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Summary: Purpose: To reduce falls in hospitalized patients with mental disorders, the patients should be sensitive to fall risk perception. This study identified the sensitivity to fall risk perceptions and associated factors, including demographic, clinical, and fall-related factors, among inpatients with mental disorders. Methods: We used a descriptive, cross-sectional design, recruiting 170 inpatients with mental disorders from two psychiatric hospitals in South Korea. Sensitivity to fall risk perception was classified using fall occurrence and the Fall Risk Perception Questionnaire. Results: The prevalence of falls was 16.5%. Approximately 47% of falls occurred within 10 days of hospitalization, 67.9% within 1 month, and 85.7% within 2 months. Among the 28 participants who fell, 60.7% had inadequate low sensitivity to fall risk perception. Among the 142 participants who did not fall, 11.3% had inadequate high sensitivity to fall risk perception. A low sensitivity to fall risk perception was related to diagnosis, psychiatric symptoms, and fall history due to the mental disorder. A high sensitivity to fall risk perception was related to age at the onset of the mental disorder, urinary or bowel problems, and fear of falling. The multiple logistic regression analysis found that the diagnosis and fall history due to the mental disorder were associated with inadequate low sensitivity, and age at the onset and fear of falling were associated with inadequate high sensitivity to fall risk perception. Conclusion: Over 60% of patients who fell had low sensitivity to fall risk perception. Inadequate low and high sensitivity to fall risk perception are related to the demographic, clinical, and fall-related characteristics among inpatients with mental disorders. Therefore, nurses should assess fall risk perception, consider these factors together during this assessment, and manage them appropriately in hospitalized patients with mental disorders.

Summary: Purpose: Although the significance of health literacy (HL) in fall-prevention strategies is growing, limited knowledge is available regarding the relationship, impact, and role of HL in falls. This scoping review aimed to explore and synthesize the current evidence regarding the role of HL in enhancing fall prevention in hospital and community settings. Methods: We adhered to the Joanna Briggs Institute manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews. PubMed, CINAHL, EMBASE, and the Cochrane Library were searched until November 2023 using Medical Subject Headings and text words. Studies related to HL and falls, regardless of study design, were considered eligible. Results: We screened 99,249 records, of which 27 were included: 12 interventional studies, seven observational studies, four qualitative studies, and four mixed-methods studies. Two-thirds of the studies were conducted in community-based settings. Four observational studies reported that HL was associated with fall-related outcome including fall incidence. Although intervention studies did not encompass all elements of HL based on the Health Literacy Framework, eight out of 12 intervention studies reported the effect of HL-embedded fall-prevention interventions, and HL was effective in fall-related outcomes including fall incidence in six studies. Three of 14 studies reported the measurement properties of fall-related HL. While HL can be increased through tailored information, verbal debriefing, interactive communication, and culturally adapted interventions, low HL impedes the understanding of education, engaging interventions, and using technological devices in implementing fall-prevention interventions in qualitative and mixed-methods studies. Conclusion: This scoping review suggests that nurses need to recognize and assess patients’ HL as a potential risk factor for falls and implement fall-prevention interventions based on the HL level of participants. Further research is required to develop culturally adapted and fall-relevant HL measures applicable to various vulnerable populations and settings.

BackgroundPCR and culture tests are used together to confirm the diagnosis of active tuberculosis (TB). Due to the long culture period, if the PCR test is negative, it takes a significant amount of time for the culture result to be available. Interferon-γ release assays (IGRAs), which are widely used to diagnose TB or latent tuberculosis infection (LTBI), cannot effectively discriminate TB from LTBI. The purpose of this study is to analyze the diagnostic performance of various markers for differentiating between TB from LTBI.MethodsPubMed-Medline, EMBASE, Cochrane Library, and Web of Science were searched up to the end of May 2024, without restrictions on publication date and population. Articles describing the diagnostic value of at least one biomarker for differentiating between TB and LTBI were included. The QUADAS-2 tool was used to assess study quality. Two independent researchers assessed the articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The network meta-analysis (NMA) was performed for diagnostic tools of 11 groups used to differentiate TB from LTBI.ResultsOut of 164 identified articles, 159 reports were included in the systematic review and 58 in the meta-analysis. Seventy results from 58 reports accounting for 9,291 participants were included. When measuring interleukin-2 (IL-2) after stimulation with latency antigen, the most significant odds ratio was shown in terms of sensitivity, specificity, positive predictive value and negative predictive value. The values were 9.46, 18.5, 11.30, and 9.61, respectively.ConclusionThis study shows that the IL-2 level after stimulation with latent antigen is a potential biomarker for differentiating TB from LTBI.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024542996.

Background Bronchiectasis is a chronic respiratory disease that leads to airway inflammation, destruction, and airflow limitation, which reflects its severity. Impulse oscillometry (IOS) is a non-invasive method that uses sound waves to estimate lung function and airway resistance. The aim of this study was to assess the usefulness of IOS in predicting the severity of bronchiectasis. Methods We retrospectively reviewed the IOS parameters and clinical characteristics in 145 patients diagnosed with bronchiectasis between March 2020 and May 2021. Disease severity was evaluated using the FACED score, and patients were divided into mild and moderate/severe groups. Results Forty-four patients (30.3%) were in the moderate/severe group, and 101 (69.7%) were in the mild group. Patients with moderate/severe bronchiectasis had a higher airway resistance at 5 Hz (R5), a higher difference between the resistance at 5 and 20 Hz (R5−R20), a higher resonant frequency (Fres), and a higher area of reactance (AX) than patients with mild bronchiectasis. R5 ≥0.43, resistance at 20 Hz (R20) ≥0.234, R5−R20 ≥28.3, AX ≥1.02, reactance at 5 Hz (X5) ≤−0.238, and Fres ≥20.88 revealed significant univariable relationships with bronchiectasis severity (p

Background It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and 100 and

BackgroundDiapers are commonly used by older patients with urination disorders. A smart diaper system (SDS) may be able to estimate the weight of urine comparably to conventional measurements made by weighing diapers. ObjectiveThe aim of the current research is to determine the degree of accuracy of an SDS technology specifically designed for the management of urination routines and the use of incontinence pads in older adults. MethodsFrom January to December 2022, 97 older patients with at least 1 chronic disease from 3 nursing homes were included. In this study, the SDS was used for 1 month per patient after obtaining their consent; all patients originally used traditional diapers in the nursing home. The index test measured the change in electrical resistance of the SDS and the reference test measured the change in actual urine weight. When measuring the actual urine weight, the degree of absorption was directly confirmed with the naked eye because the expression value varied according to pressure changes caused by the user’s movement or position. The Pearson correlation was used to determine the correlation between the 2 test methods, the intraclass correlation coefficient (ICC) was used to check the degree of agreement between the evaluators, and the Bland-Altman test was used to confirm whether there was a significant difference between the 2 test methods. ResultsThe average age of the 97 participants was 86.48 (SD 6.26) years, with 10 men and 87 women. There were 73 patients (75%) with hypertension, 86 patients (88%) with dementia, and 86 patients (88%) with 2 or more comorbidities, accounting for the majority. The Pearson correlation coefficient and ICC were 0.971 and 0.985 (P

