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Background: Targeting the tumor microenvironment represents an emerging therapeutic strategy for cancer. Macrophages are an essential part of the tumor microenvironment. Macrophage polarization is modulated by mitochondrial metabolism, including oxidative phosphorylation (OXPHOS), the tricarboxylic acid (TCA) cycle, and reactive oxygen species content. Isocitrate dehydrogenase 2 (IDH2), an enzyme involved in the TCA cycle, reportedly promotes cancer progression. However, the mechanisms through which IDH2 influences macrophage polarization and modulates tumor growth remain unknown. Methods: In this study, IDH2-deficient knockout (KO) mice and primary cultured bone marrow-derived macrophages (BMDMs) were used. Both in vivo subcutaneous tumor experiments and in vitro co-culture experiments were performed, and samples were collected for analysis. Western blotting, RNA quantitative analysis, immunohistochemistry, and flow cytometry were employed to confirm changes in mitochondrial function and the resulting polarization of macrophages exposed to the tumor microenvironment. To analyze the effect on tumor cells, subcutaneous tumor size was measured, and growth and metastasis markers were identified. Results: IDH2-deficient macrophages co-cultured with cancer cells were found to possess increased mitochondrial dysfunction and fission than wild-type BMDM. Additionally, the levels of M2-associated markers decreased, whereas M1-associated factor levels increased in IDH2-deficient macrophages. IDH2-deficient macrophages were predominantly M1. Tumor sizes in the IDH2-deficient mouse group were significantly smaller than in the wild-type mouse group. IDH2 deficiency in macrophages was associated with inhibited tumor growth and epithelial–mesenchymal transition. Conclusions: Our findings suggest that IDH2 deficiency inhibits M2 macrophage polarization and suppresses tumorigenesis. This study underlines the potential contribution of IDH2 expression in macrophages and tumor microenvironment remodeling, which could be useful in clinical cancer research. [ABSTRACT FROM AUTHOR]

In this study, we examined the mechanisms of cadmium exposure-induced endoplasmic reticulum (ER) stress response and apoptosis in spermatocytes. Responses to cadmium toxicity were investigated using spermatocytes overexpressing p50ATF6, ATF4, and spliced XBP1s, belonging to the 3 unfolded protein response pathways. The ER stress and apoptosis response to cadmium were most strongly stimulated through the activating transcription factor 6 (ATF6) pathway; in contrast, siRNA-induced inhibition of protein expression could reduce apoptosis under stressful conditions. An in vivo experiment using mice confirmed that upregulation of p50ATF6 in the testis increased apoptosis in response to cadmium exposure. Further, when confirming the correlation between ER stress and MAPK in cadmium toxicity, p38 MAPK phosphorylation was strongly regulated by p50ATF6; p-p38 also mediated the activity of p50ATF6. Overall, these findings suggest that modulating the activity of p38 MAPK and p50ATF6 in cadmium exposure-induced toxicity can be considered a potential strategy to treat infertility. [ABSTRACT FROM AUTHOR]

Simple Summary: This prospective exploratory study suggested the feasibility of circulating tumor cells (CTCs) and peripheral blood cells (PBCs), especially platelets, as predictive biomarkers in patients with unresectable stage III non-small cell lung cancer (NSCLC) who received concurrent chemoradiotherapy (CCRT) and durvalumab. This comprehensive analysis of CTC and PBC counts could provide valuable insights into a biomarker-driven strategy for further management after the completion of CCRT, and could aid in the risk stratification of patients with unresectable stage III NSCLC who are eligible for durvalumab during treatment. We recruited 50 patients with unresectable stage III NSCLC who received CCRT between March 2020 and March 2021. Durvalumab consolidation (DC) was administered to patients (n = 23) without progression after CCRT and programmed death-ligand 1 (PD-L1) ≥ 1%. Blood samples were collected before (C0) and after CCRT (C1) to calculate PBC counts and analyze CTCs. CTCs, isolated by the CD-PRIMETM system, exhibited EpCAM/CK+/CD45− phenotype in BioViewCCBSTM. At median follow-up of 27.4 months, patients with residual CTC clusters at C1 had worse median PFS than those without a detectable CTC cluster (11.0 vs. 27.8 months, p = 0.032), and this trend was noted only in the DC group (p = 0.034). Patients with high platelets at C1 (PLThi, >252 × 103/µL) had worse median PFS than those with low platelets (PLTlo) (5.9 vs. 17.1 months, p < 0.001). In multivariable analysis, PLThi and residual CTC clusters at C1 were independent risk factors for PFS, and DC group with PLThi and residual CTC clusters at C1 showed the worst median PFS (2.6 months, HR 45.16, p = 0.001), even worse than that of the CCRT alone group with PLThi (5.9 months, HR 15.39, p = 0.001). The comprehensive analysis of CTCs and PBCs before and after CCRT revealed that the clearance of CTC clusters and platelet counts at C1 might be potential biomarkers for predicting survival. [ABSTRACT FROM AUTHOR]

Background: In-hospital mortality and short-term mortality are indicators that are commonly used to evaluate the outcome of emergency department (ED) treatment. Although several scoring systems and machine learning-based approaches have been suggested to grade the severity of the condition of ED patients, methods for comparing severity-adjusted mortality in general ED patients between different systems have yet to be developed. The aim of the present study was to develop a scoring system to predict mortality in ED patients using data collected at the initial evaluation and to validate the usefulness of the scoring system for comparing severity-adjusted mortality between institutions with different severity distributions.Methods: The study was based on the registry of the National Emergency Department Information System, which is maintained by the National Emergency Medical Center of the Republic of Korea. Data from 2016 were used to construct the prediction model, and data from 2017 were used for validation. Logistic regression was used to build the mortality prediction model. Receiver operating characteristic curves were used to evaluate the performance of the prediction model. We calculated the standardized W statistic and its 95% confidence intervals using the newly developed mortality prediction model.Results: The area under the receiver operating characteristic curve of the developed scoring system for the prediction of mortality was 0.883 (95% confidence interval [CI]: 0.882-0.884). The Ws score calculated from the 2016 dataset was 0.000 (95% CI: - 0.021 - 0.021). The Ws score calculated from the 2017 dataset was 0.049 (95% CI: 0.030-0.069).Conclusions: The scoring system developed in the present study utilizing the parameters gathered in initial ED evaluations has acceptable performance for the prediction of in-hospital mortality. Standardized W statistics based on this scoring system can be used to compare the performance of an ED with the reference data or with the performance of other institutions. [ABSTRACT FROM AUTHOR]

• Novel route for cokeless methane to olefins, aromatics, and hydrogen (MTOAH). • Synergistic effect of hydrocarbon cofeeding on the MTOAH process was demonstrated. • Greater sustainability by metaheuristic optimization with machine learning models. • Successful prediction of the optimal reaction conditions for MTOAH. • Enhanced hydrocarbon selectivity in MTOAH, with suppressed coke formation. Methane to olefins, aromatics, and hydrogen (MTOAH) has received considerable attention because it can potentially provide an energy-efficient and environmentally friendly method for converting methane into valuable compounds. However, the optimization of the MTOAH process significantly hinders its economic feasibility because methane pyrolysis in the MTOAH process consumes considerable energy and carbon resources and requires several control factors. In this study, focusing on methane pyrolysis in the gas phase, a method for improving the MTOAH process with a hydrocarbon effect was successfully developed using metaheuristic optimization based on machine learning (ML) models. Because the trained ML models reasonably predicted various reaction outcomes, metaheuristic methods coupled with these ML models could optimize the reaction parameters to achieve the maximum hydrocarbon yield. By constructing score functions, various reaction conditions with maximum hydrocarbon yields and different coke selectivities were proposed. This provides key evidence for understanding the reaction mechanism and presents strategies for developing a sustainable cokeless catalytic reactor. Moreover, the importance of acetylene and the synergistic effect of hydrocarbon on the MTOAH process was verified using ML models. The optimal hydrocarbon content for cofeeding was determined based on the reaction temperature, but can be achieved at lower temperatures by loading a catalyst in a pre-gas phase reactor. Thus, our findings of the prioritization of the reaction parameters on the MTOAH mechanism will facilitate the development of a sustainable catalytic reactor under mild reaction conditions. [ABSTRACT FROM AUTHOR]

