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Cerebral blood flow (CBF) plays a vital role in delivering cerebral oxygen, and the accurate assessment of CBF is crucial for the intraoperative management of critically ill infants. Although the direct measurement of CBF is challenging, CBF velocity (CBFV) can be assessed using transcranial Doppler. Recent advances in point-of-care ultrasound have introduced brain ultrasound as a feasible intraoperative option, in which transfontanelle ultrasonography (TFU) has been applied to measure the CBFV through the anterior fontanelle. However, the intraoperative application of TFU in pediatric patients remains limited. The present review highlights the procedural aspects and clinical applications of TFU for anesthetic and intensive care management in pediatric patients. TFU facilitates the visualization of cerebral vessels and allows a noninvasive assessment of cerebral hemodynamics. The clinical significance of TFU involves its usefulness in various clinical scenarios, including monitoring CBF during cardiac surgery, assessing fluid responsiveness, and estimating intracranial pressure. TFU also enables the detection of cerebral emboli and the evaluation of anatomical abnormalities such as hydrocephalus or intracranial hemorrhage. TFU has demonstrated potential as an invaluable tool in pediatric care, despite limited familiarity among anesthesiologists. Additional research is needed to explore the associations between CBF and clinical outcomes, focusing on autoregulation, the impact of physiological changes, the associations of TFU findings with other brain monitoring tools such as electroencephalography, cerebral oximetry, and the implications of microemboli. TFU is a significant advancement and valuable tool for noninvasively assessing cerebral hemodynamics and CBF in pediatric patients with open fontanelles. [ABSTRACT FROM AUTHOR]

Background: The incidence of hypotension in parturients with coronavirus disease (COVID-19) undergoing regional anesthesia remains controversial. This study aimed to investigate the incidence of hypotension during spinal anesthesia in parturients infected with COVID-19, as well as to identify associated risk factors. Methods: This retrospective study compared COVID-19-positive parturients who underwent cesarean section under spinal anesthesia (COVID-19 group) with a control group between January 2017 and June 2022. We reviewed the medical records and collected the following information: basic patient characteristics, spinal anesthesia, and newborn-related data. Results: Compared with the control group, the COVID-19 group did not show any significant differences in terms of hypotension occurrence and vasopressor usage. A positive correlation was noted in the COVID-19 group between heart rate and duration of hospital stay (P < 0.001, Spearman’s rho = 0.422). In subgroup analysis of the COVID-19 group, group with a baseline heart rate ≥ 100 (group H) had lower Apgar scores at 1 min, longer hospital stays, and more severe COVID-19 symptoms than the with a baseline heart rate < 100 (group L). Moreover, in group H, there was a positive correlation between the heart rate and the lowest systolic blood pressure after spinal anesthesia (P = 0.012, Spearman’s rho = 0.528). Conclusions: Parturients with COVID-19 do not appear to have a higher risk of hypotension during cesarean section under spinal anesthesia than those without COVID-19. Given the close association between preoperative heart rate and extent of hypotension in parturients with COVID-19 undergoing spinal anesthesia, vigilant monitoring of vital signs by anesthesiologists is crucial during the perioperative period. [ABSTRACT FROM AUTHOR]

This article introduces The CompanionshipModel as a template for conducting ethical and affirming assessment sessions for transgender and nonbinary youths (TNBY) and their guardians. The Companionship Model emphasizes proactive clinical companionship as TNBY and their guardians navigate access to gender-affirming care. The model offers specific action steps for establishing a therapeutic alliance and centers TNBY and their guardians' access to resources based on the informed consent/assent process. In this article, we provide sample session questions and illustrative clinical examples. [ABSTRACT FROM AUTHOR]

Background: To identify a screening tool for obstructive sleep apnea (OSA) and evaluate the effects of endoscopic transsphenoidal surgery on improving OSA in patients with acromegaly. Methods: We prospectively enrolled adults with acromegaly scheduled for endoscopic transsphenoidal surgery. All measurements were conducted when participants were admitted for a baseline work-up for acromegaly before surgery and surveillance approximately 3 to 6 months after surgery. Respiratory event index (REI) was used as a surrogate for apnea-hypopnea index (Trial Registration: NCT03526016). Results: Of the 35 patients with acromegaly (median age, 47 years; 40% men; median body mass index, 24.4 kg/m2), 24 (68.6%) had OSA (REI =5/hour), 15 (42.9%) had moderate-to-severe OSA (REI =15/hour). At baseline, serum insulin-like growth factor 1 (IGF-1) levels were positively correlated with the REI (ρ=0.53, P=0.001). The sensitivity and negative predictive value of a Snoring, Tiredness, Observed apnea, high blood Pressure-Body mass index, age, Neck circumference, and Gender (STOP-Bang) score = 3 were 93.3% and 87.5%, respectively, detecting moderate-to-severe OSA. Biochemical acromegaly remission was achieved in 32 (91.4%) patients. The median difference in the REI was -9.5/hour (95% confidence interval, -13.3 to -5.3). Half of the 24 patients diagnosed with OSA preoperatively had REI <5/hour postoperatively. In a linear mixed-effects model, changes in the REI across surgery were related to changes in IGF-1 levels. Conclusion: The STOP-Bang questionnaire is a reliable tool for OSA among patients with acromegaly. Improvement in OSA severity after surgery is related to decreased IGF-1 levels. [ABSTRACT FROM AUTHOR]

Objective(s): MicroRNAs (miRNAs) are small non-coding RNAs that function in all biological processes. Recent findings suggest that exosomes, which are small vesicles abundantly secreted by various cell types, can transport miRNAs to target cells. Here, we elucidated the effect of miRNAloaded exosomes on lipopolysaccharide (LPS)-induced inflammation in H9c2 cardiomyocytes. Materials and Methods: Exosomes were isolated from mesenchymal stem cells (MSC) and loaded with miR-412-5p. Additionally, the effect of the miR-412-5p-loaded exosomes on LPS-induced inflammation in H9c2 cardiomyocytes was evaluated by assessing the levels of nitric oxide (NO), reactive oxygen species (ROS), and prostaglandin E2 (PGE2). The expression of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), inflammatory cytokines, and mitogen-activated protein kinase (MAPK) signaling factors was evaluated using reverse transcription-quantitative PCR and western blotting. Results: miR-412-5p-loaded exosomes inhibited LPS-induced secretion of inflammatory mediators (NO, PGE2, and ROS), pro-inflammatory cytokines (IL-1β and IL-6), and COX-2 and iNOS expression. Additionally, miR-412-5p-loaded exosomes significantly decreased the expression of MAPK signaling molecules, including p-extracellular signal-regulated kinase (ERK), p-p38, and p-Jun kinase (JNK), in H9c2 cardiomyocytes. Conclusion: These findings showed that miR-412-5p-loaded exosomes ameliorated LPS-induced inflammation in H9c2 cardiomyocytes by inhibiting COX-2 and iNOS expression, inflammatory mediators, and pro-inflammatory cytokines via the MAPK pathway. The findings indicate that miR- 412-5p-loaded exosomes may be effective for the prevention of myocardial injury. [ABSTRACT FROM AUTHOR]

The mortality rates among critically ill patients with COVID-19 have been high. The national and institutional infection control policies and resource shortages caused by the pandemic led patients to undergo deaths without dignity and inevitably changed intensive care unit (ICU) end-of-life care (EOLC) practices. This study explores ICU nurses' experiences of providing EOLC for patients with COVID-19 who died. Eight nurses participated in a qualitative phenomenological study. Semi-structured interviews were conducted from July to September 2022. Colaizzi's data analysis method was used, and the following four main themes emerged: (i) only companion in the death journey; (ii) helping families prepare for death; (iii) EOLC trapped within a framework; and (iv) EOLC in retrospect. To secure high-quality EOLC in ICU, it is important to promote practical support for nurses and EOLC-related discussions/education. Technical support, such as digital communication technologies, should be reinforced to help patients and their families participate in EOLC. [ABSTRACT FROM AUTHOR]