PurposeThe use of artificial intelligence (AI) for chest X-ray (CXR) analysis is becoming increasingly prevalent in medical environments. This study aimed to determine whether AI in CXR can unexpectedly detect lung nodule detection and influence patient diagnosis and management in non-respiratory outpatient clinics.MethodsIn this retrospective study, patients over 18 years of age, who underwent CXR at Yongin Severance Hospital outpatient clinics between March 2021 and January 2023 and were identified to have lung nodules through AI software, were included. Commercially available AI-based lesion detection software (Lunit INSIGHT CXR) was used to detect lung nodules.ResultsOut Of 56,802 radiographic procedures, 40,191 were from non-respiratory departments, with AI detecting lung nodules in 1,754 cases (4.4%). Excluding 139 patients with known lung lesions, 1,615 patients were included in the final analysis. Out of these, 30.7% (495/1,615) underwent respiratory consultation and 31.7% underwent chest CT scans (512/1,615). As a result of the CT scans, 71.5% (366 cases) were found to have true nodules. Among these, the final diagnoses included 36 lung cancers (7.0%, 36/512), 141 lung nodules requiring follow-up (27.5%, 141/512), 114 active pulmonary infections (22.3%, 114/512), and 75 old inflammatory sequelae (14.6%, 75/512). The mean AI nodule score for lung cancer was significantly higher than that for other nodules (56.72 vs. 33.44, p < 0.001). Additionally, active pulmonary infection had a higher consolidation score, and old inflammatory sequelae had the highest fibrosis score, demonstrating differences in the AI analysis among the final diagnosis groups.ConclusionThis study indicates that AI-detected incidental nodule abnormalities on CXR in non-respiratory outpatient clinics result in a substantial number of clinically significant diagnoses, emphasizing AI’s role in detecting lung nodules and need for further evaluation and specialist consultation for proper diagnosis and management.

Purpose: To investigate the various strategies used for the treatment of premature ejaculation (PE); these encompassed behavioral, drug and surgical interventions. Materials and Methods: We retrieved data from electronic literature searches of PubMed and Cochrane library using the MeSH (Medical Subject Headings terms) and text keywords from the earliest available date of indexing through September 2022. The subject headings and text keywords included those related to the population (male patients with PE), interventions & comparisons (mono and combination treatment), and outcomes (ejaculation latency time, ELT). Results: The initial search identified a total of 454 articles from electronic databases. Finally, a total of 10,474 patients from 59 direct comparison trials were included 143 effect sizes with 43 treatments. Of these, 9 of mono treatments and 4 of combination treatments were statistically significant. Pharmaceutical agents commonly used for patients with PE are prescribed off-label, except for dapoxetine. The surface under the cumulative ranking curve values of ranking probabilities for each treatment performance, which indicated that tramadol 100 mg ranked first in terms of ELT. Conclusions: Medications recommended by the American Urological Association and the Sexual Medicine Society of North America were all incorporated within the present review, together with additional management approaches that have been evaluated in randomized controlled trials. The findings indicated that in addition to SSRIs, tramadol, clomipramine, topical agents and PDE5 inhibitors could be used in the therapy of PE.

Abstract Background Despite the publication of several meta-analyses regarding the efficacy of certain therapies in helping individuals with interstitial cystitis (IC) / bladder pain syndrome (BPS), these have not provided a comprehensive review of therapeutic strategies. The study aimed to determine the efficacy of various therapies for IC/BPS and identify potential moderating factors using randomized controlled trials (RCTs). Methods We queried the PubMed, Cochrane, and Embase databases to identify prospective RCTs using inclusion criteria: 1) patients diagnosed with IC, 2) interventions included relevant treatments, 3) comparisons were a specified control or placebo, 4) outcomes were mean differences for individual symptoms and structured questionnaires. The pairwise meta-analysis and network meta-analysis (NMA) were performed to compare the treatments used in IC/BPS. Hedges’ g standardized mean differences (SMDs) were used for improvement in all outcomes using random-effects models. Efficacy outcomes included individual symptoms such as pain, frequency, urgency, and nocturia, as well as structured questionnaires measuring IC/BPS symptoms. Results A comprehensive literature search was conducted which identified 70 RCTs with 3,651 patients. The analysis revealed that certain treatments, such as instillation and intravesical injection, showed statistically significant improvements in pain and urgency compared to control or placebo groups in traditional pairwise meta-analysis. However, no specific treatment demonstrated significant improvement in all outcomes measured in the NMA. The results of moderator analyses to explore influential variables indicated that increasing age was associated with increased nocturia, while longer follow-up periods were associated with decreased frequency. Conclusion This systematic review and meta-analysis provide insights into the efficacy of various treatments for IC. Current research suggests that a combination of therapies may have a positive clinical outcome for patients with IC, despite the fact that treatment for this condition is not straightforward. Trial registration PROSPERO CRD42022384024

Abstract Genetic neuromuscular diseases are clinically and genetically heterogeneous genetic disorders that primarily affect the peripheral nerves, muscles, and neuromuscular junctions. This study aimed to identify pathogenic variants, calculate carrier frequency, and predict the genetic prevalence of autosomal recessive neuromuscular diseases (AR-NMDs). We selected 268 AR-NMD genes and analyzed their genetic variants sourced from the gnomAD database. After identifying the pathogenic variants using an algorithm, we calculated the carrier frequency and predicted the genetic prevalence of AR-NMDs. In total, 10,887 pathogenic variants were identified, including 3848 literature verified and 7039 manually verified variants. In the global population, the carrier frequency of AR-NMDs is 32.9%, with variations across subpopulations ranging from 22.4% in the Finnish population to 36.2% in the non-Finnish European population. The predicted genetic prevalence of AR-NMDs was estimated to be 24.3 cases per 100,000 individuals worldwide, with variations across subpopulations ranging from 26.5 to 41.4 cases per 100,000 individuals in the Latino/Admixed American and the Ashkenazi Jewish populations, respectively. The AR-NMD gene with the highest carrier frequency was GAA (1.3%) and the variant with the highest allele frequency was c.-32-13 T>G in GAA with 0.0033 in the global population. Our study revealed a higher-than-expected frequency of AR-NMD carriers, constituting approximately one-third of the global population, highlighting ethnic heterogeneity in genetic susceptibility.

Abstract Curcuma longa L. extract (CLE) exerts various biological functions including antioxidant, anti-inflammation, anticancer, and antiallergenic effects. However, its immune-enhancing capacity remains unclear. Therefore, the immune-enhancing effect of CLE was investigated in RAW 264.7 cells and cyclophosphamide (CPP)-induced immunosuppression model. CLE upregulated nitric oxide (NO) and reactive oxygen species production and increased inducible nitric oxide synthase and cyclooxygenase-2 expression without affecting the RAW 264.7 cells viability. The results of quantitative real-time reverse transcription polymerase chain reaction and sandwich enzyme-linked immunosorbent assay showed that CLE increased the gene expression and protein levels of tumor necrosis factor-α, interleukin-6, and interleukin-1β in RAW 264.7 cells. Moreover, CLE upregulated p65, I kappa B kinase α/β, and I kappa B α (IκBα) phosphorylation and downregulated IκBα expression in RAW 264.7 cells. CLE also increased p65 translocation from the cytoplasmic to the nucleus in RAW 264.7 cells. The oral administration of CLE increased organ indexes (including the spleen and thymus) and NO production in peritoneal macrophages and improved natural killer cell activity in CPP-induced immunosuppression BALB/c mice. Overall, CLE could be a useful health functional food material that can improve innate immunity via macrophage activation.

