Earticle

An innovative packaging solution, Flip Chip with Copper (Cu) Column bond on lead (BOL) Enhanced Process (fcCuBE$^{(R)}$) delivers a cost effective, high performance packaging solution over typical bond on capture pad (BOC) technology. These advantages include improved routing efficiency on the substrate top layer thus allowing conversion functionality; furthermore, package cost is lowered by means of reduced substrate layer count and removal of solder on pad (SOP). On the other hand, as electronic packaging technology develops to meet the miniaturization trend from consumer demand, reliability testing will become an important issue in advanced technology area. In particular, electromigration (EM) of flip chip bumps is an increasing reliability concern in the manufacturing of integrated circuit (IC) components and electronic systems. This paper presents the results on EM characteristics on BOL and BOC structures under electrical current stressing in order to investigate the comparison between two different typed structures. EM data was collected for over 7000 hours under accelerated conditions (temperatures: $125^{\circ}C$, $135^{\circ}C$, and $150^{\circ}C$ and stress current: 300 mA, 400 mA, and 500 mA). All samples have been tested without any failures, however, we attempted to find morphologies induced by EM effects through cross-sectional analysis and investigated the interfacial reaction characteristics between BOL and BOC structures under current stressing. EM damage was observed at the solder joint of BOC structure but the BOL structure did not show any damage from the effects of EM. The EM data indicates that the fcCuBE$^{(R)}$ BOL Cu column bump provides a significantly better EM reliability.

This study aims to examine the effects of taping of the ankle joint on the static and dynamic balance and gait ability of stroke patients. Twenty-six stroke patients receiving physical therapy at a hospital located in Gyeonggi-do were divided equally into a group that had taping in physical therapy and an ordinary physical therapy group. They exercised for 30 minutes each, 3 times per week for 8 weeks from June to August 2011. Romberg's eye open and eye closed tests, limits of stability(LOS), forward and back test, timed up and go test(TUG) and 10-meter gait velocity test were performed to evaluate static balance, dynamic balance, and gait ability, respectively, prior to and 8 weeks after the intervention. Differences within each group in relation to the lapse of time were compared by a paired t-test. Differences between the two groups were compared by an independent t-test. Regarding comparison of differences within each group, all tests resulted in significant changes in both groups after the intervention (p<.05). Comparison of differences between the two groups showed that taping in the physical therapy group had significantly better test results than the ordinary physical therapy group in all measured items(p<.05). The after effects of ankle taping on stroke patients are more efficient and effective than ordinary physical therapy alone in improving balance and gait ability.

Objective: This study aimed to compare the amount of tooth movement after multiple horizontal (MH) and single vertical (SV) micro-osteoperforations (MOPs), and evaluate the histological changes after orthodontic force application in rabbits. Methods: The mandibles of 24 white rabbits were subjected to two experimental interventions: MH and SV MOPs. Defect volume of the MOPs between the two groups was kept similar. A force of 100 cN was applied via a coil spring between the incisor teeth and the first premolars. The amount of tooth movement was measured. Differences in the amount of tooth movement and bone variables at three time points and between the two groups were evaluated using repeated-measures analysis of variance. Results: The first premolar showed a mesial movement of 1.47 mm in the MH group and 1.84 mm in the SV group, which was significantly different at Week 3 (p < 0.05). No significant difference was observed in bone volume and bone fraction between the groups. Tartrate-resistant acidic phosphatase-positive cell count was also significantly greater at Week 3 than at Week 1 in both the SV and MH groups. Conclusions: The amount of tooth movement showed significant differences between Weeks 1 and 3 in the SV and MH MOP groups, but showed no differences between the two groups. Therefore, SV MOP could be considered an effective tool for enhancing tooth movement, especially for molar distalization, uprighting, and protraction to an edentulous area.

