Sex-dependent different clinicopathological characterization of Epstein-Barr virus-associated gastric carcinoma: a large-scale study.

BACKGROUND: Epstein-Barr virus (EBV)-associated gastric cancer (EBVaGC) has been reported to account for approximately 5-16% of all GCs with good prognosis compared to EBV-negative GC. We evaluated the clinicopathological characteristics of EBVaGC including survival rate in South Korea. METHODS: A total of 4,587 patients with GC who underwent EBV in situ hybridization (EBV-ISH) were prospectively enrolled at the Seoul National University Bundang Hospital from 2003 to 2021. Age, sex, smoking status, cancer type and stage, tumor size and location, histological type, molecular features and survival information were analyzed. RESULTS: A total of 456 patients with GC (9.9%) were positive for EBV. The EBVaGC group displayed a higher proportion of males (P < 0.001), a predominant presence in the proximal stomach (P < 0.001), a higher proportion of undifferentiated cancer (P < 0.001), and a lower cancer stage (P = 0.004) than the EBV-negative group. Cox multivariate analyses revealed age (hazard ratio [HR] = 1.025, P < 0.001), tumor size (HR = 1.109, P < 0.001), and cancer stage (stage2 HR = 4.761, P < 0.001; stage3 HR = 13.286, P < 0.001; stage4 HR = 42.528, P < 0.001) as significant risk factors for GC-specific mortality, whereas EBV positivity was inversely correlated (HR = 0.620, P = 0.022). Furthermore, the EBVaGC group displayed statistically significant survival advantages over the EBV-negative cancer group in terms of both overall (P = 0.021) and GC-specific survival (P = 0.007) on the Kaplan-Meier survival curve. However, this effect was evident only in males. CONCLUSIONS: EBVaGC patients showed better prognoses despite their association with proximal location and poorly differentiated histology in male, probably due to the difference in immunity between males and females.

Evaluation of R-FIND SARS-CoV-2 Neutralizing Antibody ELISA and FREND COVID-19 SP Rapid Fluorescence Immunoassay.

BACKGROUND: Serology testing is useful to determine the past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We evaluated the comparative performance of a newly developed neutralizing antibody test (R-FIND SARS-CoV-2 Neutralizing Antibody ELISA, SG Medical, Seoul, Korea) and a rapid fluorescence immunoassay (FREND™ COVID-19 SP, NanoEntek, Hwaseong, Korea) for the detection of SARS-CoV-2 spike protein antibody. They were compared with cPass™ SARS-CoV-2 Neutralization Antibody Detection Kit (Genscript Biotech, Piscataway, NJ, USA) and ADVIA Centaur SARS-CoV-2 Total (COV2T) (Siemens Healthineers, Erlangen, Germany). Forty COVID-19 samples and 80 negative samples were collected after nucleic acid tests. RESULTS: The positive percent agreement (%) of the kit in samples from 6 - 7 days, 8 - 14 days, and 15 - 45 days after symptom onset were as follows: R-FIND (83.3, 76.9, 95.2), cPass (83.3, 69.2, 90.5), FREND (66.6, 84.6, 100), and COV2T (66.6, 69.2, 76.2). The negative percent agreement (%) was 100, 97.5, 92.5, and 100 for R-FIND, cPass, FREND, and COV2T. The total agreement rate between the neutralizing antibody kits (R-FIND and cPass) was 96.7%. FREND showed high agreement with two neutralizing antibody kits (96.7% for R-FIND and 93.3% for cPass). CONCLUSIONS: R-FIND Neutralizing Antibody and FREND COVID-19 SP showed comparable detecting ability to commercial tests.

Multisystem Inflammatory Syndrome in an Adult Following COVID-19 mRNA Vaccination: Successful Treatment With Medium-Dose Steroids and Colchicine.

