Relationship between sensory attributes and instrumental texture properties in meat analog patty system substituted with sweet potato stem

BACKGROUND

Understanding the relationship between the perceived sensory attributes and measurable instrumental properties is crucial for replicating the distinct textures of meat in plant-based meat analogs. In this study, plant-based patties composed of textured vegetable protein (TVP) and 10%, 20%, and 30% TVPs were substituted with fibers from the sweet potato stem (SPS), and their instrumental texture and sensory properties were evaluated.

RESULTS

Samples with 20% SPS showed hardness, cohesiveness, and chewiness, which are the mechanical indicators most similar to those of meat. A descriptive sensory analysis of ten trained participants indicated that the SPS-supplemented meat analog patties exhibited characteristics similar to pork patties in terms of firmness, toughness, cohesiveness, and smoothness compared to the TVP-only sample. A strong positive correlation between instrumental hardness and sensory firmness was observed (p < 0.01); however, cohesiveness, springiness, and chewiness did not show any correlation between instrumental and sensory analyses. The Warner-Bratzler shear force (WBSF) values showed positive correlations with sensory cohesiveness, chewiness, toughness, fibrousness, moistness, firmness, and springiness (p < 0.05).

CONCLUSION

The results demonstrated the feasibility of physically treated fibers from SPS as a partial substitute for TVP in developing meat analogs. Additionally, this study suggested that instrumental hardness and WBSF measurements can be sound parameters for representing sensory texture characteristics while further developing plant-based meat analogs. This article is protected by copyright. All rights reserved.

Characterization of yeast protein isolates extracted via high-pressure homogenization and pH shift: A promising protein source enriched with essential amino acids and branched-chain amino acids

In the global food industry, plant-based protein isolates are gaining prominence as an alternative to animal-based counterparts. However, their nutritional value often falters due to insufficient essential amino acids. To address this issue, our study introduces a sustainable protein isolate derived from yeast cells, achieved through high-pressure homogenization (HPH) and alkali pH-shifting treatment. Subjected to HPH pressures ranging from 60 to 120 MPa and 1 to 10 cycles, higher pressure and cycle numbers resulted in enhanced disruption of yeast cells. Combining HPH with alkali pH-shifting treatment significantly augmented protein extraction. Four cycles of HPH at 100 MPa yielded the optimized protein content, resulting in a yeast protein isolate (YPI) with 75.3 g protein per 100 g powder, including 30.0 g of essential amino acids and 18.4 g of branched-chain amino acids per 100 g protein. YPI exhibited superior water and oil-holding capacities compared to pea protein isolate, whey protein isolate (WPI), and soy protein isolate. Although YPI exhibited lower emulsifying ability than WPI, it excelled in stabilizing protein-stabilized emulsions. For foaming, YPI outperformed others in both foaming ability and stabilizing protein-based foam. In conclusion, YPI surpasses numerous plant-based protein alternatives in essential amino acids and branched-chain amino acids contents, positioning it as an excellent candidate for widespread utilization as a sustainable protein source in the food industry, owing to its exceptional nutritional advantages, as well as emulsifying and foaming properties. PRACTICAL APPLICATION: This study introduces a sustainable protein isolate derived from yeast cells. YPI exhibited considerable promise as a protein source. Nutritionally, YPI notably surpassed plant-based protein isolates in EAA and BCAA contents. Functionally, YPI demonstrated superior water-holding and oil-holding capacities, as well as an effective emulsion and foam stabilizer.

A label-free aptamer-based colorimetric biosensor for rapid gliadin detection in foods: a focus on pasta, bread and cookies

Despite numerous advancements in gluten detection, a substantial need remains for innovative, cost-effective, in situ methods that can be employed without complex analytical instruments. Addressing this demand, this study introduces a pioneering label-free colorimetric biosensor for the in situ detection of gliadin, a major component of gluten, which is a prevalent trigger of food allergies. Our novel approach employs the strategic coating of gold nanoparticles (AuNP) with gliadin-specific aptamers. In the absence of gliadin, these aptamers stably disperse AuNP, preventing their aggregation. However, upon the introduction of gliadin and in the presence of sodium chloride, AuNP aggregate, yielding a measurable colorimetric signal that facilitates the precise quantification of gliadin. Under rigorously optimized conditions, this AuNP/aptamer-based colorimetric biosensor demonstrated exceptional sensitivity and selectivity, with a detection limit of 32.1 ng mL-1 and a linear response range of 0-300 ng mL-1. Critically, the sensor maintained reliable performance when applied to real-world food samples, including gluten-free bread, cookies, and pasta. Due to its simplicity, selectivity, speed, and cost-effectiveness, this assay represents a significant advancement over current gluten detection methods. Moreover, the developed AuNP/aptamer-based colorimetric biosensor design holds promising potential for adaptation to detect other food allergens or protein toxins through selective aptamer modifications.

Citrus peel pectin and alginate-based emulgel particles for small intestine-targeted oral delivery of curcumin

Polysaccharides are a prominent choice in the realm of food-grade oral delivery systems due to their resistance to degradation by digestive enzymes in the oral, gastric, and small intestinal environments, as well as their ease of production, cost-effectiveness, and potential health benefits as prebiotics. Furthermore, their ability to respond to pH-induced dissolution, along with their emulsifying properties, can be strategically employed to achieve precise targeting of lipophilic bioactives to the small intestine. In this study, citrus peel pectin and alginate served as stabilizers for emulgel particles without supplementary emulsifiers or gelling agents. Within this system, pectin functioned as an emulsifier, while alginate acted as a gelling agent, facilitated by Ca2+-induced ionic crosslinking. The synergistic interplay between pectin and alginate efficiently protected curcumin in gastric conditions and controlled dissolution in the small intestine, depending on the pectin/alginate ratio. These controlled phenomena facilitated lipolysis, curcumin release, and ultimately enhanced curcumin bioaccessibility. Furthermore, once the emulgel particle released all the entrapped curcumin in the small intestine, residual polysaccharides underwent facile degradation by pectinase and alginate lyase, yielding fermentable monosaccharides. This confirms the potential of the emulgel particles for use as a prebiotic in the colon. These findings offer significant promise for enhancing the systematic design of food-grade delivery systems that encapsulate lipophilic bioactives, achieving controlled release, enhanced stability, and improved bioaccessibility. Importantly, this system can comprise components that undergo complete digestion, absorption, and utilization in the human body, encompassing materials such as oil, nutraceuticals, and prebiotics, all without presenting health risks.

The technical potential of a sous-vide processing method for developing high-moisture textured soy protein

This study explored the potential of sous-vide processing as a novel technique for transforming low-moisture textured soy protein (TSP) into a product with high moisture content and texture comparable to meat. We hypothesized that the sous-vide treatment would enable precise control of the TSP microstructure. In the ensuing process, the TSP maintained the moisture content at approximately 70% and changed color towards darker tones. Additionally, the porous microstructure changed, transitioning from a large to a smaller air layer. As the treatment continued, both the hardness and texturization index of the TSP were reduced. Furthermore, the secondary structure of the protein exhibited an increase in β-sheet and α-helix structures, indicating enhanced hydrogen bonds, hydrophobic interactions, and disulfide bonds. Optimally, a sample with 24 h at 90℃ displayed textural characteristics similar to chicken breast. The investigation underlines the sous-vide method as a revolutionary technique yielding high-moisture content and improved texture for TSP.

Retrograded octenylsuccinylated maize starch-based emulgels for a promising oral delivery system of curcumin

Emulgels are a type of soft solid delivery system that exploit the merits of both emulsions and gels, namely, bioactive encapsulability and structural stability, respectively. We utilized retrograded/octenylsuccinylated maize starch (ROMS) to fabricate the curcumin-loaded emulgel. Emulgels (oil volume fraction, 0.20) prepared with 1-4 % w/w ROMS exhibited fluid-like behaviors while emulgels with 5-8 % w/w ROMS exhibited a gel-like consistency. Compared to a fluidic emulsion stabilized with 3 % w/w octenylsuccinylated maize starch, the emulgels showed more sustained lipolysis and controlled curcumin release patterns. These results were attributed to rigid ROMS structures at the outer layer of oil droplets, hindering the lipase approach onto the oil/water interface and curcumin diffusion from the interface. Additionally, the bioaccessibility of curcumin in ROMS-stabilized emulgels was enhanced >9.6-fold compared to that of a curcumin solution. Furthermore, emulgels prepared with 8 % w/w ROMS exhibited a high yield stress (376.4 Pa) and maintained appearance and droplet size for 60 days of storage at 4 °C. Consequently, this emulgel has potential as a lipophilic bioactive-containing soft gel with sustained digestion and controlled release properties. Our findings may provide insights into rational delivery system designs.

Anti-inflammatory effects of Allium cepa L. peel extracts via inhibition of JAK-STAT pathway in LPS-stimulated RAW264.7 cells

ETHNOPHARMACOLOGICAL RELEVANCE

Allium cepa L. (A. cepa) is one of the oldest cultivated plants in the world. A. cepa has been used in traditional folk medicine to treat inflammatory disease in several regions, such as Palestine and Serbia. A. cepa peel has a higher content of flavonoids, such as quercetin, than the edible parts. These flavonoids alleviate inflammatory diseases. However, the anti-inflammatory effects of A. cepa peel extract-obtained using various extraction methods-and their underlying mechanisms require further investigation.

