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Because single-photon emission computed tomography (SPECT) is one of the widely used nuclear medicine imaging systems, it is extremely important to acquire high-quality images for diagnosis. In this study, we designed a super-resolution (SR) technique using dense block-based deep convolutional neural network (CNN) and evaluated the algorithm on real SPECT phantom images. To acquire the phantom images, a real SPECT system using a99mTc source and two physical phantoms was used. To confirm the image quality, the noise properties and visual quality metric evaluation parameters were calculated. The results demonstrate that our proposed method delivers a more valid SR improvement by using dense block-based deep CNNs as compared to conventional reconstruction techniques. In particular, when the proposed method was used, the quantitative performance was improved from 1.2 to 5.0 times compared to the result of using the conventional iterative reconstruction. Here, we confirmed the effects on the image quality of the resulting SR image, and our proposed technique was shown to be effective for nuclear medicine imaging.

Background Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease that affects 1–3% of adults worldwide. Currently, it is not possible to completely cure AD; therefore, alternative treatments need to be developed to meet the patients’ needs. Here, based on our previous pilot study, we conducted the first confirmatory randomized controlled trial to evaluate the effect of acupuncture in patients with mild to moderate AD. Methods A randomized, participant- and assessor-blinded, sham-controlled trial was designed with an intervention period twice-weekly for 4 weeks and a 4-week follow-up. We equally allocated 36 participants to the verum acupuncture (VA) and sham acupuncture (SA) groups. The main outcome measure was the change in SCORing Atopic Dermatitis index (SCORAD) score before and after treatment. Results A total of 36 participants, aged 19 to 38 years, were enrolled, and 35 were included in the intention-to-treat analyses. The mean change in total SCORAD score differed significantly among the two groups at 4 weeks after randomization (P P Conclusions Twice-weekly acupuncture treatment was effective in reducing AD symptoms in patients with mild to moderate AD without serious adverse events. Trial registration Clinical Research Information Service Identifier: KCT0002796.

Acupuncture has been known to be effective for atopic dermatitis, especially ameliorating itch; however, its mechanisms are still unclear. The aim of this study was to test the anti-itch effects of acupuncture and to investigate its possible mechanisms. Acupuncture was performed at Gok-Ji (LI11) acupoints just before the injection of pruritogens in the mouse cheek model of acute itch and of MC903-induced atopic dermatitis displaying serotonergic chronic itch. Acupuncture significantly reduced acute itch triggered by compound 48/80, chloroquine, or especially serotonin. It also markedly reduced scratching behaviors evoked by the serotonin 5-HT2 receptor agonist α-methylserotonin and selective 5-HT7 receptor agonist LP 44. In addition, acupuncture treatment at LI11 had the preventive and therapeutic effects on persistent itch as well as the robust skin inflammation with epidermal thickening in mice with MC903-induced atopic dermatitis. It also considerably reduced the increased expression of 5-HT2A, 5-HT2B and 5-HT7 receptors in atopic dermatitis-like skin lesions in mice treated with MC903. Taken together, these findings highlight that acupuncture significantly ameliorates not only skin inflammation, but also acute and chronic serotonergic itch, possibly through blockade of serotonin 5-HT2 and 5-HT7 receptors.

Background We hypothesized utilizing machine learning (ML) algorithms for screening septic shock in ED would provide better accuracy than qSOFA or MEWS. Methods The study population was adult (≥20 years) patients visiting ED for suspected infection. Target event was septic shock within 24 h after arrival. Demographics, vital signs, level of consciousness, chief complaints (CC) and initial blood test results were used as predictors. CC were embedded into 16-dimensional vector space using singular value decomposition. Six base learners including support vector machine, gradient-boosting machine, random forest, multivariate adaptive regression splines and least absolute shrinkage and selection operator and ridge regression and their ensembles were tested. We also trained and tested MLP networks with various setting. Results A total of 49,560 patients were included and 4817 (9.7%) had septic shock within 24 h. All ML classifiers significantly outperformed qSOFA score, MEWS and their age-sex adjusted versions with their AUROC ranging from 0.883 to 0.929. The ensembles of the base classifiers showed the best performance and addition of CC embedding was associated with statistically significant increases in performance. Conclusions ML classifiers significantly outperforms clinical scores in screening septic shock at ED triage.

Objectives The aim of this study was to evaluate the effects of a practice guideline of postreduction management of intussusception in children on the length of stay (LOS) from reduction in the pediatric emergency department (PED) and on the incidence of recurrence. Methods We developed a practice guideline of postreduction management of intussusception in the PED. The practice guideline involved feeding 2 hours after reduction and discharge 2 hours after successful feeding. The guideline was implemented on October 1, 2012. Retrospective quasi-experimental study was conducted for evaluation of the difference in LOS in the PED after reduction of intussusceptions, and the recurrence rate of intussusceptions between the preimplementation and postimplementation periods. Piecewise regression was performed to determine the differences between groups. Results In total, 45 and 52 patients were included in the preimplementation and postimplementation periods, respectively. The median LOS in the postimplementation period was significantly shorter than that in the preimplementation period (289 vs 532 minutes, respectively; P = 0.001). The slope of the LOS changed from 0.68 to -0.29. The slope decreased by 0.97 after practice guideline implementation. This difference was not statistically significant (P = 0.123), but it changed from a positive to negative gradient. The recurrence rate was not significantly different between the 2 periods (P = 0.605). Conclusions Implementation of a practice guideline involving early feeding and discharge after reduction of intussusception resulted in a reduced LOS from reduction of intussusception in the PED and was not associated with recurrence of intussusception.

Objectives To investigate the inhibitory effects of an herbal formulation of Cheongsangbangpoong-tang (CBT) on inflammatory acne lesions as the control of the ‘Heat’ pattern. Design A single center study. Randomized, placebo-controlled, parallel group, double-blind trial Setting Fifty-six subjects, who had more than 10 acne inflammatory lesions each, were randomly allocated into the CBT or placebo groups and took 5 g CBT extract (CBT group) or 5 g placebo extract (control group), respectively, three times a day for 8 weeks. Pattern identification, change of the inflammatory and non-inflammatory acne lesions, temperature of the facial points, serum cortisol level, serum dehydroepiandrosterone-sulfate level, number rating scale, investigator global assessment (IGA), and severity score on the Korean acne grading system were measured. Main outcome measure mean change of the inflammatory acne lesions. Results After CBT/placebo administration, the percentage count of inflammatory lesions in subjects was significantly reduced in the CBT group when compared with the control group. The other outcomes showed no significant difference between the two groups. On pattern identification, subjects with the Wind-Heat pattern (風熱型, WHP) and Disharmony of the thoroughfare and conception vessels pattern (衝任不調型, DTCVP) tended show better effect than those with other patterns. Conclusions CBT is a potential therapeutic agent for the treatment of acne vulgaris, linked to inhibition of inflammatory lesions and facial heat. Trial registration CRiS (Clinical Research Information Service, Republic of Korea), KCT0001468. Registered 06 May 2015.

Background An accurate disease severity score that can quickly predict the prognosis of patients with sepsis in the emergency department (ED) can aid clinicians in distributing resources appropriately or making decisions for active resuscitation measures. This study aimed to compare the prognostic performance of quick sequential organ failure assessment (qSOFA) with that of other disease severity scores in patients with septic shock presenting to an ED. Methods We performed a prospective, observational, registry-based study. The discriminative ability of each disease severity score to predict 28-day mortality was evaluated in the overall cohort (which included patients who fulfilled previously defined criteria for septic shock), the newly defined sepsis subgroup, and the newly defined septic shock subgroup. Results A total of 991 patients were included. All disease severity scores had poor discriminative ability for 28-day mortality. The sequential organ failure assessment and acute physiology and chronic health evaluation II scores had the highest area under the receiver-operating characteristic curve (AUC) values, which were significantly higher than the AUC values of other disease severity scores in the overall cohort and the sepsis and septic shock subgroups. The discriminative ability of each disease severity score decreased as the mortality rate of each subgroup increased. Conclusions All disease severity scores, including qSOFA, did not display good discrimination for 28-day mortality in patients with serious infection and refractory hypotension or hypoperfusion; additionally, none of the included scoring tools in this study could consistently predict 28-day mortality in the newly defined sepsis and septic shock subgroups.

