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The increasing prevalence of multidrug-resistant organism (MDRO) carriage poses major challenges to medicine as healthcare costs increase. Recently, faecal microbiota transplantation (FMT) has been discussed as a novel and effective method for decolonising MDRO.To compare the efficacy of different FMT methods to optimise the success rate of decolonisation in patients with MDRO carriage.This prospective cohort study enrolled patients with MDRO carriages from 2018 to 2021. Patients underwent FMT via one of the following methods: oral capsule, oesophagogastroduodenoscopy (EGD), colonoscopy, or gastric tube.A total of 57 patients underwent FMT for MDRO decolonisation. The colonoscopy group required the shortest time for decolonisation, whereas the EGD group required the longest (24.9 vs. 190.4 days, p = 0.022). The decolonisation rate in the oral capsule group was comparable to that in the EGD group (84.6% vs. 85.7%, p = 0.730). An important clinical factor associated with decolonisation failure was antibiotic use after FMT (odds ratio = 6.810, p = 0.008). All four groups showed reduced proportions of MDRO species in microbiome analysis after FMT.Compared to other conventional methods, the oral capsule is an effective FMT method for patients who can tolerate an oral diet. The discontinuation of antibiotics after FMT is a key factor in the success of decolonisation.

Infective endocarditis (IE) is a severe and fatal infection with high in-hospital and overall mortality rates of approximately up to 30%. Valve culture positivity was associated with in-hospital mortality and postoperative complications; however, few studies have analyzed the relationship between valve cultures and overall mortality over a long observation period. This study aimed to compare the association of valve culture positivity with overall mortality in patients with IE who underwent valve surgery.A total of 416 IE patients admitted to a tertiary hospital in South Korea from November 2005 to August 2017 were retrospectively reviewed. A total of 202 IE patients who underwent valve surgery and valve culture were enrolled. The primary endpoint was long-term overall mortality. Kaplan-Meier curve and Cox proportional hazards model were used for survival analysis.The median follow-up duration was 63 (interquartile range, 38-104) months. Valve cultures were positive in 22 (10.9%) patients. The overall mortality rate was 15.8% (32/202) and was significantly higher in valve culture-positive patients (36.4%, p = 0.011). Positive valve culture [hazard ratio (HR) 3.921, p = 0.002], Charlson Comorbidity Index (HR 1.181, p = 0.004), Coagulase-negative staphylococci (HR 4.233, p = 0.001), new-onset central nervous system complications (HR 3.689, p 0.001), and new-onset heart failure (HR 4.331, p = 0.001) were significant risk factors for overall mortality.Valve culture positivity is a significant risk factor for long-term overall mortality in IE patients who underwent valve surgery. The importance of valve culture positivity needs to be re-evaluated, as the valve culture positivity rate increases with increasing early surgical intervention.

Background The reward system regulates motivated behavior, and repeated practice of specific motivated behavior might conversely modify the reward system. However, the detailed mechanisms by which they reciprocally regulate each other are not clearly understood. Methods Mice subjected to chronic restraint stress show long-lasting depressive behavior, which is rescued by continual engagement with playable objects. A series of molecular, pharmacological, genetic, and behavioral analyses, combined with microarray, liquid chromatography, and chemogenetic tools are used to investigate the neural mechanisms of anti-depressive effects of playable objects. Results Here we show that repeated restraint induces dopamine surges into the nucleus accumbens-lateral shell (NAc-lSh), which cause upregulation of the neuropeptide PACAP in the NAc-lSh. As repeated stress is continued, the dopamine surge by stressors is adaptively suppressed without restoring the PACAP upregulation, and the resulting enhanced PACAP inputs from NAc-lSh neurons to the ventral pallidum (VP) facilitate depressive-like behaviors. Continual engagement with playable objects in mice subjected to chronic stress remediates the reduced dopamine response to new stressors, enhanced PACAP upregulation, and depressive-like behaviors. Overactivation of D1 dopamine receptors over the action of D2 receptors in the NAc-lSh promotes depressive-like behaviors. Conversely, inhibition of D1 receptors or PACAP upregulation in the NAc-lSh confers resilience to chronic stress-induced depressive-like behaviors. Histochemical and chemogenetic analyses reveal that engagement with playable objects produces anti-depressive effects by reshaping the ventral tegmental area-to-NAc-lSh and NAc-lSh-to-VP circuits. Conclusions These results suggest that behavioral engagement with playable objects remediates depressive-like behaviors by resolving stress-induced maladaptive changes in the reward system.

