Prescription patterns and effectiveness of medications for chronic obstructive pulmonary disease: A retrospective study of real-world settings.

This study aimed to define real-world prescription patterns in Korea and compare the effectiveness of chronic obstructive pulmonary disease (COPD) medications. We used national claims data provided by the Health Insurance Review and Assessment Service in Korea and examined patients who were first diagnosed with COPD and started treatment between May 1, 2017, and April 30, 2018, with no change in drug regimen. Among 30,784 patients with COPD, long-acting ß2 agonist (LABA) combined with long-acting muscarinic antagonist (LAMA) (32.7%), inhaled corticosteroid-LABA (ICS-LABA) (25.6%), LAMA (18.3%), ICS (5.8%), or LABA (4.6%) were prescribed as the first-choice inhalers. The use of LABA-LAMA (hazard ratio [HR], 0.248-0.584), LAMA (HR, 0.320-0.641), ICS-LABA (HR, 0.325-0.643), and xanthine (HR, 0.563-0.828) significantly reduced the total and severe exacerbation rates compared with no use of each medication. However, the use of ICS or LABA individually did not yield such effects. The continued use of LABA-LAMA, LAMA, and ICS-LABA showed a significant effect on exacerbation rate, whereas the long-term use of ICS, LABA, and xanthine did not. Moreover, some high doses of ICS-LABA did not show significant effects. This real-world study revealed that LAMA and/or LABA could be the first choice of therapy, as recommended by recent guidelines. However, ICS, xanthine, and high-dose ICS-LABA are still being prescribed frequently as first-line drugs in Korea.

A comparative study on modeling of the ferromagnetic and paramagnetic states of uranium hydride using a DFT+U method.

Uranium hydride is a promising material for stationary hydrogen storage in fusion reactors. In this work, various material properties of uranium hydride in both ferromagnetic (FM) and paramagnetic (PM) states are calculated to determine the optimal first-principles calculation method. For the treatment of strongly correlated f-electrons, the PBE functional with a Hubbard U parameter of 0.6 eV is selected as the optimal method and provides accurate formation energies and reasonable structural properties of the FM state. Using this method, we test four model spin configurations to approximately simulate the PM state: FM, antiferromagnetic (AFM), special quasi-random structure (SQS) and nonmagnetic (NM) configurations. The FM and AFM configurations provide formation energy and lattice constants comparable to those of the SQS configuration, which is used as the reference PM state. In addition, the experimental results on thermal expansion and the bulk modulus in the PM states are well reproduced with the FM, AFM and SQS configurations. These results demonstrate that PBE+U with FM, AFM and SQS configurations can approximately simulate the PM states, although there are some properties that can only be qualitatively reproduced by DFT calculations, such as the magnetic transition. This study enables the design of multiscale modeling for uranium hydride while maintaining simultaneous efficiency and accuracy.

Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon.

The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.

Harman Measurements for Thermoelectric Materials and Modules under Non-Adiabatic Conditions.

Accuracy of the Harman measurement largely depends on the heat transfer between the sample and its surroundings, so-called parasitic thermal effects (PTEs). Similar to the material evaluations, measuring thermoelectric modules (TEMs) is also affected by the PTEs especially when measuring under atmospheric condition. Here, we study the correction methods for the Harman measurements with systematically varied samples (both bulk materials and TEMs) at various conditions. Among several PTEs, the heat transfer via electric wires is critical. Thus, we estimate the thermal conductance of the electric wires, and correct the measured properties for a certain sample shape and measuring temperature. The PTEs are responsible for the underestimation of the TEM properties especially under atmospheric conditions (10-35%). This study will be useful to accurately characterize the thermoelectric properties of materials and modules.

Coherent scattering microscopy as an effective inspection tool for analyzing performance of phase shift mask.

The imaging performance of a half-tone phase shift mask (PSM) has been analyzed using coherent scattering microscopy (CSM), which allows analysis of the actinic characteristics of an extreme ultraviolet (EUV) mask such as its reflectivity, diffraction efficiency, and phase information. This paper presents the 1st experimental result showing the effect of 180° phase difference between the absorber and reflector in EUV mask. This reveals that a PSM offers a 46% improvement in 1st/0th diffraction efficiency and 14% improvement in image contrast when compared to a binary intensity mask (BIM). The horizontal-vertical critical dimension (H-V CD) bias is also reduced by 1.37 nm at 22 nm line and space (L/S) patterns. Since the performance of PSM can be evaluated without a wafer patterning process, CSM is expected to be a useful inspection tool for the development of novel EUV masks.