OBJECTIVE To test the hypothesis that the quick Sepsis-related Organ Failure Assessment (qSOFA) score, derived from vital signs taken during triage and recommended by current sepsis guidelines for screening patients with infections for organ dysfunction, is not sensitive enough to predict the risk of mortality in emergency department (ED) sepsis patients. METHODS Patients diagnosed with severe sepsis and septic shock using the old definition between May 2014 and April 2015 were retrospectively reviewed in three urban tertiary hospital EDs. The sensitivities of systemic inflammatory response syndrome (SIRS) criteria, qSOFA, and Sequential Organ Failure Assessment (SOFA) scores ≥2 were compared using McNemar's test. Diagnostic performances were evaluated using specificity, positive predictive value, and negative predictive value. RESULTS Among the 928 patients diagnosed with severe sepsis or septic shock using the old definition, 231 (24.9%) died within 28 days. More than half of the sepsis patients (493/928, 53.1%) and more than one-third of the mortality cases (88/231, 38.1%) had a qSOFA score

We developed a method to measure the relative blood flow speed using optical coherence tomography angiography (OCTA) in retina and choroid, and investigated the feasibility of this method for assessing microcirculatory function in rat models of sepsis and hemorrhagic shock. Two sepsis models, 6-h severe sepsis without treatment and 30-h moderate sepsis maintaining mean arterial pressure, and volume controlled hemorrhagic shock and fluid resuscitation model were used to see the change of microcirculation. The blood flow index (BFI), which was calculated from the OCTA images to represent the average relative blood flow, was decreasing during the 6-h severe sepsis model. Its change is in parallel with the mean arterial blood pressure (MAP) and blood lactate levels. In the 30-h moderate sepsis model, the BFI was decreased while maintaining MAP, and lactate was increased. In the hemorrhagic shock model, the change of BFI is in line with MAP and lactate levels. In all models, BFI change is more sensitive in choroid than in retina. This study presents the OCTA-based retinal and choroidal microcirculatory blood flow monitoring method and shows its utility for assessment of critical illness.

Objective: Itch is an unpleasant sensation associated with an urge to scratch and is a major health care issue associated with atopic dermatitis (AD). Contagious itch, i.e., subjective feelings of itchiness induced by watching others’ scratching behavior, is common in patients with AD. Using electroencephalography, we examined alpha (8–13 Hz) oscillations in sensorimotor areas associated with the desire to scratch in patients with AD. Methods: Thirty-six patients with AD and 34 healthy controls (HCs) participated in this study. They evaluated their itch levels after watching short videos of a model scratching or tapping parts of his body. Neural oscillations were recorded from nine electrodes, including those placed over sensorimotor areas. Time–frequency analysis was used to compare mu rhythm suppression over the sensorimotor areas in response to these videos between patients with AD and HCs. Results: The behavioral test showed that the visual stimuli induced increased feelings of itchiness in patients with AD relative to HCs under the tapping and scratching conditions. The time–frequency analysis revealed that mu rhythm suppression in response to scratching images was significantly prominent in patients with AD, but not in HCs. Conclusion: Patients with AD exhibited increased susceptibility to contagious itch. This phenomenon might be related to enhanced mu rhythm suppression in sensorimotor areas of the brain in these patients. Our findings provide new insight into the neurophysiological basis of itch sensations in patients with AD.

This study aimed to address the impact of 1-hr bundle achievement on outcomes in septic shock patients. Secondary analysis of multicenter prospectively collected data on septic shock patients who had undergone protocolized resuscitation bundle therapy at emergency departments was conducted. In-hospital mortality according to 1-h bundle achievement was compared using multivariable logistic regression analysis. Patients were also divided into 3 groups according to the time of bundle achievement and outcomes were compared to examine the difference in outcome for each group over time: group 1 (≤1 h reference), group 2 (1–3 h) and group 3 (3–6 h). In total, 1612 patients with septic shock were included. The 1-h bundle was achieved in 461 (28.6%) patients. The group that achieved the 1-h bundle did not show a significant difference in in-hospital mortality compared to the group that did not achieve the 1-h bundle on multivariable logistic regression analysis (&lt, 1 vs. &gt, 1 h) (odds ratio = 0.74, p = 0.091). However, 3- and 6- h bundle achievements showed significantly lower odds ratios of in-hospital mortality compared to the group that did not achieve the bundle (&lt, 3 vs. &gt, 3 h, &lt, 6 vs. &gt, 6 h, odds ratio = 0.604 and 0.458, respectively). There was no significant difference in in-hospital mortality over time for group 2 and 3 compared to that of group 1. One-hour bundle achievement was not associated with improved outcomes in septic shock patients. These data suggest that further investigation into the clinical implications of 1-h bundle achievement in patients with septic shock is warranted.

Atopic dermatitis (AD) is a relapsing and remitting chronic inflammatory skin disease for which a variety of etiological factors are involved. Treatment strategies should be multifaceted and have few side effects. In this respect, acupuncture has become increasingly popular as a safe, consistently effective, and drug-free therapy that treats multiple AD symptoms. We aim to not only verify the effectiveness of acupuncture but also suggest patient-specific response determinants and a new underlying mechanism implicating the gut-brain axis. We have designed a randomized, participant-blinded, sham-controlled clinical trial for 60 mild to moderate AD patients. In a previous study, we observed that the clinical skin symptoms of AD were closely associated with gastrointestinal (GI) symptoms. From these findings, we developed an intervention with six acupuncture points: three for AD symptoms and three for GI symptoms. Also, since high responders and low responders to the acupuncture treatment could be identified in the previous study, we now aim to explore response-determining factors, with a particular focus on GI symptoms. Therefore, we will precisely evaluate not only AD symptoms using the SCORAD, EASI, and DLQI tools, but also GI symptoms using the GSRS, TDS, BSFS, and AR tools and abdominal examination. AD develops in association with complicated pathophysiological factors, such as skin barrier function, genetic susceptibility, and immunological factors. Moreover, the underlying mechanism by which acupuncture treatment works has not been clearly elucidated. We, therefore, will conduct a simultaneous cross-sectional study with a sample of 40 healthy individuals, wherein potential indicators, such as fMRI, gut microbiota, and serum TARC and ATX, will be investigated to determine the gut-brain axis-associated mechanism of acupuncture. We expect that the results of this study could provide important clinical evidence for the effects of acupuncture and help elucidate the therapeutic mechanisms that underlie acupuncture’s efficacy in AD treatment. This trial is registered with https://clinicaltrials.gov/ct2/show/KCT0005422 (Trial registration: Korean Clinical Trial Registry (http://cris.nih.go.kr; registration number: KCT0005422); date of registration: September 23, 2020).

