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Hyaluronic acid (HA) is a polysaccharide found in the extracellular matrix of the epithelial, nervous, and connective tissues of vertebrates. It is widely used in the treatment of ocular surface diseases (OSDs), including dry eye, due to its high water-retaining capacity, viscoelasticity, and role as a signaling molecule in inflammation and wound healing. This paper reviews the physicochemical and biological properties of HA related to the treatment of OSDs and the results of published preclinical studies, clinical trials, and meta-analyses on the effects of HA eye drops on the tear film, the mechanism of action of HA eye drops, and its clinical effects and adverse events in OSDs, such as corneal/conjunctival epithelial defects, dry eye, and postoperative dry eye. This review should help inform clinical judgments by providing clinical evidence and precautions on the use of HA eye drops in OSDs, including dry eye.

Epoxyeicosatrienoic acids (EETs) are arachidonic acid metabolites with biological effects, including anti-apoptotic, anti-inflammatory, and anti-fibrotic functions. Soluble epoxide hydrolase (sEH)-mediated hydrolysis of EETs to dihydroxyeicosatrienoic acids (DHET) attenuates these effects. Recent studies have demonstrated inhibition of sEH prevents renal tubulointerstitial fibrosis and inflammation in chronic kidney disease (CKD) model. Given the pathophysiological role of the EET pathway in CKD, we investigated if administration of EETs regioisomers and/or sEH inhibition will promote anti-fibrotic and reno-protective effects in renal fibrosis following UUO. EETs administration abolished tubulointerstitial fibrogenesis, as demonstrated by reduced fibroblast activation and collagen deposition after UUO. Inflammatory response was prevented as demonstrated by decreased neutrophil and macrophage infiltration and expression of cytokines in EETs-administered UUO kidneys. EETs administration and/or sEH inhibition significantly reduced M1 macrophage markers while M2 macrophage markers were highly upregulated. Furthermore, UUO-induced oxidative stress, tubular injury, and apoptosis were all downregulated following EETs administration. Combined EETs administration and sEH inhibition however, had no additive effect in attenuating inflammation and renal interstitial fibrogenesis after UUO. Taken together, our findings provide a mechanistic understanding of how EETs prevent kidney fibrogenesis during obstructive nephropathy, and suggest EETs treatment as a potential therapeutic strategy to treat fibrotic diseases.

Kidney ischemia reperfusion injury (IRI) is characterized by tubular cell death. DNA double-strand breaks is one of the major sources of tubular cell death induced by IRI. 2-Mercaptoethanol (2-ME) is protective against DNA double-strand breaks derived from calf thymus and bovine embryo. Here, we sought to determine whether treatment with 2-ME attenuated DNA double-strand breaks, resulting in reduced kidney dysfunction and structural damage in IRI.Kidney IRI or sham-operation in mice was carried out. The mice were treated with 2-ME, Ras-selective lethal 3, or vehicle. Kidney function, tubular injury, DNA damage, antioxidant enzyme expression, and DNA damage response (DDR) kinases activation were assessed.Treatment with 2-ME significantly attenuated kidney dysfunction, tubular injury, and DNA double-strand breaks after IRI. Among DDR kinases, IRI induced phosphorylation of ataxia telangiectasia mutated (ATM) and ataxia telangiectasia and Rad3 related (ATR), but IRI reduced phosphorylation of other DDR kinases including ataxia telangiectasia and Rad3 related, checkpoint kinase 1 (Chk1), Chk2, and Chinese hamster cells 1 (XRCC1). Treatment with 2-ME enhanced phosphorylation of ATM and ATM-mediated effector kinases in IRI-subjected kidneys, suggesting that 2-ME activates ATM-mediated DDR signaling pathway. Furthermore, 2-ME dramatically upregulated glutathione peroxidase 4 (GPX4) in IRI-subjected kidneys. Inhibition of GPX4 augmented adverse IRI consequences including kidney dysfunction, tubular injury, DNA double-strand breaks, and inactivation of ATM-mediated DDR signaling pathway after IRI in 2-ME-treated kidneys.We have demonstrated that exogenous 2-ME protects against DNA double-strand breaks after kidney IRI through GPX4 upregulation and ATM activation.

Evidence of poor sleep health among children in foster care continues to mount, but information about whether and how sleep problems are addressed is unavailable. The goal of this study was to begin to fill these significant knowledge gaps.Four hundred eighty-five foster caregivers from across the United States completed a survey focused on the sleep health of one child, 4 to 11 years ( M = 6.4; SD = 2.2) currently in their care. Caregivers provided quantitative and qualitative responses to questions regarding training, information, and services received in relation to their child's sleep. Caregivers also reported on the factors and strategies they perceived as most important for helping children in their care sleep well.Only 13% of caregivers reported receiving any information/education about sleep from agencies or case workers, whereas 55% had sought help from a health provider related to their child's sleep. Nearly half of all caregivers (46%) reported giving their child melatonin. Caregivers reported that a bedtime routine/consistency, reassurance of safety/love, and a calming environment were most important for helping their child sleep well. A recurrent theme in qualitative responses was a need to mitigate child fear/anxiety at night.Children in foster care face a range of risk factors that increase the likelihood of poor/insufficient sleep, but these findings suggest this critical aspect of health requires greater clinical and research attention. As these data were collected during the initial months of the COVID-19 pandemic, replication studies are necessary.