AIM OF THE STUDY

Although research to find safe anti-inflammatory substances in various natural products has been actively conducted for many years, it is important to continue identifying potential anti-inflammatory effects in natural materials. The purpose of this study was to investigate the ethnopharmacological properties of the A. cepa peel extract, whose efficacy when obtained through different extraction methods and underlying action mechanisms is not well known. The present study specifically aimed to observe the anti-inflammatory effects of the A. cepa peel extracts obtained using various extraction methods and the related detailed mechanisms of A. cepa peel extracts in lipopolysaccharide (LPS)-induced RAW264.7 cells.

MATERIALS AND METHODS

The total flavonoid content of the A. cepa peel extracts was determined the diethylene glycol colorimetric method and measured using a calibration curve prepared using quercetin as a standard solution. The antioxidant activity was evaluated using the ABTS assay, and cytotoxicity was measured using the MTT assay. NO production was measured using Griess reagent. Protein levels were measured by western blotting, and mRNA expression was measured by RT-qPCR. Secreted cytokines were analyzed using ELISA or cytokine arrays. In the GSE160086 dataset, we calculated Z-scores for individual genes of interest and displayed using a heat map.

RESULTS

Of the three A. cepa peel extracts obtained using different extraction methods, the A. cepa peel 50% EtOH extract (AP50E) was the most effective at inhibiting LPS-induced nitric oxide (NO) and inducible nitric oxide synthase (iNOS). Furthermore, AP50E significantly reduced the levels of pro-inflammation cytokines interleukin (IL)-1α, IL-1β, IL-6, and IL-27. Additionally, AP50E directly inhibited the Janus kinase-signaling transducer and activator of transcription (JAK-STAT) pathway.

CONCLUSIONS

These results showed that AP50E exhibited an anti-inflammatory effect in LPS-induced RAW264.7 mouse macrophages by directly inhibiting JAK-STAT signaling. Based on these findings, we propose AP50E as a potential candidate for the development of preventive or therapeutic agents against inflammatory diseases.

An observational, prospective, open label, multicenter study to evaluate the safety and effectiveness of pegfilgrastim as secondary prophylaxis to decrease the incidence of febrile neutropenia in Korean female patients with breast cancer

PURPOSE

Pegfilgrastim is a widely used long-acting granulocyte colony-stimulating factor (G-CSF) that prevents febrile neutropenia (FN) in patients with breast cancer receiving chemotherapy. This study aimed to evaluate the incidence of chemotherapy-related FN events and other adverse events (AEs) during chemotherapy in Korean patients with breast cancer treated with pegfilgrastim as secondary prophylactic support.

MATERIALS AND METHODS

This was a multicenter, open-label, prospective, observational study. A total of 1255 patients were enrolled from 43 institutions. The incidence of FN was evaluated as the primary endpoint. The secondary endpoints included (1) incidence of bone pain, (2) proportion of patients with a relative dose intensity (RDI) of ≥85%, and (3) proportion of patients with AE.

RESULTS

Pegfilgrastim administration reduced FN by 11.8-1.6%. The highest incidence of bone pain was observed at the time point of the 1st day after the administration and mild bone pain was the most common of all bone pain severity. The mean RDI was 98.5 ± 7.3%, and the proportion of the patients with and RDI≥85% was 96.9% (1169/1233). AEs were reported in 52.6% of the patients, and serious drug reactions occurred in only 0.7%.

CONCLUSION

The use of pegfilgrastim as secondary prophylaxis was effective and safe for preventing FN in patients with breast cancer who were treated with chemotherapy.

Imaging findings of granular cell tumours of the head and neck

AIM

To review the imaging characteristics of granular cell tumours in the head and neck and assess their associations with pathological findings.

MATERIALS AND METHODS

Eleven patients (10 [91%] women, mean age 43 years) with histopathologically confirmed granular cell tumours were included in this study. Preoperative imaging studies were performed, including computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound. The location of the tumours, their imaging features, and histopathological findings were analysed.

RESULTS

Among the 11 granular cell tumours, four (36%), three (27%), and two (18%) tumours were found in the submucosal layer, subcutaneous layer, and intramuscular area, respectively. On CT, all tumours exhibited homogeneous iso-attenuating enhancement compared with adjacent muscle, and nine out of the 11 tumours (81%) demonstrated well-defined margins. On T2-weighted imaging (T2WI), four out of five tumours (80%) demonstrated iso-signal intensity compared with adjacent muscles, and four tumours (80%) exhibited homogeneous signal intensity. The apparent diffusion coefficient (ADC) values ranged from 0.68-0.81 × 10-3 mm2/s. Histopathological examination revealed densely packed tumour cells with variable amounts of fibrous stroma.

CONCLUSION

Granular cell tumours were characterised by well-defined and iso-signals on T2WI and low mean ADC values, and were predominantly located in the submucosal, subcutaneous, or intramuscular areas in middle-aged women. The characteristic locations, demographic characteristics, and imaging findings can help to differentiate granular cell tumours from other soft-tissue tumours in the head and neck.

Ion trap and release dynamics enables nonintrusive tactile augmentation in monolithic sensory neuron

An iontronic-based artificial tactile nerve is a promising technology for emulating the tactile recognition and learning of human skin with low power consumption. However, its weak tactile memory and complex integration structure remain challenging. We present an ion trap and release dynamics (iTRD)-driven, neuro-inspired monolithic artificial tactile neuron (NeuroMAT) that can achieve tactile perception and memory consolidation in a single device. Through the tactile-driven release of ions initially trapped within iTRD-iongel, NeuroMAT only generates nonintrusive synaptic memory signals when mechanical stress is applied under voltage stimulation. The induced tactile memory is augmented by auxiliary voltage pulses independent of tactile sensing signals. We integrate NeuroMAT with an anthropomorphic robotic hand system to imitate memory-based human motion; the robust tactile memory of NeuroMAT enables the hand to consistently perform reliable gripping motion.

Postoperative peritoneal inflammatory granuloma mimicking peritoneal metastasis in a patient with breast cancer: a case report

Peritoneal metastasis from breast cancer is a relatively rare life-threatening condition. The gold standard for diagnosing peritoneal metastasis is a direct peritoneal biopsy. In this report, we describe an interesting case of peritoneal inflammation mimicking peritoneal metastasis in a patient with breast cancer, as confirmed by laparoscopic peritoneal biopsy. A 45-year-old woman with a history of right breast cancer presented with a peritoneal wall mass seen on an abdominal computed tomography (CT) in routine follow-up. She underwent right skin-sparing mastectomy with sentinel lymph node biopsy with direct to implant reconstruction 6 years prior and underwent right salpingo-oophorectomy 2 years before. Positron emission tomography-computed tomography (PET-CT) and abdominopelvic CT showed multiple enhancing nodules in small bowel mesentery and right peritoneal wall with a small amount of ascites, which led to a strong suspicion of peritoneal metastasis. After a multidisciplinary conference, the possibility of peritoneal seeding became doubtful. Laparoscopic biopsy was performed, and peritoneal wall mass biopsy was subsequently performed. Pathologic results showed no evidence of peritoneal metastasis of breast cancer. The peritoneal biopsy specimen revealed postoperative fibrosis and inflammation with some meal content. Although rare in breast cancer, peritoneal metastasis can produce a devastating outcome if left undiagnosed. Despite the imaging findings strongly suggesting metastasis, biopsy confirmation for the suspected lesion was necessary. This not only verifies true metastasis but also determines the treatment options available for the patient and thus unnecessary treatment can be avoided.

StemRegenin-1 Attenuates Endothelial Progenitor Cell Senescence by Regulating the AhR Pathway-Mediated CYP1A1 and ROS Generation

Endothelial progenitor cell (EPC)-based stem cell therapy is a promising therapeutic strategy for vascular diseases. However, continuous in vitro expansion for clinical studies induces the loss of EPC functionality due to aging. In this study, we investigated the effects of StemRegenin-1 (SR-1), an antagonist of aryl hydrocarbon receptor (AhR), on replicative senescence in EPCs. We found that SR-1 maintained the expression of EPC surface markers, including stem cell markers, such as CD34, c-Kit, and CXCR4. Moreover, SR-1 long-term-treated EPCs preserved their characteristics. Subsequently, we demonstrated that SR-1 showed that aging phenotypes were reduced through senescence-associated phenotypes, such as β-galactosidase activity, SMP30, p21, p53, and senescence-associated secretory phenotype (SASP). SR-1 treatment also increased the proliferation, migration, and tube-forming capacity of senescent EPCs. SR-1 inhibited the AhR-mediated cytochrome P450 (CYP)1A1 expression, reactive-oxygen species (ROS) production, and DNA damage under oxidative stress conditions in EPCs. Furthermore, as a result of CYP1A1-induced ROS inhibition, it was found that accumulated intracellular ROS were decreased in senescent EPCs. Finally, an in vivo Matrigel plug assay demonstrated drastically enhanced blood vessel formation via SR-1-treated EPCs. In summary, our results suggest that SR-1 contributes to the protection of EPCs against cellular senescence.

