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The two key mechanisms affected by internet gaming disorder (IGD) are cognitive and reward processing. Despite their significance, little is known about neurophysiological features as determined using resting-state electroencephalography (EEG) source functional connectivity (FC).
We compared resting-state EEG source FC within the default mode network (DMN) and reward/salience network (RSN) between patients with IGD and healthy controls (HCs) to identify neurophysiological markers associated with cognitive and reward processing. A total of 158 young male adults (79 patients with IGD and 79 HCs) were included, and the source FC of the DMN and RSN in five spectral bands (delta, theta, alpha, beta, and gamma) were assessed.
Patients with IGD showed increased theta, alpha, and beta connectivity within the DMN between the orbitofrontal cortex and parietal regions compared with HCs. In terms of RSN, patients with IGD exhibited elevated alpha and beta connectivity between the anterior cingulate gyrus and temporal regions compared with HCs. Furthermore, patients with IGD showed negative correlations between the severity of IGD symptoms and/or weekly gaming time and theta and alpha connectivity within the DMN and theta, alpha, and beta connectivity within the RSN. However, the duration of IGD was not associated with EEG source FC.
Hyper-connectivities within the DMN and RSN may be considered potential state markers associated with symptom severity and gaming time in IGD.
Nosocomial transmission of COVID-19 among immunocompromised hosts can have a serious impact on COVID-19 severity, underlying disease progression and SARS-CoV-2 transmission to other patients and healthcare workers within hospitals. We experienced a nosocomial outbreak of COVID-19 in the setting of a daycare unit for paediatric and young adult cancer patients. Between 9 and 18 November 2020, 473 individuals (181 patients, 247 caregivers/siblings and 45 staff members) were exposed to the index case, who was a nursing staff. Among them, three patients and four caregivers were infected. Two 5-year-old cancer patients with COVID-19 were not severely ill, but a 25-year-old cancer patient showed prolonged shedding of SARS-CoV-2 RNA for at least 12 weeks, which probably infected his mother at home approximately 7–8 weeks after the initial diagnosis. Except for this case, no secondary transmission was observed from the confirmed cases in either the hospital or the community. To conclude, in the day care setting of immunocompromised children and young adults, the rate of in-hospital transmission of SARS-CoV-2 was 1.6% when applying the stringent policy of infection prevention and control, including universal mask application and rapid and extensive contact investigation. Severely immunocompromised children/young adults with COVID-19 would have to be carefully managed after the mandatory isolation period while keeping the possibility of prolonged shedding of live virus in mind.
Accurate prognostication is important for patients and their families to prepare for the end of life. Objective Prognostic Score (OPS) is an easy-to-use tool that does not require the clinicians’ prediction of survival (CPS), whereas Palliative Prognostic Score (PaP) needs CPS. Thus, inexperienced clinicians may hesitate to use PaP. We aimed to evaluate the accuracy of OPS compared with PaP in inpatients in palliative care units (PCUs) in three East Asian countries.
This study was a secondary analysis of a cross-cultural, multicenter cohort study. We enrolled inpatients with far-advanced cancer in PCUs in Japan, Korea, and Taiwan from 2017 to 2018. We calculated the area under the receiver operating characteristics (AUROC) curve to compare the accuracy of OPS and PaP.
A total of 1,628 inpatients in 33 PCUs in Japan and Korea were analyzed. OPS and PaP were calculated in 71.7% of the Japanese patients and 80.0% of the Korean patients. In Taiwan, PaP was calculated for 81.6% of the patients. The AUROC for 3-week survival was 0.74 for OPS in Japan, 0.68 for OPS in Korea, 0.80 for PaP in Japan, and 0.73 for PaP in Korea. The AUROC for 30-day survival was 0.70 for OPS in Japan, 0.71 for OPS in Korea, 0.79 for PaP in Japan, and 0.74 for PaP in Korea.
Significance of results
Both OPS and PaP showed good performance in Japan and Korea. Compared with PaP, OPS could be more useful for inexperienced physicians who hesitate to estimate CPS.