Red pepper seedlings were inoculated either alone or with a mixture of all five species of arbuscular mycorrhizal fungi (AMF). After 10 weeks of growth in the greenhouse, the seedlings were transplanted into fields and cultivated without chemical fertilizers and pesticides for 10 weeks. The results showed that plant growth was significantly increased under both greenhouse and field conditions, suggesting that AMF inoculation has a positive effect on the growth of Capsicum annuum and improves the physical properties of the soil by increasing the concentration of glomalin. The application of AMF can positively contribute to sustainable agriculture by reducing the use of chemical fertilizers while increasing crop growth.

Chronic stress induces adaptive changes in the brain via the cumulative action of glucocorticoids, which is associated with mood disorders. Here we show that repeated daily five-minute restraint resolves pre-existing stress-induced depressive-like behavior in mice. Repeated injection of glucocorticoids in low doses mimics the anti-depressive effects of short-term stress. Repeated exposure to short-term stress and injection of glucocorticoids activate neurons in largely overlapping regions of the brain, as shown by c-Fos staining, and reverse distinct stress-induced gene expression profiles. Chemogenetic inhibition of neurons in the prelimbic cortex projecting to the nucleus accumbens, basolateral amygdala, or bed nucleus of the stria terminalis results in anti-depressive effects similarly to short-term stress exposure, while only inhibition of neurons in the prelimbic cortex projecting to the bed nucleus of the stria terminalis rescues defective glucocorticoid release. In summary, we show that short-term stress can reverse adaptively altered stress gains and resolve stress-induced depressive-like behavior., Chronic stress induces maladaptive changes in the neural networks and it’s associated with mood disorders. Here, the authors show that repeated exposure to short-term stress can resolve pre-existing chronic stress induced depressive-like behaviour in mice.

C-reactive protein (CRP) or procalcitonin (PCT) alone has limitations in the early detection of infection or inflammation due to shortcomings in specificity and varied cut-off values. Recently, interleukin (IL)-6 has been assessed, but it is not known to what extent the three values are homogeneous in reality. This retrospective study was conducted with two large datasets (discrepancy set with results within 24 h of admission [7149 patients] and follow-up set until 2 weeks of hospital stay [5261 tests]) consisting of simultaneous examinations of CRP, PCT, and IL-6 between January 2015 and August 2021. The specific discrepant group (n = 102, 1.4%) with normal CRP (

Background The increasing prevalence of multi-drug resistant organism (MDRO) carriage imposes significant medical challenges by increasing healthcare costs. Since MDRO carriage impacts treatment outcome and prognosis, many decolonization strategies were proposed but were not as effective as expected. Recently, fecal microbiota transplantation (FMT) has been discussed as a novel and effective method of MDRO decolonization. In this study, we compared the effectiveness of different FMT delivery methods to find suitable methods and optimize the success rate of decolonization for the patients with MDRO carriage. Methods In this prospective cohort study, we enrolled patients with MDRO carriage from 2018 to 2021. Patients received FMT via one of the four following methods; oral capsule, esophagogastroduodenoscopy, colonoscopy, or gastric tube. FMT delivery method was chosen according to the medical condition or eligibility for oral diet. The participants were followed up for one year. Decolonization and recolonization with MDRO were determined by the follow-up stool cultures. Microbiome analysis was done to assess the successful restoration of the gut microbiome. Results A total of 57 patients received FMT for MDRO decolonization. The number of patients who received FMT via oral capsule, EGD, colonoscopy, and gastric tubes was 14, 9, 23, and 11. The overall decolonization rate was 69.2%, and the recolonization rate was 19.3%. The colonoscopy group required the shortest time for decolonization, while the EGD group was the longest (24.9 vs. 190.4 days, p-value=0.022). The decolonization rate was the highest in the EGD group (85.7%) and the lowest in the gastric tube group (50.5%). The oral capsule group had a comparable decolonization rate to the EGD group (84.6% vs. 85.7%, p=0.730). The clinical factor associated with decolonization was antibiotic usage after FMT (Odds ratio= 6.810, p-value=0.008). Microbiome analysis data showed improvement in alpha index in the Oral capsule and the EGD group. All four groups showed a reduced proportion of MDRO species after FMT. Comparison of ACE index of Taxonomic data with different FMT modalities Conclusion The oral capsule is an effective FMT method for patients who are tolerable to an oral diet compared to the other conventional methods. Discontinuation of antibiotics after FMT is critical in decolonization. Disclosures All Authors: No reported disclosures.

