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Background In patients with out-of-hospital cardiac arrest (OHCA), guidelines recommend advanced airway (AA) management at the advanced cardiovascular life support stage; however, the ideal timing remains controversial. Therefore, we evaluated the prognosis according to the timing of AA in patients with OHCA. Methods We conducted a retrospective observational study of patients with OHCA at six major hospitals in Daegu Metropolitan City, South Korea, from August 2019 to June 2022. We compared groups with early and late AA and evaluated prognosis, including recovery of spontaneous circulation (ROSC), survival to discharge, and neurological evaluation, according to AA timing. Results Of 2,087 patients with OHCA, 945 underwent early AA management and 1,142 underwent late AA management. The timing of AA management did not influence ROSC in the emergency department (5–6 minutes: adjusted odds ratio [aOR], 0.97; p=0.914; 7–9 minutes: aOR, 1.37; p=0.223; ≥10 minutes: aOR, 1.32; p=0.345). The timing of AA management also did not influence survival to discharge (5–6 minutes: aOR, 0.79; p=0.680; 7–9 minutes: aOR, 1.04; p=0.944; ≥10 minutes: aOR, 1.86; p=0.320) or good neurological outcomes (5–6 minutes: aOR, 1.72; p=0.512; 7–9 minutes: aOR, 0.48; p=0.471; ≥10 minutes: aOR, 0.96; p=0.892). Conclusion AA timing in patients with OHCA was not associated with ROSC, survival to hospital discharge, or neurological outcomes.

Objective: Female urethral diverticulum (UD), an evagination of the urethral mucosa into the surrounding connective tissue, is extremely rare in pregnancy. No clear guidelines on the optimal management of UD have been established, except for a common conservative approach. Here, we discuss how to manage UD with pregnancy. Case report: A 39-year-old gravida 4, para 0, abortion 3 (G4P0A3) woman at 34+0 gestational weeks (GW) visited our outpatient department with a 6-cm septate vaginal mass. Transvaginal ultrasound sonography (TVUS) revealed a 5.5 x 4.9-cm multicystic mass, which was confirmed as UD with pelvic MRI. She was admitted because of preterm labor. A cesarean section was performed at 36+5 GW due to a previous myomectomy, and a healthy male baby was born. UD was still observed in the patient two months after delivery. Periurethral diverticulectomy was performed, and pathological analysis revealed UD with chronic inflammation and edema. Conclusion: Previous reports and our case report show that UD can develop during pregnancy and that pelvic MRI is suitable for its accurate diagnosis. Vaginal delivery is possible in pregnant women with the small size of the UD. UD aspiration can permit vaginal delivery in a few cases; however, pus can occur at the aspirated site after the operation. If UD is still observed after delivery, urethral diverticulectomy is recommended.

Abstract Background The demand for organ transplants, both globally and in South Korea, substantially exceeds the supply, a situation that might have been aggravated by the enactment of the Life-Sustaining Treatment Decision Act (LSTDA) in February 2018. This legislation may influence emergency medical procedures and the availability of organs from brain-dead donors. This study aimed to assess LSTDA’s impact, introduced in February 2018, on organ donation status in out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city and identified related factors. Methods We conducted a retrospective analysis of a regional cardiac arrest registry. This study included patients aged 16 or older with cardiac arrest and a cerebral performance category (CPC) score of 5 from January 2015 to December 2022. The exclusion criteria were CPC scores of 1–4, patients under 16 years, and patients declared dead or transferred from emergency departments. Logistic regression analysis was used to analyse factors affecting organ donation. Results Of the 751 patients included in this study, 47 were organ donors, with a median age of 47 years. Before the LSTDA, there were 30 organ donations, which declined to 17 after its implementation. In the organ donation group, the causes of cardiac arrest included medical (34%), hanging (46.8%), and trauma (19.2%). The adjusted odds ratio for organ donation before the LSTDA implementation was 6.12 (95% CI 3.09–12.12), with non-medical aetiology as associated factors. Conclusion The enactment of the LSTDA in 2018 in South Korea may be linked to reduced organ donations among patients with OHCA, underscoring the need to re-evaluate the medical and legal aspects of organ donation, especially considering end-of-life care decisions.

Background Atrial fibrillation detected after stroke (AFDAS) refers to the identification of newly diagnosed atrial fibrillation (AF) following an ischemic stroke in patients without known AF (KAF). The objective of this study was to compare the functional outcomes of patients diagnosed with AFDAS and those with KAF who underwent mechanical thrombectomy. Methods and Results We conducted a retrospective analysis of patients who underwent mechanical thrombectomy and with either new AF diagnosed during hospitalization or KAF. We compared the baseline characteristics, clinical, and procedure‐related variables between those with AFDAS and KAF. The primary outcome was the achievement of functional independence, defined as a modified Rankin Scale score of 0 to 2, at 3 months after stroke. Of the 252 patients, 101 (40.1%) were classified into the AFDAS group. The KAF group exhibited a higher rate of stroke history compared with the AFDAS group (32.5% versus 13.9%; P=0.001). Tandem occlusion was more common in the KAF group (13.2% versus 5.9%), while M2 occlusion was more common in the AFDAS group (11.3% versus 20.8%). The proportion of patients who achieved functional independence was higher in the AFDAS group (37.7% versus 52.5%; P=0.029). Multivariable analysis showed that AFDAS was associated with a favorable functional outcome (odds ratio, 2.67 [95% CI, 1.39–5.14]; P=0.003). Conclusions AFDAS demonstrated a positive association with functional independence in patients with stroke who underwent mechanical thrombectomy and were finally diagnosed to have AF during hospitalization. The observed disparities in occlusion site, intractable thrombus, and history of previous stroke may have contributed to these findings.

Parvalbumin-positive (PV+) GABAergic interneurons in the dentate gyrus provide powerful perisomatic inhibition of dentate granule cells (DGCs) to prevent overexcitation and maintain the stability of dentate gyrus circuits. Most dentate PV+ interneurons survive status epilepticus, but surviving PV+ interneuron mediated inhibition is compromised in the dentate gyrus shortly after status epilepticus, contributing to epileptogenesis in temporal lobe epilepsy. It is uncertain whether the impaired activity of dentate PV+ interneurons recovers at later times or if it continues for months following status epilepticus. The development of compensatory modifications related to PV+ interneuron circuits in the months following status epilepticus is unknown, although reduced dentate GABAergic inhibition persists long after status epilepticus. We employed whole-cell patch-clamp recordings from dentate PV+ interneurons and DGCs in slices from male and female sham controls and intrahippocampal kainate (IHK) treated mice that developed spontaneous seizures months after status epilepticus to study epilepsy-associated changes in dentate PV+ interneuron circuits. Electrical recordings showed that: 1) Action potential firing rates of dentate PV+ interneurons were reduced in IHK treated mice up to four months after status epilepticus; 2) spontaneous inhibitory postsynaptic currents (sIPSCs) in DGCs exhibited reduced frequency but increased amplitude in IHK treated mice; and 3) the amplitude of IPSCs in DGCs evoked by optogenetic activation of dentate PV+ cells was upregulated without changes in short-term plasticity. Video-EEG recordings revealed that IHK treated mice showed spontaneous electrographic seizures in the dentate gyrus and that chemogenetic activation of PV+ interneurons abolished electrographic seizures. Our results suggest not only that the compensatory changes in PV+ interneuron circuits develop after IHK treatment, but also that increased PV+ interneuron mediated inhibition in the dentate gyrus may compensate for cell loss and reduced intrinsic excitability of dentate PV+ interneurons to stop seizures in temporal lobe epilepsy.

