Deep Learning-Based Dynamic Risk Prediction of Venous Thromboembolism for Patients With Ovarian Cancer in Real-World Settings From Electronic Health Records.

PURPOSE: Patients with epithelial ovarian cancer (EOC) have an elevated risk for venous thromboembolism (VTE). To assess the risk of VTE, models were developed by statistical or machine learning algorithms. However, few models have accommodated deep learning (DL) algorithms in realistic clinical settings. We aimed to develop a predictive DL model, exploiting rich information from electronic health records (EHRs), including dynamic clinical features and the presence of competing risks. METHODS: We extracted EHRs of 1,268 patients diagnosed with EOC from January 2007 through December 2017 at the National Cancer Center, Korea. DL survival networks using fully connected layers, temporal attention, and recurrent neural networks were adopted and compared with multi-perceptron-based classification models. Prediction accuracy was independently validated in the data set of 423 patients newly diagnosed with EOC from January 2018 to December 2019. Personalized risk plots displaying the individual interval risk were developed. RESULTS: DL-based survival networks achieved a superior area under the receiver operating characteristic curve (AUROC) between 0.95 and 0.98 while the AUROC of classification models was between 0.85 and 0.90. As clinical information benefits the prediction accuracy, the proposed dynamic survival network outperformed other survival networks for the test and validation data set with the highest time-dependent concordance index (0.974, 0.975) and lowest Brier score (0.051, 0.049) at 6 months after a cancer diagnosis. Our visualization showed that the interval risk fluctuating along with the changes in longitudinal clinical features. CONCLUSION: Adaption of dynamic patient clinical features and accounting for competing risks from EHRs into the DL algorithms demonstrated VTE risk prediction with high accuracy. Our results show that this novel dynamic survival network can provide personalized risk prediction with the potential to assist risk-based clinical intervention to prevent VTE among patients with EOC.

Molecular Detection and Phylogenetic Analysis of Tick-Borne Encephalitis Virus from Ticks Collected from Cattle in Kyrgyzstan, 2023.

Ticks are important vectors of the tick-borne encephalitis virus (TBEV). In Kyrgyzstan, the livestock farming trade and nomadic lifestyle enable tick-borne diseases to be imported from neighboring countries, but there are few relevant studies. In this study, we collected 40 ticks from cattle in Kyrgyzstan. Molecular marker analysis identified the ticks as Ixodes persulcatus (97.5%; n = 39) and Haemaphysalis punctata (2.5%; n = 1). Real-time PCR screening revealed two ticks to be positive for TBEV, but only one tick was amplified using nested PCR targeting the TBEV envelope (E) and non-structure 5 (NS5) gene. The obtained sequences belonged to the TBEV Siberian subtype and phylogenetic tree analysis results confirmed that the virus was related to the Bosnia strain. We also performed next-generation sequencing, which confirmed the TBEV Siberian subtype. Continuous research and surveillance of TBEV in Kyrgyzstan are required to provide further information on tick-borne diseases.

Molecular Detection of Anaplasma, Ehrlichia and Rickettsia Pathogens in Ticks Collected from Humans in the Republic of Korea, 2021.

Tick-borne pathogens (TBPs), transmitted by the bites of ticks, are of great medical and veterinary importance. They include bacteria, viruses, and protozoan parasites. To provide fundamental data on the risk of tick contact and public health strategies, we aimed to perform a molecular investigation on four tick-borne bacterial pathogens in ticks collected from humans across the Republic of Korea (ROK) in 2021. In total, 117 ticks were collected, including Haemaphysalis longicornis (56.4%), Amblyomma testudinarium (26.5%), Ixodes nipponensis (8.5%), H. flava (5.1%), and I. persulcatus (0.9%). Among the ticks, 20.5% (24/117) contained tick-borne bacterial pathogens, with infection rates of 17.9% for Rickettsia (Candidatus Rickettsia jingxinensis, R. tamurae, R. monacensis, and Candidatus Rickettsia tarasevichiae), 2.5% for Anaplasma (A. phagocytophilum, A. capra, and A. bovis), and 0.9% for Ehrlichia (Ehrlichia sp.). Additionally, the co-detection rate for R. monacensis and A. phagocytophilum was 0.9%. To our knowledge, this is the first report of A. capra and A. bovis detection in ticks collected from humans in the ROK. This study contributes to the understanding of the potential risk of tick contact and provides fundamental data for establishing a public health strategy for tick-borne disease management in the ROK.

