

Holography has been considered as the ultimate technology for three-dimensional visual experience. Compared to the well-established static holographic technology, holographic video display is still in the research and development stage, before commercial products. This paper reviews various kinds of researches and related systems from the beginning of holographic video display to recent improvements, compares each specification, and describes their features. We discuss the key requirements for holographic display to be commercialized and widely used in everyday life.

Electrically Actuated Varifocal Lens Based on Liquid-Crystal-Embedded Dielectric Metasurfaces.

Compact varifocal lenses are essential to various imaging and vision technologies. However, existing varifocal elements typically rely on mechanically actuated systems with limited tuning speeds and scalability. Here, an ultrathin electrically controlled varifocal lens based on a liquid crystal (LC) encapsulated dielectric metasurface is demonstrated. Enabled by the field-dependent LC anisotropy, applying a voltage bias across the LC cell modifies the local phase response of the silicon meta-atoms, in turn modifying the metalens focal length. In a numerical implementation, a voltage-actuated metalens with continuous zoom and up to 20% total focal shift is demonstrated. The LC-based metalens concept is experimentally verified through the design and fabrication of a bifocal metalens that facilitates high-contrast switching between two discrete focal lengths upon application of a 9.8 Vpp voltage bias. Owing to their ultrathin thickness and adaptable design, LC-driven dielectric metasurfaces open new opportunities for compact varifocal lensing in a diversity of modern imaging applications.

Large-area liquid crystal beam deflector with wide steering angle.

A slim beam deflector that satisfies both a large steering angle and a large area can be very useful in various applications. However, a smaller electrode pitch for a large steering angle and enlargement of its area are trade-off relations due to the limited number of control channels in an electrically tunable beam deflector system. For a large steering angle in the active area where actual diffraction occurs, an indium tin oxide electrode of 2 µm pitch was implemented through a stepper lithography. The via-hole process was developed to expand the reduced active area due to the small electrode pitch. We developed a beam deflector with 7200 controllable channels in an active area of 14.4mm×14.4mm. The maximum steering angle is 7.643° at a wavelength of 532 nm.

Dual-focal waveguide see-through near-eye display with polarization-dependent lenses.

A waveguide near-eye display (NED) with a dual-focal plane using a polarization-dependent lens device is proposed. The novel optical device is composed of a geometric phase holographic lens, a wave plate, and a circular polarizer, which is operating as a concave lens or a see-through optical window, depending on the polarization state of the input beam. Such property and ultra-thinness of about 1.5 mm can be applied to a combiner-eyepiece lens for augmented reality. This optical device attached to the waveguide provides two depth planes with polarization multiplexing. We have demonstrated that our proof-of-concept system has image planes at infinity and 20 diopters. The devised system can be expected to offer a better immersive experience, compared to a NED system with a single-focal plane.

Hypoxia promotes acquisition of aggressive phenotypes in human malignant mesothelioma.

BACKGROUND: Hypoxia is a hallmark of the solid tumor microenvironment and is associated with poor outcomes in cancer patients. The present study was performed to investigate mechanisms underlying the hypoxia-induced phenotypic changes using human malignant mesothelioma (HMM) cells. METHODS: Hypoxic conditions were achieved by incubating HMM cells in the air chamber. The effect of hypoxia on phenotype changes in HMM cells was investigated by performing in vitro clonogenicity, drug resistance, migration, and invasion assays. Signaling pathways and molecules involved in the more aggressive behaviors of HMM cells under hypoxia were investigated. A two-tailed unpaired Student's t-test or one-way ANOVA with Bonferroni post-test correction was used in this study. RESULTS: Hypoxic conditions upregulated hypoxia-inducible factor 1 alpha (HIF-1α) and HIF-2α in parallel with the upregulation of its target, Glut-1, in HMM cells. In vitro clonogenicity of HMM cells was significantly increased in hypoxic conditions, but the proliferation of cells at a high density in hypoxia was lower than that in normoxic conditions. The expression levels of HIF-2α and Oct4 were increased in hypoxic HMM cells. The percentage of cells with high CD44 expression was significantly higher in HMM cells cultured in hypoxia than those cultured in normoxia. Hypoxia significantly enhanced the resistance of HMM cells to cisplatin, which occurred through cytoprotection against cisplatin-induced apoptosis. While cisplatin treatment decreased the ratio of Bcl-2 to Bax in normoxic condition, hypoxia conversely increased the ratio in HMM cells treated with cisplatin. Hypoxia increased the mobility and invasiveness of HMM cells. Epithelial to mesenchymal transition was promoted, which was indicated by the repression of E-cadherin and the concomitant increase of vimentin in HMM cells. CONCLUSIONS: The data illustrated that hypoxic conditions augmented the aggressive phenotypes of HMM cells at the biological and molecular levels. The present study provides valuable background information beginning to understand aggressiveness of HMM in tumor microenvironments, suggesting that a control measure for tumor hypoxia may be an effective therapeutic strategy to reduce the aggressiveness of cancer cells in HMM patients.

