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Background: While awake, flexible bronchoscopic intubation has long been considered the gold standard for managing anticipated difficult airways, the videolaryngoscope has emerged as a viable alternative. In addition, the decision to perform awake intubation or to proceed with airway management after induction of general anesthesia should be grounded in a comprehensive assessment of risks and benefits. Case presentation: A 41-year old female patient was scheduled for excision of bilateral, mobile, and pedunculated masses on both aryepiglottic folds, which covered almost the entire upper part of the glottis. We conducted a comprehensive evaluation of the patient's signs and symptoms, which included neither stridor nor dyspnea in any position, along with the otolaryngologist's opinion and the findings from the laryngeal fiberscopic examination. Given the potential challenges and risks associated with awake flexible bronchoscopic intubation for this patient, we decided to proceed with gentle tracheal intubation using a videolaryngoscope under general anesthesia. In case of failed mask ventilation and tracheal intubation, we had preplanned strategies, including awakening the patient or performing an emergent tracheostomy, along with preparations to support these strategies. Ensuring that mask ventilation was maintained with ease, the patient was sequentially administered intravenous propofol, remifentanil, and rocuronium. Under sufficient depth of anesthesia, intubation using a videolaryngoscope was successfully performed without any complications. Conclusions: Videolaryngoscopic intubation after induction of general anesthesia can be a feasible alternative for managing difficult airways in patients with supraglottic masses. This approachshould be based on a comprehensive preoperative evaluation, adequate preparation, and preplanned strategies to address potential challenges, such as inadequate oxygenation and unsuccessful tracheal intubation. [ABSTRACT FROM AUTHOR]

Background: Evidence-based practice (EBP) is crucial for delivering high-quality healthcare and effective self-care. Enhancing clinical nurses' research competencies through structured mentorship is key to the widespread application of EBP. This study evaluated a newly developed Research Competency Enhancement Program (RCEP), aimed at bolstering EBP among experienced nurses. Methods: Conducted in a tertiary university hospital in Korea, this single-group study employed a pretest-post-test design and a mixed-methods approach. The RCEP involved 11 experienced clinical nurses in an 8-week intervention, featuring mentor-led workshops, interactive sessions, and resource-driven activities. Data were collected using the Evidence-Based Practice Beliefs Scale (EBPB), the Evidence-Based Practice Attitude Scale (EBPA), and the Research Practice Ability (RPA) tool, alongside qualitative feedback. These measures assessed the program's feasibility, acceptability, and preliminary effectiveness. Results: The quantitative analysis indicated significant improvements in research competency post-intervention. Mean scores on the EBPB and RPA scales increased (Z = -2.53, p =.011; Z = -2.66, p =.008). Participants described the RCEP as inspirational and challenging, creating an environment conducive to research. Facilitators included mentor support and innovative learning tools, while barriers were internet connectivity and scheduling conflicts. Suggestions for improvement included more hands-on sessions, small team collaborations, and integration with academic institutions. Conclusion: The RCEP, facilitated by EBP mentors, significantly improved the research competencies and attitudes of clinical nurses towards EBP. The study underscores the importance of continual RCEP refinement, integrating structured, interactive, and collaborative elements to further empower nurses in evidence-based practice. The program shows promise in enhancing research competencies and fostering a commitment to EBP in clinical settings. [ABSTRACT FROM AUTHOR]

Background: During in-hospital cardiac arrest events, clinical nurses are often the first responders; therefore, nurses require sufficient advanced cardiac life support (ACLS) competency. This study aimed to verify the effects of a hybrid team-based ACLS simulation (HTAS) program (developed in this study) on nurses' ACLS performance, specifically ACLS knowledge, cardiopulmonary resuscitation (CPR) self-efficacy, and CPR-related stress. Methods: The developed HTAS comprised four lecture videos, one team-based skills training video, and a team-based ACLS simulation. A quasi-experimental pretest-posttest design with a comparison group (CG) was used to evaluate the effectiveness of the HTAS. Of the 226 general ward nurses with more than 6 months of clinical experience, 117 were allocated to the intervention group (IG), which attended the HTAS, and 109 to the CG, which attended only basic ACLS training. Results: The IG's ACLS performance significantly improved (t = 50.8, p < 0.001) after the training. Relative to the respective pretest conditions, posttest ACLS knowledge (t = 6.92, p < 0.001) and CPR self-efficacy (t = 6.97, p < 0.001) of the IG also significantly increased. However, when the mean difference values were compared, there was no significant difference between the two groups with respect to ACLS knowledge (t = 1.52, p = 0.130), CPR self-efficacy (t = -0.42, p = 0.673), and CPR stress (t = -0.88, p = 0.378). Conclusion: The HTAS for ward nurses was effective at enhancing the nurses' ACLS performance. It is necessary to develop effective training methods for team-based ACLS and verify the sustained effects of such training. [ABSTRACT FROM AUTHOR]

Self-care activities are important to prevent transplant-related side effects and complications among kidney transplant recipients. Therefore, we developed a theory-based self-management program for kidney transplant recipients hospitalized after surgery. This study aimed to examine the feasibility of the program and to identify its preliminary effects on autonomy, competence, and self-care agency. We assessed feasibility using quantitative data collected based on a single group repeated-measures design, along with qualitative data such as patients' feedback on satisfaction during patient counseling. The program comprised video education and individual counseling by nurses. Thirty patients completed this program. Outcome variables were measured thrice: before education, immediately following the first week of video education, and after two consecutive weeks of counseling. A repeated measures ANOVA showed a statistically significant increase in autonomy (F = 5.03, p =.038), competence (F = 17.59, p <.001), and self-care agency (F = 24.19, p <.001). Our pilot study provided preliminary evidence supporting the feasibility for implementation of the theory-based self-management program, and suggesting its preliminary effects in improving autonomy, competence, and self-care agency among kidney transplant recipients. Further research is needed to examine the short- and long-term effects of this program in a longitudinal, randomized control study with a larger sample. [ABSTRACT FROM AUTHOR]

Background: In South Korea, the number of Q fever cases has rapidly increased since 2015. Therefore, this study aimed to characterize the epidemiological and clinical features of Q fever in South Korea between 2011 and 2017. Methods/Principal findings: We analyzed the epidemiological investigations and reviewed the medical records from all hospitals that had reported at least one case of Q fever from 2011 to 2017. We also conducted an online survey to investigate physicians' awareness regarding how to appropriately diagnose and manage Q fever. The nationwide incidence rate of Q fever was annually 0.07 cases per 100,000 persons annually. However, there has been a sharp increase in its incidence, reaching up to 0.19 cases per 100,000 persons in 2017. Q fever sporadically occurred across the country, with the highest incidences in Chungbuk (0.53 cases per 100,000 persons per year) and Chungnam (0.27 cases per 100,000 persons per year) areas. Patients with acute Q fever primarily presented with mild illnesses such as hepatitis (64.5%) and isolated febrile illness (24.0%), whereas those with chronic Q fever were likely to undergo surgery (41.2%) and had a high mortality rate (23.5%). Follow-up for 6 months after acute Q fever was performed by 24.0% of the physician respondents, and only 22.3% of them reported that clinical and serological evaluations were required after acute Q fever diagnosis. Conclusions: Q fever is becoming an endemic disease in the midwestern area of South Korea. Given the clinical severity and mortality of chronic Q fever, physicians should be made aware of appropriate diagnosis and management strategies for Q fever. Author summary: Human Q fever, zoonosis caused by Coxiella burnetii, presents with diverse clinical manifestations, from self-limited febrile illnesses to endocarditis. It is usually diagnosed using serological tests. Because of the diagnostic challenge and nonspecific symptoms, it has been considered an underrecognized infectious disease, particularly in non-endemic or non-epidemic areas. In South Korea, Q fever was designated as a notifiable disease in 2006, and the number of Q fever cases has increased sharply since 2015. This study shows that Q fever is becoming an endemic disease in the midwestern area of South Korea. In this study, patients with acute Q fever primarily presented with mild illnesses such as hepatitis (64.5%) and isolated febrile illness (24.0%). However, patients with chronic Q fever presented with vascular infection (52.9%) and endocarditis (35.3%); such patients were likely to undergo surgery (41.2%) and had a high mortality rate (23.5%). We also surveyed physicians' awareness regarding how to appropriately diagnose and manage Q fever. This survey showed that more than half of the physicians did not follow-up suspected patients with acute Q fever who had negative serological results at the early stage of illness using a serological test and that follow-ups for identifying chronic Q fever after primary C. burnetii infection were only performed by 24.0% of physicians. [ABSTRACT FROM AUTHOR]