Seatbelts and airbags are safety devices designed to prevent road traffic injuries (RTI). They reduce fatal outcomes in patients with RTI; however, studies comparing the preventive effectiveness of these devices are limited. This study aimed to compare the effectiveness of these devices in reducing mortality of patients with RTI. This retrospective cohort study was conducted using the Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between January 2011 and December 2020. All patients who sustained RTI in vehicles with <10 seats were eligible. The target population was categorized into four groups: seat belt use and airbag deployment, seatbelt use-only, airbag deployment-only and non-use. The primary and secondary outcomes were in-hospital mortality and intracranial injury. The adjusted odds ratios (AORs) (95% confidence intervals (CIs)) of safety device use for related outcomes were calculated using multivariate logistic regression analysis. Among the 82,262 patients, 13,929 (16.9%) were classified into the seat belt use and airbag deployment group; 47,123 (57.4%), seat belt use-only; 1820 (2.2%), airbag deployment-only; and, 19,300 (23.5%), non-use group. Compared to the seat belt use-only group, the AORs (95% CIs) for in-hospital mortality and intracranial injury were 1.70 (1.31–2.19) and 1.29 (1.13– 1.47) in the seat belt use and airbags deployment group and 10.24 (7.49–13.99) and 3.00 (2.42–3.72) in the airbags deployment-only group, respectively. Seat belt use had significant preventive effects on in-hospital mortality and intracranial injury. Airbag deployment individually had no additional protective effect on clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Visual impairment, hearing impairment, and masticatory discomfort each influence quality of life (QoL). However, little is known regarding the impact of their coexistence on QoL. Therefore, we aimed to investigate the influence of the coexistence of visual impairment, hearing impairment, and masticatory discomfort on QoL among middle-aged adults aged 40-64. Methods: This study involved a secondary data analysis utilizing the data from years 1 and 2 of the eighth Korea National Health and Nutrition Examination Survey. To evaluate the influence of the coexistence of visual impairment, hearing impairment, and masticatory discomfort on QoL, we conducted a complex sample hierarchical multiple regression analysis. Results: When visual impairment, hearing impairment, and masticatory discomfort coexisted, the QoL was significantly lower than in individuals without any of these conditions. Conclusion: The coexistence of visual impairment, hearing impairment, and masticatory discomfort was negatively correlated with QoL. Therefore, it is important to prepare for old age through appropriate health management during middle age. [ABSTRACT FROM AUTHOR]

Adolescents seeking gender-affirming medical care (GAMC) face numerous barriers that may delay or inhibit their access to these services. Such obstacles include mental health professional (MHP) assessment requirements prior to initiating GAMC.MHP letters ultimately carry little benefit for patients. Their formulaic nature discourages nuance, reduces likelihood of capturing gender embodiment goals (beyond a narrow definition of gender dysphoria), and may cause clinicians to overlook presenting mental health concerns. MHP assessment requirements also reinforce the conception of gender dysphoria as a mental health disorder. Moreover, studies have not shown that requiring MHP assessment letters effectively reduces regret among patients. Fortunately, primary clinicians who provide GAMC are most often capable of assessing patients without additional input from an MHP. In this article, we provide an ethical framework for clinicians that prioritizes patient autonomy through an informed assent approach. We discuss Appelbaum's criteria and its application, and contexts in which MHP consultation is appropriate. We also address common questions about informed assent among clinicians, patients, and families. Finally, we advocate for bolstering multidisciplinary support teams involved in GAMC to facilitate the informed assent process. This approach upholds patient autonomy, expands access to GAMC, and utilizes the mental health workforce more effectively. [ABSTRACT FROM AUTHOR]

Many Mendelian disorders, such as Huntington's disease (HD) and spinocerebellar ataxias, arise from expansions of CAG trinucleotide repeats. Despite the clear genetic causes, additional genetic factors may influence the rate of those monogenic disorders. Notably, genome-wide association studies discovered somewhat expected modifiers, particularly mismatch repair genes involved in the CAG repeat instability, impacting age at onset of HD. Strikingly, FAN1, previously unrelated to repeat instability, produced the strongest HD modification signals. Diverse FAN1 haplotypes independently modify HD, with rare genetic variants diminishing DNA binding or nuclease activity of the FAN1 protein, hastening HD onset. However, the mechanism behind the frequent and the most significant onset-delaying FAN1 haplotype lacking missense variations has remained elusive. Here, we illustrated that a microRNA acting on 3'-UTR (untranslated region) SNP rs3512, rather than transcriptional regulation, is responsible for the significant FAN1 expression quantitative trait loci signal and allelic imbalance in FAN1 messenger ribonucleic acid (mRNA), accounting for the most significant and frequent onset-delaying modifier haplotype in HD. Specifically, miR-124-3p selectively targets the reference allele at rs3512, diminishing the stability of FAN1 mRNA harboring that allele and consequently reducing its levels. Subsequent validation analyses, including the use of antagomir and 3'-UTR reporter vectors with swapped alleles, confirmed the specificity of miR-124-3p at rs3512. Together, these findings indicate that the alternative allele at rs3512 renders the FAN1 mRNA less susceptible to miR-124-3p-mediated posttranscriptional regulation, resulting in increased FAN1 levels and a subsequent delay in HD onset by mitigating CAG repeat instability. [ABSTRACT FROM AUTHOR]

Background/Aims: This study aims to investigate the effect of a fermented rice drink with Lactiplantibacillus plantarum JSA22 on symptoms, blood tests, microbiomes, and fecal metabolites in patients with irritable bowel syndrome (IBS) who were overweight. Methods: Sixty overweight (body mass index = 23 kg/m2) patients aged between 20 and 65 with IBS were enrolled. Patients were divided into 2 groups and administered either a fermented rice drink or an nonfermented rice drink for a month. The symptom questionnaire, blood samples, and stool samples for microbiome and metabolite were collected before and after the month of rice drink administration. The primary efficacy variable was the subject's global assessment of IBS symptoms. Results:In both groups, global IBS symptoms, including abdominal pain, bowel habit, urgency, and abdominal distension, improved significantly (P < 0.01). The abdominal bloating was more significantly improved in the fermented rice drink group than in the nonfermented rice drink group (P < 0.05). Significant changes were not observed in metabolic syndrome-related blood tests or fecal metabolites in either group. However, microbiome analysis showed significant differences in genus levels before and after consuming fermented rice drink, such as in Blautia in stool (P = 0.020) and Prevotella (P = 0.017) and Oribacterium (P = 0.018) in saliva. Conclusions: The fermented rice drink with L. plantarum JSA22 showed a beneficial effect in reducing abdominal distension in IBS patients. Bacteria that reduce visceral fat accumulation increased in the stool and saliva of patients who consumed fermented rice drinks. [ABSTRACT FROM AUTHOR]

To develop a universal coronavirus (CoV) vaccine, long-term immunity against multiple CoVs, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, Middle East respiratory syndrome (MERS)-CoV, and future CoV strains, is crucial. Following the 2015 Korean MERS outbreak, we conducted a long-term follow-up study and found that although neutralizing antibodies and memory T cells against MERS-CoV declined over 5 years, some recovered patients exhibited increased antibody levels during the COVID-19 pandemic. This likely resulted from cross-reactive immunity induced by SARS-CoV-2 vaccines or infections. A significant correlation in antibody responses across various CoVs indicates shared immunogenic epitopes. Two epitopes--the spike protein's stem helix and intracellular domain--were highly immunogenic after MERS-CoV infection and after SARS-CoV-2 vaccination or infection. In addition, memory T cell responses, especially polyfunctional CD4+ T cells, were enhanced during the pandemic, correlating significantly with MERS-CoV spike-specific antibodies and neutralizing activity. Therefore, incorporating these cross-reactive and immunogenic epitopes into pan-CoV vaccine formulations may facilitate effective vaccine development. [ABSTRACT FROM AUTHOR]

