Abstract
This study is the first attempt to generate a three-dimensional (3D) coronal electron density distribution based on the pix2pixHD model, whose computing time is much shorter than that of the ...magnetohydrodynamic (MHD) simulation. For this, we consider photospheric solar magnetic fields as input, and electron density distribution simulated with the MHD Algorithm outside a Sphere (MAS) at a given solar radius is taken as output. We consider 155 pairs of Carrington rotations as inputs and outputs from 2010 June to 2022 April for training and testing. We train 152 deep-learning models for 152 solar radii, which are taken up to 30 solar radii. The artificial intelligence (AI) generated 3D electron densities from this study are quite consistent with the simulated ones from lower radii to higher radii, with an average correlation coefficient 0.97. The computing time of testing data sets up to 30 solar radii of 152 deep-learning models is about 45.2 s using the NVIDIA TITAN XP graphics-processing unit, which is much less than the typical simulation time of MAS. We find that the synthetic coronagraphic images estimated from the deep-learning models are similar to the Solar Heliospheric Observatory (SOHO)/Large Angle and Spectroscopic Coronagraph C3 coronagraph data, especially during the solar minimum period. The AI-generated coronal density distribution from this study can be used for space weather models on a near-real-time basis.
The ARTIST (Adjuvant Chemoradiation Therapy in Stomach Cancer) trial was the first study to our knowledge to investigate the role of postoperative chemoradiotherapy therapy in patients with ...curatively resected gastric cancer with D2 lymph node dissection. This trial was designed to compare postoperative treatment with capecitabine plus cisplatin (XP) versus XP plus radiotherapy with capecitabine (XP/XRT/XP).
The XP arm received six cycles of XP (capecitabine 2,000 mg/m2 per day on days 1 to 14 and cisplatin 60 mg/m2 on day 1, repeated every 3 weeks) chemotherapy. The XP/XRT/XP arm received two cycles of XP followed by 45-Gy XRT (capecitabine 1,650 mg/m2 per day for 5 weeks) and two cycles of XP.
Of 458 patients, 228 were randomly assigned to the XP arm and 230 to the XP/XRT/XP arm. Treatment was completed as planned by 75.4% of patients (172 of 228) in the XP arm and 81.7% (188 of 230) in the XP/XRT/XP arm. Overall, the addition of XRT to XP chemotherapy did not significantly prolong disease-free survival (DFS; P = .0862). However, in the subgroup of patients with pathologic lymph node metastasis at the time of surgery (n = 396), patients randomly assigned to the XP/XRT/XP arm experienced superior DFS when compared with those who received XP alone (P = .0365), and the statistical significance was retained at multivariate analysis (estimated hazard ratio, 0.6865; 95% CI, 0.4735 to 0.9952; P = .0471). CONCLUSION The addition of XRT to XP chemotherapy did not significantly reduce recurrence after curative resection and D2 lymph node dissection in gastric cancer. A subsequent trial (ARTIST-II) in patients with lymph node-positive gastric cancer is planned.
In this Letter, we generate realistic high-resolution (1024 × 1024 pixels) pseudo-magnetograms from Ca ii K images using a deep learning model based on conditional generative adversarial networks. ...For this, we consider a model "pix2pixHD" that is specifically devised for high-resolution image translation tasks. We use Ca ii K 393.3 nm images from the Precision Solar Photometric Telescope at the Rome Observatory and line-of-sight magnetograms from the Helioseismic and Magnetic Imager (HMI) at the Solar Dynamics Observatory from 2011 January to 2015 June. 2465 pairs of Ca ii K and HMI are used for training except for January and July data. The remaining 436 pairs are used for an evaluation of the model. Our model shows that the mean correlation coefficient (CC) of total unsigned magnetic flux between AI-generated and real ones is 0.99 and the mean pixel-to-pixel CC after 8 × 8 binning over the full disk is 0.74. We find that the AI-generated absolute magnetic flux densities are highly consistent with real ones, even to the fine scale structures of quiet regions. On the other hand, the mean pixel-to-pixel correlations of magnetic flux densities strongly depend on a region of interest: 0.81 for active regions and 0.24 for quiet regions. Our results suggest a sufficient possibility that we can produce high-resolution solar magnetograms from historical Ca ii data.
