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Background: The purpose of this study was to find out the relationship between appropriateness of antibiotic prescription and clinical outcomes in patients with community-acquired acute pyelonephritis (CA-APN). Methods: A multicenter prospective cohort study was performed in 8 Korean hospitals from September 2017 to August 2018. All hospitalized patients aged ≥19 years diagnosed with CA-APN at admission were recruited. Pregnant women and patients with insufficient data were excluded. In addition, patients with prolonged hospitalization due to medical problems that were not associated with APN treatment were excluded. The appropriateness of empirical and definitive antibiotics was divided into “optimal,” “suboptimal,” and “inappropriate,” and optimal and suboptimal were regarded as appropriate antibiotic use. The standard for the classification of empirical antibiotics was defined reflecting the Korean national guideline for the antibiotic use in urinary tract infection 2018. The standards for the classification of definitive antibiotics were defined according to the result of in vitro susceptibility tests of causative organisms. Clinical outcomes including clinical failure (mortality or recurrence) rate, hospitalization days, and medical costs were compared between patients who were prescribed antibiotics appropriately and those who were prescribed them inappropriately. Results: In total, 397 and 318 patients were eligible for the analysis of the appropriateness of empirical and definitive antibiotics, respectively. Of these, 10 (2.5%) and 18 (5.7%) were inappropriately prescribed empirical and definitive antibiotics, respectively, and 28 (8.8%) were prescribed either empirical or definitive antibiotics inappropriately. Patients who were prescribed empirical antibiotics appropriately showed a lower mortality rate (0 vs 10%; P = .025), shorter hospitalization days (9 vs 12.5 days; P = .014), and lower medical costs (US$2,333 vs US$4,531; P = .007) compared to those who were prescribed empirical antibiotics “inappropriately.” In comparison, we detected no significant differences in clinical outcomes between patients who were prescribed definitive antibiotics appropriately and those who were prescribed definitive antibiotics inappropriately. Patients who were prescribed both empirical and definitive antibiotics appropriately showed a lower clinical failure rate (0.3 vs 7.1%; P = .021) and shorter hospitalization days (9 vs 10.5 days; P = .041) compared to those who were prescribed either empirical or definitive antibiotics inappropriately. Conclusions: Appropriate use of antibiotics leads patients with CA-APN to better clinical outcomes including fewer hospitalization days and lower medical costs.
The present article aimed to evaluate the impact of congenital Müllerian anomalies (MA) on twin pregnancy after 24 gestational weeks in Korean women. All records of twin pregnancies in a large maternity hospital in Korea between January 2005 and July 2013 were analyzed. Patients with monochorionic monoamniotic (MCMA) twins, non-Korean patients, patients with twins delivered prior to 24 gestational weeks, and patients with miscarriage of one fetus or intrauterine fetal death (IUFD) before 24 gestational weeks were excluded from data analysis. In total, 1,422 women with twin pregnancy were eligible for data analysis, including 17 (1.2%) who had a known congenital MA (septate uterus, bicornuate uterus, arcuate uterus, and unicornuate uterus). Except for the mode of conception, baseline demographics were similar between women with MA and those without MA. No significant differences were found in pregnancy outcomes of gestational age at delivery (p = .86), birth weight of smaller and larger twins (p = .54 and p = .65), and number of twins with birth weight <5th percentile for gestational age (p = .43).The rates of obstetrical complications such as pre-eclampsia, gestational diabetes mellitus (GDM), placenta previa, cerclage, IUFD, and postpartum hemorrhage were not significantly different between the two groups either. We concluded that the presence of congenital MA may not increase obstetrical risks in outcomes of pregnancy of twins delivered after 24 gestational weeks.
It is unclear how brain reserve interacts with gender and apolipoprotein E4 (APOE4) genotype, and how this influences the progression of Alzheimer's disease (AD). The association between intracranial volume (ICV) and progression to AD in subjects with mild cognitive impairment (MCI), and differences according to gender and APOE4 genotype, was investigated.
Data from subjects initially diagnosed with MCI and at least two visits were downloaded from the ADNI database. Those who progressed to AD were defined as converters. The longitudinal influence of ICV was determined by survival analysis. The time of conversion from MCI to AD was set as a fiducial point, as all converters would be at a similar disease stage then, and longitudinal trajectories of brain atrophy and cognitive decline around that point were compared using linear mixed models.