Abstract BackgroundA large language model is a type of artificial intelligence (AI) model that opens up great possibilities for health care practice, research, and education, although scholars have emphasized the need to proactively address the issue of unvalidated and inaccurate information regarding its use. One of the best-known large language models is ChatGPT (OpenAI). It is believed to be of great help to medical research, as it facilitates more efficient data set analysis, code generation, and literature review, allowing researchers to focus on experimental design as well as drug discovery and development. ObjectiveThis study aims to explore the potential of ChatGPT as a real-time literature search tool for systematic reviews and clinical decision support systems, to enhance their efficiency and accuracy in health care settings. MethodsThe search results of a published systematic review by human experts on the treatment of Peyronie disease were selected as a benchmark, and the literature search formula of the study was applied to ChatGPT and Microsoft Bing AI as a comparison to human researchers. Peyronie disease typically presents with discomfort, curvature, or deformity of the penis in association with palpable plaques and erectile dysfunction. To evaluate the quality of individual studies derived from AI answers, we created a structured rating system based on bibliographic information related to the publications. We classified its answers into 4 grades if the title existed: A, B, C, and F. No grade was given for a fake title or no answer. ResultsFrom ChatGPT, 7 (0.5%) out of 1287 identified studies were directly relevant, whereas Bing AI resulted in 19 (40%) relevant studies out of 48, compared to the human benchmark of 24 studies. In the qualitative evaluation, ChatGPT had 7 grade A, 18 grade B, 167 grade C, and 211 grade F studies, and Bing AI had 19 grade A and 28 grade C studies. ConclusionsThis is the first study to compare AI and conventional human systematic review methods as a real-time literature collection tool for evidence-based medicine. The results suggest that the use of ChatGPT as a tool for real-time evidence generation is not yet accurate and feasible. Therefore, researchers should be cautious about using such AI. The limitations of this study using the generative pre-trained transformer model are that the search for research topics was not diverse and that it did not prevent the hallucination of generative AI. However, this study will serve as a standard for future studies by providing an index to verify the reliability and consistency of generative AI from a user’s point of view. If the reliability and consistency of AI literature search services are verified, then the use of these technologies will help medical research greatly.

Purpose: To investigate the efficacy of medical treatment options for Peyronie's disease (PD) including oral drugs, intralesional treatment and mechanical treatment compared with placebo treatment using network meta-analysis (NMA). Materials and Methods: We searched the randomized controlled trials (RCTs) of PD in PubMed, Cochrane library, and EMBASE up to October 2022. RCTs included medical treatment options: oral drugs, intralesional treatment and mechanical treatment. Studies reporting at least one of the outcome measures of interest including curvature degree, plaque size, and structured questionnaires (International Index of Erectile Function, IIEF) were included. Results: Finally, 24 studies including 1,643 participants met our selection criteria for NMA. There was no statistically significant treatment compared to placebo of the curvature degree, plaque size, IIEF in Bayesian analysis. The SUCRA values of ranking probabilities for each treatment performance, which indicated that hyperthermia device ranked first in NMA. However, in frequentist analysis, 7 of mono treatments (coenzyme Q10 [CoQ10] 300 mg, hyperthermia device, interferon alpha 2b, pentoxifylline 400 mg, propionyl-L-carnitine 1 g, penile traction therapy [PTT], vitamin E 300 mg) and 2 of combination treatments (“PTT–extracorporeal shockwave treatment”, “vitamin E 300 mg–propionyl-L-carnitine 1 g”) were statistically significant for improvement of curvature degree, and 9 of mono treatments (CoQ10 300 mg, hyaluronic acid 16 mg, hyperthermia device, interferon alpha 2b, pentoxifylline 400 mg, propionyl-L-carnitine 1 g, verapamil 10 mg, vitamin E 300 mg, vitamin E 400 U) and 3 of combination treatments ("interferon alpha 2b–vitamin E 400 U", "verapamil 10 mg–antioxidants", “vitamin E 300 mg–propionyl-L-carnitine 1 g”) were statistically significant in the improvement of plaque size. Conclusions: At present, there is no clinical treatment alternatives that have been demonstrated to be effective compared to placebo. Nonetheless, as the frequentist approach has shown that a number of agents are efficacious, further research is expected to develop more effective treatment options.

Abstract The increased risk of hearing loss with macrolides remains controversial. We aimed to systematically review and meta-analyze data on the clinical risk of hearing loss, tinnitus, and ototoxicity following macrolide use. A systematic search was conducted across PubMed, MEDLINE, Cochrane, and Embase databases from database inception to May 2023. Medical Subject Heading (MeSH) terms and text keywords were utilized, without any language restrictions. In addition to the electronic databases, two authors manually and independently searched for relevant studies in the US and European clinical trial registries and Google Scholar. Studies that involved (1) patients who had hearing loss, tinnitus, or ototoxicity after macrolide use, (2) intervention of use of macrolides such as azithromycin, clarithromycin, erythromycin, fidaxomicin, roxithromycin, spiramycin, and/or telithromycin, (3) comparisons with specified placebos or other antibiotics, (4) outcomes measured as odds ratio (OR), relative risk (RR), hazard ratio (HR), and mean difference for ototoxicity symptoms using randomized control trial (RCT)s and observational studies (case–control, cross-section, and cohort studies) were included. Data extraction was performed independently by two extractors, and a crosscheck was performed to identify any errors. ORs along with their corresponding 95% confidence intervals (CIs) were estimated using random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines for RCTs and Meta-Analysis of Observational Studies in Epidemiology guidelines for observational studies were followed. We assessed the hearing loss risk after macrolide use versus controls (placebos and other antibiotics). Based on data from 13 studies including 1,142,021 patients (n = 267,546 for macrolide and n = 875,089 for controls), the overall pooled OR was 1.25 (95% CI 1.07–1.47). In subgroup analysis by study design, the ORs were 1.37 (95% CI 1.08–1.73) for RCTs and 1.33 (95% CI 1.24–1.43) for case–control studies, indicating that RCT and case–control study designs showed a statistically significant higher risk of hearing loss. The group with underlying diseases such as multiple infectious etiologies (OR, 1.16 [95% CI 0.96–1.41]) had a statistically significant lower risk than the group without (OR, 1.53 [95% CI 1.38–1.70] P = .013). The findings from this systematic review and meta-analysis suggest that macrolide antibiotics increase the risk of hearing loss and that healthcare professionals should carefully consider this factor while prescribing macrolides.

Setting the population, intervention, comparison, and outcome (PICO) elements during a search strategy development stage for a systematic review (SR) defines a research question specifically. In contrast to traditional methods that rely on researcher discretion, we propose a text network analysis (TNA) method using the R language to set the correct basis for the PICO. First, we collected 80 related papers from the PubMed database using ‘Health Impact Assessment of arsenic exposure’ as an example topic. Next, we recorded the keywords of each paper into a dataframe and converted the dataframe into an edge list format to create a network. Finally, we confirmed the connectivity and frequency of each keyword through network visualization and the importance of keywords according to three metrics through centrality analysis. As a result, arsenic could be expected to have detrimental effects on the occurrence of heart- and blood-related diseases or on mothers. By setting important keywords as the PICO elements known through a TNA, the reliability of SRs is improved, and this methodology can be equally applied to various topics.

