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BackgroundThe purpose of a rapid response system (RRS) is to reduce the incidence of preventable cardiopulmonary arrests (CPAs) and patient deterioration in general wards. The objective of this study is to investigate the incidence and temporal trends of preventable CPAs and determine factors associated with preventable CPAs in a hospital with a mature RRS.MethodsThis was a single-center prospective cohort study of all CPAs occurring in the general ward between March 2017 and June 2020. The RRS operates from 07:00 to 23:00 on weekdays and from 07:00 to 12:00 on Saturdays. All CPAs were reviewed upon biweekly conference, and a panel of intensivists judged their preventability. Trends of preventable CPAs were analyzed using Poisson regression models and factors associated with preventable CPAs were analyzed using multivariable logistic regression.ResultsThere were 253 CPAs over 40 months, and 64 (25.3%) of these were preventable. The incidence rate of CPAs was 1.07 per 1000 admissions and that of preventable CPAs was 0.27 per 1000 admissions. The number of preventable CPAs decreased by 24% each year (incidence rate ratio = 0.76; p = 0.039) without a change in the total CPA incidence. The most common contributor to the preventability was delayed response from physicians (n = 41, 64.1%). A predictable CPA with a pre-alarm sign had increased odds in the occurrence of preventable CPAs, while a cardiac cause of CPAs and RRS operating hours had decreased odds in terms of occurrence of preventable CPA.ConclusionOur study showed that one-fourth of all CPAs occurring in the general wards were preventable, and these arrests decreased each year. A mature RRS can evolve to reduce preventable CPAs with regular self-evaluation. Efforts should be directed at improving physicians' response time since a delay in their response was the most common cause of preventable CPAs.

Background Poorly differentiated thyroid carcinoma (PDTC) accounts for a small portion of thyroid carcinomas but contributes to a significant proportion of thyroid carcinoma-associated deaths. The clinicopathological prognostic factors and clinical outcomes of PDTC remain unclear. We aimed to evaluate the clinical outcomes of patients with PDTC after curative treatment. Methods A comprehensive search was performed up to September 2023. We included studies investigating treatment outcomes in patients with PDTC who underwent initial surgery. The 5-year disease-free survival (DFS) and overall survival (OS) were extracted. In this meta-analysis, the enrolled PDTC histological criteria included 3rd, 4th, and 5th World Health Organization (WHO) and Memorial Sloan Kettering Cancer Center (MSKCC) classification. A random-effects model was used for the pooled proportion analysis. Meta-regression analysis was conducted to evaluate the prognostic factors. Results Twenty retrospective studies published between 2007 and 2023, including 1,294 patients, met all inclusion criteria. Studies that diagnosed PDTC based on various histological criteria including 3rd WHO (n=5), 4th WHO (n=12), 5th WHO (n=2), and MSKCC (n=1) were included. Overall, 5-year DFS and 5-year OS were 49.4% (95% confidence interval [CI], 42.3 to 56.4) and 73.8% (95% CI, 66.5 to 79.9), with moderate heterogeneity of 58% and 55%, respectively. In meta-regression analysis, extrathyroidal extension (ETE) was a prognostic factor for OS. Conclusion The meta-analysis of DFS and OS in patients with PDTC show the moderate heterogeneity with a variety of histological criteria. ETE appears to have a significant impact on OS, regardless of histological criteria.

Abstract Background Brugada syndrome (BrS) and arrhythmogenic cardiomyopathy (ACM) are inherited cardiac diseases that may predispose to ventricular arrhythmia. Although overlapping features between BrS and ACM have been demonstrated previously, it remains to be determined whether genetic testing for ACM-related genes is needed in BrS probands. Method Based on a single-center, retrospective registry of BrS, we aimed to verify genetic profiles of BrS using a next-generation sequencing panel, and further analyzed genetic testing of ACM-related variants in Brugada phenotypes. Results Among a total of 119 Brugada phenotypes, 114 patients (95.8%) were male and the mean age of onset was 43.6 years. Genetic variants were identified in 25 of the 42 patients who underwent genetic testing. Fifteen patients had BrS-related genotypes, including SCN5A in 6 patients, and non-SCN5A genes in 9 patients (SCN10A, HCN4, SCN3B, and KCNE3). Nineteen patients underwent additional genetic testing with cardiomyopathy panel, which revealed ACM-related genotypes (2 PKP2, 1 DSG2, 1 TMEM43, 1 JUP, and 1 DSP) present in 6 patients (31.5%). None of the patients had structural or electrocardiographic features that fulfilled the diagnostic criteria for ACM. Conclusions In clinical setting, ACM-related genes were identified in a significant proportion of Brugada phenotypes, supporting the argument that genetic testing of ACM overlapping is needed. Follow-up imaging studies should be considered to monitor if the disease progresses to ACM.