Large ICV increased the risk of conversion to AD in males (HR: 4.24, 95% confidence interval (CI): 1.17–15.40) and APOE4 non-carriers (HR: 10.00, 95% CI: 1.34–74.53), but not in females or APOE4 carriers. Cognitive decline and brain atrophy progressed at a faster rate in males with large ICV than in those with small ICV during the two years before and after the time of conversion.
Large ICV increased the risk of conversion to AD in males and APOE4 non-carriers with MCI. This may be due to its influence on disease trajectory, which shortens the duration of the MCI stage. A longitudinal model of progression trajectory is proposed.
Cerebral white matter hyperintensities (WMH) are prevalent incident findings on brain MRI scans among elderly people and have been consistently implicated in cognitive dysfunction. However, differential roles of WMH by region in cognitive function are still unclear. The aim of this study was to ascertain the differential role of regional WMH in predicting progression from mild cognitive impairment (MCI) to different subtypes of dementia.
Participants were recruited from the Clinical Research Center for Dementia of South Korea (CREDOS) study. A total of 622 participants with MCI diagnoses at baseline and follow-up evaluations were included for the analysis. Initial MRI scans were rated for WMH on a visual rating scale developed for the CREDOS. Differential effects of regional WMH in predicting incident dementia were evaluated using the Cox proportional hazards model.
Of the 622 participants with MCI at baseline, 139 patients (22.3%) converted to all-cause dementia over a median of 14.3 (range 6.0–36.5) months. Severe periventricular WMH (PWMH) predicted incident all-cause dementia (Hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.43–3.43) and Alzheimer's disease (AD) (HR 1.86; 95% CI 1.12–3.07). Subcortical vascular dementia (SVD) was predicted by both PWMH (HR 16.14; 95% CI 1.97–132.06) and DWMH (HR 8.77; 95% CI 1.77–43.49) in more severe form (≥ 10 mm).
WMH differentially predict dementia by region and severity. Our findings suggest that PWMH may play an independent role in the pathogenesis of dementia, especially in AD.
Introduction: Internet game overuse is an emerging disorder and features diminished impulse control and poor reward-processing. In an attempt to understand the neurobiological bases of Internet game overuse, we investigated the differences in regional cerebral glucose metabolism at resting state between young individuals with Internet game overuse and those with normal use using 18F-fluorodeoxyglucose positron emission tomography study.
Methods: Twenty right-handed male participants (9 normal users: 24.7±2.4 years of age, 11 overusers: 23.5±2.9 years of age) participated. A trait measure of impulsivity was also completed after scanning.
Results: Internet game overusers showed greater impulsiveness than the normal users and there was a positive correlation between the severity of Internet game overuse and impulsiveness. Imaging data showed that the overusers had increased glucose metabolism in the right middle orbitofrontal gyrus, left caudate nucleus, and right insula, and decreased metabolism in the bilateral postcentral gyrus, left precentrai gyrus, and bilateral occipital regions compared to normal users.
Conclusion: Internet game overuse may be associated with abnormal neurobiological mechanisms in the orbitofrontal cortex, striatum, and sensory regions, which are implicated in impulse control, reward processing, and somatic representation of previous experiences. Our results support the idea that Internet game overuse shares psychological and neural mechanisms with other types of impulse control disorders and substance/non-substance-related addiction.
There is increasing evidence of a relationship between underweight or obesity and dementia risk. Several studies have investigated the relationship between body weight and brain atrophy, a pathological change preceding dementia, but their results are inconsistent. Therefore, we aimed to evaluate the relationship between body mass index (BMI) and cortical atrophy among cognitively normal participants.
We recruited cognitively normal participants (n = 1,111) who underwent medical checkups and detailed neurologic screening, including magnetic resonance imaging (MRI) in the health screening visits between September 2008 and December 2011. The main outcome was cortical thickness measured using MRI. The number of subjects with five BMI groups in men/women was 9/9, 148/258, 185/128, 149/111, and 64/50 in underweight, normal, overweight, mild obesity, and moderate to severe obesity, respectively. Linear and non-linear relationships between BMI and cortical thickness were examined using multiple linear regression analysis and generalized additive models after adjustment for potential confounders.
Among men, underweight participants showed significant cortical thinning in the frontal and temporal regions compared to normal weight participants, while overweight and mildly obese participants had greater cortical thicknesses in the frontal region and the frontal, temporal, and occipital regions, respectively. However, cortical thickness in each brain region was not significantly different in normal weight and moderate to severe obesity groups. Among women, the association between BMI and cortical thickness was not statistically significant.