Several studies supported the usefulness of “the surprise question” in terms of 1-year mortality of patients. “The surprise question” requires a “Yes” or “No” answer to the question “Would I be surprised if this patient died in [specific time frame].” However, the 1-year time frame is often too long for advanced cancer patients seen by palliative care personnel. “The surprise question” with shorter time frames is needed for decision making. We examined the accuracy of “the surprise question” for 7-day, 21-day, and 42-day survival in hospitalized patients admitted to palliative care units (PCUs).
This was a prospective multicenter cohort study of 130 adult patients with advanced cancer admitted to 7 hospital-based PCUs in South Korea. The accuracy of “the surprise question” was compared with that of the temporal question for clinician's prediction of survival.
We analyzed 130 inpatients who died in PCUs during the study period. The median survival was 21.0 days. The sensitivity, specificity, and overall accuracy for the 7-day “the surprise question” were 46.7, 88.7, and 83.9%, respectively. The sensitivity, specificity, and overall accuracy for the 7-day temporal question were 6.7, 98.3, and 87.7%, respectively. The c-indices of the 7-day “the surprise question” and 7-day temporal question were 0.662 (95% CI: 0.539–0.785) and 0.521 (95% CI: 0.464–0.579), respectively. The c-indices of the 42-day “the surprise question” and 42-day temporal question were 0.554 (95% CI: 0.509–0.599) and 0.616 (95% CI: 0.569–0.663), respectively.
Significance of results
Surprisingly, “the surprise questions” and temporal questions had similar accuracies. The high specificities for the 7-day “the surprise question” and 7- and 21-day temporal question suggest they may be useful to rule in death if positive.
Outdoor air pollution continues to be a challenging health issue, even as countries experience economic growth. By exploiting a unique transboundary setting in East Asia, we study the impact of an increase in particulate matter (PM) concentrations on fetal deaths. Due to the westerlies in the mid-latitudes, residents in South Korea at times experience intermittent exposure to high levels of air pollution. Using such atmospheric setting, we estimate a reduced-form impact of high PM events on fetal deaths, which captures in utero exposure to pollution. Controlling for local weather and pollution trends, regression results indicate that high PM events in Beijing lead to a significant increase in daily fetal mortality rates in Korea, by approximately 7.4 per cent. This research finding provides lower-bound estimates of not only negative spillovers manifested in fetal health but also the impact of pollution on the health of the Chinese population and calls for a need to tackle transboundary air pollution via international cooperation.
A recent meta-analysis suggested that the association between vitamin D and risk of hypertension was markedly stronger in women aged <55 years in observational data, while the association became null in women aged ≥55 years. We therefore hypothesized that this difference in associations might potentially be caused by the change in oestrogen around menopause. Our objective was to investigate associations between vitamin D status and hypertension risk and to evaluate those associations as they may differ according to menopausal status.
A cross-sectional population survey conducted by the US Centers for Disease Control and Prevention, National Center for Health Statistics.
The National Health and Nutrition Examination Surveys (NHANES) 2007–2010 formed the setting for the present study.
We analysed data from 2098 premenopausal women and 2298 postmenopausal women.
After adjustment for sociodemographic, behavioural and dietary factors, higher concentrations both of serum total 25-hydroxyvitamin D (25(OH)D) and serum 25-hydroxycholecalciferol (25(OH)D3) revealed significant dose-dependent trends with lower risk of hypertension (Ptrend = 0·005 and 0·014, respectively) in premenopausal women. In those women, 25(OH)D ≥ 50 nmol/l (sufficient; in contrast to deficient, vitamin D < 30 nmol/l) appeared to have a protective effect against hypertension (OR = 0·64, 95 % CI 0·39, 1·02 for total 25(OH)D and OR = 0·60, 95 % CI 0·36, 1·00 for 25(OH)D3). Neither association with hypertension was observed in postmenopausal women.
Serum 25(OH)D concentrations were associated with lower risk of hypertension in premenopausal women, but not in postmenopausal women.
A number of multiple-casualty incidents during 2014 and 2015 brought changes to Korea’s disaster medical assistance system. We report these changes here.
Reports about these incidents, revisions to laws, and the government’s revised medical disaster response guidelines were reviewed.
