Validity of Modified STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea.

OBJECTIVES: The aim of this study was to evaluate the validity of a modified STOP-Bang questionnaire with different body mass index reference as a screening tool for obstructive sleep apnea in Korean population. METHODS: The medical records of 1417 participants who underwent overnight Level I polysomnography were retrospectively analyzed. Predictive parameters were calculated for each of the 3 groups classified by obstructive sleep apnea severity with a cut-off value of 3 or 4. Responses to modified and traditional questionnaires were comparatively analyzed by receiver-operator characteristic curves and area under the receiver-operator characteristic curves. RESULTS: The optimal cut-off values of the modified and traditional questionnaires were both 3.5. The area under the receiver-operator characteristic curve of modified STOP-Bang questionnaire for any obstructive sleep apnea group was 0.786 ± 0.018, which was significantly higher than that of the traditional questionnaire. The modified STOP-Bang questionnaire with a cut-off value ≥4 showed significantly higher sensitivity than the traditional one for any obstructive sleep apnea group. The diagnostic accuracy of the modified questionnaire was also significantly higher for the any obstructive sleep apnea group when the cut-off value was 4. CONCLUSION: The modified STOP-Bang questionnaire, with a cut-off value of 4, can be used as an alternative to the traditional screening tool for the Korean population.

Motor subtypes and clinical characteristics in sporadic and genetic Parkinson's disease groups: analysis of the PPMI cohort.

Introduction: The extensive clinical variations observed in Parkinson's disease (PD) pose challenges in early diagnosis and treatment initiation. However, genetic research in PD has significantly transformed the clinical approach to its treatment. Moreover, researchers have adopted a subtyping strategy based on homogeneous clinical symptoms to improve clinical diagnosis and treatment approaches. We conducted a study to explore clinical characteristics in genetic PD groups with motor symptom subtyping. Methods: Data was driven from the Parkinson's Progression Markers Initiative (PPMI) database. The sporadic PD (sPD) group and the genetic PD group including patients with leucine-rich kinase 2 (LRRK2) or glucosylceramidase ß (GBA) mutations were analyzed. Motor subtyping was performed using Movement Disorder Society-Unified Parkinson's disease rating scale (MDS-UPDRS) scores. I-123 FP-CIT SPECT scans were used to calculate specific binding ratios (SBRs) in the caudate and putamen. Clinical symptoms of each group were also compared. Results: MDS-UPDRS III scores were lower in the LRRK2 group, compared with the GBA and sPD group (P < 0.001), but no significant differences in striatal SBRs. The putaminal SBR value of the LRRK2 group was higher than the sPD group (P < 0.05). Within the GBA group, we observed lower SBR values in the postural instability/gait difficulty (PIGD) subtype GBA group compared to the tremor-dominant (TD) subtype GBA group (P < 0.05). The TD subtype GBA group exhibited superior putaminal SBRs compared to the TD subtype sPD group (P < 0.05). The TD subtype LRRK2 group had better putaminal SBR values (P < 0.001) and MDS-UPDRS Part III scores (P < 0.05) compared to the TD sPD group. Discussions: Our subtyping approach offers valuable insights into the clinical characteristics and progression of different genetic PD subtypes. To further validate and expand these findings, future research with larger groups and long-term follow-up data is needed. The subtyping strategy based on motor symptoms holds promise in enhancing the diagnosis and treatment of genetic PD.

Influence of endoscopists' expertise level on clinical outcomes after bridge-to-surgery stenting in obstructive colorectal cancer.