Our findings suggested that underweight might be an important risk factor for pathological changes in the brain, while overweight or mild obesity may be inversely associated with cortical atrophy in cognitively normal elderly males.
We investigated the microstructural evolution of Sn96.4Ag2.8Cu0.8 solder through in situ heating transmission electron microscopy observations. As-soldered bump consisted of seven layers, containing the nanoeutectic lamella structure of AuSn and Au5Sn phases, and the polygonal grains of AuSn2 and AuSn4, on Au-plated Cu bond pads. Here, we found that there are two nanoeutectic lamellar layers with lamella spacing of 40 and 250 nm. By in situ heating above 140°C, the nanoeutectic lamella of AuSn and Au5Sn was decomposed with structural degradation by sphering and coarsening processes of the lamellar interface. At the third layer neighboring to the lamella layer, on the other hand, Au5Sn particles with a zig-zag shape in AuSn matrix became spherical and were finally dissipated in order to minimize the interface energy between two phases. In the other layers except both lamella layers, polycrystal grains of AuSn2 and AuSn4 grew by normal grain growth during in situ heating. The high interface energy of nanoeutectic lamella and polygonal nanograins, which are formed by rapid solidification, acted as a principal driving force on the microstructural change during the in situ heating.
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.
The synthesis, structure, and electrical performances of titanium dioxide (TiO2 and also doped TiO2) thin films, a capacitor dielectric for dynamic random access memory (DRAM) and a resistance switching material in resistance switching RAM (ReRAM), are reviewed. The three-dimensionality of these structures and the extremely small feature sizes (<20 nm) of these memory devices require the synthesis method of TiO2-based layers to exhibit high degree of conformality. Atomic layer deposition is, therefore, the method of choice in respect of film growth for these applications. The unique arrangement of the TiO6-octahedra in the rutile structure, which results in the value for dielectric constant of the dielectric layer, εr (>100), makes the material especially attractive as the capacitor dielectric layer in DRAM. Removing some of the oxygen ions from the rutile structure and arranging the resulting oxygen vacancies on a specific crystallographic plane results in the so called Magnéli phase materials, which show distinctive conducting semiconductor or metallic characteristics. External electrical stimuli can cause the repeated formation and rupture of conducting channels that consist of these Magnéli phase materials in the insulating TiO2 matrix, and this aspect makes the material a very feasible choice for applications in ReRAM. This article reviews the material properties, fabrication process, integration issues, and prospect of TiO2 films for these applications.
We present a versatile and facile route for highly sensitive detection of
analytes through coupling the enlargement of gold nanoparticles (Au NPs)
with fluorescence decrease. The fluorescence intensity of dye molecules
(e.g., fluorescein or rhodamine B) significantly decreased with the
increasing concentration of reducing agents, such as hydrogen peroxide and
hydroquinone. The sensitivity for the detection of reducing agents was much
higher than other detection methods based on the absorbance measurement of
enlarged gold nanoparticles or quantum dot-enzyme hybridization. We could
successfully detect acetylthiocholine with the detection limit of several nM
orders, using an enzymatic reaction by acetylcholinesterase, a key route for
the detection of toxic organophosphate compounds. The fluorescence
decreasing approach described in this work requires only a simple addition
of fluorescence dye to the reaction solution without any chemical
modification. The strategy of fluorescence decrease coupled with
nanoparticle growth will be applied on the fluorescent substrate to develop
detection templates for highly sensitive optical biosensor.
Recently, the Antarctic Peninsula has received more attention due to the pronounced warming in that region. Non-glaciated coastal areas on the Peninsula can be significant energy sources for the atmosphere when they are exposed during summer despite the high degree of cloud associated with the frequent passage of low pressure systems. An eddy covariance system was established in December 2002 to evaluate the turbulent energy exchanges between the atmosphere and a non-glaciated coastal area on King George Island. Monthly average downward shortwave radiation was less than 210 Wm-2 in summer. Due to the low albedo of 0.12, monthly average net radiation reached > 130 Wm-2, a magnitude that was significantly larger than the reported magnitudes of < ~70 Wm-2 at glaciated areas with a high albedo on the Peninsula. The sum of monthly average sensible heat (< 64 Wm-2) and latent heat (< 20 Wm-2) fluxes amounted up to ~80 Wm-2, which was an order of magnitude larger than those at glaciated areas on the Antarctic Peninsula. Given that non-glaciated areas should be enlarged if the warming continues, more attention may need to be paid to the role of non-glaciated areas in the local climate to predict climate change on the Antarctic Peninsula.