To fully harness the potential of smart textiles, it is cruical to develop energy harvesters which can function both as fabric and energy generator. In this work, we present a high performance low-cost piezoelectric nano-fabric using even-number Nylon (i.e., Nylon-6). Nylon-6 was chosen for optimal mechanical properties such as mechanical strength and stiffness. To maximize the voltage output, Nylon six nanofibers with varying diameter and crystallinity were synthesized by adjusting the polymer precursor and solvent, along with electrospinning parameters, followed by post thermal treatment. The average diameter of electrospun nanofibers was finely tuned (down to 36 nm) by adjusting solution polymer precursor content and electrospinning parameters. The content of desired piezoelectric-active γ crystal phase enhanced upto 76.4% by controlling solvent types and post thermal annealing. The highest peak to peak voltage (V33) of 1.96 V were achieved from γ-phase dominant (>60%) Nylon-6 nanofiber fabric which has an average nanofiber diameter of 36 nm with high fiber fraction (i.e., > 98%). Unlike its thin film counterpart, piezoelectric electrospun nanofiber fabric demonstrated durability against wear and washing. This work paves a new way to utilize Nylon-6 nanofibers in next-generation electronic textiles.

Essential properties for a Point of Use (POU) water filter include maintaining high removal capacity and rate, with excellent mechanical properties to withstand pressure drop. Herein, mechanically robust tri-composite polyamide 6/iron oxide nanoparticles/tetra-n-butylammonium bromide (PA6/α-Fe2O3/TBAB) nanofiber composite membranes were electrospun for phosphate (P) remediation, where the diameter and composition were tuned by controlling solution compositions and electrospinning conditions. Tri-composite composition and morphology affect phosphate uptake where the adsorption capacity followed Langmuir isotherm whereas the adsorption kinetics followed pseudo second order behavior. Mechanical properties (i.e., Young’s Modulus (E) and toughness) were significantly influenced by the composition and morphology of the tri-composite, as well. Although additional TBAB and iron oxide decreased toughness, there are optimum composition ranges which resulted in maximum Young’s Modulus. Of the synthesized nanofiber membranes, PA6/α-Fe2O3/TBAB nanofibers with 17% α-Fe2O3 and 2% TBAB showed excellent phosphate uptake capacity [i.e., 8.9 mg/g (52 mg of P/g of α-Fe2O3)] while it is bendable, stretchable, and able to plastically deform without fracturing (i.e., Young’s modulus of 2.06 × 108 Pa and Toughness of 1.35 × 106 J m−3). With concerns over the impact of P on water resources and the long-term availability of limited P resources, this tri-composite membrane is well suited for applications in both wastewater treatment and resource recovery.

Abstract The risk of having atrial fibrillation (AF) is associated with alcohol intake. However, it is not clear whether sudden cardiac arrest (SCA) and ventricular arrhythmia (VA) including ventricular tachycardia, flutter, or fibrillation have similar associations with alcohol. We aimed to evaluate the association of alcohol intake with all-cause death, new-onset AF, VA, and SCA using single cohort with a sufficient sample size. A total of 3,990,373 people without a prior history of AF, VAs, or SCA was enrolled in this study based on nationwide health check-up in 2009. We classified the participants into four groups according to weekly alcohol consumption, and evaluated the association of alcohol consumption with each outcome. We observed a significant association between mild (hazard ratio [HR] = 0.826; 95% confidence interval [CI] = 0.815–0.838) to moderate (HR = 0.930; 95% CI = 0.912–0.947) drinking with decreased risk of all-cause mortality. However heavy drinking (HR = 1.108; 95% CI = 1.087–1.129) was associated with increased all-cause death. The risk of new-onset AF was significantly associated with moderate (HR = 1.129; 95% CI = 1.097–1.161) and heavy (HR = 1.298; 95% CI = 1.261–1.337) drinking. However, the risk of SCA showed negative association with all degrees of alcohol intake: 20% (HR = 0.803; 95% CI = 0.769–0.839), 15% (HR = 0.853; 95% CI = 0.806–0.902), and 8% (HR = 0.918; 95% CI = 0.866–0.974) lower risk for mild, moderate, and heavy drinkers, respectively. Mild drinking was associated with reduced risk of VA with moderate and heavy drinking having no associations. In conclusion, the association between alcohol and various outcomes in this study were heterogeneous. Alcohol might have different influences on various cardiac disorders.

