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This study presents findings indicating that the ferroelectric tunnel junction (FTJ) or resistive random-access memory (RRAM) in one cell can be intentionally selected depending on the application. The HfAlO film annealed at 700 °C shows stable FTJ characteristics and can be converted into RRAM by forming a conductive filament inside the same cell, that is, the process of intentionally forming a conductive filament is the result of defect generation and redistribution, and applying compliance current prior to a hard breakdown event of the dielectric film enables subsequent RRAM operation. The converted RRAM demonstrated good memory performance. Through current–voltage fitting, it was confirmed that the two resistance states of the FTJ and RRAM had different transport mechanisms. In the RRAM, the 1/f noise power of the high-resistance state (HRS) was about ten times higher than that of the low-resistance state (LRS). This is because the noise components increase due to the additional current paths in the HRS. The 1/f noise power according to resistance states in the FTJ was exactly the opposite result from the case of the RRAM. This is because the noise component due to the Poole–Frenkel emission is added to the noise component due to the tunneling current in the LRS. In addition, we confirmed the potentiation and depression characteristics of the two devices and further evaluated the accuracy of pattern recognition through a simulation by considering a dataset from the Modified National Institute of Standards and Technology. [ABSTRACT FROM AUTHOR]

This study presents a preliminary exploration of thermally oxidized TaOx-based memristors and their potential as artificial synapses. Unlike the 10-min annealed devices, which display instability due to current overshoots, the 5-min annealed device exhibits stable resistive switching, retention, and endurance characteristics. Moreover, our memristor showcases synaptic behaviors encompassing potentiation, depression, spike-timing-dependent plasticity, and excitatory postsynaptic currents. This synaptic emulation holds tremendous promise for applications in neuromorphic computing, offering the opportunity to replicate the adaptive learning principles observed in biological synapses. In addition, we evaluate the device's suitability for pattern recognition within a neural network using the modified National Institute of Standards and Technology dataset. Our assessment reveals that the Pt/TaOx/Ta memristor with an oxidized insulator achieves outstanding potential manifested by an accuracy of 93.25% for the identical pulse scheme and an impressive accuracy of 95.42% for the incremental pulse scheme. [ABSTRACT FROM AUTHOR]

Predicting outcomes in pulmonary tuberculosis is challenging despite effective treatments. This study aimed to identify factors influencing treatment success and culture conversion, focusing on artificial intelligence (AI)-based chest X-ray analysis and Xpert MTB/RIF assay cycle threshold (Ct) values. In this retrospective study across six South Korean referral centers (January 1 to December 31, 2019), we included adults with rifampicin-susceptible pulmonary tuberculosis confirmed by Xpert assay from sputum samples. We analyzed patient characteristics, AI-based tuberculosis extent scores from chest X-rays, and Xpert Ct values. Of 230 patients, 206 (89.6%) achieved treatment success. The median age was 61 years, predominantly male (76.1%). AI-based radiographic tuberculosis extent scores (median 7.5) significantly correlated with treatment success (odds ratio [OR] 0.938, 95% confidence interval [CI] 0.895–0.983) and culture conversion at 8 weeks (liquid medium: OR 0.911, 95% CI 0.853–0.973; solid medium: OR 0.910, 95% CI 0.850–0.973). Sputum smear positivity was 49.6%, with a median Ct of 26.2. However, Ct values did not significantly correlate with major treatment outcomes. AI-based radiographic scoring at diagnosis is a significant predictor of treatment success and culture conversion in pulmonary tuberculosis, underscoring its potential in personalized patient management. [ABSTRACT FROM AUTHOR]

Are highly specialized hikers really more likely to behave in a pro-environmental manner? By discussing a negative linkage between recreation specialization and pro-environmental behavior, this study tackles a narrowly optimistic view that specialized hikers are always likely to behave pro-environmentally. We examined survey data from South Korean hikers and found that while recreation specialization does not significantly affect attitudes, it negatively affects perceived behavioral control. Further, all types of pro-environmental behavior were significantly impacted by their attitude, but only one pro-environmental behavior (i.e., following designated trails) was strongly impacted by perceived behavioral control. By synthesizing our findings with current literature, we suggest comprehensively evaluating all three motivational factors—self-interest, prosocial, and affective motivations—to predict pro-environmental behavior. [ABSTRACT FROM AUTHOR]

The use of Hf0.5Zr0.5O2 (HZO) films within hafnia‐based ferroelectric tunnel junctions (FTJ) presents a promising avenue for next‐generation non‐volatile memory devices. HZO exhibits excellent ferroelectric properties, ultra‐thinness, low power consumption, nondestructive readout, and compatibility with silicon devices. In this study, Mo/HZO/n+ Si devices are investigated, incorporating a 1 nm HfO2 dielectric layer at the top and bottom of the HZO ferroelectric layer. Comparing the FTJ device configurations, it is observed that the metal‐ferroelectric‐dielectric‐semiconductor (MFIS) outperforms the metal‐dielectric‐ferroelectric‐semiconductor (MIFS) in terms of ferroelectricity, displaying a high 2Pr value of ≈69 µC cm−2. Additionally, MFIS exhibits lower leakage current, higher tunneling electro‐resistance ratio, and a thin dead layer during short pulse switching, as confirmed through DC double sweeping of I−V characteristics. The modified half‐bias scheme demonstrates a maximum array size of 191 for MFIS, showcasing its superior performance over MIFS. Synaptic characteristics, including potentiation, depression, paired‐pulse facilitation, spike‐rate‐dependent plasticity, and excitatory postsynaptic current, are measured using MFIS, highlighting its outstanding ferroelectric properties. As a physical reservoir, the FTJ device implements 16 states of 4 bits in reservoir computing. Finally, pattern recognition using a deep learning neural network achieves high accuracy with using the Modified National Institute of Standards and Technology dataset. [ABSTRACT FROM AUTHOR]