The criterion for the remission period of chronic cluster headache (CCH) was recently revised from < 1 month to < 3 months in the third edition of the International Classification of Headache ...Disorders (ICHD-3). However, information on the clinical features of CCH based on the ICHD-3 criteria is currently limited. The present study aimed to investigate the clinical features of CCH based on ICHD-3 using data from the Korean Cluster Headache Registry (KCHR). The KCHR is a multicentre prospective registry of patients with cluster headache (CH) from 15 hospitals. Among the 250 participants with CH, 12 and 176 participants were classified as having CCH and episodic cluster headache (ECH), respectively. Among 12 participants with CCH, 6 (50%) had remission periods of < 1 month, and the remaining 6 (50%) had a remission period of 1-3 months. Six participants had CCH from the time of onset of CH, and in the other 6 participants, CCH evolved from ECH. CCH subjects had later age of onset of CH, developed the condition after a longer interval after CH onset, and had more migraine and less nasal congestion and/or rhinorrhoea than ECH subjects. Clinical features of CCH with remission periods < 1 month were not significantly different from those of CCH with remission periods of 1-3 months, except for the total number of bouts. More current smoking and less diurnal rhythmicity were observed in participants with CCH evolved from ECH compared to those with ECH. In conclusion, the number of subjects with CCH doubled when the revised ICHD-3 criteria were used. Most of clinical characteristics of CCH did not differ when the previous and current version of ICHD was applied and compared. Some clinical features of CCH were different from those of ECH, and smoking may have a role in CH chronification.
Few studies have compared the long-term outcomes of endoscopic resection and surgery. The aim of this study was to compare the long-term outcomes of endoscopic resection with those of surgery for ...early gastric cancer (EGC).
We reviewed prospectively collected data of patients who had undergone endoscopic resection (1,290 patients) or surgery (1,273 patients) for EGC. To reduce the effect of selection bias, we performed a propensity score-matching analysis between the two groups. The primary outcome was overall survival (OS). The secondary outcomes were disease-specific survival, disease-free survival (DFS), recurrence-free survival (RFS), occurrence of metachronous gastric cancer, treatment-related complications, length of hospital stay, and 30-day outcomes. The study was designed as a non-inferiority study and tested in an intention-to-treat analysis.
In a propensity-matched analysis of 611 pairs, the 10-year OS proportion was 96.7% in the endoscopic resection group and 94.9% in the surgery group (P=0.120) (risk difference -1.8%, 95% confidence interval (CI) -4.04-0.44, Pnon-inferiority=0.014), which met the non-inferiority criterion. In contrast, the 10-year RFS proportion was 93.5% in the endoscopic resection group and 98.2% in the surgery group (P<0.001) (risk difference 4.7%, 95% CI 2.50-6.97, Pnon-inferiority=0.820), which did not meet the non-inferiority criterion, mainly because of metachronous recurrence in the endoscopic resection group. The rate of early complications was higher in the endoscopic resection group than in the surgery group (9.0 vs. 6.6%, P=0.024), whereas the rate of late complications was higher in the surgery group than in the endoscopic resection group (0.5 vs. 2.9%, P<0.001). In the multiple Cox regression analysis, patient's age, the comorbidity index, the performance index, sex, tumor morphology, and depth of invasion were predictors of OS in patients with EGC.
Endoscopic resection might not be inferior to surgery with respect to OS in patients with EGC lesions that meet the absolute or expanded criteria. However, DFS, RFS, and metachronous RFS might be lower after endoscopic resection than after surgery.
Although cranial autonomic symptoms (CAS) are typical in cluster headache (CH), some individuals with CH show no CAS during their headache attacks. Probable cluster headache (PCH) is a subtype of CH ...that fulfils all but one criterion of CH. This study aimed to investigate the frequency and clinical features of CH and PCH without CAS in comparison to those with CAS. We analysed data from the Korea Cluster Headache Registry, a prospective multicentre registry involving data from 16 hospitals. Of the 216 participants with CH and 26 with PCH, 19 (8.8%) and 7 (26.9%), respectively, did not have CAS. Participants with CH without CAS exhibited less severe anxiety (General Anxiety Disorder-7 score, median interquartile range, 2.0 1.0-6.0 vs 8.0 3.0-12.0, p = 0.001) and depression (Patient Health Questionnaire-9 score, 3.0 1.0-7.0 vs 7.0 3.0-11.0, p = 0.042) than those with CAS. Among participants with PCH, headache intensity was less severe in participants without CAS than in those with CAS (numeric rating scale, 8.0 7.0-8.0 vs 9.5 8.0-10.0, p = 0.015). In conclusion, a significant proportion of participants with CH and PCH did not have CAS. Some clinical features of CH and PCH differed based on the presence of CAS.
Acute isovolemic anemia occurs when blood loss is replaced with fluid. It is often observed after surgery and negatively influences short-term and long-term outcomes.
To evaluate the efficacy and ...safety of ferric carboxymaltose to treat acute isovolemic anemia following gastrectomy.
The FAIRY trial was a patient-blinded, randomized, phase 3, placebo-controlled, 12-week study conducted between February 4, 2013, and December 15, 2015, in 7 centers across the Republic of Korea. Patients with a serum hemoglobin level of 7 g/dL to less than 10 g/dL at 5 to 7 days following radical gastrectomy were included.
Patients were randomized to receive a 1-time or 2-time injection of 500 mg or 1000 mg of ferric carboxymaltose according to body weight (ferric carboxymaltose group, 228 patients) or normal saline (placebo group, 226 patients).