Phase II study of a trastuzumab biosimilar in combination with paclitaxel for HER2-positive recurrent or metastatic urothelial carcinoma: KCSG GU18-18

BACKGROUND

Human epidermal growth factor receptor 2 (HER2) is a widely explored therapeutic target in solid tumors. We evaluated the efficacy and safety of trastuzumab-pkrb, a biosimilar of trastuzumab, in combination with paclitaxel, in HER2-positive recurrent or metastatic urothelial carcinoma (UC).

PATIENTS AND METHODS

We enrolled 27 patients; they were administered a loading dose of 8 mg/kg trastuzumab-pkrb on day 1, followed by 6 mg/kg and 175 mg/m2 paclitaxel on day 1 every 3 weeks, intravenously. All patients received six cycles of the combination treatment and continued to receive trastuzumab-pkrb maintenance until disease progression, unacceptable toxicity, or for up to 2 years. HER2 positivity (based on immunohistochemistry analysis) was determined according to the 2013 American Society of Clinical Oncology /College of American Pathologists HER2 testing guidelines. The primary endpoint was objective response rate (ORR); the secondary endpoints were overall survival (OS), progression-free survival (PFS), and safety.

RESULTS

Twenty-six patients were evaluated via primary endpoint analysis. The ORR was 48.1% (1 complete and 12 partial responses) and the duration of response was 6.9 months [95% confidence interval (CI) 4.4-9.3 months]. With a median follow-up of 10.5 months, the median PFS and OS were 8.4 months (95% CI 6.2-8.8 months) and 13.5 months (95% CI 9.8 months-not reached), respectively. The most common treatment-related adverse event (TRAE) of any grade was peripheral neuropathy (88.9%). The most common grade 3/4 TRAEs were neutropenia (25.9%), thrombocytopenia (7.4%), and anemia (7.4%).

CONCLUSIONS

Trastuzumab-pkrb plus paclitaxel demonstrates promising efficacy with manageable toxicity profiles in patients with HER2-positive recurrent or metastatic UC.

Image findings of anti-neutrophil cytoplasmic antibody-associated vasculitis involving the skull base

AIM

To investigate computed tomography (CT) and magnetic resonance imaging (MRI) features of skull bases involving anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV).

MATERIALS AND METHODS

A retrospective review was undertaken to identify an institutional historical cohort of 17 patients with confirmed AAV who underwent CT or MRI and had skull base involvement between 2002 and 2021. Two radiologists reviewed the extent and features of the lesions, bone changes, and other MRI findings.

RESULTS

A total of 17 patients (12 men; mean age ± standard deviation, 46.5 ± 17.1 years) were selected. AAV presented as infiltrative lesions with involvement at various sites. Most cases involved the paranasal sinuses (PNS; 88%, 15/17), nasopharynx (88%, 15/17), pterygopalatine fossa (82%, 14/17), and parapharyngeal space (82%, 14/17), frequently accompanied by mucosal irregularity of the PNS and nasopharynx (71%, 12/17). Central skull base and temporal bone involvement were seen in 53% (9/17) and 38% (6/16) of cases, respectively. On T1-weighted imaging (WI) and T2WI MRI, all lesions (15/15) showed predominant signal iso-intensity to grey matter.

CONCLUSIONS

Although radiological findings of AAV are non-specific and skull base involvement is less common, AAV may be considered if infiltrative lesions predominantly involving the PNS, nasopharynx, pterygopalatine fossa, and parapharyngeal space with combined bone changes of skull base are seen.

The Protective Role of Glutathione against Doxorubicin-Induced Cardiotoxicity in Human Cardiac Progenitor Cells

This study investigated the protective effect of glutathione (GSH), an antioxidant drug, against doxorubicin (DOX)-induced cardiotoxicity. Human cardiac progenitor cells (hCPCs) treated with DOX (250 to 500 nM) showed increased viability and reduced ROS generation and apoptosis with GSH treatment (0.1 to 1 mM) for 24 h. In contrast to the 500 nM DOX group, pERK levels were restored in the group co-treated with GSH and suppression of ERK signaling improved hCPCs' survival. Similarly to the previous results, the reduced potency of hCPCs in the 100 nM DOX group, which did not affect cell viability, was ameliorated by co-treatment with GSH (0.1 to 1 mM). Furthermore, GSH was protected against DOX-induced cardiotoxicity in the in vivo model (DOX 20 mg/kg, GSH 100 mg/kg). These results suggest that GSH is a potential therapeutic strategy for DOX-induced cardiotoxicity, which performs its function via ROS reduction and pERK signal regulation.

Physically defined long-term and short-term synapses for the development of reconfigurable analog-type operators capable of performing health care tasks

Extracting valuable information from the overflowing data is a critical yet challenging task. Dealing with high volumes of biometric data, which are often unstructured, nonstatic, and ambiguous, requires extensive computer resources and data specialists. Emerging neuromorphic computing technologies that mimic the data processing properties of biological neural networks offer a promising solution for handling overflowing data. Here, the development of an electrolyte-gated organic transistor featuring a selective transition from short-term to long-term plasticity of the biological synapse is presented. The memory behaviors of the synaptic device were precisely modulated by restricting ion penetration through an organic channel via photochemical reactions of the cross-linking molecules. Furthermore, the applicability of the memory-controlled synaptic device was verified by constructing a reconfigurable synaptic logic gate for implementing a medical algorithm without further weight-update process. Last, the presented neuromorphic device demonstrated feasibility to handle biometric information with various update periods and perform health care tasks.

Impact of Atrial Fibrillation on Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI): The K-TAVI Registry

PURPOSE

The incidence and prognostic implications of atrial fibrillation (AF) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) are controversial, especially for Korean patients. Furthermore, the pattern of antithrombotic therapy for these patients is unknown. The present study sought to identify the impact of AF on Korean patients undergoing TAVI and demonstrate the status of antithrombotic therapy for these patients.

MATERIALS AND METHODS

A total of 660 patients who underwent TAVI for severe AS were recruited from the nationwide K-TAVI registry in Korea. The enrolled patients were stratified into sinus rhythm (SR) and AF groups. The primary endpoint was all-cause death at 1-year.

RESULTS

AF was recorded in 135 patients [pre-existing AF 108 (16.4%) and new-onset AF 27 (4.1%)]. The rate of all-cause death at 1 year was significantly higher in patients with AF than in those with SR [16.2% vs. 6.4%, adjusted hazard ratio (HR): 2.207, 95% confidence interval (CI): 1.182-4.120, p=0.013], regardless of the onset timing of AF. The rate of new pacemaker insertion at 1 year was also significantly higher in patients with AF than in those with SR (14.0% vs. 5.5%, adjusted HR: 3.137, 95%CI: 1.621-6.071, p=0.001). Among AF patients, substantial number of patients received the combination of multiple antithrombotic agents (77.8%), and the most common combination was that of aspirin and clopidogrel (38.1%).

CONCLUSION

AF was an independent predictor of 1-year mortality and new pacemaker insertion in Korean patients undergoing TAVI.

Breast Cancer Statistics in Korea, 2019

This article provides an annual update of Korean breast cancer statistics, including the incidence, tumor stage, type of surgical treatment, and mortality. The data was collected from the Korean Breast Cancer Society registry system and Korean Central Cancer Registry. In 2019, 29,729 women were newly diagnosed with breast cancer. Breast cancer has continued to increase in incidence since 2002 and been the most common cancer in Korean women since 2019. Of the newly diagnosed cases in 2019, 24,820 (83.5%) were of invasive carcinomas, and 4,909 (16.5%) were of carcinoma in situ. The median age of women with breast cancer was 52.8 years, and breast cancer was most commonly diagnosed in the age group of 40-49 years. The number of patients who have undergone breast conserving surgery has continued to increase since 2016, with 68.6% of patients undergoing breast conserving surgery in 2019. The incidence of early-stage breast cancer continues to increase, with stage 0 or I breast cancer accounting for 61.6% of cases. The most common subtype of breast cancer is the hormone receptor-positive human epidermal growth factor receptor 2-negative subtype (63.1%). The 5-year relative survival rate of patients with breast cancer from 2015 to 2019 was 93.6%, with an increase of 14.3% compared to that from 1993 to 1995. This report improves our understanding of breast cancer characteristics in South Korea.

Immediate versus staged complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: results from a prematurely discontinued randomized multicenter trial

BACKGROUND

We aimed to compare clinical outcomes between immediate and staged complete revascularization in primary percutaneous coronary intervention (PCI) for treating ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD).

METHODS

A total of 248 patients were enrolled in a prospective, randomized, and multicenter registry. Immediate revascularization was defined as one-time PCI of culprit and non-culprit lesions at the initial procedure. Staged revascularization was defined as PCI of non-culprit lesions at a later date (mean, 4.4 days; interquartile range, 1-11.4), following initial culprit revascularization. The end points were major adverse cardiovascular events (MACE; composite of total death, recurrent myocardial infarction, and revascularization), any individual components of MACE, cardiac death, stent thrombosis, and stroke at 12 months.