Background & Aims: Previous epidemiological data on the association between cigarette smoking and risk of gallstone development remain controversial, and most relevant studies have relied on self-reported questionnaires. We aimed to elucidate this association using both an objective biomarker of tobacco exposure (urinary cotinine) and a self-reported questionnaire. Methods: We analyzed 221,721 asymptomatic adults who underwent abdominal ultrasonography and urinary cotinine measurement between January 2011 and December 2016. Cotinine-verified current smokers were defined as participants with urinary cotinine levels ≥50 ng/mL. Results: The mean age of the study population was 35.9 years, and the proportion of men was 55.8%. The proportions of self-reported and cotinine-verified current smokers were 21.3% and 21.2%, respectively. After adjusting for confounding factors, self-reported current smoking was associated with an increased risk of gallstone development [adjusted odds ratio (aOR) 1.14; 95% confidence interval (95%CI), 1.04-1.25]. Moreover, among the current smokers, the risk of gallstone development increased with an increase in the amount of cigarette smoking (<20 and ≥20 pack-years vs. never smoked; aOR=1.11 and 1.25; 95%CI: 1.01-1.22 and 1.07-1.45, respectively). Cotinine-verified current smoking was also associated with an increased risk of gallstone development (aOR=1.16; 95%CI: 1.07-1.25). Among the self-reported never or former smokers, the cotinine-verified current smokers (aOR=1.20; 95%CI: 1.01-1.44) showed a significantly higher risk of gallstones than cotinine-verified never smokers. Conclusions: Cotinine-verified and self-reported current smoking were independent risk factors for gallstones, suggesting a distinct role of tobacco smoking in gallstone development. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a lifelong disease that markedly impairs quality of life. AD is considered a starting point of the “atopic march,” which begins at a young age and may progress to systemic allergic diseases. Moreover, it is strongly associated with comorbid allergic and inflammatory diseases including arthritis and inflammatory bowel disease. Understanding the pathogenesis of AD is essential for the development of targeted therapies. Epidermal barrier dysfunction, immune deviation toward a T helper 2 proinflammatory profile, and microbiome dysbiosis play important roles via complex interactions. The systemic involvement of type 2 inflammation, weather acute or chronic, and whether extrinsic or intrinsic, is evident in any type of AD. Studies on AD endotypes with unique biological mechanisms have been conducted according to clinical phenotypes, such as race or age, but the endotype for each phenotype, or endophenotype, has not yet been clearly identified. Therefore, AD is still being treated according to severity rather than endotype. Infancy-onset and severe AD are known risk factors leading to atopic march. In addition, up to 40% of adult AD are cases of infancy-onset AD that persist into adulthood, and these are often accompanied by other allergic diseases. Therefore, early intervention strategies to identify high-risk infants and young children, repair an impaired skin barrier, and control systemic inflammation may improve long-term outcomes in AD patients. However, to the best of our knowledge, no study has evaluated the effectiveness of early intervention on atopic march using systemic therapy in high-risk infants. This narrative review addresses the latest knowledge of systemic treatment, including Th2 cytokine receptor antagonists and Janus kinase inhibitors, for children with moderate to severe AD that is refractory to topical-treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Neuroanatomical evidence suggests that behavioral speech-in-noise (SiN) perception and the underlying cortical structural network are altered by aging, and these aging-induced changes could be initiated during middle age. However, the mechanism behind the relationship between auditory performance and neural substrates of speech perception in middle-aged individuals remains unclear. In this study, we measured the structural volumes of selected neuroanatomical regions involved in speech and hearing processing to establish their association with speech perception ability in middle-aged adults. METHODS: Sentence perception in quiet and noisy conditions was behaviorally measured in 2 different age groups: young (20-39 years old) and middle-aged (40-59-year-old) adults. Anatomical magnetic resonance images were taken to assess the gray matter volume of specific parcellated brain areas associated with speech perception. The relationships between these and behavioral auditory performance with age were determined. RESULTS: The middle-aged adults showed poorer speech perception in both quiet and noisy conditions than the young adults. Neuroanatomical data revealed that the normalized gray matter volume in the left superior temporal gyrus, which is closely related to acoustic and phonological processing, is associated with behavioral SiN perception in the middle-aged group. In addition, the normalized gray matter volumes in multiple cortical areas seem to decrease with age. CONCLUSION: The results indicate that SiN perception in middle-aged adults is closely related to the brain region responsible for lower-level speech processing, which involves the detection and phonemic representation of speech. Nonetheless, the higher-order cortex may also contribute to age-induced changes in auditory performance. [ABSTRACT FROM AUTHOR]

Purpose: Missed injuries and delayed diagnoses are likely when diagnosing patients with severe trauma. This research aimed to investigate the incidence of missed fractures in the upper extremities by retrospectively analyzing factors leading to an overlooked diagnosis. Methods: We retrospectively investigated patients hospitalized with newly diagnosed upper-extremity fractures after an initial diagnosis at Severe Trauma Center of Pusan National University Hospital. We analyzed the accompanying injuries, Injury Severity Score (ISS), reasons for a missed diagnosis, and treatment results. Results: Twenty-four patients and 27 cases were identified. The incidence of fracture was 0.4%, and the average diagnostic period was 33 days. The mean ISS was 24.3. Among the 27 cases of neglected fractures there were 1 intercondylar fracture of the humerus, 11 were radial or ulnar forearm fractures, six were carpus or metacarpal fractures, and nine were phalangeal fractures. Among the 24 patients with a delayed diagnosis, 21 patients had orthopedic-related fractures at other sites at the time of initial diagnosis. There were 12 cases of fracture in the ipsilateral limb. At final follow-up, 15 patients exhibited <50% of normal range of motion in the injured area. Conclusion: A neglected upper-extremity fracture can result in missing the optimal surgery window and rehabilitation period, culminating in poor outcomes. Therefore, an orthopedic surgeon must conduct repeated, careful physical examinations with appropriate consideration of the injury mechanisms. [ABSTRACT FROM AUTHOR]

Background: This study investigates the association between thyroid function and frailty in the old patients using representative data. Methods: The study was conducted using data from the Korea National Health and Nutrition Examination Survey conducted from 2013 to 2015. The study population included 2,416 participants aged 50 years and older with available thyroid function test data. Frailty assessment was performed using the Fried frailty phenotype. The prevalence of frailty was analyzed across different thyroid diseases and thyroid function parameters. Results: The significant association between thyroid dysfunction and frailty was observed in overt hyperthyroidism and subclinical hyperthyroidism. After adjusting for various factors, the association between thyroid dysfunction and frailty remained significant. On the other hand, overt hypothyroidism did not show a significant association with frailty in the adjusted analysis. For individuals with overt hyperthyroidism and subclinical hyperthyroidism, higher levels of free thyroxine (FT4) were significantly associated with an increased risk of frailty (aOR >999; 95% CI, >999 to 999). Among individuals with overt hypothyroidism, lower level of FT4 levels and high thyrotropin (TSH) levels showed a significant association with frailty risk (FT4: aOR, <0.01; TSH: aOR, 999). In participants with subclinical hypothyroidism, there were no significant associations between parameters for thyroid and frailty risk. Conclusion: These findings suggest that thyroid dysfunction, particularly overt hyperthyroidism and subclinical hyperthyroidism, may be associated with an increased risk of frailty in the old patients. [ABSTRACT FROM AUTHOR]