Background: Serine is a hypoallergenic but inefficient chemical exfoliant. Serine paired with arginine (ion‐paired amino acid, IPA) shows enhanced lipophilicity, skin permeation, and exfoliation efficacy. Aim: This study was conducted to determine whether exfoliation using an emulsion containing IPA could reduce enlarged facial pores and improve the dermis density. Methods: IPA formation was validated by spectroscopic analysis. Enhanced permeability and exfoliation efficacy were evaluated ex vivo using porcine skin. In a clinical trial, healthy Korean women aged 20‐49 years (mean age ± SD: 35.6 ± 8.6, n = 64) were evaluated, and the right and left sides of the cheeks were randomly chosen. An emulsion containing 4.0% IPA and placebo emulsion were applied to each side for 6 weeks. To evaluate pore sizes following treatment, the number of enlarged facial pores, inner skin structures from the stratum corneum to epidermal‐dermal interface, and dermal density on each cheek of the participants were assessed. Results: IPA showed a significantly increased partition coefficient in n‐octanol‐water. In porcine skin, permeation of serine after 12 hour was 70% higher for the IPA than for serine alone at the same percent weight concentrations. In the clinical trial, after 6 weeks, the number of enlarged facial pores was changed by −19.317% in the IPA emulsion group (P <.001) and −2.930% in placebo emulsion group (P =.254). Conclusion: Exfoliation with an IPA‐containing emulsion reduced enlarged facial pores and increased the dermis density. IPA, effective mild exfoliator, can be used as a major ingredient for the cosmeceutical skincare products in the future. [ABSTRACT FROM AUTHOR]

A low-temperature synthesis of α-alumina was studied using a flux consisting of salts and additives. Al(OH) 3 was used as a precursor for the preparation of alumina; NaCl–KCl, NaCl, Na 2 SO 4 and K 2 SO 4 were used as the salts in the flux; and cryolite (Na 3 AlF 6) was used as an additive. Using a flux consisting of Na 3 AlF 6 with each salt confirmed that a phase change to α-alumina was possible even at a low temperature of 600 °C. Among the salts used, NaCl was the most effective. The flux with NaCl and Na 3 AlF 6 could produce highly pure and highly crystalline platelet α-alumina crystals at 700 °C. Herein, NaCl exhibited interfacial activity during the phase change process and contributed to the growth of the α-alumina plate-like crystals with a clear crystal surface. Na 3 AlF 6 was found to contribute significantly to the formation of crystal nuclei for the initiation of the phase change to α-alumina even with the addition of small amounts, namely, a 0.02–0.03 M ratio (Na 3 AlF 6 /Al(OH) 3). [ABSTRACT FROM AUTHOR]

Background: No study has compared the clinical impact of indexation of left ventricular mass (LVM) on adverse clinical outcomes in pre-dialysis patients with chronic kidney disease (CKD). Methods: We reviewed 2,101 patients from a large-scale multi-center prospective study that gathered anthropometric and echocardiographic measurements and clinical outcomes. The LVM was indexed as body surface area (LVMI-BSA) and height raised to the power of 2.7 (LVMI-H2.7). The main outcomes were composite renal and cardiovascular events and all-cause mortality. Left ventricular hypertrophy (LVH) was defined as the highest sex-specific quartile of LVMI-BSA or LVMI-H2.7. Results: During a mean period of 3.5 years, 692 patients developed composite outcomes (32.9%). The area under the curve at 5 year of LVM (60.6%) for composite outcome was smaller than that for LVMI-BSA (63.2%, P <0.001) and LVMI-H2.7 (63.4%, P <0.001). The hazard ratio (HR) and 95% confidence interval (CI) per one unit increase in LVM (g), LVMI-BSA (g/m2), and LVMI-H2.7 (g/m2.7) for composite outcomes were 1.004 (1.002–1.005, P <0.001), 1.011 (1.006–1.016, P <0.001), and 1.023 (1.012–1.035, P <0.001), respectively. Patients with LVH determined by LVMI-BSA and LVMI-H2.7 (HR 1.352, 95% CI 1.123–1.626, P = 0.001) and LVH determined by only LVMI-BSA (HR 1.908, 95% CI 1.233–2.953, P = 0.004) showed an independent increase in the risk of composite-outcome development, when compared with patients without LVH, according to LVMI-BSA and LVMI-H2.7. Conclusion: Indexation of LVM improved the prediction of adverse outcomes. BSA may be as useful as height2.7 in indexing of LVM for predicting adverse outcomes in pre-dialysis patients with CKD. [ABSTRACT FROM AUTHOR]

Conversion to shockable rhythm from an initial non-shockable rhythm is associated with good neurologic prognoses in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether conversion to shockable rhythm has an association with good neurologic outcomes, according to the etiology of cardiac arrest. We conducted a nationwide, population-based, cohort study using the OHCA data from the Korea Centers for Disease Control and Prevention database in 2012–2016. We included patients with OHCA and an initial non-shockable rhythm. The primary outcome was good neurologic outcome at discharge, etiologies of arrest were categorized to medical, non-medical cause. We analyzed the effect of conversion to a shockable rhythm on outcome according to causes of cardiac arrest using multiple regression analysis. Of 114,628 patients with an initial non-shockable rhythm, 25,042 (21.8%) experienced conversion to a shockable rhythm; 83,437 (72.8%) had medical causes and 31,191(27.2%) had non-medical causes. In all patients with OHCA and initial non-shockable rhythm, adjusted odds ratio (OR) of conversion for good neurologic outcome was 2.051 (95% confidence interval [CI] 1.181–2.297). The medical cause group showed an adjusted OR 1.789 (95% CI 1.586–2.019) of conversion for good neurologic outcome. In non-medical cause group, the adjusted OR of conversion was 0.644 (95% CI 0.372–1.114). Conversion to shockable rhythm had an association with good neurologic outcome in patients with OHCA with initial non-shockable rhythms, especially due to cardiac cause. However, rhythm conversion was not associated with better outcome in patients with non-medical causes. [ABSTRACT FROM AUTHOR]

Abstract In this study, a carbon/epoxy-aluminium hybrid upper arm of a pantograph for high-speed trains was designed and the mechanical performance was experimentally verified under operating conditions. For high driving speeds, i.e., above 300 km/h, the structural stiffness of the upper arm, which is the most crucial component of a pantograph, was enhanced by using high-stiffness carbon/epoxy composites. After fabricating the hybrid upper arm of the pantograph, the structural integrity was evaluated by thermal cycle testing under driving conditions (dynamic impact loading and environmental temperature of −35 to 40 °C). The results prove that the developed hybrid upper arm of the pantograph has a 21% weight reduction and 90% stiffness enhancement. [ABSTRACT FROM AUTHOR]

Abstract Revealing detailed catalytic and magnetic properties and the corresponding structural changes of Fe oxide materials are extremely important for their diverse applications. For this, magnetic properties of thermally phase transformed β-FeOOH nanorods (NRs) (to porous α-Fe 2 O 3) were examined in the temperature up to 550 °C. The thermal treatment enhances the lattice strain (ε) that facilitates in creating pore structures. Fundamental physicochemical properties were examined by X-ray diffraction (XRD), transmission electron microscopy (TEM), scanning electron microscopy (SEM), diffuse reflectance UV–visible absorption spectroscopy, and X-ray photoelectron spectroscopy (XPS). An average size of pores and pore-size distribution were characterized by Brunauer-Emmett-Teller (BET) surface area analysis. Temperature and field dependent magnetic properties of calcination samples were investigated by vibrating sample magnetometer (VSM) for understanding the morphology-dependent magnetic behavior of NRs. The phase transformation behavior of these thermally treated magnetic NRs was analyzed through magnetic property characterization by considering all possible relationships with lattice strain effects, oxygen vacancies, magnetic, and morphology anisotropy. Highlights • Porous α-Fe 2 O 3 NRs obtained under thermal treatment via strain induced structural phase transformation of β-FeOOH.. • Systematic characterization and analysis provided for the phase transformation of β-FeOOH. • Surface area, porosity and defects have significant role on the magnetic properties of NRs. • The surface OH groups, lattice strain of NRs have been effected the CO oxidation rate. [ABSTRACT FROM AUTHOR]

Abstract In order to overcome the shortcomings of conventional fibrous composites, such as the limitations in the mass production of continuous fiber-reinforced composites and the inferior mechanical properties of short fiber-reinforced composites, long fiber prepreg sheets (LFPSs) are introduced in this paper. The LFPS is designed to form complex structures by thermoforming; however, highly complex shapes require mechanical fastening, after the composite parts are thermoformed. For this purpose, wing-type metal inserts embedded in the LFPS during thermoforming are investigated, and the most appropriate insert configuration is suggested. The specimens are subjected to a pull-through test, in accordance with insert parameters, such as the width and length of the insert wings, and the condition that ensures the highest pull-through force is determined. To check for wing deformation after thermoforming, the projected area and bending angle are measured through X-ray observation, and correlated with the pull-through force. [ABSTRACT FROM AUTHOR]