RESULTS

During a follow-up of 1 year, MACE occurred in 12 patients (11.6%) in the immediate revascularization group and in 8 patients (7.5%) in staged revascularization group (hazard ratio [HR] 1.60, 95% confidence interval [CI] 0.65-3.91). The incidence of total death was numerically higher in the immediate group than in the staged group (9.7% vs 2.8%, HR 3.53, 95% CI 0.97-12.84); There were no significant differences between the 2 groups in risks of any individual component of MACE, cardiac death, stroke, and in-hospital complications, such as need for transfusion, bleeding, acute renal failure, and acute heart failure. This study was prematurely terminated due to halt of production of everolimus-eluting stents (manufactured as PROMUS Element by Boston Scientific, Natick, Massachusetts).

CONCLUSIONS

Due to its limited power, no definite conclusion can be drawn regarding complete revascularization strategy from the present study. Further large randomized clinical trials would be warranted to confirm optimal timing of complete revascularization for patients with STEMI and MVD.

Degradation phenomena of quantum dot light-emitting diodes induced by high electric field

Quantum dots possess exceptional optoelectronic properties, such as narrow bandwidth, controllable wavelength, and compatibility with solution-based processing. However, for efficient and stable operation in electroluminescence mode, several issues require resolution. Particularly, as device dimensions decrease, a higher electric field may be applied through next-generation quantum dot light-emitting diode (QLED) devices, which could further degrade the device. In this study, we conduct a systematic analysis of the degradation phenomena of a QLED device induced by a high electric field, using scanning probe microscopy (SPM) and transmission electron microscopy (TEM). We apply a local high electric field to the surface of a QLED device using an atomic force microscopy (AFM) tip, and we investigate changes in morphology and work function in the Kelvin probe force microscopy mode. After the SPM experiments, we perform TEM measurements on the same degraded sample area affected by the electric field of the AFM tip. The results indicate that a QLED device could be mechanically degraded by a high electric field, and work function changes significantly in degraded areas. In addition, the TEM measurements reveal that In ions migrate from the indium tin oxide (ITO) bottom electrode to the top of the QLED device. The ITO bottom electrode also deforms significantly, which could induce work function variation. The systematic approach adopted in this study can provide a suitable methodology for investigating the degradation phenomena of various optoelectronic devices.

Safety and Efficacy of Everolimus-Eluting Bioresorbable Vascular Scaffold Versus Second-Generation Drug-Eluting Stents in Real-World Practice

BACKGROUND

The risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance.

METHODS

The SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patient-oriented composite outcome (POCO) at 2 years.

RESULTS

Patient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group. Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel. Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487-3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663-3.012, P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups.

CONCLUSION

With meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02601404, NCT04265443.

A feasibility study on deep-neural-network-based dose-neutral dual-energy digital breast tomosynthesis

BACKGROUND

Diagnostic performance based on x-ray breast imaging is subject to breast density. Although digital breast tomosynthesis (DBT) is reported to outperform conventional mammography in denser breasts, mass detection and malignancy characterization are often considered challenging yet.

PURPOSE

As an improved diagnostic solution to the dense breast cases, we propose a dual-energy DBT imaging technique that enables breast compositional imaging at comparable scanning time and patient dose compared to the conventional single-energy DBT.

METHODS

The proposed dual-energy DBT acquires projection data by alternating two different energy spectra. Then, we synthesize unmeasured projection data using a deep neural network that exploits the measured projection data and adjacent projection data obtained under the other x-ray energy spectrum. For material decomposition, we estimate partial path lengths of an x-ray through water, lipid, and protein from the measured and the synthesized projection data with the object thickness information. After material decomposition in the projection domain, we reconstruct material-selective DBT images. The deep neural network is trained with the numerical breast phantoms. A pork meat phantom is scanned with a prototype dual-energy DBT system to demonstrate the feasibility of the proposed imaging method.

RESULTS

The developed deep neural network successfully synthesized missing projections. Material-selective images reconstructed from the synthesized data present comparable compositional contrast of the cancerous masses compared with those from the fully measured data.

CONCLUSIONS

The proposed dual-energy DBT scheme is expected to substantially contribute to enhancing mass malignancy detection accuracy particularly in dense breasts.

Reducing the production of acrylamide during the roasting of balloon flower roots in consumer appliances and industrial equipment

This study aimed to determine what conditions were needed to reduce the production of acrylamide when balloon flower roots [Platycodon grandiflorum (Jacq. A. DC.)] were heated. The conditions of temperature, time, and the type of equipment (i.e., consumer appliance or industrial equipment) were the important variables in the experiment. The official criterion for a recommended standard of acrylamide in tea product is less than 1000 µg/kg as determined by the Ministry of Food and Drug Safety in South Korea. A response surface methodology was used to determine whether the heated samples met the safety requirements. The most significant condition for consumer appliances was time and for industrial equipment was temperature. The optimal roasting time was 3.01 min with a consumer appliance and 4.18 min with industrial equipment at 110 ℃, a typical temperature in the field. The acrylamide content of the tested sample was significantly in agreement with the predicted amount (R ² > 0.950).

Supplementary Information

The online version contains supplementary material available at 10.1007/s10068-023-01242-z.

Development of flaxseed gum/konjac glucomannan with agar as gelling agents with enhanced elastic properties

In this study, a natural-based gelling agent comprised of blended flax seed gum (FSG), konjac glucomannan (KG), and agar gel (AG) was developed for application to control the textural properties of foods. The compound gels, including FSG, KG, and AG, were investigated to determine their moisture affinity, including minimum gelling concentration, water binding capacity, water soluble index, and swelling power. In addition, we analyzed the rheological properties of the compound gel through texture analysis, frequency sweep, and creep and recovery. The microstructure of the compound gel was identified and compared with the viscoelastic properties of the gel. Overall, these results showed that the F4K6 (4:6:2 of FSG:KG:AG) could serve as an excellent gelling agent, which endowed food gel with the promoted elastic properties, water capacity, and rigid surface morphology. This work suggests that novel gelling agents, including FSG, KGM, and AG, successfully prepared food gels with improved physicochemical properties.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10068-022-01179-9.

Assessment of clinical outcomes after reduction of depressed calcaneal fractures using the push-out molding technique

Introduction

As minimal invasive techniques for depressed calcaneal fracture treatment have become more common, great progress has been achieved with various surgical methods. While these techniques are still currently utilized, new methods have been developed. This study aimed to report the radiologic and clinical outcomes of depressed calcaneal fracture treatment with the "push-out molding" technique and to propose its clinical utility.

Materials and methods

From March 2009 to October 2020, a retrospective study was conducted with 52 patients, who received the "push-out molding" technique to treat depressed intra-articular calcaneal fractures (Sanders type II, III, IV). Exclusion criteria were as follows: patients with bilateral calcaneal fractures, open fractures, and a follow-up period <12 months. Radiologic parameters were assessed at following periods: preoperative, postoperative, 3-month follow-up, and last follow-up. Limitation of range of motion (ROM), subjective satisfaction, and complications were assessed at the last follow-up period. Repeated measures ANOVA was used to analyze values at preoperative, postoperative, 3-month, and last follow-up periods.

Results

Significant differences in the talo-calcaneal angle (p < 0.001), Böhler's angle (p=<0.001), Gissane's angle (p = 0.023), distance from the lower cortical border of calcaneus to the anterior (p=<0.001) and posterior (p=<0.001) points of posterior articular surface, calcaneal length (p = 0.019), and talo-calcaneal height (p=<0.001). Postoperatively, the posterior articular surface was well maintained, while 21.2% retained a ROM limitation by 20° or higher. Subjective satisfaction was as follows: excellent (42.3%), good (48.1%), fair (9.6%), and poor (0%).

Conclusion

The "push-out molding" is a simple technique with the advantage of not requiring much force to treat depressed calcaneal fractures. It can be used as a beneficial surgical technique with minimal damage to the soft tissue, owing to the reduction from the depressed interior part and less severe ROM limitation.

Humanlike spontaneous motion coordination of robotic fingers through spatial multi-input spike signal multiplexing

With advances in robotic technology, the complexity of control of robot has been increasing owing to fundamental signal bottlenecks and limited expressible logic state of the von Neumann architecture. Here, we demonstrate coordinated movement by a fully parallel-processable synaptic array with reduced control complexity. The synaptic array was fabricated by connecting eight ion-gel-based synaptic transistors to an ion gel dielectric. Parallel signal processing and multi-actuation control could be achieved by modulating the ionic movement. Through the integration of the synaptic array and a robotic hand, coordinated movement of the fingers was achieved with reduced control complexity by exploiting the advantages of parallel multiplexing and analog logic. The proposed synaptic control system provides considerable scope for the advancement of robotic control systems.