This paper was to present how an affordable, high-temperature, interlaminar tension (ILT) strength testing method was explored and developed for ceramic matrix composites (CMCs), leading to development of a diametral-compression test methodology. The test methodology was first delved and verified at ambient temperature by employing a model, 2D-woven polymer matrix composite (PMC) with various test-specimen configurations. The test method was then applied to and confirmed with two different gas-turbine grade CMCs of 2D melt-infiltrated (MI) SiC/SiC and 2D N720/alumina oxide/oxide at both ambient and elevated temperatures. Life prediction testing was also conducted at 1316°C for the MI SiC/SiC to validate the effectiveness of test method for a long-term life prediction testing. All of the results on strength and life prediction testing indicated an applicability and feasibility as an appropriate high-temperature ILT test methodology in CMCs with provisions of simplicity, affordability, and technical soundness. [ABSTRACT FROM AUTHOR]

Purpose: Healthy aging is an important concern in an aging society. Although the causal relationship between hypogonadism and erectile dysfunction in elderly men remains unclear, many physicians have achieved positive results after implementing exogenous testosterone supplementation therapy in patients with normal or slightly low blood testosterone. The purpose of this study was to conduct a systematic review and meta-analysis on whether testosterone replacement therapy (TRT) could improve sexual function in the elderly, as reported recently. Materials and Methods: As a comprehensive literature search was performed to find articles published in PubMed, Embase, and Cochrane databases by January 2022. The search used keywords of ‘aged’, ‘male’, ‘sexual behavior’, and ‘testosterone’. Randomized controlled trials (RCTs) were finally selected. As the main effect variable, results of a questionnaire on sexual function were analyzed and the effects of TRT were compared to those of placebo control. Results: Five RCT studies were included in this meta-analysis. The overall improvement by mean difference of sexual function for testosterone supplementation was 0.082 (95% CI: -0.049 to 0.213). In subgroup analysis, only intramuscular injection of 1,000 mg testosterone significantly improved sexual function of the elderly (0.229, 95% CI: 0.112 to 0.347). There was no significant difference in sexual function according to testosterone dose in meta-ANOVA (p=0.957). The difference was not statistically significant either in the meta-regression test (p=0.310). Egger’s regression coefficient test did not indicate a publication bias (p=0.132). Conclusions: Although our overall effect size (that is, sexual function effect of TRT) did not show a significant improvement, the direction of improvement in erection and motivation was clearly shown. The injection formulation resulted in a significant sexual function improvement. Since only a few RCTs were included in the analysis, more well-designed prospective studies are needed to have a definite conclusion.

Background Coronary artery calcium score (CACS) has become an important tool for evaluating cardiovascular disease (CVD). This study evaluated the significance of CACS for future CVD through more than 10 years of follow-up in asymptomatic Korean populations with type 2 diabetes mellitus (T2DM) known to have a relatively low CACS burden. Methods We enrolled 981 asymptomatic T2DM patients without CVD at baseline who underwent CACS evaluation using multidetector computed tomography between January 2008 and December 2014. They were grouped into five predefined CACS categories based on Agatston scores and followed up by August 2020. The primary endpoint was incident CVD events, including coronary, cerebrovascular, and peripheral arterial disease. Results The relative risk of CVD was significantly higher in patients with CACS ≥10, and the significance persisted after adjustment for known confounders. A higher CACS category indicated a higher incidence of future CVD: hazard ratio (95% confidence interval) 4.09 (1.79 to 9.36), 12.00 (5.61 to 25.69), and 38.79 (16.43 to 91.59) for 10≤ CACS

COVID-19 pandemic clearly demonstrates that seafarers are essential for sustaining world shipping services and global supply chain. Understanding the characteristics of supply and demand in seafarer market will be a solution for the bottleneck issues of seafarer change and shipping services. This paper explores the supply and demand of seafarer market in Korea and evaluates the effects of COVID-19 on both supply and demand sides of Korean seafarers by adopting regression models with panel data for the supply and time series data for the demand. First, this paper finds that the effects of COVID-19 are negative in the demand of Korean seafarer market even with the wider increase of tonnage of the Korean flagged ships in 2020. The demand shock seems to be resulted by the traveling restriction and stricter immigration measures to travellers after the announcement of COVID-19 pandemic. Second, supply in the regression models of panel data is affected negatively after declaration of the COVID-19 pandemic in 2020. The COVID-19 pandemic may trigger the hesitation of seafaring due to the travelling restriction and bottlenecks from seafarer changes onboard. Besides these findings, the correlation coefficients between the number of Korean seafarers of merchant ships and merchant fleet illustrate a diverse relationship between the two. The expansion of Korean ocean-going fleet is accompanied by the decrease of Korean seafarers on the Korean flag. The employment of foreign seafarers since 1992 has resulted in the continual decrease of ratings employment in the Korean flagged ships. The inflow of foreign deck officers in the Korean flagged ships after 2005 could lessen the officer deficiency caused by high separation rate of Korean deck officers. This inflow implies that seafarer market in a country not only affects global seafarer market in the world through the changes of seafarer supply and demand in the country, but is affected by the global market. The dual markets of Korean seafarers in ocean-going and coastal shipping present the following phenomena: severe aging of seafarers in coastal shipping and wider difference in welfare level of seafarers between the two. Further research on wage and career advancement of Korean seafarers would widen and deepen our understanding on seafarer market both for Korea and the rest of the world.

Purpose Surgical management of obstructive left colon cancer (OLCC) is still a matter of debate. The classic Hartmann procedure (HP) has a disadvantage that requires a second major operation. Subtotal colectomy/total abdominal colectomy (STC/TC) with ileosigmoid or ileorectal anastomosis is proposed as an alternative procedure to avoid stoma and anastomotic leakage. However, doubts about morbidity and functional outcome and lack of long-term outcomes have made surgeons hesitate to perform this procedure. Therefore, this trial was designed to provide data for morbidity, functional outcomes, and long-term outcomes of STC/TC. Methods This study retrospectively analyzed consecutive cases of OLCC that were treated by STC/TC between January 2000 and November 2020 at a single tertiary referral center. Perioperative outcomes and long-term outcomes of STC/TC were analyzed. Results Twenty-five descending colon cancer (45.5%) and 30 sigmoid colon cancer cases (54.5%) were enrolled in this study. Postoperative complications occurred in 12 patients. The majority complication was postoperative ileus (10 of 12). Anastomotic leakage and perioperative mortality were not observed. At 6 to 12 weeks after the surgery, the median frequency of defecation was twice per day (interquartile range, 1–3 times per day). Eight patients (14.5%) required medication during this period, but only 3 of 8 patients required medication after 1 year. The 3-year disease-free survival was 72.7% and 3-year overall survival was 86.7%. Conclusion The risk of anastomotic leakage is low after STC/TC. Functional and long-term outcomes are also acceptable. Therefore, STC/TC for OLCC is a safe, 1-stage procedure that does not require diverting stoma.

Abstract Aim The aim of the study was to determine the multiple potential contributing factors in preventive behaviours, including COVID‐19 vaccination for an effective campaign strategy. Design This is a descriptive correlation study to examine the effects of the behavioural outcome, attitude, subjective norm, perceived behavioural control, optimistic bias and social stigma on the intention of preventive behaviour, based on Ajen's Theory of Planned Behaviour. Methods The survey was performed by a professional research company online from 16–19 July 2021. Two hundred and thirty‐three participants who had not been vaccinated against COVID‐19 at the time of data collection completed the survey. Results Perceived benefit, perceived behavioural control and social stigma are significantly associated with intention of preventive behaviours. The factors engaging in preventive behaviour presents us that our society is strongly influenced by social groups. Social groups influence decision‐making in intention of preventing behaviour. Public education using social networks can increase such desirable behaviour.