The goal of this work was to improve the strength of sintered zirconia (3 mol% yttria stabilized) by surface treatment, using a low expansion glass (Mg3Al2Si6O18) at high temperature. The room-temperature strength was increased by about 42% when the glass was penetrated for 30 min. There was a drastic increase in the Weibull modulus. However, the longer holding time led to grain coarsening and the excess glass deteriorated the strength. The magnitude of the strength increment was on the order of surface stress measured experimentally and thermo-elastic stress predicted theoretically. A significant contribution of phase transformation of zirconia from tetragonal to monoclinic phase on the residual stress was also found. Furthermore, compared to the as-sintered zirconia, the glass-treated sample (penetrated for 30 min) exhibited relatively higher strength at elevated temperature (750 °C) and also showed a significant improvement in the thermal shock resistance behavior.
The hydrophobicity of poly Si is reported to introduce different polishing behavior with careful control of post CMP cleaning process. The purpose of this study was to investigate the effect of poly Si wettability on its CMP behavior. The adhesion force of polymeric particle on the poly Si wafer surfaces was measured in the KOH solution (pH 11) as a function of solution A concentration. Adhesion force decreased and saturated as a function of concentration of solution A. The change of surface wettability affects not only the polishing rates but also the level of contamination on wafer because the interactions between particles and substrates are dependent on the wettability of the surface. Also, hydrophobic poly Si surfaces attracted much more pad particles with water marks than hydrophilic
Vertically-aligned Mn (10%)-doped Fe3O4 (Fe2.7Mn0.3O4) nanowire arrays were produced by the reduction/substitution of pre-grown Fe2O3 nanowires. These nanowires were ferromagnetic with a Verwey temperature of 129 K. X-ray magnetic circular dichroism measurements revealed that the Mn2+ ions preferentially occupy the tetrahedral sites, substituting for the Fe3+ ions. We observed that the Mn substitution decreases the magnetization, but increases the electrical conductivity. We developed highly sensitive gas sensors using these nanowire arrays, operating at room temperature, whose sensitivity showed a correlation with their bond strength of diatomic/triatomic molecules. Based on the fact that the sensitivity was highest toward water vapor, an excellent-performance humidity sensor was fabricated.
Metal oxide nanoparticles within the protein ferritin can act as an energy storage source in nano-bio batteries containing ferrous ferritin and a reconstituted ferritin cage containing different inorganic elements, such as Co, Mn, Ni, and Pt. These components were introduced as two ferritin half-cells with different redox potentials existing between the ferrous ferritin and the reconstituted ferritin. The reduction of ferritin was analyzed in a solution containing 3-[N-morpholino] propanesulfonic acid buffer and oxidized methyl viologen using cyclic voltammetry. The reduction and oxidation peaks of the methyl viologen occurred at potentials of −300 and −100 mV, respectively, and the reduction and the oxidation peaks of the released Fe occurred at potentials of −300 and −100 mV, respectively. The reduction of ferritin was influenced by the pH of the ferritin solution.
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.
Composite nanofibers including ferritin nanoparticles or multiwalled carbon nanotubes (MWCNTs) were fabricated to enhance the physical properties of the nanofibers, such as the elastic modulus and electrical conductivity. The ferritin was homogeneously incorporated in the polymeric nanofibers, but excess carbon nanotubes (CNTs) added to the polymer solution resulted in the fabrication of composite nanofibers with rough surfaces. PVA/ferritin/CNT composite nanofibers were fabricated that had smooth surfaces, and had a good dispersion of ferritin and CNTs. These composite nanofibers are applicable to artificial muscles requiring enhanced physical properties.
We have studied the pyroelectric properties of the PLT(10) thin film deposited on a p-doped poly-Si electrode by using the sol-gel method. Measurement of the dielectric constant as a function of temperature shows the typical characteristics of a ferroelectric. The dielectric constant reaches a maximum at 295°C, which can be thought of as the Curie temperature. The PLT(10) thin film on p-doped poly-Si fabricated in this research shows excellent pyroelectric properties. The pyroelectric coefficient and the fiqures of merit, Fv and FD at room temperature are measured as 5.76 × 10−8 C/cm2 °C, 1.17 × 10−10C-cm/J and 0.93 × 10−8C-cm/J, respectively.
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