Idiopathic membranous nephropathy (MN) is the most common glomerulonephritis in elderly patients showing nephrotic syndrome. However, little is known about its treatment options and outcomes in elderly MN patients at long term follow-up. We retrospectively enrolled patients with biopsy-proven MN between April 1990 and December 2015 from eight tertiary hospitals in Korea. Among them, we excluded patients who had secondary causes of MN and subnephrotic-range proteinuria. We evaluated the presenting features and clinical outcomes and analyzed the all-cause mortality, renal outcomes, infection, and remission with respect to age. During the median follow-up at 77.2 months, 198 younger patients (<65 years) and 133 elderly patients (≥65 years) were enrolled. Age was an independent risk factor for all-cause mortality, renal outcome, and infection (for all P <  0.05) except remission. In elderly patients, there was no significant factor associated with mortality rate. The use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) was significantly associated with renal outcome and infection (renal outcome, hazard ration [HR] 0.06, 95% confidence intervals [CI] 0.01–0.36, P  = 0.003; infection, HR 0.20, 95% CI 0.04–0.94, P  = 0.041). Immunosuppressant therapy significantly increased renal outcome ( P  = 0.045) and infection ( P  = 0.029) compared with conservative therapy. In conclusion, old age is one of the clinically important predictors for MN patients. Among the treatment of elderly MN patients, only ACEI or ARB was associated with beneficial effects on renal outcome and infection. Elderly MN patients need a more tailored regimen considering their comorbidities and condition. [ABSTRACT FROM AUTHOR]

In this work, low-velocity impact-induced damages such as matrix cracking and delamination in composite laminates made of unidirectional carbon fiber/epoxy and woven carbon prepregs with different stacking sequences were investigated by using a poly(vinylidene fluoride–trifluoroethylene) (P(VDF-TrFE)) film sensor. The effect of insertion of film sensor having various areal ratios on the structural integrity of the host composite was investigated by conducting tensile and short beam shear tests. The findings revealed that the degradation rates of the Young's modulus, strength, and inter-laminar shear strength were in the acceptable range; the degradation rate was 7–8% even under unrealistically harsh conditions. Subsequently, low-velocity impact tests were performed by using a drop-weight impact machine (11.77–28.25 J). For damage characterization of the composite laminates, four P(VDF-TrFE) film sensors were inserted at different sites in each composite laminate at the impact point. By considering the relationships between impact energy, voltage output from the sensors, and the corresponding material failure modes, an estimation technique for the potential failure of the composite laminates that experienced low-velocity impacts was suggested. [ABSTRACT FROM AUTHOR]

Background The estimated glomerular filtration rate (eGFR) is an important parameter in the management of patients with kidney diseases, yet eGFR quality goals are lacking. We examined the uncertainties in eGFR determinations and assessed their impact on patient classifications, aiming to set eGFR quality goals. Methods Adult patients undergoing creatinine concentration assessments at our hospital, between June 2014 and October 2016, were included (N = 285,982). Using 7 eGFR equations, we calculated the imprecisions in the eGFR, based on the imprecisions in determining creatinine and/or cystatin C concentrations. The uncertainties in the eGFR were expressed as functions of creatinine and/or cystatin C concentration uncertainties. Subsequently, the number of ambiguous cases was assessed, based on the calculated uncertainty in the eGFR. Results Uncertainties in the eGFRs varied according to the eGFR calculation equation used. Although a 0.8% expanded uncertainty in the eGFR caused a 3.5% ambiguous case rate, a 10% expanded uncertainty resulted in a 42.3% rate of ambiguous cases. To meet minimal quality requirements, creatinine imprecision should be ≤ 3.0%. Conclusions Even a low level of uncertainty in the eGFR may cause noticeable impacts on patient classifications. Laboratory physicians should be aware, and cautious, of the uncertainties in eGFR calculations. [ABSTRACT FROM AUTHOR]

Background/Aims: No studies have examined the association among serum hepcidin, iron indices, or anemia status based on the kidney function of non-dialysis chronic kidney disease (CKD) patients. Methods: We reviewed data of 2238 patients from a large-scale multicenter prospective Korean study (2011-2016) and excluded 198 patients with missing data regarding serum hepcidin, hemoglobin, transferrin saturation (TSAT), ferritin, and usage of erythropoiesisstimulating agents (ESA) or supplemental iron and 363 patients using ESA or supplemental iron. Finally, 1677 patients were included. Results: The mean patient age was 53.5 years, and 65.4% were men. TSAT and serum hepcidin were significantly associated with anemia status, whereas serum ferritin was not, regardless of anemia severity. For patients with an estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m², a 10% increase of TSAT was associated with hemoglobin <13 g/dL (odds ratio [OR], 0.628; 95% confidence interval [CI], 0.515-0.765; P<0.001) and hemoglobin <11.5 g/dL (OR, 0.672; 95% CI, 0.476-0.950; P=0.024), whereas a 10-ng/mL increase of serum hepcidin was associated with hemoglobin <11.5 g/dL (OR, 1.379; 95% CI, 1.173-1.620; P<0.001) and hemoglobin <10.0 g/dL (OR, 1.360; 95% CI, 1.115-1.659; P=0.002) for patients with eGFR <45 mL/min/1.73 m² according to multivariate logistic analysis. Conclusions: TSAT was associated with less severe anemia in early CKD patients. Serum hepcidin was associated with more severe anemia in advanced CKD patients. [ABSTRACT FROM AUTHOR]

Aims The relationship between directly measured body fat and all-cause mortality has been rarely studied. The aim of this study was to evaluate the predictive significance of computed tomography ( CT)-measured body fat, including both visceral fat area ( VFA) and subcutaneous fat area ( SFA), for mortality. Methods The study included 36 656 participants who underwent abdominal CT as part of a health check-up at a single university-affiliated healthcare center in 2007 to 2015. Of those, 32 593 participants with data regarding vital status as of May 2016 were included in the final analysis. The main factors evaluated were VFA, SFA and visceral-to-subcutaneous fat area ratio ( VSR), and the primary outcome was all-cause mortality. Results There were 253 deaths during a mean follow-up of 5.7 years. Increased SFA was associated with decreased all-cause mortality, whereas an increased VFA and VSR were related to increased all-cause mortality. Compared with the predictive power of body mass index ( BMI), SFA and VSR showed a larger area under the curve than did BMI. In Kaplan- Meier survival curve analysis, increased SFA and VSR were associated with decreased and increased hazard of all-cause death, respectively. However, in multivariate Cox proportional hazard regression analysis, only VSR was independently associated with all-cause mortality. Moreover, this relationship was paralleled by the harmful impact of increased VSR on metabolic profiles. Conclusion Increased VSR was an independent predictor of all-cause mortality. This suggests that the location of fat deposits may be more important than the actual amount of body fat. [ABSTRACT FROM AUTHOR]

Background and objectives: To determine whether the delivery method is associated with the rate of anemia in later life, using the data from the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: This study used data from the KNHANES 2010–2012. Among 25,534 participants, 8,126 cases were included in this study after exclusion of males and other inappropriate data. The study population was divided into three groups according to the delivery modes: vaginal delivery (VD) only group, single cesarean delivery (SCD) group and repetitive cesarean delivery (RCD) group. The primary outcome was anemia and iron deficiency. Anemia was defined as hemoglobin <12 g/dl in accordance with the World Health Organization criteria. Iron deficiency was defined as low transferrin saturation (TSAT) or ferritin levels. Multivariate analysis was used for determination of association between the delivery modes and anemia. Results: The mean age was 53.4 years and the median time from the last delivery to the survey was 25 years. The VD only group was composed of 6,493 (79.9%) women, while 685 (8.4%) were classified as the SCD group and 948 (11.7%) were classified as a RCD group. The rates of anemia were 11.8%, 13.9%, and 19.7% in VD only group, SCD group, and RCD group, respectively. However, those groups were significantly different in many confounding factors. Therefore, to adjust those factors, multivariate analysis and subgroup analysis were followed. The odds of SCD for anemia and iron deficiency were not different from those of VD only. However, RCD was independently associated with anemia [Odds ratio(OR) 1.47, 95% Confidence interval (CI) 1.21–1.79, P <0.001] and iron deficiency (OR 1.42, 95% CI 1.21–1.67, P <0.001) compared to VD only. In the subgroup analysis, RCD was significantly associated with anemia in perimenopausal women, women with iron deficiency, those without any comorbidity and those without anemia-prone treatment. Conclusion: Repetitive cesarean section may be a risk factor for future development of anemia in later life, especially in perimenopausal period. Therefore, evaluation and management of anemia in longer postpartum period should be considered for women who experience repetitive cesarean section. [ABSTRACT FROM AUTHOR]

