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Abstract Endoscopic endonasal surgery (EES) is widely employed for interventions in skull base. Despite advancements in surgical techniques, cerebrospinal fluid (CSF) leakage remains a significant concern. The introduction of nasoseptal flap (NSF) dramatically reduced the CSF leakage rates, yet reconstruction techniques continue to vary among institutions and lack standardization. Recently, injectable hydroxyapatite (HA), traditionally used in open skull base reconstruction, has been adapted for use in EES. This study compares the effectiveness of HA and NSF reconstruction with the standard multilayer NSF reconstruction alone. We searched for eligible studies in PubMed, Embase, and Cochrane Library. CSF leakage rates and reconstruction-associated complication rates were thoroughly evaluated. We initially reviewed 3650 records, narrowing down to 13 articles for full-text examination. Of these, 3 retrospective cohort studies met our inclusion criteria, comparing outcomes of HA combined with NSF to NSF alone. The HA plus NSF group tended to exhibit lower rates of CSF leakage compared to the NSF alone group. Similarly, the rate of reconstruction-associated complication was also lower in the HA plus NSF group than in the control group. Skull base reconstruction using HA and NSF can be an effective way to minimize CSF leakage without major complications.

Abstract Alcohol and cocaine (COC) are commonly co-used drugs that cause addiction and have harmful effects. Their abuse may threaten the health of the abuser and public safety by causing serious accidents or crimes. The recidivism rate of drug-related crimes closely correlates with alcoholism. Several incidences of alcohol consumption in combination with drug abuse have been reported. Here, liquid chromatography tandem mass spectrometric method was developed to simultaneously analyze ethyl glucuronide (EtG), a metabolite of ethanol; COC; cocaethylene (CE), an alcohol-derived metabolite of COC; and benzoylecgonine (BZE), a major metabolite of COC, to determine the concurrent use of alcohol with COC. For pre-treatment, ultracentrifugation (5 min, 50,000 g) and mixed-mode anion exchange solid-phase extraction were used to increase the recovery of target compounds and minimize the matrix effect of hair. The lower limits of quantification were: 7 pg/mg (EtG), 2 pg/mg (COC), 10 pg/mg (CE), and 1 pg/mg (BZE). The correlation coefficient (r) of the calibration curve within the quantified range of target compounds was ≥ 0.9978. The intra- and inter-day accuracies were − 6.1–9.7% and − 9.3–8.3%, and intra- and inter-day precisions were 0.5–10.3% and 0.6–14.4%, respectively. The recovery, matrix effect, process efficiency, and autosampler stability were 89.2–104.8%, 81.6–105.4%, 81.5–107.1%, and 96.6–109.7%, respectively. The novel analytical method was validated with hair samples from individuals suspected of alcohol and COC use, and the method could distinguish between independent and concurrent use. Based on the findings, the analytical approach developed in this study is anticipated to be valuable in drug and alcohol dependence tests that require the simultaneous detection of alcohol and COC abuse.

IntroductionIt is uncertain whether burnout is associated with suicidal ideation among workers not in health care services. The aim of this study was to identify how burnout and suicidal ideation are linked among employees in various occupations and whether depression affects this link.MethodsThis cross-sectional study collected data from 12,083 participants aged 19–65 years from 25 companies and public institutions who underwent workplace mental health screening. Burnout and depression were assessed using both the Oldenburg Burnout Inventory and the Center for Epidemiologic Studies Depression Scale. Suicidal ideation was assessed by a self-rated questionnaire from the Korea National Health and Nutrition Examination Survey.ResultsExhaustion but not the cynicism dimension of burnout was associated with increased odds of suicidal ideation after adjustment for depression and other covariates (odds ratio [OR] = 1.47, 95% CI = 1.26–1.72). The association of exhaustion with suicidal ideation was significant in both depressed (OR = 1.36, 95% CI = 1.14–1.61) and not depressed (OR = 1.77, 95% CI = 1.13–2.76) participants. In exhausted participants, insufficient job control, an unfavorable occupational climate, low educational level, and depression were associated with increased odds of suicidal ideation.ConclusionExhaustion is linked with risk of suicidal ideation in employees not in health care service, regardless of depression status. Exhausted employees, particularly those having poor job resources, should be recognized as an at-risk group.

