We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure coreplatform@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This study aims to identify factors associated with divorce following breast cancer diagnosis and measures the impact of divorce on the quality of life (QoL) of patients.
Methods
We used cross-sectional survey data collected at breast cancer outpatient clinics in South Korea from November 2018 to April 2019. Adult breast cancer survivors who completed active treatment without any cancer recurrence at the time of the survey (N = 4,366) were included. The participants were classified into two groups: “maintaining marriage” and “being divorced,” between at the survey and at the cancer diagnosis. We performed logistic regression and linear regression to identify the factors associated with divorce after cancer diagnosis and to compare the QoL of divorced and nondivorced survivors.
Results
Approximately 11.1/1,000 of married breast cancer survivors experienced divorce after cancer diagnosis. Younger age, lower education, and being employed at diagnosis were associated with divorce. Being divorced survivors had significantly lower QoL (Coefficient [Coef] = −7.50; 95% CI = −13.63, −1.36), social functioning (Coef = −9.47; 95% CI = −16.36, −2.57), and body image (Coef = −8.34; 95% CI = −6.29, −0.39) than survivors who remained married. They also experienced more symptoms including pain, insomnia, financial difficulties, and distress due to hair loss.
Conclusion
Identifying risk factors of divorce will ultimately help ascertain the resources necessary for early intervention.
This study aimed to determine the effect of donor-transmitted atherosclerosis on the late aggravation of cardiac allograft vasculopathy in paediatric heart recipients aged ≥7 years.
Methods:
In total, 48 patients were included and 23 had donor-transmitted atherosclerosis (baseline maximal intimal thickness of >0.5 mm on intravascular ultrasonography). Logistic regression analyses were performed to identify risk factors for donor-transmitted atherosclerosis. Rates of survival free from the late aggravation of cardiac allograft vasculopathy (new or worsening cardiac allograft vasculopathy on following angiograms, starting 1 year after transplantation) in each patient group were estimated using the Kaplan–Meier method and compared using the log-rank test. The effect of the results of intravascular ultrasonography at 1 year after transplantation on the late aggravation of cardiac allograft vasculopathy, correcting for possible covariates including donor-transmitted atherosclerosis, was examined using the Cox proportional hazards model.
Results:
The mean follow-up duration after transplantation was 5.97 ± 3.58 years. The log-rank test showed that patients with donor-transmitted atherosclerosis had worse survival outcomes than those without (p = 0.008). Per the multivariate model considering the difference of maximal intimal thickness between baseline and 1 year following transplantation (hazard ratio, 22.985; 95% confidence interval, 1.948–271.250; p = 0.013), donor-transmitted atherosclerosis was a significant covariate (hazard ratio, 4.013; 95% confidence interval, 1.047–15.376; p = 0.043).
Conclusion:
Paediatric heart transplantation recipients with donor-transmitted atherosclerosis aged ≥7 years had worse late cardiac allograft vasculopathy aggravation-free survival outcomes.
Network approach has been applied to a wide variety of psychiatric disorders. The aim of the present study was to identify network structures of remitters and non-remitters in patients with first-episode psychosis (FEP) at baseline and the 6-month follow-up.
Methods
Participants (n = 252) from the Korean Early Psychosis Study (KEPS) were enrolled. They were classified as remitters or non-remitters using Andreasen's criteria. We estimated network structure with 10 symptoms (three symptoms from the Positive and Negative Syndrome Scale, one depressive symptom, and six symptoms related to schema and rumination) as nodes using a Gaussian graphical model. Global and local network metrics were compared within and between the networks over time.
Results
Global network metrics did not differ between the remitters and non-remitters at baseline or 6 months. However, the network structure and nodal strengths associated with positive-self and positive-others scores changed significantly in the remitters over time. Unique central symptoms for remitters and non-remitters were cognitive brooding and negative-self, respectively. The correlation stability coefficients for nodal strength were within the acceptable range.