Background We aimed to investigate the association between initial fluid resuscitation in septic shock patients with isolated hyperlactatemia and outcomes. Methods This multicenter prospective study was conducted using the data from the Korean Shock Society registry. Patients diagnosed with isolated hyperlactatemia between October 2015 and December 2018 were included and divided into those who received 30 mL/kg of fluid within 3 or 6 h and those who did not receive. The primary outcome was in-hospital mortality; the secondary outcomes were intensive care unit (ICU) admission, length of ICU stay, mechanical ventilation, and renal replacement therapy (RRT). Results A total of 608 patients were included in our analysis. The administration of 30 mL/kg crystalloid within 3 or 6 h was not significantly associated with in-hospital mortality in multivariable logistic regression analysis ([OR, 0.8; 95% CI, 0.52–1.23, p = 0.31], [OR, 0.96; 95% CI, 0.59–1.57, p = 0.88], respectively). The administration of 30 mL/kg crystalloid within 3-h was not significantly associated with mechanical ventilation and RRT ([OR, 1.19; 95% CI, 0.77–1.84, p = 0.44], [OR, 1.2; 95% CI, 0.7–2.04, p = 0.5], respectively). However, the administration of 30 mL/kg crystalloid within 6 h was associated with higher ICU admission and RRT ([OR, 1.57; 95% CI, 1.07–2.28, p = 0.02], [OR, 2.08; 95% CI, 1.19–3.66, p = 0.01], respectively). Conclusions Initial fluid resuscitation of 30 mL/kg within 3 or 6 h was neither associated with an increased or decreased in-hospital mortality in septic shock patients with isolated hyperlactatemia.

Background Sepsis has a high mortality rate, but no specific drug has been proven effective, prompting the development of new drugs. Immunologically, sepsis can involve hyperinflammation, immune paralysis, or both, which might pose challenges during drug development. Recently, mitochondrial transplantation has emerged as a treatment modality for various diseases involving mitochondrial dysfunction, but it has never been tested for sepsis. Methods We isolated mitochondria from L6 muscle cells and umbilical cord mesenchymal stem cells and tested the quality of the isolated mitochondria. We conducted both in vivo and in vitro sepsis studies. We investigated the effects of intravenous mitochondrial transplantation on cecal slurry model in rats in terms of survival rate, bacterial clearance rate, and the immune response. Furthermore, we observed the effects of mitochondrial transplantation on the immune reaction regarding both hyperinflammation and immune paralysis. To do this, we studied early- and late-phase cytokine production in spleens from cecal slurry model in rats. We also used a lipopolysaccharide (LPS)-stimulated human PBMC monocyte model to confirm the immunological effects of mitochondrial transplantation. Apoptosis and the intrinsic apoptotic pathway were investigated in septic spleens. Results Mitochondrial transplantation improved survival and bacterial clearance. It also mitigated mitochondrial dysfunction and apoptosis in septic spleens and attenuated both hyperinflammation and immune paralysis in the spleens of cecal slurry model in rats. This effect was confirmed with an LPS-stimulated human PBMC study. Conclusions In rat polymicrobial cecal slurry model, the outcome is improved by mitochondrial transplantation, which might have an immunomodulatory effect.

Background: The effects of hyperbaric oxygen therapy (HBOT) in sepsis remain unclear. This study evaluated its effects on acute liver injury and survival in a rat model. Methods: Cecal slurry peritonitis was induced in male rats, which were then randomly allocated into the HBOT and control groups. In the survival experiment, six 90 min HBOT sessions (2.6 atmospheres absolute 100% oxygen) were performed over 48 h, the survival rate was determined 14 days after sepsis induction. In the acute liver injury experiment, three HBOT sessions were performed, followed by liver and plasma harvesting, 24 h after sepsis induction. Serum levels of alanine aminotransferase (ALT), interleukin (IL)-6, and IL-10 were measured, and the hepatic injury scores were determined. Reactive oxygen species (ROS) generation was detected by 2&prime, 7&prime, dihydrodichlorofluorescein diacetate (H2DCF-DA) assay. Western blot assays assessed protein kinase B (Akt), phosphorylated-Akt (p-Akt), glycogen synthase kinase (GSK)-3&beta, phosphorylated-GSK-3&beta, and cleaved caspase-3 levels. Results: Survival in the HBOT group (57.1%) was significantly higher than that in the controls (12.5%, p = 0.029), whereas IL-6, IL-10, and ALT levels were significantly lower in the HBOT group. The ROS generation was significantly inhibited to a greater extent in the HBOT group than in the control group. Additionally, in the HBOT group, the p-Akt and p-GSK-3&beta, increased significantly and cleaved caspase-3 levels decreased significantly. Conclusions: HBOT showed a beneficial effect on acute liver injury and rat survival by enhancing the Akt signaling pathway and decreasing apoptosis.

The non-local means (NLM) noise reduction algorithm is well known as an excellent technique for removing noise from a magnetic resonance (MR) image to improve the diagnostic accuracy. In this study, we undertook a systematic review to determine the effectiveness of the NLM noise reduction algorithm in MR imaging. A systematic literature search was conducted of three databases of publications dating from January 2000 to March 2020, of the 82 publications reviewed, 25 were included in this study. The subjects were categorized into four major frameworks and analyzed for each research result. Research in NLM noise reduction for MR images has been increasing worldwide, however, it was found to have slightly decreased since 2016. It was found that the NLM technique was most frequently used on brain images taken using the general MR imaging technique, these were most frequently performed during simultaneous real and simulated experimental studies. In particular, comparison parameters were frequently used to evaluate the effectiveness of the algorithm on MR images. The ultimate goal is to provide an accurate method for the diagnosis of disease, and our conclusion is that the NLM noise reduction algorithm is a promising method of achieving this goal.

Background The human placenta (HP) is a complex organ used to alleviate tiredness and promote wound healing. Previous research showed the hair growth-promoting effect of HP. However, no reports have addressed the effects of HP on hair regrowth in chemotherapy-induced alopecia. In this study, we investigated the effects of HP on the apoptosis and proliferation of hair follicles in chemotherapy-induced alopecia. Methods Male C57BL/6 mice in telogen were depilated to enter anagen. After 9 days, dystrophic catagen was induced by the intraperitoneal injection of 150 mg/kg cyclophosphamide. During 9 to 16 days, 0.1 and 1 mg/mL HP were topically applied to depilated dorsal skin. Results Dystrophic hair follicles by cyclophosphamide were recovered by HP treatment. New hair shafts containing hair fibers appeared to be straight after HP treatment. Immunohistological staining revealed a significant increase of Ki67-positive cells in hair follicles treated with 1 mg/mL HP. Topical HP treatment increased the ratio of Bcl-2/Bax, while it attenuated the expression of pro-apoptotic Bax, p53, and cytochrome c with caspase-9 and -3. In addition, the expression of KGF and the phosphorylation of AKT were upregulated by HP treatment. Conclusion These results suggest that HP treatment induced hair growth by inhibiting apoptosis and promoting the proliferation of hair follicles. HP may be useful for treating chemotherapy-induced alopecia.

Shear wave elastography with ultrasound is a noninvasive method used for measuring stiffness in the human body. Shear wave elastography can be used for accurately and quantitatively measuring stiffness. However, its disadvantage is that the stiffness value can vary significantly because the region of interest (ROI) setting depends on the diagnostic operator. In this study, a stiffness measurement program using color mapping in shear wave elastography was developed to address the above-mentioned disadvantage. Color map and color ratios were obtained and evaluated for major lower limb muscles (i.e., biceps femoris, medial gastrocnemius, rectus femoris, and tibialis anterior) at active voluntary contraction. According to the result, when the developed program was used, a small standard deviation compared to the conventional stiffness measurement method, such as kilopascal or meter per second unit using ROIs, was measured in all cases. In conclusion, our results demonstrate that the stiffness measurement method using our program is expected to improve reliability in shear wave elastography ultrasound imaging.