BACKGROUND AND AIM: This study aimed to investigate the effect of stenting-related factors, including endoscopists' expertise, on clinical outcomes after bridge-to-surgery (BTS) stenting for obstructive colorectal cancer (CRC). METHODS: We analyzed BTS stenting-related factors, including stenting expertise and the interval between stenting and surgery, in 233 patients (63 [13] years, 137 male) who underwent BTS stenting for obstructive CRC. We evaluated the influence of these factors on post-BTS stenting clinical outcomes such as stent-related complications and cancer recurrence. RESULTS: The interval between stenting and surgery was ≤ 7 days in 79 patients (33.9%) and > 7 days in 154 patients (66.1%). BTS stenting was performed by endoscopists with ≤ 50, 51-100, and > 100 prior stenting experiences in 94, 43, and, 96 patients, respectively. The clinical success rate of BTS stenting was 93.1%. Stent-related and postoperative complications developed in 19 (8.2%) and 20 (8.6%) patients, respectively. Cancer recurrence occurred in 76 patients (32.6%). Short BTS interval of ≤ 7 days increased the risk of postoperative complications (odds ratio [OR], 2.61 [1.03-6.75]; P = 0.043). Endoscopists' stenting experience > 100 showed greater clinical success of stenting (OR, 5.50 [1.45-28.39]; P = 0.021) and fewer stent-related complications (OR, 0.26 [0.07-0.80]; P = 0.028) compared with stenting experience ≤ 50. BTS stenting-related factors did not affect long-term oncological outcomes. CONCLUSION: Greater expertise of endoscopists was associated with better short-term outcomes, including high stenting success rate and low rate of stent-related complications after BTS stenting for obstructive CRC. An interval of > 7 days between BTS stenting and surgery was required to decrease postoperative complications.

Highly water-soluble diacetyl chrysin ameliorates diabetes-associated renal fibrosis and retinal microvascular abnormality in db/db mice.

BACKGROUND/OBJECTIVES: Chronic or intermittent hyperglycemia is associated with the development of diabetic complications. Oxidative stress and inflammation can be altered by hyperglycemia in diverse tissues, including kidneys and eyes, and play a pivotal role in diabetic complications. Our previous studies showed that the water-insoluble 5,7-dihydroxyflvone chrysin effectively combats diabetic damages incurred in diabetic kidneys and retinas. The current study employed the newly-synthesized 5.7-di-O-acetylchrysin, having higher solubility than chrysin, to compare the effects on diabetes-associated renal fibrosis and abnormal retinal neovascularization. MATERIALS/METHODS: In the in vivo study, db/db mice as animal models of type 2 diabetes were orally administrated 10 mg/kg BW diacetylchrysin, daily for 10 weeks. RESULTS: Unlike chrysin, oral administration of 10 mg/kg diacetylchrysin did not lower the blood glucose level and 24 h urine volume in db/db mice. Nevertheless, the urinary albumin excretion was markedly reduced. The administration of diacetylchrysin also diminished the deposition of collagen fibers in diabetic glomeruli and tubules by suppressing the induction of connective tissue growth factor and collagen IV in diabetic kidneys. Supplying diacetylchrysin enhanced the membrane type-1 matrix metalloproteinase (MMP) expression reduced in diabetic kidneys, while the tissue inhibitor of MMP-2 induction was attenuated in diacetylchrysin-challenged diabetic kidneys. In addition, supplementing diacetylchrysin to diabetic mice ameliorated renal injury due to glomerulosclerosis and tubular interstitial fibrosis. Furthermore, the reduced retinal inductions of Zonula occludens-1 and vascular endothelial cadherin in db/db mice were elevated in the retinal tissues of diacetylchrysin-treated animals. Oral administration of diacetylchrysin curtailed the induction of vascular endothelial growth factor (VEGF) and VEGF receptor 2 in db/db mice, ultimately retarding diabetes-associated retinal neovascularization. Additionally, the retinal formation of acellular capillaries with leaky vessels was reduced in diacetylchrysin-treated db/db mice. CONCLUSION: Diacetylchrysin may act as a potent pro-health agent for treating renal fibrosis-associated diabetic nephropathy and retinal neovascularization-associated diabetic retinopathy.

Comparison of inactivation kinetics of Yersinia enterocolitica in vegan and non-vegan kimchi during fermentation.

Yersinia enterocolitica is occasionally detected in kimchi, a traditional food prepared from fermented vegetables. Changes in growth properties of Y. enterocolitica during kimchi fermentation are largely unknown. We investigated the viability of Y. enterocolitica during the fermentation of vegan and non-vegan kimchi at different temperatures. Changes in Y. enterocolitica population, pH, and titratable acidity were measured for 24 days. In a suspension test with kimchi juice, populations of three Y. enterocolitica strains were above 3.30 log10 CFU/mL at pH > 5 for 7 days. Yersinia enterocolitica counts in vegan kimchi were considerably reduced at 0 °C and 6 °C. During fermentation at 6 °C, Y. enterocolitica populations in non-vegan kimchi and vegan kimchi were not detected starting from days 14 and 10, respectively. In kimchi samples stored at 0 °C and 6 °C, Y. enterocolitica survival correlated with pH changes during fermentation; in samples stored for up to 24 days, Y. enterocolitica was not detected. According to the k max values from the "log-linear with shoulder and tail" model, Y. enterocolitica was more sensitive to vegan kimchi fermentation than to non-vegan kimchi fermentation. Our findings provide an important basis for ensuring the safe production of kimchi without Y. enterocolitica contamination. Further research is necessary to elucidate the mechanism of Y. enterocolitica inactivation and the major bacterial and physicochemical factors involved in kimchi fermentation.