Optimized End Functionality of Silane-Terminated Liquid Butadiene Rubber for Silica-Filled Rubber Compounds.

As the world is shifting from internal combustion engine vehicles to electric vehicles in response to environmental pollution, the tire industry has been conducting research on tire performance to meet the requirements of electric vehicles. In this experiment, functionalized liquid butadiene rubber (F-LqBR) with triethoxysilyl groups at both ends was introduced into a silica-filled rubber compound as a substitute for treated distillate aromatic extract (TDAE) oil, and comparative evaluation was conducted according to the number of triethoxysilyl groups. The results showed that F-LqBRs improved silica dispersion in the rubber matrix through the formation of chemical bonds between silanol groups and the base rubber, and reduced rolling resistance by limiting chain end mobility and improving filler-rubber interaction. However, when the number of triethoxysilyl groups in F-LqBR was increased from two to four, self-condensation increased, the reactivity of the silanol groups decreased, and the improvement of properties was reduced. As a result, the optimized end functionality of triethoxysilyl groups for F-LqBR in silica-filled rubber compound was two. The 2-Azo-LqBR with the optimized functionality showed an improvement of 10% in rolling resistance, 16% in snow traction, and 17% in abrasion resistance when 10 phr of TDAE oil was substituted.

Dynamic Pore Modulation of Stretchable Electrospun Nanofiber Filter for Adaptive Machine Learned Respiratory Protection.

The recent emergence of highly contagious respiratory disease and the underlying issues of worldwide air pollution jointly heighten the importance of the personal respirator. However, the incongruence between the dynamic environment and nonadaptive respirators imposes physiological and psychological adverse effects, which hinder the public dissemination of respirators. To address this issue, we introduce adaptive respiratory protection based on a dynamic air filter (DAF) driven by machine learning (ML) algorithms. The stretchable elastomer fiber membrane of the DAF affords immediate adjustment of filtration characteristics through active rescaling of the micropores by simple pneumatic control, enabling seamless and constructive transition of filtration characteristics. The resultant DAF-respirator (DAF-R), made possible by ML algorithms, successfully demonstrates real-time predictive adapting maneuvers, enabling personalizable and continuously optimized respiratory protection under changing circumstances.

Binary genetic algorithm for optimal joinpoint detection: Application to cancer trend analysis.

The joinpoint regression model (JRM) is used to describe trend changes in many applications and relies on the detection of joinpoints (changepoints). However, the existing joinpoint detection methods, namely, the grid search (GS)-based methods, are computationally demanding, and hence, the maximum number of computable joinpoints is limited. Herein, we developed a genetic algorithm-based joinpoint (GAJP) model in which an explicitly decoupled computing procedure for optimization and regression is used to embed a binary genetic algorithm into the JRM for optimal joinpoint detection. The combinations of joinpoints were represented as binary chromosomes, and genetic operations were performed to determine the optimum solution by minimizing the fitness function, the Bayesian information criterion (BIC) and BIC3 . The accuracy and computational performance of the GAJP model were evaluated via intensive simulation studies and compared with those of the GS-based methods using BIC, BIC3 , and permutation test. The proposed method showed an outstanding computational efficiency in detecting multiple joinpoints. Finally, the suitability of the GAJP model for the analysis of cancer incidence trends was demonstrated by applying this model to data on the incidence of colorectal cancer in the United States from 1975 to 2016 from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Thus, the GAJP model was concluded to be practically feasible to detect multiple joinpoints up to the number of grids without requirement to preassign the number of joinpoints and be easily extendable to cancer trend analysis utilizing large datasets.