Conclusion
Our findings indicate that network structure and some nodal strengths were more flexible in remitters. Negative-self could be an important target for therapeutic intervention.
Radiocarbon (14C) dating has been widely used to determine the age of deposits, but there have been frequent reports of inconsistencies in age among different dating materials. In this study, we performed radiocarbon dating on a total of 33 samples from 8-m-long sediment cores recovered from the wetland of the Muljangori volcanic cone on Jeju Island, South Korea. Ten pairs of humic acid (HA) and plant fragments (PF) samples, and three pairs of HA and humin samples, from the same depths were compared in terms of age. The PF were consistently younger than the HA. Interestingly, the age difference between HA and PF samples showed a long-term change during the past 8000 years. To test whether there was an association between this long-term age difference and climate change, we compared with the carbon/nitrogen (C/N) ratios and total organic carbon isotope (δ13CTOC) values of the sediments, as indicators of the relative abundance of terrestrial and aquatic plants; these parameters showed similar long-term trends. This suggests that the increasing (decreasing) trend in age difference was influenced by long-term dry (wet) climate change.
As far as plastron is sustained, superhydrophobic (SHPo) surfaces are expected to reduce skin-friction drag in any flow conditions including large-scale turbulent boundary-layer flows of marine vessels. However, despite many successful drag reductions reported using laboratory facilities, the plastron on SHPo surfaces was persistently lost in high-Reynolds-number flows on open water, and no reduction has been reported until a recent study using certain microtrench SHPo surfaces underneath a boat (Xu et al., Phys. Rev. Appl., vol. 13, no. 3, 2020, 034056). Since scientific studies with controlled flows are difficult with a boat on ocean water, in this paper we test similar SHPo surfaces in a high-speed towing tank, which provides well-controlled open-water flows, by developing a novel $0.7\ \textrm {m} \times 1.4\ \textrm {m}$ towing plate, which subjects a $4\ \textrm {cm} \times 7\ \textrm {cm}$ sample to the high-Reynolds-number flows of the plate. In addition to the 7 cm long microtrenches, trenches divided into two in length are also tested and reveal an improvement. The skin-friction drag ratio relative to a smooth surface is found to be decreasing with increasing Reynolds number, down to 73 % (i.e. 27 % drag reduction) at $Re_x\sim 8\times 10^6$, before starting to increase at higher speeds. For a given gas fraction, the trench width non-dimensionalized to the viscous length scale is found to govern the drag reduction, in agreement with previous numerical results.
Early replacement of a new central venous catheter (CVC) may pose a risk of persistent or recurrent infection in patients with a catheter-related bloodstream infection (CRBSI). We evaluated the clinical impact of early CVC reinsertion after catheter removal in patients with CRBSIs.
Methods:
We conducted a retrospective chart review of adult patients with confirmed CRBSIs in 2 tertiary-care hospitals over a 7-year period.
Results:
To treat their infections, 316 patients with CRBSIs underwent CVC removal. Among them, 130 (41.1%) underwent early CVC reinsertion (≤3 days after CVC removal), 39 (12.4%) underwent delayed reinsertion (>3 days), and 147 (46.5%) did not undergo CVC reinsertion. There were no differences in baseline characteristics among the 3 groups, except for nontunneled CVC, presence of septic shock, and reason for CVC reinsertion. The rate of persistent CRBSI in the early CVC reinsertion group (22.3%) was higher than that in the no CVC reinsertion group (7.5%; P = .002) but was similar to that in the delayed CVC reinsertion group (17.9%; P > .99). The other clinical outcomes did not differ among the 3 groups, including rates of 30-day mortality, complicated infection, and recurrence. After controlling for several confounding factors, early CVC reinsertion was not significantly associated with persistent CRBSI (OR, 1.59; P = .35) or 30-day mortality compared with delayed CVC reinsertion (OR, 0.81; P = .68).
Conclusions:
Early CVC reinsertion in the setting of CRBSI may be safe. Replacement of a new CVC should not be delayed in patients who still require a CVC for ongoing management.