The primary end point was the number of hemoglobin responders, defined as a hemoglobin increase of 2 g/dL or more from baseline, a hemoglobin level of 11 g/dL or more, or both at week 12. Secondary end points included changes in hemoglobin, ferritin, and transferrin saturation levels over time, percentage of patients requiring alternative anemia management (oral iron, transfusion, or both), and quality of life at weeks 3 and 12.
Among 454 patients who were randomized (mean age, 61.1 years; women, 54.8%; mean baseline hemoglobin level, 9.1 g/dL), 96.3% completed the trial. At week 12, the number of hemoglobin responders was significantly greater for ferric carboxymaltose vs placebo (92.2% 200 patients for the ferric carboxymaltose group vs 54.0% 115 patients for the placebo group; absolute difference, 38.2% 95% CI, 33.6%-42.8%; P = .001). Compared with the placebo group, patients in the ferric carboxymaltose group experienced significantly greater improvements in serum ferritin level (week 12: 233.3 ng/mL for the ferric carboxymaltose group vs 53.4 ng/mL for the placebo group; absolute difference, 179.9 ng/mL 95% CI, 150.2-209.5; P = .001) and transferrin saturation level (week 12: 35.0% for the ferric carboxymaltose group vs 19.3% for the placebo group; absolute difference, 15.7% 95% CI, 13.1%-18.3%; P = .001); but there were no significant differences in quality of life. Patients in the ferric carboxymaltose group required less alternative anemia management than patients in the placebo group (1.4% for the ferric carboxymaltose group vs 6.9% for the placebo group; absolute difference, 5.5% 95% CI, 3.3%-7.6%; P = .006). The total rate of adverse events was higher in the ferric carboxymaltose group (15 patients 6.8%, including injection site reactions 5 patients and urticaria 5 patients) than the placebo group (1 patient 0.4%), but no severe adverse events were reported in either group.
Among adults with isovolemic anemia following radical gastrectomy, the use of ferric carboxymaltose compared with placebo was more likely to result in improved hemoglobin response at 12 weeks.
clinicaltrials.gov Identifier: NCT01725789.
Abstract Objective Although malnutrition is common in cancer patients in Korea, little attention is paid to its risks and consequences. This study was carried out to investigate the prevalence and ...risk factors of malnutrition in hospitalized cancer patients according to tumor location and stage. Methods Of 14 972 cancer patients admitted to the National Cancer Center, screening examinations were carried out for 12 112 patients and nutritional status was assessed in 8895 patients. Information on age, sex, length of hospital stay, and tumor location and stage were collected from the electronic medical records system. The nutritional status of each subject was assessed using body mass index, serum albumin, total lymphocyte count, and diet and classified into three groups: high risk, moderate risk, and low risk of malnutrition. Results About 61% of hospitalized patients were malnourished and the prevalence of malnutrition was higher in male patients with longer hospital stays (60.2%, P = 0.0101) and readmitted patients (66.6%, P < 0.0001). Patients with liver and lung cancer (86.6% and 60.5%, respectively) and patients with advanced cancer stage (60.5%, III or IV) had a higher prevalence of malnutrition than other patients ( P < 0.0001). Logistic regression analysis showed that patients with advanced cancer stage and longer hospital stay and readmitted patients were at a higher risk for malnutrition. Conclusion The prevalence of malnutrition in hospitalized cancer patients was high and varied across tumor location and stage. Early identification of malnutrition status is required for proper nutritional intervention during hospitalization.
In obesity, increased mitochondrial metabolism with the accumulation of oxidative stress leads to mitochondrial damage and β-cell dysfunction. In particular, β-cells express antioxidant enzymes at ...relatively low levels and are highly vulnerable to oxidative stress. Early in the development of obesity, β-cells exhibit increased glucose-stimulated insulin secretion in order to compensate for insulin resistance. This increase in β-cell function under the condition of enhanced metabolic stress suggests that β-cells possess a defense mechanism against increased oxidative damage, which may become insufficient or decline at the onset of type 2 diabetes. Here, we show that metabolic stress induces β-cell hypoxia inducible factor 2α (HIF-2α), which stimulates antioxidant gene expression (e.g., Sod2 and Cat) and protects against mitochondrial reactive oxygen species (ROS) and subsequent mitochondrial damage. Knockdown of HIF-2α in Min6 cells exaggerated chronic high glucose-induced mitochondrial damage and β-cell dysfunction by increasing mitochondrial ROS levels. Moreover, inducible β-cell HIF-2α knockout mice developed more severe β-cell dysfunction and glucose intolerance on a high-fat diet, along with increased ROS levels and decreased islet mitochondrial mass. Our results provide a previously unknown mechanism through which β-cells defend against increased metabolic stress to promote β-cell compensation in obesity.
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