Multisystem inflammatory syndrome in children and adults (MIS-C/A) was rarely reported as a complication of coronavirus disease 2019 (COVID-19) and potential adverse events following COVID-19 vaccination. Recently, the case definition of MIS-C/A was developed by the Brighton Collaboration Network. However, only a limited number of adult patients with MIS-A following immunization have been reported, and there is still little evidence for adequate treatment. A 57-year-old man presented with fever, headache, vomiting, and hypotension 24 days after receiving the second COVID-19 vaccination with the Pfizer-BioNTech vaccine. According to the Brighton Collaboration Case Definition, the patient met a definitive case of MIS-A after vaccination (level 1 of diagnostic certainty). After administration of medium-dose prednisolone (20 mg/d) with colchicine (1.2 mg/d), all symptoms and signs improved rapidly. The dose of prednisolone was gradually tapered from the third week, and the patient confirmed a full recovery without medication after 8 weeks. This is the first report showing that low-dose steroids in combination with colchicine may be an effective treatment option for MIS-A after vaccination.

The Validity of Wireless Earbud-Type Wearable Sensors for Head Angle Estimation and the Relationships of Head with Trunk, Pelvis, Hip, and Knee during Workouts.

The present study was performed to investigate the validity of a wireless earbud-type inertial measurement unit (Ear-IMU) sensor used to estimate head angle during four workouts. In addition, relationships between head angle obtained from the Ear-IMU sensor and the angles of other joints determined with a 3D motion analysis system were investigated. The study population consisted of 20 active volunteers. The Ear-IMU sensor measured the head angle, while a 3D motion analysis system simultaneously measured the angles of the head, trunk, pelvis, hips, and knees during workouts. Comparison with the head angle measured using the 3D motion analysis system indicated that the validity of the Ear-IMU sensor was very strong or moderate in the sagittal and frontal planes. In addition, the trunk angle in the frontal plane showed a fair correlation with the head angle determined with the Ear-IMU sensor during a single-leg squat, reverse lunge, and standing hip abduction; the correlation was poor in the sagittal plane. Our results indicated that the Ear-IMU sensor can be used to directly estimate head motion and indirectly estimate trunk motion.

A novel physical unclonable function (PUF) using 16 × 16 pure-HfOxferroelectric tunnel junction array for security applications.

As the computing paradigm has shifted toward edge computing, improving the security of edge devices is attracting significant attention. However, because edge devices have limited resources in terms of power and area, it is difficult to apply a conventional cryptography system to protect them. On the other hand, as a simple security application, a physical unclonable function (PUF) can be implemented without power and area problems because it provides a security key by utilizing process variations without additional external circuits. Ferroelectric tunnel junctions (FTJs) are 2-terminal devices that store information by changing the resistance of a ferroelectric material, where the resistance is determined by the polarization states of the ferroelectric domains. Because polycrystalline ferroelectric materials have a multi-domain nature, domain variation can also be used as a randomness source to induce cell-to-cell variations along with process variations. In this paper, we demonstrate PUF operations of a low-power, small area 16 × 16 hafnium oxide (pure-HfOx)-based FTJ array using certain metrics. It is clear that the proposed array consisting of scaled FTJs has adequate randomness for security applications such that the array-level PUF operations are robust against model-based machine learning attacks.

Fungal arthritis with adjacent osteomyelitis caused by Candida pelliculosa: a case report.

BACKGROUND: Candida sp. osteoarticular infection is rare and most often due to hematogenous seeding during an episode of candidemia in immunocompromised patients. However, the diagnosis can be delayed in patients with subtle symptoms and signs of joint infection without a concurrent episode of candidemia. CASE PRESENTATION: A 75-year-old woman presented with a three-year history of pain and swelling of the left knee. Candida pelliculosa was detected from the intraoperative tissue when the patient had undergone left total knee arthroplasty 32 months ago, but no antifungal treatment was performed. One year after the total knee arthroplasty, C. pelliculosa was repeatedly isolated from the left knee synovial fluid and antifungal treatment comprising amphotericin B deoxycholate and fluconazole was administered. However, joint infection had extended to the adjacent bone and led to progressive joint destruction. The patient underwent surgery for prosthesis removal and received prolonged antifungal treatment with micafungin and fluconazole. CONCLUSIONS: This case shows that C. pelliculosa, an extremely rare non-Candida albicans sp., can cause fungal arthritis and lead to irreversible joint destruction owing to delayed diagnosis and treatment.

