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Aquagenic urticaria is a rare form of physical urticaria in which a 1-2 mm wheal is produced by contact with water. Treatment options include antihistamines, ultraviolet monotherapy, topical barrier creams, and acetylcholine antagonists. Despite these pharmacologic measures, the symptoms are frequently refractory to therapy. Aquagenic urticaria lowers the patient’s quality of life and causes daily discomfort. Recently, a patient with aquagenic urticaria treated with omalizumab was reported. Here, we describe a 22-year-old man with a 3-year history of aquagenic urticaria confirmed by a water immersion test. Because he showed no improvement with antihistamines, the patient began omalizumab treatment and demonstrated an excellent response. This case provides new information for clinicians.

Globally, renewable energies are indispensable resources on account of RE100 and the Paris Agreement. The most developed renewable energies are photovoltaics (PV) and wind energy, and they are continuously expanding. This study aims to optimize and analyze the nuclear power plant (NPP) load-following operation in various PV conditions in a metropolitan region. With theoretically estimated power demand and PV power, a mixed-integer problem (MIP) with ramping cycle constraint (RCC) was constructed for a safe load-following operation and simulated through duck curves under various NPP load-following regions (the extreme, normal, and safe regions). The simulation showed two major results for NPP load-following. Technically, RCC successfully controlled the NPP ramp cycle and was assured to be an optimization tool for NPP operation. Numerically, NPP load-following alleviated PV intermittency to almost 50%, 30%, and 15% depending on the load-following region. However, these effects were restricted when the PV capacity rate was high, especially when it exceeded 60%. Thus, PV system capacity is recommended to be 63% of the maximum power demand in the metropolitan region with NPP load-following, and larger PV systems need more flexibility.

The acceleration of super-heavy ions (SHIs) from plasmas driven by ultrashort (tens of femtoseconds) laser pulses is a challenging topic waiting for breakthrough. The detecting and controlling of the ionization process, and the adoption of the optimal acceleration scheme are crucial for the generation of highly energetic SHIs. Here, we report the experimental results on the generation of deeply ionized super-heavy ions (Au) with unprecedented energy of 1.2 GeV utilizing ultrashort laser pulses (22 fs) at the intensity of 10^22 W/cm2. A novel self-calibrated diagnostic method was developed to acquire the absolute energy spectra and charge state distributions of Au ions abundant at the charge state of 51+ and reaching up to 61+. The measured charge state distributions supported by 2D particle-in-cell simulations serves as an additional tool to inspect the ionization dynamics associated with SHI acceleration, revealing that the laser intensity is the crucial parameter for the acceleration of Au ions over the pulse duration. The use of double-layer targets results in a prolongation of the acceleration time without sacrificing the strength of acceleration field, which is highly favorable for the generation of high-energy super heavy ions.

Vasoactive and inotropic medications are essential for sepsis management, however, the association between the maximum Vasoactive-Inotropic score (VISmax) and clinical outcomes is unknown in adult patients with sepsis. We investigated the VISmax as a predictor for mortality among such patients in the emergency department (ED) and compared its prognostic value with that of the sequential organ failure assessment (SOFA) score. This single-center retrospective study included 910 patients diagnosed with sepsis between January 2016 and March 2020. We calculated the VISmax using the highest doses of vasopressors and inotropes administered during the first 6 h on ED admission and categorized it as 0–5, 6–15, 16–30, 31–45, and &gt, 45 points. The primary outcome was 30-day mortality. VISmax for 30-day mortality was significantly higher in non-survivors than in survivors. The mortality rates in the five VISmax groups were 17.2%, 20.8%, 33.3%, 54.6%, and 70.0%, respectively. The optimal cut-off value of VISmax to predict 30-day mortality was 31. VISmax had better prognostic value than the cardiovascular component of the SOFA score and initial lactate levels. VISmax was comparable to the APACHE II score in predicting 30-day mortality. Multivariable analysis showed that VISmax 16–30, 31–45, and &gt, 45 were independent risk factors for 30-day mortality. VISmax in ED could help clinicians to identify sepsis patients with poor prognosis.

