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Rationale: Tuberculous meningitis (TBM) is severe extrapulmonary tuberculosis that can cause poor outcomes without timely treatment. We report a case of presumed TBM that presented solely ocular complaints without other neurological features. Patient’s concerns: A 71-year-old man presented with a sudden central visual defect in both eyes for 10 days. Fundoscopy showed bilateral hyperaemic swelling disc with infiltrates. Diagnosis: A diagnosis of presumptive TBM was made with Mantoux test reading 15 mm, elevated erythrocyte sedimentation rate, subdural effusion on CT scan, and high opening pressure. Intervention: Anti-tuberculous treatment. Outcomes: Bilateral vision improved and optic discs swelling resolved. Lessons: Early recognition of TBM with optic nerve infiltration is crucial for prompt treatment that may lead to a good prognosis. Neuroimaging will facilitate the diagnosis when other investigations show a borderline result.

In this study, the CeO2-Fe2O3 mixed oxide catalysts have been prepared by combustion method using gel-created tartaric acid. The ability of effective carbon monoxide (CO) oxidation to carbon dioxide (CO2) by CeO2-Fe2O3 catalyst under low-temperature conditions was also demonstrated. The calcined CeO2-Fe2O3 material has a porous honeycomb structure and good gaseous absorption-desorption ability. The solid solution of CeO2-Fe2O3 mixed oxides was formed by the substitution of Fe+3 ions at some Ce4+ ion sites within the CeO2 crystal lattice. The results also showed that the calcination temperature and the molar ratio of Ce3+ ions to Fe3+ ions (CF) affected the formation of the structural phase and the catalytic efficiency. The catalytic properties of the CeO2-Fe2O3 mixed oxide were good at the CF ratio of 1 : 1, the average crystal size was near 70 nm, and the specific surface area was about 20.22 m2.g-1. The full conversion of CO into CO2 has been accomplished at a relatively low temperature of 270 °C under insufficient O2 conditions.

Rationale: Infectious keratopathy is an ocular emergency with the potential to cause irreversible blindness. Patient's concerns: A 63-year-old diabetic man presented with a 3-day history of painful red right eye. He had a history of multiple ocular surgeries in the affected eye without recent ocular trauma. Diagnosis: Infective crystalline keratopathy secondary to Citrobacter koseri. Interventions: Topical corticosteroids were discontinued, and dual topical antibiotic therapy of moxifloxacin 5% and gentamycin 0.3% were applied. Outcomes: Twelve hours after the start of treatment, the crystalline nature of the infiltrate disappeared, with enlargement of the epithelial defect. The antibiotic regime was continued and the lesion healed within a week of presentation with residual scarring. Lessons: Infective crystalline keratopathy classically presents with intrastromal branching fern-like opacities and minimal anterior segment inflammation in an immunosuppressed eye. The mainstay of management is corticosteroid discontinuation and the administration of empirical antibiotics until the results of the culture and sensitivity are available. In Citrobacter-related cases, treatment may result in a suppurative appearance before healing of the lesion.

Toxocariasis is a widespread zoonotic parasitic disease with a significant socioeconomic impact, particularly on underprivileged communities. Limitations of existing diagnostic tools and vague presenting symptoms may lead to misdiagnosis, thus underestimating the actual global impact of the disease. The present study describes the isolation and production of novel recombinant monoclonal antibodies against Toxocara canis recombinant TES-26 antigen (rTES-26) utilizing a human helminth scFv phage display library. The isolated antibody clones were characterized based on their gene sequences and binding characteristics. Three clones representing unique gene families (clone 48: IgHV3-LV1; clone 49: IgHV3-LV3; clone 50: IgHV6-LV3) were isolated, but only clones 48 and 49 showed successful insertion of the full-length scFv antibody sequence after sub-cloning. Both clones produced antibody proteins of good solubility and satisfactory yield and purity. Binding assays via Western blot and ELISA using rTES-26 and Toxocara canis native protein showed that both monoclonal antibodies were highly specific and sensitive to the target antigen. A preliminary antigen detection ELISA showed the diagnostic potential of the monoclonal antibody proteins. The proteins can also be useful in studying host–parasite interactions and therapeutic applications.

The problem of increasing farmers’ income has been a hot issue of social concern. Understanding the farmers’ income and the overall development trend is conducive to the rational layout of the social economy and promotes the steady development of a well-off society. Based on this, the paper selects the per capita disposable income (PCDI) of farmers’ households from 2012 to 2019 in 11 cities of Hebei Province as the research object and applies the fractional grey model (FGM (1,1)) to predict farmers’ income from 2020 to 2024. The results show that the farmers’ income will increase in the next five years. However, the growth rate of farmers’ income is slow in the areas with a large base of farmers’ income and strong in the areas with a small base of farmers’ income. The area with the highest trend in the growth rate of farmers’ income is Zhangjiakou and the lowest place is Handan. Only Shijiazhuang’s income growth rate is on the rise. Finally, suggestions are given to promote farmers’ income in Hebei Province.

In this paper, we are interested by advanced backward stochastic differential equations (ABSDEs), in a probability space equipped with a Brownian motion and a single jump process, with a jump at time τ. ABSDEs are BSDEs where the driver depends on the future paths of the solution. We show, that under immersion hypothesis between the Brownian filtration and its progressive enlargement with τ, assuming that the conditional law of τ is equivalent to the unconditional law of τ, and a Lipschitz condition on the driver, the ABSDE has a solution.