Abstract To interact successfully with objects, it is crucial to accurately perceive their spatial extent, an enclosed region they occupy in space. Although the topographic representation of space in the early visual cortex (EVC) has been favored as a neural correlate of spatial extent perception, its exact nature and contribution to perception remain unclear. Here, we inspect the topographic representations of human individuals’ EVC and perception in terms of how much their anisotropy is influenced by the orientation (co-axiality) and radial position (radiality) of stimuli. We report that while the anisotropy is influenced by both factors, its direction is primarily determined by radiality in EVC but by co-axiality in perception. Despite this mismatch, the individual differences in both radial and co-axial anisotropy are substantially shared between EVC and perception. Our findings suggest that spatial extent perception builds on EVC’s spatial representation but requires an additional mechanism to transform its topographic bias.

Background and Objectives: The association between neurological disability, prognosis, and telomere length (TL) in patients with stroke has been investigated in various ways. However, analysis of the type of stroke and ischemic stroke subgroups is limited. In this study, we aimed to determine the association between TL and neurological disability according to stroke type. Materials and Methods: This prospective study included patients with stroke who visited a single-center emergency department (ED) between January 2022 and December 2023. The association between TL and neurological disabilities, using the Modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS), was evaluated according to the patient’s stroke type and subgroup of ischemic stroke. Multivariate analysis was performed to determine the association between neurological disabilities in patients with ischemic stroke and the subgroups. Results: A total of 271 patients with stroke were enrolled. The NIHSS score was found to be higher at the time of ED visit (adjusted odds ratio [OR], 5.23; 95% confidence interval [CI], 1.59–17.2, p < 0.01) and 1 day later (adjusted OR, 7.78; 95% CI, 1.97–30.70, p < 0.01) in the ischemic stroke group with a short TL. In the other determined etiology (OD) or undetermined etiology (UD) group, the NIHSS was higher in the short TL group at the ED visit (adjusted OR, 7.89; 95% CI, 1.32–47.25, p = 0.02) and 1 day after (adjusted OR, 7.02; 95% CI, 1.14–43.47, p = 0.04). Conclusions: TL is associated with neurological disability in early ischemic stroke and is prominent in the UD and OD subgroups.

Abstract The dipole characteristics of Frenkel excitons and charge-transfer excitons between donor and acceptor molecules in organic heterostructures such as exciplexes are important in organic photonics and optoelectronics. For the bilayer of the organic donor 4,4′,4′′-tris[(3-methylphenyl)phenylamino]triphenylamine and acceptor 2,4,6-tris(biphenyl-3-yl)-1,3,5-triazine molecules, the exciplexes form aligned dipoles perpendicular to the Frenkel excitons, as observed in back focal plane photoluminescence images. The angular chromism of exciplexes observed in the 100 meV range indicates possible delocalization and angle-sensing photonic applications. The blue shift of the peak position and increase in the linewidth of photoluminescene spectra with increasing excitation power are caused by the repulsive aligned exciplex dipole moments with a long lifetime (4.65 μs). Electroluminescence spectra of the exciplex from organic light-emitting diodes using the bilayer are blue-shifted with increasing bias, suggesting unidirectional alignment of the exciplex dipole moments. The observation of exciplex dipole moment alignments across molecular interfaces can facilitate the controlled coupling of exciton species and increase efficiency of organic light-emitting diodes.

Study Design This was an analysis using three-dimensional simulation software for spinal screw placement and computed tomographic scan images. Purpose To assess the feasibility of achieving multiple (three or four) screw fixation points in C2 vertebra by using a combination of pedicle and laminar screws. Overview of Literature Secure C2 fixation using multiple screws is required or beneficial in some unique cases. However, to the best of our knowledge, no reports have analyzed the feasibility of multiple screw fixation in C2. Methods We used computed tomographic scan images with an interval of 1.0 mm obtained from 100 patients (50 men and 50 women) and screw trajectory simulation software. The diameter of all screws was set at 3.5 mm, considering its common usage in real surgery. The anatomical feasibility of placing both pedicle and laminar screws on the same side was evaluated. For all feasible sides, the three-dimensional distance between the screw entry points was measured. Results In 85% of the cases under study, both pedicle and laminar screws could be placed on both sides, allowing the insertion of four screws. In 11% of the cases under study, two screws could be placed on one side, whereas only one screw was feasible on the other side, resulting in the placement of three screws. In all 181 sides where both screw types could be inserted, the distance between their entry points exceeded 16.1 mm, which was sufficient to prevent collision between the screw heads. Conclusions The C2 vertebra can accommodate three (11%) or four (85%) screws in 96% of the cases under study.

Abstract Background Prehospital factors play a vital role in out-of-hospital cardiac arrest (OHCA) survivability, and they vary between countries and regions. We investigated the prehospital factors associated with OHCA outcomes in a single metropolitan city in the Republic of Korea. Methods This study included adult medical OHCA patients enrolled prospectively, using data from the citywide OHCA registry for patients registered between 2018 and 2021. The primary outcome was survival to hospital discharge. Multivariable logistic regression analysis was conducted to determine the factors associated with the study population’s clinical outcomes, adjusting for covariates. We performed a sensitivity analysis for clinical outcomes only for patients without prehospital return of spontaneous circulation prior to emergency medical service departure from the scene. Results In multivariable logistic regression analysis, older age (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.95–0.97), endotracheal intubation (adjusted odds ratio [aOR] 0.29; 95% [CIs] 0.17–0.51), supraglottic airway (aOR 0.29; 95% CI 0.17–0.51), prehospital mechanical chest compression device use (OR 0.13; 95% CI 0.08–0.18), and longer scene time interval (OR 0.96; 95% CI 0.93–1.00) were negatively associated with survival. Shockable rhythm (OR 24.54; 95% CI 12.99–42.00), pulseless electrical activity (OR 3.11; 95% CI 1.74–5.67), and witnessed cardiac arrest (OR 1.59; 95% CI 1.07–2.38) were positively associated with survival. In the sensitivity analysis, endotracheal intubation, supraglottic airway, prehospital mechanical chest compression device use, and longer scene time intervals were associated with significantly lower survival to hospital discharge. Conclusions Regional resuscitation protocol should be revised based on the results of this study, and modifiable prehospital factors associated with lower survival of OHCA should be improved.