Background Surgical site infection is a clinically significant postoperative complication and a major cost burden of healthcare-associated infections. Although many studies compare minimally invasive surgery and open surgery, few studies have focused on surgical site infection. This study aimed to investigate the differences in the incidence of surgical site infection after open and robotic-assisted gastrectomy in patients with gastric cancer. Methods We retrospectively reviewed adult patients with gastric cancer who underwent open and robotic-assisted gastrectomy at a 2,400-bed tertiary hospital in Seoul from January 2015 to December 2015. Postoperative outcomes, including surgical site infection between open and robotic-assisted gastrectomy, were compared. Risk factors of surgical site infection were analyzed by logistic regression multivariable analysis. Results A total of 684 patients, including 448 patients who underwent open gastrectomy and 236 patients who underwent robotic-assisted gastrectomy, were enrolled. The median age was 58 years. The overall incidence of surgical site infection was 7.6%. The incidence of surgical site infection was significantly lower in the robotic-assisted gastrectomy group than in the open gastrectomy group (9.2% vs. 4.7%, p=0.035). The length of hospital stay was significantly shorter in the robotic-assisted gastrectomy group than in the open gastrectomy group (5 vs. 8 days, p< 0.001). Multivariate logistic regression revealed that the operative time, history of smoking, and open gastrectomy were independent risk factors influencing the incidence of surgical site infection. Conclusion Robotic-assisted gastrectomy is a good multimodality treatment option for gastric cancer in terms of reduced length of hospital stay and incidence of surgical site infection. Disclosures All Authors: No reported disclosures.

Dehydroepiandrosterone (DHEA) is an adrenal steroid converted to potent androgens. This study aimed to discover the association between serum DHEA levels and immunologic response in people with HIV/AIDS (PLWHA). We enrolled patients aged ≥ 18 years who were treated with combination antiretroviral therapy (cART). We measured CD4+ and CD8+ T-cell counts, HIV-RNA titres, and serum DHEA levels. We assigned each patient to a good- or poor-responder group depending on their CD4+ T-cell counts at study enrolment. Participants with CD4+ T-cell counts > 200/µL were assigned to the good-responder group, whilst those with CD4+ T-cell counts < 200/µL were assigned to the poor-responder group. The participants were followed up for 2 years. The poor-responder group showed lower CD4+ T-cell counts and higher HIV PCR titres at their initial HIV diagnosis and in their 2-year follow-up data. Serum DHEA level was lower in the poor-responder group. Multivariable logistic analysis showed that BMI, initial CD4+ T-cell counts, and serum DHEA level were clinical factors associated with poor immunologic responsiveness to cART in PLWHA. Therefore, DHEA may be used as an indicator of the immunological recovery of PLWHA.

The importance of corporate responsibility for society and environments is emphasized by increasing influence of firms on various stakeholders. Firms strengthen environmental, social, and governance (ESG) activities, which are critical elements for sustainable management. However, there are inconsistent findings on the relationship between ESG activities and firms’ financial performance in prior studies because of the lack of full consideration of internal mechanisms and external conditions. To overcome this limitation, this study investigates the mediating effect of non-financial performance and the moderating effect of the institutional environment on the relationship between firms’ ESG activities and their financial performance in a unified moderated mediation model. Samples for empirical analyses were collected by a survey from 304 small and medium-sized Chinese manufacturers. The results of a mediation analysis reveal that each ESG activity has a positive effect on firms’ financial performance, and the impact of ESG activities on financial performance is completely mediated by non-financial performance. The results of a moderated mediation analysis further indicate that the mediating effect varies depending on the level of institutional pressure from the government, consumers, and competitors. The study suggests the need for interdisciplinary research in sustainable management and institutional theory and emphasizes the importance of sustainable management for performance improvement in a changing environment.

