Simultaneous lateral and subxiphoid access methods for safe and accurate resection of a superior vena cava aneurysm:A case report

BACKGROUND Superior vena cava(SVC)aneurysms are a relatively uncommon disease that has not been widely reported.The conventional surgical approach for treating SVC aneurysms includes open thoracotomy and mid-sternotomy.However,in this case,the aneurysm could be safely resected by thoracoscopic simultaneous lateral and subxiphoid access methods.CASE SUMMARY A 58-year-old male presented with intermittent chest pain and persistent discomfort in the chest area.A chest computed tomography scan revealed a 6.2 cm aneurysm in the left innominate vein and SVC junction.For surgical resection,simultaneous lateral and subxiphoid access were planned to achieve optimal proximal and distal aneurysm control.The approach site was 1 cm below the xiphoid process,the fifth mid-axillary line and the seventh anterior axillary line on the right side.The aneurysm was resected using a stapler.The patient was discharged on the third day after chest tube removal on the second postoperative day with no particular issues.CONCLUSION Aneurysms located within the mediastinum can be accessed through thoracoscopic approach without open surgery and safely resected using vascular staples.

Extension of Goal-Directed Behavior Model for Post-Pandemic Korean Travel Intentions to Alternative Local Destinations: Perceived Risk and Knowledge

Since the outbreak of COVID-19,tourists have been increasingly concerned over various risks of international travel,while knowledge of the pandemic appears to vary significantly.In addition,as travel restrictions continue to impact adversely on international tourism,tourism efforts should be placed more on the domestic markets.Via structural equation modeling,this study unearthed different risk factors impacting Korean travelers’choices of alternative local destinations in the post-pandemic era.In addition,this study extended the goal-directed behavior framework with the acquisition of perceived risk and knowledge of COVID-19,which was proven to hold a sig-nificantly superior explanatory power of tourists’decisions of local alternatives over foreign countries during the COVID-19 pandemic.Furthermore,desire was found to play an imminent mediating role in the conceptual mod-el,maximizing the impact of perceived risk on travel intentions.Henceforth,this research offers meaningful the-oretical implication as thefirst empirical study to deepen the goal-directed behaviour framework with perceived risk and knowledge in the context of post-COVID-19 era.It also serves as insightful knowledge for Korean tour-ism authorities and practitioners to understand local tourists’decision-making processes and tailor effective recovery strategy for domestic tourism.

Spectral Properties and Photochromic Characteristics of Spiropyran Dyes

A bis-benzospiropyran（BBSP） and nitro-substituted indoline spirobenzopyrans（SBP） were prepared by following a simple procedure. The reaction mechanism of synthesizing bis-benzospiropyran is discussed. A comparative analysis of the spectral and photochromic properties between SBP and BBSP was carried out with the aid of a PMMA film. The results indicate that chemical structures and UV irradiation played an important role in the spectral and photochromic properties of SBP and BBSP, which would readily affect λmax of the colored forms and the reversibility. The IR spectra and ^1H NMR spectra of these compounds are used to interpret the photochromic phenomena under different UV irradiation and determine the configurations of SBP and BBSP.

Insulinotrophic and hypolipidemic effects of Ecklonia cava in streptozotocin-induced diabetic mice

Objective:To explore the anti-diabetic activity of Ecklonia cava(EC) in streptozotocin(STZ)-induced diabetic mice.Methods:Diabetes was induced by a single intraperitoneal injection of STZ(90 mg/kg).Normal and diabetic mice were treated with 0%,3%,and 5%EC diet for 4 weeks. Serum glucose and insulin concentrations,serum lipid profile,oral glucose tolerance test,and liver and pancreaticβ-cell histopathological observations were performed.In addition,in vitro glucose-induced insulin secretion was determined using pancreaticβ-islet cells.Results:EC supplementation significantly and dose-dependently decreased serum glucose concentration, and improved glucose homeostasis in diabetic mice by preventing loss ofβ-cell mass resulting in increase of insulin secretion.The triglyceride and total cholesterol concentrations in the serum and liver were markedly reduced by EC treatment in STZ-diabetic mice.Moreover,LDL-,and HDL-cholesterol levels were ameliorated in EC supplemented diabetic mice.Liver steatosis induced by STZ was ameliorated by EC supplementation.Furthermore,in vitro insulinotrophic effect of EC extract was observed in pancreaticβ-islets.Conclusions:This study demonstrated that EC is a potent and efficacious hypoglycemic and hypolipidemic agent,and prevents the loss ofβ-cell mass resulting in increase of insulin secretary capacity.