Surgical pain management is a critical component in the success of bariatric procedures. With the opioid epidemic, there have been increased efforts to decrease opioid use. In 2019, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program developed the BSTOP protocol, a multimodal perioperative pain management regimen to minimize opioid use. The objective of this study is to evaluate the effectiveness of the BSTOP protocol on patients' need for opioid medications during their perioperative care.This is a single-institution prospective cohort study on patients who underwent bariatric surgery from 10/2019 to 5/2021. Data was collected on morphine equivalent dose of opioids during different stages of inpatient and outpatient care. BSTOP was implemented on 7/2020. Primary outcomes were total inpatient and outpatient opioid use as well as hospital length of hospital stay (LOS). Gabapentin was removed from the protocol between 10/20/2020 and 12/31/2020 due to side effects; it was re-implemented on 1/1/2021 due to observed spikes in opioid use during its absence.1264 patients who had bariatric surgery between 10/2019 and 5/2021 were included in the study, with 409 patients before (pre-BSTOP) and 855 patients after BSTOP implementation. There was a 36% reduction in total inpatient opiate use and a 57% reduction in total outpatient opiate use. LOS also significantly decreased, from 1.53 to 1.28 days. 179 patients received BSTOP without gabapentin. These patients used more opioids in the post-anesthesia care unit and on the inpatient floors compared to pre-BSTOP and BSTOP with gabapentin patients. With total inpatient and outpatient opioid use, patients on BSTOP without gabapentin used fewer opioids than those pre-BSTOP. However, those on BSTOP without gabapentin used more opioids than those with gabapentin.The BSTOP protocol significantly reduced inpatient and outpatient opioid use as well as LOS. Gabapentin is a crucial component of the BSTOP protocol.

Introduction Experiencing one-time traumatic events such as a hurricane is known to produce sleep disturbances that may contribute to the development and maintenance of PTSD symptoms (Mellman, 2019). Additionally, greater exposure to media coverage during and following such events has been shown to contribute to elevated post-traumatic stress (PTS; Shin & Sommers, 2021). However, whether media consumption might moderate the relationship between sleep disturbances and PTS symptoms has not been examined. We examined these relationships in a sample of college students following Hurricane Harvey, an epic storm that hit Texas in 2017 and received non-stop media coverage for an extended period after the storm. Methods Participants were undergraduate students (N=260, M age=21.32) at the University of Houston during Hurricane Harvey. Students answered online surveys 6-8 months following the hurricane that measured sleep quality and PTS symptoms over the last month, and media use both during and immediately following the hurricane. Sleep was assessed using the Pittsburg Sleep Quality Index (PSQI) and PTS symptoms were assessed using the PTSD Checklist for DSM-5 with sleep questions removed. Results Results indicated that active media consumption post hurricane was significantly correlated with PTS symptoms (r=.21, p Conclusion Previous research has found both sleep disturbance and greater exposure to media coverage of traumatic events are associated with greater symptoms of PTS. Although media exposure to trauma may impact sleep quality, our findings suggest these factors to exert independent effects on PTS symptoms. Better understanding of the role of media consumption in the aftermath of trauma is needed to understand these relationships. Support (if any)

Introduction As rates and severity of natural disasters increase due to climate change, it is crucial to consider their effects on mental health. Among Hurricane Katrina survivors, stressors experienced following the Hurricane, including financial losses, were more robustly predictive of rates of PTSD than traumatic experiences occurring during the Hurricane (Galea et al., 2008). Because sleep disturbance is intimately associated with trauma exposure and has been implicated in the etiology of PTSD, we examined relationships between experiences during and after Hurricane Harvey (a historic storm that hit Texas in 2017) and sleep disturbance in sample of college students impacted by the storm. Methods Undergraduate students (N = 191, age: M = 21.25, SD = 3.14) at the University of Houston completed online surveys 6-8 months after Hurricane Harvey. Sleep quality was measured using the Pittsburg Sleep Quality Index (PSQI) and post-traumatic stress (PTS) symptoms were measured using the PTSD Checklist for DSM-5, excluding sleep items. Participants also reported on experiences/events during, immediately after, and in the weeks/months following the Hurricane. Total traumatic experiences during the Hurricane (e.g., thinking oneself or others would get hurt or die) and stressful experiences after the storm (e.g., losing power, damage to car or property) were calculated. Financial stress was examined as a unique predictor. Analyses controlled for total traumatic life events measured with the Life Events Checklist for DSM-5. Results In a multiple linear regression model, we tested whether traumatic experiences during, stressors after, and financial stressors due to the Hurricane predicted global PSQI score, controlling for other traumatic life experiences and total PTS symptoms. The overall model was significant (R2 = 0.22, F (5,185) = 10.48, p < .000). Traumatic experiences during the Hurricane (B = 0.37, p = 0.04), but not stressors (B = 0.02, p = 0.87) or financial stress (B = -0.29, p = 0.67) following the Hurricane significantly predicted poor sleep quality at present. Conclusion Our findings suggest that among a sample of young adult college students impacted by Hurricane Harvey, traumatic experiences during the storm were the most robust predictor of sleep disturbance several months later even after accounting for PTS symptoms. Support (if any)

Objective The disparity of problems, impairments, and disorders among children in foster care is well-documented and spans virtually every domain of functioning. Sleep, however, has received minimal attention among this vulnerable group, which is concerning given the multitude of ways sleep affects children’s development, health, and behavior. Methods A total of 485 foster caregivers from across the United States completed a survey including quantitative items and qualitative, open-ended questions about sleep and related health and behavior for one child (M = 6.4 years, SD = 2.2; range 4–11 years) currently in their care. Results Overall, caregivers reported developmentally appropriate child sleep and wake times; however, difficulty falling asleep (avg. 46 min per night) and staying asleep (avg. 34 min awake overnight) were common. Additionally, a high prevalence of sleep-related problems was reported including moving to someone else’s bed during the night (85.8%), nightmares (51.2%), sleep terrors (26.4%), snoring (32.8%), bedwetting (31.6%), and teeth grinding (21.8%). Qualitative responses indicated emotional and behavioral challenges at bedtime, particularly elevated fear, and anxiety. Conclusions Findings are consistent with previous work finding significant health disparities among children placed in foster care. Results highlight a need for trauma-informed, behavioral sleep interventions for this pediatric population which might serve to reduce other health disparities.