Multiplexed Complementary Signal Transmission for a Self-Regulating Artificial Nervous System

Neuromorphic engineering has emerged as a promising research field that can enable efficient and sophisticated signal transmission by mimicking the biological nervous system. This paper presents an artificial nervous system capable of facile self-regulation via multiplexed complementary signals. Based on the tunable nature of the Schottky barrier of a complementary signal integration circuit, a pair of complementary signals is successfully integrated to realize efficient signal transmission. As a proof of concept, a feedback-based blood glucose level control system is constructed by incorporating a glucose/insulin sensor, a complementary signal integration circuit, an artificial synapse, and an artificial neuron circuit. Certain amounts of glucose and insulin in the initial state are detected by each sensor and reflected as positive and negative amplitudes of the multiplexed presynaptic pulses, respectively. Subsequently, the pulses are converted to postsynaptic current, which triggered the injection of glucose or insulin in a way that confined the glucose level to a desirable range. The proposed artificial nervous system demonstrates the notable potential of practical advances in complementary control engineering.

Sex-related impact on clinical outcomes of patients treated with drug-eluting stents according to clinical presentation: Patient-level pooled analysis from the GRAND-DES registry

BACKGROUND

The contribution of sex and initial clinical presentation to the long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated.

METHODS

Individual patient data from 5 Korean-multicenter drug-eluting stent (DES) registries (The GRAND-DES) were pooled. A total of 17,286 patients completed 3-year follow-up (5216 women and 12,070 men). The median follow-up duration was 1125 days (interquartile range 1097-1140 days), and the primary endpoint was cardiac death at 3 years.

RESULTS

The clinical indication for PCI was stable angina pectoris (SAP) in 36.8%, unstable angina pectoris (UAP) or non-ST-segment elevation myocardial infarction (NSTEMI) in 47.4%, and ST-segment elevation myocardial (STEMI) in 15.8%. In all groups, women were older and had a higher proportion of hypertension and diabetes mellitus compared with men. Women presenting with STEMI were older than women with SAP, with the opposite seen in men. There was no sex difference in cardiac death for SAP or UAP/NSTEMI. In STEMI patients, the incidence of cardiac death (7.9% vs. 4.4%, p = 0.001), all-cause mortality (11.1% vs. 6.9%, p = 0.001), and minor bleeding (2.2% vs. 1.2%, p = 0.043) was significantly higher in women. After multivariable adjustment, cardiac death was lower in women for UAP/NSTEMI (HR 0.69, 95% CI 0.53-0.89, p = 0.005), while it was similar for STEMI (HR 0.97, 95% CI 0.65-1.44, p = 0.884).

CONCLUSIONS

There was no sex difference in cardiac death after PCI with DES for SAP and UAP/NSTEMI patients. In STEMI patients, women had worse outcomes compared with men; however, after the adjustment of confounders, female sex was not an independent predictor of mortality.

BioMatrix Versus Orsiro Stents for Coronary Artery Disease: A Multicenter, Randomized, Open-Label Study

BACKGROUND

Comparative studies of ultrathin-strut biodegradable polymer sirolimus-eluting stent (BP-SES) have reported promising results and validated its excellent outcomes in terms of safety and efficacy. However, there are limited studies comparing BP drug-eluting stents with struts of different thicknesses. We compared the long-term clinical outcomes of patients treated with an ultrathin-strut BP-SES or a thick-strut biodegradable polymer biolimus-eluting stent (BP-BES).

METHODS

The BIODEGRADE trial (Biomatrix and Orsiro Drug-Eluting Stents in Angiographic Result in Patients With Coronary Artery Disease) is a multicenter prospective randomized study comparing coronary revascularization in patients with ultrathin-strut BP-SES and thick-strut BP-BES with the primary end point of target lesion failure at 18 months posttreatment. We performed the prespecified analysis of 3-year clinical outcomes.

RESULTS

In total, 2341 patients were randomized to receive treatment with ultrathin-strut BP-SES (N=1175) or thick-strut BP-BES (N=1166). The 3-year incidence rate of target lesion failure was 3.2% for BP-SES and 5.1% for BP-BES (P=0.023). The difference was primarily due to differences in ischemia-driven target lesion revascularization (BP-SES, 1.5%; BP-BES, 2.8%; P=0.035) between groups. A landmark analysis of the late follow-up period showed significant differences in target lesion failure, with outcomes being better in BP-SES. Cardiac death and target lesion revascularization were significantly lower in the BP-SES group.

CONCLUSIONS

In a large, randomized trial, the long-term clinical outcome of target lesion failure at 3 years was significantly better among patients treated with the ultrathin-strut BP-SES. The results indicate the superiority of the ultrathin-strut BP-SES compared with the thick-strut BP-BES.

REGISTRATION

URL: https://clinicaltrials.gov; Unique identifier: NCT02299011.

Epidemiology of Second Non-breast Primary Cancers among Survivors of Breast Cancer: A Korean Population-based Study by the SMARTSHIP group

Purpose

To evaluate the incidence and prognosis of second non-breast primary cancer (SNBPC) among Korean survivors of breast cancer.

Materials and Methods

Data from the Korean National Health Insurance Service were searched to identify women who received curative surgery for initial breast cancer (IBC) between 2003 and 2008 (n=64,340). Among them, patients with the following characteristics were excluded: other cancer diagnosis before IBC (n=10,866), radiotherapy before IBC (n=349), absence of data on sex or age (n=371), or male (n=248). Accordingly, data of 52,506 women until December, 2017 were analyzed. SNBPC was defined as a newly diagnosed SNBPC that occurred five years or more after IBC diagnosis.

Results

The median follow-up time of all patients was 12.13 years. SNBPC was developed in 3,084 (5.87%) women after a median 7.61 years following IBC diagnosis. The 10-year incidence of SNBPC was 5.78% (95% CI, 5.56-6.00). Higher SNBPC incidence was found in survivors with the following factors: old age at IBC diagnosis, low household income, and receiving combined chemotherapy with endocrine therapy, whereas receiving radiotherapy was related to a lower incidence of SNBPC (hazard ratio = 0.89, p<0.01). Among the patients with SNBPC, the 5-year survival rate was 62.28% (95% CI, 65.53-69.02).

Conclusion

Approximately 5% of breast cancer survivors developed SNBPC within 10 years after IBC diagnosis. The risk of SNBPC was associated with patient's age at IBC diagnosis, income level, and a receipt of systemic treatments.

Effect of the physical fibrillated sweet potato (Ipomoea batatas) stem on the plant-based patty analogues

In this study, a dietary fiber extracted from sweet potato stems (Ipomoea batatas, PS) was evaluated for its ability to improve the quality of vegetable patty analogues. A patty analogues containing 0-50 wt% dietary fiber were prepared to analyze the utilized dietary fiber's performance. To evaluate the manufactured patty analogues, texture profile analysis, color analysis, emulsion stability, and microstructural analysis were conducted. As the PS increased, the hardness decreased, while the total expressible fluids tended to increase. The color analysis revealed that the a* value, which represents red, declined as the PS content increased, and heterogeneous colors showed at least 40 wt% of PS. According to the microstructural analysis, PS is a structure in which massive fiber bundles are integrated between textured vegetable protein networks, which is believed to have given the patty analogue soft characteristics. The findings of this study can serve as a foundation for future research into the application of carbohydrates to plant-based meat analogues.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10068-022-01211-y.

A Wide Bandgap Halide Perovskite Based Self-Powered Blue Photodetector with 84.9% of External Quantum Efficiency

A self-powered, color-filter-free blue photodetector (PD) based on halide perovskites is reported. A high external quantum efficiency (EQE) of 84.9%, which is the highest reported EQE in blue PDs, is achieved by engineering the A-site monovalent cations of wide-bandgap perovskites. The optimized composition of formamidinium (FA)/methylammonium (MA) increases the heat of formation, yielding a uniform and smooth film. The incorporation of Cs⁺ ions into the FA/MA composition suppresses the trap density and increases charge-carrier mobility, yielding the highest average EQE of 77.4%, responsivity of 0.280 A W^-1 , and detectivity of 5.08 × 10¹² Jones under blue light. Furthermore, Cs⁺ improves durability under repetitive operations and ambient atmosphere. The proposed device exhibits peak responsivity of 0.307 A W^-1 , which is higher than that of the commercial InGaN-based blue PD (0.289 A W^-1 ). This study will promote the development of next-generation image sensors with vertically stacked perovskite PDs.

Distant migration of gel filler: imaging findings following breast augmentation

Recently, many attempts have been made to use injectable materials in the subcutaneous fat layer anywhere in the body, including the breast and face, for cosmetic purposes. A 56-year-old woman presented with multiple palpable lumps without tenderness or skin color changes on the anterior and lateral chest and the abdominal walls. Magnetic resonance imaging showed fluid-like collections without surrounding soft tissue inflammatory changes in the chest wall, abdominal wall, and deeper within the abdomen. The lesions penetrated the peritoneum and were observed adjacent to the liver dome. Ultrasonography also showed hypoechogenicity suggestive of fluid collection in the left axilla and trunk. The differential diagnosis based on radiologic findings included parasite manifestation, non-specific inflammatory conditions, and chronic granulomatous infections such as tuberculosis or non-tuberculous mycobacterial infections. However, these conditions are usually accompanied by changes in the adjacent subcutaneous fat layers, but our patient did not show any other abnormalities in the adjacent soft tissue. After biopsy and aspiration analysis, the patient was found to have a history of filler injection for breast augmentation approximately 17 years prior. It is often difficult to make a differential diagnosis without detailed knowledge of the patient's medical history. Here we describe a rare case of distant migration of the filler to the axilla, chest wall, abdominal wall, and peritoneum following breast augmentation with filler injection. Knowledge of the radiologic characteristics and migration patterns of gel fillers and their related complications is useful for making an accurate diagnosis.

