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Reversal learning measures the ability to form flexible associations between choice outcomes with stimuli and actions that precede them. This type of learning is thought to rely on several cortical and subcortical areas, including the highly interconnected orbitofrontal cortex (OFC) and basolateral amygdala (BLA), and is often impaired in various neuropsychiatric and substance use disorders. However, the unique contributions of these regions to stimulus- and action-based reversal learning have not been systematically compared using a chemogenetic approach particularly before and after the first reversal that introduces new uncertainty. Here, we examined the roles of ventrolateral OFC (vlOFC) and BLA during reversal learning. Male and female rats were prepared with inhibitory designer receptors exclusively activated by designer drugs targeting projection neurons in these regions and tested on a series of deterministic and probabilistic reversals during which they learned about stimulus identity or side (left or right) associated with different reward probabilities. Using a counterbalanced within-subject design, we inhibited these regions prior to reversal sessions. We assessed initial and pre-/post-reversal changes in performance to measure learning and adjustments to reversals, respectively. We found that inhibition of the ventrolateral orbitofrontal cortex (vlOFC), but not BLA, eliminated adjustments to stimulus-based reversals. Inhibition of BLA, but not vlOFC, selectively impaired action-based probabilistic reversal learning, leaving deterministic reversal learning intact. vlOFC exhibited a sex-dependent role in early adjustment to action-based reversals, but not in overall learning. These results reveal dissociable roles for BLA and vlOFC in flexible learning and highlight a more crucial role for BLA in learning meaningful changes in the reward environment.

Hyun Jung Lee,1 Ji Seon Chae,2 Sang-Mee An,2 Hye-Won Oh,1 Youn Jin Kim,1 Jae Hee Woo1 1Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea; 2Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, South KoreaCorrespondence: Jae Hee Woo, Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, 260 Gonghangdaero, Gangseo-gu, Seoul, 07804, South Korea, Tel +82-2-6986-4300, Fax +82-2-6986-4960, Email jheewoo@ewha.ac.krPurpose: Monitoring end-tidal carbon dioxide partial pressure (PETCO2) is a noninvasive, continuous method, but its accuracy is reduced by prolonged capnoperitoneum and the steep Trendelenburg position in robot-assisted radical prostatectomy (RARP). Transcutaneous carbon dioxide partial pressure (PTCCO2) monitoring, which is not affected by ventilator–perfusion mismatch, has been suggested as a suitable alternative. We compared the agreement of noninvasive measurements with the arterial carbon dioxide partial pressure (PaCO2) over a long period of capnoperitoneum, and investigated its sensitivity and predictive power for detecting hypercapnia.Patients and Methods: The patients who underwent RARP were enrolled in this study prospectively. Intraoperative measurements of PETCO2, PTCCO2, and PaCO2 were analyzed. The primary outcome was the agreement of noninvasive monitoring with PaCO2 during prolonged capnoperitoneum. Bias and precision between noninvasive measurements and PaCO2 were assessed using Bland–Altman analysis. The bias and mean absolute difference were compared using a two-tailed Wilcoxon signed-rank test for pairs. The secondary outcome was the sensitivity and predictive power for detecting hypercapnia. To assess this, the Yates corrected chi-square test and the area under the receiver operating characteristic curve were used.Results: The study analyzed 219 datasets from 46 patients. Compared with PETCO2, PTCCO2 had lower bias, greater precision, and better agreement with PaCO2 throughout the RARP. The mean absolute difference in PETCO2 and PaCO2 was larger than that of PTCCO2 and PaCO2, and continued to exceed the clinically acceptable range of 5 mmHg after 1 hour of capnoperitoneum. The sensitivity during capnoperitoneum and overall predictive power of PTCCO2 for detecting hypercapnia were significantly higher than those of PETCO2, suggesting a greater contribution to ventilator adjustment, to treat hypercapnia.Conclusion: PTCCO2 monitoring measured PaCO2 more accurately than PETCO2 monitoring during RARP requiring prolonged capnoperitoneum and a steep Trendelenburg position. PTCCO2 monitoring also provides more sensitive measurements for ventilator adjustment and detects hypercapnia more effectively than PETCO2 monitoring.Keywords: intraoperative carbon dioxide monitoring, capnoperitoneum, robotic surgery, end-tidal carbon dioxide monitoring, general anesthesia

We present models of the Hβ-emitting broad-line region (BLR) in seven Seyfert 1 galaxies from the Lick AGN Monitoring Project 2011 sample, drawing inferences on the BLR structure and dynamics as well as the mass of the central supermassive black hole. We find that the BLR is generally a thick disk, viewed close to face-on, with preferential emission back toward the ionizing source. The dynamics in our sample range from near-circular elliptical orbits to inflowing or outflowing trajectories. We measure black hole masses of for PG 1310-108, for Mrk 50, for Mrk 141, for Mrk 279, for Mrk 1511, for NGC 4593, and for Zw 229-015. We use these black hole mass measurements along with cross-correlation time lags and line widths to recover the scale factor f used in traditional reverberation mapping measurements. Combining our results with other studies that use this modeling technique, which brings our sample size to 16, we calculate a scale factor that can be used for measuring black hole masses in other reverberation mapping campaigns. When using the root-mean-square (rms) spectrum and using the line dispersion to measure the line width, we find pred = 0.57 0.19. Finally, we search for correlations between f and other AGN and BLR parameters and find marginal evidence that f is correlated with M BH and the BLR inclination angle, but no significant evidence of a correlation with the AGN luminosity or Eddington ratio.

© Author(s) 2018. Accurate and consistent monitoring of anthropogenic combustion is imperative because of its significant health and environmental impacts, especially at city-to-regional scale. Here, we assess the performance of the Copernicus Atmosphere Monitoring Service (CAMS) global prediction system using measurements from aircraft, ground sites, and ships during the Korea-United States Air Quality (KORUS-AQ) field study in May to June 2016. Our evaluation focuses on CAMS CO and CO2 analyses as well as two higher-resolution forecasts (16 and 9km horizontal resolution) to assess their capability in predicting combustion signatures over east Asia. Our results show a slight overestimation of CAMS CO2 with a mean bias against airborne CO2 measurements of 2.2, 0.7, and 0.3ppmv for 16 and 9km CO2 forecasts, and analyses, respectively. The positive CO2 mean bias in the 16km forecast appears to be consistent across the vertical profile of the measurements. In contrast, we find a moderate underestimation of CAMS CO with an overall bias against airborne CO measurements of -19.2 (16km), -16.7 (9km), and -20.7ppbv (analysis). This negative CO mean bias is mostly seen below 750hPa for all three forecast/analysis configurations. Despite these biases, CAMS shows a remarkable agreement with observed enhancement ratios of CO with CO2 over the Seoul metropolitan area and over the West (Yellow) Sea, where east Asian outflows were sampled during the study period. More efficient combustion is observed over Seoul (dCO dCO2 Combining double low line 9ppbvppmv-1) compared to the West Sea (dCO dCO2 Combining double low line 28ppbvppmv-1). This "combustion signature contrast" is consistent with previous studies in these two regions. CAMS captured this difference in enhancement ratios (Seoul: 8-12ppbvppmv-1, the West Sea: ∼ 30ppbvppmv-1) regardless of forecast/analysis configurations. The correlation of CAMS CO bias with CO2 bias is relatively high over these two regions (Seoul: 0.64-0.90, the West Sea: ∼ 0.80) suggesting that the contrast captured by CAMS may be dominated by anthropogenic emission ratios used in CAMS. However, CAMS shows poorer performance in terms of capturing local-to-urban CO and CO2 variability. Along with measurements at ground sites over the Korean Peninsula, CAMS produces too high CO and CO2 concentrations at the surface with steeper vertical gradients (∼ 0.4ppmvhPa-1 for CO2 and 3.5ppbvhPa-1 for CO) in the morning samples than observed (∼ 0.25ppmvhPa-1 for CO2 and 1.7ppbvhPa-1 for CO), suggesting weaker boundary layer mixing in the model. Lastly, we find that the combination of CO analyses (i.e., improved initial condition) and use of finer resolution (9km vs. 16km) generally produces better forecasts.