Developing a material with a new morphology is very important for improving the functional performance and finding new applications. Monoclinic samarium oxysulfate ( Sm2O2SO4) nanoplates were first prepared using a hydrothermal process followed by a post-annealing treatment of an as-synthesized Sm2( OH) 4SO4· 2H2O plate at 450 °C. The fundamental physicochemical properties were examined by scanning electron microscopy, high-resolution transmission electron microscopy, Rietveld X-ray diffraction crystallographic data analysis, thermogravimetric analysis/differential scanning calorimetry, Fourier transform-infrared spectroscopy, Raman spectroscopy, ultraviolet-visible- NIR absorption, and X-ray photoelectron spectroscopy. [ABSTRACT FROM AUTHOR]

Background: Development of acute kidney injury (AKI) is common and is associated with poor outcomes. We aimed to determine whether hypoalbuminemia (HA) at admission could be a risk factor for the development of AKI and mortality in hospitalized patients. Methods: We enrolled patients who were admitted to Seoul National University Bundang Hospital from January 2013 to December 2013. HA at admission was defined as a serum albumin level < 3.4 mg/dL measured within two days after admission. AKI was defined as an increase in the serum creatinine level by ≥0.3 mg/dL or ≥1.5 times of the baseline value during the hospital stay. Results: A total of 19,472 patients were enrolled and divided into HA and normoalbuminemia (NA) groups at admission. The incidence of AKI was 10.7% (340/3179) in the HA group and 4.1% (662/16293) in the NA group (adjusted odds ratio [OR], 1.243; 95% confidence interval [CI], 1.069–1.445; P = 0.005). The hazard ratios for the 30-day, 90-day, and 1-year mortality were 1.873 (95% CI, 1.383–2.537; P < 0.001), 1.710 (95% CI, 1.410–2.072; P < 0.001), and 1.372 (95% CI, 1.214–1.551; P < 0.001), compared to the NA group. In patients with AKI, albumin replacement improved renal recovery (OR, 2.605; 95% CI, 1.450–4.681; P = 0.001). The mortality rate was not different according to albumin replacement. Conclusions: HA is associated with the development of AKI and high mortality in hospitalized patients. Replacement of albumin after the development of AKI may contribute to renal recovery. Further clinical trials are warranted. [ABSTRACT FROM AUTHOR]

Background and Objectives: Both hyponatremia and acute kidney injury (AKI) are common and harmful in hospitalized patients. However, their combined effects on patient mortality have been little studied. Methods: We retrospectively enrolled 19191 adult patients who were admitted for 1 year. Pre-existing hyponatremia was defined as a serum sodium level < 135 mmol/L on the first measurement of their admission. AKI was defined as a rise in serum creatinine by ≥ 26.5 μmol/L or ≥ 1.5 times of the baseline value of creatinine during the hospital stay. Results: The prevalence of pre-existing hyponatremia was 8.2%. During a median 6.0 days of hospital stay, the incidence rates of AKI and in-hospital patient mortality were 5.1% and 0.9%, respectively. Pre-existing hyponatremia independently predicted AKI development and in-hospital mortality (adjusted hazard ratio [HR] 1.300, P = 0.004; HR 2.481, P = 0.002, respectively). Pre-existing hyponatremia and subsequent development of AKI increased in-hospital mortality by 85 times, compared to the patients with normonatremia and no AKI. In subgroup analysis, the AKI group showed higher rates of de novo hypernatremia than the non-AKI group during the admission. De novo hypernatremia, which might be associated with over-correction of hyponatremia, increased in-hospital mortality (HR 3.297, P <0.001), and patients with AKI showed significantly higher rates of de novo hypernatremia than patients without AKI (16.2% vs. 1.4%, P < 0.001, respectively). Conclusion: Pre-existing hyponatremia may be associated with the development of AKI in hospitalized patients, and both hyponatremia and hospital-acquired AKI could have a detrimental effect on short term patient mortality, which might be related to the inappropriate correction of hyponatremia in AKI patients. [ABSTRACT FROM AUTHOR]

Background: Elderly patients have an increased risk for acute kidney injury (AKI). However, few studies have reported on predictors for AKI in geriatric patients. Therefore, we aimed at determining the effect of frailty as a predictor of AKI. Methods: We retrospectively enrolled 533 hospitalized elderly patients (aged ≥ 65 years) who had their creatinine levels measured (≥ 1 measurement) during admission for a period of 1 year (2013) and conducted a comprehensive geriatric assessment (CGA) within 1 year before the index hospitalization. We examined five variables (activity of daily living [ADL] and instrumental ADL dependence, dementia, nutrition, and polypharmacy) from CGA. We categorized the patients into 3 groups according to the tertile of aggregate frailty scores: Group 1, score 1–2; Group 2, score 3–4; Group 3, score 5–8). Results: Fifty-four patients (10.1%) developed AKI (median duration, 4 days). The frailest group (Group 3) showed an increased risk of AKI as compared to Group 1, (hazard ratio [HR] = 3.536, P = 0.002). We found that discriminatory accuracy for AKI improved with the addition of the tertile of aggregate frailty score to covariates (area under the receiver operator characteristics curves [AUROC] 0.641, AUROC 0.739, P = 0.004). Forty-six patients (8.6%) were transferred to nursing facilities and 477 patients (89.5%) were discharged home. The overall 90-day and 1-year mortality for elderly inpatients were 7.9% and 26.3%. The frailest group also demonstrated an increased risk of discharge to nursing facilities, and 90-day and 1-year mortality as compared to Group 1, independent of AKI severity (nursing facilities: odd ratio = 4.843, P = 0.002; 90-day mortality: HR = 6.555, P = 0.002; 1-year mortality: HR = 3.249, P = 0.001). Conclusions: We found that frailty may independently predict the development of AKI and adverse outcomes in geriatric inpatients. [ABSTRACT FROM AUTHOR]

Background and Objectives: Cardiovascular outcomes and mortality rates are poor in advanced chronic kidney disease (CKD) patients. Novel risk factors related to clinical outcomes should be identified. Methods: A retrospective analysis of data from a randomized controlled study was performed in 440 CKD patients aged > 18 years, with estimated glomerular filtration rate 15–60 mL/min/1.73m2. Clinical data were available, and the albumin-adjusted serum anion gap (A-SAG) could be calculated. The outcome analyzed was all-cause mortality. Results: Of 440 participants, the median (interquartile range, IQR) follow-up duration was 5.1 (3.0–5.5) years. During the follow-up duration, 29 participants died (all-cause mortality 6.6%). The area under the receiver operating characteristic curve of A-SAG for all-cause mortality was 0.616 (95% CI 0.520–0.712, P = 0.037). The best threshold of A-SAG for all-cause mortality was 9.48 mmol/L, with sensitivity 0.793 and specificity 0.431. After adjusting for confounders, A-SAG above 9.48 mmol/L was independently associated with increased risk of all-cause mortality, with hazard ratio 2.968 (95% CI 1.143–7.708, P = 0.025). In our study, serum levels of beta-2 microglobulin and blood urea nitrogen (BUN) were positively associated with A-SAG. Conclusions: A-SAG is an independent risk factor for all-cause mortality in advanced CKD patients. The positive correlation between A-SAG and serum beta-2 microglobulin or BUN might be a potential reason. Future study is needed. Trial Registration: Clinicaltrials.gov [ABSTRACT FROM AUTHOR]