Electrically tunable transmission-type beam deflector using liquid crystal with high angular resolution.

Highly efficient transmission-type beam deflectors that have high angular resolution have been widely used for various applications. Continuously tunable beam deflectors have also been needed for many purposes. An indium-tin-oxide (ITO), widely used for transparent electrodes, was placed on the upper and lower glass substrate. The ITO layer on the lower substrate was patterned by the contact mask aligner for relatively wide input and output pad compared to main grating ITO patterns in the active area. These input and output pads on the lower substrate are connected to each driving integrated circuit (IC), which has 360 channels for continuous control. A small pixel pitch of grating patterns of 6 µm (the electrode width is 3 µm with a 3 µm spacing) was developed, and the maximum diffraction angle is calculated and measured at 2.541° with a wavelength of 532 nm. A minimal cell gap of 2.5 µm was applied for the full 2π phase modulation by using a high-birefringence liquid crystal. A driving module for continuous beam steering is also developed and applied to the beam deflector system. A diffraction efficiency of about 50.9% is observed at an angle of diffraction about 2.541°.

Coherent anti-Stokes Raman scattering under frequency comb excitation.

We study the efficiency of coherent anti-Stokes Raman scattering (CARS) under frequency comb excitation. We calculate the power density of the anti-Stokes signal for two major cases: (1) molecular excitation by frequency comb and cw probe and, (2) both excitation and probing by frequency combs. In the first case, average CARS power varies as an inverse third degree of frequency combs free spectral range (FSR-3); in the second case, it varies as FSR-5. These results were applied to the CARS on blood glucose under frequency comb excitation. It was found that the resulting glucose CARS signal could approach nanowatt (nW) level at FSR=10 GHz.

Visible Wavelength Color Filters Using Dielectric Subwavelength Gratings for Backside-Illuminated CMOS Image Sensor Technologies.

We report transmissive color filters based on subwavelength dielectric gratings that can replace conventional dye-based color filters used in backside-illuminated CMOS image sensor (BSI CIS) technologies. The filters are patterned in an 80 nm-thick poly silicon film on a 115 nm-thick SiO2 spacer layer. They are optimized for operating at the primary RGB colors, exhibit peak transmittance of 60-80%, and have an almost insensitive response over a ± 20° angular range. This technology enables shrinking of the pixel sizes down to near a micrometer.

Slim coherent backlight unit for holographic display using full color holographic optical elements.

The coherent backlight unit (BLU) using a holographic optical element (HOE) for full-color flat-panel holographic display is proposed. The HOE BLU consists of two reflection type HOEs that change the optical beam path and shape by diffraction. The illumination area of backlight is 150 mm x 90 mm and the thickness is 10 mm, which is slim compared to other conventional coherent backlight units for holographic display systems. This backlight unit exhibits a total efficiency of 8.0% at red (660 nm), 7.7% at green (532 nm), and 3.2% at blue (460 nm) using optimized recording conditions for each wavelength. As a result, we could get a bright full color hologram image.

Surgical versus nonsurgical treatment of lumbar degenerative kyphosis.

PURPOSE: Surgery is widely performed for lumbar degenerative kyphosis (LDK), but its effectiveness as compared with nonsurgical treatment has not been demonstrated. METHODS: In this prospective study, surgical candidates with LDK were enrolled at three spine centres. Two treatment options were performed either surgery using a pedicle subtraction osteotomy or nonsurgical care. Outcomes were measured using a Visual analogue scale (VAS) of back pain as a primary endpoint, the Oswestry disability index (ODI), the 36-item short-form health survey (SF-36), sagittal vertical axis (SVA) and treatment-related complications. RESULTS: Of the 126 LDK patients treated during the reference period, 97 patients were enrolled (47 in the surgical group and 50 in the nonsurgical group). Surgical group produced statistically reduced VAS of back pain and better functional outcomes than nonsurgical group since 12 months after treatment, but the rate of serious complications was higher after surgery. Interestingly, both surgical and nonsurgical groups had improved outcomes in terms of pain intensity and function at the 2-year follow-up period. CONCLUSIONS: Surgery might be a preferred treatment option for LDK, but great caution is needed. And conservative treatment could be the considerable treatment option for LDK who is unwilling or has poor medical condition to operate.