Augmented risk of ischemic stroke in hypertrophic cardiomyopathy patients without documented atrial fibrillation

Background

Ischemic stroke is a common complication in patients with hypertrophic cardiomyopathy (HCM) (1). Although atrial fibrillation (AF) is a well-established risk factor for ischemic stroke in HCM, the risk of ischemic stroke in patients with HCM without documented AF is less recognized (1, 2). This study aimed to determine the risk of ischemic stroke and identify its risk factors in patients with HCM without documented AF.

Methods

This nationwide population-based cohort study used the Korean National Health Insurance database. After excluding patients with a prior history of AF, thromboembolic events, cancer, or the use of anticoagulants, we identified 8,328 HCM patients without documented AF and 1:2 propensity score-matched 16,656 non-HCM controls. The clinical outcome was an incident ischemic stroke.

Results

During a mean follow-up of approximately 6 years, ischemic stroke occurred in 328/8,328 (3.9%) patients with HCM and 443/16,656 (2.7%) controls. Among individuals who developed ischemic stroke, the proportion of AF concomitantly detected accounted for 26.5% (87/328) and 5.8% (26/443) in the HCM and control groups, respectively. The overall incidence of ischemic stroke was 0.716/100 person-years in the HCM group, which was significantly higher than that in the control group (0.44/100 person-years) (HR 1.643; 95% CI, 1.424–1.895; P&lt;0.001, Figure 1). The subgroup analysis according to age, sex, and comorbidities (chronic heart failure, hypertension, dyslipidemia, and vascular disease) consistently demonstrated a higher risk of ischemic stroke in the HCM group (P for interaction &gt;0.05). In the HCM group, age ≥65 years (adjusted hazard ratio [HR] 2.741; 95% confidence interval [CI], 2.156–3.486; P&lt;0.001) and chronic heart failure (adjusted HR 1.748; 95% CI, 1.101–2.745; P=0.018) were independent risk factors for ischemic stroke. Overall incidence was 1.360/100 in patients with HCM aged ≥65 and 2.315/100 person-years years in those with chronic heart failure, respectively. Also, compared to controls aged &lt;65 years and without CHF, adjusted HR for ischemic stroke was 4.756 (95% CI 3.807–5.867) in patients with HCM aged ≥65 years and 2.539 (95% CI 1.638–3.936) in those with CHF, respectively (Figure 2).

Conclusions

Patients with HCM without documented AF are at a higher risk of ischemic stroke than the propensity score-matched general population. Age ≥65 years and chronic heart failure are two strong independent risk factors for ischemic stroke in this population.

Funding Acknowledgement

Type of funding sources: None.

Sodium-glucose co-transporter-2 inhibitors after acute myocardial infarction in type 2 diabetes patients: a population-based investigation from South Korea

Background

Whether the early use of sodium-glucose co-transporter-2 (SGLT2) inhibitors has cardioprotective effects following acute myocardial infarction (AMI) is unknown.

Purpose

We aimed to evaluate the association between the early initiation of SGLT2 inhibitors and cardiac event rates in diabetes patients with AMI undergoing percutaneous coronary intervention (PCI).

Methods

Based on the National Health Insurance claims data in South Korea, patients aged 18 years or older who had undergone PCI for the diagnosis of AMI between 2014 and 2018 were analyzed. Patients treated with SGLT2 inhibitors or other glucose-lowering drugs were matched based on a propensity score. The primary endpoint was a composite of all-cause mortality and hospitalizations for heart failure (HF). Major adverse cardiac events (MACE; a composite of all-cause death, non-fatal MI, and ischemic stroke) were compared as the secondary endpoint.

Results

After 1:2 propensity score matching, a total of 26,814 patients were assigned to the SGLT2 inhibitors group (938 patients) and the no use of SGLT2 inhibitors group (1,876 patients), respectively. During a median follow-up of 2.1 years, compared to no use of SGLT2 inhibitors, the early use of SGLT2 inhibitors was associated with lower risks of both the primary endpoint (9.8% vs. 13.9%, adjusted hazard ratio [HR] = 0.68, 95% confidence interval [CI]: 0.54 to 0.87, p=0.002) and secondary endpoint (9.1% vs. 11.6%, adjusted HR = 0.77, 95% CI: 0.60 to 0.99, p=0.04) (Figure 1). All-cause mortality and hospitalizations for HF were significantly lower in the early use of SLGT2 inhibitors group (adjusted HR = 0.55; 95% CI: 0.37 to 0.80; p=0.002; and HR = 0.74; 95% CI: 0.56 to 0.98; p=0.03, respectively). The incidence of non-fatal MI and ischemic stroke were not statistically different (Figure 2).

Conclusions

The early use of SGLT2 inhibitors in diabetes patients treated with PCI for AMI was associated with a significantly lower risk of cardiovascular events including all-cause mortality, hospitalizations for HF, and MACE. Our results suggest that the use of SGLT2 inhibitors could expand to the acute phase of AMI survivors with diabetes to reduce mortality and the subsequent development of congestive HF and ischemic events.

Funding Acknowledgement

Type of funding sources: Private hospital(s). Main funding source(s): This work was partly supported by the Research Institute of Medical Science, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea.

Improve the Prevention of Sudden Cardiac Arrest in Patients With Post-Acute Myocardial Infarction

BACKGROUND

Implantable cardioverter-defibrillator (ICD) implantation to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients varies by geography but remains low in many regions despite guideline recommendations.

OBJECTIVES

This study aimed to characterize the care pathway of post-MI patients and understand barriers to referral for further SCD risk stratification and management in patients meeting referral criteria.

METHODS

This prospective, nonrandomized, multi-nation study included patients ≥18 years of age, with an acute MI ≤30 days and left ventricular ejection fraction <50% ≤14 days post-MI. The primary endpoint was defined as the physician's decision to refer a patient for SCD stratification and management.

RESULTS

In total, 1,491 post-MI patients were enrolled (60.2 ± 12.0 years of age, 82.4% male). During the study, 26.7% (n = 398) of patients met criteria for further SCD risk stratification; however, only 59.3% of those meeting criteria (n = 236; 95% CI: 54.4%-64.0%) were referred for a visit. Of patients referred for SCD risk stratification and management, 94.9% (n = 224) attended the visit of which 56.7% (n =127; 95% CI: 50.1%-63.0%) met ICD indication criteria. Of patients who met ICD indication criteria, 14.2% (n = 18) were implanted.

CONCLUSIONS

We found that ∼40% of patients meeting criteria were not referred for further SCD risk stratification and management and ∼85% of patients who met ICD indications did not receive a guideline-directed ICD. Physician and patient reasons for refusing referral to SCD risk stratification and management or ICD implant varied by geography suggesting that improvement will require both physician- and patient-focused approaches. (Improve Sudden Cardiac Arrest [SCA] Bridge Study; NCT03715790).

Neurorobotic approaches to emulate human motor control with the integration of artificial synapse

The advancement of electronic devices has enabled researchers to successfully emulate human synapses, thereby promoting the development of the research field of artificial synapse integrated soft robots. This paper proposes an artificial reciprocal inhibition system that can successfully emulate the human motor control mechanism through the integration of artificial synapses. The proposed system is composed of artificial synapses, load transistors, voltage/current amplifiers, and a soft actuator to demonstrate the muscle movement. The speed, range, and direction of the soft actuator movement can be precisely controlled via the preset input voltages with different amplitudes, numbers, and signs (positive or negative). The artificial reciprocal inhibition system can impart lifelike motion to soft robots and is a promising tool to enable the successful integration of soft robots or prostheses in a living body.

Biocompatibility evaluation of peo-treated magnesium alloy implants placed in rabbit femur condyle notches and paravertebral muscles

BACKGROUND

Magnesium alloys have been receiving much attention for use in biodegradable metal implants because of their excellent mechanical properties and biocompatibility. However, their rapid breakdown and low bioactivity can cause the implant to lose mechanical integrity before the bone is completely healed. Moreover, hydrogen gas released during degradation can significantly delay the tissue regeneration process. To solve the instability of magnesium alloys, Zn and Ca can be added to improve the mechanical properties and biocompatibility. One other way to improve the mechanical properties of Mg is plasma electrolytic oxidation (PEO), which provides a dense, thick ceramic-like coating on the Mg surface. In this study, high-purity Mg was selected as the control, and Mg-1wt%Zn-0.1wt%Ca alloy and PEO-treated Mg-1wt%Zn-0.1wt%Ca alloy were selected as the test materials; the results of radiographic and histological analyses of their biocompatibility are reported herein.