Refugees commonly experience difficulties with emotional processing, such as alexithymia, due to stressful or traumatic experiences. However, the functional connectivity of the amygdala, which is central to emotional processing, has yet to be assessed in refugees. Thus, the present study investigated the resting-state functional connectivity of the amygdala and its association with emotional processing in North Korean (NK) refugees.
Methods
This study included 45 NK refugees and 40 native South Koreans (SK). All participants were administered the Toronto Alexithymia Scale (TAS), Beck Depression Inventory (BDI), and Clinician-administered PTSD Scale (CAPS), and differences between NK refugees and native SK in terms of resting-state functional connectivity of the amygdala were assessed. Additionally, the association between the strength of amygdala connectivity and the TAS score was examined.
Results
Resting-state connectivity values from the left amygdala to the bilateral dorsolateral prefrontal cortex (dlPFC) and dorsal anterior cingulate cortex (dACC) were higher in NK refugees than in native SK. Additionally, the strength of connectivity between the left amygdala and right dlPFC was positively associated with TAS score after controlling for the number of traumatic experiences and BDI and CAPS scores.
Conclusions
The present study found that NK refugees exhibited heightened frontal–amygdala connectivity, and that this connectivity was correlated with alexithymia. The present results suggest that increased frontal–amygdala connectivity in refugees may represent frontal down-regulation of the amygdala, which in turn may produce alexithymia.
Our aim was to examine the prevalence, correlates, and association of depressive and anxiety disorders with quality of life (QoL) and such other outcomes as the need for psychosocial services in cancer patients.
Method:
A total of 400 patients participated in a multicenter survey involving five cancer centers located throughout Korea. The Short-Form Health Survey, the MD Anderson Symptom Inventory, the Mini-Mental Adjustment to Cancer (MINI-MAC), and Mini-International Neuropsychiatric Interview were administered.
Results:
The prevalence rates for depressive and anxiety disorders were 16 and 17.1%, respectively. Younger age and poor Eastern Cooperative Oncology Group performance status, and all physical symptoms, as well as helplessness/hopelessness, anxious preoccupation (AP), and cognitive avoidance (CA) on the MINI-MAC were found to be significantly related to depressive disorder (DD) in a univariate logistic regression analysis. Metastases, the symptoms of disturbed sleep, dry mouth, and numbness or tingling, as well as AP and CA were significantly correlated with anxiety disorder (AD) in the univariate analysis. In the multivariate analyses, only AP was significant for AD (odds ratio = 2.94, p < 0.001), while none reached statistical significance for DD. Psychiatric comorbidity status had a detrimental effect on various dimensions of QoL. Patients with DD or AD reported a significantly higher need for professional psychosocial services.
Significance of results:
Given the substantial prevalence and pervasive impact of DD and AD on various aspects of QoL, its assessment and care should be integrated as a regular part of oncological care throughout the cancer continuum.
The National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute neuropsychology protocol consists of only verbal tasks, and is proposed as a brief screening method for vascular cognitive impairment. We evaluated its feasibility within two weeks after stroke and ability to predict the development of post-stroke dementia (PSD) at 3 months after stroke.
Method:
We prospectively enrolled subjects with ischemic stroke within seven days of symptom onset who were consecutively admitted to 12 university hospitals. Neuropsychological assessments using the NINDS-CSN 5-minute and 60-minute neuropsychology protocols were administered within two weeks and at 3 months after stroke onset, respectively. PSD was diagnosed with reference to the American Heart Association/American Stroke Association statement, requiring deficits in at least two cognitive domains.
Results:
Of 620 patients, 512 (82.6%) were feasible for the NINDS-CSN 5-minute protocol within two weeks after stroke. The incidence of PSD was 16.2% in 308 subjects who had completed follow-up at 3 months after stroke onset. The total score of the NINDS-CSN 5-minute protocol differed significantly between those with and without PSD (4.0 ± 2.7, 7.4 ± 2.7, respectively; p < 0.01). A cut-off value of 6/7 showed reasonable discriminative power (sensitivity 0.82, specificity 0.67, AUC 0.74). The NINDS-CSN 5-minute protocol score was a significant predictor for PSD (adjusted odds ratio 6.32, 95% CI 2.65–15.05).