Microstructural and optical properties of CdSe/CdS/ZnS core-shell-shell quantum dots.

CdSe/CdS/ZnS core-shell-shell quantum dots (QDs) were synthesized by using a solution process. High-resolution transmission electron microscopy images and energy dispersive spectroscopy profiles confirmed that stoichiometric CdSe/CdS/ZnS core-shell-shell QDs were formed. Ultraviolet-visible absorption and photoluminescence (PL) spectra of CdSe/CdS/ZnS core-shell-shell QDs showed the dominant excitonic transitions from the ground electronic subband to the ground hole subband (1S(e)-1S(3/2)(h)). The PL mechanism is suggested; the carriers generated by the exciting high-energy photons in the shell region are relaxed to the band-edge states of the core region and recombined to emit lower-energy photons. The activation energy of the carriers confined in the CdSe/CdS/ZnS core-shell-shell QDs, as obtained from temperature-dependent PL spectra, was 200 meV. The quantum efficiency of the CdSe/CdS/ZnS core-shell-shell QDs at 300 K was estimated to be approximately 57%.

Predictors of Motor Weakness and Delayed Recovery in Cervical Disk Herniation.

STUDY DESIGN: Retrospective study. OBJECTIVE: To identify the significant risk factors for motor weakness caused by cervical disk herniation and for delayed recovery after surgery. SUMMARY OF BACKGROUND DATA: There were a few clinical trials for detecting the significant risk factors for motor weakness after anterior cervical surgery. MATERIALS AND METHODS: We retrospectively examined 72 patients with degenerative disk disease of the cervical spine who were treated with single-level anterior cervical discectomy and fusion. The possible risk factors, including age, sex, symptom duration, operation time, surgery level, preoperative radiologic parameters, and preoperative Neck Disability Index score, were evaluated using multivariate logistic regression analysis. RESULTS: The patients included 22 women and 50 men; average age, 47.1±7.8 years. Of these 72 patients, 38 (52.8%) patients had motor deficit before surgery. Complete recovery of motor deficit was seen in 33 (86.8%) patients, and the average duration from surgery to complete recovery was 4.2 months. Multivariate logistic regression analysis showed that disk height (P=0.001, odds ratio=0.32), percentage of herniated nucleus pulposus (HNP) in the spinal canal (P=0.0012, odds ratio=1.24), and presence of signal intensity change in the spinal cord (P=0.0015, odds ratio=35.57) were important risk factors for motor weakness. When the cut-off value of disk height was 5.8 mm, the sensitivity and specificity were 39.5% and 94.1%, respectively. When the cut-off value of HNP in the spinal canal was 28.1%, the sensitivity and specificity were 57.9% and 82.4%, respectively. Furthermore, signal intensity change was identified as an important risk factor for delayed recovery. CONCLUSIONS: Decreased disk height, percentage of HNP in the spinal canal, or presence of signal intensity change in the spinal cord seem to be the important risk factors for motor weakness in patients with cervical disk herniation. Moreover, the presence of signal intensity change in the spinal cord seems to be an important risk factor for delayed recovery.

Carrier transfer and thermal escape in CdTe/ZnTe quantum dots.

We report on the carrier transfer and thermal escape in CdTe/ZnTe quantum dots (QDs) grown on a GaAs substrate. The significant emission-energy-dependent decay time at high excitation intensity (35 W/cm2) is attributed to the lateral transfer of carriers in the QDs. At low temperature (< 35 K) and low emission energy (< 2.168 eV), a thermally activated transition occurs between two different states separated by approximately 9 meV, while the main contribution to nonradiative processes is the thermal escape from QDs that is assisted by carrier scattering via the emission of longitudinal phonons through the excited QD states at high temperature, with energies of approximately 19 meV.

Modulation efficiency of double-phase hologram complex light modulation macro-pixels.

The modulation efficiency of the double-phase hologram macro-pixel that is designed for complex modulation of light waves is defined and analyzed. The scale-down of the double-phase hologram macro-pixel associated with the construction of complex spatial light modulators is discussed.

Usefulness of the introducer method for percutaneous endoscopic gastrostomy using ultrathin transnasal endoscopy.