Currently, Hyphantira cunea Drury, the fall webworms (FWW), is one of the most severe insect pest for various landscaping trees and mulberry trees. In this study, we investigated whether FWW might be managed by Sodium saccharin (SAC) which is a food additive and not toxic to humans and environment. We found that FWW larvae treated with various concentrations of SAC showed dose-dependent delayed development and low survival rates. The lethalconcentration 50% of FWW larvae to SAC was 0.03 M. We also confirmed that SAC can be used to control FWW larvae attacking mulberry trees in the field. Compared to not-treated or tap-water-spraying control groups, SAC-spraying groups showed significantly higher mortality rates of FWW larvae (56.2%). Thus, SAC can be used for control FWW larvae in mulberry trees. [ABSTRACT FROM AUTHOR]

Background and Objectives: To date, no studies have been conducted on the interaction between extracellular heat shock protein 70 (Hsp70) and C-X-C chemokine receptor type 4 (CXCR4) in the upper airway. We aimed to evaluate the relationship between extracellular Hsp70 and CXCR4 and their role in the primary human nasal epithelium. Methods: We cultured primary human nasal epithelial (HNE) cells in an air-liquid interface. Macrogen performed single-cell quantitative polymerase chain reaction and sequencing. We conducted western blot analysis for the CXCR4 and mitogen-activated protein kinase (MAPK) pathways. Results: Extracellular Hsp70 treatment significantly increased the genetic expression and protein levels of CXCR4 in primary HNE cells. Phospho-ERK expression was increased by cotreatment with Hsp70 and CXCL12, but inhibited by pretreatment with AMD3100, a CXCR4 inhibitor. Pretreatment with an anti-Hsp70 antibody reduced phospho-ERK expression upregulation induced by cotreatment with Hsp70 and CXCL12. Conclusion: Extracellular Hsp70 participates in the activation of the CXCR4-dependent downstream signaling pathway in HNE cells. Further studies should evaluate the extracellular Hsp70-CXCL12/CXCR4 axis and the role of its components in the development of inflammatory diseases. [ABSTRACT FROM AUTHOR]

Background/Aims: Although an association between achalasia and esophageal cancer has been reported, whether achalasia confers a substantial increase in mortality is unknown. Moreover, the causes of death related to achalasia have not been investigated. We performed this nationwide, population-based cohort study on achalasia because no such study has been performed since the introduction of high-resolution manometry in 2008. Methods: This study was performed using data extracted from the Korean National Health Insurance Service database, covering a 9-year period from 2009 to 2017. Control participants without a diagnostic code for achalasia were randomly selected and matched by sex and birth year at a case-to-control ratio of 1:4. Data on the cause of death from Statistics Korea were also analyzed. Results: The overall incidence of achalasia was 0.68 per 100,000 person-years, and the prevalence was 6.46 per 100,000 population. Patients with achalasia (n=3,063) had significantly higher adjusted hazard ratio (aHR) for esophageal cancer (aHR, 3.40; 95% confidence interval [CI], 1.25 to 9.22; p=0.017), pneumonia (aHR, 2.30; 95% CI, 1.89 to 2.81; p<0.001), aspiration pneumonia (aHR, 3.92; 95% CI, 2.38 to 6.48; p<0.001), and mortality (aHR, 1.68; 95% CI, 1.44 to 1.94; p<0.001). Esophageal cancer carried the highest mortality risk (aHR, 8.82; 95% CI, 2.35 to 33.16; p=0.001), while pneumonia had the highest non-cancer mortality risk (aHR, 2.28; 95% CI, 1.31 to 3.96; p=0.004). Conclusions: In this nationwide study, achalasia was associated with increased risk of mortality. Esophageal cancer and pneumonia were the most common comorbidities and the major causes of death in patients with achalasia. [ABSTRACT FROM AUTHOR]

Background: Traditionally, the patient's head is placed in a neutral position with a chin-lift to facilitate light wand guided endotracheal intubation. However, our study found that the sniffing position was more effective. In this study, we aimed to compare the two positions of light wand guided endotracheal intubation. Methods: Sixty adult patients were included in the study, after obtaining informed consent, and were randomly assigned to one of two groups: a control group in a neutral position with a chin-lift (group C, n = 30) and a sniffing position group (group S, n = 30). In group C, the anesthesiologist inserted a light wand after lifting the patient's mandible using the thumb of their non-dominant hand inside the patient's mouth. In group S, a light wand was inserted after the patient's head was flexed with the neck extended. We assessed variables such as light-search time, number of intubation attempts, time to achieve intubation, and side effects including blood tinge on the endotracheal tube, hoarseness, sore throat, and anesthesiologist satisfaction. Results: The light-search and intubation times were shorter in group S than in group C. The incidence of blood tinge on the endotracheal tube was higher in group C than in group S. Anesthesiologist satisfaction was higher in group S than in group C. Conclusions: The sniffing position was more effective in facilitating light wand guided endotracheal intubation than the neutral position with a chin-lift. [ABSTRACT FROM AUTHOR]

Purpose Patient-derived tumor cells can be a powerful resource for studying pathophysiological mechanisms and developing robust strategies for precision medicine. However, establishing organoids from patient-derived cells is challenging because of limited access to tissue specimens. Therefore, we aimed to establish organoids from malignant ascites and pleural effusions. Materials and Methods Ascitic or pleural fluid from pancreatic, gastric, and breast cancer patients was collected and concentrated to culture tumor cells ex vivo. Organoids were considered to be successfully cultured when maintained for five or more passages. Immunohistochemical staining was performed to compare the molecular features, and drug sensitivity was assayed to analyze the clinical responses of original patients. Results We collected 70 fluid samples from 58 patients (pancreatic cancer, n=39; gastric cancer, n=21; and breast cancer, n=10). The overall success rate was 40%; however, it differed with types of malignancy, with pancreatic, gastric, and breast cancers showing 48.7%, 33.3%, and 20%, respectively. Cytopathological results significantly differed between successful and failed cases (p=0.014). Immunohistochemical staining of breast cancer organoids showed molecular features identical to those of tumor tissues. In drug sensitivity assays, pancreatic cancer organoids recapitulated the clinical responses of the original patients. Conclusion Tumor organoids established from malignant ascites or pleural effusion of pancreatic, gastric, and breast cancers reflect the molecular characteristics and drug sensitivity profiles. Our organoid platform could be used as a testbed for patients with pleural and peritoneal metastases to guide precision oncology and drug discovery. [ABSTRACT FROM AUTHOR]

The article provides information about cancer treatment and therapy-induced senescence (TIS) cells, which are cancer cells resistant to apoptosis. It discusses the challenges of identifying and characterizing TIS cells and the need for more effective therapy screening methods to improve clinical outcomes.