Aristolochic acid (AA) is notorious for inducing nephrotoxicity, but the influence of sex on AA-induced kidney injury was not clear. This study sought to investigate sex differences in kidney dysfunction and tubular injury induced by AA. Male and female mice were bilaterally orchiectomized and ovariectomized, respectively. Fourteen days after gonadectomy, the mice were intraperitoneally injected with AA (10 mg/kg body weight/day) daily for 2 days and sacrificed 7 days after the first injection. Body weight, kidney function, and tubular structure were assessed. When compared between male and female non-gonadectomized mice, AA-induced body weight loss was greater in male mice than in female mice. Functional and structural damages in male kidneys were markedly induced by AA injection, but kidneys in AA-injected female mice showed no or mild damages. Ovariectomy had no effect on AA-induced nephrotoxic acute kidney injury in female mice. However, orchiectomy significantly reduced body weight loss, kidney dysfunction, and tubular injury in AA-induced nephrotoxicity in male mice. This study has demonstrated that testis causes AA-induced nephrotoxic acute kidney injury.

Anesthesia for pituitary surgery is tailored to each individual patient and the type of tumor they have. Anesthetic considerations include difficult airways, hormonal and electrolyte abnormalities, cardiac abnormalities, the potential for catastrophic hemorrhage, and the importance of a smooth extubation. The anesthesiologist is able to assist the surgeons by keeping the patient motionless and lowering the blood pressure to minimize surgical bleeding. Postoperative nausea and vomiting are also of greater importance than usual, as the Valsalva movements associated with retching could cause bleeding and disruption of the surgical site.

Purpose To present our experience in urethral duplication focusing on detailed surgical management. Methods We retrospectively reviewed the records of 12 male patients treated for urethral duplication between 2005 and 2017. Evaluations included ultrasound, retrograde urethrography, cystoscopy, and voiding cystourethrography. Results The age at presentation ranged from birth to 11 years. All 12 cases were classified using the Effmann classification. Case 1–4 patients with type I underwent excision of the dorsal accessory urethra by stripping technique. In case 5 patient(type IA) with two adjacent apical urethras, the septum was opened to form a single channel. Case 6 patient with type IB underwent visual internal urethrotomy near bulbous urethra to combine urethra into one channel. Five patients classified as type II (one with a type IIA1, and four with type IIA2 urethras). Urethral duplication was incidentally found during epispadias repair in case 7 patient with type IIA1, which was corrected by ventral plication, and excision of the dorsal epispadial urethra with stripping technique just below pubic bone. Case 8 patient with type IIA2 also required dorsal urethral excision with stripping technique. The two Y-type patients (case 10, 11) underwent urethrourethrostomy with a single-stage buccal mucosa tube graft, followed by repetitive surgeries owing to urethral stricture. One type III patient presented with penile inflammation and suprapubic pain, and underwent excision of both the dorsal urethra and nonfunctional anterior bladder. Conclusions Urethral duplication requires individualized surgical approaches based on the anatomical and functional characteristics. Because prognosis is variable depending on type and accompanied anomalies, these should be taken into account when planning a comprehensive workup and surgical management. Level of evidence Level IV.

Cisplatin is a well-known chemotherapy medication used to treat numerous cancers. However, treatment with cisplatin in cancer therapy has major side effects, such as nephrotoxic acute kidney injury. Adult vertebrate kidneys are commonly used as models of cisplatin-induced nephrotoxic acute kidney injury. Embryonic zebrafish kidney is more simplified and is composed simply of two nephrons and thus is an excellent model for the investigation of cisplatin nephrotoxicity. Here, we developed a novel model to induce cisplatin nephrotoxicity in adult zebrafish and demonstrated that intraperitoneal injection of cisplatin caused a decline in kidney proximal tubular function based on fluorescein-labeled dextran uptake and alkaline phosphatase staining. We also showed that cisplatin induced histological injury of the kidney tubules, quantified by tubular injury scores on the periodic acid-Schiff-stained kidney sections. As shown in a mouse model of cisplatin-induced nephrotoxicity, the activation of poly(ADP-ribose) polymerase (PARP), an enzyme implicated in cisplatin-induced cell death, was markedly increased after cisplatin injection in adult zebrafish. Furthermore, pharmacological inhibition of PARP using a specific PARP inhibitor PJ 34 hydrochloride (PJ34) or 3-aminobenzamide ameliorated kidney proximal tubular functional and histological damages in cisplatin-injected adult zebrafish kidneys. Administration of a combination of PARP inhibitors PJ34 and 3-aminobenzamide additively protected renal function and histology in zebrafish and mouse models of cisplatin nephrotoxicity. In conclusion, these data suggest that adult zebrafish are not only suitable for drug screening and genetic manipulation but also useful as a simplified but powerful model to study the pathophysiology of cisplatin nephrotoxicity and establish new therapies for treating human kidney diseases.