Background Little is known about the adverse events (AEs) associated with coronavirus disease 2019 (COVID-19) vaccination in patients with type 2 diabetes mellitus (T2DM). Methods This study used vaccine AE reporting system data to investigate severe AEs among vaccinated patients with T2DM. A natural language processing algorithm was applied to identify people with and without diabetes. After 1:3 matching, we collected data for 6,829 patients with T2DM and 20,487 healthy controls. Multiple logistic regression analysis was used to calculate the odds ratio for severe AEs. Results After COVID-19 vaccination, patients with T2DM were more likely to experience eight severe AEs than controls: cerebral venous sinus thrombosis, encephalitis myelitis encephalomyelitis, Bell’s palsy, lymphadenopathy, ischemic stroke, deep vein thrombosis (DVT), thrombocytopenia (TP), and pulmonary embolism (PE). Moreover, patients with T2DM vaccinated with BNT162b2 and mRNA-1273 were more vulnerable to DVT and TP than those vaccinated with JNJ-78436735. Among patients with T2DM administered mRNA vaccines, mRNA-1273 was safer than BNT162b2 in terms of the risk of DVT and PE. Conclusion Careful monitoring of severe AEs in patients with T2DM may be necessary, especially for those related to thrombotic events and neurological dysfunctions after COVID-19 vaccination.

Cnidium monnieri fructus is widely used in traditional Oriental medicine for treating female genital disorders, male impotence, frigidity, and skin-related conditions in East Asia. However, the role of C. monnieri fructus extract (CMFE) in melanin synthesis is not well elucidated. This study aimed to investigate the anti-melanogenesis effect and mechanism of action of CMFE in α-MSH-stimulated B16F10 cells. Intracellular melanin content and tyrosinase activity were measured in α-MSH-stimulated B16F10 cells treated with various concentrations of CMFE (0.5–5 μg/mL). mRNA and protein levels of tyrosinase and MITF were evaluated using qRT-PCR and ting. CMFE’s effect on the proteasomal degradation of tyrosinase was confirmed using a proteasomal degradation inhibitor, MG132. CMFE treatment activated p38, a protein associated with proteasomal degradation. Treatment with CMFE at up to 5 μg/mL showed no significant cytotoxicity. CMFE significantly reduced α-MSH-stimulated melanin production (43.29 ± 3.55% decrease, p < 0.05) and cellular tyrosinase activity (31.14 ± 3.15% decrease, p < 0.05). Although mRNA levels of MITF and tyrosinase increased, CMFE suppressed tyrosinase protein levels. The suppressive effect of CMFE on tyrosinase protein was blocked by MG132. CMFE inhibited melanogenesis by promoting the proteasome degradation of tyrosinase through p38 activation. These findings suggest that CMFE has the potential to be a natural whitening agent for inhibiting melanogenesis.

Background & aimsGait disturbances are commonly observed in patients with neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, and higher-level gait disorders, which are associated with cholinergic deficits. We conducted a systematic review and meta-analysis to investigate the effects of rivastigmine on improvement in gait.MethodsA comprehensive literature search was conducted using Medical Subject Heading (MeSH) terms and text keywords related to gait and falls after rivastigmine treatment for neurodegenerative disorders. The intervention (rivastigmine), comparison (control or no treatment), and outcomes of improvement in gait speed and fall were assessed from database inception to April 2024. References and collected data were meticulously reviewed to ensure the integrity of the included studies. Standardized mean differences (SMDs) and Hedges'g, along with their 95% confidence intervals (Cls), were calculated for gait speed and number of falls.ResultsA total of 222 articles were identified during the initial search across different electronic databases, 50 including PubMed (n = 23), Cochrane (n = 19), Embase (n = 139), Scopus (n = 38), and a manual search (n = 3). Finally, we conducted a systematic review and meta-analysis focusing on the final four studies, encompassing 286 participants. The pooled SMD for the overall gait speed without a comparison group was 0.761 (95% CI: -1.165 to 2.688), indicating no significant improvement in gait speed. For the overall number of falls between the rivastigmine treatment and control groups, the pooled SMD was -0.366 (95% CI: -0.650 to -0.083). A statistically significant reduction in the number of falls was observed in the rivastigmine group than in the control group.ConclusionRivastigmine treatment in patients with neurodegenerative disorders tend to improve gait speed and significantly reduces fall incidence. Given the limited efficacy of current treatments for gait disturbances and falls, dual cholinesterase inhibitors like rivastigmine could be a promising therapeutic option.

BackgroundThere have been reports of otolaryngological adverse event following immunization (AEFI) such as instances of olfactory and gustatory dysfunction following COVID-19 vaccination. This study aimed to analyze otolaryngological AEFIs following COVID-19 vaccination.MethodsThis study was conducted with a secondary data analysis that the Vaccine Adverse Events Reporting System (VAERS) and the COVID-19 Data Tracker, which are both administered by the Centers for Disease Control and Prevention in the US. Using Medical Dictionary for Regulatory Activities (MedDRA) concepts, AEFIs included: Considering the overall frequency and similarity of symptoms in the first 153 PTs, they were grouped into major 19 AEFIs groups. The incidence rates (IRs) of AEFIs per 100,000 were calculated on individual and cumulative AEFIs levels, involving people who received complete primary series and an updated bivalent booster dose with one of the available COVID-19 vaccines in the US. The proportions of AEFIs by age, sex, and vaccine manufacturer were reported. We also calculated the proportional reporting ratio (PRR) of AEFIs.ResultsWe identified 106,653 otorhinolaryngologic AEFIs from the VAERS database, and a total of 226,593,618 people who received complete primary series in the US. Overall, the IR of total Otorhinolaryngologic AEFIs was 47.068 of CPS (completed primary series) and 7.237 UBB (updated bivalent booster) per 100,000. For most symptoms, being female was associated with statistically significant higher AEFIs. Upon examining the impact of different vaccine manufacturers, the researchers found that Janssen’s vaccine exhibited higher IRs for hearing loss (5.871), tinnitus (19.182), ear infection (0.709), dizziness (121.202), sinusitis (2.088), epistaxis (4.251), anosmia (5.264), snoring (0.734), allergies (5.555), and pharyngitis (5.428). The highest PRRs were for Anosmia (3.617), Laryngopharyngeal Reflux - Acid Reflux (2.632), and Tinnitus -Ringing in the ears (2.343), in that order, with these three significantly incidence than other background noises.ConclusionThis study, utilizing an extensive sample sizes, represents a significant step toward comprehensively characterizing the otolaryngological AEFIs associated with COVID-19 vaccinations. This large-scale analysis aims to move beyond isolated case reports and anecdotal evidence, providing a robust and detailed portrait of the otolaryngological AEFIs landscape in response to COVID-19 vaccinations.