• Three dose primary Hantavax® immunization was immunogenic. • Hantavax® vaccination showed a booster effect. • Revised 3 + 1 vaccination schedule can provide rapid protection against hantavirus infection. • Adverse events did not increase with repeated vaccinations. Hemorrhagic fever with renal syndrome is a serious health problem in Eurasian countries. This study aimed to evaluate the immunogenicity and safety of formalin-inactivated Hantaan virus vaccine (Hantavax®) with a 3 + 1 vaccination schedule. A phase III, multi-center clinical trial was conducted to evaluate the immunogenicity and safety of Hantavax® (three primary doses and a booster dose schedule at 0, 1, 2 and 13 months) among healthy adults. Immune responses were assessed using the plaque reduction neutralizing antibody test (PRNT) and immunofluorescent antibody assay (IFA). Systemic and local adverse events were assessed. A total of 320 healthy subjects aged ≥19 years were enrolled. Following three primary doses of Hantavax®, the seroconversion rate was 80.97% and 92.81% by PRNT and IFA, respectively. With booster administration, seropositive rates were 67.47% and 95.68% at one-month post-vaccination according to PRNT and IFA, respectively. Solicited local and systemic adverse events were reported in 30.50–42.81% and 16.67–33.75% during the three primary dose vaccination, while those were reported 36.57% and 21.36% after the booster doses. Both local and systemic adverse events did not increase with repeated vaccinations. Hantavax® showed a high seroconversion rate after the three-dose priming, and additional dose administration with 11-month interval induced good booster effects. (ClinicalTrials.gov Identifier: NCT02553837). [ABSTRACT FROM AUTHOR]

The aim was to determine whether various clinical specimens obtained from COVID-19 patients contain the infectious virus. To demonstrate whether various clinical specimens contain the viable virus, we collected naso/oropharyngeal swabs and saliva, urine and stool samples from five COVID-19 patients and performed a quantitative polymerase chain reaction (qPCR) to assess viral load. Specimens positive with qPCR were subjected to virus isolation in Vero cells. We also used urine and stool samples to intranasally inoculate ferrets and evaluated the virus titres in nasal washes on 2, 4, 6 and 8 days post infection. SARS-CoV-2 RNA was detected in all naso/oropharyngeal swabs and saliva, urine and stool samples collected between days 8 and 30 of the clinical course. Notably, viral loads in urine, saliva and stool samples were almost equal to or higher than those in naso/oropharyngeal swabs (urine 1.08 ± 0.16–2.09 ± 0.85 log 10 copies/mL, saliva 1.07 ± 0.34–1.65 ± 0.46 log 10 copies/mL, stool 1.17 ± 0.32 log 10 copies/mL, naso/oropharyngeal swabs 1.18 ± 0.12–1.34 ± 0.30 log 10 copies/mL). Further, viable SARS-CoV-2 was isolated from naso/oropharyngeal swabs and saliva of COVID-19 patients, as well as nasal washes of ferrets inoculated with patient urine or stool. Viable SARS-CoV-2 was demonstrated in saliva, urine and stool samples from COVID-19 patients up to days 11–15 of the clinical course. This result suggests that viable SARS-CoV-2 can be secreted in various clinical samples and respiratory specimens. [ABSTRACT FROM AUTHOR]

Fluid overload (FO) has been shown to adversely affect multiple organs and survival in critically ill patients. Liver transplantation (LT) carries the risk of massive transfusion, which frequently results in FO. We investigated the association of postoperative weight gain with graft failure, early allograft dysfunction (EAD), and overall mortality in LT. 1833 living donor LT (LDLT) recipients were retrospectively analysed. Patients were divided into 2 groups according to postoperative weight gain (<3% group [n = 1391] and ≥3% group [n = 442]) by using maximally selected log-rank statistics for graft failure. Multivariate Cox and logistic regression analyses were performed. The ≥3% group was associated with graft failure (adjusted HR [aHR], 1.763; 95% CI, 1.248–2.490; P = 0.001). When postoperative weight change was used as a continuous variable, the aHR for each 1% increase in postoperative weight was 1.045 (95% CI, 1.009–1.082; P = 0.015). In addition, the ≥3% group was associated with EAD (adjusted OR [aOR], 1.553; 95% CI, 1.024–2.356; P = 0.038) and overall mortality (aHR, 1.731; 95% CI, 1.182–2.535; P = 0.005). In conclusion, postoperative weight gain may be independently associated with increased risk of graft failure, EAD, and mortality in LDLT recipients. [ABSTRACT FROM AUTHOR]

• TNA films grown on Ti substrates are transferred onto FTO via a two-step anodization. • TNA films are vertically aligned in normal and reverse ways, and irradiated through FTO (SE) or solution (EE). • The front and back planes of TNA films are the same in XRD, XPS, and UV–vis transmittance. • Irradiation direction is a key factor in photocurrent generation. • In photocatalysis, the effect of alignment direction is comparable to that of irradiation direction. Although one-dimensional TiO 2 nanotube arrays (TNA) grown on Ti substrates via electrochemical anodization are extensively studied in photoelectrochemistry, the photo(electro)catalytic activity of TNA detached from the Ti substrates remains unexplored. Herein, we synthesize TNA samples with various pore sizes (40–100 nm) and tube lengths (4–15 μm) via two-step electrochemical anodization, and transfer them to transparent conducting oxide (i.e. fluorine-doped tin oxide; FTO) substrates in normal (n) alignment (front plane outward) and reverse (r) alignment (backplane outward). The front and back planes of the as-fabricated TNA film are the same based on X-ray diffraction (anatase structure), X-ray photoelectron spectroscopy (Ti and O), and UV–vis transmittance data, though the tubes are open in the front and closed in the back. Regardless of the direction of irradiation (SE : FTO → TNA vs. EE : TNA → FTO), longer tubes generate a higher photocurrent (I ph) due to the large light absorption. However, for the same alignment of TNA (either n- or r -TNA), SE irradiation leads to a very large I ph (e.g., nSE > nEE), whereas n -TNA consistently generates a larger I ph than r -TNA for a given irradiation direction (i.e., n > r). The photocatalytic decomposition of phenol follows the same tendency (n > r); however, the Faraday efficiency (based on the photocharge) is higher with EE (nEE 28%, rEE 20%) than SE (rSE 11%, nSE 7%) irradiation. These photoelectrochemical and photocatalytic behaviors are explained in terms of charge carrier generation (FTO/TNA vs. TNA/solution), dissimilar charge carrier transfer pathways (e − transfer through tube framework vs. h + transfer via radial direction), and charge injection at the tube (open vs. clogged tube mouth)/solution interface. The time-resolved photoluminescence (TRPL) emission and incident photon-to-current efficiency (IPCE) are also studied to gain insight into the charge transfer kinetics. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • The in-situ cogeneration effects of OH and H 2 O 2 is examined for the first time using Sb-SnO 2 (SS) and CNT electrocatalysts. • An increase in the potential of SS enhances the OH generation yet decreases the current efficiency (CE) of OH (max. 30%). • The CE of H 2 O 2 with CNT is high at a less negative potential, reaching ∼80% with O 2 purging. • The SS/CNT pair exhibits similar OH generation kinetics and yet significantly enhanced H 2 O 2 generation kinetics. • The simultaneous evolution of O 2 microbubbles leads to a synergistic effect through the production of H 2 O 2. Abstract This study examines the co-generation effect of hydroxyl radicals (OH) via water oxidation and H 2 O 2 via O 2 reduction in electrocatalytic processes with Sb-doped SnO 2 (SS) anode and carbon nanotube (CNT) cathode pairs facing each other as a function of applied SS/CNT cell voltage and purging gas (O 2 vs. N 2). Prior to coupling the electrodes, both electrodes are examined for the generation kinetics and current efficiency of reactive oxygen species as well as the decomposition kinetics and total organic carbon (TOC) removal of phenol, as a function of applied half-potential (E SS or E CNT) and the purging gas. Regardless of the purging gas, a stepwise increase in E SS enhances the OH generation and phenol decomposition, yet inversely decreases the current efficiency of OH (max. ∼30%), owing to competitive O 2 evolution. Similar to this, the current efficiency of H 2 O 2 is high at a less negative E CNT , reaching ∼80% with O 2 purging. However, phenol decomposition with CNT is trivial, owing to the limited reactivity between H 2 O 2 and phenol. With N 2 purging, H 2 O 2 is not produced nor is phenol decomposed. Compared to the sum of the performance of the two half-electrodes, the SS/CNT pair exhibits similar OH generation kinetics regardless of the purging gas, yet significantly enhanced H 2 O 2 generation kinetics. The phenol decomposition and TOC removal with the pair are more than double their sums of the two half-electrodes at all E cell s with O 2 purging, whereas such a synergistic effect is found only at high E cell s when N 2 is purged. The simultaneous evolution of O 2 microbubbles appears to create an in situ oxic environment between the SS and CNT, leading to a synergistic effect through the production of H 2 O 2 , even under anoxic and anoxic-like conditions. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • White TiO 2 nanotube arrays grown on Ti foils are transplanted onto FTO. • W-TNAs/FTO is electrochemically reduced, forming blackish TNAs (B-TNAs/FTO). • B-TNAs/FTO shows an 8-fold larger photocurrent compared to W-TNAs/FTO. • The OER and urea oxidation reaction using B-TNAs/FTO are enhanced by 3 and 20 times, respectively. • The charge transfer in the B-TNAs/FTO is an order of magnitude-accelerated. Abstract Free-standing, one-dimensional TiO 2 nanotube arrays (TNAs) with a disordered surface structure are synthesized on transparent conducting substrates, and their opto-physicochemical properties and photoelectrocatalytic (PEC) performances are examined in detail. A two-step anodization process is used to transplant TNAs grown on titanium foils onto fluorine-doped SnO 2 substrates (denoted as W-TNAs), after which they are electrochemically reduced for 20 and 90 s (denoted as B-TNAs-20 and 90, respectively). The as-transplanted W-TNAs exhibit low PEC activities in terms of their photocurrent, oxygen evolution reaction (OER), and oxidations of inorganic and organic substrates (iodide and urea, respectively) under simulated sunlight (AM 1.5; 100 mW cm−2), primarily because of the sluggish charge transfer through the poor electrically conductive TNA framework. The quick electrochemical reduction of the W-TNAs leads to an 8-fold larger photocurrent, while significantly accelerating the OER (by three times) and iodide and urea oxidation reactions (by 2 and ∼20 times, respectively). These enhanced PEC activities of the B-TNAs are attributed to the creation of Ti3+ and associated oxygen vacancies which strengthen their n-type characteristics and thereby increase their electrical conductivity. The time-resolved photoluminescence spectra further reveal that the lifetime (τ) of the photogenerated charge carriers in the B-TNAs (τ = 0.33 ns) is an order of magnitude shorter than that of the W-TNAs (τ = 3.63 ns). The disordered surface exhibits a lower Faradaic efficiency for multi-electron transfer oxidation reactions and a higher Faradaic efficiency for single-electron transfer oxidation reactions compared to the W-TNAs. The detailed surface characterization and PEC mechanism are discussed. [ABSTRACT FROM AUTHOR]