Microvascular reconstruction is often limited by the availability and length of the pedicle. The harvesting of autologous vein grafts adds morbidity and may not provide a good match. Expanded polytetrafluoroethylene (ePTFE) grafts have been used routinely in macrovascular surgery. However, there are no conclusive data on the performance of small-diameter PTFE grafts for pedicle lengthening in free flaps in a low-pressure situation. In this study, we evaluated the efficacy of 3-mm diameter stretch ePTFE grafts to lengthen the venous pedicle of a free flap. Methods: Fifteen male New Zealand white rabbits were operated on under sterile conditions. Using an operating microscope, an epigastric flap was raised and the pedicle was exposed and dissected to its origin from the superficial femoral vessels. A segment of the vein of 1cm to 3cm was replaced with a stretch ePTFE graft. Microsurgical anastomoses were performed using 9-0 nylon sutures. Four weeks postoperatively, the flaps were raised again with the pedicles re-explored. The graft was then removed and examined histologically. Results: All the grafts demonstrated immediate patency. There were no cases of flap loss on the control side at 4 weeks postoperatively. When re-explored, the patent ePTFE grafts appeared to be covered by connective tissue. Light microscopy showed neoendothelialization with fibrovascular ingrowth. Conclusion: From this study, we can conclude that 3-mm diameter stretch ePTFE grafts can be used successfully as an alternative to bridging autologous vein grafts in free-flap pedicles.

Structural variants (SVs) are significant contributors to inter-individual genetic variation associated with traits and diseases. Current SV studies using whole-genome sequencing (WGS) have a largely Eurocentric composition, with little known about SV diversity in other ancestries, particularly from Asia. Here, we present a WGS catalogue of 73,035 SVs from 8392 Singaporeans of East Asian, Southeast Asian and South Asian ancestries, of which ~65% (47,770 SVs) are novel. We show that Asian populations can be stratified by their global SV patterns and identified 42,239 novel SVs that are specific to Asian populations. 52% of these novel SVs are restricted to one of the three major ancestry groups studied (Indian, Chinese or Malay). We uncovered SVs affecting major clinically actionable loci. Lastly, by identifying SVs in linkage disequilibrium with single-nucleotide variants, we demonstrate the utility of our SV catalogue in the fine-mapping of Asian GWAS variants and identification of potential causative variants. These results augment our knowledge of structural variation across human populations, thereby reducing current ancestry biases in global references of genetic variation afflicting equity, diversity and inclusion in genetic research., (© 2024. The Author(s).)

Background: Carbon monoxide (CO) poisoning can lead to significant morbidity and mortality. However, relatively few studies have investigated its long-term mortality impact. This nationwide population-based cohort study examined the association between CO poisoning and long-term mortality., Methods: This retrospective study utilized data from the National Health Insurance Service database in South Korea. We compared the patients with CO poisoning to those without CO poisoning. Inverse probability treatment weights were applied to both groups to control for potential confounding factors. Subsequently, mortality was assessed using the incidence rate and Cox proportional hazard ratios., Results: This study included 23,387 patients with CO poisoning and 359,851 without it. Over a median follow-up period of 7.6 years after CO poisoning diagnosis, the mortality risk was 2.6 times higher in patients with CO poisoning compared to that in the control group. In a long-term follow-up of patients surviving beyond 30 days, mortality remained 2.18 times higher. Additionally, a higher mortality risk was observed in the relatively younger age group (18-39 years) and the group with fewer underlying diseases, as indicated by a Charlson Comorbidity Index score of 0., Conclusions: CO poisoning is associated with an elevated long-term mortality rate particularly in a relatively young and healthy population.

Background: Lactate is a commonly used biomarker for sepsis, although it has limitations in certain cases, suggesting the need for novel biomarkers. We evaluated the diagnostic accuracy of plasma renin concentration and renin activity for mortality and kidney outcomes in patients with sepsis with hypoperfusion or hypotension., Methods: This was a multicenter, prospective, observational study of 117 patients with septic shock treated at three tertiary emergency departments between September 2021 and October 2022. The accuracy of renin activity, renin, and lactate concentrations in predicting 28-day mortality, acute kidney injury (AKI), and renal replacement requirement was assessed using the area under the ROC curve (AUC) analysis., Results: The AUCs of initial renin activity, renin, and lactate concentrations for predicting 28-day mortality were 0.66 (95% confidence interval [CI], 0.55-0.77), 0.63 (95% CI, 0.52-0.75), and 0.65 (95% CI, 0.53-0.77), respectively, and those at 24 hrs were 0.74 (95% CI, 0.62-0.86), 0.70 (95% CI, 0.56-0.83), and 0.67 (95% CI, 0.54-0.79). Renin concentrations and renin activity outperformed initial lactate concentrations in predicting AKI within 14 days. The AUCs of renin and lactate concentrations were 0.71 (95% CI, 0.61-0.80) and 0.57 (95% CI, 0.46-0.67), respectively ( P =0.030). The AUC of renin activity (0.70; 95% CI, 0.60-0.80) was also higher than that of lactate concentration ( P =0.044)., Conclusions: Renin concentration and renin activity show comparable performance to lactate concentration in predicting 28-day mortality in patients with septic shock but superior performance in predicting AKI.