Background and Objective: When multiple complex air pollutants are combined in real‐world settings, the reliability of estimating the effect of a single pollutant is questionable. This study aimed to investigate the combined effects of changes in air pollutants on small airway dysfunction (SAD). Methods: We analysed Korea National Health and Nutrition Examination Survey (KNHANES) V–VIII database from 2010 to 2018 to elucidate the associations between annual changes in air pollutants over a previous 5‐year period and small airway function. We estimated the annual concentrations of five air pollutants: NO2, O3, PM2.5, SO2 and CO. Forced expiratory flow between 25% and 75% of vital capacity (FEF25%–75%) <65% was defined as SAD. Using the quantile generalized‐Computation (g‐Computation) model, the combined effect of the annual changes in different air pollutants was estimated. Results: A total of 29,115 individuals were included. We found significant associations between SAD and the quartiles of annual changes in NO2 (OR = 1.10, 95% CI = 1.08–1.12), O3 (OR = 1.03, 95% CI = 1.00–1.05), PM2.5 (OR = 1.03, 95% CI = 1.00–1.05), SO2 (OR = 1.04, 95% CI = 1.02–1.08) and CO (OR = 1.16, 95% CI = 1.12–1.19). The combined effect of the air pollutant changes was significantly associated with SAD independent of smoking (OR = 1.31, 95% CI = 1.26–1.35, p‐value <0.001), and this trend was consistently observed across the entire study population and various subgroup populations. As the estimated risk of SAD, determined by individual‐specific combined effect models, increased and the log odds for SAD increased linearly. Conclusion: The combined effect of annual changes in multiple air pollutant concentrations were associated with an increased risk of SAD. [ABSTRACT FROM AUTHOR]

This study implements a highly uniform 3D vertically stack resistive random‐access memory (VRRAM) with a four‐layer contact hole structure. The fabrication process of a four‐layer VRRAM is demonstrated, and its physical and electrical properties are thoroughly examined. X‐ray photoelectron spectroscopy and transmission electron microscopy are employed to analyze the chemical distribution and physical structure of the VRRAM device. Multilevel capability, reliable endurance (>104 cycles), and retention (104 s) are successfully obtained. Synaptic memory plasticity, such as spike time‐dependent plasticity, spike rate‐dependent plasticity, excitatory post‐synaptic current, paired‐pulse facilitation, and long‐term potentiation and depression is presented. Finally, the vector‐matrix multiplication (VMM) operation is conducted on a 4 × 12 VRRAM array, according to the low resistance state ratio. It is ascertained that the accuracy drop, which can occur due to VMM error, can be limited to a decrease of less than 0.44% point. Utilizing the high‐density, multilevel, and biological characteristics of VRRAM, it is possible to implement high‐performance neuromorphic systems that require densely integrated synaptic devices. [ABSTRACT FROM AUTHOR]

Background and objectives: Few studies have reported which inhaled combination therapy, either bronchodilators and/or inhaled corticosteroids (ICSs), is beneficial in patients with bronchiectasis and airflow obstruction. Our study compared the efficacy and safety among different inhaled combination therapies in patients with bronchiectasis and airflow obstruction. Methods: Our retrospective study analyzed the patients with forced expiratory volume in 1 s (FEV1)/forced vital capacity < 0.7 and radiologically confirmed bronchiectasis in chest computed tomography between January 2005 and December 2021. The eligible patients underwent baseline and follow-up spirometric assessments. The primary endpoint was the development of a moderate-to-severe exacerbation. The secondary endpoints were the change in the annual FEV1 and the adverse events. Subgroup analyses were performed according to the blood eosinophil count (BEC). Results: Among 179 patients, the ICS/long-acting beta-agonist (LABA)/long-acting muscarinic antagonist (LAMA), ICS/LABA, and LABA/LAMA groups were comprised of 58 (32.4%), 52 (29.1%), and 69 (38.5%) patients, respectively. ICS/LABA/LAMA group had a higher severity of bronchiectasis and airflow obstruction, than other groups. In the subgroup with BEC ≥ 300/uL, the risk of moderate-to-severe exacerbation was lower in the ICS/LABA/LAMA group (adjusted HR = 0.137 [95% CI = 0.034–0.553]) and the ICS/LABA group (adjusted HR = 0.196 [95% CI = 0.045–0.861]) compared with the LABA/LAMA group. The annual FEV1 decline rate was significantly worsened in the ICS/LABA group compared to the LABA/LAMA group (adjusted β-coefficient=-197 [95% CI=-307–-87]) in the subgroup with BEC < 200/uL. Conclusion: In patients with bronchiectasis and airflow obstruction, the use of ICS/LABA/LAMA and ICS/LABA demonstrated a reduced risk of exacerbation compared to LABA/LAMA therapy in those with BEC ≥ 300/uL. Conversely, for those with BEC < 200/uL, the use of ICS/LABA was associated with an accelerated decline in FEV1 in comparison to LABA/LAMA therapy. Further assessment of BEC is necessary as a potential biomarker for the use of ICS in patients with bronchiectasis and airflow obstruction. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is a risk factor for pneumonia in the elderly, and the timed up-and-go test (TUG) can be used as a screening tool for sarcopenia in this population. This study aimed to evaluate the association between TUG test results and future pneumonia or ventilator care. Materials and methods: From the National Health Insurance Service-Senior Cohort database, we identified 19,804 people without neurological diseases who underwent the TUG test in the National Screening Program for Transitional Ages at the age of 66 years during 2007–2008. Gait abnormality was defined as taking 10 s or longer to perform the TUG test. Pneumonia occurrence was defined using the International Classification of Diseases 10th Revision (ICD-10) code for pneumonia (J12–J18, J69), and ventilator care was defined by procedure codes (M5830, M5850, M5867, M5858, M5860, M5859) according to the Healthcare Common Procedure Coding system codes from 2007 to 2015. Results: The mean follow-up period was 7.4 years (standard error, SE 0.02). The incidence rates of pneumonia in the normal and slow TUG groups were 38 and 39.5/1000 person-years, respectively. The slow TUG group did not show a higher risk of pneumonia (adjusted hazard ratio [aHR], 1.042; 95% confidence interval [95% CI], 0.988–1.107]). Regarding ventilator care, the incidence was 4.7 and 5.2 cases per 1,000 person-years in the normal and slow TUG groups, respectively. Slow TUG groups also did not show an increased risk of ventilator occurrence (aHR, 1.136, [95% CI = 0.947–1.363]). Conclusion: The TUG test result was not associated with future pneumonia or ventilator care and may not be useful for predicting pneumonia in community-dwelling elderly individuals. Further studies are needed to identify additional functional tools for sarcopenia associated with future pneumonia occurrences. [ABSTRACT FROM AUTHOR]