Background: Influenza virus infection is a common reason for visits to the emergency department (ED) during the influenza season. A rapid and accurate diagnosis of influenza virus infection is important to reduce unnecessary antibiotic prescription and to improve patient care. The aim of this study was to examine whether using the Influenza Virus Rapid Antigen Test (IVRAT) in the ED affects the decision to prescribe antibiotics or the length of hospital stay (LOS). Methods: Data from patients suffering from an influenza-like illness (ILI) and who were discharged after visiting the ED at Chungbuk National University Hospital were reviewed over two influenza seasons: 2010–2011, when IVRAT was not used in the ED, and 2011–2012, when it was. The numbers of antibiotic prescriptions issued and the ED LOS during these two seasons were then compared. Results: The number of antibiotic prescriptions was significantly lower in 2011–2012 (54/216, 25.0%) than in 2010–2011 (97/221, 43.9%; P<0.01). However, the median ED LOS for patients in 2011–2012 was much longer than that of patients in 2010–2011 (213 minutes vs. 257 minutes; P<0.01). During the 2011–2012 influenza season, 73 ILI patients showed a positive IVRAT result whereas 123 showed a negative result. Upon discharge, antibiotics were given to 42/123 (34.1%) ILI patients with a negative IVRAT result, but to only 7/73 (9.6%) patients with a positive IVRAT result (P<0.01). Conclusions: Performing IVRAT in the ED reduced the prescription of antibiotics to ILI patients discharged after ED care. However, the ED LOS for patients who underwent IVRAT was longer than that for patients who did not. Thus, performing IVRAT in the ED reduces the unnecessary prescription of antibiotics to ILI patients during the influenza season. [ABSTRACT FROM AUTHOR]

Highlights: [•] Carbon materials successfully catalyzed Eosin Y-sensitized H2 production under solar light. [•] H2 production and photocurrent generations were 9- and 4-fold enhanced by CNT, respectively. [•] Pt-loading onto carbon materials further enhanced the H2 production by 10 times. [•] Eosin Y underwent spectral shifts because of de-bromination. [ABSTRACT FROM AUTHOR]

Congo-red substituted hexagonal mesoporous silica materials(Congo-SBA15)have been synthesized from tetraethoxysilane(TEOS)and Congo-red modified precursor by sol-gel method. In the present investigation, poly(ethylene oxide-b-propylene oxide-b-ethylene oxide)was used as the template to prepare highly ordered mesoporous materials. Well-ordered hexagonal arrays of the mesopores were shown in small-angle X-ray scattering(SAXS)and transmission electron microscopy(TEM)measurements. The modification of congo-red precursor was proved by FT-IR spectroscopy. [ABSTRACT FROM AUTHOR]

• The long-term impact of immunogenicity induced by the primary COVID-19 vaccine series were evaluated. • Humoral and cellular immunogenicity were evaluated by anti-spike protein antibody, SARS-CoV-2–specific IGRA, and multiplex cytokine assays. • The primary vaccine series with BNT162b2 showed stronger immunogenicity than ChAdOx1 after the third booster dose and BA.1/2 breakthrough infections. • Differences in immunogenicity based on the type of primary vaccine platform persisted over time. The long-term impact of initial immunogenicity induced by different primary COVID-19 vaccine series remains unclear. A prospective cohort study was conducted at 10 tertiary hospitals in Korea from March 2021 to September 2022. Immunogenicity assessments included anti–spike protein antibody (Sab), SARS-CoV-2–specific interferon-gamma releasing assay (IGRA), and multiplex cytokine assays for spike protein–stimulated plasma. Spike proteins derived from wild-type SARS-CoV-2 and alpha variant (Spike 1) and beta and gamma variant (Spike 2) were utilized. A total of 235 healthcare workers who had received a two-dose primary vaccine series of either ChAdOx1 or BNT162b2, followed by a third booster dose of BNT162b2 (166 in the ChAdOx1/ChAdOx1/BNT162b2 (CCB) group and 69 in the BNT162b2/BNT162b2/BNT162b2 (BBB) group, based on the vaccine series) were included. Following the primary vaccine series, the BBB group exhibited significantly higher increases in Sab levels, IGRA responses, and multiple cytokines (CCL2/MCP-1, CCL3/MIP-1α, CCL4/MIP-1β, interleukin (IL)-1ra, IFN-γ, IL-2, IL-4, and IL-10) compared to the CCB group (all P < 0.05). One month after the third BNT162b2 booster, the CCB group showed Sab levels comparable to those of the BBB group, and both groups exhibited lower levels after six months without breakthrough infections (BIs). However, among those who experienced BA.1/2 BIs after the third booster, Sab levels increased significantly more in the BBB group than in the CCB group (P < 0.001). IGRA responses to both Spike 1 and Spike 2 proteins were significantly stronger in the BBB group than the CCB group after the third booster, while only the Spike 2 response were higher after BIs (P = 0.007). The BBB group exhibited stronger enhancement of T-cell cytokines (IL-2, IL-4, and IL-17A) after BIs than in the CCB group (P < 0.05). Differences in immunogenicity induced by the two primary vaccine series persisted, modulated by subsequent booster vaccinations and BIs. [ABSTRACT FROM AUTHOR]

Studying the effect of nanoscale morphology on the photoelectrochemical performance of semiconductor electrodes has been in the forefront of research for over a decade, there are still major inconsistencies and controversies in the literature. Here we aimed to resolve some of these issues, by the controlled preparation of TiO 2 photoelectrodes from nanoparticles, nanorods, and nanosheets, where the nano dimension of the 0D, 1D, and 2D structures was kept similar (about 10 nm). XRD, Raman spectroscopy, XPS and UPS were employed to confirm that the chemical nature of the nanostructures is nearly identical, they only differ in their morphology. Photoelectrodes were prepared keeping the loading amount, surface area, or the film thickness identical, to deconvolute all trivial effects, and only scrutinize the role of morphology. TiO 2 nanorod (NR) films exhibited the best photoelectrochemical performance in all comparisons, achieving ~4 mA cm−2 at 0.2 V vs. Ag/AgCl (under 100 mW cm−2, Xe-lamp illumination). In stark contrast, TiO 2 nanosheet (NS) film showed the lowest performance owing to the small amount of active sites on the basal plane of the NSs and the insufficient charge carrier transport through the film. Overall, we have demonstrated that under carefully controlled conditions, it is possible to compare the PEC behavior of TiO 2 photoelectrodes, and that the 1D nanostructures outperformed its 0D and 2D counterparts. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Memory T cell responses have been demonstrated in COVID-19 convalescents, but ex vivo phenotypes of SARS-CoV-2-specific T cells have been unclear. We detected SARS-CoV-2-specific CD8+ T cells by MHC class I multimer staining and examined their phenotypes and functions in acute and convalescent COVID-19. Multimer+ cells exhibited early differentiated effector-memory phenotypes in the early convalescent phase. The frequency of stem-like memory cells was increased among multimer+ cells in the late convalescent phase. Cytokine secretion assays combined with MHC class I multimer staining revealed that the proportion of interferon-γ (IFN-γ)-producing cells was significantly lower among SARS-CoV-2-specific CD8+ T cells than those specific to influenza A virus. Importantly, the proportion of IFN-γ-producing cells was higher in PD-1+ cells than PD-1− cells among multimer+ cells, indicating that PD-1-expressing, SARS-CoV-2-specific CD8+ T cells are not exhausted, but functional. Our current findings provide information for understanding of SARS-CoV-2-specific CD8+ T cells elicited by infection or vaccination. • SARS-CoV-2-specific CD8+ T cells are effector memory cells in convalescents • CCR7+CD45RA+ cells are increased among SARS-CoV-2-specific cells in the late phase • SARS-CoV-2-specific CD8+ T cells have fewer IFN-γ+ cells than flu-specific cells • PD-1-expressing SARS-CoV-2-specific CD8+ T cells are not exhausted but functional T cell responses have been demonstrated in COVID-19 patients, but ex vivo phenotypes and functions of SARS-CoV-2-specific T cells remain unclear. Rha et al. examined SARS-CoV-2-specific CD8+ T cells in acute and convalescent COVID-19 patients using MHC class I multimers, finding that PD-1-expressing SARS-CoV-2-specific CD8+ T cells are not exhausted but functional. [ABSTRACT FROM AUTHOR]