Background: Early risk stratification is crucial due to septic patients' heterogeneity. Serum albumin level may reflect the severity of sepsis and host status. This study aimed to evaluate the prognostic ability of the initial sequential organ failure assessment (SOFA) score alone and combined with serum albumin levels for predicting 28-day mortality in patients with septic shock. Methods: We conducted an observational study using a prospective, multicenter registry of septic shock patients between October 2015 and May 2022 from 12 emergency departments in the Korean Shock Society and the results were validated by examining those from the septic shock cohort in Asan Medical Center. The primary outcome was 28-day mortality. The area under the receiver operating characteristic (ROC) curve was used to compare the predictive values of SOFA score alone and SOFA score combined with serum albumin level. Results: Among 5805 septic shock patients, 1529 (26.3%) died within 28 days. Mortality increased stepwise with decreasing serum albumin levels (13.6% in albumin ≥3.5, 20.7% in 3.5-3.0, 29.7% in 3.0-2.5, 44.0% in 2.5-2.0, 56.4% in <2.0). The albumin SOFA score was calculated by adding the initial SOFA score to the 4 points assigned for albumin levels. ROC analysis for predicting 28-day mortality showed that the area under the curve for the albumin SOFA score was 0.71 (95% CI 0.70-0.73), which was significantly higher than that of the initial SOFA score alone (0.68, 95% CI: 0.67-0.69). Conclusions: The combination of the initial SOFA score with albumin can improve prognostic accuracy for patients with septic shock, suggesting the albumin SOFA score may be used as an early mortality stratification tool.

Background: The interaction between COVID-19 and tuberculosis (TB) is not yet fully understood, and large-scale research on the mortality outcome of such dual infection has been limited. This study aimed to investigate the impact of PTB on mortality among patients with COVID-19 within a Korean population by conducting an extensive analysis of a nationwide large dataset., Method: We investigated the mortality and disease severity among COVID-19 patients who had PTB in South Korea. This study analyzed 462,444 out of 566,494 COVID-19 patients identified between January 2020 and December 2021., Result: A total of 203 COVID-19 with PTB patients and 812 matched COVID-19 without PTB were analyzed using 1:4 propensity score matching. COVID-19 patients with PTB exhibited higher in-hospital mortality (odds ratio (OR) 3.02, 95% confidence interval (CI) 1.45-6.27, p -value = 0.003) and were at increased risk of requiring conventional oxygen therapy (OR 1.57, 95% CI 1.10-2.25, p -value = 0.013) as well as high flow nasal cannula (HFNC) or noninvasive ventilation (NIV) oxygen therapy (OR 1.91, 95 CI 1.10-3.32, p -value = 0.022) compared to those without PTB. Compared to matched COVID-19 without PTB, co-infected patients showed increased mortality rates across various timeframes, including during hospitalization, and at 30 day and 90 day intervals. In-hospital mortality rates were particularly elevated among women, individuals with malignancy, and those with lower incomes. Furthermore, the increased in-hospital mortality among PTB patients persisted irrespective of the timing of TB diagnosis or vaccination status against COVID-19., Conclusion: We suggest that physicians be aware of the risk of mortality and severity among COVID-19 patients with PTB; coinfection with COVID-19 is a critical situation that remains to be further explored and needs more attention in countries with an intermediate to high PTB burden., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lee, Kim, Oh, Kang, Yoo, Ko, Lim, Kim, Lee, Kim, Sohn, Yoon, Choi, Cho and Park.)

Despite notable advancements in cancer therapeutics, metastasis remains a primary obstacle impeding a successful prognosis. Our prior study has identified heme oxygenase 2 (HO2) as a promising therapeutic biomarker for the aggressive subsets within tumor. This study aims to systematically evaluate HO2 as a therapeutic target of cancer, with a specific emphasis on its efficacy in addressing cancer metastasis. Through targeted inhibition of HO2 by TiNIR (tumor-initiating cell probe with near infrared), we observed a marked increase in reactive oxygen species. This, in turn, orchestrated the modulation of AKT and cJUN activation, culminating in a substantial attenuation of both proliferation and migration within a metastatic cancer cell model. Furthermore, in a mouse model, clear inhibition of cancer metastasis was unequivocally demonstrated with an HO2 inhibitor administration. These findings underscore the therapeutic promise of targeting HO2 as a strategic intervention to impede cancer metastasis, enhancing the effectiveness of cancer treatments., Competing Interests: Competing interests: The authors declare that they have no competing interests., (Copyright © 2024 Seul-Ki Mun et al.)

Purpose: To develop and validate a deep learning system (DLS) for estimation of vertical cup-to-disc ratio (vCDR) in ultra-widefield (UWF) and smartphone-based fundus images., Methods: A DLS consisting of two sequential convolutional neural networks (CNNs) to delineate optic disc (OD) and optic cup (OC) boundaries was developed using 800 standard fundus images from the public REFUGE data set. The CNNs were tested on 400 test images from the REFUGE data set and 296 UWF and 300 smartphone-based images from a teleophthalmology clinic. vCDRs derived from the delineated OD/OC boundaries were compared with optometrists' annotations using mean absolute error (MAE). Subgroup analysis was conducted to study the impact of peripapillary atrophy (PPA), and correlation study was performed to investigate potential correlations between sectoral CDR (sCDR) and retinal nerve fiber layer (RNFL) thickness., Results: The system achieved MAEs of 0.040 (95% CI, 0.037-0.043) in the REFUGE test images, 0.068 (95% CI, 0.061-0.075) in the UWF images, and 0.084 (95% CI, 0.075-0.092) in the smartphone-based images. There was no statistical significance in differences between PPA and non-PPA images. Weak correlation (r = -0.4046, P < 0.05) between sCDR and RNFL thickness was found only in the superior sector., Conclusions: We developed a deep learning system that estimates vCDR from standard, UWF, and smartphone-based images. We also described anatomic peripapillary adversarial lesion and its potential impact on OD/OC delineation., Translational Relevance: Artificial intelligence can estimate vCDR from different types of fundus images and may be used as a general and interpretable screening tool to improve community reach for diagnosis and management of glaucoma.