The Seyfert 1 galaxy Arp 151 was monitored as part of three reverberation mapping campaigns spanning 2008-2015. We present modeling of these velocity-resolved reverberation mapping data sets using a geometric and dynamical model for the broad-line region (BLR). By modeling each of the three data sets independently, we infer the evolution of the BLR structure in Arp 151 over a total of 7 yr and constrain the systematic uncertainties in nonvarying parameters such as the black hole mass. We find that the BLR geometry of a thick disk viewed close to face-on is stable over this time, although the size of the BLR grows by a factor of ∼2. The dynamics of the BLR are dominated by inflow, and the inferred black hole mass is consistent for the three data sets, despite the increase in BLR size. Combining the inference for the three data sets yields a black hole mass and statistical uncertainty of log10(/) = with a standard deviation in individual measurements of 0.13 dex.

We provide an updated calibration of C iv broad emission line-based single-epoch (SE) black hole (BH) mass estimators for active galactic nuclei (AGNs) using new data for six reverberation-mapped AGNs at redshift with BH masses (bolometric luminosities) in the range106.5-107.5 M⊙(1041.7-1043.8 erg s-1). New rest-frame UV-to-optical spectra covering 1150-5700 Å for the six AGNs were obtained with the Hubble Space Telescope (HST). Multicomponent spectral decompositions of the HST spectra were used to measure SE emission-line widths for the C iv, Mg ii, and Hβ lines, as well as continuum luminosities in the spectral region around each line. We combine the new data with similar measurements for a previous archival sample of 25 AGNs to derive the most consistent and accurate calibrations of the C iv-based SE BH mass estimators against the Hβ reverberation-based masses, using three different measures of broad-line width: full width at half maximum (FWHM), line dispersion (σline), and mean absolute deviation (MAD). The newly expanded sample at redshift z = 0.005-0.234 covers a dynamic range in BH mass (bolometric luminosity) of log MBH M⊙ = 6.5-9.1(log Lbol/erg s-1 = 41.7-46.9), and we derive the new C iv-based mass estimators using a Bayesian linear regression analysis over this range. We generally recommend the use of or MAD rather than FWHM to obtain a less biased velocity measurement of the C iv emission line, because its narrow-line component contribution is difficult to decompose from the broad-line profile.

We conduct a multiwavelength continuum variability study of the Seyfert 1 galaxy NGC 5548 to investigate the temperature structure of its accretion disk. The 19 overlapping continuum light curves (1158 A oto 9157 A o) combine simultaneous Hubble Space Telescope, Swift, and ground-based observations over a 180 day period from 2014 January to July. Light-curve variability is interpreted as the reverberation response of the accretion disk to irradiation by a central time-varying point source. Our model yields the disk inclination i = 36° ±10° temperature T1 = 44 ±6 ) × 10 3 K at 1 light day from the black hole, and a temperatureradius slope (T ∞r-a) of a = 0.99 ±0.03. We also infer the driving light curve and find that it correlates poorly with both the hard and soft X-ray light curves, suggesting that the X-rays alone may not drive the ultraviolet and optical variability over the observing period. We also decompose the light curves into bright, faint, and mean accretion-disk spectra. These spectra lie below that expected for a standard blackbody accretion disk accreting at L LEdd = 0.1.

Hyun Jung Lee,1 Jae Hee Woo,2 Sooyoung Cho,3 Hye-Won Oh,1 Hyunyoung Joo,3 Hee Jung Baik2 1Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea; 2Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea; 3Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul, South KoreaCorrespondence: Hee Jung BaikDepartment of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul 07804, Republic of KoreaTel +82-2-2650-2868Fax +82-2-2655-2924Email baikhj@ewha.ac.krPurpose: In pediatric patients, the most common reason for delaying surgical intervention is an upper respiratory tract infection (URI). To date, there has been no consensus regarding the optimal timeframe for deferring surgery in children with URI. We conducted this study to evaluate whether a URI symptom-free period and other risk factors affect the incidence of perioperative respiratory adverse events (RAEs).Patients and Methods: The study population included 267 pediatric patients (aged 0 to 13 years) with a recent URI episode who underwent surgery under general anesthesia. Following a retrospective review of medical records, several risk factors including a URI symptom-free period for intra- and postoperative RAEs were analyzed using univariate and multivariate logistic regression analyses.Results: RAEs occurred in 23 of 267 patients (8.6%). Univariate analysis revealed that abnormal preoperative chest images (odds ratio [OR], 7.48; 95% confidence interval [CI], 2.46– 22.68, p < 0.001) and emergency operations (OR, 2.84; 95% CI, 1.03– 7.81, p = 0.04) were associated with RAEs. Four variables (abnormal preoperative chest images, emergency operations, age under 1 year and symptom-free period of 7– 13 days) with a significance of < 0.20 in the univariate logistic regression analysis were selected as candidate risk factors for the multivariate model. Among the four variables, abnormalities in preoperative chest images (OR, 7.60; 95% CI, 2.28– 25.3, p = 0.001) and a symptom-free period of 7– 13 days (OR, 0.13; 95% CI, 0.02– 0.88, p = 0.04) were independently associated with RAEs in multivariate logistic regression analysis.Conclusion: For pediatric patients who require surgery and have a recent history of URI, procedures should be performed after a URI symptom-free period of at least 1– 2 weeks. Confirming the absence of abnormalities in preoperative chest images can reduce the incidence of perioperative RAEs.Keywords: pediatric, general anesthesia, upper respiratory tract infection, respiratory adverse event

During an intensive Hubble Space Telescope (HST) Cosmic Origins Spectrograph (COS) UV monitoring campaign of the Seyfert 1 galaxy NGC 5548 performed from 2014 February to July, the normally highly correlated far UV continuum and broad emission line variations decorrelated for ∼60-70 days, starting ∼75 days after the first HST/COS observation. Following this anomalous state, the flux and variability of the broad emission lines returned to a more normal state. This transient behavior, characterized by significant deficits in flux and equivalent width of the strong broad UV emission lines, is the first of its kind to be unambiguously identified in an active galactic nucleus reverberation mapping campaign. The largest corresponding emission line flux deficits occurred for the high ionization, collisionally excited lines C iv and Si iv(+O iv]), and also He ii(+O iii]), while the anomaly in Lywas substantially smaller. This pattern of behavior indicates a depletion in the flux of photons with relative to those near 13.6 eV. We suggest two plausible mechanisms for the observed behavior: (i) temporary obscuration of the ionizing continuum incident upon broad line region (BLR) clouds by a moving veil of material lying between the inner accretion disk and inner (BLR), perhaps resulting from an episodic ejection of material from the disk, or (ii) a temporary change in the intrinsic ionizing continuum spectral energy distribution resulting in a deficit of ionizing photons with energies >54 eV, possibly due to a transient restructuring of the Comptonizing atmosphere above the disk. Current evidence appears to favor the latter explanation.

We present ground-based optical photometric monitoring data for NGC 5548, part of an extended multiwavelength reverberation mapping campaign. The light curves have nearly daily cadence from 2014 January to July in nine filters (BVRI and ugriz). Combined with ultraviolet data from the Hubble Space Telescope and Swift, we confirm significant time delays between the continuum bands as a function of wavelength, extending the wavelength coverage from 1158 Å to the z band (∼9160 Å). We find that the lags at wavelengths longer than the V band are equal to or greater than the lags of high-ionization-state emission lines (such as He ii and λ1640 and λ4686), suggesting that the continuum-emitting source is of a physical size comparable to the inner broad-line region (BLR). The trend of lag with wavelength is broadly consistent with the prediction for continuum reprocessing by an accretion disk with τ ∝ λ 4 . However, the lags also imply a disk radius that is 3 times larger than the prediction from standard thin-disk theory, assuming that the bolometric luminosity is 10% of the Eddington luminosity (L = 0.1 L Edd ). Using optical spectra from the Large Binocular Telescope, we estimate the bias of the interband continuum lags due to BLR emission observed in the filters. We find that the bias for filters with high levels of BLR contamination (∼20%) can be important for the shortest continuum lags and likely has a significant impact on the u and U bands owing to Balmer continuum emission.