Purpose: Internal mammary lymph node (IMN) involvement is associated with poor prognosis in breast cancer. This study investigated the treatment outcomes of initial clinically IMN-positive breast cancer patients who received adjuvant radiotherapy (RT), including IMN irradiation, following primary breast surgery. Materials and Methods: We retrospectively reviewed data of 95 breast cancer patients with clinically detected IMNs at diagnosis treated with surgery and RT between June 2009 and December 2015. Patients received adjuvant RT to the whole breast/chest wall and regional lymph node (axillary, internal mammary, and supraclavicular) areas. Twelve patients received an additional boost to the IMN area. Results: The median follow-up was 43.2 months (range, 4.5 to 100.5 months). Among 77 patients who received neoadjuvant chemotherapy, 52 (67.5%) showed IMN normalization and 19 (24.6%) showed a partial response to IMN. There were 3 and 24 cases of IMN failure and any recurrence, respectively. The 5-year IMN failure-free survival, disease-free survival (DFS), and overall survival (OS) were 96%, 70%, and 84%, respectively. IMN failure-free survival was significantly affected by resection margin status (97.7% if negative, 87.5% for close or positive margins; p = 0.009). All three patients with IMN failure had initial IMN size ≥1 cm and did not receive IMN boost irradiation. The median age of the three patients was 31 years, and all had hormone receptor-negative tumors. Conclusion: RT provides excellent IMN control without the support of IMN surgery. Intensity-modulated radiotherapy, including IMN boost for breast cancer patients, is a safe and effective technique for regional lymph node irradiation.

This study investigated the use of polyglyceryl esters (PGE) as stabilizer in improving stability and anti-inflammatory activity of nanosuspended branched-chain amino acids (BCAAs). BCAAs nanosuspended with stabilizer (BS) exhibited improved stability at concentration of 5% saturation level during storage as compared to BCAAs nanosuspended with aqueous solution (BA). Additionally, anti-inflammatory activity of BS was found to be greater than that of BA. Nitric oxide scavenging activity was found to be dose-dependent, with activity of BS in sodium nitroprusside system being significantly higher than that of BA (p < 0.05) at 2.5-20 mg/mL. BS also possesses greater inhibitory activity on production of pro-inflammatory factors including inducible nitric oxide synthase, cyclooxygenase-2 (COX-2), interleukin-$1{\beta}$ ($IL-1{\beta}$), interleukin-6 (IL-6) in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells through suppressed phosphorylation of p65 subunit of $NF-{\kappa}B$ at 0.5, 2, 8 mg/mL. These results suggest that PGE used as stabilizer improves solubility and biological activity of nanosuspended BCAAs.

Background: Early extubation after cardiovascular surgery has some clinical advantages, including reduced hospitalization costs. Herein, we review the results of ultra-fast-track (UFT) extubation, which refers to extubation performed on the operating table just after the operation, or within 1-2 hours after surgery, in patients with congenital cardiac disease. Methods: We performed UFT extubation in patients (n=72) with a relatively simple congenital cardiac defect or who underwent a simple operation starting in September 2016. To evaluate the feasibility and effectiveness of our recently introduced UFT extubation strategy, we retrospectively reviewed 195 patients who underwent similar operations for similar diseases from September 2015 to September 2017, including the 1-year periods immediately before and after the introduction of the UFT extubation protocol. Propensity scores were used to assess the effects of UFT extubation on length of stay (LOS) in the intensive care unit (ICU), hospital LOS, and medical costs. Results: After propensity-score matching using logistic regression analysis, 47 patients were matched in each group. The mean ICU LOS ($16.3{\pm}28.6$ [UFT] vs. $28.0{\pm}16.8$ [non-UFT] hours, p=0.018) was significantly shorter in the UFT group. The total medical costs ($182.6{\pm}3.5$ [UFT] vs. $187.1{\pm}55.6$ [non-UFT] ${\times}100,000$ Korean won [KRW], p=0.639) and hospital stay expenses ($48.3{\pm}13.6$ [UFT] vs. $54.8{\pm}29.0$ [non-UFT] ${\times}100,000KRW$, p=0.164) did not significantly differ between the groups. Conclusion: UFT extubation decreased the ICU LOS and mechanical ventilation time, but was not associated with postoperative hospital LOS or medical expenses in patients with simple congenital cardiac disease.

Idiopathic nephrotic syndrome (INS) in children is characterized by massive proteinuria and hypoalbuminemia. Minimal change nephrotic syndrome (MCNS) is the most common form of INS in children. The pathogenesis of MCNS still remains unclear, however, several hypotheses have been recently proposed. For several decades, MCNS has been considered a T-cell disorder, which causes the impairment of the glomerular filtration barrier with the release of different circulating factors. Increased levels of several cytokines are also suggested. Recently, a "two-hit" theory was proposed that included the induction of CD80 (B7-1) and regulatory T-cell (Treg) dysfunction, with or without impaired autoregulatory functions of the podocyte. In contrast to the well-established involvement of T cells, the role of B cells has not been clearly identified. However, B-cell biology has recently gained more attention, because rituximab (a monoclonal antibody directed against CD20-bearing cells) demonstrated a very good therapeutic response in the treatment of childhood and adult MCNS. Here, we discuss recent insights into the pathogenesis of MCNS in children.