Objective To investigate the epidemiology of sepsis in Korea and identify risk factors for death in sepsis. Methods We conducted a longitudinal, population-based epidemiological study of sepsis in Korea from 2005 to 2012 using the National Health Insurance Service-National Sample Cohort, a population-based cohort representing 2.2% of the Korean population. The primary objective was to assess the incidence, mortality and cost of sepsis. The secondary objective was to identify the risk factors for death in sepsis. Claim records of admitted adult patients (aged ≥15 years) were analyzed. Sepsis was defined as 1) bacterial or fungal infection or the conditions they often complicate, 2) prescription of intravenous antibiotics, and 3) presence of any organ dysfunction. Comorbidities were defined using the Charlson/Deyo method. Risk factors for 6-month mortality were assessed using multivariable logistic regression. Results A total of 22,882 cases were identified. Both incidence and 6-month mortality increased from 265.7 (95% confidence interval [CI], 254.7 to 277.1) to 453.1 (95% CI, 439.0 to 467.5) per 100,000 person-years (P-trend

In dental computed tomography (DCT), metal artifact reduction (MAR) is a critical issue to improve the clinical usefulness of DCT and remains a challenging problem. Although various MAR methods have been developed in medical CT, those methods may not work robustly in DCT because teeth themselves, as well as metallic objects, have high X-ray attenuation. In this study, we investigated an MAR method that was based on sinogram normalization interpolation with an artifact-reduced prior for DCT. The method consisted of three main steps: segmentation of a metal trace, generation of an artifact-reduced prior image, and sinogram completion followed by DCT reconstruction. We performed a computational simulation and performed an experiment on a teeth phantom with several metal inserts to validate the proposed method. With respect to the root-mean-square error and the structural similarity, we compared our results with the ones obtained by using the combined prior-based MAR (CP-MAR) method. Our results indicate that the proposed MAR method reduced metal artifacts considerably in DCT images and showed an image performance that was better than that obtained by using the state of the art method (CP-MAR) in reducing streak artifacts without introducing any contrast anomaly.

To avoid artifacts and interpretation mistakes, improvements in the uniformity of magnetic resonance imaging (MRI) is very important. The aim of this study is to develop a bias field-based uniformity correction algorithm and to confirm the feasibility of its application with an integrated positron emission tomography (PET)/MRI system using standard MRI pulse sequences (T2-weighted, half-Fourier, single-shot turbo spin echo, T2-weighted turbo spin echo with fat suppression, and three-dimensional, volumetric, T1-weighted gradient recalled echo interpolated breath-hold examination using controlled aliasing in parallel imaging that results in increased acceleration). We used phantoms containing NaCl and NaCl + NiSO4 solutions, and considered the percent image uniformity (PIU) as the evaluation parameter. The elicited PIU results using the correction algorithm were distinct for all sequences and phantoms. The results of this study suggested that the bias field-based algorithm allows uniformity improvements in MRI in terms of PIU.

Digital tomosynthesis (DTS) images reconstructed from the limited-angle scanned projections are often limited in image performance due mainly to superimposed shadow artifacts caused by high attenua...

Atopic dermatitis (AD) is a chronic relapsing eczematous skin disease with an increasing prevalence. In Korea, Jaungo is a traditional medicinal ointment, which is commonly used for treating skin wounds.Thus, we aim to explore the basic clinical efficacy and safety data for Jaungo in patients with AD.This study was a pilot randomized, double-blind, placebo-controlled, single-center trial with three groups. The participants in treatment group 1 applied Jaungo to the lesion twice a day for 3 weeks. Those in treatment group 2 applied Jaungo and placebo ointments to the lesion once a day for 3 weeks. Those in the placebo group applied placebo ointments to the lesion twice a day for 3 weeks. The Eczema Area and Severity Index and SCORing Atopic Dermatitis scores, transepidermal water loss value, and Dermatology Life Quality Index score were assessed. The outcomes used to evaluate safety were the Draize score, blood test results, and expert opinion.In total, 28 patients (82.4%) completed the study. During the study, significant decline of EASI scores in treatment group 2 and placebo group was observed (p 0.05). And there was significant decline of SCORAD scores in treatment group1 and placebo group (p 0.05). Patients in all groups showed decreased TEWL and DLQI scores with no significant difference. There was significant decline of IL-17 in all groups (p 0.05). No serious adverse event was observed.This is the first study that has explored the potential therapeutic effect of Jaungo as a complementary therapy for AD. However, further large study with adjusting placebo ingredients is needed to confirm the effectiveness of Jaungo in patients with chronic-phase AD.

Objective This study aimed to describe the conceptualization, development, and implementation processes of the newly established Korean Cardiac Arrest Resuscitation Consortium (KoCARC) to improve out-of-hospital cardiac arrest (OHCA) outcomes. Methods The KoCARC was established in 2014 by recruiting hospitals willing to participate voluntarily. To enhance professionalism in research, seven research committees, the Epidemiology and Preventive Research Committee, Community Resuscitation Research Committee, Emergency Medical System Resuscitation Research Committee, Hospital Resuscitation Research Committee, Hypothermia and Postresuscitation Care Research Committee, Cardiac Care Resuscitation Committee, and Pediatric Resuscitation Research Committee, were organized under a steering committee. The KoCARC registry was developed with variables incorporated in the currently existing regional OHCA registries and Utstein templates and were collected via a web-based electronic database system. The KoCARC study population comprises patients visiting the participating hospitals who had been treated by the emergency medical system for OHCA presumed to have a cardiac etiology. Results A total of 62 hospitals volunteered to participate in the KoCARC, which captures 33.0% of the study population in Korea. Web-based data collection started in October 2015, and to date (December 2016), there were 3,187 cases compiled in the registry collected from 32 hospitals. Conclusion The KoCARC is a self-funded, voluntary, hospital-based collaborative research network providing high level evidence in the field of OHCA and resuscitation. This paper will serve as a reference for subsequent KoCARC manuscripts and for data elements collected in the study.

Rapid response systems (RRSs) have been introduced into hospitals to help reduce the incidence of sudden cardiopulmonary arrest (CPA). This study evaluated whether an RRS reduces the incidence of in-hospital postoperative CPA. This retrospective before-and-after analysis evaluated data collected from electronic medical records during a pre-intervention (January 2008 to September 2012) and post-intervention (implementation of an RRS) interval (October 2012 to December 2016) at a single tertiary care institution. The primary outcome was a change in the rate of CPA in surgical patients recovering in a general ward. A Poisson regression analysis adjusted for the Charlson Comorbidity Index (CCI) was used to compare CPA rates during these two intervals. Of the 207,054 surgical procedures performed during the study period, mean (95% confidence interval [CI]) CPA events per 10,000 cases of 7.46 (5.72 to 9.19) and 5.19 (3.85 to 6.52) were recorded before and after RRS intervention, respectively (relative risk [RR], 0.73; 97.5% CI, 0.48 to 1.13; P = 0.103). Cardiopulmonary arrest incidence was reduced during RRS operational hours of 07:00–22:00 Monday-Friday and 07:00–12:00 Saturday (RR, 0.56; 97.5% CI, 0.31 to 1.02; P = 0.027) but was unchanged when the RRS was not operational (RR, 0.86; 97.5% CI, 0.52 to 1.40; P = 0.534). The CCI-adjusted RR of CPA after RRS implementation was lower than before RRS intervention (0.63; 97.5% CI, 0.41 to 0.98; P = 0.018) but this reduction was still only apparent during RRS operational hours (RR, 0.48; 97.5% CI, 0.27 to 0.89; P = 0.008 vs RR, 0.85; 97.5% CI, 0.45 to 1.58; P = 0.55). Implementation of an RRS reduced the incidence of postoperative CPA in patients recovering in a general ward. Furthermore, this reduction was observed only during RRS operational hours.