Background and Objectives: There has been little published information on risk factors for poor long-term outcome in adult biopsy-proven minimal change disease (MCD). Methods: Data from sixty-three adult, biopsy-proven primary MCD patients treated at a tertiary university hospital between 2003 and 2013 were analyzed. Baseline clinical and pathologic factors were assessed for the associations with composite outcome of creatinine doubling, end stage renal disease, or all-cause mortality. Results: During a median (interquartile) 5.0 (2.8–5.0) years, the composite outcome occurred in 11.1% (7/63) of patients. The rate of glomerular immune deposits was 23.8% (15/63). Patients with glomerular immune deposits showed a significantly lower urine protein creatinine ratio than those without deposits (P = 0.033). The rate of non-responders was significantly higher in patients with glomerular immune deposits than in those without deposits (P = 0.033). In patients with deposits, 26.7% (4/15) developed the composite outcome, while only 6.3% (3/48) developed the composite outcome among those without deposits (P = 0.049). In multivariate Cox proportional hazards regression analysis, the presence of glomerular immune deposits was the only factor associated with development of the composite outcome (hazard ratio: 2.310, 95% confidence interval: 1.031–98.579, P = 0.047). Conclusion: Glomerular immune deposits were associated with increased risk of a composite outcome in adult MCD patients. The higher rate of non-responders in patients with deposits might be related to the poor outcome. Future study is needed. [ABSTRACT FROM AUTHOR]

A polarization reconfigurable patch antenna with electric current disturbance is proposed in this paper. The proposed antenna mainly consists of a rhombus-shaped patch with a single feed, two conductive pads with a via hole, and two PIN diodes. The antenna can produce the linear polarization (LP), right-hand circular polarization (RHCP), and left-hand circular polarization (LHCP) by adjusting bias state of two PIN diodes. Besides, positions of the PIN diodes help that a bias circuit can be simply designed. The fabricated antenna provides a 10-dB bandwidth of 50 MHz in the two-off state of PIN diodes (LP, 2.635–2.685 GHz), 60 MHz in the two-on state of PIN diodes (LP, 2.625–2.685 GHz), 100 MHz in the RHCP and LHCP (2.57–2.67 GHz). Besides, it has −3 dB axial ratio bandwidth of 55 MHz in the circular polarization states. Details of the antenna design are shown, and the simulated and measured results for the constructed prototype are also presented and discussed. [ABSTRACT FROM AUTHOR]

Background and Objectives: Although acute kidney injury (AKI) is the most frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), few studies have been conducted on the risk factors of AKI. We performed this study to identify the risk factors of AKI associated with in-hospital mortality. Methods: Data from 322 adult patients receiving ECMO were analyzed. AKI and its stages were defined according to Kidney Disease Improving Global Outcomes (KDIGO) classifications. Variables within 24 h before ECMO insertion were collected and analyzed for the associations with AKI and in-hospital mortality. Results: Stage 3 AKI was associated with in-hospital mortality, with a hazard ratio (HR) (95% CI) of 2.690 (1.472–4.915) compared to non-AKI (p = 0.001). The simplified acute physiology score 2 (SAPS2) and serum sodium level were also associated with in-hospital mortality, with HRs of 1.02 (1.004–1.035) per 1 score increase (p = 0.01) and 1.042 (1.014–1.070) per 1 mmol/L increase (p = 0.003). The initial pump speed of ECMO was significantly related to in-hospital mortality with a HR of 1.333 (1.020–1.742) per 1,000 rpm increase (p = 0.04). The pump speed was also associated with AKI (p = 0.02) and stage 3 AKI (p = 0.03) with ORs (95% CI) of 2.018 (1.129–3.609) and 1.576 (1.058–2.348), respectively. We also found that the red cell distribution width (RDW) above 14.1% was significantly related to stage 3 AKI. Conclusion: The initial pump speed of ECMO was a significant risk factor of in-hospital mortality and AKI in patients receiving ECMO. The RDW was a risk factor of stage 3 AKI. [ABSTRACT FROM AUTHOR]

Circulating tumor cells (CTCs) are defined as cells that have detached from a primary tumor and are circulating in the bloodstream. Their isolation and quantification is of great value for cancer prognoses and drug testing. Here, the development of a centrifugal affinity plate (CAP) system is described, in which centrifugal force and antibody-based capture are exploited to enrich CTCs on one plate and hematological cells on the other. The CAP is rotated to exert centrifugal force on the cells in a blood sample, quickly transporting them to the anti-epithelial adhesion molecule (EpCAM)-coated and anti-CD45-coated surface of the CAP to shorten the reaction time and increase the adhesion force between the tumor and blood cells and each antibody. The effect of a rotating process on cell capture was investigated, and the capture efficiency was demonstrated using blood samples from healthy donors spiked with human non-small cell lung cancer (NCI-H1650) and breast cancer (MCF-7) cells. The CAP system was capable of rapid isolation and identification of CTCs without the requirement for pretreatment of blood samples. Finally, the CAP system was tested to evaluate the detection efficiency of CTCs in the blood samples of breast cancer patients. The number of captured CTCs in only 1 ml of blood varied from 6 to 10. [ABSTRACT FROM AUTHOR]

We report on the molecular weight effect of polystyrene (PS) gate dielectric on the characteristics of pentacene thin-film transistors. Dielectric layers were formed by using three different PS molecules of high molecular weight (PS-H) and low molecular weight (PS-L), and their blend (PS-B). The transistor having the PS-H gate dielectric exhibited the most pronounced drain currents as well as mobility. The gate-leakage current for the device with PS-H was even lower by one order of magnitude than that for the device with PS-L. The results are explained with the relationship between the surface characteristics of gate dielectric layer together with pentacene grain size and the transistor performances. [ABSTRACT FROM AUTHOR]

Highlights: [•] Tm2O3 nanosquare sheets were synthesized by a hydrothermal method. [•] The crystal structures and planes were fully examined. [•] Spectroscopic properties were fully revealed. [•] H2, O2 and CO activities of the sheets were tested. [ABSTRACT FROM AUTHOR]

Abstract: The longevity of subsurface U(IV) produced by reduction of U(VI) during in situ bioremediation can be limited by reoxidation to more mobile U(VI) species. Coupling of the biogeochemical cycles of U and Mn may affect the fate and transport of uranium. Manganese oxides can act as a powerful oxidant that accelerates the oxidative dissolution of UO2. This study investigated the physical and chemical factors controlling the interaction between UO2 and MnO2, which are both poorly soluble minerals. A multi-chamber reactor with a permeable membrane was used to eliminate direct contact of the two minerals while still allowing transport of aqueous species. The oxidation of UO2 was not significantly enhanced by MnO2 if the two solids were physically separated. Complete mixing of MnO2 with UO2 led to a much greater extent and rate of U oxidation. When direct contact is not possible, the reaction slowly progresses through release of soluble U(IV) with its adsorption and oxidation on MnO2. Continuously-stirred tank reactors (CSTRs) were used to quantify the steady-state rates of UO2 dissolution induced by MnO2. MnO2 dramatically promoted UO2 dissolution, but the degree of promotion leveled off once the MnO2:UO2 ratio exceeded a critical value. Substantial amounts of U(VI) and Mn(II) were retained on MnO2 surfaces. The total production of Mn(II) was less than that of U(VI), indicating that the fate of Mn products and their impact on UO2–MnO2 reaction kinetics were complicated and may involve formation of Mn(III) phases. At higher dissolved inorganic carbon concentrations, UO2 oxidation by MnO2 was faster and less U(VI) was adsorbed to MnO2. Such an inverse relationship suggested that U(VI) may passivate MnO2 surfaces. A conceptual model was developed to describe the oxidation rate of UO2 by MnO2. This model is potentially applicable to a broad range of water chemistry conditions and is relevant to other environmental redox processes involving two poorly soluble minerals. [Copyright &y& Elsevier]

Abstract: This study describes a new QuEChERS method referred to as the dry ice-partitioning QuEChERS method. This current method can be differentiated from the other QuEChERS methods in the sense that it uses dry ice rather than salts or buffers to extract and partition pesticides in the first extraction step. The dry ice-partitioning QuEChERS method consists of extraction method A (for detection of the acetonitrile layer) and extraction method B (for detection of both acetonitrile and aqueous layers). The extraction efficiency was then compared with the citrate-buffering QuEChERS method by means of recovery. Recovery values of the tested 168 pesticides were above 76%, with relative standard deviations of less than 20%. Certain problematic pesticides, including benfuracarb, carbosulfan, dichlofluanid, probenazole, pymetrozine, tolylfluanid, TFNA, and TFNG evidenced acceptable recoveries via the dry ice-partitioning QuEChERS method compared to the less than 70% recoveries of the citrate-buffering QuEChERS method examined herein. The matrix effect of paprika on the method developed herein was not significant, and matrix-matched calibration was performed well, with an r 2 ≥0.99. The dry ice-partitioning QuEChERS method is capable of detecting the aqueous layer as well as the acetonitrile layer; this interesting feature makes it worth in application as an alternative QuEChERS method for the multiresidue analysis of pesticides within a broad polarity range in various matrices. [Copyright &y& Elsevier]