Purpose: Cardiovascular disease (CVD) is one of the leading causes of death, accounting for one-third of all deaths worldwide. Patients with CVD are three times more likely to complain of sexual dysfunction than healthy people. Causes of sexual dysfunction in patients with CVD include physical/mental changes and drug side effects. The prevalence of sexual dysfunction in patients with CVD has been estimated to be up to 89%. Ordinary treatments such as pharmacotherapy cannot effectively reduce sexual problems. Therefore, sexual rehabilitation has a broad spectrum, including exercise therapy such as pelvic floor muscle treatment, appropriate counseling, a multidisciplinary approach, and partner rehabilitation. In this study, systematic review and meta-analysis was performed to investigate the effect of sexual rehabilitation on sexual problems in patients with CVD. Materials and Methods: Comprehensive literature searches were conducted using MEDLINE, Cochrane Library electronic database, and EMBASE through June 2022. Questionnaire scores at the end point as outcomes of the study were recorded as were standardized mean difference (SMD) with their 95% confidence intervals (CIs). Meta-regression analysis was conducted for each moderator. We performed a risk of bias evaluation for included studies using the RoB 2 tool. Results: The overall SMD in the meta-analysis for sexual rehabilitation versus no-sexual rehabilitation was 0.430 (95% CI, 0.226–0.633). There was a statistical difference between groups. SMD changes were 0.674 (95% CI, 0.308–1.039) at one month and 0.320 (95% CI, 0.074–0.565) at six months. The regression analysis with all variables (number of patients, study duration, and questionnaire types) revealed no significance. Conclusions: This study indicates that sexual rehabilitation is an effective method with high therapeutic potential for sexual dysfunction of patients with CVD. However, for clinical application, well-designed studies with many patients should be conducted in the future and the standardization of rehabilitation protocols is required.

Abstract Photobiomodulation (PBM) is a therapeutic tool that uses red or near-infrared light in medical applications. It’s applications in both central (CNS) and peripheral nervous system (PNS) are widely studied. Among glial cells, astrocytes are known to be activated in injured or damaged brains. Astrocytic cell migration is crucial for maintaining homeostasis in the brain. Our previous study showed that PBM led to astrocyte proliferation and differentiation, but the effects on migration has not been investigated. The aim of this study was to evaluate the effect of PBM on astrocyte migration, drebrin (DBN) expression and cytoplasmic morphology using primary cultured rat astrocyte. We applied a 660-nm light-emitting diode (LED) with fluence of 6, 12 and 18 J/cm2. PBM effects on astrocyte migration were analyzed by two different migration assays (scratch assay and transwell assay). We used immunofluorescence microscopy for visualizing DBN and glial-fibrillary acidic protein (GFAP) and analysis of DBN expression and astrocyte cytoplasmic morphology. Both scratch assay and transwell assay showed significant difference in astrocyte migration following PBM irradiation. With these specific fluence conditions, differences in DBN expression and cell morphology were revealed. PBM could increase the astrocyte migration by altering the cell morphology and DBN expression pattern.

Abstract Background DNA mutations of diverse types provide the raw material required for phenotypic variation and evolution. In the case of crop species, previous research aimed to elucidate the changing patterns of repetitive sequences, single-nucleotide polymorphisms (SNPs), and small InDels during domestication to explain morphological evolution and adaptation to different environments. Additionally, structural variations (SVs) encompassing larger stretches of DNA are more likely to alter gene expression levels leading to phenotypic variation affecting plant phenotypes and stress resistance. Previous studies on SVs in rice were hampered by reliance on short-read sequencing limiting the quantity and quality of SV identification, while SV data are currently only available for cultivated rice, with wild rice largely uncharacterized. Here, we generated two genome assemblies for O. rufipogon using long-read sequencing and provide insights on the evolutionary pattern and effect of SVs on morphological traits during rice domestication. Results In this study, we identified 318,589 SVs in cultivated and wild rice populations through a comprehensive analysis of 13 high-quality rice genomes and found that wild rice genomes contain 49% of unique SVs and an average of 1.76% of genes were lost during rice domestication. These SVs were further genotyped for 649 rice accessions, their evolutionary pattern during rice domestication and potential association with the diversity of important agronomic traits were examined. Genome-wide association studies between these SVs and nine agronomic traits identified 413 candidate causal variants, which together affect 361 genes. An 824-bp deletion in japonica rice, which encodes a serine carboxypeptidase family protein, is shown to be associated with grain length. Conclusions We provide relatively accurate and complete SV datasets for cultivated and wild rice accessions, especially in TE-rich regions, by comparing long-read sequencing data for 13 representative varieties. The integrated rice SV map and the identified candidate genes and variants represent valuable resources for future genomic research and breeding in rice.

Objectives Postprostatectomy urinary incontinence (PPUI) is a serious complication despite surgical advances. Treatment options for PPUI include conservative care like Pelvic floor muscle exercise (PFME), which is a physiotherapy performed by the patients themselves; Pelvic floor muscle therapy (PFMT), a physiotherapy performed under the guidance of a therapist, and duloxetine treatment; and surgical interventions. In this study, network meta-analysis (NMA) was performed for direct comparison of these treatment options. Materials and Methods The NMA pooled the odds ratios and 95% credible intervals using the number of patients achieving urinary continence and the total number of patients in an intention-to-treat population. The treatments were ranked based on the surface under the cumulative ranking curve (SUCRA) probabilities and the rankograms. Results The pooled overall ORs of patients achieving urinary continence compared with no treatment was 1.73 (95% CrI: 0.657, 4.71) in PFME, 2.62 (95% CrI: 0.553, 13.5) in PFME plus Duloxetine, and 4.05 (95% CrI: 1.70, 10.2) in PFMT. The SUCRA values of ranking probabilities for each treatment showed high rates of continence in the order of PFMT, PFME plus Duloxetine, and PFME. Conclusion The results suggest that patients with PPUI should undergo PFMT and consider duloxetine as an additional treatment option.

Abstract Euro 6 is the latest vehicle emission standards for pollutants such as CO, NO2 and PM, that all new vehicles must comply, and it was introduced in September 2015 in South Korea. This study examined the effect of Euro 6 by comparing the measured pollutant concentrations after 2016 (Euro 6–era) to the estimated concentrations without Euro 6. The concentration without Euro 6 was estimated by first modeling the air quality using various environmental factors related to diesel vehicles, meteorological conditions, temporal information such as date and precursors in 2002–2015 (pre–Euro 6–era), and then applying the model to predict the concentration after 2016. In this study, we used both recurrent neural network (RNN) and random forest (RF) algorithms to model the air quality and showed that RNN can achieve higher R2 (0.634 ~ 0.759 depending on pollutants) than RF, making it more suitable for air quality modeling. According to our results, the measured concentrations during 2016–2019 were lower than the concentrations predicted using RNN by − 1.2%, − 3.4%, and − 4.8% for CO, NO2 and PM10. Such reduction can be attributed to the result of Euro 6.

Abstract Among the five members of the dual-specificity tyrosine-phosphorylation-regulated kinase (DYRK) family, the cellular functions of DYRK3 have not been fully elucidated. Some studies have indicated limited physiological roles and substrates of DYRK3, including promotion of glioblastoma, requirement in influenza virus replication, and coupling of stress granule condensation with mammalian target of rapamycin complex 1 signaling. Here, we demonstrate that serum deprivation causes a decrease in intracellular DYRK3 levels via the proteolytic autophagy pathway, as well as the suppression of DYRK3 gene expression. To further demonstrate how DYRK3 affects cell viability, especially in neurons, we used a yeast two-hybrid assay and identified multiple DYRK3-binding proteins, including SNAPIN, a SNARE-associated protein implicated in synaptic transmission. We also found that DYRK3 directly phosphorylates SNAPIN at the threonine (Thr) 14 residue, increasing the interaction of SNAPIN with other proteins such as dynein and synaptotagmin-1. In central nervous system neurons, SNAPIN is associated with and mediate the retrograde axonal transport of diverse cellular products from the distal axon terminal to the soma and the synaptic release of neurotransmitters, respectively. Moreover, phosphorylation of SNAPIN at Thr-14 was found to positively modulate mitochondrial retrograde transport in mouse cortical neurons and the recycling pool size of synaptic vesicles, contributing to neuronal viability. In conclusion, the present study demonstrates that DYRK3 phosphorylates SNAPIN, positively regulating the dynein-mediated retrograde transport of mitochondria and SNARE complex-mediated exocytosis of synaptic vesicles within the neurons. This finding further suggests that DYRK3 affects cell viability and provides a novel neuroprotective mechanism.