Background: Comorbidities of chronic obstructive pulmonary disease (COPD) influence clinical characteristics and prognosis. Objectives: This study compared the clinical characteristics and exacerbation rate of COPD according to the presence of depression or anxiety. Design: This study used data from The Korea COPD Subgroup Study (KOCOSS) cohort, a nationwide prospective cohort from 54 medical centers, between April 2012 and 2019. Methods: Depression and anxiety were diagnosed with the Beck Depression Inventory and Beck Anxiety Inventory. Negative binomial regression analysis was performed to analyze the frequency of exacerbations in depressed patients and anxiety. Differences in lung function trajectory according to presence of depression/anxiety were analyzed using a linear mixed model. Results: In all, 2147 patients were enrolled. Depressed patients or anxiety had lower lung function, higher modified Medical Research Council (mMRC) grade, St. George Respiratory Questionnaire (SGRQ) score, and COPD assessment test score, and higher rates of exacerbation in the past year than those without depression/anxiety. Depressed patients had a higher frequency of moderate to severe exacerbations [Incidence Rate Ratio (IRR): 1.57, CI: 1.17–2.11, p = 0.002] and those with anxiety had higher frequencies of moderate to severe (IRR: 1.52, CI: 1.03–2.27, p = 0.038) and severe exacerbations (IRR: 2.13, CI: 1.09–4.15, p = 0.025) during 1-year follow-up compared to those without these comorbidities. The differences in the change in annual forced expiratory volume in 1 seconds (FEV1) over 3 years according to the presence of depression or anxiety were not statistically significant. Conclusion: Depressed and anxious patients showed increased respiratory symptoms and exacerbation rate as well as reduced health-related quality of life, whereas there were no significant differences in changes in lung function between groups with and without depression/anxiety. [ABSTRACT FROM AUTHOR]

Background: The Rome proposal provides an objective assessment tool for severity of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) but requires validation. Objectives: We aimed to evaluate the predictive performance of the Rome proposal in patients with AE-COPD. Design: This observational study assessed the patients who visited the emergency room (ER) or were hospitalized due to AE-COPD between January 2010 and December 2020. Methods: We compared the performance of the Rome Proposal with that of the DECAF score or GesEPOC 2021 criteria in predicting intensive care unit (ICU) admission, need for non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), and in-hospital mortality. Results: A total of 740 events of ER visit or hospitalization due to AE-COPD were reviewed and classified into mild (30.9%), moderate (58.6%), or severe (10.4%) group according to the Rome proposal. The severe group had a higher rate of ICU admission, required more NIV or IMV, and had a higher in-hospital mortality than the mild and moderate groups. The predictive performance of the Rome proposal was significantly better for ICU admission [area under the receiver operating characteristic curve (AU-ROC) = 0.850 versus 0.736, p = 0.004] and need for NIV or IMV (AU-ROC = 0.870 versus 0.770, p = 0.004) than that of the GesEPOC 2021 criteria but better than that of the DECAF score only in female patients. There was no significant difference in predicting the in-hospital mortality between the Rome proposal and DECAF score or GesEPOC 2021 criteria. Conclusion: External validation of the Rome Proposal in Korean patients demonstrated excellent performance for ICU admission and need for NIV or IMV and an acceptable performance for in-hospital mortality. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to comprehensively evaluate the factors associated with mortality and progressive disease in NTM-LD patients. We conducted a literature search to identify the eligible studies, dated between January 1, 2007, and April 12, 2021. Forty-one studies with total 10,452 patients were included. The overall all-cause mortality rate was 20% (95% CI 17–24%). The overall rates of clinical and radiographic progressive disease were 46% (95% CI 39–53%) and 43% (95% CI 31–55%), respectively. Older age, male sex, history of TB, diabetes, chronic heart disease, malignancy, systemic immunosuppression, chronic liver disease, presence of cavity, consolidative radiologic features, acid-fast bacillus (AFB) smear positivity, hypoalbuminemia, anemia, increasing platelet count, high CRP, and high ESR were significantly associated with increased all-cause mortality, whereas increasing body mass index (BMI), hemoptysis, and treatment with rifamycin regimen (in M. xenopi) were significantly associated with decreased all-cause mortality in multivariable analysis. History of TB, Aspergillus co-infection, cough, increased sputum, weight loss, presence of cavity, and AFB smear positivity were significantly associated with increased clinical progression with treatment, while older age and low BMI were significantly associated with decreased clinical progression in multivariable analysis. Older age, interstitial lung disease, presence of cavity, consolidative radiologic feature, anemia, high CRP, and leukocytosis were significantly associated with increased radiographic progression after adjusting for covariates. Older age, history of tuberculosis, presence of cavity, consolidative radiologic features, AFB smear positivity, anemia, and high C-reactive protein were common significant factors associated with the all-cause mortality and clinical or radiographic progressive disease of NTM-LD. These factors are thought to directly affect NTM-LD related mortality. The future prediction models for the prognosis of NTM-LD should be established considering these factors. [ABSTRACT FROM AUTHOR]

In this work, we analyze a resistive switching random access memory (RRAM) device with the metal–insulator–metal structure of Al/αTiOx/Al. The transport mechanism of our RRAM device is trap-controlled space-charge limited conduction, which does not change during the endurance test. As the number of resistive switching (RS) cycles increases, the current in the low-resistance state (LRS) does not change significantly. In contrast, degradation in the high-resistance state (HRS) is noticeably evident. According to the RS cycle, the current shift fits well with the stretched-exponential equation. The normalized noise power spectral density (Si/I2) measured in the HRS is an order of magnitude higher than that in the LRS owing to the difference in the degree of trap occupancy, which is responsible for the transition of resistance states. During the consecutive RS, the Si/I2 in the HRS rapidly decreases for approximately 100 cycles and then saturates. In contrast, in the LRS, the Si/I2 does not change significantly. Here we propose a model associated with the endurance degradation of the experimental device, and the model is verified with a 1 / f noise measurement. [ABSTRACT FROM AUTHOR]