We create a baseline of the black hole (BH) mass (MBH).stellar-velocity dispersion () relation for active galaxies, using a sample of 66 local (0.02 < z < 0.09) Seyfert-1 galaxies, selected from the Sloan Digital Sky Survey (SDSS). Analysis of SDSS images yields AGN luminosities free of host-galaxy contamination, and morphological classification. 51/66 galaxies have spiral morphology. Out of these, 28 bulges have Sersic index n < 2 and are considered candidate pseudo-bulges, with eight being definite pseudo-bulges based on multiple classification criteria met. Only 4/66 galaxies show signs of interaction/merging. High signal-to-noise ratio Keck spectra provide the width of the broad Hβ emission line free of Fe II emission and stellar absorption. AGN luminosity and Hβ line widths are used to estimate MBH. The Keck-based spatially resolved kinematics is used to determine stellar-velocity dispersion within the spheroid effective radius (σspat,reff). We find that σ can vary on average by up to 40% across definitions commonly used in the literature, emphasizing the importance of using selfconsistent definitions in comparisons and evolutionary studies. The MBH-σ relation for our Seyfert-1 galaxy sample has the same intercept and scatter as that of reverberation-mapped AGNs as well as that of quiescent galaxies, consistent with the hypothesis that our single epoch MBH estimator and sample selection function do not introduce significant biases. Barred galaxies, merging galaxies, and those hosting pseudo-bulges do not represent outliers in the MBH-σ relation. This is in contrast with previous work, although no firm conclusion can be drawn on this matter due to the small sample size and limited resolution of the SDSS images.

In the Spring of 2011 we carried out a 2.5 month reverberation mapping campaign using the 3 m Shane telescope at Lick Observatory, monitoring 15 low-redshift Seyfert 1 galaxies. This paper describes the observations, reductions and measurements, and data products from the spectroscopic campaign. The reduced spectra were fitted with a multicomponent model in order to isolate the contributions of various continuum and emission-line components. We present light curves of broad emission lines and the active galactic nucleus (AGN) continuum, and measurements of the broad Hβ line widths in mean and rms spectra. For the most highly variable AGNs we also measured broad Hβ line widths and velocity centroids from the nightly spectra. In four AGNs exhibiting the highest variability amplitudes, we detect anticorrelations between broad Hβ width and luminosity, demonstrating that the broad-line region "breathes" on short timescales of days to weeks in response to continuum variations. We also find that broad Hβ velocity centroids can undergo substantial changes in response to continuum variations; in NGC 4593, the broad Hβ velocity shifted by ∼250 km s-1 over a 1 month period. This reverberation-induced velocity shift effect is likely to contribute a significant source of confusion noise to binary black hole searches that use multi-epoch quasar spectroscopy to detect binary orbital motion. We also present results from simulations that examine biases that can occur in measurement of broad-line widths from rms spectra due to the contributions of continuum variations and photon-counting noise.

We investigate the cosmic evolution of the black hole (BH) mass-bulge luminosity relation using a sample of 52 active galaxies at z ∼ 0.36 and z ∼ 0.57 in the BH mass range of 107.4-109.1 M o. By consistently applying multicomponent spectral and structural decomposition to high-quality Keck spectra and high-resolution Hubble Space Telescope images, BH masses (M oBH) are estimated using the Hβ broad emission line combined with the 5100 Å nuclear luminosity, and bulge luminosities (L bul) are derived from surface photometry. Comparing the resulting M oBH-L bul relation to local active galaxies and taking into account selection effects, we find evolution of the form M oBH-L bul(1 + z)γ with γ = 1.8 ± 0.7, consistent with BH growth preceding that of the host galaxies. Including an additional sample of 27 active galaxies with 0.5 < z < 1.9 taken from the literature and measured in a consistent way, we obtain γ = 0.9 ± 0.7 for the M oBH-L bul relation and γ = 0.4 ± 0.5 for the M oBH-total host galaxy luminosity (L host) relation. The results strengthen the findings from our previous studies and provide additional evidence for host galaxy bulge growth being dominated by disk-to-bulge transformation via minor mergers and/or disk instabilities.

Shukho Kim,1 Jung Hwa Woo,1 Nayeong Kim,1 Mi Hyun Kim,1 Se Yeon Kim,1 Joo Hee Son,1 Dong Chan Moon,2 Suk-Kyung Lim,2 Minsang Shin,1 Je Chul Lee1 1Department of Microbiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; 2Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon-si, Gyeongsangbuk-do, Republic of KoreaCorrespondence: Je Chul LeeDepartment of Microbiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of KoreaTel +82-53-420-4844Fax +82-53-427-5664Email leejc@knu.ac.krPurpose: Colistin resistance in gram-negative bacteria from humans and livestock has been increasingly reported worldwide. The aim of this study was to investigate the underlying mechanisms of chromosome-mediated colistin resistance in Escherichia coli isolates from livestock in Korea.Materials and methods: Thirty mcr-1-negative isolates were selected from a collection of colistin-resistant E. coli isolates collected from livestock in 2005 and 2015 in Korea. Amino acid alterations in PmrAB, PhoPQ, MgrB, and PmrD were investigated. Colistin-resistant derivatives were produced by serial passage of colistin-susceptible E. coli isolates in colistin-containing media.Results: Thirty colistin-resistant mcr-negative E. coli isolates were classified into 26 sequence types. Twenty-two isolates carried diverse amino acid alterations in PmrB, PhoP, PhoQ, MgrB, and/or PmrD, whereas no mutation in any of these genes was found in the remaining eight isolates. Sixteen out of the 22 isolates shared a total of nine polymorphic positions that were found in colistin-susceptible E. coli strains. Colistin-resistant derivatives from two colistin-susceptible isolates showed the same genetic alterations that were observed in colistin-resistant clinical isolates.Conclusion: Our results suggest that the mechanism underlying chromosome-mediated colistin resistance remain to be discovered in E. coli. Selective pressure of colistin in vitro induced the same genetic mutations associated with colistin resistance in vivo. Efforts to reduce colistin consumption in livestock should be redoubled, to prevent the occurrence of colistin-resistant E. coli strains.Keywords: colistin resistance, two-component system, livestock, genetic mutation, mcr gene

Yong Seon Choi,1,* Hye-Min Sohn,2,* Sang-Hwan Do,2 Kyeong Tae Min,1 Jae Hee Woo,3 Hee Jung Baik3 1Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; 2Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 3Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea *These authors contributed equally to this work Background: Postoperative nausea and vomiting (PONV) is a common complication after surgery, which increases physical and psychological discomfort and delays recovery. The aim of this study was to test the hypothesis that ramosetron is comparable to ondansetron for the treatment of established PONV after laparoscopic surgery using a prospective, randomized, double-blinded, noninferiority study.Methods: Patients who had at least two risk factors of PONV and underwent laparoscopic surgery under general anesthesia were assessed for eligibility. Patients who developed PONV within the first 2 h after anesthesia received ondansetron (4 mg) or ramosetron (0.3 mg) intravenously in a randomized double-blind manner. Patients were then observed for 24 h after drug administration. The incidence of nausea and vomiting, severity of nausea, rescue antiemetic necessity, and adverse effects at 0–2 or 2–24 h after drug administration was evaluated. The primary endpoint was the rate of patients exhibiting a complete response, defined as no emesis and no further rescue antiemetic medication for 24 h after drug administration.Results: Among the 583 patients, 210 (36.0%) developed PONV and were randomized to either the ondansetron (n=105) or ramosetron (n=105) group. Patient’s characteristics were similar between the groups. The complete response rate was 44.1% in the ondansetron group and 52.9% in the ramosetron group after 24 h of initial antiemetic administration. The incidence of adverse events was not different between the groups.Conclusion: We found evidence to support the noninferiority of ramosetron (0.3 mg) compared to ondansetron (4 mg) for the treatment of established PONV in moderate to high-risk patients undergoing laparoscopic surgery. Keywords: laparoscopic surgery, ondansetron, postoperative nausea and vomiting, ramosetron, non-inferiority, antiemetic