Among the various robotic devices that exist for urologic surgery, the most common are synergistic telemanipulator systems. Several have achieved clinical feasibility and have been licensed for use in humans: the standard da Vinci, Avatera, Hinotori, Revo-i, Senhance, Versius, and Surgenius. Handheld and hands-on synergistic systems are also clinically relevant for use in urologic surgeries, including minimally invasive and endoscopic approaches. Future trends of robotic innovation include an exploration of more robust haptic systems that offer kinesthetic and tactile feedback; miniaturization and microrobotics; enhanced visual feedback with greater magnification and higher fidelity detail; and autonomous robots.

Introduction An estimated 450,000 children were in the U.S. foster care system in 2019. Early adversity including maltreatment and/or neglect renders this vulnerable population at high risk for negative outcomes, both physical and psychological. Burgeoning evidence suggests that children in foster care develop high rates of sleep disruption. Sleep disruption is associated with negative life outcomes including heart disease, diabetes, and psychiatric disorders. However, there is still a lack of knowledge examining sleep health in children adopted from foster care. Methods Sleep quality and problems were examined among a sample of children adopted from foster care (n = 234) within the past two years, ages 4 to 11 years (M = 5.94, SD = 1.97). Caregivers across the US were invited to complete an anonymous Qualtrics survey via private Facebook groups for foster families. The Child Sleep Habits Questionnaire (CSHQ) was completed by foster parents to assess child sleep problems (e.g., nightmares, bedwetting, snoring, etc.) and overall sleep quality. Caregivers endorsed sleep problems and frequency using responses “Never,” “Sometimes,” and “Usually; sleep quality was rated using a Likert scale from 1 = Very Poor to 10 = Excellent. Results Paired-samples t-test compared first month (i.e., when first arrived in the home) and current child sleep quality based on caregiver-report. Sleep quality showed significant improvement since arrival in the foster home; t(233) = 12.98, p < .001, d = 0.85. However, on the CSHQ, 99% of the sample scored above the clinical cutoff for this measure indicating elevated sleep problems. Conclusion Children adopted from foster care show some improvement in sleep quality after achieving permanency. However, these data suggest this population continues to experience clinical levels of sleep problems even after being adopted. Our results suggest a need for specialized intervention services targeting sleep health among children recently adopted from foster care. Support (If Any) None

INTRODUCTION AND OBJECTIVE:Estimated glomerular filtration rate(eGFR) based on serum creatinine is commonly used to follow the renal function of patients after nephrectomy. Although it is well know...

An adequate minimal surgical margin for partial nephrectomy (PN) has not yet been conclusively established. Therefore, we aimed to compare PN recurrence rates according to surgical margin status and to establish an adequate minimal surgical margin.We retrospectively studied patients with clinically localized renal cell carcinoma who underwent PN between 2005 and 2014. Surgical margin width (SMW) was assessed for all surgical tissues and divided into three groups: SMW1 mm, SMW ≥1 mm, and positive surgical margin (PSM). The data were analyzed using the Kaplan-Meier method with log-rank tests and multivariate Cox regression models.Of 748 patients (median age, 55 years; interquartile range, 46-64 years; 220 female), 704 (94.2%) and 44 (5.8%) patients had negative and PSMs, respectively. Recurrence-free survival was significantly lower in patients with PSMs (A PSM after PN significantly increases the risk of recurrence. We discovered that even a submillimeter safety surgical margin may be enough to prevent recurrence. To maximize normal renal parenchyma preservation and to avoid cancer recurrence in renal parenchymal tumor patients, PN may be a safe treatment, except for those with a PSM in the final pathology.

To evaluate the microwave absorption properties of the graphene oxide (GO) sheets capsulated on carbonyl iron particles (CIP), we synthesized the GO capsulated on carbonyl iron particles (GOCIPs) by a simple wet stirring process. Complex permittivity were increased with the increment of mass ratio of GO in GOCIPs from 0.5 to 2 wt% while the complex permeability values were not changed. The maximum reflection loss (RLmax) and frequency bandwidth at −10 dB (BW@-10 dB) of the 1.9 mm thick-GOCIP composite with 2.0 wt% of GO in GOCIPs exhibited about −56.4 dB @10.8 GHz and 5.1 GHz. The RLmax frequency shifted to lower frequency with the increment of absorber thickness from 1 mm to 3 mm. BW@-10 dB decreased with the increment of absorber thickness.

Many anatomical variants on the sternocleidomastoid muscle have been reported. In this study, supernumerary clavicular heads of sternocleidomastoid muscle in a Korean female cadaver were bilaterally displayed. The observed supernumerary heads were classified as follows: one sterno-mastoid, one cleido-occipital and one cleido-mastoid on the right side, and one sterno-mastoid-occipital, four cleido-occipitals, and one cleido-mastoid on the left side. The sterno-mastoid and sterno-mastoid-occipital and the cleido-occipital made the superficial layer of the sternocleidomastoid muscle, while others made deep layer. We discussed clinical relevance and developmental basis of these muscular variations important for clinicians and anatomists.