Detection and characterization of an emerging type of Babesia sp. similar to Babesia motasi for the first case of human babesiosis and ticks in Korea.

Babesiosis is a tick-transmitted intraerythrocytic zoonosis. In Korea, the first mortalities were reported in 2005 due to Babesia sp. detection in sheep; herein we report epidemiological and genetic characteristics of a second case of babesiosis. Microscopic analysis of patient blood revealed polymorphic merozoites. To detect Babesia spp., PCR was performed using Babesia specific primers for ß-tubulin, 18S rDNA, COB, and COX3 gene fragments. 18S rDNA analysis for Babesia sp., showed 98% homology with ovine Babesia sp. and with Babesia infections in Korea in 2005. Moreover, phylogenetic analysis of 18S rDNA, COB, and COX3 revealed close associations with B. motasi. For identifying the infectious agent, Haemaphysalis longicornis (296) and Haemaphysalis flava (301) were collected around the previous residence of the babesiosis patient. Babesia genes were identified in three H. longicornis: one sample was identified as B. microti and two samples were 98% homologous to B. motasi. Our study is the first direct confirmation of the infectious agent for human babesiosis. This case most likely resulted from tick bites from ticks near the patient house of the babesiosis patient. H. longicornis has been implicated as a vector of B. microti and other Babesia sp. infections.

Atomic layer deposition and tellurization of Ge-Sb film for phase-change memory applications.

We studied the atomic layer deposition (ALD) and the tellurization of Ge-Sb films to prepare conformal crystalline Ge-Sb-Te (GST) films and to achieve void-free gap filling for emerging phase-change memory applications. ALD Ge-Sb film was prepared by alternating exposures to GeCl2-dioxane and Sb(SiEt3)3 precursors at 100 °C. The growth rate was 0.021 nm per cycle, and the composition ratio of Ge to Sb was approximately 2.2. We annealed the ALD Ge-Sb films with a pulsed feeding of di(tert-butyl)tellurium. The ALD Ge-Sb films turned into GST films by the tellurization annealing. When the tellurization temperature was raised to 190 °C or higher temperatures, the Raman peaks corresponding to Ge-Sb bond and amorphous Ge-Ge bond disappeared. The Raman peaks corresponding to Ge-Te and Sb-Te bonds were evolved at 200 °C or higher temperatures, resulting in the phase transition temperature of 123 °C. At 230 °C or higher temperatures, the entire film was fully tellurized to form a GST film having a relatively uniform composition of Ge3Sb2Te6, and the carbon impurities in the as-deposited ALD Ge-Sb film were eliminated. As the tellurization temperature increases, the volume of the ALD film is expanded owing to the incorporation of tellurium, resulting in complete filling of a trench pattern by GST film after the tellurization at 230 °C.

Three-Component Reactions to Spirocyclic Pyrrolidinonylformimidamides: α-Isocyano Lactams as Two-Atom Unit in Silver-Catalyzed Formal [3 + 2] Cycloaddition Reactions.

A facile approach to spirocyclic pyrrolidinonylformimidamides has been developed via three-component reactions of isocyanides, alkenes, and amines. The reaction proceeds through a sequence of two distinct reaction pathways; the base-catalyzed conjugate addition of α-isocyano lactams to electron-deficient alkenes and the Ag(I)-catalyzed amine insertion to the isocyanide moiety. Both reactions display markedly different reaction kinetics, allowing the one-pot three-component reactions to be performed in the presence of respective catalysts, a Brønsted base and a silver salt. The formation of spirocyclic pyrrolidin-2-ones represents an unusual use of α-isocyano lactam as a two-atom unit in a formal [3 + 2] cycloaddition reaction. The successful identification of ways to defy the typical three-atom unit role of α-isocyano carbonyl compounds in the [3 + 2] cycloaddition pathways manifests a rapid assembly of medicinally important spirocyclic scaffolds from readily available starting materials.

Knowledge and Perception about Clinical Research Shapes Behavior: Face to Face Survey in Korean General Public.