The number of DMAT (Disaster Medical Assistance Team) staff members was reduced to 4 from 8, and the mobilization method changed. An emergency response manual was created that contains the main content of the DMAT, and there is now a DMAT training program to educate staff. The government created and launched a national 24-hour Disaster Emergency Medical Service Situation Room, and instead of the traditional wireless communications, mobile instant smart phone messaging has been added as a new means of communication. The number of disaster base hospitals has also been doubled.
Although there are still limitations that need to be remedied, the changes to the current emergency medical assistance system are expected to improve the system’s response capacity. (Disaster Med Public Health Preparedness. 2017;11:526–530)
A 44-year-old man developed sudden non-fluent aphasia and right hemiplegia due to left striatocapsular infarction (Figure). Neurologic examination revealed gaze deviation to the right with eyes closed, but not with eyes open (Video). There was no spontaneous or gaze-evoked nystagmus, even after elimination of visual fixation. Leftward pursuit was impaired in a craniotopic frame of reference, and horizontal saccades were hypometric in both directions. Head impulse test was normal in the horizontal plane and there were no visual field defects. The contralesional gaze deviation with eye closure persisted for ten days.
Background: Highly educated participants with normal cognition show lower incidence of Alzheimer's disease (AD) than poorly educated participants, whereas longitudinal studies involving AD have reported that higher education is associated with more rapid cognitive decline. We aimed to evaluate whether highly educated amnestic mild cognitive impairment (aMCI) participants show more rapid cognitive decline than those with lower levels of education.
Methods: A total of 249 aMCI patients enrolled from 31 memory clinics using the standard assessment and diagnostic processes were followed with neuropsychological evaluation (duration 17.2 ± 8.8 months). According to baseline performances on memory tests, participants were divided into early-stage aMCI (−1.5 to −1.0 standard deviation (SD)) and late-stage aMCI (below −1.5 SD) groups. Risk of AD conversion and changes in neuropsychological performances according to the level of education were evaluated.
Results: Sixty-two patients converted to AD over a mean follow-up of 1.43 years. The risk of AD conversion was higher in late-stage aMCI than early-stage aMCI. Cox proportional hazard models showed that aMCI participants, and late-stage aMCI participants in particular, with higher levels of education had a higher risk of AD conversion than those with lower levels of education. Late-stage aMCI participants with higher education showed faster cognitive decline in language, memory, and Clinical Dementia Rating Sum of Boxes (CDR-SOB) scores. On the contrary, early-stage aMCI participants with higher education showed slower cognitive decline in MMSE and CDR-SOB scores.
Conclusions: Our findings suggest that the protective effects of education against cognitive decline remain in early-stage aMCI and disappear in late-stage aMCI.
Platelet-derived growth factor (PDGF)-BB can induce abnormal proliferation and migration of vascular smooth muscle cells (VSMC) that are involved in the development of CVD. In our preliminary study, phytoalexin glyceollins (glyceollins I, II and III) isolated from soyabean seeds cultured with Aspergillus sojae showed strong antioxidant and anti-inflammatory activity. Since antioxidants showed beneficial effects on chronic inflammatory diseases, the purpose of the present study was to examine the effects of glyceollins on PDGF-induced proliferation and migration in human aortic smooth muscle cells (HASMC). Incubation of resting HASMC with glyceollins for 24 h significantly diminished PDGF-increased cell number and DNA synthesis in a dose-dependent manner without any cytotoxicity. In addition to blocking of the PDGF-inducible progression through the G0/G1 to the S phase of the cell cycle, glyceollins down-regulated the expression of cyclin-dependent kinase (CDK)2 and cyclin D1, and up-regulated the expression of CDK inhibitors such as p27kip1 and p53.Glyceollins also effectively inhibited reactive oxygen species generation and phosphorylation of PDGF receptor-β, phospholipase Cγ1, Akt and extracellular signal-regulated kinase 1/2 by PDGF stimulation. Furthermore, glyceollins were found to inhibit PDGF-induced dissociation of actin filaments and cell migration. Thus, the results suggest that glyceollins could become a potent therapeutic agent for regulating VSMC-associated vascular disease such as atherosclerosis and restenosis after angioplasty.