Environmental Characterization of Periphyton Community

The present paper deals with the behavior of the Attached Microbial Community (AMC) for water self-purification at different riverbeds in a typical local river. The study quantitatively investigated the problem starting with in-situ sampling. It was found that more biomass of AMC was at riffles with wider distribution than in pools. High current velocity (HCV) plays a negative role at the initial stage of attachment on the riverbed, but HCV aids the community proliferation after stable attachment. External disturbances such as rainfalls and discharges from dams or reservoirs would detach the periphyton depending on the intensity of turbulence in water. However, it was discovered that the flock of periphyton could be restored very quickly because it was not completely removed. Thus, in order to enhance self-purification by periphyton, a suitable configuration of the riverbed must be constructed, and occasional appropriate repair along the channels would improve the decontamination of the river.

Comparison of clinical outcomes between culprit vessel only and multivessel percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel coronary diseases

Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction （STEMI） pa- tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention （PPCI） were analyzed. We used propensity score matching （PSM） to control differences of baseline characteristics between culprit only intervention （CP） and multivessel percutaneous coronary interventions （MP）, and between double vessel disease （DVD） and triple vessel disease （TVD）. The major adverse cardiac event （MACE） was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE （14.2% vs. 8.6%, P = 0.01）, any cause of revascularization （10.6% vs. 5.9%, P - 0.01）, and repeated PCI （9.5% vs. 5.7%, P = 0.02）, as compared to DVD patients during one year after discharge. MP reduced MACE effectively （7.3% vs. 13.8%, P = 0.03）, as compared to CP for one year, but all cause of death （1.6% vs. 3.2%, P= 0.38）, Ml （0.4% vs. 0.8%, P = 1.00）, and any cause ofrevascularization （5.3% vs. 9.7%, P = 0.09） were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.

Diagnosis of gastric epithelial neoplasia:Dilemma for Korean pathologists

The histopathological diagnosis of gastric mucosal biopsy and endoscopic mucosal resection/endoscopic submucosal dissection specimens is important,but the diagnostic criteria,terminology,and grading system are not the same in the East and West.A structurally invasive focus is necessary to diagnose carcinoma for most Western pathologists,but Japanese pathologists make a diagnosis of cancer based on severe dysplastic cytologic atypia irrespective of the presence of invasion.Although the Vienna classification was introduced to reduce diagnostic discrepancies,it has been difficult to adopt due to different concepts for gastric epithelial neoplastic lesions.Korean pathologists experience much difficulty making a diagnosis because we are influenced by Japanese pathologists as well as Western medicine.Japan is geographically close to Korea,and academic exchanges are active.Additionally,Korean doctors are familiar with Western style medical terminology.As a result,the terminology,definitions,and diagnostic criteria for gastric intraepithelial neoplasia are very heterogeneous in Korea.To solve this problem,the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists has made an effort and has suggested guidelines for differential diagnosis:(1) a diagnosis of carcinoma is based on invasion;(2) the most important characteristic of low grade dysplasia is the architectural pattern such as regular distribution of crypts without severe branching,budding,or marked glandular crowding;(3) if nuclear pseudostratification occupies more than the basal half of the cryptal cells in three or more adjacent crypts,the lesion is considered high grade dysplasia;(4) if severe cytologic atypia is present,careful inspection for invasive foci is necessary,because the risk for invasion is very high;and(5) other structural or nuclear atypia should be evaluated to make a final decision such as cribriform pattern,papillae,ridges,vesicular nuclei,high nuclear/cytoplasmic ratio,loss of nuclear polarity,thick and irregular nuclear membrane,and nucleoli.