Effect of Repetitive Transcranial Magnetic Stimulation According to the Stimulation Site in Stroke Patients With Dysphagia.

OBJECTIVE: To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) according to the stimulation site in subacute stroke patients with dysphagia. METHODS: This study was designed as a matched comparative study. Twenty-four patients who had dysphagia after ischemic stroke were recruited, and they were divided into two groups after matching for age and stroke lesion. The patients in group A received rTMS over the brain cortex where motor evoked potential (MEP) was obtained from the suprahyoid muscle. Group B received rTMS over the brain cortex where MEP was obtained from the abductor pollicis brevis muscle. rTMS was performed at 110% of MEP threshold, 10 Hz frequency for 10 seconds, and then repeated every minute for 10 minutes. Dysphagia status was measured by the Functional Dysphagia Scale (FDS), the Penetration-Aspiration Scale (PAS), and the Dysphagia Outcome and Severity Scale (DOSS) using the results of a videofluoroscopic swallowing study. These evaluations were measured before, immediately, and 4 weeks after rTMS. RESULTS: Group A showed significant improvement compared to group B in the DOSS score immediately and 4 weeks after rTMS. There were no significant differences in the changes of FDS and PAS scores between groups A and B immediately and 4 weeks after rTMS. CONCLUSION: rTMS over a hot spot for the suprahyoid muscle caused more improvement in swallowing function when compared to that over the interconnected site.

Effect of Hypertonic Saline in Intra-Articular Hydraulic Distension for Adhesive Capsulitis.

BACKGROUND: Maintaining the integrity of the capsule along with infusing a sufficient amount of fluid is 1 of the therapeutic concepts in intra-articular hydraulic distension (IHD) for adhesive capsulitis. It has been known that hypertonic saline solution decreases tissue edema and increases the fluid volume within the epidural space, causing microdissection, in epidural adhesiolysis. OBJECTIVE: To investigate the effect of hypertonic saline solution in capsule-preserving intra-articular hydraulic distension (CPIHD) for adhesive capsulitis. DESIGN: Prospective randomized controlled trial. SETTING: University outpatient clinic of physical medicine and rehabilitation. PARTICIPANTS: A total of 64 patients who were diagnosed as adhesive capsulitis of shoulder were randomly assigned to 1 of 2 treatment groups. The hypertonic saline group was treated by CPIHD with hypertonic saline (3% NaCl), and the normal saline group with normal saline solution (0.9% NaCl). METHODS: Both groups were treated with CPIHD, a method that preserves the capsule with maximal distension without inducing capsule rupture. The volume of saline solution necessary to adequately distend the capsule was recorded. Injection materials contained 4 mL of 1% lidocaine, 1 mL of triamcinolone (10 mg), and saline solution (hypertonic or normal saline). The intra-articular injection was monitored with ultrasound to maximize the infused volume while preserving the capsule. MAIN OUTCOME MEASUREMENTS: The Shoulder Pain and Disability Index (SPADI) and shoulder passive range of motion (PROM) was measured before the procedure and 2 weeks after CPIHD. RESULTS: The mean CPIHD volume was 20.2 ± 5.2 mL for the hypertonic saline group and 19.5 ± 5.9 mL for the normal saline group. The hypertonic saline group showed statistically significant improvement in shoulder PROM and SPADI score compared with the normal saline group. Side effects such as soreness or complications related to injection were not reported. CONCLUSIONS: Our results suggest that CPIHD with hypertonic saline solution is more effective than that using normal saline solution in patients with adhesive capsulitis.

Evaluation of Metal Absorber Materials for Beyond Extreme Ultraviolet Lithography.

In addition to the development of extreme ultraviolet lithography (EUVL), studies on beyond extreme ultraviolet lithography (BEUVL), which uses radiation with a wavelength of 6.7 nm, are in progress for their application in high-volume manufacturing. The BEUV wavelength, which is much shorter than the EUV wavelength, improves the resolution of patterned features. However, suitable materials for the mask stack of BEUVL are still under development. In this study, the applicability of metallic materials, such as Ni, Co, Ir, W, and Ta, as the absorber in a binary-intensity BEUVL mask was evaluated. The mask-imaging properties were simulated by adopting a thickness that ensured a reflectivity of <1% for each material. Furthermore, we used a multilayered La/B mirror--which exhibited a high reflectivity at a wavelength of 6.7 nm--because BEUV light is absorbed by most materials, and therefore uses reflective optics as desired. The numerical aperture (NA), angle of incidence, and demagnification factor were 0.5 and 0.6, 6 degrees, and 8x, respectively. We confirmed that a line-and-space pattern with a half-pitch of 11 nm can be patterned with metallic absorbers by using a high NA.