Purpose Surgery to create a stoma for decompression might be required for unresectable stage IV cancer patients with complete colonic obstruction. The aim of this study was to compare the results of blowhole colostomy with those of loop ostomy. Methods Palliative ileostomy or colostomy procedures performed at a single center between January 2011 and October 2020, were analyzed retrospectively. Fifty-nine patients were identified during this period. The demographic characteristics and outcomes between the blowhole colostomy group (n=24) and the loop ostomy group (n=35) were compared. Results The median operative time tended to be shorter in the blowhole colostomy group (52.5 minutes; interquartile range [IQR], 43–65) than in the loop ostomy group (60 minutes; IQR, 40–107), but the difference did not reach statistical significance (P=0.162). The median length of hospital stay was significantly shorter with blowhole colostomy (blowhole, 13 days [IQR, 9–23]; loop, 21 days [IQR, 14–37]; P=0.013). Mean cecum diameter was significantly larger in the blowhole group than in the loop group (8.83±1.91 cm vs. 6.78±2.36 cm, P=0.001), and the emergency operation rate was higher in the blowhole group than in the loop group (22 of 24 [91.7%] vs. 23 of 35 [65.7%], P=0.021). Conclusion In surgical emergencies, diverting a blowhole colostomy can be safe and effective for palliative management of colonic obstruction in patients with end-stage cancer and might reduce the operative time in emergent situations.

This study was conducted to estimate the effectiveness of marine-derived resources for treating specific diseases, as well as identify the most effective methods for applying such resources in therapeutic applications. Bibliographic databases (PubMed, Embase, and Cochrane) were searched from their inception until May 2023 using Medical Subject Headings terms and text keywords related to seawater, mineral water, or ocean therapy. Fifteen eligible studies were included, involving 1325 participants aged 42.7–63.0 years. In the subgroup analysis based on treatment type, the mean difference was −1.581 (95% CI: −1.889, −1.274) for seawater with sun exposure and −1.210 (95% CI: −1.417, −1.002) for seawater with sun exposure, mud pack application, and sulfur pool therapy. The pooled standardized mean difference was calculated for different outcomes; the results were −1.110 (95% CI: −3.028, 0.806) for osteoarthritis severity, −0.795 (95% CI: −0.982, −0.607) for arthritis pain, −1.623 (95% CI: −2.036, −1.209) for fibromyalgia pain, and −1.498 (95% CI: −1.888, −1.108) for quality of life. Marine therapy is, therefore, promising for treating chronic skin issues, easing musculoskeletal discomfort, and enhancing the quality of life among patients with musculoskeletal pain.

Whole-brain imaging is important for understanding brain functions through deciphering tissue structures, neuronal circuits, and single-neuron tracing. Thus, many clearing methods have been developed to acquire whole-brain images or images of three-dimensional thick tissues. However, there are several limitations to imaging whole-brain volumes, including long image acquisition times, large volumes of data, and a long post-image process. Based on these limitations, many researchers are unsure about which light microscopy is most suitable for imaging thick tissues. Here, we compared fast-confocal microscopy with light-sheet fluorescence microscopy for whole-brain three-dimensional imaging, which can acquire images the fastest. To compare the two types of microscopies for large-volume imaging, we performed tissue clearing of a whole mouse brain, and changed the sample chamber and low- magnification objective lens and modified the sample holder of a light-sheet fluorescence microscope. We found out that light-sheet fluorescence microscopy using a 2.5× objective lens possesses several advantages, including saving time, large-volume image acquisitions, and high Z-resolution, over fast-confocal microscopy, which uses a 4× objective lens. Therefore, we suggest that light-sheet fluorescence microscopy is suitable for whole mouse brain imaging and for obtaining high-resolution three-dimensional images.

Robotic pancreatectomy, which has received attention in recent years, is subdivided into robotic distal pancreatectomy and robotic pancreatoduodenectomy. Benign and borderline malignant pancreatic tumors can be treated with robotic pancreatectomy, which has several advantages inherent to robotic surgery. The indications for robotic pancreatectomy are similar to those of laparoscopic pancreatectomy, and there are no absolute contraindications. The perioperative outcomes of robotic pancreatectomy are comparable to those of open or laparoscopic pancreatectomy. A high spleen preservation rate, low intraoperative blood loss, and a low open conversion rate are advantages of robotic pancreatectomy. Although robotic pancreatectomy is possible for the treatment of pancreatic cancer, appropriate case selection is required, and more research is needed.

Complications arising from breast augmentation procedures are broadly categorized as either surgery-related or prosthesis-related. Many reports have described complications associated with breast augmentation. However, to date, periareolar post-inflammatory hyperpigmentation (PIH) after breast augmentation has not been reported. Herein, we report a case of PIH after augmentation mammoplasty using a silicone implant through the periareolar approach. A 35-year-old woman, who underwent bilateral breast augmentation using a periareolar approach, presented with bilateral periareolar tissue changes, with dark brown, irregular macules appearing 6 weeks postoperatively. Based on clinical symptoms and histological examination, the lesion was diagnosed as PIH. Topical hydroquinone and retinoic acid were applied for 8 weeks after the pigmentation appeared. After 6 months of observation, the pigmentation faded. To summarize, we report a case of pigmentation around the bilateral nipples after periareolar breast augmentation along with a literature review.

Abstract Background Pneumocystis jirovecii pneumonia (PCP) with acute respiratory failure can result in development of pneumothorax during treatment. This study aimed to identify the incidence and related factors of pneumothorax in patients with PCP and acute respiratory failure and to analyze their prognosis. Methods We retrospectively reviewed the occurrence of pneumothorax, including clinical characteristics and results of other examinations, in 119 non-human immunodeficiency virus patients with PCP and respiratory failure requiring mechanical ventilator treatment in a medical intensive care unit (ICU) at a tertiary-care center between July 2016 and April 2019. Results During follow up duration, twenty-two patients (18.5%) developed pneumothorax during ventilator treatment, with 45 (37.8%) eventually requiring a tracheostomy due to weaning failure. Cytomegalovirus co-infection (odds ratio 13.9; p = 0.013) was related with occurrence of pneumothorax in multivariate analysis. And development of pneumothorax was not associated with need for tracheostomy and mortality. Furthermore, analysis of survivor after 28 days in ICU, patients without pneumothorax were significantly more successful in weaning from mechanical ventilator than the patients with pneumothorax (44% vs. 13.3%, p = 0.037). PCP patients without pneumothorax showed successful home discharges compared to those who without pneumothorax (p = 0.010). Conclusions The development of pneumothorax increased in PCP patient with cytomegalovirus co-infection, pneumothorax might have difficulty in and prolonged weaning from mechanical ventilators, which clinicians should be aware of when planning treatment for such patients.