Classification-Specific Treatment Improves Pain, Disability, Fear-Avoidance Beliefs, and Erector Spinae Muscle Activity During Walking in Patients With Low Back Pain Exhibiting Lumbar Extension-Rotation Pattern: A Randomized Controlled Trial.

OBJECTIVE: Low back pain (LBP) has commonly been managed via classification-specific interventions in homogeneous groups. However, it is largely unknown whether treatment tailored to specific classifications is more effective than generic treatment. The purpose of this study was to evaluate the effects of classification-specific treatment on the self-reported responses and erector spinae (ES) activity of patients with LBP exhibiting a lumbar extension-rotation (ExtRot) pattern. METHODS: In total, 39 patients exhibiting the lumbar ExtRot pattern were randomized to an experimental (n = 19) group and a control (n = 20) group. Participants in the experimental group received classification-specific treatment, which included exercise to control or prevent lumbopelvic motion during lower-extremity movement. Participants in the control group were encouraged to perform general exercises and were educated about LBP. Patient-reported pain intensity, disability, and fear-avoidance belief and ES muscle activity during walking were assessed prior to and after the intervention. Two-way analysis of covariance was used to examine the effects of classification-specific treatment. RESULTS: After 6-week intervention, significant time-by-group interaction effects were demonstrated on pain intensity, disability, fear-avoidance beliefs-physical activity score, and ES muscle activity during walking. There were significant effects of group on pain, disability, and fear-avoidance beliefs-physical activity score after intervention. After the 6-week intervention, the ES muscle activity significantly decreased in the experimental group during walking, but does not represent an all-events decrease. CONCLUSION: Classification-specific treatment may be effective in patients with LBP exhibiting the lumbar ExtRot pattern, reducing pain intensity, disability, fear-avoidance beliefs, and ES muscle activity during walking.

The use of motivational interviewing during an interdisciplinary Service-Learning activity for older adults at risk for dementia.

This study aimed to develop a service-learning program based on motivational interviewing for older adults living alone and at risk for dementia. This paper focused on description and implementation of the developed program and students' preliminary outcomes as a mixed-methods pilot study. Participants were nine students in occupational therapy, physical therapy, and social work and three older adults matched to each of the three interdisciplinary student groups. Students' attitudes about community service improved. Also, participation in the program was regarded as a new useful experience that helped in realizing the importance of interprofessional collaboration, expanding knowledge about other disciplines, contributing to the community and professional development, and understanding older adults living alone. Future study should include a larger sample size and measure the program's effectiveness for both the students and older adults.

Effects of Posterior X Taping on Movement Quality and Knee Pain Intensity during Forward-Step-Down in Patients with Patellofemoral Pain Syndrome.

Excessive tibiofemoral rotation in weight-bearing position may be associated with patellofemoral pain syndrome (PFPS). A previous literature suggested that "posterior X taping" method is effective for correcting the reduction of hip adduction and tibiofemoral rotation in weight bearing position. The purpose of this study was to determine the effects of posterior X taping on the angles of hip adduction, tibiofemoral rotation, grades of the forward-step-down (FSD) performance test, and intensity of knee pain when descending stair in patients with PFPS. We recruited patients with PFPS. The knee pain intensity during FSD was measured using visual analogue scale system (100 mm) under both no-tape and tape conditions. A three-dimensional motion analysis system was used to assess the kinematics of lower limb joints during FSD. In addition, scoring system of FSD performance test was used to assess the movement deviation of the trunk and lower limb and one-leg balance. Participants with PFPS showed reduced pain intensity (p = 0.001) and improved scores on FSD performance test (p = 0.002) with posterior X taping compared to the no-tape condition during FSD. No significant alterations changes were noted in three dimensional angles of the hip, knee and ankle joints, especially hip adduction and tibiofemoral rotation between conditions. Posterior X taping decreases knee pain and improves the scores on FSD performance test for patients with PFPS.