Background Although alopecia affects the quality of life, its pathogenesis is unknown, because cellular interactions in the hair follicle are complex. Several authors have suggested using herbal medicine to treat alopecia, and bioinformatics and network pharmacology may constitute a new research strategy in this regard because herbal medicines contain various chemical components. This study used association rule mining (ARM) and network analysis to analyze the combinations of medicinal herbs used to treat alopecia. Methods We searched Chinese, Korean, and English databases for literature about alopecia treatment, extracting the names of each herbal prescription and herb. The meridian tropism and classification category of each herb were also investigated. Using ARM, we identified frequently combined two-herb and three-herb sets. Using network analysis, we divided the herbs into several modules according to prescription pattern. Results Fifty-six articles and 489 herbal medicines were included—312 internal and 177 external medicines. Among the 312 medicinal herbs used in internal medicine group, the most frequently combined two-herb set was Polygonum multiflorum Thunb. (何首烏) and Angelica sinensis (Oliv.) Dlels (當歸). The most frequently used three-herb combination was Polygonum multiflorum Thunb., Angelica sinensis (Oliv.) Dlels, and Ligusticum chuanxiong Hort. (川芎). In network analysis, three modules were identified. The herbs of Module 1 were related to the liver and kidney meridians, and those of Module 3 were related to the Stomach meridian. Conclusions We identified the frequency, characteristics, and functional modules of herb combinations frequently used in alopecia treatment. We confirmed the value of classical medicinal herb theory. This finding will prompt further bioinformatics and network pharmacology research on alopecia. Electronic supplementary material The online version of this article (10.1186/s12906-018-2269-7) contains supplementary material, which is available to authorized users.

Ischemia/reperfusion injury is characterized by excess generation of reactive oxygen species (ROS). The purpose of this study is to test the effect of reoxygenation speed on ROS production and the cellular injury responses in hypoxic macrophages RAW 264.7 cells and its potential mechanisms for the generation of ROS.After hypoxic exposure of RAW 264.7 cells for 20 h, reoxygenation was performed for 6 h by stepwise increase in oxygen concentration (0.8% increase of oxygen every 15 min) in the slow reoxygenation (SRox) group or by moving the culture flasks quickly to a normoxic incubator in the rapid reoxygenation (RRox) group. To identify the potential effect of reoxygenation speed on the generation of ROS, the cells were pretreated with apocynin, VAS2870, and MitoTEMPO before the induction of hypoxia.SRox significantly decreased cell death and cytotoxicity compared with RRox (P 0.05). RRox resulted in significantly more generation of ROS, interleukin-1β, interleukin-6, and nitric oxide than SRox (P 0.05). SRox also increased the expression of prosurvival proteins and decreased apoptosis. In cells pretreated with VAS2870 or MitoTEMPO, the reduced ROS generation by SRox was maintained. However, pretreatment with apocynin abolished the effect of reoxygenation speed on ROS generation.SRox compared with RRox decreased cellular injury in hypoxic RAW 264.7 cells by decreasing ROS and inflammatory cytokine production and decreasing apoptosis.

In mammography examination, compression of the breast is essential for reducing scattered X-rays and the radiation dose and for preventing motion artifacts, thereby producing optimal diagnostic breast images. However, mechanical compression of the breast often causes discomfort and pain during and after the examination and deters some patients from routine mammography screening. In this study, we propose a novel soft-compression mammography based on a weighted l1-norm scatter correction scheme in attempt to overcome these difficulties. We implemented the proposed algorithm and performed a simulation and experiment to demonstrate the feasibility of using the proposed method. According to our results, the structure of the breast phantom was much more clearly visible in the scatter-corrected image than in the original scatter-corrupted image. The contrast-to-noise ratio (CNR) for the scatter-corrected image was about 6.3, about 4.1 times larger than that for the scatter-corrupted image, indicating much improved image visibility. The proposed approach seems very promising for scatter correction in conventional mammography, thus allowing soft-compression breast examination in clinics.

Objective Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. Methods The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. Results and conclusion Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible.

Background When an out-of-hospital cardiac arrest (OHCA) patient receives cardiopulmonary resuscitation (CPR) in the emergency department (ED), blood laboratory test results can be obtained by using point-of-care testing during CPR. In the present study, the relationship between blood laboratory test results during CPR and outcomes of OHCA patients was investigated. Methods This study was a multicenter retrospective analysis of prospective registered data that included 2716 OHCA patients. Data from the EDs of three university hospitals in different areas were collected from January 2009 to December 2014. Univariate and multivariable analyses were conducted to elucidate the factors associated with survival to discharge and neurological outcomes. A final analysis was conducted by including patients who had no prehospital return of spontaneous circulation and those who underwent rapid blood laboratory examination during CPR. Results Overall, 2229 OHCA patients were included in the final analysis. Among them, the rate of survival to discharge and a good Cerebral Performance Categories Scale score were 14% and 4.4%, respectively. The pH level was independently related to survival to hospital discharge (adjusted OR 6.287, 95% CI 2.601–15.197; p 8.5 mEq/L) during CPR. Conclusions Among the blood laboratory test results during CPR of OHCA patients, pH and potassium levels were observed as independent factors associated with survival to hospital discharge, and pH level was considered as an independent factor related to neurological recovery.

Summary Background CT radiation is arguably carcinogenic. Results from single-centre studies, mostly retrospective, have advocated lowering the CT radiation dose for the diagnosis of appendicitis. However, adoption of low-dose CT has been slow. We aimed to assess the effectiveness of low-dose CT compared with standard-dose CT in the diagnosis of appendicitis in adolescents and young adults. Methods We did this pragmatic, multicentre, randomi s ed controlled non-inferiority trial at 20 South Korean teaching hospitals with little experience with low-dose CT. Patients aged 15–44 years with suspected appendicitis were randomly assigned (1:1), via computer-generated random assignments (permuted block sizes of two, four, six, and eight) concealed in sequentially numbered envelopes, to receive low-dose CT (2 mSv) or standard-dose CT (≤8 mSv). Randomisation was stratified by site. Group allocation was concealed from patients, outcome assessors, and adverse event adjudicators; care providers, site pathologists, and data collectors were aware of allocation. The primary endpoint was the negative (unnecessary) appendectomy rate among all appendectomies, with a non-interiority margin of 4·5% for low-dose versus standard-dose CT. Primary analy s is was by modified intention to treat, which included all patients who received an appendectomy in the group to which they were assigned. This trial is registered with ClinicalTrials.gov, number NCT01925014. Findings Between Dec 4, 2013, and Aug 18, 2016, we assigned 1535 patients to the low-dose CT group and 1539 patients to the standard-dose CT group. 22 (3·9%) of 559 patients had a negative appendectomy in the low-dose group versus 16 (2·7%) of 601 patients in the standard-dose group (difference 1·3%, 95% CI −0·8 to 3·3; p=0·0022 for the non-inferiority test). We recorded 43 adverse events in 43 (2·8%) of 1535 patients in the low-dose group and 41 adverse events in 40 (2·6%) of 1539 patients in the standard-dose group. One life-threatening adverse event of anaphylaxis caused by an iodinated contrast material occurred in the low-dose group. Interpretation Radiation dose of appendiceal CT for adolescents and young adults can be reduced to 2 mSv without impairing clinical outcomes. In view of the vast number of appendiceal CT examinations done worldwide, use of low-dose CT could prevent a sizeable number of radiation-associated cancers in the future. Funding Korea Health Industry Development Institute, Seoul National University Bundang Hospital, Dasol Life Science, and Bracco Imaging Korea.