Background: Pain after laparoscopic cholecystectomy (LC) is multifactorial and usually not effectively treated. Rectus sheath block (RSB) has been proven to reduce the pain from midline abdominal incision and laparoscopic surgery. We investigated the preemptive analgesic effect of RSB after LC. Methods: In this prospective, randomized, single-center trial, 200 patients undergoing LC were randomized into preoperative RSB (pre-RSB) or postoperative RSB (post-RSB) group. An ultrasound-guided RSB was performed before skin incision in the pre-RSB group or after skin closure in the post-RSB group. The primary outcome was total rescue analgesic consumption at 24 h post-surgery. The secondary outcomes were cumulated rescue analgesic consumption and postoperative pain measured by numerical rating scale (NRS) at 0, 1, 2, 6, 9, 18, and 24 h post-surgery. Results: Total rescue analgesic consumption at 24 h post-surgery was significantly lower in the pre-RSB group than in the post-RSB group (p = 0.020). The cumulated rescue analgesic consumption was significantly lower in the pre-RSB group than in the post-RSB group at 1 h (p = 0.023), 9 h (p = 0.020) and 18 h (p = 0.002) post-surgery. NRS was significantly lower in the pre-RSB group than in the post-RSB group at 0 h post-surgery (p = 0.023). Conclusion: The pre-RSB reduced the analgesic requirements in patients undergoing LC compared with the post-RSB. [ABSTRACT FROM AUTHOR]

Background Although human-to-human transmission of severe fever with thrombocytopenia syndrome phlebovirus (SFTSV) via direct contact with body fluids has been reported, the role of specific body fluids from SFTSV-infected hosts has not been investigated in detail. Methods To demonstrate the virus transmission kinetics in SFTSV-infected hosts, we adapted the ferret infection model and evaluated the virus shedding periods, virus titers, and transmission modes from various specimens of infected ferrets. Results Large amounts of infectious SFTSV are shed through nasal discharge, saliva, and urine from SFTSV-infected ferrets. Virus could be detected from 2 dpi and persisted until 12 dpi in these specimens, compared with the relatively short virus-shedding period in sera. Further, transmission studies revealed that SFTSV can be transmitted to close direct and indirect contact naïve animals through various mediums, especially through contact with serum and urine. Further, ferrets contacted with human urine specimens from SFTSV-positive patients were successfully infected with SFTSV, suggesting that urine specimens could be a source of SFTSV infection in humans. Conclusions Our results demonstrate that the SFTSV can be shed in various body fluids for more than 12 days and that these specimens could be a source for direct or indirect transmission through close personal contact. [ABSTRACT FROM AUTHOR]

Background: Pain after laparoscopic cholecystectomy (LC) is multifactorial and usually not effectively treated. Rectus sheath block (RSB) has been proven to reduce the pain from midline abdominal incision and laparoscopic surgery. We investigated the preemptive analgesic effect of RSB after LC. Methods: In this prospective, randomized, single-center trial, 200 patients undergoing LC were randomized into preoperative RSB (pre-RSB) or postoperative RSB (post-RSB) group. An ultrasound-guided RSB was performed before skin incision in the pre-RSB group or after skin closure in the post-RSB group. The primary outcome was total rescue analgesic consumption at 24 h post-surgery. The secondary outcomes were cumulated rescue analgesic consumption and postoperative pain measured by numerical rating scale (NRS) at 0, 1, 2, 6, 9, 18, and 24 h post-surgery. Results: Total rescue analgesic consumption at 24 h post-surgery was significantly lower in the pre-RSB group than in the post-RSB group (p = 0.020). The cumulated rescue analgesic consumption was significantly lower in the pre-RSB group than in the post-RSB group at 1 h (p = 0.023), 9 h (p = 0.020) and 18 h (p = 0.002) post-surgery. NRS was significantly lower in the pre-RSB group than in the post-RSB group at 0 h post-surgery (p = 0.023). Conclusion: The pre-RSB reduced the analgesic requirements in patients undergoing LC compared with the post-RSB. [ABSTRACT FROM AUTHOR]

Pleural effusion and hypoalbuminaemia frequently occur after hepatectomy. Despite the emphasis on the safety of donors, little is known about the impact of postoperative albumin level on pleural effusion in liver donors. We retrospectively assessed 2316 consecutive liver donors from 2004 to 2014. The analysis of donors from 2004 to 2012 showed that postoperative pleural effusion occurred in 47.4% (970/2046), and serum albumin levels decreased until postoperative day 2 (POD2) and increased thereafter. In multivariable analysis, the lowest albumin level within POD2 (POD2ALB) was inversely associated with pleural effusion (OR 0.28, 95% CI 0.20-0.38; P < 0.001). POD2ALB ≤3.0 g/dL, the cutoff value at the 75th percentile, was associated with increased incidence of pleural effusion after propensity score (PS) matching (431 pairs; OR 1.69, 95% CI 1.30-2.21; P < 0.001). When we further analysed data from 2010 to 2014, intraoperative albumin infusion was associated with higher POD2ALB (P < 0.001) and lower incidence of pleural effusion (P = 0.024), compared with synthetic colloid infusion after PS matching (193 pairs). In conclusion, our data showed that POD2ALB is inversely associated with pleural effusion, and that intraoperative albumin infusion is associated with a lower incidence of pleural effusion when compared to synthetic colloid infusion in liver donors. [ABSTRACT FROM AUTHOR]

The Streptococcus anginosus group (SAG) is a subgroup of viridans streptococci comprising three species: S. anginosus, S. constellatus, and S. intermedius. SAG usually resides in the oral cavity and colonizes the throat, and the gastrointestinal and genitourinary tracts. SAG can form abscesses in various parts of the body; however, the clinical features of SAG infection are not clear. Here, we reviewed the medical records of all SAG bacteremia patients aged over 18 years who were diagnosed between January 2010 and December 2021 at a tertiary university hospital. We then compared clinical characteristics, source of infection, need for surgical or interventional treatment, and 28-day mortality rates among each species of SAG. Differences in percentages between groups were compared using a proportion test, and differences between mean values were assessed using the Kruskal-Wallis test with post-hoc Bonferroni correction. In total, 84 cases of SAG bacteremia (40 S. anginosus cases, 31 S. constellatus cases, and 13 S. intermedius cases) were identified. The most common comorbidity was diabetes mellitus (n = 26, 31%), and the most common source was hepatobiliary infection (n = 30, 35.7%). Polymicrobial bacteremia was observed in 22.6% (19/84) of cases. Twenty-eight day mortality due to S. anginosus bacteremia was 12.5%; no deaths were reported in the S. constellatus and S. intermedius groups. However, the difference among the groups was not significant (p = 0.054). Hepatobiliary infection was the most common source of SAG bacteremia. In addition, S. anginosus bacteremia resulted in more severe disease and higher mortality rates than S. constellatus or S. intermedius bacteremia. [ABSTRACT FROM AUTHOR]

• With increasing pneumococcal vaccine uptake, epidemiology of community-acquired pneumonia may change. • Indirect effect from pediatric PCV13 immunization might be insufficient. • PPSV23 might reduce the severity of pneumococcal pneumonia in the elderly. • Serotypes 3 and 19A were still the major serotypes of pneumococcal pneumonia in adults. South Korea has been providing 10-valent pneumococcal conjugate vaccine/(PCV10)/13-valent pneumococcal conjugate vaccine (PCV13) to children and 23-valent pneumococcal polysaccharide vaccine (PPSV23) to older adults as part of a national immunization program. From September 2015 to August 2017, a prospective cohort study was conducted for adults aged ≥19 years with community-acquired pneumonia (CAP) at four university hospitals. All-cause and pneumococcal CAP incidence and mortality rates were evaluated on the basis of hospital catchment population. Serotype distribution of pneumococcal CAP was also evaluated. Among 2669 patients with CAP, 252 cases (9.4%) were pneumococcal CAP cases. The annual incidences of all-cause and pneumococcal CAP were 194.3 cases and 18.3 cases respectively, per 100,000 persons. Serotyped Streptococcus pneumoniae was identified in 107 cases (42.5%) through culture or a serotype-specific urinary antigen detection assay. Pneumococcal CAP caused by the PCV13 and PPSV23 serotypes were 50 cases (46.7% of serotyped pneumococcal CAP and 19.8% of pneumococcal CAP), and 83 cases (77.6% of serotyped pneumococcal CAP and 32.9% of pneumococcal CAP), respectively. The most prevalent serotype was 3 (n = 21, 19.6% of serotyped pneumococcal CAP), followed by 19A (n = 10, 9.3% of serotyped pneumococcal CAP) and 11A (n = 10, 9.3% of serotyped pneumococcal CAP). Compared with non-pneumococcal CAP patients, pneumococcal CAP patients were more likely to have a higher CURB-65 scores (P = 0.002). The overall 30-day mortality rate of pneumococcal CAP was higher than that of non-pneumococcal CAP (6.3% versus 5.6%; odds ratio [OR], 1.15; 95% confidence interval [CI], 0.67–1.96), but this trend was reversed in patients aged 65–74 years (4.2% versus 8.6%; OR, 0.47; 95% CI, 0.14–1.54). The disease burden of PCV13-serotype pneumococcal CAP remains significantly high in Korean adults, particularly among elderly people, even after a high uptake of pediatric PCVs. [ABSTRACT FROM AUTHOR]