Fossil fuels are associated with problems such as resource depletion and pollution, necessitating the exploration of alternatives. Giant miscanthus (Miscanthus × giganteus Greef et Deu), a perennial that can be harvested yearly, requires a low production energy input. It has less ash content and high heat efficiency and has attracted attention as an energy source. An on-site processing equipment, powered via a tractor and equipped with a chipper and a two-stage compression roller, was developed that can harvest 1000 kg of giant miscanthus per hour and simultaneously produce compressed pellets eliminating unnecessary processes such as transportation and processing. With its use, 33–74.5 kWh/t of electrical energy can be saved by producing pellets. The changes in moisture content between the produced compressed pellets and two samples of the ground product were measured immediately before compression for 24 h at relative humidity ranging from 65% to 80%. The moisture content was 6% initially; it ranged from 6.71% to 7.81% in compressed pellets, depending on the conditions, and from 7.44% to 9.82% in the ground sample immediately before compression, indicating the effect of the physical form of the biomass and humidity in the environment. The possible storage period (while maintaining the moisture content at 8–10% for optimal biofuel efficiency based on the measured data) was predicted. The optimal relative humidity of the storage environment for maintaining biomass quality for more than 6 months was predicted to be ≤77% and ≤70% for the compressed pellet and ground sample, respectively. Moreover, at a relative humidity ≥77%, giant miscanthus biomass, immediately before compression, had >10% moisture content in 2 days, warranting caution in storage. [ABSTRACT FROM AUTHOR]

Background: The Rome proposal provides an objective assessment tool for severity of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) but requires validation. Objectives: We aimed to evaluate the predictive performance of the Rome proposal in patients with AE-COPD. Design: This observational study assessed the patients who visited the emergency room (ER) or were hospitalized due to AE-COPD between January 2010 and December 2020. Methods: We compared the performance of the Rome Proposal with that of the DECAF score or GesEPOC 2021 criteria in predicting intensive care unit (ICU) admission, need for non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), and in-hospital mortality. Results: A total of 740 events of ER visit or hospitalization due to AE-COPD were reviewed and classified into mild (30.9%), moderate (58.6%), or severe (10.4%) group according to the Rome proposal. The severe group had a higher rate of ICU admission, required more NIV or IMV, and had a higher in-hospital mortality than the mild and moderate groups. The predictive performance of the Rome proposal was significantly better for ICU admission [area under the receiver operating characteristic curve (AU-ROC) = 0.850 versus 0.736, p = 0.004] and need for NIV or IMV (AU-ROC = 0.870 versus 0.770, p = 0.004) than that of the GesEPOC 2021 criteria but better than that of the DECAF score only in female patients. There was no significant difference in predicting the in-hospital mortality between the Rome proposal and DECAF score or GesEPOC 2021 criteria. Conclusion: External validation of the Rome Proposal in Korean patients demonstrated excellent performance for ICU admission and need for NIV or IMV and an acceptable performance for in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background: Comorbidities of chronic obstructive pulmonary disease (COPD) influence clinical characteristics and prognosis. Objectives: This study compared the clinical characteristics and exacerbation rate of COPD according to the presence of depression or anxiety. Design: This study used data from The Korea COPD Subgroup Study (KOCOSS) cohort, a nationwide prospective cohort from 54 medical centers, between April 2012 and 2019. Methods: Depression and anxiety were diagnosed with the Beck Depression Inventory and Beck Anxiety Inventory. Negative binomial regression analysis was performed to analyze the frequency of exacerbations in depressed patients and anxiety. Differences in lung function trajectory according to presence of depression/anxiety were analyzed using a linear mixed model. Results: In all, 2147 patients were enrolled. Depressed patients or anxiety had lower lung function, higher modified Medical Research Council (mMRC) grade, St. George Respiratory Questionnaire (SGRQ) score, and COPD assessment test score, and higher rates of exacerbation in the past year than those without depression/anxiety. Depressed patients had a higher frequency of moderate to severe exacerbations [Incidence Rate Ratio (IRR): 1.57, CI: 1.17-2.11, p = 0.002] and those with anxiety had higher frequencies of moderate to severe (IRR: 1.52, CI: 1.03-2.27, p = 0.038) and severe exacerbations (IRR: 2.13, CI: 1.09-4.15, p = 0.025) during 1-year follow-up compared to those without these comorbidities. The differences in the change in annual forced expiratory volume in 1 seconds (FEV1) over 3 years according to the presence of depression or anxiety were not statistically significant. Conclusion: Depressed and anxious patients showed increased respiratory symptoms and exacerbation rate as well as reduced health-related quality of life, whereas there were no significant differences in changes in lung function between groups with and without depression/anxiety. [ABSTRACT FROM AUTHOR]

Limited data are available in COVID-19 patients on the prediction of treatment response to systemic corticosteroid therapy based on systemic inflammatory markers. There is a concern whether the response to systemic corticosteroid is different according to white blood cell (WBC) counts in COVID-19 patients. We aimed to assess whether WBC count is related with the clinical outcomes after treatment with systemic corticosteroids in severe COVID-19. We conducted a retrospective cohort study and analysed the patients hospitalised for severe COVID-19 and received systemic corticosteroids between July 2020 and June 2021. The primary endpoint was to compare the composite poor outcome of mechanical ventilation, extracorporeal membrane oxygenation, and mortality among the patients with different WBC counts. Of the 585 COVID-19 patients who required oxygen supplementation and systemic corticosteroids, 145 (24.8%) belonged to the leukopoenia group, 375 (64.1%) belonged to the normal WBC group, and 65 (11.1%) belonged to the leukocytosis group. In Kaplan-Meier curve, the composite poor outcome was significantly reduced in leukopoenia group compared to leukocytosis group (log-rank p-value < 0.001). In the multivariable Cox regression analysis, leukopoenia group was significantly associated with a lower risk of the composite poor outcome compared to normal WBC group (adjusted hazard ratio [aHR] = 0.32, 95% CI 0.14–0.76, p-value = 0.009) and leukocytosis group (aHR = 0.30, 95% CI = 0.12–0.78, p-value = 0.013). There was no significant difference in aHR for composite poor outcome between leukocytosis and normal WBC group. Leukopoenia may be related with a better response to systemic corticosteroid therapy in COVID-19 patients requiring oxygen supplementation. In severe COVID-19 treated with systemic corticosteroids, patients with leukopoenia showed a lower hazard for composite poor outcome compared to patients with normal white blood cell counts or leukocytosis. Leukopoenia may be a potential biomarker for better response to systemic corticosteroid therapy in COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