Objective To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). Methods This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. Results A total of 468 patients were enrolled (median age, 71.3 years; male, 55.1%; refractory hypotension, 82.9%; hyperlactatemia without hypotension, 17.1%). Respiratory infection was the most common source of infection (31.0%). The median Sepsis-related Organ Failure Assessment score was 7.5. The sepsis bundle compliance was 91.2% for lactate measurement, 70.3% for blood culture, 68.4% for antibiotic administration, 80.3% for fluid resuscitation, 97.8% for vasopressor application, 68.0% for central venous pressure measurement, 22.0% for central venous oxygen saturation measurement, and 59.2% for repeated lactate measurement. Among patients who underwent interventions for source control (n=117, 25.1%), 43 (36.8%) received interventions within 12 hours of ED arrival. The in-hospital, 28-day, and 90-day mortality rates were 22.9%, 21.8%, and 27.1%, respectively. The median ED and hospital lengths of stay were 6.8 hours and 12 days, respectively. Conclusion This preliminary report revealed a mortality of over 20% in patients with septic shock, which suggests that there are areas for improvement in terms of the quality of initial resuscitation and outcomes of septic shock patients in the ED.

Objective Many studies have described constructing a prediction model for bacteremia in community-acquired pneumonia (CAP), but these studies were not validated in external heterogeneous groups. The objective of this study was to test the generalizability of a previous bacteremia prediction model for CAP by external validation. Methods This multicenter retrospective cohort analysis was performed in eight tertiary urban hospital emergency departments (ED). We reviewed adult patients who were hospitalized after presentation to the ED with CAP. We categorized the enrolled patients into three groups according to the bacteremia prediction model score and calculated the number of patients with or without a blood culture-positive result. We performed a multivariable analysis to identify significant predictors for bacteremia. Results Among the enrolled 2,001 patients, 1,592 (79.6%), 371 (18.5%), and 38 (1.9%) were stratified to a low, moderate, and high-risk group, respectively, and this proportion was similar with previous study. Each group had a bacteremia-positive rate as follows: 1.2% for the low-risk group, 7.2% for the moderate-risk group, and 31.5% for the high-risk group. The area under the receiver operating characteristic curve for the bacteremia model in the external validation cohort was 0.81, and there was no significant difference with that of the previous internal validation cohort (p = 0.246). Assuming that blood cultures were not performed in the low-risk patients, the sensitivity and specificity of this model were 0.68 and 0.81, respectively. Additionally, the positive predictive value and negative predictive value were 9.54% and 98.87%, respectively. A platelet count less than 130,000 cell/μL, albumin less than 3.3 mg/dL, and C-reactive protein (CRP) greater than 17 mg/dL were identified as significant predictors with a sensitivity and specificity of, 0.70 and 0.83, respectively. Conclusion The bacteremia prediction model was well validated in the general population and could help physicians make the decision to reduce the number of blood cultures in patients with CAP. This article is protected by copyright. All rights reserved.

Acne is a chronic skin disease caused by inflammation led by Propionibacterium acnes (P. acnes) in the pilosebaceous unit. This study investigated whether plant Aloe ferox (AF) components may have anti-P. acnes and anti-inflammatory properties that may serve for acne treatment. Extracts of Aloe ferox (500 g) were prepared by extracting with 4 L volumes of distilled water (AFW), 50% ethanol (AF50), or 95% ethanol (AF95). AF95 was further fractionated with 2 L volumes of ethyl acetate (AF95E), butanol (AF95B) or water (AF95W). The antibiotic potency against P. acnes was determined by the paper disc diffusion method along with measuring minimal inhibitory concentration and minimal bactericidal concentrations. The anti-inflammatory effect of Aloe ferox was determined by measuring TNF-α, IL-1β, IL-6, and IL-8 levels in THP-1 cells co-cultured with P. acnes. Proliferation of P. acnes was inhibited by 25 mg/mL AFW, AF50 and AF95; however, AF95 had the highest anti-P. acnes activity. AF95 and all its fractions (AF95E, AF95 B and AF95W) remarkably reduced P. acnes-induced elevated levels of inflammatory cytokines (TNF-α, IL-1β, IL-6, and IL-8). From these fractions, AF95E had the largest cytokine dampening. In conclusion, extracts of Aloe ferox had anti-P. acnes and anti-inflammatory effects, suggesting that Aloe ferox could be further studied as a potential treatment for acne.

In recent computed tomography (CT) reconstruction, iterative methods have been often used owing to the potential to provide three-dimensional (3D) images of superior reconstruction quality to common filtered-backprojection (FBP)-based methods. However, these methods require enormous computational cost in the iterative process, which has still been an obstacle to put them to practical use. In this work, to overcome these difficulties, we propose a new cone-beam CT reconstruction with a dual-resolution voxelization strategy for a small region-of-interest (ROI) reconstruction in which the voxels outside the target ROI are binned by, for example, 2 × 2 × 2, 4 × 4 × 4, 8 × 8 × 8, etc., while the other voxels remain unbinned. We considered a compressed-sensing (CS)-based algorithm with a dual regularization strategy, rather than common FBP-based methods, for more accurate CT reconstruction. We implemented the proposed CS-based algorithm and performed a systematic simulation and experiment. Our results indicate that the proposed method seems to be effective for reducing computational cost considerably in iterative CT reconstruction, keeping the reconstruction quality inside the target ROI not much degraded.

To avoid imaging artifacts and interpretation mistakes, an improvement of the uniformity in gamma camera systems is a very important point. We can expect excellent uniformity using cadmium zinc telluride (CZT) photon counting detector (PCD) because of the direct conversion of the gamma rays energy into electrons. In addition, the uniformity performance such as integral uniformity (IU), differential uniformity (DU), scatter fraction (SF), and contrast-to-noise ratio (CNR) varies according to the energy window setting. In this study, we compared a PCD and conventional scintillation detector with respect to the energy windows (5%, 10%, 15%, and 20%) using a 99m Tc gamma source with a Geant4 Application for Tomography Emission simulation tool. The gamma camera systems used in this work are a CZT PCD and NaI(Tl) conventional scintillation detector with a 1-mm thickness. According to the results, although the IU and DU results were improved with the energy window, the SF and CNR results deteriorated with the energy window. In particular, the uniformity for the PCD was higher than that of the conventional scintillation detector in all cases. In conclusion, our results demonstrated that the uniformity of the CZT PCD was higher than that of the conventional scintillation detector.

Background Atopic dermatitis (AD) is a common pruritic inflammatory skin disease with increasing prevalence. It can manifest with many different clinical phenotypes; however, in its chronic stage, hyperpigmentation, excoriation, lichenification, and dryness are the main symptoms. Jaungo comprises two herbs, Lithospermi radix and Angelica gigantis radix, and three carrier oils, and is an approved herbal ointment for xerosis cutis in Korea. In past studies, we demonstrated that Jaungo had anti-inflammatory and antiallergic activity in in vitro and in vivo AD models; however, there are few relevant randomized controlled clinical trials on Jaungo in AD. Methods/design A randomized, double-blind, placebo-controlled, single-center, phase IIa clinical trial was designed to investigate the safety, preliminary efficacy, and dose response of Jaungo in AD. The study protocol was approved by the Institutional Review Boards of the Kyung Hee University Korean Medicine Hospital (No. KOMCIRB-160617-HR-027) and the Korea Food and Drug Administration (No. 30907). The study aims to enroll 34 AD patients to be randomly distributed among three parallel groups: treatment 1, treatment 2, and the placebo group. Treatment group 1 applies Jaungo twice a day, while treatment group 2 applies Jaungo and the placebo ointment once a day, separately, and the placebo group applies the placebo ointment twice a day, for a total of 3 weeks each. Participants will be evaluated for eczema before and after the application of the ointments based on several parameters including the Eczema Area and Severity Index, the SCORing of Atopic Dermatitis Index, the Dermatology Life Quality Index, transepidermal water loss, total IgE level, eosinophil count, and IL-17, IL-22, and IFN-γ levels. Discussion The trial is currently ongoing and the enrollment of subjects has been initiated. There is an urgent need to develop a drug for the treatment of dry, hyperpigmented, scaly, and thickened skin in chronic-stage AD. This study will determine the efficacy and safety of Jaungo in AD, providing evidence for specific AD symptoms treated by Jaungo. Trial registration Clinical Trials.gov, identifier: NCT02900131. Registered on 2 September 2016. Korea Clinical Research Information Service, identifier: KCT0002060. Registered on 22 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1920-9) contains supplementary material, which is available to authorized users.