Discussion:
The NINDS-CSN 5-minute protocol is feasible to evaluate cognitive functions in patients with acute ischemic stroke. It might be a useful screening method for early identification of high-risk groups for PSD.
A life-threatening cardiopulmonary resuscitation (CPR)-related injury can cause recurrent arrest after return of circulation. Such injuries are difficult to identify during resuscitation, and their contribution to failed resuscitation can be missed given the limitations of conventional CPR. Extracorporeal cardiopulmonary resuscitation (ECPR), increasingly being considered for selected patients with potentially reversible etiology of arrest, may identify previously occult CPR-related injuries by restoring arterial pressure and flow. Herein, we describe two cases of severe CPR-related injuries contributing to recurrent arrest. Each case had ECPR implemented within 60 minutes of the start of CPR. After the presumed cardiac etiology had been addressed with percutaneous coronary intervention, life-threatening cardiovascular injuries with recurrent arrest were noted, and resuscitative thoracotomy was performed under ECPR. One patient survived to hospital discharge.
ECPR may provide an opportunity to identify and correct severe resuscitation-related injuries causing recurrent arrest. Chest compression depth >6 cm, especially in older women, may contribute to these injuries.
To determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents.
Methods
A prospective randomized, double-blind, placebo-controlled trial was conducted for patients with suspected appendicitis. The patients were randomized to receive placebo (normal saline intravenous [IV]) infusions over 5 minutes or the study drug (morphine 5 mg IV). All of the clinical evaluations by surgical residents were performed 30 minutes after administration of the study drug or placebo. After obtaining the clinical probability of appendicitis, as determined by the surgical residents, abdominal computed tomography was performed. The primary objective was to compare the influence of IV morphine on the ability of surgical residents to diagnose appendicitis.
Results
A total of 213 patients with suspected appendicitis were enrolled. Of these patients, 107 patients received morphine, and 106 patients received placebo saline. The negative appendectomy percentages in each group were similar (3.8% in the placebo group and 3.2% in the pain control group, p=0.62). The perforation rates in each group were also similar (18.9% in the placebo group and 14.3% in the pain control group, p=0.75). Receiver operating characteristic analysis revealed that the overall diagnostic accuracy in each group was similar (the area under the curve of the placebo group and the pain control group was 0.63 v. 0.61, respectively, p=0.81).
Conclusions
Early pain control in patients with suspected appendicitis does not affect the diagnostic performance of surgical residents.
The mitochondrial genome is maternally inherited in animals, despite the fact that paternal mitochondria enter oocytes during fertilization. Autophagy and ubiquitin-mediated degradation are responsible for the elimination of paternal mitochondria in Caenorhabditis elegans; however, the involvement of these two processes in the degradation of paternal mitochondria in mammals is not well understood. We investigated the localization patterns of light chain 3 (LC3) and ubiquitin in mouse and porcine embryos during preimplantation development. We found that LC3 and ubiquitin localized to the spermatozoon midpiece at 3 h post-fertilization, and that both proteins were colocalized with paternal mitochondria and removed upon fertilization during the 4-cell stage in mouse and the zygote stage in porcine embryos. Sporadic paternal mitochondria were present beyond the morula stage in the mouse, and paternal mitochondria were restricted to one blastomere of 4-cell embryos. An autophagy inhibitor, 3-methyladenine (3-MA), did not affect the distribution of paternal mitochondria compared with the positive control, while an autophagy inducer, rapamycin, accelerated the removal of paternal mitochondria compared with the control. After the intracytoplasmic injection of intact spermatozoon into mouse oocytes, LC3 and ubiquitin localized to the spermatozoon midpiece, but remnants of undegraded paternal mitochondria were retained until the blastocyst stage. Our results show that paternal mitochondria colocalize with autophagy receptors and ubiquitin and are removed after in vitro fertilization, but some remnants of sperm mitochondrial sheath may persist up to morula stage after intracytoplasmic spermatozoon injection (ICSI).