Background Scrub typhus and severe fever with thrombocytopenia syndrome (SFTS) are the 2 most common tick-borne infectious diseases in Korea. Every year, an increasing number of cases are reported, which is a public health concern. Therefore, we aimed to investigate the prevalence of SFTS–scrub typhus coinfection in patients with SFTS. Methods Clinical samples were collected from 129 patients with SFTS. One-step reverse-transcription polymerase chain reaction (PCR) was performed to identify the SFTS virus (SFTSV), and real-time PCR followed by nested PCR was performed to detect the Orientia tsutsugamushi gene for scrub typhus. Phylogenetic analysis was conducted to confirm the evolutionary relationships among different species. Results Among 129 SFTS cases, 2 patients with SFTSV were positive for O. tsutsugamushi with a prevalence of coinfection of 1.6% (95% confidence interval,.001–.06). Phylogenetic analysis confirmed these as O. tsutsugamushi strain Boryong. Conclusions Our study found that 1.6% of patients were coinfected with SFTS and scrub typhus infection. We believe that this information will add a new dimension to clinical diagnosis, which should be considered for better public health management. Further research is needed to better understand the ecological transmission dynamics and geographical distribution of SFTSV and O. tsutsugamushi in endemic countries. [ABSTRACT FROM AUTHOR]

Background Immune responses to each vaccine must be investigated to establish effective vaccination strategies for the ongoing coronavirus disease (COVID-19) pandemic. We investigated the long-term kinetics of immune responses after heterologous booster vaccination in relation to Omicron breakthrough infection (BI). Methods Our study included 373 healthcare workers who received primary ChAdOx1 vaccine doses and a third BNT162b2 vaccine dose. BIs that occurred after the third vaccine were investigated. Blood specimens were collected before and 3 months after the booster dose from participants without BI and 1, 4, and 6 months after BI from participants who experienced BI. Spike-specific binding and neutralizing antibody levels against the wild-type virus, Omicron BA.1, and Omicron BA.5, as well as cellular responses, were analyzed. Results A total of 346 participants (82 in the no BI group; 192 in the BI group during the BA.1/BA.2 period; 72 in the BI group during the BA.5 period) were included in the analysis. Participants without BI exhibited the highest binding and neutralizing antibody concentrations and greatest cellular response 1 month after the third vaccination, which reached a nadir by the ninth month. Antibody and cellular responses in participants who experienced BI substantially increased postinfection. Neutralizing antibody titers in individuals who experienced BI during the BA.1/BA.2 period showed more robust increase against wild-type virus than against BA.1 and BA.5. Conclusions Our findings provide evidence of antigenic imprinting in participants who received a heterologous booster vaccination, thereby serving as a foundation for further studies on the impact of BIs on immune responses. [ABSTRACT FROM AUTHOR]

This study synthesizes heterojunction CuO and CuFeO 2 (CFO) films via electrodeposition on Ti and Ni-deposited transparent conducting substrates and examines their photoelectrochemical behavior and unassisted photocatalytic activities for CO 2 conversion in aqueous bicarbonate solutions at circumneutral pH. Deposition of 15 nm and 50 nm-thick metal layers increases the electrical conductivity of the substrate, improving the deposition kinetics of the CFO precursors and establishing firm contact between CFO and the substrate. CFO films with Ti and Ni underlayers (Ti/CFO and Ni/CFO) exhibit higher photocurrent generation than bare CFO, owing to the rapid charge transfer and low interfacial charge-transfer resistance. Despite comparable apparent solar-to-chemical conversion (STC) efficiencies (∼1%), the C1 chemical (formate) is the sole product in the bare CFO film, whereas mixed C1–C4 chemicals are produced in Ti- and Ni-underlayered CFO films. When estimated based on transmitted light, the Ti/CFO and Ni/CFO films exhibit STCs of ∼7% and 3%, respectively. [Display omitted] • CFO films with Ti and Ni underlayers are electrochemically synthesized. • Metal-underlayered CFO films exhibit high solar CO 2 conversion efficiencies. • Metal-underlayered CFO films produce C-C coupled aliphatic acid anions from CO 2. • The metals provide good conductivity and robust contact between CFO and FTO. • The high W f value of metals leads to fast charge separation in CFO film. [ABSTRACT FROM AUTHOR]

This study analyzed HGA and SFTS in patients with suspected tick-borne infection by focusing on key differences that clinicians can easily recognize. A retrospective analysis was performed on confirmed patients with HGA or SFTS in 21 Korean hospitals from 2013 to 2020. A scoring system was developed by multivariate regression analysis and accuracy assessment of clinically easily discriminable parameters was performed. The multivariate logistic regression analysis revealed that sex (especially male sex) (odds ratio [OR] 11.45, P = 0.012), neutropenia (< 1500) (OR 41.64, P < 0.001), prolonged activated partial thromboplastin time (OR 80.133, P < 0.001), and normal C-reactive protein concentration (≤ 1.0 mg/dL; OR 166.855, P = 0.001) were significantly associated with SFTS but not with HGA. Each factor, such as meaningful variables, was given 1 point, and a receiver-operating characteristic curve with a cutoff value (> 1) in a 5-point scoring system (0–4 points) was analyzed to evaluate the accuracy of differentiation between HGA and SFTS. The system showed 94.5% sensitivity, 92.6% specificity, and an area under the receiver-operating characteristic curve of 0.971 (0.949–0.9). Where HGA and SFTS are endemic, the scoring system based on these four parameters such as sex, neutrophil count, activated partial thromboplastin time, and C-reactive protein concentration will facilitate the differential diagnosis of HGA and SFTS in the emergency room in patients with suspected tick-borne infectious diseases. [ABSTRACT FROM AUTHOR]

Comparative analyses of SARS-CoV-2-specific immune responses elicited by diverse prime-boost regimens are required to establish efficient regimens for the control of COVID-19. In this prospective observational cohort study, spike-specific immunoglobulin G (IgG) and neutralizing antibodies (nAbs) alongside spike-specific T -cell responses in age-matched groups of homologous BNT162b2/BNT162b2 or AZD1222/AZD1222 vaccination, heterologous AZD1222/BNT162b2 vaccination, and prior wild-type SARS-CoV-2 infection/vaccination were evaluated. Peak immune responses were achieved after the second vaccine dose in the naïve vaccinated groups and after the first dose in the prior infection/vaccination group. Peak titers of anti-spike IgG and nAb were significantly higher in the AZD1222/BNT162b2 vaccination and prior infection/vaccination groups than in the BNT162b2/BNT162b2 or AZD1222/AZD1222 groups. However, the frequency of interferon-γ-producing CD4+ T cells was highest in the BNT162b2/BNT162b2 vaccination group. Similar results were observed in the analysis of polyfunctional T cells. When nAb and CD4+ T -cell responses against the Delta variant were analyzed, the prior infection/vaccination group exhibited higher responses than the groups of other homologous or heterologous vaccination regimens. nAbs are efficiently elicited by heterologous AZD1222/BNT162b2 vaccination, as well as prior infection/vaccination, whereas spike-specific CD4+ T -cell responses are efficiently elicited by homologous BNT162b2 vaccination. Variant-recognizing immunity is more efficiently generated by prior infection/vaccination than the other homologous or heterologous vaccination regimens. [ABSTRACT FROM AUTHOR]

The threat of severe fever with thrombocytopenia syndrome (SFTS) to public health has been increasing due to the rapid spread of the ticks that carry the causative viral agent. The SFTS virus (SFTSV) was first identified in China and subsequently detected in neighboring countries, including South Korea, Japan, and Vietnam. In addition to the tick-mediated infection, human-to-human transmission has been recently reported with a high mortality rate; however, differential study of the pathogen has been limited by the route of infection. In this study, we investigated the pathogenic potential of SFTSV based on the infection route in aged ferrets, which show clinical signs similar to that of human infections. Ferrets inoculated with SFTSV via the intramuscular and subcutaneous routes show clinical signs comparable to those of severe human infections, with a mortality rate of 100%. Contrastingly, intravascularly infected ferrets exhibit a comparatively lower mortality rate of 25%, although their early clinical signs are similar to those observed following infection via the other routes. These results indicate that the infection route could influence the onset of SFTS symptoms and the pathogenicity of SFTSV. Thus, infection route should be considered in future studies on the pathogenesis of SFTSV infection. [ABSTRACT FROM AUTHOR]