Objectives: The need for interoperability at the national level was highlighted in Korea, leading to a consensus on the importance of establishing national standards that align with international technological standards and reflect contemporary needs. This article aims to share insights into the background of the recent national health data standardization policy, the activities of the Health Data Standardization Taskforce, and the future direction of health data standardization in Korea., Methods: To ensure health data interoperability, the Health Data Standardization Taskforce was jointly organized by the public and private sectors in December 2022. The taskforce operated three working groups. It reviewed international trends in interoperability standardization, assessed the current status of health data standardization, discussed its vision, mission, and strategies, engaged in short-term standardization activities, and established a governance system for standardization., Results: On September 15, 2023, the notice of "Health Data Terminology and Transmission Standards" in Korea was thoroughly revised to improve the exchange of health information between information systems and ensure interoperability. This notice includes the Korea Core Data for Interoperability (KR CDI) and the Korea Core Data Transmission Standard (HL7 FHIR KR Core), which are outcomes of the taskforce's efforts. Additionally, to reinforce the standardized governance system, the Health-Data Standardization Promotion Committee was established., Conclusions: Active interest and support from medical informatics experts are needed for the development and widespread adoption of health data standards in Korea.

Background/aims: Four-week treatment of linvencorvir (RO7049389) was generally safe and well tolerated, and showed anti-viral activity in chronic hepatitis B (CHB) patients. This study evaluated the efficacy, safety, and pharmacokinetics of 48-week treatment with linvencorvir plus standard of care (SoC) in CHB patients., Methods: This was a multicentre, non-randomized, non-controlled, open-label phase 2 study enrolling three cohorts: nucleos(t)ide analogue (NUC)-suppressed patients received linvencorvir plus NUC (Cohort A, n=32); treatment-naïve patients received linvencorvir plus NUC without (Cohort B, n=10) or with (Cohort C, n=30) pegylated interferon-α (Peg-IFN-α). Treatment duration was 48 weeks, followed by NUC alone for 24 weeks., Results: 68 patients completed the study. No patient achieved functional cure (sustained HBsAg loss and unquantifiable HBV DNA). By Week 48, 89% of treatment-naïve patients (10/10 Cohort B; 24/28 Cohort C) reached unquantifiable HBV DNA. Unquantifiable HBV RNA was achieved in 92% of patients with quantifiable baseline HBV RNA (14/15 Cohort A, 8/8 Cohort B, 22/25 Cohort C) at Week 48 along with partially sustained HBV RNA responses in treatment-naïve patients during follow-up period. Pronounced reductions in HBeAg and HBcrAg were observed in treatment-naïve patients, while HBsAg decline was only observed in Cohort C. Most adverse events were grade 1-2, and no linvencorvir-related serious adverse events were reported., Conclusion: 48-week linvencorvir plus SoC was generally safe and well tolerated, and resulted in potent HBV DNA and RNA suppression. However, 48-week linvencorvir plus NUC with or without Peg-IFN did not result in the achievement of functional cure in any patient.

Sex differences in the in-hospital management of sepsis exist. Previous studies either included patients with sepsis that was defined using previous definitions of sepsis or evaluated the 3-h bundle therapy. Therefore, this study sought to assess sex differences in 1-h bundle therapy and in-hospital management among patients with sepsis and septic shock, defined according to the Sepsis-3 definitions. This observational study used data from Korean Shock Society (KoSS) registry, a prospective multicenter sepsis registry. Adult patients with sepsis between June 2018 and December 2021 were included in this study. The primary outcome was adherence to 1-h bundle therapy. Propensity score matching (PSM) and multivariable logistic regression analyses were performed. Among 3264 patients with sepsis, 3129 were analyzed. PSM yielded 2380 matched patients (1190 men and 1190 women). After PSM, 1-h bundle therapy was performed less frequently in women than in men (13.0% vs. 19.2%; p < 0.001). Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently in women than in men (25.4% vs. 31.6%, p < 0.001), whereas adequate fluid resuscitation was performed more frequently in women than in men (96.8% vs. 95.0%, p = 0.029). In multivariable logistic regression analysis, 1-h bundle therapy was performed less frequently in women than in men [adjusted odds ratio (aOR) 1.559; 95% confidence interval (CI) 1.245-1.951; p < 0.001] after adjustment. Among the bundle therapy components, broad-spectrum antibiotics were administered less frequently to women than men (aOR 1.339, 95% CI 1.118-1.605; p = 0.002), whereas adequate fluid resuscitation was performed more frequently for women than for men (aOR 0.629, 95% CI 0.413-0.959; p = 0.031). Invasive arterial blood pressure monitoring was performed less frequently in women than in men. Resuscitation fluid, vasopressor, steroid, central-line insertion, ICU admission, length of stay in the emergency department, mechanical ventilator use, and renal replacement therapy use were comparable for both the sexes. Among patients with sepsis and septic shock, 1-h bundle therapy was performed less frequently in women than in men. Continuous efforts are required to increase adherence to the 1-h bundle therapy and to decrease sex differences in the in-hospital management of patients with sepsis and septic shock., (© 2024. The Author(s).)