Northeast Asia suffers from high concentrations of particulate matter (PM), prompting nations to actively implement emission reduction policies. This study evaluated the recent inter-annual changes in the chemical transformation and transboundary transport of PM over Northeast Asia, based on both ground and aircraft measurements, as well as WRF-Chem simulations, during two comprehensive campaigns: the Korea-United States Air Quality (KORUS-AQ) campaign in 2016 and the Satellite Integrated Joint Monitoring of Air Quality (SIJAQ) campaign in 2022, both conducted around the Korean Peninsula. Ground measurements in 2022 revealed significant reductions in air pollutants compared to 2016 levels. In the Beijing-Tianjin-Hebei region, PM 2.5 and SO 2 concentrations decreased by 47.2% and 73.9%, respectively, attributable to successful SO x and NO x emission reduction strategies. Similar trends were observed in downwind areas, including Seoul, where PM 2.5 and SO 2 levels declined by 30.0% and 41.4%, respectively. WRF-Chem model results indicated substantial decreases in sulfates, nitrates, and their precursors in both surface and upper atmosphere in 2022 compared to 2016. Moreover, model-calculated gas-to-particle conversion ratios, which peaked in the Yellow Sea in 2016, decreased by 15% in 2022 and shifted slightly eastward to the western Korean Peninsula. This shift suggests a potential decline in secondary PM formation processed in the Yellow Sea, coinciding with reduced long-range transport of gaseous pollutants. A comparison of model sensitivity experiments, accounting for both bottom-up emission changes and meteorological variations, revealed that while weather and climate factors such as precipitation and pressure patterns between 2016 and 2022 contributed to the overall decrease in PM concentrations, the primary driver was the reduction in emissions during this period. This study highlighted that the main driver of the substantial improvement in air quality over East Asia was the implementation of emission reduction policies targeting PM and its precursors in the main source regions in China., Competing Interests: Declaration of Competing Interest ☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ☐ The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:, (Copyright © 2024. Published by Elsevier Ltd.)

Intrinsic uncertainty in the reward environment requires the brain to run multiple models simultaneously to predict outcomes based on preceding cues or actions, commonly referred to as stimulus- and action-based learning. Ultimately, the brain also must adopt appropriate choice behavior using reliability of these models. Here, we combined multiple experimental and computational approaches to quantify concurrent learning in monkeys performing tasks with different levels of uncertainty about the model of the environment. By comparing behavior in control monkeys and monkeys with bilateral lesions to the amygdala or ventral striatum, we found evidence for dynamic, competitive interaction between stimulus-based and action-based learning, and for a distinct role of the amygdala. Specifically, we demonstrate that the amygdala adjusts the initial balance between the two learning systems, thereby altering the interaction between arbitration and learning that shapes the time course of both learning and choice behaviors. This novel role of the amygdala can account for existing contradictory observations and provides testable predictions for future studies into circuit-level mechanisms of flexible learning and choice under uncertainty.

In the pursuit of carbon neutrality, China's 2060 targets have been largely anchored in reducing greenhouse gas emissions, with less emphasis on the consequential benefits for air quality and public health. This study pivots to this critical nexus, exploring how China's carbon neutrality aligns with the World Health Organization's air quality guidelines (WHO AQG) regarding fine particulate matter (PM 2.5 ) exposure. Coupling a technology-rich integrated assessment model, an emission-concentration response surface model, and exposure and health assessment, we find that decarbonization reduces sulfur dioxide (SO 2 ), nitrogen oxides (NO x ), and PM 2.5 emissions by more than 90%; reduces nonmethane volatile organic compounds (NMVOCs) by more than 50%; and simultaneously reduces the disparities across regions. Critically, our analysis reveals that further targeted reductions in air pollutants, notably NH 3 and non-energy-related NMVOCs, could bring most Chinese cities into attainment of WHO AQG for PM 2.5 5 to 10 years earlier than the pathway focused solely on carbon neutrality. Thus, the integration of air pollution control measures into carbon neutrality strategies will present a significant opportunity for China to attain health and environmental equality.

The use of integrative Korean medicine treatment (IKMT) for patients with knee osteoarthritis (OA) has been reported previously; however, to date, no studies have investigated the long-term prognosis of these patients following IKMT for primary knee OA. We aimed to examine the long-term effects of IKMT in patients diagnosed with primary knee OA and receiving IKMT during hospitalization. This retrospective observational study, complemented by a follow-up survey, included patients with primary knee OA who received IKMT during hospitalization across 7 Korean medicine hospitals. The primary outcome was the Numerical Rating Scale knee-pain score, whereas the secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5 dimension-5 level questionnaire (EQ-5D-5L), and Patient Global Impression of Change scores. Patients were evaluated at admission, discharge, and during follow-up. Of the 180 included patients, 81 responded to the survey. Compared with the corresponding values at admission, the Numerical Rating Scale score decreased by 2.44 (2.08-2.81) points at discharge and 1.89 (1.5-2.26) points at follow-up. Additionally, compared with their scores at admission, the WOMAC score decreased by 17.20 (13.68-20.71) points at discharge and 25.74 (22.22-29.26) points at follow-up, whereas the EuroQol-5 dimension-5 level questionnaire score improved by -0.15 (-0.18 to -0.12) points at discharge and -0.12 (-0.15 to -0.09) points at follow-up. The patients expressed high satisfaction with pharmacopuncture (65.4%), acupuncture (54.03%), physical therapy (35.8%), and herbal medicine (34.6%). Regarding Patient Global Impression of Change, 96.30% of the patients reported improvement. IKMT was effective in improving pain, functional disability, and quality of life in patients with primary knee OA. Its effects were maintained throughout the long-term follow-up period, and physical functions continuously improved., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

During the coronavirus disease 2019 (COVID-19) pandemic, conclusively evaluating possible associations between COVID-19 vaccines and potential adverse events was of critical importance. The National Academy of Medicine of Korea established the COVID-19 Vaccine Safety Research Center (CoVaSC) with support from the Korea Disease Control and Prevention Agency to investigate the scientific relationship between COVID-19 vaccines and suspected adverse events. Although determining whether the COVID-19 vaccine was responsible for any suspected adverse event necessitated a systematic approach, traditional causal inference theories, such as Hill's criteria, encountered certain limitations and criticisms. To facilitate a systematic and evidence-based evaluation, the United States Institute of Medicine, at the request of the Centers for Disease Control and Prevention, offered a detailed causality assessment framework in 2012, which was updated in the recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM) in 2024. This framework, based on a weight-of-evidence approach, allows the independent evaluation of both epidemiological and mechanistic evidence, culminating in a comprehensive conclusion about causality. Epidemiological evidence derived from population studies is categorized into four levels-high, moderate, limited, or insufficient-while mechanistic evidence, primarily from biological and clinical studies in animals and individuals, is classified as strong, intermediate, weak, or lacking. The committee then synthesizes these two types of evidence to draw a conclusion about the causal relationship, which can be described as "convincingly supports" ("evidence established" in the 2024 NASEM report), "favors acceptance," "favors rejection," or "inadequate to accept or reject." The CoVaSC has established an independent committee to conduct causality assessments using the weight-of-evidence framework, specifically for evaluating the causality of adverse events associated with COVID-19 vaccines. The aim of this study is to provide an overview of the weight-of-evidence framework and to detail the considerations involved in its practical application in the CoVaSC., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)

The beach chair position (BCP) is widely used in shoulder surgery; however, it frequently leads to hypotension. Hypotension in BCP is prevalent among older patients who are at risk of secondary complications such as ischemic injuries. Therefore, this prospective study aimed to investigate the association and predictive value of frailty, as assessed by ultrasound-measured quadriceps depth and questionnaire, in patients aged ≥65 years undergoing elective shoulder surgery under general anesthesia. A multivariable logistic regression analysis was performed to identify independent risk factors for hypotension in BCP under general anesthesia. Receiver operating characteristic curves were constructed to assess the predictive values of various parameters. The results indicated that a quadriceps depth < 2.3 cm and BCP for an extended period significantly increased the risk of hypotension. The combined consideration of quadriceps depth < 2.3 cm and frailty demonstrated markedly superior predictive power compared with each factor individually. In conclusion, the study findings facilitate the screening and identification of risk factors for older patients undergoing surgery in BCP, thereby enhancing perioperative management.