We examine the self-control problems of U.S households and their effects on households' retirement preparedness based on the Behavioral Life-Cycle Hypothesis. Using the 2010 Survey of Consumer Finances dataset, the level of retirement adequacy was estimated with income replacement ratio (IRR), and only 42% of households were adequately prepared for retirement. Results from logistic regression analysis indicated that households with loan payment and saving self-control problems were less likely to be prepared adequately for retirement compared to those without such problems. Age, education, race/ethnicity, marital status, employment status, retirement plans, expected retirement age and risk tolerance were significantly related to retirement preparedness. This study provides financial educator and researchers with suggestions on how to help household make a better retirement plan.

Background: In the present study, various freezing containers were tested for mouse embryos of respective developmental stages; embryos were vitrified and then their survival rate and developmental rate were monitored. Mouse two cell, 8 cell, and blastula stage embryos underwent vitrification freezing-thawing and then their recovery rate, survival rate, development rate, and hatching rate were investigated. Methods: EM-grid, OPS, and cryo-loop were utilized for vitrification freezing-thawing of mouse embryos. Results: It was found that recovery rate and survival rate were higher in the group of cryo-loop compared to those of EM-grid (p < 0.05). Embryonic development rate, two cell embryos to blastocyst, as well as hatching rate were higher in the control group compared to the EM-grid group and OPS group (p < 0.05), yet no difference was noted between the control group and cryo-loop group. Development rate and hatching rate of eight cell morulae and blastocysts were all lower in the treatment groups than the control group whilst hatching rate of blastocysts was higher in the control group compared to the groups of EM-grid and OPS (p < 0.05); although the cryo-loop group was shown to be slightly higher than other groups, it was not statistically significant. Conclusions: In the study, we investigate effects of freezing containers on vitrified embryos of respective developmental stages; it was demonstrated that higher developmental rate was shown in more progressed (or developed) embryos with more blastomeres. There was however, no difference in embryonic development rate was shown amongst containers. Taken together, further additional studies are warranted with regards to 1) manipulation techniques of embryos for various vitrification freezing containers and 2) preventive measures against contamination via liquid nitrogen.

We recently reported that the antimicrobial peptide Lumbricusin (NH₂-RNRRWCIDQQA), isolated from the earthworm, increases cell proliferation in neuroblastoma SH-SY5Y cells. Here, we investigated whether Lumbricusin has neurotropic activity in mouse neural stem cells (MNSCs) and a protective effect in a mouse model of Parkinson's disease (PD). In MNSCs isolated from mouse brains, Lumbricusin treatment significantly increased cell proliferation (up to 12%) and reduced the protein expression of p27^Kip1 through proteasomal protein degradation but not transcriptional regulation. Lumbricusin inhibited the 6-OHDA-induced apoptosis of MNSCs, and also showed neuroprotective effects in a mouse PD model, ameliorating the motor impairments seen in the pole, elevated body swing, and rotation tests. These results suggest that the Lumbricusin-induced promotion of neural cell proliferation via p27^Kip1 degradation has a protective effect in an experimental PD model. Thus, the antimicrobial peptide Lumbricusin could possibly be developed as a potential therapeutic agent for the treatment of PD.

A 75-year-old woman who had previously undergone a double valve replacement was admitted to Asan Medical Center because of severe bioprosthetic mitral valve dysfunction and tricuspid regurgitation. Under hypothermic fibrillatory arrest without aortic cross-clamping, minimally invasive mitral and tricuspid valve surgery was performed via a right minithoracotomy.

Background: Minimally invasive cardiac surgery has emerged as an alternative to conventional open surgery. This report reviews our experience with atrial septal defect using the da VinciTM surgical robot system. Materials and Methods: This retrospective study included 50 consecutive patients who underwent atrial septal defect repair using the da VinciTM surgical robot system between October 2007 and May 2011. Among these, 13 patients (26%) were approached through a totally endoscopic approach and the others by mini-thoracotomy. Nineteen patients had concomitant procedures including tricuspid annuloplasty (n=10), mitral valvuloplasty (n=9), and maze procedure (n=4). The mean follow-up duration was $16.9{\pm}10.4$ months. Results: No remnant interatrial shunt was detected by intraoperative or postoperative echocardiography. The atrial septal defects were mainly repaired by Gore-Tex patch closure (80%). There was no operative mortality or serious surgical complications. The aortic cross clamping time and cardiopulmonary bypass time were $74.1{\pm}32.2$ and $157.6{\pm}49.7$ minutes, respectively. The postoperative hospital stay was $5.5{\pm}3.3$ days. Conclusion: The atrial septal defect repair with concomitant procedures like mitral valve repair or tricuspid valve repair using the da VinciTM system is a feasible method. In addition, in selected patients, complete port access can be helpful for better cosmetic results and less musculoskeletal injury.