MATERIALS AND METHOD

Nineteen New Zealand white rabbits were used in the study. Rod-bars (Ø2.7 × 13.6 mm) were placed on both paravertebral muscles, and cannulated screws (Ø2.7x10mm) were placed on both femur condyle notches. Each animal was implanted in all four sites. X-rays were taken at 0, 2, 4, 8, and 12 weeks, micro-CT, and live-CT were taken at 4, 8, and 12 weeks. At weeks 4, 8, and 12, individuals representing each group were selected and sacrificed to prepare specimens for histopathological examination.

RESULT

The results confirm that in vivo, Mg-1wt%Zn-0.1wt%Ca alloy had higher corrosion resistance than high-purity Mg and safely degraded over time without causing possible side effects (foreign body or inflammatory reactions, etc.). In addition, PEO treatment of Mg-1wt%Zn-0.1wt%Ca alloy had a positive effect on fracture recovery by increasing the bonding area with bone.

CONCLUSION

Our results suggest that PEO treatment of Mg-1wt%Zn-0.1wt%Ca alloy can be a promising biomaterials in the field of various clinical situations such as orthopedic and maxillofacial surgerys.

Non-von Neumann multi-input spike signal processing enabled by an artificial synaptic multiplexer

Multiplexing is essential for technologies that require processing of a large amount of information in real time. Here, we present an artificial synaptic multiplexing unit capable of realizing parallel multi-input control system. Ion gel was used as a dielectric layer of the artificial synaptic multiplexing unit because of its ionic property, allowing multigating for parallel input. A closed-loop control system that enables multi-input-based feedback for actuator bending control was realized by incorporating an ion gel-based artificial synaptic multiplexing unit, an actuator, and a bending angle sensor. The proposed multi-input control system could simultaneously process input and feedback signals, offering a breakthrough in industries in which the processing of vast amounts of streaming data is essential.

Trends in body mass index changes among Korean adolescents between 2005-2020, including the COVID-19 pandemic period: a national representative survey of one million adolescents

OBJECTIVE

The impact of the coronavirus disease 2019 (COVID-19) pandemic on weight gain in children and adolescents remains unknown. We aimed to identify an estimated 15-year trend in mean body mass index (BMI) changes and prevalence of obesity and overweight among Korean adolescents from 2005 to 2020, including the period of the COVID-19 pandemic.

PATIENTS AND METHODS

We analyzed data taken from a nationwide survey (Korea Youth Risk Behavior Survey), between 2005 and 2020. Representative samples of one million Korean adolescents aged 13-18 years (n=1,057,885) were examined. The 15-year trends in mean BMI and proportion of obesity or overweight, and the changes due to the COVID-19 pandemic were analyzed.

RESULTS

The data of 1,057,885 Korean adolescents were analyzed (mean age: 14.98 years; females, 48.4%). The estimated weighted mean BMI was 20.5 kg/m2 [95% confidence interval (CI), 20.4-20.5] from 2005 to 2008 and 21.5 kg/m2 (95% CI, 21.4-21.6) in 2020 (during the COVID-19 pandemic). Although the 15-year trend of mean BMI gradually increased, the change in mean BMI before and during the pandemic significantly lessened (βdiff, -0.027; 95% CI, -0.028 to -0.026). The 15-year (2005-2020) trend changes in the prevalence of obesity and overweight were similar (obesity prevalence from 2005-2008, 3.2%; 95% CI, 3.1-3.3 vs. obesity prevalence in 2020, 8.6%; 95% CI, 8.2-9.0; βdiff, -0.309; 95% CI, -0.330 to -0.288).

CONCLUSIONS

The 15-year trend of overall mean BMI and obesity and overweight prevalence demonstrated a significant increase; however, its slope decreased during the pandemic. These landmark results suggest the need for the development of precise strategies to prevent pediatric obesity and overweight during the COVID-19 pandemic.

A prospective, multicenter, open-label study of the clinical efficacy of tapentadol extended-release in the treatment of cancer-related pain and improvement in the quality of life of opioid-naïve or opioid-resistant patients

Purpose

This study aimed to investigate the clinical efficacy of tapentadol extended-release (ER) on pain control and the quality of life (QoL) of patients with moderate to severe chronic cancer pain in clinical practice in Korea.

Methods

In this prospective, open-label, multicenter trial, patients with sustained cancer pain as well as chronic pain, who were or were not using other analgesics were enrolled. Thirteen centers recorded a total of 752 patients during the 6-month observation period, based on the tapentadol ER dose and tolerability, prior and concomitant analgesic treatment, pain intensity, type of pain, adverse effects, and clinical global impression change (CGI-C). Of those 752 patients, 688 were enrolled, and 650 completed the study for efficacy and adverse drug reactions; among them, 349 were cancer patients.

Results

Tapentadol ER significantly reduced the mean pain intensity including neuropathic pain during the observation period by 2.9 points (from a mean 7 ± 0.87 to 4.1 ± 2.02). Furthermore, QoL was observed to be significantly improved based on the CGI-C, an objective measure.

Conclusion

This study showed that tapentadol ER was effective for treating patients with moderate to severe cancer pain and neuropathic pain, and therefore it significantly improved the patients’ QoL.

Commensurate Assembly of C60 on Black Phosphorus for Mixed-Dimensional van der Waals Transistors

2D crystals can serve as templates for the realization of new van der Waals (vdW) heterostructures via controlled assembly of low-dimensional functional components. Among available 2D crystals, black phosphorus (BP) is unique due to its puckered atomic surface topography, which may lead to strong epitaxial phenomena through guided vdW assembly. Here, it is demonstrated that a BP template can induce highly oriented assembly of C₆₀ molecular crystals. Transmission electron microscopy and theoretical analysis of the C₆₀ /BP vdW heterostructure clearly confirm that the BP template results in oriented C₆₀ assembly with higher-order commensurism. Lateral and vertical devices with C₆₀ /BP junctions are fabricated via a lithography-free clean process, which allows one to investigate the ideal electrical properties of pristine C₆₀ /BP junctions. Effective tuning of the C₆₀ /BP junction barrier from 0.2 to 0.5 eV and maximum on-current density higher than 10⁴  mA cm^-2 are achieved with graphite/C₆₀ /BP vertical vdW transistors. Due to the formation of high-quality C₆₀ film and the semitransparent graphite top-electrode, the vertical transistors show high photoresponsivities up to ≈100 A W^-1 as well as a fast response time under visible light illumination.

Abstract P3-12-25: Risk of second primary cancers after curative treatment of breast cancer: A Korean nationwide population-based study

Purpose:This study was performed to analyze the risk of second non-breast primary cancers (2nd_PrimaryCa) among Korean women who had received curative treatment for breast cancer. Methods:By using data from the Korean National Health Insurance Service Database between 2002 and 2017, we identified 399,621 women with invasive breast cancer. To analyze the long-term risk of 2nd_PrimaryCa, we included 52,506 women who underwent curative surgery between 2003 and 2008, and no history of cancers before the date of breast cancer surgery. The cumulative incidence of 2nd_PrimaryCa was estimated using the Kaplan-Meier analysis. Cox regression analysis was used to analyze the association between 2nd_PrimaryCa occurrence and factors including age, income level, receipt of systemic treatment or radiotherapy, family history of cancers, alcohol intake, and BRCA gene mutations.Results:A total of 3,084 (5.87%) patients developed 2nd_PrimaryCa. The 10-year incidence of 2nd_PrimaryCa was 5.78% (range, 5.56 – 6.00%). The median time to 2nd_PrimaryCa was 7.61 years (range, 6.22 – 9.31 years). Types of organs involved by 2nd_PrimaryCa were as followings: thyroid (18.84%), gynecological organs (12.78%), hepatobiliary structures (12.48%), thorax (11.25%), lower gastrointestinal (GI) tract (9.63%), upper GI tract (9.18%), skin (4.22%), lymphoma or leukemia (4.09%), brain (3.15%), head and neck (2.56%), and others (11.84%). The risk of 2nd_PrimaryCa was significantly associated with ≥ 60 years of age (hazard ratio (HR) = 2.15, 95% confidence interval (CI) = 1.60 – 2.90, p &lt; 0.01), Medical Aid recipients (HR = 8.79, 95% CI = 6.73 – 10.85, p &lt; 0.01), and receipt of chemotherapy and endocrine therapy (HR = 1.27, 95% CI = 1.12 – 1.43, p &lt; 0.01). Radiotherapy was related to lower incidence of 2nd_PrimaryCa (HR = 0.87, 95% CI = 0.81 – 0.94, p &lt; 0.01). Alcohol intake, family history of cancer, or carrying BRCA gene mutations was not related to the risk of 2nd_PrimaryCa. Among the patients with 2nd_PrimaryCa, the 5-year overall survival (OS) rate was 67.28% after the diagnosis of 2nd_PrimaryCa. Age of ≥ 60 years (HR = 1.67, 95% CI = 1.01 – 2.78, p = 0.04) and receiving chemotherapy and endocrine therapy (HR = 1.88, 95% CI = 1.43 – 2.46, p &lt; 0.01) were significantly related to inferior OS. Conclusions:The risk of 2nd_PrimaryCa was associated with personal and treatment factors in Korean patients with breast cancer. These factors are needed to be considered in the surveillance of breast cancer survivors.