BACKGROUND: The introducer method of percutaneous endoscopic gastrostomy (PEG) minimizes procedure-related peristomal infection. Ultrathin transnasal endoscopy (UTE) allows comfortable endoscopic examination of patients with fewer adverse effects and passage of the endoscope through a narrow esophagus or oropharynx. This study aimed to investigate the clinical outcomes for the introducer method of PEG with UTE. METHODS: Patients who underwent the introducer method of PEG with UTE between March 2009 and May 2012 were analyzed. The outcomes and complications of the patients within 180 days after gastrostomy placement were investigated. RESULT: During the study period, 92 patients (31.9 % male; age, 67.7 ± 16.6 years) underwent the introducer method of PEG with UTE. The major indications for PEG insertion were stroke (40.4 %), esophageal cancer or head and neck cancer (27.1 %), and neurologic disorder (14.9 %). Esophageal stenosis was identified by endoscopy or imaging in 14 patients before PEG. In all the patients, UTE was successfully introduced through the nasal cavity. In 90 (97.8 %) of the 92 patients, PEG was successfully inserted. Insertion of the endoscope into the stomach was impossible in two patients because head and neck cancer caused severe narrowing of the upper esophagus. No procedure-related peristomal infection, gastric contents leakage, or bleeding occurred within 30 days after gastrostomy placement. In eight patients (8.7 %), catheter displacement occurred within 30 days. Catheter displacement in 44 patients (47.8 %) and gastric contents leakage in eight patients (9 %) occurred within 30-180 days after gastrostomy placement. CONCLUSION: Introducer PEG with UTE is a useful method for gastrostomy placement with a high success rate. This technique allows procedure-related complications to be avoided and permits the use of endoscopy in patients with narrow esophagi or oropharynges. However, the long-term durability of the balloon-type catheter is questionable.

Can unilateral-approach minimally invasive transforaminal lumbar interbody fusion attain indirect contralateral decompression? A preliminary report of 66 MRI analysis.

PURPOSE: Few studies have measured the amount of indirect decompression at the contralateral neural foramen after unilateral-approach minimally invasive transforaminal lumbar interbody fusion (MITLIF). This study examined the amount of intraoperative indirect decompression at the contralateral neural foramen after a unilateral-approach MITLIF in patients with bilateral foraminal stenosis. METHODS: From February 2009 to October 2012, 66 consecutive patients with bilateral foraminal stenosis underwent unilateral-approach MITLIF and postoperative magnetic resonance imaging (MRI). Direct decompression was performed at the central canal and approach-side neural foramen, while indirect decompression using cage distraction was pursued at the contralateral neural foramen. Qualitative parameters of the central canal (dural sac morphology) and neural foramen (foramen morphology) were analyzed using pre- and post-operative MRI. Quantitative measurement on the central canal (dural sac cross-sectional area) and neural foramen (foramen height and width) were also measured. RESULTS: A total of 69 intervertebral levels in the 66 patients were analyzed. Qualitative parameters of the central canal and contralateral neural foramen improved significantly after unilateral-approach MITLIF (both P < 0.001). The mean dural sac cross-sectional area increased from 51.1 ± 28.8 to 84.8 ± 30.2 mm(2) (P < 0.001). The mean preoperative contralateral foramen height, maximum foramen width, and minimum foramen width were 11.8 ± 2.0, 4.9 ± 1.5, and 1.5 ± 0.7 mm, respectively, and these values increased postoperatively to 14.7 ± 2.5, 6.5 ± 1.8, and 2.4 ± 1.0 mm, respectively (all P < 0.001). CONCLUSION: Quantitative and qualitative parameters of the central canal and contralateral neural foramen increased significantly after unilateral-approach MITLIF.

Heterointerface Effects on Carrier Dynamics in Colloidal Quantum Dots and Their Application to Light-Emitting Diodes.

Colloidal quantum dots (QDs) are promising candidates for next-generation display technology because of their unique optical properties and have already appeared in the market as a high-end product. On the basis of their extraordinary properties, QD emissions with a given chemical composition can be tailored in a wide spectral window due to quantum size effects, which constitutes a key advantage of QDs in the display field. Specifically, investigations of structure-dependent and composition-dependent characterizations outside the quantum confinement effect have become an important part of practical applications. Therefore, from the perspective of designing nanostructures with well-defined heterointerfaces, strong quantum confinement effects with effective carrier confinement are desirable. Our results show that the photoluminescence (PL) intensity of CdSe/CdZnS core-shell QDs was enhanced 5.7 times compared with that of the CdSe core QDs. Supplementary analytical techniques involving transmission electron microscopy revealed the heterointerface configuration and composition distribution of the core and shell materials. The effects of the heterointerface on carrier dynamics in core-shell QDs were revealed by monitoring wavelength-dependent time-resolved PL. To further develop the QD light-emitting diodes (QD-LEDs), we produced an all-solution processed inverted QD-LEDs using CdSe/CdZnS core-shell QDs as the emitter. The electroluminescence spectrum of deep-red emissive QD-LEDs with CIE chromaticity coordinates of (0.68, 0.32) exhibited a peak at 638 nm.