Block copolymers have been investigated for fabricating functional nanomaterials due to their properties of self-assembly. We prepared polystyrene-b-poly(2-vinyl pyridine) (PS-b-P2VP) lamellar films which is hydrophobic block-hydrophilic polyelectrolyte block polymer have 57 kg/mol-b-57 kg/mol. The lamellar stacks are obtained by exposing the spin coated film under chloroform. The P2VP blocks were then quaternized and crosslinked to various extents using 5 wt% of iodomethane. PS-b-P2VP films showed excellent photonic bands at 630 nm after swelling with ethanol and 661 nm with water after treated with Calcium Carbonate. We observed significant band shift from 663 nm (deep red) to 531 nm (green) during UV-irradiation for 40 seconds. The phase separation process of BCP was very sensitive to the film thickness. The quarternized films with thickness varied from 0.43 µm (446 nm transmittance minimum) to 0.25 μm (478 nm transmittance minimum). This study shows that the total film thickness and UV irradiation effectively change the transmittance band by affecting the thickness of layers consisting of PS-b-P2VP photonic crystals. [ABSTRACT FROM AUTHOR]

Methane and nitrous oxide are both potent greenhouse gasses, with global warming potentials approximately 25 and 298 times that of carbon dioxide. A matrix of soil microcosms was constructed with landfill cover soils collected from the King Highway Landfill in Kalamazoo, Michigan and exposed to geochemical parameters known to affect methane consumption by methanotrophs while also examining their impact on biogenic nitrous oxide production. It was found that relatively dry soils (5% moisture content) along with 15 mg NH (kg soil)−1 and 0.1 mg phenylacetylene∙(kg soil)−1 provided the greatest stimulation of methane oxidation while minimizing nitrous oxide production. Microarray analyses of pmoA showed that the methanotrophic community structure was dominated by Type II organisms, but Type I genera were more evident with the addition of ammonia. When phenylacetylene was added in conjunction with ammonia, the methanotrophic community structure was more similar to that observed in the presence of no amendments. PCR analyses showed the presence of amoA from both ammonia-oxidizing bacteria and archaea, and that the presence of key genes associated with these cells was reduced with the addition of phenylacetylene. Messenger RNA analyses found transcripts of pmoA, but not of mmoX, nirK, norB, or amoA from either ammonia-oxidizing bacteria or archaea. Pure culture analyses showed that methanotrophs could produce significant amounts of nitrous oxide, particularly when expressing the particulate methane monooxygenase (pMMO). Collectively, these data suggest that methanotrophs expressing pMMO played a role in nitrous oxide production in these microcosms. [ABSTRACT FROM AUTHOR]

Abstract: This paper reports the results of single-cell assays in a compact disc (CD)-like lab chip, with the single cells trapped by a centrifugal force. This study aims to implement a single-cell assay on a chip, with the advantage of excluding the paracrine effect of the adjacent cells. The spiral channel in the CD-like lab chip had many pitfalls outside its microchannel wall, and it was here that the cells were trapped. Each cell in the trapping pitfall was treated with a toxic chemical that was transported by centrifugal pumping. The parameters that affected the cell trapping were the size of the cells, the structure of the micro-pattern, the magnitude of the centrifugal force, and the duration of trapping. The trapping ratio of the HEK293 cells was around 80% at optimal conditions, at 1200rpm, and at 120s duration. After the cells were trapped, cytotoxicity and apoptosis tests were performed on the CD to investigate the effect of single-cell assay. The cytotoxicity was tested by treating the cells with parformaldehyde, and the apoptosis was caused by UV light illumination. The results of both assays showed that the overall trend of the single-cell assay in the chip was in good agreement with that of conventional assay methods. However, the cytotoxicity test showed that the rate of survival of the single-cells in the chip in the single-cell assay was higher than that of the crowded cells due to the effect of harmful proteases from the lysis of the adjacent cells. On the contrary, the apoptosis assay results did not show any significant difference. Therefore, this study demonstrated that single-cell assay on a CD-like chip can exhibit different results according to the assay method and could be a valuable tool in the study and analysis of various single-cell assays. [Copyright &y& Elsevier]

Abstract: Several studies have shown that there is an imbalance between pro-inflammatory and anti-inflammatory cytokines in major depressive disorder (MDD). However, little is known about the role of cytokines in suicide. In the present study, amounts of IL-6, IL-2, IFN-γ, IL-4, and TGF-β1 produced by mitogen-stimulated whole blood were measured in 36 MDD patients who had recently attempted suicide, 33 non-suicidal MDD patients, and 40 normal controls. The severity of depression symptoms and suicidal behaviors was evaluated using Hamilton''s depression rating scale (HDRS), the Lethality Suicide Attempt Rating Scale (LSARS), and the Risk-Rescue Rating (RRR). Non-suicidal MDD patients had significantly higher IL-6 production than suicidal MDD patients and normal controls (p <0.001). Suicidal MDD patients had significantly lower IL-2 compared with non-suicidal patients and normal controls (p <0.001). Both MDD groups, with or without attempted suicide, had significantly lower IFN-γ and IL-4 and higher TGF-β1 production. HDRS scores had significant positive correlations with IL-6, IFN-γ, and the Th1/Th2 ratio and significant negative correlations with IL-4 in non-suicidal depression patients (p <0.005); however, these correlations did not hold true for suicidal patients. Suicidal MDD patients had no significant correlations between the LSARS or RRR scores and cytokine release. Our findings suggest that the immune response has distinct differences between non-suicidal patients and suicidal patients. Non-suicidal MDD may be associated with increased IL-6 production and a Th1/Th2 imbalance with a shift to Th1, while suicidal MDD may be associated with decreased IL-2. [Copyright &y& Elsevier]

Summary: Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite aggressive respiratory support, one succumbed to respiratory failure 3.5h after inhalation. The other patient also rapidly progressed to respiratory failure. Extracorporeal life support (ECLS) was started 5h after exposure at the ED. During ECLS, hypoxia improved, but pulmonary oedema shown by chest radiography became aggravated. N-Acetyl cysteine and calcium gluconate were given i.v. on the first day of admission and nebulised for 48h after exposure. Pulmonary secretions were significantly reduced 24h after the nebulising therapy began. Ultimately, the patient was discharged without serious pulmonary or neurological complications after 28 days of hospitalisation. In this case, early ECLS, nebulised antioxidant and antidote were available to treat potentially fatal pulmonary oedema after exposure to nitric and hydrofluoric acid fumes. [Copyright &y& Elsevier]

Summary: Extracorporeal life support has been used as an extension of conventional cardiopulmonary resuscitation (CPR). However, the appropriate indications for extracorporeal CPR (ECPR) including the duration of CPR are unknown. We present a case of a male, 37-year-old out-of-hospital cardiac arrest patient who received prolonged CPR followed by ECPR. Despite advanced cardiac life support, he did not regain a sustained spontaneous circulation and had recurrent ventricular fibrillation (VF) during the prolonged CPR. VF was unresponsive to CPR, defibrillation, adrenaline (epinephrine), and antiarrhythmics. The CPR time before ECPR was approximately 2h. During extracorporeal life support, the VF did not recur and percutaneous coronary angioplasty was achieved. Ultimately, the patient was discharged without neurological complications. Although cardiac arrest occurred out-of-hospital and CPR was performed for a long time, a patient might be a candidate for ECPR if perfusing rhythms are restored transiently but not successfully maintained due to recurrent VF. ECPR may be used for VF unresponsive to standard CPR techniques. [Copyright &y& Elsevier]

Abstract: This paper reports the pre-concentration of C-reactive protein (CRP) antigen with packed beads in a microfluidic chamber to enhance the sensitivity of the miniaturized fluorescence detection system for portable point-of-care testing devices. Although integrated optical systems in microfluidic chips have been demonstrated by many groups to replace bulky optical systems, the problem of low sensitivity is a hurdle for on-site clinical applications. Hence we integrated the pre-concentration module with miniaturized detection in microfluidic chips (MDMC) to improve analytical sensitivity. Cheap silicon-based photodiodes with optical filter were packaged in PDMS microfluidic chips and beads were packed by a frit structure for pre-concentration. The beads were coated with CRP antibodies to capture antigens and the concentrated antigens were eluted by an acid buffer. The pre-concentration amplified the fluorescence intensity by about 20-fold and the fluorescence signal was linearly proportional to the concentration of antigens. Then the CRP antigen was analyzed by competitive immunoassay with an MDMC. The experimental result demonstrated that the analytical sensitivity was enhanced up to 1.4nM owing to the higher signal-to-noise ratio. The amplification of fluorescence by pre-concentration of bead-based immunoassay is expected to be one of the methods for portable fluorescence detection system. [Copyright &y& Elsevier]