Epidemiology and Antifungal Susceptibility Profile of Aspergillus Species: Comparison between Environmental and Clinical Isolates from Patients with Hematologic Malignancies.

Global data on the epidemiology and susceptibility of Aspergillus are crucial in the management of invasive aspergillosis. Here, we aimed to determine the characteristics of clinical and environmental Aspergillus isolates, focusing mainly on hematologic malignancy patients. We prospectively collected all consecutive cases and clinical isolates of culture-positive proven/probable invasive aspergillosis patients from January 2016 to April 2018 and sampled the air inside and outside the hospital. Cryptic species-level identification of Aspergillus, antifungal susceptibilities, and cyp51 gene sequencing were performed, and clinical data were analyzed. This study was conducted as part of the Catholic Hematology Hospital Fungi Epidemiology (CAFÉ) study. A total of 207 proven/probable invasive aspergillosis and 102 clinical and 129 environmental Aspergillus isolates were included in this analysis. The incidence of proven/probable invasive aspergillosis was 1.3 cases/1,000 patient-days during the study period. Cryptic Aspergillus species accounted for 33.8%, with no differences in proportions between the clinical and environmental isolates. Section Nigri presented a high proportion (70.5%) of cryptic species, mainly from A. tubingensis and A. awamori: the former being dominant in environmental samples, and the latter being more common in clinical isolates (P < 0.001). Of 91 A. fumigatus isolates, azole-resistant A. fumigatus was found in 5.3% of all A. fumigatus isolates. Three isolates presented the TR34/L98H mutation of the cyp51A gene. Patients with invasive aspergillosis caused by azole-resistant A. fumigatus showed 100% all-cause mortality at 100 days. This study demonstrates the significant portion of cryptic Aspergillus species and clinical implications of azole resistance and underscores the comparison between clinical and environmental isolates.

Nonvolatile Memory (NVM) Operation of Tunnel Field-Effect Transistor (TFET) Using Ferroelectric HfO2 Sidewall.

In this paper, we propose a new type of nonvolatile memory (NVM) device based on a tunnel field-effect transistor (TFETs) with Ferroelectric HfO2 sidewall. By simply utilizing the ferroelectricity of orthorhombic HfO2 and conventional sidewall spacer technique, TFET can operate as a NVM device. The polarized charges in the ferroelectric HfO2 spacer induced by program/erase pulse modulate the tunneling barrier between the source and channel; thus, change the threshold voltage (Vt) of TFET. The proposed NVM TFET has lower subthreshold swing (SS) and higher on/off ratio than conventional NVM TFETs while maintaining equivalent program/erase efficiency. Further-more, we also investigate the optimal HfO2 sidewall formation conditions to achieve higher NVM performances.

Tunnel Field Effect Transistor with Ferroelectric Gate Insulator.

Ferroelectric tunnel field effect transistor (Fe-TFET) having improved DC performance in comparison to the conventional TFET (c-TFET) is proposed and investigated through the technology computer-aided design (TCAD) simulation. By inserting ferroelectric material into the gate insulator of TFET, enhanced on-current (Ion) is obtained. It is attributed to the polarization characteristic of the ferroelectric materials which brings the capacitance boosting effect. Through the TCAD simulation, the characteristics of the ferroelectric material for the optimal performance conditions are also studied.

Partial Contact Etching and Gate Lowering on Tunneling Field Effect Transistor for Performance and Power Enhancement.

In this paper, it is shown that MOL capacitance reduction is one of the major performance boosting knobs for the tunneling field effect transistor (TFET) used for logic application. Low driving current is the weakness of TFET in terms of switching speed, however it can gain advantage fully from reducing MOL capacitance owing to negligible impact of MOL resistance degradation. We have proposed partial contact etching and gate height lowering to reduce MOL capacitance. As a result, 7.3% of delay improvement and 9.0% of reduced energy consumption is achieved with optimized MOL structure.

Stability Control and Turning Algorithm of an Alpine Skiing Robot.