Axillary odor is a malodor produced by bacterial metabolism near the apocrine glands, which often causes discomfort in an individual's daily life and social interactions. A deodorant is a personal care product designed to alleviate or mask body odor. Currently, most deodorants contain antimicrobial chemicals and fragrances for odor management; however, direct application to the underarm skin can result in irritation or sensitivity. Therefore, there is a growing interest in technologies that enable disinfection and odor control without the antiperspirants or perfumes. The cold atmospheric plasma temporally generates reactive radicals that can eliminate bacteria and surrounding odors. In this study, cultured Staphylococcus hominis and Corynebacterium xerosis, the causative bacteria of axillary bromhidrosis, were killed after 90% plasma exposure for 3 min. Moreover, the electronic nose system indicated a significant reduction of approximately 51% in 3-hydroxy-3-methylhexanoic acid and approximately 34% in 3-methyl-3-sulfanylhexan-1-ol, the primary components of axillary odor, following a 5-min plasma exposure. These results support the dual function of our deodorant in eliminating bacteria and axillary odors without the chemical agents. Therefore, cold atmospheric plasma-applied deodorant devices have great potential for the treatment and management of axillary odors as a non-contact approach without chemical use in daily life., (© 2024. The Author(s).)

Carbon monoxide (CO) poisoning is difficult to diagnose owing to its nonspecific symptoms. Multiwave pulse oximetry can be used to quickly screen patients for CO poisoning. However, few studies have analyzed patients with CO poisoning who presented to the emergency department (ED). The primary aim of our study was to determine the correlation between COHb levels measured in blood gas analysis and COHb levels measured in multiwave pulse oximetry. Secondary aims were the sensitivity and specificity of the COHb level cutoff value using multiwave pulse oximetry to predict a 25% COHb level in blood gas analysis. This single-center retrospective observational study included patients with CO poisoning who visited the ED of a university-affiliated hospital in Seoul, Korea between July 2021 and June 2023. COHb poisoning was determined using blood gas analysis and multiwave pulse oximetry. The correlation of COHb levels between the two tests was evaluated using correlation analysis. The area under the receiver operating characteristic curve (AUC) of multiwave pulse oximetry was calculated to predict COHb levels from the blood gas analysis. The optimal cutoff values, sensitivity, and specificity of COHb were determined. A total of 224 patients who had COHb levels measured using both multiwave pulse oximetry and blood gas analysis were included in the analysis. In the correlation analysis, COHb showed a high positive correlation with COHb measured using blood gas analysis (Spearman correlation coefficient = 0.86, p < 0.001). The AUC of COHb measured by multiwave pulse oximetry to predict 25% of the COHb level (which can be an indication of hyperbaric oxygen treatment) measured by blood gas analysis was 0.916. When the COHb levels measured with multiwave pulse oximetry were 20% the sensitivity was 81% and the specificity was 83%, and when the COHb levels were 25% the sensitivity was 50% and the specificity was 95%. The COHb value measured using multiwave pulse oximetry blood gas analysis showed a high correlation. However, additional research using large-scale studies is required for validation.

Background: There is a need to update the cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score to reflect the current practice in sepsis. We previously proposed the modified CV SOFA score from data on blood pressure, norepinephrine equivalent dose, and lactate as gathered from emergency departments. In this study, we externally validated the modified CV SOFA score in multicenter intensive care unit (ICU) patients., Methods: A multicenter retrospective observational study was conducted on ICU patients at six hospitals in Korea. We included adult patients with sepsis who were admitted to ICUs. We compared the prognostic performance of the modified CV/total SOFA score and the original CV/total SOFA score in predicting 28-day mortality. Discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and the calibration curve, respectively., Results: We analyzed 1,015 ICU patients with sepsis. In overall patients, the 28-day mortality rate was 31.2%. The predictive validity of the modified CV SOFA (AUROC, 0.712; 95% confidence interval [CI], 0.677-0.746; P < 0.001) was significantly higher than that of the original CV SOFA (AUROC, 0.644; 95% CI, 0.611-0.677). The predictive validity of modified total SOFA score for 28-day mortality was significantly higher than that of the original total SOFA (AUROC, 0.747 vs. 0.730; 95% CI, 0.715-0.779; P = 0.002). The calibration curve of the original CV SOFA for 28-day mortality showed poor calibration. In contrast, the calibration curve of the modified CV SOFA for 28-day mortality showed good calibration., Conclusion: In patients with sepsis in the ICU, the modified SOFA score performed better than the original SOFA score in predicting 28-day mortality., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2023 The Korean Academy of Medical Sciences.)

An acute brain lesion (ABL) identified by brain magnetic resonance imaging (MRI) after acute carbon monoxide (CO) poisoning is a strong prognostic factor for the development of delayed neuropsychiatric syndrome (DNS). This study aimed to identify predictors of ABLs on MRI in patients with acute CO poisoning. This was a multicenter prospective registry-based observational study conducted at two tertiary hospitals. A total of 1,034 patients were included. Multivariable logistic regression analysis showed that loss of consciousness (LOC) (adjusted odds ratio [aOR] 2.68, 95% Confidence Interval [CI]: 1.49-5.06), Glasgow Coma Scale (GCS) score < 9 (aOR 2.41, 95% CI: 1.49-3.91), troponin-I (TnI) (aOR 1.22, 95% CI: 1.08-1.41), CO exposure duration (aOR 1.09, 95% CI: 1.05-1.13), and white blood cell (WBC) (aOR 1.05, 95% CI: 1.01-1.09) were independent predictors of ABLs on MRI. LOC, GCS score, TnI, CO exposure duration, and WBC count can be useful predictors of ABLs on MRI in patients with acute CO poisoning, helping clinicians decide the need for an MRI scan or transfer the patient to an appropriate institution for MRI or hyperbaric oxygen therapy., (© 2023. The Author(s).)