An indexed offset distance of the tricuspid septal leaflet ⩾8 mm/m2 is a quantitative criterion for the diagnosis of Ebstein’s anomaly. The purpose of this study was to investigate the validity of this criterion for the discrimination of Ebstein’s anomaly from pulmonary atresia with intact ventricular septum in neonatal patients. A total of 122 neonatal patients, 56 with Ebstein’s anomaly and 66 with pulmonary atresia with intact ventricular septum, were enrolled. Diagnosis of each anomaly was based on typical morphologic features. Echocardiographic variables, including the offset distance of the tricuspid septal leaflet, were measured via an offline analysis of images recorded before 1 month of age. The offset distance of the tricuspid septal leaflet was indexed by the body surface area, and the indexed offset distances in the Ebstein’s anomaly and pulmonary atresia with intact ventricular septum groups were 34.2 mm/m2 (7.1–119.1 mm/m2) and 7.2 mm/m2 (0.0–25.6 mm/m2), respectively. The indexed offset distance was ⩾8 mm/m2 in 29 (43.9%) of the patients with pulmonary atresia with intact ventricular septum; clinical and echocardiographic characteristics were comparable between these 29 patients and the remaining 37 patients with pulmonary atresia with intact ventricular septum. When an indexed offset distance ⩾8 mm/m2 was applied as a cut-off for the diagnosis of Ebstein’s anomaly, the sensitivity was 0.963 and the specificity was 0.561. In conclusion, indexed offset distance ⩾8 mm/m2 cannot be used as a cut-off for the diagnosis of complicated Ebstein’s anomaly in neonatal patients with pulmonary atresia with intact ventricular septum.
Interspecies intracytoplasmic sperm injection has been carried out to understand species-specific differences in oocyte environments and sperm components during fertilization. While sperm aster organization during cat fertilization requires a paternally derived centriole, mouse and hamster fertilization occur within the maternal centrosomal components. To address the questions of where sperm aster assembly occurs and whether complete fertilization is achieved in cat oocytes by interspecies sperm, we studied the fertilization processes of cat oocytes following the injection of cat, mouse, or hamster sperm. Male and female pronuclear formations were not different in the cat oocytes at 6 h following cat, mouse or hamster sperm injection. Microtubule asters were seen in all oocytes following intracytoplasmic injection of cat, mouse or hamster sperm. Immunocytochemical staining with a histone H3-m2K9 antibody revealed that mouse sperm chromatin is incorporated normally with cat egg chromatin, and that the cat eggs fertilized with mouse sperm enter metaphase and become normal 2-cell stage embryos. These results suggest that sperm aster formation is maternally dependent, and that fertilization processes and cleavage occur in a non-species specific manner in cat oocytes.
In this investigation on the formation of multiple-layered Kirkendall voids at Cu/Sn–3.5Ag solder joints, Sn–3.5Ag solder balls were reacted with Cu under bump metallurgy (UBM), which was electroplated using bis-sodium sulfopropyl–disulfide, C6H12O6S4Na2 (SPS) additive. The sequence of multilayer Kirkendall voids and Cu–Sn IMC (intermetallic compounds) formations are explained with the aid of cross-sectional scanning electron microscopy (SEM) micrographs and schematic diagrams. During the aging treatment at 150 °C, layers of Cu6Sn5/Cu3Sn formed at the solder joints and Kirkendall voids nucleated at the Cu3Sn/Cu interface as a result of the segregation of residual S originating from SPS. However, with Kirkendall void growth, the net section area of the Cu/Cu3Sn interface decreased and the Cu flux into Cu3Sn was inhibited. As the atomic ratio of Cu against Sn in the Cu3Sn dropped, transformation of Cu3Sn into Cu6Sn5 ensued. Subsequent diffusion of Sn atoms into the remaining Cu UBM through the remaining ligament of the Cu6Sn5/Cu interface precipitated secondary Cu3Sn beneath the primary Cu3Sn/Cu interface, and the secondary Kirkendall voids formed at the new Cu3Sn/Cu interface and so on.