Assessing Level of Ubiquitous Computing Services for Ubiquitous Business Design

We are entering into a new era of enterprise computing that is characterized by an emphasis on broadband convergence, knowledge sharing, and calm services. Some people refer to this as the 'ubiquitous network' business model because its focus is on a high degree of connectivity between a company and its customers, suppliers, and channel partners. Moreover, immediate access to ideas, goods, and services will be of greater value than the traditional model of permanent and ponderous possession. This paper illustrates how ubiquitous computing technology can be combined with legacy computer-based information systems, along with thoughts on relevant issues of ubiquitous commerce. We also propose a model for how to assess levels of ubiquitous computing services.

Effects of mother-child interaction on school adaptation of children according to maternal depression

Objective:Factors influencing school adaptation of school-aged children include both executive function(EF)and parent–child interaction.This study aims to investigate the developmental trajectory of mother–child interaction longitudinally using latent growth model analysis.Methods:A longitudinal descriptive survey study was conducted.The par ticipants comprised of 1,614 mothers and school-aged children,who participated in the Panel Study on Korean Children(6 th–8 th panel surveys).A model was designed and analyzed using latent growth modeling to estimate the pattern of change over time.Results:In the group where the maternal depression was within the normal range,only the path by which the change rate of mother–child interaction affected school adaptation of children was statistically nonsignificant(t=1.007,p=0.314).In the group where maternal depression was mild or higher,only the paths by which the initial value of mother–child interaction affected EF difficulty(t=-2.75,p=0.032)and EF difficulty affected school adaptation(t=-7.876,p<0.001)were statistically significant.Conclusions:This study confirms the research models developed by dividing mother–child interaction into two groups according to depression levels(i.e.,normal range and mild or higher-level depression).The findings provide a basis for construction of individualized interventions.

Fire risk of green building technical components

The concept of the green building as sustainable construction has continuously been studied,developed and distributed.Technologies to realize the green building to use less energy,while protecting the environment and improving the quality of residences have increasingly been used in not only new buildings in the design phase,but also in existing ones to reduce the energy and environment loads.Therefore,the number of green buildings is increasing.However,there are some cases that green building technologies for low energy use,low carbon emissions and pleasant indoor environment violate fire safety standards;so it is imminent to address the issue.Furthermore,unlike continuous studies on development and distribution of green buildings,there are few studies on the issue because of the lack of fire safety awareness of green buildings.Therefore,this study intends to raise the awareness of fire safety awareness of green buildings through theoretical consideration and analysis of cases about green building technologies.

Randomized controlled trial to evaluate the efficacy and safety of fexuprazan compared with esomeprazole in erosive esophagitis

BACKGROUND Fexuprazan,a novel potassium-competitive acid blocker,reversibly suppresses the K+/H+-ATPase enzyme in proton pumps within gastric parietal cells.Fexuprazan’s suppression of gastric acid was maintained in healthy individuals for 24 h in a dose-dependent manner.AIM To compare fexuprazan to esomeprazole and establish its efficacy and safety in patients with erosive esophagitis(EE).METHODS Korean adult patients with endoscopically confirmed EE were randomized 1:1 to receive fexuprazan 40 mg or esomeprazole 40 mg once daily for eight weeks.The primary endpoint was the proportion of patients with healed EE confirmed by endoscopy at week 8.The secondary endpoints included the healing rate of EE at week 4,symptom response,and quality of life assessment.Safety profiles and serum gastrin levels were compared between the groups.RESULTS Of the 263 randomized,218 completed the study per protocol(fexuprazan 40 mg,n=107;esomeprazole 40 mg,n=111).Fexuprazan was non-inferior to esomeprazole regarding the healing rate at week 8[99.1%(106/107)vs 99.1%(110/111)].There were no between-group differences in the EE healing rate at week 4[90.3%(93/103)vs 88.5%(92/104)],symptom responses,and quality of life assessments.Additionally,serum gastrin levels at weeks 4 and 8 and drug-related side effects did not significantly differ between the groups.CONCLUSION Fexuprazan 40 mg is non-inferior to esomeprazole 40 mg in EE healing at week 8.We suggest that fexuprazan is an alternative promising treatment option to PPIs for patients with EE.