Background: Rapid forced expiratory volume in 1 s (FEV1) decliners have been considered a unique subgroup of patients with chronic obstructive pulmonary disease (COPD). Rapid FEV1 decline manifests early and is associated with poor prognosis. This necessitates the pre-emptive identification of risk factors for rapid FEV1 decline. Objectives: We aimed to determine the risk factors and clinical outcomes in patients with COPD. Methods: This longitudinal, observational study was based on the Korea COPD Subgroup Study cohort (NCT02800499) from January 2012 to December 2019 across 54 medical centers in South Korea. Eligible patients were followed up for 3 years with serial spirometric tests. We calculated the annualized percentage change in FEV1 from baseline. Rapid decliners were defined as the quartile of patients with the highest annualized percentage FEV1 decline. Results: Of the 518 patients, 130 were rapid decliners who lost 6.2%/year and 100 mL/year of FEV1. The multivariable logistic regression identified male sex, current smoking, blood eosinophil count <150/µL, and high forced vital capacity as the independent risk factors for rapid FEV1 decline. Among rapid decliners, the lung function deteriorated more rapidly in current smokers and patients with severe dyspnea, while triple combination therapy attenuated lung function decline in comparison with mono-bronchodilator therapy. Rapid decliners had a higher rate of severe exacerbation than nonrapid decliners (0.2/year vs. 0.1/year, p value = 0.032). Conclusions: We identified the independent risk factors for rapid FEV1 decline. This information may assist physicians in the early detection and pertinent management of rapid decline among patients with COPD. [ABSTRACT FROM AUTHOR]

Background: The standard treatment regimen for drug-sensitive tuberculosis (TB), comprising four companion drugs, requires a minimum duration of 6 months, and this lengthy treatment leads to poor adherence and increased toxicity. To improve rates of adherence, reduce adverse events, and lower costs, a simplified and shortened treatment regimen is warranted.Methods: This study is a multicenter, open-label randomized clinical trial of non-inferiority design that compares a new regimen with the conventional regimen for drug-sensitive pulmonary TB. The investigational group will use a regimen of high-dose rifampicin (30 mg/kg/day) with isoniazid and pyrazinamide, and the treatment will be maintained for 12 weeks after the achievement of negative conversion of sputum culture. The control group will be treated for 6 months with a World Health Organization-endorsed regimen consisting of isoniazid, rifampicin (10 mg/kg/day), ethambutol, and pyrazinamide. The primary endpoint is the proportion of unfavorable outcomes at 18 months after randomization. Secondary outcomes include time to unfavorable treatment outcome, time to culture conversion on liquid medium, treatment success rate at the end of treatment, proportion of recurrence at 18 months after randomization, time to recurrence after treatment completion, and adverse events of grade 3 or higher during the treatment. We predict a 10% unfavorable outcome for the control group, and 0% difference from the investigational group. Based on 80% verification power and a 2.5% one-sided significance level for a non-inferiority margin of 6%, 393 participants per group are required. Considering the 15% dropout rate, a total of 926 participants (463 in each group) will be recruited.Discussion: This study will inform on the feasibility of the treatment regimen using high-dose rifampicin with a shortened and individualized treatment duration for pulmonary TB.Trial Registration: ClinicalTrials.gov NCT04485156 . Registered on July 24, 2020. [ABSTRACT FROM AUTHOR]

Background: Impaired lung function is associated with a higher risk of developing lung cancer. However, lung function is a dynamic variable and must be evaluated longitudinally. This study reports on the relationship between accelerated lung function decline and development of lung cancer.Research Question: Is accelerated lung function decline associated with the development of lung cancer?Study Design and Methods: A longitudinal, observational study was performed by using epidemiologic data from two population-based studies comprising subjects assessed biannually from 2001 to 2019 in South Korea. Eligible subjects were between 40 and 69 years of age and were followed up by using spirometry. Spirometry measurements were made at each follow-up. Patients with a decline in FEV1 > 60 mL per year were defined as rapid FEV1 decliners. The relationship between lung cancer and rapid FEV1 decline was evaluated by using adjusted Cox regression models with covariates, including age, sex, smoking history, FEV1/FVC, and WBC count.Results: Among the 8,549 eligible subjects, 1,287 (15.1%) had rapid FEV1 decline, and 48 (0.6%) had newly developed lung cancer. The risk of lung cancer development was increased in the subjects aged ≥ 45 years and those with ≥ 30 pack-years of smoking, low baseline FEV1/FVC, low forced expiratory flow between 25% and 75% of vital capacity, rapid FEV1 decline, and increased WBC count. Rapid FEV1 decline was an independent risk factor for lung cancer development (adjusted hazard ratio, 2.34; 95% CI, 1.28-4.28; P = .006). Time-dependent net reclassification improvement showed a benefit of FEV1 decline rate in determining subjects at risk of lung cancer when added to conventional practice (categorical, 0.32 [95% CI, 0.00-0.64]; continuous, 0.83 [95% CI, 0.14-1.25]).Interpretation: The FEV1 decline rate may be a potential biomarker for lung cancer development. Further study is needed to identify whether patients with rapid FEV1 decline warrant lung cancer assessment or screening. [ABSTRACT FROM AUTHOR]

Background: Flexible bronchoscopy is widely used to diagnose and treat various respiratory diseases. However, caution is warranted for post-bronchoscopy adverse events. Although desaturation frequently occurs during bronchoscopy, its clinical impact and the optimal oxygen saturation level during the procedure remain unclear. This study aimed to investigate whether the percutaneous oxygen saturation (SpO2) level during bronchoscopy is associated with the development of post-bronchoscopy respiratory adverse events. Methods: In this single-center retrospective cohort study conducted from March 2020 to February 2021, 569 patients were classified into high or low oxygen saturation groups based on the SpO2 level during bronchoscopy. The primary outcome was post-bronchoscopy respiratory adverse events, and secondary outcomes were other post-bronchoscopy adverse events and clinical outcomes. Results: Among 569 patients, 458 and 111 patients were classified into the high oxygen saturation (SpO2 > 96%) and low oxygen saturation (SpO2 ≤ 94%) groups, respectively. After propensity score matching, the low oxygen saturation group had more post-bronchoscopy respiratory and febrile adverse events than the high oxygen saturation group. In the multivariable regression analysis, low SpO2 level during bronchoscopy was an independent risk factor for post-bronchoscopy respiratory adverse events (odds ratio = 3.16 [95% confidence interval 1.37–7.30]). In the low oxygen saturation group, the high-risk subgroups for post-bronchoscopy respiratory adverse events were the elderly, women, current smokers, and patients with chronic obstructive pulmonary disease or acute decompensated heart failure before bronchoscopy. There was no significant difference in the length of hospital stay, intensive care unit admission, or mortality between the high and low oxygen saturation groups. Conclusions: Close monitoring is recommended for patients with SpO2 ≤ 94% during bronchoscopy due to the increased risk of respiratory adverse events after the procedure. [ABSTRACT FROM AUTHOR]