Nanoparticle/graphene hybrid composites have been of great interest in various disciplines due to their unique synergistic physicochemical properties. In this study, we report a facile and generalized synthesis method for preparing nanoparticle/exfoliated graphene (EG) composites by tailored electrostatic interactions. EG was synthesized by an electrochemical method, which produced selectively oxidized graphene sheets at the edges and grain boundaries. These EG sheets were further conjugated with polyethyleneimine to provide positive charges at the edges. The primary organic ligands of the colloidal nanoparticles were exchanged with Cl- or MoS42- anions, generating negatively charged colloidal nanoparticles in polar solvents. By simple electrostatic interactions between the EG and nanoparticles in a solution, nanoparticles were controllably assembled at the edges of the EG. Furthermore, the generality of this process was verified for a wide range of nanoparticles, such as semiconductors, metals, and magnets, on the EG. As a model application, designed composites with size-controlled FeCo nanoparticle/EG were utilized as electromagnetic interference countermeasure materials that showed a size-dependent shift of the frequency ranges on the electromagnetic absorption properties. The current generalized process will offer great potential for the large-scale production of well-designed graphene nanocomposites for electronic and energy applications.

Lex orandi, lex credendi, lex vivendi is conventional concepts of the Christian life, but those are still relevant to solve problems of modern society. The interconnectedness of worship (lex orandi), theology (lex credendi), life (lex vivendi) is emphasized in the Christian sphere. Nevertheless, God's mission as the role of Christians was not highlighted in their relationship. The Commitment of Cape Town strongly stresses that Christians accomplishes God's mission with holistic ways in domains of gospel, world, church. In this study, the notion of lex orandi, lex credendi, lex vivendi will be explained about relationship and interaction. Then the Commitment of Cape Town will be analyzed in detail in connection with lex orandi, lex credendi, lex vivendi. The researcher uses the literature review method with answer to one question, that is ‘what is the true role of Christians in the world?’ The result of this study concluded that when Christians stand before God holistically in the notion of lex orandi, lex credendi, and lex vivendi, Christians can live by accomplishing God's mission in the church, with gospel, and into the world.

Clear cell renal cell carcinoma (ccRCC) alters metabolic signals frequently, leading to mitochondrial dysfunction, such as increase of glycolysis and accumulation of lipid. Sirtuin3 (SIRT3) is a key factor for the regulation of both mitochondrial integrity and function. SIRT3 is downregulated and contributes in both cancer development and progression in ccRCC. The aim of this study is to investigate SIRT3-regulated mitochondrial biogenesis in ccRCC. SIRT3 overexpression alone reduced glucose uptake rate and enhanced membrane potential in mitochondria. ccRCC with overexpressed SIRT3 further improved the lethal effects when combined with anticancer drugs (Resveratrol, Everolimus and Temsirolimus). Cell viability was markedly decreased in a dose-dependent manner when treated with resveratrol or mTOR inhibitors in SIRT3 overexpressing ccRCC. In conclusion, SIRT3 improved mitochondrial functions in ccRCC through metabolic reprogramming. Mitochondrial reprogramming by SIRT3 regulation improves the sensitivity to anticancer drugs. The combination of SIRT3 and resveratrol functioned synergistically lethal effect in ccRCC.

From the evolutionary myology, the additional tendon of the extensor hallucis longus (EHL) muscle represents the sample of a new acquisition. We aimed to determine whether the insertion pattern of the EHL muscle differs in Koreans according to demographic populations, especially between Jeju islanders and the Korean Peninsula inhabitants. We used 69 Korean cadavers and classified the tendinous insertion of the EHL muscle as Pattern I, Pattern II, and Pattern III. The ratio of each Pattern in adult cadaveric samples was compared between demographic populations. The proportion of Pattern I, Pattern II, and Pattern III of the EHL muscle was 30.43, 63.77, and 5.80%, respectively, further divided into 18.00 vs. 36.04%, 72.00 vs. 60.47%, 10.00 vs. 3.49% in Jeju islanders vs. peninsular Koreans. There was a considerable difference in the insertion patterns of the EHL muscle in each regional group (p = 0.032), but not in each gender, age, and body sides of lower limbs. The findings of this study indicate that there was a higher incidence of the accessory tendon(s) of the EHL muscle in Koreans and the distributed insertion patterns of the EHL muscle was significantly different between Jeju islanders and peninsular Koreans.

Background Pulmonary embolism (PE) is a known risk of lumbar spinal fusion surgery that can lead to sudden and unexpected death. Treatment often involves systemic anticoagulation when the risk of potentially fatal hemodynamic deterioration is judged to outweigh the risk of epidural hematoma and paralysis. Acute massive PE with obstruction of more than 50% of the pulmonary arterial tree causes right heart failure, hypotension, and often rapid death, and may require aggressive medical intervention with thrombolytic agents, such as alteplase, although in the postoperative period this entails an extremely high risk of bleeding and the associated potential neurologic morbidity. Case Description We report the first case, to our knowledge, of intraoperative thrombolytic therapy during spine surgery in a 68-year-old woman who developed a massive PE with cardiac arrest while undergoing lumbar instrumented fusion surgery in the prone position and detail the postoperative course that was complicated by severe bleeding. Conclusions Our experience is that chemical thrombolysis can be a lifesaving option to address pending circulatory arrest, but that severe bleeding is a likely consequence. If used to treat an intraoperative emergency, a smaller than standard dose of thrombolytic should be considered.

The microbiome has recently become a key interest for cancer research. Anti-tumor effects of reinforced clostridium media (RCM) were investigated for all ingredients of RCM, which showed that yeast extract could be a candidate for this phenomenon. MTT assay, cell counting, cell death analysis, cell cycle analysis, and Western blotting were done on colorectal cancer cells with or without 5-fluorouracil resistance (SNU-C5 and SNU-C5/5-FUR). Yeast extract treatment showed dose- and time-dependent anti-tumor effects on SNU-C5 and SNU-C5/5-FUR. Anti-tumor effects were related to G0/G1 phase arrest with increased p21, reactive oxygen species scavenger activities, and decreased free iron. Yeast extract treatment significantly increased apoptosis, which was effectively blocked with the PARP inhibitor. Anti-tumor effects of yeast extract were correlated with the increased phosphorylation of p38 and p53. These results suggest that yeast extract might inhibit the proliferation of colorectal cancer cells via the activation of the p38-p53-p21 cascade.