Solid oxide fuel cells (SOFCs) are highly efficient, low-emission, and fuel-flexible energy conversion devices. However, their commercialization has lagged due to the lack of long-term durability. Among several performance degradation mechanisms, cathode degradation and elemental inter-diffusion of the electrolyte and cathode has been identified as the predominant factors. In the most common SOFC systems, a cobalt-based perovskite material is used, for example LSC or LSCF. These cobalt-based materials offer mixed conductivity and higher concentration of oxygen vacancies as compared to LSM at lower operating temperature leading to favorable reduction kinetics. However, the presence of cobalt results in higher cost, higher thermal expansion co-efficient (TEC) mismatch and most importantly leads to rapid degradation. Various elements like strontium, cobalt, cerium, chromium, or zirconium accumulate or deposit at the electrode-electrolyte interface, which results in sluggish reaction kinetics of the oxygen reduction reaction (ORR). These elements react to form secondary phases that have lower ionic and electronic conductivity, cover active reaction sites, and eventually lead to cell and system deterioration. Over the past decade, several studies have focused on preventative and protective measures to prolong SOFC lifetime which includes novel fabrication techniques, introduction of new layers, addition of thin films to block the cation transport. Such efforts to prevent the formation of insulating phases and decomposition of the cathode have resulted in a remarkable improvement in long-term stability. In this review paper, current research on leading mechanisms responsible for the degradation of cobaltite cathode of solid oxide fuel cell has been summarized and durability improvement strategies of cobalt-based SOFC cathodes have been discussed., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Background: Out-of-hospital cardiac arrest (OHCA) is a major public health problem and a leading cause of death worldwide. Previous studies have focused on improving the survival of people who have had OHCA by analyzing short-term survival outcomes, such as the return of spontaneous circulation, 30-day survival, and survival to discharge. Research has been conducted on prehospital prognostic factors to improve the survival of patients with OHCA, among which the association between socioeconomic status (SES) and survival has been reported. SES could affect bystander cardiopulmonary resuscitation rates and whether OHCA is witnessed, and low cardiopulmonary resuscitation education rates are associated with low SES. It has been reported that areas with high SES have shorter hospital transfer times and more public defibrillators per person. Previous studies have shown the impact of SES disparities on the short-term survival of patients with OHCA. However, understanding the impact of SES on the long-term prognosis of OHCA survivors remains limited. As long-term outcomes are more indicative of a patient's ongoing health care needs and the burden on public health than short-term outcomes, understanding the long-term prognosis of OHCA survivors is important., Objective: This study aimed to identify whether SES influenced the long-term outcomes of OHCA., Methods: Using health claims data obtained from the National Health Insurance (NHI) service in Korea, we included OHCA survivors who were hospitalized between January 2005 and December 2015. The patients were divided into 2 groups: NHI and Medical Aid (MA) groups, with the MA group defined as having a low SES. Cumulative mortality was estimated using the Kaplan-Meier method, and a Cox proportional hazards model was used to evaluate the impact of SES on long-term mortality. A subgroup analysis was performed based on whether cardiac procedures were performed., Results: We followed 4873 OHCA survivors for up to 14 years (median of 3.3 years). The Kaplan-Meier survival curve showed that the MA group had a significantly decreased long-term survival rate compared to the NHI group. With an adjusted hazard ratio (aHR) of 1.52 (95% CI 1.35-1.72), low SES was associated with increased long-term mortality. The overall mortality rate of the patients who underwent cardiac procedures in the MA group was significantly higher than that of the NHI group (aHR 1.72, 95% CI 1.05-2.82). The overall mortality rate of patients without cardiac procedures was also increased in the MA group compared to the NHI group (aHR 1.39, 95% CI 1.23-1.58)., Conclusions: OHCA survivors with low SES had an increased risk of poor long-term outcomes compared with those with higher SES. OHCA survivors with low SES who have undergone cardiac procedures need considerable care for long-term survival., (©Kyung Hun Yoo, Yongil Cho, Jaehoon Oh, Juncheol Lee, Byuk Sung Ko, Hyunggoo Kang, Tae Ho Lim, Sang Hwan Lee. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 11.07.2023.)

Human cord blood-derived γδ T cells (CB γδ ) display a highly diverse TCR γδ repertoire and have a unique subtype composition different from fetal or adult peripheral blood counterparts. We expanded CB γδ in vitro using an irradiated Epstein-Barr virus-transformed feeder cell-based modified rapid expansion protocol (REP). Single-cell RNA sequencing tracked progressive differentiation of naïve CB γδ into cells expressing neoantigen-reactive tumor-infiltrating lymphocyte as well as tissue-resident memory precursor-like and antigen-presenting cell-like gene signatures. TCR γδ clonal tracing revealed a bias toward cytotoxic effector differentiation in a much larger proportion of V δ 2 - clones compared to V δ 2 + clones, resulting in the former being more cytotoxic at the population level. These clonotype-specific differentiation dynamics were not restricted to REP and were recapitulated upon secondary nonviral antigen stimulations. Thus, our data showed intrinsic cellular differences between major subtypes of human γδ T cells already in operation at early postnatal stage and highlighted key areas of consideration in optimizing cell manufacturing processes.