Degree of expression of programmed death-ligand 1 (PD-L1) is related with Immune check point inhibitors (ICIs) response but it needs sufficient tumor tissue. There is unmet need for easily accessible and prognostic peripheral blood (PB) biomarkers. We investigated the application of serum peripheral lymphocyte count (PLC) as a predictive PB biomarker for ICI response in patients with NSCLC. We conducted a retrospective study and reviewed the patients with NSCLC who were treated with ICIs from April 1, 2016, to March 31, 2019. The PLC before and after 1 month of immunotherapy was collected. We evaluated the association between PLC and progression-free survival (PFS), overall survival (OS) and adverse events. A total of 231 patients were treated with ICIs for NSCLC. The median follow-up period was 4.7 months and the disease progressed in 138 patients (59.7%). Compared with the lowest quartile (Q1: the lowest 25%), the highest quartile (Q4: the highest 25%) of post-treatment PLC showed a significantly higher PFS (HR 0.28, 95% CI 0.16–0.52) and OS (HR 0.35, 95% CI 0.19–0.65) in the adjusted model. An association between adverse events and PLC was not observed. We revealed that an increased pre- and post-treatment PLC was associated with favorable PFS and OS with NSCLC patients treated with ICIs. PLC could be a helpful for ICI responses in NSCLC. [ABSTRACT FROM AUTHOR]

Kplo-MAGnetometer (KMAG) is one of the scientific instruments of Korea Pathfinder Lunar Orbiter (KPLO) set to be launched in 2022. Its objectives are magnetic field investigation and technical demonstration near the surface of the Moon. Specifically, it will investigate the lithospheric magnetism of the Moon and measure the electromagnetic wave properties near the lunar surface. It consists of three fluxgate magnetometers on a 1.2 m long boom, which is relatively shorter than the boom used in other missions. The three magnetometers are included for scientific measurements, redundancy checks, and multi-sensor technical investigation. The magnetometers and an inner Anisotropic Magneto-Resistive sensor perform simultaneous sampling to correct for the magnetic field interference caused by the spacecraft. The fully integrated flight model assembly showed that the magnetometer noise level was less than 30 pT Hz−1/2 at 1 Hz and stability was within ±0.2 nT at the 10 Hz sampling rate. This paper describes the configuration and performance of the KMAG using the multi-sensing method. KPLO, THEMIS-ARTEMIS spacecraft, and Commercial Lunar Payload Service modules will be in their operational phase simultaneously. Therefore, the KMAG will be able to contribute to multi-site in-situ measurements of the lunar magnetic field. We expect that the KMAG will provide an up-to-date lunar observation data set and an opportunity to perform the multi-sensor observation. [ABSTRACT FROM AUTHOR]

Background: The presence and progression of interstitial lung abnormalities (ILAs) is known to be associated with a decline of lung function and increased risk of mortality.Research Question: We aimed to elucidate the clinical course according to ILAs in patients with COPD.Study Design and Methods: A retrospective study was conducted between January 2013 and December 2018 of COPD patients who underwent chest CT imaging and longitudinal pulmonary function tests. We evaluated radiologic findings, history of acute exacerbations of COPD, and lung function changes during the longitudinal follow-up.Results: Of 363 patients with COPD, 44 and 103 patients had equivocal and definite ILAs, respectively. Patients with ILAs were significantly older and had lower FEV1 and FVC than patients without ILAs. During the mean follow-up period of 5.2 years, ILAs were associated significantly with the annual incidence of moderate to severe acute exacerbation of COPD (β ± SD, 0.38 ± 0.12; P = .002) and with the risk of frequent exacerbation (adjusted OR, 2.03; P = .045). Patients with progressive ILAs showed a significantly higher rate of annual decline in FEV1 and FVC than those showing no change in, or improved, ILAs.Interpretation: ILAs were associated significantly with moderate to severe acute exacerbation in patients with COPD, and the progression of ILAs was associated with an accelerated decline in lung function. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence of tuberculosis (TB) in patients with rheumatic diseases receiving high-dose glucocorticoids and to evaluate the preventive effect of isoniazid (INH). Methods: This study included 1618 treatment episodes of prolonged (≥4 weeks), high-dose steroids (≥30mg/day of prednisone) in 1160 patients. Of these, INH was administered in 152 (9.4%) treatment episodes (INH group), while others received no prophylaxis (control group). The high-risk subgroup (n = 92) was defined as patients with 1) incomplete adherence to treatment of previous TB, 2) positive interferon-γ release assay, and/or 3) linear/reticular fibrotic lesions on chest radiographs. Primary outcome was 1-year incidence of TB in each group. Results: During 1579.8 person-years, 21 cases of TB occurred. The high-risk subgroup showed a significantly higher TB incidence than the non-high-risk subgroup (Incidence rate ratio = 8.29). INH did not significantly affect the 1-year TB incidence in the whole population but numerically reduced it only in the high-risk subgroup [adjusted hazards ratio = 0.37 (95% CI, 0.002–5.10)]. The incidence of adverse drug reactions (ADRs) related to INH was 111.6 (89.3–137.9)/100 person-years, including one fatal occurrence of fulminant hepatitis. The number needed to treat (NNT) to prevent one case of TB was lower than the number needed to harm (NNH) for one case of severe ADR only in the high-risk subgroup (11 vs. 16). Conclusion: INH treatment to prevent TB might be effective in high-risk patients but has a risk of frequent ADRs, which limits its use in general practice in patients not at a high risk of developing TB. [ABSTRACT FROM AUTHOR]