Considering general public as potential patients, identifying factors that hinder public participation poses great importance, especially in a research environment where demands for clinical trial participants outpace the supply. Hence, the aim of this study was to evaluate knowledge and perception about clinical research in general public. A total of 400 Seoul residents with no previous experience of clinical trial participation were selected, as representative of population in Seoul in terms of age and sex. To minimize selection bias, every fifth passer-by was invited to interview, and if in a cluster, person on the very right side was asked. To ensure the uniform use of survey, written instructions have been added to the questionnaire. Followed by pilot test in 40 subjects, the survey was administered face-to-face in December 2014. To investigate how perception shapes behavior, we compared perception scores in those who expressed willingness to participate and those who did not. Remarkably higher percentage of responders stated that they have heard of clinical research, and knew someone who participated (both, P < 0.001) compared to India. Yet, the percentage of responders expressed willingness to participate was 39.3%, a significantly lower rate than the result of the India (58.9% vs. 39.3%, P < 0.001). Treatment benefit was the single most influential reason for participation, followed by financial gain. Concern about safety was the main reason for refusal, succeeded by fear and lack of trust. Public awareness and educational programs addressing these negative perceptions and lack of knowledge will be effective in enhancing public engaged in clinical research.

Age structure at diagnosis affects aggression in a psychiatric inpatient population: age structure affecting inpatient aggression.

Study of inpatient aggression in psychiatric inpatient units (PIUs), where vulnerable patients interact intensely in small groups, is hampered by a lack of systematic monitoring of aggressive events in the context of group dynamics. Our current study examines the relationship between aggression and group structure in the PIU of a general tertiary-care hospital over a 9-month period. The severity of aggression was monitored daily using the Overt Aggression Scale (OAS). Clinical data including the daily number and mean age of subpopulations with different diagnoses were acquired. Cross-correlation function and autoregressive integrated moving average modeling were used to assess the effects of various group structure parameters on the incidence of aggressive events in the PIU. The daily total OAS score correlated positively with the daily mean age of patients with schizophrenia and bipolar disorder. By contrast, the OAS total score demonstrated a negative correlation with the daily mean age of patients with major depression. The age of the patients at diagnosis is an important group structure that affects the incidence of aggression in a PIU.

Insecticide susceptibility of field-collected populations of Culex tritaeniorhynchus in the Republic of Korea.

The toxicities of 10 insecticides were examined against late third instar Culex tritaeniorhynchus Giles (Diptera: Culicidae) using the direct-contact mortality bioassay. Six geospatially-distant field mosquitoes were collected from Chuncheon-si, Hwaseong, Seosan. Jeonju, Daegu, and Busan in the Republic of Korea. Marked regional variations of insecticide susceptibility were observed. Field populations of Seosan, Jeonju, and Daegu from agricultural areas showed higher to extremely higher insecticide susceptibility to pyrethroids than those of Chuncheon-si, Hwaseong, and Busan strains from non-agricultural areas. Extremely high to low levels of susceptibility were measured: bifenthrin, susceptible ratio (SR) = 2.7-896.3; ß-cyfluthrin, SR = 1.8-633.3; α-cypermethrin, SR = 1.2-1,051.9; deltamethrin, SR = 1.3-711.1; permethrin, SR = 1.5-1,053.4; etofenprox, SR = 2.2-29.3; chlorfenapyr, SR = 5.1-103.6; chlorpyrifos, SR = 2.3- 337.0; fenitrothion, SR = 2.0-142.3; and fenthion, SR = 1.4-186.2. Cx. tritaeniorhynchus populations from rice paddies had been under heavy selection pressure due to the agricultural insecticides, and that's why the mosquito species demonstrated high resistance to pyrethroids, which were used for a long time to control agricultural pests in the localities. These results indicate that careful selection and rotational use of these insecticides may result in continued satisfactory control against field populations of Japanese encephalitis vector mosquitoes.

Novelty-seeking and avoidant coping strategies are associated with academic stress in Korean medical students.