Interstitial lung disease (ILD) is characterized by progressive pathological changes that require timely and accurate diagnosis. The early detection and progression assessment of ILD are important for effective management. This study introduces a novel quantitative evaluation method utilizing chest radiographs to analyze pixel-wise changes in ILD. Using a weakly supervised learning framework, the approach incorporates the contrastive unpaired translation model and a newly developed ILD extent scoring algorithm for more precise and objective quantification of disease changes than conventional visual assessments. The ILD extent score calculated through this method demonstrated a classification accuracy of 92.98% between ILD and normal classes. Additionally, using an ILD follow-up dataset for interval change analysis, this method assessed disease progression with an accuracy of 85.29%. These findings validate the reliability of the ILD extent score as a tool for ILD monitoring. The results of this study suggest that the proposed quantitative method may improve the monitoring and management of ILD.

(1) Background: Irritable bowel syndrome (IBS) is a common disease in the gastrointestinal (GI) tract. Atractylodes macrocephala Koidz (AMK) is known as one of the traditional medicines that shows a good efficacy in the GI tract. (2) Methods: We investigated the effect of AMK in a network pharmacology and zymosan-induced IBS animal model. In addition, we performed electrophysiological experiments to confirm the regulatory mechanisms related to IBS. (3) Results: Various characteristics of AMK were investigated using TCMSP data and various analysis systems. AMK restored the macroscopic changes and weight to normal. Colonic mucosa and inflammatory factors were reduced. These effects were similar to those of amitriptyline and sulfasalazine. In addition, transient receptor potential (TRP) V1, voltage-gated Na + (NaV) 1.5, and NaV1.7 channels were inhibited. (4) Conclusion: These results suggest that AMK may be a promising therapeutic candidate for IBS management through the regulation of ion channels.

Ulaanbaatar (UB), the fast-growing capital of Mongolia, is known for its world's worst level of particulate matter (PM) concentrations in winter. However, current anthropogenic emission inventories over the UB are based on data from more than fifteen years ago, and satellite observations are scarce because UB is in high latitudes. During the winter of 2020-21, the first period of the Fine Particle Research Initiative in East Asia considering the National Differences (FRIEND), several times higher concentrations of PM in UB compared to other urban sites in East Asia were observed but not reproduced with a chemical transport model mainly due to the underestimated anthropogenic emissions. Therefore, we devised a method for sequentially adjusting emissions based on the reactivity of PM precursors using ground observations. We scaled emission rates for the inert species (CO, elemental carbon (EC), and organic carbon (OC)) to reproduce their observed ambient concentrations, followed by SO 2 to reproduce the concentration of SO 4 2- , which was examined to have the least uncertainty based on the abundance of observed NH 3 , and finally NO and NH 3 for NO 3 - , and NH 4 + . This improved estimation is compared to regional inventories for Asia and suggests more than an order of magnitude increase in anthropogenic emissions in UB. Using the improved emission inventory, we were able to successfully reproduce independent observation data on PM 2.5 concentrations in UB in December 2021 from the U.S. Embassy. During the campaign period, we found more than 50% of the SO 4 2- , NO 3 - , and NH 4 + increased in UB due to the improvement could travel to Beijing, China (BJ), and about 20% of the SO 4 2- could travel to Noto, Japan (NT), more than 3000 km away. Also, the anthropogenic emissions in UB can effectively increase OC, NO 3 - , and NH 4 + concentrations in BJ when Gobi dust storms occur., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background/aims: : In 2019, the American Society for Gastrointestinal Endoscopy (ASGE) established clinical predictors for choledocholithiasis. Our study was designed to evaluate these predictors within the Korean clinical context, establish cutoff values, and develop a predictive model., Methods: : This retrospective study analyzed patients who underwent laparoscopic cholecystectomy. The relationships between choledocholithiasis and predictors including age, blood tests, and imaging findings were assessed through univariate and multivariate logistic regression analyses. We established Korean cutoff values for these predictors and developed a scoring system for choledocholithiasis using a multivariate logistic regression. The performance of this scoring system was then compared with that of the 2019 ASGE guidelines through a receiver operating characteristic curve., Results: : We established Korean cutoff values for age (>70 years), alanine aminotransferase (>26.5 U/L), aspartate aminotransferase (>28.5 U/L), gamma-glutamyl transferase (GGT; >82.5 U/L), alkaline phosphatase (ALP; >77.5 U/L), and total bilirubin (>0.95 mg/dL). In the multivariate analysis, only age >70 years, GGT >77.5 U/L, ALP >77.5 U/L, and common bile duct dilatation remained significant. We then developed a new Korean risk stratification model from the multivariate analysis, with an area under the curve of 0.777 (95% confidence interval, 0.75 to 0.81). Our model was stratified into the low-risk, intermediate-risk, and high-risk groups with the scores being <1.0, 1.0-5.5, and >5.5, respectively., Conclusions: : Predictors of choledocholithiasis in cholecystectomy patients and their cutoff values in Korean should be adjusted and further studies are needed to develop appropriate guidelines.

Purpose To develop an artificial intelligence (AI) system for humeral tumor detection on chest radiographs (CRs) and evaluate the impact on reader performance. Materials and Methods In this retrospective study, 14 709 CRs (January 2000 to December 2021) were collected from 13 468 patients, including CT-proven normal ( n = 13 116) and humeral tumor ( n = 1593) cases. The data were divided into training and test groups. A novel training method called false-positive activation area reduction (FPAR) was introduced to enhance the diagnostic performance by focusing on the humeral region. The AI program and 10 radiologists were assessed using holdout test set 1, wherein the radiologists were tested twice (with and without AI test results). The performance of the AI system was evaluated using holdout test set 2, comprising 10 497 normal images. Receiver operating characteristic analyses were conducted for evaluating model performance. Results FPAR application in the AI program improved its performance compared with a conventional model based on the area under the receiver operating characteristic curve (0.87 vs 0.82, P = .04). The proposed AI system also demonstrated improved tumor localization accuracy (80% vs 57%, P < .001). In holdout test set 2, the proposed AI system exhibited a false-positive rate of 2%. AI assistance improved the radiologists' sensitivity, specificity, and accuracy by 8.9%, 1.2%, and 3.5%, respectively ( P < .05 for all). Conclusion The proposed AI tool incorporating FPAR improved humeral tumor detection on CRs and reduced false-positive results in tumor visualization. It may serve as a supportive diagnostic tool to alert radiologists about humeral abnormalities. Keywords: Artificial Intelligence, Conventional Radiography, Humerus, Machine Learning, Shoulder, Tumor Supplemental material is available for this article. © RSNA, 2024.

Emission uncertainty in North Korea can act as an obstacle when developing air pollution management plans in the country and neighboring countries when the transboundary transport of air pollutants is considered. This study introduces a novel approach for adjusting and reallocating North Korean CO emissions, aiming to complement the limited observational and emissions data on the country's air pollutants. We utilized ground observations from demilitarized zone (DMZ) and vertical column density (VCD) data from a TROPOspheric Monitoring Instrument (TROPOMI), which were combined with the Community Multi-Scale Air Quality (CMAQ) chemistry transport model simulations. The Clean Air Support System (CAPSS) and Satellite Integrated Joint Monitoring of Air Quality (SIJAQ) emissions inventories served as the basis for our initial simulations. A two-step procedure was proposed to adjust both the emission intensity and the spatial distribution of emissions. First, air quality simulations were conducted to explore model sensitivity to changes in North Korean CO emissions with respect to ground concentrations. DMZ observations then constrained these simulations to estimate corresponding emission intensity. Second, the spatial structure of North Korean CO emission sources was reconstructed with the help of TROPOMI CO VCD distributions. Our two-step hybrid method outperformed individual emissions adjustment and spatial reallocation based solely on surface or satellite observations. Validation using ground observations from the Chinese Dandong site near the China-North Korea border revealed significantly improved model simulations when applying the updated CO emissions. The adjusted CO emissions were 10.9 times higher than those derived from the bottom-up emissions used in this study, highlighting the lack of information on North Korean pollutants and emission sources. This approach offers an efficient and practical solution for identifying potential missing emission sources when there is limited on-site information about air quality on emissions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