Infections caused by Fusobacterium species are rare; however serious infections with complications or mortality may occur occasionally. We conducted a retrospective study to investigate the clinical features of patients with Fusobacterium infections and the differences between infections caused by the species F. necrophorum, F. nucleatum, and F. varium. Additionally, we attempted to identify risk factors for Fusobacterium-associated mortality. This study included all patients at a large tertiary care teaching hospital in South Korea with Fusobacterium infections from January 2006 to April 2021. Demographic, clinical, laboratory, and outcome data were analyzed. Multiple logistic regression analysis was performed to assess the risk factors for in-hospital mortality associated with F. nucleatum and F. varium infections. We identified 272 patients with Fusobacterium infections during the study period. The number of Fusobacterium cases has increased recently, with F. varium infections markedly increasing since 2016 and causing a significant proportion of infections. Patients with F. varium infections were older and had a higher proportion of nosocomial infections than the other groups. The F. nucleatum and F. varium groups showed higher in-hospital mortality than the F. necrophorum group. Through logistic regression analysis, APACHE II score and serum albumin level were considered risk factors for in-hospital mortality. APACHE II score was positively correlated with age, red cell distribution width, and serum blood urea nitrogen, and negatively correlated with serum albumin level. Infections caused by Fusobacterium species are increasing. F. varium causes a significant proportion of severe infections.

With the introduction of combination antiretroviral therapy (cART), the prevalence of human immunodeficiency virus (HIV)-associated nontuberculous mycobacteria (NTM) disease has declined. However, NTM diseases still occur in people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA). We analysed the clinical and microbiological features of NTM diseases in PLWHA in South Korea. PLWHA who were diagnosed with NTM diseases between January 2000 and March 2021 were retrospectively enrolled from five different hospitals in South Korea. Data on baseline demographics, HIV status, CD4+ T cell counts, viral load, past and current cART regimens, isolated NTM species, results of antimicrobial susceptibility tests, treatment regimens, and outcomes were collected by reviewing medical records. A total of 34 cases of NTM in PLWHA were included. Pulmonary and extrapulmonary NTM diseases accounted for 58.8% (n = 20) and 41.2% (n = 14), respectively. The lymph node was the most common site of extrapulmonary NTM disease (64.3%). The age at the time of NTM disease diagnosis was younger in the extrapulmonary NTM group than in the pulmonary NTM group (37.0 vs. 49.0 years). Mean CD4+ T cell counts at the time of NTM disease diagnosis was 186.6 cells/μL (range: 1–1394). Nine patients (26.5%) had fully suppressed viral loads at the time of NTM disease diagnosis. Mycobacterium avium complex (MAC) was the most common species found, followed by M. intracellulare and M. kansasii. MAC isolates were all susceptible to clarithromycin, but the rates of non-susceptibility to moxifloxacin, linezolid, ethambutol, and rifampin were 75%, 37.5%, 12.5%, and 12.5%, respectively. The average duration of treatment was 17 months and the mortality rate was 8.8%. NTM diseases may occur in PLWHA, even with completely suppressed viral loads. The identified clinical features of NTM diseases are essential for its clinical management in South Korea.

The monoamine hypothesis of depression, namely that the reduction in synaptic serotonin and dopamine levels causes depression, has prevailed in past decades. However, clinical and preclinical studies have identified various cortical and subcortical regions whose altered neural activities also regulate depressive-like behaviors, independently from the monoamine system. Our systematic review indicates that neural activities of specific brain regions and associated neural circuitries are adaptively altered after chronic stress in a specific direction, such that the neural activity in the infralimbic cortex, lateral habenula and amygdala is upregulated, whereas the neural activity in the prelimbic cortex, hippocampus and monoamine systems is downregulated. The altered neural activity dynamics between monoamine systems and cortico-limbic systems are reciprocally interwoven at multiple levels. Furthermore, depressive-like behaviors can be experimentally reversed by counteracting the altered neural activity of a specific neural circuitry at multiple brain regions, suggesting the importance of the reciprocally interwoven neural networks in regulating depressive-like behaviors. These results promise for reshaping altered neural activity dynamics as a therapeutic strategy for treating depression.