Purpose: This study compared the functional and cosmetic treatment outcomes of intramedullary nailing (IM nail) and minimally invasive plate osteosynthesis (MIPO) for distal tibia shaft fractures. Materials and Methods: Forty-eight patients with distal tibia shaft fractures (distal 1/3 of the diaphysis, AO/OTA [AO Foundation/ Orthopaedic Trauma Association]) 43 managed by an IM nail (n=30) or MIPO (n=18) who had minimum one-year follow-up were enrolled in this study. The radiological, functional, and cosmetic outcomes in the two groups were compared retrospectively. Results: All patients achieved bone union. The mean bone union time of the IM nail and MIPO groups was 18.5 and 22.6 weeks, respectively (p=0.078). One patient in the MIPO group showed posterior angulation and valgus deformity of more than five degrees. The mean American Orthopaedic Foot and Ankle Society (AOFAS) functional scores were similar: 83.3 in the IM nail group and 84.6 in the MIPO group (p=0.289). The most salient difference was the cosmetic result of the surgical scar. The length of the scars around the ankle in the IM nail group was significantly smaller than the MIPO group (2.6 cm vs. 10.6 cm; p=0.035). The patient satisfaction survey of surgical scars revealed a significantly higher satisfaction rate in the IM nail group than in the MIPO group (93% vs. 44%; p<0.001). Conclusion: This study showed that both treatment methods for distal tibia shaft fractures have similar therapeutic efficacy regarding the radiological and functional outcomes. On the other hand, the IM nail technique showed superior cosmetic outcomes than the MIPO technique. IM nails may be more recommended in patients with high demand for cosmetic results. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to compare the volume and normative percentiles of brain volumetry in the Korean population using quantitative brain volumetric MRI analysis tools NeuroQuantⓇ (NQ) and DeepBrainⓇ (DB), and to evaluate whether the differences in the normative percentiles of brain volumetry between the two tools is related to cranial shape. Materials and Methods In this retrospective study, we analyzed the brain volume reports obtained from NQ and DB in 163 participants without gross structural brain abnormalities. We measured threedimensional diameters to evaluate the cranial shape on T1-weighted images. Statistical analyses were performed using intra-class correlation coefficients and linear correlations. Results The mean normative percentiles of the thalamus (90.8 vs. 63.3 percentile), putamen (90.0 vs. 60.0 percentile), and parietal lobe (80.1 vs. 74.1 percentile) were larger in the NQ group than in the DB group, whereas that of the occipital lobe (18.4 vs. 68.5 percentile) was smaller in the NQ group than in the DB group. We found a significant correlation between the mean normative percentiles obtained from the NQ and cranial shape: the mean normative percentile of the occipital lobe increased with the anteroposterior diameter and decreased with the craniocaudal diameter. Conclusion The mean normative percentiles obtained from NQ and DB differed significantly for many brain regions, and these differences may be related to cranial shape. [ABSTRACT FROM AUTHOR]

Adrenal incidentalomas represent an increasingly common clinical conundrum with significant implications for patients. The revised 2023 European Society of Endocrinology (ESE) guideline incorporates cutting-edge evidence for managing adrenal incidentalomas. This paper provides a concise review of the updated contents of the revised guideline. In the 2023 guideline, in patients without signs and symptoms of overt Cushing’s syndrome, a post-dexamethasone cortisol level above 50 nmol/L (>1.8 μg/dL) should be considered as mild autonomous cortisol secretion. Regarding the criteria of benign adrenal adenomas, a homogeneous adrenal mass with ≤10 Hounsfield units on non-contrast computed tomography requires no further follow-up, irrespective of its size. The updated guideline also discusses steroid metabolomics using tandem mass spectrometry to discriminate malignancy. It underscores the importance of high-volume surgeons performing adrenalectomy and emphasizes the pivotal role of a multidisciplinary team approach in deciding the treatment plan for indeterminate adrenal masses. The guideline advocates for more proactive surgical treatment for indeterminate adrenal masses in young patients (<40 years) and pregnant women. This review of the 2023 ESE guideline underscores the ongoing evolution of the adrenal incidentaloma management landscape, emphasizing the need for further research and adaptation of diagnostic and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Necrotizing enterocolitis is a severe inflammatory disease of the intestine and is the main cause of death in infants, mostly occurring in premature infants. Intestinal obstruction may occur during the medical treatment of necrotizing enterocolitis. A common cause of intestinal obstruction is intestinal stricture, and entero-enteric fistulas may form in the proximal portion of the intestinal stricture. Several mechanisms may be suggested for the development of entero-enteric fistula. Intestinal ischemia and subsequent necrosis do not become intestinal perforation over time, causing an inflammatory reaction, and are attached to the adjacent intestine, forming a fistula. Alternatively, a subacute perforation may be sealed off by the adjacent intestine, resulting in fistula formation. Entero-enteric fistulas are closely related to distal stricture and occurs when there is a localized perforation rather than a generalized perforation. Fistulas can be diagnosed via contrast enema examination or distal loopogram, and surgical resection is required. Here, I report a case of a preterm infant with an entero-colonic fistula secondary to necrotizing enterocolitis. The patient had abdominal distention and bloody stool and was confirmed to have rotavius enteritis. Plain abdominal radiographs showed pneumatosis intestinalis. The patient received medical treatment for necrotizing enterocolitis. While the symptoms were improving, he vomited again, and intestinal obstruction was suspected. Gastrografin enema was performed due to intestinal obstruction, and an enterocolonic fistula was found. [ABSTRACT FROM AUTHOR]

The field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing acknowledgement of the needs of transgender, nonbinary, and gender expansive (TNG) patients and the health disparities they experience compared to the cisgender population. There is also increased interest among clinicians and trainees in providing gender-affirming care in all medical specialties. This is particularly relevant in psychiatry as mental health disparities in TNG patients have been well-documented. TNG patients experience significant minority stress and higher rates of psychiatric illness, self-harm, suicidality, and psychiatric hospitalization compared to their cisgender peers. In this review, we will cover potential interactions and side effects relevant to psychiatric medication management for the three most common medication classes prescribed as part of gender-affirming hormone therapy (GAHT): gonadotropin-releasing hormone receptor agonists, estradiol, and testosterone. Although no studies directly examining the efficacy of psychiatric medications or their interactions with GAHT for TNG patients have been published yet, we have synthesized the existing literature from both cisgender and TNG patients to shed light on health care disparities seen in TNG patients. Since clinicians' lack of comfort and familiarity with gender-affirming care contributes significantly to these disparities, we hope this narrative review will help psychiatric prescribers provide TNG patients with the same quality of care that cisgender patients receive. [ABSTRACT FROM AUTHOR]

Background/Aims: The ursodeoxycholic acid (UDCA) response score (URS) was developed to identify poor responders to UDCA before treatment, in order to offer timely and proactive intervention. However, validation of the URS in Asian population is warranted. Methods: A total of 173 Asian patients diagnosed with primary biliary cholangitis (PBC) between 2007 and 2016 at seven academic institutions in Korea who started UDCA treatment were analyzed to validate the performance of URS. UDCA response was defined as an alkaline phosphatase level less than 1.67 times the upper limit of normal after 1-year of UDCA treatment. In addition, prognostic performance of URS for liver-related events, defined as newly developed hepatic decompensation or hepatocellular carcinoma was evaluated. Results: After 1 year of UDCA treatment, 133 patients (76.9%) achieved UDCA response. UDCA response rate was 98.7% for those with URS ≥1.41 (n=76) and 58.8% for those with URS <1.41 (n=97). The area under the receiver operating characteristic curve of URS in predicting UDCA response was 0.84 (95% confidence interval, 0.78 to 0.88). During a median follow-up of 6.5 years, liver-related events developed in 18 patients (10.4%). Among 117 patients with PBC stage I-III by histological evaluation, the 5-year liver-related event-free survival rate differed according to the URS; 100% for URS ≥1.41 and 86.5% for URS <1.41 (p=0.005). Conclusions: URS demonstrated good performance in predicting a UDCA treatment response in Asian PBC patients. In addition, the risk of liver-related events differed according to the URS for the PBC stage. Thus, URS can be used to predict the response and clinical outcome in patients with PBC. [ABSTRACT FROM AUTHOR]

Studies on human papillomavirus (HPV) prevention education and its educational effects for elementary school students are necessary. This study aimed to examine the effects of human papillomavirus (HPV) prevention education on knowledge about cervical cancer, HPV, immunization, and attitude about immunization among girls in the sixth grade elementary school of South Korea. A quasi-experimental pretest-posttest control group design is used. The sample included 131 girls (Intervention: n = 65, Control: n = 66) in the sixth grade elementary school of South Korea. Human papillomavirus (HPV) prevention education included the contents of the definition of human papillomavirus, types of human papillomavirus, humanpapillomavirus-related diseases, cervical cancer, human papillomavirus prevention methods, types of vaccines, vaccination effects, vaccination costs, vaccination frequency for 12-year-old girls, and recommended vaccination age. Human papillomavirus (HPV) prevention education was applied on the intervention group in a total of one 40-minute class in the classroom. There were statistically significant differences in knowledge about cervical cancer (t = 9.712, p<.001), knowledge about HPV (t = 9.638, p<.001), knowledge about immunization (t = 5.178, p<.001), and attitude about immunization (t = 3.113, p=.002) between the groups. This study suggests that human papillomavirus (HPV) prevention education was an effective intervention for improving knowledge about cervical cancer, knowledge about HPV, knowledge about immunization, and attitude about immunization. In public health education, human papillomavirus (HPV) prevention education can be implied for Korean girls in sixth grade elementary school. [ABSTRACT FROM AUTHOR]