This systematic review evaluated psychiatric adverse events (AEs) following vaccination against coronavirus disease 2019 (COVID-19). We included studies that reported or investigated psychiatric AEs in individuals who had received an approved COVID-19 vaccine in the Republic of Korea. Systematic electronic searches of Ovid-Medline, Embase, CENTRAL, and KoreaMed databases were conducted on March 22, 2023. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-randomized Studies 2.0. The study protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023449422). Of the 301 articles initially selected, 7 were included in the final analysis. All studies reported on sleep disturbances, and 2 highlighted anxiety-related AEs. Sleep disorders like insomnia and narcolepsy were the most prevalent AEs, while depression was not reported. Our review suggests that these AEs may have been influenced by biological mechanisms as well as the broader psychosocial context of the COVID-19 pandemic. Although this study had limitations, such as a primary focus on the BNT162b2 vaccine and an observational study design, it offered a systematic, multi-vaccine analysis that fills a critical gap in the existing literature. This review underscores the need for continued surveillance of psychiatric AEs and guides future research to investigate underlying mechanisms, identify risk factors, and inform clinical management.

The COVID-19 Vaccine Safety Research Committee (CoVaSC) was established in November 2021 to address the growing need for independent, in-depth scientific evidence on adverse events (AEs) following coronavirus disease 2019 (COVID-19) vaccination. This initiative was requested by the Korea Disease Control and Prevention Agency and led by the National Academy of Medicine of Korea. In September 2022, the COVID-19 Vaccine Safety Research Center was established, strengthening CoVaSC's initiatives. The center has conducted various studies on the safety of COVID-19 vaccines. During CoVaSC's second research year, from September 29, 2022 to July 19, 2023, the center was restructured into 4 departments: Epidemiological Research, Clinical Research, Communication & Education, and International Cooperation & Policy Research. Its main activities include (1) managing CoVaSC and the COVID-19 Vaccine Safety Research Center, (2) surveying domestic and international trends in AE causality investigation, (3) assessing AEs following COVID-19 vaccination, (4) fostering international collaboration and policy research, and (5) organizing regular fora and training sessions for the public and clinicians. Causality assessments have been conducted for 27 diseases, and independent research has been conducted after organizing ad hoc committees comprising both epidemiologists and clinical experts on each AE of interest. The research process included protocol development, data analysis, interpretation of results, and causality assessment. These research outcomes have been shared transparently with the public and healthcare experts through various fora. The COVID-19 Vaccine Safety Research Center plans to continue strengthening and expanding its research activities to provide reliable, high-quality safety information to the public.

Background: SMARCA4-deficient non-small cell lung carcinoma (SD-NSCLC) is a relatively rare tumor, which occurs in 5-10% of NSCLC. Based on World Health Organization thoracic tumor classification system, SMARCA4-deficient undifferentiated tumor (SD-UT) is recognized as a separate entity from SD-NSCLC. Differentiation between SD-NSCLC and SD-UT is often difficult due to shared biological continuum, but often required for choosing appropriate treatment regimen. Therefore, the aim of our study was to identify the clinicopathologic, computed tomography (CT), and positron emission tomography (PET)-CT imaging features of SD-NSCLC., Methods: Nine patients of pathologically confirmed SD-NSCLC were included in our analysis. We reviewed electronic medical records for clinical information, demographic features, CT, and PET-CT imaging features were analyzed., Results: Smoking history and male predominance are observed in all patients with SD-NSCLC (n=9). On CT, SD-NSCLC appeared as relatively well-defined masses with lobulated contour (n=8) and peripheral location (n=7). Invasion of adjacent pleura or chest wall (n=7) were frequently observed, regardless of small tumor size. Four cases showed lymph node metastases. Among nine patients, three patients showed multiple bone metastases, and one patient showed lung-to-lung metastases., Conclusions: In patient with SD-NSCLC, there was tendency for male smokers, peripheral location and invasion of adjacent pleural or chest wall invasion regardless of small tumor size, when compared to SD-UT., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-1606/coif). The authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)

Polypropylene (PP), polystyrene (PS), and polyethylene (PE) plastics are commonly used in household items such as electronic housings, food packaging, bottles, bags, toys, and roofing membranes. The presence of inhalable microplastics in indoor air has become a topic of concern as many people spent extended periods of time indoors during the COVID-19 pandemic lockdown restrictions, however, the toxic effects on the respiratory system are not properly understood. We examined the toxicity of PP, PS, and PE microplastic fragments in the pulmonary system of C57BL/6 mice. For 14 days, mice were intratracheally instilled 5 mg/kg PP, PS, and PE daily. The number of inflammatory cells such as macrophages, neutrophils, and eosinophils in the bronchoalveolar lavage fluid (BALF) of PS-instilled mice was significantly higher than that in the vehicle control (VC). The levels of inflammatory cytokines and chemokines in BALF of PS-instilled mice increased compared to the VC. However, the inflammatory responses in PP- and PE-stimulated mice were not significantly different from those in the VC group. We observed elevated protein levels of toll-like receptor (TLR) 2 in the lung tissue of PP-instilled mice and TLR4 in the lung tissue of PS-instilled mice compared with those to the VC, while TLR1, TLR5, and TLR6 protein levels remained unchanged. Phosphorylation of nuclear factor kappa B (NF-κB) and IĸB-α increased significantly in PS-instilled mice compared with that in VC. Furthermore, Nucleotide‑binding oligomerization domain‑like receptor family pyrin domain‑containing 3 (NLRP3) inflammasome components including NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), and Caspase-1 in the lung tissue of PS-instilled mice increased compared with that in the VC, but not in PP- and PE-instilled mice. These results suggest that PS microplastic fragment stimulation induces pulmonary inflammation due to NF-ĸB and NLRP3 inflammasome activation by the TLR4 pathway., Supplementary Information: The online version contains supplementary material available at 10.1007/s43188-023-00224-x., Competing Interests: Conflict of interestAll authors confrm that there is no confict of interest., (© The Author(s) 2024.)

Purpose: This study aimed at developing a novel tube thoracostomy technique using the sternum, a fixed anatomical structure, as an indicator to reduce the possibility of incorrect chest tube positioning and complications in patients with chest trauma., Methods: This retrospective study analyzed the data of 184 patients with chest trauma who were aged ≥18 years, visited a single regional trauma center in Korea between April and June 2022, and underwent chest computed tomography (CT) with their arms down. The conventional gold standard, 5th intercostal space (ICS) method, was compared to the lower 1/2, 1/3, and 1/4 of the sternum method by analyzing CT images., Results: When virtual tube thoracostomy routes were drawn at the mid-axillary line at the 5th ICS level, 150 patients (81.5%) on the right side and 179 patients (97.3%) on the left did not pass the diaphragm. However, at the lower 1/2 of the sternum level, 171 patients (92.9%, P<0.001) on the right and 182 patients (98.9%, P= 0.250) on the left did not pass the diaphragm. At the 5th ICS level, 129 patients (70.1%) on the right and 156 patients (84.8%) on the left were located in the safety zone and did not pass the diaphragm. Alternatively, at the lower 1/2, 1/3, and 1/4 of the sternum level, 139 (75.5%, P=0.185), 49 (26.6%, P<0.001), and 10 (5.4%, P<0.001), respectively, on the right, and 146 (79.3%, P=0.041), 69 (37.5%, P<0.001), and 16 (8.7%, P<0.001) on the left were located in the safety zone and did not pass the diaphragm. Compared to the conventional 5th ICS method, the sternum 1/2 method had a safety zone prediction sensitivity of 90.0% to 90.7%, and 97.3% to 100% sensitivity for not passing the diaphragm., Conclusions: Using the sternum length as a tube thoracostomy indicator might be feasible., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (© 2024 The Korean Society of Traumatology.)