Diagnostic value of serum procalcitonin and C-reactive protein in discriminating between bacterial and nonbacterial colitis: a retrospective study.

BACKGROUND: Differentiating between bacterial and nonbacterial colitis remains a challenge. We aimed to evaluate the value of serum procalcitonin (PCT) and C-reactive protein (CRP) in differentiating between bacterial and nonbacterial colitis. METHODS: Adult patients with three or more episodes of watery diarrhea and colitis symptoms within 14 days of a hospital visit were eligible for this study. The patients' stool pathogen polymerase chain reaction (PCR) testing results, serum PCT levels, and serum CRP levels were analyzed retrospectively. Patients were divided into bacterial and nonbacterial colitis groups according to their PCR. The laboratory data were compared between the two groups. The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic accuracy. RESULTS: In total, 636 patients were included; 186 in the bacterial colitis group and 450 in the nonbacterial colitis group. In the bacterial colitis group, Clostridium perfringens was the commonest pathogen (n=70), followed by Clostridium difficile toxin B (n=60). The AUC for PCT and CRP was 0.557 and 0.567, respectively, indicating poor discrimination. The sensitivity and specificity for diagnosing bacterial colitis were 54.8% and 52.6% for PCT, and 52.2% and 54.2% for CRP, respectively. Combining PCT and CRP measurements did not increase the discrimination performance (AUC, 0.522; 95% confidence interval, 0.474-0.571). CONCLUSION: Neither PCT nor CRP helped discriminate bacterial colitis from nonbacterial colitis.

High-throughput multi-gate microfluidic resistive pulse sensing for biological nanoparticle detection.

A microfluidic resistive pulse sensing technique offers a simple method for detecting and analysing microparticles in various fields, yet it has challenges such as the noise during detection and low throughput as the signal obtained from a small single sensing aperture and particle position is nonuniform. This study presents a microfluidic chip with multiple detection gates in the main channel to enhance the throughput while maintaining a simple operational system. A hydrodynamic sheathless particle focusing on a detection gate by modulation of the channel structure and measurement circuit with a reference gate to minimize the noise during detection is used for detecting resistive pulses. The proposed microfluidic chip can analyse the physical properties of 200 nm polystyrene particles and exosomes from MDA-MB-231 with high sensitivity with an error of <10% and high-throughput screening of more than 200 000 exosomes per seconds. The proposed microfluidic chip can analyse the physical properties with high sensitivity, so that it can be potentially used for exosome detection in biological and in vitro clinical applications.

Combination of metformin/efavirenz/fluoxetine exhibits profound anticancer activity via a cancer cell-specific ROS amplification.

The possible anticancer activity of combination (M + E + F) of metformin (M), efavirenz (E), and fluoxetine (F) was investigated in normal HDF cells and HCT116 human colon cancer cells. Metformin increased cellular FOXO3a, p-FOXO3a, AMPK, p-AMPK, and MnSOD levels in HDFs but not in HCT116 cells. Cellular ATP level was decreased only in HDFs by metformin. Metformin increased ROS level only in HCT116 cells. Transfection of si-FOXO3a into HCT116 reversed the metformin-induced cellular ROS induction, indicating that FOXO3a/MnSOD is the key regulator for cellular ROS level. Viability readout with M, E, and F alone decreased slightly, but the combination of three drugs dramatically decreased cell survival in HCT116, A549, and SK-Hep-1 cancer cells but not in HDF cells. ROS levels in HCT116 cells were massively increased by M + E + F combination, but not in HDF cells. Cell cycle analysis showed that of M + E + F combination caused cell death only in HCT116 cells. The combination of M + E + F reduced synergistically mitochondrial membrane potential and mitochondrial electron transport chain complex I and III activities in HCT116 cells when compared with individual treatments. Western blot analysis indicated that DNA damage, apoptosis, autophagy, and necroptosis-realated factors increased in M + E + F-treated HCT116 cells. Oral administration with M + E + F combination for 3 weeks caused dramatic reductions in tumor volume and weight in HCT116 xenograft model of nude mice when compared with untreated ones. Our results suggest that M + E + F have profound anticancer activity both in vitro and in vivo via a cancer cell-specific ROS amplification (CASRA) through ROS-induced DNA damage, apoptosis, autophagy, and necroptosis.