Background & Aims: The association between nonalcoholic fatty liver disease (NAFLD) and pulmonary function remains elusive because of the heterogeneous spectrum and inaccurate diagnostic methods of NAFLD, and insufficient pulmonary function data. We conducted this study to identify the association between histological severity of NAFLD and pulmonary function. Methods: This study included patients ≥18 years old with baseline pulmonary function data between August 2014 and July 2019 within a biopsy‐evaluated prospective NAFLD cohort. Cross‐sectionally, pre‐/post‐bronchodilator spirometric data with diffusing capacity (DLCO) were compared according to histological severity of NAFLD in the various demographic and metabolic subgroups. Multivariable‐adjusted analysis revealed specific histological features associated with reduced pulmonary function. Results: In a total of 420 patients with biopsy‐proven NAFLD, pre‐/post‐bronchodilator forced vital capacities (FVCs; a percentage of the predictive value) were inversely correlated with histological severity of NAFLD. Conversely, pre‐bronchodilator forced expiratory volume in 1 second (FEV1)/FVC was positively correlated with NAFLD severity. Post‐bronchodilator FVC (%) decreased and DLCO/alveolar volume (VA) increased linearly with worsening histological severity of NAFLD in multivariable analysis. In particular, fibrosis stage remained a significant independent predictor of decreased post‐bronchodilator FVC (%) (β‐coefficient, 4.41; 95% confidence interval [−8.39, −0.43]; P =.031) even after adjusted for clinical variables, exclusively in age <65 years, female, never‐smoker and nonchronic obstructive pulmonary disease subgroups. Conclusions: Pulmonary function deteriorates with worsening histological severity of NAFLD, especially at the fibrosis stage. The common pathogenesis of reduced pulmonary function and NAFLD fibrosis progression should be further explored. [ABSTRACT FROM AUTHOR]

Postural dysfunction is one of the most common community health symptoms and frequent chief complaints in hospitals. Sarcopenia is a syndrome characterized by degenerative loss of skeletal muscle mass, muscle quality, and muscle strength, and is the main contributor to musculoskeletal impairment in the elderly. Previous studies reported that loss of muscle mass is associated with a loss of diverse functional abilities. Meanwhile, there have been limited studies concerning postural dysfunction among older adults with sarcopenia. Although sarcopenia is primarily a disease of the elderly, its development may be associated with conditions that are not exclusively seen in older persons. Also, recent studies recognize that sarcopenia may begin to develop earlier in life. The objective of this paper was to investigate the association between the prevalence of sarcopenia and postural dysfunction in a wide age range of adults using data from a nationally representative cohort study in Korea. Korean National Health & Nutrition Exhibition Survey V (KNHANES V, 2010–2012) data from the fifth cross-sectional survey of the South Korean population performed by the Korean Ministry of Health and Welfare were used. Appendicular skeletal muscle mass (ASM)/height (ht)2 was used to define sarcopenia, and the Modified Romberg test using a foam pad ("foam balance test") was performed to evaluate postural dysfunction. ASM/ht2 was lower in women and significantly decreased with age in men. Subjects with sarcopenia were significantly more likely to fail the foam balance test, regardless of sex and age. Regression analysis showed a significant relationship between sarcopenia and postural dysfunction (OR: 2.544, 95% CI: 1.683–3.846, p<0.001). Multivariate regression analysis revealed that sarcopenia (OR: 1.747, 95% CI: 1.120–2.720, p = 0.014) and age (OR: 1.131, 95% CI: 1.105–1.158, p<0.001) are independent risk factors for postural instability. In middle age subjects, the adjusted OR for sarcopenia was 3.344 (95% CI: 1.350–8.285) (p = 0.009). The prevalence of postural dysfunction is higher in sarcopenia patients, independent of sex and age. [ABSTRACT FROM AUTHOR]

Background: There are limited data available on whether drug-induced hepatotoxicity (DIH) affects the clinical outcomes of tuberculosis (TB) treatment. We explored the effects of DIH on the clinical course and outcomes of pulmonary TB.Methods: In this retrospective cohort study, we included patients with culture-proven pulmonary TB treated in a tertiary hospital from 2013 to 2016. DIH was defined as proposed by the official American Thoracic Society statement. We compared the clinical outcomes of DIH and non-DIH patients.Results: Between January 1, 2013 and December 31, 2016, a total of 168 TB patients were included, and 20 (11.9%) were diagnosed with DIH. These patients were significantly older, had a higher Charlson Comorbidity Index score, exhibited more chronic liver disease, included more chronic alcoholics, and had a lower body mass index than non-DIH patients. We found no significant differences between DIH and non-DIH patients in the 2-month sputum culture conversion rate, the time to sputum culture conversion, treatment outcomes, or total treatment duration. However, the ratio of treatment interruption time to total treatment duration and the proportion of hepatotonic users were significantly higher among DIH patients.Conclusion: DIH development during TB treatment does not significantly affect the clinical outcomes of pulmonary TB. However, treatment interruption caused by DIH may increase the risks of future relapse and acquired resistance. Further study is needed. [ABSTRACT FROM AUTHOR]

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Background: We aimed to evaluate whether serum activin-A levels are elevated and have any value in predicting severity and prognosis in acute respiratory distress syndrome (ARDS).Methods: Retrospective cohort study was performed with patients who were admitted to MICU with diagnosis of ARDS and have serum samples stored within 48 h of Intensive care unit (ICU) admission between March 2013 and December 2016 at a single tertiary referral hospital. Serum activin-A levels were measured with ELISA kit, and were compared with those of normal healthy control and non-ARDS sepsis patients.Results: Total 97 ARDS patients were included for the study. Levels of Activin-A were elevated in ARDS patients compared to those of healthy controls (Log-transformed activin-A levels 2.89 ± 0.36 vs. 2.34 ± 0.11, p < 0.001, absolute activin-A levels 1525.6 ± 1060.98 vs. 225.9 ± 30.1, p = 0.016) and non-ARDS sepsis patients (Log-transformed activin-A levels 2.89 ± 0.36 vs. 2.73 ± 0.34, p = 0.002, Absolute activin-A levels 1525.6 ± 1060.98 vs. 754.8 ± 123.5 pg/mL, p = 0.036). When excluding five outliers with extremely high activin-A levels, activin-A showed statistically significant correlation with in-hospital mortalities (In-hospital survivors 676.2 ± 407 vs. non-survivors 897.9 ± 561.9 pg/mL, p = 0.047). In predicting in-hospital mortality, serum activin-A concentrations showed superior area under curve compared to that of Acute physiologic and chronic health evaluation II scores (0.653; 95% CI [0541, 0.765] vs. 0.591, 95% CI [0.471, 0.710]). With cut-off level of 708 pg/mL, those with high serum activin-A levels had more than twofold increased risk of in-hospital mortalities. However, those relations were missing when outliers were in.Conclusions: Serum activin-A levels in ARDS patients are elevated. However, its levels are weakly associated with ARDS outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Chronic obstructive pulmonary disease is an independent risk factor of postoperative pulmonary complications (PPCs). It is unknown whether a perioperative systemic corticosteroid would be beneficial in patients with obstructive airway disease. Objectives: The present study was conducted to determine the effect of a perioperative systemic corticosteroid on PPCs in patients who showed airway obstruction in preoperative spirometry. Methods: Retrospective medical record reviews were performed on records from January 2010 to December 2011 in a referral hospital. We analyzed the data of patients who were referred to pulmonologists before elective abdominal surgery and had a prebronchodilator FEV1/FVC of <70%. We compared the PPCs between the steroid group and the non‐steroid group. Results: A total of 270 patients were referred to pulmonologists and, of these, 86 had a FEV1/FVC of <70% in the preoperative spirometry. In the 30 patients in the steroid group, the mean FEV1 was 52.2% and half of these had previously used a bronchodilator. Use of a perioperative systemic corticosteroid was significantly associated with reduced incidence of PPCs in the multivariate logistic regression with adjustment by propensity score (adjusted odds ratio = 0.036, 95% confidence interval [CI] = 0.003–0.505; P = 0.014). Conclusion: In our retrospective study we showed that those treated with steroids had better outcomes. However, future prospective and randomized controlled trials are needed. [ABSTRACT FROM AUTHOR]