Abstract Background Underweight imposes significant burden on cardiovascular outcomes in patients with diabetes mellitus. However, less is known about the impact of serial change in body weight status measured as body mass index (BMI) on the risk of sudden cardiac arrest (SCA). This study investigated the association between SCA and temporal change in BMI among patients with diabetes mellitus. Methods Based on Korean National Health Insurance Service database, participants with diabetes mellitus who underwent health examination between 2009 and 2012 and had prior health examination data (four years ago, 2005–2008) were retrospectively analyzed. BMI was measured at baseline (2005–2008) and 4-year follow-up health examination (2009–2012). Patients were classified in four groups according to the body weight status and its temporal change: sustained non-underweight, sustained underweight, previous underweight, and newly developed underweight. Primary outcome was defined as occurrence of SCA. Results A total of 1,355,746 patients with diabetes mellitus were included for analysis, and SCA occurred in 12,554 cases. SCA was most common in newly developed underweight (incidence rate = 4.45 per 1,000 person-years), followed by sustained underweight (incidence rate = 3.90), previous underweight (incidence rate = 3.03), and sustained non-underweight (incidence rate = 1.34). Adjustment of covariates resulted highest risk of SCA in sustained underweight (adjusted hazard ratio = 2.60, 95% confidence interval [2.25–3.00], sustained non-underweight as a reference), followed by newly developed underweight (2.42, [2.15–2.74]), and previous underweight (2.12, [1.77–2.53]). Conclusions In diabetes mellitus, sustained underweight as well as decrease in body weight during 4-year follow-up imposes substantial risk on SCA. Recovery from underweight over time had relatively lower, but yet increased risk of SCA. Both underweight and dynamic decrease in BMI can be associated with increased risk of SCA.

Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous disorder commonly caused by drugs. TEN is often treated with corticosteroids, intravenous immunoglobulin (IVIG), or cyclosporine; however, the efficacy of these treatments is controversial. Etanercept (a TNF-α antagonist) was proven to decrease skin-healing time in a randomized clinical trial. Herein, we report the case of a 44-month-old boy who developed TEN due to deflazacort as the probable culprit drug and was successfully treated with etanercept. The patient presented to the emergency department complaining of erythematous maculopapular rashes and vesicles all over the face and body, with vesicles on the hands, feet, and trunk. Symptoms started 4 days before presentation, with edema of the upper lip, which progressed to erythematous macules over the body. He was started on deflazacort for nephrotic syndrome 21 days before the visit. Approximately 20% of the body surface area (BSA) was covered by vesicular lesions. Under the diagnosis of Steven Johnson syndrome/TEN, deflazacort was discontinued, and intravenous dexamethasone (1.5 mg/kg/day), a 5-day course of IVIG (0.4 mg/kg/day), and cyclosporine (3 mg/kg/day) were administered. The lesions seemed to be stationary for 3 days, but on the 6th day of hospitalization, when IVIG was discontinued, the vesicular lesions progressed to approximately 60% of the BSA. Etanercept 0.8 mg/kg was administered subcutaneously. Lesions stopped progressing, and bullous lesions started epithelialization. However, on the 15th day, around 30% of the BSA was still involved; thus, a second dose of etanercept was administered. No acute or sub-acute complications were observed. In conclusion, the use of etanercept in children with TEN that is not controlled with conventional therapy is both effective and safe.

Purpose To investigate the MRI markers for the prediction of amyloid β (Aβ)-positivity in mild cognitive impairment (MCI) and Alzheimer’s disease (AD), and to evaluate the differences in MRI markers between Aβ-positive (Aβ [+]) and -negative groups using the machine learning (ML) method. Materials and Methods This study included 139 patients with MCI and AD who underwent amyloid PET-CT and brain MRI. Patients were divided into Aβ (+) (n = 84) and Aβ-negative (n = 55) groups. Visual analysis was performed with the Fazekas scale of white matter hyperintensity (WMH) and cerebral microbleeds (CMB) scores. The WMH volume and regional brain volume were quantitatively measured. The multivariable logistic regression and ML using support vector machine, and logistic regression were used to identify the best MRI predictors of Aβ-positivity. Results The Fazekas scale of WMH (p = 0.02) and CMB scores (p = 0.04) were higher in Aβ (+). The volumes of hippocampus, entorhinal cortex, and precuneus were smaller in Aβ (+) (p < 0.05). The third ventricle volume was larger in Aβ (+) (p = 0.002). The logistic regression of ML showed a good accuracy (81.1%) with mini-mental state examination (MMSE) and regional brain volumes. Conclusion The application of ML using the MMSE, third ventricle, and hippocampal volume is helpful in predicting Aβ-positivity with a good accuracy.