Background: A majority (>70%) of Q fever patients in South Korea do not have a history of animal contact. Therefore, unconscious environmental exposure is suspected. The aim of this study was to investigate exposure of Q fever patients to environmental contamination and animal shedding. Methods: Two goat farmers were enrolled. One was diagnosed with Q fever 3 years ago (Farm 1). Among 20 goats on Farm 1, five were tested randomly and found to be Q fever PCR‐positive. Three of the five were Q fever ELISA‐positive. Two of five environmental samples taken in 2015 were PCR‐positive. In 2018, 17 of 18 environmental samples were PCR‐positive. On Farm 2, 54 of the 77 goats were PCR‐positive, and 63 were ELISA‐positive. Twelve of 14 environmental samples were PCR‐positive. Repeat administration of oxytetracycline to goats led to a gradual reduction in PCR‐positive tests over a 5‐month period. However, PCR‐positivity of the farm environment persisted for 5 months. Conclusion: The environment on farms owned by Q fever patients was contaminated extensively and persistently, even after antibiotic treatment of goats and environmental decontamination. Undetected environmental contamination can be a major source of sporadic Q fever infection in South Korea. Q fever is a zoonotic disease that is transmitted to humans via inhalation of the causative organism (Coxiella burnetii) or via direct contact with infected animals. Farms owned by Q fever patients' in South Korea were investigated. We found that most animals were infected with C. burnetii and shed the bacteria for up to 5 months despite antibiotic treatment. The farm environment was also extensively contaminated with C. burnetii. Epidemiologic and geographic data, including animals and the environment, around Q fever patients will provide a more accurate picture of the risk of Q fever in each area. [ABSTRACT FROM AUTHOR]

Severe fever with thrombocytopenia syndrome (SFTS) and scrub typhus are disorders with similar clinical features; therefore, differentiating between them is difficult. We retrospectively collected data from 183 SFTS and 178 scrub typhus patients and validated an existing scoring system to develop a more sensitive, specific, and objective scoring system. We first applied the scoring systems proposed by Kim et al. to differentiate SFTS from scrub typhus. Multivariable logistic regression revealed that altered mental status, leukopenia, prolonged activated partial thromboplastin time (aPTT), and normal C-reactive protein (CRP) level (≤1.0 mg/dL) were significantly associated with SFTS. We changed the normal CRP level from ≤1.0 mg/dL to ≤3.0 mg/dL and replaced altered mental status with the creatine kinase (CK) level. The modified scoring system showed 97% sensitivity and 96% specificity for SFTS (area under the curve (AUC): 0.983) and a higher accuracy than the original scoring system (p = 0.0308). This study's scoring system had 97% sensitivity and 98% specificity for SFTS (AUC: 0.992) and a higher accuracy than Kim et al.'s original scoring system (p = 0.0308). Our scoring system that incorporated leukopenia, prolonged aPTT, normal CRP level (≤3.0 mg/dL), and elevated CK level (>1000 IU/L) easily differentiated SFTS from scrub typhus in an endemic area. [ABSTRACT FROM AUTHOR]

The clinical characteristics and the effect of viral RNA loads on fatality in 56 patients with severe fever with thrombocytopenia syndrome (SFTS) were analyzed. The non-survival group (12 patients) demonstrated a significantly higher mean age (77 years) than the survival group (44 patients, 65 years) (p = 0.003). The survival rates were 91.7% and 8.3% in patients with Ct values ≥30 and differed significantly (p = 0.001) in the survival and non-survival groups, respectively. The survival rates were 52.4% and 47.6% in patients with viral copy numbers ≥10,000 and 94.3% and 5.7% in patients with viral copy numbers <10,000 in the survival and non-survival groups, respectively (p = 0.001). In a multivariate analysis, viral copy numbers and initial Acute Psychologic Assessment and Chronic Health Evaluation II (APACHE II) scores were identified as the factors affecting fatality (p = 0.015 and 0.011, respectively). SFTS viral RNA loads can be useful markers for the clinical prediction of mortality and survival. [ABSTRACT FROM AUTHOR]

• Serotype 3 and 19A were still most prevalent in adults in the era vaccines. • Ceftriaxone non-susceptible rate was high (32.5%) in invasive pneumococci. • Serotypes 11A/E and 19A pneumococci showed low ceftriaxone susceptibility. • Ceftriaxone non-susceptibility was related to sequence type 166 and 320. Invasive pneumococcal disease (IPD) is associated with substantial morbidity and mortality in children and elderly populations. Serotype distribution and antibiotic susceptibility of IPD isolates are changing with the implementation of pneumococcal vaccination and increasing antibiotic use worldwide. We aimed to determine serotype distribution, antibiogram, and molecular epidemiology of pneumococci in the late stage of PCV13 era. Prospective multicenter IPD surveillance study was conducted for adults aged ≥ 19 years from July 2019 to June 2021. Clinical and epidemiologic data were collected. In addition, antibiotic susceptibility test, serotype identification and multi-locus sequence typing (MLST) was taken for pneumococcal isolates. A total of 160 IPD cases were collected with mean age of 65.1 years (male, 72.5%). Serotyping was taken for 116 available pneumococcal isolates. PCV13 and PPSV23 serotypes were 32.8% (n = 38) and 56.0% (n = 65), respectively. Serotype 3 (13.8%) and 19A (9.5%) were the most common causative agents of IPD, followed by serogroup 11 (6.9%), 23A (6.9%), 10A (4.3%), and 15B (4.3%). Notably, 32.5% of invasive pneumococcal isolates were non-susceptible to ceftriaxone. Serotypes 11A, 11E and 19A pneumococci showed high ceftriaxone non-susceptible rate (80%, 100% and 81.8% respectively), and they were related to sequence type (ST) 166 and ST320. In comparison, most serotype 3 isolates were ceftriaxone susceptible and related to ST180. PCV serotypes, especially 3 and 19A, are still prevalent in adult IPDs, suggesting that individual PCV13 immunization would be necessary for the elderly people and chronically ill patients. Ceftriaxone non-susceptible rate was remarkably high in invasive pneumococcal isolates. [ABSTRACT FROM AUTHOR]

Background: Despite use of the 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) over the last decade, the disease burden of pneumococcal pneumonia is still high. We evaluated the field effectiveness of PCV13, PPSV23, and sequential vaccination against pneumococcal pneumonia in older adults.Methods: This prospective multicenter study was conducted in adults aged ≥65 years hospitalized with community-acquired pneumonia (CAP) between September 2015 and August 2017. The case-control test-negative design was used to estimate vaccine effectiveness (VE) against pneumococcal CAP.Results: Of 1525 cases with CAP hospitalization, 167 (11.0%) were identified as pneumococcal CAP. In the elderly aged ≥65 years, the adjusted VE of pneumococcal vaccines against pneumococcal CAP was statistically insignificant: 40.0% (95% confidence interval [CI], -10.8% to 67.5%) for PCV13 and 11.0% (95% CI, -26.4% to 37.3%) for PPSV23. However, in the younger subgroup (aged 65-74 years), sequential PCV13/PPSV23 vaccination showed the highest adjusted VE of 80.3% (95% CI, 15.9%-95.4%), followed by single-dose PCV13 (adjusted VE, 66.4% [95% CI, .8%-88.6%]) and PPSV23 (adjusted VE, 18.5% [95% CI, -38.6% to 52.0%]).Conclusions: Sequential PCV13/PPSV23 vaccination is most effective for preventing pneumococcal CAP among the elderly aged 65-74 years. [ABSTRACT FROM AUTHOR]

We designed a highly sensitive reverse transcription nested polymerase chain reaction targeting the M-segment (NPCR-M) of severe fever with thrombocytopenia syndrome (SFTS) virus. NPCR-M was performed in parallel with three other referenced PCR assays QPCR-S, PCR-M, and NPCR-S to assess their clinical usefulness as routine diagnostic techniques for SFTS. In this multi-centered prospective study, 122 blood samples from 38 laboratory-confirmed SFTS patients and 85 control samples were used. The results demonstrated that QPCR-S and NPCR-S had better sensitivity rate up to 21 days after symptom onset however, the PCR-M showed poor sensitivity after 7 days of symptom onset. Our designed NPCR-M had a higher detection rate up to 40 days from symptom onset and revealed the persistence of SFTSV RNA in the early convalescent phase. No false-positive results were seen for the control samples. Additionally, NPCR-M showed positive results for a sample that initially showed negative results from other PCRs and for many other samples collected in the convalescent phase of SFTS. Our designed nested PCR is suitable for SFTSV detection in patients' blood collected in the acute and early convalescent phase of SFTS, and shows better sensitivity and high specificity even up to 40 days after symptom onset. [ABSTRACT FROM AUTHOR]

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an acute, febrile, and potentially fatal tick-borne disease caused by the SFTS Phlebovirus. Here, we evaluated the effects of steroid therapy in Korean patients with SFTS. Methods: A retrospective study was performed in a multicenter SFTS clinical cohort from 13 Korean university hospitals between 2013 and 2017. We performed survival analysis using propensity score matching of 142 patients with SFTS diagnosed by genetic or antibody tests. Results: Overall fatality rate was 23.2%, with 39.7% among 58 patients who underwent steroid therapy. Complications were observed in 37/58 (63.8%) and 25/83 (30.1%) patients in the steroid and non-steroid groups, respectively (P <.001). Survival analysis after propensity score matching showed a significant difference in mean 30-day survival time between the non-steroid and steroid groups in patients with a mild condition [Acute Physiology and Chronic Health Evaluation II (APACHE II) score <14; 29.2 (95% CI 27.70–30.73] vs. 24.9 (95% CI 21.21–28.53], P =.022]. Survival times for the early steroid (≤5 days from the start of therapy after symptom onset), late steroid (>5 days), and non-steroid groups, were 18.4, 22.4, and 27.3 days, respectively (P =.005). Conclusions: After steroid therapy, an increase in complications was observed among patients with SFTS. Steroid therapy should be used with caution, considering the possible negative effects of steroid therapy within 5 days of symptom onset or in patients with mild disease (APACHE II score <14). Author summary: Severe fever with thrombocytopenia syndrome (SFTS) is an acute, febrile, and potentially fatal tick-borne disease caused by the SFTS Phlebovirus. Here, we evaluated the effects of steroid therapy in Korean patients with SFTS. We performed survival analysis using propensity score matching of 142 patients with SFTS diagnosed by genetic or antibody tests. In patients with SFTS, steroid therapy should be used with caution, considering the possible negative effects of steroid therapy within 5 days of symptom onset or in patients with mild disease (APACHE II score <14). [ABSTRACT FROM AUTHOR]