Abstract: Objective: In the Emergency Department, it would be worthwhile to treat pneumothorax patients on an outpatient basis by utilizing a small-calibre catheter and Heimlich valve insertion. We evaluated this treatment and compared it with the closed thoracostomy. Methods: In this comparative study, the success rate, complications and recurrence rate of treating spontaneous pneumothorax patients by using a small-calibre catheter and Heimlch valve were compared with those of a similar-sized group treated by closed thoracostomy. Results: Pneumothorax was successfully treated on an ambulatory basis by using the small-calibre catheter and Heimlch valve in 20 patients (47%); this was less than the 42 patients (89%) who were successfully treated by closed thoracostomy. While no complications were encountered in the group treated using the small-calibre catheter and Heimlich valve, 11 patients in the group treated by closed thoracostomy developed complications. The medical expenses for the treatment involving the small-calibre catheter and Heimlich valve were less than those for closed thoracostomy. Conclusion: Prior to the treatment, the patients should be fully informed of the success rate of this treatment and the possibility of requiring closed thoracostomy in the event of treatment failure. [Copyright &y& Elsevier]

Summary: Aims: The purpose of this study was to determine the clinical value of arterial minus end-tidal CO2 [P(a–et)CO2] and alveolar dead space ventilation ratio (V dA/V t) as indicators of hospital mortality in patients that have been resuscitated from cardiac arrest at emergency department. Materials and methods: Forty-four patients with a return of spontaneous circulation (ROSC) after cardiac arrest were studied in the emergency department of a university teaching hospital from March 2004 to February 2006. Mean arterial pressure (MAP), serum lactate, arterial blood gas studies, end-tidal CO2 (EtCO2), P(a–et)CO2, and V dA/V t were evaluated at 1h after ROSC. We compared these variables between hospital survivors and non-survivors. Results: The rates of ventricular fibrillation and pulseless ventricular tachycardia in hospital survivors were higher than those of non-survivors (53.0 and 9.7%, respectively, p =0.002). Hospital survivors had significantly higher MAP, lower serum lactate, lower P(a–et)CO2, and lower V dA/V t value than non-survivors. Receiver operator characteristic (ROC) curves of serum lactate, P(a–et)CO2, and V dA/V t showed significant sensitivity and specificity for hospital mortality. Specifically, lactate ≥10.0mmol/L, P(a–et)CO2 ≥12.5mmHg, and V dA/V t ≥0.348 were all associated with high hospital mortality (p =0.000, 0.001 and 0.000, respectively). Conclusions: This study showed that high serum lactate, high P(a–et)CO2 and high V dA/V t during early ROSC in cardiac arrest patients suggest high hospital mortality. If future studies validate this model, the P(a–et)CO2 and V dA/V t may provide useful guidelines for the early post-resuscitation care of cardiac arrest patients in emergency departments. [Copyright &y& Elsevier]

The importance of oral mucosal wetness in the condition of dry mouth and the role of salivary proteins in proper oral function are acknowledged. A negative correlation between mucosal wetness and the protein concentration of residual saliva has been reported in normosalivators. Here, to examine the suggestion that a reduction in residual salivary volume leads to a concomitant elevation of its protein concentration, the amount of residual saliva and minor salivary gland secretions, and their protein concentrations, were measured in hyposalivators and normosalivator controls. A Periotron 8000® micro-moisture meter was used to measure the thickness of the mucosal film at six selected mucosal surfaces and the minor salivary gland secretion rate at two mucosal surfaces. The unstimulated whole salivary flow rate was measured by the spitting method. The total protein concentration of all salivary samples was measured by bicinchoninic acid assay. The hyposalivators had significantly lower amounts of residual saliva and minor salivary gland secretions than the normosalivators at all selected mucosal sites except the soft palate. In both groups, the site with the thinnest coat of residual saliva was the anterior hard palate and the wettest site was the anterior dorsal mucosa of the tongue. The protein concentration of residual saliva was significantly higher in hyposalivators than normosalivators. In the minor salivary gland secretions there was no significant difference in protein concentration between the normo- and hyposalivators. When the hyposalivators were divided into two subgroups according to their severity of dryness, the reduction of residual salivary volume and the elevation of protein concentration were more apparent in the group with the more severe dry mouth. Collectively, these results indicate that oral mucosal wetness is associated with the flow rate of unstimulated whole saliva. The function of the minor salivary glands was less affected and relatively well preserved in patients with dry mouth. The increased protein concentration of residual saliva in the hyposalivators appeared to be the result of decreased salivary volume. [Copyright &y& Elsevier]

Background. In the Republic of Korea, a trauma care system was not created until 2012, at which point regional trauma centers (RTCs) were established nationwide. In accordance with the national emergency care system and legislation, regional and local emergency medical centers (EMCs) also treat patients presenting with trauma. The aim of the present study was to assess whether treatment in RTCs is truly associated with better patient outcomes than that in EMCs by means of propensity score-matched comparisons and to identify populations that would benefit from treatment in RTCs. Methods. This study analyzed the data of patients with consecutive emergency visits between January 1, 2018, and December 31, 2018, collected in the National Emergency Department Information System registry. Data from RTCs, designated regional EMCs, or local EMCs were included; data from smaller emergency departments were excluded because, in Korea, dedicated RTCs are established only in hospitals with regional or local EMCs. Propensity scores for treatment in RTCs or EMCs were estimated by logistic regression using linear terms. Mortality rates in RTCs and EMCs were compared between the matched samples. Results. The in-hospital mortality rates in the matched cases treated in RTCs and EMCs were 1.4% and 1.6%, respectively. The odds ratio for in-hospital mortality in RTCs over EMCs was 0.984 (95% confidence interval: 0.813–1.191). Among the subgroups evaluated, the subgroup of patients with injuries involving the chest or lower limbs showed a significant difference in the in-hospital mortality rate. Conclusion. There was no significant difference in the overall severity-adjusted mortality rate between patients treated in RTCs and EMCs. Treatment in an RTC might benefit those with injuries involving the chest or lower limbs. [ABSTRACT FROM AUTHOR]

Background: Despite advancements in emergency medical systems, inter-hospital transfer (IHT) remains a critical component. Several studies have analyzed the impact of IHT on patient outcomes. Some studies have reported positive effects, indicating that transfers can improve patient prognosis. However, other studies have suggested that transfers may worsen outcomes. We investigated whether IHT is associated with in-hospital mortality. Methods: This retrospective observational study utilized data on patient outcomes from the National Emergency Department Information System (NEDIS) from 2016 to 2018, focusing on patients admitted to hospitals after visiting the emergency department (ED). The primary outcome was the in-hospital mortality rate. Results: This study included 2,955,476 adult patients admitted to emergency medical centers, with 832,598 (28.2%) undergoing IHT. The in-hospital mortality rate was significantly higher in the transfer group (6.9%) than in the non-transfer group (4.8%). Multiple logistic regression analysis revealed that IHT was an independent predictor of in-hospital mortality (adjusted odds ratio [aOR] 1.114, 95% confidence interval [CI] 1.101–1.128) after adjusting for variables. Sub-analysis indicated that higher severity scores, shorter symptom onset-to-arrival duration, and diagnoses of infectious or respiratory diseases were significantly associated with increased in-hospital mortality among transferred patients. Conclusions: This study identifies IHT as a significant factor associated with increased in-hospital mortality. Additionally, it suggested the need for policies to mitigate the risks associated with IHT, particularly in critically ill patients, those with the acute phase response, and those with infectious, genitourinary, and respiratory diseases. [ABSTRACT FROM AUTHOR]