Purpose This study investigated the relationship between increased working hours and suicidal ideation among Korean full-time employees by gender. Methods Participants were employees from 54 companies and local government organizations in Korea, aged 19 to 68, who completed a self-reported questionnaire on sociodemographic factors, daily perceived stress, resilience, depressive symptoms, and suicidal ideation. Of the initial 15,360 respondents, participants who worked less than 40 hours were excluded. The final sample size was 9,326 (5,652 men, 3,674 women). Sociodemographic factors and psychological characteristics of participants with suicidal ideation were analyzed using Student’s t-tests and chi-square tests for continuous and categorical variables, respectively. Hierarchical logistic regression analyses were performed using suicidality as the dependent variable respectively for all participants, for male, and female. Furthermore, we used these results to compare differences between men and women associated with regard to long working hours to better understand how long working hours correlate with suicidal ideation; further, we examined the impact of gender on this relationship. Results In univariate analyses, suicidal ideation was associated with increased working hours. Hierarchical logistic regression analyses of sociodemographic and psychological factors found no association between long working hours and suicidal ideation for the participants overall. However, they showed significant differences between men and women, such that long working hours were associated with suicidal ideation in men but were non-significant for women. Conclusion Suicidal ideation is associated with long working hours among Korean male full-time workers, while other factors are more likely to lead to suicidal ideation among female workers. Suicide prevention measures for employees should thus be developed based on gender.

Abstract We aimed to evaluate the radiographic and clinical outcomes after gamma knife radiosurgery (GKRS) for trigeminal schwannomas (TSs). A total of 87 patients who underwent GKRS for TSs between 1990 and 2020 were enrolled. The mean tumor volume was 4.3 cm3. The median prescribed dose for the margins of the tumor was 13 Gy. The median follow-up duration was 64.3 months (range 12.0–311.5 months). The overall local tumor control rate was 90%, and the symptom response rate was 93%. The response rate for each symptom was 88% for facial pain, 97% for facial sensory change, and 86% for cranial nerve deficits. Nineteen (22%) patients showed transient swelling, which had regressed at the time of the last follow-up. Cystic tumors were associated with transient swelling (p = 0.04). A tumor volume of

Workplace bullying is a prevalent issue with a significant impact on employees’ mental health. This study aimed to explore the relationship between workplace bullying and the prevalence of depression, with a particular focus on the role of gender. A total of 12,344 Korean employees aged 19–65 years were included in the study. They completed the Center for Epidemiologic Studies Depression Scale (CES-D) and a score of 16 or higher in CES-D indicated depression. The association between workplace bullying and depression was analyzed using logistic regression analyses. The average CES-D scores were higher for both male and female employees who experienced bullying than for those who did not (p < 0.001). The association between the experience of workplace bullying and the prevalence of depression was statistically significant for both genders, with a stronger correlation observed among male employees (p for interaction < 0.001). Organizations are urged to address workplace bullying, particularly for male employees, through the implementation of anti-bullying strategies and policies, as well as the provision of mental health resources and support.

Estimating the measurement uncertainty (MU) is becoming increasingly mandatory in analytical toxicology. This study evaluates the uncertainty in the quantitative determination of urinary amphetamine (AP) and 4-hydroxyamphetamine (4HA) using a liquid chromatography–tandem mass spectrometry (LC–MS/MS) method based on the dilute-and-shoot approach. Urine sample dilution, preparation of calibrators, calibration curve, and method repeatability were identified as the sources of uncertainty. To evaluate the MU, the Guide to the Expression of Uncertainty in Measurement (GUM) approach and the Monte Carlo method (MCM) were compared using the R programming language. The MCM afforded a smaller coverage interval for both AP (94.83, 104.74) and 4HA (10.52, 12.14) than that produced by the GUM (AP (92.06, 107.41) and 4HA (10.21, 12.45)). The GUM approach offers an underestimated coverage interval for Type A evaluation, whereas the MCM provides an exact coverage interval under an abnormal probability distribution of the measurand. The MCM is useful in complex settings where the measurand is combined with numerous distributions because it is generated from the uncertainties of input quantities based on the propagation of the distribution. Therefore, the MCM is more practical than the GUM for evaluating the MU of urinary AP and 4HA concentrations using LC–MS/MS.

Purpose This study aimed to analyze the alcohol use patterns that may influence suicide attempt in employees who have suicidal ideation. Methods The 15,199 participants were classified into three groups according to suicide risk severity. Participant scores on the Alcohol Use Disorders Identification Test-Korea (AUDIT-K), subscale for drinking amount/frequency (AUDIT-C, items 1–3), subscale for dependence/related problems (AUDIT-D/P, items 4–10), and other sociodemographic and psychiatric scales were analyzed between the groups using one-way analysis of variance (ANOVA) and the chi-square test, followed by post hoc analysis using the Bonferroni correction. Results A statistically significant difference between all three groups was observed for AUDIT-D/P scores after post hoc analysis (P < 0.001), indicating an increasing trend for greater suicide risk. This trend was present in both sexes and across all age groups above 30 years old. Conclusion Alcohol dependence/related problems are significantly associated with suicide attempt among employees. Assessing and preventing suicide risk according to these issues may minimize socioeconomic losses due to suicide.