• Titania nanotube arrays grown onto perforate Ti foils are electrochemically reduced and loaded with Co2+. • The electrochemical reduction enhances Co2+ adsorption by 7 times. • The surface modification facilitates the charge transfer kinetics. • The modified TNTs exhibit remarkably high electrocatalytic activities. • The production of OOH radicals is significantly enhanced with the modified TNTs. This study examines the electrocatalytic activity of disordered titania nanotube arrays modified with Co2+ for the oxidation of (in)organic substrates and inactivation of E. coli in a flow-through electrochemical device. As-anodized TiO 2 nanotubes (TNTs) on perforated Ti foils are electrochemically reduced to create Ti3+ states and oxygen vacancies. The electrochemically reduced TNTs (r-TNTs) are capable of adsorbing Co2+ in ~7 times larger amounts than the bare TNTs. Among the bare and modified TNT samples (TNTs, r-TNTs, Co-TNTs, and Co-r-TNTs), Co-r-TNTs exhibit the lowest interfacial charge-transfer resistance and fastest internal charge-transfer kinetics. The electron spin resonance analysis further reveals an enhanced production of OOH radicals in Co-r-TNTs. The combined effect of the excellent charge-transfer behavior and the radical production of Co-r-TNTs leads to faster decomposition of N,N -dimethyl-p-nitrosoaniline, higher current efficiency in the oxidation of iodide to triiodide, and greater inactivation of E. coli as compared to r-TNTs. Details on the surface characterization of the bare and modified TNTs samples are presented and the role of the adsorbed Co2+ is discussed. [ABSTRACT FROM AUTHOR]

Background: After pandemic, A(H1N1)pdm09 is generally known to be associated with younger adults' infection and greater severity than seasonal A(H3N2) but some inconsistences between recent studies exist. Objectives: We aimed to compare the epidemiology and clinical outcomes of A(H1N1)pdm09 and A(H3N2) to verify and consolidate about the knowledge of known differences of subtypes. Methods: Data were retrospectively collected from the hospital‐based influenza morbidity and mortality surveillance in South Korea in nine tertiary care hospitals, from August 31, 2014, to August 25, 2018. Patients with H1N1pdm09 or H3N2 infection admitted in the emergency room or ward were recruited. Results: A total of 1747 patients had influenza A and were divided into two groups those with A(H1N1)pdm09 (n = 240) and those with A(H3N2) (n = 1507). A(H1N1)pdm09 group had younger age (mean age ± standard deviation 50.0 ± 18.8 in H1N1 vs 53.4 ± 21.1 in H3N2, P =.030), lower influenza vaccination (27.9% vs 43.9%, P <.001) and pneumococcal vaccination rates (41.0% vs 51.9%, P <.001), and fewer underlying diseases (67.5% vs 74.0%, P =.035) than the A(H3N2) group. Influenza A subtypes were not associated with pneumonia risk (adjusted odds ratios [AOR] of A(H1N1)pdm09: 0.7 [95% confidence interval [CI]: 0.4‐1.2, P =.172]) and in‐hospital mortality (hazard ratio (HR) of A(H1N1)pdm09: 1.0 (95% CI: 0.3‐3.1, P =.983)). Influenza vaccination reduced in‐hospital mortality in hospitalized patients (HR: 0.3 (95% CI: 0.1‐0.7), P =.005). Conclusions: A(H1N1)pdm09 infection was more common in younger patients without significant difference in pneumonia risk and in‐hospital mortality between subtypes. Influenza vaccination was associated with reduced in‐hospital mortality. [ABSTRACT FROM AUTHOR]

Background: The number of human Q fever cases in South Korea has been rapidly increasing since 2015. We report the first isolation of Coxiella burnetii in Korea in two patients who initially presented with non-specific febrile illness and were finally diagnosed with acute Q fever in South Korea.Case Presentation: Two adult patients with fever had serologic tests against C. burnetii initially negative, and polymerase chain reaction against 16S rRNA using whole blood was also negative. After bacterial amplification of C. burnetii in immune-depressed mice, we isolated C. burnetii from patients with acute Q fever. The isolates KZQ2 and KZQ3 were confirmed by polymerase chain reaction, nucleotide sequence analysis, and morphologic observation using a transmission electron microscope.Conclusions: These results can help us understand the clinical and epidemiologic features of Q fever in South Korea. [ABSTRACT FROM AUTHOR]

• The effectiveness of repeated influenza vaccination was investigated. • Repeated vaccination was not effective during consecutive flu A/H3N2 epidemics. • About 80% of Korean elderly people receive influenza vaccination annually. • Poor influenza vaccine effectiveness was pronounced among the elderly population. Annually, about 80% of the Korean elderly aged ≥65 years receive influenza vaccination. Repeated annual vaccination has been suggested as an important factor of poor influenza vaccine effectiveness (VE), though reported conflicting results. During the consecutive A/H3N2-dominant influenza seasons between 2012 and 2015, we comparatively evaluated the VE (repeated vs. current season only) against laboratory-confirmed influenza, pneumonia and hospitalization in the elderly aged ≥65 years with influenza-like illness (ILI). Clinical and demographic data were collected prospectively, and vaccination status of prior and current seasons was verified using the immunization registry data of Korean Centers for Disease Control and Prevention. During the first A/H3N2-dominant season in 2012–2013, influenza vaccine showed statistically significant effectiveness against influenza A infection only and when vaccinated in the current season only (VE 53%, 95% CI 15–77). In the latter two seasons (2013–2015 years), the adjusted VE for influenza A was indistinguishable between repeated vaccination and vaccination in the current season only. During consecutive influenza A/H3N2 epidemics, poor influenza vaccine effectiveness may be more pronounced among the elderly population with a high annual vaccine uptake rate. [ABSTRACT FROM AUTHOR]

Background: Acute Q fever usually presents as a nonspecific febrile illness, and its occurrence is rapidly increasing in South Korea. This study investigated the clinical characteristics of acute Q fever patients in South Korea and the time from symptom onset to serologic diagnosis. The clinical courses were examined according to antibiotic treatment.Methods: Data of patients diagnosed with acute Q fever at Chungbuk National University Hospital between January 2015 and February 2018 were retrospectively collected. Demographic and epidemiologic data were reviewed. The time from symptom onset to serologic diagnosis by an immunofluorescence assay (IFA) was analyzed. Clinical courses and the percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) were compared between patients administered antibiotics with anti-Coxiella burnetii activity and patients not administered such antibiotics.Results: Forty-eight patients (median age: 51.5 years) were included. Most were male (95.8%) and had no history of animal contact (91.7%). The median time from illness onset to serologic diagnosis was 21 days. Thirty-nine patients received antibiotics with anti-C. burnetii activity. The length of hospital stay and fever duration did not significantly differ between patients who received antibiotics with anti-C. burnetii activity (7 and 15 days) and those who did not (5 and 8 days) (P = 0.110 and P = 0.137, respectively). The percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) did not significantly differ between patients who received antibiotics with anti-C. burnetii activity and those who did not (P = 0.340).Conclusions: Most acute Q fever patients had a nonspecific febrile illness with mild elevation of transaminases and no history of animal contact or occupational risk. The time from symptom onset to a positive IFA test was longer than the fever duration in most acute Q fever patients. Consequently, it may be difficult for clinicians to serologically diagnose acute Q fever. However, inappropriate antibiotic treatment was not associated with prolongation of symptoms or progression to chronic Q fever. [ABSTRACT FROM AUTHOR]