As the degradation of polymer electrolyte membranes (PEMs) shows catastrophic failures with pinholes and cracks, studies on PEM degradation are essential to improve the reliability and lifetime of polymer electrolyte membrane fuel cell (PEMFC) membrane electrode assemblies (MEAs). However, the investigation of the degradation patterns and understanding of the degradation mechanisms of PEMs are still very limited at the PEMFC MEA level. Herein, open-circuit voltage (OCV) hold (chemical degradation) and humidity cycle test (mechanical degradation) protocols are applied to assess the durability of membrane components of PEMFC MEAs. OCV hold test is conducted at low relative humidity (30%) and OCV condition for 540 h. Humidity cycle test (5000 cycles) is carried out under repeating low (0%) and high (150%) relative humidities. We investigate degradation patterns and mechanisms of PEMs for MEAs after OCV hold and humidity cycle tests using various electrochemical and physicochemical analyses tools. The present study, by providing fundamental understanding of major degradation mechanisms, generates scientific information regarding design tools for the fabrication of highly durable PEMs. Additionally, this study, through accelerated degradation tests, can provide baseline information regarding the durability and lifetime of PEMs by statistically analyzing the deterioration pattern of MEAs.

IntroductionSuicide is an important public health problem. Well-established risk factors of suicide include depression, family history of mental disorders, substance problem, chronic physical illness, and others. Sensory impairment, especially visual impairment (VI), has a critical impact on both mental and physical health. However, the association between VI and risk of suicide has not been thoroughly investigated and remains controversial. Our aim is to systematically review and meta-analyze the current evidence on the association between VI and risk of suicide and to evaluate the direction and magnitude of the association.Methods and analysisWe aim to search PubMed, EMBASE and the Cochrane Library to identify all population-based studies on the association between VI and risk of suicide. Two reviewers will independently conduct study selection, data extraction and risk of bias (ROB) assessment. The Newcastle-Ottawa scale will be applied to evaluate the methodologic quality of the included studies for ROB assessment. The primary outcome measure will be the relative risk (RR) of suicide, and the secondary outcome measures will be the risks of suicidal ideation (SI) and suicide attempt (SA). Estimates of risk with 95% confidence intervals (CIs) for suicide, SI and SA, respectively, will be calculated and summarized. We will perform random-effects meta-analyses to combine the pooled effects. Meta-regression will be applied to investigate the effects of multiple factors across studies. Subgroup and sensitivity analyses will be conducted for screening of any potential sources of heterogeneity. Publication bias will be evaluated by funnel plot and Begg and Mazumdar correlation testing. The body of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ConclusionThis article presents a study protocol for investigating the association between VI and risk of suicide. The findings of this study will contribute to our current knowledge of the impact of VI as a risk factor of suicide. In addition, meta-regression and subgroup analyses will provide further insights to factors affecting the association between VI and suicide risk.Trial registrationSystematic review registration: PROSPERO CRD 42022325106.

In terms of medical health, we are currently living in the era of data science, which has brought tremendous change. Big data related to healthcare includes medical data, genome data, and lifelog data. Among medical data, public medical data is very important for actual research and medical policy reflection because it has data on a large number of patients and is representative. However, there are many difficulties in actually using such public health big data and designing a study, and conducting systematic review (SR) on the research topic can help a lot in the methodology. In this review, in addition to the importance of research using big data for the public interest, we will introduce important public medical big data in Korea and show how SR can be specifically applied in research using public medical big data.

OBJECTIVES The objective of this study is to introduce methods to use all of the information without omission when individual studies provide multiple effect sizes according to multiple cut-off values (thresholds) during diagnostic test accuracy (DTA) for data integration. For diagnostic test meta-analysis, a general performance method for synthesizing data according to one cut value in one study and a performance method for synthesizing data according to two or more cut values in one study were compared and analyzed. METHODS As sample data for meta-analysis of DTA studies, 13 DTA studies on prostate cancer (34 effect sizes including total cut-offs) were collected. The summary statistics were calculated and the summary line was analyzed using the “meta”, “mada”, and “diagmeta” packagesof the R software. RESULTS The summary statistics of the random effect model univariate analysis of the “meta” package with a single cut-off corresponding to the highest Youden index in a single study and those of the bivariate analysis of the “mada” package were highly similar. However, in the bivariate analysis of the “diagmeta” package including all cut-off values, the sensitivity decreased and the specificity increased as the amount of data increased. CONCLUSIONS Considering the heterogeneity of the summary receiver op erating characteristic curve and the use of all given cut-offs, the use of the bivariate analysis model of the “diagmeta” package is recommended. This study focused on practical methods of DTA rather than theoretical concepts for use by researchers whose fields of study are non-statistics related. By performing this study, we hope that many researchers will use R software to determine the DTA more easily, and that there will be greater interest in related research.

This study aimed to establish an efficient plant regeneration system from leaf-derived embryogenic structure cultures of Daphne genkwa. To induce embryogenic structures, fully expanded leaf explants of D. genkwa were cultured on Murashige and Skoog (MS) medium supplemented with 0, 0.1, 0.5, 1, 2, and 5 mg·L−1 2,4-dichlorophenoxyacetic acid (2,4-D), respectively. After 8 weeks of incubation, the highest frequency of embryogenic structure formation reached 100% when the leaf explants were cultivated on MS medium supplemented with 0.1 to 1 mg·L−1 2,4-D. At higher concentrations of 2,4-D (over 2 mg·L−1 2,4-D), the frequency of embryogenic structure formation significantly declined. Similar to 2,4-D, indole butyric acid (IBA) and α-naphthaleneacetic acid (NAA) treatments were also able to form embryogenic structures. However, the frequency of embryogenic structure formation was lower than that of 2,4-D. In particular, the yellow embryonic structure (YES) and white embryonic structure (WES) were simultaneously developed from the leaf explants of D. genkwa on culture medium containing 2,4-D, IBA, and NAA, respectively. Embryogenic calluses (ECs) were formed from the YES after subsequent rounds of subculture on MS medium supplemented with 1 mg·L−1 2,4-D. To regenerate whole plants, the embryogenic callus (EC) and the two embryogenic structures (YES and WES) were transferred onto MS medium supplemented with 0.1 mg·L−1 6-benzyl aminopurine (BA). The YES had the highest plant regeneration potential via somatic embryo and shoot development compared to the EC and WES. To our knowledge, this is the first successful report of a plant regeneration system via the somatic embryogenesis of D. genkwa. Thus, the embryogenic structures and plant regeneration system of D. genkwa could be applied to mass proliferation and genetic modification for pharmaceutical metabolite production in D. genkwa.

This study aims to examine the metabolic discrimination between in vitro grown adventitious roots and the standard medicinal parts of Atractylodes macrocephala. To achieve this goal, firstly, in vitro culture conditions of adventitious roots such as indole-3-butyric acid (IBA) concentrations, types of media, inorganic salt strength of culture medium, and elicitor types and concentrations were optimized. The optimal culture conditions for proliferation of adventitious roots was found to consist of Murashige and Skoog (MS) medium containing 5 mg L−1 IBA. Whole cell extracts from adventitious roots and the standard medicinal parts of A. macrocephala were subjected to Fourier transform infrared spectroscopy (FT-IR). Principal component analysis (PCA) and partial least square discriminant analysis (PLS-DA) from FT-IR spectral data showed that adventitious roots and standard medicinal parts were clearly distinguished in the PCA and PLS-DA score plot. Furthermore, the overall metabolite pattern from adventitious roots was changed depending on the dose-dependent manner of chemicals. These results suggest that FT-IR spectroscopy can be applied as an alternative tool for the screening of higher metabolic root lines and for discriminating metabolic similarity between in vitro grown adventitious roots and the standard medicinal parts. In addition, the adventitious roots proliferation system established in this study can be directly applied as an alternative means for the commercial production of A. macrocephala.