Purpose To analyze the difference in the prediction accuracy with an active surveillance (AS) protocol between two eras (pre-International Society of Urological Pathology [pre-ISUP]-2014 vs. post-ISUP2014). Materials and Methods We retrospectively analyzed 118 candidates for AS who underwent radical prostatectomy between 2009 and 2017. We divided our patients into two groups (group 1 [n=57], operation date 2009–2015; group 2 [n=61], operation date 2016–2017). Pathologic slides in group 1 were reviewed to distinguish men with cribriform pattern (CP) because the determination of Gleason scores in old era had been based on pre-ISUP2014 classification. Postoperative outcomes in the two eras were analyzed twice: first, all men in group 1 vs. group 2; second, the remaining men after excluding those with CPs in group 1 vs. group 2. Results The proportion of men with insignificant prostate cancer (iPCa) was significantly lower in group 1 than in group 2 (36.8% vs. 57.4%, p=0.040). After excluding 11 men with CPs from group 1, those remaining (46 men) were compared again with group 2. In this analysis, the proportion of men with iPCa was similar between the two groups (old vs. contemporary era: 41.3% vs. 57.4%, p=0.146). Nine of 11 men with CP had violated the criteria for iPCa in the earlier comparison. Conclusions The accuracy of the AS protocol has been affected by the coexistence of CPs and pure Gleason 6 tumors in the pre-ISUP2014 era. We suggest to use only contemporary (post-ISUP2014) data to analyze the accuracy with AS protocols in future studies.

Duplex system is the most common upper urinary tract anomaly in childhood. The purpose of our study was to investigate the incidence, characteristics, and progression of lower pole hydronephrosis in children with duplex system who underwent transurethral incision (TUI) of upper pole ureterocele.Among children who underwent transurethral incision of ureteroceles between 2006 and 2018, 69 renal units with duplex systems were included after exclusion of preoperative lower pole vesicoureteral reflux and follow up loss. We retrospectively analyzed the postoperative progression of lower pole hydronephrosis and compared patient characteristics between two groups according to the presence of lower pole hydronephrosis.The median age at operation and follow-up duration were 3.0 months (range 0-242 months) and 59 months, respectively. The median size of ureteroceles preoperatively was 14.5 mm. Thirty-five renal units (50.7%) demonstrated preoperative lower pole hydronephrosis of any grade (grade I in 13 [37.1%], II in 6 [17.1%], III in 10 [28.7%], and IV in 6 [17.1%]). In majority of cases, lower pole hydronephrosis drastically improved after transurethral incision, and 28 renal units (80%) demonstrated improvement of lower pole hydronephrosis to grade 0 or I. The preoperative diameter of upper pole ureter was significantly increased with lower pole hydronephrosis than without (11.30 ± 4.19 vs. 7.02 ± 4.94 mm, p 0.01). Postoperative vesicoureteral reflux on upper pole was found in 16 (23%), five (7%) in lower pole. Eleven patients developed complications after TUI which required secondary surgeries. The differential renal function of affected renal units was decreased after TUI in group with preoperative lower pole hydronephrosis (46.77 ± 8.21 to 44.24 ± 8.55, p = 0.003), while it was maintained without significant difference in group without lower pole hydronephrosis (47.90 ± 6.39 to 46.24 ± 8.90, p = 0.091).Lower pole hydronephrosis was found in a considerable number of renal units (50.7%), and the occurrence was related with the diameter of upper pole ureter. Most of renal units demonstrated significant improvement of lower pole hydronephrosis after transurethral incision of ureterocele. Given that differential renal function may be decreased even after improvement of hydronephrosis with TUI, a more careful monitoring on renal function is required in patients with hydronephrosis on lower pole.

Recent motion recognition devices are widely used as inputs to analyze the interaction with motion and sports and entertainment content. However, the performance and efficiency of the conventional motion recognition apparatus are degraded despite the good quality information using a plurality of cameras and sensors. In this paper, we propose an algorithm that can be used as input means for posture analysis, posture supplementation, and interaction with contents in sport and entertainment by overcoming limitations of conventional motion recognition devices and using specific posture similarity judgment.

The purpose of this study was to develop a golf swing recognition system using forty pressure sensors embedded insoles and a smartphone. This system detects golf swing event using pressure data from a pair of insoles and recorded sound level. And mobile application provides the center of pressure trajectory overlaid at swing events. Users can record the pressure data and observe center of pressure trajectory of their golf swing easily with this system. In the future, this system could be a new golf swing analysis system in the field.

Ethnopharmacological relevance Orostachys japonica A. Berger, also known as Wa-song in Korea, has traditionally been used as a folk medicine, but the potential anti-cancer effects of aqueous extract of Orostachys japonica (OJe) have not yet been thoroughly investigated. Aim of the study To evaluate the anti-cancer effects of OJe, its possible mechanisms of action were investigated in 5-fluorouracil (5-FU) resistant SNU-C5/5-FUR colorectal cancer cells. Materials and methods The functional compounds of OJe were identified with high performance liquid chromatography. The anti-cancer effects of OJe in SNU-C5/5-FUR cells were investigated by a cell viability assays, flow cytometry analysis, and a subcutaneous xenograft model employing BALB/c-nude mice. Possible signalling pathways were assayed with Western blotting. Results OJe (250 μg/ml) showed anti-cancer effects in SNU-C5/5-FUR cells, that were mediated via apoptosis as well as cell cycle arrest at the G0/G1 phase. Gallic acid and (−)-epicatechin, the major functional components of OJe, induced cell cycle arrest. OJe treatment (250 mg/kg, p.o.) produced a significant anti-proliferative effect in the xenograft model via decreased β-catenin/GSK3β and increased p27 expression. OJe treatment significantly activated ERK and p38 both in vitro and in vivo. Conclusions These results suggest that OJe has anti-proliferative effects on 5-FU-resistant colorectal cancer cells via regulation of MAPK signalling pathways.