In this paper, we present technique to fabricate nanopatterns on Cu thin films via an electrochemical nanomachining (ECN) using an atomic force microscope (AFM). A conductive AFM cantilever tip (Pt/Ir5 coated) was used to form an electric field between tip and Cu substrate with applying a voltage pulse, resulting in the generation of an etched nanopattern. In order to precisely construct the nanopatterns, an ultra-short pulse was applied onto the Cu film through the AFM cantilever tip. The line width of the nanopatterns (the lateral dimension) increased with increased pulse amplitude, on-time, and frequency. The tip velocity effect on the nanopattern line width was also investigated that the line width is decreased with increasing tip velocity. Experimental results were compared with an equivalent electrochemical circuit model representing an ECN technique. The study described here provides important insight for fabricating nanopatterns precisely using electrochemical methods with an AFM cantilever tip.
The relationship between dietary Zn intake and the risk of atherosclerosis remains unclear, and no epidemiological studies have been reported on the effects of dietary Zn intake on morphological changes in the vascular wall. We examined the relationship between dietary Zn intake and common carotid intima-media thickness (IMT) as a marker of subclinical atherosclerosis among the middle-aged and elderly populations. A cross-sectional analysis of a prospective cohort baseline study was performed with 4564 adults aged 40–89 years and free of clinical CVD. Dietary data were collected by trained interviewers using an FFQ. Common carotid IMT was measured using a B-mode ultrasound imaging technique. Subclinical atherosclerosis was determined using carotid IMT, and defined as >80th percentile of carotid IMT or ≥ 1 mm of carotid IMT. After adjustment for potential confounders, the mean carotid IMT in the low Zn intake group was higher than that in the high Zn intake group. When subclinical atherosclerosis was defined as >80th percentile value of IMT or ≥ 1 mm of carotid IMT, after adjustment for potential confounders, Zn intake was inversely related to subclinical atherosclerosis (5th v. 1st quintile, OR 0·64, 95 % CI 0·45, 0·90, P for trend = 0·069; 5th v. 1st quintile, OR 0·34, 95 % CI 0·16, 0·70, P for trend = 0·005, respectively). In persons free of clinical CVD, dietary Zn intake was inversely correlated with subclinical atherosclerosis. The present findings suggest a putative protective role of dietary Zn intake against the development of atherosclerosis.
Ferromagnetic Cu-doped GaN film was grown on a GaN-buffered sapphire (0001) substrate by a hybrid physical-chemical-vapor-deposition method (HPCVD). The GaCuN film (Cu: 3.6 at.%) has a highly c-axis-oriented hexagonal wurtzite crystal structure, which is similar to GaN buffer but without any secondary phases such as metallic Cu, CuxNy, and CuxGay compounds. Two weak near-band edge (NBE) emissions at 3.38 eV and donor-acceptor-pair (DAP) transition at 3.2 eV with a typical strong broad yellow emission were observed in photoluminescence spectra for GaN buffer. In contrast, the yellow emission was completely quenched in GaCuN film because Ga vacancies causing the observed yellow emission in undoped GaN were substituted by Cu atoms. In addition, GaCuN film exhibits a blue shift of NBE emission, which could be explained with the +2 oxidation state of Cu ions, replacing +3 Ga ions resulting in band gap increment. The valance sate of Cu in GaCuN film was also confirmed by x-ray photoelectron spectroscopy (XPS) analysis. The GaCuN film shows ferromagnetic ordering and possesses a residual magnetization of 0.12 emu/cm3 and a coercive field of 264 Oe at room temperature. The unpaired spins in Cu2+ ions (d9) are most likely to be responsible for the observed ferromagnetism in GaCuN.
Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P= .023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P = .022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.