Objective Accurate interpretation of computed tomography (CT) scans is critical for patient care in the emergency department. We aimed to identify factors associated with an incorrect interpretation of abdominal CT by novice emergency residents and to analyze the characteristics of incorrectly interpreted scans.Methods This retrospective analysis of a prospective observational cohort was conducted at three urban emergency departments. Discrepancies between the interpretations by postgraduate year-1 (PGY-1) emergency residents and the final radiologists’ reports were assessed by independent adjudicators. Potential factors associated with incorrect interpretation included patient age, sex, time of interpretation, and organ category. Adjusted odds ratios (aORs) for incorrect interpretation were calculated using multivariable logistic regression analysis.Results Among 1,628 eligible cases, 270 (16.6%) were incorrect. The urinary system was the most correctly interpreted organ system (95.8%, 365/381), while the biliary tract was the most incorrectly interpreted (28.4%, 48/169). Normal CT images showed high false-positive rates of incorrect interpretation (28.2%, 96/340). Organ category was found to be a major determinant of incorrect interpretation. Using the urinary system as a reference, the aOR for incorrect interpretation of biliary tract disease was 9.20 (95% confidence interval, 5.0–16.90) and the aOR for incorrectly interpreting normal CT images was 8.47 (95% confidence interval, 4.85–14.78).Conclusion Biliary tract disease is a major factor associated with incorrect preliminary interpretations of abdominal CT scans by PGY-1 emergency residents. PGY-1 residents also showed high false-positive interpretation rates for normal CT images. Emergency residents’ training should focus on these two areas to improve abdominal CT interpretation accuracy.

Objective This study aimed to describe the timely strategies used to prevent the spread of the emerging coronavirus disease 2019 (COVID-19) and present the activities performed in a regional base hospital in South Korea, from the identification of the index patient until the pandemic declaration. Methods This is a descriptive study detailing the step-by-step guidelines implemented to manage COVID-19 in a regional tertiary base hospital from January to March 2020. We described our three-phase response to the COVID-19 outbreak as per the national and global quarantine procedures applied during each critical event and highlighted the activities implemented from the perspective of public health crisis preparedness involving emerging infectious diseases. Results During the COVID-19 outbreak in Korea, we improved and implemented a rapid and flexible screening system for visiting patients using patient history and radiological testing and created a separate isolation zone for patients under investigation. This active identification-isolation strategy has been effectively applied in the COVID-19 outbreak. Conclusions The step-by-step enforced strategies to prevent the spread of COVID-19, though not perfect, adequately reduced the risk of transmission of the highly contagious infectious disease in the hospital while maintaining the emergency medical system.

Background: This study evaluated the prognostic value of lactate levels and lactate clearance for the prediction of mortality in sepsis and septic shock patients.Methods: We performed a retrospective cohort study of sepsis and septic shock patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (Results: Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower lactate clearance than those of survivors. Six-hour lactate levels and lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097–1.294] and 0.989 [0.983–0.995], respectively). Six-hour lactate levels had better prognostic value than lactate clearance (area under the curve, 0.720 [95% CI, 0.670–0.765] vs. 0.656 [0.605–0.705]; p = 0.018). A 6-hour lactate level of ≥3.5 mmol/L and a lactate clearance of Conclusions: Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than lactate clearance.

With the recent advances in ultrahigh intensity lasers, exotic astrophysical phenomena can be investigated in laboratory environments. Collisionless shock in a plasma, prevalent in astrophysical events, is produced when a strong electric or electromagnetic force induces a shock structure in a time scale shorter than the collision time of charged particles. A near-critical-density (NCD) plasma, generated with an intense femtosecond laser, can be utilized to excite a collisionless shock due to its efficient and rapid energy absorption. We present electrostatic shock acceleration (ESA) in experiments performed with a high-density helium gas jet, containing a small fraction of hydrogen, irradiated with a 30 fs, petawatt laser. The onset of ESA exhibited a strong dependence on plasma density, consistent with the result of particle-in-cell simulations on relativistic plasma dynamics. The mass-dependent ESA in the NCD plasma, confirmed by the preferential reflection of only protons with two times the shock velocity, opens a new possibility of selective acceleration of ions by electrostatic shock.