Although user innovation has been regarded as an important source of firms&rsquo, competitive advantage, the internal processes and mechanisms involved in the relationship between firms&rsquo, user innovation activities and market performance are seldom studied. By applying moderated mediation analyses, we examine (1) whether firms&rsquo, user innovation activities have a positive impact on market performance and (2) how and under what conditions user innovation activities can have a positive impact on a firm&rsquo, s market performance. The findings on a sample of Korean manufacturing firms indicate that user innovation activities significantly increase firms&rsquo, innovation performance, which consequently leads to superior market performance (confirming the mediation effect of innovation performance). Additionally, we observe the positive mediation effect of innovation performance only in firms with higher levels of absorptive capacity (confirming the moderated mediation effect of absorptive capacity). Further analysis confirms that the positive interaction effects between user innovation activities and absorptive capacity on market performance through innovation performance were more pronounced for firms with higher Chief Executive Officer (CEO) shareholding levels (confirming the moderated mediation effect of CEO&rsquo, s shareholding). Our findings provide theoretical and practical implications on the successful implementation of user innovation strategies.

Chronic stress produces adaptive changes in the brain via the cumulative action of glucocorticoids, which causes psychiatric illnesses such as depression. Here we show that a behavioral method implementing weak stress does not strengthen but resolves existing stress gains. Chronic stress produces persistent depressive behaviors in mice, and repeated daily treatment with 5-min restraint produces antidepressive effects. Repeated treatment with low-dose glucocorticoids mimics the anti-depressive effects of weak stress. Repeated weak stress or low-dose glucocorticoid treatment distinctively activates the prelimbic cortex (PL), and reverses the stress-induced altered gene expression profiles. Chemogenetic inhibition of PL outputs projecting to the nucleus accumbens, basolateral amygdala, or bed nucleus of the stria terminalis (BNST) dissipates antidepressive effects of weak stress, but only the PL-to-BNST circuit produces changes in dysregulated glucocorticoid release. Our results suggest that behavioral appraisal by implementing weak stress can resolve adaptively altered stress gains and rectify stress-induced depressive behaviors.

Residential treatment centers (RTCs) are successful in isolating and closely monitoring adults confirmed with coronavirus disease 2019 (COVID-19), but there are concerns for children who need care. This study was conducted as a retrospective analysis of the surveillance of guardians who entered an RTC with infected pediatric patients to identify the secondary attack rate of COVID-19 to close contacts in a single RTC and to provide directions for developing guidelines for caregivers who co-isolate with infected children. When caregivers were admitted to this RTC, aside from negative confirmation before discharge, tests were additionally performed one or two times. There were 57 index children and adolescent patients who entered the RTC with their parents as caregivers. The secondary attack rate by pediatric patients to close contacts outside their households was 25% (95% confidence interval, 10.0 to 40.0) (8 out of 32 contacts). The transmissibility of SARS-CoV-2 in children was close to zero at 6 days after the confirmation tests. It is reasonable to test the close contacts of pediatric patients after 7 days of isolation to identify infections among caregivers.

A new species of arbuscular mycorrhizal fungi (Glomeromycota), Acaulospora koreana, was isolated from forest soils in South Korea. This novel fungus was collected from the rhizosphere of Lindera obtusiloba and Styrax obassia in forest and propagated with Sorghum bicolor in pot. Morphological characteristics of spores of A. koreana are rarely distinguished from Acaulospora mellea, which is reported as one of the most abundant mycorrhizal species in Korea. However, molecular evidence of rDNA sequence using improved primers for glomeromycotan fungal identification strongly supported that A. koreana is different from A. mellea but also any other species belonging to the genus Acaulospora. This is the first novel glomeromycatan fungus introduced in South Korea, but it suggests that there is a high possibility for discovering new arbuscular mycorrhizal fungi considering the abundance of plant species and advanced phylogenetic analysis technique.