Abstract Our perception is often attracted to what we have seen before, a phenomenon called ‘serial dependence.’ Serial dependence can help maintain a stable perception of the world, given the statistical regularity in the environment. If serial dependence serves this presumed utility, it should be pronounced when consecutive elements share the same identity when multiple elements spatially shift across successive views. However, such preferential serial dependence between identity-matching elements in dynamic situations has never been empirically tested. Here, we hypothesized that serial dependence between consecutive elements is modulated more effectively by the spatial correspondence in relative space than by that in absolute space because spatial correspondence in relative coordinates can warrant identity matching invariantly to changes in absolute coordinates. To test this hypothesis, we developed a task where two targets change positions in unison between successive views. We found that serial dependence was substantially modulated by the correspondence in relative coordinates, but not by that in absolute coordinates. Moreover, such selective modulation by the correspondence in relative space was also observed even for the serial dependence defined by previous non-target elements. Our findings are consistent with the view that serial dependence subserves object-based perceptual stabilization over time in dynamic situations.

Background and Purpose Moderate-intensity statin plus ezetimibe versus high-intensity statin alone may provide a greater low-density lipoprotein cholesterol (LDL-C) reduction in patients with recent ischemic stroke. Methods This randomized, open-label, controlled trial assigned patients with recent ischemic stroke

Serious acupuncture-related complications are rare in infants. We experienced a case of a 58-day-old infant with an umbilical hernia who received acupuncture from a non-professional guardian. Upon initial examination in the emergency department, the omentum protruded through the skin defect caused by acupuncture performed on top of the hernia. The infant underwent emergency surgery, and subsequently recovered uneventfully.

Corrective feedback received on perceptual decisions is crucial for adjusting decision-making strategies to improve future choices. However, its complex interaction with other decision components, such as previous stimuli and choices, challenges a principled account of how it shapes subsequent decisions. One popular approach, based on animal behavior and extended to human perceptual decision-making, employs "reinforcement learning," a principle proven successful in reward-based decision-making. The core idea behind this approach is that decision-makers, although engaged in a perceptual task, treat corrective feedback as rewards from which they learn choice values. Here, we explore an alternative idea, which is that humans consider corrective feedback on perceptual decisions as evidence of the actual state of the world rather than as rewards for their choices. By implementing these "feedback-as-reward" and "feedback-as-evidence" hypotheses on a shared learning platform, we show that the latter outperforms the former in explaining how corrective feedback adjusts the decision-making strategy along with past stimuli and choices. Our work suggests that humans learn about what has happened in their environment rather than the values of their own choices through corrective feedback during perceptual decision-making.

Terahertz waves have gained attention owing to their potential for various bio-applications, including broadband spectroscopy, imaging, and sensing. For development of practical applications in clinical fields, highly sensitive molecular detection is essential. Notably, the molecular sensitivity of optical sensing can be enhanced by utilizing localized electromagnetic waves in metallic optical resonators. In this study, we theoretically design terahertz (THz) metamaterial sensors based on the Fano resonance, enabling highly sensitive and selective molecular sensing without additional molecular labeling. The metamaterial sensors consisting of symmetry-broken unit resonators are designed to support Fano resonances with strongly localized electromagnetic waves through coupling of the resonators. The key concept behind the design is to match the Fano resonance with the characteristic resonance in the target molecules, leading to pronounced changes in the transmission spectra of THz waves through the metamaterial with the analytes. We numerically demonstrate the sensing performance by considering steroids as the target molecules and explain the sensing mechanism using both temporal coupled-mode theory and FDTD numerical simulations.

Abstract Interlayer excitons (IXs) at the interface of heterostructures (HSs) with a staggered band alignment are fascinating quantum quasi‐particles with light‐emitting and long‐lifetime characteristics. In this study, the energy band alignments (EBAs) of the HS of MAPbI3 perovskite thin sheets with CdSe‐ZnS core–shell quantum dot (QD) layers are modulated by using different diameters of the QDs. Far‐red IX emission is observed at 1.42 eV from the HS of MAPbI3/CdSe‐ZnS‐QD (λem = 645 nm) with type‐II EBA owing to charge transfer. The lifetime of the far‐red IXs is estimated to be 5.68 µs, which is considerably longer than that (0.715 ns) of the intralayer excitons from CdSe‐ZnS‐QD. With increasing incident excitation power, the PL peak and its intensity of IXs are blue‐shifted and linearly increased, respectively, indicating a strong dipole alignment of far‐red IXs at the heterojunction. Back focal plane imaging suggests that the directions of dipole moments of the IXs are relatively out‐of‐plane compared to those of the intralayer excitons (MAPbI3 and CdSe‐ZnS‐QD). Notably, the abnormal behavior of the optical characteristics is observed near the phase transition temperature (90 K) of MAPbI3. MAPbI3/CdSe‐ZnS‐QD HS photodetectors show the increase in photocurrent and detectivity compared to MAPbI3 at IX excitation.

Current study provides a novel strategy to synthesize the nano-sized MnO nanoparticles from the quick, ascendable, sol-gel synthesis strategy. The MnO nanoparticles are supported on nitrogen-doped carbon derived from the cheap sustainable source. The resulting MnO/N-doped carbon catalysts developed in this study are systematically evaluated via several physicochemical and electrochemical characterizations. The physicochemical characterizations confirms that the crystalline MnO nanoparticles are successfully synthesized and are supported on N-doped carbons, ascertained from the X-ray diffraction and transmission electron microscopic studies. In addition, the developed MnO/N-doped carbon catalyst was also found to have adequate surface area and porosity, similar to the traditional Pt/C catalyst. Detailed investigations on the effect of the nitrogen precursor, heat treatment temperature, and N-doped carbon support on the ORR activity is established in 0.1 M of HClO4. It was found that the MnO/N-doped carbon catalysts showed enhanced ORR activity with a half-wave potential of 0.69 V vs. RHE, with nearly four electron transfers and excellent stability with just a loss of 10 mV after 20,000 potential cycles. When analyzed as an ORR catalyst in dual-chamber microbial fuel cells (DCMFC) with Nafion 117 membrane as the electrolyte, the MnO/N-doped carbon catalyst exhibited a volumetric power density of ~45 mW m2 and a 60% degradation of organic matter in 30 days of continuous operation.