Aim We designed this study to evaluate the prevalence of comorbidities, their monitoring states and association with treatment medication in Korean rheumatoid arthritis (RA) patients compared with patients from other countries. Methods We analyzed 1050 RA patients from 11 Korean centers and compared them with 3520 patients from 16 other countries using an international, cross-sectional study evaluating comorbidities of RA (COMORA) database. Results Annual evaluations of cardiovascular (CV) risk were less frequently performed in Korea (P = 0.0011). The prevalence of CV-associated morbidity was similar between Korean and international RA patients, although the proportions of current smokers, patients with a family history of CV disease, patients with hyperlipidemia, and patients with Framingham score > 20% were significantly lower in Korea (P < 0.0001 for all), and the antiplatelet agents were more optimally used in Korea (P = 0.0004). Prostate cancer screening was less frequently performed compared to other countries (P < 0.0001). Less than 10% of Korean RA patients were given influenza and pneumococcal vaccinations according to current recommendations. Conclusions There are differences in the prevalence of comorbidities and monitoring states of the risk factors between patients in Korea and in other countries. The prevalence of CV morbidity was similar between the two groups although the prevalence of CV risk factors was significantly low in Korea, suggesting that rheumatologists in Korea need to pay more attention to yearly CV risk monitoring, in addition to the screening of malignancy and vaccination of RA patients against infectious diseases.

The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (

Bilateral sagittal split ramus osteotomy is considered a standard technique in mandibular orthognathic surgeries to reduce unexpected bilateral stress in the temporomandibular joints. Unilateral sagittal split ramus osteotomy (USSO) was recently introduced to correct facial asymmetry caused by asymmetric mandibular prognathism and has shown favorable outcomes. If unilateral surgery could guarantee long-term postoperative stability as well as favorable results, operation time and the incidence of postoperative complications could be reduced compared to those in bilateral surgery. This report highlights three consecutive cases with long-term follow-up in which USSO was used to correct asymmetric mandibular prognathism. Long-term postoperative changes in the condylar contour and ramus and condylar head length were analyzed using routine radiography and computed tomography. In addition, prior USSO studies were reviewed to outline clear criteria for applying this technique. In conclusion, patients showing functional-type asymmetry with predicted unilateral mandibular movement of less than 7 mm can be considered suitable candidates for USSO-based correction of asymmetric mandibular prognathism with or without maxillary arch surgeries.

Background: Diagostic imaging can help in the management of toxicologic emergencies. The authors report on a patient who presented to the emergency department with coma and suppressed respirations after ingestion of an unknown substance. Methods: Ingestion of chloroform with radiopaque material in the bowel on abdominal radiograph was documented. The patient was treated with haemoperfusion, activated charcoal, and laxatives to decrease the toxicities. Results: Hepatotoxicity occurred on post-ingestion day 3 and elevation of liver enzymes reached peak levels on post-ingestion day 5. The patient received N-acetylsystein and supportive care during hospitalisation. The patient improved from hepatic dysfunction and was discharged without complication on post-ingestion day 11. Conclusion: Radiographic studies in toxicology may confirm a diagnosis and assist in therapeutic intervention.

Castleman’s disease is a rare atypical lymphoproliferative disorder. Although HHV-8 has been reported to be a cause of Castleman’s disease, the etiology and pathogenesis of the disease remains mostly unknown. We experienced a 51year-old female patient who was concurrently diagnosed with Castleman’s disease and systemic lupus erythematosus. Castleman’s disease has been rarely reported in patients with systemic lupus erythematosus. Thus, we report the case and briefly discuss relevant articles.