Impact of Sarcopenia on Clinical Course of Inflammatory Bowel Disease in Korea.

BACKGROUND AND AIMS: Reduced body muscle mass is a poor prognostic factor for inflammatory bowel disease (IBD). In this study, we investigated the prevalence of sarcopenia at diagnosis and its clinical significance in Korean patients with IBD. METHODS: The prevalence of sarcopenia in IBD patients between June 1989 and December 2016 was investigated using a well-characterized referral center-based cohort. Abdominopelvic computed tomography within six months from IBD diagnosis was used for the evaluation. Sarcopenia was defined as an L3 skeletal muscle index of < 49 cm2/m2 for male and < 31 cm2/m2 for female. The clinical characteristics and outcomes were evaluated with respect to sarcopenia. RESULTS: A total of 1,027 patients (854 Crohn's disease [CD]; 173 ulcerative colitis [UC]) were evaluated. Sarcopenia was found in 56.8% of the population (CD, 57.5%; UC, 53.2%), and male were more likely to be sarcopenic (CD, 94.3%; UC, 91.6%). There were no significant differences in the cumulative risk of using steroids, immunomodulators, biologics, and bowel resections (or colectomy) with or without sarcopenia during follow-up (median: CD, 5.8 years; UC, 3.7 years). In sarcopenic patients with CD, there was a significantly higher cumulative risk of perianal surgeries than in non-sarcopenic patients with CD (Log-rank test; P = 0.001). However, the risk of perianal surgeries was not significant in multivariate analysis (Odds ratio 1.368; 95% confidence interval 0.782-2.391; P = 0.272). CONCLUSION: Sarcopenia at diagnosis may have no significant prognostic value for medical treatment and bowel resection, but it may be associated with perianal CD.

FOXO3a Mediates Homologous Recombination Repair (HRR) via Transcriptional Activation of MRE11, BRCA1, BRIP1, and RAD50.

To test whether homologous recombination repair (HRR) depends on FOXO3a, a cellular aging model of human dermal fibroblast (HDF) and tet-on flag-h-FOXO3a transgenic mice were studied. HDF cells transfected with over-expression of wt-h-FOXO3a increased the protein levels of MRE11, BRCA1, BRIP1, and RAD50, while knock-down with siFOXO3a decreased them. The protein levels of MRE11, BRCA1, BRIP1, RAD50, and RAD51 decreased during cellular aging. Chromatin immunoprecipitation (ChIP) assay was performed on FOXO3a binding accessibility to FOXO consensus sites in human MRE11, BRCA1, BRIP1, and RAD50 promoters; the results showed FOXO3a binding decreased during cellular aging. When the tet-on flag-h-FOXO3a mice were administered doxycycline orally, the protein and mRNA levels of flag-h-FOXO3a, MRE11, BRCA1, BRIP1, and RAD50 increased in a doxycycline-dose-dependent manner. In vitro HRR assays were performed by transfection with an HR vector and I-SceI vector. The mRNA levels of the recombined GFP increased after doxycycline treatment in MEF but not in wt-MEF, and increased in young HDF comparing to old HDF, indicating that FOXO3a activates HRR. Overall, these results demonstrate that MRE11, BRCA1, BRIP1, and RAD50 are transcriptional target genes for FOXO3a, and HRR activity is increased via transcriptional activation of MRE11, BRCA1, BRIP1, and RAD50 by FOXO3a.

The Effect of Pharyngeal Surgery on Positive Airway Pressure Therapy in Obstructive Sleep Apnea: A Meta-Analysis.