Typical atrial flutter commonly occurs in patients with atrial fibrillation (AF). Limited information exists regarding the effects of concurrent atrial flutter on the long-term outcomes of rhythm control. This study investigated the association between concurrent typical atrial flutter and cavotricuspid isthmus (CTI) ablation and the recurrence of atrial arrhythmia. The data were obtained from a multicenter registry of cryoballoon ablation for AF (n = 2,689). Patients who were screened for typical atrial flutter were included in the analysis (n = 1,907). All the patients with typical atrial flutter underwent CTI ablation. The primary endpoint was the late recurrence of atrial arrhythmia, including AF, atrial flutter, and atrial tachycardia. Among the 1,907 patients, typical atrial flutter was detected in 493 patients (25.9%). Patients with concurrent atrial flutter had a lower incidence of persistent AF and a smaller size of the left atrium. Patients with atrial flutter had a significantly lower recurrence rate of atrial arrhythmia (19.7% vs. 29.9%, p

Abstract Background Diabetes mellitus (DM) is associated with various cardiovascular complications, including sudden cardiac arrest (SCA). Furthermore, the severity of DM, as assessed by fasting blood glucose (FBG), is associated with the risk of SCA. However, whether long-term changes in FBG influence on SCA risk remains to be determined. Methods This study used sequential nationwide health screening data from 2009 and 2011. FBG was measured at each health screening, and ΔFBG was calculated as FBG in 2011–FBG in 2009. Results Overall, 2,801,153 people were analyzed, and the mean follow-up duration was 6.33 years. Compared with the euglycemic group (− 20 ≤ ΔFBG

Abstract Background Dyslipidemia measured as low-density lipoprotein (LDL)-cholesterol is an established risk factor of cardiovascular disease, which is more pronounced in diabetes population. Less is known about the association of LDL-cholesterol level and sudden cardiac arrest (SCA) risk in diabetes mellitus patients. This study investigated the association of LDL-cholesterol level and SCA risk in diabetes population. Methods This study was based on Korean National Health Insurance Service database. Patients who received general examination from 2009 to 2012 and diagnosed as type 2 diabetes mellitus were analyzed. Primary outcome was defined as SCA event identified with International Classification of Disease code. Results A total of 2,602,577 patients were included, with total follow-up duration of 17,851,797 person * year. Mean follow-up duration was 6.86 years, and 26,341 SCA cases were identified. Overall incidence of SCA was highest in the lowest LDL-cholesterol group (

BackgroundThe pulmonary veins play a major role in the pathogenesis of atrial fibrillation (AF) and may be affected by cardiac remodeling due to pulmonary vascular dysfunction. It remains to be determined whether pulmonary artery pressure (PAP) is associated with the recurrence of AF after radiofrequency catheter ablation (RFCA).MethodsConsecutive patients with paroxysmal and persistent AF who underwent RFCA, including wide circumferential pulmonary vein isolation, were analyzed. Systolic PAP was measured using transthoracic echocardiography, and clinical outcomes were compared between patients with PAP

In-situ polymerization is a method for fabricating lithium-ion batteries to contain solid or gel electrolytes without major manufacturing changes. Gel polymer electrolytes (GPEs) wherein some polymer in incorporated, decreasing the volume of liquid electrolyte, have been pursued as they may be safer. One challenge with GPEs is reduced ion transport properties. In this work, macromonomers with different chain chemistry and ionic monomers are crosslinked on electrospun polyvinylidene difluoride (PVDF) in the presence of solvents, without conventional salt, to in-situ fabricate GPEs with elevated transference number within coin cells. These GPEs would be single-ion conductors in the case of complete ionic monomer polymerization to the crosslinked network. The effect of chain chemistry and the percentage of macromonomers and ionic monomers in the GPEs on conductivity are investigated. It is found that poly(siloxane) diacrylate (PDMSDA)- and perfluoropolyether tetra-acrylate (PFPETA)-based GPEs outperform the poly(propylene glycol) diacrylate (PPGDA)- and poly(tetrahydrofuran) diacrylate (PTHFDA)-based GPEs in terms of ionic conductivity. The highest ionic conductivity was achieved for a PDMSDA-based GPE at 4.2 × 10 ^−4 S cm ^−1 at 23 °C. Graphite/NMC-811 full cells prepared with the in-situ polymerized PDMSDA-based GPEs show capacity retention of 82.6% after 100 cycles, albeit with limited electrode utilization due to ion transport limitations.