Background To prepare for future work stoppages in the medical industry, this study aimed to identify the effects of healthcare worker strikes on the mortality rate of patients visiting the emergency department (ED) at six training hospitals in Daegu, South Korea. Methods We used a retrospective, cross-sectional, multicenter design to analyze the medical records of patients who visited six training hospitals in Daegu (August 21–September 8, 2020). For comparison, control period 1 was set as the same period in the previous year (August 21–September 8, 2019) and control period 2 was set as July 1–19, 2020. Patient characteristics including age, sex, and time of ED visit were investigated along with mode of arrival, length of ED stay, and in-hospital mortality. The experimental and control groups were compared using t-tests, and Mann-Whitney U-test, chi-square test, and Fisher exact tests, as appropriate. Univariate logistic regression was performed to identify significant factors, followed by multivariate logistic regression analysis. Results During the strike period, 31,357 patients visited the ED, of which 7,749 belonged to the experimental group. Control periods 1 and 2 included 13,100 and 10,243 patients, respectively. No significant in-hospital mortality differences were found between strike periods; however, the results showed statistically significant differences in the length of ED stay. Conclusion The ED resident strike did not influence the mortality rate of patients who visited the EDs of six training hospitals in Daegu. Furthermore, the number of patients admitted and the length of ED stay decreased during the strike period.

Abstract Background Quantum dots (QDs) have been used as fluorophores in various imaging fields owing to their strong fluorescent intensity, high quantum yield (QY), and narrow emission bandwidth. However, the application of QDs to bio-imaging is limited because the QY of QDs decreases substantially during the surface modification step for bio-application. Results In this study, we fabricated alloy-typed core/shell CdSeZnS/ZnS quantum dots (alloy QDs) that showed higher quantum yield and stability during the surface modification for hydrophilization compared with conventional CdSe/CdS/ZnS multilayer quantum dots (MQDs). The structure of the alloy QDs was confirmed using time-of-flight medium-energy ion scattering spectroscopy. The alloy QDs exhibited strong fluorescence and a high QY of 98.0%. After hydrophilic surface modification, the alloy QDs exhibited a QY of 84.7%, which is 1.5 times higher than that of MQDs. The QY was 77.8% after the alloy QDs were conjugated with folic acid (FA). Alloy QDs and MQDs, after conjugation with FA, were successfully used for targeting human KB cells. The alloy QDs exhibited a stronger fluorescence signal than MQD; these signals were retained in the popliteal lymph node area for 24 h. Conclusion The alloy QDs maintained a higher QY in hydrophilization for biological applications than MQDs. And also, alloy QDs showed the potential as nanoprobes for highly sensitive bioimaging analysis. Graphical Abstract

GSK-650394 is an inhibitor of serum- and glucocorticoid-regulated kinase 1 that displays potency for treating cancer, hypertension, cardiovascular and neuronal diseases, such as Parkinson’s disease. However, the biopharmaceutical properties and pharmacokinetics of GSK-650394 have not been studied extensively. Also, there are currently no bioanalytical assays available for this new drug candidate. In this study, we developed a simple and sensitive liquid chromatography-tandem mass spectrometry method to quantify GSK-650394 in rat plasma and validated its selectivity, linearity, accuracy and precision, sensitivity, matrix effects, extraction recovery, and stability, following the United States Food and Drug Administration guidelines. In vitro studies showed the biopharmaceutical properties of GSK-650394, including its low solubility in water and simulated gastrointestinal fluids, passive transport in Caco-2 cell monolayers, high plasma protein binding, and primary metabolism by glucuronide conjugation in the small intestine and liver of rats. Following intravenous administration (2 mg/kg) to rats, GSK-650394 exhibited low total clearance (11.18 ± 1.28 mL/min/kg) and volume of distribution at steady-state (346.1 ± 120.6 mL/kg). Following oral administration (2, 5, and 10 mg/kg) to rats, GSK-650394 underwent enterohepatic circulation, with low bioavailability (∼9%). The insignificant difference in bioavailability among three oral doses suggests that GSK-650394 may follow linear pharmacokinetics up to an oral dose of 10 mg/kg. In addition, the total form of parent drug and glucuronide conjugate in rat plasma from three oral doses showed a much higher value of area under the plasma concentration versus time curve than the parent drug, indicating that the primary metabolism process of GSK-650394 was glucuronidation. Our findings suggest that the low oral bioavailability of GSK-650394 is associated with its low solubility, instability under acidic gastric conditions, and extensive glucuronidation metabolism.

Background/Aims Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality. Methods Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality. Results Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28-day mortality. Conclusions PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.

Objective This study aimed to compare the outcomes of adult out-of-hospital cardiac arrest (OHCA) before and after the coronavirus disease 2019 (COVID-19) outbreak in a large metropolitan city. Methods This before-and-after observational study used a prospective citywide OHCA registry. Adult patients with emergency medical service-treated OHCA, with presumed cardiac etiology, pre- and post-COVID-19 outbreak were enrolled. The study period spanned 2 months, starting from February 18, 2020. The control period was 2 months from February 18, 2019. The primary and secondary outcomes were good neurologic outcome and survival to hospital discharge, respectively. The association between the COVID-19 outbreak and OHCA outcomes was assessed using multivariable logistic regression analysis. Results This study analyzed 297 OHCA patients (control period, 145; study period, 152). The bystander cardiopulmonary resuscitation rates were 64.8% and 60.5% during the control and study periods, respectively. Response and on-scene times increased by 2 minutes, supraglottic airway use increased by 35.6%, and mechanical chest compression device use increased by 13% post-COVID-19 outbreak. Good neurologic outcome was significantly lower during the study period in overall OHCAs (adjusted odds ratio, 0.23; 95% confidence interval, 0.05–0.98) and in witnessed OHCAs (adjusted odds ratio, 0.14; 95% confidence interval, 0.02–0.90). No significant difference was found in the survival to hospital discharge of OHCA patients between the two periods. Conclusion During the COVID-19 pandemic, the response and on-scene times were longer, and good neurologic outcome was significantly lower than that in the control period.

Abstract Astrocytes and microglia are brain‐resident glia that can establish harmful inflammatory environments in disease contexts and thereby contribute to the progression of neuronal loss in neurodegenerative disorders. Correcting the diseased properties of glia is therefore an appealing strategy for treating brain diseases. Previous studies have shown that serum/ glucocorticoid related kinase 1 (SGK1) is upregulated in the brains of patients with various neurodegenerative disorders, suggesting its involvement in the pathogenesis of those diseases. In this study, we show that inhibiting glial SGK1 corrects the pro‐inflammatory properties of glia by suppressing the intracellular NFκB‐, NLRP3‐inflammasome‐, and CGAS‐STING‐mediated inflammatory pathways. Furthermore, SGK1 inhibition potentiated glial activity to scavenge glutamate toxicity and prevented glial cell senescence and mitochondrial damage, which have recently been reported as critical pathologic features of and therapeutic targets in Parkinson disease (PD) and Alzheimer disease (AD). Along with those anti‐inflammatory/neurotrophic functions, silencing and pharmacological inhibition of SGK1 protected midbrain dopamine neurons from degeneration and cured pathologic synuclein alpha (SNCA) aggregation and PD‐associated behavioral deficits in multiple in vitro and in vivo PD models. Collectively, these findings suggest that SGK1 inhibition could be a useful strategy for treating PD and other neurodegenerative disorders that share the common pathology of glia‐mediated neuroinflammation.