This study aimed to evaluate the efficacy of the 2020 European Society of Gynecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology (ESGO/ESTRO/ESP) guidelines for endometrial cancer (EC). Additionally, a novel risk category incorporating clinicopathological and molecular factors was introduced. The predictive value of this new category for recurrence and survival in Korean patients with EC was assessed, and comparisons were made with the 2013 and 2016 European Society of Medical Oncology (ESMO) risk classifications. Patients with EC were categorized into the POLE-mutated (POLEmut), mismatch repair-deficient (MMRd), p53-aberrant (P53abn), and nonspecific molecular profile (NSMP) subtypes. Recurrence, survival, and adjuvant therapy were assessed according to each classification. Notably, patients with the POLEmut subtype showed no relapse, while patients with the P53abn subtype exhibited higher recurrence (31.8%) and mortality rates (31.8%). Regarding adjuvant therapy, 33.3% of low-risk patients were overtreated according to the 2020 ESGO/ESTRO/ESP guidelines. Overall and progression-free survival differed significantly across molecular classifications, with the POLEmut subtype showing the best and the P53abn subtype showing the worst outcomes. The 2020 ESGO molecular classification system demonstrated practical utility and significantly influenced survival outcomes. Immunohistochemistry for TP53 and MMR, along with POLE sequencing, facilitated substantial patient reclassification, underscoring the clinical relevance of molecular risk categories in EC management.

Accurate estimation of emissions from industrial point sources is crucial in understanding the effectiveness of reduction efforts and establishing reliable emission inventories. In this study, we employ an airborne Chemical Ionization Mass Spectrometry (CIMS) instrument to quantify sulfur dioxide (SO 2 ) emissions from prominent industrial facilities in South Korea, including power plants, a steel mill, and a petrochemical facility. Our analysis utilizes the box mass balance technique to derive SO 2 emissions and associated uncertainty. We evaluate the interpolation methods between 2D kriging and 3D radial basis function. The results demonstrate that the total uncertainty of the box mass balance technique ranges from 5 % to 28 %, with an average of 20 %. Mixing ratio ground extrapolation from the lowest altitude of the airborne sampling to the ground emerges as the dominant source of uncertainty, followed by the determination of the boundary layer height. Adequate sampling at multiple altitudes is found to be essential in reducing the overall uncertainty by capturing the full extent of the plume. Furthermore, we assess the uncertainty of the single-height transect mass balance method commonly employed in previous studies. Our findings reveal an average precision of 47 % for this method, with the potential for overestimating emissions by up to 206 %. Samplings at fewer altitudes or with larger altitude gaps increase the risk of under-sampling and elevate method uncertainties. Therefore, this study provides a quantitative basis to evaluate previously airborne observational emission constraints., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare. All co-authors have seen and agree with the manuscript's contents, and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication., (Copyright © 2023. Published by Elsevier B.V.)

This study aimed to create Greenhouse Gas - Air Pollution Interactions and Synergies (GAINS)-Korea, an integrated model for evaluating climate and air quality policies in Korea, modeled after the international GAINS model. GAINS-Korea incorporates specific Korean data and enhances granularity for enabling local government-level analysis. The model includes source-receptor matrices used to simulate pollutant dispersion in Korea, generated through CAMx air quality modeling. GAINS-Korea's performance was evaluated by examining different scenarios for South Korea. The business as usual scenario projected emissions from 2010 to 2030, while the air quality scenario included policies to reduce air pollutants in line with air quality and greenhouse gas control plans. The maximum feasible reduction scenario incorporated more aggressive reduction technologies along with air quality measures. The developed model enabled the assessment of emission reduction effects by both greenhouse gas and air pollutant emission reduction policies across 17 local governments in Korea, including changes in PM 2.5 (particulate matter less than 2.5 μm) concentration and associated benefits, such as reduced premature deaths. The model also provides a range of visualization tools for comparative analysis among different scenarios, making it a valuable resource for policy planning and evaluation, and supporting decision-making processes., (© 2024. The Author(s).)

The current design codes i.e. AISC 360-16, CSA-S16-19, EC-04 etc. provide empirical relationships to estimate the capacity of shear connectors which were developed based on pushout tests of headed studs and channels connectors in exposed type sections. Therefore, these equations may result inaccurate predictions for strength of connectors in infilled-type sections. This study presents a detailed experimental study investigating the performance of angle connectors in composite sections. The testing program consisted two series of pushout tests. A total of 36 specimens were tested, considering the influence of several important parameters i.e. the length ( L c ), height ( h c ), and web-thickness ( t w ) of angle connector, length of the weld ( w ) and the direction of shear connector (forward/backward) etc. The tests results demonstrated that with increasing connector height h s, and thickness, the maximum load P max and slip δ u were increased. The connector direction didn't change much the load-slip behavior. The prediction accuracy of the existing shear capacity models was evaluated by comparing the predictions with experimental results. The current equations were noticed to be highly inconsistent in predicting the shear capacity of angle connectors, especially in case of infilled type sections. When the entire length of connector was taken as the effective length, the models overestimated the shear capacity. While in case when the welding length was taken as effective length in calculations, the models underestimated the shear strength of angle connectors., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

It is challenging to estimate local emission conditions of a downwind area solely based on concentrations in the downwind area. This is because air pollutants that have a long residence time in the atmosphere can be transported over long distances and influence air quality in downwind areas. In this study, a Two-step Emissions Adjustment (TEA) approach was developed to adjust downwind emissions of target air pollutants with surface observations, considering their long-range transported emission impacts from upwind areas calculated from air quality simulations. Using the TEA approach, CO, NO x , and SO 2 emissions were adjusted in China and South Korea between 2016 and 2021 based on existing bottom-up emissions inventories. Simulations with the adjusted emissions showed that the 6-year average normalized mean biases of the monthly mean concentrations of CO, NO x , and SO 2 improved to 0.3 %, -2 %, and 2 %, respectively, in China, and to 5 %, 7 %, and 4 %, respectively, in South Korea. When analyzing the emission trends, it was estimated that the annual emissions of CO, NO x , and SO 2 in China decreased at a rate of 7.2 %, 4.5 %, and 10.6 % per year, respectively. The decrease rate of emissions for each of these pollutants was similar to that of ambient concentrations. When considering upwind emission impacts in the emissions adjustment, CO emissions increased by 1.3 %/year in South Korea, despite CO concentrations in the country decreasing during the study period. During the study period, NO x and SO 2 emissions in South Korea decreased by 3.9 % and 0.5 %/year, respectively. Moreover, the TEA approach can account for drastic short-term emission changes (e.g., social distancing due to COVID-19). Therefore, the TEA approach can be used to adjust emissions and improve reproducibility of concentrations of air pollutants suitable for health studies for areas where upwind emission impacts are significant., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Intraoperative hypotension is a risk factor for perioperative adverse outcomes and is highly prevalent in older patients. Frailty has been associated with hemodynamic instability but its impact on postinduction hypotension is unclear. Therefore, we assessed the association between frailty and postinduction hypotension in older patients., Methods: We retrospectively evaluated electronic medical records of patients aged ≥65 years who were assessed for preoperative frailty and underwent noncardiac surgery under general anesthesia. Reported Edmonton Frail Scale (REFS) scores were used to stratify patients into a nonfrail (REFS scores 0-5), prefrail (6-7), and frail (8-18) groups. Postinduction hypotension was defined as a mean blood pressure below 65 mmHg or 20% from baseline occurring within the first 20 minutes after anesthesia induction and evaluated using multivariate logistic regression analysis., Results: Independent factors related to postinduction hypotension in our sample (421 patients) were status of frail (REFS score ≥8) compared to nonfrail (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.44-5.18; p = .002), lower baseline mean blood pressure in the operating room (OR, 0.98; 95% CI, 0.96-0.999; p = .034) and at the presurgical center (OR, 0.96; 95% CI, 0.94-0.99; p = .003), and orthopedic (compared to urologic) surgery (OR, 2.22; 95% CI, 1.14-4.30; p = .019)., Conclusion: Preoperative frail status based on REFS scores is associated with postinduction hypotension. Frailty screening tool for older patients may enhance traditional risk calculators and improve patient selection for noncardiac surgery under general anesthesia., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Patients with inflammatory bowel disease (IBD), including ulcerative colitis (UC), show an increased incidence of anxiety and depression; however, the association between UC-associated psychiatric disorders and the gut microbiota is unclear. This study aimed to examine whether gut microbiota from patients with UC can alter colonic gene expression, leading to anxiety- and depression-like behavior in mice receiving fecal microbiota transplantation (FMT). RNA sequencing transcriptome analyses revealed a difference in colonic gene expression between mice receiving FMT from patients with UC (UC-FMT mice) and those receiving FMT from healthy controls (HC-FMT mice). Gene ontology analysis revealed the downregulation of neuropeptide signaling pathways, including neuropeptide Y (NPY) expression, in the colons of UC-FMT mice. The protein levels of NPY also decreased in the colon and plasma of UC-FMT mice compared to those in HC-FMT mice. The oral administration of Enterococcus mundtii (EM), a bacterium isolated from the feces of patients with UC, reduced NPY expression in the colons of mice and induced intestinal inflammation, anxiety, and depression-like behavior. Reduced NPY protein levels were also observed in the plasma and hippocampus of EM-treated mice. Intraperitoneal administration of NPY significantly alleviated anxiety- and depressive-like behaviors induced by EM in mice. Capsular polysaccharide in EM was associated with EM-induced NPY downregulation in the colon. Analysis of Gene Expression Omnibus datasets showed markedly reduced NPY expression in the inflamed colons of patients with UC compared with that in the colons of healthy controls. In summary, EM-induced reduction in the colonic expression of NPY may be associated with a decrease in hippocampal NPY and anxiety- and depression-like behavior in mice.