FeCoNi-coated glass fibers were synthesized using the electroless plating method, and the hyperthermic effects of FeCoNi-coated glass fibers in alternating magnetic fields were evaluated. The thickness of the coated FeCoNi was approximately $1.1~\mu \text{m}$ on glass fibers with a diameter of approximately 15– $17~\mu \text{m}$ . The saturation magnetization was approximately 150 emu/g. The heat elevations of FeCoNi-coated glass fibers were measured with the increasing number of fibers (4, 8, 12, 16, and 20 pieces of fibers) in silicon oil under an alternating magnetic field (AMF) at different intensities and frequencies. The elevated equilibrium temperatures linearly increased from 34.3 °C to 55.9 °C with an increasing number of FeCoNi-coated glass fibers from 4 to 20 pieces under an AMF of 105 Oe and 250 kHz. The specific loss power (SLP) was approximately 30 W/g. The heat behavior was examined as a function of the AMF and frequency. The AMF intensity was changed 60, 75, 90, and 105 Oe at 250 kHz, and the AMF frequency was changed 169, 213, 250, and 291 kHz at 105 Oe. The elevated equilibrium temperatures of 20 pieces of fibers increased from 46.8 °C to 56 °C and 46.7 °C to 61 °C with the increasing AMF intensity and frequency, respectively. The SLP also increased from 12.8 to 36.5 W/g.

Introduction A strong association between sleep disturbances and externalizing symptoms has been found among school-aged children. In particular, there is a known association between sleep disturbances, irritability, emotional dysregulation, and hyperactivity (e.g., Coto et al., 2018). Limited research, however, has examined this association in a high-risk population of children, such as those in foster care who are at increased risk for sleep disturbances due to heightened exposure to trauma. Thus, the following study sought to assess the association between sleep quality and externalizing symptoms in a population of children in foster care. Methods Caregivers with children ages 4–11 were sampled from private Facebook community foster care groups across the United States (n = 410). Caregivers were provided a link to a survey powered by Qualtrics where they were asked to report on the children under their care’s weekday bedtime, overall sleep quality (e.g., “Please rate your child’s overall sleep quality over the last two weeks”), and sleep onset (e.g. “On weekdays, how long does it usually take for your child to fall asleep?”). Child behavioral issues were assessed via the Eyberg Child Behavior Inventory (ECBI) Parent Rating Form. Results A linear regression model was utilized to assess if child weekday bedtime, weekday total sleep duration, and overall sleep quality were unique predictors of externalizing symptoms when controlling for age. Results suggest that weekday sleep duration and bedtime were not significant unique predictors of child behavioral issues, though were significantly and positively correlated at the bivariate level (p=.02, p=.04). Sleep onset and overall sleep quality, irrespective of child age, were found to be significant unique predictors of child behavioral issues and accounted for 1% and 11% of the total variance, respectively. Conclusion Results suggest that delayed sleep onset and poorer sleep quality were predictive of increased behavioral issues for children in foster care. Findings persisted when controlling for age, which suggests that children in foster care experiencing sleep disturbances may benefit from more behaviorally focused sleep interventions to improve externalizing behaviors and increase sleep health. Support (if any)

Introduction Electronic media (EM) use has long been associated with poor sleep in children. Children’s use of EM may also be related to emotional distress – anxiety being one of the more prevalent issues, which has been tied to sleep-related problems as well (e.g., Fors & Barch, 2019; Alfano et al., 2007). Children in foster care have often been victims of trauma, which can lead to significant emotional and sleep difficulties (e.g., Kovachy et al., 2013). The Fostering Sleep study examined the association between EM use and sleep among children in foster care; and the additional influence of anxiety. Methods Participants were caregivers of foster care children recruited from private Facebook foster care support groups across the United States. The study used a cross-sectional design examining sleep patterns and behaviors, EM use and mental health among children in foster care. An online survey, hosted by Qualtrics, was distributed to caregivers via Facebook. The data of 443 foster care children between the ages of four and 11 (M=6.37, SD=2.21) were included in the analyses. Results Children in foster care using EM at bedtime go to bed later than those who are not (p Conclusion This preliminary analysis indicates the prevalence of EM use close to bedtime may not necessarily be detrimental to sleep for this population; perhaps activities such as watching one’s favorite programming or talking to a loved one online can be comforting and therefore helpful to sleep onset (Eggermont & Van den Bulck, 2006). However, examination of other factors such as type of technology, content of media, and duration of use is warranted. Moreover, children with anxiety as a primary diagnosis may be using less EM at bedtime because EM use may trigger symptoms of anxiety (i.e., Fors & Barch, 2019). Support (if any)