Background & Aims: Previous epidemiological data on the association between cigarette smoking and risk of gallstone development remain controversial, and most relevant studies have relied on self-reported questionnaires. We aimed to elucidate this association using both an objective biomarker of tobacco exposure (urinary cotinine) and a self-reported questionnaire. Methods: We analyzed 221,721 asymptomatic adults who underwent abdominal ultrasonography and urinary cotinine measurement between January 2011 and December 2016. Cotinine-verified current smokers were defined as participants with urinary cotinine levels ≥50 ng/mL. Results: The mean age of the study population was 35.9 years, and the proportion of men was 55.8%. The proportions of self-reported and cotinine-verified current smokers were 21.3% and 21.2%, respectively. After adjusting for confounding factors, self-reported current smoking was associated with an increased risk of gallstone development [adjusted odds ratio (aOR) 1.14; 95% confidence interval (95%CI), 1.04-1.25]. Moreover, among the current smokers, the risk of gallstone development increased with an increase in the amount of cigarette smoking (<20 and ≥20 pack-years vs. never smoked; aOR=1.11 and 1.25; 95%CI: 1.01-1.22 and 1.07-1.45, respectively). Cotinine-verified current smoking was also associated with an increased risk of gallstone development (aOR=1.16; 95%CI: 1.07-1.25). Among the self-reported never or former smokers, the cotinine-verified current smokers (aOR=1.20; 95%CI: 1.01-1.44) showed a significantly higher risk of gallstones than cotinine-verified never smokers. Conclusions: Cotinine-verified and self-reported current smoking were independent risk factors for gallstones, suggesting a distinct role of tobacco smoking in gallstone development. [ABSTRACT FROM AUTHOR]

Objective: The present study investigated whether protodioscin (PD), a steroidal saponin mainly found in rhizome of Dioscorea species, alleviates oxidative stress-induced damage of porcine oocytes during in vitro maturation. Methods: Oocytes were treated with different concentrations of PD (0, 1, 10, 100, and 200 µM) in the presence of 200 µM H2O2 during in vitro maturation. Following maturation, spindle morphology and mitogen-activated protein kinase activity was assessed along with reactive oxygen species level, GSH activity, and mRNA expression of endogenous antioxidant genes at the MII stage. On the day 7 after parthenogenetic activation, blastocyst formation rate was calculated and the quality of embryo and mRNA expression of development-related genes was evaluated. Results: Developmental competence was significantly poorer in the 0 µM PD-treated (control) group than in the non-treated (normal) and 10 µM PD-treated (10PD) groups. Although the reactive oxygen species level did not significantly differ between these three groups, the glutathione level and mRNA expression of antioxidant genes (superoxide dismutase 1 [SOD1], SOD2, nuclear factor erythroid 2-related factor 2 [Nrf2], and hemo oxygenase-1 [HO-1]) were significantly higher in the normal and 10PD groups than in the control group. In addition, the percentage of oocytes with defective spindle and abnormal chromosomal alignment was significantly lower and the ratio of phosphorylated p44/42 to total p44/42 was significantly higher in the normal and 10PD groups than in the control group. The total cell number per blastocyst was significantly higher in the 10PD group than in the control group. The percentage of apoptotic cells in blastocysts was highest in the control group; however, the difference was not significant. mRNA expression of developmentrelated genes (POU domain, class 5, transcription factor 1 [POU5F1], caudal type homeobox 2 [CDX2], Nanog homeobox [NANOG]) was consistently increased by addition of PD. Conclusion: The PD effectively improves the developmental competence and quality of blastocysts by protecting porcine oocytes against oxidative stress. [ABSTRACT FROM AUTHOR]

As complex mixtures of carcinogenic metalloids, arsenic compounds have been reported to possess anticytotoxic and antitumor effects. In this study, we evaluated the in vitro protective effects of arsenic compounds tetraarsenic oxide and arsenic trioxide against 3-methylcholanthrene-induced toxicity in human keratinocytes. Human keratinocytes were treated with varying concentrations of arsenic compounds alone or in combination with 3-methylcholanthrene. Treatment with arsenic compounds did not significantly affect cell viability, whereas, 3-methylcholanthrene significantly reduced the viability of human keratinocytes. Furthermore, both tetraarsenic oxide and arsenic trioxide decreased the expression of cytochrome P4501A1 at messenger ribonucleic acid and protein levels in human keratinocytes cells treated with 3-methylcholanthrene. In addition, these arsenic compounds increased the expression of nicotinamide adenine dinucleotide phosphate quinone oxidoreductase 1, which was shown to be inhibited by 3-methylcholanthrene treatment. Together, these findings suggest that tetraarsenic oxide and tetraarsenic oxide significantly inhibit 3-methylcholanthrene-induced cytotoxicity in human keratinocytes by decreasing the expression of cytochrome P4501A1 and increasing the expression of nicotinamide adenine dinucleotide phosphate quinone oxidoreductase 1. Additionally, tetraarsenic oxide was found to be more effective than arsenic trioxide against 3-methylcholanthrene-induced cytotoxicity in vitro. [ABSTRACT FROM AUTHOR]

Studies on human papillomavirus (HPV) prevention education and its educational effects for elementary school students are necessary. This study aimed to examine the effects of human papillomavirus (HPV) prevention education on knowledge about cervical cancer, HPV, immunization, and attitude about immunization among girls in the sixth grade elementary school of South Korea. A quasi-experimental pretest-posttest control group design is used. The sample included 131 girls (Intervention: n = 65, Control: n = 66) in the sixth grade elementary school of South Korea. Human papillomavirus (HPV) prevention education included the contents of the definition of human papillomavirus, types of human papillomavirus, humanpapillomavirus- related diseases, cervical cancer, human papillomavirus prevention methods, types of vaccines, vaccination effects, vaccination costs, vaccination frequency for 12-year-old girls, and recommended vaccination age. Human papillomavirus (HPV) prevention education was applied on the intervention group in a total of one 40-minute class in the classroom. There were statistically significant differences in knowledge about cervical cancer (t = 9.712, p < .001), knowledge about HPV (t = 9.638, p < .001), knowledge about immunization (t = 5.178, p < .001), and attitude about immunization (t = 3.113, p=.002) between the groups. This study suggests that human papillomavirus (HPV) prevention education was an effective intervention for improving knowledge about cervical cancer, knowledge about HPV, knowledge about immunization, and attitude about immunization. In public health education, human papillomavirus (HPV) prevention education can be implied for Korean girls in sixth grade elementary school. [ABSTRACT FROM AUTHOR]

A previous study reported lateral habenula (LHb) lesions decelerated appetitive extinction. Therefore, we examined whether LHb activation accelerated appetitive extinction. In this study, rats received appetitive Pavlovian conditioning, pairing a conditioned stimulus (CS, light) with an unconditioned stimulus (food pellets), followed by CS-alone presentations. Chemogenetic LHb activation accelerated the decline in conditioned food-cup responses during extinction. The present results and the reports of previous LHb lesion studies suggest that LHb mediates appetitive extinction. [ABSTRACT FROM AUTHOR]