• Biochars made from rice straw (RSB) were used as support of Ru-ReO x catalysts. • Surface property and porosity were engineered by varying pyrolysis atmosphere. • Alkali metals contained in RSB affected the catalytic properties. • Ru-ReO x /RSB catalysts were active for furan conversion into platform chemicals. In this study, biochars produced in two different atmospheres were used as catalysts for the valorization of furan, which derives from the hemicellulosic component of waste biomass. The biochars were produced from rice straw via pyrolysis in either an N 2 or a CO 2 environment (RSB-N 2 or RSB-CO 2) to modify their surface area and porosity. The biochars were then employed as a catalyst to support a bifunctional Ru–ReO x catalyst. The biochar-supported Ru–ReO x catalysts (Ru–ReO x /RSB) were compared to a conventional activated charcoal (AC)-supported Ru–ReO x catalyst (Ru–ReO x /AC). The biochar-supported catalysts exhibited differences in reducibility and contained a different form of Re species compared to the AC-supported catalyst, which was attributed to the presence of alkali metal (e.g., potassium) in the biochar catalysts. The reducibility and metal dispersion on the support were also strongly associated with the atmosphere under which the biochar was produced. In particular, the Ru–ReO x /RSB-CO 2 catalyst consumed 24% more hydrogen than did the Ru–ReO x /RSB-N 2 catalyst within a temperature range of 250 to 560 °C. The biochar-supported catalysts had 12 times fewer surface metal sites than did the AC-supported catalyst due to their lower surface area. The reaction rate on a per-site basis for the conversion of furan to tetrahydrofuran and 1,4-butanediol was also measured for the catalysts. The Ru–ReO x /RSB-N 2 catalyst was twice as active as the Ru–ReO x /RSB-CO 2 catalyst and three times more active than the Ru–ReO x /AC catalyst. This study thus proposes a straightforward strategy for modifying the catalytic properties of biochar catalysts and suggests a new application of biochar in the production of value-added chemicals from biomass and waste. The results also highlight the potential of biochar as a replacement for conventional catalysts in biorefineries. [ABSTRACT FROM AUTHOR]

Purpose: This study compared clinical outcomes depending on the fixation modality in patients who underwent arthrodesis surgery for Eaton-Littler stage III trapeziometacarpal (TM) joint arthritis between 2009 and 2022. Methods: In total, 39 patients with 44 hands (five patients had surgery on both hands) were selected. Depending on the operative fixation instruments, patients were divided into two groups: group 1, surgery with 25-gauge interosseous wiring and Kirschner wire or headless screw fixation; group 2, surgery with only multiple headless screws for fixation. Bone union was achieved at 62 days after surgery in group 1 and 75 days in group 2 (p=0.165). Results: The preoperative mean visual analogue scores improved during the postoperative outpatient follow-up period in both groups (group 1, from 4.0 preoperatively to 1.0 at the final follow-up; group 2, from 5.0 preoperatively to 2.0 at the final follow-up). Mean grip strength and pinch strength increased after surgery. One patient (4.8%) experienced nonunion in group 1, whereas nonunion occurred in four patients (17.4%) in group 2. This difference was not statistically significant. Four patients in group 1 and no patients in group 2 underwent fixation instrument removal after sound union. Conclusion: Adequate stability can be achieved during arthrodesis by combining interosseous wiring and other implants or multiple headless compression screws, resulting in successful outcomes for patients with Eaton-Littler stage III degenerative TM arthritis. [ABSTRACT FROM AUTHOR]

Objective: Conversion to shockable rhythm from an initial non-shockable rhythm is associated with good neurologic prognoses in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether conversion to shockable rhythm has an association with good neurologic outcomes, according to the etiology of cardiac arrest.Methods: We conducted a nationwide, population-based, cohort study using the OHCA data from the Korea Centers for Disease Control and Prevention database in 2012-2016. We included patients with OHCA and an initial non-shockable rhythm. The primary outcome was good neurologic outcome at discharge, etiologies of arrest were categorized to medical, non-medical cause. We analyzed the effect of conversion to a shockable rhythm on outcome according to causes of cardiac arrest using multiple regression analysis.Results: Of 114,628 patients with an initial non-shockable rhythm, 25,042 (21.8%) experienced conversion to a shockable rhythm; 83,437 (72.8%) had medical causes and 31,191(27.2%) had non-medical causes. In all patients with OHCA and initial non-shockable rhythm, adjusted odds ratio (OR) of conversion for good neurologic outcome was 2.051 (95% confidence interval [CI] 1.181-2.297). The medical cause group showed an adjusted OR 1.789 (95% CI 1.586-2.019) of conversion for good neurologic outcome. In non-medical cause group, the adjusted OR of conversion was 0.644 (95% CI 0.372-1.114).Conclusion: Conversion to shockable rhythm had an association with good neurologic outcome in patients with OHCA with initial non-shockable rhythms, especially due to cardiac cause. However, rhythm conversion was not associated with better outcome in patients with non-medical causes. [ABSTRACT FROM AUTHOR]

In patients with out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm, the prognostic significance of conversion to a shockable rhythm (or hereafter "conversion") during resuscitation remains unclear. We investigated whether conversion is associated with good neurologic outcome. We included patients with OHCA with medical causes and an initial non-shockable rhythm by using the national OHCA surveillance cohort database of the Korea Centers for Disease Control and Prevention for 2012~2016. The primary outcome was good neurologic outcome at hospital discharge. Of 85,602 patients with an initial non-shockable rhythm, 17.9% experienced conversion. Patients with and those without conversion had good neurologic outcome rates of 3.2% and 1.0%, respectively (p < 0.001). In multiple regression analysis, conversion was associated with good neurologic outcome (adjusted odds ratio (OR) 2.604; 95% confidence interval (CI) 2.248–3.015) in the patients with an initial non-shockable rhythm, and had the association with good neurologic outcome (adjusted OR 3.972, 95% CI 3.167–4.983) in unwitnessed patients by emergency medical services (EMS) without pre-hospital return of spontaneous circulation (ROSC) among the population. In patients with OHCA with an initial non-shockable rhythm, even if with unwitnessed arrest by EMS and no pre-hospital ROSC, continuing resuscitation needs to be considered if conversion to a shockable rhythm occurred. [ABSTRACT FROM AUTHOR]

There has been paucity of data regarding the secular trend of adverse outcomes in peritoneal dialysis (PD) as compared with hemodialysis (HD) in Korea. 96,596 patients who started dialysis between 2004–2015 in Korea were identified using the National Health Insurance Service database. The adjusted hazard ratio (HR) (95% confidence interval, CI) of PD over HD for mortality was 1.31 (1.27–1.36; P < 0.001) in the period of 2004–2007 and 1.21 (1.16–1.27; P < 0.001) in the period of 2008–2011. However, the hazard of PD over HD for mortality turned out to be insignificant in the period of 2012–2015. Similar trend was noted for nonfatal cardiovascular events (CVEs). In subgroup analysis, the hazard of PD over HD for mortality was evident, regardless of the status of age, diabetes, and comorbidity burden in 2004–2011. In 2012–2015, however, the hazard of PD over HD for mortality was insignificant when follow up was censored at one year, which became significant when follow up follow up was censored at three or five year. In conclusion, the mortality of PD over HD in Korea has been significantly improved, a finding that was paralleled by the improved nonfatal CVEs. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid function is evaluated by thyroid stimulating hormone (TSH) and free thyroxine (fT4). Although many studies have indicated an intimate relationship between thyroid hormones and kidney functions, reports about the simultaneous evaluation of TSH and fT4 are rare. Objective: We aimed to analyze the association between TSH and kidney function, with emphasis on a potential nonlinear relationship, and identify an independent relationship between fT4 and kidney function. Methods: We reviewed the data of 7,061 subjects in the Korea National Health and Nutrition Examination Surveys who were randomly subsampled for thyroid function evaluation between 2013 and 2015. A total of 5,578 subjects were included in the final analysis, after excluding people <18 years old, and those with a short fasting time, abnormal fT4 levels, and thyroid disease or related medications. Creatinine-based estimated glomerular filtration rate (eGFR) was used to define kidney function. Results: A 1 mmol/L increase of logarithmic TSH was associated with decreased eGFR (β: –1.8; 95% CI –2.3 to –1.2; p < 0.001), according to multivariate linear regression analysis. On the multivariate generalized additive model plot, TSH demonstrated an L-shaped relationship with eGFR, showing a steeper slope for 0–4 mIU/L of TSH. A 1 µg/dL increase of fT4 was also associated with decreased eGFR (β: –7.0; 95% CI –0.94 to –4.7; p < 0.001) on the multivariate linear regression analysis; this association was reversed after adjusting for age. On the mediation analysis, the indirect effect via age and direct effect per 1 µg/dL increase of fT4 on eGFR was 9.9 (8.1 to 11.7, p < 0.001) and –7.1 (–9.3 to –4.8, p < 0.001), respectively. Conclusions: Increased TSH was associated with decreased eGFR, particularly in the reference range. The direct effect of increased fT4 was decreased eGFR, which may be affected indirectly by age. [ABSTRACT FROM AUTHOR]