OBJECTIVE: The aim of this study was to identify work stress associated with the development of suicidal ideation with a focus on gender and age differences among Korean employees. METHODS: The data of 95 356 healthy employees aged >18 years who had undergone at least two comprehensive health examinations at Kangbuk Samsung Hospital Health Screening Center, South Korea, were analyzed. Risk of suicidal ideation was assessed using a self-reported questionnaire examining suicidal ideation during the past year. Work stress was measured using the Korean Occupational Stress Scale-Short Form. A Cox proportional hazards model was used to examine relationship between work stress and suicidal ideation. Considering gender and age differences in the association between work stress and suicidal ideation, the data were stratified by gender and age groups. RESULTS: During 289 706 person-years of follow-up, suicide ideation was identified in 3 460 participants. For male workers, high job demands and lack of reward were associated with the risk of suicidal ideation in young adults and midlife decade group. Job insecurity was associated with the risk of suicidal ideation in midlife decade and middle-aged and older adulthood. Organizational injustice was associated with the risk of suicidal ideation in middle-aged and older adulthood. Discomfort in an organizational climate was associated with the development of suicidal ideation in all age groups. For female workers, organizational injustice and discomfort in an organizational climate were associated with the risk of suicidal ideation in early adulthood. CONCLUSION: The results suggested that certain work stressors are risk factors of suicidal ideation. Gender and age differences in components of work stress associated with suicidal ideation were also observed.

Abstract Numerous confidence estimation methods have been proposed for classification neural networks; however, this problem has not been well addressed for regression neural networks. That is, softmax layers are not available in regression networks and the interpretation of confidence becomes less clear. To alleviate these problems, a simple but effective method is proposed that computes the confidences of regression results. First, the confidence is considered as a scalar value representing relative error‐levels. Then, a mini‐batch based training method based on this interpretation is developed. Precisely, in each mini‐batch, desired outputs for confidence values are assigned by sorting current errors. Experimental results on the loose wheel nut detection problem as well as a simulated example have shown that the proposed method can be successfully applied to regression problems.

We developed and evaluated an interpersonal model of depression in employees, where passion and perseverance affect occupational stress and perceived control, which in turn affect risk of depression. The participants were employees of 18 private companies and local government organizations in Korea aged 19 to 65 years. A total of 11,422 participants completed questionnaires including the Korean version of the Grit scale, the occupational stress scale, the perceived control subscale in the perceived stress scale, and the Center for Epidemiologic Studies Depression Scale. Mediation analysis was performed to determine relationships among trait-level passion and perseverance, work-related stress, perceived control, and depression. Passion and perseverance preceded depression in employees. Higher occupational stress and lower perceived control mediated the association between passion and depression, and between perseverance and depression. Passion and perseverance exert preventive effects on depression by decreasing workplace stress and elevating perceived control. Future studies should investigate the effects of psychological characteristics on the development of depression in employees.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important human pathogen that is cross-resistant to most β-lactam antibiotics. We investigated whether oxacillin, which is a β-lactam antibiotic, alone or in combination with punicalagin can affect the penicillin binding protein 2a (PBP2a)-mediated resistance of MRSA. Susceptibility testing of punicalagin with oxacillin was performed using the microdilution and checkerboard assay and the growth curve assay. Binding affinity of punicalagin for cell wall peptidoglycan (PGN) was confirmed by an increased concentration of PGN in bacterial cultures containing punicalagin. The level of PBP2a was analyzed by western blotting. Punicalagin exhibited antimicrobial activity in the viability assay and increased the susceptibility of MRSA to oxacillin. PGN interfered with the antimicrobial activity of punicalagin and prevented the synergistic activity of punicalagin and oxacillin. Increasing the concentration of punicalagin and maintaining a constant concentration of oxacillin resulted in synergistic suppression of the expression of the mec operon (mecA, mecI, and mecR1). The production of PBP2a was suppressed by the addition of punicalagin to oxacillin. Our findings demonstrate that punicalagin potentiates the effect of oxacillin on MRSA by reducing the transcription of mecA (a gene marker for methicillin resistance), which resulted in a reduced level of PBP2a. Keywords: MRSA, Punicalagin, PBP2a, β-lactam, Synergistic