Introduction Sleep during childhood has a major impact on physiological, psychological, and cognitive development. Limited research has focused on vulnerable populations such as children in foster care. Foster care children endure placement instability, which may contribute to disrupted sleep patterns and unpredictability around bedtime (Leathers, et al., 2019). The Fostering Sleep study examined foster caregivers’ perceptions of children’s sleep challenges and strategies for improving sleep difficulties. Methods Foster caregivers of children ages 4–11 throughout the US were invited to complete the Qualtrics Sleep Health among Children in Foster Care Survey via foster care Facebook groups. The survey included quantitative and qualitative questions focused on sleep patterns and behaviors. Qualitative questions on barriers and opportunities to improve sleep were examined: what helps foster care children sleep well; what kinds of difficulties do foster care children experience at bedtime? Results 483 foster care parents responded. Responses to bedtime difficulties were coded using 27 categories (e.g., parasomnias, bedtime resistance, trouble self-soothing); responses to what helps your child sleep well were coded based on 22 categories (e.g., comfort items, melatonin, TV as in intervention, communication to reassure safety). The most prevalent sleep/bedtime difficulties were fear/anxiety (23.2%), nightmares (19.6%), environment (18.4%). For example, one parent responded: “He fears never waking up. He fears that the sun is not going to come back up. He fears that the bad guys will come get him.” Difficulties varied by age-- 4–5: fear/anxiety, destabilization from call/visit biological parent, nightmares; 6–9: nightmares, fear/anxiety, environment; 10–11: fear/anxiety, nightmares, emotional/behavioral difficulties. Most frequent parenting approaches were bedtime routine (63.0%), reading before bedtime (36.5%), physical reassurance (26.6%). Interventions also varied according to age-- 4–5: routine, reading, physical reassurance; 6–9: routine, reading, noise control; 10–11: routine, technology regulation, reading. Conclusion Foster caregivers reported fear/anxiety as most common bedtime difficulty and physical reassurance as most frequent parenting strategy for healthy sleep. Findings suggest that anxiety and fear often interfere with sleep and, in turn, physical reassurance as a helpful bedtime strategy. Undoubtedly, there is a need for sleep research and preventive interventions for children in foster care. Support (if any) Summer Student Research Support, Loyola University Maryland, College of Arts and Sciences

Mitochondrial NADP+-dependent isocitrate dehydrogenase (IDH2) catalyzes the oxidative decarboxylation of isocitrate to α-ketoglutarate, synthesizing NADPH, which is essential for mitochondrial redox balance. Ischemia-reperfusion (I/R) is one of most common causes of AKI. I/R disrupts the mitochondrial redox balance, resulting in oxidative damage to mitochondria and cells. Here, we investigated the role of IDH2 in I/R-induced AKI. I/R injury in mice led to the inactivation of IDH2 in kidney tubule cells. Idh2 gene deletion exacerbated the I/R-induced increase in plasma creatinine and BUN levels and the histologic evidence of tubule injury, and augmented the reduction of NADPH levels and the increase in oxidative stress observed in the kidney after I/R. Furthermore, Idh2 gene deletion exacerbated I/R-induced mitochondrial dysfunction and morphologic fragmentation, resulting in severe apoptosis in kidney tubule cells. In cultured mouse kidney proximal tubule cells, Idh2 gene downregulation enhanced the mitochondrial damage and apoptosis induced by treatment with hydrogen peroxide. This study demonstrates that Idh2 gene deletion exacerbates mitochondrial damage and tubular cell death via increased oxidative stress, suggesting that IDH2 is an important mitochondrial antioxidant enzyme that protects cells from I/R insult.

The microbiome has recently attracted research interest in a variety of subjects, including cancer. In the present study, it was determined that reinforced clostridium media (RCM) for microbiome culture, exerts antitumor effects on renal cell carcinoma cells when compared to the microbiome 'X'. The antitumor effects of RCM were investigated for all ingredients of RCM, and the results revealed that yeast extract could be a candidate for the ingredient driving this phenomenon. Further experiments including MTT assay, cell counting, cell death analysis, cell cycle analysis and western blotting were conducted with yeast extract on renal cell carcinoma cells (Caki‑1 and Caki‑2) and normal human proximal tubular cells (HK‑2). As a result, yeast extract exhibited dose‑dependent antitumor effects on Caki‑1 and Caki‑2, but only slight effects on HK‑2. In addition, yeast extract only exhibited slight effects on necrosis, autophagy, or apoptosis of Caki‑1 and Caki‑2. Yeast extract produced cell cycle arrest with an increased G0/G1 fraction and a decreased S fraction, and this was considered to be related to the decreased cyclin D1. Although yeast extract treatment increased anti‑oxidant activities, the antitumor effects of yeast extract were also related to iron metabolism, based on the decreased transferrin receptor and increased ferritin. In addition, decreased GPX4 may be related to iron‑dependent cell death, particularly in Caki‑2. These results revealed that yeast extract may inhibit proliferation of renal cell carcinoma cells by regulating iron metabolism. Since an increased iron requirement is a classic phenomenon of cancer cells, yeast extract may be a candidate for adjuvant treatment of renal cell carcinoma.

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The jugulocephalic anastomosis is a rare anatomical variant which normally undergoes atrophy during embryonic development. We found 2 cases of the jugulocephalic vein variant with supraclavicular course in Korean male cadavers. In a 50-year-old cadaver, the right cephalic vein ascended anterior to the clavicle, and terminated into the external jugular vein as well as to the axillary vein through a classic branch. In a 76-year-old cadaver, the left cephalic vein ascended supraclavicular course without any branch to the axillary vein, and terminated to the external jugular vein. We discussed the embryological explanation as well as its frequency since this jugulocephalic vein variant could cause unpredicted danger during clinical procedures.