Purpose: Lung cancer (LC) is the leading cause of cancer-related death globally, and understanding symptom clusters (SCs) among LC patients could improve symptom management. This scoping review provides a comprehensive summary of the most common SCs and their compositions identified in studies specifically investigating SCs of LC patients. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology. The study included LC patients as participants, SCs as the concept, and studies with distinct aim to investigate LC SCs as the context. We searched studies from inception to September 2022 in PubMed, Embase, PsycINFO, CINAHL, and the Cochrane Library databases using the terms: "lung cancer," "cancer survivors, " and "symptom cluster." Results: Of 41 reviewed reports, 188 SCs were identified. Both a priori and de novo method were used to identify LC SCs, with exploratory factor analysis being the most commonly used statistical method in the de novo approach. The three most frequent SCs were respiratory, gastrointestinal (GI), and psychological SCs. The most common respiratory SC included cough + dyspnea. Nausea + vomiting was the most prevalent cluster membership among GI SCs. Sad + feeling irritable + feeling nervous + worrying was the most common cluster membership among psychological SCs. Conclusion: Respiratory, GI, and psychological SCs were common among LC patients, and addressing these clusters could improve symptom management strategies. Further research on SCs across the lung cancer trajectory is essential to enhance our understanding about SCs and facilitate effective symptom management throughout the disease course. [ABSTRACT FROM AUTHOR]

Essential properties for a Point of Use (POU) water filter include maintaining high removal capacity and rate, with excellent mechanical properties to withstand pressure drop. Herein, mechanically robust tri-composite polyamide 6/iron oxide nanoparticles/tetra-n-butylammonium bromide (PA6/α-Fe[sub 2]O[sub 3]/TBAB) nanofiber composite membranes were electrospun for phosphate (P) remediation, where the diameter and composition were tuned by controlling solution compositions and electrospinning conditions. Tri-composite composition and morphology affect phosphate uptake where the adsorption capacity followed Langmuir isotherm whereas the adsorption kinetics followed pseudo second order behavior. Mechanical properties (i.e., Young's Modulus (E) and toughness) were significantly influenced by the composition and morphology of the tricomposite, as well. Although additional TBAB and iron oxide decreased toughness, there are optimum composition ranges which resulted in maximum Young's Modulus. Of the synthesized nanofiber membranes, PA6/α-Fe2O3/TBAB nanofibers with 17% α-Fe2O3 and 2% TBAB showed excellent phosphate uptake capacity [i.e., 8.9 mg/g (52 mg of P/g of α-Fe2O3)] while it is bendable, stretchable, and able to plastically deform without fracturing (i.e., Young's modulus of 2.06 x 108 Pa and Toughness of 1.35 x 106 J m-3). With concerns over the impact of P on water resources and the long-term availability of limited P resources, this tri-composite membrane is well suited for applications in both wastewater treatment and resource recovery. [ABSTRACT FROM AUTHOR]

Purpose To investigate the MRI markers for the prediction of amyloid β (Aβ)-positivity in mild cognitive impairment (MCI) and Alzheimer's disease (AD), and to evaluate the differences in MRI markers between Aβ-positive (Aβ [+]) and -negative groups using the machine learning (ML) method. Materials and Methods This study included 139 patients with MCI and AD who underwent amyloid PET-CT and brain MRI. Patients were divided into Aβ (+) (n = 84) and Aβ-negative (n = 55) groups. Visual analysis was performed with the Fazekas scale of white matter hyperintensity (WMH) and cerebral microbleeds (CMB) scores. The WMH volume and regional brain volume were quantitatively measured. The multivariable logistic regression and ML using support vector machine, and logistic regression were used to identify the best MRI predictors of Aβ-positivity. Results The Fazekas scale of WMH (p = 0.02) and CMB scores (p = 0.04) were higher in Aβ (+). The vol-umes of hippocampus, entorhinal cortex, and precuneus were smaller in Aβ (+) (p < 0.05). The third ventricle volume was larger in Aβ (+) (p = 0.002). The logistic regression of ML showed a good accuracy (81.1%) with mini-mental state examination (MMSE) and regional brain volumes. Conclusion The application of ML using the MMSE, third ventricle, and hippocampal volume is helpful in predicting Aβ-positivity with a good accuracy. [ABSTRACT FROM AUTHOR]