Background: Delayed neuropsychiatric sequelae (DNS) are a severe complication of carbon monoxide (CO) poisoning, and predicting DNS is difficult. This study aimed to investigate whether cardiac markers can be used as biomarkers to predict DNS occurrence following acute CO poisoning., Methods: This was a retrospective observational study that included patients with acute CO poisoning who visited two emergency medical centers in Korea from January 2008 to December 2020. The primary outcome was whether the occurrence of DNS was associated with laboratory results., Results: Of the 1327 patients with CO poisoning, 967 patients were included. Troponin I and BNP were significantly higher in the DNS group. As a result of multivariate logistic regression analysis, it was found that troponin I, mentality, creatine kinase, brain natriuretic peptide, and lactate levels independently influenced DNS occurrence in CO poisoning patients. The adjusted odds ratios for DNS occurrence were 2.12 (95% CI 1.31-3.47, p = 0.002) for troponin I and 2.80 (95% CI 1.81-3.47, p < 0.001) for BNP., Conclusion: Troponin I and BNP might be useful biomarkers for predicting the occurrence of DNS in patients with acute CO poisoning. This finding can help to identify high-risk patients who require close monitoring and early intervention to prevent DNS.

Poly-L-lactic acid (PLLA) fillers correct cutaneous volume loss by stimulating fibroblasts to synthesize collagen and by augmenting the volume. PLLA triggers the macrophage-induced activation of fibroblasts that secrete transforming growth factor-β (TGF-β). However, whether M2 macrophage polarization is involved in PLLA-induced collagen synthesis via fibroblast activation in aged skin is not known. Therefore, we evaluated the effect of PLLA on dermal collagen synthesis via M2 polarization in an H 2 O 2 -induced cellular senescence model and aged animal skin. H 2 O 2 -treated macrophages had increased expression levels of the M1 marker CD80 and decreased expression levels of the M2 marker CD163, which were reversed by PLLA. The expression levels of interleukin (IL)-4 and IL-13, which mediate M2 polarization, were decreased in H 2 O 2 -treated macrophages and increased upon the PLLA treatment. CD163, IL-4, and IL-13 expression levels were decreased in aged skin, but increased after the PLLA treatment. The expression levels of TGF-β, pSMAD2/SMAD2, connective tissue growth factor (CTGF), alpha-smooth muscle actin (α-SMA), collagen type 1A1 (COL1A1), and COL3A1 were also decreased in aged skin, but increased after the PLLA treatment. Moreover, PLLA upregulated phosphatidylinositol 3-kinase p85α (PI3-kinase p85α)/protein kinase B (AKT) signaling, leading to fibroblast proliferation. PLLA decreased the expression of matrix metalloproteinase (MMP) 2 and MMP3, which destroy collagen and elastin fibers in aged skin. The amount of collagen and elastin fibers in aged skin increased following the PLLA treatment. In conclusion, PLLA causes M2 polarization by increasing IL-4 and IL-13 levels and upregulating TGF-β expression and collagen synthesis in aged skin.

Detection and analysis of viral genomes with Nanopore sequencing has shown great promise in the surveillance of pathogen outbreaks. However, the number of virus detection pipelines supporting Nanopore sequencing is very limited. Here, we present VirPipe, a new pipeline for the detection of viral genomes from Nanopore or Illumina sequencing input featuring streamlined installation and customization., Availability and Implementation: VirPipe source code and documentation are freely available for download at https://github.com/KijinKims/VirPipe, implemented in Python and Nextflow., (© The Author(s) 2023. Published by Oxford University Press.)

Background: Chronic discogenic pain includes degeneration-driven changes under the mechanical macroenvironment of an internal disc, which leads to the progressive changes of biochemical microenvironment that induce abnormal ingrowth of the nociceptor. The propriety of the animal model reflecting the pathologic natural history has not been assessed., Objectives: This study investigated the biochemical evidence of chronic discogenic pain by employing a discogenic pain animal model induced by shear force., Study Design: Animal study utilizing rats in vivo model of a shear force device., Methods: Fifteen rats were divided into 3 groups (n = 5/group) according to the period for which sustained dorsoventral shear force was applied (1 week or 2 weeks); the control group received the spinous attachment unit, without a spring. Pain data were collected using von Frey hairs on the hind paws. Growth factor and cytokine abundance was analyzed in the dorsal root ganglion (DRG) and plasma., Results: After the shear force devices were installed, the significant variables were found to markedly increase in the DRG tissues of the 2-week group; however, they were not altered in the 1-week group. Specifically, interleukin (IL)-6, neurogrowth factor (NGF), transforming growth factor (TGF)-alpha, platelet-derived growth factor (PDGF)-beta, and vascular endothelial growth factor (VEGF) were increased. Meanwhile, the plasma levels of tumor necrosis factor-alpha, IL-1beta, IL-5, IL-6, IL-12, and NGF were increased in the 1-week group; whereas, TGF-alpha, PDGF-beta, and VEGF were increased in the 2-week group., Limitations: The limitations include the general limitations of quadrupedal animals, the poor precision and flexural deformation of shear force devices, inaccuracies regarding the evaluation of histological denaturation, and short intervention and observational periods., Conclusions: This animal model effectively generated biochemical responses to shear loading with evidence of neurological changes induced without direct macrodamage to the outer annulus fibrosus. Chemical internals were induced by mechanical externals among the contributing factors of chronic discogenic pain.