There is controversy about the effect of pharyngeal surgery for obstructive sleep apnea (OSA) on positive airway pressure (PAP) adherence, and the related results of meta-analysis have not yet been available. Therefore, the purpose of this meta-analysis was to assess the effect of pharyngeal OSA surgery on PAP therapy parameters such as optimal pressure levels and usage time. We selected studies investigating optimal PAP levels or usage time before and after pharyngeal OSA surgery, regardless of the study design. Pharyngeal OSA surgery included uvulopalatopharyngoplasty and its variants, tonsillectomy, Pillar implants, radiofrequency ablation, tongue base surgery and its variants, and genioglossus advancement. Studies in which isolated nasal surgery was performed were excluded. The random-effects model was used due to significant heterogeneity among the studies. Nine studies were included in the meta-analysis of optimal PAP levels, and five studies in the meta-analysis of PAP usage time. After pharyngeal OSA surgery, the summed optimal PAP level was significantly decreased (standardized mean difference (SMD), -1.113; 95% confidence interval (CI), -1.667 to -0.559)), and the summed usage time of PAP was significantly increased (SMD, 0.794; 95% CI, 0.259 to 1.329). This study illustrated that pharyngeal OSA surgery lowered optimal PAP levels and enhanced PAP usage time. The results of the meta-analysis contribute to our understanding of the role of pharyngeal OSA surgery in patients with PAP intolerance.

Effect of Polyvinylpolypyrrolidone Surfactant on Characteristics of Iron-Oxide Nanoparticles Synthesized by Using Recycled Waste Permanent Magnets.

In this study, iron oxide nanoparticles (FeOx NPs) were synthesized by using Fe solution recycled from NdFeB permanent magnet scrap. Furthermore, the effect of polyvinylpolypyrrolidone (PVP) as a surfactant on the characteristics of the FeOx NPs was investigated. Firstly, Fe solution was prepared by using 10% H2SO4 solution and Na2SO4 salt. In addition, three reducing agent solutions were prepared by dissolving PVP in 0.5 M NH4OH solution in distilled (D.I.) water with concentrations of 0 wt%, 1 wt%, and 2 wt%, respectively. Each reducing agent solution was added dropwise into the Fe solution to precipitate three precursors of FeOx NPs, and they were heat-treated at 400 °C to prepare three FeOx NPs samples, P0, P1, and P2. In X-ray diffractometer (XRD) analysis, diffraction peaks of P0 sample are consistent with the Fe3O4 with (311) preferred orientation. The XRD peak shifted from Fe3O4 to Fe2O3 structure as PVP concentration increased, and the crystal structure of P2 sample was transformed to Fe2O3 with (104) preferred orientation. Brunauer, Emmett, and Teller (BET) specific surface area increased in proportional to PVP concentration. HRTEM observation also supported the tendency; the particle size of the P0 sample was less than 40 nm, and particle size decreased as PVP concentration increased, leading to the particle size of the P2 sample being less than 20 nm in width. In addition, particle morphology started to be transformed from particle to rod shape as PVP concentration increased and, in the P2 sample, all the morphology of particles was transformed to a rod shape. Magnetic properties analysis revealed that the P0 sample exhibited the highest value of magnetic moment, 65.6 emu/g, and the magnetic moment was lowered in the P1 sample, and the P2 sample exhibited the lowest value of magnetic moment, 2.4 emu/g.

Serial changes of I-123 FP-CIT SPECT binding asymmetry in Parkinson's disease: Analysis of the PPMI data.

Background: Dopaminergic denervation and motor symptoms are usually asymmetric at the onset of Parkinson's disease (PD). In this study, we estimated the asymmetry of specific binding ratio (SBR) of I-123 FP-CIT SPECT images during 4-years of follow up, to demonstrate the pattern of serial changes of asymmetry. Methods: Clinical and I-123 FP-CIT SPECT image data of 301 PD patients and 141 normal controls were reviewed from the Parkinson's Progression Markers Initiative cohort. I-123 FP-CIT SPECT images were taken at baseline, 1-, 2-, and 4-year follow up periods for PD patients, and at baseline for normal controls. Asymmetry index were calculated by two methods. Method 1, by using the ratio of absolute difference of right and left SBRs to the average SBR. Method 2, by using the ratio of absolute difference of right and left SBRs to the SBR values of age-matched normal controls. Results: Asymmetry index by method 2 revealed a more significant decrease during the 4-year follow up period, compared with method 1. The baseline asymmetry index of the putamen by method 2 showed significant correlation with the non-dominant putamen SBRs. However, there were no significant correlation with the baseline asymmetry index by method 2 and motor symptoms, cognition, nor autonomic symptoms. Conclusion: We suggest a novel asymmetry index in association to age-matched normal SBR values. This novel index could be adopted in predicting and evaluating the natural course of PD.