We present a novel drug screening approach for discovering neuraminidase inhibitors, in which viral neuraminidase is a well-characterized target to develop anti-influenza pharmaceuticals. In this study, a series of molecular dynamics-driven structures for a glycosylated form of the neuraminidase N1 was introduced during an in silico screening process. The efficiency of this approach was confirmed by activity-based in vitro screening for inhibitory chemicals of the neuraminidase from H1N1 (A/California/04/2009). This is the first report on a virtual screening method for neuraminidase using a computational glycosylated structure model for N1. [ABSTRACT FROM AUTHOR]

The prevalence and clinical implications of discordance between Xpert MTB/RIF assays and the AdvanSure TB/NTM real-time polymerase chain reaction (PCR) for bronchial washing specimens have not been studied in pulmonary TB (PTB) patients. The discordant proportion and its clinical impact were evaluated in 320 patients from the bronchoscopy registry whose bronchial washing specimens were tested simultaneously with Xpert MTB/RIF and the TB/NTM PCR assay for three years, and the accuracy of the assays, including the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were studied. The clinical risk factors for discordance and false positivity of assays were also studied. Among 130 patients who were clinically diagnosed with PTB, 64 patients showed positive acid-fast bacilli culture results, 56 patients showed positive results in molecular methods and clinician diagnosed PTB without results of microbiology in 10 patients. The sensitivity, specificity, PPV, and NPV were 80.0%, 98.95%, 98.1%, and 87.9%, respectively, for Xpert MTB/RIF and 81.5%, 92.6%, 88.3%, and 88.0%, respectively, for TB/NTM PCR. The discordant proportion was 16.9% and was higher in culture-negative PTB compared to culture-confirmed PTB (24.3% vs. 9.4%, p = 0.024). However, there were no significant differences in the clinical characteristics, regardless of the discordance. The diagnostic yield increased with an additional assay (7.7% for Xpert MTB/RIF and 9.2% for TB/NTM PCR). False positivity was less common in patients tested with Xpert MTB/RIF (1.05% vs. 7.37%, p = 0.0035). No host-related risk factor for false positivity was identified. The Xpert MTB/RIF and TB/NTM PCR assay in bronchial washing specimens can improve the diagnostic yields for PTB, although there were considerable discordant results without any patient-related risk factors. [ABSTRACT FROM AUTHOR]

Background: Fluoroquinolone is recommended as a pivotal antituberculous agent for treating multi-drug-resistant pulmonary tuberculosis. However, its effectiveness as first-line treatment remains controversial. The present study was conducted to validate the fluoroquinolone-containing regimen for drug-sensitive pulmonary tuberculosis. Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials until June 5, 2015. Randomized controlled trials (RCTs) that compared antituberculous regimens containing fluoroquinolone with the standard regimen were included. Results: Eleven RCTs that included 6,334 patients were selected. Fluoroquinolone-containing regimens had a higher rate of sputum culture conversion at 2 months of treatment (M-H fixed odds ratio [OR], 1.36; 95% confidence interval [CI], 1.20–1.54). However, the outcomes were less favorable (M-H fixed OR, 0.69; 95% CI, 0.59–0.82) and the associated total adverse events were more frequent (M-H fixed OR, 1.84; 95% CI, 1.46–2.31) in the fluoroquinolone-containing regimen group, without a significant heterogeneity according to treatment duration. Treatment with the fluoroquinolone-containing regimen for 4 months showed a higher relapse rate. Conclusions: Despite a higher culture conversion rate at 2 months of treatment, the fluoroquinolone-containing regimen had limitations, including less favorable outcomes and more adverse events, as the first-line therapy for drug-sensitive pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Background and objective There are limited data regarding serum activin-A as a biomarker for sepsis. We examined whether serum activin-A concentration could predict sepsis severity and prognosis in the management of critically ill patients with sepsis. Methods The subjects were adult patients suspected of having sepsis and admitted to intensive care unit (ICU) from January 2013 to March 2014. Serum activin-A concentration was measured in blood sampled within 48 h after ICU admission. The primary and secondary outcomes were the diagnostic value of serum activin-A concentration as a biomarker of sepsis and the prognostic value for predicting the clinical outcomes of sepsis, respectively. Results One hundred and thirty patients who had clinically suspected sepsis were included. Most (66.2%) were male; their median age was 65 years, and their Acute Physiology and Chronic Health Evaluation II score was 22.3. Serum activin-A concentration tended to increase with sepsis severity and differed significantly between those with non-sepsis and severe sepsis and between those with severe sepsis and septic shock. The risks of sepsis, severe sepsis and septic shock were significantly higher in patients with a serum activin-A concentration of 251, 319 and 432 pg/mL or greater, respectively. Serum activin-A concentration was significantly associated with the Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, Charlson comorbidity index and ICU mortality. Conclusion Serum activin-A was a predictor of sepsis severity and a prognostic marker in critically ill patients with sepsis. Serum activin-A concentration in the early phase of sepsis was associated with prognostic indexes on ICU admission and with ICU mortality. [ABSTRACT FROM AUTHOR]