Summary: In the terahertz (THz) electromagnetic wave regime, which has recently received great attention in the fields of communication and security, shielding of THz waves is a significant issue. Therefore, carbon-based nanostructures or polymer–carbon nanocomposites have been widely explored. Herein, significantly enhanced THz shielding efficiency is reported for silver nanowires coated with reduced graphene oxide (rGO) and nanoscale THz metamaterials, as compared to the cases without nanoscale metamaterials. Using a nanoslot-patterned metamaterial with strong resonances at certain frequencies, THz transmission in intensity is enhanced up to three orders of magnitude. Enhanced transmission by nanopatterns substantially increases the shielding performance to the external THz waves, even for ultrathin films (several tens of nanometers) produced by a simple spray of rGO (a few nm of flakes) on a complex random nanowire network. Excellent shielding performance is presented and the shielding mechanism is investigated by the nanoprobing configuration at the same time.

X-linked adrenoleukodystrophy (ALD) caused by the ABCD1 mutation, is the most common inherited peroxisomal disease. Previously, we generated an ALD patient-derived SCHi001-A iPSC model. In this study, we have performed the first genome editing of ALD patient-derived SCHi001-A iPSCs using homology-directed repair (HDR). The mutation site, c.1534G > A [GenBank: NM_000033.4], was corrected by introducing ssODN and the CRISPR/Cas9 system. The cell line exhibited normal iPSC plulipotency marker expression following genome editing. Mutation-corrected iPSCs from SCHi001-A iPSC line can be used in research into the pathophysiology of and therapeutics for ALD.

A novel stent retriever device for in vivo mechanical thrombectomy for acute cerebral infarction has been developed. In this study, we compared the thrombus removal capacity, potential complications, and extent of vessel wall damage of this novel device with those of the Solitaire FR device by performing a histopathologic analysis using an autopsied canine model. Through this experimental evaluation, we aimed to assess the safety and efficacy of the newly developed thrombus removal device for cerebral infarction. Blood clots (autologous thrombus) were injected into 12 canines. Mechanical thrombectomy was performed in six canines using the newly developed Tromba thrombectomy device (experimental group) and in the other six canines using the Solitaire FR thrombectomy device (control group). Angiographic and histopathologic evaluations were performed 1 month after the blood vessels underwent mechanical thrombectomy. In the experimental group, the reperfusion patency was classified as “no narrowing” in five cases and “moderate narrowing (25%–50% stenosis)” in one case. In the control group, the reperfusion patency was classified as “no narrowing” in four cases, “moderate narrowing (25%–50% stenosis)” in one case, and “slight narrowing (less than 25% stenosis)” in one case. In the experimental group, intimal proliferation was observed in only two cases, endothelial loss was observed in two cases, and device-induced medial injury was observed in one case. In the control group, intimal proliferation was observed in two cases, endothelial loss was observed in one case, and thrombosis (fibrin/platelet) was observed in one case. The Tromba thrombectomy device showed no significant difference to the conventional Solitaire device in angiographic and histopathologic evaluations after thrombus removal. The stability and efficiency of the newly developed Tromba device are considered to be high and comparable to those of Solitaire.

People experience the same event but do not feel the same way. Such individual differences in emotion response are believed to be far greater than those in any other mental functions. Thus, to understand what makes people individuals, it is important to identify the systematic structures of individual differences in emotion response and elucidate how such structures relate to what aspects of psychological characteristics. Reflecting this importance, many studies have attempted to relate emotions to psychological characteristics such as personality traits, psychosocial states, and pathological symptoms across individuals. However, systematic and global structures that govern the across-individual covariation between the domain of emotion responses and that of psychological characteristics have been rarely explored previously, which limits our understanding of the relationship between individual differences in emotion response and psychological characteristics. To overcome this limitation, we acquired high-dimensional data sets in both emotion-response (8 measures) and psychological-characteristic (68 measures) domains from the same pool of individuals (86 undergraduate or graduate students) and carried out the canonical correlation analysis in conjunction with the principal component analysis on those data sets. For each participant, the emotion-response measures were quantified by regressing affective-rating responses to visual narrative stimuli onto the across-participant average responses to those stimuli, while the psychological-characteristic measures were acquired from 19 different psychometric questionnaires grounded in personality, psychosocial-factor, and clinical-problem taxonomies. We found a single robust mode of population covariation, particularly between the 'accuracy' and 'sensitivity' measures of arousal responses in the emotion domain and many 'psychosocial' measures in the psychological-characteristics domain. This mode of covariation suggests that individuals characterized with positive social assets tend to show polarized arousal responses to life events.

Odor is a very serious problem worldwide. Thus, odor prediction research has been conducted consistently to help prevent odor. Odor substances that are complex odors are known, but complex odors and odor substances do not have a linear dependence. In addition, depending on the combination of odor substances, the causal relationships, such as synergy and antagonism, are different for complex odors. Research is needed to know this, but the situation is incomplete. Therefore, in this study, research was conducted through data-based research. The complex odor was predicted using various machine learning methods, and the effect of odor substances on the complex odor was verified using an explainable artificial intelligence method. In this study, according to the Malodor Prevention Act in Korea, complex odors are divided into two categories: acceptable and unacceptable. Analysis of variance and correlation analysis were used to determine the relationships between variables. Six machine learning methods (k-nearest neighbor, support vector classification, random forest, extremely randomized tree, eXtreme gradient boosting, and light gradient boosting machine) were used as predictive classification models, and the best predictive method was chosen using various evaluation metrics. As a result, the support vector machine that performed best in five out of six evaluation metrics was selected as the best model (f1-score = 0.7722, accuracy = 0.8101, sensitivity = 0.7372, specificity = 0.8656, positive predictive value = 0.8196, and negative predictive value = 0.8049). In addition, the partial dependence plot method from explainable artificial intelligence was used to understand the influence and interaction effects of odor substances.

Abstract Probing the kinetic evolution of nanoparticle (NP) growth in liquids is essential for understanding complex nano‐phases and their corresponding functions. Terahertz (THz) sensing, an emerging technology for next‐generation laser photonics, has been developed with unique photonic features, including label‐free, non‐destructive, and molecular‐specific spectral characteristics. Recently, metasurface‐based sensing platforms have helped trace biomolecules by overcoming low THz absorption cross‐sectional limits. However, the direct probing of THz signals in aqueous environments remains difficult. Here, the authors report that vertically aligned nanogap‐hybridized metasurfaces can efficiently trap traveling NPs in the sensing region, thus enabling us to monitor the real‐time kinetic evolution of NP assemblies in liquids. The THz photonics approach, together with an electric tweezing technique via spatially matching optical hotspots to particle trapping sites with a nanoscale spatial resolution, is highly promising for underwater THz analysis, forging a route toward unraveling the physicochemical events of nature within an ultra‐broadband wavelength regime.