Citation Format: Haeyoung Kim, Su SSan Kim, Ji Sung Lee, Jae Sun Yoon, Hyuk Jai Shin, Jeong Eon Lee, Sei Kyung Lee, Il Yong Chung, So-Youn Jung, Young Jin Choi, Korean Breast Cancer Society. Risk of second primary cancers after curative treatment of breast cancer: A Korean nationwide population-based study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-25.

The Clinical Impact of β-Blocker Therapy on Patients With Chronic Coronary Artery Disease After Percutaneous Coronary Intervention

The general knowledge that β-blockers are cardioprotective for patients with chronic coronary artery disease (CAD) is mainly extrapolated from positive evidence in patients with myocardial infarction (MI) or heart failure. In this propensity score-matched cohort study of 1,170 pairs of patients with chronic CAD who underwent percutaneous coronary intervention, we analysed medical records for β-blockers with prescription doses and types in each patient at 3-month intervals after discharge. β-blockers were not associated with better clinical outcomes for mortality and MI. Additionally, no significant associations were found for the clinical outcomes with different doses and types of β-blockers.

Background and Objectives

The outcome benefits of β-blockers in chronic coronary artery disease (CAD) have not been fully assessed. We evaluated the prognostic impact of β-blockers on patients with chronic CAD after percutaneous coronary intervention (PCI).

Methods

A total of 3,075 patients with chronic CAD were included from the Grand Drug-Eluting Stent registry. We analyzed β-blocker prescriptions, including doses and types, in each patient at 3-month intervals from discharge. After propensity score matching, 1,170 pairs of patients (β-blockers vs. no β-blockers) were derived. Primary outcome was defined as a composite endpoint of all-cause death and myocardial infarction (MI). We further analyzed the outcome benefits of different doses (low-, medium-, and high-dose) and types (conventional or vasodilating) of β-blockers.

Results

During a median (interquartile range) follow-up of 3.1 (3.0–3.1) years, 134 (5.7%) patients experienced primary outcome. Overall, β-blockers demonstrated no significant benefit in primary outcome (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.63–1.24), all-cause death (HR, 0.87; 95% CI, 0.60–1.25), and MI (HR, 1.25; 95% CI, 0.49–3.15). In subgroup analysis, β-blockers were associated with a lower risk of all-cause death in patients with previous MI and/or revascularization (HR, 0.38; 95% CI, 0.14–0.99) (p for interaction=0.045). No significant associations were found for the clinical outcomes with different doses and types of β-blockers.

Conclusions

Overall, β-blocker therapy was not associated with better clinical outcomes in patients with chronic CAD undergoing PCI. Limited mortality benefit of β-blockers may exist for patients with previous MI and/or revascularization.

Trial Registration

ClinicalTrials.gov Identifier: NCT03507205

The effect of curdlan and the resting process on the quality of the dried whole tofu noodles

The aim of this study is to make dried noodles having high contents of whole tofu (60% (w/w)). To control the high moisture of the whole tofu, curdlan was added and a high-temperature resting process was applied. The elasticity of the dough sample rested at 45°C for 45 min increased over 50% more than the non-rested one. The addition of curdlan and the high-temperature resting process helped to form a compact internal structure in the dough, which might have been induced by the gelation of curdlan and the swelling of starch. In addition, these treatments resulted in about 20% and 15% reduction in cooking time and cooking loss, respectively. Whole tofu noodles having high protein content with improved texture and cookability was developed. These results could be helpful to the development of the bread based on a high hydration dough.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10068-021-01020-9.

Prognostic value of metabolic activity of the psoas muscle evaluated by preoperative 18F-FDG PET-CT in breast cancer: a retrospective cross-sectional study

Background

This study aimed to evaluate the potential of metabolic activity of the psoas muscle measured by ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography to predict treatment outcomes in patients with resectable breast cancer.

Methods

The medical records of 288 patients who had undergone surgical resection for stages I–III invasive ductal carcinoma of the breast between January 2014 and December 2014 in Pusan National University Hospital were reviewed. The standardized uptake values (SUVs) of the bilateral psoas muscle were normalized using the mean SUV of the liver. SUVRmax was calculated as the ratio of the maximum SUV of the average bilateral psoas muscle to the mean SUV of the liver. SUVRmean was calculated as the ratio of the mean SUV of the bilateral psoas muscle to the mean SUV of the liver.

Results

Univariate analyses identified a higher T stage, higher N stage, estrogen receptor negativity, progesterone receptor negativity, human epidermal growth factor receptor 2 positivity, triple-negative breast cancer, mastectomy (rather than breast-conserving surgery), SUVRmean > 0.464, and SUVRmax > 0.565 as significant adverse factors for disease-free survival (DFS). Multivariate Cox regression analysis revealed that N3 stage (hazard ratio [HR] = 5.347, P = 0.031) was an independent factor for recurrence. An SUVRmax > 0.565 (HR = 4.987, P = 0.050) seemed to have a correlation with shorter DFS.

Conclusions

A higher SUVRmax of the psoas muscle, which could be a surrogate marker of insulin resistance, showed strong potential as an independent prognostic factor for recurrence in patients with resectable breast cancer.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08886-2.

Effect of clinical anesthesia preoperative evaluation on the length of preoperative period and total hospitalization of patients undergoing laparoscopic cholecystectomy

OBJECTIVE

Anesthesia preoperative evaluation clinics (APECs) are currently operating in several South Korean hospitals. While several studies have investigated the impact of APEC operations on the length of total hospital stay (LTHS), few have investigated their impact on the length of preoperative hospital stay (LPHS) for patients. In this study, we aimed to determine whether APEC affected the LPHS and LTHS.

METHODS

Data of all patients who underwent surgery at Chungbuk National University Hospital between September 2009 and August 2019 were analyzed retrospectively. All patients who had undergone laparoscopic cholecystectomy over the last 10 years were categorized into two groups: those who visited the APEC (Group A), and those who did not (Group B). The age, sex, American Society of Anesthesiologists physical status score, LPHS, and LTHS of the two groups were compared.

RESULTS

The LPHS was 1.03±0.2 days in Group A and 1.61±1.6 days in Group B. The LTHS was 4.77±1.9 days in Group A and 5.63±2.6 days in Group B. The LPHS and LTHS of the two groups differed by 0.58 and 0.9 days, respectively.

CONCLUSION

We evaluated the effect of APEC operations on the LPHS and LTHS of inpatients undergoing laparoscopic cholecystectomy and observed a decrease in both the LPHS and LTHS. Understanding and accepting the importance of APEC is significant for physicians and administrators working to improve hospital efficiency and patient outcomes. Further research is needed to investigate the need and benefits of APECs.

A rare case of acute meningitis shortly after lumbar selective nerve root block: a case report

A 57-year-old man underwent lumbar selective nerve root block (SNRB) for low back pain and lower radiating pain caused by left-sided L4 disc herniation. He presented to the emergency department with fever, headache and aggravated low back pain approximately 3 hours after the procedure. Infection was suspected; hence, blood tests, cerebrospinal fluid (CSF) tests, lumbar magnetic resonance imaging, and brain computed tomography were performed. Imaging findings were not suggestive of infection. The CSF was turbid and yellowish with pleiocytosis; however, the CSF culture was negative. Based on these findings, the patient was diagnosed with acute meningitis. Broad-spectrum antibiotics and steroid therapy were initiated considering the patient's age and general condition. From hospital day (HD) 2, fever and headache were reduced and disappeared completely by HD 5. At the last follow-up, 1 month after discharge, the patient had no symptoms. Acute meningitis is associated with a high mortality and neurologic deficits. Hence, timely tests, diagnosis, and treatment are critical for positive outcomes. Symptoms of meningitis following a nerve block generally occur within 24-48 hours after the procedure. This case is notable, as it involved a quicker and more sudden onset of symptoms; meningitis occurred only a few hours after lumbar selective nerve root block.

Elastic gels based on flaxseed gum with konjac glucomannan and agar

In this study, we prepared hydrocolloid gels in which flaxseed gum (FSG), konjac glucomannan (KGM), and agar (AG) were blended in different ratios for use as a viscoelastic food. The prepared hydrogels' physicochemical properties were analyzed concerning their water solubility index (WSI), swelling power (SL), frequency sweep results, and microstructures. As the FSG ratio decreased, the WSI value of the compound gel tended to increase. However, it showed a tendency to have a relatively high SP value and a low tan δ value according to a specific KGM/FSG/AG mixing ratios (8:2:1.5 and 6:4:1.5). Through microstructure analysis, the FKA821.5 sample showed a relatively small, monodispersed gel building structure, correlated with the rheological results. In conclusion, the FKA821.5 gel was determined to have good water retention capacity and high structural strength. These results are expected to increase the applicability of FSG-based gelling agents in the food industry.