High levels of stress and depression in medical students is raising concern. In this study, we sought to identify coping strategies and other factors influencing academic stress in medical students. We enrolled 157 students from the University of Ulsan College of Medicine, Korea, in November, 2010. We used the Medical Stress Scale, Temperament and Character Inventory, Hamilton Depression Scale, Beck Depression Inventory, and Coping Response Inventory to assess psychological parameters. We used Pearson's correlation and linear regression analyses to analyze the data. Novelty-seeking, self-directedness, cooperativeness, coping strategy, and depression scale scores all correlated significantly with stress level. Linear regression analysis indicated that students who are novelty-seeking, likely to use avoidant coping strategies, and unlikely to use active-cognitive and active-behavioral strategies tend to have higher stress levels. Reduction of stress in medical students may be achieved through evaluation of coping strategies and personality features and use of interventions to promote active coping strategies.

In-stent area stenosis on 64-slice multi-detector computed tomography coronary angiography: optimal cutoff value for minimum lumen cross-sectional area of coronary stents compared with intravascular ultrasound.

We aimed to prospectively assess the optimal cutoff value for a minimum lumen cross-sectional area (CSA) on a 64-slice multidetector computed tomography (MDCT) compared with an intravascular ultrasound (IVUS). In 39 patients with 43 stents, the minimum lumen diameter, stent diameter, diameter stenosis, minimum lumen CSA, stent CSA, and area stenosis at the narrowest point were measured independently on 64-slice MDCT and IVUS images. For the assessment of diameter and CSA, 64-slice MDCT showed good correlations with IVUS (r = 0.82 for minimum lumen diameter, r = 0.66 for stent diameter, r = 0.79 for minimum lumen CSA, and r = 0.75 for stent CSA, respectively, P < 0.0001). For the assessment of diameter and area stenoses, a 64-slice MDCT showed good correlations with IVUS (r = 0.89 and 0.91, respectively, P < 0.0001). The overall sensitivity, specificity, positive predictive value, and negative predictive value to detect in-stent area restenosis (≥ 50 % area stenosis) of a 64-slice MDCT were 77, 100, 100, and 91 %, respectively. The cutoff value of a 64-slice MDCT, determined by receiver operator characteristic (ROC) analysis, was 5.0 mm(2) with 76.5 % sensitivity and 92.3 % specificity for significant in-stent area restenosis; the area under the ROC curve was 0.902 (P < 0.0001). A good correlation was found between a 64-slice MDCT and the IVUS, regarding the assessment of diameter and area stenoses of coronary stents in selected patients implanted with stents of more than 3 mm in diameter. Optimal cutoff value for the minimum lumen CSA of coronary stents on the 64-slice MDCT is 5 mm(2) to predict a CSA of 4 mm(2) on IVUS.

Cardiovascular parameters correlated with metabolic syndrome in a rural community cohort of Korea: the ARIRANG study.

Although metabolic syndrome (MetS) is associated with increased cardiovascular mortality and the development of atherosclerosis, consensus is still lacking on the status of cardiovascular function and geometry in MetS patients. We investigated the relation between MetS and left ventricle (LV) geometry and function, carotid intima-media thickness (IMT) and arterial stiffness in a community-based cohort of 702 adult subjects. Subjects were categorized into three groups according to the number of MetS components present, as defined by the Adult Treatment Panel III guidelines: 1) Absent (0 criteria), 2) Pre-MetS (1-2 criteria) or 3) MetS (> or =3 criteria). In female subjects, LV mass, LV mass/height(2.7), deceleration time, and aortic pulse wave velocity increased, and E/A ration decreased in a stepwise manner across the three groups. These changes were not observed in male subjects. The mean carotid IMT was higher in the MetS group than in the other two groups. The degree of MetS clustering is found to be strongly correlated with geometric eccentricity of LV hypertrophy, diastolic dysfunction and arterial changes irrespective of age and blood pressure status, particularly in females. Waist circumference is found to have the most powerful effect on cardiovascular parameters.