In conventional mammography, contrast sensitivity remains limited due to the superimposition of breast tissue and scattered X-rays, which induces low visibility of lesions in the breast and, thus, an excessive number of false-positive findings. Several methods, including digital breast tomosynthesis as a multiplanar imaging modality, air-gap and slot techniques for the reduction of scatters, phase-contrast imaging as another image-contrast modality, etc., have been investigated in attempt to overcome these difficulties. However, those techniques typically require a higher imaging dose or special equipment. In this work, as an alternative, we propose a new image restoration method based on a radiographic scattering model in which the intensity of scattered X-rays and the direct transmission function of a given medium are estimated from a single projection by using the dark-channel prior. We implemented the proposed algorithm and performed an experiment to demonstrate its viability. Our results indicate that most of the structures in the examined breast were very discernable even with no adjustment in the display-window level, thus preserving superior image features and edge sharpening.

Background The prognosis for cardiac arrest (CA) is associated with the degree of cerebral ischemia. We investigated the relationship between the wavelet coherence of cerebral oxyhemoglobin (HbO2) among different channels and outcomes after CA. Moreover, we aimed to develop a prognostication method after CA. Methods Eighty-three post-resuscitation patients were included. The HbO2 data were collected during the post-resuscitation period (median day, 1) using functional near-infrared spectroscopy. The coherence between sections of prefrontal HbO2 oscillations in five frequency intervals (I, 0.6–2 Hz; II, 0.15–0.6 Hz; III, 0.05–0.15 Hz; IV, 0.02–0.05 Hz; and V, 0.0095–0.02 Hz) were analyzed. We evaluated the outcomes using cerebral performance category (CPC) scores (good outcome, CPC ≤ 2 and poor outcome, CPC ≥ 3) at 3 months after CA. Additionally, the predictive method was developed using the biomarker and coherence value after CA. Results Among the included patients, 19 patients (22.9%) had a good outcome. Poor outcome group had significantly lower phase coherence in the myogenic frequency interval III compared to good outcome group (0.36 ± 0.14 vs. 0.54 ± 0.18, P Conclusions The predictive method using NSE and phase coherence of HbO2 in the interval III from the vascular smooth muscle cells could be a useful tool for prognosticating after CA. This suggests that evaluating cerebral ischemia using phase coherence of HbO2 might be a helpful outcome predictor following CA.

Digital breast tomosynthesis (DBT) is well-established in breast imaging modality to overcome the loss of depth-information in a three-dimension (3D) object in 2D mammography. However, the reconstructed DBT images suffer from shading artifacts caused by scatter radiation, beam-hardening effect, and unique geometric conditions. In this study, we investigated the application of a non-uniformity correction framework with TV-penalty in the DBT system for substantial improvement of its image visibility. We modeled a modified solver to estimate the non-uniformity field component, which is inspired by the normalized intensity-gradient joint-histogram-based energy minimization. The proposed framework was compared to the reference slice with only primary component in Monte-Carlo simulation and the uniformity was experimentally improved using the projection at low exposure condition. To quantitative evaluate image performance, percent integral uniformity (PIU) was calculated in acquired images. Our results indicated that the proposed framework well-operated to compensate for distorted flatness due to beam hardening, scatter, and unique DBT geometry. Especially, the measured PIU value of the corrected DBT slice was 14.2, it is almost same compared to that of mono-energy DBT slice (primary only) in simulation study. Moreover, the profile flatness of the corrected DBT slice was significantly improved from conventional DBT slice with much noise component. The uniformity correction of the DBT slice is necessary to reduce the misdiagnosis. Consequently, our results demonstrate that the proposed framework successfully corrects the non-uniformity at low X-ray exposure condition, and its scheme is expected to be applicable for efficient DBT imaging performance.

Intra-abdominal infection (IAI) is a common and important cause of infectious mortality in intensive care units. Adequate source control and appropriate antimicrobial regimens are key in the management of IAI. In community-acquired IAI, guidelines recommend the use of different antimicrobial regimens according to severity. However, the evidence for this is weak. We investigated the effect of enterococcal coverage in antimicrobial regimens in a severe polymicrobial IAI model. We investigated the effects of imipenem/cilastatin (IMP) and ceftriaxone with metronidazole (CTX+M) in a rat model of severe IAI. We observed the survival rate and bacterial clearance rate. We identified the bacteria in blood culture. We measured lactate, alanine aminotransferase (ALT), creatinine, interleukin (IL)-6, IL-10, and reactive oxygen species (ROS) in the blood. Endotoxin tolerance of peripheral blood mononuclear cells (PBMCs) was also estimated to determine the level of immune suppression. In the severe IAI model, IMP improved survival and bacterial clearance compared to CTX+M. Enterococcus spp. were more frequently isolated in the CTX+M group. IMP also decreased plasma lactate, cytokine, and ROS levels. ALT and creatinine levels were lower in IMP group. In the mild-to-moderate IAI model, however, there was no survival difference between the groups. Immune suppression of PBMCs was observed in IAI model, and it was more prominent in the severe IAI model. Compared to CTX+M, IMP improved the outcome of rats in severe IAI model.

Background A number of questionnaires designed for analyzing family members’ inconvenience and demands in intensive care unit (ICU) care have been developed and validated in North America. The family satisfaction in the intensive care Unit-24 (FS-ICU-24) questionnaire is one of the most widely used of these instruments. This study aimed to translate the FS-ICU-24 questionnaire into Korean and validate the Korean version of the questionnaire. Methods The study was conducted in the medical, surgical, and emergency ICUs at three tertiary hospitals. Relatives of all patients hospitalized for at least 48 hours were enrolled for this study participants. The validation process included the measurement of construct validity, internal consistency, and interrater reliability. The questionnaire consists of 24 items divided between two subscales: satisfaction with care (14 items) and satisfaction with decision making (10 items). Results In total, 200 family members of 176 patients from three hospitals completed the FS-ICU-24 questionnaire. Construct validity for the questionnaire was superior to that observed for a visual analog scale (Spearman’s r = 0.84, p < 0.001). Cronbach’s αs were 0.83 and 0.80 for the satisfaction with care and satisfaction with decision making subscales, respectively. The mean (± standard deviation) total FS-ICU-24 score was 75.44 ± 17.70, and participants were most satisfied with consideration of their needs (82.13 ± 21.03) and least satisfied with the atmosphere in the ICU waiting room (35.38 ± 34.84). Conclusions The Korean version of the FS-ICU-24 questionnaire demonstrated good validity and could be a useful instrument with which to measure family members’ satisfaction about ICU care.

Background Patients with atopic dermatitis (AD) exhibit various symptoms, especially itching. Recently, herbal medicines (HMs) are being used in combination with antihistamines for the treatment of AD in Korea. While oral antihistamines can alleviate itching, HMs appear to exert anti-inflammatory effects with minimal side effects. However, there is little evidence regarding the effectiveness and safety of using HMs in combination with antihistamines for AD. Methods To observe the effectiveness and safety of combination treatment with HMs and antihistamines, we performed a retrospective chart review of inpatients with AD who received this combination treatment for at least 7 days in a hospital. Results Of 163 inpatients, 40 met the inclusion criteria. All patients received HMs three times, and one or two antihistamines, a day after HM intake. A large proportion of patients received first-generation antihistamines. HMs comprised a mixture of an average of 20.69 different herbs in decoction. The mean total, objective, and subjective SCORing Atopic Dermatitis scores showed a significant decrease after combination treatment. Changes in the mean levels of aspartate transaminase, alanine transaminase, blood urea nitrogen, and creatinine were not statistically significant among treatments. There were no adverse events of pseudoaldosteronism or interstitial pneumonia. Conclusion We observed that the short-term use of HMs in combination with oral antihistamines was safe and effective, with a low risk of adverse reactions. This study was limited by its retrospective design, and prospective studies with long-term follow-up periods are warranted to further elucidate the safety of this combination treatment for AD.