Soon Myung Jung 1 , Jin Taek Yoo 1 , Young Hwan Kim 1 , Yu Na Seo 2 , Na Young Lee 3 , Seong Geun Lee 4 , Seong Hu Park, Young Eun Park, Seung Hoon Baek, Geun Tae Kim, Sung-Il Kim, Joung Wook Lee Departments of Internal Medicine, Radiology and Pediatrics, Busan St. Mary’s Medical Center, Department of Internal Medicine, Pusan National University School of Medicine, Kosin University College of Medicine, Busan, Korea

Background: Brachial ankle pulse wave velocity (BaPWV) and cardio ankle vascular index (CAVI), as indicators of arterial stiffness, are increased in type 2 diabetes. Albuminuria, as a cardiovascular risk factor in type 2 diabetes, can cause endothelial dysfunction and atherosclerosis, and these can increase arterial stiffness. So we investigated the hypothesis that increased albuminuria reflects increased BaPWV and CAVI in type 2 diabetes. Methods: We retrospectively analyzed 106 patients (58 men and 48 women) with type 2 diabetes from March 2005 to September 2006. Urine albumin creatinine ratio (ACR) to evaluate urinary albumin excretion, BaPWV and CAVI were measured in all patients. Results: All patients were divided 3 groups, normal group (ACR 300 mg/g Cr., n = 33). BaPWV and CAVI in microalbuminuria group and proteinuria group are faster than normal group. In bivariate correlation analysis, BaPWV was not associated with ACR, but CA VI was positively correlated to ACR (r = 0.285, P = 0.003). BaPWV was positively correlated to age, diabetes duration, body mass index, systolic blood pressure, diastolic pressure, pulse pressure and negatively correlated to glomerular filtration rate (GFR). CAVI was positively correlated to age, diabetes duration and negatively correlated to GFR. In multiple linear stepwise regression analysis, BaPWV was not associated with ACR, but ACR was independent predictor for CAVI (P = 0.002). Conclusion: In type 2 diabetes, albuminuria was independent predictor for indicators of arterial stiffness

Purpose: If damage to the neurovascular bundle of the mandibular canal during dental implant surgery of the mandible is to be prevented, accurate measurement of the distance between the alveolar crest and the mandibular canal, as seen on panoramic radiographs, is important. The purpose of this study was to compare the accuracy of panoramic radiography using a lead ruler with that of computed tomography for the measurement of the distance between the alveolar crest and superior border of the mandibular canal and to evaluate the usefulness of panoramic radiography using a lead ruler. Materials and Methods: For control study, panoramic radiography of the dry mandible was undertaken using a lead ruler, and computed tomography was added. The distances between the alveolar crest and the superior border of the mandibular canal and between the alveolar crest and the lowest border of the body of the mandible were measured at the level of the 2nd premolar to the 3rd molar. These measurements were compared with actual measurements of the dry mandible in the same areas. The cases of 87 patients[49 men, 38 women; age range, 20-84 (mean, 42) years] who had undergone panoramic radiography using a lead ruler were reviewed. They were catergorized according to sex, the presence of teeth, and whether under or over 50 years of age. All measurements were compared and analyzed using the Student t-test. Results: Measured values obtained from a panoramic radiograph using a lead ruler(magnification:100.32%5.92) and from a computed tomograph(magnification:100.22%5.55) deviated less from actual measurements on the dry mandible (p 0.05). The distance from the 2nd premolar to the 3rd molar was greater in male adults (19.62 mm 3.95) than in female (17.54 mm 4.04) (p 0.05), except the 3rd molar. In addition, the distance was greater in dentulous patients(18.81 mm 3.33) than in edentulous (16.23 mm 1.75)(p 0.05), except the 3rd molar. There was, howerer, no significant difference between patients under and over 50 years of age (p 0.05), except 2nd pre molar and 1st molar in the female. Conclusion: Panoramic radiography using a lead ruler is a simple and accurate modality for the presurgical planning of dental implant surgery. It is suggested that the successful long-term rate of dental implantation may be higher in dentulous male than in edentulous female molars.