The significance of clopidogrel low-responsiveness on stent thrombosis and cardiac death assessed by the verifynow p(2)y(12) assay in patients with acute coronary syndrome within 6 months after drug-eluting stent implantation.

BACKGROUND AND OBJECTIVES: Clopidogrel resistance or low-responsiveness may be associated with recurrent atherothrombotic events after drug-eluting stent (DES) implantation. We prospectively evaluated the association between clopidogrel resistance assessed by the Verifynow P(2)Y(12) assay (Accumetrics, San Diego, CA, USA) and stent thrombosis (ST) or cardiac death (CD) in patients with acute coronary syndrome (ACS) within 6 months after DES implantation. SUBJECTS AND METHODS: We enrolled 237 consecutive patients (160 males, 65.2+/-10.3 years) with ACS who received a DES implantation. The composite endpoint was defined to CD or ST by Academic Research Consortium definitions within 6 months post-implantation. Clopidogrel resistance was defined as <20% inhibition of the P(2)Y(12) receptor. RESULTS: Baseline demographic characteristics were similar between 142 normal individuals and 95 clopidogrel resistant patients. CD occurred in one case (0.7%) in the normal group and two cases (2.13%) in the resistant group (p=0.344). There was no episode of ST in the normal group and four episodes in the resistant group (4.2%, four definite ST) (p=0.035). Univariate logistic regression revealed an adjusted odds ratio (OR) for composite end point of CD or ST of 9.646 {95% confidence interval (CI) 1.139-81.679}, and multivariate logistic regression for composite end point revealed an OR of 12.074 (95% CI 1.205-120.992). CONCLUSION: Clopidogrel low-responsiveness assessed by the Verifynow P(2)Y(12) assay is an independent predictor of ST and composite end point of ST or CD in patients with ACS within 6 months after DES implantation.

Experience of subjective symptoms in euthymic patients with bipolar disorder.

Bipolar patients often experience subjective symptoms even if they do not have active psychotic symptoms in their euthymic state. Most studies about subjective symptoms are conducted in schizophrenia, and there are few studies involving bipolar patients. We examined the nature of the subjective symptoms of bipolar patients in their euthymic state, and we also compared it to that of schizophrenia and normal control. Thirty bipolar patients, 25 patients with schizophrenia, and 21 normal control subjects were included. Subjective symptoms were assessed using the Korean version of the Frankfurter Beschwerde Fragebogen (K-FBF) and the Symptom Check List 90-R (SCL90-R). Euthymic state was confirmed by assessing objective psychopathology with the Positive and Negative Syndrome scale of Schizophrenia (PANSS), the Young Mania Rating Scale (YMRS), and the Montgomery Asberg Depression Rating Scale (MADRS). K-FBF score was significantly higher in bipolar patients than in normal controls, but similar to that in schizophrenia patients (F=5.86, p=0.004, R2=2033.6). In contrast, SCL90-R scores did not differ significantly among the three groups. Euthymic bipolar patients experience subjective symptoms that are more confined to cognitive domain. This finding supports the hypothesis that subtle cognitive impairments persists in euthymic bipolar patients.

Korean translation and validation of the functional assessment of cancer therapy-lung (FACT-L) version 4.

In this study, we have translated and cross-culturally adapted the Functional Assessment of Cancer Therapy-Lung (FACT-L) version 4 into Korean, and we have evaluated its reliability and validity. The FACT-L version 4 was translated into Korean following the standard Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology. The psychometric properties of the FACT-L were evaluated in 122 lung cancer patients (mean age, 60.88 years). Pre-testing was performed in 22 patients, and these results indicated good content coverage and overall comprehensibility. In validating the FACT-L version 4, our results indicated high internal consistency of the FACT-L scales, with Cronbach's alpha coefficients ranging from 0.52 to 0.84. The FACT-L also demonstrated good convergent and divergent validity when correlated with the Functional Living Index-Cancer (FLIC) and the shortened forms of the Profile of Mood States (POMS). This reliable and valid instrument can now be used to properly evaluate the quality of life of Korean lung cancer patients.