Background • Dementia, a degenerative disease, requires alternative treatment to maintain function, but previous studies suggest only the therapeutic effect of a temporary program. Primary Study Objective • The current study aimed to examine the effects of assistive technologies on cognitive function, daily living ability, and psychosocial symptoms in elderlies with mild cognitive impairment, elderlies with mild dementia and their caregivers. Design • The research team designed an experimental study that used application as the intervention. Setting • To recruit participants living in the local community, research participation was supported through local public health centers, welfare centers, and social welfare organizations. Evaluation and intervention were conducted by visiting the participant’s home. Participant • The study participants were 29 Mild Cognitive Impairment (MCI) and 16 mild Alzheimer type dementia (AD) patients over the age of 75 with a total of 45 patients, 10 MCI caregivers and 11 AD caregivers with a total of 21 caregivers. Intervention • The assistive technologies used for intervention are 3 area (8 daily living assistive devices, 7 safety assistive technologies, and 7 cognitive assistive technologies). Up to 5 assistive technologies were provided to one subject, and they were instructed to use them every day for 8 weeks. Outcome measure • Participants were evaluated at baseline and postintervention using specific scales appropriate to an area: cognitive function, activities of daily living, depression, anxiety, quality of life, satisfaction. Results • Cognitive function showed statistically significant changes in the MCI group. Basic activities of daily living, depression, anxiety, quality of life, satisfaction showed statistically significant positive effects in both MCI and AD groups. Instrumental activities of daily living did not show any statistically significant differences. Conclusion • As an alternative to dementia care in the future, the application and management of assistive technologies for each area should be provided at the government level. [ABSTRACT FROM AUTHOR]

The article aims to highlight the development of 'Summer King,' an early-maturing apple cultivar in Korea, achieved through a 2010 breeding program by the Apple Research Institute. This cultivar, resulting from the cross between 'Fuji' and 'Golden Delicious,' offers an early harvest in late July, showcasing excellent taste, low self-compatibility and parthenocarpy, contributing to seedless fruit production. '

Background: This study aimed to determine the optimal cut-off values of visceral fat area (VFA) and visceral-to-subcutaneous fat ratio (VSR) for predicting incident type 2 diabetes mellitus (T2DM). Methods: A total of 10,882 individuals (6,835 men; 4,047 women) free of T2DM at baseline aged between 30 and 79 years who underwent abdominal computed tomography scan between 2012 and 2013 as a part of routine health check-ups were included and followed. VFA, subcutaneous fat area, and VSR on L3 vertebral level were measured at baseline. Results: During a median follow-up of 4.8 years, 730 (8.1% for men; 4.3% for women) incident cases of T2DM were identified. Receiver operating characteristic curve analysis showed that the optimal cut-off values of VFA and VSR for predicting incident T2DM were 130.03 cm2 and 1.08 in men, respectively, and 85.7 cm2 and 0.48 in women, respectively. Regardless of sex, higher VFA and VSR were significantly associated with a higher risk of incident T2DM. Compared with the lowest quartiles of VFA and VSR, the highest quartiles had adjusted odds ratios of 2.62 (95% confidence interval [CI], 1.73 to 3.97) and 1.55 (95% CI, 1.14 to 2.11) in men, respectively, and 32.49 (95% CI, 7.42 to 142.02) and 11.07 (95% CI, 3.89 to 31.50) in women, respectively. Conclusion: Higher VFA and VSR at baseline were independent risk factors for the development of T2DM. Sex-specific reference values for visceral fat obesity (VFA ≥130 cm2 or VSR ≥1.0 in men; VFA ≥85 cm2 or VSR ≥0.5 in women) are proposed for the prediction of incident T2DM. [ABSTRACT FROM AUTHOR]

Purpose To develop a denoising convolutional neural network-based image processing technique and investigate its efficacy in diagnosing breast cancer using low-dose mammography imaging. Materials and Methods A total of 6 breast radiologists were included in this prospective study. All radiologists independently evaluated low-dose images for lesion detection and rated them for diagnostic quality using a qualitative scale. After application of the denoising network, the same radiologists evaluated lesion detectability and image quality. For clinical application, a consensus on lesion type and localization on preoperative mammographic examinations of breast cancer patients was reached after discussion. Thereafter, coded low-dose, reconstructed full-dose, and full-dose images were presented and assessed in a random order. Purpose To develop a denoising convolutional neural network-based image processing technique and investigate its efficacy in diagnosing breast cancer using low-dose mammography imaging. Materials and Methods A total of 6 breast radiologists were included in this prospective study. All radiologists independently evaluated low-dose images for lesion detection and rated them for diagnostic quality using a qualitative scale. After application of the denoising network, the same radiologists evaluated lesion detectability and image quality. For clinical application, a consensus on lesion type and localization on preoperative mammographic examinations of breast cancer patients was reached after discussion. Thereafter, coded low-dose, reconstructed full-dose, and full-dose images were presented and assessed in a random order. [ABSTRACT FROM AUTHOR]

The Korean National Health Information Database (NHID) contains big data combining information obtained from the National Health Insurance Service and health examinations. Data are provided in the form of a cohort, and the NHID can be used to conduct longitudinal studies and research on rare diseases. Moreover, data on the cause and date of death are provided by Statistics Korea. Research and publications based on the NHID have increased explosively in the field of endocrine disorders. However, because the data were not collected for research purposes, studies using the NHID have limitations, particularly the need for the operational definition of diseases. In this review, we describe the characteristics of the Korean NHID, operational definitions of endocrine diseases used for research, and an overview of recent studies in endocrinology using the Korean NHID. [ABSTRACT FROM AUTHOR]

Vaginal bleeding is reported among 4%-11% of postmenopausal women. Hematometra is commonly associated with cervical stenosis due to senile atrophy, radiotherapy, or a uterine neoplastic lesion in women of postmenopausal age. Ovarian steroid cell tumor is a rare hormone-secreting tumor subtype accounting for approximately 0.1% of all ovarian tumors. Here we report a case of hematometra in a postmenopausal woman with high estrogen levels who was later diagnosed with a steroid cell tumor. [ABSTRACT FROM AUTHOR]

The author experienced a case of autologous platelet-rich plasma (PRP) affecting the recovery of a chronic neuropathic diabetic foot ulcer combined with infection. A 65-year-aged male with uncontrolled diabetes presented with a Wagner grade 2 diabetic foot ulcer on his left forefoot of more than 2 weeks duration. Osteomyelitis, gangrene, and ischemia requiring acute intervention were absent. Although infection was controlled to a moderate degree, wound healing was unsatisfactory following surgical debridement and simple dressing. Therefore, intralesional autologous PRP injection was performed 5 times as an adjuvant regeneration therapy, and the recalcitrant ulcer healed in 3 months. Intralesional PRP injections are worthwhile as they promote wound regeneration, are evidence-based, safe, and can be easily performed in ambulatory care facilities. [ABSTRACT FROM AUTHOR]

Purpose mTORC1 and mTORC2 inhibition by Ku-0063794 could confer profound anticancer effects against cancer cells because it eliminates feedback activation of Akt. Herein, we aimed to determine anticancer effects of docetaxel and Ku-0063794, individually or in combination, against breast cancer cells, especially triple-negative breast cancer (TNBC) cells. Materials and Methods MCF-7 breast cancer and MDA-MB-231 TNBC cell lines for in vitro studies and mouse xenograft model for in vivo studies were used to investigate the effect of docetaxel, Ku-0063794, or their combination. Results In the in vitro experiments, combination therapy synergistically reduced cell viability and induced higher apoptotic cell death in breast cancer cells than the individual monotherapies (p < 0.05). Western blot analysis and flow cytometric analysis showed that the combination therapy induced higher apoptotic cell death than the individual monotherapies (p < 0.05). In the in vivo experiment, docetaxel and Ku-0063794 combination therapy reduced the growth of MDA-MB-231 cells xenografted in the nude mice better than in the individual monotherapies (p < 0.05). Immunohistochemistry showed that the combination therapy induced the highest expression of cleaved caspase-3 and the lowest expression of Bcl-xL in the MDA-MB-231 cells xenografted in the nude mice (p < 0.05). Western blot analysis and immunofluorescence, incorporating both in vitro and in vivo experiments, consistently validated that unlike individual monotherapies, docetaxel and Ku-0063794 combination therapy significantly inhibited epithelial-mesenchymal transition (EMT) and autophagy (p < 0.05). Conclusion These data suggest that docetaxel and Ku-0063794 combination therapy has higher anticancer activities over individual monotherapies against MDA-MB-231 TNBC cells through a greater inhibition of autophagy and EMT. [ABSTRACT FROM AUTHOR]