In this work, Nd–Fe–B alloy powders are fabricated via high energy ball milling and their fracture behavior and magnetic properties are investigated at different milling times. The powder characteristics (particle shape, size, size distribution, and microstructure) and magnetic properties of the Nd–Fe–B alloys are systematically analyzed. The initial spherical Nd–Fe–B powder is cracked/crushed even after a short period of milling (30 s) due to the high impact energy generated during high energy ball milling. These randomly cracked polygonal-shaped powders are fragmented after 5 min of milling and converted to fine powders. Interestingly, the fine particles after milling for 5 min are conducive to agglomeration at longer milling times (20–60 min) and formed spherically-shaped agglomerated powder. Additionally, the sphericity of the powder increased to 92% by re-pulverization and agglomeration at 60 min. The milled powder shows the Nd _2 Fe _14 B phase, and the x-ray diffraction patterns exhibit peak broadening with increasing milling time, clearly confirming the powder refinement behavior by high energy ball milling. The magnetic properties of the milled powders are systematically investigated and their behavior is elucidated as a function of the milling time.

Background: Blood glucose fluctuation is linked to mortality in critically or non-critically ill patients, as well as cardiovascular events after acute myocardial infarction. However, its association with poststroke outcome is largely unknown. The aim of this study was to determine whether initial glucose fluctuation is related to cardiovascular mortality in patients with acute ischemic stroke. Methods: We registered consecutive patients with acute ischemic stroke in Soonchunhyang University Hospital between Mar 2005 and Feb 2015. Six hundred and thirty-nine diabetic patients within 72 hours from stroke onset were included. Serum glucose levels were checked 4 times per day during the first 3 hospital days. J-indices were calculated for glycemic variability in all patients, and divided into 4 groups by quartiles. Cardiovascular death and modified Rankin scale at 3 months were prospectively recorded. Multivariable logistic regression analyses were performed after adjusting covariates for outcome variables. Results: Cardiovascular deaths at 3 months were identified in 57 patients (8.9%): 11 (7.1%), 8 (5.1%), 13 (8.0%) and 25 (15.2%) in each of the J-index quartiles, respectively. Multivariable logistic regression analysis indicated that the incidence of cardiovascular deaths were significantly associated with the group of highest J-index (odds ratio 3.38; 95% confidence interval 1.15-12.04; P=.04). Conclusion: Fluctuation of serum glucose during the first 3 days was associated with cardiovascular death at 3 months after acute ischemic stroke. Further studies are required to determine the pathophysiologic correlation between glycemic variation and cardiovascular deaths.

Curcumin, a natural polyphenolic flavonoid extracted from the rhizome of Curcuma longa L., was shown to possess superior potency to resensitize methicillin-resistant Staphylococcus aureus (MRSA) to antibiotics. Previous studies have shown the synergistic activity of curcumin with β-lactam and quinolone antibiotics. Further, to understand the anti-MRSA mechanism of curcumin, we investigated the potentiated effect of curcumin by its interaction in diverse conditions. The mechanism of anti-MRSA action of curcumin was analyzed by the viability assay in the presence of detergents, ATPase inhibitors and peptidoglycan (PGN) from S. aureus, and the PBP2a protein level was analyzed by western blotting. The morphological changes in the curcumin-treated MRSA strains were investigated by transmission electron microscopy (TEM). We analyzed increased susceptibility to MRSA isolates in the presence of curcumin. The optical densities at 600 nm (OD600) of the suspensions treated with the combinations of curcumin with triton X-100 and Tris were reduced to 63% and 59%, respectively, compared to curcumin without treatment. N,N'-dicyclohexylcarbodiimide (DCCD) and sodium azide (NaN3) were reduced to 94% and 55%, respectively. When peptidoglycan (PGN) from S. aureus was combined with curcumin, PGN (0–125 μg/mL) gradually blocked the antibacterial activity of curcumin (125 μg/mL); however, at a concentration of 125 µg/mL PGN, it did not completely block curcumin. Curcumin has a significant effect on the protein level of PBP2a. The TEM images of MRSA showed damage of the cell wall, disruption of the cytoplasmic contents, broken cell membrane and cell lysis after the treatment of curcumin. These data indicate a remarkable antibacterial effect of curcumin, with membrane permeability enhancers and ATPase inhibitors, and curcumin did not directly bind to PGN on the cell wall. Further, the antimicrobial action of curcumin involved in the PBP2a-mediated resistance mechanism was investigated.