Effects of Scutellaria baicalensis on neurogenesis in the hippocampal dentate gyrus and on spatial memory of adult rats

We investigated the effects of ethanol extracted Scutellaria baicalensis（EESB） on spatial memory function and neurogenesis in the hippocampal dentate gyrus.Adult Sprague-Dawley rats were orally administered 50,100,or 200 mg/kg of EESB for 6 successive days.The radial-arm maze test showed that 200 mg/kg of EESB improved the spatial memory of adult rats.Confocal microscopy results showed that 100 mg/kg of EESB increased the number of bromodeoxyuridine（BrdU）-and neuron-specific nuclear protein-positive cells in the granular cell layer,and that 100 and 200 mg/kg of EESB increased the number of BrdU-/neuron-specific nuclear protein-positive cells in the sub-granular zone.200 mg/kg of EESB increased the number of BrdU-/glial fibrillary acid protein-positive cells in the subgranular zone.These findings indicate that EESB can effectively promote neurogenesis in the hippocampal dentate gyrus and improve spatial memory function.

Minimally Invasive Widening of the Facet Joints in Cervical Radiculopathy by Modified Needles： Technical Report

Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects, we devised a new minimally invasive treatment method that widens the facet joints to decompress nerve roots and release the muscle spasm in cervical radiculopathy with acupuncture needles with blunt tip and mini-scalpel, and named it modified acupuncture procedure. MAP （Modified acupuncture procedure） was administered for 37 patients （mean age = 53.1 years, follow-up = 14.2 months） with cervical radiculopathy who did not recover from 4 weeks of nonsurgical treatment. We analyzed clinical outcomes of patients before and after the procedure through VAS （Visual Analogue Scale） and NDI （Neck Disability Index）. On average, patients received 1.4 MAP （modified acupuncture procedures）. The VAS score difference on the day after procedure and at 1 year follow-up was 36.8 ± 26.5 （from 60.1 ± 25.3 at the baseline to 25.3 ± 17.8 at the reading） （P 〈 0.01） and 31.0 ± 30.4 （29.0 ± 21.8 at the reading） respectively. The NDI value dropped by 19.9 ± 18.3 （from 37.2 ± 19.7 at the baseline to 17.2 ± 15.0 at the reading） （P〈 0.01） on 1 year follow up. MAP was found to have clinical efficacy for cervical radiculopathy.

Changes in smoking behavior and adherence to preventive guidelines among smokers after a heart attack

Objective Risk factor modification is key to preventing subsequent cardiac events after a heart attack. This study was designed to investigate the disparity between preventive guidelines and clinical practice among smoking patients. Methods The study was carried out in smokers admitted with myocardial infarction (MI). Atotal of 275 patients who had been regularly followed for over one year after MI were randomly selected and enrolled in this study.We investigated changes in smoking behavior and the adherence rate to ACC/AHA Guidelines for secondary prevention in patients with coronary artery disease at the time of, and one year after, the index event. Results The study population consisted of 275 patients (97.1% males) with a mean age of 57.0 ±11.2 years. Achievement of target goals at one year was as follows: smoking cessation, 52.3%; blood pressure, 83.9%; HbA1c, 32.7%; lipid profile, 65.5%; and body mass index (BMI), 50.6%. Over one year, 80% of the patients attempted to quit smoking; 27% of them re-started smoking within one month after discharge while 65% succeeded in cessation of smoking. At one year, only 52% of the patients overall had stopped smoking. From the multivariate logistic analysis including smoking patterns and clinical characteristics, the severity of coronary artery disease was the only independent predictor for smoking cessation (Relative risk (RR): 1.230; P = 0.022). Conclusions Only a small percentage of MI patients adhere to guidelines for secondary prevention and a sizable proportion fail to stop smoking. These findings underscore the need for an effective patient education system.