Carbon contamination analysis and its effect on extreme ultra violet mask imaging performance using coherent scattering microscopy/in-situ accelerated contamination system.

The coherent scattering microscopy/in-situ accelerated contamination system (CSM/ICS) is a developmental metrology tool designed to analyze the impact of carbon contamination on the imaging performance. It was installed at 11B EUVL beam-line of the Pohang Accelerator Laboratory (PAL). Monochromatized 13.5 nm wavelength beam with Mo/Si multilayer mirrors and zirconium filters was used. The CSM/ICS is composed of the CSM for measuring imaging properties and the ICS for implementing acceleration of carbon contamination. The CSM has been proposed as an actinic inspection technique that records the coherent diffraction pattern from the EUV mask and reconstructs its aerial image using a phase retrieval algorithm. To improve the CSM measurement accuracy, optical and electrical noises of main chamber were minimized. The background noise level measured by CCD camera was approximately 8.5 counts (3 sigma) when the EUV beam was off. Actinic CD measurement repeatability was <1 A (3 sigma) at 17.5 nm line and space pattern. The influence of carbon contamination on the imaging properties can be analyzed by transferring EUV mask to CSM imaging center position after executing carbon contamination without a fine alignment system. We also installed photodiode and ellipsometry for in-situ reflectivity and thickness measurement. This paper describes optical design and system performance observed during the first phase of integration, including CSM imaging performance and carbon contamination analysis results.

Dose ascites mean more severe Crohn's disease?

BACKGROUND/AIMS: Ascites that can be induced by various causes is not a rare finding in Crohn's disease. The clinical implication of ascites in Crohn's disease remains unknown in the cases without any specific cause of ascites except Crohn's disease itself. The purpose of this study was to investigate the clinical implication and characteristics of ascites in Crohn's disease. METHODS: We reviewed the medical records of the patients with Crohn's disease who underwent abdominal CT scan. Patients were categorized into two groups: patients with ascites (22 cases) and without ascites (23 cases). We compared clinical features, disease activities and clinical courses of the two groups. RESULTS: Serum albumin level was significantly lower and the C-reactive protein level was significantly higher in the ascites group than in the control group. Harvey and Bradshaw index was significantly higher in the ascites group (8.32 +/- 2.51) than in the control group (6.09 +/- 2.07) (p=0.002). The average dose of prednisolone was higher in the ascites group. On the other hand, there was no significant difference in the number of cases requiring surgery due to complication between two groups. CONCLUSIONS: Our results suggest that the presence of ascites in Crohn's disease is associated with increased disease activity and inflammations requiring more aggressive treatment.

[Clinical characteristics of colonic diverticulitis in Koreans].

BACKGROUND/AIMS: In western countries, symptomatic diverticulitis develops in about 20% of the population with colonic diverticula, and it is mainly located at the left-sided colon. The clinical characteristics of diverticulitis have rarely been investigated although its incidence is increasing in Asia including Korea. The aim of this study was to compare diverticulitis with asymptomatic diverticulosis and to compare the clinical characteristics of right-sided diverticulitis with those of left-sided diverticulitis. METHODS: We retrospectively investigated the medical records of the patients who had symptoms and signs of diverticulitis. Their diagnosis was confirmed with computed tomography, barium study, colonoscopy and/or operations at Samsung Medical Center from September 1998 to February 2002. The control cases of asymptomatic and incidental diverticulosis were randomly selected during routine health check-up after matching age and sex. RESULTS: Twenty-seven patients with diverticulitis (male : female = 14 : 13) were included. The mean age was 53 (27~86). The ratio of right and left diverticulitis was 20:7, which was similar to the ratio of diverticulosis. The complications, especially perforation, were more frequent in the patients with left-sided diverticulitis (p<0.05). CONCLUSIONS: Colonic diverticulitis is more prevalent at the right colon and left colonic diverticulitis has more complications than right colonic diverticulitis in Korea.