Background: Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Treatment failure and consequent lethal outcomes are very common. The aim of this study was to evaluate titanium plate fixation as a treatment for sternal dehiscence following major cardiac surgery. Materials and Methods: Between 2010 and 2012, 17 patients underwent sternal reconstruction using horizontal titanium plating for the treatment of post-cardiac-surgery sternal dehiscence. The plates were cut and shaped, and then were fixed to corresponding costal segments using 2-3 titanium screws per each side. Results: The median age of our patients was 66 years (range, 50 to 78 years) and 9 were female. Indications for sternal reconstruction included aseptic sternal dehiscence in 3 patients and osteomyelitis in 14 patients including 6 patients who were diagnosed with mediastinitis. During the operation, sternal resection and autologous flap interposition were combined in 11 patients. One patient died due to sepsis. Two patients required additional soft tissue wound revisions. Another patient presented with a tuberculous wound infection which was resolved using anti-tuberculosis medications. The postoperative course was uncomplicated in the other 13 patients. Conclusion: Titanium plate fixation that combines appropriate debridement and flap interposition is very effective for the treatment of sternal dehiscence following major cardiac surgery.

A 74-year-old man was diagnosed with aortic root aneurysm and two-vessel coronary disease. Echocardiographic assessment revealed an enlarged sinus of Valsalva 60 mm in diameter with mild aortic regurgitation. Florida sleeve repair was performed using a vascular graft combined with coronary artery bypass grafting. The postoperative course was uncomplicated and follow-up echocardiographic evaluations showed an aortic root diameter of 38 mm without aortic insufficiency up to 1 year after surgery.

The main active components of Panax ginseng are ginsenosides. Ginsenoside Rb1 and Rg1 are accepted as marker substances for quality control worldwide. The analytical methods currently used to detect these two compounds unfairly penalize steamed and dried (red) P. ginseng preparations, because it has a lower content of those ginsenosides than white ginseng. To manufacture red ginseng products from fresh ginseng, the ginseng roots are exposed to high temperatures for many hours. This heating process converts the naturally occurring ginsenoside Rb1 and Rg1 into artifact ginsenosides such as ginsenoside Rg3, Rg5, Rh1, and Rh2, among others. This study highlights the absurdity of the current analytical practice by investigating the time-dependent changes in the crude saponin and the major natural and artifact ginsenosides contents during simmering. The results lead us to recommend (20S)- and (20R)-ginsenoside Rg3 as new reference materials to complement the current P. ginseng preparation reference materials ginsenoside Rb1 and Rg1. An attempt has also been made to establish validated qualitative and quantitative analytical procedures for these four compounds that meet International Conference of Harmonization (ICH) guidelines for specificity, linearity, range, accuracy, precision, detection limit, quantitation limit, robustness and system suitability. Based on these results, we suggest a validated analytical procedure which conforms to ICH guidelines and equally values the contents of ginsenosides in white and red ginseng preparations.

Background: A diagnosis and treatment of chest wall tuberculosis (CWTB) is both difficult and controversial. The aim of this study was to collect information on the optimal treatment for CWTB. Methods: The clinical features, radiographic findings, and treatment outcomes of 26 patients, who underwent surgery and were diagnosed histopathologically, were retrospectively analyzed. Results: The most common presenting symptom was a palpable mass found in 24 patients (92.3%). In all patients, CT revealed a soft tissue mass that was accompanied by a central low density, with or without peripheral rim enhancement. The sensitivity and specificity of the bone scintigram for bone involvement were 87.5% and 100%, respectively. CWTB was diagnosed preoperatively by aspiration cytology and smear for acid-fast bacilli in five out of 11 patients. Twenty-three patients (88.5%) underwent a radical excision and three underwent incision/drainage or an incisional biopsy. The duration of antituberculous medication was 7.5${\pm}$3.98 months with a follow-up period of 28.2${\pm}$26.74 months. Among the 20 patients who completed their treatment, nine received chemotherapy for six months or less and 11 received chemotherapy for nine months or more. Two patients had a recurrence four and seven months after starting their medication. Conclusion: A 6 month regimen may be appropriate for CWTB patients who have undergone a complete excision.