U-10wt.%Zr metallic fuel slugs containing rare-earth (RE: a rare-earth alloy comprising 53% Nd, 25% Ce, 16% Pr and 6% La) elements for a sodium-cooled fast reactor were fabricated by modified injection casting as an alternative method. The distribution, size and composition of the RE inclusions in the metallic fuel slugs were investigated according to the content of the RE inclusions. There were no observed casting defects, such as shrunk pipes, micro-shrinkage or hot tears formed during solidification, in the metallic fuel slugs fabricated by modified injection casting. Scanning electron micrographs and energy-dispersive X-ray spectroscopy (SEM-EDS) showed that the Zr and RE inclusions were uniformly distributed in the matrix and the composition of the RE inclusions was similar to that of a charged RE element. The content and the size of the RE inclusions increased slightly according to the charge content of the RE elements. RE inclusions in U-Zr alloys will have a positive effect on fuel performance due to their micro-size and high degree of distribution.

Background The current Surviving Sepsis Campaign guidelines recommend the remeasurement of lactate levels if the initial lactate level is elevated; however, the prognostic value of lactate kinetics is limited and inconsistent. We attempted to determine the efficacy of the lactate area score (calculated from repeated lactate measurements during initial resuscitation) as a prognostic marker of septic shock in the emergency department (ED). Methods We performed a retrospective study of adult patients with septic shock in the ED of a single tertiary medical center. Serial lactate levels were measured five times within 12 hours. We also compared the initial lactate level, maximum lactate level, and lactate area score. The lactate area score was defined as the sum of the area under the curve measured at 2, 4, 6, and 12 hours following the initial measurement. Results A total of 362 patients were enrolled in this study, and the overall 28-day mortality was 31.8%. The lactate area score of serial lactate levels as well as the initial (median [interquartile range], 4.9 [3.4 to 10.5]; P=0.003) and maximum (7.3 [4.2 to 13.2]; P

This paper presents a low noise 0.6-V 400-kS/s asynchronous successive approximation register (SAR) analog-to-digital converter (ADC) for input-referred noise reduction. A dual-domain comparator is proposed to optimize the power, noise, and sampling rate of the ADC in the 10-bit conversion. In order to optimize the figure of merits (FoM) of the ADC, the 10-bit conversion consists of a 7-bit coarse conversion with the double-tail dynamic comparator and a 3-bit fine conversion with the VCDL-based time-domain comparator. An asynchronous timing controller is also proposed to improve the ADC sampling rate and optimize the power consumption of the dual-domain comparator. The proposed SAR ADC is fabricated in 180-nm CMOS technology with an area of 0.836 mm2. At a 0.6-V supply voltage and a 400-kS/s sampling rate, the implemented SAR ADC achieves a signal-to-noise and distortion ratio (SNDR) of 56.59 dB and an effective number of bits (ENOB) of 9.16 bits. The peak values of DNL and INL are +0.47/−0.53 LSB and +0.92/−0.64 LSB, respectively. The FoM is 10.31 fJ/conversion step with a power consumption of 2.36 μW.

Induced pluripotent stem cell (iPSC) line HUi002-A was reprogrammed from skin fibroblasts via non-integrating, virus free self-replicating RNA. Skin fibroblasts from a 53-year-old male Caucasian, non-familial Parkinson's disease patient, idiopathic (clinical summary confirmed Parkinson's disease) was obtained from the Coriell Institute (AG20442). Generated iPSCs were characterized and pluripotency was confirmed.

Background. Timely treatment is important for patients with acute ischemic stroke (AIS). However, the coronavirus disease 2019 (COVID-19) outbreak may have caused delays in patient management. Therefore, we analyzed the prognosis and the time spent at the prehospital and hospital stages in managing patients diagnosed with AIS during the COVID-19 outbreak. Methods. This retrospective study evaluated patients diagnosed with AIS in the emergency department (ED) at five medical centers in Daegu city between February 18 and April 17 each year from 2018 to 2020. Data on the patients’ clinical features and time spent on management were collected and compared according to COVID-19 and pre-COVID-19 summaries. Results. From a total of 533 patients diagnosed with AIS, 399 patients visited the ED before COVID-19 and 134 during the COVID-19 outbreak. During the COVID-19 outbreak, compared with pre-COVID-19, AIS patients had poor National Institute of Health Stroke Scale scores at the initial hospital visit (6 vs. 4, p=0.013) and discharge (3 vs. 2, p=0.001). During the COVID-19 outbreak, the proportion of direct visits to hospitals through public emergency medical services (EMS) increased, and the onset of symptoms-to-ED door time via the public EMS was delayed (87 min vs. 68 min, p=0.006). Conclusions. The prognosis of AIS patients during the COVID-19 outbreak was worse than that of pre-COVID-19 patients with delays at the prehospital stage, despite the need for timely care.

Pupillometry, thanks to its strong relationship with cognitive factors and recent advancements in measuring techniques, has become popular among cognitive or neural scientists as a tool for studying the physiological processes involved in mental or neural processes. Despite this growing popularity of pupillometry, the methodological understanding of pupillometry is limited, especially regarding potential factors that may threaten pupillary measurements' validity. Eye blinking can be a factor because it frequently occurs in a manner dependent on many cognitive components and induces a pulse-like pupillary change consisting of constriction and dilation with substantive magnitude and length. We set out to characterize the basic properties of this "blink-locked pupillary response (BPR)," including the shape and magnitude of BPR and their variability across subjects and blinks, as the first step of studying the confounding nature of eye blinking. Then, we demonstrated how the dependency of eye blinking on cognitive factors could confound, via BPR, the pupillary responses that are supposed to reflect the cognitive states of interest. By building a statistical model of how the confounding effects of eye blinking occur, we proposed a probabilistic-inference algorithm of de-confounding raw pupillary measurements and showed that the proposed algorithm selectively removed BPR and enhanced the statistical power of pupillometry experiments. Our findings call for attention to the presence and confounding nature of BPR in pupillometry. The algorithm we developed here can be used as an effective remedy for the confounding effects of BPR on pupillometry.

Soil health deteriorates through the contamination and remediation processes, resulting in the limitation of the reuse and recycling of the remediated soils. Therefore, soil health should be recovered for the intended purposes of reuse and recycling. This study aimed to evaluate the applicability and effectiveness of several amendments to revitalize total petroleum hydrocarbon contaminated soils remediated by the landfarming process. Ten inorganic, organic, and biological amendments were investigated for their dosage and duration, and nine physicochemical, four fertility, and seven microbial (soil enzyme activity) factors were compared before and after the treatment of amendments. Finally, the extent of recovery was quantitatively estimated, and the significance of results was confirmed with statistical methods, such as simple regression and correlation analyses assisted by principal component analysis. The landfarming process is considered a somewhat environmentally friendly remediation technology to minimize the adverse effect on soil quality, but four soil properties—such as water holding capacity (WHC), exchangeable potassium (Ex. K), nitrate-nitrogen (NO3-N), available phosphorus (Av. P), and urease—were confirmed to deteriorate through the landfarming process. The WHC was better improved by organic agents, such as peat moss, biochar, and compost. Zeolite was evaluated as the most effective material for improving Ex. K content. The vermicompost showed the highest efficacy in recovering the NO3-N content of the remediated soil. Chlorella, vermicompost, and compost were investigated for their ability to enhance urease activity effectively. Although each additive showed different effectiveness according to different soil properties, their effect on overall soil properties should be considered for cost-effectiveness and practical implementation. Their overall effect was evaluated using statistical methods, and the results showed that compost, chlorella, and vermicompost were the most relevant amendments for rehabilitating the overall health of the remediated soil for the reuse and/or recycling of agricultural purposes. This study highlighted how to practically improve the health of remediated soils for the reuse and recycling of agricultural purposes.