Importance: The recent American Heart Association guidelines added a sixth link in the chain of survival highlighting recovery and emphasized the importance of psychiatric outcome and recovery for survivors of out-of-hospital cardiac arrest (OHCA). The prevalence of psychiatric disorders among this population was higher than that in the general population., Objective: To examine the prevalence of depression or anxiety and the association of these conditions with long-term mortality among individuals who survive OHCA., Design, Setting, and Participants: A longitudinal population-based cohort study was conducted to analyze long-term prognosis in patients hospitalized for OHCA between January 1, 2005, and December 31, 2015, who survived for 1 year or longer. Patients with cardiac arrest due to traumatic or nonmedical causes, such as injuries, poisoning, asphyxiation, burns, or anaphylaxis, were excluded. Data were extracted on depression or anxiety diagnoses in this population within 1 year from the database of the Korean National Health Insurance Service and analyzed April 7, 2022, and reanalyzed January 19 to 20, 2023., Main Outcomes and Measures: Follow-up data were obtained for up to 14 years, and the primary outcome was long-term cumulative mortality. Long-term mortality among patients with and without a diagnosis of depression or anxiety were evaluated., Results: The analysis included 2373 patients; 1860 (78.4%) were male, and the median age was 53.0 (IQR, 44.0-62.0) years . A total of 397 (16.7%) patients were diagnosed with depression or anxiety, 251 (10.6%) were diagnosed with depression, and 227 (9.6%) were diagnosed with anxiety. The incidence of long-term mortality was significantly higher in the group diagnosed with depression or anxiety than in the group without depression or anxiety (141 of 397 [35.5%] vs 534 of 1976 [27.0%]; P = .001). With multivariate Cox proportional hazards regression analysis, the adjusted hazard ratio of long-term mortality for total patients with depression or anxiety was 1.41 (95% CI, 1.17-1.70); depression, 1.44 (95% CI, 1.16-1.79); and anxiety, 1.20 (95% CI, 0.94-1.53)., Conclusions and Relevance: In this study, among the patients who experienced OHCA, those diagnosed with depression or anxiety had higher long-term mortality rates than those without depression or anxiety. These findings suggest that psychological and neurologic rehabilitation intervention for survivors of OHCA may be needed to improve long-term survival.

Objective: The COVID-19 pandemic might have adversely affected outcomes of patients in emergency departments (EDs). The aim of this study is to evaluate the impact of the COVID-19 pandemic on in patients admitted through the emergency department., Methods: This study is a single-center, retrospective, observational cohort study. We compared the prognosis of patients admitted through the ED before the COVID-19 pandemic (November 2018 to June 2019) and after COVID-19 (November 2020 to June 2021). The primary outcome was in-hospital mortality. Multivariable logistic regression analysis was performed to determine whether the COVID-19 pandemic was independently associated with patient prognosis., Results: The number of patients admitted through the ED before and after COVID-19 was 5,333 and 4,625, respectively. The mean ED length of stay before and after COVID-19 was 401 and 442 minutes, respectively (P<0.001). The number of in-hospital deaths before and after COVID-19 were 269 (5.0%) and 322 (7.0%), respectively (P<0.001). Multivariable logistic regression analysis showed that the COVID-19 period was significantly associated with higher in-hospital mortality (adjusted odds ratio, 1.37; 95% confidence interval, 1.12-1.67; P=0.002)., Conclusion: In the COVID-19 period, in-hospital mortality increased compared to that before COVID-19 among hospitalized ED patients.

Welding defects are common during the production of large welded structures. However, few studies have explored methods of compensating for clear welding defects without resorting to re-welding. Here, an ultrasonic peening method to compensate for the deteriorated mechanical properties of overlap weld defects without repair welding was studied. We experimentally investigated changes in the mechanical properties of defective welds before and after ultrasonic peening. The weld specimen with an overlap defect contained a large cavity-type defect inside the weld bead, which significantly reduced the fatigue life. When the surface of the defective test piece was peened, the fatigue life of the weld plate was restored, resulting in an equivalent or higher number of cycles to failure, compared to a specimen with a normal weld. The recovery of mechanical properties was attributed to the effect of surface work hardening by ultrasonic peening and the change in stress distribution. Thus, ultrasonic peening could compensate for the deterioration of mechanical properties such as tensile strength, fatigue life, and elongation due to overlap defects, without resorting to repair welding.

Background: Occupational hand eczema (OHE) is common among healthcare workers (HCWs), especially during the coronavirus disease 2019 (COVID-19) pandemic., Aims: Our study aimed to determine the prevalence of OHE among HCWs and to identify its associated risk factors., Methods: We conducted a cross-sectional study. A self-administered questionnaire study was done. It was followed by a clinical assessment of subjects with skin changes on their hands to determine the likely cause and its severity. Descriptive analysis and inferential analysis were performed to determine the prevalence of OHE and its associated risk factors., Results: A total of 1004 HCWs with a mean age of 34.58 years old were recruited. Of these, 50.1% were nurses, another 24.6% were doctors. A 1-year prevalence of 42.3% and a point prevalence of 16.5% were reported. Dry skin ( n = 368, 86.6%) and itching ( n = 274, 64.5%) were the common symptoms. Risk factors that were significantly associated with OHE were atopic eczema, allergic rhinitis, frequent hand washing and caring for children under four years old, whereas HCWs who frequently use alcoholic disinfectant and moisturizer hand cream showed lower odds of OHE. No significant association was found between age, gender, profession, involvement in COVID-19 care, number or duration of glove usage and occurrence of hand eczema., Conclusions: We report a high prevalence of OHE among HCWs during the current COVID-19 pandemic. Education and effective preventive measures are paramount to prevent and improve occupational dermatosis., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Dermatology.)