Giant piezoelectricity in group IV monochalcogenides with ferroelectric AA layer stacking

The piezoelectricity of group IV monochalcogenides (MXs, with M = Ge, Sn and X = S, Se) has attracted much attention due to their substantially higher piezoelectric coefficients compared to other 2D materials. However, with increasing layer number, their piezoelectricity rapidly disappears due to the antiferroelectric stacking order, severely limiting their practical applications. Using first-principles calculations, we investigated the piezoelectricity of MXs with the ferroelectric AA stacking configuration, which has recently been stabilized in experiments. We found that AA-stacked MXs have a ferroelectric ground state with the smallest lattice constant among other stacking configurations, resulting in a giant piezoelectric coefficient, which is the first demonstration of a strategy where the piezoelectric coefficients can increase with the number of layers. This can be attributed to a strong negative correlation between the lattice constant along the armchair direction and the piezoelectric coefficient, and spontaneous compressive strain stabilized in ferroelectric AA stacking configuration.Comment: 16 pages and 5 figures for main manuscript. 9pages and 3 figures for S

EFFECT OF SEAT TUBE ANGLE ON THE WORK EFFICIENCY OF LOWER LIMB MUSCLES DURING CYCLING

The effect of seat tube angle (STA) on work efficiency at lower limb muscle was evaluated during a pedal rotation using inverse dynamic model. Since the target is not professional cyclist, the various seat tube angles of 78, 68, 58 and 48 degrees was investigated. Cycling simulation was performed at 250W and 60rpm. The works of individual muscle of lower limb and the total work was estimated. The result shows that the total work of single leg at seat tube angles of 78, 68, 58 and 48 degrees were 168.1(J), 167.9(J), 168.9(J) and 170.8(J) respectively. In conclusion, the exertion of lower limb for delivering same amount of work to the crank is the smallest at around 72 degree of seat tube angle which mean work efficiency of lower limb is the greates

Pre-operative clonal hematopoiesis is related to adverse outcome in lung cancer after adjuvant therapy

Background Clonal hematopoiesis (CH) frequently progresses after chemotherapy or radiotherapy. We evaluated the clinical impact of preoperative CH on the survival outcomes of patients with non-small cell lung cancer (NSCLC) who underwent surgical resection followed by adjuvant therapy. Methods A total of 415 consecutive patients with NSCLC who underwent surgery followed by adjuvant therapy from 2011 to 2017 were analyzed. CH status was evaluated using targeted deep sequencing of blood samples collected before surgery. To minimize the possible selection bias between the two groups according to CH status, a propensity score matching (PSM) was adopted. Early-stage patients were further analyzed with additional matched cohort of patients who did not receive adjuvant therapy. Results CH was detected in 21% (86/415) of patients with NSCLC before adjuvant therapy. Patients with CH mutations had worse overall survival (OS) than those without (hazard ratio [95% confidence interval] = 1.56 [1.07–2.28], p = 0.020), which remained significant after the multivariable analysis (1.58 [1.08–2.32], p = 0.019). Of note, the presence of CH was associated with non–cancer mortality (p = 0.042) and mortality of unknown origin (p = 0.018). In patients with stage IIB NSCLC, there was a significant interaction on OS between CH and adjuvant therapy after the adjustment with several cofactors through the multivariable analysis (HR 1.19, 95% CI 1.00–1.1.41, p = 0.041). Conclusions In resected NSCLC, existence of preoperative CH might amplify CH-related adverse outcomes through adjuvant treatments, resulting in poor survival results

Bronchoesophageal fistula in a patient with Crohn’s disease receiving anti-tumor necrosis factor therapy

Tuberculosis is an adverse event in patients with Crohn’s disease receiving anti-tumor necrosis factor (TNF) therapy. However, tuberculosis presenting as a bronchoesophageal fistula (BEF) is rare. We report a case of tuberculosis and BEF in a patient with Crohn’s disease who received anti-TNF therapy. A 33-year-old Korean woman developed fever and cough 2 months after initiation of anti-TNF therapy. And the symptoms persisted for 1 months, so she visited the emergency room. Chest computed tomography was performed upon visiting the emergency room, which showed BEF with aspiration pneumonia. Esophagogastroduodenoscopy with biopsy and endobronchial ultrasound with transbronchial needle aspiration confirmed that the cause of BEF was tuberculosis. Anti-tuberculosis medications were administered, and esophageal stent insertion through endoscopy was performed to manage the BEF. However, the patient’s condition did not improve; therefore, fistulectomy with primary closure was performed. After fistulectomy, the anastomosis site healing was delayed due to severe inflammation, a second esophageal stent and gastrostomy tube were inserted. Nine months after the diagnosis, the fistula disappeared without recurrence, and the esophageal stent and gastrostomy tube were removed

Stratifying non-small cell lung cancer patients using an inverse of the treatment decision rules: validation using electronic health records with application to an administrative database

To validate a stratification method using an inverse of treatment decision rules that can classify non-small cell lung cancer (NSCLC) patients in real-world treatment records. (1) To validate the index classifier against the TNM 7th edition, we analyzed electronic health records of NSCLC patients diagnosed from 2011 to 2015 in a tertiary referral hospital in Seoul, Korea. Predictive accuracy, stage-specific sensitivity, specificity, positive predictive value, negative predictive value, F1 score, and c-statistic were measured. (2) To apply the index classifier in an administrative database, we analyzed NSCLC patients in Korean National Health Insurance Database, 2002–2013. Differential survival rates among the classes were examined with the log-rank test, and class-specific survival rates were compared with the reference survival rates. (1) In the validation study (N = 1375), the overall accuracy was 93.8% (95% CI: 92.5–95.0%). Stage-specific c-statistic was the highest for stage I (0.97, 95% CI: 0.96–0.98) and the lowest for stage III (0.82, 95% CI: 0.77–0.87). (2) In the application study (N = 71,593), the index classifier showed a tendency for differentiating survival probabilities among classes. Compared to the reference TNM survival rates, the index classification under-estimated the survival probability for stages IA, IIIB, and IV, and over-estimated it for stages IIA and IIB. The inverse of the treatment decision rules has a potential to supplement a routinely collected database with information encoded in the treatment decision rules to classify NSCLC patients. It requires further validation and replication in multiple clinical settings