Heterotopic cesarean scar pregnancy (HCSP) is a combination of cesarean scar pregnancy (CSP) and intrauterine pregnancy (IUP). Cesarean scar pregnancy is accompanied by life-threatening complications, such as uterine rupture and massive bleeding. Herein, we present a case of HCSP treated with selective potassium chloride injection into the CSP under ultrasonography in association with uterine cerclage to control vaginal bleeding; this led to a successful IUP preservation and full-term delivery. Additionally, we will review several previous reports on HCSP management, including our case.

Induced pluripotent stem cell (iPSC) line HUi001-A was reprogrammed from skin fibroblasts via non-integrating, virus free self-replicating RNA. Skin fibroblasts from an 81-year-old female Caucasian familial Alzheimer’s disease patient of Volga German family carrying N141I mutation in the PSEN2 gene (familial AD4, clinical summary confirmed Alzheimer’s disease) was obtained from the Coriell Institute (AG09908). Generated iPSCs were characterized and pluripotency was confirmed.

Despite limited information and knowledge, we personally form beliefs about certain properties of objects encountered in our daily life-popularity of a newly released movie, for example. Since such beliefs are prone to error, we often revise our initial beliefs according to the beliefs of others to improve accuracy. Optimal revision requires modulating the degree of accepting others' beliefs based on various cues for accuracy-number of opinions, for example-such that the more accurate others' beliefs are, the more we accept them. Although previous studies have shown that such accuracy cues can influence the degree of acceptance during social revision, they primarily investigated problems with 'factually correct' answers, and rarely problems with 'socially correct' answers. Here we examined which accuracy cues are objectively useful (utility of cues), and how those cues are used (use of cues), in the social revision of people's beliefs about problems with 'socially correct' answers. We asked people to estimate the 'shared preferences (SPs)' for sociocultural items, the answers to which are determined by socially aggregated beliefs-how popular an abstract painting will be among a large crowd, for example-and then to revise their initial estimates after being exposed to other people's estimates about the same items. We considered 'confidence', 'agreement among estimates', and 'number of estimates' as accuracy cues. We found that, while all three cues validly signaled the accuracy of SP estimates, only the 'number' cue has a significant utility, but the other cues are much less useful for optimal revision. Nevertheless, people used the cues of 'agreement' and their own 'confidence' to the extent comparable to that of the 'number' cue. Our findings suggest that the utility and use of accuracy cues for problems with 'socially correct' answers differ from those with 'factually correct' answers, as follows: (i) confidence does not have a significant utility and (ii) but people use their own confidence while ignoring others' confidence.

Background and Objectives: We aimed to analyze the morphology of the common femoral artery (CFA) and common femoral vein (CFV) and the anatomical relationship between the two blood vessels, and to investigate the factors that influence the size of these blood vessels. Materials and Methods: This retrospective study included 584 patients who underwent abdominal and pelvic computed tomography from 1 February to 28 February 2021. We measured the vessels at three regions on both lower extremities (inguinal ligament, distal vessel bifurcation, midpoint) and analyzed and classified the degree of overlap between the CFA and CFV into three types, as well as the factors affecting vessel size. Results: After comparing the femoral vessels according to location, it was confirmed that the CFA and CFV were larger distally than proximally on both sides (p < 0.001). The degree of overlap increased distally (p < 0.001) but was less at the middle (p < 0.001) and distal (p = 0.011) regions on the right side. It was found that the size of CFA and CFV were related to age, sex, and body mass index (BMI) and that malignancy also affects the CFA size. Conclusions: The morphology of the CFA and CFV was conical and increased distally. The degree of overlap between the two blood vessels also increased distally but was less on the right than on the left. Age, sex, and BMI are significant factors affecting the sizes of the CFA and CFV, and malignancy is associated with the CFA size.

Intrinsic, rhythmic subthreshold oscillations have been described in neurons of regions throughout the brain and have been found to influence the timing of action potentials induced by synaptic inputs. Some oscillations are sodium channel-dependent while others are calcium channel-dependent. These oscillations allow neurons to fire coherently at preferred frequencies and represent the main mechanism for maintaining high frequency network activity, especially in the cortex. Because cortical circuits are incapable of maintaining high frequency activity in the gamma range for prolonged periods, those processes dependent on continuous gamma band activity are subserved by subthreshold oscillations. As such, intrinsic oscillations, coupled with synaptic circuits, are essential to prolonged maintenance of such functions as sensory perception and “binding”, problem solving, memory, waking, and rapid eye movement (REM) sleep.

The mortality and morbidity rates of non-tubal ectopic pregnancies with abdominal hemorrhaging are 7–8 times higher than those of tubal pregnancies. Diaphragmatic pregnancy is a rare non-tubal ectopic form, causing acute abdominal hemoperitoneum. Here, we present a case of a primary diaphragmatic ectopic pregnancy with hemorrhage that was immediately diagnosed and successfully managed with laparoscopic surgery. Rapid and accurate diagnosis using appropriate imaging modalities is critical for improving the prognosis of a child-bearing woman with an abdominal pregnancy.

Background and Objectives: Due to the unexpected spread of coronavirus disease 2019 (COVID-19), there was a serious crisis of emergency medical system collapse. Healthcare workers working in the emergency department were faced with psychosocial stress and workload changes. Materials and Methods: This was a cross-sectional survey of healthcare workers in the emergency department in Daegu and Gyeongbuk, Korea, from November 16 to 25, 2020. In the survey, we assessed the general characteristics of the respondents; changes in the working conditions before and after the COVID-19 pandemic; and resulting post-traumatic stress disorder, depression and anxiety statuses using 49 questions. Results: A total of 529 responses were collected, and 520 responses were included for the final analyses. Changes in working conditions and other factors due to COVID-19 varied by emergency department level, region and disease group. Working hours, intensity, role changes, depression and anxiety scores were higher in the higher level emergency department. Isolation ward insufficiency and the risk of infection felt by healthcare workers tended to increase in the lower level emergency department. Treatment and transfer delay were higher in the fever and respiratory disease groups (M = 3.58, SD = 1.18; M = 4.08, SD = 0.95), respectively. In all the disease groups, both treatment and transfer were delayed more in Gyeongbuk than in Daegu. Conclusions: Different goals should be pursued by the levels and region of the emergency department to overcome the effects of the COVID-19 pandemic and promote optimal care.