Purpose: The COVID-19 pandemic led to significant changes in the lifestyle patterns of children and affected the patterns of pediatric injuries. This study analyzed the changing patterns of pediatric injury overall and by age groups, based on the datasets before and during the COVID-19 pandemic., Methods: This study is based on the data of patients who presented with injuries at 23 hospital emergency departments participating in the Emergency Department-based Injury In-depth Surveillance (EDIIS) conducted by the Korea Disease Control and Prevention Agency. The surveillance data was categorized by injury mechanism, location, activity, and severity. We analyzed the injury patterns of pediatric patients aged 0 to 15 years. Subgroup analysis was conducted by age group in children aged 7 to 15 years, 1 to 6 years, and <1 year., Results: When comparing the COVID-19 pandemic period to the pre-COVID-19 period, the total number of pediatric patients with injuries decreased by 38.7%, while the proportions of in-home injuries (57.9% vs. 67.9%), and minor injuries (38.9% vs. 39.7%) increased. In the 7 to 15 years group, bicycle riding injuries (50.9% vs. 65.6%) and personal mobility device injuries (2.4% vs. 4.6%) increased. The 1 to 6 years group also showed an increase in bicycle accident injuries (15.8% vs. 22.4%). In the <1 year group, injuries from falls increased (44.5% vs. 49.9%). Self-harm injuries in the 7 to 15 years group also increased (1.6% vs. 2.8%)., Conclusions: During the COVID-19 pandemic period, the overall number of pediatric injuries decreased, while injuries occurring at home and during indoor activities increased. Traffic accidents involving bicycles and personal mobility devices and self-harm injuries increased in the 7 to 15 years group. In the <1 year group, the incidence of falls increased. Medical and societal preparedness is needed so that we might anticipate these changes in the patterns of pediatric injuries during future infectious disease pandemics., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (© 2023 The Korean Society of Traumatology.)

Purpose: To assess corneal tomographic, topographic, and refractive changes in children with high astigmatism and their ability to exclude keratoconus., Methods: In this longitudinal observational study, the medical records of children with high regular cylindrical refraction of ≥3.50 D referred to the Hospital for Sick Children, Toronto, to exclude keratoconus between January 2009 and June 2020 were reviewed retrospectively. Corneal tomography records (Scheimpflug imaging) were reviewed for subjects with total astigmatism of ≥ +3.50 D by retinoscopy. Children with abnormal anterior segment examination and/or other risk factors for corneal disease or ectasia and those with unreliable corneal tomography were excluded. Baseline demographic, longitudinal tomographic, topographic, and refractive data were analyzed., Results: A total of 67 eyes of 37 children (mean age, 9.1 ± 3.5 years) were included. Mean cylindrical refraction at presentation was 5.10 ± 1.30 D. Mean follow-up was 2.3 ± 1.8 years. Twenty-nine eyes had Kmax ≥47.20 D at baseline, with no change at last follow-up. Ksteep, Kmax, and thinnest pachymetry were 46.44 ± 2.33 D, 47.06 ± 2.57 D, and 525.86 ± 35.45 μm, respectively, at baseline compared with 46.40 ± 2.28 D, 46.98 ± 2.40 D, and 527.61 ± 37.67 μm at last follow-up (P > 0.05). All eyes were predicted as not having keratoconus using inferior-superior dioptric asymmetry ratio (I-S ratio), and the keratometry, inferior-superior, and astigmatism index (KISA%), which also incorporates skew percentage. The other tomographic indices predicted keratoconus or subclinical keratoconus in at least 22.4% of eyes. All parameters did not significantly change during follow-up., Conclusions: In the absence of other risk factors for keratoconus, children with high regular astigmatism demonstrated clinical and tomographic stability over time. Based on our results, we recommend that I-S ratio and KISA% be primarily used when monitoring normal children with high astigmatism to rule out keratoconus-related changes., (Copyright © 2023 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Background: Systemic artery to pulmonary artery fistula (SA-PAF) is an uncommon disease which is often incidentally diagnosed during evaluation of hemoptysis patients. The aim of our study was to describe the cases of SA-PAF in our institution and to report the correlating clinical and radiological findings., Methods: We reviewed 231 chest computed tomography (CT) scans performed in our institution due to hemoptysis from January 2020 to February 2023. In patients diagnosed with SA-PAF had their electronic medical records and CT images analyzed., Results: In 231 patients, 19 (8.2%) of them had SA-PAF findings which was characterized by a peripheral nodular soft tissue opacity in the subpleural lung and traceable vascular structure in continuity with one or more peripheral pulmonary artery branches in CT. Etiology of each patient was categorized as either congenital (7, 36.8%), and acquired (12, 63.2%). The origins of SA-PAFs were 16 intercostal, two anterior mediastinal, and one costocervical artery. Eight of 19 patients did not show any associated intralobar imaging abnormalities, while bronchiectasis, cellular bronchiolitis, centrilobular emphysema, and pleura effusion were observed in 11 patients., Conclusions: SA-PAF is a benign vascular anomaly which is frequently overlooked when evaluating hemoptysis by either clinician or radiologists but is an important factor in the differential diagnosis of patients with hemoptysis., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-861/coif). The authors have no conflicts of interest to declare., (2023 Journal of Thoracic Disease. All rights reserved.)

The aim of this study was to design a novel matrix tablet with enhanced dissolution and pH-independent controlled release of sildenafil citrate (SIL), a drug with pH-dependent solubility, by using solid dispersions (SDs) and polyelectrostatic interactions. SIL-loaded SDs were prepared using various polymeric carriers such as poloxamer 188, poloxamer 407, Soluplus®, polyvinylpyrrolidone (PVP) K 12, and PVP K 17 by the solvent evaporation method. Among these polymers, Soluplus® was found to be the most effective in SDs for enhancing the drug dissolution over 6 h in pH 6.8 intestinal fluid. SIL was well dispersed in Soluplus®-based SDs in an amorphous form. When the Soluplus®-based SDs were added in the tablet containing positively charged chitosan and negatively charged Eudragit® L100, the drug release rate was further modulated in a controlled manner. The charge density of the tablet was higher at pH 6.8 than at pH 1.2 due to the polyelectrostatic interaction between chitosan and Eudragit® L100. This interaction could provide a pH-independent controlled release of SIL. Our study demonstrates that a combinatory approach of Soluplus®-based SDs and polyelectrostatic interactions can improve the dissolution and pH-independent release performance of SIL. This approach could be a promising pharmaceutical strategy to design a matrix tablet of poorly water-soluble drugs for the enhanced bioavailability., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)