• National immunization program for PPV23 for the elderly was implemented in Korea. • PPV23 was effective against IPD and NBPP for young elderly patients aged 65–74. • Effectiveness of PPV23 against IPD was higher for PPV23 unique serotypes. • PPV23 was non-protective against IPD caused by PCV13 serotypes. While herd effects and serotype replacement by childhood pneumococcal protein conjugated vaccines (PCVs) continues to accumulate worldwide, direct effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPV23) against pneumococcal diseases in the elderly has been challenged. We estimated the direct effectiveness of PPV23 in the elderly population. For a hospital-based case-control study, cases of invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) (adults ≥ 65 years) were identified in 14 hospitals participated in the pneumococcal surveillance program from March 2013 to October 2015, following implementation of PPV23 national immunization program (NIP) for the elderly in the Republic of Korea. Controls matched by age, sex, and hospital were selected at ratios of 1:2 (IPD) or 1:1 (NBPP). Clinical data and vaccination records were collected. Vaccine effectiveness was calculated as (1-adjusted odds ratio) × 100. We enrolled 148 IPD and 557 NBPP cases, and 295 IPD and 557 NBPP controls for analyses. Overall effectiveness of PPV23 against IPD was 28.5% [95% confidence interval (CI) −5.8%–51.6%] and against NBPP was 10.2% (-15.1-30.6) in all patients ≥ 65 years. However, in subgroup analysis of patients aged 65–74 years, PPV23 was protective against IPD [effectiveness 57.4% (19.4–77.5)] and against NBPP [effectiveness 35.0% (2.3–56.7)]. Furthermore, serotype-specific effectiveness of PPV23 against IPD was 90.6% (27.6–98.8) for PPV23-unique serotypes and 81.3% (38.6–94.3) for PPV23 serotypes excluding serotype 3. This study indicates that PPV23 with broad serotype coverage might be beneficial in preventing IPD and NBPP due to non-PCV13 serotypes in the young-elderly, with potentially increasing effectiveness in the setting of childhood PCV NIP. [ABSTRACT FROM AUTHOR]

Background: Influenza and pneumonia are leading causes of morbidity and mortality among the elderly. Although vaccination is a main strategy to prevent these infectious diseases, concerns remain with respect to vaccine effectiveness. Methods: During three influenza seasons (2014–2015, 2015–2016 and 2016–2017), we evaluated the effectiveness of the influenza and pneumococcal vaccines against pneumonia and acute exacerbation of cardiopulmonary diseases among the elderly aged ≥65 years with influenza-like illness (ILI). Demographic and clinical data were collected prospectively. Results: Among 2,119 enrolled cases, 1,302 (61.4%) and 871 (41.1%) received the influenza vaccine and 23-valent pneumococcal polysaccharide vaccine (PPV23), respectively. During an A/H3N2-dominant season with poor influenza vaccine effectiveness (2014–2015 season), neither the influenza vaccine nor PPV23 showed significant effectiveness against pneumonia or acute exacerbation of cardiopulmonary diseases. During seasons with good influenza vaccine effectiveness (2015–2016 and 2016–2017 seasons), the influenza vaccine was effective in preventing pneumonia, but PPV23 was not. In particular, the influenza vaccine was effective in preventing acute exacerbation of heart diseases (75.0%) during the A/H1N1-dominant 2015–2016 season. Conclusion: The influenza vaccine was effective in preventing pneumonia only during vaccine-matched seasons with good effectiveness against circulating influenza viruses. In addition, the influenza vaccine was cardio-protective during a vaccine-matched A/H1N1-dominant season. [ABSTRACT FROM AUTHOR]

Highlights • National immunization of the elderly with the 23-valent polysaccharide vaccine (PPSV23) was implemented in Korea in 2013. • Overall in-hospital mortality was 34.2% for adult invasive pneumococcal disease (IPD) and 51.0% for patients ≥75 years of age. • Mortality risks were older age, higher bacteremia score, and immunocompromised status. • An effective vaccination strategy for those at higher risk of IPD is needed. Abstract Objectives This study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK). Methods Clinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015. Results A total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18–49 years, 23.7% in those aged 50–64 years, 33.0% in those aged 65–74 years, and 51.0% in those aged ≥75 years (p < 0.001). In particular, early death within 7 days of hospitalization accounted for 60.6% (66/109). While old age (≥65 years), higher Pitt bacteremia score (≥4), and bacteremic pneumonia were independently associated with IPD mortality in all age groups, an additional mortality risk factor of immunocompromised status was identified for patients aged 50–64 years. PPSV23 serotypes accounted for 64.4% (122/189) of the pneumococcal isolates serotyped. Conclusions This study suggests that vaccine-type IPD continues to place a substantial burden on older adults in the ROK, necessitating an effective vaccination strategy for those at higher risk. [ABSTRACT FROM AUTHOR]

We aimed to characterize the lineages of influenza B viruses obtained from clinical specimens during the 2007–2014 seasons in South Korea. RT-PCR for the partial hemagglutinin gene of influenza B virus was performed on laboratory-confirmed influenza B samples from the 2007–2008 season to 2013–2014 season. A phylogenetic tree was generated, and current influenza vaccine strains for the Northern Hemisphere were used as representative strains of Victoria and Yamagata lineages. A total of 571 influenza B virus sequences were analyzed. During the 2009–2010 season, most of the circulating influenza B viruses matched the vaccine strain; 91.0% (91/100) of viruses belonged to the Victoria lineage. In the 2007–2008, 2011–2012, and 2013–2014 seasons, co-circulation of each influenza B lineage was found with a match ratio to the vaccine strain of 53.2% (42/79), 40.9% (63/154), and 58.3% (134/230), respectively. Overall, 41.7% (238/571) of the circulating influenza B viruses belonged to the lineage mismatching the vaccine strain. During the seven influenza seasons, influenza B epidemics were substantial in four seasons in South Korea. Significant mismatches of the vaccine and lineage of the circulating influenza B viruses were found. The current trivalent influenza vaccine may not be fully suitable for effective protection against influenza B. [ABSTRACT FROM AUTHOR]

Background: The influenza virus is reportedly associated with 3‐5 million cases of severe illness and 250 000‐500 000 deaths annually worldwide. Objectives: We investigated the variation of influenza A virus in Korea and examined the association with death. Methods: A total of 13 620 cases were enrolled in the Hospital‐based Influenza Morbidity & Mortality surveillance system in Korea during 2011‐2016. Among these cases, a total of 4725 were diagnosed with influenza using RT‐PCR (influenza A; n = 3696, influenza B; n = 928, co‐infection; n = 101). We used 254 viral sequences from the 3696 influenza A cases for phylogenetic analysis using the BioEdit and MEGA 6.06 programs. Results: We found that the sequences of A/H3N2 in the 2011‐2012 season belong to subgroup 3C.1, whereas the sequences in the 2012‐2013 season pertain to subgroup 3C.2. The sequences in the 2013‐2014 and 2014‐2015 seasons involve subgroups 3C.3a and 3C.2a. The A/H1N1pdm09 subtype belongs to subgroup 6 and contains two clusters. In addition, sequence analysis confirmed the several substitutions of internal genes and gene substitutions associated with drug resistance (I222V in NA and S31N in M2) in the fatal cases. While statistical analysis found no significant associations between genetic differences in the viruses and mortality, mortality was associated with certain host factors, such as chronic lung disease. Conclusions: In conclusion, influenza A virus clade changes occurred in Korea during the 2011‐2016 seasons. These data, along with antigenic analysis, can aid in selecting effective vaccine strains. We confirmed that fatality in influenza A cases was related to underlying patient diseases, such as chronic lung disease, and further studies are needed to confirm associations between mortality and viral genetic substitutions. [ABSTRACT FROM AUTHOR]

During January 2013-April 2014, we subjected nasopharyngeal specimens collected from patients with acute febrile respiratory illness in a military hospital to PCR testing to detect 12 respiratory viruses and sequence a partial hexon gene for human adenovirus (HAdV) molecular typing. We analyzed the epidemiologic characteristics of HAdV infections and compared clinical characteristics of HAdV types. Among the 305 patients with acute febrile respiratory illness, we detected respiratory viruses in 139 (45.6%) patients; HAdV was the most prevalent virus (69 cases). Of the 40 adenoviruses identified based on type, HAdV-55 (29 cases) was the most prevalent, followed by HAdV-4 (9 cases). HAdV-55 was common in patients with pneumonia (odds ratio 2.17; 95% CI 0.48-9.86) and hospitalized patients (odds ratio 5.21; 95% CI 1.06-25.50). In soldiers with HAdV infection in Korea, HAdV-55 was the most prevalent type and might be associated with severe clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is a leading infectious cause of morbidity and mortality among adults. Pneumococcal pneumonia (PP) is the most common vaccine-preventable bacterial etiology of pneumonia. In this study, we estimated the incidence of community-acquired pneumonia (CAP) and pneumococcal diseases among Korean adults. Methods: Clinical and microbiological databases from three hospitals were retrospectively reviewed to determine the incidence and case fatality rates of CAP and pneumococcal diseases in Korean adults aged ≥19 years from 2011 to 2014. Incidence and case fatality rates of CAP, PP and invasive pneumococcal diseases (IPD) were evaluated based on the catchment population. Catchment population was calculated using national health insurance data, estimating the proportion of patients with pneumonia that were medically attended at each hospital. Results: Among 5,783 patients with medically attended CAP, 833 (14.4%) had PP. For IPD, a total of 91 culture-confirmed cases were identified. The overall incidence of CAP was 307.7 cases per 100,000 persons per year with an in-hospital mortality rate of 6.2%. The estimated annual incidence of pneumococcal pneumonia was 42.2–49.4 cases per 100,000 persons per year, increasing with age to >280 per 100,000 persons per year in older patients over 70 years. The annual incidence of IPD had a range of 4.1–6.5 cases per 100,000 persons per year. The overall case fatality rate for invasive pneumococcal diseases was 30.8% with the highest rate of 66.7% in patients over 80 years. Conclusion: Over the study period, incidences of CAP, PP and IPD were consistently high, particularly in older people. These results provide baseline data to establish healthcare strategies and estimate their impact among Korean adults. [ABSTRACT FROM AUTHOR]