Design-space adaptation method for multiobjective and multidisciplinary optimization

This paper developed a new method that adaptively adjusts a design space by considering the actual solution distribution of a problem to overcome the conventional design-space adaptation method that assumes the solutions distribution to be a normal distribution because the distributions of solutions are rarely normal distributions for real-world problems.The developed method was applied to nineteen multiobjective test functions that are widely used to evaluate the characteristics and performance of optimization approaches.The results showed that this method adapted the design space to an appropriate design space where the solution existence probability was high.The optimization performance achieved using the developed method was higher than that of the conventional methods.Furthermore,the developed method was applied to the conceptual design of an unmanned spacecraft to confirm its validity in real-world design and multidisciplinaryoptimization problems.The results showed that the Pareto solutions of the developed method were superior to those of conventional methods.Additionally,the optimization efficiency with the developed method was improved by more than 1.4 times over that of the conventional methods.In this regard,the developed method has the potential to be applied to complicated real-world optimization problems to achieve better performance and efficiency.

Virtual vibration test rig for fatigue analysis of dozer push arms

To obtain accurate fatigue life results for construction machinery components,acquiring load spectra is crucial,as their authenticity and validity directly determine the precision of the analysis.In working conditions,component attitudes change continuously,but they remain static on the vibration test rig(VTR),so the acquired target signals should match with the actual component attitudes in the driving signal generation.This paper proposes an efficient and economical simulation-based virtual VTR for fatigue analysis of dozers.First,the relationship between the push arm rotation angle and the cylinder stroke is established,since the cylinder strokes can be measured easily in data acquisition experiments.Second,load decomposition is used to determine the attitude relationship between virtual VTR conditions and actual conditions,and target signals are calculated based on this attitude relationship and measured data.According to the system's frequency response function,the driving signals are iterated until the system's response signals converge with the target signals.Finally,the iteratively obtained load spectra are utilized for fatigue life analysis.The results show that the virtual VTR can effectively and accurately obtain the results of fatigue analysis and has engineering application significance.

计算机导航系统辅助下全髋关节表面置换的初步经验

目的初步评估计算机辅助下行全髋关节表面置换的手术方法及假体植入的精确性。方法对40例患者分成导航组（20例）和对照组（20例），分别采用计算机导航系统辅助和标准常规技术完成全髋关节表面置换术。比较两组手术时间、术中失血量、Harris髋关节评分（HHS），以及髋臼杯外展角和前倾角的偏移度及股骨假体柄干角和前倾角的偏移度。结果手术时间导航组较对照组长38．7min（P〈0．05），术中平均出血量导航组较对照组多109．4ml（P〈0．05）。随访平均14．5个月，HHS评分两组比较差异无统计学意义（P〉0．05）。对照组髋臼杯外展角偏移度（7.3°±4.3°）大于导航组（1．9°±1．3°）（P〈0．05），对照组髋臼杯前倾角偏移度（3．9°±2．3°）大于导航组（2．4°±1．5°）（P〈0．05）。导航组股骨假体柄干角偏移度（1．5°±1．0°）小于对照组（11．3°±1.3°）（P〈0．05），导航组股骨假体前倾角偏移度（1．8°±2.3°）小于对照组（6．5°±5．3°）（P〈0．05）。结论计算机导航系统辅助下行全髋关节表面置换术可以提高假体植入的精确性，避免股骨颈皮质骨切迹，降低股骨颈骨折的风险。

Multifunctional core-shell-like nanoarchitectures for hybrid supercapacitors with high capacity and long-term cycling durability