This study was conducted to evaluate the feasibility of using electrosorption to remove cesium (Cs+) ions from aqueous solutions using the membrane capacitive deionization (MCDI) process. The electrochemical properties were analyzed using cyclic voltammetry (CV) and impedance spectroscopy (EIS). The activated carbon electrode coated by a polymer layer showed higher specific adsorption capacity (SAC) and removal efficiency of Cs+ than the AC electrode. The effects of potential, flow rate, initial Cs+ concentration, and pH values were investigated to optimize the electrosorption performance. The electrosorption capacity increased with an increase in the applied potential and the concentration of Cs+ in the influent water. The pH value is an important parameter on electrosorption performance. The removal of Cs+ ions was affected by the pH of the influent water because H+ ions acted as competing ions during the electrosorption process. Cs+ was preferentially adsorbed to the electrode in the early stages of adsorption but was later replaced by H+. A higher presence of H+ ions could reduce the adsorption capacity of Cs+ ions. The ion-exchange layer coated AC electrode was shown to be favorable for the removal of Cs+, despite the limited electrosorption ability in a highly acidic solution.

Background: Since the first report of a diaphragmatic hernia from Ambroise Paré’s necropsy in 1610, the Bochdalek hernia (BH) of the congenital diaphragmatic hernia (CDH) has been the most common types with high morbidity and mortality in the neonatal period. Due to the nature of the disease, CDH associated with pregnancy is too infrequent to warrant reporting in the literature. Mortality of obstruction or strangulation is mostly due to failure to diagnose symptoms early. Data sources and study selection: A systematic literature search of maternal BH during pregnancy was conducted using the electronic databases (PubMed and EMBASE) from January 1941 to December 2020. Because of the rarity of the disease, this review included all primary studies, including case reports or case series that reported at least one case of maternal BH in pregnant. Searches, paper selection, and data extraction were conducted in duplicate. The analysis was performed narratively regardless of the control groups’ presence due to their rarity. Results: The search retrieved 3450 papers, 94 of which were deemed eligible and led to a total of 43 cases. Results of treatment showed 16 cases in delayed delivery after hernia surgery, 10 cases in simultaneous delivery with hernia surgery, 3 cases in non-surgical treatment, and 14 cases in hernia surgery after delivery. Of 16 cases with delayed delivery after hernia surgery, 13 (81%) cases had emergency surgery and three (19%) cases had surgery after expectant management. Meanwhile, 10 cases underwent simultaneous delivery with hernia surgery, 6 cases (60%) had emergent surgery, and 4 cases (40%) had delayed hernia surgery after expectant management. 3 cases underwent non-surgical treatment. In this review, the maternal death rate and fetal/neonatal loss rate from maternal BH was 5% (2/43) and 16% (7/43), respectively. The preterm birth rate has been reported in 35% (15/43) of maternal BH, resulting from maternal deaths in 13% (2/15) of cases and 6 fetal loss in 40% (6/15) of cases; 44% (19/43) of cases demonstrated signs of bowel obstruction, ischemia, or perforation of strangulated viscera in the operative field, resulting from maternal deaths in 11% (2/19) of cases and fetal-neonatal loss in 21% (4/19) of cases. Conclusion: Early diagnosis and surgical intervention are imperative, as a gangrenous or non-viable bowel resection significantly increases mortality. Therefore, multidisciplinary care should be required in maternal BH during pregnancies that undergo surgically repair, and individualized care allow for optimal results for the mother and fetus.

Background and Objectives: Frontline medical staff usually experience high levels of stress, which could greatly impact their work output. We conducted a survey to investigate the level of stress and its association with job types, work departments, and medical centers among COVID-19 pandemic frontline medical personnel. Materials and Methods: We conducted a cross-sectional survey using a self-administered questionnaire among 307 frontline medical staff who cared for COVID-19 patients in Daegu city. We used a 33-item questionnaire to assess respondents’ general characteristics, job stress, personal effects associated with the COVID-19 pandemic, and their stress level. A general health questionnaire-12 (GHQ-12) was included in our questionnaire. Results: Majority (74.3%) of the respondents were in the stress group. The mean GHQ-12 score was 14.31 ± 4.96. More females (67.4%, p < 0.05) and nurses (73.3%, p = 0.001) were in the stress group compared to males and doctors. Medical staff in the general ward considered the severity of the COVID-19 pandemic situation higher. Nurses perceived work changes (p < 0.05), work burden (p < 0.05), and personal impact (p < 0.05) more serious than doctors. Medical staff in Level 3 emergency department (ED) perceived a lack of real-time information (p = 0.012), a lack of resources, and negative personal impacts associated with the pandemic as more serious than staff in Level 1 and Level 2 EDs. Medical staff in the intensive care unit perceived work changes (p < 0.05), work burden (p < 0.05), and lack of personal protective equipment (p = 0.002) as more serious than staff in the ED and general ward. Conclusion: Providing real-time information and resources for reducing work burden and negative personal impact is central to maximizing the work output of the COVID-19 pandemic frontline medical staff. Supporting their mental health through regular programs and intervention is also imperative.

Cultured neural stem/precursor cells (NSCs) are regarded as a potential systematic cell source to treat Parkinson's disease (PD). However, the therapeutic potential of these cultured NSCs is lost during culturing. Here, we show that treatment of vitamin C (VC) enhances generation of authentic midbrain-type dopamine (mDA) neurons with improved survival and functions from ventral midbrain (VM)-derived NSCs. VC acted by upregulating a series of mDA neuron-specific developmental and phenotype genes via removal of DNA methylation and repressive histone code (H3K9m3, H3K27m3) at associated gene promoter regions. Notably, the epigenetic changes induced by transient VC treatment were sustained long after VC withdrawal. Accordingly, transplantation of VC-treated NSCs resulted in improved behavioral restoration, along with enriched DA neuron engraftment, which faithfully expressed midbrain-specific markers in PD model rats. These results indicate that VC treatment to donor NSCs could be a simple, efficient, and safe therapeutic strategy for PD in the future.

Study objective: To evaluate the feasibility and safety of vaginal vault drainage after complicated single-port access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH). Design: Retrospective cohort study. Setting: Ulsan University Hospital (tertiary teaching hospital), South Korea. Patients: A total of 359 women underwent SPA-LAVH for the following conditions: benign uterine tumor, preinvasive uterine lesion, and microinvasive cervical cancer. Interventions: The participants included 124 women with vault drains and 235 women without drains. Measurements: Surgical outcomes, perioperative complications and morbidity, postoperative febrile morbidity. Results: There were no differences in background features between drain and no-drain groups. In surgical outcomes, mean uterine weight (364.2±184.9 g vs. 263.7±138.6 g; p