In single-photon-emission computed tomography (SPECT) with a pixelated semiconductor detector (PSD), not only pinhole collimators but also parallel-hole collimators are often used in preclinical nuclear-medicine imaging systems. The purpose of this study was to evaluate and compare pinhole and parallel-hole collimators in a PSD. For that purpose, we paired a PID 350 (Ajat Oy Ltd., Finland) CdTe PSD with each of the four collimators most frequently used in preclinical nuclear medicine: (1) a pinhole collimator, and (2) low-energy high-resolution (LEHR), (3) low-energy general-purpose (LEGP), and (4) low-energy high-sensitivity (LEHS) parallel-hole collimators. The sensitivity and spatial resolution of each collimator was evaluated using a point source and a hot-rod phantom. The highest sensitivity was achieved using LEHS, followed by LEGP, LEHR, and pinhole. Also, at a source-to-collimator distance of 2 cm, the spatial resolution was 1.63, 2.05, 2.79, and 3.45 mm using pinhole, LEHR, LEGP, and LEHS, respectively. The reconstructed hot-rod phantom images showed that the pinhole collimator and the LEHR parallel-hole collimator give a fine spatial resolution for preclinical SPECT with PSD. In conclusion, we successfully compared different types of collimators for a preclinical pixelated semiconductor SPECT system.

Background The cecal slurry model was introduced as an alternative method for creating an animal sepsis model. This study was performed to evaluate dose-dependent mortality and organ injury in a sepsis model of cecal slurry peritonitis. Materials and methods Male Sprague-Dawley rats were divided into 5.0, 7.5, 10, or 15 mL/kg groups, according to the volume of cecal slurry administered into the peritoneal cavity. In the survival study, rats were observed for 14 d after sepsis induction. In the second experiment, blood and tissue were harvested to measure organ injury and the 2′, 7′-dichlorofluorescein diacetate concentrations. Results All rats in the 5.0 mL/kg group survived for 14 d, whereas all rats in the 15 mL/kg group died within 24 h. The survival rates in the 7.5 mL/kg and 10 mL/kg groups were 60% and 30%, respectively. In the arterial blood gas analysis, lactate concentrations increased and HCO3− decreased in a dose-dependent manner across the groups. Alanine aminotransferase and blood urea nitrogen concentrations increased as the dose of cecal slurry increased. 2′, 7′-Dichlorofluorescein diacetate concentrations also increased in a dose-dependent manner. Conclusions The cecal slurry model of sepsis evaluated in this study demonstrates dose-dependent mortality, metabolic acidosis, liver and kidney injuries, and reactive oxygen species production, and it could be used for subsequent sepsis experiments, considering the severity of sepsis induced.

The purpose of this study was to determine whether the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level could be a useful marker for Kawasaki disease in the pediatric emergency department (PED) and in the presence of fever duration of 4 days or less (hyper-acute phase of Kawasaki disease). Medical records of patients who were 1 month to 15 years old of age and presented at the PED with suspected Kawasaki disease from January 1, 2010, to December 31, 2014, were collected retrospectively. Two hundred thirty-nine patients with a history of fever for 4 days or less were diagnosed with Kawasaki disease, as well as 111 patients with other febrile diseases, and were enrolled. The NT-proBNP level was significantly higher in patients with Kawasaki disease (Kawasaki disease vs. other febrile disease group, 444.8 (189.7-951.5) vs. 153.4 (68.9-287.6) pg/mL; p 0.001), and a cutoff value of 244.7 pg/mL yielded a sensitivity and specificity of 68.6 and 70.3 %, respectively. The area under the curve of the NT-proBNP for predicting Kawasaki disease was 0.763 (95 % CI 0.712-0.814).NT-proBNP might be an adjunctive laboratory marker for hyper-acute phase of Kawasaki disease in the PED. What is Known: • N-terminal pro-brain natriuretic peptide level has been reported as a useful marker for diagnosis in patients with the acute phase of Kawasaki disease. • But, in the cases of less than 5 days of fever, the appropriate level of NT-proBNP for differentiating Kawasaki disease in PED has not been yet evaluated. What is New: • NT-proBNP might be an adjunctive laboratory marker for hyper-acute phase of Kawasaki disease.

The radiation therapy is most important treatment technique in the field of the oncology. With the improved radiation therapy technologies such as proton image-guided radiation therapy (IGRT), the accuracy of the patient alignment system has been emphasized. The purpose of this study was to validate the possibility of cone-beam computed tomography (CBCT) reconstruction algorithm using X-ray and 3-D proton IGRT by acquiring images sequentially with continuous 360° gantry rotation. To confirm the feasibility of CBCT reconstruction algorithm, we acquired the reconstruction images of the proton IGRT for a mouse and ball phantom, respectively. According to the results, we demonstrated the feasibility of reconstruction algorithm for the proton IGRT. In conclusion, this reconstruction algorithm can help the determination of a treatment target and will be used a main patient alignment system for the proton IGRT. In the future work we need to compare the 180 projection view using X-ray imaging system of the proton therapy with other efficient projection views.

Objective Red cell distribution width (RDW) is associated with mortality in patients with community-acquired pneumonia (CAP). However, little is known about the effect of changes in RDW during treatment on mortality. Thus, the objective of this study was to evaluate the association between RDW changes and mortality in hospitalized patients with CAP. Methods Retrospective analyses were performed using medical records of patients hospitalized for CAP from April 2008 to February 2014. The abstracted laboratory values included RDW (from days one to four), clinical variables, and pneumonia severity index (PSI) scores. The ΔRDWn-1 was defined as the change in RDW calculated as: (RDWday1-RDWday-n)/RDWday1×100 (%), where ‘day n’ refers to hospital day. Results During the study period, a total of 1,069 patients were hospitalized for CAP. The 30-day mortality was 100/1,069 (9.4%). The median RDW at baseline was 14.1% (range, 11.1 to 30.2) and differed significantly between survivors and non-survivors (P

Objective Current studies have not found sufficient evidence to encourage the use of ultrasound for assessing dehydration in children. We introduce a new sonographic parameter, the "aorta/inferior vena cava (IVC) cross-sectional area index" (Ao/IVCA) measured just inferior to the xiphoid process, for the effective evaluation of dehydration in children. Methods This is a prospective, observational study. We enrolled children who presented to the pediatric emergency department (PED) between May 2014 and January 2015. We measured the maximum diameter of the aorta from inner wall to inner wall, and the long and short axis diameters of IVC using a convex array transducer. Ao/IVCA was calculated and compared with aorta/IVC maximal diameter index (Ao/IVCD) and the clinical dehydration scale (CDS). Results A total of 34 children were enrolled. We found a statistically significant correlation between Ao/IVCA and CDS ( R 2 = 0.30; P R 2 = 0.08; P =.11). The ability of Ao/IVCA and Ao/IVCD to predict CDS ≥1 was assessed using the receiver operating characteristic analysis. The area under the receiver operating characteristic curve for Ao/IVCA was larger than that for Ao/IVCD (0.87 vs 0.75, P = .04). The cut-off value of Ao/IVCA that yielded the maximum value of Youden index was 1.81 (sensitivity: 72%, specificity: 89%). Conclusions Ao/IVCA might be a promising index for the assessment of dehydration. The diagnostic performance of Ao/IVCA for dehydration might be higher than that of the method that uses the maximum diameter of IVC and the aorta.