Transition metal oxide/hydroxide with multif unctional hierarchical nano structures has attracted widespread attention in supercapacitors(SCs)because of their large accessible surface area,high electrochemical activity and superior redox chemistry.Herein,core-shell-like copper(Cu)hydroxide nano tube arrays grafted nickel aluminum layered double hydroxide n anosheets were facilely synthesized on porous Cu foam(CH NTAs@NiAI LDH NSs)for use as an efficient battery-type electrode in hybrid SCs.With the synergistic effects of NiAl LDH NSs on well-adhered CH NTAs/CF,the core-shell-like composite(prepared for 24 h)delivered a maximum areal capacity of 334.3 pAh/cm2 at a current density of 3 mA/cm2 in 2 M KOH electrolyte,which is comparatively higher than other samples synthesized at different growth times.Moreover,the core-shell-like CH NTAs@NiAI LDH NSs-24 demonstrated an outstanding cycling stability of 134.3%after 10,000 cycles.Utilizing high capacity and stability of CH NTAs@NiAI LDH NSs-24,a pouch-type hybrid SC was further assembled with core-shell-like composite as a positive electrode and reduced graphene oxide as a negative electrode with a filter paper as a separator in aqueous alkaline electrolyte.The hybrid SC showed a high areal capacity of 250 pAh/cm2 at 2 mA/cm2 with maximum areal energy and power densities of 181.9 pWh/cm2 and 24,991.5 pW/cm2,respectively.Successfully harvest!ng the solar energy via solar cell panel and subsequently delivering the stored en ergy to switching and proximity applicati ons also dem on strated the real-time applicability of our hybrid SCs.

Modulation of signal transduction pathways by natural compounds in cancer

Cancer is generally regarded as the result of abnormal growth of cells. According to World Health Organization, cancer is the leading cause of mortality worldwide. Mother nature provides a large source of bioactive compounds with excellent therapeutic efficacy. Numerous phytochemicals from nature have been investigated for anticancer properties. In this review article, we discuss several natural compounds, which have shown anti-cancer activity. Natural compounds induce cell cycle arrest, activate intrinsic and extrinsic apoptosis pathways, generate Reactive Oxygen Species(ROS), and down-regulate activated signaling pathways, resulting in inhibition of cell proliferation, progression and metastasis of cancer. Several preclinical studies have suggested that natural compounds can also increase the sensitivity of resistant cancers to available chemotherapy agents. Furthermore, combining FDA approved anti-cancer drugs with natural compounds results in improved efficacy. On the basis of these exciting outcomes of natural compounds against several cancer types, several agents have already advanced to clinical trials. In conclusion, preclinical results and clinical outcomes against cancer suggest promising anticancer efficacy of agents from natural sources.

Bojungbangdocktang inhibits vascular endothelial growth factor induced angiogenesis via blocking the VEGF/VEGFR2 signaling pathway in human umbilical vein endothelial cells

Oriental herbal medicines have been widely used for the prevention or treatment of various diseases including cancer in Asia. However, to prove their chemo preventive efficacies in modern times, scientific evidence for those herbal medicines is required. Thus, in the present study, an effective herbal cocktail Bojungbangdocktang (BJBDT) was investigated to elucidate antiangiogenic mechanism in vitro and in vivo. BJBDT significantly inhibited vascular endothelial growth factor (VEGF) induced proliferation in HUVECs at nontoxic concentrations, despite weak cytotoxicity against human umbilical vein endothelial cells (HUVECs). BJBDT also significantly suppressed VEGF-induced migration and tube formation of HUVECs. Furthermore, BJBDT treatment resulted in pale color and low hemoglobin level in Matrigel plugs, as well as dark red color and high hemoglobin level in untreated control. Interestingly, BJBDT specifically inhibited the binding of VEGF to vascular endothelial growth factor receptor 2 (VEGFR2), but not VEGFR1. In addition, friedelin, formononetin, ginsenoside Rb1, naringin, atractyloside, diosgenin, and allantonin were identified from BJBDT by high-performance liquid chromatography (HPLC) analysis as a quality of control. Taken together, these results suggest that BJBDT is a potent angiogenesis inhibitor blocking the VEGF/VEGFR2 signaling pathway in HUVECs.