Background/Aims: Data regarding the prognosis of early esophageal cancer are lacking. This study investigated the long-term outcomes and factors affecting the survival of patients with mucosal esophageal squamous cell carcinoma (T1aESCC). Methods: We analyzed the clinical and tumor-specific parameters of 263 patients who received surgical resection (SR; n=63) or endoscopic resection (ER; n=200) for T1aESCC. Underlying comorbidities were scored using the Charlson comorbidity index (CCI). Overall survival (OS) was the primary outcome, and multivariate regression analysis was performed to predict factors for OS. Results: Of the study patients (age, 64.5±8.0 years), the CCI was 1.0±1.4 in the ER group and 0.6±0.9 in the SR group (p=0.107). The 5-year OS rate during follow-up (54.4±20.4 months) was 85.7% (ER group, 86.8%; SR group, 82.4%; p=0.631). The cumulative 5-year incidence of esophageal cancer recurrence was 10.5% in the ER group (vs 0% in the SR group). The overall mortality rate was 12.9% (ER group, 12.0%; SR group, 15.9%; p=0.399). The most common cause of mortality was second primary cancers in the ER group (75%) and organ dysfunction or postoperative complications in the SR group (70%). According to multivariate analysis, only CCI was significantly associated with OS (p<0.001). The 5-year OS rate in patients with a CCI >2 and in those with a CCI ≤2 was 60.2% and 88.2%, respectively (p<0.001). The treatment method (ER vs SR) was not a significant affecting factor (p=0.238). Conclusions: The long-term prognosis of patients with T1aESCC was significantly associated with underlying comorbidities. [ABSTRACT FROM AUTHOR]

Metaplastic carcinoma of the breast is a heterogeneous group of neoplasms with mixed epithelial and mesenchymal differentiation. Metaplastic carcinoma of the breast is a rare and aggressive malignancy, with high recurrence and metastasis. Metaplastic carcinoma with chondroid differentiation is an uncommon subtype that tends to have a relatively good prognosis than that of other subtypes. We report the imaging features of three cases of pathologically proven metaplastic carcinoma with chondroid differentiation as follows: a high-density mass with amorphous or coarse heterogeneous calcifications on mammography; a microlobulated or partially indistinct, complex cystic, and solid mass on sonography; and a relatively circumscribed or partially indistinct, irregular mass with heterogeneous T2 high-signal intensity and heterogeneous or rim enhancement with initial fast enhancement and delayed washout on MRI. [ABSTRACT FROM AUTHOR]

Background/Aims Little is known about the association between infantile colic and the later onset of irritable bowel syndrome (IBS). Methods This study examined all 917 707 children who were born in Korea between 2007 and 2008. Infantile colic was defined with 1 or more diagnoses of ICD-10 code R10.4 or R68.1 at the age of 5 weeks to 4 months, and infants with a diagnosis of infantile colic and without were allocated into the infantile colic group and the control group. IBS was defined as 2 or more diagnoses of ICD-10 code K58.X after 4 years of age. Each child was traced until 2017. The risk of IBS with infantile colic was evaluated using a Cox proportional hazards model with propensity score inverse probability of treatment weighting (IPTW). Results After IPTW, 363 528 and 359 842 children were allocated to the control group and the infantile colic group, respectively. The infantile colic group had a higher risk of developing IBS in childhood (hazard ratio [95% CI], 1.12 [1.10 to 1.13]) than the control group. Moreover, the subgroup analyses according to the feeding status, birth weight, sex, or economic status, showed that the risk of IBS with former infantile colic remained statistically significant. Conclusions Children with a diagnosis of infantile colic during the infant period had a significant risk of developing IBS after 4 years of age. Understanding the pathogenesis of infantile colic in the neonatal period may reduce the prevalence and severity of functional gastrointestinal disorders from childhood to adolescence to adulthood. [ABSTRACT FROM AUTHOR]

This article discusses the impact of anthropogenic greenhouse gases and aerosols on the 2022 Central Andes spring drought. Climate models suggest that human activity has a weak contribution to the drought, with compensating effects between greenhouse gases and aerosols. The Central Andes region is vulnerable to hydroclimatic extremes, and this study aims to assess the anthropogenic contribution to the drought and provide information for climate change mitigation and adaptation strategies. The study finds that the observed drought frequency has been increasing since 2010, with aerosol forcing having a marginal contribution to droughts in 2022, while greenhouse gas forcing has likely decreased the probability of droughts. Further research is needed to understand the combined impact of aerosol and greenhouse gas forcing under different sea surface conditions. The document is a list of references that cover various topics related to climate change, drought, and precipitation in South America, particularly in the Andean region. [Extracted from the article]

Neonatal seizures are the most common neurological symptoms caused by various etiologies in the neonatal period, but their diagnosis and treatment are challenging because their pathophysiology and electroclinical manifestations differ from those of patients in older age groups. Many seizures present as electrographic-only events without clinical signs or as obscure clinical manifestations that are difficult to distinguish from other neonatal behaviors. Accordingly, a new definition and classification of neonatal seizures was recently proposed by the International League Against Epilepsy Task Force on neonatal seizures, highlighting the role of electroencephalography in diagnosing and treating neonatal seizures. Neonatal seizures are defined as electrographic events with sudden, paroxysmal, and abnormal alteration of activity and divided into electroclinical seizures and electrographic-only seizures according to their clinical signs, thus excluding clinical events without an electrographic correlation. Seizure types are described by their predominant clinical features and divided into motor (automatisms, clonic, epileptic spasms, myoclonic, tonic, and sequential), nonmotor (autonomic and behavioral arrest), and unclassified. Although many neonatal seizures are acute reactive events caused by hypoxic-ischemic encephalopathy or vascular insults, structural, genetic, or metabolic etiologies of neonatal-onset epilepsy should also be thoroughly evaluated to determine their appropriate management. [ABSTRACT FROM AUTHOR]

While learning a broad sense of compassion (feeling/being kind), students are seldom given a sustained opportunity to learn why they feel angry at the suffering of the other and what to do with that anger. Prosocial anger that adheres to compassion is not deemed as official affective knowledge in schools. While defining compassion as a virtue, this paper conceptualizes compassionate anger as a mobilizer for social justice. Becoming empathetic towards the suffering of the other is, and should be, one of the core educational goals in the era of a pandemic and the Black Lives Matter movement. To this end, by examining the interaction between compassion as an ontological virtue and anger as an emotion, which is a somewhat paradoxical relationship, this paper theoretically juxtaposes compassion with four prosocial angers (impersonal, defensive, Aristotelean, and political) to construct four curriculum approaches to social justice (conservative, experiential, rational, and emancipatory). [ABSTRACT FROM AUTHOR]

We introduce the notion of a left-twisted ring, and we construct a left-zero ring which is not a ring. We show that such a left-twisted ring does not have an identity. Also, we show that every non-zero element of the left-twisted ring is a pseudo unit of it. [ABSTRACT FROM AUTHOR]