Copper was supplied to Sn–3.5Ag by electroplating Cu/Ni double under-bump metallization (UBM), and the amount of Cu was controlled by varying the Cu UBM thickness. Supposed Cu contents in the solder were; 0.2, 0.5, and 1.0 wt%, respectively, and the solder joint microstructure was investigated after 1, 5, and 10 reflows. In the case of specimens with 0.2 and 1.0 wt% Cu, only one type of intermetallic compound (IMC) formed, either (Cu,Ni)6Sn5 or (Ni,Cu)3Sn4, while two types formed in specimen with 0.5 wt% Cu. No correlation could be found between the solder joint microstructure and the ball shear test. However, drop test results showed two opposite trends. The drop resistance of 0.2 and 1.0 wt% Cu specimens was quite good initially but degraded dramatically with multiple reflows, in contrast to that of the 0.5 wt% Cu specimen, which was very poor after one reflow but improved substantially later on. The former was ascribed to thickening of IMC during reflow, while the latter was related to (Ni,Cu)3Sn4 thickening beneath (Cu,Ni)6Sn5 and subsequent spalling of (Cu,Ni)6Sn5 from (Ni,Cu)3Sn4.
The swelling behavior of chitosan hydrogels in ionic liquid–water binary systems was studied using hydrophilic room-temperature ionic liquids (RTILs) to elucidate the swelling properties of chitosan hydrogels. It was confirmed that chitosan hydrogels are much stiffer after immersing in a pure RTIL because the water existing inside the chitosan polymer network is extracted into the RTIL. The pH of the binary system changes when the RTIL is in contact with water. The chitosan hydrogels were fully dissociated at a 90% water content in the BMI-BF4-water binary system. The equilibrium binary system content behavior of the chitosan hydrogels depended upon the amount of free water present. The water behavior in a pure RTIL was examined using differential scanning calorimetry.
Composite fibers composed of chitosan and single-wall carbon nanotubes (CNTs) have been fabricated using a wet spinning method. The dispersion was improved by the sonic agitation of the CNTs in a chitosan solution followed by centrifugation to remove tube aggregates and any residual catalyst. The mechanical behavior was investigated using a dynamic mechanical analyzer (DMA). The mechanical tests showed a dramatic increase in Young's modulus for the chitosan/CNT composite fibers fabricated using the improved dispersion method. The strain on the microfibers was determined from tensile load measurements during pH switching in acidic or basic electrolyte solutions. The microfibers showed a general actuation behavior of expanding at pH = 2 and contracting at pH = 7 under low tensile loads. However, a reverse of this actuation behavior was exhibited under high tensile loads. This anomalous pH actuation is both new and surprising. It was explained from an analysis of the differences in sample stiffness and Poisson’s ratio under tensile load in electrolyte solutions with different pH values.
System in package (SiP) is a superb candidate to enhance the area efficiency and performance of electronic packaging. Here, recent work on stacked chip type 3D SiP with vertically interconnected through hole vias are reported. The process includes; formation of 50um-diameter via holes, conformal deposition of SiO2 dielectric layer, deposition of Ta and Cu barrier layers, via filling by Cu electroplating, Cu/Sn bump formation for multi-chip stacking, and finally chip-to-PCB bonding using Sn-3.0Ag-0.5Cu solder and ENIG pad. A prototype 3D SiP stacked up to 10 layers was successfully fabricated.
A high frequency electrical model of the through hole via was proposed and the model parameters were extracted from measured S-parameters. The proposed model was verified by TDR/TDT (time domain reflectometry/time domain transmission) and eye-diagram measurement. Contact resistances of Cu via and bump joint were presented.