This paper proposes a general stability control method that uses the concept of zero-moment-point (ZMP) and a turning algorithm with a light detection and ranging (LiDAR) sensor for a bipedal alpine skiing robot. There is no elaborate simulator for skiing robots since the snow has complicated characteristics, such as compression and melting. However, real experiments are laborious because of the many varied skiing conditions. The proposed skiing simulator could be used, so that a humanoid robot can track its desired turning radius by modeled forces that are similar to real ones in the snow. Subsequently, the robot will be able to pass through gates with LiDAR sensors. By using ZMP control, the robot can avoid falling down while tracking its desired path. The performance of the proposed stabilization method and autonomous turning algorithm are verified by a dynamics simulation software, Webots, and the simulation results are obtained while using the small humanoid robot platform DARwIn-OP.

Risk factors and clinical outcomes of breakthrough yeast bloodstream infections in patients with hematological malignancies in the era of newer antifungal agents.

Although yeast bloodstream infections (BSIs) are increasingly being reported in patients with hematological malignancies undergoing antifungal therapy, clinical information regarding breakthrough infections is scarce. The aim of this study was to determine the risk factors for and clinical outcomes of breakthrough yeast BSIs in patients with hematological malignancies in the era of newer antifungal agents. Between 2011 and 2014, all consecutive patients with hematological malignancies who developed yeast BSIs were included in a case-control study wherein breakthrough infections (cases) and de novo infections (controls) were compared. Of 49 patients with yeast BSIs, 21 (43%) met the criteria for breakthrough infections. The proportions of Candida krusei and Candida tropicalis in the cases and controls were significantly different (32% [7/22] vs. 3% [1/29], P = .015; 5% [1/22] vs. 38% [11/29], P = .007, respectively). Acute leukemia, presence of a central venous catheter and neutropenia in the 3 days prior to BSI were significant risk factors for breakthrough infections. Six-week mortality rates was 33% [7/21] in the cases and 43% [12/28] in the controls (P = .564). Refractory neutropenia and the Pitt bacteremia score were independent predictors of 6-week mortality. In conclusion, breakthrough infections accounted for a significant proportion of yeast BSIs in patients with hematological malignancies. However, these infections did not increase the risk of death by themselves. Our results suggest that current clinical management of breakthrough yeast BSIs, which includes switching to a different antifungal class and prompt catheter removal is reasonable.

A 1T Dynamic Random Access Memory Cell Based on Gated Thyristor with Surrounding Gate Structure for High Scalability.

In this study, we investigate a one-transistor (1T) dynamic random access memory (DRAM) cell based on a gated-thyristor device utilizing voltage-driven bistability to enable high-speed operations. The structural feature of the surrounding gate using a sidewall provides high scalability with regard to constructing an array architecture of the proposed devices. In addition, the operation mechanism, I-V characteristics, DRAM operations, and bias dependence are analyzed using a commercial device simulator. Unlike conventional 1T DRAM cells utilizing the floating body effect, excess carriers which are required to be stored to make two different states are not generated but injected from the n+ cathode region, giving the device high-speed operation capabilities. The findings here indicate that the proposed DRAM cell offers distinct advantages in terms of scalability and high-speed operations.

Volatile and Nonvolatile Characteristics of Asymmetric Dual-Gate Thyristor RAM with Vertical Structure.

In this paper, the volatile and nonvolatile characteristics of asymmetric dual-gate thyristor random access memory (TRAM) are investigated using the technology of a computer-aided design (TCAD) simulation. Owing to the use of two independent gates having different gate dielectric layers, volatile and nonvolatile memory functions can be realized in a single device. The first gate with a silicon oxide layer controls the one-transistor dynamic random access memory (1T-DRAM) characteristics of the device. From the simulation results, a rapid write speed (<8 ns) and a large on-off current ratio (>107) can be achieved. The second gate, whose dielectric material is composed of oxide/nitride/oxide (O/N/O) layers, is used to implement the nonvolatile property by trapping charges in the nitride layer. In addition, this offers an advantage when processing the 3D-stack memory application, as the device has a vertical channel structure with polycrystalline silicon.