Protective mechanisms of loquat leaf extract and ursolic acid against diabetic pro-inflammation.

The pharmacological effectiveness of loquat leaf extract (LE) and its important component, ursolic acid (UA), in the treatment of diabetes mellitus, has been well established in traditional medicine; however, the mechanism underlying their action is still unclear. We evaluated the protective effects of LE and UA against hyperglycemia-induced advanced glycation end product (AGE) formations and hepatic pro-inflammation. Oral administration of UA and LE at a dose of 50 mg/kg/day for 15 days yielded no significant hypoglycemic effect in diabetic db/db mice. UA and LE suppressed hepatic oxidative stress and AGE formation in diabetic mice, and this was followed by the downregulated mitogen-activated protein kinase signaling and nuclear factor κ B (NF-κB) activity. To identify the molecular target of LE and UA, a docking simulation was performed, and this predicted UA to bind to liver kinase B1 (LKB1), an upstream of AMP-activated protein kinase (AMPK)/transcription factor forkhead box O3 (FOXO3) axis. UA reversed the high-glucose-induced downregulation of LKB1-AMPK1-FOXO3 activation and antioxidant gene transcription. These findings demonstrated the antioxidant and anti-inflammatory effects of UA and LE against hyperglycemia-induced hepatic inflammation. Furthermore, we speculate that the LKB1/AMPK/FOXO3 pathway is a potential target responsible for these beneficial effects of LE and UA.

Implementation of Flip-Chip Microbump Bonding between InP and SiC Substrates for Millimeter-Wave Applications.

Flip-chip microbump (µ-bump) bonding technology between indium phosphide (InP) and silicon carbide (SiC) substrates for a millimeter-wave (mmW) wireless communication application is demonstrated. The proposed process of flip-chip µ-bump bonding to achieve high-yield performance utilizes a SiO2-based dielectric passivation process, a sputtering-based pad metallization process, an electroplating (EP) bump process enabling a flat-top µ-bump shape, a dicing process without the peeling of the dielectric layer, and a SnAg-to-Au solder bonding process. By using the bonding process, 10 mm long InP-to-SiC coplanar waveguide (CPW) lines with 10 daisy chains interconnected with a hundred µ-bumps are fabricated. All twelve InP-to-SiC CPW lines placed on two samples, one of which has an area of approximately 11 × 10 mm2, show uniform performance with insertion loss deviation within ±10% along with an average insertion loss of 0.25 dB/mm, while achieving return losses of more than 15 dB at a frequency of 30 GHz, which are comparable to insertion loss values of previously reported conventional CPW lines. In addition, an InP-to-SiC resonant tunneling diode device is fabricated for the first time and its DC and RF characteristics are investigated.

Oral beclomethasone dipropionate as an add-on therapy and response prediction in Korean patients with ulcerative colitis.

BACKGROUND/AIMS: We aimed to investigate the oral beclomethasone dipropionate's (BDP) efficacy as an add-on therapy and to clarify the predictive factor for response to oral BDP in Korean ulcerative colitis (UC) patients. METHODS: Patients with a stable concomitant drug regimen with exposure to oral BDP (5 mg/day) within 30 days before BDP initiation were included. Partial Mayo score (pMS) was used to evaluate response to oral BDP. Clinical remission (CREM) was defined as a post-treatment pMS ≤ 1 point. Clinical response (CRES) was defined as an at least 2-point decrease in post-treatment pMS and an at least 30% decrease from baseline pMS. Patients without CREM or CRES were considered nonresponders (NRs). RESULTS: Of all, 37 showed CREM, 19 showed CRES, and 44 were NRs. The CREM group included more patients with mild disease activity (75.7% vs. 43.2%, p = 0.011) than NRs. In contrast to NRs, CREM and CRES patients showed significant improvement of post-treatment erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (ESR with p = 0.001, CRP with p = 0.004, respectively). Moreover, the initial rectal bleeding subscore (RBS) was significantly different between CREM and CRES, or NR (both with p < 0.001). In multivariate analyses, initial stool frequency subscore (SFS) of 0 and RBS of 0 were predictive factors for CREM (odds ratio [OR], 15.359; 95% confidence interval [CI], 1.085 to 217.499; p = 0.043 for SFS, and OR, 11.434; 95% CI, 1.682 to 77.710; p = 0.013 for RBS). CONCLUSION: Oral BDP is an efficacious add-on therapy in Korean UC patients. Patients with initial SFS or RBS of 0 may be particularly good candidates for oral BDP.