Selection of proper antibiotics for blood culture-negative infective endocarditis (BCNIE) is difficult due to limited data on antibiotic regimens for BCNIE in existing literature. The aim of this study was to compare ampicillin-sulbactam, other β-lactams antibiotics, and vancomycin among patients with BCNIE to determine the proper antibiotic regimens. This retrospective study included adult patients with BCNIE admitted to Severance Hospital from November 2005 to August 2017. Patients were classified into three groups as, treated with ampicillin-sulbactam, other β-lactams, and vancomycin. The primary outcome was 1-year all-cause mortality. A total of 74 cases with BCNIE were enrolled in this study. There were no statistically significant differences in clinical characteristics between the three groups. One-year mortality did not significantly differ between the study groups either. Further, in-hospital mortality, 28-day mortality and overall mortality showed no difference. However, Cox-regression analysis showed nosocomial infective endocarditis as an independent risk factor and a protective effect of surgery on 1-year mortality. This study showed no clear difference in the outcomes of BCNIE as per the antibiotic therapy but suggested the beneficial effect of surgical treatment. With increasing global concern of antimicrobial resistance, it might be reasonable to select ampicillin-sulbactam-based antibiotic therapy while actively considering surgical treatment in BCNIE.

Individuals with autism spectrum disorder (ASD) have altered gut microbiota, which appears to regulate ASD symptoms via gut microbiota-brain interactions. Rapid assessment of gut microbiota profiles in ASD individuals in varying physiological contexts is important to understanding the role of the microbiota in regulating ASD symptoms. Microbiomes secrete extracellular membrane vesicles (EVs) to communicate with host cells and secreted EVs are widely distributed throughout the body including the blood and urine. In the present study, we investigated whether bacteria-derived EVs in urine are useful for the metagenome analysis of microbiota in ASD individuals. To address this, bacterial DNA was isolated from bacteria-derived EVs in the urine of ASD individuals. Subsequent metagenome analysis indicated markedly altered microbiota profiles at the levels of the phylum, class, order, family, and genus in ASD individuals relative to control subjects. Microbiota identified from urine EVs included gut microbiota reported in previous studies and their up- and down-regulation in ASD individuals were partially consistent with microbiota profiles previously assessed from ASD fecal samples. However, overall microbiota profiles identified in the present study represented a distinctive microbiota landscape for ASD. Particularly, the occupancy of g_Pseudomonas, g_Sphingomonas, g_Agrobacterium, g_Achromobacter, and g_Roseateles decreased in ASD, whereas g_Streptococcus, g_Akkermansia, g_Rhodococcus, and g_Halomonas increased. These results demonstrate distinctively altered gut microbiota profiles in ASD, and validate the utilization of urine EVs for the rapid assessment of microbiota in ASD.

The dopamine system has been characterized in motor function, goal-directed behaviors, and rewards. Recent studies recognize various dopamine system genes as being associated with autism spectrum disorder (ASD). However, how dopamine system dysfunction induces ASD pathophysiology remains unknown. In the present study, we demonstrated that mice with increased dopamine functions in the dorsal striatum via the suppression of dopamine transporter expression in substantia nigra neurons or the optogenetic stimulation of the nigro-striatal circuitry exhibited sociability deficits and repetitive behaviors relevant to ASD pathology in animal models, while these behavioral changes were blocked by a D1 receptor antagonist. Pharmacological activation of D1 dopamine receptors in normal mice or the genetic knockout (KO) of D2 dopamine receptors also produced typical autistic-like behaviors. Moreover, the siRNA-mediated inhibition of D2 dopamine receptors in the dorsal striatum was sufficient to replicate autistic-like phenotypes in D2 KO mice. Intervention of D1 dopamine receptor functions or the signaling pathways-related D1 receptors in D2 KO mice produced anti-autistic effects. Together, our results indicate that increased dopamine function in the dorsal striatum promotes autistic-like behaviors and that the dorsal striatum is the neural correlate of ASD core symptoms.