Implementation of Hospital Policy for Healthcare Workers and Patients Exposed to Varicella-Zoster Virus.

Varicella-zoster virus (VZV) causes a highly contagious and generally benign, self-limited disease. However, in high-risk populations including immunocompromised patients, pregnant women, and neonates, VZV infection can be associated with significant morbidity and mortality. Healthcare-associated transmission of VZV occurs among healthcare workers (HCWs) and patients by airborne transmission or by direct contact with the index case. To minimize the risk of transmission in healthcare settings, all VZV-susceptible HCWs should be encouraged strongly to be immunized with the varicella vaccine. For post-exposure management, active immunization (varicella vaccine), passive immunization (varicella-zoster immune globulin) and/or antiviral agents, and isolation could be used in specific situations. To prevent the transmission of VZV infection in the hospital settings, the development and implementation of hospital policies for appropriate infection control is also warranted. This article reviews the general information and healthcare-associated transmission of VZV and summarizes the recommendations for the pre- and post-exposure management of HCWs and patients, in hospital settings.

Breakthrough invasive fungal diseases during voriconazole treatment for aspergillosis: A 5-year retrospective cohort study.

Breakthrough invasive fungal diseases (bIFDs) during voriconazole treatment are concerning, as they are associated with high rates of mortality and pathogen distribution. To evaluate the prevalence, incidence, patient characteristics, including IFD events, and overall mortality of bIFDs during voriconazole treatment for invasive aspergillosis (IA). We retrospectively analyzed the medical records of consecutive patients who had undergone voriconazole treatment for IA and who had bIFD events between January 2011 and December 2015. Eleven bIFD events occurred in 9 patients. The prevalence and incidence of bIFDs were 2.25% (9/368) and 0.22 cases per year, respectively. Overall mortality was 44.4% (4/9). The severity of the illness and persistence of immunodeficiency, mixed infection, and low concentration of the treatment drug at the site of infection were identified as possible causes of bIFDs. Seven of 11 events (63.6%) required continued voriconazole treatment with drug level monitoring. In 4 (36.3%) cases, the treatment was changed to liposomal amphotericin B. Two cases resulted in surgical resection (18.2%). Clinicians should be aware that bIFDs during voriconazole treatment for IA can occur, and active therapeutic approaches are required in these cases.

Effect of Humeral-Elevation Angle on Electromyographic Activity in the Serratus Anterior During the Push-Up-Plus Exercise.

CONTEXT: The push-up-plus (PP) exercise has been recommended for strengthening of the serratus anterior (SA). Previous studies have investigated the effect of different stability properties of the base of support to adjust the difficulty level of SA muscle-strengthening exercises in the PP position. However, the optimal humeral-elevation angle (HEA) for selective activation and maximum contraction of the SA during PP has not been investigated. OBJECTIVES: To assess the effects of HEA during PP on electromyographic (EMG) activity in the SA, upper trapezius (UT), and pectoralis major (PM) and on the UT:SA and PM:SA activity ratios. DESIGN: Comparative, repeated-measures design. SETTING: University research laboratory. PARTICIPANTS: 29 healthy men. MAIN OUTCOME MEASURES: The subjects performed PP at 3 different HEAs (60°, 90°, and 120°); EMG activity in the SA, UT, and PM was measured, and the UT:SA and PM:SA activity ratios were calculated. Differences in muscle activity and ratios between the 60°, 90°, and 120° HEAs were assessed using 1-way repeated-measures analysis of variance; the Bonferroni correction was applied. RESULTS: SA muscle activity was significantly increased, in order of magnitude, at the 120°, 90°, and 60° HEAs. UT:SA and PM:SA activity ratios were significantly greater during performance of the PP at an HEA of 60° than at HEAs of 120° and 90°. CONCLUSION: The results suggest that an HEA of 120° should be used during performance of the PP because it produces greater SA activation than HEAs of 60° and 90°.