We studied 52 children in order to assess the prevalence, natural history, and electrophysiologic effects of cardiac rhabdomyoma in tuberous sclerosis. Their ages ranged from one day to 12 years (median age 1.33 year). The tumors in the heart were found in 22 patients through cross-sectional echocardiography. The overall prevalence of cardiac rhabdomyoma was 42%. The prevalence of cardiac tumors in patients first seen in infancy was 77%, and that in patients over one year of age was 31%. Those with cardiac tumors diagnosed in infancy had more tumors per person than did the patients diagnosed after infancy, and the tumors were smaller in the patients diagnosed over one year of age. Follow-up cross-sectional echocardiography showed that almost all tumors showed spontaneous regression. Complete regression occurred more commonly in younger patients, and in those with smaller tumors. About 70% of patients with cardiac tumors had either normal findings or infrequent premature contractions on 24hour Holter monitorings. The rest of the patients with cardiac tumors showed either frequent premature contractions, atrioventricular block, or atrial tachycardia, but antiarrhythmic medication was rarely required. Cross-sectional echocardiography, therefore, seems to be the best diagnostic tool for screening cardiac rhabdomyomas in patients with tuberous sclerosis. The tumors may be managed more conservatively in view of their high rate of spontaneous regression and rather rare association with symptomatic arrhythmias.
The good field-emission properties of carbon nanotubes coupled with their high mechanical strength, chemical stability, and high aspect ratio, make them ideal candidates for the construction of efficient and inexpensive field-emission electronic devices. The fabrication process reported here has considerable potential for use in the development of integrated radio frequency amplifiers or field emission-controllable cold electron guns for field emission displays. This fabrication process is compatible with currently used semiconductor processing technologies. Micropatterned vertically aligned carbon nanotubes were grown on planar Si surface or inside the trenches, using chemical vapor deposition, photolithography, pulsed-laser deposition, reactive ion etching, and the lift-off method. To control the field-emission current by a 3rd electrode, the gate electrode, we grew carbon nanotubes inside the trenches. This triode-type structure is the best to realize the gray-scale carbon nanotube field emission. This carbon nanotube fabrication process can be widely applied for the development of electronic devices using carbon nanotube field emitters as cold cathodes and could revolutionize the area of field-emitting electronic devices such as RF amplifiers and field emission displays.
We have grown well-aligned carbon nanotube arrays by thermal chemical vapor deposition at 800°C on Fe nanoparticles deposited by a pulsed laser on a porous Si substrate. Porous Si substrates were prepared by the electrochemical etching of p-Si(100) wafers with resistivities of 3 to 6 ωcm. These well-aligned carbon nanotube field emitter arrays are suitable for electron emission applications such as cold-cathode flat panel displays and vacuum microelectronic devices like microwave power amplifier tubes. Field emission characterization has been performed on the CNT-cathode diode device at room temperature and in a vacuum chamber below 10−6 Torr. The anode is maintained at a distance of 60[.proportional]m away from the carbon nanotube cathode arrays through an insulating spacer of polyvinyl film. The measured field emitting area is 4.0×10−5cm2. Our carbon nanotube field emitter arrays emit 1mA/cm2at the electric field, 2V/[.proportional]m. And they emit a large current density as high as 80mA/cm2 at 3V/[.proportional]m. The open tip structure of our carbon nanotubes and their good adhesion through Fe nanoparticles to the Si substrate are part of the reason why we can attain a large field emission current density within a low field. The field emitter arrays in our diode device are vertically well-aligned carbon nanotubes on the Si-wafer substrate.
The microwave dielectric properties of Ca[(Li1/3Nb2/3)1−xMx]O3−δ (M = Sn, Ti, 0 ≤ x ≤ 0.5) ceramics were investigated. In general, the ceramics prepared were multiphase materials. However, single-phase specimens having orthorhombic perovskite structure similar to CaTiO3 could be obtained in the vicinity of Sn = 0.2 to 0.3, and Ti = 0.2. As Sn concentration increased, the dielectric constant (εr) decreased and the quality factor (Q) significantly increased within the limited Sn concentration. As Ti concentration increased, the dielectric constant (εr) increased, the quality factor (Q) decreased, and the temperature coefficient of resonant frequency (τf) changed from a negative to positive value. The temperature coefficient of resonant frequency of 0 ppm/°C was realized at Ti = 0.2. The Q · fo value and εr for this composition were found to be 26100 GHz and 38.6, respectively.