Improved adenoma detection by a novel distal attachment device-assisted colonoscopy: a prospective randomized controlled trial.

BACKGROUND AND AIMS: WingCap (A&A Medical Supply LLC, Seongnam, South Korea) is a novel distal attachment device for colonoscopy that combines a cap and an existing mucosal exposure device, such as Endocuff Vision (Arc Medical Design Ltd, Leeds, UK) and AmplifEYE (Medivators Inc, Minneapolis, Minn, USA). We aimed to investigate whether WingCap-assisted colonoscopy can improve the adenoma detection rate (ADR) and adenoma per colonoscopy (APC) and simultaneously shorten cecal intubation time compared with standard colonoscopy. METHODS: We conducted a single-center, prospective, randomized controlled trial for outpatients aged ≥18 years undergoing colonoscopy. The primary outcome was ADR differences with the assistance of WingCap. Secondary outcomes were APC and other colonoscopy quality indicators, such as cecal intubation and withdrawal times. RESULTS: In total, 537 patients were randomized for WingCap-assisted or standard colonoscopy. Their mean age was 59.3 years, and 48.5% were men. ADR was significantly higher in the WingCap group than in the control group (37.2% vs 26.6%, P = .012). APC was greater with WingCap than with standard colonoscopy (.72 ± 1.34 vs .45 ± 0.97, P = .008), prominently for nonpedunculated (.65 ± 1.25 vs .42 ± .95, P = .015) and diminutive (.42 ± .94 vs .20 ± .64, P = .002) adenomas. With WingCap, ADR and APC significantly increased for beginner endoscopists, whereas a modest increase was seen for experienced endoscopists. There were no differences in cecal intubation and withdrawal times between the 2 arms. No serious adverse event was associated with the use of WingCap. CONCLUSIONS: WingCap-assisted colonoscopy was tolerable and efficacious for improving ADR and APC compared with standard colonoscopy, especially for nonpedunculated and diminutive adenomas and for beginner endoscopists. (Clinical trial registration number: KCT0005214.).

Magazine capacity limits and home security.

In response to several mass-casualty shootings in the United States, multiple legislative bodies have promoted or adopted laws that restrict the magazine capacity of firearms. The stated intent of these laws is to reduce the number of rounds a bad actor can fire in a mass-casualty situation. However, objectors argue that the laws not only are ineffective but could also cause an undue burden on the ability of law-abiding gun owners to protect themselves. Using agent-based simulation modeling, a home-invasion model including two-armed bad actors and a one-armed homeowner was created to test this hypothesis. The homeowner engaged the bad actors with different capacity magazines, and the survival rate was recorded and compared across the spectrum of capacities. This model showed that reducing the homeowner's magazine capacity resulted in an increased casualty rate for the homeowner.

Improving hydrogen production by pH adjustment in pressurized gas fermentation.

Gas fermentation utilizes syngas converted from biomass or waste as feedstock. A bubble column reactor for pressurizing was designed to increase the mass transfer rate between gas and liquid, and reduce energy consumption by medium agitation. Thermococcus onnurineus, a hydrogenic CO-oxidizer, was cultured initially under ambient pressure with the initial inlet gas composition; 60% CO and 40% N2. The maximum H2 productivity was 363 mmol/l/h, without pH adjustment. When additional pressure was applied, the pH rapidly declined; this may be attributed to the increased CO2 solubility under pressure. By controlling pH, H2 productivity increased up to 450 mmol/l/h; which is comparable to the previously reported H2 productivity in a continuous stirred tank reactor. The results may suggest energy saving potentials of bubble column reactors in gas fermentation. This finding may be applied to other gas fermentation processes, as syngas itself contains CO2 and many microbial processes also release CO2.